CAJ | 학술논문

目的探讨PFNA治疗股骨转子间伴或不伴外侧壁骨折的临床疗效.方法回顾性分析2008年5月至2011年6月应用PFNA治疗102例股骨转子间骨折资料.术前根据CT三维重建图像所示外侧壁情况分为2组:外侧壁骨折组(A组,41例,其中AO/OTA 31-A2型5例,31-A3型36例),外侧壁未骨折组(B组,61例,均为AO/OTA 31-A2型).比较两组患者的手术时间、术中出血量、住院天数,根据术后2周的X线片及CT三维重建图像比较外侧壁爆裂情况.采用老年髋部骨折功能恢复量表(functional recovery scale,FRS)对术后疗效进行评估.结果 A组手术时间为(56±8) min、术中出血量为(238±21)ml、住院天数为(17±3)d,均高于B组的(45±6) min、(175±11)ml、(15±3)d,两者比较差异均有统计学意义.术后X线片示A组8例(19.5％,8/41)、B组3例(4.9％,3/61)发生外侧壁爆裂;而术后CT三维重建示A组36例(87.8％,36/41)、B组45例(73.8％,45/61)发生外侧壁爆裂.82例患者获得随访,随访时间6～35个月,平均19.5个月.随访时间在1年以上有56例,FRS评分:A组为(64.2±4.8)分,B组为(76.5±7.9)分.结论 PFNA治疗不稳定型股骨转子间骨折时,容易造成股骨转子外侧壁骨折或加重外侧壁损伤,影响患者髋部功能恢复.CT三维重建技术可有效评估该类医原性创伤.
목적 탐토PFNA치료고골전자간반혹불반외측벽골절적림상료효.방법 회고성분석2008년5월지2011년6월응용PFNA치료102례고골전자간골절자료.술전근거CT삼유중건도상소시외측벽정황분위2조:외측벽골절조(A조,41례,기중AO/OTA 31-A2형5례,31-A3형36례),외측벽미골절조(B조,61례,균위AO/OTA 31-A2형).비교량조환자적수술시간、술중출혈량、주원천수,근거술후2주적X선편급CT삼유중건도상비교외측벽폭렬정황.채용노년관부골절공능회복량표(functional recovery scale,FRS)대술후료효진행평고.결과 A조수술시간위(56±8) min、술중출혈량위(238±21)ml、주원천수위(17±3)d,균고우B조적(45±6) min、(175±11)ml、(15±3)d,량자비교차이균유통계학의의.술후X선편시A조8례(19.5％,8/41)、B조3례(4.9％,3/61)발생외측벽폭렬;이술후CT삼유중건시A조36례(87.8％,36/41)、B조45례(73.8％,45/61)발생외측벽폭렬.82례환자획득수방,수방시간6～35개월,평균19.5개월.수방시간재1년이상유56례,FRS평분:A조위(64.2±4.8)분,B조위(76.5±7.9)분.결론 PFNA치료불은정형고골전자간골절시,용역조성고골전자외측벽골절혹가중외측벽손상,영향환자관부공능회복.CT삼유중건기술가유효평고해류의원성창상.
Objective To evaluate the clinical effect of the intertrochanteric fractures with or without lateral femoral wall fractures using proximal femoral nail antirotation (PFNA).Methods From May 2008 to June 2011,102 patients with intertrochanteric fractures were treated with PFNA.In accordance with the preoperative three dimensional CT reconstruction(3D CT) images,the group A included 41 cases with lateral femoral wall fractures,and the other 61 cases with an intact lateral wall were in group B.According to the AO/OTA classification,there were 5 cases in 31-A2,36 in 31-A3 in group A,and 61 in 31-A2 in group B.The operative time,operative blood loss,average length of stay,postoperative X-ray images,and 3D CT images were collected for each patient.Time of partial weight-bearing,full weight-bearing and fracture healing were also recorded.Clinical evaluation was made using the functional recovery scale (FRS) of hip fractures.Results The mean operation time was 56±8 min in group A vs 45±6 min in group B; the mean blood loss was 238±21 ml vs 175±11 ml; the average length of stay was 17±3 days vs 15±3 days.On the postoperative radiography,the blowout of lateral trochanteric wall only occurred in 8 (19.5％,8/41) cases in group A and 3 (4.9％,3/61) in group B.According to the postoperative 3D CT,the similar findings were seen in 36 (87.8％.36/41) cases in group A and 45 (73.8％,45/61) in group B.Eighty-two cases were followed up for 6 to 35 months (mean.19.5 months).The mean FRS score was 64.2±4.8 points in group A and 76.5±7.9 points in group B.Conclusion When treating unstable intertrochanteric fractures,iatrogenic fractures in lateral trochanteric wall could be easily caused with using PFNA.3D CT could effectively evaluate iatrogenic trauma in the intertrochanteric fractures.