Use of Compression Hip Screws in Trochanteric Fracture in the Elderly : Some Effects of Plate Angle on Clinical Results

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  • 高齢者大腿骨転子部骨折のcompression hip screw方法 : 固定角度の治療結果への影響

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大腿骨転子部骨折に対するlow angle compression hip screw(135° CHS)法とhigh angle compression hip screw(150°CHS)法の治療結果の比較を目的とした.CHS方法を用いた60歳以上の患者(135° CHS群83例,150°CHS群47例)を対象とした.術前と術後のX線検査所見などの諸項目,手術中の諸項目について評価検討を行った.評価項目について両群を比較するにあたり,多変量間の交絡などのbiasを回避するために多変量解析も援用して統計学的に解析した.その結果,(1)手術時問,(2)整復状態,(3)screwの骨頭内刺入位置,(4)骨癒合期間の4項目で135° CHS法と150° CHS法間に有意差が見られた.4項目のうち135°と150°の角度の差が影響していた項目は,手術時間と骨癒合期間であった.理論上および諸家の実験的研究からも,両群で有意差の生じることが予想されるsliding距離と問題となる変形の発生では有意差は見られず,135°と150°の角度の差も影響していなかった.

The purpose of this study is to compare the clinical results of the use of low-angle compression hip screws (135° CHSs) and high-angle compression hip screws (150° CHSs) for the surgical treatment of trochanteric fractures. The subjects were 130 patients 60 years of age or older who underwent CHS implantation (135° CHSs: 83 subjects; 150° CHSs: 47 subjects). Evaluation was performed based on radiographic findings and intraoperative variables. To compare these evaluation items between the two CHS groups, statistical analyses were performed; Multivariate analysis (MA) was used to eliminate confounding bias. Significant differences are found for four variables: (1) operative time, (2) quality of fracture reduction, (3) insertion position of screw into femoral head, and (4) healing time. Among these variables, operative time and healing time were affected by the differences in screw-plate angle. The use of 150° CHSs lengthened operative time and shortened healing time. There were no significant differences seen in extent of sliding and incidence of problematic deformity for which significant differences were expected on a theoretical basis based on the results of previous studies, and these two variables were not affected by differences in screw-plate angle.

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