항회전 근위 대퇴 골수정을 이용한 대퇴골 전자하 골절의 치료

Abstract

Purpose: The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). Materials and Methods: From January 2008 to December 2011, 25 consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA of the length over 200 mm and were possible for over 12 months follow up. The average duration of follow up was 19.1 months (range, 12-35 months). According to the Seinsheimer's classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. Functional outcomes were assessed according to modified Koval index and Katz index of independence in activities of daily living index. Results: Union was achieved in 23 of 25 cases, in an average of 17 weeks (range, 12∼33 weeks). Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown 80% of 5, 6, 8 and 9 zone, the tip apex distance was 19.6 mm (6.2 to 30.2 mm), the mean sliding distance was 4.4 mm(0∼16.1 mm) and the mean change of femur neck and shaft angle was varus 3 degree (0∼9 degree) at the final follow-up. The complication include 3 cases of delayed union and 2 cases of nonunion. 22 patients (88%) were restored to their preoperative walking ability. 21 patients (84%) were able to live independently without support. Conclusion: Because of early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. And limited open reduction and additional fixation such as cable grip are recommended if it is hard to obtain anatomical reduction by closed reduction.

Key Words: Femur, Subtrochanteric fracture, limited open reduction, Proximal femoral nail anti-rotation (PFNA)