Internal Fixation of Undisplaced Femoral Neck Fractures with DHS or Multiple Cannulated Screws: Outcome Comparison in the Elderly

年長病人的非位移性股骨頸骨折之內固定法：Dynamic Hip Screw與Cannulated Screw的比較

李懿訓(Yih-Shiunn Lee) ； 駱亭穎(Ting-Ying Lo) ； 黃慧玲(Hui-Ling Huang)

《北市醫學雜誌》 3卷7期 (2006/07) Pp. 673-682

https://doi.org/10.6200/TCMJ.2006.3.7.04

摘要

目的：目前常用來治療非位移性股骨頸骨折的兩種固定物分別是Cannulated Screw及Dynamic Hip Screw (DHS)，但究竟哪一種方法比較好，目前仍未有定論。本篇論文主要來比較兩種內固定物的優缺點。方法：介於1997及2002年間，總共42位年紀大於60歲的病人，因非位移性股骨頸骨折接受Cannulated Screw或DHS的內固定手術治療。病人的結果以Harris的髖關節評分來評估。而手術傷口大小，手術時間，術後血色素下降，輸血機率，住院天數，及整體成功率皆詳加記載。結果：兩組在手術時間，住院天數，整體成功率及髖關節平均分數並無差異（P值＞0.34）。DHS的手術傷口較大，術後血色素下降較多，且輸血機率高（P值＜0.05）。結論：手術利用Cannulated screw固定的優點是較少侵入性合併較小傷口，較少出血及較低的輸血機率，而DHS的主要優點則是固定很穩且具有相當高的成功率。

關鍵字

Cannulated Screw ； Dynamic Hip Screw ； 年長病人 ； 股骨頸骨折 ； 內固定

並列摘要

Background and Purpose: Multiple cannulated screws or dynamic hip screw (DHS) has been commonly used to treat undisplaced femoral neck fractures. Although these two techniques advocated in the literature could achieve good results, it is unclear which one is the best. It is the purpose of our study to compare the clinical outcomes of undisplaced femoral neck fractures that were treated with DHS or multiple cannulated screws. Methods: Between 1997 and 2002, a total of 42 elderly patients (＞60 years of age) with complete followup data meeting our inclusion criteria, had an undisplaced femoral neck fracture surgically treated by either the DHS or the cannulated screws. Functional results were evaluated using the Harris hip scoring system. The incision length, surgery time, hemoglobin level drop, blood transfusion, hospital stay, and overall success rates were recorded. Results: The surgery time, hospital stay, overall success rate, and hip score were similar between the two groups (p values＞0.34). The DHS group had larger operative wound, more hemoglobin level drop and higher blood transfusion rate than cannulated screw group (p values＜0.05). Conclusion: The advantages of cannulated screwing were less invasive surgery associated with a small incision, less blood loss, and lower rate of blood transfusion. The major advantage of the DHS was stable fixation with a high rate of overall success.

並列關鍵字

cannulated screw ； DHS ； elderly ； femoral neck fracture ； internal fixation