고관절 반 치환술의 대퇴 골절 예방을 위한 강선 고정의 효과 = The Effect of Prophylactic Cable Fixation for Prevention of Femoral Fractures in Hemiarthroplasties

국문 초록 (Abstract)

목적: 무시멘트형 양극성 반 인공 관절 치환술에 있어서 수술 도중 발생하는 대퇴 골절 예방을 위한 예방적 강선 고정술의 효과를 분석하고자 한다. 대상 및 방법: 2004년 1월부터 2008년 8월까지 무시멘트형 양극 인공 관절 치환술을 받은 65세 이상의 환자 48명(1군)을 대상으로 하여 강선을 사용하지 않은 48명의 환자(2군)와 비교하였다. 평균 나이는 75.4세(1), 73.6세(2)이었고 평균 추시 기간은 19.1개월(1), 18.3개월(2)이었다. 수술 도중 골절 발생율 외에 수술 시간, 수술 도중 예상 출혈량, 입원 기간, 방사선학적 안정성을 측정하였고 임상적 평가를 위한 대퇴 통증과 Jensen의 기능 점수와 Parker와 Palmer의 활동 점수를 비교하였다. 결과: 1군에서는 수술 도중 골절이 발생하지 않았으며 2군에서 4예(8.3%)가 발생하였다(p=0.041). 수술 시간은 각각 172분(1), 162분(2) 예상 출혈량은 866 cc(1), 855 cc(2), 입원기간 36일(1), 35일(2)이었다. 방사선학적으로 침강은 1.59 mm(1), 1.67 mm(2)이었으며 임상적으로 대퇴 통증이 1예(1), 2예(2) 관찰되었다. 임상적으로 Jensen의 기능 점수는 평균 2점(1) 2.2점(2), Parke와 Palmer의 활동 점수는 평균 5.2점(1), 5.3점 (2)이었다. 결론: 무시멘트형 인공 관절 치환술에 있어서 예방적 강선 고정술은 골절률을 의의있게 감소시켰다.

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to assess the effect of a prophylactic cable fixation for prevention of femoral fractures in cementless bipolar hemiarthoplasties. Materials and Methods: Forty-eight cementless bipolar hemiarthroplasties with prophylactic cable fixations on the femur were performed in patients>65 years of age between January 2004 and August 2008 (group 1). The control group which did not undergo prophylactic cable fixation included 48 cases (group 2). The mean age was 75.4 years (group 1) and 73.6 years (group 2). The patients were followed up for an average of 19.1 (group 1) and 18.3 months (group 2). The intra-operative fracture rates were compared. Additionally, operative time, estimated blood loss (EBL), and length of hospital stay were compared. Radiologic assessment for stem stability was performed. Clinical assessment was evaluated by the thigh pain and Jensen`s functional score, and Parker & Palmer`s mobility score. Results: There was no fractures in the cabled group (1), and 4 fractures (8.3%) in the control group (2; p=0.041). The mean operative time was 172 minutes (1) and 162 minutes (2), the EBL was 866 cc (1) and 855 cc (2), and the duration of admission was 36 (1) and 35 days (2), respectively. Radiologically, subsidence was 1.59 mm (1) and 1.67 mm (2). Clinically, one (1) and two (2) thigh pains were recorded and the functional score of Jensen was 2 (1) and 2.2 points (2), and the mobility score of Parker and Palmer was 5.2 (1) and 5.3 points (2), respectively. Conclusion: Prophylactic cable fixation is effective for reducing intra-operative femoral fractures.

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