护理干预对原发性高血压患者甲襞微循环的影响

ObjectiveTo observe the effects of nursing intervention on nail fold microcirculation and blood pressure in patients with essential hypertension. MethodsFifty eight patients with essential hypertension were randomly divided into treatment group (n=18) and treatment+nursing intervention group (n=40). All patients received individualized treatment with antihypertensive drugs and the patients of intervention group also received additional nursing intervention. Blood pre ssure stable, before and 30 days after nursing intervention, nail fold microcirculation of all patients were monitored by capillaroscope (ZL104) and microcirculatory image software (the treatment group was also detected at the same time). ResultsBefore nursing intervention, there was no difference betweentwo groups in body weight, the number of smokers and drinkers, the number of loops, diameter and blood flow rate of nail fold capillary (P>0.05). After one month treatment, blood pressure increased in treatment group while decreased in treatment+nursing intervention group, with no significant difference (P>0.05). Compared with baseline, the number and diameter of capillary loops, and blood flow velocity of nail fold capillary after treatment in patients of treatment group showed no difference (P>0.05). While in treatment+intervention group, compared with baseline, the number of capillary loops [（5.20±1.01）strip/mm vs ( 4.97±0.83）strip/mm, P>0.05], diameters of input capillary [（7.55±0.99） μm vs (7.07±1.23）μm, P>0.05] and output capillary [(10.65±1.55) μm vs (9.98±1.90）μm, P>0.05] and blood flow velocity of nail fold capillary [(466.43±61.11) μm/s vs (427.33±65.04) μm/s, P＜0.05] increased after treatment. ConclusionNursing intervention combined with individualized drug therapy can improve microcirculation in the patients with essential hypertension.     

附加钢板治疗髓内钉固定后股骨萎缩性骨不连

目的 探讨附加钢板治疗髓内钉固定后股骨萎缩性骨不连的手术适应证和操作技术.方法1999年6月-2009年6月,应用附加钢板合并开放植骨治疗12例髓内钉固定后股骨萎缩性骨不连.小切口微创清除骨折端肉芽组织,硬化骨去皮质化,足量髂骨纵形平铺于骨不连间隙和骨皮质骨床上,选择5～6孔钛合金限制接触型动力接骨板,3.0 mm克氏针钻孔,4～6枚皮质骨螺钉双皮质固定.术后保护性负重,1,3,6,12个月临床与影像学评估.结果全部获得骨性愈合,随访时问7 ～26个月,平均17.4个月.取髂骨植骨并附加钢板固定手术时间共50～120 min,平均77.5 min;出血量150～350 ml,平均252 ml.术后供骨区疼痛9例,7例1个月内缓解,2例3个月后缓解.临床骨性愈合时间5～9个月,平均7.1个月;影像学愈合时间7～12个月,平均9.4个月.无感染、钢板螺钉松动、断裂等.结论附加钢板合并植骨适用于髓内钉固定后股骨干骺端骨不连、AO分型B型骨折骨不连、骨缺损>1 cm以及扩髓更换髓内钉失败的萎缩性骨不连.

Abstract：

Objective To investigate the operative indications and operation techniques for augmentative plate fixation in treatment of femoral shaft atrophic nonunions subsequent to intramedullary fixation. Methods Twelve femoral nonunions after internal fixation with intramedullary nailing were treated with augmentative plate internal fixation and bone graft from June 1999 to June 2008. All femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all the patients during operation. Minimally invasive removal of the granulation tissue at fracture site and the sclerotic bone was dccorticated. The adequate lilac bone was tiled longitudinally on the nonunion gap and the cortical bone bed. The fixation involved the limited-contact dynamic titanium plate with 5-6 holes, 3.0 mm Kirschner wire and 4-6 double cortex cortical screw fixation.Protective weight-bearing was given after surgery and the tunction was evaluated at 1,3, 6 and 12 months with imaging. Results All patients were followed up for 7-26 months ( average 17.4 months), which showed radiological solid union (7-12 months, average 9.4 months) and clinical union (5-9 months, average 7.1 months ). The operation lasted for 50-120 minutes ( average 77.5 minutes), with blood volume of 150-350 ml ( average 252 ml). There were nine patients with bone pain, of whom the pain was relieved within one month in seven patients and three months in two. No infection, hardware loosening or breaking were found. Conclusion The plate augmentation and cancellous bone grafting leaving the nail in situ can be an effective solution for nonisthmal femoral nonunion, bone defect and failed exchange nailing.     

