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1 대한골절학회지제 19 권, 제 3 호, 2006 년 7 월 Journal of the Korean Fractrure Society Vol. 19, N o. 3, July, 2006 대퇴전자간골절의치료에서 ITST 골수정과근위대퇴골수정 () 의비교 손욱진김세동김인환변성준 영남대학교의과대학정형외과학교실 목적 : 대퇴전자간골절환자에게 ITST 골수정과근위대퇴골수정 () 으로수술을시행한환자군의결과를비교분석하고자하였다. 대상및방법 : 2002 년 7 월부터 2005 년 11 월까지대퇴전자간골절을가진환자중 ITST 골수정과근위대퇴골수정을사용하여수술을시행한각각 30 예를대상으로하였다. 방사선적결과는수술전및수술후정기적으로시행한방사선촬영을분석하였으며, 결과는 Parker 와 Palmer 의보행점수와 Salvati 와 Wilson 의고관절기능점수및 Jensen 의사회기능점수를이용하여분석하였다. 결과 : 방사선적결과중지연나사의평균활강은 ITST 군이 4.1 mm, 군이 6.6 mm 로유의한차이를보였다 (p=0.003). 임상적결과로 Parker 와 Palmer 의보행점수와 Salvati 와 Wilson 의고관절기능점수의하락은 ITST 군과 군에서서로유사하게나타났다. 근위외측대퇴부통증을호소한환자는 ITST 군에서 5 예 (17%), 군에서 8 예 (27%) 였다. 결론 : 대퇴전자간골절에서 ITST 골수정과 을이용한치료는안정골절및불안정골절에서양군모두좋은결과를얻었다. 색인단어 : 대퇴전자간골절, 근위대퇴골수정, ITST 골수정 A Comparative Study of Trochanteric Fractures Treated with the Intertrochanteric/subtrochanteric Fixation or the Proximal Femoral Nail Oog Jin Sohn, M.D., Sae Dong Kim, M.D., In Whan Kim, M.D., Seong Joon Byun, M.D. Department of Orthopaedic Surgery, Yeung Nam University Hospital, Daegu, Korea Purpose: To evaluate the radiographic, clinical results and the complications between who had intertrochanteric fracture, treated with the ITST or the. Materials and Methods: We selected each 30 patients of intertrochanteric fracture which were treated with ITST or from July 2002 to November We evaluated the radiographic results by follow-up radiography and the clinical results with the mobility score of Parker and Palmer, Salvati and Wilson hip function scoring system and Jensen index. Results: The mean distance of lag screw sliding was 4.1 mm at the ITST group and 6.6 mm at the group. Decrease of mobility score of Parker and Palmer, Salvati and Wilson hip function score were similar. Patients complaint pain over lateral thigh area in 5 cases (ITST group) and 8 cases ( group). Conclusion: The ITST nail and were seen good results in treatment of stable and unstable intertrochanteric fracture. Key Words: Femur intertrochanteric fracture, Proximal femoral nail, Intertrochanteric/subtrochanteric fixation 통신저자 김세동 Address reprint requests to Sae Dong Kim, M.D. Department of Orthopaedic Surgery, Yeung Nam University Hospital, 317-1, Deamyeong-dong, Nam-gu, Daegu , Korea Tel Fax Tel Fax sdk@med.yu.ac.kr sdk@med.yu.ac.kr 303

2 304 서 론 2. 수술방법및재활 대상및방법 3. 평가방법 1. 연구대상

305 대퇴 전자간 골절의 치료에서 ITST 골수정과 근위 대퇴 골수정()의 비교 결 과 평균 수술시간은 ITST군에서 89.3분, 군에서 98.2분이 었으며 평균 수혈량은 각각 2.4, 2.2 pint였다. 또 평균 재원 기간은 각각 25.1일과 26일이었다 (Table 1). 방사선적 결과로 골 유합 기간은 각각 5.3개월과 5.

$1 98.2 2.2 26.0 Fig. 1. (A) 72 years old female who had trochanteric fracture by slip down. (B) Treated with ITST nail. Postoperative AP view, length of lag screw was 36.2 mm.$

3 305 대퇴 전자간 골절의 치료에서 ITST 골수정과 근위 대퇴 골수정()의 비교 결 과 평균 수술시간은 ITST군에서 89.3분, 군에서 98.2분이 었으며 평균 수혈량은 각각 2.4, 2.2 pint였다. 또 평균 재원 기간은 각각 25.1일과 26일이었다 (Table 1). 방사선적 결과로 골 유합 기간은 각각 5.3개월과 5.5개월 로 두 군 간의 차이는 없었으나 두 군 모두 안정형 골절이 Table 1. Intra-, postoperative data ꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚ ITST Mean Op time (min.) Transfusion (pint) Hospital day Fig. 1. (A) 72 years old female who had trochanteric fracture by slip down. (B) Treated with ITST nail. Postoperative AP view, length of lag screw was 36.2 mm. (C) Lag screw sliding was checked 4.6 mm at follow up 7 months. Fig. 2. (A) 58 years old male who got traffic accident. (B) Treated with. Postoperative AP view, length of lag screw was 38.7 mm. (C) Lag screw sliding was checked 7.2 mm at follow up 15 months.

) Stable Unstable Totally Lag screw sliding (mm) Stable Unstable Totally Change of neck-shaft angle ( o ) 4.6 5.6 5.3 4.7 5.9 5.5 나타내었다. 지연 나사의 평균 활강은 ITST 군에서 4.1 mm (0 12.5 mm), 군에서는 6.6 mm (2.

