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1 대한골절학회지제 19 권, 제 3 호, 2006 년 7 월 Journal of the Korean Fractrure Society Vol. 19, N o. 3, July, 2006 후향적유연성금속정을이용한상완골간부골절의치료 정필현황정수강석김종필김영성박승복안광욱 동국대학교의과대학정형외과학교실 목적 : 상완골간부골절에있어후향적유연성금속정을이용한골수강내고정술의임상적및방사선학적결과에대해보고하고자한다. 대상및방법 : 2002 년 7월부터 2005 년 3월까지상완골간부골절에서후향적유연성정을이용하여치료한 17예중추시관찰이가능했던 15예를대상으로임상적및방사선학적결과를분석하였다. 결과 : 수술후 15예모두에서만족스러운골유합을얻었으며술후견, 주관절의운동제한및통증은없었으며 ASES를이용한평가에서 점의우수한결과를보여주었다. 지연유합이 1예, 유연성정의원위부전위가 3예있었으나그외심각한합병증은없었다. 결론 : 동반된신경및혈관손상이없는상완골간부골절에서후향적유연성정을이용한골수강내고정술은광범위연부조직의박리와회전근개의손상을피할수있는좋은치료방법의하나라고사료된다. 색인단어 : 골절, 상완골간부, 골수강내고정술, 후향적유연성정 Treatment of Humeral Shaft Fracture with Retrograde Flexible Nail Phil Hyun Chung, M.D., Chung Soo Hwang, M.D., Suk Kang, M.D., Jong Pil Kim, M.D., Young Sung Kim, M.D., Sung Pock Park, M.D., Kwang Uk An, M.D. Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Gyeongju, Korea Purpose: To evaluate and report the clinical and radiological results of the intramedullary fixation by retrograde flexible nail in the humeral shaft fracture. Materials and Methods: From July 2002 to May 2005, seventeen cases who had the humeral shaft fracture were treated with the intramedullary fixation by retrograde flexible nail. Fifteen cases were followed up and the clinical and radiological results were analyzed. Results: All of the cases had satisfactory fracture union, and none of the patient had limitation in shoulder or elbow joint movement, and shoulder or elbow joint pain, and average ASES was point. There was 1 case of delayed union, and 3 cases of distal nail displacement. Another severe complications were not occurred. Conclusion: Intramedullary fixation by retrograde flexible nail is one of the effective method in the humeral shaft fracture without nerve or vessel injuries, and also can avoid the complication of wide soft tissue incision or rotator cuff injury. Key Words: Fracture, Humerus shaft, Intramedullary fixation, Retrograde flexible nail 통신저자 박승복 Address reprint requests to Sung Pock Park, M.D. Department of Orthopaedic Surgery, College of Medicine Dongguk University, 646-1, Jukdo 2-dong, Buk-gu, Pohang , Korea Tel Fax Tel Fax yblood4@hanmail.net yblood4@hanmail.net 340

341 서 론 대상및방법 Fig. 1. Schematic presentation of operative procedure.

Expose the distal humerus shaft with a triceps longitudinal splitting

5 cm proximal to the superior edge of the olecranon fossa and portal

$(A) Preoperative radiograph shows mid 1/3 left humeral shaft fracture.$ $(B) Immediate postoperative radiograph shows humeral shaft fracture fixed$

2 341 서 론 대상및방법 Fig. 1. Schematic presentation of operative procedure. Place the patient prone position with the elbow in 90 o flexion. Expose the distal humerus shaft with a triceps longitudinal splitting incision. Entrance portal is placed 2.5 cm proximal to the superior edge of the olecranon fossa and portal should be 1cm wide and cm long. Fig. 2. (A) Preoperative radiograph shows mid 1/3 left humeral shaft fracture. (B) Immediate postoperative radiograph shows humeral shaft fracture fixed by retrograde flexible intramedullary nail. (C) The distal diplaced nail was noted after 6 weeks of the operation (white arrows). (D) At postoperative 11 weeks, the fracture appeared to be healed and the flexible nail was removed.

3 342 결과 Table 1. Demographic data Frontal Sagittal Bony Nail Shoulder Elbow ASES Case plane plane Shortening union removal VAS Complication ROM ROM score No. angulation angulation (POD #1yr) time time (POD #1yr) (POD #1yr) (POD*#1yr) (POD #1yr) (POD #1yr) (POD #1yr) (week) (week) 1. Varus 5 o Post. 5 o Full Full Varus 3 o Post. 10 o Full Full Valgus 7 o Ant. 5 o Full Full Varus 5 o Post. 5 o Full Flexion con tracture (10 o ) 5. Valgus 10 o Ant. 8 o 10 mm 9 10 Full Full Varus 7 o Post. 7 o Nail displace Full Full Valgus 3 o Post. 5 o Full Full Valgus 5 o Ant. 10 o 5 mm Full Full Varus 7 o Post. 7 o Nail displace Full Full Varus 3 o Post. 10 o Full Full Varus 5 o Ant. 8 o Full Full Valgus 5 o Post. 7 o Full Full Varus 5 o Ant. 5 o Full Full Valgus 7 o Post. 7 o Nail displace Full Full Valgus 3 o Post 5 o Full Full 0 42 Mean 10.4 Mean 12.2 Mean POD: Post-operative day, VAS: Visual analogue scale, ASES score: American Shoulder and Elbow Surgeon s score.

