以較小傷口及傳統傷口治療股骨轉子間骨折之結果分析比較

Comparison of Less Invasive and Conventional Surgical Techniques for Intertrochanteric Hip Fractures

目的：本研究在比較以較小傷口及一般傷口治療股骨轉子間骨折病患術後結果之差異。方法：本研究收集3年間於本院接受動力髖骨螺釘治療之轉子間骨折病患之資料及手術結果。總共231位病患，46位接受較小傷口手術，其餘185位接受傳統傷口手術。結果：兩組具有相似之術前及術後之血紅素及血比容，在較小傷口組有顯著較低之術後白血球。此外較小傷口組有顯著較小之手術傷口、較少之手術失血、較低之術前及術中輸血量。兩組在住院天數以及手術併發症及死亡率沒有顯著差異。結論：以較小傷口置入動力髖骨螺釘來治療股骨轉子間骨折是一個安全且有效之手術技巧。與傳統術式比較，較小傷口術式可減少傷口大小，減低手術失血量及減少輸血量。

Objectives. To compare the treatment outcomes of less invasive dynamic hip screw fixation (less invasive DHS) with conventional dynamic hip screw fixation (conventional DHS) for intertrochanteric hip fractures (ITF). Methods. From Jan. 2008 to Dec. 2010, we retrospectively reviewed 231 patients who had received surgical procedures for ITF in Taoyuan General Hospital. Forth-six patients received less invasive DHS and 185 patients received conventional DHS. Main outcomes were wound size, pre-operative and post-operative hemoglobin and hematocrit, blood loss, blood transfusion, operative time, length of hospital stay, complications and mortality. Results. The two groups have similar pre-operative and post-operative lab data except lower post-operative WBC in the less invasive DHS group. The less invasive DHS group also has smaller wound size, lower blood loss, less pre-operative and intra-operative blood transfusion. There was no significant difference in the operative time, length of hospital stay, post-operative complications and mortality between the two groups. Conclusions. Less invasive DHS fixation for ITF is a safe and effective surgical procedure capable of significantly reducing the blood loss, blood transfusion and wound length without increasing the number of complications and mortality rate.