Effects of hyperbaric oxygen on TF、TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head

Objective To investigate dynamic changes in serum TF and TNF-α in the rabbit model of steroid-induced avascular osteonecrosis of femoral head ( SANFH) and also to explore the mechanism of SANFH, as well as effects of hyperbaric oxygen ( HBO) on SANFH. Methods Seventy-eight New Zealand male rabbits were randomly divided into 3 groups:the normal control (group N) (7 animals), the model group (group M) (41 animals) and the HBO group (group H) (30 animals). The model group was subdivided into the immediate model group (the M0 group) (10 animals), the two-week model group (the M2 group) (10 animals), the four-week model group (the M4 group) (10 animals) and the six-week model group (the M6 group) (11 animals). The HBO group was further divided into the 2-week HBO therapy group (HBO2) (7 animals), the 4-week HBO therapy group (HBO4) (11 animals) and the 6-week HBO therapy group (HBO6) (12 animals). Through injection of endotoxin and methyl-prednisolone, rabbits in the group HBO2, HBO4 and HBO6 received HBO therapy 1 hour daily from the second day of the experiment. The durations of HBO therapy were 2 weeks ( HBO2), and 4 weeks respectively. The animals were sacrificed after blood samples were taken at respective blood collection time. Then, levels of TF, TNF-α in the serum were measured and the histological changes in the femoral heads were observed. Results Levels of TF and TNF-α in group M0 increased significantly, when compared with those of group N (P ＜0. 05 or P ＜0.01), while for the HBO subgroups the expression of TF and TNF-α measured at the same time points all decreased, when compared with that of the model subgroups (P＜0. 05 or P ＜0.01). To elaborate, TF levels in group M2 and M4 were much higher than those in group HBO2 and HBO4 ( P＜0. 01 ). TF level in group M6 was higher than that in group HB06 ( P ＜ 0.05). TNF-α in group M0 also increased significantly, when compared with that in group N( P ＜0.01). TNF-α levels in group M2 and M6 were also much higher than those in group HBO2 and HBO6 ( both P ＜0. 01 ). TNF-α in group M4 was higher than that in group HBO4 (P＜0.01). Histological examination revealed that tissues of the femoral heads in group N were normal, osteonecrosis and thrombus could be noted in group M2 and M4, hyperplasia fibrosis could be found in group M6, and osteonecrosis in HBO2 and HB04 groups seemed less severer than that in M2 and M4 groups, no thrombi in HBO2, HBO4 groups were noted, and growth of new bones were detected in HBO4 and HBO6. Conclusions The levels of TF and TNF-α levels increased in the rabbit model of SANFH, inducing blood coagulation. Thrombosis at the femoral heads was one of the causes of SANFH. HBO therapy could inhibit the release of TF and TNF-α, thus improving the abnormality of blood coagulation and enhancing treatment of osteonecrosis.     

Preoperative embolization of primary bone tumors:A case control study

AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss,intraoperative blood transfusion volume and surgical time.METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities,hip or vertebrae before resection and stabilization.The primary osseous tumors included giant cell tumors,aneurysmal bone cyst,osteoblastoma,chondroblastoma and chondrosarcoma.Twenty-six patients were included for the statistical analysis(embolization group)as they were operated within 0-48 h within preoperative embolization.A control group(non-embolization group,n = 28)with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.RESULTS:The mean intraoperative blood loss was 1300 mL(250-2900 mL),the mean intraoperative blood transfusion was 700 m L(0-1400 m L)and the mean surgical time was 221 ± 76.7 min for embolization group(group Ⅰ,n = 26).Non-embolization group(group Ⅱ,n = 28),the mean intraoperative blood loss was 1800 m L(800-6000 m L),the mean intraoperative blood transfusion was 1400 mL(700-8400 mL)and the meansurgical time was 250 ± 69.7 min.On comparison,statistically significant(P < 0.001)difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion.There was no statistical difference between the two groups for the surgical time.No patients developed any angiography or embolization related complications.CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.     

