목적: 고령 환자의 불안정성 대퇴전자간 골절에서 무작위로 전향적으로 시행한 내고정술과 고관절 부분 치환술간의 연령별 임 상 결과를 비교 분석하고자 하였다. 대상 및 방법: 2004년 1월부터 2007년 2월까지 70세 이상 고령에서 대퇴 전자간 불안정성 골절로 내고정이나 고관절 부분 치환 술을 시행한 62예에 대해 최소 12개월(12개월~36개월) 추시 관찰하여 SF-36을 통해 임상적 평가를 시행하였다. 내고정을 시행 한 군은30명, 부분 치환술을 시행한 군은 32명이다. 임상 결과 분석은 SF-36을 이용하였으며 SPSS를 통해 통계 분석하였다. 결과: 70대에서는 동통, 파행, 보조기 사용 여부 항목에서 부분 치환술 군이 유의하게 좋은 결과를 보였고, 80대에서는 파행 항 목에서만 부분 치환술 군이 좋은 결과를 보였으나(P<0.05), 나머지 항목에서는 각 군간에 유의한 차이가 없었다. 내고정군에서 고정물 실패가 4 예 있었고, 부분 치환술 군에서 감염에 의한 실패가 2예, 탈구로 인한 재치환술이 2예 있었다. 결론: 고령의 불안정성 대퇴 전자간 골절 시 내고정술보다 초기 안정성으로 동통이 적고 조기 기동이 가능한 고관절 부분 치환 술이 더 유용할 것으로 사료되었다.

Purpose: We wanted to analyze the clinical outcomes of prospectively randomized surgeries between internal fixation and hemiarthroplasty for treating unstable intertrochanteric hip fracture in elderly patients. Materials and Methods: From January, 2004 to December, 2007, 62 cases of unstable intertrochanteric fracture that underwent internal fixation or hemiarthroplasty were analyzed retrospectively for the clinical outcomes with using the SF-36. Thirty cases were treated with internal fixation and 32 cases were treated with hemiarthroplasty. The clinical outcomes, as assessed by using the SF-36, were statistically analyzed with using SPSS for Windows. Results: Hemiarthroplasty show a better result than internal fixation for pain, limping and the support scales in the 70~79 years old group, and the limping scale was also better in the over 80 years old group (P<0.05). There were no differences between the two groups according to age. Four cases of internal fixation failed due to loss of fixation (3) and nonunion (1), and 4 cases of hemiarthroplasty failed due to infection (2) and revision for dislocation (2). Conclusion: Primary hemiarthroplasty should be more beneficial than osteosynthesis, such as performing internal fixation, for treating unstable intertrochanteric fracture in elderly patients because of the reduced pain and early ambulation that are due to the early stabilization.

Purpose: We wanted to analyze the clinical outcomes of prospectively randomized surgeries between internal fixation and hemiarthroplasty for treating unstable intertrochanteric hip fracture in elderly patients. Materials and Methods: From January, 2004 to December, 2007, 62 cases of unstable intertrochanteric fracture that underwent internal fixation or hemiarthroplasty were analyzed retrospectively for the clinical outcomes with using the SF-36. Thirty cases were treated with internal fixation and 32 cases were treated with hemiarthroplasty. The clinical outcomes, as assessed by using the SF-36, were statistically analyzed with using SPSS for Windows. Results: Hemiarthroplasty show a better result than internal fixation for pain, limping and the support scales in the 70~79 years old group, and the limping scale was also better in the over 80 years old group (P<0.05). There were no differences between the two groups according to age. Four cases of internal fixation failed due to loss of fixation (3) and nonunion (1), and 4 cases of hemiarthroplasty failed due to infection (2) and revision for dislocation (2). Conclusion: Primary hemiarthroplasty should be more beneficial than osteosynthesis, such as performing internal fixation, for treating unstable intertrochanteric fracture in elderly patients because of the reduced pain and early ambulation that are due to the early stabilization.

Unstable intertrochanteric fracture, Internal fixation, Hemiarthroplasty