고령의 대퇴 경부 골절 환자에서 시행한 양극성 반치환술 = Bipolar Hemiarthroplasty for Femoral Neck Fractures in the Elderly고령의 대퇴 경부 골절 환자에서 시행한 양극성 반치환술

국문 초록 (Abstract)

목적: 고령의 대퇴 경부 골절 환자에 대한 양극성 반치환술 후 추시 관찰한 결과를 분석하여 문헌 고찰과 함께 보고하고자 한다. 대상 및 방법: 1995년 3월부터 2005년 3월까지 75세 이상 대퇴 경부 골절 환자 중, 양극성 반치환술 시행 후 2년 이상 추시가능하였던 186예를 대상으로 하였다. 평균 연령은 84.3(75~99)세였고 남자가 48예(26%), 여자가 138예(74%)였으며 추시 기간은 68.4(24~113)개월이었다. Modified Harris 고관절 점수, 보행능력, 일상 생활 활동력, 합병증, 골다공증 등을 분석하여 임상적 평가와 방사선적 평가를 시행하였다. 결과: Modified Harris 고관절 점수는 89.2(74~95)점이었고 보행시작 시기는 6.5(3~9)일이었다. 163예(87.6%)에서 수상 전보행능력을 회복하였으며 159예(85.4%)에서 수상 전 일상 생활 활동력이 가능하였다. 비구컵의 전이 3예, 무균성 해리 3예가 시멘트형 주대에서 발생했고, 대퇴부 동통은 시멘트형 주대 8예, 무시멘트형 주대 4예에서 발생하였다. 결론: 고령의 대퇴 경부 골절 환자에 시행한 양극성 반치환술은, 추시 결과상 안정된 주대 및 견고한 골절부 고정으로 조기보행, 합병증 감소와 낮은 사망률을 나타내므로 적절한 주대 선택과 숙련된 기술로 시행된다면, 골다공증과 분쇄 골절이 심한 고령의 환자에 유용한 치료방법으로 사료된다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate outcomes after treatment of femoral neck fractures in patients 75 years of age or older. Materials and Methods: We reviewed the records of 186 patients 75 years of age or older who underwent bipolar hemiarthroplasty between March 1995 and March 2005 and who were followed for more than two years after surgery. The mean patient age was 84.3 years (range 75~99 years). Forty-eight patients were men, and 138 patients were women. The mean follow-up period was 68.4 months (range 24~113 months). We evaluated the results by analyzing modified Harris hip score, walking ability, activities of daily living, complications, osteoporosis, and radiologic findings. Results: The mean Harris hip score was 89.2 (range 74~95). Walking ability was recovered in 87.6% of cases (163 cases), and activities of daily living were achieved in 85.4% of cases (159 cases). There were 3 cases of acetabular erosion or proximal migration and 3 cases of aseptic loosening in a cemented stem. Thigh pain occurred in 8 cemented stems and in 4 cementless stems. Conclusion: We believe bipolar hemiarthroplasty is a useful treatment in elderly patients with femoral neck fractures and severe osteoporosis, especially in view of the stable and rigid fixation of the femoral stem, early ambulation, and the low rate of complications and death, even if the operation is technically very difficult.

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