CAJ | 학술논문

目的：比较倒置股骨远端微创内固定系统(LISS)与股骨近端防旋髓内钉(PFNA)治疗老年股骨近端骨折合并髋关节内翻畸形的临床疗效。方法回顾性分析2009年1月至2012年12月采用PFNA和倒置LISS钢板内固定治疗的且随访时间均超过10个月的45例老年股骨近端骨折合并髋关节内翻畸形患者的病例资料，其中采用LISS倒置钢板治疗者22例(LISS组)，采用PFNA内固定治疗者23例(PFNA组)，两组患者术前一般资料比较差异均无统计学意义(P>0.05)，具有可比性。比较两组患者的术前美国麻醉学会(American Society of Anesthesiologists，ASA)评分、手术时间、术中出血量、骨折复位质量、住院时间、术后负重时间、骨折愈合时间、颈干角丢失情况、术后并发症发生情况以及术后8个月髋关节Harris评分等。结果所有患者获得10~13个月的随访，平均11.8个月。两组术前ASA评分、手术时间、术中出血、骨折复位质量、住院时间、术后8个月髋关节Harris评分及术后并发症方面比较差异均无统计学意义(P>0.05)；LISS组钢板倒置完全负重时间和骨折愈合时间较PFNA组延长[分别为(16.8±3.5)周、(30.4±11.9)周vs (9.7±1.9)周、(18.3±7.4)周；P值均<0.05]，两组术前及术后颈干角差异无统计学意义，随访10个月后，LISS组和PFNA组颈干角差异有统计学意义[(125.1±7.1)°vs (121.3±7.4)°， P<0.05]。结论 PFNA可允许老年股骨近端骨折合并髋关节内翻畸形早期负重，但对于骨质疏松严重、内固定切割风险较高的患者，LISS钢板倒置可降低术后髋内翻的发生率。
목적：비교도치고골원단미창내고정계통(LISS)여고골근단방선수내정(PFNA)치료노년고골근단골절합병관관절내번기형적림상료효。방법회고성분석2009년1월지2012년12월채용PFNA화도치LISS강판내고정치료적차수방시간균초과10개월적45례노년고골근단골절합병관관절내번기형환자적병례자료，기중채용LISS도치강판치료자22례(LISS조)，채용PFNA내고정치료자23례(PFNA조)，량조환자술전일반자료비교차이균무통계학의의(P>0.05)，구유가비성。비교량조환자적술전미국마취학회(American Society of Anesthesiologists，ASA)평분、수술시간、술중출혈량、골절복위질량、주원시간、술후부중시간、골절유합시간、경간각주실정황、술후병발증발생정황이급술후8개월관관절Harris평분등。결과소유환자획득10~13개월적수방，평균11.8개월。량조술전ASA평분、수술시간、술중출혈、골절복위질량、주원시간、술후8개월관관절Harris평분급술후병발증방면비교차이균무통계학의의(P>0.05)；LISS조강판도치완전부중시간화골절유합시간교PFNA조연장[분별위(16.8±3.5)주、(30.4±11.9)주vs (9.7±1.9)주、(18.3±7.4)주；P치균<0.05]，량조술전급술후경간각차이무통계학의의，수방10개월후，LISS조화PFNA조경간각차이유통계학의의[(125.1±7.1)°vs (121.3±7.4)°， P<0.05]。결론 PFNA가윤허노년고골근단골절합병관관절내번기형조기부중，단대우골질소송엄중、내고정절할풍험교고적환자，LISS강판도치가강저술후관내번적발생솔。
Objective To compare the clinical effects of proximal femoral nail antirotation blade (PFNA) with reverse less invasive stabilization system (LISS) in the treatment of proximal femur fractures complicated with coxa vam.Methods From Jan 2009 to Dec 2012, 45 patients with proximal femur fractures complicated with coxa vam were treated with reverse LISS (22 patients) and PFNA (23 patients). There were no significant differences in the general data of the patients between the two groups (P>0.05). The physical status of patients was evaluated according to the American Society of Anesthesiologists (ASA) score. After the operation, the operation duration and volume of blood loss, full weight bearing time, fracture healing time, and neck-shaft angle discrepancy related to contralateral side were assessed in the two groups, respectively. Functional recovery was evaluated according to Harris score and compli-cation. Results The patients were followed up for 10 to 13 months (13.8 months in average). There was no significant differences between the two groups in operation time, perioperative blood, hospital stay, quality reduction, time of bone union, and postoperative complications or Harris score at 8 months postoperation (P>0.05). The time for full weight bearing and fracture healing in the two groups were (16.8 ± 3.5) weeks vs (9.7 ± 1.9) weeks, and (30.4 ± 11.9) weeks vs (18.3 ± 7.4) weeks respectively, with no significant differences (P<0.05). There was no significant difference in Neck-shaft angle between LISS group and PFNA group before and after surgery, but at 10 months after surgery, a sig-nificant difference appeared [(125.1 ± 7.1)° vs (121.3 ± 7.4)° , P<0.05]. Conclusion The results of PFNA and reverse LISS in the treatment of proximal femur fracture are satisfactory. The fracture treated by PFNA allowed earlier weight bearing. Reverse LISS could avoid coxa vam effectively.