CAJ | 학술논문

目的：探讨老年股骨转子间骨折应用动力髋螺钉（ DHS）、Gamma钉、双极人工股骨头置换术治疗的临床效果。方法回顾性分析自2011年5月至2013年5月收治股骨转子间骨折患者122例临床资料。按照治疗方式不同，分为三组：DHS组40例，Gamma钉组47例，双极人工股骨头组35例。观察三组患者的术中出血量、手术时间、住院时间、术后负重时间、术后6个月髋关节Harris评分。结果术后随访6~24个月，平均16.8个月。所有病例术后随访均未出现感染、内固定失效。人工关节置换组均未出现关节脱位、人工假体松动、下沉或断裂。三组在手术时间、住院时间、术后6个月髋关节Harris评分上相比较差异均无统计学意义（ P >0.05）。人工关节组术中出血量最高，明显高于DHS组和Gamma钉组，差异有统计学意义（ P <0.05），且DHS组术中出血量高于Gamma钉组，差异有统计学意义（ P <0.05）；双极人工股骨头组术后负重时间明显短于DHS组和Gamma钉，差异具有统计学意义（ P <0.05），而DHS组与Gamma钉组相比较差异无统计学意义（ P >0.05）。结论采用DHS、Gamma钉、双极人工股骨头治疗老年转子间骨折均具有髋关节功能恢复好、术后并发症少、住院时间短的优点，而人工关节置换更早进行负重功能锻炼，在高龄、长期卧床患者可考虑选择人工关节置换。但人工关节置换术中出血量大，术前需关注血红蛋白含量，必要时术前予以纠正。
목적：탐토노년고골전자간골절응용동력관라정（ DHS）、Gamma정、쌍겁인공고골두치환술치료적림상효과。방법회고성분석자2011년5월지2013년5월수치고골전자간골절환자122례림상자료。안조치료방식불동，분위삼조：DHS조40례，Gamma정조47례，쌍겁인공고골두조35례。관찰삼조환자적술중출혈량、수술시간、주원시간、술후부중시간、술후6개월관관절Harris평분。결과술후수방6~24개월，평균16.8개월。소유병례술후수방균미출현감염、내고정실효。인공관절치환조균미출현관절탈위、인공가체송동、하침혹단렬。삼조재수술시간、주원시간、술후6개월관관절Harris평분상상비교차이균무통계학의의（ P >0.05）。인공관절조술중출혈량최고，명현고우DHS조화Gamma정조，차이유통계학의의（ P <0.05），차DHS조술중출혈량고우Gamma정조，차이유통계학의의（ P <0.05）；쌍겁인공고골두조술후부중시간명현단우DHS조화Gamma정，차이구유통계학의의（ P <0.05），이DHS조여Gamma정조상비교차이무통계학의의（ P >0.05）。결론채용DHS、Gamma정、쌍겁인공고골두치료노년전자간골절균구유관관절공능회복호、술후병발증소、주원시간단적우점，이인공관절치환경조진행부중공능단련，재고령、장기와상환자가고필선택인공관절치환。단인공관절치환술중출혈량대，술전수관주혈홍단백함량，필요시술전여이규정。
Objective To evaluate the effect of the dynamic hip screw( DHS),the Gamma nail and the bipolar hemiarthroplasty with bi-plor prosthesis for treatment in the intertrochanteric femoral fractures. Methods 122 cases of intertrochanteric femoral fractures were treated with the dynamic hip screw(DHS),the Gamma nail and the bipolar hemiarthroplasty with biplor prosthesis from May 2011 to May 2013. They were treated with respectively with DHS(40 patients),Gamma(47 patients)and bipolar hemiarthroplasty(35 patients). All patients were assessed from time of operatiion,hospital stay,complications and harris score after six months,to evaluate the effect of clinical results and postoperative functional recovery. Results The patients were followed up for average 16. 8 months(range,6~24 months). All patients did not have infection, no reduction loss,no joint dislocation,or loosening,subsidence or rupture of the prosthesis. All patients did not show significant differences in op-erative time ,hospital stay,complications and harris score after six months( P >0. 05). Compared with group DHS and group Gamma nail,pa-tients of group bipolar hemiarthroplasty had fewer ambulation time with significant differences( P <0. 05). Conclusion The use of DHS,Gam-ma nail,bipolar femoral head treatment of senile intertrochanteric fractures have hip function recovery,fewer complications,shorter hospital stay, the advantages of artificial joint replacement and weight-bearing exercise earlier in the elderly,bedridden patients can consider options artificial joint replacement. But arthroplasty had high blood loss,preoperative hemoglobin content to be concerned,to be corrected if necessary before surgery.