84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]陳立和,麥偉發(fā).加長型股骨近端防旋髓內(nèi)釘聯(lián)合鋼纜內(nèi)固定治療股骨轉(zhuǎn)子下粉碎性骨折的臨床研究[J].中醫(yī)正骨,2019,31(01):5-9.
　CHEN Lihe,MAI Weifa.Internal fixation with long proximal femoral nail antirotation and wirerope for treatment of femoral subtrochanteric comminuted fracture:a clinical study[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(01):5-9.
點擊復(fù)制

加長型股骨近端防旋髓內(nèi)釘聯(lián)合鋼纜內(nèi)固定治療股骨轉(zhuǎn)子下粉碎性骨折的臨床研究()
分享到：

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年01期
頁碼:
5-9
欄目:
臨床研究
出版日期:
2019-01-20

文章信息/Info

Title:
Internal fixation with long proximal femoral nail antirotation and wirerope for treatment of femoral subtrochanteric comminuted fracture:a clinical study
作者:
陳立和; 麥偉發(fā)
(廣州市南沙區(qū)第六人民醫(yī)院,廣東 廣州 511470)
Author(s):
CHEN Lihe; MAI Weifa
The Sixth People's Hospital of Nansha District,Guangzhou 511470,Guangdong,China
關(guān)鍵詞:
髖骨折;  轉(zhuǎn)子下骨折;  骨折; 粉碎性;  骨折固定術(shù); 髓內(nèi);  骨固定鋼絲;  骨板
Keywords:
hip fractures;  subtrochanteric fractures;  fractures; comminuted;  fracture fixation; intramedullary;  bone wires;  bone plates
摘要:
目的:觀察加長型股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)聯(lián)合鋼纜內(nèi)固定治療股骨轉(zhuǎn)子下粉碎性骨折的臨床療效及安全性。方法:將74例股骨轉(zhuǎn)子下粉碎性骨折患者隨機分為2組,每組37例。分別采用加長型PFNA聯(lián)合鋼纜內(nèi)固定(髓內(nèi)釘組)和股骨近端解剖鎖定鋼板(proximal femoral locking plate,PFLP)聯(lián)合鋼纜內(nèi)固定(鎖定鋼板組)治療。記錄并比較兩組患者的手術(shù)時間、術(shù)中出血量、術(shù)后完全負重開始時間、骨折愈合時間、Harris髖關(guān)節(jié)功能評分和并發(fā)癥發(fā)生情況。結(jié)果:所有患者均獲隨訪,隨訪時間6個月至2年,中位數(shù)8個月。髓內(nèi)釘組有6例植骨,鎖定鋼板組有8例植骨。2組患者的手術(shù)時間比較,差異無統(tǒng)計學(xué)意義[(127.76±25.76)min,(133.28±22.68)min,t=3.226,P=0.317]; 髓內(nèi)釘組的術(shù)中出血量少于鎖定鋼板組[(113.89±20.97)mL,(133.45±19.82)mL,t=5.537,P=0.037],術(shù)后完全負重開始時間和骨折愈合時間均短于鎖定鋼板組[(2.31±0.45)個月,(3.13±0.66)個月,t=6.089,P=0.034;(3.32±0.60)個月,(3.78±0.71)個月,t=5.411,P=0.042]。髓內(nèi)釘組切口感染1例、髖內(nèi)翻1例、深靜脈血栓1例、內(nèi)固定失敗1例,鎖定鋼板組切口感染2例、髖內(nèi)翻3例、深靜脈血栓3例、骨折不愈合2例、內(nèi)固定失敗1例,髓內(nèi)釘組的并發(fā)癥發(fā)生率低于鎖定鋼板組(χ2=4.097,P=0.043)。3例切口感染者,采用抗生素治療后均治愈; 4例髖內(nèi)翻畸形者,2例行楔形截骨矯正術(shù)后髖關(guān)節(jié)功能恢復(fù),2例未進行治療; 4例深靜脈血栓形成者,1例行抗凝治療、2例行溶栓治療、1例穿戴彈力襪治療,均好轉(zhuǎn); 2例骨折不愈合者,行髓內(nèi)釘固定聯(lián)合異體骨植骨后骨折愈合; 2例內(nèi)固定失敗者,行翻修手術(shù)后效果良好。術(shù)后6個月采用Harris髖關(guān)節(jié)功能評分評價綜合療效,髓內(nèi)釘組(87.64±16.37)分,優(yōu)19例、良12例、可4例、差2例; 鎖定鋼板組(81.39±12.86)分,優(yōu)11例、良15例、可4例、差7例; 髓內(nèi)釘組的綜合療效優(yōu)于鎖定鋼板組(Z=-2.061,P=0.039)。結(jié)論:與PFLP聯(lián)合鋼纜內(nèi)固定治療相比,加長型PFNA聯(lián)合鋼纜內(nèi)固定治療股骨轉(zhuǎn)子下粉碎性骨折,術(shù)中出血量少、術(shù)后可早期完全負重、骨折愈合時間短、綜合療效好、安全性高。
Abstract:
Objective:To observe the clinical curative effects and safety of internal fixation with long proximal femoral nail antirotation(PFNA)and wirerope for treatment of femoral subtrochanteric comminuted fracture.Methods:Seventy-four patients with femoral subtrochanteric comminuted fractures were randomly divided into 2 groups,37 cases in each group.The patients were treated with internal fixation with long PFNA and wirerope(intramedullary nail group)and internal fixation with proximal femoral locking