不同内固定方案对高龄股骨转子间骨折患者日常生活能力及运动功能的影响

doi:10.3969/j.issn.1671-7171.2018.05.019

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要【目的】比较不同内固定方案对高龄股骨转子间骨折患者日常生活能力及运动功能的影响。【方法】收集2014年3月至2017年2月本院诊治的高龄股骨转子间骨折195例,采用随机数表法分为三组,分别采用股骨近端防旋髓内钉(Proximal Femoral Nail Anti-rotation,PFNA)、动力髋螺钉(Dynamic Hip Screw,DHS)、股骨近端锁定钢板(Locking Proximal Femoral Plate,LPFP)治疗,每组65例。比较三组患者手术情况、恢复情况、并发症发生情况及Barthel指数及运动功能恢复情况。【结果】PFNA组术中出血量、骨折愈合时间少于DHS组、LPFP组,LPFP组术中出血量、手术时间低于DHS组,其骨折愈合时间高于DHS组,组间比较差异有统计学意义(P＜0.05)。PFNA组术后并发症发生率为4.62%,明显低于DHS组的7.69%和DHS组的15.38%,组间比较差异有统计学意义(P＜0.05)。所有患者均获得有效随访,三组患者术后6~ 12个月Barthel指数均较术前升高,PFNA组术后6~ 12个月Barthel指数均高于DHS组和LPFP组,组间比较差异有统计学意义(P＜0.05)。术后1年PFNA组临床优良率高于DHS组,DHS组临床优良率高于LPFP组,组间比较差异有统计学意义(P＜0.05)。【结论】较DHS和LPFP而言,PFNA治疗高龄股骨转子间骨折的疗效及安全性最为理想,可有效改善患者日常生活能力、促进运动功能恢复,值得临床推广应用。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	盖伟
	龚子顺
	朱东波
	李长飞

关键词 ：股骨骨折, 骨折固定术, 内/方法, 日常生活活动, 运动活动

Abstract：【Objective】To compare the effects of different internal fixation schemes on the activities of daily living and motor function in elderly patients with intertrochanteric fractures to provide references for the selection of internal fixations. 【Methods】 A total of 195 cases of elderly intertrochanteric femoral fractures in our hospital from March 2014 ~2017 February were collected for the study. Patients were divided into three groups: Proximal Femoral Nail Anti-rotation, (PFNA) group, Dynamic Hip Screw (DHS) group, and Locking Proximal Femoral Plate (LPFP), with 65 cases in each group. The operation, recovery, complications, Barthel index (activities of daily living) and motor function of three groups were compared. The advantages and disadvantages of the three internal fixation schemes were summarized, and the clinical treatment ideas were discussed. 【Results】 In group PFNA, intraoperative blood loss and fracture healing time were lower than those in group DHS and group LPFP. The amount of bleeding and operative time in the LPFP group were lower than those in the DHS group, and the fracture healing time in the PFNA group was higher than that in the DHS.group. All these differences between groups were statistically significant (P<0.05). The incidence of postoperative complications in the PFNA group was 4.62%, which was lower than that in the DHS group (7.69%) and the LPFP group (15.38%); the differences between groups were statistically significant (P<0.05).All patients were followed up with for one year. Barthel index at 6 to 12 months after surgery in three groups were higher than that before operation. The Barthel index at 6 to 12 months after surgery was higher in the PFNA group than in the DHS group and LPFP group. The clinical excellent rate of the PFNA group was higher than that of the DHS group at 1 year after surgery. The clinical and excellent rate of the DHS group was higher than that of the LPFP group. The difference between groups was statistically significant (P<0.05).【Conclusion】The efficacy and safety of PFNA in the treatment of elderly patients with femoral intertrochanteric fractures are the most ideal, and PFNA can also effectively improve the activities of daily living and promote the recovery of motor function. It is worthy of clinical promotion.

