Hip & pelvis

  • 제21권3호
  • /
  • Pages.252-256
  • /
  • 2009
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지

항회전 근위 대퇴 골수정(PFNA)을 이용한 대퇴전자부 골절의 치료(PFNA를 이용한 대퇴전자부 골절의 치료)

The Treatment of Trochanteric Femoral Fracture with Using Proximal Femoral Nail Antirotation (PFNA)

  • 장세앙 (대구파티마병원 정형외과) ;
  • 조영호 (대구파티마병원 정형외과) ;
  • 변영수 (대구파티마병원 정형외과) ;
  • 한재휘 (대구파티마병원 정형외과) ;
  • 박재영 (대구파티마병원 정형외과) ;
  • 이충열 (대구파티마병원 정형외과)
  • Chang, Se-Ang (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Cho, Young-Ho (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Byun, Young-Soo (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Han, Jae-Hui (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Park, Jae-Young (Department of Orthopaedic Surgery, Daegu Fatima Hospital) ;
  • Lee, Chung-Yeol (Department of Orthopaedic Surgery, Daegu Fatima Hospital)
  • 발행 : 2009.09.30

⟨ 이전 논문 다음 논문 ⟩

초록

목적: 대퇴 전자부 골절에 대해 항회전 근위대퇴 골수정을 이용하여 치료하고 그 결과 및 합병증을 분석하여 유용성을 알아보고자 하였다. 대상 및 방법: 2006년 9월부터 2008년 11월까지 항회전 근위대퇴 골수정을 이용하여 고정한 36예의 대퇴 전자부 골절 환자를 대상으로 수술시간, 출혈량, 골절유합기간, Tip Apex Distance(TAD), Cleveland index, 항회전 근위대퇴 골수정 칼날의 이동거리와 합병증 등을 평가하였고 보행능력의 회복정도와 기능회복정도를 평가하였다. 결과: 평균 수술시간은 54분, 평균 출혈량은 119 cc였으며 36예중 32예에서 4개월 이내에 골유합이 되었고 4예는 추가적인 수술 없이 6개월까지 골유합이 되었다. 평균 TAD는 16 mm였고 평균 항회전 근위대퇴 골수정 칼날의 이동거리는 3.8 mm이었다. 임상적으로 Shin 등의 보행평가 기준에 의하면 평균 1.2단계의 보행능력의 감소가 있었고 Jensen 등에 의한 기능회복 지수는 평균 지수는 1.8이었다. 골수정 칼날의 외측 돌출이 한 례에서 관찰되었으나 피부 문제는 발생하지 않았다. 전 례에서 심각한 합병증도 발생하지 않았다. 결론: 항회전 근위대퇴 골수정을 이용한 고령의 대퇴전자부 골절의 치료는 유용한 치료방법이라 사료된다.

Purpose: This study was performed to evaluate the usefulness of proximal femoral nail antirotation (PFNA) for internal fixation of femur trochanteric fractures. Materials and Methods: We operated on 36 femur trochanteric fracture patients with performing PFNA from September, 2006 to November, 2008 and we analyzed the operation time, the blood loss, the union time, the tip apex distance (TAD), the Cleveland index, the sliding distance of the blade and the complications. We also evaluated the clinical results according to the recovery of ambulatory function and the functional recovery score. Results: The mean operation time was 54 minutes and the mean amount of blood loss amount was 119cc. Thirty two cases progressed to union within 4 months and 4 cases also progressed to union within 6 months without a further operation. The mean TAD was 16mm and the mean sliding distance was 3.8 mm. Clinically, the mean loss of ambulation ability was 1.2 grades and the Jensen functional recovery score was 1.8. There was one case of back out of the blade, but there was no skin problem. There were no significant complications. Conclusion: The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of trochanteric fracture of the femur.

