CAJ | 학술논문

目的对比改良后外侧微创入路与传统后外侧入路结合组配式股骨头假体治疗老年股骨颈骨折的临床疗效. 方法选择2008年10月-2010年6月收治的老年股骨颈骨折患者70例,其中男26例,女44例；年龄67 ～95岁,平均78.3岁.新鲜股骨颈骨折62例,陈旧性股骨颈骨折8例(伤后2～4个月),均为GardenⅢ、Ⅳ型.所有手术均由同一手术组完成.采用改良后外侧入路组32例,其中男12例,女20例；传统后外侧入路组38例,其中男14例,女24例.对两组患者手术切口大小、手术时间、围术期并发症、假体的稳定性及髋关节功能进行评价. 结果术后随访12 ～28周,平均16周.两组患者手术时间差异无统计学意义(P＞0.05),切口长度、围术期失血量、输注血制品量差异均有统计学意义(P＜0.01).术后6周两组患者均可下地负重行走.两组Charnley髋关节功能差异有统计学意义(P＜0.05),末次随访Harris髋关节功能两组间差异无统计学意义(P＞0.05). 结论采用改良后外侧微创入路结合组配式股骨头假体置换术可减少术中组织损伤和出血量,缩短康复时间.
목적 대비개량후외측미창입로여전통후외측입로결합조배식고골두가체치료노년고골경골절적림상료효. 방법 선택2008년10월-2010년6월수치적노년고골경골절환자70례,기중남26례,녀44례；년령67 ～95세,평균78.3세.신선고골경골절62례,진구성고골경골절8례(상후2～4개월),균위GardenⅢ、Ⅳ형.소유수술균유동일수술조완성.채용개량후외측입로조32례,기중남12례,녀20례；전통후외측입로조38례,기중남14례,녀24례.대량조환자수술절구대소、수술시간、위술기병발증、가체적은정성급관관절공능진행평개. 결과 술후수방12 ～28주,평균16주.량조환자수술시간차이무통계학의의(P＞0.05),절구장도、위술기실혈량、수주혈제품량차이균유통계학의의(P＜0.01).술후6주량조환자균가하지부중행주.량조Charnley관관절공능차이유통계학의의(P＜0.05),말차수방Harris관관절공능량조간차이무통계학의의(P＞0.05). 결론 채용개량후외측미창입로결합조배식고골두가체치환술가감소술중조직손상화출혈량,축단강복시간.
Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femoral neck fractures (26 males and 44 females; at age range of 67-95 years,mean 78.3 years) treated from October 2008 to June 2010.There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures (2-4 months post-injury),all of whom were type Ⅲ or Ⅳ fractures according to the Garden' s classification.All surgeries were completed by the same operation group.The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females.The two groups were compared in aspects of incision size,operative time,perioperative complications,prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks (range,12-18 weeks).The differences between the two groups were significant regarding the incision length,perioperative blood loss,and blood product transfusio amount (P ＜0.01 ),but insignificant in operative time ( P ＞ 0.05 ).All patients were able to take weight-bearing walk six weeks postoperatively.The two groups showed significant difference in the hip joint function by Chamley's criteria six weeks postoperatively ( P ＜ 0.05 ),but insignificant difference in the hip joint function by Harris' s criteria at the last follow-up ( P ＜ 0.05). Conclusion The modified posterolateral minimally invasive approach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients,for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time.