CAJ | 학술논문

背景：经皮加压接骨板（PCCP）和防旋股骨近端髓内钉（PFNA）是目前治疗股骨转子间骨折的较先进的内固定方式，但仍缺少关于两种方法疗效比较的相关研究。 　　目的：比较闭合复位PCCP和PFNA治疗股骨转子间骨折的临床疗效。 　　方法：回顾性分析2010年1月至2012年12月我院收治的随访资料完整的82例股骨转子间骨折患者的临床资料。根据手术方式不同，分为PCCP组（37例）和PFNA组（45例）。分别对两组患者的手术创伤、并发症、手术疗效进行比较。结果：PCCP组手术时间、透视时间和住院时间略长，但两组比较无显著统计学差异（P＞0.05）。PCCP组术中出血量显著多于PFNA组（P＜0.05），但两组术后血红蛋白下降水平无显著统计学差异（P＞0.05）。随访时间12~25个月，平均16个月，所有切口及骨折均获得愈合。PFNA组股骨头颈螺钉倒钉、退钉的发生率显著高于PCCP组（P＜0.05）。两组术后切口感染、下肢深静脉血栓形成、髋内翻等并发症无显著统计学差异（P＞0.05）。PFNA组开始下地负重时间和完全负重时间显著早于PCCP组（P＜0.05），但两组骨折愈合时间及末次随访Harris评分均无显著统计学差异（P＞0.05）。结论：PCCP和PFNA均是A1、A2型股骨转子间骨折较为理想的内固定方式。相比PFNA，PCCP对骨折断端加压作用更强，头颈螺钉倒钉、退钉发生率低，未见术中股骨干远端皮质劈裂，术后股骨干骨折等并发症。
배경：경피가압접골판（PCCP）화방선고골근단수내정（PFNA）시목전치료고골전자간골절적교선진적내고정방식，단잉결소관우량충방법료효비교적상관연구。 　　목적：비교폐합복위PCCP화PFNA치료고골전자간골절적림상료효。 　　방법：회고성분석2010년1월지2012년12월아원수치적수방자료완정적82례고골전자간골절환자적림상자료。근거수술방식불동，분위PCCP조（37례）화PFNA조（45례）。분별대량조환자적수술창상、병발증、수술료효진행비교。결과：PCCP조수술시간、투시시간화주원시간략장，단량조비교무현저통계학차이（P＞0.05）。PCCP조술중출혈량현저다우PFNA조（P＜0.05），단량조술후혈홍단백하강수평무현저통계학차이（P＞0.05）。수방시간12~25개월，평균16개월，소유절구급골절균획득유합。PFNA조고골두경라정도정、퇴정적발생솔현저고우PCCP조（P＜0.05）。량조술후절구감염、하지심정맥혈전형성、관내번등병발증무현저통계학차이（P＞0.05）。PFNA조개시하지부중시간화완전부중시간현저조우PCCP조（P＜0.05），단량조골절유합시간급말차수방Harris평분균무현저통계학차이（P＞0.05）。결론：PCCP화PFNA균시A1、A2형고골전자간골절교위이상적내고정방식。상비PFNA，PCCP대골절단단가압작용경강，두경라정도정、퇴정발생솔저，미견술중고골간원단피질벽렬，술후고골간골절등병발증。
Background:Percutaneous compression plate (PCCP) and proximal femoral nail antirotation (PFNA) is popular in treating intertrochanteric fractures of femur, but it is still lack of comparative studies on the clinical outcome of the two methods. Objective:To compare the efficacy of internal fixation between PCCP and PFNA for intertrochanteric fractures of femur. Methods:A retrospective analysis was conducted in 82 patients with intertrochanteric fractures treated in our hospital be-tween January 2010 and December 2012. The patients were divided into PCCP group (n=37) and PFNA group (n=45). Sur-gical trauma, complications, and clinical efficacy were compared between groups. Results:Operative time, fluoroscopy time and length of stay in PCCP group were longer than those in PFNA group, but the difference was not statistically significant (P>0.05). Intraoperative blood loss in PCCP group was significantly more than that in PFNA group (P<0.05). There was no significant difference in decreased postoperative hemoglobin between groups (P>0.05). The mean follow-up period was 16 months (range, 12-25 months). All fractured bones were healed. The incidence of screw loosening in PFNA group was significantly higher than that in PCCP group (P<0.05). There were no significant dif-ferences in the incidences of postoperative wound infection, deep vein thrombosis, or coxa vara between two groups (P>0.05). Beginning time of weight-bearing exercises and full weight bearing walking time in PFNA group were significantly earlier than those in PCCP group (P<0.05), but no significant difference was found in fracture healing time or Harris score at the last follow-up between groups (P>0.05). Conclusions:Both PCCP and PFNA are suitable for the treatment of type A1 and A2 intertrochanteric fractures during inter-nal fixation. Compared to PFNA, PCCP has stronger compression for broken ends of fractured bone and lower incidence of screw loosening without postoperative distal cortical splitting or femoral fracture.