키워드

참고문헌

  1. Adams CI, Robinson CM, Court-Brown CM, McQueen MM. Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur. J Orthop Trauma, 15: 394-400, 2001. https://doi.org/10.1097/00005131-200108000-00003
  2. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The Value if the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg, 77-A: 1058-1064, 1995.
  3. Boldin C, Seibert FJ, Fankhauser F, Peicha G, Grechenig W, Szyszkowitz R. The proximal femoral nail (PFN) -$\alpha$ minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a followup of 15 months. Acta Orthop Scand, 74: 53-58, 2003. https://doi.org/10.1080/00016470310013662
  4. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochanteric fractures of the femur. A randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg, 73-B: 330-334, 1991.
  5. Butt MS, Krikler SJ, Nafie S, Ali MS. Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial, Injury. 26: 615-618, 1995. https://doi.org/10.1016/0020-1383(95)00126-T
  6. Cleveland M, Bosworth DM, Thompson FR, Wilson HJ Jr, Ishizuka T. A ten-year analysis of intertrochanteric fractures of the femur. J Bone Joint Surg, 41(A)-A: 1399- 1408, 1959.
  7. Domingo LJ, Cecilia D, Herrera A, Resines C. Trochanteric fractures treated with a proximal femoral nail. Int Orthop, 25: 298-301, 2001. https://doi.org/10.1007/s002640100275
  8. Friedl W, Clausen J. Experimental examination for optimized stabilization of trochanteric femur fractures, intra-or extramedullary implant localization and influence of femur neck component profile on cut-out risk. Chirurg, 72: 1344-1352, 2001. https://doi.org/10.1007/s001040170041
  9. Gullberg B, Duppe H, Nilsson B, Redlund-Johnell I, Sernbo I, Obrant K, Johnell O. Incidence of hip fractures in Malmo, Sweden (1950-1991). Bone, 14 (suppl 1): s23- s29, 1993. https://doi.org/10.1016/8756-3282(93)90345-B
  10. Halder SC. The Gamma nail for peritrochanteric fractures. J Bone Joint Surg, 74-B: 340-344, 1992.
  11. Jensen JS. Determining factors for the mortality following hip fractures. Injury, 15: 411-414, 1984 https://doi.org/10.1016/0020-1383(84)90209-2
  12. Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone, 18(1 Suppl): 575-635, 1996. https://doi.org/10.1016/8756-3282(96)00082-8
  13. Lee KB, Lee BT. Complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN). J Korean Fracture Soc, 20: 33-39, 2007.
  14. Pajarinen J, Lindahl J, Michelsson O, V. Savolainen, E. Hirvensalo. Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. J Bone Joint Surg, 87-B: 76-81, 2005.
  15. Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E. A randomized comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Arch Orthop Trauma Surg, 125: 462-468, 2005. https://doi.org/10.1007/s00402-005-0021-5
  16. Radford PJ, Needoff M, Webb JK. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg, 75-B: 789-793, 1993.
  17. Shin DK, Kwun KW, Kim SK, Lee SW, Choi CH, Go SB. Ambulatory recovery after fixation of intertrochanteric fracture with Gamma nail in the elderly. J Korean Fracture Soc, 13: 771-778, 2000.
  18. Simmermacher RKJ, Bosch AM, Van der Werken C. AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures. Injury, 30: 327-332, 1999. https://doi.org/10.1016/S0020-1383(99)00091-1
  19. Strauss E, Frank J, Lee J, Kummer FJ, Tejwani N. Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation. Injury, 37: 984-9, 2006. https://doi.org/10.1016/j.injury.2006.06.008
  20. Thorngren KG: Optimal treatment of hip fractures. Acta Orthip Scand, Suppl, 241: 31-34, 1991.
  21. Windolf J, Hollander DA, Hakimi M, Linhart W. Pitfalls and complications in the use of the proximal femoral nail. Langenbecks Arch Surg, 390: 59-65, 2005. https://doi.org/10.1007/s00423-004-0466-y