근위대퇴골수정을 이용한 대퇴 전자간 골절의 치료-장기추시결과-
Proximal Femoral Nail for intertrochanteric fracture-Long TERM Follow up resurt-
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목적: 대퇴골 전자간 골절의 수술적 방법으로 선택될 수 있는 근위대퇴골수정(PFN)의 치료 효용성에 대한 결과에 대해 보고하고자 한다. 대상 및 방법: 2000년 10월부터 2004년 12월까지 본원에 내원하여 수술을 시행한 대퇴골 전자간 골절 환자 중 근위대 퇴골수정으로 치료한 82명, 82예를 연구대상으로 하였으며 평균 추시 기간은 31개월이었다. 환자의 평균 연령은 72.8세(범위, 25~93세)로 남자 28례, 여자 54례였다. 의무기록과 방사선 사진을 토대로 수술시간, 수혈량, 출혈량(술 후배액관의 양), 재원기간, 골유합 기간, 대퇴 경간각, 골절부 감입정도, 보행 시작 시기, 수술 중 및 추시중 합병증 및 술전, 후 환자의 기능 등을 조사하였다. 결과: 수술 시간은 평균 54분 소요되었고, 수혈량은 평균 320 ml, 출혈량은 평균 77 ml였다. 재원기간은 평균 19일이었고, 방사선학적 골유합은 평균 13.7주에 얻을 수 있었다. 대퇴 경간각은 수술 직후 평균 132.1도에서 최종 추시 시에는 평균 129.7도로 평균 2.4도 내반 전위를 보였고, 골절부 감입은 평균 4.2 mm였다. 평균 3.3일에 부분체중부하를 시행하였으며, 평균 9주째 전 체중부하가 가능하였다. 합병증으로는 경부나사의 전자부 외측 돌출 2예, 수술 부위 표재성 감염증 1예, 5도 이상의 대퇴 경간각 소실 4예, 지연나사의 관절 내 돌출 1예, 지연 나사들의 지나친 전위로 인한 Z-현상(Z-effect)이 1예 있었다. 결론: 근위 대퇴 골수정 내고정술의 장기 추시 결과 생역학적으로 유리하고, 최소 침습적이어서 술 후 환자의 기능 회복을 조기에 도모할 수 있고 합병증이 적어 대퇴전자부 골절의 치료에 유용한 방법 중 하나라고 사료된다.
Abstract
Purpose: This study was conducted to evaluate the efficacy of proximal femoral nail (PFN) for intertrochanteric fractures. Materials and Methods: From October 2000 to December 2004, 82 cases of intertrochanteric fracture were treated with proximal femoral nail. Mean duration of follow-up was 31 months. The mean age was 72.8 years and there were 28 males and 54 females. Such factors as the operating time, the amount of blood loss(Hemovac count) and transfusion, duration of hospital stay, mean duration to bone union, neck-shaft angle, lag screw sliding by follow-up radiograph, ambulation time, intra-operative and post-operative complication and functional status were analyzed. Results: The average operation time was 54 minutes, the mean amount of transfusion was 320 ml, and postoperative mean Hemo-vac count was 77 ml. The mean hospital stay was 19 days, and mean duration of radiologic bone union was 13.7weeks. The average neck-shaft angle on immediate postoperative X-ray was 132.1 degrees and 129.7 degrees at the last follow-up(average varus displacement, 2.4 degrees). The average amount of fracture impaction was 4.2 mm. The average partial weight bearing started 3.3 days after operation, and full weight bearing was permitted at 9 weeks after surgery. Complications were hip pin and neck screw protrusion for 2 hips, superficial infection for one, loss of neck-shaft angle more than 5 degrees for 4, intra-articular cutting out of neck screw for one, and Z-effect by excessive displacement of femur neck screw and hip pin for one hip. Conclusion: The proximal femoral nail could be preferable for the fixation of intertrochanteric fracures after the long term follow-up because of reducing operating time, blood loss, low complication rates and favorable postoperative function.
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