대퇴골 경부 골절의 내고정 방법에 따른 치료 결과의 비교 분석
Comparison of the Results of Internal Fixation of Femoral Neck Fracture According to the Fixation Methods
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목적: 대퇴골 경부 골절에서 압박고 나사와 다발성 유관 나사를 이용한 내고정술 후 안정성, 합병증, 기능 회복 등의 치료 결과 를 비교 분석하기 위함이다. 대상 및 방법: 2000년 10월부터 2007년 01월까지 대퇴부 경부 골절 진단 하에 다발성 유관 나사를 이용하여 내고정술을 시행 받은 76명과 압박고 나사를 이용한 내고정술을 시행받은 50명을 대상으로 임상적, 방사선학적 분석을 시행하였다. 예후에 영 향을 미치는 요소로서 연령 및 성별, 골절의 원인, 수술시간, 총 실혈량, 손상부터 수술까지의 시간 등을 분석하고, 기능적 회복 정도는 FIMTM 점수를 사용하였으며, 수술 전 방사선 사진상 Garden 분류법에 의한 전위정도, Singh씨 지수,후방 피질골 분쇄 유무, 수술 후 방사선 사진상 골유합 정도와 함께 합병증의 발생 유무를 관찰하였다. 결과: 연령 및 성별 분포, 손상부터 수술까지의 시간, 골절의 원인 등은 두 군간에 통계학적으로 유의한 차이가 없었으며, 골절의 전위 정도, 술 후 골절 정복의 정확성 및 나사못의 위치, FIMTM 점수를 이용한 기능적 회복 정도, 합병증에서는 두 집단간에 통계 학적인 차이는 없었으나, 수술시간 및 총실혈량에서는 다발성 유관 나사 고정군에서 통계학적으로 유의하게 낮게 나타났다. 결론: 대퇴골 경부 골절 수술시 출혈량 및 수술시간 단축을 위해서는 다발성 유관나사 고정법이 더 유용할 것으로 사료된다.
Abstract
Purpose: We wanted to compare the stability, the complications and the patients’functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck. Materials and Methods: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIMTM score, the complications and the failure rate. Results: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIMTM score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05). Conclusion: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.
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