CAJ | 학술논문

目的：探讨三种不同内固定方法治疗高龄股骨粗隆间骨折的临床疗效。方法：2008年1月-2013年6月笔者所在医院收治的高龄(≥80岁)股骨粗隆间骨折并通过手术治疗的患者共128例：其中经皮加压钢板(PCCP组)固定47例，动力髋加压螺钉(DHS组)固定57例，股骨近端解剖锁定板(LCP组)固定24例，比较疗效。结果：PCCP组2例失访，45例患者术后获平均10.5个月(8~15个月)的随访；DHS组3例失访，54例患者术后获平均11.2个月(10~17个月)的随访；LCP组1例失访，23例患者术后获平均11.5个月(8~17个月)的随访。三组骨折愈合时间、并发症及Harris关节功能评分比较，差异无统计学意义(P>0.05)。结论：三种手术方式均有较好的效果。对高龄患者来说，PCCP和微创DHS是最合适的。不能耐受麻醉的患者，PCCP更为合适。严重骨质疏松的患者，PCCP或近端锁定钢板更为合适。针对粉碎性骨折，选择近端锁定钢板更好。采用PCCP的内固定方式可以允许患者早期部分负重。
목적：탐토삼충불동내고정방법치료고령고골조륭간골절적림상료효。방법：2008년1월-2013년6월필자소재의원수치적고령(≥80세)고골조륭간골절병통과수술치료적환자공128례：기중경피가압강판(PCCP조)고정47례，동력관가압라정(DHS조)고정57례，고골근단해부쇄정판(LCP조)고정24례，비교료효。결과：PCCP조2례실방，45례환자술후획평균10.5개월(8~15개월)적수방；DHS조3례실방，54례환자술후획평균11.2개월(10~17개월)적수방；LCP조1례실방，23례환자술후획평균11.5개월(8~17개월)적수방。삼조골절유합시간、병발증급Harris관절공능평분비교，차이무통계학의의(P>0.05)。결론：삼충수술방식균유교호적효과。대고령환자래설，PCCP화미창DHS시최합괄적。불능내수마취적환자，PCCP경위합괄。엄중골질소송적환자，PCCP혹근단쇄정강판경위합괄。침대분쇄성골절，선택근단쇄정강판경호。채용PCCP적내고정방식가이윤허환자조기부분부중。
Objective:To separately investigate the best surgical tactic among the DHS,LCP and PCCP for each senior patients with different fracture condition.Method:The surgeries were performed in Wuxi People’s Hospital from January 2008 to June 2013,47 patients aged over 80 years old with intertrochanteric femoral fractures were treated with PCCP method(the PCCP group),57 patients with DHS method(the DHS gruop) and 24 patients with LCP method(the LCP group),the effect of three groups were compared.Result:In the PCCP group,from 8 to 15 months(mean 10.5 months) follow-up after surgery, whereas the DHS group had from 10 to 17 months(mean 11.2 months) follow-up and the LCP group had from 8 to 17 months(mean 11.5 months) follow-up.The mean healing time,complications and Harris Hip Scores of three groups,there was no statistical significance(P<0.05).Conclusion:Each surgery method performes well. The PCCP group and DHS group have a better prognosis.The PCCP and LCP technique,performe better among the patients with severe osteopenia or osteoprosis. The LCP system indicates better osteogensis and restoration of hip function in comminutied fracture.The PCCP method allowes the patients early-stage and partial weight bearing,which enhances the rehabilitation.And we also find,for the patient being intolerance to anesthesia,the PCCP is the outstanding way to surgery.