09-05 성열보(국)

ORIGINAL ARTICLE http://dx.doi.org/10.5371/hp.2013.25.1.57 Print ISSN 2287-3260 Online ISSN 2287-3279 Traumatic Dislocation of the Hip with a Femoral Head Fracture Yerl-Bo Sung, MD, PhD, Jung-Yun Choi, MD, Jong-Woo Kim, MD Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University, Seoul, Korea Purpose: This study was designed in order to evaluate the clinical results and frequency of complications of patients who underwent surgical treatment for traumatic dislocation of the hip with a femoral head fracture. Materials and Methods: Eighteen cases of Thompson-Epstein type V femoral head fracture with dislocation of the hip from November 2002 to November 2011 were analyzed retrospectively. We divided the cases into two groups according to availability of closed reduction and reduction time, and analyzed the clinical results according to Epstein criteria and frequency of avascular necrosis of the femoral head and posttraumatic osteoarthritis. Results: Among all patients, the observed complications included three cases of avascular necrosis and one case of posttraumatic osteoarthritis. The data showed that 14 cases were available for closed reduction; otherwise, there were four cases of failure. Significant differences were observed in clinical results and frequency of complications. Results regarding reduction time showed that 10 cases took 6 hours, and the other eight cases took more than 6 hours. There were no differences in clinical results, but, better results were achieved with a reduction time in 6 hours. However, significant differences were observed in frequency of complications. Conclusion: The availability of closed reduction would be an important factor for achievement of good clinical results in traumatic dislocation of the hip with a femoral head fracture. In order to obtain better clinical results, closed reduction should be performed as rapidly as possible. Key Words: Femoral head fracture, Dislocation of the hip, Thompson-Epstein type V Submitted: November 2, 2012 1st revision: December 11, 2012 2nd revision: January 9, 2013 3rd revision: February 1, 2013 4th revision: March 5, 2013 Final acceptance: March 5, 2013 Address reprint request to Yerl-Bo Sung, MD, PhD Department of Orthopedic Surgery, Sang-Gye Paik Hospital, College of Medicine, Inje University, 761-1 Sang-Gye 7-dong, Nowon-gu, Seoul 139-707, Korea TEL: +82-2-950-1032 FAX: +82-82-2-934-6342 E-mail: ybs58@paik.ac.kr 본논문의요지는 2012 년도대한정형외과학회추계학술대회에서발표되었음. 