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[1]吳天然,陳夏平,李銘雄,等.微創(chuàng)孟氏架外固定治療老年股骨順轉(zhuǎn)子間骨折的臨床研究[J].中醫(yī)正骨,2016,28(05):5-8.
　WU Tianran,CHEN Xiaping,LI Mingxiong,et al.A clinical study of minimally invasive external fixation with Meng's fixator for treatment of femoral antegrade intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):5-8.
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微創(chuàng)孟氏架外固定治療老年股骨順轉(zhuǎn)子間骨折的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年05期
頁碼:
5-8
欄目:
臨床研究
出版日期:
2016-05-20

文章信息/Info

Title:
A clinical study of minimally invasive external fixation with Meng's fixator for treatment of femoral antegrade intertrochanteric fractures in the aged
作者:
吳天然; 陳夏平; 李銘雄; 吳成專; 陳長賢; 劉聯(lián)群; 王瑞雄; 葉志強(qiáng); 張昭興
福建省泉州市正骨醫(yī)院,福建 泉州 362000
Author(s):
WU Tianran; CHEN Xiaping; LI Mingxiong; WU Chengzhuan; CHEN Changxian; LIU Lianqun; WANG Ruixiong; YE Zhiqiang; ZHANG Zhaoxing
Quanzhou Orthopedic Hospital,Quanzhou 362000,Fujian,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子間骨折;  外固定器;  股骨近端防旋髓內(nèi)釘;  老年人;  臨床試驗
Keywords:
hip fractures;  intertrochanteric fractures;  external fixators;  proximal femoral nail antirotation;  aged;  clinical trial
摘要:
目的:觀察微創(chuàng)孟氏架外固定治療老年股骨順轉(zhuǎn)子間骨折的臨床療效及安全性。方法:回顧性分析205例老年股骨順轉(zhuǎn)子間骨折患者的病例資料,其中采用微創(chuàng)孟氏架外固定96例,采用股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)固定109例。男98例,女107例。年齡63～99歲,中位數(shù)76歲。按照股骨轉(zhuǎn)子間骨折的Evans分型,Ⅰa型20例、Ⅰb型43例、Ⅰc型86例、Ⅰd型56例。受傷至手術(shù)時間3～7 d,中位數(shù)4 d。比較2組患者的手術(shù)時間、術(shù)中出血量、骨折愈合時間、術(shù)后開始部分負(fù)重行走時間及并發(fā)癥發(fā)生率,比較2組術(shù)后3個月采用Harris髖關(guān)節(jié)功能評分標(biāo)準(zhǔn)評定的臨床療效。結(jié)果:所有患者均獲隨訪,隨訪時間12～24個月,中位數(shù)16個月。孟氏架組的手術(shù)時間、骨折愈合時間及術(shù)后開始部分負(fù)重行走時間均短于PFNA組[(33.09±3.18)min,(52.23±6.99)min,t=-12.370,P=0.000;(12.00±0.80)周,(16.30±1.30)周,t=-12.524,P=0.000;(13.40±1.10)d,(27.80±1.10)d,t=-12.546,P=0.000],其術(shù)中出血量小于PFNA組[(11.10±2.20)mL,(100.30±12.20)mL,t=-12.390,P=0.000]。術(shù)后孟氏架組出現(xiàn)2例針孔感染、2例下肢深靜脈血栓形成、4例固定物松動、3例髖內(nèi)翻,PFNA組出現(xiàn)1例切口感染、2例下肢深靜脈血栓形成、2例內(nèi)固定物松動、1例髖內(nèi)翻,2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=2.379,P=0.099)。孟氏架組優(yōu)71例、良15例、差10例,PFNA組優(yōu)80例、良20例、差9例,2組患者的臨床療效比較,差異無統(tǒng)計學(xué)意義(Z=0.473,P=0.789)。結(jié)論:孟氏架外固定治療老年股骨順轉(zhuǎn)子間骨折,療效及安全性與PFNA內(nèi)固定相當(dāng),但其具有手術(shù)時間短、術(shù)中出血少、骨折愈合快、患者可早期行走等優(yōu)點(diǎn),值得臨床推廣應(yīng)用。
Abstract:
Objective:To observe the clinical curative effect and safety of minimally invasive external fixation with Meng's fixator in treatment of femoral antegrade intertrochanteric fractures in the aged.Methods:The medical records of 205 aged patients with femoral antegrade intertrochanteric fractures were analyzed retrospectively.Ninety-six patients were treated with minimally invasive external fixation with Meng's fixator(Meng's fixator group),while the others were treated with proximal femoral nail antirotation(PFNA group).The patients consisted of 98 males and 107 females,and ranged in age from 63 to 99 years(Median=76 yrs)and ranged in disease course from 3 to 7 days(Median=4 days).According to the Evans classification of intertrochanteric fractures,the fractures belonged to typesIa(20),Ib(43),Ic(86)and Id(56).The operative time,blood loss,fracture healing time,postoperative partial weight-bearing walk start time and complication incidences were compared between the 2 groups.The clinical curative effect were evaluated according to Harris hip function scoring standard and were compared between the 2 groups at 3 months after the surgery.Results:All patients in the 2 groups were followed up for 12-24 months with a median of 16 months.The operative time,fracture healing time and postoperative partial weight-bearing walk start time were shorter in Meng's fixator group compared to PFNA group(33.09+/-3.18 vs 52.23+/-6.99 min,t=-12.370,P=0.000; 12.00+/-0.80 vs 16.30+/-1.30 weeks,t=-12.524,P=0.000; 13.40+/-1.10 vs 27.80+/-1.10 days,t=-12.546,P=0.000),while the blood loss was less in Meng's fixator group compared to PFNA group(11.10+/-2.20 vs 100.30+/-12.20 ml,t=-12.390,P=0.000).After the surgery,pin hole infection(2),lower extremity deep venous thrombosis(2),loosening of internal fixator(4)and coxa vara(3)were found in Meng's fixator group; while incision infection(1),lower extremity deep venous thrombosis(2),loosening of internal fixator(2)and coxa vara(1)were found in PFNA group.There was no statistical difference in complication incidences between the two groups(χ2=2.379,P=0.099).Seventy-one patients obtained an excellent result,15 good and 10 poor in Meng's fixator group; while 80 patients obtained an excellent result,20 good and 9 poor in PFNA group.There was no statistical difference in clinical curative effects between the 2 groups(Z=0.473,P=0.789).Conclusion:External fixation with Meng's fixator is similar to PFNA internal fixation in the total curative effect and safety in treatment of femoral antegrade intertrochanteric fractures in the aged,while the former has the advantages of shorter operative time,less blood loss,faster fracture healing and earlier ambulation,so it is worthy of popularizing in clinic.

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更新日期/Last Update: 2016-10-30