untitled

Size: px

Start display at page:

Download "untitled"

서겨 복
6 years ago
Views:

1 ISSN (Print) ISSN (Online) 대한골절학회지제 28 권, 제 1 호, 2015 년 1 월 J Korean Fract Soc 2015;28(1): Original Article 골결손을동반한고령의원위요골분쇄골절에서동종해면골이식과수장측잠김금속판을이용한치료 강홍제 신창현 원광대학교의과대학정형외과교실, 원광의과학연구소 Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly Hong Je Kang, M.D., Chang Hyun Shin, M.D. Department of Orthopedic Surgery, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea Purpose: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. Materials and Methods: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. Results: Using the MMWS, 13 cases were classified as good, 10 fair, and 5 normal. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as good, 14 fair, and 7 normal. Conclusion: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly. Key Words: Distal radius fracture, Allogenic Cancellous Bone Graft, Volar Locking Plate Received June 9, 2014 Revised August 18, 2014 Accepted September 25, 2014 Address reprint requests to: Hong Je Kang, M.D. Department of Orthopedic Surgery, Wonkwang University College of Medicine, 460 Iksan-daero, Iksan , Korea Tel: ㆍFax: kanghongje@hanmail.net Financial support: None. Conflict of interest: None. 서 원위요골분쇄골절에서보존적치료만을시행했을경우정상적해부학적구조를회복하지못하여외상후관절염이발생하거나정복소실, 불안정성, 부정유합, 신경손상등의많은합병증이발생할수있어수술적치료가선호되고있다. 1,2) 론 Copyright c 2015 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 8

Treatment of the Communited Distal Radius Fracture Using Volar Plate with Allogenic

따라서이러한문제점들을최소화하기위해골결손부위에골이식또는골대치물삽입등이고려될수있다.

Demographic Data of the Patients (n=29) Patient data Gender (male : female) Age (yr)

1 (65-81) 22.4 (12-36) A3.1: 2, A3.2: 4, A3.3: 5 C2.2: 3, C2.3: 5, C3.2: 6, C3.

$A 71-year-old woman with an AO/OTA classification C3.2 type fracture.$

2 Treatment of the Communited Distal Radius Fracture Using Volar Plate with Allogenic Bone Graft 9 원위요골분쇄골절의수술적치료방법으로는외고정장치를이용한고정술, 도수정복및경피적 K-강선을이용한내고정술, 관혈적정복및금속판을이용한내고정술등이있으며, 3,4) 그중최근고안된수장측잠김금속판은잠김나사와금속판의기계적인연결으로안정성을얻고후방고정시발생하는신전건의파열이나자극증상, 건막염등의합병증을피할수있다는장점이있어점차흔하게사용되고있다. 3) 하지만심한골결손을동반한고령의원위요골분쇄골절에서금속판만을이용한내고정술을시행하면수술후골간단부골결손과피질골의약화로이차적인전위나관절면의붕괴가일어날수있다. 따라서이러한문제점들을최소화하기위해골결손부위에골이식또는골대치물삽입등이고려될수있다. 5-8) 본연구는심한골결손을동반한고령의원위요골분쇄골절에서동종해면골이식술과수장측잠김금속판을이용한내고정술의임상적, 방사선적치료결과에대해알 Table 1. Demographic Data of the Patients (n=29) Patient data Gender (male : female) Age (yr) Follow-up duration (mo) Fracture type (AO/OTA) Value 4 (13.7) : 25 (86.2) 73.1 (65-81) 22.4 (12-36) A3.1: 2, A3.2: 4, A3.3: 5 C2.2: 3, C2.3: 5, C3.2: 6, C3.3: 4 Values are presented as number (%), medians (range), or number only. Fig. 1. A 71-year-old woman with an AO/OTA classification C3.2 type fracture. (A) Preoperative anteroposterior and lateral radiographs. (B) Preoperative 3-dimensional computed tomography. (C) Piled up allogenous cancellous bone chip at bone defect lesion (arrow). (D) Postoperative anteroposterior and lateral radiographs. (E) Postoperative 12 months anteroposterior and lateral radiographs.

