CAJ | 학술논문

目的比较人工关节置换与髓内钉固定治疗高龄严重骨质疏松股骨转子间骨折的疗效. 方法回顾性分析2002年1月至2011年12月期间收治且获得随访的142例75岁以上、骨密度T值≤-2.5的股骨转子间骨折患者资料,根据治疗方式不同分为两组:关节置换组(89例),男38例,女51例；平均年龄为(80.3±4.5)岁；采用人工关节置换治疗.髓内钉组(53例),男22例,女31例；平均年龄为(79.6±5.7)岁；采用髓内钉固定治疗.比较两组患者的手术时间、切口长度、术中出血量,以及术后2周、3个月、6个月及12个月疼痛视觉模拟评分(VAS)、髋关节Harris评分及健康调查简表(SF-36)评分等. 结果关节置换组患者的手术时间[(55.4±8.4) min]较髓内钉组[(60.6±11.6) min]短,切口长度[(12.7±2.3)cm]较髓内钉组[(8.5±2.3)cm]长,差异均有统计学意义(P＜0.05).两组患者的术中出血量、功能训练时间比较差异均无统计学意义(P＞0.05).术后2周、3个月及6个月关节置换组疼痛VAS评分明显低于髓内钉组,髋关节Harris评分及SF-36评分明显高于髓内钉组,差异均有统计学意义(P＜0.05)；术后12个月时两组患者以上项目比较差异均无统计学意义(P＞0.05). 结论对于高龄严重骨质疏松股骨转子间骨折,人工关节置换治疗较髓内钉固定在提高患者生活质量方面更有优势.
목적 비교인공관절치환여수내정고정치료고령엄중골질소송고골전자간골절적료효. 방법 회고성분석2002년1월지2011년12월기간수치차획득수방적142례75세이상、골밀도T치≤-2.5적고골전자간골절환자자료,근거치료방식불동분위량조:관절치환조(89례),남38례,녀51례；평균년령위(80.3±4.5)세；채용인공관절치환치료.수내정조(53례),남22례,녀31례；평균년령위(79.6±5.7)세；채용수내정고정치료.비교량조환자적수술시간、절구장도、술중출혈량,이급술후2주、3개월、6개월급12개월동통시각모의평분(VAS)、관관절Harris평분급건강조사간표(SF-36)평분등. 결과 관절치환조환자적수술시간[(55.4±8.4) min]교수내정조[(60.6±11.6) min]단,절구장도[(12.7±2.3)cm]교수내정조[(8.5±2.3)cm]장,차이균유통계학의의(P＜0.05).량조환자적술중출혈량、공능훈련시간비교차이균무통계학의의(P＞0.05).술후2주、3개월급6개월관절치환조동통VAS평분명현저우수내정조,관관절Harris평분급SF-36평분명현고우수내정조,차이균유통계학의의(P＜0.05)；술후12개월시량조환자이상항목비교차이균무통계학의의(P＞0.05). 결론 대우고령엄중골질소송고골전자간골절,인공관절치환치료교수내정고정재제고환자생활질량방면경유우세.
Objective To compare the effectiveness of hip arthroplasty (HA) versus intramedullary nailing (IN) in the treatment of intertrochanteric fractures in aged patients with severe osteoporosis.Methods We retrospectively reviewed 142 patients with an age of more than 75 years and T value of bone density ≤-2.5 who had been treated in our department from January 2002 to December 2011 for intertrochanteric fractures and completely followed up.They were divided into 2 groups according to the treatment they had received.In the HA group,there were 38 men and 51 women,with an average age of 80.3 ±4.5 years.In the IN group,there were 22 men and 31 women,with an average age of 79.6 ± 5.7 years.The 2 groups were compared in terms of operation time,incision length,intraoperative blood loss,visual analogue scale (VAS) scores,Harris scores of the hip and scores of the 36-item Form Health Survey (SF-36) at 2 weeks,3,6 and 12 months postoperation.Results The HA group had significantly shorter operation time (55.4 ± 8.4 minutes versus 60.6 ± 11.6 minutes) and significantly longer incision (12.7 ± 2.3 cm versus 8.5 ± 2.3 cm) than the IN group (P ＜ 0.05).There were no significant differences between the 2 groups in intraoperative blood loss or time for functional rehabilitation (P ＞ 0.05).At 2 weeks,3 and 6 months postoperation,the HA group had significantly lower VAS scores and significantly higher Harris and SF-36 scores than the IN group (P ＜ 0.05).However,such significant differences in the 3 sorts of scores were not observed at 12 months postoperation (P ＞ 0.05).Conclusion Hip arthroplasty may be more advantageous in increasing postoperative quality of life than intramedullary nailing for aged patients with intertrochanteric fracture and serious osteoporosis.