医学综述
醫學綜述
의학종술
Medical Recapitulate
2015年
20期
3802-3803,3808
,共3页
王岩民%樊勇%牛伟亚%高强
王巖民%樊勇%牛偉亞%高彊
왕암민%번용%우위아%고강
高龄不稳定型股骨粗隆间骨折%防旋型股骨近端髓内钉%半髋关节置换术
高齡不穩定型股骨粗隆間骨摺%防鏇型股骨近耑髓內釘%半髖關節置換術
고령불은정형고골조륭간골절%방선형고골근단수내정%반관관절치환술
Unstable intertrochanteric fracture in senile patients%Proximal femoral nail antirotation%Hemiarthroplasty
目的:比较半髋关节置换和防旋型股骨近端髓内钉( PFNA)治疗高龄不稳定型股骨粗隆间骨折患者的临床疗效。方法选取2008年1月至2012年12月新疆维吾尔自治区人民医院北院收治的高龄不稳定型股骨粗隆间骨折患者368例,采用随机数字表法将其分为Ⅰ组(184例)和Ⅱ组(184例)。Ⅰ组患者实施半髋关节置换术,Ⅱ组患者实施PFNA进行治疗,观察对比两组患者手术疗效。结果Ⅰ组手术时间、出血量、术后引流量显著高于Ⅱ组[(52±7) min比(64±7) min,(139±19) mL比(121±18) mL,(81±17) mL 比(70±15) mL],患肢开始负重时间显著短于Ⅱ组[(16.5±2.6) min比(26.8±3.7) min],差异有统计学意义(P<0.01)。1年后Ⅰ组髋关节功能优良率显著高于Ⅱ组(78.8%比63.0%),Ⅰ组早期并发症发生率高于Ⅱ组(14.1%比4.9%),晚期并发症发生率低于Ⅱ组(5.4%比19.0%),差异有统计学意义(P<0.05)。结论半髋关节置换术适用于身体情况好的患者,但早期并发症较多;对于身体状况较差合并有慢性内科疾病的患者,可选择PFNA 治疗,但晚期并发症多。
目的:比較半髖關節置換和防鏇型股骨近耑髓內釘( PFNA)治療高齡不穩定型股骨粗隆間骨摺患者的臨床療效。方法選取2008年1月至2012年12月新疆維吾爾自治區人民醫院北院收治的高齡不穩定型股骨粗隆間骨摺患者368例,採用隨機數字錶法將其分為Ⅰ組(184例)和Ⅱ組(184例)。Ⅰ組患者實施半髖關節置換術,Ⅱ組患者實施PFNA進行治療,觀察對比兩組患者手術療效。結果Ⅰ組手術時間、齣血量、術後引流量顯著高于Ⅱ組[(52±7) min比(64±7) min,(139±19) mL比(121±18) mL,(81±17) mL 比(70±15) mL],患肢開始負重時間顯著短于Ⅱ組[(16.5±2.6) min比(26.8±3.7) min],差異有統計學意義(P<0.01)。1年後Ⅰ組髖關節功能優良率顯著高于Ⅱ組(78.8%比63.0%),Ⅰ組早期併髮癥髮生率高于Ⅱ組(14.1%比4.9%),晚期併髮癥髮生率低于Ⅱ組(5.4%比19.0%),差異有統計學意義(P<0.05)。結論半髖關節置換術適用于身體情況好的患者,但早期併髮癥較多;對于身體狀況較差閤併有慢性內科疾病的患者,可選擇PFNA 治療,但晚期併髮癥多。
목적:비교반관관절치환화방선형고골근단수내정( PFNA)치료고령불은정형고골조륭간골절환자적림상료효。방법선취2008년1월지2012년12월신강유오이자치구인민의원북원수치적고령불은정형고골조륭간골절환자368례,채용수궤수자표법장기분위Ⅰ조(184례)화Ⅱ조(184례)。Ⅰ조환자실시반관관절치환술,Ⅱ조환자실시PFNA진행치료,관찰대비량조환자수술료효。결과Ⅰ조수술시간、출혈량、술후인류량현저고우Ⅱ조[(52±7) min비(64±7) min,(139±19) mL비(121±18) mL,(81±17) mL 비(70±15) mL],환지개시부중시간현저단우Ⅱ조[(16.5±2.6) min비(26.8±3.7) min],차이유통계학의의(P<0.01)。1년후Ⅰ조관관절공능우량솔현저고우Ⅱ조(78.8%비63.0%),Ⅰ조조기병발증발생솔고우Ⅱ조(14.1%비4.9%),만기병발증발생솔저우Ⅱ조(5.4%비19.0%),차이유통계학의의(P<0.05)。결론반관관절치환술괄용우신체정황호적환자,단조기병발증교다;대우신체상황교차합병유만성내과질병적환자,가선택PFNA 치료,단만기병발증다。
Objective To compare the clinical efficacy of hemiarthroplasty and proximal femoral intr-amedullary nailing treatment ( PFNA) for treating elderly unstable intertrochanteric fracture.Methods A total of 368 cases of unstable intertrochanteric fracture were selected from North Hospital of People′s Hospital in Xinjiang Uygur Autonomous Region from Jan .2008 to Dec.2012.They were divided intogroup Ⅰ(184 cases) and groupⅡ(184 cases) by random number table method.GroupⅠ was treated with hemiarthroplas-ty,and group Ⅱwas treated with PFNA.The clinical efficacy of the two groups was compared.Results The operation time,blood lost,drainage volume after operation,limb weight bearing time of group Ⅰwere signifi-cantly higher than group Ⅱ[(52 ±7) min vs (64 ±7) min,(139 ±19) mL vs (121 ±18) mL,(81 ±17) mL vs (70 ±15) mL] and the limb weight bearing start time was significantly lower than group Ⅱ[(16.5 ± 2.6) min vs (26.8 ±3.7) min],the difference was statistically significant(P <0.01).After 1 year,the excellent and good rate of hip function rate was significantly higher than group Ⅱ(78.8% vs 63.0%),early complication incidence was significantly higher than groupⅡ, and late complication incidence was signifi-cantly lower thangroupⅡ(14.1% vs 4.9%,5.4% vs 19.0%).There were statistically significant differ-ences(P<0.05).Conclusion Hemiarthroplasty is suitable for patients with good body condition,but has a high early complication incidence rate.For patients with poor body condition and more basic diseases,PFNA can be a better choice,which may have more complications later.