重型颅脑创伤后脑疝伴失血性休克救治策略

Objective To explore emergency treatment strategies for the patients with brain hernia combined with hemorrhagic shock after severe traumatic brain injury and their effect on prognosis.Methods A retrospective analysis was made on 54 patients (study group) with brain hernia combined with hemorrhagic shock treated with selective treatment strategies from May 2006 to May 2009. Another 48 patients with the same injuries treated with no selective treatment strategies from April 2003 to April 2006 were used as control group. The mortality within one week and the GOS six months after injury were compared in two groups. Results There was no statistical difference in aspects of sex, age, injury mechanism, GCS and blood loss in both groups (P＞0.05). Thirteen patients died in the study group within the first week, with mortality rate of 24.1%. While 16 patients died in the control group at the first week, with mortality rate of 33.3% (P＜0.05). GOS half year after injury in the study group was better than that in the control group (P＜0.05).Conclusion Early selective treatment strategy based on degree of shock may obtain better outcome for patients with brain hernia combined with hemorrhagic shock after severe brain injury.     

重型颅脑创伤后脑疝伴失血性休克救治策略

Objective To explore emergency treatment strategies for the patients with brain hernia combined with hemorrhagic shock after severe traumatic brain injury and their effect on prognosis.Methods A retrospective analysis was made on 54 patients (study group) with brain hernia combined with hemorrhagic shock treated with selective treatment strategies from May 2006 to May 2009. Another 48 patients with the same injuries treated with no selective treatment strategies from April 2003 to April 2006 were used as control group. The mortality within one week and the GOS six months after injury were compared in two groups. Results There was no statistical difference in aspects of sex, age, injury mechanism, GCS and blood loss in both groups (P＞0.05). Thirteen patients died in the study group within the first week, with mortality rate of 24.1%. While 16 patients died in the control group at the first week, with mortality rate of 33.3% (P＜0.05). GOS half year after injury in the study group was better than that in the control group (P＜0.05).Conclusion Early selective treatment strategy based on degree of shock may obtain better outcome for patients with brain hernia combined with hemorrhagic shock after severe brain injury.     

盐酸肾上腺素在骨水泥型髋关节置换术中预防骨水泥植入综合征发生的作用

Objective To investigate the clinical application of epinephrine hydrochloride in the prevention of bone cement implantation syndrome in the cemented hip replacement. Methods The clinical data of 48 patients treated with cemented hip replacement from July 2008 to April 2009 were retrospectively analyzed. All the patients were divided into control group and intervention group. The bone marrow cavities of 24 patients in the control group were not pretreated with saline epinephrine hydrochloride before implantation of bone cement; the bone marrow cavities of 24 patients in the intervention group were pretreated with saline epinephrine hydrochloride before implantation of bone cement. Systolic blood pressure (SBP), diastolic blood pressure (DBP), the mean arterial pressure (MAP), heart rate (HR)and pulse oxygen saturation ( SPO2 ) were compared between the two groups before bone cement implantation and 1,2, 3, 4, 5, 6, 7, 8, 9, 10 minutes after bone cement implantation. The data were analyzed with variance analysis and Q test. Results (1) In the control group: the blood pressure was decreased in control group one minute after bone cement implantation and a significant decrease of the blood pressure was observed at 2-6 minutes after the implantation ( P ＜ 0. 01 ). The blood pressure was increased seven minutes after the implantation, with the most significant increase of DBP ( P ＜ 0.05 ).The blood pressure recovered to normal 10 minutes later. The SPO2 was decreased significantly ( P ＜0.05 ) but no significant change was observed in HR ( P ＞ 0.05). (2) In the intervention group: the bone marrow cavity was pretreated with saline epinephrine hydrochloride before implantation of bone cement.ity. No significant difference was found in SBP, DBP, MAP, HR and SPO2 at different time points before and after bone cement implantation (P ＞0.05 ). Significant decrease of blood pressure and SPO2 was observed in control group and a significant hemodynamic change was detected at 2-6 minutes after the bone cement implantation. In the intervention group, no hemodynamic change was found in all the patients except that one patient was found with decrease of blood pressure and another one with the occasional premature ventricular contractions. Conclusion Pretreatment of bone marrow cavity with saline epinephrine hydrochloride can effectively prevent bone cement implantation syndrome.     

