80세 이상 노인의 고관절 골절에서 시행한 인공 고관절 반치환술 - 대퇴골 경부 골절과 전자간 골절의 비교 -
Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture -
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목적: 80세 이상 노인의 불안정 대퇴골 전자간 골절에서 시행한 인공 고관절 반치환술의 상대적 수술적 위험도와 문제점들을 알아보고자 하였다. 대상 및 방법: 2005년 4월부터 2010년 5월까지 80세 이상의 고관절 골절 환자 58명을 대상으로 하였다. 1군은 경부 골절 환자 30명, 2군은 전자간 골절 환자 28명이었다. 두 군에서 나이, 내과적 질환, 골절 전 보행 상태에는 차이가 없었다. 각 군의 외상에서 수술까지 기간, 수술 시간, 출혈량, 보행 시작 시기, 입원 기간, 합병증, 재수술율, 보행 상태를 조사하여 비교하였다. 결과: 평균 수술 시간은 1군이 85.2분, 2군이 97.5분이었으며(P=0.03), 평균 출혈량은 1군이 483 cc, 2군이 695 cc이었다(P=0.006). 수술 후 보행 시작과 초기 보행 능력의 회복은 양군에 차이가 없었으며, 입원기간, 합병증, 재수술률에도 차이가 없었다. 그러나 추시에서 수상 전 보행 회복은 1군이 30예 중 25예(83.3%)이었으며, 2군은 28예 중 19예(67.8%)이었다. 결론: 2군에서 1군보다 수술시간이 길고 출혈량은 많았지만 수술적 위험도나 합병증의 발생률은 두 군에서 비슷하였다. 따라서 고령의 환자에서 발생한 전자간 골절의 일차적 치료로 인공 고관절 반치환술은 하나의 좋은 방법이 될 수 있을 것으로 생각된다.
Abstract
Purpose: The purpose of this study is to investigate the relative surgical risk and problems in hip hemiarthroplasty for treatment of an unstable intertrochanteric fracture in elderly patients over 80 years old. Materials and Methods: Between April 2005 and May 2010, 58 patients whose age was over 80 years were available for inclusion in this study. They were divided into two groups: group 1 included 30 patients with femoral neck fracture and group 2 included 28 patients with intertrochanteric fracture. No significant differences in average age, concomitant disease, and walking ability before development of fracture were noted between the two groups. The following factors, including interval from development of fracture to operation, operation time, amount of blood loss, start time of walking after operation, duration of hospital stay, complications, revision rate, and walking ability were compared between the two groups. Results: Operation time was an average of 85.2 minutes in group 1 and 97.5 minutes in group 2(P=0.03). The amount of bleeding was an average of 483 cc in group 1 and 695 cc in group 2(P=0.006). Similar results for walking start and recovery of walking ability after operation were observed in the two groups. No significant differences were observed in duration of hospital stay, complications, and revision rate. While 25 patients in group 1(83.3%) showed restoration of walking ability after operation to the same level of walking before injury, 19 patients in group 2(67.8%) showed restoration of walking ability postoperatively. Conclusion: Even though patients in group 2 showed a longer operation time and a higher amount of blood loss, compared with those in group 1, patients in group 2 had similar surgical risk and complications, compared with those in group 1. Therefore, primary hip hemiarthropalsty could be a good treatment option for intertrochanteric fracture in elderly.
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