Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients - Minimum 2-years Follow-up Results -
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 고령의 전자간부 골절 환자에서 시멘트 대퇴 주대를 이용한 양극성 반치환술의 결과를 임상적 및 방사선학적으로 분석 하고자 하였다. 대상 및 방법: 1995년 12월부터 2002년 12월까지 전자간부 골절로 시멘트 대퇴 주대를 이용한양극성 고관절 반치환술을 시행 받은 고령의 환자 중 2년 이상 추시가 가능하였던 47명을 대상으로 하였다. 임상적 평가는 최종 추시시 Harris 고관절 점수와 Koval의 분류에 의한 수상전 및 최종 추시 보행상태를 분석하였으며, 단순 방사선 사진을 통해 방사선학적 평가를 하였다. 결과: 최종 추시시 Harris 고관절 평균점수는 84.6점 이었으며, Koval에 의한 보행 능력은 수상전 보행능력으로 회복 15명(31.9%), 수상전보다 1단계 감소 31명(66.0%), 2단계 감소 1명(2.1%)로 나타났으며, 골용해나 대퇴주대 이완을 보이는 소견은 관찰되지 않았다. 술 후 합병증의 경우 폐렴, 심부 혈전증, 폐색전증, 폐부종이 각각 1예(2.1%), 스트레스성 궤양이 3예(6.4%),천부 감염 및 심부 감염이 각각 1예(2.1%), 천부 욕창 2예(4.2%) 발생하였으며, 수술 후 섬망이9예(19.1%), 방광 부분 파열이 1예(2.1%) 발생하였다. 결론: 시멘트형 대퇴 주대를 사용한 양극성 인공관절 반치환술은 고령 환자의 대퇴골 전자간부골절의 우수한 치료법으로 향후 합병증에 대한 연구가 필요하다.
Abstract
Purpose: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. Materials and Methods: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval’s classification before the fracture and at last follow-up, and Harris’s hip score at the last follow up. Radiological evaluation was done via the plain radiographs. Results: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%),degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. Conclusion: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.
참고문헌 (18)
- Bickel WH, "Intertrochanteric fractures of the femur; an analysis of the end results of 126 fractures treated by various methods", Surg Gynecol Obstet, 91, pp.14~24 (1950)
- Cobelli NJ, "Ender rod versus compression screw fixation of hip fractures", Clin Orthop Relat Res, pp.123~129 (1985)
- Lee JI, "Comparison of compression hip screw to hemiarthroplasty of unstable intertrochanteric fractures in elderly patients", J Korean Hip Society, 2, pp.401~408 (1996)
- Park MS, "Bipolar hemiarthroplasty for the treatment of femoral neck and unstable intertrochanteric fracture in elderly patients", J Korean Fracture Society, 26, pp.482~488 (1991)
- Khan RJ, "Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures", Int Orthop, 26, pp.229~232 (2002)
- Haentjens P, "Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients", Acta Orthop Belg, 60, pp.124~128 (1994)
- Kim YH, "Bipolar hemiarthroplasty using cement for the treatment of intertrochanteric femoral fracture in elders - 2 to 5 year results", J Korean Hip Society, 13, pp.330~337 (2001)
- Ling R, "Cememting technique in the femur", Techniques in orthopaedics, 6, pp.34~39 (1991)
- Koval KJ, "Ambulatory ability after hip fracture in A prospective study in geriatric patients", Clin Orthop Relat Res, 310, pp.150~159 (1995)
- Kelly AJ, "Poor reproducibility in radiographic grading of femoral cementing technique in total hip arthroplasty", J Arthroplasty, 11, pp.525~528 (1996)
- Gruen TA, "“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening", Clin Orthop Relat Res, pp.17~27 (1979)
- Emery RJ, "Bipolar hemiarthroplasty for subcapital fracture of the femoral neck in A prospective randomised trial of cemented Thompson and uncemented Moore stems", J Bone Joint Surg Br, 73, pp.322~324 (1991)
- Kim YH, "Cemented bipolar hemiarthroplasty for the hemoral intertrochanteric fracture in elderly patients", J Korean Hip Society, 10, pp.149~155 (1998)
- Carrington NC, "The Exeter Universal cemented femoral component at 15 to 17 years: an update on the first 325 hips", J Bone Joint Surg Br, 91, pp.730~737 (2009)
- Rowe SM, "An epidemiologic study of hip fracture - a comparison between 1991 and 2001 in Proceeding of annual spring meeting", The Korean Society of Bone Metabolism (2001)
- Rowe SM, "An epidemiological study of hip fracture in Honam", Korea. Int orthop, 17, pp.139~143 (1993)
- Sierra RJ, "Contemporary cementing technique and mortality during and after Exeter total hip arthroplasty", J Arthroplasty, 24, pp.325~332 (2009)
- Ereth MH, "Cemented versus noncemented total hip arthroplasty--embolism, hemodynamics, and intrapulmonary shunting", Mayo Clin Proc, 67, pp.1066~1074 (1992)