4 343 고 찰 결론

5 344 참고문헌 1) Bae SW, Kim WJ, Song BY, Choi NH and Lee JH: Postoperative functional assessments in adult humerus shaft fractures: comparison among plates and screws, intramedullary nail and external fixator. J Korean Fracture Soc, 14: , ) Barnes CE and Shuler TE: Complications associated with the Seidel nail. Ortho Review, 22: , ) Bell MJ, Beauchamp CG, Kellam JK and McMurtry RY: The results of plating humeral shaft fractures in patients with multiple injuries: the sunnybrook experience. J Bone Joint Surg, 67-B: , ) Blum J and Rommens PM: Surgical approaches to the humeral shaft. Acta Chir Belg, 97: , ) Chapman JR, Henley MB, Agel J and Benca PJ: Randomized prospective study of humeral shaft fracture fixation: intramedullary nail versus plates. J Orthop Trauma, 14: , ) Choy WS, Kim HJ, Lee KW and Park KH: The treatement of humeral shaft fracture by Kuntcher intramedullary nailing. J Korean Orthop Assoc, 27: , ) Christensen S: Humeral shaft fractures operative and conservative treatment. Acta Chir scand, 133: , ) Chung ES and Jeon IY: The comparative study of treatment between IM nailing and the plate fuation of the humerus shaft fracture. J Korean Fracture Soc, 12: , ) Finkkila T, Hyvonen P, Lakovaara M, Linden T, Ristiniemi J and Hamalainen M: Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand, 70: , ) Vander Griend R, Tomasin J and Ward EF: Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg, 68-A: , ) Healy WL, White GM, Mick CA, Brooker AF Jr and Weiland AJ: Nonunion of the humeral shaft. Clin Orthop, 219: , ) Heim D, Herkert F, Hess P and Regazzoni P: Surgical treatment of humeral shaft fractures--the Base experience. J Trauma, 35: , ) Hems TE and Bhullar TP: Interlocking nailing of humeral shaft fractures: the Oxford experience 1991 to Injury, 27: , ) Jensen CH, Hansen D and Jorgensen U: Humeral shaft fractures treated by interlocking nailing: a preliminary report on 16 patients. Injury, , ) Kim BH, Yim JI, Chung HY and Park JY: Closed intramedullary nailing of the humerus shaft fracture. J Korean Fracture Soc, 9: , ) Kim JR, Lee JH and Hwang BY: A comparison of treatment between plate fixation and antegrade intramedullary fixation of the humeral shaft fractures. J Korean Fracture Soc, 12: , ) Lin J: Treatment of humeral shaft fractures with humeral locked nail and comparison with plate fixation. J Trauma, , ) McCormack RG, Brien D, Buckley RE, McKnee MD, Powell J and Schemitsch EH: Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg, 82-B: , ) Meekers FS and Broos PL: Operative treatment of humeral shaft fractures: the Leuven experience. Acta Orthop Belg, 68: , ) Research Committee, American Shoulder and Elbow Surgeons: A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg, , ) Robert J, Brumback, Michael J, Poka A, Andrew R and Burgess: Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma. J Bone Joint Surg, 68-A: , ) Rockwood C and Matson F: The shoulder. Philadelphia, WB Saunders: 161, ) Robinson CM, Bell KM, Court-Brown CM and McQueen MM: Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. J Bone Joint Surg, 74-B: , ) Rommens PM, Verbruggen J and Bross PL: Retrograde locked nailing of humeral shaft fractures. A review of 39 patients. J Bone Joint Surg, 77-B: 84-89, ) Seidel H: Humeral locking nail: a preliminary report. Orthopaedics, 12: , ) Shin DK, Kwun KW, Kim SK, Lee SW, Choi CH and Ko SB: Treatment of humerus shaft fracture with intramedullary nail. J Korean Fracture Soc, 13: , ) Shin HD, Rhee KJ, Kim KC and Song HS: Operative treatment of traumatic humeral shaft fracture: comparison of interlocking IM nailing and plate fixation by posterior approach. J Korean Fracture Soc, 18: 93-99, 2005.

6 345 28) Son CM, Bae JB, Seo SS, et al: Treatment of humerus shaft fracture with closed interlocking nail. J Korean Orthop Assoc, 30: , ) Suh JT, Jung SW, Ku JK and Yoo CI: Operative treatment of the humeral shaft fracture: comperative study of dynamic compression plate and interlocking intramedullary nail. J Korean Fracture Soc, 15: , ) Wagner MS, Patters BM, Wilber JH and Sonititch JK: Comparison of outcomes for humeral diaphysis fractures treated with either closed intramedullary nailing or open reduction internal fixation using a dynamic compression plate in the multiple trauma patients. Procs Annual Meeting of the Orthopaedic Trauma Association, , 1995.

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical