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[1]費國芳,費紅良,王金法.兩種內(nèi)固定方法治療老年不穩(wěn)定性股骨轉子間骨折的對比研究[J].中醫(yī)正骨,2016,28(05):9-12.
　FEI Guofang,FEI Hongliang,WANG Jinfa.Comparison of two kinds of internal fixation for treatment of unstable femoral intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):9-12.
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兩種內(nèi)固定方法治療老年不穩(wěn)定性股骨轉子間骨折的對比研究()
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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:
9-12
欄目:
臨床研究
出版日期:
2016-05-20

文章信息/Info

Title:
Comparison of two kinds of internal fixation for treatment of unstable femoral intertrochanteric fractures in the aged
作者:
費國芳; 費紅良; 王金法
浙江省湖州市南潯區(qū)人民醫(yī)院,浙江 湖州 313009
Author(s):
FEI Guofang; FEI Hongliang; WANG Jinfa
Nanxun People's Hospital of Huzhou City,Huzhou 313009,Zhejiang
關鍵詞:
髖骨折;  轉子間骨折;  老年人;  骨質疏松;  骨板;  骨折固定術; 髓內(nèi);  療效比較研究
Keywords:
hip fractures;  intertrochanteric fractures;  aged;  osteoporosis;  bone plates;  fracture fixation; intramedullary;  comparative effectiveness research
摘要:
目的:比較股骨近端防旋髓內(nèi)釘(proximal femoral nail antirotation,PFNA)固定和股骨近端解剖鎖定接骨板(anatomic proximal femoral locking plate,ALP)固定治療老年不穩(wěn)定性股骨轉子間骨折的臨床療效和安全性。方法:回顧性分析122例不穩(wěn)定性股骨轉子間骨折老年患者的病例資料,57例采用PFNA固定治療(PFNA組)、65例采用ALP固定治療(ALP組)。比較2組患者的部分負重時間、完全負重時間、骨折愈合時間、術后6個月時的Harris髖關節(jié)評分及并發(fā)癥發(fā)生率。結果:PFNA組的部分負重時間、完全負重時間和骨折愈合時間均比ALP組短[(4.25±3.90)周,(5.57±2.90)周,t=1.988,P=0.049;(10.85±5.51)周,(13.75±6.75)周,t=2.576,P=0.011;(16.55±8.14)周,(20.50±9.86)周,t=2.393,P=0.018]; 術后6個月PFNA組的Harris評分高于ALP組[(87.30±9.21)分,(79.57±11.56)分,t=4.517,P=0.001]。至術后6個月時,PFNA組1例出現(xiàn)患側下肢短縮,1例發(fā)生螺釘從股骨頭切出,行人工髖關節(jié)置換術治療; ALP組3例發(fā)生骨折延遲愈合,取出部分螺釘并植骨后愈合,2例發(fā)生鋼板斷裂,取出鋼板后1例行關節(jié)置換術、1例以動力髁螺釘固定。2組患者的并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.361,P=0.548)。結論:與ALP固定相比,采用PFNA固定治療老年不穩(wěn)定性股骨轉子間骨折,患者可以更早地下床負重活動,獲得更快的骨折愈合和更好的髖關節(jié)功能,二者的安全性相當。
Abstract:
Objective:To compare the clinical curative effects and safety of proximal femoral nail antirotation(PFNA)fixation versus anatomic proximal femoral locking plate(ALP)fixation for treatment of unstable femoral intertrochanteric fractures in the aged.Methods:The medical records of 122 aged patients with unstable femoral intertrochanteric fractures were analyzed retrospectively.Fifty-seven patients were treated with PFNA fixation(PFNA group),while the others were treated with ALP fixation(ALP group).The partial weight-bearing walk start time,complete weight-bearing walk start time,fracture healing time,Harris hip scores and complication incidences at six months after surgery were compared between the 2 groups.Results:The partial weight-bearing walk start time,complete weight-bearing walk start time and fracture healing time were shorter in PFNA group compared to ALP group(4.25+/-3.90 vs 5.57+/-2.90 weeks,t=1.988,P=0.049; 10.85+/-5.51 vs 13.75+/-6.75 weeks,t=2.576,P=0.011; 16.55+/-8.14 vs 20.50+/-9.86 weeks,t=2.393,P=0.018).The Harris hip scores at six months after surgery were higher in PFNA group compared to ALP group(87.30+/-9.21 vs 79.57+/-11.56 points,t=4.517,P=0.001).At six months after surgery,lower limb shortening in affected side(1)and screw protrusion from femoral head(1)were found in PFNA group,then artificial hip replacement were performed on the two patients.The delayed union of fractures were found in 3 patients in ALP group and the fractures healed after removing part of the screws and bone grafting.The plate breakage were found in 2 patients in ALP group,and one case was treated with joint replacement after removing the plate and the other one was treated with dynamic condylar screw fixation.There was no statistical difference in complication incidences between the two groups(χ2=0.361,P=0.548).Conclusion:Earlier weight-bearing activities,faster fracture healing and better hip joint function can be obtained after PFNA fixation compared to ALP fixation in aged patients with unstable femoral intertrochanteric fractures,while the two kinds of internal fixation are similar to each other in safety.

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備注/Memo

備注/Memo:
通訊作者:王金法 E-mail:[email protected]
更新日期/Last Update: 2016-10-30