CAJ | 학술논문

背景：虽然股骨近端防旋髓内钉具有良好的生物力学基础，在治疗老年股骨转子间骨折方面具有明显优势，但是临床上因材料匹配、手术细节等问题处理不当，仍然出现许多问题，影响治疗效果及功能恢复。目的：分析股骨近端防旋髓内钉治疗60岁以上老年股骨转子间骨折的效果及出现的问题。方法：自2011年7月至2012年7月采用股骨近端防旋髓内钉治疗老年股骨转子间骨折患者56例，建立临床资料库，对治疗过程中出现的问题及治疗后出现的并发症进行统一分析。治疗后1，3，6，9，12个月进行门诊及电话随访，评估治疗效果及髋关节功能恢复情况。结果与结论：4例患者治疗后1年内死亡，7例患者因其他原因1年内失访，其余45例患者随访时间12-24个月，平均随访18.2个月。Harris评分为(85.00±6.75)分，其中优26例，良15例，中3例，差1例，优良率为91%。治疗后骨折断端位置不满意18例，股骨近端防旋髓内钉与股骨近端不匹配9例，螺旋刀片位置及长度不满意7例，并发外侧皮质骨折7例；治疗后并发肺栓塞1例，心脑血管疾病1例，股骨近端局部肿胀9例，髋部疼痛13例，骨折延长愈合5例。结果可见股骨近端防旋髓内钉置入修复老年股骨转子间骨折效果较好，但是对骨折断端分离及减少治疗中、治疗后并发症的发生还有待改善。
배경：수연고골근단방선수내정구유량호적생물역학기출，재치료노년고골전자간골절방면구유명현우세，단시림상상인재료필배、수술세절등문제처리불당，잉연출현허다문제，영향치료효과급공능회복。목적：분석고골근단방선수내정치료60세이상노년고골전자간골절적효과급출현적문제。방법：자2011년7월지2012년7월채용고골근단방선수내정치료노년고골전자간골절환자56례，건립림상자료고，대치료과정중출현적문제급치료후출현적병발증진행통일분석。치료후1，3，6，9，12개월진행문진급전화수방，평고치료효과급관관절공능회복정황。결과여결론：4례환자치료후1년내사망，7례환자인기타원인1년내실방，기여45례환자수방시간12-24개월，평균수방18.2개월。Harris평분위(85.00±6.75)분，기중우26례，량15례，중3례，차1례，우량솔위91%。치료후골절단단위치불만의18례，고골근단방선수내정여고골근단불필배9례，라선도편위치급장도불만의7례，병발외측피질골절7례；치료후병발폐전새1례，심뇌혈관질병1례，고골근단국부종창9례，관부동통13례，골절연장유합5례。결과가견고골근단방선수내정치입수복노년고골전자간골절효과교호，단시대골절단단분리급감소치료중、치료후병발증적발생환유대개선。
BACKGROUND:Proximal femoral nail anti-rotation has good biomechanical basis, and has obvious advantages for intertrochanteric fracture in aged patients, but there are some problems in the clinic, because of improper handling of material matching and operation details, which can impact therapeutic effects and functional recovery. OBJECTIVE:To analyze the efficacy and issues of proximal femoral nail anti-rotation in the treatment of intertrochanteric fracture in patients at more than 60 years old. METHODS:From July 2011 to July 2012, proximal femoral nail anti-rotation was used to treat 56 cases of intertrochanteric fractures. Clinical data bank was established to analyze intraopeative problems and postoperative complications. At 1, 3, 6, 9 and 12 months postoperatively, outpatient and telephone folow-up were carried out to evaluate therapeutic effects and functional recovery of hip joint. RESULTS AND CONCLUSION:Four patients died within 1 year. Seven patients lost within a year for other reasons. The remaining 45 patients were folowed with the time from 12 to 24 months, with an average time of 18.2 months. Harris score was (85.00±6.75) points. There were excelent in 26 cases, good in 15 cases, average in 3 cases and poor in 1 case, with an excelent and good rate of 91%. 18 cases were not satisfied with the position of fracture fragments. In 9 cases, proximal femur was not match with the proximal femoral nail anti-rotation. Seven cases were not satisfied because of the location and length of the spiral blade. Seven cases affected lateral cortex fracture. One case experienced postoperative pulmonary embolism. One case suffered from cardiovascular and cerebrovascular diseases. Nine cases suffered from local sweling. 13 cases experienced hip pain. Five cases affected the healing of fracture extended. Results showed that proximal femoral nail anti-rotation for intertrochanteric fracture in aged patients obtained good outcomes, but we should improve the separation of fracture fragments and reduce intraoperative and postoperative complications.