大腿骨近位部骨折手術患者の手術待機期間と歩行能力獲得について

Relation between the Timing of Surgery for Hip Fractures and Postoperative Ambulatory Ability

　大腿骨近位部骨折の手術待機日数と術後歩行能力について検討した．2004年1月から2006年12月までに手術した大腿骨近位部骨折407例のうち，術後合併症がなく杖歩行を達成した152例を対象とした．大腿骨近位部骨折においては，待機日数と杖歩行達成までの期間に相関は見られなかったが，大腿骨転子部・転子下骨折においては，手術を1日待機すると杖歩行達成が約2.8日遅れるという結果が得られた．よって術後合併症の予防に加え，歩行能力改善のため，特に転子部・転子下骨折では早期手術が望ましいと考えられた．

　We analyzed the relation between the timing of surgery for hip fractures in 407 patients and their postoperative ambulatory ability. Internal fixation with cannulated screws, bipolar hip arthroplasty, captured hip screw, or intramedullary hip nailing was performed, depending on the fracture type. The 152 patients who resumed crutch walking postoperatively and had no perioperative complications were the subjects of the analysis. There was no significant correlation between the timing of surgery and postoperative ambulatory ability after surgery for femoral neck fractures, but a 1-day delay in surgery prolonged the rehabilitation period until resumption of crutch walking by 2.8 days after sugery for femoral trochanteric/subtrochanteric fractures. Therefore, early surgery is required not only to prevent postoperative complications but to improve postoperative ambulatory ability, especially in patients with femoral trochanteric/subtrochanteric fractures.