20∼30대에서 발생한 대퇴 경부 골절에 대한 내고정술 후 결과 = Internal Fixation for Femoral Neck Fracture in Patients between the Ages of Twenty and Forty Years

국문 초록 (Abstract)

목적: 20∼30대에서 발생한 대퇴 경부 골절의 내고정술 후 결과를 후향적으로 분석하였다. 대상 및 방법: 1998년부터 2005년까지 대퇴 경부 골절로 내고정술을 시행한 20∼30대 환자 중 술 후 최소 2년 이상 추시 가능하였던 20예를 대상으로 하였다. 평균 연령은 32.2세(범위; 21∼39세)였고, 평균 추시 기간은 26.3개월(범위; 24∼45개월)이었다. 골절의 양상은 술 전 시행한 단순 방사선 검사에서 Garden 분류 I형 6예, II형 10예, III형 4예였다. 골절의 해부학적 위치에 따른 분류는 골두하 골절 7예, 중간 경부 골절 9예, 하경부 골절 4예였다. 전례에서 수상 후 12시간 이내에 수술적 치료를 시행하였으며, 수술적 치료는 해부학적 정복을 얻은 후 유관나사를 이용하여 내고정술을 시행하였다. 추시 시 임상 및 방사선학적 검사를 바탕으로 수술적 치료 결과를 분석하였다. 결과: 전례에서 수술 직후 시행한 단순 방사선 검사에서 Garden 정렬 지수에 만족하는 해부학적 정복을 얻었다. 술 후 4.5개월(범위; 3∼6개월)에 전례에서 골유합을 얻었다. 합병증으로 대퇴 골두 무혈성 괴사가 전체 환자 중 7예(35.0%)에서 발생하였다. 무혈성 괴사의 발생 시기는 술 후 평균 10.7(9∼15)개월이었다. 비전위성 골절(Garden I, II)에서 5예(31.3%), 전위성 골절(Garden III)에서 2예(50.0%)가 발생하였고, 골절의 해부학적 위치에 따라 골두하 골절 4예, 중간 경부 골절 3예에서 발생하였다. 결론: 20∼30대에서 발생한 전위성과 비전위성 대퇴 경부 골절의 수술적 치료 결과 두 군 간의 합병증으로 대퇴 골두 무혈성 괴사의 발생률엔 유의한 차이를 보이지 않았다.

다국어 초록 (Multilingual Abstract)

Purpose: To retrospectively analysis of results of operatively treatment for femoral neck fracture occurred in twenties to thirties. Materials and Methods: 20 patients were selected whom we were able to follow up at least 2 years after internal fixation for femoral neck fracture in twenties to thirties from 1998 to 2005. Mean age was 32.2 (21∼39) and average follow up period was 26.3 (24∼45) months. According to preoperative X-ray, there were 6 cases for Garden classification stage I, 10 for stage II and 4 for stage III, and 7 cases for subcapital fracture, 9 for transcervical fracture, 4 for basicervical fracture. In all cases, operations were performed within 12 hours after the injury. The operations were done after satisfying reduction with the Garden alignment index, with three cannulated screws for internal fixation. Postoperative results were analyzed by clinical symptoms and radiological examinations during follow up periods. Results: In immediately postoperative radiological examination, satisfying anatomical reduction with Garden alignment index was obtained in all cases, and unions were obtained within 4.5 months after the operation (3∼6 month). Avascular necrosis of femoral head occurred in 7 cases of all patients (35.0%). The average time of occurrence of avascular necrosis of femoral head after operation was 10.7 months (9∼15 months). Avascular necrosis was occutted 5 (31.3%) in fracture without displacement (Garden stage I, II), 2 (50.0%) in fracture with displacement (Garden stage III) and 4 in subcapital fracture, 3 in transcervical fracture. Conclusion: The incidence of avascular necrosis of femoral head after the operation for displaced and nondisplaced femoral neck fracture between twenties and forty years was no significant difference.

참고문헌 (Reference)

1 임수재, "금속 내고정술을 이용한 대퇴 경부 골절의 고정 실패에 영향을 미치는 인자 분석" 대한골절학회 19 (19): 1-1, 2006

2 Lunceford EM, "Use of the moore self-locking vitallium prosthesis in acute fractures of the femoral neck" 47 : 832-841, 1965

3 Park SW, "Treatment of femoral neck with multiple pinning" 12 : 220-230, 1999

4 Swiontkowski MF, "Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density" 5 : 433-444, 1987

5 Bray TJ, "The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective, randomized comparison" 230 : 127-140, 1988

6 Garden RS, "Stability and union in subcapital fractures of the femur" 46 : 630-647, 1964

7 Manninger J, "Significance of urgent (within 6h) internal fixation in the management of fractures of the neck of the femur" 20 : 101-105, 1989

8 Lindequist S, "Screw positions in femoral neck fractures. Comparison of two different screw positions in cadavers" 64 : 67-70, 1993

9 Garden RS, "Reduction and fixation of subcapital fractures of the femur" 5 : 683-712, 1974

10 Haidukewych GJ, "Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years" 86 : 1711-1716, 2004

11 Hammer AJ, "Nonunion of subcapital femoral neck fractures" 6 : 73-77, 1992

12 Banks HH, "Nonunion in fractures of the femoral neck" 5 : 865-885, 1974

13 Gautam VK, "Management of displaced femoral neck fractures in young adults (a group at risk)" 29 : 215-218, 1998

14 Asnis SE, "Intracapsular fractures of the femoral neck. Results of cannulated screw fixation" 76 : 1793-1803, 1994

15 Keller CS, "Indications for open reduction of femoral neck fractures" 152 : 131-137, 1980

16 Ficat RP, "Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment" 67 : 3-9, 1985

17 Muckle DS, "Fractures of the femoral neck in the ‘young’ elderly" 12 : 41-44, 1980

18 Sadat-Ali M, "Fractured neck of the femur in young adults" 23 : 311-313, 1992

19 Kofoed H, "Femoral neck fractures in young adults" 14 : 146-150, 1982

20 skin SR, "Femoral neck fractures in young adults" 114 : 259-264, 1976

21 Protzman RR, "Femoral neck fractures in young adults" 58 : 689-695, 1976

22 Tooke SM, "Femoral neck fractures in skeletally mature patients, fifty years old or less" 67 : 1255-1260, 1985

23 Dedrick DK, "Complications of femoral neck fracture in young adults" 26 : 932-937, 1986

24 Chang JS, "A clinical study of treatment of displaced fractures of femur neck with internal fixation in elderly patients" 27 : 131-138, 1992