심한 골다공증 환자에서 압박 고 나사 금속판을 이용한 대퇴 전자간 골절의 치료
Treatment of Intertrochanteric Fractures in Patients with Severe Osteoporosis with Dynamic Compression Hip Screws
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목적: 골다공증이 심한 대퇴 전자간 골절환자를 압박 고 나사 금속판으로 치료 후 임상적 결과를 관찰하고자 한다. 대상 및 방법: 2003년 3월부터 2006년 2월까지 압박 고 나사 금속판으로 수술한 대퇴 전자간 골절환자 중 건측 대퇴 경부의 골밀도 검사에서 T score가 -4.0 이상인 환자 56명과 T score가 -2.5 미만인 46명의 대조군과 임상적 결과를 비교하였다. 두 군간의 사망율, 술 후 전신적 합병증 및 고정실패 빈도와 유형을 후향적으로 비교하였다. 결과: 술 후 1년이내 사망한 환자는 제 1군이 17명(30.4%)이었으며 이 중 12명(21.4%)이 술 후 6개월이내 사망하였고, 제 2 군은 10명(21.8%)이 술 후 1년이내 사망하였다(p<0.05). 방사선적으로 골절형태는 두 군간 AO/OTA 분류상 차이가 없었고, 고정실패는 제 1군에서 11예(19.6%)가 발생하였으며, 제 2군은 6예(13.0%)가 발생하였다(p<0.05). 결론: 골다공증이 심한 대퇴 전자간 골절환자에서 압박 고 나사 금속판의 치료결과 대조군에 비해 술 후 의미있게 높은 사망률 (30.4%:21.4%)과 고정실패(19.6%:13.0%)가 발생하였다.
Abstract
Purpose: The purpose of this study was to compare the clinical results in the treatment of femoral intertrochanteric fractures with dynamic compression hip screws (DHS) in patients with or without osteoporosis. Materials and Methods: Between March 2003 and February 2006, the clinical results in the treatment of intertrochanteric fractures of the femur with DHS in patients with severe osteoporosis (T score<-4.0 at the femoral neck by DXA; 56 patients [group 1]) and in non-osteoporotic patients (T score>-2.5; 46 patients [group 2]) were reviewed. We retrospectively compared the mortality rate, the incidence of postoperative complications or fixation failures, and the patterns between the two groups. Results: The mortality rate in group 1 was 30.4% at postoperative 1 year and 21.4% at 6 months. The mortality rate at 1 year was 21.8% in group 2 (p<0.05). There were no differences in fracture patterns according to the AO/OTA classification between the two groups. However, the incidence of fixation failures were 19.6% in group 1 vs. 13.0% in group 2 (p<0.05). Conclusion: There was a higher postoperative mortality rate at 1 year (30.4% vs. 21.4%), and the incidence of fixation failures (19.6% vs. 13.0%) in the treatment of osteoporotic intertrochanteric fractures by DHS in osteoporotic compared to non-osteoporotic fractures.
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