본논문은 2012 년도인제대학교학술연구조성비보조에의한것임. (This work was supported by the 2012 Inje University Research Grant) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서 론 외상성탈구는정형외과적응급상황으로이중외상성고관절후방탈구는약 5% 를차지하고있고, 대퇴골두의골절을동반하는경우가외상성고관절후방탈구의약 7% 를차지하고있다 1,2). 대퇴골두골절을동반한외상성고관절후방탈구는다른장기의동반손상이빈번할뿐아니라대퇴골두의무혈성괴사, 외상성관절염등합병증을초래할수있어수상초기에신속하고정확한처지와지속적인추시관찰이필요하다. 대퇴골두의골절은드문골절로이에대한임상결과와합병증에대한국내보고도부족한상황이며, 정복까지걸린시간과의연관성을비교분석한연구들도여전히논란의여지가있다. 따라서저자들은 Epstein 3) 기준을이용하여 Thompson-Epstein 4) 분류 V 형에해당하는환자중대퇴골두골절양상에따라 Pipkin 5) 의 Copyright c 2012 by Korean Hip Society 57

4 가지형으로분류하여도수정복가능여부및정복까지걸린시간에따라각각두군으로나누어서이에대해각각의임상결과와합병증발생빈도를알아보고자하였다. 대상및방법 2002 년 11 월부터 2011 년 11 월까지본원에내원한고관절후방탈구환자중대퇴골두골절이동반된 18 예를대상으로 1 년이상추시관찰하여의무기록과방사선기록을후향적으로검토하였다. 포함기준 (inclusion criteria) 은본원에서방사선학적검사및관혈적정복술을모두시행한환자였으며, 제외기준 (exclusion criteria) 은해부학적도수정복후안정성확보및골편의완전정복으로보존적치료를시행한환자였다. 총 18 예중남자가 11 명, 여자가 7 명이었고, 연령분포를보면수상당시연령은최소 17 세에서최대 85 세로평균 44 세였으며, 추시기간은최소 12 개월부터최대 122 개월까지평균 30.8 개월이었다. 수상원인으로교통사고가 13 예로대부분을차지하였고, 5 예에서추락사고에의해발생하였다. 교통사고중차량내부에탑승한상태에서발생한 10 예중 9 예는안전벨트를착용한운전자였고, 1 예는착용하지않은상태로뒷좌석에앉아있었으며, 오토바이탑승으로발생한경우가 3 예였다. 방사선학적측정은 Marosis M-view 5.4(Marotech, Seoul, Korea) 를이용하였으며, 골반골의전후면, 사면상, 입구상, 출구상단순방사선사진과컴퓨터단층촬영검사를분석하여 Thompson-Epstein 4) V형을 Pipkin 5) 분류에따라골절양상을나누었으며, I형이 4예, II형이 2예, IV형이 12예였다. 대퇴골두골절과동반된손상으로 Pipkin I형에서척추손상 1예, 편측대퇴경부골절 1예가있었으며, IV형중 3예에서동측의슬개골골절, 1예에서무릎의측부인대손상과중족골골절, 1예에서발목골절과다발성늑골골절, 1예에서두부손상과삼각골골절, 1예에서전완부골절, 1예에서좌골신경마비가있었다. 정복시기는도수정복이가능하였던 14예중본원에직접내원하여 Allis 6,7) 방법과 Stimpson 6,8) 방법을통해서정복을시행한경우가 12예, 타병원에서정복후전원된경우가 2예였으며, 도수정복이실패하여수술적정복을시행한경우가 4예였다. 정복까지걸린시간은 10예에서 6시간이내에정복을시행할수있었으며, 8예에서 6시간이후에정복을시행할수있었다. 수술접근법은관절경을이용한골편제거술을시행한 2 예를제외한 16예중대퇴골두에나사못고정술을시행한 4예에서는 flip osteotomy, 비구에내고정이필요한 12예에서 Kocher-Langenbeck 도달법을사용하였으며, 이중대퇴골두의내고정이추가로필요한 2예에서 Kocher- Langenbeck 도달법시행후 flip osteotomy를병행하였 Table 1. Criteria for Evaluating Clinical and Radiographic Results Clinical Radiographic Excellent No Pain Normal Relationship between Femoral Head and Acetabulum (All of the Full Range of Hip Motion Normal Articular Cartilage Space Following) No Limp Normal Density of the Head of the Femur No Spur Formation No Calcification in the Capsule Good No Pain Normal Relationship between Femoral Head and Acetabulum Free Motion Minimum Narrowing of the Cartilage Space (75% of Normal Hip) Minimum Deossification Slight Limp Minimum Spur Formation Minimum Capsular Calcification Fair Pain, but not Disabling Normal Relationship between Femoral Head and Acetabulum Limited Motion of Hip Moderate Narrowing of the Cartilage Space : No Adduction Deformity