대퇴골 전자간 골절 환자에서 125도와 130도의 각도를 가진 제2형 항회전 근위 대퇴 골수정을 이용한 수술의 임상적, 방사선학적 결과 비교 (Comparison of the Clinical and Radiographic Results between 125° and 130° Caput-Collum-Diaphyseal Angle Proximal Femoral Nail Anti-Rotation II in Patients with Intertrochanteric Fracture)

서지정보

· 발행기관 : 대한골절학회
· 수록지 정보 : Journal of Musculoskeletal Trauma / 33권 / 4호 / 210 ~ 216페이지
· 저자명 : 임수재, 박용복, 김현권, 박신형

초록

목적: 대퇴골 전자간 골절 환자에서 125도, 130도의 제2형항회전 근위 대퇴 골수정(PFNA-II)을 이용한 수술의 결과를분석하였다.
대상 및 방법: 대퇴골 전자간 골절로 PFNA-II를 이용한 수술을 시행 받은 환자 65예를 후향적으로 분석하였다. 이 중 30 예는 125도 PFNA-II를 사용하였고, 35예는 130도 PFNA-II 를 사용하였다. 수술 후 대퇴부 동통 외 임상적 점수를 조사하였고 삽입물의 위치 및 정복 정도, 추가적으로 대전자 끝에서 나선형 칼날 삽입구까지의 거리, vastus ridge 끝에서 나선형 칼날 삽입구까지의 거리를 측정하여 비교하였다.
결과: 대전자 끝에서 나선형 칼날 삽입구까지의 거리는 125 도 PFNA-II 집단에서는 52.60±3.53 mm였고, 130도 PFNA- II 집단에서는 58.07±5.54 mm였다. Vastus ridge 끝에서 나선형 칼날 삽입구까지의 거리는 125도 PFNA-II 집단에서는 16.48±2.54 mm였고(p=0.031), 130도 PFNA-II 집단에서는 21.19±4.43 mm였다(p=0.012).
결론: 125도 PFNA-II 집단이 130도 PFNA-II 집단보다 나선형 칼날의 위치가 좀 더 상방, 외측에 위치하였다.

영어초록

Purpose: This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures.
Materials and Methods: From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared.
Results: The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012).
Conclusion: The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally.

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