10 Hong Je Kang and Chang Hyun Shin 아보고자 하였다.

대상 2009년 4월부터 2013년 4월까지 원광대학교 의과대학병 원에서 원위 요골

수술적 치료는 10도 이상의 후방 굴곡, 5 mm 이상의 요골 단축 혹은 2 mm

이 중 나이가 65세 이상이며 골 결손과 함께 분쇄골절이 동반하여 동종 해면골 이식술을

동 종 해면골 이식술은 전방과 후방 피질골의 심한 분쇄와 골 결손으로 수술 중 골정복의

$classification C3.3 type fracture.$ (A) Preoperative anteroposterior and lateral

3 10 Hong Je Kang and Chang Hyun Shin 아보고자 하였다. 대상 및 방법 1. 대상 2009년 4월부터 2013년 4월까지 원광대학교 의과대학병 원에서 원위 요골 골절에 대하여 수장측 잠김 금속판을 이 용하여 187예를 치료하였다. 수술적 치료는 10도 이상의 후방 굴곡, 5 mm 이상의 요골 단축 혹은 2 mm 이상의 관절 내 층형성을 보이는 불안정성 골절에서 시행하였다. 이 중 나이가 65세 이상이며 골 결손과 함께 분쇄골절이 동반하여 동종 해면골 이식술을 동시에 시행하고 12개월 이상 추시 관찰이 가능하였던 29예를 대상으로 하였다. 동 종 해면골 이식술은 전방과 후방 피질골의 심한 분쇄와 골 결손으로 수술 중 골정복의 유지가 어려운 환자에게 시행 Fig. 2. A 78-year-old woman with an AO/OTA classification C3.3 type fracture. (A) Preoperative anteroposterior and lateral radiographs. (B) Preoperative 3-dimensional computed tomography. (C) Piled up allogenous cancellous bone chip at bone defect lesion (arrow). (D) Postoperative anteroposterior and lateral radiographs. (E) Postoperative 15 months anteroposterior and lateral radiographs.