Mottling of the Femoral Head Moderate Limp Moderate Spur Formation Moderate to Severe Capsular Calcification Depression of the Subchondral Cortex of the Femoral Head Poor Disabling Pain Almost Complete Obliteration of the Cartilage Space Marked Limitation of Relative Increase in Density of the Femoral Head Hip Motion Subchondral Cyst Formation or Adduction Deformity Formation of Sequestra Redislocation Gross Deformity of the Femoral Head Severe Spur Formation Acetabular Sclerosis 58 www.hipandpelvis.or.kr

Yerl-Bo Sung et al.: Traumatic Dislocation of the Hip with a Femoral Head Fracture 다. 제 1 저자가모든수술을집도하였고, 환자의추시는수술후 1 개월, 3 개월, 6 개월, 12 개월에하였으며, 그후는 1 년간격으로외래진료를통해서임상적및방사선학적평가를시행하였다. 골반과고관절의단순방사선사진을통해평가하고, 고관절동통및운동범위제한등의이상소견을보일때컴퓨터단층촬영을시행하였으며, 임상적평가에서대퇴골두의무혈성괴사가의심될때자기공명영상을시행하였다. 합병증으로는대퇴골두의무혈성괴사및외상성관절염발생유무에대해서평가하였다. 도수정복이가능한군 (Group R) 과도수정복이불가능한군 (Group NR) 두군으로나누어임상결과와합병증발생빈도를비교분석하였다. 또한, 도수정복까지걸린시간에따라 6 시간을기준으로 6 시간이내정복한군 (Group S) 과 6 시간이후정복한군 (Group L) 두군으로나누어임상결과와합병증발생빈도를비교분석하였다. 임상결과는 Epstein criteria 3,9) 에따라우수, 양호, 보통, 불량으로나누어평가를시행하였다 (Table 1). 통계학적분석은도수정복가능여부및정복까지걸린시간에따른임상결과, 합병증발생빈도, 성별및 Pipkin type 의연관성에대해피셔의정확검정 (Fisher`s exact test) 를사용하여검정하였고, 선형대선형결합법 (linear by linear association) 을이용하여경향성분석 (trend test) 를시행하였다. 나이차이에대해서는 t-test 를이용하였다. 통계분석은상용화된 SPSS 소프트웨어 (SPSS for Windows release 16.0, SPSS, Chicago, IL, USA) 를사용 하였고, P<0.05 일때유의한것으로정의하였다. 결 과 대퇴골두골절을동반한외상성탈구후도수정복이가능한군 (Group R) 은 14 예 ( 우수 5 예, 양호 7 예, 보통 2 예 ), 실패한군 (Group NR) 은 4 예 ( 보통 1 예, 불량 3 예 ) 로두군간에임상결과는유의한차이를보였으며 (P=0.002), 도수정복이가능할수록 Epstein 기준에따른임상결과가좋아지는경향이있었다 (P=0.001). 또한전체합병증발생빈도에서는유의한차이를보였고 (P=0.019), 도수정복이실패한 4 예모두합병증이발생하였다. 나이와성별에따른도수정복가능여부는통계학적으로유의한차이를보이지않았으며 (P=0.336, P=0.119), 대퇴골두골절양상에따라분류한 Pipkin type 역시유의한차이를보이지않았다 (P=0.540) (Table 2). 외상성고관절후방탈구에동반된대퇴골두골절의정복까지걸린시간은 6 시간이내 (Group S) 가 10 예 ( 우수 4 예, 양호 5 예, 보통 1 예 ), 6 시간이후 (Group L) 가 8 예 ( 우수 1 예, 양호 2 예, 보통 2 예, 불량 3 예 ) 로임상결과에서유의한차이를보이지않았으나 (P=0.151), 6 시간이내에대퇴골두의정복을시행할수록임상결과가좋아지는경향이있었다 (P=0.022). 또한, 전체합병증발생빈도에서는유의한차이를보였고 (P=0.023), 6 시간이내에도수정복을시행한 10 예서는합병증이발생하지않았다. 나이와성별 Table 2. Comparison of Clinical Results and the Complications between Group R and Group NR According to the Availability of Reduction Availability of Reduction Linear by linear Group R Group NR P-value Association (n=14) (n=4) (P-value) Age 46.9±21.4 35.8±9.7 0.336 Sex (Male/Female) 7/7 4/0 0.119 Pipkin Type 0.540 0.229 I (n=4) 4 (100) 0 (0)00 II (n=2). 