75세이상 대퇴골 경부 골절에서 시행한 무시멘트대퇴스템을 이용한 양극성 골두 치환술
Uncemented Bipolar Hemiarthroplastyfor Femoral Neck Fracture in Patients Older Than 75 Years of Age
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목적: 골다공증을 동반한 고령 환자의 대퇴골 경부 골절에서 무시멘트 대퇴스템을 이용한 양극성 골두 치환술을 시행한 후 임상 적, 방사선학적 결과를 알아보고자 하였다. 대상 및 방법: 2002년 3월부터 2004년 7월까지 대퇴골 경부 골절로 Zweymuller (Plus Orthopedics AG, Rotkreuz, Switzerland)형 무시멘트 대퇴스템을 이용한 양극성 골두 치환술을 받은 75세 이상의 환자 중 추시 기간 동안 사망한 1명을 제 외한 47명, 48례를 대상으로 하였다. 남자가 11명, 여자가 36명이었다. 수술 당시 평균 연령은 81세(75~94세)였으며 평균 추 시 기간은 42개월(24~58개월)이었다. 모든 례에서 골밀도를 측정하여 골다공증 여부를 확인하였고, 모든 례에서 골수강 확대 율(canal flare index)를 측정하여 대퇴강 형태를 측정하였다. 결과: 골절환자의 평균 골밀도는 T 점수 -3.9(-2.9~-5.3)이었고 대퇴강 형태가 연통(stove pipe) 형인 경우가 33례( 69 %) 이었다. 수술 후 최종 추시상 통증에 대한 평균Visual analogue scale(VAS) score는 2.7(1~6)점이었고 평균 Harris 고관절 점 수는 85(75~93)점이었다. 13례(27%)에서 서혜부 통증을 호소하였으며 1례에서만 중등도의 통증, 나머지는 경도의 통증을 호 소하였다. 방사선학적으로 모든 대퇴스템에서 골용해 및 해리가 관찰되지 않았으며 대퇴스템의 침강 없이 안정 골성 고정을 유 지하였다. 결론: 골다공증을 동반한 고령의 대퇴골 경부 골절 환자에서 Zweymuller형 무시멘트 대퇴스템은 쐐기형 스템 형태에 의해 대퇴강 내에서 조기 고정을 얻을수 있었고 grit-blasted 표면처리에 의해 이차적 안정성을 얻을수 있어 양호한 임상적 결과를 나타내었다
Abstract
Purpose: This study examined the clinical and radiographic outcomes of uncemented bipolar hemiarthroplasty for femoral neck fractures in elderly patients with osteoporosis Materials and Methods: Between March 2002 and July 2004, 48 uncemented bipolar hemiarthroplasty procedures (Zweymuller, Plus Orthopedics AG, Rotkreuz, Switzerland) for femoral neck fractures were performed in 47 patients older than 75 years of age. Of the 48 patients, 1 patient died during the follow-up period. There were 11 men and 36 women. The mean age of the patients at the time of surgery was 81 years (range, 75 ~ 94 years), and the mean follow up period was 42 months(range, 24 ~ 58 months). The bone mineral density and canal flare index of the proximal femur were measured in all patients. Results: The mean bone mineral density (T score) was -3.9 points (range, -2.9 ~ -5.3) and the proximal femoral morphology showed stove pipe shapes in 33 hips. At the last follow up, the mean Harris hip scores and visual analogue scale score was 85 (range, 75~93) and 2.7 (range, 1 ~ 6)points, respectively. Inguinal pain was observed in thirteen hips, among which the degree of pain was moderate in 1 and mild in 12. Radiologically, none of the stems showed evidence of osteolysis and aseptic loosening, and remained well osseointegrated without subsidence. Conclusion: Uncemented bipolar hemiarthroplasty using a Zweymuller stem in elderly patients associated with osteoporosis can provide favorable clinical and radiographic results because the stem imparts good primary stability due to its rectangular tapered shape and long-term secondary stability due to excellent osseointegration on the gritblasted surface.
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