CAJ | 학술논문

背景：目前国内外学者对于老年性髋部骨折越来趋向于积极的手术治疗。手术治疗首先要根据不同骨折部位、骨折类型、不同年龄和是否合并有内科基础疾病从而选择不同的固定方式，对于老年性髋部骨折治疗的成败起到非常重要的作用。 　　目的：探讨老年骨质疏松性髋部骨折的优化治疗方案。 　　方法：2000年1月至2012年1月根据具体情况采用不同方法治疗老年骨质疏松性髋部骨折176例，年龄(76.7±6.3)岁。股骨转子间骨折84例，其中保守治疗7例，动力髋螺钉内固定34例，空心加压螺钉固定18例，解剖钢板内固定7例，人工股骨头置换12例，人工全髋关节置换6例。股骨颈骨折92例，其中双极人工股骨头置换40例，人工全髋关节置换37例，空心加压螺钉固定15例。不同治疗方法的治疗效果按 Harris 髋关节功能评分标准评定，并观察患者并发症发生情况。 　　结果与结论：股骨转子间骨折76例，股骨颈骨折85例获随访，随访时间8-26个月。内固定治疗的平均愈合时间为(5.7±1.3)个月。3例发生治疗后感染，1例治疗后10 d 并发心肺功能衰竭死亡。不同治疗方法的并发症包括股骨头切割、围术期骨折，内固定或假体松动、术后骨折、股骨头缺血坏死、髋内翻、下肢短缩、骨折延期愈合及对髋再骨折等。双极人工股骨头置换与人工全髋关节置换患者的并发症发生率显著低于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P<0.05)。双极人工股骨头置换与人工全髋关节置换患者的 Harris 评分优良率显著高于保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者(P<0.05)。而保守治疗、空心加压螺钉、解剖钢板及动力髋螺钉置入内固定患者相互之间的并发症发生率、Harris评分优良率比较，双极人工股骨头置换与人工全髋关节置换患者的并发症发生率、Harris评分优良率比较，差异无显著性意义(P>0.05)，提示老年骨质疏松性髋部骨折需要积极的综合治疗，对于高龄股骨颈骨折患者最好采用双极人工股骨头置换或人工全髋关节置换治疗为宜。揹景：目前國內外學者對于老年性髖部骨摺越來趨嚮于積極的手術治療。手術治療首先要根據不同骨摺部位、骨摺類型、不同年齡和是否閤併有內科基礎疾病從而選擇不同的固定方式，對于老年性髖部骨摺治療的成敗起到非常重要的作用。 　　目的：探討老年骨質疏鬆性髖部骨摺的優化治療方案。 　　方法：2000年1月至2012年1月根據具體情況採用不同方法治療老年骨質疏鬆性髖部骨摺176例，年齡(76.7±6.3)歲。股骨轉子間骨摺84例，其中保守治療7例，動力髖螺釘內固定34例，空心加壓螺釘固定18例，解剖鋼闆內固定7例，人工股骨頭置換12例，人工全髖關節置換6例。股骨頸骨摺92例，其中雙極人工股骨頭置換40例，人工全髖關節置換37例，空心加壓螺釘固定15例。不同治療方法的治療效果按 Harris 髖關節功能評分標準評定，併觀察患者併髮癥髮生情況。 　　結果與結論：股骨轉子間骨摺76例，股骨頸骨摺85例穫隨訪，隨訪時間8-26箇月。內固定治療的平均愈閤時間為(5.7±1.3)箇月。3例髮生治療後感染，1例治療後10 d 併髮心肺功能衰竭死亡。不同治療方法的併髮癥包括股骨頭切割、圍術期骨摺，內固定或假體鬆動、術後骨摺、股骨頭缺血壞死、髖內翻、下肢短縮、骨摺延期愈閤及對髖再骨摺等。雙極人工股骨頭置換與人工全髖關節置換患者的併髮癥髮生率顯著低于保守治療、空心加壓螺釘、解剖鋼闆及動力髖螺釘置入內固定患者(P<0.05)。雙極人工股骨頭置換與人工全髖關節置換患者的 Harris 評分優良率顯著高于保守治療、空心加壓螺釘、解剖鋼闆及動力髖螺釘置入內固定患者(P<0.05)。而保守治療、空心加壓螺釘、解剖鋼闆及動力髖螺釘置入內固定患者相互之間的併髮癥髮生率、Harris評分優良率比較，雙極人工股骨頭置換與人工全髖關節置換患者的併髮癥髮生率、Harris評分優良率比較，差異無顯著性意義(P>0.05)，提示老年骨質疏鬆性髖部骨摺需要積極的綜閤治療，對于高齡股骨頸骨摺患者最好採用雙極人工股骨頭置換或人工全髖關節置換治療為宜。
배경：목전국내외학자대우노년성관부골절월래추향우적겁적수술치료。수술치료수선요근거불동골절부위、골절류형、불동년령화시부합병유내과기출질병종이선택불동적고정방식，대우노년성관부골절치료적성패기도비상중요적작용。 　　목적：탐토노년골질소송성관부골절적우화치료방안。 　　방법：2000년1월지2012년1월근거구체정황채용불동방법치료노년골질소송성관부골절176례，년령(76.7±6.3)세。고골전자간골절84례，기중보수치료7례，동력관라정내고정34례，공심가압라정고정18례，해부강판내고정7례，인공고골두치환12례，인공전관관절치환6례。고골경골절92례，기중쌍겁인공고골두치환40례，인공전관관절치환37례，공심가압라정고정15례。불동치료방법적치료효과안 Harris 관관절공능평분표준평정，병관찰환자병발증발생정황。 　　결과여결론：고골전자간골절76례，고골경골절85례획수방，수방시간8-26개월。내고정치료적평균유합시간위(5.7±1.3)개월。3례발생치료후감염，1례치료후10 d 병발심폐공능쇠갈사망。불동치료방법적병발증포괄고골두절할、위술기골절，내고정혹가체송동、술후골절、고골두결혈배사、관내번、하지단축、골절연기유합급대관재골절등。쌍겁인공고골두치환여인공전관관절치환환자적병발증발생솔현저저우보수치료、공심가압라정、해부강판급동력관라정치입내고정환자(P<0.05)。쌍겁인공고골두치환여인공전관관절치환환자적 Harris 평분우량솔현저고우보수치료、공심가압라정、해부강판급동력관라정치입내고정환자(P<0.05)。이보수치료、공심가압라정、해부강판급동력관라정치입내고정환자상호지간적병발증발생솔、Harris평분우량솔비교，쌍겁인공고골두치환여인공전관관절치환환자적병발증발생솔、Harris평분우량솔비교，차이무현저성의의(P>0.05)，제시노년골질소송성관부골절수요적겁적종합치료，대우고령고골경골절환자최호채용쌍겁인공고골두치환혹인공전관관절치환치료위의。
