CAJ | 학술논문

目的：探讨全髋关节置换术（ THA）与人工股骨头置换术（ HA）治疗老年移位型（即Garden Ⅲ型－Garden Ⅳ型）股骨颈骨折的临床疗效。方法本组自2007年1月至2013年12月回顾性分析91例70岁以上老年移位股骨型颈骨折的患者，年龄72～98（76．65±7．35）岁，GardenⅢ型67例，Garden Ⅳ型24例，其中采用THA治疗组为48例，HA治疗组43例。分别对手术时间、术中出血、术后离床时间、住院时间、术后髋关节功能进行比较，分析临床疗效。结果本组91例患者中，其中3～5年内通过门诊随访51例，家访及电话进行随访37例，平均随访（4．11±0．73）年，3例失访，术后髋关节功能采用改良Aubigné－Postel评分系统进行评价。 THA组与HA组相比较，在住院时间、术后切口引流量两者无统计学差异，手术时间、住院费用及术中出血量HA组优于THA组，术后髋关节功能，THA组优于HA组。结论 THA和HA在治疗70岁以上老年移位股骨颈骨折治疗方面各有利弊，对于那些相对年龄较轻（＜75岁）或者术后对髋关节功能要求高的老年患者，宜采用THA治疗，对于85岁以上生活质量较差，甚至预期寿命3年内者，宜采用双极人工股骨头置换术治疗。
목적：탐토전관관절치환술（ THA）여인공고골두치환술（ HA）치료노년이위형（즉Garden Ⅲ형－Garden Ⅳ형）고골경골절적림상료효。방법본조자2007년1월지2013년12월회고성분석91례70세이상노년이위고골형경골절적환자，년령72～98（76．65±7．35）세，GardenⅢ형67례，Garden Ⅳ형24례，기중채용THA치료조위48례，HA치료조43례。분별대수술시간、술중출혈、술후리상시간、주원시간、술후관관절공능진행비교，분석림상료효。결과본조91례환자중，기중3～5년내통과문진수방51례，가방급전화진행수방37례，평균수방（4．11±0．73）년，3례실방，술후관관절공능채용개량Aubigné－Postel평분계통진행평개。 THA조여HA조상비교，재주원시간、술후절구인류량량자무통계학차이，수술시간、주원비용급술중출혈량HA조우우THA조，술후관관절공능，THA조우우HA조。결론 THA화HA재치료70세이상노년이위고골경골절치료방면각유리폐，대우나사상대년령교경（＜75세）혹자술후대관관절공능요구고적노년환자，의채용THA치료，대우85세이상생활질량교차，심지예기수명3년내자，의채용쌍겁인공고골두치환술치료。
Objective To investigate the clinical efficacy of total hip arthroplasty ( TH ) and hemiarthroplasty ( HA) in the treatment for displaced femoral neck fractures ( Garden Ⅲ type-Garden Ⅳtype) in the elderly.Methods From January 2007 to December 2013, a retrospective analysis was carried out on 91 patients over 70 years old with displaced femoral neck fractures , and the age range was 7 2-98 (76.65 ±7.35) years.Among the patients, 67 cases were Garden Ⅲ, and 24 cases were GardenⅣ.The THA group consisted of 48 cases, and the HA group consisted of 43 cases.The operative time, blood loss, postoperative ambulation time , length of hospital stay , and the postoperative hip functions were compared in order to analyze the clinical efficacy .Results The 91 patients were followed up except three patients were lost and two patients died within five years .51 patients were followed up by out-patient service, and 37 cases were followed up by home visits and telephone for three to five years; the mean follow-up time was (4.11 ±0.73) years.The postoperative hip functions were evaluated by modified Aubigné-Postel scoring system.The THA group were compared with the HA group for the length of hospital stay and the postoperative wound drainage and no significant difference was found .As for the operative time, blood loss, hospital costs, the HA group were better than the THA group;while the postoperative hip functions of the THA group were better than the HA group .Conclusions THA and HA have their own advantages and disadvantages in the treatment of the femoral neck fractures with displacement in the patients over 70 years old; for the patients younger than 75 years who have higher requirement of postoperative hip functions , THA would be a better choice , while for the patients older than 85 years with poor life quality , hemiarthroplasty would be good .