대퇴골 경부 골절 환자에서 이극성 고관절 반치환술 후 하지부동이 결과에 미치는 영향
The Relationship between Limb-Length Discrepancy on Function, Dislocation, Pain and Acetabular Wear after Bipolar Hemiarthroplasty for Femoral Neck Fracture
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목적: 노인의 대퇴 경부 골절 환자에서 이극성 반치환술을 시행 후 하지 부동이 임상적, 방사선학 적 결과에 미치는 영향을 보고자 하였다. 대상 및 방법: 2004년 8월부터 2007년 1월까지 65세 이상의 대퇴 경부 골절로 이극성 반치환술 을 시행 받고 2년 이상의 추시가 가능한 60명의 환자를 술 후 하지부동이 5 mm인 1군, 30예와 5 mm 미만인 2군, 30예를 후향적으로 비교하였다. Harris 고관절 점수와 Activity of daily living (ADL), 탈구 발생율과 visual analogue scale (VAS) score를 이용하였으며, 비구 연골의 마모 는 방사선 사진으로 분석하였다. 결과: 1, 2군 각각에서 Harris 고관절 점수는 평균 80.0점과 76.2점(P=0.09), ADL은 술 전 평균 36점과 29점과 술 후 56점과 52점이었다(P=0.21). VAS score는 평균 3.53점과 2.23점이었다 (P=0.002). 관절 간격의 감소는 각각 6예와 8예에서 보였다(P=0.11). VAS score는 통계학적으 로 유의하였고, 탈구, 비구의 연골마모는 유의하지 않았다(P>0.05). 결론: 수술 후 하지 부동이 기능적 결과에 미치는 영향은 적었으나, 동통이 증가하였다.
Abstract
Purpose: To evaluate the relationship between a limb-length discrepancy and the clinical and radiological outcomes after bipolar hemiarthroplasty for femur neck fractures in elderly patients. Materials and Methods: Between August 2004 and January 2007, 60 out of 80 cases over 65 years who underwent cemented bipolar hemiarthroplasty for femur neck fractures with a more than 2 years follow-up were evaluated retrospectively by dividing the patients into two groups, > 5 mm (group 1) and < 5 mm (group 2) of limblengthening. Harris hip score, the activity of daily living(ADL), dislocation rate, pain by a visual analogue scale (VAS) and acetabular wear by radiographic measurements were analyzed. Results: For each group, the Harris hip score in group 1 and 2 was 80.0 and 76.2, respectively. The ADL in group 1 and 2 was respectively, 36 and 29 preoperatively, 56 and 52 postoperatively. The visual analogue scale in group 1 and 2 was 3.53 and 2.23 (P=0.002), respectively, and acetabular wear was encountered in 6 and 8 cases in group 1 and 2, respectively. The VAS score was significant. There was no difference in acetabular wear and dislocation between the two groups (P>0.05). Conclusion: Limb-lengthening by hemiarthroplasty may be a cause of pain but with little effect on the overall functional outcome.
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