The Results of Proximal Femoral Nail for Intertrochanteric Fracture in Hemodialysis Patient
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. Materials and Methods: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. Results: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Conclusion: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
Abstract
Purpose: Hip fractures in hemodialysis patients are accompanied by high rates of complications and morbidities. Previous studies have mainly reported on nonunion and avascular necrosis of femoral neck fractures in this patient group. In this study the complication and clinical results of hemodialysis patients with intertrochanteric fractures treated with proximal femoral intramedullary nailing have been investigated through comparison with patients with normal kidney function. Materials and Methods: Forty-seven patients were included; the hemodialysis group (n=17) and the control group with normal kidney function (n=30). The medical history and clinical findings including preoperative and postoperative blood examinations, radiological examinations and ambulatory status (measured using the Koval score). The rate of complications and morbidities were also investigated and compared. Results: Preoperative hemoglobin/hematocrit was lower but a significant increase in partial thromboplastin time was observed in the hemodialysis group. The amount of bleeding/transfusions were higher and operative time was longer in the hemodialysis group. Upon radiologic examination, there was no significant difference in rate of unstable fracture and nonunion between the two groups. However the postoperative Koval score was significantly worse and the odds ratio of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Conclusion: There was no significant difference in radiological results, but the risk of inability to walk after surgery was 13.5 times higher in the hemodialysis group. Hemodialysis patients have more morbidities and are hemodynamically unstable therefore require special attention. Accurate reduction and firm fixation is required and attentive postoperative rehabilitation is needed.
참고문헌 (29)
- National Kidney Foundation, "K", DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification, 2002, pp.39(2 Suppl 1), S1~S266
- Stehman-Breen CO, "Risk factors for hip fracture among patients with end-stage renal disease", Kidney Int, 58, pp.2200~2205 (2000)
- Alem AM, "Increased risk of hip fracture among patients with end-stage renal disease", Kidney Int, 58, pp.396~399 (2000)
- Karaeminogullari O, "Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis", J Bone Joint Surg Am, 89, pp.324~331 (2007)
- Tierney GS, "Mortality after fracture of the hip in patients who have end-stage renal disease", J Bone Joint Surg Am, 76, pp.709~712 (1994)
- Coco M, "Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone", Am J Kidney Dis, 36, pp.1115~1121 (2000)
- Tosun B, "Operative treatment of hip fractures in patients receiving hemodialysis", Musculoskelet Surg, 94, pp.71~75 (2010)
- Kalra S, "Intracapsular hip fractures in end-stage renal failure", Injury, 37, pp.175~184 (2006)
- 이준환, "혈액 투석 환자의 고관절 골절에서 시행한 무시멘트 인공 고관절 반치환술", Hip and Pelvis, 24(3), pp.200~205 (2012), 대한고관절학회[DOI]
- Protopsaltis TS, "Computed tomography for the classification of intertrochanteric fractures: correlation of fracture patterns and lag screw collapse with outcome scores", Paper presented at: 69th Annual Meeting of the American Academy of Orthopaedic Surgeons (2002), AAOS
- Koval KJ, "Rockwood and Green’s fractures in adults", pp.1635~1663 (2001), Lippincott Williams & Wilkins
- Vidyadhara S, "One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly--randomised clinical trial", Injury, 38, pp.806~814 (2007)
- Koval KJ, "Ambulatory ability after hip fracture. A prospective study in geriatric patients", Clin Orthop Relat Res, (310), pp.150~159 (1995)
- Chen CY, "Surgical treatment of basicervical fractures of femur--a prospective evaluation of 269 patients", J Trauma, 64, pp.427~429 (2008)
- Kuo LT, "The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis", Arch Orthop Trauma Surg, 134, pp.39~45 (2014)
- Stein MS, "Prevalence and risk factors for osteopenia in dialysis patients", Am J Kidney Dis, 28, pp.515~522 (1996)
- Cunningham J, "Osteoporosis in chronic kidney disease", Am J Kidney Dis, 43, pp.566~571 (2004)
- National Kidney Foundation, "K", DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease, 2003, pp.42(4 Suppl 3), S1~S201
- Martinez I, "The importance of dietary calcium and phosphorous in the secondary hyperparathyroidism of patients with early renal failure", Am J Kidney Dis, 29, pp.496~502 (1997)
- Buckwalter J, "Rockwood and Green’s fractures in adults" (2010), Lippincott Williams & Wilkins
- Ravikumar KJ, "Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study", Injury, 31, pp.793~797 (2000)
- Rogmark C, "A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years", J Bone Joint Surg Br, 84, pp.183~188 (2002)
- Lu-Yao GL, "Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports", J Bone Joint Surg Am, 76, pp.15~25 (1994)
- Altner PC, "Reasons for failure in treatment of intertrochanteric fractures", Orthop Rev, 11, pp.117~ (1982)
- Boyd HB, "Nonunion of trochanteric and subtrochanteric fractures", Surg Gynecol Obstet, 104, pp.463~470 (1957)
- Kohlmeier M, "Bone fracture history and prospective bone fracture risk of hemodialysis patients are related to apolipoprotein E genotype", Calcif Tissue Int, 62, pp.278~281 (1998)
- Piraino B, "Fractures and vertebral bone mineral density in patients with renal osteodystrophy", Clin Nephrol, 30, pp.57~62 (1988)
- Schaab PC, "Femoral neck fractures in patients receiving long-term dialysis", Clin Orthop Relat Res, 260, pp.224~231 (1990)
- Klein DM, "Operative treatment of hip fractures in patients with renal failure", Clin Orthop Relat Res, 350, pp.174~178 (1998)