Kyle-Gustilo Type III 형 불안정성 대퇴골 전자간부 골절 치료시소 전자부의 케이블 고정군과 비고정군의 비교
The Comparison of the Cable Fixation of Lesser Trochanter in the Treatment of Kyle-Gustilo Type III Unstable Intertrochanter Fractures
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목적: 압박 고 나사를 이용한 불안정성 전자간부 골절 치료 시 소 전자부의 케이블 고정유무가 임상적 및 방사선학적 결 과에 미치는 영향을 골다공증 정도와 연관하여 분석하고자 하였다. 대상 및 방법: 1999년부터 2005년까지 Kyle-Gustilo type III형인 전자간 불안정 골절로 치료 받고 최소 12개월 이상 추시가 가능하였던 54예를 대상으로 압박 고 나사로 치료한 30예(1군)와 소 전자부의 케이블 고정을 추가하여 치료한 24예(2군)를 지연나사의 활강 정도, 골유합 유무 및 기간, 체중 부하시기 및 고정의 부분 소실에 대해 골다공증의 정도 와 연관하여 후향적으로 통계학적 비교 분석 하였다. 결과: 1군과 2군에서 지연 나사의 활강은 평균 15.27 mm와 12.13 mm로 유의한 차이를 보였으며(p=0.0453), 골유 합은 평균 14.63주와 13.71주였으며(p=0.4623), 체중 부하시기는 평균 3.03주와 2.83주였으나(p=0.1697), Singh index가 Grade IV 이상인 2군에서 유의하게 조기에 체중 부하를 시행하였다(p=0.0291). 고정의 부분소실은 각각 5예 발생하였으며(p=0.9688), 골다공증의 정도가 심할수록 유의하게 증가하였다(p＜0.05). 결론: 불안정 전자간 골절에서 경도의 골다공증 환자에서 소전자부의 케이블 추가 고정은 과도한 지연 나사의 전이를 예 방하는데 도움이 되며, 조기 보행이 가능하게 하는 수술 기법으로 사료되며, 중등도의 골다공증 환자에서는 케이블 고정 이 큰 역할을 하지 못한 것으로 사료된다.
Abstract
Purpose: To evaluate the availability of cable fixation of the lesser trochanter in the treatment of unstable intertrochanter fractures using a sliding compressive hip screw (CHS) on the clinical and radiological results related to osteoporosis. Materials and Methods: Fifty-four cases of Kyle-Gustilo type III unstable intertrochanter fractures between January 1999 to January 2005 were classified into 2 groups: groups 1(30 cases CHS) and 2(24 cases additional cable). The sliding distance of the lag screw, bony union, weight bearing time, and the loss of fixations related to osteoporosis in the two groups were compared retrospectively after a follow up of at least 1 year. Results: The average sliding distances of the lag screw in groups 1 and 2 was 15.27 and 12.13 mm (p=0.0453), respectively. The time to bony union in groups 1 and 2 was 14.63 and 13.71 weeks (p=0.4623), respectively. The average weight bearing time in groups 1 and 2 was 3.03 and 2.83 weeks (p=0.1697), respectively. Early weight bearing was allowed in patients in group 2 with a Singh index greater than grade IV (p=0.0291), and a loss of fixation was encountered 5 cases in each group (p=0.9688), which increased significantly with increasing severity of osteoporosis (p<0.05). Conclusion: Additional cable fixation of the lesser trochanter for mild osteoporotic patients in unstable intertrochanter fractures is recommended for preventing the excessive sliding of lag screws and for allowing early ambulation. However, this procedure is not effective in patients with severe osteoporotic
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