고령의 불안정성 대퇴 전자부 골절 환자에서 대퇴거 대치형 주대를 사용한 인공 고관절 반치환술
Bipolar Hemiarthroplasty Using Calcar Replacement Stem for Unstable Intertrochanteric Femoral Fracture in Elderly Patients
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목적: 고령의 불안정성 대퇴 전자부 골절 환자에서 대퇴거 대치형 주대를 사용한 인공 고관절 반치환술 후 추시 관찰한 결과를 보고하고자 한다. 대상 및 방법: 1998년 3월부터 2008년 3월까지, 불안정성 대퇴 전자부 골절로 대퇴거 대치형 주대를이용하여 인공 고관절 반치환술을 시행하고 전자부 분쇄 골절에 대해 8자 및 원형 강선술을 시행한75세 이상의 환자 중, 24개월 이상 추시 가능하였던 79예를 대상으로 하였다. 평균 연령은 82.4세(75-92세)였고 추시 기간은 평균 68개월(24-92개월)이었다. 결과: 술 후 modified Harris 고관절 점수는 82.1점(62-92점)이었고, 56예(71%)에서 수상 전 보행능력을 회복하였다. 최종 추시 시, 대퇴 주대의 고정상태는 골성고정 70예(89%), 섬유성 안정고정 9예(11%)를 나타냈고, 응력 방패현상은 21예(27%)에서 나타났다. 전자부의 불유합은 3예(4%)에서 나타났고 전자부 유합 후 3예에서 강선 파열이 관찰되었다. 전자부 골절의 평균 골유합 기간은 16.3주(12-38주)였다. 1예에서 무균성 해리가 관찰되었고 2예에서 골두의 비구돌출이 나타났다. 결론: 고령의 불안정성 대퇴 전자부 골절 환자에 시행한 대퇴거 대치형 주대를 이용한 무시멘트 인공고관절 반치환술은 추시 결과 만족스러운 임상적, 방사선학적 결과를 나타내었다.
Abstract
Purpose: The purpose of this study is to evaluate the results of bipolar hemiarthroplasty using calcar replacement stem for comminuted intertrochanteric fracture in elderly patients. Materials and Methods: Between March 1998 and March 2008, the clinical records of 79 cases who were older than 75 years of age and underwent bipolar hemiarthroplaty, using calcar replacement stem with figure of eight and cerclage wiring, were reviewed. Their mean age was 82.4 years(75-92 years) and the mean follow-up period was 68 months(24-92 months). Results: The mean postoperative Harris hip score was 82.1(62-92), and preoperative walking ability was recovered in 56 cases(71%). Bony ingrowth fixation was achieved in 70 cases(89%), and fibrous stable fixation was in 9 cases(11%). Stress shields were revealed in 21 cases(27%). Nonunion of trochanter was found in 3cases(4%), and wire fixation breakages were in 3 cases after bony union. The mean duration of bony union was 16.3 weeks(12-38 weeks). Aseptic loosening was observed in 1 case and protrusio acetabuli were in 2 cases. Conclusion: The result of clinical and radiological evaluations of bipolar hemiarthroplasty, using calcar replacement stem with figure of eight and cerclage wiring, were satisfactory in elderly patients with comminuted intertrochanteric fracture.
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