中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
6期
848-852
,共5页
股骨粗隆间骨折%股骨近端防旋髓内钉%髋部螺钉
股骨粗隆間骨摺%股骨近耑防鏇髓內釘%髖部螺釘
고골조륭간골절%고골근단방선수내정%관부라정
Intertrochanteric fracture%Proximal femoral nail anti-rotation%Dynamic hip screw
目的 分析股骨近端防旋髓内钉(PFN-A)与髋部螺钉治疗股骨粗隆间骨折的效果,比较两种治疗方法对老年股骨粗隆间骨折手术干预的影响以及各自的优缺点.方法 选择我科2008年1月至2012年1月收治的60例老年(年龄＞60岁)股骨粗隆间骨折患者为临床研究对象,根据股骨近端防旋髓内钉和髋部螺钉治疗的方式不同将患者以抽签方式随机分成PFN-A组(30例)、髋部螺钉组(30例),分析2组患者的手术时间、术中出血量、术后平均住院时间和术后髋关节Harris功能评分.结果 手术时间:PFN-A组为(73 19) min,髋部螺钉组为(118 ± 30) min;术中出血量:PFN-A组为(48 ± 10)ml,髋部螺钉组为(295 ± 51) ml;术后平均住院时间:PFN-A组为(12.8 ±3.0)d,髋部螺钉组为(22.8 ± 1.4)d;愈合时间:PFN-A组为(12.3 ± 1.6)周,髋部螺钉组为(15.4 ± 1.4)周;Harris功能评分:PFN-A组为90.1 ±2.1,髋部螺钉组为80.2 ±3.9,2组不同手术方法治疗的老年股骨粗隆间骨折患者手术时间、术中出血量、术后平均住院时间、愈合时间、Harris功能评分比较,差异均有统计学意义(均P＜0.01).2组患者Harris评分在下肢畸形、活动范围方面差异无统计学意义(下肢畸形:PFN-A组为3.1±0.5,髋部螺钉组为3.3 ±0.4;活动范围:PFN-A组为3.1±0.6,髋部螺钉组为3.0±0.8;均P＞0.05),疼痛、步态、功能性活动总分方面PFN-A组优于髋部螺钉组,差异均有统计学意义[疼痛:PFN-A组为42 ±3,髋部螺钉组为36 ±2;步态:PFN-A组为30.1 ±3.5,髋部螺钉组为27.9 ± 2.2;功能性活动:PFN-A组为11.9±2.1,髋部螺钉组为10.1±2.4;均P＜0.01].结论 PFN-A具有技术成熟,手术时间短,术中出血少,术后平均住院时间短,骨折愈合时间短,可早期离床活动,术后效果更好等优点.
目的 分析股骨近耑防鏇髓內釘(PFN-A)與髖部螺釘治療股骨粗隆間骨摺的效果,比較兩種治療方法對老年股骨粗隆間骨摺手術榦預的影響以及各自的優缺點.方法 選擇我科2008年1月至2012年1月收治的60例老年(年齡＞60歲)股骨粗隆間骨摺患者為臨床研究對象,根據股骨近耑防鏇髓內釘和髖部螺釘治療的方式不同將患者以抽籤方式隨機分成PFN-A組(30例)、髖部螺釘組(30例),分析2組患者的手術時間、術中齣血量、術後平均住院時間和術後髖關節Harris功能評分.結果 手術時間:PFN-A組為(73 19) min,髖部螺釘組為(118 ± 30) min;術中齣血量:PFN-A組為(48 ± 10)ml,髖部螺釘組為(295 ± 51) ml;術後平均住院時間:PFN-A組為(12.8 ±3.0)d,髖部螺釘組為(22.8 ± 1.4)d;愈閤時間:PFN-A組為(12.3 ± 1.6)週,髖部螺釘組為(15.4 ± 1.4)週;Harris功能評分:PFN-A組為90.1 ±2.1,髖部螺釘組為80.2 ±3.9,2組不同手術方法治療的老年股骨粗隆間骨摺患者手術時間、術中齣血量、術後平均住院時間、愈閤時間、Harris功能評分比較,差異均有統計學意義(均P＜0.01).2組患者Harris評分在下肢畸形、活動範圍方麵差異無統計學意義(下肢畸形:PFN-A組為3.1±0.5,髖部螺釘組為3.3 ±0.4;活動範圍:PFN-A組為3.1±0.6,髖部螺釘組為3.0±0.8;均P＞0.05),疼痛、步態、功能性活動總分方麵PFN-A組優于髖部螺釘組,差異均有統計學意義[疼痛:PFN-A組為42 ±3,髖部螺釘組為36 ±2;步態:PFN-A組為30.1 ±3.5,髖部螺釘組為27.9 ± 2.2;功能性活動:PFN-A組為11.9±2.1,髖部螺釘組為10.1±2.4;均P＜0.01].結論 PFN-A具有技術成熟,手術時間短,術中齣血少,術後平均住院時間短,骨摺愈閤時間短,可早期離床活動,術後效果更好等優點.