Comparison of computed tomography findings between bacteremic and non-bacteremic acute pyelonephritis due to Escherichia coli

AIM:To identify computed tomography(CT)findings that are associated with the presence of bacteremia in patients with acute pyelonephritis(APN)due to Escherichia coli(E.coli).METHODS:The clinical data and contrast-enhanced CT findings of 128 patients who were diagnosed with APN due to E.coli and showed renal abnormality on contrast-enhanced CT between January 2003 and November 2013 were retrospectively reviewed.The patients were divided into two groups according to the presence of bacteremia:The bacteremia group and the non-bacteremia group.The abnormality on contrast-enhanced CT were categorized into 5 renal and 4 extrarenal CT findings and compared between the two groups using the χ~2 test and multivariate logistic regression.RESULTS:Among the 128 patients,34 patients(26.6%)were classified into the bacteremia group and 94 patients(73.4%)into the non-bacteremia group.There was no statistically significant difference in gender between the two groups(P = 0.09),but the age of thepatients in the bacteremia group was higher than that of the patients in the non-bacteremia group(P < 0.01).Compared to the non-bacteremia group,1 renal CT finding such as urothelial thickening and 3 extrarenal CT findings such as diffuse peritoneal thickening,cystitis and pulmonary congestion were more frequently observed in the bacteremia group with statistical significance.The logistic regression analysis revealed that CT findings,including urothelial thickening,diffuse peritoneal thickening,cystitis and pulmonary congestion were suggested as the predictive CT findings of bacteremic APN.CONCLUSION:On CT,urothelial thickening,diffuse peritoneal thickening,cystitis,and pulmonary congestion are more frequently observed in patients with bacteremic APN due to E.coli.     

重型颅脑损伤患者血清血栓调节蛋白和血管性假血友病因子动态变化及其临床意义

Objective To investigate the changes of thrombomodulin (TM) and von Willebrand factor (vWf) and their clinical significance in patients with severe brain injury. Methods The study involved 62 patients with severe brain injury who were divided into diffuse axonal injury group (28 patients) and focal brain injury group (34 patients). Then, the 62 patients were divided into young group (16-30 years old, 20 patients), middle-aged group (31-65 years old, 20 patients) and elderly group ( ＞65 years old, 22 patients). The serum levels of TM and vWf were determined at days 1 and 7 after injury respectively. ELISA method was employed to determine the serum levels of TM and vWf.Results The vWf in focal brain injury group was significantly higher than that of diffuse axonal injury group at days 1-7 after injury ( P ＜ 0.05 ). Compared with the young and middle-aged groups, the TM and vWf levels in the elderly group at day 1 after injury were significantly elevated ( P ＜ 0. 05 ). The TM levels in patients with delayed traumatic intracerebral hematoma (DTICH) were significantly higher than that in patients without DTICH (P ＜ 0. 05). Conclusions In the acute stage of severe brain injury,injury severity and activation of endothelial cells varies in patients with different types of injury and at different ages. TM is one of sensitive indicators to reflect the cerebal vascular endothelial cell injury. It is very meaningful to assess the prognosis of severe brain injury by measuring serum levels of TM and vWf and take TM as a predictive indicator for DTICH.     

股骨近端髓内钉与防旋股骨近端髓内钉治疗股骨转子间骨折的比较

目的 比较股骨近端髓内钉(proximal femoral nail,PFN)与防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)两种内固定方法治疗股骨转子间骨折的效果.方法 回顾性分析PFN和PFNA治疗股骨转子间骨折患者233例,其中PFN组188例,PFNA组45例.对两组患者的手术资料和术后功能恢复情况进行比较.结果 平均随访22.8个月.两组骨折均获得愈合.两组切口长度、手术时间、术中出血量差异具有统计学意义.PFN组优良率为89.9%,PFNA组优良率为91.1%,差异无统计学意义(X<'2>=0.06,P>0.05).PFN组防旋钉退出2例,1例发生髋螺钉切割,继而发生髋内翻畸形.PFNA组未发生类似并发症.结论 两种股骨近端髓内钉对股骨转子间骨折均能起到良好的治疗作用.PFNA较PFN手术时间更短,出血量更少,对老年骨质疏松患者更具优势.     

