Dyna Locking Trochanter (DLT) 금속정을 이용한 대퇴 전자간 골절의 치료
Treatment of Intertrochanteric Fracture of the Femur Using a Dyna Locking Trochanteric (DLT) Nail
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목적: DLT 금속정을 이용한 대퇴 전자간 골절 치료 후 임상적 및 방사선적 결과를 관찰하고자 한다. 대상 및 방법: 2008년 3월부터 2009년 2월까지 DLT 금속정을 이용하여 수술한 대퇴 전자간 골절환자 43명 중 6개월 이상 추시가 가능하였던 36명(남자 10예, 여자 26예)을 대상으로 하였다. 환자의 평균 나이는 76.4세 (65~90세)였고 평균 추시기간은 13.4개월(9~21개월)이었다. 최종방사선 추시상 대퇴 경간각과 지연나사의 활강거리, 술 중 합병증, 수술 경과시간, 술 후 실혈양,및 고정실패 빈도를 관찰하였다. 결과: 최종 추시상 대퇴 경간각은 평균 131.1도, 지연나사의 활강거리는 평균 3.6 mm이었으며원위 교합나사 삽입과정 및 금속정 삽입 과정 중 각각 1예(총 2 예, 5.6%)에서 대퇴간부 골절이발생하였고 대퇴 경부 스트레스성 골절이 1예 발생하였다. 1예에서 심부감염이 발생하여 불유합이 발생하였고, 1예에서 내반변형이 관찰되어 총 2 예(5.6%)에서 고정실패가 발생하였다. 결론: DLT 금속정을 이용한 고령의 대퇴 전자간 골절 치료에서 만족할 만한 방사선적 결과 및 고정실패 빈도가 관찰되어 유용한 내고정물이라고 사료된다.
Abstract
Purpose: We analyzed the clinical and radiological results after treatment of intertrochanteric fracture of the femur using a Dyna locking trochanteric (DLT) nail. Materials and Methods: From March 2008 to February 2009, 36 patients (10 males and 26 females) who had at least 6 months follow-up among 43 patients were included in our study. The average age of the patients was 76.4years (age range: 65~90 ages) and the average follow-up period was 13.4 months (age range: 9~21 months). We evaluated the radiological results such as the neck-shaft angle and the sliding length of the lag screw at last follow-up and the clinical results such as intraoperative complications, the operation time, the postoperative blood loss and the incidence of fixation failure. Results: The average neck-shaft angle at last follow-up was 131.1 degrees and the average sliding length of lag screw was 3.6 mm. Two cases (5.6%) of femoral shaft fracture during the insertion of a lag screw or nail happened and one case of stress fracture of the femoral neck occurred. Two cases of fixation failure developed due to deep infection or varus angulation. Conclusion: Fixation using a DLT nail can be a good option for the treatment of intertrochanteric fractures of the femur.
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