CAJ | 학술논문

目的：比较髓外固定系统，髓内固定系统及人工股骨头置换治疗老年股骨转子间骨折疗效．方法：将220例股骨转子间骨折资料完整的患者分动力髋螺钉（DHS）组、股骨近端防旋髓内钉（PFNA）组、人工股骨头置换组（HHA）进行回顾性分析，其中DHS组82例、PFNA组68例、人工股骨头置换组70例．男性92例，女性128例，年龄70～101岁，平均79.8岁，骨折按Jensen-Evans分型：Ⅰ型22例、Ⅱ型51例、Ⅲ型78例、Ⅳ型44例、Ⅴ型20例、R型（逆粗隆型）5例．比较三组患者术前情况、手术时间、术中出血量、术后下地时间和完全负重时间、骨折愈合时间、患髋功能及并发症等．结果：术后患者获得8～24个月随访，平均13个月．三组疗效满意，优良率比较差异无显著性意义（P＞0.05），三组患者在性别、年龄、骨折类型、内科合并症方面差异无显著性意义．手术时间与术中出血量：PFNA组与DHS组及人工股骨头置换组、PFNA、DHS组比较具有统计学意义（P＜0.05）．PFNA手术时间最短，术中出血量最少，人工股骨头置换组手术时间最长，术中出血量最多，DHS组居中．术后下地时间和完全负重时间：人工股骨头置换组与PFNA组、DHS组、PFNA组与DHS组比较具有统计学意义（P＜0.05）；术后骨折愈合时间PF-NA组与DHS组比较无统计学意义．术后并发症29例（13.2％）．人工股骨头置换组Harris评分最高，差异有统计学意义．结论：三种方法均可以有效的治疗老年股骨转子间骨折，但应根据年龄、身体状况、骨质疏松情况、骨折类型等进行综合评估．对于不稳定型并有严重疏松且不能耐受关节置换术者，髓内固定为首选；对于高龄不稳定骨折，严重骨质疏松，术前可行走，能耐受一次较大手术者可首选人工股骨头置换．而对骨折稳定、骨质疏松不严重、身体状况较好者，也可选用DHS髓外固定．目的：比較髓外固定繫統，髓內固定繫統及人工股骨頭置換治療老年股骨轉子間骨摺療效．方法：將220例股骨轉子間骨摺資料完整的患者分動力髖螺釘（DHS）組、股骨近耑防鏇髓內釘（PFNA）組、人工股骨頭置換組（HHA）進行迴顧性分析，其中DHS組82例、PFNA組68例、人工股骨頭置換組70例．男性92例，女性128例，年齡70～101歲，平均79.8歲，骨摺按Jensen-Evans分型：Ⅰ型22例、Ⅱ型51例、Ⅲ型78例、Ⅳ型44例、Ⅴ型20例、R型（逆粗隆型）5例．比較三組患者術前情況、手術時間、術中齣血量、術後下地時間和完全負重時間、骨摺愈閤時間、患髖功能及併髮癥等．結果：術後患者穫得8～24箇月隨訪，平均13箇月．三組療效滿意，優良率比較差異無顯著性意義（P＞0.05），三組患者在性彆、年齡、骨摺類型、內科閤併癥方麵差異無顯著性意義．手術時間與術中齣血量：PFNA組與DHS組及人工股骨頭置換組、PFNA、DHS組比較具有統計學意義（P＜0.05）．PFNA手術時間最短，術中齣血量最少，人工股骨頭置換組手術時間最長，術中齣血量最多，DHS組居中．術後下地時間和完全負重時間：人工股骨頭置換組與PFNA組、DHS組、PFNA組與DHS組比較具有統計學意義（P＜0.05）；術後骨摺愈閤時間PF-NA組與DHS組比較無統計學意義．術後併髮癥29例（13.2％）．人工股骨頭置換組Harris評分最高，差異有統計學意義．結論：三種方法均可以有效的治療老年股骨轉子間骨摺，但應根據年齡、身體狀況、骨質疏鬆情況、骨摺類型等進行綜閤評估．對于不穩定型併有嚴重疏鬆且不能耐受關節置換術者，髓內固定為首選；對于高齡不穩定骨摺，嚴重骨質疏鬆，術前可行走，能耐受一次較大手術者可首選人工股骨頭置換．而對骨摺穩定、骨質疏鬆不嚴重、身體狀況較好者，也可選用DHS髓外固定．
목적：비교수외고정계통，수내고정계통급인공고골두치환치료노년고골전자간골절료효．방법：장220례고골전자간골절자료완정적환자분동력관라정（DHS）조、고골근단방선수내정（PFNA）조、인공고골두치환조（HHA）진행회고성분석，기중DHS조82례、PFNA조68례、인공고골두치환조70례．남성92례，녀성128례，년령70～101세，평균79.8세，골절안Jensen-Evans분형：Ⅰ형22례、Ⅱ형51례、Ⅲ형78례、Ⅳ형44례、Ⅴ형20례、R형（역조륭형）5례．비교삼조환자술전정황、수술시간、술중출혈량、술후하지시간화완전부중시간、골절유합시간、환관공능급병발증등．결과：술후환자획득8～24개월수방，평균13개월．삼조료효만의，우량솔비교차이무현저성의의（P＞0.05），삼조환자재성별、년령、골절류형、내과합병증방면차이무현저성의의．수술시간여술중출혈량：PFNA조여DHS조급인공고골두치환조、PFNA、DHS조비교구유통계학의의（P＜0.05）．PFNA수술시간최단，술중출혈량최소，인공고골두치환조수술시간최장，술중출혈량최다，DHS조거중．술후하지시간화완전부중시간：인공고골두치환조여PFNA조、DHS조、PFNA조여DHS조비교구유통계학의의（P＜0.05）；술후골절유합시간PF-NA조여DHS조비교무통계학의의．술후병발증29례（13.2％）．인공고골두치환조Harris평분최고，차이유통계학의의．결론：삼충방법균가이유효적치료노년고골전자간골절，단응근거년령、신체상황、골질소송정황、골절류형등진행종합평고．대우불은정형병유엄중소송차불능내수관절치환술자，수내고정위수선；대우고령불은정골절，엄중골질소송，술전가행주，능내수일차교대수술자가수선인공고골두치환．이대골절은정、골질소송불엄중、신체상황교호자，야가선용DHS수외고정．
