大腿骨転子部/転子下骨折症例と人工骨頭置換術症例における早期手術の有用性の検討

Early Surgery for Trochanteric/Subtrochanteric Fractures and for Endoprosthesis of Subcapital Fractures

　大腿骨近位部骨折に対する早期手術における有用性につき検討した．対象は受傷後7日以内に手術を施行した50歳以上の大腿骨転子部/転子下骨折430例と，大腿骨頚部骨折に対して人工骨頭置換術を施行した220例である．早期手術を転子部/転子下骨折症例では受傷後1日以内，人工骨頭置換術症例では受傷後2日以内と定義した．転子部/転子下骨折症例で早期手術群は通常手術群に比して術後入院期間が短縮された(早期vs.通常：39.3±24.2　vs. 44.8±27.2日．p＜0.05)．人工骨頭置換術症例では通常手術群に抗凝固薬/抗血小板薬内服症例が多かったが，術中出血量は早期手術群に多かった(早期vs.通常：164.2±150.5　vs. 126.5±101.5日．p＜0.05)．両症例群とも術後合併症には早期手術群と通常群で差はなかったが，周術期血清アルブミン値は早期手術群が通常群に比して術後1日目と術後2週で有意に高値であった．大腿骨近位部骨折に対する早期手術は，入院期間の短縮と術後の血清アルブミン低下を防ぐ点で有用である．

　The advantages of early surgery for hip fractures are highlighted.　A group of 430 patients with trochanteric or subtrochanteric fractures were surgically treated by osteosynthesis (trochanteric group) and a group of 220 patients with subcapital fractures were surgically treated by endoprosthesis (endoprosthesis group) within 7 days after the initial trauma were enrolled in this study.　The patients in each group were subdivided into 2 groups：an early operation group (early group) and a conventional operation group (conventional group).　An early operation was defined as an operation performed within 1 day after the trauma in the trochanteric group and within 2 days after the trauma in the endoprosthesis group, and a conventional operation was defined as an operation performed anytime thereafter.　In the trochanteric group the length of hospital stay was shorter in the early group than in the conventional group (early vs.　conventional：39.3±24.2 vs. 44.8±27.2 days, p＜0.05).　In the endoprosthesis group, more patients in the conventional group received anticoagulant or antiplatelet therapy, however, blood loss was greater in the early group (early vs. conventional：164.2±150.5 vs. 126.5±101.5 ml, p＜0.05).　No differences in postoperative complications were observed between the early group and conventional group in either the trochanteric group or the endoprosthesis group.　The serum albumin level 1 day and 2 weeks after the operation was higher in the early group than in the conventional group in both the trochanteric group and endoprosthesis groups.　Early operation on hip fractures benefited the patients in both the trochanteric group and endoprosthesis group by shortening the length of hospital stay and by preventing a decrease in serum albumin level.