股骨近端(抗旋转)髓内钉内固定在老年股骨转子间骨折的手术方法和临床疗效观察
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摘要
目的:观察股骨近端(抗旋转)髓内钉(PFNA)内固定在老年股骨转子间骨折的手术方法和临床疗效。方法:选择2012年1月-2016年12月在本院进行股骨转子间骨折手术治疗的老年患者100例进行临床研究。所有患者均经X线、CT等影像学检查确诊。使用随机数字表将患者分为观察组和对照组,各50例。对照组患者给予动力髋螺钉(DHS)内固定治疗,观察组患者行PFNA手术,比较两组的疗效和手术相关指标。结果:观察组患者术中出血量、切口长度、手术时间、术后下地时间以及骨折愈合时间均明显少于对照组,差异均有统计学意义(P<0.05);随访12周,使用Harris评分评价髋关节功能,观察组患者优良率为92.00%,略高于对照组的88.00%,但差异无统计学意义(P>0.05);观察组5例患者发生术后并发症,发生率为10.00%,对照组12例发生术后并发症,发生率为12.00%。观察组并发症发生率略低于对照组,差异无统计学意义(P>0.05)。结论:PFNA内固定对于老年股骨转子间骨折具有良好的临床疗效,手术创伤小,患者恢复快,且疗效稳定,术后并发症较少,是老年股骨转子间骨折患者的较好选择。
Objective:To observe the surgical method and clinical effect of proximal femur(anti rotation) intramedullary nail(PFNA) fixation in elderly patients with intertrochanteric fracture.Method:The clinical study of 100 elderly patients with intertrochanteric fracture in our hospital from January 2012 to December 2016 was selected. All patients were diagnosed by X-ray, CT and other imaging examinations. The patients were divided into the observation group and the control group, each with a random number table, 50 cases in each group. The patients in the control group were treated with dynamic hip screw(DHS) internal fixation, and the patients in the observation group were operated on by PFNA.The results of two groups were compared and the related indexes of the operation were compared.Result:The amount of bleeding,the length of incision,the time of operation,postoperative time and fracture healing time of the fracture of the observation group were significantly less than those of the control group,and the differences were statistically significant(P<0.05).12 weeks of follow-up,the hip joint function of patients was evaluated with Harris score,the excellent rate of the observation group was 92.00%,it was slightly higher than 88.00% of the control group,but there was no difference between two groups(P>0.05).The complication rate of the observation group was 10.00%(5 cases),the control group was 12.00%(6 cases),the observation group was slightly lower than that of the control group,but there was no difference between two groups(P>0.05).Conclusion:PFNA fixation has a good clinical curative effect for elderly patient with intertrochanteric fracture,the surgical trauma is small,recovered quickly,the curative effect is stable,less postoperative complications,is a good choice for elderly patients with intertrochanteric fracture.
Objective:To observe the surgical method and clinical effect of proximal femur(anti rotation) intramedullary nail(PFNA) fixation in elderly patients with intertrochanteric fracture.Method:The clinical study of 100 elderly patients with intertrochanteric fracture in our hospital from January 2012 to December 2016 was selected. All patients were diagnosed by X-ray, CT and other imaging examinations. The patients were divided into the observation group and the control group, each with a random number table, 50 cases in each group. The patients in the control group were treated with dynamic hip screw(DHS) internal fixation, and the patients in the observation group were operated on by PFNA.The results of two groups were compared and the related indexes of the operation were compared.Result:The amount of bleeding,the length of incision,the time of operation,postoperative time and fracture healing time of the fracture of the observation group were significantly less than those of the control group,and the differences were statistically significant(P<0.05).12 weeks of follow-up,the hip joint function of patients was evaluated with Harris score,the excellent rate of the observation group was 92.00%,it was slightly higher than 88.00% of the control group,but there was no difference between two groups(P>0.05).The complication rate of the observation group was 10.00%(5 cases),the control group was 12.00%(6 cases),the observation group was slightly lower than that of the control group,but there was no difference between two groups(P>0.05).Conclusion:PFNA fixation has a good clinical curative effect for elderly patient with intertrochanteric fracture,the surgical trauma is small,recovered quickly,the curative effect is stable,less postoperative complications,is a good choice for elderly patients with intertrochanteric fracture.
