Hip & pelvis

  • 제21권4호
  • /
  • Pages.339-344
  • /
  • 2009
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지

90세 이상의 고령 환자에서 발생한 전자간 골절의 근위 대퇴정을 이용한 치료

Treatment of Intertrochanteric Fracture Using Proximal Femoral Nail for Patients over 90 Years Old

  • 남우동 (강원대학교 의과대학 강원대학병원 정형외과학 교실, 강원대학교 병원 임상 의학연구소) ;
  • 박일호 (강원대학교 의과대학 강원대학병원 정형외과학 교실, 강원대학교 병원 임상 의학연구소) ;
  • 한계영 (강원대학교 의과대학 강원대학병원 정형외과학 교실, 강원대학교 병원 임상 의학연구소)
  • Nam, Woo-Dong (Department of Orthopedic Surgery, Kangwon National University, College of Medicine, Clinical Research Institute, Kangwon National University Hospital) ;
  • Park, Ill-Ho (Department of Orthopedic Surgery, Kangwon National University, College of Medicine, Clinical Research Institute, Kangwon National University Hospital) ;
  • Han, Kye-Young (Department of Orthopedic Surgery, Kangwon National University, College of Medicine, Clinical Research Institute, Kangwon National University Hospital)
  • 발행 : 2009.12.31

⟨ 이전 논문 다음 논문 ⟩

초록

목적: 90세 이상의 고령 환자에서 발생한 전자간 골절의 근위 대퇴정을 이용한 치료 결과를 알아보고자 하였다. 대상 및 방법: 2005년 1월부터 2008년 12월까지 근위 대퇴정을 이용하여 치료받은 90세 이상인 대퇴골 전자간 골절 환자 20예중 6개월 이상 추시가 가능한 16예를 대상으로 하였다. 환자들의 평균 연령은 93.9세였고 여자는 13명, 남자는 3명이었다. 임상적 분석은 환자의 활동도를 변형 Koval 지수를 사용하여 분석하였고 방사선학적 분석으로는 단순 방사선 사진을 통하여 골유합 상태 및 합병증을 조사하였다. 결과: 변형 Koval 지수는 술 전 평균 3.1에서 술 후는 평균 1.8로 감소하였다. 수상 전 상태로 기능적 회복이 가능하였던 환자는 5명이었다. 방사선적 골유합 시기는 평균 8.2주였고 골두 천공 및 불유합 등이 관찰된 환자는 없었다. 결론: 90세 이상의 고령 환자에서 근위 대퇴정을 이용한 전자간 골절 치료 결과는 31%의 환자에서 수상 전 보행 상태로 회복을 보였다. 그러나 방사선학적 검사상 모두 골유합 되었고 내고정과 관련된 합병증이 발생하지 않았던 바 90세 이상 고령 환자의 대퇴 전자간 골절 치료에 유용한 내고정물로 생각된다.

Purpose: This study examined the clinical and radiologic results of a proximal femoral nail (PFN) used to treat an intertrochanteric fracture of the femur in elderly people more than 90 years of age. Materials and Methods: Between January 2005 and December 2008, 20 patients over 90 years old with an intertrochanteric fracture were treated with a PFN. Among them, 16 patients (mean age, 93.9 years; 13 females and 3 males) were followed up for a minimum of 6 months. Clinically, the modified Koval index was evaluated. Radiological bony union and complications were evaluated from the plain X-ray film. Results: The average modified Koval index decreased from 3.1 before surgery to 1.8 after surgery. Only 5 cases could return to their pre-injury status. Radiologic bony union was achieved after an average of 8.2 weeks and there were no complications, such as non-union and femoral head perforations. Conclusion: Thirty one percent of patients older than 90 years and treated for an intertrochanteric fracture with a PFN had recovered to their pre-injury ambulatory status. However, all cases showed bony union and no complications. Overall, PFN might be a good treatment option for intertrochanteric fractures in elderly people older than 90 years.

키워드

참고문헌

  1. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in prediction failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg, 77-A: 1058-1064, 1995.
  2. Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and cost. J Am Geriatr Soc, 51: 364-370, 2003. https://doi.org/10.1046/j.1532-5415.2003.51110.x
  3. Chan KC, Gill GS. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop Relat Res, 371: 206-215, 2000. https://doi.org/10.1097/00003086-200002000-00025
  4. 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
  5. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg, 31-B: 190-203, 1949.
  6. Haidukewych GJ, Berry DJ. Hip arthroplasty for salvage of failed treatment of intertrochanteric hip fractures. J Bone Joint Surg, 85-A: 899-904, 2003.
  7. Green S, Moore T, Proano F. Bipolar prosthetic replacement for the management of unstable intertrochanteric hip fractures in the elderly. Clin Orthop Relat Res, 224: 167- 177, 1987.
  8. Rhyu KH, Han KY, Chae WY. Comparision of the $Targon {\circledR}$ proximal femoral nail and the compression hip screw for treating intertrochanteric fracture of the femur. J Korean Hip Soc, 20: 278-285, 2008.
  9. Herrera A, Doming LJ, Calvo A, Martinez A, Cuenca J. A comparative study of trochanteric fractures treated with the gamma nail or the proximal femoral nail. Int Orthop, 26: 365-369, 2002. https://doi.org/10.1007/s00264-002-0389-6
  10. Anglen JO, Weinstein JN. Weinstein. Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database. J Bone Joint Surg, 90-A: 700-707, 2008.
  11. Korea National Statistical Office. 2005 Population and housing census report. Daejeon, The Office, 2006.
  12. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res, 310: 150-159, 1995.
  13. Koval KJ, Zuckerman JD. Functional recovery after fracture of the hip. J Bone Joint Surg, 76-A: 751-758, 1994.
  14. Robert DD, James EE, David EL, Leroy DV, Frank LM. Introduction to anesthesia 9th ed. Philadelphia, WB Saunders Co.: 18-19, 1997.
  15. Forte ML, Virnig BA, Kane RL, et al. Geographic variation in device use for intertrochanteric hip fracture. J Bone Joint Surg, 90-A: 691-699, 2008.
  16. Moon YW, Suh DH, Kang ST, Kwon DJ, Ji YN, Lee KB. The proximal femoral nail for intertrochanteric fracture of the femur. J Korean Soc Fractures, 16: 29-36, 2003.
  17. Nam WD, Han KY, Kim KW, et al. Targon proximal femoral nail used for treatment of intertrochanteric femoral fractures not observed in any cases. J Korean Hip Soc, 20: 7-14, 2008.
  18. Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E. A randomised 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
  19. Parker MJ, Khan RJ, Crawford J, Pryor GA. Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients. J Bone Joint Surg, 84-B: 1150-1155, 2002.
  20. Simmermacher RK, Bosch AM, Van der Werken C. The The 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
  21. Steinberg GG, Desai SS, Kornwitz NA, Sullivan TJ. The intertrochanteric hip fracture. A retrospective analysis. Orthopaedics, 11: 265-273, 1988.
  22. Sung YB, Sohn YJ, Yum JG, et al. Proximal femoral nail(PFN) for intertrochanteric fracuture: long-term follow-up results. J Korean Hip Soc, 17: 141-148, 2005.
  23. Templeman D, Baumgaertner MR, Leighton RK, Lindsey RW, Moed BR. Reducing complications in the surgical treatment of intertrochanteric fractures. Instr Course Lect, 54: 409-415, 2005.
  24. Zuckerman JD, Skovron ML, Koval KJ, Aharonoff G, Frankel VH. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg, 77-A: 1551-1556, 1995.