CAJ | 학술논문

目的:对比观察Gamma钉与股骨近端髓内钉置入治疗高龄股骨转子间骨折患者的临床疗效.方法:选择2005-01/2008-01解放军第二军医大学长海医院骨科收治的股骨转子间骨折患者131例,男39例,女92例,年龄70～81岁,平均76岁.骨折类型按AO分型系统:A1型56例,A2型75例.全部患者随机分为Gamma组(n=65)和股骨近端髓内组(n=66).记录两组患者术中术后出血量、输血量、手术时间及住院时间,置入过程中置入后并发症发生情况.观察术后9个月两组患者患肢功能变化.结果:131例股骨转子间骨折患者均获得9个月的随访,两组术中出血量、输血量、置入时间及住院时间相比,差异均无显著性意义(P>0.05).两组患者均未发生置入过程中并发症、置入后并发症中,股骨近端髓内钉组6例(8.5%)出现伤口处表皮感染,其中2例为合并糖尿病患者;无固定物切出股骨头、股骨干骨折、内固定断裂、脱钉等现象.全部骨折均在9个月随访时间内达到骨性愈合,未出现骨不连或骨折延迟愈合,无患肢短缩病例.结论:对于高龄股骨转子间骨折,Gamma钉与股骨近端髓内钉疗效相当.
목적:대비관찰Gamma정여고골근단수내정치입치료고령고골전자간골절환자적림상료효.방법:선택2005-01/2008-01해방군제이군의대학장해의원골과수치적고골전자간골절환자131례,남39례,녀92례,년령70～81세,평균76세.골절류형안AO분형계통:A1형56례,A2형75례.전부환자수궤분위Gamma조(n=65)화고골근단수내조(n=66).기록량조환자술중술후출혈량、수혈량、수술시간급주원시간,치입과정중치입후병발증발생정황.관찰술후9개월량조환자환지공능변화.결과:131례고골전자간골절환자균획득9개월적수방,량조술중출혈량、수혈량、치입시간급주원시간상비,차이균무현저성의의(P>0.05).량조환자균미발생치입과정중병발증、치입후병발증중,고골근단수내정조6례(8.5%)출현상구처표피감염,기중2례위합병당뇨병환자;무고정물절출고골두、고골간골절、내고정단렬、탈정등현상.전부골절균재9개월수방시간내체도골성유합,미출현골불련혹골절연지유합,무환지단축병례.결론:대우고령고골전자간골절,Gamma정여고골근단수내정료효상당.
OBJECTIVE: To compare the clinical effect between Gamma nail and proximal femoral nail (PFN) on the treatment for femoral intertrochanteric fractures in the elderly.METHODS: A total of 131 cases (39 males and 92 females; aged 70?81 years, mean age of 76 years) with femoral intertrochanteric fractures were collected from the Department of Orthopaedics, the Affiliated Changhai Hospital of the Second Military Medical University of Chinese PLA from January 2005 to January 2008. Femoral intertrochanteric fractures were classified based on AO system, including type A1 (n=56) and type A2 (n=75). All cases were randomly divided into Gamma nail group (n=65) and PFN group (n=66). Pre- and post-operative blood loss, blood transfusion volume, operating time, and length of stay were recorded, while the complications were detected following nail implantation. Functional changes of injured limbs were detected after 9 months.RESULTS: At 9 months after following up, there was no significant difference in blood loss, blood transfusion volume, operating time, and length of stay between the two groups before and after implantation (P> 0.05). Furthermore, complications did not occur during or after implantation. Six cases in the PFN group had infection in which of them had diabetes mellitus. There were no complications such as cutting out of femoral head, femoral shaft fractures, breakage of internal device or pushing out phenomenon. All cases got bone union at the final follow-up of nine months and did not get nonunion, delayed union of fractures or shortening of injured extremity.CONCLUSION: Gamma nail and PFN have equal effect on the treatment of femoral intertrochanteric fractures in the elderly.