Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지

Modified Double Tension Band Wiring for Reattaching the Greater Trochanter When Performing Hemiarthroplasty for Intertrochanteric Fracture in Elderly Patients

고령의 대퇴 전자간 골절에서 인공관절 치환술시 변형된 이중 긴장강선 고정술을 이용한 대전자 고정술

  • Kim, Weon-Yoo (Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University College of Medicine) ;
  • Shin, Eun-Soo (Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University College of Medicine) ;
  • Moon, Chang-Yun (Department of Orthopedic Surgery, St. Mary's Hospital, The Catholic University College of Medicine)
  • 김원유 (가톨릭대학교 의과대학 대전성모병원 정형외과학교실) ;
  • 신은수 (가톨릭대학교 의과대학 대전성모병원 정형외과학교실) ;
  • 문창윤 (가톨릭대학교 의과대학 대전성모병원 정형외과학교실)
  • Published : 2009.09.30

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Abstract

Purpose: We wanted to evaluate the clinical and radiological results after performing arthroplasty for an intertrochanteric fracture in patients 70 years of age or older, and we used a new fixation technique of the greater trochanter. Material and Methods: From January, 2004 to August 2007, we treated 21 cases (M/F: 3/18) of intertrochanteric fracture with hemiarthroplasty with modified double tension band wiring. All the cases were above type 2 (AO/OTA A1.3) according to the Jensen modification of the Evans classification, and all the patients were elderly. The fractures were evaluated for the fracture pattern by using simple radiography and 3D computed tomography. We analyzed the clinical and radiological results at a minimum of 12 months (range: 12~36 months). Results: We performed hemiarthroplasty with modified double tension band wiring. Two cases (9.5%) among the 21 cases developed loss of reduction due to an additional injury and one of them underwent reoperation using a greater trochanter reattachment device (GTRD). The greater trochanters were well maintained without displacement and excellent union was seen at the fracture site of 19 cases. Conclusion: The modified double tension band wiring technique, along with several other fixation methods, should be considered to easily obtain rigid fixation in an unstable intertrochanteric fracture.

목적: 70세 이상의 고령환자의 불안정성 대퇴골 전자간부 골절의 치료로 인공 고관절 반치환술시행 시 대전자부 골절에 대하여 변형된 이중 긴장 강선을 이용한 내고정술의 효과를 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2007년 8월까지 70세 이상 고령환자의 대퇴골 전자간부 골절 중Evans-Jensen분류상 2형 이상 (AO/OTA A1.3이상)에서 인공 고관절 반치환술 시 변형된 이중긴장 강선 고정술을 시행한 21예(남/여: 8/13)에 대해 최소 12개월(12개월~36개월)이상 추시 관찰하여 임상 결과를 분석하였다. 결과: 변형된 이중 긴장 강선 고정술을 시행한 21예 중 2예(9.5%)에서 추가 손상에 의한 정복 소실이 발생하여 그 중 1예에서 대전자 재부착 기구를 이용한 재수술을 시행하였다. 19예에서는 수술 후 12개월째 골절부의 완전한 유합을 확인할 수 있었다. 결론: 고령 환자의 불안정성 대퇴골 전자간부 골절의 치료로 인공 고관절 반치환술 시행 시 대전자 고정 방법 중 변형된 이중 긴장 강선을 이용한 대전자부 고정술은 쉽게 확고한 고정력을 얻을 수 있는 성공율이 높은 방법이라 사료된다.

Keywords

References

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