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      불안정성 대퇴골 전자간 골절의 치료에서 항회전 근위 대퇴 골수정과 전자부 안정화 금속판을 이용한 압박 고 나사의 비교 = Proximal Femoral Nail Antirotation versus Compression Hip Screw with Trochanter Stabilizing Plate for Unstable Intertrochanteric Hip Fractures

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      Purpose: To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP). Materials and Methods: We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer. Results: Group I showed shorter operation time and less blood loss with significance than group II (p<0.05), but there were no differences between the groups in the mean time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, and social-function score of Jensen (p>0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications. Conclusion: We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.
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      Purpose: To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with...

      Purpose: To analyze and compare the clinical and radiologic results of treatments in unstable intertrochanteric fractures of the femur with proximal femoral nail antirotation (PFNA) and compression hip screw with trochanter stabilizing plate (CHS with TSP). Materials and Methods: We retrospectively reviewed the results of 66 cases of unstable intertrochanteric fractures of the femur treated with PFNA (Group I) and CHS with TSP (Group II) which could be followed up for minimum a year. We evaluated several comparative factors such as operation time, blood loss, time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, social-function score of Jensen, and mobility score of Parker and Palmer. Results: Group I showed shorter operation time and less blood loss with significance than group II (p<0.05), but there were no differences between the groups in the mean time to bone union, changes in neck-shaft angle, sliding of screw (or blade), complications, postoperative pain, and social-function score of Jensen (p>0.05). Two cases of cutting out of the blade through the femoral head were found in group I. One case of cutting out of the screw, one case of the breakage of the plate, and loosening of the plate were found in group II as complications. Conclusion: We think that there were no significant differences between PFNA and CHS with TSP in view point of radiologic and clinical outcomes in unstable intertrochanteric fractures of the femur, but PFNA is less invasive device than CHS with TSP, therefore it may be useful device in elderly patients.

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      참고문헌 (Reference)

      1 박명식, "항 회전 근위 대퇴 골수정을 이용한 대퇴골 근위부 골절의 치료" 대한골절학회 22 (22): 91-97, 2009

      2 강수용, "불안정성 대퇴골 전자간 골절에서 전자부 안정화 금속판 사용 후 발생한 고정실패 - 생역학적 분석 및 3예 보고 -" 대한정형외과학회 41 (41): 176-180, 2006

      3 김영창, "골다공증성 불안정 대퇴 전자간부 골절의 치료 -활강 압박 고 나사 단독 사용과 전자부 안정화 금속판(Trochanter Stabilizing Plate) 병용 사용의 비교-" 대한정형외과학회 40 (40): 741-748, 2005

      4 Bonaro JJ, "Treatment of intertrochanteric fractures with a sliding nail-plate" 22 : 205-215, 1982

      5 Simmermacher RK, "The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study" 39 : 932-939, 2008

      6 Brunner A, "The PFNA proximal femur nail in treatment of unstable proximal femur fractures--3 cases of postoperative perforation of the helical blade into the hip joint" 22 : 731-736, 2008

      7 Simmermacher RK, "The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures" 30 : 327-332, 1999

      8 Mereddy P, "The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures" 40 : 428-432, 2009

      9 Yoshimine F, "Sliding characteristics of compression hip screws in the intertrochanteric fracture: a clinical study" 7 : 348-353, 1993

      10 Adams CI, "Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur" 15 : 394-400, 2001

      1 박명식, "항 회전 근위 대퇴 골수정을 이용한 대퇴골 근위부 골절의 치료" 대한골절학회 22 (22): 91-97, 2009

      2 강수용, "불안정성 대퇴골 전자간 골절에서 전자부 안정화 금속판 사용 후 발생한 고정실패 - 생역학적 분석 및 3예 보고 -" 대한정형외과학회 41 (41): 176-180, 2006

      3 김영창, "골다공증성 불안정 대퇴 전자간부 골절의 치료 -활강 압박 고 나사 단독 사용과 전자부 안정화 금속판(Trochanter Stabilizing Plate) 병용 사용의 비교-" 대한정형외과학회 40 (40): 741-748, 2005

      4 Bonaro JJ, "Treatment of intertrochanteric fractures with a sliding nail-plate" 22 : 205-215, 1982

      5 Simmermacher RK, "The new proximal femoral nail antirotation (PFNA) in daily practice: results of a multicentre clinical study" 39 : 932-939, 2008

      6 Brunner A, "The PFNA proximal femur nail in treatment of unstable proximal femur fractures--3 cases of postoperative perforation of the helical blade into the hip joint" 22 : 731-736, 2008

      7 Simmermacher RK, "The AO/ASIF-proximal femoral nail (PFN): a new device for the treatment of unstable proximal femoral fractures" 30 : 327-332, 1999

      8 Mereddy P, "The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures" 40 : 428-432, 2009

      9 Yoshimine F, "Sliding characteristics of compression hip screws in the intertrochanteric fracture: a clinical study" 7 : 348-353, 1993

      10 Adams CI, "Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur" 15 : 394-400, 2001

      11 Koval KJ, "Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture" 80 : 352-356, 1998

      12 이진영, "PFNA를 이용한 대퇴골 근위부 관절외 골절의 치료-근위 대퇴정(PFN)과의 비교-" 대한고관절학회 19 (19): 183-189, 2007

      13 Lunsjo K, "One-way compression along the femoral shaft with the Medoff sliding plate. The first European experience of 104 intertrochanteric fractures with a 1-year follow-up" 66 : 343-346, 1995

      14 Strauss E, "Helical blade versus sliding hip screw for treatment of unstable intertrochanteric hip fractures: a biomechanical evaluation" 37 : 984-989, 2006

      15 Aune AK, "Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients" 65 : 127-130, 1994

      16 Rha JD, "Factors affecting sliding of the lag screw in intertrochanteric fractures" 17 : 320-324, 1993

      17 Park YS, "Effect of trochanter stabilizing plate in unstable intertrochanteric fracture" 13 : 779-787, 2000

      18 Madsen JE, "Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw" 12 : 241-248, 1998

      19 Albareda J, "Complications and technical problems with the gamma nail" 20 : 47-50, 1996

      20 Babst R, "Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures" 12 : 392-399, 1998

      21 Jensen JS, "Classification of trochanteric fractures" 51 : 803-810, 1980

      22 Kyle RF, "Analysis of six hundred and twenty-two intertrochanteric hip fractures" 61 : 216-221, 1979

      23 Medoff RJ, "A new device for the fixation of unstable pertrochanteric fractures of the hip" 73 : 1192-1199, 1991

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