CAJ | 학술논문

目的：比较股骨转子下骨折髓内、髓外固定系统的疗效，探讨各类型固定系统特点、影响骨折预后的因素及固定方式选择。方法2009年8月至2014年6月，我院应用股骨近端防旋髓内钉( proximal femoral nail antirotation，PFNA )( A 组)及( less invasive stabilization system，LISS )钢板倒置和股骨近端解剖锁定钢板( anatomic proximal femoral locking plate，APFLP )髓外固定组( B 组)治疗股骨转子下骨折共95例，比较髓内、髓外组病例手术时间、术中出血量、骨折愈合时间、并发症及功能评分，并评价影响骨折预后因素。结果 A 组手术时间为(75.68±15.35) min，术中出血量为(249.36±62.36) ml，愈合时间为(16.58±4.12)周，术后并发症3例，功能评分(90.04±4.71)分；B 组手术时间为(75.23±15.74) min，术中出血量为(186.88±70.99) ml，愈合时间为(19.99±4.92)周，术后并发症2例，功能评分(90.17±3.81)分，两组在手术时间、术后并发症及功能评分上差异均无统计学意义(P＞0.05)，而术中出血量 B 组比 A 组少，骨折愈合时间 A 组比 B 组时间短，差异有统计学意义(P＜0.01)。结论股骨转子下骨折的手术治疗，当以术后功能评分为评价标准时，髓内、髓外固定均适用，如内、外侧有较大骨块建议髓外固定。骨折类型与骨折预后相关，是影响骨折预后评分的因素，且骨折类型越复杂，预后越差，年龄、手术时间、术中出血量、临床愈合时间及是否髓内固定与骨折预后没有相关性。
목적：비교고골전자하골절수내、수외고정계통적료효，탐토각류형고정계통특점、영향골절예후적인소급고정방식선택。방법2009년8월지2014년6월，아원응용고골근단방선수내정( proximal femoral nail antirotation，PFNA )( A 조)급( less invasive stabilization system，LISS )강판도치화고골근단해부쇄정강판( anatomic proximal femoral locking plate，APFLP )수외고정조( B 조)치료고골전자하골절공95례，비교수내、수외조병례수술시간、술중출혈량、골절유합시간、병발증급공능평분，병평개영향골절예후인소。결과 A 조수술시간위(75.68±15.35) min，술중출혈량위(249.36±62.36) ml，유합시간위(16.58±4.12)주，술후병발증3례，공능평분(90.04±4.71)분；B 조수술시간위(75.23±15.74) min，술중출혈량위(186.88±70.99) ml，유합시간위(19.99±4.92)주，술후병발증2례，공능평분(90.17±3.81)분，량조재수술시간、술후병발증급공능평분상차이균무통계학의의(P＞0.05)，이술중출혈량 B 조비 A 조소，골절유합시간 A 조비 B 조시간단，차이유통계학의의(P＜0.01)。결론고골전자하골절적수술치료，당이술후공능평분위평개표준시，수내、수외고정균괄용，여내、외측유교대골괴건의수외고정。골절류형여골절예후상관，시영향골절예후평분적인소，차골절류형월복잡，예후월차，년령、수술시간、술중출혈량、림상유합시간급시부수내고정여골절예후몰유상관성。
Objective To explore the signiifcance of optional internal ifxations of subtrochanteric fractures and prognostic factors by comparing the effects of various kinds of internal fixations.Methods Ninety-five cases were analyzed from August 2009 to June 2014. All patients were divided into intramedullary ifxation group ( proximal femoral nail antirotation, PFNA ) ( group A ), extramedullary ifxation group ( group B ) which contains reversed less invasive stabilization system ( LISS ) and anatomic proximal femoral locking plate ( APFLP ). Data of each group were collected for statistical analysis on the following aspects: operative time, blood loss, clinical healing time of fractures, post-operative restored functions and complications.Results Group A: the operative time was ( 75.68±15.35 ) min; blood loss during the operation was ( 249.36±62.36 ) ml; clinical healing time of fractures was ( 16.58±4.12 ) weeks; postoperative complications occurred in 3 cases; postoperative restored function score was ( 90.04±4.71 ) points. Group B: operative time was ( 75.23±15.74 ) min; blood loss during the operation was ( 186.88±70.99 ) ml; clinical healing time of fractures was ( 19.99±4.92 ) weeks; postoperative complications occurred in 2 cases; postoperative restored function score was ( 90.17±3.81 ) points. The differences of the operative time, postoperative restored function scores and complications between group A, B were of no statistical signiifcance (P>0.05 ). The differences of the blood loss between group A, B were of statistical signiifcance (P<0.01 ), the group B was less than the group A. The differences of the clinical healing time between group A, B were of statistical signiifcance (P<0.01 ), the group A was of shorter than the group B.Conclusions When the postoperative restored function is used as the evaluation standard, both of the two kinds of internal ifxation are applicable for subtrochanteric fractures. If the medial side or lateral side of the bone block is too big, it is better to conduct extramedullary ifxation. The type of fractures is related to the prognosis, which affects prognostic scores. More complicated the type is, worse the prognosis is. The age, operative time, blood loss,clinical healing time of fractures, intramedullary ifxation or not, are not related to the prognosis.