加长PFNA与重建钉治疗股骨干合并同侧转子间骨折疗效对比

目的比较分析加长型股骨近端防旋髓内钉(PFNA)与股骨重建髓内钉治疗股骨干合并同侧转子间骨折的临床效果。方法收集2009年1月~2015年1月采用加长PFNA或股骨重建髓内钉治疗股骨干骨折合并同侧转子间骨折患者100例,依据采用的髓内钉不同分为重建组(50例)和加长PFNA组(50例),两组患者的一般资料具有可比性,记录两组患者手术时间、术中出血、术中透视次数、切口长度、骨折愈合时间、术后并发症率、Harris评分及髋关节功能恢复情况。结果加长型PFNA组患者手术时间、术中出血量、术中透视次数、切口长度均高于重建钉组,差异具有统计学意义(P0.05),加长型PFNA组患者骨折愈合时间及术后6、12个月髋关节功能均优于重建钉组(P0.05),两组患者并发症发生率差异无统计学意义(P0.05)。结论相比股骨重建髓内钉,加长型PFNA治疗股骨干骨折合并同侧转子间骨折术中创伤较大、出血量及透视次数较多,但固定牢靠,术后骨折愈合时间短,患者功能恢复好。     

Gamma-3钉与防旋型股骨近端髓内钉(PFNA)治疗股骨粗隆间骨折的疗效比较

目的探讨Gamma-3钉与防旋型股骨近端髓内钉(PFNA)治疗股骨粗隆间骨折的临床疗效。方法回顾性分析2010年6月~2014年6月治疗的36例股骨粗隆间骨折患者资料,男性20例,女性16例;年龄35~82岁,平均(58.4±10.8)岁。其中20例行PFNA内固定手术,16例行Gamma-3钉治疗,术后对两组手术临床指标、功能评分和并发症进行统计比较。结果 PFNA组手术用时(63.5±21.4)min、透视次数(8.5±4.4)次、出血量(120.4±21.5)m L,结果显著性低于Gamma-3钉组的(79.6±15.8)min、(10.8±3.5)次、(180.9±56.6)m L;PFNA组切口长度为(7.3±2.4)cm与Gamma-3钉组的(6.6±2.1)cm差异无统计学意义;PFNA组骨折的愈合时间和髋关节功能评分分别为(10.9±3.1)周和(88.6±11.4)分,与Gamma-3钉组的(12.2±1.9)周、(84.5±15.3)分差异无统计学意义;两组手术均未出现骨不连、内固定断裂及切出股骨头等并发症,无再次骨折发生,并发症差异无统计学意义。结论与Gamma-3钉内固定术相比,PFNA内固定术具备固定可靠、术中射线暴露少、术中出血少、手术时间短等优势,值得临床推广与应用。     

动力髋螺钉与股骨近端防旋型髓内钉治疗股骨粗隆间骨折的临床疗效分析

目的比较动力髋螺钉(DHS)和股骨近端防旋型髓内钉(PFNA)在股骨粗隆间骨折治疗中的临床疗效。方法笔者2011年1月~2014年1月收治股骨粗隆间骨折患者58例,排除非手术治疗患者4例,选取54例,分别采用DHS(DHS组,n=20)以及PFNA(PFNA组,n=34)治疗并随访股骨粗隆间骨折患者。比较手术切口长度、住院时间、手术时间、术中出血量、术后引流量、骨折愈合时间及术后患髋功能及并发症。结果两组手术时间、术中出血量、住院时间、术后引流量及骨折平均愈合时间等数据两组间差异有统计学意义(P0.05),PFNA组要优于DHS组,而手术切口长度两组间差异无统计学意义(P0.05)。患髋功能评分:DHS组优良率为85%,PFNA组优良率为91.2%。结论 PFNA治疗股骨粗隆间骨折具有方法简单,手术时间短,手术出血量少、创伤小及愈合时间短的优点,适用于所有类型的股骨粗隆间骨折,特别对骨质疏松的高龄粗隆间骨折、不稳定型骨折和并发症较多的患者疗效显著。     

