CAJ | 학술논문

目的：比较应用防旋型股骨近端髓内钉(PFNA)和动力髁螺钉(DCS)治疗60岁以上老年不稳定性粗隆间骨折的临床疗效。结果回顾性分析2010年3月至2012年1月期间在我科治疗的68例不稳定粗隆间骨折患者的临床资料，应用PFNA治疗36例(PFNA组)，DCS治疗32例(DCS组)，术后对所有患者进行随访，记录两组随访时间、手术操作时间、下地时间、骨折临床愈合时间、Harris评分、术后相关并发症等数据并进行统计学分析。结果两组患者的性别、年龄、损伤机制以及AO分型等一般情况比较差异均无统计学意义(P>0.05)。PFNA组随访时间为(14.34±4.28)个月，手术操作时间为(61.24±19.36) min，下地时间为(8.13±3.64) d，骨折愈合时间为(16.13±3.59)周，Harris评分为(78.56±7.54)分，其中8例出现术后并发症；DCS组随访时间为(15.25±4.36)个月，手术操作时间为(92.21±25.16) min，下地时间为(21.35±9.46) d，骨折愈合时间为(21.68±7.94)周，Harris评分为(63.14±8.35)分，13例出现术后并发症。PFNA组手术操作时间明显低于DCS组(P<0.01)，PFNA组愈合时间明显短于DCS组(P<0.01)，术后Harris评分PFNA明显高于DCS组(P<0.01)。两组术后并发症比较差异无统计学意义(P>0.05)。结论相比于DCS，PFNA可以为患者提供更加坚强的力学稳定性，实现更好的功能恢复，是一种治疗不稳定粗隆间骨折更加有效的方法。
목적：비교응용방선형고골근단수내정(PFNA)화동력과라정(DCS)치료60세이상노년불은정성조륭간골절적림상료효。결과회고성분석2010년3월지2012년1월기간재아과치료적68례불은정조륭간골절환자적림상자료，응용PFNA치료36례(PFNA조)，DCS치료32례(DCS조)，술후대소유환자진행수방，기록량조수방시간、수술조작시간、하지시간、골절림상유합시간、Harris평분、술후상관병발증등수거병진행통계학분석。결과량조환자적성별、년령、손상궤제이급AO분형등일반정황비교차이균무통계학의의(P>0.05)。PFNA조수방시간위(14.34±4.28)개월，수술조작시간위(61.24±19.36) min，하지시간위(8.13±3.64) d，골절유합시간위(16.13±3.59)주，Harris평분위(78.56±7.54)분，기중8례출현술후병발증；DCS조수방시간위(15.25±4.36)개월，수술조작시간위(92.21±25.16) min，하지시간위(21.35±9.46) d，골절유합시간위(21.68±7.94)주，Harris평분위(63.14±8.35)분，13례출현술후병발증。PFNA조수술조작시간명현저우DCS조(P<0.01)，PFNA조유합시간명현단우DCS조(P<0.01)，술후Harris평분PFNA명현고우DCS조(P<0.01)。량조술후병발증비교차이무통계학의의(P>0.05)。결론상비우DCS，PFNA가이위환자제공경가견강적역학은정성，실현경호적공능회복，시일충치료불은정조륭간골절경가유효적방법。
Objective To compare the effect of PFNA with DCS for peritrochanteric femoral fracture patients older than 60 years old. Methods Sixty-eight patients with intertrochanteric fracture of femur admitted in our hospital from March 2010 to January 2012 were enrolled in this retrospective study. Among them, 36 were treated with PFNA (PFNA group) and 32 with DCS (DCS group). All the patients were followed up. The operation time, partial weight-bearing, fracture healing time, Harris scores and the number of complications of each group was recorded and an-alyzed. Results No significant differences were discovered between two groups with regard to gender, age, mecha-nism of trauma or AO fracture classification (P>0.05). The mean follow-up time, operation time, partial weight bearing time, the fracture healing time, Harris scores was (14.34 ± 4.28) months, (61.24 ± 19.36) minutes, (8.13 ± 3.64) days. (16.13±3.59) weeks, (78.56±7.54) in PFNA group, and (15.25±4.36) months, (92.21±25.16) minutes, (21.35±9.46) days. (21.68±7.94) weeks, (63.14±8.35) in DCS group, respectively. Compared to the DCS group, the average operation time was significantly shorter in PFNA group (P<0.01), the fracture healing time was significantly shorter (P<0.01). and the Harris score was significantly higher (P<0.01). Eight patients in PFNA group and 13 patients in DCS group had postop-erative complications, with no significant difference between the two groups (P>0.05). Conclusion Compared with DCS, PFNA is a better choice for the treatment for unstable peritrochanteric fractures in the elderly.