| 关节置换与内固定治疗中老年人髋部骨折的临床研究 |
| Alternative Title | Clinical Comparative study of arthroplasty and internal fixation for treatment of hip fracture in middled-aged and elderly
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| 陈扎根 |
| Subtype | 硕士
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| Thesis Advisor | 王文己
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| 2016-05-24
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| Degree Grantor | 兰州大学
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| Place of Conferral | 兰州
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| Degree Name | 硕士
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| Keyword | 髋部骨折
股骨颈骨折
转子间骨折
股骨近端锁定钢板
动力髋螺钉
股骨近端髓内钉
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| Abstract | 目的：比较关节置换与不同的内固定术治疗髋部骨折的疗效。
方法：回顾性分析我院2012年1月至2015年1月收治的髋部骨折患者110例。其中，男性50例，女性60例。年龄50～90岁，平均年龄68.49岁，受伤因素主要为行走时摔倒和交通伤。其中股骨颈骨折患者58例，女性32例，男性26例，按garden分型：Ⅰ型6例，Ⅱ型11例，Ⅲ型23例，Ⅳ型18例。粗隆间骨折52例，其中女性28例，男性24例，按Tronzo-Evans分型：Ⅰ型8例，Ⅱ型9例，Ⅲ型15例， Ⅳ型12例，Ⅴ型8例。根据不同的手术方式将患者分为关节置换组56例和内固定组54例。关节置换组有全髋置换（THR）30例，半髋置换26例；内固定有髓外固定32例（动力髋螺钉—DHS17例、股骨近端锁定钢板—PFLP15例）和股骨近端髓内钉—PFN22例。通过比较患者手术时间、术中出血量、术后下地时间、术后并发症和术后髋关节功能方面进行比较。
结果：全髋关节置换组的手术时间、术中出血量、下地时间和其他组比较均有统计学差异（p＜0.05），住院天数与髓内固定组、髓外固定组有统计学差异，但与半髋置换组比较差异无统计学意义；半髋置换组的术中出血量和下地时间与髓内固定组、髓外固定组比较均有统计学差异（p＜0.05），手术时间与髓内、髓外固定组均无统计学差异；髓外固定组出血量和下地时间与髓内固定组比较有统计学差异（p＜0.05），手术时间和住院天数差异无统计学意义。髓外固定组与其它三组在并发症上均存在明显差异（p＜0.05），其他三组间差异无统计学意义。全髋关节置换组术后髋关节功能评分与其它三组比较均存在明显差异（p＜0.05），其它三组间差异无统计学意义。
结论：关节置换术治疗髋部骨折术后并发症少、术后髋关节功能恢复良好，有适应症的条件下优先考虑关节置换。髓内固定髓内有牢固的支撑装置，可以承受很大的重力，相比髓外固定可使患者早期下地，减轻患者不能下地活动带来的并发症，如果患者不能耐受更大的手术可选择近端髓内钉。 |
| Other Abstract | Objective: To compare the clinical efficacy of arthroplasty and different internal fixation on hip fractures.
Methods: A retrospective analysis of 110 patients with hip fracture were treated in our hospital from January 2012 to January 2015. Among them, 50 cases of male, female 60 cases. Aged 50 to 90 years, the average age of 68.49 years. The main injury factors were traffic accident and falling. Femoral neck fracture patients were 58 cases,32 cases were females,and 26 males,by garden type: Ⅰtype in 6 cases, type Ⅱ 11 cases, type Ⅲ 23 cases, type Ⅳ 18 cases. Intertrochanteric fracture were 52 cases, of which 28 females, 24 males, according to Tronzo-Evans classification: Ⅰtype 8 cases, type Ⅱ 9 cases, type Ⅲ 15 cases, type Ⅳ 12 cases, type Ⅴ 8 cases. patients were divided into two groups, arthroplasty group were 56 cases and internal fixation group 54 cases according to the surgical methods. Arthroplasty group included total hip replacement (THR) 30 cases and Hemiarthroplasty (FHA)26 cases. Internal fixation group included extramedullary fixation 32 cases (dynamic hip screw -DHS17 cases, proximal femoral locking plate -PFLP15 cases) and proximal femoral nail -PFN22 cases.Data were collected for statistical analysis as following aspects: operative time, blood loss, postoperative ambulation time, postoperative complications and postoperative hip function.
Results: The operative time, blood loss, postoperative ambulation time of THA group were statistically significant from other groups(p <0.05), length of hospitalized were significantly different from intramedullary fixation group or extramedullary fixation group, but, was not statistically significant from hemiarthroplasty group(p <0.05); The blood loss and the postoperative ambulation time of hemiarthroplasty group were significant different from intramedullary fixation group or extramedullary fixation group (p <0.05), but operation time was not statistically different;The postoperative ambulation time and blood loss of the extramedullary fixation group were significant different from intramedullary fixation group(p <0.05),but operative time and length of hospitalized was no significant difference. The complications of extramedullary fixation group were significantly different from the other three groups (p <0.05) , the other three groups showed no significant difference each others. The hip score of total hip arthroplasty were significantly different from other three groups (p <0.05), the o... |
| URL | 查看原文
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| Language | 中文
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| Document Type | 学位论文
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| Identifier | https://ir.lzu.edu.cn/handle/262010/201210
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| Collection | 第一临床医学院
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Recommended Citation
GB/T 7714 |
陈扎根. 关节置换与内固定治疗中老年人髋部骨折的临床研究[D]. 兰州. 兰州大学,2016.
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