2 (100) 0 (0)00 IV (n=12) 8 (67)0 4 (33)0 Clinical Result 0.002* 0.001* Excellent (n=5) 5 (100) 0 (0)00 Good (n=7) 7 (100) 0 (0)00.Fair (n=3) 2 (67)0 1 (33)0 Poor (n=3) 0 (0)00 3 (100) Complication 0.019* AVN (n=3)0 0 (0)00 3 (100). OA (n=1) 0 (0)00 1 (100) Group R were possible for the reduction, Group NR failed in the reduction. The values are given as the number of hips, with the percentage in parentheses. * Significant at P<0.05. P-value using Fisher s exact test. AVN: Avascular Necrosis of Femoral Head, OA: Post-traumatic Osteoarthritis. www.hipandpelvis.or.kr 59

Table 3. Comparison of Clinical Results and the Complications between Group S and Group L According to the Reduction Time Reduction Time (Hour) Linear by linear Group S Group L P-value Association (n=10) (n=8) (P-value) Age 47.8±20.3 40.1±19.5 0.429 Sex (Male/Female) 5/5 6/2 0.367 Pipkin Type 0.397 0.163 I (n=4) 3 (75) 1 (25) II (n=2). 02 (100) 0 (0)0 IV (n=12) 5 (42) 7 (58) Clinical Result 0.151 00.022* Excellent (n=5) 4 (80) 1 (20) Good (n=7) 5 (71) 2 (29).Fair (n=3) 1 (33) 2 (67) Poor (n=3) 0 (0)0 03 (100) Complication 0.023* AVN (n=3). 0 (0)0 03 (100) 0 OA (n=1) 0 (0)0 01 (100) Group S: Reduction time took in 6 hours, Group L: Reduction time took over 6 hours. The values are given as the number of hips, with the percentage in parentheses. * Significant at P<0.05. P-value using Fisher s exact test. AVN: Avascular Necrosis of Femoral Head, OA: Post-traumatic Osteoarthritis. A B C D Fig. 1. (A, B) A 23-year-old male sustained Pipkin type I fracture of hip. (C, D) Open reduction and internal fixation of femoral head with trochanter flip osteotomy was done. The radiograph and CT at postoperative 20 months shows complete healing of the fracture, and there is no evidence of avascular necrosis of femoral head or post-traumatic osteoarthritis. 60 www.hipandpelvis.or.kr

Yerl-Bo Sung et al.: Traumatic Dislocation of the Hip with a Femoral Head Fracture 에따른대퇴골두골절의정복까지걸린시간은통계학적으로유의한차이를보이지않았으며 (P=0.429, P=0.367), 대퇴골두골절양상에따라분류한 Pipkin type 역시유의한차이를보이지않았다 (P=0.397) (Table 3). Pipkin I 형의경우 2 예에서는관절경을이용한골편제거술을시행하여우수의임상적결과를얻었다. 나사못고정술을시행한 2 예중 1 예에서는우수의임상적결과를얻었고 (Fig. 1), 척추손상과편측대퇴경부골절이동반된 1 예에서는양호의임상적결과를얻었으나수상후 3 개월만에침상낙상으로인공고관절반치환술을시행하였다. Pipkin II 형의경우 2 예에서모두나사못고정술을시행하여양호의임상적결과를얻었다. Pipkin IV 형의경우 2 예에서는후벽비구골절에대해서나사못고정술을시행하였고, 10 예에서는금속판고정을시행하여 6 예에서양호이상의임상적결과를얻었으며, 나머지 6 예에서보통이하의임상적결과를얻었다. 양호이상 6 예중 1 예에서는좌골신경손상이동반되었으며 12 개월추시관찰결과회복되었고, 비구에대해서금속판고정술을시행한후 2 개월후에재탈구가인지되어수상당시손상된연부조직으로인해전치환술을시행하면반복적인재탈구가우려되어반치환술을시행하고외래에서추시관찰중이다 (Fig. 2). 보 통이하 6 예중 1 예에서외상성관절염과 3 예에서대퇴골두의무혈성괴사가인지되어불량의임상적결과를얻었으며인공고관절치환술을시행하였다 (Table 4, Fig. 3). 