[1]陈剑虹 李顺东 童培建△ 蒋招波.人工股骨头置换术与股骨近端防旋髓内钉治疗高龄 股骨转子间骨折的对比研究[J].中国中医骨伤科杂志,2016,24(02):18-21.
　CHEN Jianhong LI Shundong TONG Peijian JIANG Zhaobo.A Comparative Study of Proximal Femoral Anti-rotation Nail and Artificial Hip Joint Replacement in Treatment of Intertrochanteric Fracture[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2016,24(02):18-21.
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人工股骨头置换术与股骨近端防旋髓内钉治疗高龄 股骨转子间骨折的对比研究
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第24卷
期数:
2016年02期
页码:
18-21
栏目:
临床研究
出版日期:
2016-02-14

文章信息/Info

Title:
A Comparative Study of Proximal Femoral Anti-rotation Nail and Artificial Hip Joint Replacement in Treatment of Intertrochanteric Fracture
文章编号:
1005-0205(2016)02-0018-04
作者:
陈剑虹1 李顺东2 童培建1△ 蒋招波2
1.浙江中医药大学(浙江 杭州,310053)
2.台州市中医院
△.通信作者 E-mail:tongpeijian@163.com
Author(s):
CHEN Jianhong1 LI Shundong2 TONG Peijian1△ JIANG Zhaobo2
1.Zhejiang Traditional Chinese Medicine University, Hangzhou 310053,China;
2.The Taizhou Hospital of Traditional Chinese Medicine, Taizhou 318000,Zhejiang China.
关键词:
植入物;  人工股骨头置换;  股骨近端防旋髓内钉;  高龄股骨转子间骨折
Keywords:
implant;  proximal femoral nail antirotation;  intertrochanteric hip fractures;  eldly patients;  artificial hip replacement;  case-control study
分类号:
R683.42
文献标志码:
A
摘要:
目的:对比研究人工股骨头置换术与股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗高龄股骨转子间骨折的临床效果。方法:回顾性分析64例老年不稳定股骨转子间骨折患者的病例资料,其中采用人工股骨头置换术治疗25例(观察组),PFNA治疗39例(对照组),记录并比较2组患者术中平均手术时间、平均出血量、术后1周疼痛视觉模拟评分(visual analogue scale,VAS)、平均下床活动时间、术后近期随访(3个月～1年)髋关节功能及并发症发生情况。结果:观察组平均手术时间(60.80±17.91)min,平均出血量(173.3±39.2)mL,术后1周VAS评分(3.51±0.54)分,平均下床活动时间(15.94±8.87)d,术后1年髋关节功能Harris评分(87.8±12.1)分; 对照组平均手术时间(56.50±23.30)min,平均出血量(120.8±30.5)mL,术后1周VAS评分(2.33±0.13)分,平均下床活动时间(40.03±10.69)d,术后1年髋关节功能Harris评分(91.8±8.6)分。两组患者手术时间相近,差异无统计学意义(P>0.05); 与对照组比较,观察组患者术中出血量相对增多,术后1周VAS评分较低,下床活动时间明显缩短,差异有统计学意义(P<0.05); 术后1年观察组髋关节Harris评分低于对照组(P<0.05); 术后并发症总发生率也明显低于对照组。结论:人工股骨头置换术治疗高龄股骨转子间骨折,能迅速恢复患肢功能,缩短卧床休息时间,尽快恢复生活质量和信心,减少长期卧床所致全身并发症等,具有良好的临床疗效,值得推行使用。
Abstract:
Objective: To compare the clinical effect of artificial femoral head replacement and PFNA in the treatment of intertrochanteric fracture in elderly patients. Methods: A retrospective study of 64 cases with unstable intertrochanteric hip fractures of aged patients. 25 cases were treated with hip replacement(observation group), and 39 cases with proximal femoral nail antirotation(control group). The time of operative time, operative blood loss, visual analogue scale(VAS), average time of off-bed, hip function scores(Harris scores standard)and complication were recorded. Results: In observation group, the mean operative time was(60.80±17.91)min, mean operative blood loss(173.3±39.2)mL, mean visual analogue scale after a week(3.51±0.54)points, average time of off-bed(15.94±8.87)days, mean hip function scores(87.8±12.1)points. In control group, the mean operative time was(56.50±23.30)min, mean operative blood loss was(120.8±30.5)mL, mean visual analogue scale after a week(2.33±0.13)points, average time of off-bed(40.03±10.69)days.mean hip function scores(91.8±8.6)points. There were no significant differences in operative time(P>0.05).There were significant differences in operative blood loss, visual analogue scale and average time of off-bed between proximal femoral nail antirotation and hip replacement for femoral intertrochanteric fracture(P<0.05).Conclusion:Artificial hip replacement for complex femoral intertrochanteric fractures can effectively restore the joint function and help patients get out of bed early, with few complications caused by a long-term bed rest. It is worth clinical promotion.