BACKGROUND:Active surgical treatments are preferred for elderly hip fractures. Individual fixation method is chosen according to fracture site, type, age and whether there are basic diseases in internal medicine, which plays an important role in the successful treatment of elderly hip fractures. OBJECTIVE:To explore the effects of optimized surgical treatment on osteoporotic hip fracture in the elderly. METHODS: Totally 176 patients with osteoporotic hip fracture were treated by different methods between January 2000 and January 2012, including 63 males and 113 females, with a mean age of (76.7±6.3) years. Out of the 84 cases of interchanteric fracture, seven cases were treated with conservative methods, 34 cases were treated with dynamic hip screw internal fixation, 18 cases were treated with cannulated screw internal fixation, seven cases were treated with anatomical plate internal fixation, 12 cases were treated with bipolar femoral placement, and six cases were treated with total hip arthroplasty. Out of the 92 cases with femoral neck fractures, 40 cases were treated with bipolar femoral placement, 37 cases were treated with total hip arthroplasty and 15 cases were treated with cannulated screw internal fixation. Modified Harris hip function scores were used to evaluate the therapeutic effects of different treatment methods. Complications were observed. RESULTS AND CONCLUSION:Seventy-six cases of interchanteric fractures and 85 cases of femoral neck fractures were fol owed-up for 8-26 months with an average of (5.7±1.3) months. Three cases suffered from post-operative infection, and one case died due to cardio-pulmonary failure in 10 days after operation. Both intraoperation and postoperative complications included femoral head cutting, intraoperative fracture, internal fixation and prosthetic loosening, postoperative fracture, avascular necrosis of femoral head, coxa vara, legs shorten, and delayed fracture healing. The incidence rates of complications in patients undergoing bipolar femoral placement and total hip arthroplasty were significantly lower than those treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). The outcomes of the treatment according to Harris scoring criterion were better in patients treated with bipolar femoral placement and total hip arthroplasty than in patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P<0.05). No significant differences were found in the incidence rate of complications and Harris scores among patients treated with conservative methods, dynamic hip screw internal fixation, cannulated screw internal fixation, and anatomical plate internal fixation (P>0.05). No significant differences were found in the incidence rate of complications and Harris scores between patients treated with bipolar femoral placement and total hip arthroplasty (P>0.05). These findings indicate that the treatment of osteoporotic hip fracture in the elderly can achieve satisfactory results if the comprehensive therapies are given. Bipolar femoral placement and total hip arthroplasty are preferred for elderly femoral neck fractures.