髓内与髓外固定手术治疗股骨粗隆间骨折临床效果研究
|
摘要
目的对髓内与髓外固定手术治疗股骨粗隆间骨折的临床效果进行分析。方法将2015年1月～2018年1月期间收治的50例股骨粗隆间骨折并进行手术治疗患者作为本次研究对象,按术式分髓外组与髓内组,每组各25例患者,经治疗后对其治疗效果进行分析。结果 (1)髓外组患者术中出血量、手术时间、住院时间及骨折愈合时间分别为(140.0±32.4)mL、(110.0±13.4)min、(21.5±4.4)d及(88.0±6.0)分;髓内组患者术中出血量、手术时间、住院时间及骨折愈合时间分别为(70.0±15.8)mL、(80.0±11.3)min、(15.4±4.6)d及(84.0±5.0)分。髓内组患者术中出血量、手术时间及住院时间均比髓外组患者少,差异有统计学意义(P <0.05);两组患者近期疗效(Harris评分)差异无统计学意义(P> 0.05)。(2)髓外组患者术后并发锁骨钉松脱及穿出股骨头发生率分别为8.0%(2例)及12.0%(3例),总发生率为20.0%(5例);髓内组患者术后并发周围骨折、螺旋刀片穿出股骨头及脱出分别为4.0%(1例)、4.0%(1例)、4.0%(1例)及4.0%(1例),总发生率为16.0%(4例),组间比较差异无统计学意义(P> 0.05)。结论髓内固定手术治疗股骨粗隆间骨折的效果更为理想,具有出血少、创伤小、安全性高、手术时间短、住院时间少等优势,值得推广。
Objective To analyze the clinical effect of intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture of femur. Methods Fifty patients with intertrochanteric fracture of femur who underwent surgical treatment from January 2015 to January 2018 were collected and divided into extramedullary group and intramedullary group according to the surgical method,with 25 patients in each group.The therapeutic effect was analyzed after treatment.Results(1)The intraoperative blood loss,operation time,hospitalization time and fracture healing time of the patients in the extramedullary group were(140.0±32.4)mL,(110.0±13.4)min,(21.5±4.4)d and(88.0±6.0)min,respectively,while in the intramedullary group were(70.0±15.8)mL,(80.0±11.3)min,(15.4±4.6)days and(84.0±5.0)min.Intraoperative blood loss,operation time and hospitalization time of patients in the intramedullary group were less than those in the extramedullary group,and the difference was statistically significant(P < 0.05).There was no significant difference between the two groups in short-term efficacy(Harris score)(P > 0.05).(2)The incidence of postoperative clavicular nail loosening and femoral head perforation in the patients of the extramedullary group were 8.0%(2 cases)and 12.0%(3 cases),respectively,with a total incidence of 20.0%(5 cases).Postoperative perioperative fractures,femoral head perforation and prolapse with spiral blade were 4.0%(1 case),4.0%(1 case),4.0%(lcase) and 4.0%(1 case),respectively,in the intramedullary group,with a total incidence of 16.0%(4 cases).There was no statistically significant difference between the two groups(P > 0.05). Conclusion The effect of intramedullary fixation in the treatment of intertrochanteric fracture of femur is more ideal,which has the advantages of less bleeding,less trauma,higher safety,shorter operation time and less hospitalization time.
Objective To analyze the clinical effect of intramedullary and extramedullary fixation in the treatment of intertrochanteric fracture of femur. Methods Fifty patients with intertrochanteric fracture of femur who underwent surgical treatment from January 2015 to January 2018 were collected and divided into extramedullary group and intramedullary group according to the surgical method,with 25 patients in each group.The therapeutic effect was analyzed after treatment.Results(1)The intraoperative blood loss,operation time,hospitalization time and fracture healing time of the patients in the extramedullary group were(140.0±32.4)mL,(110.0±13.4)min,(21.5±4.4)d and(88.0±6.0)min,respectively,while in the intramedullary group were(70.0±15.8)mL,(80.0±11.3)min,(15.4±4.6)days and(84.0±5.0)min.Intraoperative blood loss,operation time and hospitalization time of patients in the intramedullary group were less than those in the extramedullary group,and the difference was statistically significant(P < 0.05).There was no significant difference between the two groups in short-term efficacy(Harris score)(P > 0.05).(2)The incidence of postoperative clavicular nail loosening and femoral head perforation in the patients of the extramedullary group were 8.0%(2 cases)and 12.0%(3 cases),respectively,with a total incidence of 20.0%(5 cases).Postoperative perioperative fractures,femoral head perforation and prolapse with spiral blade were 4.0%(1 case),4.0%(1 case),4.0%(lcase) and 4.0%(1 case),respectively,in the intramedullary group,with a total incidence of 16.0%(4 cases).There was no statistically significant difference between the two groups(P > 0.05). Conclusion The effect of intramedullary fixation in the treatment of intertrochanteric fracture of femur is more ideal,which has the advantages of less bleeding,less trauma,higher safety,shorter operation time and less hospitalization time.
引文
[1]任海鹏,路全立,王跃文,等.老年人股骨粗隆间骨折髓内与髓外固定围手术期失血特点的系统评价[J].生物骨科材料与临床研究,2015,12(6):37-41.
[2]徐杨俊,刘又生,路晓,等.比较髓外髓外侧方顶板治疗(DHS)与髓内髓内头髓钉系统治疗(PFNA)治疗外侧壁危险型股骨粗隆间骨折的临床效果及对术后功能恢复的影响[J].吉林医学,2017,38(10):1899-1901.
