CAJ | 학술논문

目的：比较老年股骨粗隆间骨折中亚洲型股骨近端防旋髓内钉（PFNAⅡ）使用导针扩髓与否的疗效。方法2010年1月至2014年3月，应用亚洲型PFNAⅡ治疗老年骨质疏松性股骨粗隆间骨折共60例。随机分成A、B两组，每组30例。 A组在插入PFNAⅡ前使用导针并扩髓；B组不用导针，开口后直接插入PFNAⅡ。比较两种方法的手术时间、术中出血量、术前及术后血红蛋白含量、术中X线暴露次数、术后并发症及治疗效果。结果 A组平均手术时间为50.5 min （40.5～80 min），术中平均失血量为75 mL（45～120 mL）；术前平均血红蛋白95 g/L（84～120 g/L），术后第2天复查为85 g/L（55~115 g/L）；A组中有2例患者因术后伤口渗血较多，给予输注浓缩红细胞血2单位。 B组平均手术时间为39 min（30～50 min），术中平均失血量为35 mL（30～55 mL）；术前平均血红蛋白为95.3 g/L（80～125 g/L），术后平均值为89 g/L（75～120 g/L）；术后无输血患者。X线暴露时间，B组平均比A组每例手术少3次。所有患者术后随访3～12个月（平均9个月），两组患者均达到临床愈合标准。 A组患髋关节Harris评分为84.5分（70～93分），B组评分为89.5分（80.5～95分）。两组患者均无髋内翻、内植物切出、内固定失败及周围骨折等并发症。结论亚洲型PFNAⅡ治疗老年骨质疏松性股骨粗隆间骨折，不使用导针插入扩髓比使用导针扩髓手术时间短，术中出血少，术后关节功能恢复更好。
목적：비교노년고골조륭간골절중아주형고골근단방선수내정（PFNAⅡ）사용도침확수여부적료효。방법2010년1월지2014년3월，응용아주형PFNAⅡ치료노년골질소송성고골조륭간골절공60례。수궤분성A、B량조，매조30례。 A조재삽입PFNAⅡ전사용도침병확수；B조불용도침，개구후직접삽입PFNAⅡ。비교량충방법적수술시간、술중출혈량、술전급술후혈홍단백함량、술중X선폭로차수、술후병발증급치료효과。결과 A조평균수술시간위50.5 min （40.5～80 min），술중평균실혈량위75 mL（45～120 mL）；술전평균혈홍단백95 g/L（84～120 g/L），술후제2천복사위85 g/L（55~115 g/L）；A조중유2례환자인술후상구삼혈교다，급여수주농축홍세포혈2단위。 B조평균수술시간위39 min（30～50 min），술중평균실혈량위35 mL（30～55 mL）；술전평균혈홍단백위95.3 g/L（80～125 g/L），술후평균치위89 g/L（75～120 g/L）；술후무수혈환자。X선폭로시간，B조평균비A조매례수술소3차。소유환자술후수방3～12개월（평균9개월），량조환자균체도림상유합표준。 A조환관관절Harris평분위84.5분（70～93분），B조평분위89.5분（80.5～95분）。량조환자균무관내번、내식물절출、내고정실패급주위골절등병발증。결론아주형PFNAⅡ치료노년골질소송성고골조륭간골절，불사용도침삽입확수비사용도침확수수술시간단，술중출혈소，술후관절공능회복경호。
Objective To compare the outcomes of Asian proximal femoral intramedullary nail anti-rotation (PFNAⅡ) with and without using guide wire and reaming for the treatment of elderly osteoporosis intertrochanteric fractures. Methods From January 2010 to March 2014, 60 elderly patients with osteoporosis intertrochanteirc fractures were treated with PFNA Ⅱ. They were randomly divided into group A and group B (n=30). In group A, guide wire and reaming were used before inserting the nail, while not used in group B. The operation time, intraoperative blood loss, pre-and post-operative hemoglobin, X-ray exposure times and postoperative outcomes between the two groups were compared. Results The average operation time of group A was 50.5 min (40.5-80 min), average intraoperative blood loss was 75 mL (45-120 mL), average pre-operative hemoglobin was 95 g/L (84-120 g/L), and 85 g/L (55-115 g/L) post-operative. 2 patients accepted concentrated red blood cells transfusion of 2 units for blood loss. The average operation time of group B was 39 min (30-50 min), average intraoperative blood loss was 35 ml (30-55 mL) with no post-operative blood transfusion, average pre-operative hemoglobin was 95.3 g/L (80-125 g/L), and 85 g/L (75-120 g/L) post-operation. No patients received blood transfusion. X-ray exposure times in group B was 3 times less than in group A for each patient on average. All the patients were followed up for 3-12 months (mean, 9 months). The Harris hip score was 84.5 (70-93) in group A and 89.5 (80.5-95) in group B. No varus hip deformities, screw cutouts, femoral shaft fractures or failure of internal fixation were observed. Conclusion When PFNAⅡis used to treat osteoporosis interonchanteric fractures of elderly patients, comparing with using guide wire and reaming, not using guide wire and reaming has the advantages of shorter operation time, less intraoperative and post-operative blood loss, and better results.