引文
[1]吴畏,李波.内固定和关节置换治疗高龄股骨转子间骨折的疗效比较[J].中华创伤杂志,2015,31(6):537-539.
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[3]张舜,陈坤峰,张传林,等.双动水泥型人工股骨头置换术治疗合并心肺脑疾病高龄股骨转子间骨折[J].中华创伤杂志,2015,31(6):531-535.
[4]施向春,梁家龙,颜斌,等.股骨近端锁定接骨板治疗股骨转子间及转子下骨折[J].中华创伤杂志,2013,29(8):766-767.
[5]张东平,徐雄,钱腾飞.股骨近端锁定加压接骨板与股骨近端抗旋转髓内钉治疗股骨粗隆间骨折的疗效分析[J].重庆医科大学学报,2013,38(11):1278-1281.
[6]谢海明,陈胜,周炳荣.亚洲型与传统股骨近端防旋髓内钉治疗股骨转子间骨折的比较[J].中华医学杂志,2015,95(29):2346-2350.
[7]Liu Ruping,Ren Jiangdong,Zhang Xiaogang,et al.Three methods of internal fixation for the treatment of intertrochanteric fracture of femur in elderly patients[J].Medical Review,2014,20(4):760-762.
[8]周波,朱琦,钟树桃.三种植入物固定修复骨质疏松性股骨转子间骨折:失效单因素及多因素分析[J].中国组织工程研究,2015,19(17):2721.
[9]杨朝君,孙智文,张爱民,等.骨水泥型加长柄关节置换治疗高龄不稳定型股骨转子间骨折[J].中华损伤与修复杂志:电子版,2014,9(3):57-60.
[10]Harris D G,Drucker C B,Brenner M L,et al.Management and outcomes of blunt common and external iliac arterial in-juries[J].J Vasc Surg,2014,51(9):180-185.
[11]Kane J B,Philip Morgan S,Harris K M,et al.The educational consequences of teen childbearing[J].Demography,2013,50(6):2129-2150.
[12]刘云,陈爱琴,梁明娟,等.LPFP、DHS与PFNA治疗老年人股骨粗隆间骨折的研究[J].实用医学杂志,2012,28(24):4110-4112.
[13]罗群强,彭维波,莫雄革,等.股骨近端解剖锁定钢板及动力髋螺钉治疗老年股骨转子间骨折的对比研究[J].中国矫形外科杂志,2012,20(10):887-889.
[14]Noordin S,Shahbano,Ahmad T,et al.Intertrochanteric hip fractures in octogenarian patients:Do we need to rethink fixationstrategy?[J].J Pak Med Assoc,2015,65(11 Suppl 3):S59-S62.
[15]高冲,徐静,宫福良,等.Inter TAN治疗老年股骨转子间骨折疗效的影响因素分析[J].实用医学杂志,2014,30(22):3638.
[16]Zhu Yunsen,Jiang Chang,Li Jun.Comparison of perioperative blood loss of Two kinds of surgery for treatment of intertrochanteric fractures in aged patients[J].Journal of traditional Chinese Medicine,2014,26(9):29-31.
[17]曾超,王一任,魏捷,等.股骨近端防旋髓内钉与动力髋螺钉固定治疗股骨转子间骨折的Meta分析[J].中南大学学报(医学版),2012,37(6):606-615.
[18]林楚标,黄海安,陈利武,等.股骨近端防旋髓内钉治疗老年股骨转子间不稳定型骨折[J].中华创伤骨科杂志,2012,14(11):1010-1012.
[19]陈歌海,郑建河,黄济嘉,等.PFNA与股骨近端锁定钢板治疗不稳定股骨转子骨折的疗效分析[J].中国医学创新,2015,12(16):4-7.
[20]潘矗,陈云丰,章伟,等.Inter Tan髓内钉治疗老年股骨转子间骨折的失败原因分析[J].中华创伤骨科杂志,2014,16(8):674-678.