[3]张雷,张哉炯.髓内与髓外固定手术治疗股骨粗隆间骨折临床效果比较[J].青岛医药卫生,2017,49(1):17-19.
[4]蔡延禄,吴漾,林瑞忠,等.股骨近端抗旋髓内钉与动力髋螺钉治疗老年人股骨粗隆间骨折的效果比较[J].广东医学,2015,36(24):3834-3836.
[5]陈明,蔡郑东.股骨粗隆间骨折手术髓内固定和髓外固定治疗的比较[J].中国矫形外科杂志,2016,24(12):1131-1133.
[6]王磊,白宝林,丛伟,等.髓内固定与髓外固定治疗对股骨粗隆间骨折疗效比较[J].兵团医学,2015,43(1):9-11.
[7]金培程,国晓明.PFNA内固定治疗股骨粗隆间骨折疗效的临床多因素研究[J].湖南师范大学学报(医学版),2018,15(2):122-124.
[8]王飞,茆文龙,李力毅,等.髓内、外内固定方式治疗高龄股骨粗隆间骨折患者失血量及相关因素分析[J].中国骨与关节损伤杂志,2016,31(10):1023-1026.
[9]吴利军.3种内固定手术治疗老年股骨粗隆间骨折的临床对照研究[J].重庆医学,2017,46(12):1681-1684.
[10]贾永.DHS和PFNA固定治疗老年股骨粗隆间骨折效果比较[J].中外医学研究,2018,16(5):51-52.
[11]王志,汤健,华兴一,等.InterTan髓内钉与股骨近端防旋髓内钉治疗老年性股骨粗隆间骨折的Meta分析[J].安徽医学,2018,39(2):136-140.
[12]杨海.比较股骨粗隆间骨折髓外固定系统与髓内固定系统的治疗效果[J].中外医疗,2017,36(18):48-49,52.
[13]王喜庆,刘明,黄伟哲,等.PFNA在老年股骨粗隆间骨折患者中的应用[J].河南外科学杂志,2015,23(4):29-30.
[14]赵谦,王春萍,黄善柳,等.股骨近端防旋转髓内钉治疗不稳定股骨粗隆间骨折的研究[J].河北医学,2015,(3):395-398.
[15]胡文雄,蒋家正,陈庆雄,等.近端髓内钉固定与滑动髋螺钉髓外固定治疗股骨粗隆间骨折效果比较[J].海南医学,2015,12(5):717-719.
[16]郑连生,向宝国,林浩,等.两种内固定方式治疗老年稳定型股骨粗隆间骨折显性及隐性失血分析?[J].医学临床研究,2015,6(8):1457-1459.
[2]徐杨俊,刘又生,路晓,等.比较髓外髓外侧方顶板治疗(DHS)与髓内髓内头髓钉系统治疗(PFNA)治疗外侧壁危险型股骨粗隆间骨折的临床效果及对术后功能恢复的影响[J].吉林医学,2017,38(10):1899-1901.
[3]张雷,张哉炯.髓内与髓外固定手术治疗股骨粗隆间骨折临床效果比较[J].青岛医药卫生,2017,49(1):17-19.
[4]蔡延禄,吴漾,林瑞忠,等.股骨近端抗旋髓内钉与动力髋螺钉治疗老年人股骨粗隆间骨折的效果比较[J].广东医学,2015,36(24):3834-3836.
[5]陈明,蔡郑东.股骨粗隆间骨折手术髓内固定和髓外固定治疗的比较[J].中国矫形外科杂志,2016,24(12):1131-1133.
[6]王磊,白宝林,丛伟,等.髓内固定与髓外固定治疗对股骨粗隆间骨折疗效比较[J].兵团医学,2015,43(1):9-11.
[7]金培程,国晓明.PFNA内固定治疗股骨粗隆间骨折疗效的临床多因素研究[J].湖南师范大学学报(医学版),2018,15(2):122-124.
[8]王飞,茆文龙,李力毅,等.髓内、外内固定方式治疗高龄股骨粗隆间骨折患者失血量及相关因素分析[J].中国骨与关节损伤杂志,2016,31(10):1023-1026.
[9]吴利军.3种内固定手术治疗老年股骨粗隆间骨折的临床对照研究[J].重庆医学,2017,46(12):1681-1684.
[10]贾永.DHS和PFNA固定治疗老年股骨粗隆间骨折效果比较[J].中外医学研究,2018,16(5):51-52.
[11]王志,汤健,华兴一,等.InterTan髓内钉与股骨近端防旋髓内钉治疗老年性股骨粗隆间骨折的Meta分析[J].安徽医学,2018,39(2):136-140.
[12]杨海.比较股骨粗隆间骨折髓外固定系统与髓内固定系统的治疗效果[J].中外医疗,2017,36(18):48-49,52.
[13]王喜庆,刘明,黄伟哲,等.PFNA在老年股骨粗隆间骨折患者中的应用[J].河南外科学杂志,2015,23(4):29-30.
[14]赵谦,王春萍,黄善柳,等.股骨近端防旋转髓内钉治疗不稳定股骨粗隆间骨折的研究[J].河北医学,2015,(3):395-398.
[15]胡文雄,蒋家正,陈庆雄,等.近端髓内钉固定与滑动髋螺钉髓外固定治疗股骨粗隆间骨折效果比较[J].海南医学,2015,12(5):717-719.
[16]郑连生,向宝国,林浩,等.两种内固定方式治疗老年稳定型股骨粗隆间骨折显性及隐性失血分析?[J].医学临床研究,2015,6(8):1457-1459.