대퇴 전자간 골절에서 고정 실패로 인한 인공 관절 치환술의 결과
Hip Arthroplasty for Failed Internal Fixation of Intertrochanteric Fractures
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 대퇴골 전자간 골절후 발생한 내고정의 실패에 대하여 인공 고관절 치환술을 시행하고 수술 시 문제점과 결과를 임상적, 방사선학적으로 알아보고자 하였다. 대상 및 방법: 1997년 1월부터 2008년 12월 까지 대퇴 전자간 골절로 수술적 치료 후, 내고정 실패를 보여 인공 고관절 치환술을 시행한 29예를 대상으로 실패 원인을 분석하였고, 수술 시 어려운 부분을 알아보고자 하였고, 인공 관절 치환술 후 결과를 임상적 결과(Harris hip score, HHS)와 방사선학적 결과로 평가 하였다. 인공 관절 치환술 후 평균 추시 기간은 34.2개월(12-96개월) 이었다. 결과: 평균 수술 시간은 174분(115-205분), 평균 출혈양은 1,335 ml(750-2,450 ml) 였으며 동종 적혈구 농축액이 평균 2.8 unit(0-10 unit) 수혈되어, 내고정물의 제거와 전위된 골절편의 정복에 따른 긴 수술 시간과 많은 출혈양을 보였다. Harris 고관절 점수는 수술전 평균 43에서 85.7점으로 향상되었고, 방사선학적으로 비구컵과 대퇴 주대의 해리를 보이는 경우는 없었고, 탈구와 감염이 각각 1예 씩 발생 하였다. 결론: 대퇴골 전자간 골절 후 발생한 내고정의 실패로 인한 인공 고관절 치환술은 비교적 만족할만한 결과를 얻을 수 있었으나 긴 수술시간과 많은 출혈 등의 위험성이 있어, 수술전 술기적 어려움과 대상 환자의 전신상태를 고려하여야 할 것으로 생각된다.
Abstract
Purpose: To analyze the clinical and radiological results of hip arthroplasty following the failed internal fixation of intertrochanteric fractures of the femur. Materials and Methods: We analyzed the reasons for failure in 29 cases of hip arthroplasty from January 1997 through December 2008 in which the hip arthroplasty was necessary due to failed internal fixation of an intertrochanteric fracture of the femur. Furthermore, we tried to find pitfalls encountered when performing the operations. We assessed those patients and drew both clinical (Harris hip score, HHS) and radiological results. The follow-up period was 34.2 months(12-96 months), on average. Results: The average operating time was 174 min.(115-205 min.) and the mean amount of perioperative bleeding was 1,335 ml(759-2,450 ml). The amount of packed RBC transfusion was 2.8 units(0-10units) on average. We could see prolonged operation time and a large amount of blood loss as we performed both the removal of the previously fixed implant and reduction of the displaced bone fragment simultaneously. The mean Harris hip score of the patients was improved from the preoperative score of 43 to the postoperative score of 85.7. No cases showed any radiological signs of loosening of acetabular cups or femoral stems, although an articular dislocation and a postoperative joint infection occurred. Conclusion: Although hip arthroplasties performed because of a failure in internal fixation could provide relatively satisfactory outcomes, as they result in extended surgery time and greater blood loss, a requirement for higher-level surgical skills, and greater consideration required for the systemic conditions of patients before performing surgery.
참고문헌 (18)
- Anue AK, "Gamma nail vs compression screw for trochanteric femoral fiactures. 15 reoperations in a prospective, randomized study of 378 patients", Acta Orthop Scand, 65, pp.127~130 (1994)
- 박명식, "항 회전 근위 대퇴 골수정을 이용한 대퇴골 근위부 골절의 치료", 대한골절학회지, 22(2), pp.91~97 (2009), 대한골절학회
- Babst R, "Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures", J Orthop Trauma, 12, pp.392~399 (1998)
- Bonamo JJ, "Treatment of intertochanteric fractures with a sliding nail-plate", J Trauma, 22, pp.205~215 (1982)
- Adams CI, "Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur", J Orthop Trauma, 15, pp.394~400 (2001)
- Albareda J, "Complications and technical problems with the gamma nail", Int Orthop, 20, pp.47~50 (1996)
- Simmermacher RK, "The AO", ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures, 1999, pp.30, 327~332
- Fracture and dislocation compendium, "Orthopedic Trauma Association Committee for Coding and Classification", J Orthop Trauma, 10(Suppl 1), pp.1~154 (1996)
- Harris WH, "Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: An end-result study using a new method of result evaluation", J Bone Joint Surg Am, 51, pp.737~755 (1969)
- Engh CA, "Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results", J Bone Joint Surg Br, 69, pp.45~55 (1987)
- Barrack RL, "Improved cementing techniques 307 and femoral component loosening in young patients with hip arthroplasty. A 12- year radiographic review", J Bone Joint Surg Br, 74, pp.385~389 (1992)
- Bong SC, "The treatment of unstable intertrochanteric fractures of the hip: a prospective trial of 150 cases", Injury, 13, pp.139~146 (1981)
- Said GZ, "Salvage of failed dynamic hip screw fixation of intertrochanteric fracutres", Injury, 37, pp.194~202 (2006)
- Haidukewych GJ, "Hip arthroplasty for salvage of failed treament of intertrochanteric hip fractures", J Bone Joint Surg Am, 85-A, pp.899~904 (2003)
- Hesse B, "Complications following the treatment of trochanteric fractures with the gamma nail", Arch Orthop Trauma Surg, 124, pp.692~698 (2004)
- Patterson BM, "Total hip arthroplasty for complications of intertrochanteric fracture. A technical note", J Bone Joint Surg Am, 72, pp.776~777 (1990)
- Edgerton BC, "Torsional strength reduction due to cortical defects in bone", J Orthop Res, 8, pp.851~855 (1990)
- Zhang B, "Hip arthroplasty for failed internal fixation of intertrochanteric fractures", J Arthroplasty, 19, pp.329~333 (2004)