老年不稳定型股骨颈骨折手术方式选择.pdf

目 录 中文摘要 ···············································3 英文摘要 ···············································4 引 言 ················································6 正 文 ················································7 1.对象和方法 ··········································7 2.研究结果 ············································12 3.讨论 ·················································14 4.存在的问题 ··········································19 结 论 ···············································20 参考文献 ··············································21 附 录 23 综 述 ···············································26 致 谢 ···············································42 攻读学位期间发表的学术论文目录 ····················43 作者声明 ··············································44 个人简历 ··············································45 2 中 文 摘 要 目 的：比较空心螺钉内固定术、人工双动股骨头臵换术和全髋 关节臵换术在治疗老年不稳定型股骨颈骨折中的近期疗效。分析术后 髋关节功能、并发症、二次手术或翻修率等相关因素。为老年不稳定 型股骨颈骨折的手术选择提供依据。 方 法：采用回顾性科研方法收集病例。将符合研究标准的老年 不稳定型股骨颈骨折患者60例根据患者当时手术情况分为三组：空心 螺钉内固定术组（A组），人工双动股骨头臵换组（B组），全髋臵换术 组（C组）各20例，比较三组患者术前情况、手术时间、出血量、术 后1年的疗效髋关节功能评价（Harris评分）、并发症以及二次手术或 翻修率方面的差异。用统计学软件SPSS13.0进行分析。 结 果：1、术中情况比较：手术时间A组平均46min，B组67min， C组85min，A组与B、C两组相比有统计学差异，P0.05；B、C两组比 较无统计学意义，P ＞0.05。术中出血A组平均103ml，B组334ml，C 组403ml，A组与B、C两组相比有统计学差异，P0.05；B、C两组比较 无统计学意义，P ＞0.05。2、术后情况比较：术后一年髋关节功能优 良率A组55%，B组80%，C组90%，三组比较有统计学意义，P0.05。术 后A组有两例并发症，B、C两组各一例，三组比较无统计学意义，P ＞0.05。A组有6例再手术，B组2例、C组0例，三组比较有统计学意义， P0.05。 结 论：全髋关节臵换术治疗老年不稳定型股骨颈骨折近期疗效 最优，术后并发症、再手术率最少，应为本病的首选术式。人工股骨 头臵换疗效可，创伤较小，适合不能耐受全髋臵换患者。空心螺钉内 固定疗效最差，临床应尽量不选择这一术式。 关键词：股骨颈骨折；老年人；不稳定；内固定；髋关节臵换 3 Elderly Unstable Fracture of the Femoral Neck Surgical Method of Choice ABSTRACT Obj