CAJ | 학술논문

目的探讨股骨近端髓内钉(PFN)治疗老年脆性股骨转子间骨折后Ⅱ期旋转移位及固定螺钉切头的原因.方法选择2006年6月-2009年2月收治的老年脆性股骨转子间骨折患者227例,均进行PFN治疗.分析术后Ⅱ期骨折旋转移位及螺钉切头的原因.运用Harris评分评价髋关节功能恢复情况.结果 221例患者获平均23个月(12～48个月)随访.术后髋关节Harris功能评分:良183例,中30例,差14例,优良率为80.6%.16例患者在1年内出现Ⅱ期骨折旋转移位及股骨颈螺钉切头,其中行Ⅱ期手术取出内固定外展位牵引治疗8例,人工关节置换8例.结论 PFN手术治疗老年脆性股骨转子间骨折在手术复位、股骨颈主拉力螺钉和防旋次螺钉的放置位置要求较高.入钉转子外侧骨皮质情况、患者术后配合情况、改良Jensen-Evans 分型、Singh骨质疏松分级等多种因素均与手术预后相关.
목적 탐토고골근단수내정(PFN)치료노년취성고골전자간골절후Ⅱ기선전이위급고정라정절두적원인.방법 선택2006년6월-2009년2월수치적노년취성고골전자간골절환자227례,균진행PFN치료.분석술후Ⅱ기골절선전이위급라정절두적원인.운용Harris평분평개관관절공능회복정황.결과 221례환자획평균23개월(12～48개월)수방.술후관관절Harris공능평분:량183례,중30례,차14례,우량솔위80.6%.16례환자재1년내출현Ⅱ기골절선전이위급고골경라정절두,기중행Ⅱ기수술취출내고정외전위견인치료8례,인공관절치환8례.결론 PFN수술치료노년취성고골전자간골절재수술복위、고골경주랍력라정화방선차라정적방치위치요구교고.입정전자외측골피질정황、환자술후배합정황、개량Jensen-Evans 분형、Singh골질소송분급등다충인소균여수술예후상관.
Objective To analyze causes for postoperative coxa vara and anti-rotation nail cutting-out after treatment of brittle femoral intertrochanteric fractures with proximal femoral nails ( PFN ).Methods An retrospective study was done on 227 patients with intertrochanteric fracture treated with PFN from June 2006 to February 2009. The causes for postoperative coxa vara and anti-rotation nail cutting-out were analyzed. Harris score was used to evaluate the functional recovery of the hip joint. Results Of all, 221 patients were followed up for 12-48 months (mean 23 months) and six patients were died from serious internal disease within one year. According to Harris evaluation system, the results were excellent and good in 183 patients, fair in 30 and poor in 14. Postoperative coxa vara and anti-rotation nail cuttingout occurred in 16 patients, eight of whom received reoperation to remove internal fixation and skeletal traction at abducent position and the other eight received prosthetic replacement. Conclusions Treatment of proximal femoral fracture with PFN requires a high precision of reduction and operation. Many factors including lateral cortical bone conditions of tuberosity, postoperative patient's cognitive condition,use of improved Jensen-Evans classification and Singh's classification may affect operation outcome.