4 Treatment of the Communited Distal Radius Fracture Using Volar Plate with Allogenic Bone Graft 11 하였다. 후방피질골에만분쇄가있거나수장측또는수배측 Barton 골절, 추가적으로후방접근법을이용하여수술을시행한경우는제외하였으며관절면의분쇄가심하여추가적으로관절내시경을이용한정복술을시행하거나외고정술을시행한경우도제외하였다. 남자는 4 명, 여자는 25 명이었고, 평균연령은 73.1 세 (65-81 세 ) 였으며, 평균추시기간은 22.4 개월 (12-36 개월 ) 이었다. 모든환자에서수술전, 대퇴경부와제 1 요추에서제 4 요추까지에너지방사선흡수계측방법을이용한골밀도검사 (bone mineral density) 를시행하였으며, t-score 는평균 4.3 ( ) 이었다. 골절의분류는단순방사선전후면및측면촬영과컴퓨터단층촬영에근거하여 AO/OTA 분류이용하였고 A 형골절이 11 예 (A3.1: 2, A3.2: 4, A3.3: 5), C 형골절이 18 예 (C2.2: 3, C2.3: 5, C3.2: 6, C3.3: 4) 였다 (Table 1). 2. 수술방법및재활 수술방법은전신마취하에상완부에지혈대를시행하였으며수술적접근은전방도달법을이용하였다. 요수근굴건의건을촉지한후피부절개를시행하여요수근굴건을척측으로견인하였다. 방형회내근노출시킨후, 요골부착부 1/3 지점인안전지대에서박리하여골절부를노출시켰다. 그리고골절부위에서골의손실이추가적으로이루어지는것에조심하고, 분쇄된피질골에서연부조직이떨어지지않도록조심하며세척술을시행하여혈종을제거하였다. 골결손부를확인후골절에대한정복을시행하였고, 골결손에의해정복유지가안되는경우먼저동종해면골 (Cancellus, Coarse, Freeze dried; CommunityTissueServices, Dayton, OH, USA) 이식을시행하여골결손부를충진한이후골절에대한정복을시행하였으며 K-강선을삽입하여추가적인고정을시행하였다. 관절면을침범한골절의경우요골경상돌기에서관절면과평행하게 K-강선을먼저삽입하여관절면골절을먼저정복하였다. 이후수장측잠김금속판 (2.3 mm Acu-Loc R Volar Distal Radius Plate; ACUMED, Hillsboro, OR, USA) 을고정하였고, C-arm fluoroscopy 을이용한정복의적절성을평가한이후골결손부가남아있는경우추가적으로골이식을시행하였다 (Fig. 1). 요척관절의불안정성을유발하는척골경상돌기기저부골절혹은척골두골절이동반된경우 K-강선이나척측잠김금속판 (Acu-Loc R VDU Plate; ACUMED) 을이용하여고정하였으며 (Fig. 2), 이경우에는장상지부목을시행하였고, 그렇지않은경우수술후 2주간단상지부목을시행하였다. 수술직후부터모든수지의능동적관절운동을시행하였으며수술후 2주부터제거가능한손목보호대를 착용하였으며능동적인손목관절운동을시행하였다. 3. 임상적결과및방사선적결과 술후임상적결과는최종추시시 modified Mayo wrist scoring system (MMWS), 손목의관절운동범위, 그리고 visual analogue pain scale (VAS) 를이용하여평가하였다. 손목의관절운동범위는 ( 굴곡, 신전, 회외전, 회내전 ) Goniometer 를이용하여측정하고건측의값과비교해백분율값을산출하였다. 술후방사선적결과는골절의유합시기와수술직후와최종추시에서 Goldfarb 등 9) 이보고한평가방법을적용하여요골길이, 요골경사각, 수장측경사각을측정하여비교하였으며, Sarmiento criteria 10) 의평가방법을적용하여요골원위부의변형, 요골단축, 요골경사의소실, 배측경사의변화정도를측정하여우수, 양호, 보통, 그리고불량의 4 단계로나누어평가하였다. 손목관절운동, 방사선적지표는 Student t-test 를시행하여분석하였다. p 값은 0.05 미만인경우를통계적인유의성이있는것으로간주하였다. 분석은 PASW Statistics ver 18.0 (IBM Co., Armonk, NY, USA) 으로검정하였다. Table 2. Clinical Outcome of Communited Distal Radius Fracture according to Modified Mayo Wrist Scoring System Grade Exellent Good Fair Poor Volar locking plate fixation with allogenic cancellous bone graft Total patients (n=29) Type A (n=11)* Type C (n=18)* 13 (44.8) 10 (34.5) 5 (17.3) 1 (3.4) 결 MMWS 에서우수 13 예, 양호 10 예, 보통 5 예, 불량 1 예로양호이상이 79.3% 였다 (Table 2). 평균손목관절운동범위평균값은굴곡 62 o (70 o, 88.5%), 신전 71 o (77 o, 92.2%), 회내전 79 o (85 o, 90.5%), 회외전 82 o (87 o, 94.0%) 였으며 VAS 는평균 1.5 점이었다 (Table 3). 방사선적결과에서평균유합기간은 12.5 주 (9-22 주 ) 전체예의환자에서방사선적유합을얻을수있었다. 수술직후요골길이는평균 13.5 mm ( mm), 요골경사각 과 Values are presented as number (%) or number only. *Classification according to the standard of AO/OTA fracture type

