노인 대퇴골 전자간 안정형 2분 골절에서 2공 압박 고 나사를 이용한 치료

목 적: 노인 대퇴골 전자간 안정형 2분 골절로 2공 측면 금속판 역동적 압박 고 나사를 이용한 수술 후 그 결과에 대해 분석하였다. 대상 및 방법: 2008년 2월부터 2014년 1월까지 가톨릭대학교 부천성모병원에서 수술 후 6개월 이상 추시한 65세 이상 환자50예를 분석하였다. 임상적 평가로 피부 절개 길이, 수술 시간, Clawson 보행 능력 상태, 방사선적 평가로 Fogagnolo 정복상태, tip-apex distance (TAD), Cleveland index, 지연나사 활강, 골유합, 합병증을 측정하였다. 결 과: 피부 절개 길이 평균 9.8 cm (범위, 8-13 cm), 수술 시간 평균 41.4분(범위, 30-60분), 총 32예가 술 전 보행능력을 회복하였다. 골유합은 48예에서 평균 10.6주(범위, 8-16주)에 얻었다. 술 후 정복상태는 good 46예, acceptable 3예, poor 1예, 평균 TAD 18.9 mm (범위, 9.0-24.9 mm), Cleveland index 5구역 45예, 8구역 3예, 6구역 2예, 지연나사 활강평균 길이 4.9 mm (범위, 0.1-19.4 mm)였다. 합병증은 불유합 1예, 불유합 및 감염 1예 있었다. 결 론: 2공 측면 금속판을 이용한 치료는 보행 능력 회복 및 골유합 측면에서 만족스러운 결과를 보였다. Purpose: The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate. Materials and Methods: From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary’s Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson’s Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done. Results: The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of “Good”, 3 cases of “Acceptable,” and 1 case of “Poor.” Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications. Conclusion: Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results