PFNA内固定治疗股骨粗隆间骨折疗效的临床多因素研究
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摘要
目的:探讨影响股骨粗隆间骨折应用股骨近端防旋髓内钉内固定(PFNA)的影响因素,给临床治疗提供理论依据和指导。方法:选取2014年12月~2015年12月在医院接受治疗的210例股骨粗隆间骨折的患者作为研究对象,根据患者治疗1个月后结局,应用Harris评分来评价患者的髋关节功能,根据Harris评分进行分组,其中Harris评分≥75分的170例患者作为疗效好组,Harris评分<75分的40例患者作为疗效差组,统计分析两组患者的性别、年龄及骨折的类型、手术情况时间、手术条件、术后并发症,分析影响股骨粗隆间骨折应用股骨近端防旋髓内钉内固定(PFNA)的影响因素。结果:疗效好的组和疗效差的组中,不同性别组成、受伤原因、合并疾病类型、手术时间间所占比例差异不明显,但股骨粗隆间骨折疗效差的患者中年龄>65、AO3型、手术时机>3天中所占的比例明显高于其他,组间差异明显,具有统计学意义,因此,年龄、骨折AO分型、手术时机是影响PFNA内固定治疗股骨粗隆间骨折临床治疗效果的单因素;年龄、骨折AO分型、手术时机是影响PFNA内固定治疗股骨粗隆间骨折临床治疗效果的独立风险因素。结论:患者的年龄较大和手术时机晚是降低股骨粗隆间骨折应用股骨近端防旋髓内钉内固定治疗效果的主要因素,在临床治疗中需特别注意。
Objective To investigate the effects of interchangeable fractures of the proximate femur fixed anti-rotation(PFNA) factors intramuscular nail, to provide a theoretical basis and clinical treatment guidance. Methods December 2014 to 2015 in December hospital for treatment of patients with interchangeable fracture in 210 cases for the study, based on patient outcomes after one month of treatment, the application of Harris hip function score was evaluated in patients, grouped according to Harris score, which Harris score ≥75 points in 170 patients as good efficacy group, Harris score <75 points in 40 patients with poor efficacy as a group, statistical analysis of two groups of sex, age and type of fracture, surgery case time, surgical conditions, postoperative complications, analyze the impact of interchangeable fractures of the proximate femur fixed anti-rotation(PFNA) factors intramuscular nail. Results The efficacy and a good group of poor efficacy group, composed of different gender, cause of injury, the merger between the type of disease, the proportion of operating time was not significantly different, but the difference interchangeable fractures in patients Age> 65, AO3 type, timing of surgery> 3 days was significantly higher than the proportion of other, significant differences between the groups, with statistical significance, therefore, age, AO fracture classification, the impact of the timing of surgery interchangeable fracture treatment of a single factor PFNA fixation for femoral; age, AO fracture classification, surgical time is within the influence PFNA fixation of interchangeable fracture treatment of independent risk factors. Conclusion Patients older and late timing of surgery is to reduce the main factor interchangeable fractures of the proximate femur intramuscular nail anti-rotation treatment, need special attention in the clinical treatment.
Objective To investigate the effects of interchangeable fractures of the proximate femur fixed anti-rotation(PFNA) factors intramuscular nail, to provide a theoretical basis and clinical treatment guidance. Methods December 2014 to 2015 in December hospital for treatment of patients with interchangeable fracture in 210 cases for the study, based on patient outcomes after one month of treatment, the application of Harris hip function score was evaluated in patients, grouped according to Harris score, which Harris score ≥75 points in 170 patients as good efficacy group, Harris score <75 points in 40 patients with poor efficacy as a group, statistical analysis of two groups of sex, age and type of fracture, surgery case time, surgical conditions, postoperative complications, analyze the impact of interchangeable fractures of the proximate femur fixed anti-rotation(PFNA) factors intramuscular nail. Results The efficacy and a good group of poor efficacy group, composed of different gender, cause of injury, the merger between the type of disease, the proportion of operating time was not significantly different, but the difference interchangeable fractures in patients Age> 65, AO3 type, timing of surgery> 3 days was significantly higher than the proportion of other, significant differences between the groups, with statistical significance, therefore, age, AO fracture classification, the impact of the timing of surgery interchangeable fracture treatment of a single factor PFNA fixation for femoral; age, AO fracture classification, surgical time is within the influence PFNA fixation of interchangeable fracture treatment of independent risk factors. Conclusion Patients older and late timing of surgery is to reduce the main factor interchangeable fractures of the proximate femur intramuscular nail anti-rotation treatment, need special attention in the clinical treatment.
引文
[1]马坤龙,工绚,栾富均,等.股骨近端防旋髓内钉、动力髓螺钉、伽马钉治疗股骨转子问骨折的系统评价[J].华西医学,2013,28(3):102-104.
[2]戚春潮,罗建光,陈石玉,等.PFNA内固定治疗股骨粗隆间骨折疗效的多因素分析[J].中国骨与关节损伤杂志,2015,30(8):794-796.
[3]陈夏平,郑尤辉,郭伟煌,等.PFNA内固定治疗股骨粗隆间骨折[J].中国骨与关节损伤杂志,2012,27(2);150-151.
