Sirus® 골수정을 이용한 대퇴골 골절의 치료: 삽입점에 따른 합병증 비교 = Treatment of the Femoral Fracture Using Sirus® Nail: A Comparison of Complication according to the Entry Potal

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study is to analyze the clinical results of fixation using Sirus® nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal. Materials and Methods: From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus® nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared. Results: The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment. Conclusion: Using Sirus® nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

참고문헌 (Reference)

1 하상호, "대퇴 간부 골절의 금속정 삽입술 치료-대전자 삽입점 및 이상와 삽입점에 따른 비교-" 대한골절학회 27 (27): 50-57, 2014

2 윤호현, "Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture" 대한정형외과학회 5 (5): 230-234, 2013

3 Ansari Moein CM, "Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip" 36 : 1337-1342, 2005

4 Linke B, "Lateral insertion points in antegrade femoral nailing and their influence on femoral bone strains" 22 : 716-722, 2008

5 Wiss DA, "Interlocked nailing for treatment of segmental fractures of the femur" 72 : 724-728, 1990

6 Khan FA, "Femoral neck fracture: a complication of femoral nailing" 26 : 319-321, 1995

7 Dora C, "Entry point soft tissue damage in antegrade femoral nailing:a cadaver study" 15 : 488-493, 2001

8 Sanders R, "Double-plating of comminuted, unstable fractures of the distal part of the femur" 73 : 341-346, 1991

9 Lakhwani OP, "Correlation of trochanter-shaft angle in selection of entry site in antegrade intramedullary femoral nail" 1-5, 2012

10 Winquist RA, "Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases" 66 : 529-539, 1984

11 Afsari A, "Clamp-assisted reduction of high subtrochanteric fractures of the femur" 91 : 1913-1918, 2009

12 Mileski RA, "Avascular necrosis of the femoral head in an adolescent following intramedullary nailing of the femur. A case report" 76 : 1706-1708, 1994

13 Ricci WM, "Angular malalignment after intramedullary nailing of femoral shaft fractures" 15 : 90-95, 2001

14 Ostrum RF, "A critical analysis of the eccentric starting point for trochanteric intramedullary femoral nailing" 19 : 681-686, 2005