CAJ | 학술논문

目的比较不稳定型转子间骨折采用股骨近端抗旋髓内钉(proximal femoral nail anti-rotation,PFNA)与股骨近端解剖型锁定钛板(anatomical locking plate,ALP)治疗的临床疗效. 方法 2008年2月-2009年9月对89例不稳定型转子间骨折患者采用PFNA(PFNA组,45例)或ALP(ALP组,44例)进行固定治疗,对两组手术时间、出血量、引流量、术后并发症、骨折愈合时间、骨折愈合后髋关节功能评分进行比较. 结果平均手术时间PFNA组为61.4 min,明显短于ALP组的114.8 min(P ＜0.01).出血量PFNA组为119.3 ml,明显少于ALP的组136.8 ml(P＜0.01).引流量PFNA组为74.9 ml,明显少于ALP组的80.3 ml(P ＜0.01).骨折愈合时间PFNA组为4个月,ALP组为4.1个月(P＞0.05)；骨折愈合后髋关节的Harris评分PFNA组为91.2分,ALP组为89.8分(P＞0.05).PFNA组2例复位欠佳,ALP组均复位良好.PFNA组无明显不良并发症,ALP组1例骨折不愈合. 结论应用PFNA和ALP治疗不稳定型转子间骨折,在骨折愈合时间、术后并发症及骨折愈合后髋关节功能方面无显著差异,但PFNA手术时间较短、出血量较少,较适合应用于老年人.
목적 비교불은정형전자간골절채용고골근단항선수내정(proximal femoral nail anti-rotation,PFNA)여고골근단해부형쇄정태판(anatomical locking plate,ALP)치료적림상료효. 방법 2008년2월-2009년9월대89례불은정형전자간골절환자채용PFNA(PFNA조,45례)혹ALP(ALP조,44례)진행고정치료,대량조수술시간、출혈량、인류량、술후병발증、골절유합시간、골절유합후관관절공능평분진행비교. 결과 평균수술시간PFNA조위61.4 min,명현단우ALP조적114.8 min(P ＜0.01).출혈량PFNA조위119.3 ml,명현소우ALP적조136.8 ml(P＜0.01).인류량PFNA조위74.9 ml,명현소우ALP조적80.3 ml(P ＜0.01).골절유합시간PFNA조위4개월,ALP조위4.1개월(P＞0.05)；골절유합후관관절적Harris평분PFNA조위91.2분,ALP조위89.8분(P＞0.05).PFNA조2례복위흠가,ALP조균복위량호.PFNA조무명현불량병발증,ALP조1례골절불유합. 결론 응용PFNA화ALP치료불은정형전자간골절,재골절유합시간、술후병발증급골절유합후관관절공능방면무현저차이,단PFNA수술시간교단、출혈량교소,교괄합응용우노년인.
Objective To compare the outcome of proximal femoral nail anti-rotation (PFNA)versus anatomical locking plate (ALP) in treatment of unstable intertrochanteric fracture.Methods The study included 89 patients who had received PFNA fixation (PFNA group,n =45) or ALP fixation (ALP group,n =44) for unstable intertrochanteric fracture between February 2008 and September 2009.Operation time,amount of bleeding,drainage volume,postoperative complications,fracture healing time and hip joint score after fracture healing were compared between two groups.Results Mean operation time in PFNA group was obviously shorter than that in ALP group (61.4 minutes vs 114.8 minutes,P ＜0.01).Mean amount of bleeding and drainage volume were significantly lower in PFNA group than in ALPgroup (119.3 mlvs 136.8ml,P＜0.01; 74.9mlvs80.3 ml,P＜0.01).While,PFNA group was not significantly different from ALP group with regard to average fracture healing time and Harris hip joint score after fracture healing (4 months vs 4.1 months,P ＞ 0.05; 91.2 points vs 89.8 points,P ＞0.05).Two patients had poor fracture reduction in PFNA group,but all patients had good fracture reduction in ALP group.No obvious adverse postoperative complications occurred in PFNA group,but one patient had fracture nonunion in ALP group.Conclusions PFNA and ALP fixation of unstable intertrochanteric fracture present insignificant differences in fracture healing time,postoperative complications and hip joint function after fracture healing.Whereas,PFNA is more suitable for the elder patients on account of shorter operation time and less intraoperative bleeding.