불안정 대퇴 전자간 골절에서 소전자부 골편의 고정 효과
Fixaton of Lesser Trochanteric Fragments on an Unstable Intertrochanteric Fracture of the Femur
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목적: 불안정 대퇴골 전자간 골절에서 소전자부를 포함한 후내측 골편의 고정이 치료 결과에 미 치는 영향을 알아보고자 하였다. 대상 및 방법: 2001년 2월부터 2008년 5월까지 불안정 대퇴골 전자간 골절 환자중 활강 압박고 나사로 치료 받고 12개월 이상 추시가 가능한 47예를 대상으로 하였다. 47예 중 강선을 이용하여 소전자부 고정을 시행한 21예(1군), 강선 고정을 시행하지 않은 26예(2군) 이었다. 술 후 방사선 사진에서 골절의 정복 상태, 골두 내 지연나사의 위치, 대퇴골 경간각을 측정하였으며, 추시 방사 선 사진에서 지연 나사의 전이와 대퇴골 경간각의 변화 및 골 유합 기간을 조사하였다. 결과: 골 유합은 47예 중 43예 91.5%에서 관찰 되었으며, 골 유합 기간은 평균 3.75개월 이었다. 4예에서 불유합이 발생하였으며 1군에서 1예, 2군에서 3예 이었다(p<0.05). 지연나사의 전이는 평균 8.76 mm 이었으며, 1군은 4.92 mm였으며 2군은 12.45 mm 이었다.(p<0.05). 15 mm 이 상의 과도한 전이는 9예에서 관찰되었으며 이중 7예가 2군 이었다. 대퇴골 경간각의 변화는 1군 에서 최대 7내반 변형이 관찰되었고, 2군에서는 최대 12내반 변형이 관찰되었다. 평균 1.28 과 5.81의 내반 변형을 보였다. 결론: 후내측의 큰 골편을 동반한 전자간 골절에서 케이블을 이용한 소전자부의 고정은 과도한 지연나사의 전이 및 내반 변형을 예방하는데 도움이 되는 것으로 사료된다.
Abstract
Purpose: We evaluated the effect of cable fixation of the lesser trochanter for treating unstable intertrochanter fractures. Materials and Methods: In this retrospective study, we assessed the availability of cable fixation of the lesser trochanter and the cause of complications in a series of 47 unstable intertrochanteric femoral fractures that were seen between February 2001 to May 2008 at our hospital. The fractures were classified using the Evans-Jensen classification system. The lesser trochanters were fixed in 21 cases. The correlations between the lag screw position, comminution of the fracture site and the radiological results were studied. Nonunion was diagnosed if patients experienced pain and the radiographs revealed a persistent, radiolucent defect at the fracture site 6 months after fracture fixation. Results: Union was observed in 43 cases (91.5%). The average union time was 3.75 months. Nonunion was observed in 4 cases (8.5%) 1 in group l and 3 in group ll. The average sliding distance of the lag screw was 8.76 mm. In groups l and ll, the distance was 4.92 mm and 12.45 mm, respectively. Excessive sliding, which was defined as more than 15mm, developed in 9 cases, and 7 of these 9 cases were in group ll. The average neck-shaft angle change was 1.28 and 5.81, respectively. Conclusion: Additional cable fixation of the lesser trochanter for treating intertrochanter fractures, including large posteromedial fragments, is recommended for preventing the excessive sliding of lag screws and varus deformity.
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