Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Comparison of the Gamma Nail and the Dynamic Hip Screw for Peritrochanteric Fracture

대퇴골 전자부 골절에서 감마정과 활강 압박 고나사의 치료 결과 비교

  • Kweon, Seok-Hyun (Department of Orthopedic Surgery, College of Medicine, Wonkwang University, Institute of Wonkwang Medical Science)
  • 권석현 (원광대학교 의과대학 정형외과학교실, 원광의과학연구소)
  • Published : 2011.06.30
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Abstract

Purpose: To retrospectively compare the clincal and radiological results between the gamma nail and dynamic hip screw (DHS) on the operative treatment of unstable peritrochanteric fractures. Materials and Methods: From January 1999 to December 2006, we selected 215 patients who could be observed at least 1 year among 246 patients who received surgical treatment for unstable peritrochanteric fractures in our hospital. Eighty-six patients were males and 129 were females; the mean age was 72 years. Evans unstable fracture was included in our study. The gamma nail was applied in 133 cases, and the dynamic hip screw was applied in 82 cases. We evaluated union times, the collapse intensity of fractured sites after union, hospitalization duration, operation time, and post-operative complications. Results: The mean union time was 15.7 weeks with the DHS and 13.7 weeks with the gamma nail. The collapse intensity of fracture sites were 3.5 mm and 1.9 mm, respectively. The mean hospital durations were 19.5 days for DHS surgery and 16.3 days for gamma nail surgery. The mean operation time was 85.5 minutes for DHS and 98.2 minutes for gamma nail. The post-operative complications were loosening of internal fixator (6 cases in DHS, 1 case in gamma nail), perforation of the femoral head (2 cases in DHS, 1 case in gamma nail), and non-union (7 cases in DHS, 2 cases in gamma nail). Conclusion: In unstable peritrochanteric fractures, biomechanically stable gamma nailing is thought to be one of the most effective treatments for reducing fracture site collapse and complications.

목적: 불안정성 대퇴골 전자부 골절의 치료로 감마정 또는 활강 압박 고나사을 이용한 내고정 술의 치료 결과를 후향적으로 비교 분석하여 하였다. 대상 및 방법: 1999년 1월에서 2006년 12월까지 본원에서 불안정성 대퇴골 전자부 골절로 수술적 치료를 받은 246명 환자 중 최소 1년 이상 추시가 가능하였던 환자 215명 215예를 대상으로 하였으며 평균 연령은 72세였고, 남자는 86명, 여자는 129명에 해당하였다. 골절 양상은 Evans 분류상 불안정성 골절을 대상으로 하였으며, 내고정물로 감마정이 133예, 활강 압박 고나사가 82예였다. 두 군간의 골유합 시기, 유합 후 전자간 골절 부위의 함몰 정도, 입원 기간, 수술 시간, 술 후 합병증을 비교하였다. 결과: 골유합 기간은 활강 압박 고나사군이 평균 15.7주 소요되었고 감마정군이 13.5주 소요되었으며, 유합 후 대퇴골 골절부 함몰 정도는 각각 평균 3.5 mm와 평균 1.9 mm로 나타났다. 입원 기간은 활강 압박 고나사군이 평균 19.5일, 감마정군은 평균 16.3일로 측정되었으며, 평균 수술 시간은 각각 평균 85.5분, 평균 98.2분으로 측정되었다. 술후 합병증으로 내고정물의 이완이 활강 압박 고나사군에서 6예, 감마정군에서 1예에서 보였으며, 대퇴골두 천공은 각각 2예, 1예, 불유합은 각각 7예, 2예를 보였다. 결론: 불안정성 대퇴골 전자부 골절의 치료에 있어 생체 역학적으로 안정성이 있는 감마정이 골절부 함몰과 합병증을 줄일 수 있는 한 방법이라 사료된다.

Keywords

References

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