防旋型股骨近端髓内钉治疗老年不稳定性股骨粗隆间骨折疗效分析

目的研究防旋型股骨近端髓内钉治疗老年不稳定性股骨粗隆间骨折的临床疗效及其对生活质量影响分析。方法笔者选取96例接受治疗的老年不稳定性股骨粗隆间骨折患者,根据治疗方法分为对照组与观察组各48例。对照组行短重建髓内钉治疗,观察组行防旋型股骨近端髓内钉治疗,比较两组患者的手术一般情况、治疗效果、生活质量评分以及术后并发症情况。结果观察组手术时间、术中出血量及术后引流量均少于对照组,两组对比差异明显,具有统计学意义(P0.05);观察组治疗有效率83.33%,对照组治疗有效率60.42%,两组对比差异明显,具有统计学意义(P0.05);观察组生活质量评分高于对照组,两组对比差异明显,具有统计学意义(P0.05);观察组晚期并发症例数少于对照组,两组对比差异明显,具有统计学意义(P0.05)。结论防旋型股骨近端髓内钉治疗老年不稳定性股骨粗隆间骨折较短重建髓内钉具有手术时间短、术中出血少、治疗有效率高等优点,但需预防其晚期并发症的发生。     

股骨近端锁定钢板与防旋髓内钉治疗稳定型股骨转子间骨折的疗效分析

目的比较股骨近端锁定钢板(PFLP)与股骨近端防旋髓内钉(PFNA)治疗稳定型(Evans分型1组及Ⅰ型2组)股骨转子间骨折的疗效。方法回顾性分析2014年12月—2017年1月安徽省第二人民医院收治的36例稳定型股骨转子间骨折患者,按手术方法不同分为PFLP组(21例)和PFNA组(15例),记录并比较两组手术时间、出血量、术后恢复时间以及髋关节功能。结果 36例患者均获得随访,时间3~18个月,两组手术时间、术后住院时间差异无统计学意义(P0.05)。两组均获得骨折愈合,PFNA组骨折愈合时间、术后下地负重时间短于PFLP组[(10.80±2.93)周vs.(15.14±2.10)周、(5.33±3.24)周vs.(8.38±2.62)周],差异有统计学意义(P0.01),术中出血量PFNA组少于PFLP组[(206.67±62.18)m L vs.(296.67±98.96)m L],差异有统计学意义(P0.01)。两组术后3个月髋关节功能评分,优良率均达70%以上,差异无统计学意义(P0.05)。两组术后没有严重并发症出现。结论 PFNA与PFLP均是稳定型转子间骨折的优秀内固定选择,但PFNA术中出血较少,术后恢复更快,更适用于稳定股骨转子间骨折。     

股骨近端防旋髓内钉与加压滑动钢板治疗老年股骨粗隆间骨折的疗效观察

目的通过股骨近端防旋髓内钉(PFNA)系统与加压滑动钢板(DHS)系统治疗老年股骨粗隆间骨折,对比两种内固定方法的疗效并进行分析。方法笔者回顾性分析2010年3月~2014年11月治疗的52例老年股骨粗隆间骨折临床资料,男性19例,女性33例;年龄62~88岁,平均73.6岁。受伤原因:摔伤43例,道路交通伤5例,坠落伤4例。27例行PFNA治疗,25例行DHS内固定治疗。比较两组手术时间、伤口长度、出血量、伤口愈合时间、骨折愈合时间、功能锻炼时间等指标。结果随访10~26个月。按照Harris评分,PFNA内固定组优良率91.6%,DHS内固定优良率84.5%。PFNA组1例伤口感染,1例术后深静脉栓塞,1例髋内翻畸形愈合;DHS组出现2例主钉退至皮下,1例骨不连再次手术,1例螺丝钉断裂畸形愈合。PFNA组在手术时间、出血量、伤口愈合时间、骨折愈合时间、功能锻炼时间等方面均优于DHS组,差异有显著统计学意义(P0.05)。结论 PFNA内固定系统在手术创伤、手术时间、出血量、骨折愈合、功能恢复等方面明显优于DHS内固定。PFNA安全有效,是治疗老年股骨粗隆间骨折的理想方法。     

