【摘要】 目的:比较股骨粗隆间骨折髓内钉固定不同尖顶距(TAD)水平对疗效与预后的影响。方法:股骨粗隆间骨折均进行髓内钉固定,根据术后不同尖顶距水平将患者分为3组,分析比较3组患者治疗后的效果以及随访1年后情况,分析不同尖顶距水平患者的疗效与预后是否存在差异,以及存在何种差异。采用SPSS17.0统计软件包分析处理数据。结果:高TAD组(TAD>25mm),中TAD组(TAD=15~25mm)以及低TAD组(TAD<15mm)患者基本特征未见差别,差异无统计学意义(P>0.05)。年龄分布、性别、BMI水平分布以及并发的基础疾病等分布特征充分可比。3组患者的手术时间差异无统计学意义(P>0.05);术中出血量以及术后输血的比例的比较结果提示,中TAD组最低,3组之间的差异均有统计学意义(P<0.05);比较3组患者的疗效以及随访1年间后情况可见,中TAD组患者的骨折愈合时间最短,3组患者差异有统计学意义(P<0.05);而且术后3个月和1年随访的Harris评分均可见中TAD组患者最高,3组患者差异均有统计学意义(P<0.05);3组患者1年随访评分均可见高于3个月评分水平(P<0.05),提示3种TAD水平患者治疗均有效,且随着时间进程逐渐恢复。另外,术后3个月随访患者发生大腿疼痛的比例中TAD组最低,3组患者差异有统计学意义(P<0.05).结论:TAD=15~25mm组患者术中出血最少,且患者术中疗效以及短期预后最佳。更多还原

【Abstract】 Objective:To compare the efficacy and prognosis of intramedullary nails with femoral intertrochanteric fractures in patients with different spikes(TAD).Methods:Intertrochanteric fractures of the femur were fixed with intramedullary nails.Patients were divided into three groups according to different levels of talus(TAD)after operation.The effects after treatment and the prognosis after 1 year of follow-up were compared among the three groups.It was helpful to guide clinical treatment and predict prognosis.SPSS17.0 statistical software package was used to analyze and process data.Results:In this study,there was no significant difference in the basic characteristics between the high TAD group(TAD>25 mm),the middle TAD group(TAD=15～25 mm)and the low TAD group(TAD<15 mm)(P>0.05).The age distribution,gender,BMI level distribution and concurrent underlying diseases were quite comparable.There was no significant difference in the operative time among the three groups(P>0.05).The intraoperative bleeding volume and the ratio of postoperative blood transfusion were the lowest in the middle TAD group(P<0.05),and there was significant difference among the three groups(P<0.05).The fracture healing time of the three groups was the shortest(P<0.05),and the Harris score of the three groups was the highest in the middle TAD group(P<0.05),and there was significant difference among the three groups(P<0.05).Of course,the 1-year follow-up scores of the three groups were higher than those of the 3-month follow-up scores(P<0.05),which showed that all the three TAD levels were effective and gradually recovered over time.In addition,the incidence of thigh pain was the lowest in the middle TAD group after 3 months followup,and there was significant difference among the three groups(P<0.05).Conclusion:Patients in group TAD=15～25 mm have the least intraoperative bleeding and the best intraoperative outcome and short-term prognosis.更多还原