参考文献/References:

[1] 王春生,张永涛,杨佩,等.关节置换与内固定治疗转子间骨折并发症的对比研究[J].中华关节外科杂志(电子版),2012,6(4):496-501.
[2] 闫剑平,张永,孔亚军.股骨粗隆间骨折四种手术方法比较[J].中国骨与关节损伤杂志,2012,27(2):149-150.
[3] 张斌,戴闽,唐亚敏,等.骨折治疗与运动康复一体化对股骨粗隆间骨折术后疗效的影响[J].中国修复重建外科杂志,2012,26(12):1453-1456.
[4] 姚绍平,孙先润,李维朝,等.不稳定型股骨转子间骨折人工股骨头置换和股骨近端髓内钉内固定疗效分析[J].创伤骨科杂志,2015,17(2):131-133.
[5] 马遇伯.全髋关节置换与股骨近端防旋髓内钉置入内固定修复老年股骨转子间骨折[J].中国组织工程研究,2013,18(53):8542-8546.
[6] 李顺东,许超,童培建,等.髋部手术围手术期隐性失血的研究进展[J].中国骨伤,2014,27(10):99-103.
[7] 孙辉,臧学慧,高立华,等.不同方式治疗老年转子间粉碎骨折患者的近期生存率及相关影响因素[J].中国老年学杂志,2015,35(8):4298-4300.
[8] 许守祥,牟海波,戴学国.Gamma钉与股骨近端髓内钉治疗老年股骨转子间骨折的比较分析[J].中华创伤骨科杂志,2006,8(6):589-590.
[9] Haentjens P,Lamraski G.Endoprosthetic replacement of unstable,comminuted intertrochanteric fracture of the femur in the elderly,osteoporotic patient:a review[J].Disabil Rehabil,2005,27(18-19):1167-1180.
[10] Sinno K,Sakr M,Girard J,et al.The effectiveness of primary bipolar arthroplasty in treatment of unstable intertrochanteric fractures in elderly patients[J].N Am J Med Sci,2010,2(12):561-568.
[11] Feng Y,Fang X,Shi Z,et al.Effects of PFNA exposure on expression of junction-associated molecules and secretory function in ratSertoli cells[J].Rep Toxicol,2010,30(3):429-437.
[12] 王亚平,路通.人工髋关节置换与股骨近端髓内钉治疗股骨转子间骨折的比较[J].中国组织工程研究,2013,17(52):8961-8966.
[13] Karthik K,Natarajan M.Unstable trochanteric fractures in elderly osteoporotic patients:role of primary hemiarthroplasty[J].Orthop Surg,2012,4(2):89-93.
[14] 杨子波,王秉钧,邬培慧,等.采用生存分析方法比较不同术式治疗老年转子间骨折对预后的影响[J].中国骨伤,2015,28(8):699-703.
[15] Kesmezacar H,Ogüt T,Bilgili MG,et al.Treatment of intertrochanteric femur fractures in elderly patients:internal fixation or hemiarthroplasty[J].Acta Orthop Traumatol Turc,2005,39(4):287-294.
[16] 董建彬,王智勇,芦浩,等.内固定术与髋关节置换术治疗股骨粗隆间骨折疗效的Meta分析[J].中国骨伤,2015,28(3):245-251.
[17] 王国胜,魏宁波,曹明宇,等.人工股骨头置换与内固定治疗老年不稳定型股骨粗隆间骨折的系统评价[J].中国矫形外科杂志,2014,22(2):121-129.

备注/Memo

备注/Memo:
收稿日期:2015-07-03
更新日期/Last Update: 2016-02-02