5 12 Hong Je Kang and Chang Hyun Shin Table 3. Wrist Functional Outcomes at Last Follow-Up Affected side Affected side/contralateral side Contralateral side Total Type A* Type C* Total Type A* Type C* p-value Flexion ( o ) Extension ( o ) Pronation ( o ) Supination ( o ) VAS (score) The angle of the joint is shown in percentile compared to normal side. *Classification according to the standard of AO/OTA fracture type. VAS: Visual analogue pain scale. Table 4. Radiological Outcomes Immediate Postoperative Date and Last Postoperative Follow-Up Radiographic Index Immediate postoperation Last postoperative follow-up Total Type A Type C Total Type A Type C p-value Radial length (mm) Radial inclination ( o ) Volar tilt ( o ) 13.5± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Values are presented as mean±standard deviation. Table 5. Results according to Sarmiento Criteria Grade Excellent Good Fair Poor Volar locking plate fixation with allogenic cancellous bone graft Total patients (n=29) Type A (n=11)* Type C (n=18)* 5 (17.3) 14 (48.3) 7 (24.1) 3 (10.3) Values are presented as number (%) or number only. *Classification according to the standard of AO/OTA fracture type. 은평균 21.5 o (18.5 o o ), 수장측경사는 7.9 o (4.8 o -7.9 o ) 였으며, 최종추시시각각평균 12.5 mm ( mm), 23.5 o (16.2 o o ), 8.1 o (6.6 o -9.3 o ) 로수술직후와비교에서는통계적으로의미있는변화는없었다 (p=0.62) (Table 4). Sarmiento criteria 상우수 5 예, 양호 14 예, 보통 7 예, 불량 3 예로양호이상이 65.6% 였다 (Table 5). 술후합병증으로 1 예에서정중신경압박증상이있어수술후 3 개월에수근관감압술을시행하였으며이후증상이소실되었다. 고 찰 원위요골분쇄골절은골결손이심하여해부학적정복 및유지에어려움이있어수술적인치료가요구된다. 원위요골골절의수술적치료방법에는관혈적정복및금속판내고정술, 도수정복후경피적 K- 강선내고정술, 외고정장치를이용한고정술등매우다양하다. 1-3) Mah 과 Atkinson 11) 은도수정복및금속강선고정술은상대적으로비침습적이고시술시간이짧으며비용적인측면에서도장점이있으나상대적으로고정력에서떨어지고골유합이이루어지는동안정복의소실과그에따른기능감소의단점이있다고보고하였다. Zhang 등 12) 은 26 명의원위요골의관절내분쇄골절환자를대상으로외고정장치를이용한수술적치료를시행하였고, 임상적및방사선적으로좋은결과를얻었다고보고하였다. 또한 Kofoed 13) 는분쇄골절과전위된관절내골절에서외고정장치및골시멘트를이용한보강을시행하였으며, 합병증없이양호한결과를보고하였다. 반면 Arora 와 Malik 14) 은외고정장치의축성신연력만으로는정상적인수근관절면의수장측경사를회복하기어렵고, 관절내골절편을충분히정복할수없을뿐아니라해면골의소실로인한정복소실이발생할수있음을보고하였으며, Mudgal 과 Jupiter 15) 는과신연으로인해수근부및수지의구축이올수있음을보고하였다. Na 등 16) 은후방분쇄및전위가있는경우후방금속판을이용한고정술로좋은결과를얻었다고보고하였다. 그러나후방접근법은신근지대의절개가필요하고, 신전건

