불안정성 대퇴 전자 주위 골절을 가진 환자에서 항회전 근위 대퇴 골수정을 이용한 치료결과
Results of the Proximal Femoral Nail-Antirotation (PFNA) in Patients with an Unstable Pertrochanteric Fracture
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목적: 불안정성 대퇴 전자 주위골절을 가진 환자의 치료에 있어서 항회전 근위 대퇴 골수정(PFNA)을 이용한 치료결과에 대해 알아보고자 한다. 대상 및 방법: 2006년 9월부터 2010년 3월까지 PFNA를 이용하여 치료한 불안정성 대퇴 전자 주위골절 환자 187명 중 47예를 대상으로 하였다. 평균 골 유합 기간, blade의 활강 정도 및 대퇴경간각의 차이, 활동 정도 및 합병증 등을 점검하였다. 결과: 방사선학적 골 유합은 평균 15.8주에 얻을 수 있었으며 술 후 66% 에서 수술 전 보행을 회복할 수 있었다. blade의 평균 활강은 5.5 mm 였으며 대퇴 경간각은 평균 4.4。의 내반 전위를 보였다. 골두의 천공 및 임박 천공이 각각 2예씩 발생하였으며, 1예에서 외상 후 골두 무혈성 괴사가발생하였다. 그리고 2예에서 술 후 추시 중 외측벽 골절(lateral wall fracture)이 발생하였다. 결론: 불안정성 대퇴전자주위골절에 있어서 항회전 근위 대퇴골수정을 이용한 수술은 수술 시간이 짧고, 환자의 거동능력 회복이 양호하며, 합병증도 적어 유용한 치료법 중 하나라고 생각된다. 그러나 골두 천공 같은 심각한 합병증을 막기 위해서는 세심한 시술이 필요하다.
Abstract
Purpose: This study was performed to review the results of PFNA (Proximal Femoral Nail Antirotation) for treating unstable femoral intertrochanteric fractures. Materials and Methods: Forty-seven out of 187 hips treated from September 2006 to March 2010 with PFNA for unstable femoral pertrochanteric fractures were enrolled in this study. The mean duration to radiologic bone union,the functional status and the complications were assessed. The Cleveland index, the tip apex distance, the sliding distance of the blade and the change in the neck-shaft angle were also measured. Results: The mean duration to radiologic bone union was 15.8 weeks and 66% of the patients recovered to a premorbid functional status. The average amount of blade sliding was 5.5 mm and the mean change of the neck-shaft angle was varus 4.4。. There were 2 cases of penetration of the blade tip, 2 cases of impending penetration, one case of posttraumatic osteonecrosis of the femoral head and 2 cases of lateral wall fractures. Conclusion: PFNA would be preferable for unstable femoral intertrochanteric fractures in terms of the short operation time, the rapid ambulatory recovery and the reduced complications. Yet careful handling is required to avoid a grave complication such as head penetration.
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