CAJ | 학술논문

目的：比较骨质疏松性股骨转子间骨折行DHS与PFNA两种内固定术后髋关节周围局部骨丢失的程度。 　　方法：对2012年1月至2012年7月期间收治的52例骨质疏松性股骨转子间骨折患者进行回顾性研究，男22例，女30例；年龄51~90岁，平均70.1岁。根据手术方式的选择，分为DHS组（n=23）和PFNA组（n=29）。骨折类型参照Ev-ans-Jensen股骨转子间骨折分型标准：Ⅰ型17例，Ⅱ型14例，Ⅲ型11例，Ⅳ型8例，Ⅴ型2例。两组患者均给予规范药物抗骨质疏松治疗。取患侧股骨颈区骨密度改变值为评价指标，分别测量术后3d、6个月时患侧髋关节的骨密度，计算患侧股骨颈区骨密度改变值。 　　结果：所有52例患者均获得随访，随访时间为6~14个月，平均8.5个月，因未能坚持药物抗骨质疏松治疗5例未入选（A组2例，B组3例）。无内固定折断及松动情况，髋关节功能恢复良好，参照Harris髋关节评分标准，所有入选的患者中优良者47例，较好者4例，尚可1例。对所有入选患者股骨颈区骨密度的改变值进行组间t检验，差异有统计学意义（P＜0.05）。 　　结论：PFNA内固定术后局部骨质丢失小于DHS内固定，更适合合并有骨质疏松的老年转子间骨折患者。
목적：비교골질소송성고골전자간골절행DHS여PFNA량충내고정술후관관절주위국부골주실적정도。 　　방법：대2012년1월지2012년7월기간수치적52례골질소송성고골전자간골절환자진행회고성연구，남22례，녀30례；년령51~90세，평균70.1세。근거수술방식적선택，분위DHS조（n=23）화PFNA조（n=29）。골절류형삼조Ev-ans-Jensen고골전자간골절분형표준：Ⅰ형17례，Ⅱ형14례，Ⅲ형11례，Ⅳ형8례，Ⅴ형2례。량조환자균급여규범약물항골질소송치료。취환측고골경구골밀도개변치위평개지표，분별측량술후3d、6개월시환측관관절적골밀도，계산환측고골경구골밀도개변치。 　　결과：소유52례환자균획득수방，수방시간위6~14개월，평균8.5개월，인미능견지약물항골질소송치료5례미입선（A조2례，B조3례）。무내고정절단급송동정황，관관절공능회복량호，삼조Harris관관절평분표준，소유입선적환자중우량자47례，교호자4례，상가1례。대소유입선환자고골경구골밀도적개변치진행조간t검험，차이유통계학의의（P＜0.05）。 　　결론：PFNA내고정술후국부골질주실소우DHS내고정，경괄합합병유골질소송적노년전자간골절환자。
Objective:To compare the bone loss after DHS or PFNA for the treatment of intertrochanteric fracture in the patients with osteoporosis. Methods:A total of 52 intertrochanteric fracture patients with osteoporosis underwent PFNA or DHS fixation in Shanxi Medical University first affiliated hospital from January 2012 to July 2012. Of them, 23 were treated by DHS (DHS group) and 29 with PFNA (PFNA group). According to Evans-Jensen classification of femoral intertrochanteric fracture:17 cases with typeⅠ, 14 cases with typeⅡ, 11 cases with typeⅢ, 8 cases with typeⅣ, and 2 cases with typeⅤ. All patients were given drug treatment for osteoporosis. Bone mineral density (BMD) of the affected hip were measured at 3 days and 6 months after surgery. The change of BMD was calculated. Results:All the patients were followed up and the mean duration was 8.5 months (range, 6-14 months). Five patients (2 in DHS group and 3 in PFNA group) failed to continuous drug treatment for osteoporosis. No internal fixation was broken and loosened, and hip joint function recovered well. According to the Harris hip score, excellent result in 47 cases, good in 4 cas-es and fair in 1 case. Conclusions:Bone loss after PFNA is less than that after DHS, which indicate that PFNA is more suitable for the elderly pa-tients with intertrochanteric fracture combined with osteoporosis.