Vancouver 분류 B1과 C 대퇴삽입물 주위 불안정성 골절에서 금속판 내고정술식을 이용한 수술적 치료
Operative Treatment of Periprosthetic Unstable Femoral Fractures of Vancouver Type B1 and C with Variable Plates
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목적: 인공고관절 치환술 이후에 발생한 대퇴삽입물 주위의 불안정성 골절 중 Vancouver 분류 B1과 C 골절에서 금속판 내고정술식을 이용한 수술적 치료의 결과를 분석하고자 한다. 대상 및 방법: 1997년부터 2010년까지 본원에서 치료한 대퇴삽입물 주위 골절 중 관혈적 정복과 금속판 내고정술식으로 치료한 15명의 환자를 대상으로 하였다. 평균 연령은 69세(53-82세)이며 평균 추시기간은 29.2개월(6-110개월)이었다. 골절의 유형은 Vancouver 분류 B1은 10명, C는 5명이었으며, 시기에 따라 총 4가지의 서로 다른 금속판을 사용하였고 모든 환자에서 금속판의 종류와는 상관없이 골이식을 시행하였다. 모든 환자에서 방사선학적 평가와 임상적 평가를 시행하였다. 결과: 모든 환자에서 수술 후 보행이 가능하였다. 골유합은 총 15명 중 15명 전례에서 얻었으며 합병증으로 술 후 탈구 1명을 보였다. 감염, 신경 손상, 대퇴삽입물 해리 등의 소견은 관찰되지 않았다. 결론: 대퇴삽입물의 해리가 없는 Vancouver 분류 B1과 C 골절에서 저자들이 사용한 금속판 내고정의 수술적 치료 결과는 만족스러웠다.
Abstract
Purpose: The purpose of this study is to evaluate the outcome after operative treatment with plate fixation in Vancouver B1 and C periprosthetic unstable femoral fractures. Materials and Methods: We conducted a retrospective assessment of 15 patients who had under gone treatment for a periprosthetic unstable femoral fracture around primary hip arthroplasty between April 1997 and July 2010. The mean age of patients was 69 years(53 to 82 years) at the time of surgery and the mean duration of follow-up was 29.2 months (six to 110 months). According to Vancouver classification, 10 patients were type B1 and five were type C. According to the time of operation, open reduction and internal fixation was performed using four different plates. Bone graft was applied in all patients, regardless of the type of plate. The present review describes the clinical and radiographic results. Results: All patients were able to ambulate without assistance of crutches or walkers. Of the 15 patients, the fracture site was united in all patients. Postoperative dislocation of the ipsilateral hip was observed in one patient;however, there was no occurrence of further complications, such as infections, nerve injuries, or loosening of the femoral stems. Conclusion: In Vancouver type B1 and C fractures, without any loosening of the femoral stems, open reduction with plate fixation using our operative methods provided a satisfactory result.
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