대퇴골두 골절을 동반한 외상성 고관절 탈구
Traumatic Dislocation of the Hip with a Femoral Head Fracture
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목적: 수술적으로 치료 받은 대퇴골두 골절을 동반한 외상성 고관절 탈구 환자들의 임상 결과와 합병증 발생 빈도를 알아보고자 하였다. 대상 및 방법: 2002년 11월부터 2011년 11월까지 내원한 고관절 탈구 환자 중 대퇴골두 골절이 동반된 Thompson-Epstein V형 18예를 대상으로 하였다. 도수 정복 가능 여부 및 정복 시간에 따라 두 군으로 나누어 Epstein 기준에 따라 임상 결과를 평가하였고, 대퇴골두의 무혈성 괴사 및 외상성 관절염 발생 빈도를 분석하였다. 결과: 전체 환자 중 대퇴골두의 무혈성 괴사가 3예, 외상성 관절염이 1예 발생하였다. 도수 정복이 가능한 군은 14예, 실패한 군은 4예로 두 군간에 임상 결과는 유의한 차이를 보였고, 전체 합병증 발생 빈도에서 유의한 차이를 보였다. 정복까지 걸린 시간은 6시간 이내가 10예, 6시간 이후가 8예로 임상 결과에서 유의한 차이를 보이지 않았으나, 경향성 분석 결과 6시간 이내에 정복을 시행할수록 보다 나은 임상 결과를 보였으며, 전체 합병증 발생 빈도에서 유의한 차이를 보였다. 결론: 대퇴골두 골절을 동반한 외상성 고관절 탈구는 도수 정복이 가능한 경우가 임상 결과가 양호하였으며, 보다 나은 임상 결과를 얻기 위해서는 수상 후 가능한 한 빠른 시간 안에 정복을 시행하여야 할 것으로 사료된다.
Abstract
Purpose: This study was designed in order to evaluate the clinical results and frequency of complications of patients who underwent surgical treatment for traumatic dislocation of the hip with a femoral head fracture. Materials and Methods: Eighteen cases of Thompson-Epstein type V femoral head fracture with dislocation of the hip from November 2002 to November 2011 were analyzed retrospectively. We divided the cases into two groups according to availability of closed reduction and reduction time, and analyzed the clinical results according to Epstein criteria and frequency of avascular necrosis of the femoral head and posttraumatic osteoarthritis. Results: Among all patients, the observed complications included three cases of avascular necrosis and one case of posttraumatic osteoarthritis. The data showed that 14 cases were available for closed reduction; otherwise,there were four cases of failure. Significant differences were observed in clinical results and frequency of complications. Results regarding reduction time showed that 10 cases took 6 hours, and the other eight cases took more than 6 hours. There were no differences in clinical results, but, better results were achieved with a reduction time in 6 hours. However, significant differences were observed in frequency of complications. Conclusion: The availability of closed reduction would be an important factor for achievement of good clinical results in traumatic dislocation of the hip with a femoral head fracture. In order to obtain better clinical results, closed reduction should be performed as rapidly as possible.
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