PFNA与人工股骨头置换术治疗老年不稳定型股骨粗隆间骨折的临床疗效分析

目的探讨股骨近端防旋髓内钉(PFNA)与人工股骨头置换术(ATBA)治疗老年不稳定型股骨粗隆间骨折的疗效及安全性。方法回顾性分析笔者医院63例老年不稳定型股骨粗隆间骨折患者临床资料,其中35例采用PFNA治疗(PFNA组),28例采用ATBA治疗(ATBA组),比较两组患者平均手术时间、术中出血量、输血量、术后引流量、术后开始部分负重时间及末次随访Harris评分。结果 PFNA组平均手术时间、术中出血量、输血量、术后引流量、术后开始部分负重时间及末次随访Harris评分分别为(42.9±11.8)min、(84.2±27.5)mL、(85.3±20.6)mL、(65.3±21.6)mL、(28.7±10.3)d、(80.9±12.5)分;ATBA组分别为(101.1±18.7)min、(311.3±105.4)mL、(273.1±45.5)mL、(217.4±35.2)mL、(5.9±3.2)d、(77.2±14.1)分,PFNA组平均手术时间、术中出血量、输血量及术后引流量均显著少于ATBA组,组间比较差异具有统计学意义(P0.05);而PFNA组术后开始部分负重时间方面明显长于ATBA组,且组间比较差异具有统计学意义(P0.05);PFNA组与ATBA组末次随访Harris评分比较,PFNA组高于ATBA组,且差异具有统计学意义(P0.05)。结论 PFNA可作为老年不稳定型股骨粗隆间骨折患者的首选治疗方式,但对于有早期下地负重需求的患者而言ATBA更为适宜。     

高龄股骨粗隆间骨折半髋关节置换与股骨髓内钉治疗临床比较研究

目的观察半髋关节置换与防旋型股骨近端髓内钉内固定治疗高龄患者股骨粗隆间骨折的临床效果。方法笔者2011年3月~2013年8月使用半髋置换术及防旋型股骨近端髓内钉治疗高龄股骨粗隆间骨折39例,其中男性17例,女性22例;年龄70~93岁,平均(75.9±4.7)岁。患者经过长达1年以上的随访,回顾性分析两组的手术时间、术后卧床时间、住院时间、术后1年内的髋关节功能、手术出血量、术后引流量及并发症。结果半髋关节置换组在手术时间、术后卧床时间、住院时间及术后1年内的髋关节功能方面均优于防旋型股骨近端髓内钉组,差异有统计学意义(P0.05)。防旋型股骨近端髓内钉组手术出血量及术后引流量方面均优于半髋关节置换组,差异有统计学意义(P0.05)。两组在并发症方面未见明显差异(P0.05)。结论半髋置换和防旋型股骨近端髓内钉均适用于高龄股骨粗隆间骨折,均获得了较为满意的疗效,两者具有不同的优缺点,临床中应该按照个体化的原则进行治疗。     

髓内钉与近端锁定钢板治疗股骨近端骨折的对比研究

目的探讨股骨近端螺旋刀片抗旋髓内钉(PFNA)和股骨近端锁定钢板(PFLCP)治疗股骨近端骨折患者的临床疗效并进行对比分析。方法笔者回顾性分析2010年3月~2014年3月采用PFNA和PFLCP法治疗股骨近端骨折70例的病例资料,PFNA内固定治疗40例,PFLCP内固定治疗30例。观察比较两组患者手术时间、术中透视时间、术中失血量、术后引流量以及Parker-Palmer评分的差异。结果所有患者随访6~9个月,平均8.9个月。末次随访时两种方法的Parker-Palmer评分差异无统计学意义(P0.05)。两种方法的手术时间、术中透视时间、术中失血量、术后引流量以及Parker-Palmer评分的差异均无统计学意义(P0.05),但PFNA组的术中透视时间明显短于PFLCP组。结论 PFNA和PFLCP均是治疗股骨近端骨折较好的内固定材料。