6 Treatment of the Communited Distal Radius Fracture Using Volar Plate with Allogenic Bone Graft 13 의손상이발생하기쉬우며, 금속판의고정을위해리스터결절의절제가필요하다는단점을가지고있다. 여러저자들은불안정한원위요골골절에서수장측잠김금속판을이용하여내고정술을시행하여좋은결과를보고하였다. 또한수장측잠김금속판은신전건의손상이적고, 배측에비해연부조직이풍부하여내고정물이만져지는합병증이적으며, 기술적으로손쉽다는장점이있다고하였다 ) 또한 T형잠금압박금속판은후방피질골분쇄를동반한불안정성골절에서도안정성을얻을수있어정확한해부학적정복및견고한고정을얻을수있다고하였다. 20) Kim 등 21) 은고령의골간단부에골결손이있는불안정한원위요골골절환자에서골결손부대체물로 calcium phosphate bone cement (CPC) 를사용하고, 수장측잠김금속판을이용하여내고정하였을때추시결과와수장측잠김금속판만을사용한후추시결과의차이가없다고보고하였다. 또한 Rhee 등 22) 은고령여성의불안정한원위요골골절에서수장측잠김금속판만을이용하여내고정하였을때, 추시상골편전위없이만족할만한치료결과를보고하였다. 한편, 여러저자들은불안정한원위요골골절에서수장측잠김금속판만을이용하여내고정하였을때, 금속판손상, 나사못빠짐현상및골편정복소실을보고하였다. 23,24) 또한다른저자들은후방분쇄골절과함께수장측피질골의분쇄및골결손이동반된경우골간단부골결손과피질골의약화로이차적인전위나관절면의붕괴가일어나기쉬울뿐더러지연유합혹은불유합이발생할수도있다고하였다. 5-8) 따라서이러한문제점들을최소화하기위해골결손부위에골이식또는대체물삽입등의부가적인시술을통한구조적인지지대가필요하다고보고하였다. 5-7,25,26) 현재임상적으로이용되는골결손부대체물로자가골이식, 동종골이식, 골시멘트, 그리고 CPC 등을삽입할수있다. Kainz 등 25) 은요골원위부의골결손을동반한분쇄골절환자에서분쇄골절부분에 CPC를사용한뒤수장측잠김금속판을이용한내고정술을시행하였을때 CPC를사용하지않은대조군과비교하여최종추시결과에서안정성을얻을수있었다고보고하였다. 또한 Büyükkurt 등 26) 은여성 37명의원위요골골절환자중골다공증이있는 20명과골다공증이없는 17명의환자에게금속판만을이용한내고정술을시행하였을때, 추시관찰시방사선학적차이는없지만골다공증환자에서관절운동제한과일상생활에제한이있음을보고하였다. 이와함께 Goto 등 27) 은고령의요골원위부의골결손을동반한분쇄골절환자에서분쇄골절부분에 hydroxyapatite 골이식을시행한뒤, 수장측잠김금속판을이용한내고정술을시행하였을때, hydroxyapatite 골이식을하지않은대 조군과비교하여최종방사선추시상만족할만한결과를보고하였다. 자가골이식은생체적합성이우수하면서적당한생역학적강도를갖고있으므로골결손이동반된불안정성골절에서골절치유를촉진한다는장점이있어전통적으로장골능에서채취한자가골이널리이용되었다. 28) 그러나자가골이식은공여부의혈종과감염, 동통, 장골능골절, 신경손상, 수술시간지연, 출혈량증가등의합병증등의보고된단점이있다. 29) 골시멘트는골실질의재형성을기대할수없고, 자가골과융합되지도않으며, 시술시의발열반응으로인해골절치유를방해할뿐아니라, 액화상태에서는세포독성이있고, 골절부외로새어나가면조직손상의위험이있다. 30) CPC는생화학적적합성과골전도능력이해면골과유사하여골대치물로많이사용되나충진된 CPC가관절밖으로흘러나와동통과관절증등합병증을유발시킬수있다는단점이있어제한적으로사용하고있다. 31) 본연구에서는고령의골다공증이있는요골원위부의심한골결손을동반한분쇄골절환자에게동종해면골이식을시행하였다. 동종해면골이식의장점으로는첫째, 이차적인전위나관절면의붕괴를막는구조적인지지대의역할을하기때문관절면에기계적안정성을부여하고정복된관절면을유지하도록하여해부학적정복을유지시키며, 둘째, 공여부의이환이없고공급의제한이없다는점, 셋째, 수술중출혈량을줄일수있고, 넷째, 이식골주위는수여자의풍부한해면골로둘러싸인부위이므로이로부터이식된동종골내부로가골이신속하게침투할수있다는점이있다. 32) 이후, 수장측잠김금속판을사용하여내고정술을시행하였고, 임상적으로만족할만한결과를보였으며, 방사선학적으로요골원위부의변형, 요골단축, 요골경사의소실, 배측경사의의미있는정복의소실이없이골유합을얻었다. 또한좀더견고한안정성을얻을수있어조기관절운동이가능하게하여일상생활로의빠른복귀가가능하였다. 수장측금속판을삽입하는경우수지굴곡건의지연성파열이발생할수있으며신경손상을유발하거나방형회내근의손상을주며전방피질골의혈액순환에피해를줄수도있으며관절면을침범한골절의경우직접관절면을볼수없다는단점이있다. 16,33) 본논문에서도정중신경압박증상이 1예에서발생하여수근관관압술을시행하였다. 또한본논문에서는관절면골절의경우먼저 C-arm fluoroscopy 를보며관절면을정복하여금속강선을이용하여고정하였으며심하게골절되어정복을잘할수없는경우에는추가적으로외고정장치를시행하거나관절경하정복술을시행하였다.