plate(PFLP)and wirerope(locking plate group)respectively.The operative time,intraoperative blood loss,postoperative full weight-bearing start time,fracture healing time,Harris hip function scores and complication incidences were recorded and compared between the 2 groups.Results:All patients in the 2 groups were followed up for 6-24 months with a median of 8 months.Bone grafting was performed on 6 patients in intramedullary nail group and 8 patients in locking plate group.There was no statistical difference in operative time between the 2 groups(127.76+/-25.76 vs 133.28+/-22.68 min,t=3.226,P=0.317).The intraoperative blood loss was less,and the postoperative full weight-bearing start time and fracture healing time were shorter in intramedullary nail group compared to locking plate group(113.89+/-20.97 vs 133.45+/-19.82 mL,t=5.537,P=0.037; 2.31+/-0.45 vs 3.13+/-0.66 months,t=6.089,P=0.034; 3.32+/-0.60 vs 3.78+/-0.71 months,t=5.411,P=0.042).Incision infection(1),coxa vara(1),deep venous thrombosis(1)and failed internal fixation(1)were found in intramedullary nail group; while incision infection(2),coxa vara(3),deep venous thrombosis(3),fracture nonunion(2)and failed internal fixation(1)were found in locking plate group.The complication incidence was lower in intramedullary nail group compared to locking plate group(χ2=4.097,P=0.043).The three patients with incision infection were cured after antibiotic treatment.Two patients with coxa vara deformity were treated with wedge-shaped osteotomy and their hip functions were recovered,and the other 2 patients with coxa vara deformity were untreated.Anticoagulant therapy,thrombolytic therapy and elastic socks therapy were performed on 1,2 and 1 patient with deep vein thrombosis respectively,and their deep vein thrombosis were improved.Combination therapy of intramedullary nail fixation and allogeneic bone grafting were performed on the 2 patients with nonunion of fracture,and the fractures were healed.Revision surgery was performed on the 2 patients with failed internal fixation and they obtained a good result.The total clinical curative effects were evaluated according to Harris hip function scores at 6 months after the surgery,and the scores were 87.64+/-16.37 points in intramedullary nail group and 81.39+/-12.86 points in locking plate group.Nineteen patients obtained an excellent result,12 good,4 fair and 2 poor in intramedullary nail group; while 11 patients obtained an excellent result,15 good,4 fair and 7 poor in locking plate group.The intramedullary nail group surpassed the locking plate group in the total clinical curative effect(Z=-2.061,P=0.039).Conclusion:Internal fixation with long PFNA and wirerope has the advantages of less intraoperative blood loss,earlier postoperative full weight-bearing activities,shorter fracture healing time,better total clinical curative effect and higher safety compared to internal fixation with PFLP and wirerope in treatment of femoral subtrochanteric comminuted fracture.

