CAJ | 학술논문

目的：探讨动力髋（Dynamic hip screws，DHS ）联合骨水泥和人工股骨头置换（Artificial femoral head replacement）治疗高龄伴有严重骨质疏松的不稳定性转子间骨折的临床疗效。方法选择2010年1月-2012年12月40例75岁以上高龄不稳定型转子间骨折患者，分为动力髋内固定组和人工股骨头置换组，每组各20例，对两组患者的术中出血量、术后输血量、住院时间、卧床时间及并发症发生情况等进行比较，并根据髋关节功能情况，对动力髋内固定组和人工股骨头置换组 Harris 评分进行比较。结果所有患者均得到随访，随访时间12～48个月，平均22个月。两组患者手术时间、术中出血量、术后输血量及住院时间差异无统计学意义（P ＞0．05）。人工股骨头置换组术后卧床时间短于动力髋内固定组，差异有统计学意义（P ＜0．05）。动力髋内固定组并发2例髋内翻，优良率为90．0％。人工股骨头置换组并发1例髋内翻，优良率为95．0％。动力髋内固定组 Harris 评分（91．8±6．1）分，人工股骨头置换组（92．5±5．6）分，两组差异无统计学意义（P ＞0．05）。结论动力髋内固定手术和人工股骨头置换手术对高龄不稳定性转子间骨折治疗各具优势，只要掌握好适应证，可以达到较好的效果。
목적：탐토동력관（Dynamic hip screws，DHS ）연합골수니화인공고골두치환（Artificial femoral head replacement）치료고령반유엄중골질소송적불은정성전자간골절적림상료효。방법선택2010년1월-2012년12월40례75세이상고령불은정형전자간골절환자，분위동력관내고정조화인공고골두치환조，매조각20례，대량조환자적술중출혈량、술후수혈량、주원시간、와상시간급병발증발생정황등진행비교，병근거관관절공능정황，대동력관내고정조화인공고골두치환조 Harris 평분진행비교。결과소유환자균득도수방，수방시간12～48개월，평균22개월。량조환자수술시간、술중출혈량、술후수혈량급주원시간차이무통계학의의（P ＞0．05）。인공고골두치환조술후와상시간단우동력관내고정조，차이유통계학의의（P ＜0．05）。동력관내고정조병발2례관내번，우량솔위90．0％。인공고골두치환조병발1례관내번，우량솔위95．0％。동력관내고정조 Harris 평분（91．8±6．1）분，인공고골두치환조（92．5±5．6）분，량조차이무통계학의의（P ＞0．05）。결론동력관내고정수술화인공고골두치환수술대고령불은정성전자간골절치료각구우세，지요장악호괄응증，가이체도교호적효과。
Objective To investigate the clinical curative effect of the treatment of DHS combined with ce-ment and femoral head replacement on unstable intertrochanteric fracture in seniors.Methods We analyzed a retrospectively the data from 40 senior patients over 75 years old with unstable intertrochanteric fractures from January 2010 to December 2012.The patients were divided equally into dynamic hip screw group and artificial femoral head replacement group.We compared data from two groups in terms of a-mount of intraoperative bleeding,intraoperative and postoperative blood transfusion,hospitalization time, time in bed and complications,and evaluated the function of hip joint after the operations according to the Harris score.Results All the patients were followed up,the follow-up time ranging from 12 to 48 months.There was no significant difference between two groups in operation time,the amount of intraop-erative bleeding and postoperative blood transfusion,and hospitalization time (P >0.05).The postopera-tive recovery time in artificial femoral head replacement group is shorter than that in dynamic hip screw group,and the difference was statistically significant (P <0.05).There were 2 cases of coxa vara compli-cations in dynamic hip screw group.The rate of excellent and good recovery was 90%.There was 1 case of coxa vara in artificial femoral head replacement group,and the rate of excellent and good recovery was 95%.Dynamic hip screw group (91.8±6.1),and artificial femoral head replacement group (92.5±5.6). No statistically significant differences appeared in the Harris scores between two groups (P >0.05).Con-clusion Each treatment has its advantages and can achieve good results,as long as we are sure of its indi-cations.