고령에서의 대퇴 경부 골절에 시행한 인공 고관절 전치환술
The Total Hip Replacement Arthroplasty for Femur Neck Fractures in the Elderly
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목적: 고령에서 대퇴 경부 골절의 치료 방법의 하나인 인공 고관절 전치환술의 임상적, 방사선학적결과를 분석한다. 대상 및 방법: 2008년 2월부터 2010년 3월까지 대퇴 경부 골절로 본원에 방문한 70세 이상 환자 중,치매가 없고 술전 보행 능력이 좋은 환자에 대해 인공 고관절 전치환술을 시행한 환자들을 후향적 분석을 하였다. 12명(13예)이 대상으로 하였고, 환자군의 평균 나이는 79.4세(70-91세)였다. 평균 추시기간은 31개월(20-49개월)이었다. 임상적 평가로는 modified Koval index를 사용하였고, 방사선학적 평가로는 비구컵의 경사각과 전염각, 치환물의 이완, 골용해, 치환물 주위 골절, 탈구를 평가하였다. 결과: Modified Koval index는 술전 평균 4.92에서 최종 추시시 평균 4.84로 감소하였지만 통계적으로 유의하지 않았다(P=0.339). 술후 탈구가 2예(2/13, 15.4%)에서 발생하였으며, 기타 다른 합병증은 발생하지 않았다. 결론: 70세 이상 고령에서 대퇴 경부 골절의 치료로서 인공 고관절 전치환술은 임상적, 방사선적으로만족스러운 결과를 보였다. 다만, 탈구율이 높아 이에 대한 주의를 요한다.
Abstract
Purpose: To analyze the clinical and radiological outcomes of total hip replacement arthroplasty (THRA) for the treatment of femur neck fractures in the elderly. Materials and Methods: Femur neck fracture patients older than70 years of age, who showed good preoperative walking ability without dementia,and underwent THRA between February, 2008 and March, 2010were reviewed retrospectively. Twelve patients(13 hips) were enrolled and the mean ages of the patients were 79.4(70-91). The mean follow-up period was 31(20-49) months. The modified Koval index was used to determine the clinical outcome. Inclination and anteversion of acetabular cup, loosening, osteolysis,periprosthetic fractures and dislocations were evaluated using the radiographs. Results: The modified Koval index decreased from 4.92 to 4.84 at the final follow-up, but the decrease was not significant (P=0.339). Dislocations occurred in 2 cases postoperatively(2/13, 15.4%). No other complications were encountered. Conclusion: The THRA for the treatment of femur neck fractures in elderly patients over 70 years of age showed satisfactory clinical and radiological outcomes. Nevertheless, caution should be taken regarding the relatively high incidence of postoperative dislocations.
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