不同治疗方式在老年股骨粗隆间骨折中的对照研究
发布时间：2019-05-25 02:27
【摘要】：背景股骨粗隆间骨折(Intertrochanteric Fracture of Femur, IFF)为临床骨科常见病,近年来该病发病率呈上升趋势,据统计其约占全身肢骨折的3.57%,占四肢骨折的25%。股骨粗隆部血运丰富,在发生骨折后,如处理得当,患者极少出现不愈合现象。但由于粗隆间骨折一般极不稳定,加之患者的平均年龄较高,多合并高血压、糖尿病以及其他慢性疾病,身体条件较差,为临床治疗带来一定难度。股骨粗隆间骨折多见于老年患者,近年来由于老龄化速度的加快,该病的发病人数呈上升趋势。目前,临床对于老年股骨粗隆间骨折可采取保守治疗和手术治疗两种方式,保守治疗由于未能对骨折端进行有效固定,患者需较长时间卧床,易发生深静脉血栓、泌尿道感染、肺部感染以及褥疮等并发症,处理较为棘手。手术治疗是目前临床常用的治疗手段,主要有人工股骨头置换、外固定、股骨近端锁定钢板(the locking compress plate, LCP)、动力髋螺钉(dynamic hip screw, DHS)以及髓内固定[股骨近端髓内钉(proximal femoral nail, PFN)/防旋股骨近端髓内钉(Proximal Femoral Nail Antirotation, PFNA)、Gamma钉]等方式,但目前对于上述常见手术方式的临床疗效研究较少。目的探讨比较不同治疗方式在老年股骨粗隆间骨折患者中的治疗效果以及并发症发生情况之间的差异,以期为临床治疗方式的选择提供相关参考。方法分析2010年1月-2012年10月收住我院的105例老年股骨粗隆间骨折患者的临床资料,患者均行手术治疗,其中外固定架23例、防旋股骨近端髓内钉(Proximal Femoral Nail Antirotation, PFNA)28例、动力髋螺钉(dynamic hip screw, DHS)26例、股骨近端锁定加压钢板(the locking compress plate, LCP)28例。术后随访12个月,参照Harries评分对各种治疗方式的临床效果进行分析,并进一步结合手术时间、切口长度、术中出血量、术后引流量以及术后并发症发生情况等指标对各手术治疗方式进行比较分析。结果105例患者骨折全部愈合,住院及随访期间无死亡。各项指标比较：各组切口长度、手术时间、术中出血、术后引流以及卧床时间均具有显著差异(F=18.34,22.16,23.62,26.76,24.72,P0.05)。两两比较发现,切口长度：PFNA组优于DHS组和LCP组(P0.05),但较外固定架组长(P0.05);手术时间：外固定架组优于DHS和LCP(P0.05),但较PFNA长((P0.05);术中出血和术后引流：PFNA组和外固定架组无显著差异(P0.05),但均优于DHS组和LCP组；卧床时间：PFNA组、DHS组和LCP组无显著差异(P0.05),但均优于外固定架组。术后随访12个月,参照Harries评分对各组患者治疗效果进行评价,其中DHS组和LCP组优良率高于外固定架组(P0.05),但低于PFNA组(P0.05)。在对各组治疗后并发症发生情况进行观察发现,PFNA组并发症发生率优于外固定架组、DHS组和LCP组(P0.05);外固定架组、DHS组和LCP组并发症发生率无显著差异(P0.05)。结论综合考虑手术疗效、手术风险以及围手术期并发症等多方面因素,PFNA具有创伤相对较小、术后疗效较好、并发症较少等优点,是治疗老年股骨粗隆间骨折的有效’术式。
[Abstract]:Background Femoral intertrochanteric fracture (IFF) is a common disease in the clinical orthopedics. In recent years, the incidence of this disease is on the rise. According to statistics, it accounts for 3.57% of the total body limb fracture, accounting for 25% of the fracture of the limbs. The femoral rough part is rich in blood, and after the fracture, if the treatment is proper, the patient has little non-union phenomenon. However, due to the general instability of the intertrochanteric fracture, combined with the high average age of the patient, the combination of hypertension, diabetes and other chronic diseases, the condition of the body is poor, which brings some difficulty to the clinical treatment. The intertrochanteric fracture of the femur is mostly seen in the elderly. In recent years, the incidence of the disease is on the rise due to the speed of aging. At present, the clinic has the advantages of conservative treatment and operation treatment for the old intertrochanteric fracture of the femur, and the conservative treatment can not be effectively fixed on the fracture end, the patient needs to be in bed for a long time, and the complications such as deep vein thrombosis, urinary tract infection, lung infection and bedsore are easy to occur, It's more difficult to deal with. Surgical treatment is one of the most commonly used treatment methods, mainly including artificial femoral head replacement, external fixation, locking compression plate (LCP), dynamic hip screw (DHS), and intramedullary fixation (proximal femoral nail). PFN)/ anti-rotation femoral proximal nail (PFNA), Gamma nail], etc., but there are few clinical efficacy studies for the above-described common surgical methods. Objective To study the treatment effect of different treatment methods in the elderly patients with intertrochanteric fracture and the occurrence of complications, with a view to providing relevant reference for the choice of clinical treatment. Methods The clinical data of 105 old intertrochanteric fractures of femur in our hospital from January 2010 to October 2012 were analyzed, and the patients were treated with operation. Among them,23 cases of external fixation,23 cases of anti-rotation femoral nail (PFNA),28 cases of dynamic hip screw (DHS) and 26 cases of dynamic hip screw (DHS) were analyzed. The proximal locking compression plate (LCP) was used in 28 cases. The clinical effect of various treatment methods was analyzed with reference to the harries score for 12 months, and the operation treatment methods were compared with the operation time, the length of the incision, the intraoperative blood loss, the postoperative drainage flow and the occurrence of postoperative complications. Results All 105 patients had full union, no death during hospitalization and follow-up. The results showed that the length of incision, time of operation, intraoperative bleeding, postoperative drainage and bed time were significantly different (F = 18.34, 22.16, 23.62, 26.76, 24.72, P0.05). The results showed that the length of incision: PFNA group was superior to that of the DHS group and the LCP group (P0.05), but the group leader of the external fixation frame (P0.05); the operation time: the external fixator group was superior to the DHS and the LCP (P0.05), but the PFNA was longer (P <0.05); there was no significant difference between the PFNA group and the external fixation group (P0.05). However, there was no significant difference between the group of the DHS group and the LCP group (P0.05), but it was better than that of the external fixation group. The treatment effect of the group was evaluated with reference to the harries score for 12 months, and the excellent and good rate of the DHS group and the LCP group was higher than that of the external fixation group (P0.05), but lower than that of the PFNA group (P0.05). The incidence of complications in the PFNA group was superior to that of the external fixator group, the DHS group and the LCP group (P0.05). The complication rate of the external fixation frame group, the DHS group and the LCP group was not significantly different (P0.05). Conclusion PFNA has the advantages of relatively small trauma, better postoperative curative effect and less complications, and is an effective method to treat the intertrochanteric fracture of the old femur.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2485411
