불안정 대퇴골 전자간 골절의 치료시 근위 대퇴정과 압박 고 나사의 비교
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Purpose: To evaluate the clinical results and the usefulness of proximal femoral nail for unstable intertrochanteric femoral fractures compared with a compression hip screw. Materials and Methods : One hundred patients with AO/A2 intertrochanteric fractures of the femur who had been operated using a comparession hip screw(fifty patients) or proximal femoral nail(fifty patients)were reviewed. All patients were follewed for a minimum of one year. Age, gender, American Society of anesthesiologist system, prefracture walking ability were recorded preoperativley and anesthesia, the amount of intraoperative and postoperative bleeding, operative time, intraoperative complications were recorded. Postoperativlye radiological evaluation, the time of bone union, complications, walking ability were assessed. Results : Patients treated with a proximal femoral nail had shorter operative times compared with those treated with a compression hip screw(P=0.03). During the operation, femoral shaft fractures occurred in two in proximal femoral nail group and none in the compression hip screw. Conversion to a total hip arthroplasty was necessary in one in the proximal femoral nail group. The compression hip screw was removed from one patient because of loss of reduction on seventh postoperative day, who was treated with proximal femoral nail. All of fractures healed. Those who were treated with the proximal femoral nail had significantly better walking ability outside the home at follow-up periods (p=0.02). Conclusions : We conclude that the proximal femoral nail is useful implant in the treatment of unstable intertrochanteric femoral fracture. It is associated with a relatively easy procedure, smaller incision, shorter operative time, and good postoperative functional status, as compared with a compression hip screw.