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대퇴골 경부 골절 양상에 따른 내고정 방법의 생역학적 연구
고무경,이광석 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.1
The fractures of femoral neck are one of the most common traumatic injuries in patients above 60 years of age. Despite many advances in the field of geriatric medicine and orthopedic surgery, the morbidity and mortality due to the fractures of the femoral neck are still significant problem in old age. Recently the incidence of femoral neck fracture seems to increase because of increasing average life span. Many trials to reduce the mortality and complication of this fracture have been performed, however the best method of fixation for this fracture has not been determined. Although hemiarthroplasty is one option most commonly chosen in the elderly, reduction and internal fixation may be a more viable alternative in younger patients and in older patients who have good bone quality. The first internal fixation for the fracture of femoral neck was performed by Dr Langenbeck in 1850, and recently multiple Knowles pinning and compression screw with plate combination are the most popular methods for the internal fixation of femoral neck fracture. But there is not absolutely recommended internal fixation device of fractures of femoral neck. To know the adequate internal fixation device of fractures of femoral neck, the author made 30˚, 50˚, 70˚ femoral neck fracture by the Pauwel's classification at the 12 cadaverous femurs as the experimental group and the other 4 femurs were used for the control group. After the fixation with Knowles pin and comporession hip screw with plate to twelve femoral neck fractures as the experimental group, the author measured and compared the maximal loading force and maximal torsion strength in the control and experimental groups. The results obtained are as follows ; 1. Average maximal loading force of normal femoral neck was 625kg and average maximal torsion strength was 504kg·cm in control group. 2. Maximal loading force in the specimen fixed with Knowles pin and compression hip screw with plate was 400kg and 125kg at Pauwel's angle 30˚. Maximal torsion strength in specimen fixed with Knowles pin and compression hip screw with plate was 100kg·cm and 80kg·cm at Pauwel's angle 30˚. 3. Maximal loading force in the specimen fixed with Knowles pin and compression hip screw with plate was 137.5kg and 375kg at Pauwel's angle 50˚. Maximal torsion strength in the specimen fixed with Knowles pin and compression hip screw with plate was 45 kg/cm and 45kg·cm at pauwel's angle 50˚ 4. Maximal loading force in the specimen fixed with Knowles pin and compression hip screw with plate was 137.5kg and 397kg at Pauwel's angle 70˚. Maxinal torsion strength in the specimen fixed with Knowles pin and compression hip screw with plate was l05kg·cm and 100kg·cm at Pauwel's angle 70˚. 5. When the gtoup fixed with Knowles pins is compared with compression hip screw with plate, Knowles pin group was superior to compression hip screw with plate group in both compression and torsion test at Pauwel's angle 30˚. At Pauwel's angle 50˚ and 70˚, compression hip screw with plate group was superior to Knowles pin group in compression test, but Knowles pin group was superior in torsion test.
전자부 골절의 연성 골수강 금속정 고정시 Lowman 골감자를 이용한 피질골의 균열 방지
채인정,우경조,이홍건,고무경 대한골절학회 1989 대한골절학회지 Vol.2 No.2
Flexible intramedullary nailing has offered the many advantages in the treatment of the trochanteric fractures. But there has been many complications such as the knee joint pain, the deformity of external rotation of the femur, insufficient fixation of the fracture, peroneal nerve palsy, cortical breakage of insertion site of nailing and linear fracture of the femur. Of these complications, the cortical breakage and linear fractures of the femur was prevented by using the Lowman clamp on the proximal site of insertion hole during the nailing. The authors have treated 31 cases of the trochanteric fractures with this method from March 1985 to December 1988 and the results are as follows: 1. There was neither cortical breakage nor linear fracture at the site of insertion hole in all cases of 31. 2. Wide operation field was obtained with Lowman damp by traction of muscles near by. 3. The handle of Lowman clamp can be used as indicator to determine the grade of anteversion. 4. It is confirmed that intramedullary nailing with Lowman clamp is simpler than conventional methad and is highly recommended.