Aim:To compare the clinical efficacy of extramedullary fixation system,intramedullary fix-ation system and hemi-hip arthroplasty in treatment of intertrochanteric fractures in the elderly.Meth-ods:A retrospective study of 220 cases of femoral intertrochanteric fracture were assigned to dynamic hip screw(DHS)group(82 cases),proximal femoral nail antirotation(PFNA)group(68 cases),hemi-hip ar-throplasty(HHA)group (70 cases).There were 92 males and 128 females,at age range of 70 ~101 years,mean 79.8 years.According to the modification Evan classification,the fracture included typeⅠin 22,type Ⅱ in 51,type Ⅲ in 78,type Ⅳ in 44,type Ⅴ in 20,type R in 5.The Preoperative conditions, postoperative function and complications,operativing time,bleeding during the operation,postoperative full weight-bearing time,fracture healing time were comparatively studied among the three groups.Results:All cases were followed up for 8~24 months,average 13 months.All patients obtained a satisfactory effect and there were no significant differences(P>0.05 )regarding the excellent and good rate,gender,age, fracture types and medical complications,the mean operativing time and blood loss:there were significant differences between the PFNA group,DHS group and HHA group;there were significant differences be-tween the PFNA group,DHS group(P<0.05 ).The operativing time of PFNA group is the shortest,bleed-ing loss is the least.HHA group had the longest operativing time and the most bleeding loss.DHS group is the medium.The mean walking time and completely loading time,PFNA group A took the least time than HHA group and DHS group,there are significant differences (P<0.05 ),union time:there are no signifi-cances between the PFNA group,the DHS group.Postoperative complications were found in 29 cases (13.2%).Harris score was highest in the HHA group,with satisfactory significances in comparison with the other two groups.Conclusion:Three kinds of treatment are effective for the elderly patients with femo-ral intertrochanteric fracture.We should take the patients age,body condition,osteoporosis,fracture type into account and choose a reasonable operation method to achieve a satisfactory clinical effect.Intramedul-lary fixation should be the treatment of choice for the patients with unstable,or severe osteoporosis frac-tures and with intolerance of HHA.HHA is suitable for the elderly patients with unstable or severe osteo-porosis fractures,capability of walk or tolerance of operation,DHS is also suitable for the patients with sta-ble or no severe osteoporosis fractures,good body condition.