압박 고나사로 치료한 대퇴골 전자간부 골절의 고정 실패 인자에 대한 분석
analysis of factors associated with failure of fixation after treatment of trochanteric fracture of the femur with compression hip screw
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목적: 대퇴골 전자간부 골절에서 압박고 나사를 이용한 수술적 치료후 발생할 수 있는 고정 실패에 영향을 미치는 인자에 대하여 분석하고자 하였다. 대상 및 방법: 1999년 1월부터 2003년 12월까지 대퇴골 전자간부 골절을 압박 고나사를 이용하여 치료하고 1년이상 추시가 가능하였던 73례를 대상으로 하였다. 이중 고정 실패는 11례였으며 성별 및 연령, 골절 양상, 골다공증, 나사의 골두 내 위치, 정복 양상 등 고정 실패에 관여할 것으로 기대되는 인자들을 통계학적으로 분석하였다. 결과: 성별 및 연령은 통계적인 차이를 보여주지 못했다(P>0.05). 골절 양상은 불안정성 여부가 고정 실패에 기여하는 유의한 인자로 나타났으며 Singh25) 지수를 이용한 골다공증을 기준으로 나눈 두 군에서도 의미있는 빈도 차이를 보여주었다(P<0.05). 대퇴골두 내 나사못이 상방에 위치한 경우와 골절의 수술적 정복후 전후면 방사선 사진상 5 mm 이상 전위된 경우에도 통계적인 차이를 보여주었다(P<0.05). 결론: 압박고 나사를 이용한 대퇴골 전자간부 골절의 치료에서 불안정성 골절, 심한 골다공증이 있는 경우 각별한 주의를 요하며 고정 실패를 방지하기 위해서는 정확한 정복이 필요하고 대퇴골두 내 압박 고나사의 상방 위치를 피하는 것이 좋을 것으로 사료된다.
Abstract
Purpose: To analyze the significant factors that may affect failure of fixation after surgical treatment of intertrochanteric fracture with compression hip screw. Materials and Methods: From January 1999 to December 2003, the authors analyzed 73 cases of trochanteric fracture of the femur treated with compression hip screw and followed for more than one year. There were eleven cases of failure of fixation. The relationship between the following factors was statistically analyzed: sex and age, fracture type, the degree of osteoporosis, placement of screw in femoral head, quality of reduction and failure of fixation. Results: Difference between age and sex were not statistically meaningful factor (P>0.05). The relationship between failure of fixation and unstable fracture was significant (P<0.05). There was a difference of prevalence between the two groups divided by the degree of osteoporosis using the Singh index (P<0.05). In the case of superior placement in the femoral head and displacement of the cortex of the proximal femur on radiologic AP view, there were more failures of fixation (P<0.05). Conclusion: More attention needs to be devoted to treatment in severe osteoporotic unstable intertrochanteric fracture. Accurate reduction and avoidance of the placement of the lag screw in the superior part of the femoral head were important factors to prevent failure of fixation in trochanteric fractures of the femur treated with the compression hip screw.
참고문헌 (29)
- "Fixation of intertrochanteric fractures of the femur:Arandomized prospective comparision of the Gamma nailand dynamic hip screw", 73a, pp.330~334 (1991)
- "Mechanical failure after internal fixation", pp.72 26~31 (1990)
- "The unstable intertrochanteric fractures of thehip", 49a, pp.440~450 (1967)
- "Trochanteric fractures.A review of 110 casestreatment by nail plate fixation", 33-b, pp.192~204 (1951)
- "A continuing end-result study of displacedintracapsular fractures of the neck of the femur treatedwith the Pugh nail", 56a, pp.1464~1472 (1974)
- "Correct placement of the screw or nail in trochantericfractures", 313, pp.206~213 (1995)
- "How tominimize failures of unstable intertrochanteric fractures", pp.26 611~9 614 (1995)
- "Use of an intramedullaryhip screw compared with a plate for intertrochantericfemoral fractures A prospective randomized study of onehundred patients", 80-A, pp.618~630 (1998), Bertens SL and Delince PE
- "Operative or conservative treatment fortrochanteric fractures of the femur", 71-b, pp.619~623 (1989)
- "Recovery of walkingability after treatment of unstable intertrochantericfractures in elderly patients:Comparison of compressionhip screw to primary hemiarthroplasty", 11, pp.22~29 (1999)
- "Stable trochantericfractures:a comparative analysis of four methods ofinternal fixation", 51, pp.949~962 (1980)
- "Classification of trochanteric fractures", 51, pp.803~810 (1980)
- "Trochanteric femoralfractures treated with McLaughlin osteosynthesis", 46, pp.795~ (1975)
- "S t a b l efixation of intertrochanteric fractures.A Biomechanicalevaluation", 56a, pp.899~907 (1974)
- "Analysis of sixhundred and twenty-two intertrochanteric hip fractures.Aretrospective and prospective study", 61-a, pp.216~221 (1979)
- "Complications of fixation inintertrochanteric fractures", 101, pp.110~119 (1974)
- "Implant failures inpatients with proximal fractures of the femur treated witha sliding screw device the British J of AccidentSurg", pp.98~100 (1989)
- "Fixation failure inpatients with proximal fractures of the femur treated witha compression hip screw", 10, pp.164~170 (1998)
- "Failure ofthe sliding hip screw in the treatment of femoral neckfractures:Left-handed surgeons for left-sided hip", 25s (1994)
- "Sliding screw and platefixation of intertrochanteric femoral fractures", 12, pp.581~591 (1972)
- "Intertrochanteric fractures of thefemur treated with sliding hip compression screw andgamma nail", 12, pp.102~111 (2000)
- "Factors affecting sliding of the lag screw inintertrochanteric fractures", 17, pp.320~324 (1993)
- "The intertrochanteric fractureof the femur in the elderly", 18, pp.755~762 (1983)
- "Sliding hipscrew:modes of failure", 20, pp.227~231 (1989)
- "Changes intrabecular pattern of the upper end of the femur as anindex of osteoporosis", 52-a, pp.457~467 (1970)
- "T h erelationship of femoral trabecular pattern index and bonemineral density in osteoporosis", 23, pp.849~860 (1988)
- "Dynamic hip screws that fail", 22(1), pp.45~46 (1991)
- "Hip nails for all occasion", 28, pp.325~331 (1977)
- "T r e a t m e n tof intertrochanteric fracture of the femur using slidingscrew plate fixation", 163, pp.148~158 (1982)