Use of Compression Hip Screws in Trochanteric Fracture in the Elderly : Effect of Screw-plate Angle on Ambulatory Ability and Change in Ambulatory Ability

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  • 高齢者大腿骨転子部骨折のCompression Hip Screw方法 : 固定角度の体動歩行能力への影響および体動歩行能力の変化

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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)法による治療後の作動歩行能力の比較をすることと,更に,CHS法による治療前後の体動歩行能力の変化を観察し変化に影響する因子を検討することを目的とした.CHS法を用いた60歳以上の患者130例(135°CHS 83例, 150° CHS 47例)を対象とした.評価項目は,体動能力関係のX線所見での項目,受傷前と退院時の体動歩行能力(社会的行動能力をも含めて)を使用した.評価項目について135°CHS法と150°CHS法の両群を比較するために,多変量間の交絡などのbiasを回避すべく多変量解析も援用して統計学的に解析した.その結果,受傷前の独歩能力維持率の項目で135°CHS法と150°CHS法間の有意差が見られたが,角度の差は独歩能力維持率を含めて体動歩行能力には影響していなかった.体動歩行能力は退院時には受傷前よりも全体的に低下していた.変化に影響する因子としては,年齢・入院時合併症・続発症が多かった.理論上からも,また諸家の実験的研究からも,角度の差が原因となって両群間に有意差の生じることが予想されるlag screwのsliding距離に有意差は認められなかった.また,sliding距離は体動歩行能力には独歩能維持率以外には影響していなかった.

The objective of this research was to compare ambulatory ability after low-angle compression hip screw fixation (135° CHS) and high-angle CHS fixation (150° CHS) used to treat trochanteric fractures. An additional objective was to observe changes in ambulatory ability before and after treatment by CHS fixation and investigate factors that influence change. Subjects were 130 patients aged 60 years and older who underwent CHS fixation (135° CHS: 83 patients, 150° CHS: 47 patients). Outcome measures used were radiological findings related to ambulatory ability and ambulatory ability (including ability to function in society) seen preinjury and at discharge. To compare 135° CHS fixation and 150° CHS fixation in terms of the above-mentioned outcome measures, multivariate statistical analysis was carried out in order to avoid bias such as confounding of multiple variables. A significant difference was seen between 135° CHS fixation and 150° CHS fixation in terms of rate of maintenance of preinjury independent gait ability, but the difference in angle had no effect on ambulatory ability including rate of maintenance of independent gait ability. Ambulatory ability had decreased overall at discharge compared with before the injury was sustained. Common factors that influenced change were age, complications on admission and deuteropathy. No significant difference was noted in extent of sliding of the lag screw, in which a significant difference between groups would be expected, both theoretically and based on experimental studies by various researchers, due to the difference in angle. Moreover, except for rate of maintenance of independent gait ability, extent of sliding did not affect ambulatory ability.

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