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不同内固定方法治疗老年人股骨粗隆间骨折疗效比较

Comparision of the effects of different fixation methods in the treatment of elderly patients with intertrochanteric fracture

摘要:

目的 比较不同内固定方法治疗老年股骨粗隆间骨折患者的临床疗效.方法 回顾性分析270例老年股骨粗隆间骨折患者的临床诊治资料,依据内固定方式不同分为三组,分别为抗旋转髓内钉(PFNA)组、动力髋内钉(DHS)组和解剖型锁定钢板(LCP)组,每组90例.比较三组治疗过程中切口长度、手术时间、术中出血量、住院时间、术后负重时间、术后渗血量、并发症发生情况;随访比较三组患者骨折愈合情况.结果 PFNA组切口长度与DHS组比较(t=11.248,P=0.000)、与LCP组比较(t=12.371,P=0.000)差异均有统计学意义;PFNA组手术时间与DHS组比较(t=15.048,P=0.000)、与LCP组比较(t=12.822,P=0.000)差异均有统计学意义;PFNA组术中出血量与DHS组比较(t=5.803,P=0.000)、与LCP组比较(t=10.879,P=0.000)差异均有统计学意义.PFNA组并发症发生率为3.33%(3/90例)、DHS组并发症发生率为10.00%(9/90例)、LCP组并发症发生率为13.33%(12/90例),三组比较,PFNA组较低(x2=5.268,P=0.026);PFNA组骨折愈合平均时间与DHS组比较(t=10.217,P=0.000)、与LCP组比较(t=4.530,P=0.000)差异均有统计学意义(均P<0.05).结论 PFNA治疗老年股骨粗隆间骨折,具有创伤小、手术时间短、失血少、并发症少、恢复快等优点,值得临床推广使用.

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abstracts:

Objective To compare the clinical efficacy of different internal fixation methods in the treatment of intertrochanteric fractures.Methods he clinical data of 270 elderly patients with intertrochanteric fracture were retrospectively analyzed.According to the different internal fixation methods,the patients were divided into three groups,namely anti-rotation intramedullary nail(PFNA) group,dynamic hip screw(DHS) group and anatomic locking plate (LCP) group,90 cases in each group.The incision length,operative time,blood loss,hospital stay,postoperative weight-bearing time,postoperative bleeding and postoperative complications were compared among the three groups.The fracture healing was compared among the three groups during follow-up.Results The incision length of PFNA group compared with the DHS group (t =11.248,P =0.000) and the LCP group (t =12.371,P =0.000),the differences were significant.The operative time of PFNA group compared with the DHS group (t =15.048,P =0.000) and the LCP group(t =12.822,P =0.000),the differences were significant.The blood loss of PFNA group compared with the DHS group (t =5.803,P =0.000) and the LCP group (t =10.879,P =0.000),the differences were significant.The incidence rates of complications in PFNA group,DHS group,LCP group were 3.33% (3/90),10.00% (9/90),13.33% (12/90),respectively,and theincidence rate of PFNA group was lower than the other two groups (x2 =5.268,P =0.026).The average period of fracture healing in PFNA group compared with the DHS group (t =10.217,P =0.000) and the LCP group (t =4.530,P =0.000),the differences were significant.Conclusion PFNA in the treatment of senile intertrochanteric fractures has advantages such as less trauma,shorter operation time,less blood loss,fewer complications,faster recovery,it is worthy of clinical use.

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