고 찰 본연구는대퇴골두골절을동반한외상성탈구에서도수정복가능여부및정복까지걸린시간에따른임상결과및합병증발생빈도사이의연관성을알아보고자하였고, 도수정복이가능하며정복까지걸린시간이 6 시간이내로빠를수록임상결과가좋아지는경향을알수있었다. 또한, 조기에도수정복이실패한경우전체합병증발생빈도가높아진다는결과를얻었다. 고관절탈구의도수정복방법으로 Canale 6) 은 Stimson 6,8) 방법, Allis 6,7) 방법, Bigelow 6) 방법이있다고하였으며, 본연구에서는 Stimson 방법과 Allis 방법을이용하였다. Lyddon 등 10) 과 Gittins 등 11) 은고관절후방탈구에서정복시단외회전근, 비구골편, 손상된비구연등에의해방해된다고하였으며, 본연구에서는 4 예에서비구골편에의해도수정복이실패하였다. Pipkin 5) 은 Thompson-Epstein 4) 분류 V 형의후방탈구 A B C D E F G Fig. 2. (A, B) A 71-year-old male sustained Pipkin type IV fracture of hip. (C) Open reduction and internal fixation of acetabulum with spring plate and screws through the Kocher-Langenbeck approach was done. (D, E) The radiograph and CT at postoperative 2 months shows neglected posterior dislocation of hip. (F, G) Bipolar hemiarthroplasty of hip was done. The radiograph at postoperative 30 months shows well maintained prosthesis. www.hipandpelvis.or.kr 61

및골절을다시대퇴골두골절양상에따라 4 가지형태로분류하였으며 Stannard 등 12), Marchetti 등 13) 은 Pipkin IV 형이제일많다고보고하였으며, 본연구에서도 IV 형이 12 예로제일많이발생하였다. Stannard 등 12) 은도수정복을최대한빠르게하고골절편을해부학적으로정복및정확한고정이좋은결과를얻을수있다고하였고, 24 시간을기준으로조기에정복하는경우가더좋은결과를보인다고보고하였으나, Marchetti 등 13) 은도수정복을 6 시간기준으로비교분석한결과유의한차이점을얻지못하였다고보고하였다. 본연구에서는 24 시간이내에는대부분도수정복이이루어져서 6 시간을기준으로하여 6 시간이내가 10 예, 이후가 8 예있었으며임상결과를비교분석한결과역시유의한차이점을얻지못하였으나 6 시간이내로조기에정복을시행하면임상결과가좋아지는경향을알수있어추후더많은대상자를통한연구가필요할것으로사료된다. Epstein 등 15) 은고관절의후방탈구시발생하는합병증으로대퇴골두의무혈성괴사이외에관절연골, 관절낭, 인대등의손상으로외상성관절염이나, 좌골신경손상, 관절주위의이소성골화등을보고하였고, Pape 등 16) 은 손상초기에적극적으로치료하는것이합병증발생률을감소시켜좋은결과를얻을수있다고하였다. 국내연구를살펴보면 Kim 등 17) 은 10 예의대퇴골두골절에대해평균 33 개월간추시관찰하여 1 예의외상성관절염과 1 예의대퇴골두의무혈성괴사를보고하였으며, Park 등 18) 은 17 예의대퇴골두골절에대해 4 예의대퇴골두의무혈성괴사와 1 예의이소성골화증의합병증을보고하였다. 대퇴골두의무혈성괴사는자기공명영상촬영을통해서진단하고 Marchetti 등 13) 과 Kloen 등 19) 은 6% 에서 23% 까지보고하고있으며수상후 17 개월째에서 2 년까지잘발생한다고하였는데 1), 본연구에서도수상후추시 2 년동안에 3 예 (16.7%) 발생하여인공고관절치환술을시행하였다. Hougaard 등 20) 은대퇴골두의무혈성괴사의위험성이대퇴탈구로부터정복까지걸린시간이 6 시간이상지연될경우발생위험도가증가한다고하였으며, 본연구에서도 6 시간을기준으로전체합병증발생빈도에는유의한상관관계가있었으나대퇴골두의무혈성괴사의발생빈도는유의한차이를발견할수없었다. 외상성관절염에대해 Watson-Jones 14) 은수상당시손상정도및대퇴골두의체중부하부위에따라발생률을결 A B C D E F Fig. 3. (A, B) A 42-year-old male sustained Pipkin type IV fracture of hip. (C) Open reduction and internal fixation with reconstruction plate and screws through the Kocher-Langenbeck approach with trochanter flip osteotomy. (D) The radiograph at postoperative 21 months shows avascular necrosis of femoral head and osteoarthritis change on the joint. (E, F) Total hip arthroplasty was done. The radiograph at postoperative 96 months shows stable fixation of cup and stem. 62 www.hipandpelvis.or.kr

