불안정성 대퇴 전자간부 골절에서 측면 방사선 사진을 이용한 술 후 안정성에 대한 방사선적 접근 = Radiologic Assessment of Postoperative Stability in Unstable Intertrochanteric Fracture Using Lateral Radiograph

국문 초록 (Abstract)

목 적: 불안정성 대퇴골 전자간부 골절의 치료 시 대퇴 경간각이 고정된 금속정을 골수강 내고정 후 발생한 지연 나사의 과도한 활강에 대하여 측면 방사선적 사진을 통한 정복 정도에 따른 활강 정도를 비교하고자 하였다. 대상 및 방법: 2009년 1월부터 2013년 10월까지 불안정성 대퇴골 전자간부 골절로 진단 받고 대퇴 경간각이 고정된 금속정으로 골수강 내 고정 시행한 뒤, 최소 6개월 이상 추시가 가능하였던 86예를 대상으로 하였다. 골절 분류는 AO/OTA 분류를 이용하였으며 전 예에서 불안정성 골절이었고 31-A22형이 20예, 31-A23형이 54예, 31-A3형 12예였다. 평균 나이는 73.7세(47-97세)였고, 남자 30명, 여자 56명였다. 술 후 측면 방사선 사진상 정복 정도에 따라 전위가 없는 군(group 1), 대퇴경부가 전방으로 전위된 군(group 2), 대퇴경부가 후방으로 전위된 군(group 3)으로 구분하였다. 영상의학적 평가는 수술 직후와 최종 추시의 방사선 사진에서 지연 나사의 활강 거리를 비교하였다. 결 과: Group 1은 42예, group 2는 22예, group 3은 22예이고, 각 group 간의 환자 특성은 유의한 차이가 없었다. 지연나사의 활강 거리는 각 군에서 각각 4.9±3.2 mm, 4.6±3.6 mm, 8.5±4.9 mm로 측정되었으며, 이는 group 3이 다른군에 비해 유의하게 크게 나타났다(p＜0.0001, p=0.024). 결 론: 대퇴 경간각이 고정된 골수강을 이용한 내고정술을 시행할 경우, 내고정 전에 측면 방사선 사진을 통한 적절한 정복을 시행하여야 지연 나사의 과도한 활강을 막아 고정 실패율을 줄일 수 있을 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to compare the sliding distance of lag screw in patients with unstable femoral intertrochanteric fractures treated with intramedullary fixation using a cephalomedullary nail with a fixed angle between the neck and shaft of the femur in relation to reduction type by lateral radiographs. Materials and Methods: Between January 2009 to October 2013, 86 cases (86 patients) with unstable femoral intertrochanteric fractures were treated with intramedullary fixation using a metal nail with a fixed neck-shaft angle and followed for at least 6 months. We used AO/OTA classification, and all cases were unstable fractures. Twenty cases were 31-A22, 54 cases were 31-A23, and 12 cases were 31-A3. There were 30 men and 56 women. Average patient age was 73.7 years (range, 47-97 years). We classified reduction types into three groups as postoperative lateral radiologic findings. Group 1 showed no displacement, group 2 showed anterior displacement of the femur neck, and group 3 showed posterior displacement of the femur neck. The radiological assessment compared the sliding distance of the lag screw between postoperative X-ray and last follow-up X-ray. Results: Forty-two cases were in group 1, 22 cases were in group 2, and the other 22 cases were in group 3. There was no significant difference in the patient characteristics of each group. The sliding distances of the lag screw were 4.9±3.2 mm, 4.6±3.6 mm, and 8.5±4.9 mm, respectively, and group 3 showed a significant result (p＜0.0001, p=0.024). Conclusion: In cases treated with intramedullary fixation using a cephalomedullary nail with a fixed neck-shaft angle, appropriate reduction with a lateral radiograph before screw fixation is needed to prevent excessive lag screw sliding.

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