CAJ | 학술논문

目的：探讨不同内固定方法在绝经后股骨转子间骨折患者中的应用效果，为其临床治疗提供可参考依据。方法共纳入90例入住我院骨科的绝经后股骨转子间骨折患者，采用随机数字法平均分为三组各30例，分别给予动力髋螺钉(A组)、股骨近端髓内钉(B组)及Gamma钉(C组)内固定治疗，观察三组患者的手术时间、住院时间及并发症等，并随访6个月评价患者的临床疗效。结果 A组、B组和C组的优良率分别为90.00%，96.67%，93.33%，Harris评分分别为(79.24±2.13)分、(82.42±2.64)分、(79.23±2.15)分，三组的优良率和Harris评分比较差异均无统计学意义（P>0.05）。A组的手术时间为(101.24±6.13) min、术中出血量为(521.3±191.11) ml，明显高于B组的(82.42±6.64) min和(319.4±142.02) ml，C组的(90.23±6.15) min和(321.3±131.12) ml，差异有统计学意义(P<0.05)；A组、B组和C组的住院时间分别为(15.33±2.11) d、(15.04±1.93) d、(14.63±2.21) d，骨折愈合时间分别为(12.02±2.51)周、(11.22±2.21)周、(11.13±2.13)周，三组的住院时间和骨折愈合时间比较差异均无统计学意义(P>0.05)。A组发生髓内翻、内固定松动等并发症的例数最多，其次为C组，B组并发症的发生最少。结论在治疗绝经后股骨颈骨折的内固定方法中，股骨近端髓内钉内固定的总体疗效好于动力髋螺钉内固定的疗效，值得临床推广应用。
목적：탐토불동내고정방법재절경후고골전자간골절환자중적응용효과，위기림상치료제공가삼고의거。방법공납입90례입주아원골과적절경후고골전자간골절환자，채용수궤수자법평균분위삼조각30례，분별급여동력관라정(A조)、고골근단수내정(B조)급Gamma정(C조)내고정치료，관찰삼조환자적수술시간、주원시간급병발증등，병수방6개월평개환자적림상료효。결과 A조、B조화C조적우량솔분별위90.00%，96.67%，93.33%，Harris평분분별위(79.24±2.13)분、(82.42±2.64)분、(79.23±2.15)분，삼조적우량솔화Harris평분비교차이균무통계학의의（P>0.05）。A조적수술시간위(101.24±6.13) min、술중출혈량위(521.3±191.11) ml，명현고우B조적(82.42±6.64) min화(319.4±142.02) ml，C조적(90.23±6.15) min화(321.3±131.12) ml，차이유통계학의의(P<0.05)；A조、B조화C조적주원시간분별위(15.33±2.11) d、(15.04±1.93) d、(14.63±2.21) d，골절유합시간분별위(12.02±2.51)주、(11.22±2.21)주、(11.13±2.13)주，삼조적주원시간화골절유합시간비교차이균무통계학의의(P>0.05)。A조발생수내번、내고정송동등병발증적례수최다，기차위C조，B조병발증적발생최소。결론재치료절경후고골경골절적내고정방법중，고골근단수내정내고정적총체료효호우동력관라정내고정적료효，치득림상추엄응용。
Objective To observe and compare the clinical curative effect of difierent intemaI flxations in the treatment of postmenopausal patients with intertrochanteric fracture. Methods Ninety patients with postmenopausal in-tertrochanteric femoral fracture admitted to our hospital were selected and randomly divided into three groups. Different internal fixation methods were used in these patients, including dynamic hip screw for group A with 30 cases, proximal femoral nail for group B with 30 cases, and gamma nail for group C with 30 cases. The operation time, hospitalization days and complications were recorded and compared among groups. Besides, 6 months follow-up were performed to evaluate the clinical effects. Results The excellent & good rate in group A, group B, and group C were 90.00%, 96.67%, and 93.33%, respectively. And the Harris score were (79.24±2.13), (82.42±2.64), and (79.23±2.15), respective-ly. There was no statistical difference in excellent&good rate and Harris score among the three groups (P>0.05). Sur-gery time in group A was (101.24 ± 6.13) min, which was statistically significantly higher than that in group B and group C [(82.42±6.64) min and (90.23±6.15) min], P<0.05. Intraoperative blood loss in group A was statistically signif-icantly higher than that in group B and group C [(521.3 ± 191.11) ml vs (319.4 ± 142.02) ml and (321.3 ± 131.12) ml, P<0.05]. The hospitalization days in group A, group B, and group C were (15.33 ± 2.11) d, (15.04 ± 1.93) d、and (14.63 ± 2.21) d, respectively, with no statistical differences. And the time of fracture healing were (12.02 ± 2.51) weeks, (11.22±2.21) weeks, and (11.13±2.13) weeks, respectively, with no statistical differences. The number of cas-es complicated with pronation and internal fixation loosening in group A, group C and group B were in descending order. Conclusion Compared with dynamic hip screw, proximal femoral nail internal fixation is safer and more reli-able for treating postmenopausal patients with femoral inntertrochanteric fractures, which should be recommended in clinical application.