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60세 이상의 대퇴골 간부 골절에서 이상와 삽입 골수강내 금속정을 이용한 치료 시 내반 변형의 변화와 불유합에 영향을 주는 요인의 분석

Analysis of the Changes in Femoral Varus Bowing and the Factors Affecting Nonunion for the Treatment of Femoral Shaft Fractures over 60 Years Old Using Piriformis Fossa Insertion Intramedullary Nailing

대한골절학회지 2020년 33권 2호 p.65 ~ 71
차용한, 박찬호, 유준일, 김정택, 김우석, 김하용, 최원식,
소속 상세정보
차용한 ( Cha Yong-Han ) - Daejeon Eulji Medical Center Department of Orthopedic Surgery
박찬호 ( Park Chan-Ho ) - Yeungnam University Medical Center Department of Orthopaedic Surgery
유준일 ( Yoo Jun-Il ) - Gyeongsang National University Hospital Department of Orthopaedic Surgery
김정택 ( Kim Jung-Taek ) - Ajou University Medical Center Department of Orthopedic Surgery
김우석 ( Kim Woo-Suk ) - Daejeon Eulji Medical Center Department of Orthopedic Surgery
김하용 ( Kim Ha-Yong ) - Daejeon Eulji Medical Center Department of Orthopedic Surgery
최원식 ( Choy Won-Sik ) - Daejeon Eulji Medical Center Department of Orthopedic Surgery

Abstract


Purpose: This study examined the bony morphological changes to analyze the factors affecting bony union in the treatment of elderly femoral shaft fractures with varus bowing using piriformis fossa insertion intramedullary nailing.

Materials and Methods: This study included 26 patients over 60 years of age, who were admitted for femoral shaft fractures between January 2005 and December 2014 and treated with piriformis fossa insertion intramedullary nailing. Age, sex, height, weight, bone mineral density, injury mechanism, fracture type, diameter and length of the nail, postoperative lengthening of the femur, postoperative change in varus angle, contact between the lateral and anterior cortex, and the gap between the fracture line and the bony union were checked. The patients were divided into a varus group and nonvarus group, as well as a bone union group and nonunion group. Logistic regression analysis was performed to analyze the factors affecting nonunion.

Results: The patients were classified into 11 in the varus group and 15 in the non-varus group and 24 in the union group and 2 in the nonunion group. The varus group showed a larger increase in leg length and varus angle reduction than the non-varus group (p<0.05). The union group had more contact with the lateral cortical bone than that of the nonunion group (p<0.05). The factor affecting bone union in regression analysis was contact of the lateral cortical bone (p<0.05).

Conclusion: Treatment of a femoral shaft fracture in elderly patients with a varus deformity of the femur using piriformis fossa insertion intramedullary nail increases the length of the femur and decreases the varus deformity. For bony union, the most important thing during surgery is contact of the lateral cortical bone with the fracture site.

키워드

Shaft fracture; Intramedullary nail; Varus deformity; Nonunion

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