Hip & pelvis

  • 제23권4호
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  • Pages.290-296
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  • 2011
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  • 2287-3260(pISSN)
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  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
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대퇴골 전자간 골절에서 가압 골시멘트 압박고나사 내고정시 대전자 안정화 금속판 보강의 효과에 대한 분석비교

The Clinical Results of Pressurized Cement-Augmented Richard Compression Hip Screw with Trochanteric Stabilizing Plate for Intertrochanteric Fracture Compared with Pressurized Cement-Augmented Richard Compression Hip Screw Only

  • 이경진 (대림성모병원 정형외과) ;
  • 이은상 (가톨릭대학교 의과대학 정형외과학교실 성모병원) ;
  • 김태균 (가톨릭대학교 의과대학 정형외과학교실 성모병원) ;
  • 우영균 (가톨릭대학교 의과대학 정형외과학교실 성모병원) ;
  • 권순용 (가톨릭대학교 의과대학 정형외과학교실 성모병원)
  • Rhee, Kyung-Jin (Department of Orthopaedic Surgery, Daelim St. Mary's Hospital) ;
  • Lee, Eun-Sang (Department of Orthopaedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Tae-Gyun (Department of Orthopaedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Woo, Young-Kyun (Department of Orthopaedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Soon-Yong (Department of Orthopaedic Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 발행 : 2011.12.31
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초록

목적: 골시멘트 보강 압박고나사(RCHS) 단독 내고정 및 대전자 안정화 금속판(TSP)을 병용한 내고정 방법으로 대퇴골 전자간부 골절의 치료 시, 두 술기에 대한 방사선 추시 결과 및 술 후 기능 평가를 비교 분석하였다. 대상 및 방법: 2006년 1월부터 2008년 12월까지 단독 내고정 방법으로 수술한 23명, 23예 및 TSP를 병용한 내고정 방법으로 수술한 24명 25예를 대상으로 하였다. 방사선적으로 골절의 분류, 골절 부위의 압박 정도, 하지 길이 단축 정도, 골절의 유합 기간을 평가하였으며, 술 후 기능 평가는 Koval 분류를 이용하였다. 결과: 골절 부위 압박 및 단축 모두 단독 내고정 군에서 통계학적으로 유의하게 증가하였으며, 유합 기간의 차이는 단독 내고정군이 5.3개월 대전자 안정화 금속판을 병용한 군이 6.6개월 이었다. 보행 능력 평가 상 대전자 안정화 금속판을 병용한 내고정 군에서 더 양호한 결과를 보였다. 고정 실패는 단독 내고정 군에서만 1예 발생하였으며, 모든 예에서 수술 전 후 전신 합병증으로 인한 사망은 발생하지 않았다. 결론: 고령의 불안정성 대퇴골 전자간부 골절의 치료 시, 단독 내고정 방법으로도 압박고나사의 골두 천공 및 해리는 방지할 수 있지만, 하지 단축을 초래하는 과도한 골절부의 압박은 불가피하다. 특히 심한 골다공증을 동반한 경우나 골절 부위 직경이 가는 경우, 잠재 골절이 있는 경우에는 대전자 안정화 금속판의 병용 사용이 권장된다.

Purpose: We analyzed the radiologic and clinical outcomes of osteosynthesis using a Richard compression hip screw (RCHS) alone or RCHS with a trochanteric stabilizing plate (TSP) in patients with an intertrochanteric fracture. Materials and Methods: From January 2006 to December 2008, 23 patients (23 cases) underwent osteosynthesis using only RCHS and 24 patients (25 cases) underwent osteosynthesis using RCHS and TSP. We evaluated the classification of fractures, the amount of collapse and shortening, and the duration of fracture union. We used a Koval classification for the evaluation of clinical outcomes. Results: The amount of collapse and shortening in the RCHS-only group was statistically greater than the amount in the RCHS-with-TSP group. The union duration of fracture was 5.3 months in the RCHS-only group and 6.6 months in the RCHS-with-TSP group. The clinical outcomes in the RCHS-with TSP-group were better than the RCHS-only group. We had one case of fixation failure in the RCHS-only group and none in the RCHS-with-TSP group. There were no perioperative systemic complications or death. Conclusion: In patients with unstable intertrochanteric fractures, we can prevent the cut out of the lag screw or screw loosening with the use of pressurized PMMA-augmented RCHS. However, we cannot prevent excessive collapse and shortening, especially in patients with severe osteoporosis, a small diameter of the femur neck, or concealed fractures. In the case of these patients, we recommend you to use RCHS with TSP for the prevention of excessive collapse and shortening.

