Vancouver분류 B2, B3형 대퇴삽입물 주위골절의 치료
Treatment of Vancouver B2 and B3 Periprosthetic Femoral Fractures
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목적: Vancouver B2, B3형 대퇴스템 주위골절 치료시 기존의 대퇴스템을 치환한 경우와 유지한 경우의 결과를 분석하였다. 대상 및 방법: 1993년 1월부터 2004년 10월까지 본원에서 수술한 Vancouver B2형 골절 19예와 B3형 골절 8예를 대상으로 하 였다. 기존 스템을 사용한 경우(A군)는 15예, 긴스템으로 치환한 경우(B군)는 12예이었다. 두군 모두 금속판 및 나사못, 케이블등 으로 견고한 내고정을 하였으며, 임상적 평가는 Harris 고관절 점수, 방사선학적 평가는 Beals 및 Tower의 기준을 이용하였다. 결과: Harris 고관절 점수는 A군이 84점, B군이 85점이었다. 80점 이하의 불만족은 A군에서 2예, B군에서 2예 관찰되었다. 방 사선학적 평가는 A군의 대퇴스템 해리 1예와, B군의 골절 불유합 1예가 불량이었고, 나머지는 모두 우수로 판정되었다. 합병증 은 대퇴스템 해리, 불유합, 표재성 감염, 탈구, 비구컵해리가 각각 1예씩 발생하였다. 결론: 골절과 대퇴스템을 견고하게 고정하고 골이식을 충분히 시행한다면 기존 대퇴 스템의 치환여부에 상관없이 우수한 임상 적 결과를 얻을 수 있을 것으로 사료된다
Abstract
Purpose: To evaluate respectively the clinical results after femoral stem exchange or retention in the treatment of Vancouver B2, B3 periprosthetic femoral fractures. Materials and Methods: Nineteen cases of Vancouver B2 fractures and 8 cases of B3 fractures that were treated surgically between January 1992 to October 2004 were reviewed. There were 15 retained stems (group A) and 12 exchanged stems (group B). Firm fixation of a fracture and stem with a plate, screw and cable was performed in both groups. The HHS and criteria of Beals and Tower was used for the clinical and radiological evaluation. Results: The mean HHS was 84 in group A and 85 in group B. Unsatisfactory (<80 HHS) results were obtained in 2 cases from each group. The radiological results were excellent in both groups with the exception of one case of femoral stem loosening in group A and one case of non-union in group B. The complications encountered were 1 case of femoral stem loosening, 1 case of non-union, 1 case of a superficial infection, 1 case of dislocation, and 1 case of cup loosening. Conclusion: Stable fixation of the fracture and stem with a sufficient bone graft in the treatment of Vancouver B2, B3 periprosthetic femoral fractures can produce favorable clinical results regardless of the level of femoral exchange.
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