양성 골 병변으로 인한 대퇴골 근위부 병적 골절의 치료

국문 초록 (Abstract)

서론: 양성 골 병변으로 인한 대퇴골 근위부 골절의 치료 결과를 평가하였다.
대상 및 방법: 1987년 2월부터 2002년 7월까지 양성 골 병변으로 인한 대퇴골 근위부 골절로 치료 받은 19명, 23예를 대상으로 하였다. 양성 골 병변은 섬유성 이형성증 15예, 단순 골낭종 3예, 동맥류성 골낭종 2예, 거대 세포종 2예 및 호산구성 육아종 1예였다. 양성 골 병변에 대한 치료는 골 소파술과 고속 드릴(high speed burr)을 이용한 보조 치료 후 자가골 이식술을 1예, 동종골 이식술을 6예 및 동종골과 자가골 이식술을 3예에서 시행하였다. 최종 골절 치료 방법은 내고정술 18예(골수강 내 금속정 10예, 압박성 고 나사 6예, 금속판 1예, 나사못 1예), 석고 고정 3예, 인공 고관절 전치환술 2예였다.
결과: 골소파술과 골이식술을 시행한 10예 모두에서 재발은 없었다. 석고 고정을 시행한 3예 중 2예에서 대퇴골 근위부의 내반 변형을 보였으며, 최종 골절 치료로써 골수강내 금속정을 이용한 내고정술을 시행한 10예에서 재골절과 변형을 방지할 수 있었다.
결론: 다발성 섬유성 골이형성증인 경우 골수강 내 금속정을 이용한 내고정술이 골절 치료, 변형 교정 및 예방에 효과적이며, 고립성 양성 골 병변인 경우 철저한 소파술, 골이식술 및 내고정술이 병변 치료 및 재발 방지에 효과적이다.

다국어 초록 (Multilingual Abstract)

Purpose: The treatment results for a proximal femur fracture caused by a benign bone lesion were evaluated.
Materials and Methods: Nineteen patients (23 cases) who had been treated for proximal femur pathologic fracture from 1987 to 2002 were enrolled in this study. The mean follow-up duration was 40 months. The causes and treatments of the pathologic fractures and complications such as nonunion, deformity and recurrence were evaluated.
Results: The benign bone lesions treated were fibrous dysplasia (15), simple bone cyst (3), aneurysmal bone cyst (2), giant cell tumor (2) and eosinophilic granuloma (1). An autograft (3), allograft (2), and both autograft and allograft (3) was performed after adjuvant curettage with a high-speed burr. There was no recurrence in these 8 cases. At the final course, internal fixation was performed in 18 cases (intramedullary nail (10), compressive hip screw (6), plate (1), screw (1)), a hip spica cast 3 cases and a THR 2 cases. Three cases where a hip spica cast had been performed showed a varus deformity. A refracture and deformity were prevented in 10 cases who underwent intra-medullary nailing.
Conclusion: The IM nail is very effective in preventing complications such as a deformity, refracture after a treatment for polyostotic fibrous dysplasia. However, in a solitary benign bone lesion, bone graft and internal fixation is effective after thorough curettage.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 결론
• 참고문헌
• 국문초록

참고문헌 (Reference)

1 EW Johnson Jr, "Treatment of giant-cell tumor of bone" 41 : 895-904, 1959

2 KA Jaffe, "Treatment of benign lesions of the femoral head and neck" 257 : 134-137, 1990

3 HN Shih, "Semistructural allografting in bone defects after curettage" J Surg Oncol 159-165, 1998

4 EK Wai, "Pathologic fractures of the proximal femur secondary to benign bone tumors" 393 : 279-286, 2001

5 WF Enneking, "Modification of the system for the functional evaluation of surgical management of musculoskeletal tumors(In Limb salvage in musculoskeletal oncology)" New York, Churchill Livingstone 626-639, 1987

6 E Sim, "Joint salvaging surgery for an extensive giant cell tumor of the proximal femur complicated by a transcervical fracture" 116 : 431-434, 1997

7 HW Sung, "Giant-cell tumor of bone: analysis of two hundred and eight cases in Chinese patients" 64 : 755-761, 1982

8 M Campanacci, "Giant-cell tumor of bone" 69 : 106-114, 1987

9 CP Duncan, "Giant cell tumour of bone: its aggressiveness and potential for malignant change" 26 : 475-476, 1983

10 JP Dormans, "Fractures through bone cysts: unicarmeral bone cysts, aneurysmal bone cysts, fibrous cortical defects, and nonossifying fibromas" 51 : 57-467, 2002

11 J DeLee, "Fractures and dislocations of the hip(In Rockwood and Greens fractures in the adult)" Philadelphia, Lippincott-Raven 1711-1714, 1996

12 WF Enneking, "Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting" 68 : 1415-1422, 1986

13 RF Ostrum, "Bone injury, regeneration, and repair. In: Simon SR ed. Orthopedic basic science" Chicago, American Academy of Orthopaedic Surgeons 277-324, 1994

14 S Gitelis, "Benign bone tumors" 45 : 425-446, 1996