대퇴 전자간 골절에서 항회전 근위 대퇴 골수정의 고정 실패
Fixation Failure of Proximal Femoral Nail Anti-rotation in Femoral Intertrochanteric Fracture
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목적: 대퇴 전자간 골절 환자에서 항회전 근위 대퇴 골수정을 이용하여 치료하고, 고정 실패로 이어진 환자들을 분석하여 그 원인 및 예방 방법을 알아보고자 하였다. 대상 및 방법: 2006년부터 2010년까지 대퇴 전자간 골절로 항회전 근위 대퇴 골수정을 이용하여 치료한 환자 중 1년 이상 추시 관찰이 가능하였던 80예의 환자를 대상으로 하였다. 남자가 20예, 여자가 60예였으며 평균 연령은 72.6세, 평균 추시 기간은 2.1년이었다. 골다공증의 정도, 골절 형태, 정복 상태 및 나선 칼날(helical blade)의 골두 내 위치 등과 고정 실패 발생과의 상관 관계를 분석하였다. 결과: 최종 추시 시 고정 실패는 6예에서 발생하였으며, 나선 칼날의 골두 천공 4예, 과도한 내반 유합 1예, 나선 칼날의 과도한 활강으로 인한 동통 1예였다. 골절의 정복 상태 및 나선 칼날의 골두 내 위치는 고정 실패의 발생과 통계학적 의의를 가졌으며 최종 추시 시까지 감염이 발생한 경우는 없었으나 대퇴 골두 무혈성 괴사가 2예에서 발생하였다. 결론: 본 연구에서 고정 실패는 비해부학적 정복 및 나선 칼날이 골두 내 상방에 위치한 경우 의미 있게 증가되었다. 따라서 수술 중 정확한 해부학적 정복을 시행하고 나선 칼날을 골두 내 중심에 위치시키기 위해 노력하여야 할 것으로 사료된다.
Abstract
Purpose: The aim of this study was to identify the causes of fixation failure and evaluate prophylactic methods in femoral intertrochanteric fractures treated with proximal femoral nail anti-rotation. Materials and Methods: Between 2006 and 2010, this study evaluated 80 cases(20 men and 60 women) of femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation after a minimum follow-up of 1 year. The mean age and follow-up period was 72.6 years and 2.1 years, respectively. The factors that could affect fixation failure, such as osteoporosis, fracture pattern, reduction status and position of helical blade on the femoral head, were analyzed retrospectively. Results: Six cases of fixation failure were encountered: 4 cases of cut out of the helical blade, 1 case of excessive varus union and 1 case of hip joint pain due to the excessive sliding of helical blade. The reduction status and position of the helical blade on the femoral head showed a significant association with the fixation failure, and there were 2 cases of osteonecrosis of the femoral head at the latest follow-up. Conclusion: Fixation failure was increased significantly in the case of non-anatomical reduction or superior position of helical blade in the femoral head. Therefore, the concerns related to the precise anatomical reduction and central location of the helical blade will need to be solved to reduce fixation failure.
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