대퇴골 경부 골절의 다발성 금속나사 고정술 후 금속나사의 이동
Migration of Multiple Cannulated Screws in the Treatment of Femur Neck Fractures
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목적: 대퇴골 경부 골절에서 다발성 유관 나사 고정술 후 가끔 관찰되는 방사선상 나사의 이동이 임상적으로 어떤 의미가 있는 지 알아보고자 하였다. 대상 및 방법: 1998년 2월부터 2005년 5월까지 대퇴골 경부 골절 환자로 다발성 유관나사로 치료 받은 66명중 최소 18개월 이상 추시 가능했던 44례를 대상으로 진료기록 및 방사선사진을 후향적으로 검토하였다. 고관절 전후면 사진상 3 mm이동을 기준으로 이동군(27례) 및 비이동군(17례)으로 분류하여 합병증, 골두내 나사 위치, Garden분류, 골절의 위치, 분쇄골절의 유 무에 따른 두군 간의 나사 이동에 관하여 비교하였으며, 이동 군에서의 나사의 이동시기 및 거리를 통계적으로 분석하였다. 결과: 두 군사이의 합병증유무(p=0.349), 골두 내 나사 위치(p=0.329), Garden 분류(p=0.370), 골절의 위치(p=0.572)에 따 른 이동의 유의한 차가 없었으나, 분쇄골절 유무에 따라 유의한 차이를 보였다(p=0.001). 이동 군에서 술 후 평균 1개월부터 시 작되어 평균 3~6개월부터 이동이 뚜렷하며, 최초 3개월의 평균거리는 4.23 mm였으며, 최종 평균이동거리는 6.51 mm였다. 결론: 경부 골절의 다발성 유관 나사 고정술 후 분쇄골절의 경우 술 후 3개월 전후에 나사의 이동 및 경부의 단축이 예상된다.
Abstract
Purpose: We wanted to assess the characteristics and clinical significance of screw migration after surgical treatment of femoral neck fractures. Materials and Methods: We reviewed 44 hips (22 males, 22 females) that were treated with closed reduction and multiple cannulated screws between February 1998 and May 2005. The medical records and radiographs were analyzed retrospectively at a minimum of 18 months after surgery. 3 mm migration was arbitrarily chosen as the differentiating measure between the migration (27cases) and the nonmigration (17 cases) groups. The anatomical location of the fracture, Garden's classification, comminution, the screw position in the femoral head and the complications were statistically compared between the migration and nonmigration groups. The time sequence of events after surgery and the distance of migration were evaluated in the migration group. Results: No significant differences between the two groups were noted in regard to complications, the screw position in the femoral head, the degree of displacement of fractures with using Garden's classification and the anatomic location of the fracture. There was a statistically significant difference between the two groups with regard to comminution (p=.001). In the migration group, the screws started migrating from 1 month after the operation and this was remarkable at 3~6 months. The average migration was 6.51 mm with 4.23 mm migration occurring in the first 3 months. Conclusion: For comminuted femur neck fractures that are treated with multiple cannulated screws, screw migration and shortening of the femoral neck can be anticipated to happen at 3 months after surgery.
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