4 306 손욱진, 김세동, 김인환, 변성준 불안정형 골절보다 골 유합 시기가 빨라 ITST군의 경우는 안 정형 골절과 불안정형 골절이 각각 4.6개월과 5.7개월로 군의 경우는 4.7개월과 5.9개월로 서로 유의한 차이를 Table 2. Comparison of radiologic results between ITST and ꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚ ITST Bone union (mo.) Stable Unstable Totally Lag screw sliding (mm) Stable Unstable Totally Change of neck-shaft angle ( o ) 나타내었다. 지연 나사의 평균 활강은 ITST 군에서 4.1 mm ( mm), 군에서는 6.6 mm ( mm)로 군이 더 큰 지연 나사의 활강을 보였다 (p=0.003) (Fig. 1, 2). 이를 안정형 골절과 불안정형 골절군으로 나누어 비교한 결 과 불안정형 골절에서 양 군 간의 지연 나사 활강의 차이가 더 유의하게 나타났다 (안정형 골절 p=0.135, 불안정형 골절 Table 3. Comparison of clinical results between ITST and ꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚꠚ ITST ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ Preop. Postop. Preop. Postop. 3 (±2.7) 4.6 (±3.2) 4.1 (±3.1) (±1.9) 7.5 (±3.3) 6.6 (±3.2) 0.9 Mobility score of Parker and Palmer Salvati and Wilson hip function scoring system Fig. 3. (A) 76 year old female had unstable hip fracture by slip down. (B) Treated with. (C) After 15 months later, she suffered lateral thigh pain. (D) Remove anti-rotation screw and change hip screw more short.

5 307 고찰 결론

6 308 Surg, 74-B: , ) Moon DH, Choi JS, Kim GB, Kim JW and Kim KT: 참고문헌 1) Al-yassari G, Langstaff RJ, Jones JW and Al-Lami M: The AO/ASIF proximal femoral nail () for the treatment of unstable trochanteric femoral fracture. Injury, 33: , ) Banan H, Al-Sabti A, Jimulia T and Hart AJ: The treatment of unstable, extracapsular hip fractures with the AO/ASIF proximal femoral nail ()--our first 60 cases. Injury, 33: , ) Butt MS, Krikler SJ, Nafie S and Ali MS: Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial. Injury, 26: , ) Chevalley F and Gamba D: Gamma nailing of pertrochanteric and subtrochanteric fractures: clinical results of a series of 63 consecutive cases. J Orthop Trauma, 11: , ) Davis TR, Sher JL, Horsman A, Simpson M, Porter BB and Checketts RG: Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg, 72-B: 26-31, ) Hardy DC, Descamps PY, Krallis P, et al: Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients. J Bone Joint Surg, 81-A: , ) Domingo LJ, Cecilia D, Herrera A and Resines C: Trochanteric fractures treated with a proximal femoral nail. Int Orthop, 25: ) Fogagnolo F, Kfuri M Jr and Paccola CA: Intramedullary fixation of pertrochanteric hip fractures with the short AO- ASIF proximal femoral nail. Arch Orthop Trauma Surg, 124: 31-37, ) Jensen JS: Determining factors for the mortality following hip fractures. Injury, 15: , ) Kaufer H: Mechanics of the treatment of hip injuries. Clin Orthop, 146: 53-61, ) Kyle RF, Cabanela ME, Russell TA, et al: Fractures of the proximal part of the femur. Instr Course Lect, 44: , ) Leung KS, Chen CM, So WS, et al: Multicenter trial of modified Gamma nail in East Asia. Clin Orthop, 323: , ) Leung KS, So WS, Shen WY and Hui PW: Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. J Bone Joint Treatment of unstable intertrochanteric femoral fracture with the AO/ASIF proximal femoral nail (). J Korean Fracture Soc, 16: , ) Pagnani MJ and Lyden JP: Postoperative femoral fracture after intramedullary fixation with a Gamma nail: case report and review of the literature. J Trauma, 37: , ) Parker MJ and Palmer CR: A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg, 75-B: , ) Radford PJ, Needoff M and Webb JK: A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg, 75-B: , ) Rosenblum SF, Zuckerman JD, Kummer FJ and Tam BS: A biomechanical evaluation of the Gamma nail. J Bone Joint Surg, 74-B: , ) Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R and Hoffmeyer P: Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study. J Bone Joint Surg, 84-A: , ) Salvati EA and Wilson PD Jr: Long-term results of femoralhead replacement. J Bone Joint Surg, 55-A: , ) Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R and Hoffmeyer P: Pertrochanteric fractures: is there an advantage to an intramedullary nail?: a randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. J Orthop Trauma, 16: , ) Schipper IB, Steyerberg EW, Castelein RM, et al: Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail. J Bone Joint Surg, 86-B: 86-94, ) Shin DK, Kwun KW, Kim SK, Lee SW, Choi CH and Kim KM: Proximal femoral nail () for femur intertrochanteric fracture. J Korean Fracture Soc, 15: , ) Simmermacher RK, Bosch AM and Van der Werken C: The AO/ASIF-proximal femoral nail (): a new device for the treatment of unstable proximal femoral fractures. Injury, 30: , ) Simpson AH, Varty K and Dodd CA: Sliding hip screws: modes of failure. Injury, 20: , ) Thorngren KG: Optimal treatment of hip fractures. Acta Orthip Scand, 241(Suppl): 31-34, ) Zafiropoulos G and Pratt DJ: Fractured Gamma nail. Injury, 25: , 1994.

11-11주석규

11-11주석규 Original Article PFNA and PFN in Intertrochanteric Fractures - Comparison Study of Sliding - Suk Kyu Choo, MD, Hyoung Keun Oh, MD, Jun Young Choi, MD Department of Orthopedic Surgery, Ilsan Paik Hospital,