Key words： FemoralFractures FractureFixation,Internal/MT ActivitiesofDailyLiving MotorActivity

收稿日期: 2018-03-12

PACS:

R683.421

引用本文:

盖伟, 龚子顺, 朱东波, 李长飞. 不同内固定方案对高龄股骨转子间骨折患者日常生活能力及运动功能的影响[J]. 医学临床研究, 2018, 35(5): 893-896.
GAI Wei, GONG Zi-shun, ZHU Dong-bo, et al. Influence of Different Internal Fixations on the Activities of Daily Living and Motor Function in Elderly Patients with Intertrochanteric Fractures. JOURNAL OF CLINICAL RESEARCH, 2018, 35(5): 893-896.

链接本文:

http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.05.019 或 http://www.jcr.net.cn/CN/Y2018/V35/I5/893

[1] He W, Zhang W. The curative effect comparison between prolonged third generation of gamma nail and prolonged dynamic hip screw internal fixation in treating femoral intertrochanteric fracture and the effect on infection[J]. Cell Biochem Biophys, 2015, 71(2): 695-699.
[2] 王为, 朱道平, 严宏伟, 等. 3 种内固定方法治疗高龄股骨转子间骨折疗效分析[J]. 临床骨科杂志, 2015, 18(1): 73-76.
[3] Han SK, Song HS, Kim R, et al. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old[J]. Eur J Trauma Emerg Surg, 2016, 42(2): 191-196.
[4] Shukla R, Utkarsh A, Abhishek G, et al. Late presentation Subtrochanteric femur fracture in 12 year old child[J]. Indian J Orthop, 2016, 2(1): 127-131.
[5] 孙启才, 茹选良, 钱志钢, 等. 髋关节置换术治疗老年股骨转子间骨折内固定失败的中期随访[J]. 中国骨伤, 2017, 30(7): 591-596.
[6] 陈维新. 股骨近端抗螺旋髓内钉手术治疗老年不稳定型股骨粗隆间骨折的效果观察[J]. 转化医学电子杂志, 2015, 15(1): 47-49.
[7] Machhi R, Patel CB, Dindod VM. Results of primary hemireplacement arthroplasty in comminuted unstable fracture of intertrochanteric region in old age patients[J]. Int J Orthop, 2017, 3(3): 78-80.
[8] 陈明初. 人工股骨头置换治疗高龄股骨转子间骨折内固定失效[J]. 临床骨科杂志, 2017, 20(1): 79.
[9] 左进步, 余磊, 梁宏伟, 等. 钉板固定, 髓内固定及人工股骨头置换修复高龄股骨转子间骨折: 选择与比较[J]. 中国组织工程研究, 2015, 19(17): 2711-2718.
[10] Johnson B, Gill T. Hip Fractures[M]. Springer:Cham, 2017: 259-265.
[11] Hélin M, Pelissier A, Boyer P, et al. Does the PFNA^TM nail limit impaction in unstable intertrochanteric femoral fracture A 115 case-control series[J]. Orthop Traumatol Surg Res, 2015, 101(1): 45-49.
[12] 王叶新, 孟纯阳, 李庆伟, 等. 经皮穿刺椎体成形术联合鲑鱼降钙素治疗老年骨质疏松性脊柱压缩骨折的疗效分析[J]. 保健医学研究与实践, 2017, 14(4): 45-48.
[13] Min BW, Lee KJ, Bae KC, et al. Result of internal fixation for stable femoral neck fractures in elderly patients[J]. Hip Pelvis, 2016, 28(1): 43-48.
[14] Lee YK, Kim JT, Alkitaini AA, et al. Conversion hip arthroplasty in failed fixation of intertrochanteric fracture: a propensity score matching study[J]. J Arthroplasty, 2017, 32(5): 1593-1598.
[15] 黄鑫, 苏柯, 王晓宁, 等. 围手术期内科并存病对高龄股骨转子间骨折术后疗效的影响[J]. 中华老年骨科与康复电子杂志, 2017, 3(1): 11-16.
[16] Li J, Cheng L, Jing J. The Asia proximal femoral nail antirotation versus the standard proximal femoral antirotation nail for unstable intertrochanteric fractures in elderly Chinese patients[J]. Orthop Traumatol Surg Res, 2015, 101(2): 143-146.
[17] Lu Q, Tang G, Zhao X, et al. Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial[J]. Arch Orthop Trauma Surg, 2017, 137(1): 27-35.