PFNA、股骨头置换及锁定钢板治疗老年股骨转子间骨折的临床疗效分析(1)
摘要：目的 比较股骨近端防旋髓内钉(PFNA)、股骨头置换(FHR)和解剖型锁定钢板(ALP)三种手术方法治疗效果。方法 对我院2011年3月～2014年12月收治的113例分别接受PFNA、FHR和ALP的患者进行回顾性分析。其中，PFNA组39例，ALP组37例，FHR组37例。对三组患者的术中情况、术后并发症及Harris髋关节功能等资料进行回顾性研究。结果 113例全部获得随访，随访时间8？19个月，平均12.7个月。平均手术时间三组间比较，F值为49.43，差异有统计学意义(P<0.05)；术中出血量比较F为437.637，比较无统计学意义(P>0.05)；术后部分负重时间：ALP组>PFNA组>FHR组，两两比较有统计学差异(P< 0.05)。三组术后并发症发生率差异无统计学意义(P>0.05)。术后1、6个月Harris评分有统计学意义(P>0.05)，而术后12个月无统计学差异(P>0.05)。结论 PFNA、FHR和ALP均可获得较满意疗效，其中PFNA组具有创伤小、固定可靠、术后并发症少等优点，可作为临床首选治疗方案。
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关键词：老年；转子间骨折； PFNA；股骨头置换；解剖锁定钢板
Analysis of Clinical Efficacy of PFNA， Femoral Head Replacement and Locking Plate in the Treatment of Elderly Femoral Intertrochanteric Fractures
ZHU Xiang-dong，WANG Gang，QIAN Li-biao，XU Zi-sheng
(Anqing Petrochemical Hospital，Nanjing Gulou Hospital Group，Nanjing 210000，Jiangsu，China)
Abstract：Objective To compare the effects of three surgical methods of proximal femoral nail anti rotation (PFNA)， femoral head replacement (FHR) and anatomical locking plate (ALP). Methods A retrospective analysis was performed on 113 patients with PFNA， FHR and ALP admitted to our hospital from March 2011 to December 2014. Among them， PFNA group of 39 cases， ALP group of 37 cases， FHR group of 37 cases. Data of 3 groups of patients in the intraoperative， postoperative complications and Harris hip function were retrospectively studied.Results All 113 cases were followed up， follow-up time from 8 to 19 months， an average of 12.7 months. The average operation time was compared between the three groups， the value of F for 49.43， the difference was statistically significant (P < 0.05)； intraoperative blood loss compared f is 437.637， no statistical significance (P > 0.05)； postoperative weight-bearing time： ALP group >PFNA group >FHR group， pairwise comparison with statistically significant difference (P< 0.05). There was no significant difference in the incidence of postoperative complications between the three groups (P> 0.05). After 1 and 6 months， Harris score was statistically significant (P> 0.05)， and no significant differenc was not statistically significant (P> 0.05).Conclusion PFNA， FHR and ALP can obtain satisfactory curative effect， the PFNA group has the advantages of less trauma， reliable fixation， less complications and so on. It can be used as the preferred clinical treatment plan.
Key words：Elderly； Intertrochanteric fractures； PFNA； Femoral head replacement； Anatomical locking plate
隨着生活水平提高，人口老龄化及生活方式改变，股骨转子间骨折发生率日益增加。非手术治疗需长期卧床，并发症较多，病死率为15%～20%。目前主张手术治疗已达成共识，合理选择手术方式成为治疗关键。目前临床上为PFNA组、FHR组、ALP组使用最为广泛，但临床采用哪种手术方式，仍存争议。本研究回顾性分析自2011年3月～2014年12月采用PFNA组、FHR组和ALP组三种内固定方法治疗113例老年股骨转子间骨折患者。现报告如下。, http://www.100md.com(朱向东 王刚 钱立标 徐自胜)
, http://www.100md.com
关键词：老年；转子间骨折； PFNA；股骨头置换；解剖锁定钢板
Analysis of Clinical Efficacy of PFNA， Femoral Head Replacement and Locking Plate in the Treatment of Elderly Femoral Intertrochanteric Fractures
ZHU Xiang-dong，WANG Gang，QIAN Li-biao，XU Zi-sheng
(Anqing Petrochemical Hospital，Nanjing Gulou Hospital Group，Nanjing 210000，Jiangsu，China)
Abstract：Objective To compare the effects of three surgical methods of proximal femoral nail anti rotation (PFNA)， femoral head replacement (FHR) and anatomical locking plate (ALP). Methods A retrospective analysis was performed on 113 patients with PFNA， FHR and ALP admitted to our hospital from March 2011 to December 2014. Among them， PFNA group of 39 cases， ALP group of 37 cases， FHR group of 37 cases. Data of 3 groups of patients in the intraoperative， postoperative complications and Harris hip function were retrospectively studied.Results All 113 cases were followed up， follow-up time from 8 to 19 months， an average of 12.7 months. The average operation time was compared between the three groups， the value of F for 49.43， the difference was statistically significant (P < 0.05)； intraoperative blood loss compared f is 437.637， no statistical significance (P > 0.05)； postoperative weight-bearing time： ALP group >PFNA group >FHR group， pairwise comparison with statistically significant difference (P< 0.05). There was no significant difference in the incidence of postoperative complications between the three groups (P> 0.05). After 1 and 6 months， Harris score was statistically significant (P> 0.05)， and no significant differenc was not statistically significant (P> 0.05).Conclusion PFNA， FHR and ALP can obtain satisfactory curative effect， the PFNA group has the advantages of less trauma， reliable fixation， less complications and so on. It can be used as the preferred clinical treatment plan.
Key words：Elderly； Intertrochanteric fractures； PFNA； Femoral head replacement； Anatomical locking plate
隨着生活水平提高，人口老龄化及生活方式改变，股骨转子间骨折发生率日益增加。非手术治疗需长期卧床，并发症较多，病死率为15%～20%。目前主张手术治疗已达成共识，合理选择手术方式成为治疗关键。目前临床上为PFNA组、FHR组、ALP组使用最为广泛，但临床采用哪种手术方式，仍存争议。本研究回顾性分析自2011年3月～2014年12月采用PFNA组、FHR组和ALP组三种内固定方法治疗113例老年股骨转子间骨折患者。现报告如下。, http://www.100md.com(朱向东 王刚 钱立标 徐自胜)
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