CAJ | 학술논문

目的比较老年股骨粗隆间骨折人工关节置换(HA)与股骨近端防旋髓内钉(PFNA)内固定两种手术方法的临床疗效.方法对2002年1月～2008年1月收治的66例分别接受了PFNA和HA手术治疗的老年股骨粗隆间骨折患者进行回顾性研究,平均随访2年.对住院时间、手术时间、术中出血鞋、术后引流量、患髋功能及并发症等作比较.结果两组患者住院期间均无死亡病例.HA组仲院时间、手术时问均短于PFNA组(P＜0.05),而出血量和术后引流量HA组均多于PFNA组(P＜0.05).HA组的术后负重时间、术后功能恢复时间明显早于PFNA组(P＜0.05).PFNA组并发术后股骨干骨折1例,无伤肢短缩等并发症;HA组全部一期愈合,无并发症.术后一个月Harris评分比较,HA组优于PFNA组.结论两种手术治疗方式均有一定优势,各种固定各有其自身特点,PFNA适用于骨质疏松的不稳定型骨折和合并症较多患者,但人工关节置换具有手术时问短、可早期下床活动等优点,更适用于高龄股骨粗隆间骨折的治疗.
목적 비교노년고골조륭간골절인공관절치환(HA)여고골근단방선수내정(PFNA)내고정량충수술방법적림상료효.방법 대2002년1월～2008년1월수치적66례분별접수료PFNA화HA수술치료적노년고골조륭간골절환자진행회고성연구,평균수방2년.대주원시간、수술시간、술중출혈혜、술후인류량、환관공능급병발증등작비교.결과 량조환자주원기간균무사망병례.HA조중원시간、수술시문균단우PFNA조(P＜0.05),이출혈량화술후인류량HA조균다우PFNA조(P＜0.05).HA조적술후부중시간、술후공능회복시간명현조우PFNA조(P＜0.05).PFNA조병발술후고골간골절1례,무상지단축등병발증;HA조전부일기유합,무병발증.술후일개월Harris평분비교,HA조우우PFNA조.결론 량충수술치료방식균유일정우세,각충고정각유기자신특점,PFNA괄용우골질소송적불은정형골절화합병증교다환자,단인공관절치환구유수술시문단、가조기하상활동등우점,경괄용우고령고골조륭간골절적치료.
Objective To compare treatment effect of two operative methods of hip arthroplasty(HA)and proximal femoral nail anti-rotation(PFNA)in the elderly femoral intertrochanteric fractures.Methods 66 cases of elderlv intertrochanteric fractures which were treated from January 2001 to January 2008 with HA and PFNA were retrospectively analyzed.They were followed up after operation in average 2 years.Length of stay,operation duration,blood loss during operation,drainage volume of blood,function of effected hip and complications were compared.Results There were no died cases in two groups.The result shows that HA group is shorter than PFNA group in length of stay and operation duration(P＜0.05),HA group is more than PFNA group in blood loss during operation and drainage volume of blood(P＜0.05).HA group is earlier both in time of bear weight after operation and in time of function recovery of effected hip than PFNA group(P＜0.05),In Harris hip score,HA group is better than PFNA group (P＜0.05).There was one femoral shaft fracture occurred after operation in PFNA group.In HA group,there is no complication,and all incisions healed bv first intention.Conclusion Each method of operation has its own benefit.PFNA is ideal method of operation for the patients that have osteoporosis unstable intertrachanteric fractures and many other diseases.But HA has many advantages,such as short operation duration,early to bear weight etc,it is especially suitable for elderly patient with femoral intertrachanteric fracture.