키워드

참고문헌

  1. Laros GS. Intertrochnteric fractures. In: Evarts CM, ed. New York: Churchill Livingstone; 1990. 2613-39.
  2. Bartucci EJ, Gonzalez MH, Cooperman DR, Freedberg HI, Barmada R, Laros GS. The effect of adjunctive methylmethacrylate on failures of fixation and function in patients with intertrochanteric fractures and osteoporosis. J Bone Joint Surg Am. 1985;67:1094-107.
  3. Bonnaire F, Gotschin U, Kuner EH. Early and late results of 200 DHS osteosynthesis in the reconstruction of pertrochanteric femoral fractures. Unfallchirurg. 1992; 95:246-53.
  4. Bridle SH, Patel AD, Bircher M, Calvert PT. Fixation of intertrochantertic fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg Br. 1991;73:330-4.
  5. Haentjens P, Casteleyn PP, De Boeck H, Handelberg F, Opdecam P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989;71:1214-25.
  6. Jensen JS. Classification of trochanteric fractures. Acta Orthop Scand. 1980;51:803-10. https://doi.org/10.3109/17453678008990877
  7. Muller Farber J, Wittner B, Reichel R. Late results in the management of pertrochanteric femoral fractures in the elderly with the dynamic hip screw. Unfallchirurg. 1988; 91:341-50.
  8. Clark DW, Ribbans WJ. Treatment of unstable intertrochanteric fractures of the femur: a prospective trial comparing anatomical reduction and valgus osteotomy. Injury. 1990;21:84-8. https://doi.org/10.1016/0020-1383(90)90060-8
  9. David A, Hufner T, Lewandrowski KU, Pape D, Muhr G. The dynamic hip screw with support plate--a reliable osteosynthesis for highly unstable "reverse" trochnateric fractures? Chirurg. 1996;67:1166-73. https://doi.org/10.1007/s001040050120
  10. Hersche O, Heim D, Bodoky A, Regazzoni P. 4 fragment fractures of the proximal femur: is the dynamic hip screw a suitable impalnt? Helv Chir Acta. 1989;56:577-80.
  11. Sarmiento A, Williams EM. The unstable intertrochanteric fracture: treatment with a valgus osteotomy and I-beam nail-plate. A preliminary report of one hundred cases. J Bone Joint Surg Am. 1970;52:1309-18.
  12. Kim BJ, Lee SJ, Kwon SY, Tak KR, Lee KY. A biomechanical study on a new surgical procedure for the treatment of intertrochnteric fractures in relation to osteoporosis of varying degree. J Biomed Eng Res. 2003; 24:401-10.
  13. Massoud EI. Fixation of basicervical and related fracture. Int Orthop. 2010;34:577-82. https://doi.org/10.1007/s00264-009-0814-1
  14. 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. 1995;310:150-9.
  15. Doppelt SH. The sliding compression screw--today's best answer for stabilization of intertrochanteric hip fractures. Orthop Clin North Am. 1980;11:507-23.
  16. Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD. Patients with femoral neck and intertrochanteric fractures. Are they the same? Clin Orthop Relat Res. 1996;330:166-72.
  17. Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77:1058-64.
  18. Haidukewych GJ, Israel TA, Berry DJ. Reverse obliquity fractures of the intertrochanteric region of the femur. J Bone Joint Surg Am. 2001;83-A:643-50.
  19. Calvert PT. The Gamma nail--a significant advance or passing fashion? J Bone Joint Surg Br. 1992;74:329-31.
  20. Fridel W, Colombo-Benkmann M, Dockter S, Machens HG, Mieck U. Gamma nail osteosynthesis of per- and subtrochanteric femoral fractures. 4 years experiences and their consequences for further implant development. Chirurg. 1994;65:953-63.
  21. Leung KS, So WS, Shen WY, Hui PW. Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Surg Br. 1992;74:345-51.