A2형 이상의 대퇴골 전자간 골절에서 무시멘트형의 직각 단면을 가진 표준형 주대를 이용한 인공 고관절 반치환술
Cementless Bipolar Hemiarthroplasty Using a Rectangular Cross-section Stem for Type A2 or above Intertrochanteric Fractures
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목적: 고령의 환자에게 발생한 A2형 이상의 전자간 골절에 대하여 무시멘트형의 직각 단면을 가진 표준형 대퇴 주대(이중 쐐기형)를 이용하여 인공 고관절 반치환술을 시행하고 그 결과를 알아보고자 하였다. 대상 및 방법: 2006년 2월부터 2010년 2월까지 본원에서 수술을 시행하고 2년 이상 추시가 가능하였던 37예의 환자를 대상으로 하였다. 평균 연령은 73.5세(65-88세) 였고 남자환자가 16예 여자 환자가 21예 였다. 수술 시간과 출혈양, 수술 후 보행능력의 회복정도와 방사선학적 결과 그리고 합병증에 대해서 알아 보았다. 결과: 평균 수술 시간은 75.3분(50-185분), 평균 출혈양은 755.5 cc(75-1,400 cc) 였다. 최종 추시 시점에서 27예의 환자(72.9%)에서 수술 전 바델 지수의 80 %를 회복 하였다(72.8±15.1). 합병증은 비구부 미란과 심부 감염이 1예, 대전자의 불유합이 3예 있었고, 인공 관절물의 해리 등의 이유로 재치환을 시행한 예는 없었다. 결론: 무시멘트형 직각 단면을 가진 표준형 대퇴 주대를 이용한 인공 고관절 반치환술은 조기 거동이 가능한 장점이 있어 고령의 환자에게 발생한 A2형 이상의 전자간 골절에 대하여 선택적으로 사용될 수 있는 수술 방법 중 하나로 생각 된다.
Abstract
Purpose: To evaluate the treatment outcome for Type A2 or above intertrochanteric fractures in elderly patients using cementless bipolar hemiarthroplasties incorporating a standard (tapered, rectangular) stem. Materials and Methods: We retrospectively reviewed the records of 37 patients who had undergone bipolar hemiarthroplasty between February 2006 and February 2010 in our hospital, and who had received follow up evaluation for more than two years after the surgery. The mean patient age was 73.5 years (range 65-88 years),and 16 patients were male and 21 were female. We evaluated the the results of their treatment by analyzing the operation duration, volume of bleeding, measured results for the recovery of walking capability, and any complications and radiologic findings. Results: The mean operation duration was 75.3 minutes(50-185 minutes). The average total volume of bleeding was of 755.5 cc(75-1,400 cc). Upon the final follow-up visit, 27 patients(72.9%) had recovered more than 80% of their pre-injury Barthel index values(72.8±15.1). Complications included one case of deep infection, one case of acetabular erosion, and 3 cases of greater trochanter non-union. There were no cases of revisions due to prosthesis loosening or for other reasons. Conclusion: Cementless bipolar hemiarthroplasty using a tapered, rectangular stem is a viable alternative treatment for type A2 intertrochanteric fractures in elderly patients which supports rapid patient mobilization ability.
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