參考文獻/References:

[1] TOMÁS J,TEIXIDOR J,BATALLA L,et al.Subtrochanteric fractures:treatment with cerclage wire and long intramedullary nail[J].J Orthop Trauma,2013,27(7):157-160.
[2] 孟位明,李彥眉,許紅生,等.股骨轉(zhuǎn)子下骨折植入物髓外及髓內(nèi)固定治療的規(guī)范化[J].中國組織工程研究,2014,18(22):3587-3592.
[3] 秦強,殷瀟凡.加長防旋股骨近端髓內(nèi)釘治療SeinsheimerⅡ～Ⅴ型股骨轉(zhuǎn)子下骨折[J].臨床骨科雜志,2015,18(3):275.
[4] 孫哲,劉紹靈,鄧進.股骨轉(zhuǎn)子下骨折的治療進展[J].創(chuàng)傷外科雜志,2018,20(5):396-398.
[5] SEINSHEIMER F.Subtrochanteric fractures of the femur[J].J Bone Joint Surg Am,1978,60(3):300-306.
[6] 張嘉,翁習(xí)生.股骨轉(zhuǎn)子下骨折的診斷和治療[J].中國骨與關(guān)節(jié)外科,2008,1(1):77-81.
[7] HARRIS WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8] 趙海生,徐耀增,王貴賢,等.股骨近端防旋髓內(nèi)釘治療股骨轉(zhuǎn)子下骨折[J].中國組織工程研究,2013,17(48):8368-8373.
[9] SAINI P,KUMAR R,SHEKHAWAT V,et al.Biological fixation of comminuted subtrochanteric fractures with proximal femur locking compression plate[J].Injury,2013,44(2):226-231.
[10] 王少林,譚祖鍵,周明全,等.解剖型鎖定鋼板固定治療累及股骨干的轉(zhuǎn)子間或轉(zhuǎn)子下骨折[J].中華骨科雜志,2012,32(7):626-630.
[11] 張雷炎,蔣建農(nóng),王勇,等.有限切開復(fù)位鈦纜環(huán)扎結(jié)合髓內(nèi)釘固定治療股骨轉(zhuǎn)子下骨折[J].臨床骨科雜志,2017,20(1):89-90.
[12] 白濤,呼瑞,張文生,等.加長型PFNA-Ⅱ和DHS治療老年骨質(zhì)疏松性股骨轉(zhuǎn)子下骨折臨床療效及CRP、IL-6、Harris評分變化[J].陜西醫(yī)學(xué)雜志,2018,47(1):81-83.
[13] 朱龍,閆英杰,程戰(zhàn)偉,等.PFLP與PFNA微創(chuàng)治療老年不穩(wěn)定型股骨粗隆間骨折的對比[J].實用骨科雜志,2014,20(10):935-938.
[14] 洪俊毅,畢大衛(wèi),許冠華,等.加長PFNA治療股骨轉(zhuǎn)子下骨折臨床療效分析[J].浙江臨床醫(yī)學(xué),2017,19(6):1058-1060.

相似文獻/References:

[1]溫超海,何忠,李永斌,等.閉合復(fù)位伽瑪釘改良成鎖定支架內(nèi)固定治療 老年股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(11):32.
[2]孫群周,阮成群,李光明,等.股骨近端防旋髓內(nèi)釘內(nèi)固定治療 老年不穩(wěn)定型股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(10):20.
[3]方策,倪新宇,王宏偉,等.遲氏正骨手法復(fù)位單臂外固定支架固定治療 老年股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(10):22.
[4]趙云昌.人工股骨頭置換治療老年粉碎性股骨轉(zhuǎn)子間骨折[J].中醫(yī)正骨,2015,27(08):31.
[5]姜自偉,黃楓,鄭曉輝,等.老年股骨轉(zhuǎn)子間骨折患者的圍手術(shù)期風(fēng)險評估與控制[J].中醫(yī)正骨,2015,27(08):33.
[6]倪新宇,方策.外固定器治療股骨轉(zhuǎn)子間骨折的研究進展[J].中醫(yī)正骨,2015,27(07):48.
[7]張明強.生物型加長柄半髖關(guān)節(jié)置換術(shù)治療 高齡不穩(wěn)定股骨轉(zhuǎn)子間骨折療效觀察[J].中醫(yī)正骨,2015,27(02):56.
[8]李書良,李啟義,李建明,等.鎖定鋼板內(nèi)固定聯(lián)合自體髂骨植骨治療 股骨近端粉碎性骨折[J].中醫(yī)正骨,2015,27(05):31.
[9]王智勇,陳柯,田可為,等.聯(lián)合應(yīng)用搖桿技術(shù)和鉗夾技術(shù)微創(chuàng)治療股骨轉(zhuǎn)子部骨折[J].中醫(yī)正骨,2015,27(05):36.
[10]鄭艷峰,吳勛,周榮昌,等.股骨近端防旋髓內(nèi)釘內(nèi)固定與動力髖螺釘內(nèi)固定治療 老年股骨轉(zhuǎn)子間骨折的對比研究[J].中醫(yī)正骨,2015,27(04):24.
　ZHENG Yanfeng,WU Xun,ZHOU Rongchang,et al.A comparative study of proximal femoral nail antirotation internal fixation versus dynamic hip screw internal fixation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):24.
[11]郭甲瑞,余進偉,陳旭.股骨近端防旋髓內(nèi)釘內(nèi)固定治療股骨轉(zhuǎn)子下骨折[J].中醫(yī)正骨,2016,28(06):48.
[12]王瑞雄,陳夏平,吳天然,等.非骨科牽引床上手法閉合復(fù)位小切口鉗夾固定在股骨轉(zhuǎn)子下骨折股骨近端防旋髓內(nèi)釘內(nèi)固定術(shù)中的應(yīng)用[J].中醫(yī)正骨,2017,29(03):45.

更新日期/Last Update: 2019-07-11