고관절 탈구를 동반한 대퇴 골두 골절의 치료 결과 -20예 증례 분석-
Outcomes of Treatment for Femoral Head Fractures with Hip Dislocation - Review of 20 Cases -
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목적: 대퇴 골두 골절 환자의 임상 결과 및 합병증의 발생을 알아보고자 한다. 대상 및 방법: 2004년 4월부터 2008년 6월까지 1년 이상 추시한 대퇴 골두 골절 20예를 대상으로 수상 기전, 탈구 정복까지 걸린 시간, Pipkin 분류, 치료 방법, 수술 접근법에 대한 조사를 하였으며 치료 후 발생한 합병증 및 임상결과를 평가하였다. 결과: Pipkin 분류별로 살펴 보면 I형 5예, II형 2예, III형 1예, IV형 12예였다. 1예를 제외한 모든환자에서 수술적 치료를 시행하였고, 골편 제거술 5예, 내고정술 7예, 인공관절 치환술 1예를 시행하였으며, Pipkin IV형 6예는 비구에 대한 수술만 시행하였다. 수술 후 1년째에 평가한 HHS는평균 80점으로 임상 결과는 우수 4예, 양호 7예, 보통 5예, 불량 4예였다. 합병증으로 대퇴 골두무혈성 괴사 2예, 외상후 관절염 2예가 발생하였다. 결론: 대퇴 골두 골절에서 골편 내고정술을 시행한 경우의 예후는 양호하였으나 골편 절제술을시행하였을 때는 예후가 불량하였다. 전방 접근법을 사용하여 Pipkin I, II형 골절의 내고정술을시행할 수 있었고, 수술적 탈구를 이용한 후방 접근법은 대퇴 골두의 혈행을 보호하고 후방 비구골절을 고정할 수 있었다.
Abstract
Purpose: We wanted to assess the clinical results and the complications of treating femoral head fractures. Materials and Methods: Twenty patients with femoral head fractures and who had a minimum 1 year follow up were enrolled in this study from April 2004 to June 2008. The clinical outcomes were evaluated according to the mechanism of injury, the reduction time, the Pipkin classification, the treatment methods, the surgical approach and the complications. Results: There were 5 cases of Pipkin type I and 2 cases of Pipkin type II, 1 case of Pipkin type III and 12 cases of Pipkin type IV. All the patients underwent operation except 1 patient; there were 5 excisions, 7 internal fixations, 1prosthesis, and 6 internal fixations of combined acetabular fixation without surgery for the femoral head fractures. The average Harris hip score at 1 year after operation was 80.0 (range: 57~99): there were 4 excellent, 7 good, 5 fair and 4 poor results. The complications of the femoral head fractures were 2 cases of avascular necrosis and 2 cases of posttraumatic osteoarthritis. Conclusion: Internal fixation of the femoral head with using Herbert screws showed a favorable outcome, while excision of the femoral head fragments did not. Internal fixation of Pipkin type 1 or 2 fractures could be performed by the anterior approach. The posterior approach combined with surgical dislocation is especially useful in internal fixation of concurrent posterior acetabular fractures, and it has the advantage of preserving the blood supply to the femoral head.
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