[4]段文江,吴宇,赵红军,等.PFNA与DSH内固定治疗老年股骨粗隆间骨折疗效比较[J].创伤外科杂志,2013,15(1):41-44.
[5]关长勇,常青,彭伟,等.PFNA内固定与人工股骨头置换术治疗高龄股骨粗隆间倡折疗效比较[J].中国骨与关节损伤杂志,2013,28(2);110-112.
[6]余颖许,谢文伟,姚汉刚,等.股骨近端锁定解剖钢板和PFNA治疗老年股骨粗隆问粉碎性骨折的疗效比较[J/C D].中华关节外科杂志(电子版),2013,7(4):477-480.
[7]宋健,程珂珂,喻爱喜,等.PFDA与LCP内固定治疗成年股骨粗隆间骨折疗效的Mata分析[J].中国骨与关节损伤杂志,2016,30(6):577-581.
[8]李志勇.股骨近端解剖锁定板与防旋髓内钉治疗股骨粗隆问骨折的比较研究[J].山西医药杂志,2014,43(1):86-88.
[9]邓海峰,胡思斌,郑继会,等.PFNA内固定治疗股倡粗隆间骨折术后隐性失血的影响因素[J].中国骨与关节损伤杂志,2013,28(8):766-768.
[10]杨沛彦,李耀许,尤元璋.股骨近端抗旋髓内钉与股骨近端解剖型锁定板治疗不稳定型转子问骨折的疗效比较[J].中华创伤杂志,2013,29(4):330-333.
[11]沈传华.股骨近端锁定加压接骨板与螺旋刀片抗旋髓内针内固定治疗股骨粗隆问骨折疗效对比[J].中国老年医学杂志,2013,32(17):3760-3761.
[12]王永安,顾龙殿,禹宝庆,等.PFNA内固定治疗股骨粗隆间骨折临床疗效观察[J].中国骨与关节损伤杂志,2013,28(6):514-518.
[13]郭剑,张斌,李永欢,等.加长型PFNA内固定治疗涉及股骨粗隆的股骨长段粉碎性骨折[[J].中国骨与关节损伤杂志,2012,27(8):732-733.
[14]姜峰,李国庆,张伟龙.等.闭合复位PFNA内固定治疗高龄股骨粗隆问骨折[J]中国医疗前沿,2013,8(11);52-53.
[15]张东平,徐雄,钱腾飞.股骨近端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问骨折的疗效分析[J].重庆医科大学学报,2013,38(11):1278-1280.
[2]戚春潮,罗建光,陈石玉,等.PFNA内固定治疗股骨粗隆间骨折疗效的多因素分析[J].中国骨与关节损伤杂志,2015,30(8):794-796.
[3]陈夏平,郑尤辉,郭伟煌,等.PFNA内固定治疗股骨粗隆间骨折[J].中国骨与关节损伤杂志,2012,27(2);150-151.
[4]段文江,吴宇,赵红军,等.PFNA与DSH内固定治疗老年股骨粗隆间骨折疗效比较[J].创伤外科杂志,2013,15(1):41-44.
[5]关长勇,常青,彭伟,等.PFNA内固定与人工股骨头置换术治疗高龄股骨粗隆间倡折疗效比较[J].中国骨与关节损伤杂志,2013,28(2);110-112.
[6]余颖许,谢文伟,姚汉刚,等.股骨近端锁定解剖钢板和PFNA治疗老年股骨粗隆问粉碎性骨折的疗效比较[J/C D].中华关节外科杂志(电子版),2013,7(4):477-480.
[7]宋健,程珂珂,喻爱喜,等.PFDA与LCP内固定治疗成年股骨粗隆间骨折疗效的Mata分析[J].中国骨与关节损伤杂志,2016,30(6):577-581.
[8]李志勇.股骨近端解剖锁定板与防旋髓内钉治疗股骨粗隆问骨折的比较研究[J].山西医药杂志,2014,43(1):86-88.
[9]邓海峰,胡思斌,郑继会,等.PFNA内固定治疗股倡粗隆间骨折术后隐性失血的影响因素[J].中国骨与关节损伤杂志,2013,28(8):766-768.
[10]杨沛彦,李耀许,尤元璋.股骨近端抗旋髓内钉与股骨近端解剖型锁定板治疗不稳定型转子问骨折的疗效比较[J].中华创伤杂志,2013,29(4):330-333.
[11]沈传华.股骨近端锁定加压接骨板与螺旋刀片抗旋髓内针内固定治疗股骨粗隆问骨折疗效对比[J].中国老年医学杂志,2013,32(17):3760-3761.
[12]王永安,顾龙殿,禹宝庆,等.PFNA内固定治疗股骨粗隆间骨折临床疗效观察[J].中国骨与关节损伤杂志,2013,28(6):514-518.
[13]郭剑,张斌,李永欢,等.加长型PFNA内固定治疗涉及股骨粗隆的股骨长段粉碎性骨折[[J].中国骨与关节损伤杂志,2012,27(8):732-733.
[14]姜峰,李国庆,张伟龙.等.闭合复位PFNA内固定治疗高龄股骨粗隆问骨折[J]中国医疗前沿,2013,8(11);52-53.
[15]张东平,徐雄,钱腾飞.股骨近端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问骨折的疗效分析[J].重庆医科大学学报,2013,38(11):1278-1280.