외상성 고관절 후방 탈구 및 골절의 치료
Treatment of Traumatic Posterior Fracture and Dislocation of the Hip
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서론: 외상성 고관절 후방 탈구 및 골절 환자의 Thompson-Epstein 분류에 따른 골절의 형태 및 치료결과와 합병증 등을 알아 보고자 하였다. 대상 및 방법: 2000년 1월부터 2005년 12월까지 최소 12개월 이상 추시가 가능 하였던 35예를 대상으로 하였고 Thompson- Epstein 분류에 따라 I형 5예(14%), II형 7예(20%), III형 5예(14%), IV형 8예(23%), V형 10예(29%)이었다. 수상 당시 평균연 령은 약 41세(19~72)였으며 남자가 26예, 여자가 9예였다. 수상원인은 교통사고가 30예, 낙상이 5예 였다. 추시기간은 평균 31개월(13~86)이었다. 탈구의 정복은 32예에서 6시간 이내에 시행하였으며 34예에서 도수정복을 시행하였는데 Allis 방법이 22예였다. 결과: Thompson-Epstein I형은 전례에서 도수 정복술 후 3주 이상의 골격 견인술을 시행하였고, II형 2예에서 골격 견인술, 4 예에서 관혈적 정복 및 금속 내고정술, 1예에서 관절경적 유리체 제거술을 시행하였고, III형과 IV 형은 13예 모두 관혈적 정복 및 금속 내고정술을 시행하였으며, V형은 6예에서 보존적 치료, 4예에서 관혈적 정복술 및 금속 내고정술, 1예에서 인공관절 전 치환술을 시행하였다. 전례에서 골유합을 얻었으며, 9예에서 외상성 관절염이 발생하였는데 IV형에서 7예가 발생하였다. 대퇴 골두 무혈성 괴사증과 심부 정맥 혈전증이 각각 1예에서 발생하였으며, 5예에서 좌골신경 손상이 발생하였다. 결론: Thompson-Epstein IV 형에서 합병증이 많이 발생하고 임상 경과도 불량하였던 것으로 사료되며 조기 정복 및 정확한 해 부학적 정복 여부가 예후에 영향을 미치는 것으로 사료되었다.
Abstract
Purpose: To evaluate outcomes and complications after traumatic posterior hip fractures and dislocations classified according to the Thompson-Epstein system. Materials and Methods: Thirty-five cases were selected from among the patients we treated between January 2000 and December 2005. According to Thompson-Epstein classification, 5 cases were type I, 7 cases were type II, 5 cases were type III, 8 cases were type IV, and 10 cases were type V. The mean age at the time of injury was 41 years (range: 19~72 years). Twenty-six patients were men, and 9 patients were women. The mechanisms of injury included traffic accidents in 30 cases and falls in 5 cases. The mean follow-up period was 31 months (range: 13~86 months). Fracture reduction was achieved within 6 hours in 32 cases. Thirty-four patients underwent closed reduction, and 22 of these patients were treated using Allis’method. Results: All Thompson-Epstein type I fractures were managed with closed reduction. Two type II fractures were treated conservatively, and 4 were treated with open reduction and internal fixation. All 13 type III and IV fractures were treated using open reduction and internal fixation. Six type V fractures were treated conservatively, 4 were treated with open reduction and internal fixation, and 1 was treated using total hip arthroplasty. Posttraumatic arthritis was observed in 9 cases, 7 of which were Thompson-Epstein type IV. Avascular necrosis (AVN) of the femoral head and deep vein thrombosis were observed in 1 case. Sciatic nerve injury was seen in 5 cases. Conclusion: Complications often occur in Thompson-Epstein type IV fractures. We believe that early, appropriate anatomical reduction helps to improve outcomes.
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