[2]Sambandam S N,Chandrasekharan J,Mounasamy V,et al.Intertrochanteric fractures:a review of fixation methods[J].Eur J Orthop Surg Traumatol,2016,26(4):339-353.
[3]张舜,陈坤峰,张传林,等.双动水泥型人工股骨头置换术治疗合并心肺脑疾病高龄股骨转子间骨折[J].中华创伤杂志,2015,31(6):531-535.
[4]施向春,梁家龙,颜斌,等.股骨近端锁定接骨板治疗股骨转子间及转子下骨折[J].中华创伤杂志,2013,29(8):766-767.
[5]张东平,徐雄,钱腾飞.股骨近端锁定加压接骨板与股骨近端抗旋转髓内钉治疗股骨粗隆间骨折的疗效分析[J].重庆医科大学学报,2013,38(11):1278-1281.
[6]谢海明,陈胜,周炳荣.亚洲型与传统股骨近端防旋髓内钉治疗股骨转子间骨折的比较[J].中华医学杂志,2015,95(29):2346-2350.
[7]Liu Ruping,Ren Jiangdong,Zhang Xiaogang,et al.Three methods of internal fixation for the treatment of intertrochanteric fracture of femur in elderly patients[J].Medical Review,2014,20(4):760-762.
[8]周波,朱琦,钟树桃.三种植入物固定修复骨质疏松性股骨转子间骨折:失效单因素及多因素分析[J].中国组织工程研究,2015,19(17):2721.
[9]杨朝君,孙智文,张爱民,等.骨水泥型加长柄关节置换治疗高龄不稳定型股骨转子间骨折[J].中华损伤与修复杂志:电子版,2014,9(3):57-60.
[10]Harris D G,Drucker C B,Brenner M L,et al.Management and outcomes of blunt common and external iliac arterial in-juries[J].J Vasc Surg,2014,51(9):180-185.
[11]Kane J B,Philip Morgan S,Harris K M,et al.The educational consequences of teen childbearing[J].Demography,2013,50(6):2129-2150.
[12]刘云,陈爱琴,梁明娟,等.LPFP、DHS与PFNA治疗老年人股骨粗隆间骨折的研究[J].实用医学杂志,2012,28(24):4110-4112.
[13]罗群强,彭维波,莫雄革,等.股骨近端解剖锁定钢板及动力髋螺钉治疗老年股骨转子间骨折的对比研究[J].中国矫形外科杂志,2012,20(10):887-889.
[14]Noordin S,Shahbano,Ahmad T,et al.Intertrochanteric hip fractures in octogenarian patients:Do we need to rethink fixationstrategy?[J].J Pak Med Assoc,2015,65(11 Suppl 3):S59-S62.
[15]高冲,徐静,宫福良,等.Inter TAN治疗老年股骨转子间骨折疗效的影响因素分析[J].实用医学杂志,2014,30(22):3638.
[16]Zhu Yunsen,Jiang Chang,Li Jun.Comparison of perioperative blood loss of Two kinds of surgery for treatment of intertrochanteric fractures in aged patients[J].Journal of traditional Chinese Medicine,2014,26(9):29-31.
[17]曾超,王一任,魏捷,等.股骨近端防旋髓内钉与动力髋螺钉固定治疗股骨转子间骨折的Meta分析[J].中南大学学报(医学版),2012,37(6):606-615.
[18]林楚标,黄海安,陈利武,等.股骨近端防旋髓内钉治疗老年股骨转子间不稳定型骨折[J].中华创伤骨科杂志,2012,14(11):1010-1012.
[19]陈歌海,郑建河,黄济嘉,等.PFNA与股骨近端锁定钢板治疗不稳定股骨转子骨折的疗效分析[J].中国医学创新,2015,12(16):4-7.
[20]潘矗,陈云丰,章伟,等.Inter Tan髓内钉治疗老年股骨转子间骨折的失败原因分析[J].中华创伤骨科杂志,2014,16(8):674-678.