Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Midterm Results of Bipolar Hemiarthroplasty for Unstable Intertrochanteric Femoral Fractures Using a Type 3C Cementless Stem

불안정성 대퇴골 전자간 골절에 3C형 무시멘트 대퇴 스템을 이용한 고관절 반치환술의 중기 결과

  • Chung, Woochull (Department of Orthopedic Surgery, St. Carollo Hospital) ;
  • Cho, Hong Man (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Kim, Sun do (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Park, Jiyeon (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Kwon, Kihyun (Department of Orthopedic Surgery, Gwangju Veterans Hospital) ;
  • Lee, Young (Veterans Medical Research Institute, Veterans Health Service Medical Center)
  • 정우철 (성가롤로병원 정형외과) ;
  • 조홍만 (광주보훈병원 정형외과) ;
  • 김선도 (광주보훈병원 정형외과) ;
  • 박지연 (광주보훈병원 정형외과) ;
  • 권기현 (광주보훈병원 정형외과) ;
  • 이영 (한국보훈복지의료공단 보훈의학연구소)
  • Received : 2020.02.28
  • Accepted : 2020.08.20
  • Published : 2020.12.30
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Abstract

Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

목적: 고령의 환자에게 발생한 대퇴골 전자간 불안정성 골절에 대하여 관혈적 정복 및 내고정 이외의 다른 대안으로 고관절 반치환술이 선택적으로 사용되고 있다. 최근 의료 시스템과 기술의 발달로 대퇴골 전자간 골절 후 생존율이 높아지면서 중장기 이상의 기간을 고려한 대퇴 스템의 선택이 필요하다. 이에 저자들은 이중으로 가늘어 지는 직각 단면의 대퇴 스템(C2 stem)을 이용하여 불안정성 전자간 골절에 고관절 반치환술을 시행하고 5년 이상 추시한 환자에 대하여 그 임상적 방사선적 결과를 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2013년 12월까지 대퇴골 전자간 불안정성 골절에 대하여 C2 스템으로 고관절 반치환술을 시행한 43명의 환자(43 고관절)를 대상으로 하였다. 평균 연령은 78.6세(70-84세), 평균 추시 기간은 85.4개월(60-96개월)이었다. 추시 기간 동안 임상적으로는 통증, 보행 능력, 고관절 기능의 변화를 알아보았고, 방사선적으로는 피질골의 골다공증과 골 흡수 등 근위 대퇴골의 변화를 알아보았으며, 탈구와 인공 관절 주변 골절 등 추시 기간 중 발생한 합병증에 대하여 알아보았다. 결과: 통증은 수술 후 유의하게 감소하였는데, 수술 후 4년부터 증가하였고 수술 후 60개월에 보행 능력 평가에서 9예의 환자가 두 단계 보행 능력이 감소하였으며 Harris 고관절 점수는 수술 후 2년부터 3년 사이에 유의하게 감소하였다. 방사선적으로 피질골 골다공증은 14예 발생하였는데, 이 중 5예의 환자가 피질골 흡수 현상으로 진행하였다. 피질골 흡수 현상을 보인 5예 중 4예는 전자부 골절편이 불유합 된 경우였고, 3예는 역사상 골절인 경우였다. 결론: 골다공증을 동반한 고령의 환자에게 발생한 불안정성 전자간 골절에 3C 형태의 무시멘트 스템을 이용하여 고관절 반치환술을 일차로 시행하는 경우 환자의 건강 상태와 잔여 수명을 고려하여 주의 깊은 선택이 필요할 것으로 생각된다.

Keywords

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