[Abstract]:Background Femoral intertrochanteric fracture (IFF) is a common disease in the clinical orthopedics. In recent years, the incidence of this disease is on the rise. According to statistics, it accounts for 3.57% of the total body limb fracture, accounting for 25% of the fracture of the limbs. The femoral rough part is rich in blood, and after the fracture, if the treatment is proper, the patient has little non-union phenomenon. However, due to the general instability of the intertrochanteric fracture, combined with the high average age of the patient, the combination of hypertension, diabetes and other chronic diseases, the condition of the body is poor, which brings some difficulty to the clinical treatment. The intertrochanteric fracture of the femur is mostly seen in the elderly. In recent years, the incidence of the disease is on the rise due to the speed of aging. At present, the clinic has the advantages of conservative treatment and operation treatment for the old intertrochanteric fracture of the femur, and the conservative treatment can not be effectively fixed on the fracture end, the patient needs to be in bed for a long time, and the complications such as deep vein thrombosis, urinary tract infection, lung infection and bedsore are easy to occur, It's more difficult to deal with. Surgical treatment is one of the most commonly used treatment methods, mainly including artificial femoral head replacement, external fixation, locking compression plate (LCP), dynamic hip screw (DHS), and intramedullary fixation (proximal femoral nail). PFN)/ anti-rotation femoral proximal nail (PFNA), Gamma nail], etc., but there are few clinical efficacy studies for the above-described common surgical methods. Objective To study the treatment effect of different treatment methods in the elderly patients with intertrochanteric fracture and the occurrence of complications, with a view to providing relevant reference for the choice of clinical treatment. Methods The clinical data of 105 old intertrochanteric fractures of femur in our hospital from January 2010 to October 2012 were analyzed, and the patients were treated with operation. Among them,23 cases of external fixation,23 cases of anti-rotation femoral nail (PFNA),28 cases of dynamic hip screw (DHS) and 26 cases of dynamic hip screw (DHS) were analyzed. The proximal locking compression plate (LCP) was used in 28 cases. The clinical effect of various treatment methods was analyzed with reference to the harries score for 12 months, and the operation treatment methods were compared with the operation time, the length of the incision, the intraoperative blood loss, the postoperative drainage flow and the occurrence of postoperative complications. Results All 105 patients had full union, no death during hospitalization and follow-up. The results showed that the length of incision, time of operation, intraoperative bleeding, postoperative drainage and bed time were significantly different (F = 18.34, 22.16, 23.62, 26.76, 24.72, P0.05). The results showed that the length of incision: PFNA group was superior to that of the DHS group and the LCP group (P0.05), but the group leader of the external fixation frame (P0.05); the operation time: the external fixator group was superior to the DHS and the LCP (P0.05), but the PFNA was longer (P <0.05); there was no significant difference between the PFNA group and the external fixation group (P0.05). However, there was no significant difference between the group of the DHS group and the LCP group (P0.05), but it was better than that of the external fixation group. The treatment effect of the group was evaluated with reference to the harries score for 12 months, and the excellent and good rate of the DHS group and the LCP group was higher than that of the external fixation group (P0.05), but lower than that of the PFNA group (P0.05). The incidence of complications in the PFNA group was superior to that of the external fixator group, the DHS group and the LCP group (P0.05). The complication rate of the external fixation frame group, the DHS group and the LCP group was not significantly different (P0.05). Conclusion PFNA has the advantages of relatively small trauma, better postoperative curative effect and less complications, and is an effective method to treat the intertrochanteric fracture of the old femur.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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相关期刊论文 前3条
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3 周毅;李兴海;陈玉楼;张心宇;;动力髁螺钉治疗不稳定型股骨粗隆间骨折[J];中国矫形外科杂志;2006年22期
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