대퇴골 전자간부 골절의 내고정 실패에 대한 원인분석 및 치료
Analysis and Management of Failed Intertrochanteric Fracture Fixation
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목적: 압박 고 나사를 이용하여 수술한 대퇴골 전자간부 골절 중 고정에 실패한 15예에 대하여 내고정 실패의 양상과 원인, 치료방법의 결과를 분석하고자 하였다. 대상 및 방법: 1999년 1월부터 2005년 8월까지 활강 압박 고 나사를 이용한 내고정술 시행 후 내고정 실패가 발생하여 치료받은 환자들 중 1년 이상 추시가 가능하였던 15예에 대해 골절의 형태, 정복의 정확도 및 실패의 양상, 추정되는 원인, 그리고 술후 임상적 결과와 방사선학적 결과에 대하여 분석하였다. 결과: 실패 양상은 골두 내 천공 7예, 압박 고 나사의 파손 1예, 압박 고 나사의 금속판으로부터의 이탈 1예, 압박 고 나사의 과도한 활강 2예, 금속판의 파손 2예, 금속판을 고정한 나사못 파손에 의한 고정소실 2예 였다. 추정되는 원인은 부적절한 내고정물의 선택이 6예, 기술적인 실패가 9예였다. 인공관절 치환술을 시행한 10예에서 술 후 Harris Hip score는 평균 67.8점(46~97점)으로 3예에서만 만족스러운 결과를 보였고, 95도 칼날 금속판을 이용하여 내고정술을 시행한 4예에서는 술 후Harris Hip score는 평균 88.4점(80~95점)이었으며 전예에서 5개월 이내에 골 유합 소견을 보였다. 결론: 대퇴골 전자간 골절의 성공적인 내고정을 위해서는 적절한 내고정물의 선택과 정확한 술기가 필요하며, 내고정 실패시 대퇴골두와 비구부가 건전할 때에는 환자의 연령과 전신상태를 파악하여 인공관절 치환술과 함께 95도 칼날 금속판등을 이용한재내고정술도 고려하여야 할것으로 판단된다.
Abstract
Purpose: We wanted to analyze the causes of fixation failure after performing compression hip screw fixation for intertrochanteric fracture and we wanted to evaluate the methods to mange this type of failure. Materials and Methods: From January 1999 to August 2005, 15 patients who underwent operation due to fixation failure after compression hip screw fixation for intertrochanteric fracture were evaluated, with at least 1 year follow up, for the fracture type, the status of the reduction, the aspects of failure, the causes of the failure and the clinical and radiologic results after operation. Results: There were 7 cases of cut out by the hip screw, 1 case of hip screw breakage, 1 case of dislodging the hip screw, 2 cases of excessive sliding of the hip screw, 2 cases of plate breakage and 2 cases of fixation loss of the plate. The failure of cases was due to incorrect choice of the implants, and that of 9 cases was due to technical error. The Harris Hip score was an average of 67.8 for 10 cases of failed arthroplasty at the last follow up and 88.4 for 4 cases of re-fixation with a 95 degree angled blade plate, and bone union was achieved at a minimum of 5 months. Conclusion: It is important to choose an adequate implant and a precise technique to achieve a successful result for fixation of unstable intertrochanteric fracture, and refixation with a 95 degree angled blade plate could be considered for the management of failed intertrochanteric fracture with arthroplasty.
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