Yerl-Bo Sung et al.: Traumatic Dislocation of the Hip with a Femoral Head Fracture 정하는데단순대퇴골두탈구보다는대퇴골두골절이동반된탈구시발생률이높다고보고하였으며발생빈도는 0% 에서 72% 까지보고가되고있고 13,20), Epstein 등 15) 은조기에관혈적정복술을시행하여관절내골절편을제거하고비구골절편을내고정하여안정성을유지하면외상성관절염의발생률을줄일수있다고하였다. 본연구에서추시 1 년후에 1 예 (5.6%) 발생하여인공고관절치환술을시 행하였다. 본연구의제한점은후향적연구로드물게발생하는대퇴골두골절이지만증례의수가적고 Pipkin III 형에대해서는연구가이루어지지않았으며, 수술방법의차이에따른예후등임상결과에영향을미치는다양한인자에대해파악하는데에도제한이있었다. Table 4. The Characteristics of 18 Patients Case Age Sex Pipkin Follow-up Clinical Type Treatment (Months) Result Complications 01 39 F I *CR 6 Hours after Injury; 26 Good 02 17 M I CR 5 Hours after Injury; 12 Excellent Excision of Fragment 03 19 F I CR 12 Hours after Injury; 26 Excellent Excision of Fragment 04 23 M I CR 3 Hours after Injury; 12 Excellent 05 37 F II CR 5 Hours after Injury; 56 Good 06 49 F II CR 3 Hours after Injury; 24 Good 07 31 M IV CR Failed; 122 Poor AVN THA 2 Years after Injury 08 47 M IV CR Failed; 72 Poor OA THA 1 Year after Injury 09 67 F IV CR 12 Hours after Injury; 18 Fair AVN THA 5 Months after Injury 10 25 M IV CR Failed; 65 Poor AVN THA 1 Year after Injury 11 40 M IV CR Failed; 19 Fair 12 59 M IV CR 6 Hours after Injury; 12 Good (Acetabulum) 13 23 M IV CR 12 Hours after Injury; 12 Good 14 69 M IV CR 8 Hours after Injury; 26 Good 15 49 F IV CR 4 Hours after Injury; 24 Excellent 16 68 M IV CR 2 Hours after Injury; 12 Good 17 85 F IV CR 6 Hours after Injury; 12 Fair 18 52 M IV CR 6 Hours after Injury; 12 Excellent * CR: Closed Reduction, ORIF: Open Reduction Internal Fixation, THA: Total Hip Arthroplasty, AVN: Avascular Necrosis of Femoral Head, OA: Post-traumatic Osteoarthritis. www.hipandpelvis.or.kr 63

결 론 처음내원시도수정복이가능한경우가임상결과가양호하였고도수정복이실패할수록대퇴골두무혈성괴사등의합병증발생빈도가높은경향을보였으며, 보다나은임상결과를얻기위해서는수상후가능한한빠른시간안에정복을시행해야할것으로사료된다. REFERENCES 01. Brumback RJ, Kenzora JE, Levitt LE, Burgess AR, Poka A. Fractures of the femoral head. Hip. 1987:181-206. 02. Butler JE. Pipkin Type-II fractures of the femoral head. J Bone Joint Surg Am. 1981;63:1292-6. 03.Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res. 1973;(92):116-42. 04.Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am. 1951; 33-A:746-78; passim. 05.Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957;39-A:1027-42; passim. 06.Canale ST, Campbell WC. Campbell s operative orthopaedics. 9th ed. St. Louis: Mosby; 1998. 2224-34. 07.Rockwood CA, Green DP, Heckman JD, Bucholz RW. Rockwood and Green s fractures in adults. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. 1559-60. 