전자간 외반 절골술을 이용한 대퇴골 경부 골절 불유합의 치료

Abstract

Non-union following fracture of the femoral neck continues to present one of the major orthopaedic problems. The present accepted methods of treatment for ununited fracture of the femoral neck include bone-grafting, valgus osteotomy, arthrodesis, femoral head replacement and total joint replacement. We report a series of 10 patients ranging from 20 to 65 years of age who had an ununited femoral neck fracture treated by a Pauwels abduction (intertrochanteric valgus) osteotomy and internal fixa- tion with sliding compression hip screw or blade plate. All patients were followed up more than 2 years (average 5.8 years) so that any late complications could be documented. One patient had required prosthetic replacement because of the femoral head avascular necrosis, and the results of 9 others were evaluated using the Harris hip rating scale and radiographic examination: 6(66%) were rated excellent, 2(22%) good, and l(11%) fair. In these patients the Harris hip score averaged 88. For active patients with non-union of a femoral neck fracture, Pauwels abduction (intertrochanteric valgus) osteotomy and intemal fixation with sliding compression hip screw or blade plate provide a high proportion of good results, and autogenous cancellous bone graft and additional multiple Knowles pins are much helpful occasionally. If osteotomy fails, prosthetic replacement is still possible.