Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Two-Incision Bipolar Hemiarthroplasty for Treating Femoral Neck Fracture -Analysis of 15 Cases -

두 개 절개를 이용한 양극성 고관절 반치환술 - 15예의 분석 -

  • Kim, Byung-Hak (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Chung, Young-Yool (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Jun, Sung-Hoon (Department of Orthopaedic Surgery, Kwangju Christian Hospital) ;
  • Choi, Dong-Hyeok (Department of Orthopaedic Surgery, Kwangju Christian Hospital)
  • 김병학 (광주기독병원 정형외과) ;
  • 정영율 (광주기독병원 정형외과) ;
  • 전성훈 (광주기독병원 정형외과) ;
  • 최동혁 (광주기독병원 정형외과)
  • Published : 2010.09.30
⟨ Previous Next ⟩

Abstract

Introduction: We wanted to evaluate the efficacy of bipolar hemiarthroplasty using Berger' two-incision surgical technique for patients with muscular weakness around the hip joint and/or a high risk of dislocation. Materials and Methods: We performed bipolar hemiarthroplasty for 15 femoral neck fractures using Berger' twoincision technique between December 2005 and July 2007. The mean age of the patients was 75.2 years old. Four of them had difficulty in walking due to the sequalae after stroke and five have been treated for psychoneurologic disorders. We investigated the operation time, the length of the anterior and posterior incisions, the amount of bleeding, the time untill walking after the operation, the total hospital stay, the recovery to activities of daily living and the complications such as dislocation. Results: The mean operating time was 93 minutes. The average anterior and posterior skin incision length was 6.4 cm and 7.2 cm, respectively. The mean amount of bleeding was 420 cc at the time of surgery and 230 cc postoperatively through a drain. The patients started walking at a mean of 3.3 (1 to 5) days after the operation and the mean hospitalization was 24.3 days. Fourteen patients went back to their pre-injured activities of daily living, except one case with an intraoperative periprosthetic fracture. As for complications, two cases (13.3%) of femoral fracture were intraoperatively observed and one case of skin necrosis on the anterior incision site occurred. There were not any cases of dislocation or infection. Conclusion: Two-incision bipolar hemiarthroplasty had advantages for rehabilitation in elderly patients who have a high risk of dislocation, as well as in the patients with muscle weakness. But the operation took a long time and it had a high complication rate.

목적: 근력 약화로 재활치료에 어려움이 예상되거나 탈구의 고위험군 환자에 한하여 Berger가 사용하였던 두 개 절개 수술 방법을 이용하여 인공 고관절 반치환술을 시행하고 이 수술 방법의 유용성에 대해 조사하였다. 대상 및 방법: 2005년 12월부터 2007년 7월까지 새로운 수술 방법을 이용한 15명을 대상으로 하였다. 평균연령은 75.2세 이었다. 15명 중 4명은 뇌경색 후유증인 편측 마비로 보행에 제한이 있었으며 5명은 신경정신과적인 문제로 치료 중이었다. 수술 시간, 출혈량, 절개 길이, 수술 후 보행시작, 입원 기간, 일상 생활 회복 정도, 합병증에 대해 조사하였다. 결과: 수술 시간은 평균 93분이었다. 절개 길이는 전방 평균 6.4 cm, 후방 평균 7.2 cm이었다 수술 중 출혈양은 평균 420 cc이었으며, 수술 후 출혈량은 평균 230 cc이었다. 보행 시작은 수술 후 평균 3.3일 (1~5일) 이었다. 입원 기간은 평균 24.3일 이었다. 15명 중 14명에서 수상 전 보행 상태를 회복하였다. 2예에서 수술 중 대퇴골 골절이 발생하여 강선을 이용하여 고정하였으며, 1예에서 전방 절개의 피부 부분 괴사가 발생하였다. 최종 추시에서 탈구나 재치환술은 없었다. 결론: 새로운 수술법은 근력의 약화가 있는 환자나 고령환자에서 재활치료에 장점이 있었으나 긴 수술시간과 높은 합병증은 문제점이었다.

Keywords

References

  1. Jain NB, Losina E, Ward DM, Harris MB, Katz JN. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relate Res. 2008;466:3116-22. https://doi.org/10.1007/s11999-008-0392-3
  2. Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fracture: a meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthop. 2006;77:359-67. https://doi.org/10.1080/17453670610046262
  3. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clinic Orthop Relat Res. 2003;417:232-41.
  4. Bal BS, Lowe JA. Muscle damage in minimally invasive total hip arthroplasty: MRI evidence that it is not significant. Instr Course Lect. 2008;57:223-29.
  5. Hur CI, Yoon TR, Park KS, Cho SG, Yim JH. Minimally invasive two-incision total hip arthroplasty for treating acute displaced femoral neck fractures in active elderly patients. J Korean Orthop Assoc. 2008;43:643-50. https://doi.org/10.4055/jkoa.2008.43.5.643
  6. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results. Hip Int. 2006, 16 Suppl 4:28-34. https://doi.org/10.1177/112070000601604S07
  7. Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006;453:293-98. https://doi.org/10.1097/01.blo.0000238859.46615.34
  8. Woolson ST. In the absence of evidence--why bother? A literature review of minimally invasive total hip replacement surgery. Instr Course Lect. 2006;55:189-93.
  9. Macaulay W, Nellans KW, Iorio R, Garvin KL, Healy WL, Rosenwasser MP; DFACTO Consortium. Total hip arthroplasty is less painful at 12 months compared with hemiarthroplasy in treatment of displaced femoral neck fracture. HSS J. 2008;4:48-54. https://doi.org/10.1007/s11420-007-9061-4
  10. Iorio R, Healy WL, Lemos DW, Appleby D, Lucchesi CA, Saleh KJ. Displaced femoral neck fractures in the elderly: outcomes and cost effectiveness. Clin Orthop Relat Res. 2001;383:229-42. https://doi.org/10.1097/00003086-200102000-00027
  11. Ninh CC, Sethi A, Hatahet M, Les C, Morandi M, Vaidya R. Hip dislocation after modular uniploar hemiarthroplasty. J Arthroplasty. 2009;24:768-74. https://doi.org/10.1016/j.arth.2008.02.019