목적 분석고골근단방선수내정(PFN-A)여관부라정치료고골조륭간골절적효과,비교량충치료방법대노년고골조륭간골절수술간예적영향이급각자적우결점.방법 선택아과2008년1월지2012년1월수치적60례노년(년령＞60세)고골조륭간골절환자위림상연구대상,근거고골근단방선수내정화관부라정치료적방식불동장환자이추첨방식수궤분성PFN-A조(30례)、관부라정조(30례),분석2조환자적수술시간、술중출혈량、술후평균주원시간화술후관관절Harris공능평분.결과 수술시간:PFN-A조위(73 19) min,관부라정조위(118 ± 30) min;술중출혈량:PFN-A조위(48 ± 10)ml,관부라정조위(295 ± 51) ml;술후평균주원시간:PFN-A조위(12.8 ±3.0)d,관부라정조위(22.8 ± 1.4)d;유합시간:PFN-A조위(12.3 ± 1.6)주,관부라정조위(15.4 ± 1.4)주;Harris공능평분:PFN-A조위90.1 ±2.1,관부라정조위80.2 ±3.9,2조불동수술방법치료적노년고골조륭간골절환자수술시간、술중출혈량、술후평균주원시간、유합시간、Harris공능평분비교,차이균유통계학의의(균P＜0.01).2조환자Harris평분재하지기형、활동범위방면차이무통계학의의(하지기형:PFN-A조위3.1±0.5,관부라정조위3.3 ±0.4;활동범위:PFN-A조위3.1±0.6,관부라정조위3.0±0.8;균P＞0.05),동통、보태、공능성활동총분방면PFN-A조우우관부라정조,차이균유통계학의의[동통:PFN-A조위42 ±3,관부라정조위36 ±2;보태:PFN-A조위30.1 ±3.5,관부라정조위27.9 ± 2.2;공능성활동:PFN-A조위11.9±2.1,관부라정조위10.1±2.4;균P＜0.01].결론 PFN-A구유기술성숙,수술시간단,술중출혈소,술후평균주원시간단,골절유합시간단,가조기리상활동,술후효과경호등우점.
Objective To observe the efficacy of proximal femoral nail anti-rotation (PFN-A) versus hip screw treating femoral intertrochanteric fracture.Methods A total of 60 elderly patients over 60 years with intertrochanteric fracture were randomly assigned to proximal femoral nail anti rotation (PFN-A)group (n =30)or hip screw (DHS) group (n =30).Operation time,the amount of intraoperative bleeding,postoperative hospitalization days and postoperative Harris hip function score were analyzed.Results Operation time was (73 ± 19)min in PFN-A group,(118 ± 30) min in DHS group (P ＜ 0.01) ; intraoperative bleeding was (48 ± 10) ml in PFN-A group,(295 ± 51) ml in DHS group (P ＜ 0.O1) ; the postoperative average hospital stay was (12.8 ± 3.0) d in PFN-A group,(22.8 ± 1.4) d in DHS group (all P ＜ 0.01),healing time was (12.3 ± 1.6) weeks in PFN-A group,(15.4±1.4)weeks in DHS group,Harris score was 90.1 ±2.1 in PFN-A group,80.2±3.9 in DHS group (P ＜0.05).The difference of Harris scores of lower limbs without deformity,range activities in the two groups were not statistically significant (lower limbs without deformity was 3.1 ± 0.5 in the PFN-A group,3.3 ±0.4 in the hip screw group; range of activities was 3.1 ± 0.6 in the PFN-A group,3.0 ± 0.8 in the hip screw group; all P ＞ 0.05),the differences of pain,gait,functional activity score were statistically significant in the PFN-A group and the hip screw group:pain was 42 ± 3 in the PFN-A group,36 ± 2 in the hip screw group; gait was 30.1 ±3.5 in the PFN-A group,27.9 ±2.2 in the hip screw group; functional activities was 11.9 ±2.1 in PFN-A group,10.1 ±2.4 in the hip screw group; all P ＜ 0.01).Conclusion PFN-A is a mature technology with short operation time,little bleeding and short fracture healing time.
