CAJ | 학술논문

目的：通过比较半髋关节置换术改良前外侧入路与后外侧入路的临床疗效，探讨改良前外侧入路半髋关节置换治疗老年性不稳定型粗隆间骨折的优越性。方法90例108髋随机分为两组，前外侧组（ASA组）56髋，行改良前外侧入路半髋关节置换术；后外侧组（PSA组）52髋，行后外侧入路半髋关节置换术；术后比较两组的手术时间、出血量、输血量、住院时间、术后关节Harris评分、疼痛评分（ VAS）、并发症发生率、翻修率，死亡率等。结果改良ASA组手术时间、术中出血量，输血量，住院时间均显著低于PSA组（P＜0．05），两组手术在关节Harris评分、疼痛评分（VAS）、并发症发生率、翻修率、死亡率方面无显著差异；术后假体脱位方面，ASA组为0，而PSA组有3例。结论选择改良前外侧入路行半髋关节置换术治疗不稳定粗隆间骨折较后外侧入路手术时间短，术中出血量少，住院时间短，术后无关节脱位，综合疗效优于PSA半髋关节置换术。
목적：통과비교반관관절치환술개량전외측입로여후외측입로적림상료효，탐토개량전외측입로반관관절치환치료노년성불은정형조륭간골절적우월성。방법90례108관수궤분위량조，전외측조（ASA조）56관，행개량전외측입로반관관절치환술；후외측조（PSA조）52관，행후외측입로반관관절치환술；술후비교량조적수술시간、출혈량、수혈량、주원시간、술후관절Harris평분、동통평분（ VAS）、병발증발생솔、번수솔，사망솔등。결과개량ASA조수술시간、술중출혈량，수혈량，주원시간균현저저우PSA조（P＜0．05），량조수술재관절Harris평분、동통평분（VAS）、병발증발생솔、번수솔、사망솔방면무현저차이；술후가체탈위방면，ASA조위0，이PSA조유3례。결론선택개량전외측입로행반관관절치환술치료불은정조륭간골절교후외측입로수술시간단，술중출혈량소，주원시간단，술후무관절탈위，종합료효우우PSA반관관절치환술。
Objective To explore the superiority of hemiarthroplasty in the treatment of senile unstable intertrochanteric fractures by modified anterolateral approach, through comparing the clinical efficacy of modified anterolateral approach and posterolateral approach.Methods 108 hips of 90 cases were randomly divided into two groups. 56 hips of anterolateral group ( ASA group ) underwent modified anterolateral approach hemiarthroplasty. 52 hips of posterolateral group ( PSA Group ) underwent posterolateral approach hemiarthroplasty.Operative time, blood loss, blood transfusion, duration of hospital stay, Harris score, Visual Analogue Scale ( VAS ) , the incidence of complications, revision rate and mortality of the two groups were compared.Results Operative time, blood loss, blood transfusion and hospitalization time in improved ASA group were significantly lower than in that in PSA group (P<0.05).Differences of Harris score, VAS, the incidence of complications, revision rate and mortality between the two groups have no statistically significant. None dislocation of the prosthesis occurred after operation in ASA group while PSA group had three cases.Conclusions Treating senile unstable intertrochanteric fractures by using modified anterolateral approach arthroplasty has the advantages including shorter operative time, less blood loss, shorter hospital stay, the less postoperative dislocations.The comprehensive effectiveness is better than posterolateral approach.