외상성 고관절 후방 탈구에 동반된 대퇴골두 골절의 치료
Treatment of Femoral head Fracturewith Traumatic Posterior Dislocationof the Hip
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목적: 대퇴 골두 골절이 동반된 후방탈구 환자의 Pipkin 분류에 따른 치료결과 및 합병증 등을 알아보고자 하였다. 대상 및 방법: 대퇴 골두 골절을 동반한 후방 탈구 중 Thompson-Epstein Ⅴ형 10예를 대상으로 하였으며, Pipkin 분류상 Ⅰ형 5예, Ⅲ형 1예, Ⅳ형 4예 이었고, 남자가 7예, 여자가 3예였다. 수상 당시 평균연령은 약 38세(19~72)였으며, 수상원인은 교통 사고가 9예, 낙상이 1예 이었고, 추시 기간은 평균 33개월(13~79) 이었다. 골절의 정복은 9예에서 6시간 이내, 1예에서 12시 간 이내에 시행되었다. 정복 후 안정성이 확인되면 골격 견인술을 이용한 보존적 치료, 불안정성 및 골절의 형태에 따른 수술적 치료방법을 선택하였으며 환자의 이학적 검사 및 방사선 사진, C-T, MRI 등을 통하여 합병증을 조사하였다. 결과: Pipkin Ⅰ형은 4예에서 보존적 치료, 1예에서 나사못을 이용한 수술적 치료를 시행하였고, Ⅲ형은 일차적 인공 고관절 치 환술, Ⅳ형 4예중 2예는 금속판 고정술, 나머지 2예는 골격 견인술을 이용한 보존적 치료를 시행하였다. 모든 예에서 골유합은 얻었으며, Ⅳ형에서 경도의 외상성 관절염과 대퇴 골두 하방 골편의 무혈성 괴사증이 각각 1예씩 발생하였다. 결론: 수상 당시의 손상정도가 예후에 영향을 미치는 것으로 사료되었다.
Abstract
Puepose: To evaluate the treatment results and complication of a femoral head fracture with posterior dislocation of the hip according to the Pipkin classification. Materials and Methods: Ten cases of Thompson-Epstein type V femoral head fracture with a posterior dislocation of the hip were evaluated. According to the Pipkin classification, 5 cases were type I, 1 case was type III, and 4 cases were type IV. The average age at time of trauma was 38 (19~72) years, and the causes were traffic accidents in 9 cases and falls in 1 case. The average follow-up period was 33 (13~79) months. A reduction of the fracture was performed within 6 hours in 9 cases and 12 hours in 1 case. When the stability was achieved after the reduction, the choice of further treatment was made from either conservative treatment while maintaining skeletal traction, or surgical treatment according to the fracture type and instability. The complications were evaluated by a physical examination, simple radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Results: In Pipkin type I fractures, 4 cases were treated with conservative treatment and 1 case was treated with surgical treatment. One case of Pipkin type III fracture was treated with primary total hip arthroplasty. In Pipkin type IV fractures, 2 cases were treated surgically using a plate and 2 cases were treated with conservative treatment with skeletal traction. Bone union was achieved in all cases. One case of mild posttraumatic arthritis and 1 case of avascular necrosis was found, respectively in Pipkin type IV. Conclusion: The extent of the initial injury has an effect on the prognosis of a hip fracture and dislocation.
참고문헌 (13)
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- "182 김정호이상홍문영래김동휘송근상Treatment of Femoral Head Fracture with Traumatic PosteriorDislocation of the HipJeoung-Ho Kim", pp.746~778 (1951)