CAJ | 학술논문

背景：目前国内外对合并帕金森病的股骨转子间骨折的手术治疗报道较少，缺乏相关的临床诊治经验。目的：探讨对合并帕金森病的股骨转子间骨折患者进行手术治疗的特点及围手术期处理。 　　方法：回顾分析2004年2月至2013年2月我院收治的股骨转子间骨折合并帕金森病的14例患者的临床资料，其中Jen-sen-EvansⅢ型3例，Ⅳ型6例，Ⅴ型5例。男4例，女10例；手术时年龄66~92岁，平均78.2岁。6例行滑动加压动力髋螺钉固定（含2例TSP接骨板），8例行髓内固定系统固定。根据Harris评分系统对所有患者进行术前和术后随访功能评定。 　　结果：5例患者在术后1年内因肺部感染和心力衰竭死亡；9例完成随访，随访时间3~60个月，平均28.7个月。Harris评分由术前20.2分（16~26分）改善至末次随访时76.3分（62~85分）。所有随访患者在术后3个月内骨折基本愈合，未出现切口感染、髋内翻畸形、拉力螺钉切出股骨头及术后再骨折等并发症。 　　结论：对于合并帕金森病的股骨转子间骨折患者，如果手术方式和内固定种类选择适当，并注意围手术期并发症防治，可以取得较好的临床疗效。但由于帕金森病对术后恢复影响较大，此类患者预后差于单纯髋部骨折患者。
배경：목전국내외대합병파금삼병적고골전자간골절적수술치료보도교소，결핍상관적림상진치경험。목적：탐토대합병파금삼병적고골전자간골절환자진행수술치료적특점급위수술기처리。 　　방법：회고분석2004년2월지2013년2월아원수치적고골전자간골절합병파금삼병적14례환자적림상자료，기중Jen-sen-EvansⅢ형3례，Ⅳ형6례，Ⅴ형5례。남4례，녀10례；수술시년령66~92세，평균78.2세。6례행활동가압동력관라정고정（함2례TSP접골판），8례행수내고정계통고정。근거Harris평분계통대소유환자진행술전화술후수방공능평정。 　　결과：5례환자재술후1년내인폐부감염화심력쇠갈사망；9례완성수방，수방시간3~60개월，평균28.7개월。Harris평분유술전20.2분（16~26분）개선지말차수방시76.3분（62~85분）。소유수방환자재술후3개월내골절기본유합，미출현절구감염、관내번기형、랍력라정절출고골두급술후재골절등병발증。 　　결론：대우합병파금삼병적고골전자간골절환자，여과수술방식화내고정충류선택괄당，병주의위수술기병발증방치，가이취득교호적림상료효。단유우파금삼병대술후회복영향교대，차류환자예후차우단순관부골절환자。
Background:Currently, there are few reports about surgical treatment of intertrochanteric fracture combined with Parkinson disease. Objective:To explore the surgical characteristics and perioperative management of intertrochanteric fracture in the patients with Parkinson disease. Methods: A retrospective study was performed on 14 intertrochanteric fracture patients who had suffered from Parkinson disease. There were 4 males and 10 females with an mean age of 78.2 years (range, 66-92 years). By Jensen-Evans classifi-cation, 3 cases in typeⅢ, 6 cases in typeⅣ, 5 cases in typeⅤ. Dynamic hip screw (DHS) system was used in 6 cases and intramedullary nail system was used in 8 cases. Results:Five patients died within 1 year after operation due to lung infection and heart failure. Nine patients were followed-up successfully for 28.7 months on average. Postoperative Harris score of the 9 patients was signicantly higher than preoper-ative one (76.3 vs 20.2). No severe complications such as incision infection, hip varus, screw cut-out and refracture were found during follow-up. Conclusions:Good curative effect will be achieved if we choose appropriate surgical treatment, implants, proper periopera-tive period management and prevention of complications for intertrochanteric fracture in patients with Parkinson disease, who always have a poor prognosis compared with other hip fracture patients.