CAJ | 학술논문

目的对应用Gamma钉和DHS微创治疗老年股骨转子间骨折患者的疗效进行分析比较.方法对2004年1月至2006年12月收入院的58例股骨转子间骨折患者进行前瞻性随机对照研究,AO分型A1型21例,A2型37例;应用Gamma钉30例,DHS 28例.术前评价两组患者一般资料差异无统计学意义,具有可比性.分别对两组患者手术创伤、术后功能及并发症等情况进行统计学分析对比.结果 Gamma钉和DHS在切口平均长度、术后6d疼痛评分方面比较,差异无统计学意义;两者对比,DHS组的手术时间相对较短,术中平均出血量、术后引流量较少,两组差异有统计学意义.Gamma钉组的早期功能恢复优于DHS组,在骨折愈合及远期疗效方面差异无统计学意义.在并发症方面,Gamma钉固定易出现股骨骨折,DHS易出现髋内翻和内固定失败,切口感染、深静脉血栓形成及骨不连等两者差异无统计学意义.结论老年股骨转子间骨折内固定术应遵循易操作、创伤小、并发症少的原则.A1型骨折尽可能采用DHS固定,A2型骨折若伴有明显骨质疏松,建议应用Gamma钉固定,以利于尽早开始功能锻炼,术中应尽可能减少扩髓.骨折部位在Gamma钉入点附近时建议使用DHS固定.
목적 대응용Gamma정화DHS미창치료노년고골전자간골절환자적료효진행분석비교.방법 대2004년1월지2006년12월수입원적58례고골전자간골절환자진행전첨성수궤대조연구,AO분형A1형21례,A2형37례;응용Gamma정30례,DHS 28례.술전평개량조환자일반자료차이무통계학의의,구유가비성.분별대량조환자수술창상、술후공능급병발증등정황진행통계학분석대비.결과 Gamma정화DHS재절구평균장도、술후6d동통평분방면비교,차이무통계학의의;량자대비,DHS조적수술시간상대교단,술중평균출혈량、술후인류량교소,량조차이유통계학의의.Gamma정조적조기공능회복우우DHS조,재골절유합급원기료효방면차이무통계학의의.재병발증방면,Gamma정고정역출현고골골절,DHS역출현관내번화내고정실패,절구감염、심정맥혈전형성급골불련등량자차이무통계학의의.결론 노년고골전자간골절내고정술응준순역조작、창상소、병발증소적원칙.A1형골절진가능채용DHS고정,A2형골절약반유명현골질소송,건의응용Gamma정고정,이리우진조개시공능단련,술중응진가능감소확수.골절부위재Gamma정입점부근시건의사용DHS고정.
Objective To evaluate and compare the outcome of Gamma nail and DHS for the treatment of elder femoral intertrochanteric fracture by minimally invasive surgery.Methods From January 2004 to December 2006.58 elder patients suffered femoral intertrochanteric fracture were treated with Gamma nail(30 patients)and DHS(28 patients)respectively,which were classified into Al(n=21)and A2(n=37)according to the AO system.The difference between the 2 groups was not significant in preoperative evaluation and comparability existed.The clinic data of surgical trauma,postoperative function and complications of the 2 groups of patients were statistically compared in our study.Results There was no statistical significance on average incision length and postoperative pain score at 6 d.DHS group resulted in a lower blood loss and less surgery time than Gamma nail group(statistically significant),consequently the former Was superior to the latter about two aspects.Compared with the DHS group,Gamma nail group had better early functional recovery.Neither union of fracture nor prospective efficacy had significant difierence between the 2 groups.Femoral fracture had a high occurrence in Gamma nail group.coxa adduction and failure of internal fixation appeared in DHS group.There were no significant differences between the two groups with regard to infection,deep venous thrombosis,nonunion.Conclusion The principles are simple-operation,microtrauma.less-complication for treatment of the elder femoral intertrochanteric fractures.DHS had better be used in A0 type A1.Gamma nail should be recommended for type A2 accompanied with osteoperosis.beneficial to do functional exercise earlier.At the same time reaming should less used to the limit.If the site of the fracture is Hear to the point of entry of Gamma nail.DHS is advised to be used.