CAJ | 학술논문

目的：评价双极人工股骨头置换与股骨近端防旋髓内针（ PFNA）内固定治疗高龄骨质疏松性股骨粗隆间骨折的临床疗效，探讨其合理的治疗方法。方法回顾性分析2009年1月～2013年9月期间，在农垦三亚医院采用双极人工股骨头置换（32例）与PFNA内固定治疗（43例）共75例70岁以上的股骨粗隆间骨折患者。骨折根据AO/OTA 系统分型：转子间二部分骨折分为A1型（稳定骨折），多部分骨折为A2型（不稳定骨折），反斜形转子间骨折为A3型（不稳定骨折）。比较2组在手术时间、出血量、术后卧床时间、并发症发生率及术后1年病死率、Harris功能评分、人工关节松动率、住院时间等方面的指标。结果75例均获得16～24个月随访，43例PFNA组骨折均顺利愈合；32例半髋关节置换假体无脱位、假体柄无明显下沉。两组术后髋关节功能优良率、内置物并发症差异不明显（P＞0.05），但半髋关节置换组内科并发症更少（P＜0.05）、切口长度较大（P＜0.05）、手术时间较长（P＜0.05）、术中出血量较多（P＜0.05）、术后卧床时间及下地时间较短（P＜0.05）。结论双极人工股骨头置换术和PFNA内固定术均是治疗高龄患者粗隆间不稳定骨折的有效方法。双极人工股骨头治疗高龄伴严重骨质疏松的不稳定型股骨粗隆间骨折，下床活动早、早期并发症发生率低、功能恢复满意，可明显提高患者的生活质量。
목적：평개쌍겁인공고골두치환여고골근단방선수내침（ PFNA）내고정치료고령골질소송성고골조륭간골절적림상료효，탐토기합리적치료방법。방법회고성분석2009년1월～2013년9월기간，재농은삼아의원채용쌍겁인공고골두치환（32례）여PFNA내고정치료（43례）공75례70세이상적고골조륭간골절환자。골절근거AO/OTA 계통분형：전자간이부분골절분위A1형（은정골절），다부분골절위A2형（불은정골절），반사형전자간골절위A3형（불은정골절）。비교2조재수술시간、출혈량、술후와상시간、병발증발생솔급술후1년병사솔、Harris공능평분、인공관절송동솔、주원시간등방면적지표。결과75례균획득16～24개월수방，43례PFNA조골절균순리유합；32례반관관절치환가체무탈위、가체병무명현하침。량조술후관관절공능우량솔、내치물병발증차이불명현（P＞0.05），단반관관절치환조내과병발증경소（P＜0.05）、절구장도교대（P＜0.05）、수술시간교장（P＜0.05）、술중출혈량교다（P＜0.05）、술후와상시간급하지시간교단（P＜0.05）。결론쌍겁인공고골두치환술화PFNA내고정술균시치료고령환자조륭간불은정골절적유효방법。쌍겁인공고골두치료고령반엄중골질소송적불은정형고골조륭간골절，하상활동조、조기병발증발생솔저、공능회복만의，가명현제고환자적생활질량。
Objective To discuss a reasonable treatment for unstable intertrochanteric fractures in the elderly patients by comparing the effects of the bipolar hemiarthroplasty and the proximal femoral nail antirotation ( PFNA) fixation.Methods 75 cases of the intertrochanteric fractures in the elderly patients with complete clinical data were retrospectively analyzed .All these patients were treated with cement bipolar hemiarthroplasty or PFNA fixation from January 2009 to September 2013.32 cases were treated with cement bipolar hemiarthroplasty , 43 cases were treated with PFNA fixation . According to AO/OTA classification, all of them belonged to unstable fracture .Comparison was made between the two treated groups in terms of the hospital stays , the length of the incision , the blood loss during the surgery , the duration of the surgical procedure , the time for bed rest postoperatively , the postoperative complications and Harris hip score which were recorded for two years after the surgery .Results The follow -up duration were 16 -24 months.Compared with the PFNA fixation group , the hemiarthroplasty group experienced shorter time of the hospital stay and the bed rest postoperatively , and had longer incision length, longer operation time , and more blood loss during the surgery .The differences between the two groups were statistically significant ( P <0.05 ) .The difference in the postoperative internal medicine complications was significant ( P <0.05 ) .The differences in the postoperative implant complications and Harris hip score two years after the surgery between the two groups were not statistically significant ( P>0.05 ) . Conclusions Both of the two methods are proper treatment methods for the unstable intertrochanteric fractures in the senile patients .Cement bipolar hemiarthroplasty has advantages of allowing early full weight bearing after the surgery , low complication rate and satisfactory functional recovery for unstable intertrochanteric hip fractures in the senile patients who accompany with osteoporosis .