08.Stimson LA. Five cases of dislocation of the hip. NY Med J. 1889;50:118-21. 09.Epstein HC. Posterior fracture-dislocations of the hip; long-term follow-up. J Bone Joint Surg Am. 1974;56:1103-27. 10. Lyddon DW Jr, Hartman JT. Traumatic dislocation of the hip with ipsilateral femoral fractures. A case report. J Bone Joint Surg Am. 1971;53:1012-6. 11.Gittins ME, Serif LW. Bilateral traumatic anterior/ posterior dislocations of the hip joints: case report. J Trauma. 1991;31:1689-92. 12. Stannard JP, Harris HW, Volgas DA, Alonso JE. Functional outcome of patients with femoral head fractures associated with hip dislocations. Clin Orthop Relat Res. 2000;(377): 44-56. 13.Marchetti ME, Steinberg GG, Coumas JM. Intermediateterm experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma. 1996;10:455-61. 14. Watson-Jones R, Wilson JN. Watson-Jones Fractures and joint injuries. 6th ed. New York: Churchill Livingstone; 1982. 885-934. 15.Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop Relat Res. 1985;(201):9-17. 16.Pape HC, Rice J, Wolfram K, Gansslen A, Pohlemann T, Krettek C. Hip dislocation in patients with multiple injuries. A follow up investigation. Clin Orthop Relat Res. 2000;(377):99-105. 17.Kim JH, Lee SH, Moon YL, Kim DH, Song KS. Treatment of femoral head fracture with traumatic posterior dislocation of the hip. J Korean Hip Soc. 2007;19:176-82. 18.Park MS, Rho CK. Clinical analysis of femoral head fracture. J Korean Orthop Assoc. 1992;27:502-10. 19.Kloen P, Siebenrock KA, Raaymakers ELFB, Marti RK, Ganz R. Femoral head fractures revisited. Eur J Trauma. 2002; 28:221-33. 20.Hougaard K, Thomsen PB. Traumatic posterior fracturedislocation of the hip with fracture of the femoral head or neck, or both. J Bone Joint Surg Am. 1988;70:233-9. 64 www.hipandpelvis.or.kr

Yerl-Bo Sung et al.: Traumatic Dislocation of the Hip with a Femoral Head Fracture 국문초록 대퇴골두골절을동반한외상성고관절탈구 성열보 최정윤 김종우인제대학교의과대학상계백병원정형외과학교실 목적 : 수술적으로치료받은대퇴골두골절을동반한외상성고관절탈구환자들의임상결과와합병증발생빈도를알아보고자하였다. 대상및방법 : 2002 년 11 월부터 2011 년 11 월까지내원한고관절탈구환자중대퇴골두골절이동반된 Thompson-Epstein V 형 18 예를대상으로하였다. 도수정복가능여부및정복시간에따라두군으로나누어 Epstein 기준에따라임상결과를평가하였고, 대퇴골두의무혈성괴사및외상성관절염발생빈도를분석하였다. 결과 : 전체환자중대퇴골두의무혈성괴사가 3 예, 외상성관절염이 1 예발생하였다. 도수정복이가능한군은 14 예, 실패한군은 4 예로두군간에임상결과는유의한차이를보였고, 전체합병증발생빈도에서유의한차이를보였다. 정복까지걸린시간은 6 시간이내가 10 예, 6 시간이후가 8 예로임상결과에서유의한차이를보이지않았으나, 경향성분석결과 6 시간이내에정복을시행할수록보다나은임상결과를보였으며, 전체합병증발생빈도에서유의한차이를보였다. 결론 : 대퇴골두골절을동반한외상성고관절탈구는도수정복이가능한경우가임상결과가양호하였으며, 보다나은임상결과를얻기위해서는수상후가능한한빠른시간안에정복을시행하여야할것으로사료된다. 색인단어 : 대퇴골두골절, 고관절탈구, Thompson-Epstein V 형 www.hipandpelvis.or.kr 65