슬관절 전치환술 후 발생한 과상부 대퇴 삽입물 주위골절의 치료-역행성 골수강 내 금속정 고정술과 잠김 금속판 고정술 간의 비교-
Treatment for Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty -Comparative Study of Retrograde Intramedullary Nailing and Locking Compression Plate Fixation-
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목적: 본연구의 목적은 슬관절 전치환술 후 발생한 과상부 대퇴삽입물 주위 골절의 수술적 치료로서 역행성 골수강 내 금속정 고정술로 치료한 군과 잠김 금속판 고정술로 치료한 군간의 임상적 및 방사선학적 결과를 비교하기 위함이다. 대상 및 방법: 2004년 1월부터 2008년 12월까지 시행한 역행적 골수강 내 금속정 고정술 10예(제1군), 잠김 압박 금속판 고정술 13예(제2군)를 대상으로 하였다. 각 군에 대하여 골절 전과 최종 추시에서의 관절 운동범위, Hospital for Special Surgery (HSS) knee score, 대퇴 경골각 및 골유합 시기 등을 비교 분석하였다. 결과: 슬관절 운동범위는 제1군은 평균 124.5o에서 116.2o, 제2군은 평균 118.2o에서 110.1o로 감소하였다. HSS knee score는 제1군은 평균 84.4점에서 75.8점, 제2군은 평균 82.3점에서 79.0점으로 감소하였다. 대퇴 경골각은 제1군은 평균 외반 6.3o에서 5.8o, 제2군은 평균 외반 6.1o에서 7.2o로 측정되었다. 골유합 시기는 제1군은 평균 2.7개월, 제2군은 평균 3개월이었다. 결론: 역행성 골수강 내 금속정 고정술과 잠김 압박 금속판 고정술은 통계적으로 유의한 차이가 없었으며, 두 수술법 모두 견고한 고정 후 조기 관절 운동이 가능하여 좋은 치료 방법으로 생각된다.
Abstract
Purpose: The purpose of this research is to compare the clinical and radiological results of retrograde intramedullary nailing and locking compression plate fixation. Both of these are surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee arthroplasty. Materials and Methods: The subject population consisted of 23 cases: there were 10 cases that underwent retrograde intramedullary nailing fixation (group 1) and 13 cases that underwent use of a locking compression plate (group 2), and in both groups supracondylar femur fracture subsequent to total knee replacement occurred during the period between January 2004 and December 2008. The range of joint motion, the Hospital for Special Surgery (HSS) knee score, the tibio-femoral angle and the time to achieve bone union in each group were comparatively analyzed. Results: The mean range of the knee joint motion decreased from 124.5o to 116.2o in group 1, and from 118.2o to 110.1o in group 2. The mean HSS knee score declined from 84.4 points to 75.8 points in group 1, and from 82.3 points to 79.0 points in group 2. The mean tibio-femoral angle changed from 6.3o eversion to 5.8o in group 1, and from 6.1o to 7.2o in group 2. The mean time to achieving bone union was 2.7 months in group 1 and 3 months in group 2. Conclusion: Both retrograde intramedullary nailing and locking compression plate fixation, as surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee replacement, allow solid fixation and early resumption of joint movement without any statistically significant differences between the two procedures. So, both procedures appear to be good methods of treatment.
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