7 14 Hong Je Kang and Chang Hyun Shin 본연구의한계점으로는증례의수가 29 예로적고, 골이식을하지않은환자와비교연구를시행하지않았다는점이있다. 또한고령의환자를대상으로하여골결손이심한젊은환자의경우골이식시행하였을때의결과에대하여는알수없다. 이와함께외상후관절염의발생유무에대해장기추시가필요할것으로생각된다. 결 심한골결손을동반한고령의원위요골분쇄골절환자에서동종해면골이식과수장측잠김금속판을이용한치료는임상적및방사선학적으로만족할만한결과를보이는효과적인치료방법이다. 론 References 1) Edwards GS Jr: Intra-articular fractures of the distal part of the radius treated with the small AO external fixator. J Bone Joint Surg Am, 73: , ) Ring D: Treatment of the neglected distal radius fracture. Clin Orthop Relat Res, (431): 85-92, ) Leung F, Tu YK, Chew WY, Chow SP: Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radial fractures. A randomized study. J Bone Joint Surg Am, 90: 16-22, ) Ring D, Prommersberger K, Jupiter JB: Combined dorsal and volar plate fixation of complex fractures of the distal part of the radius. J Bone Joint Surg Am, 86: , ) Herrera M, Chapman CB, Roh M, Strauch RJ, Rosenwasser MP: Treatment of unstable distal radius fractures with cancellous allograft and external fixation. J Hand Surg Am, 24: , ) Leung KS, Shen WY, Leung PC, Kinninmonth AW, Chang JC, Chan GP: Ligamentotaxis and bone grafting for comminuted fractures of the distal radius. J Bone Joint Surg Br, 71: , ) McBirnie J, Court-Brown CM, McQueen MM: Early open reduction and bone grafting for unstable fractures of the distal radius. J Bone Joint Surg Br, 77: , ) Wolfe SW, Pike L, Slade JF 3rd, Katz LD: Augmentation of distal radius fracture fixation with coralline hydroxyapatite bone graft substitute. J Hand Surg Am, 24: , ) Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI: Wrist fractures: what the clinician wants to know. Radiology, 219: 11-28, ) Sarmiento A, Zagorski JB, Sinclair WF: Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation. Clin Orthop Relat Res, (146): , ) Mah ET, Atkinson RN: Percutaneous Kirschner wire stabilisation following closed reduction of Colles' fractures. J Hand Surg Br, 17: 55-62, ) Zhang SX, Gu FR, Peng YL, et al: External fixation and bone grafting for collapsed and comminuted distal radius fracture. Chin J Traumatol, 8: , 164, ) Kofoed H: Comminuted displaced Colles' fractures. Treatment with intramedullary methylmethacrylate stabilisation. Acta Orthop Scand, 54: , ) Arora J, Malik AC: External fixation in comminuted, displaced intra-articular fractures of the distal radius: is it sufficient? Arch Orthop Trauma Surg, 125: , ) Mudgal CS, Jupiter JB: Plate fixation of osteoporotic fractures of the distal radius. J Orthop Trauma, 22: S106-S115, ) Na KT, Song SW, Lee YM, Kang BM: Dorsal plate fixation for dorsally displaced distal radius fractures. J Korean Soc Surg Hand, 19: 44-51, ) Orbay JL: The treatment of unstable distal radius fractures with volar fixation. Hand Surg, 5: , ) Lozano-Calderón SA, Souer S, Mudgal C, Jupiter JB, Ring D: Wrist mobilization following volar plate fixation of fractures of the distal part of the radius. J Bone Joint Surg Am, 90: , ) Murakami K, Abe Y, Takahashi K: Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci, 12: , ) Kim SJ, Cho CH: 2.4 mm volar locking compression plate for treatment of unstable distal radius fractures. J Korean Fract Soc, 24: , ) Kim JK, Koh YD, Kook SH: Effect of calcium phosphate bone cement augmentation on volar plate fixation of unstable distal radial fractures in the elderly. J Bone Joint Surg Am, 93: , ) Rhee SH, Kim J, Lee YH, Gong HS, Lee HJ, Baek GH: Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients. Bone Joint J, 95: , 2013.

8 Treatment of the Communited Distal Radius Fracture Using Volar Plate with Allogenic Bone Graft 15 23) Foo TL, Gan AW, Soh T, Chew WY: Mechanical failure of the distal radius volar locking plate. J Orthop Surg (Hong Kong), 21: , ) Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M: Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma, 21: , ) Kainz H, Dall'Ara E, Antoni A, Redl H, Zysset P, Weninger P: Calcium phosphate cement augmentation after volar locking plating of distal radius fracture significantly increases stability. Eur J Orthop Surg Traumatol, 24: , ) Büyükkurt CD, Bülbül M, Ayanoğlu S, Esenyel CZ, Oztürk K, Gürbüz H: The effects of osteoporosis on functional outcome in patients with distal radius fracture treated with plate osteosynthesis. Acta Orthop Traumatol Turc, 46: 89-95, ) Goto A, Murase T, Oka K, Yoshikawa H: Use of the volar fixed angle plate for comminuted distal radius fractures and augmentation with a hydroxyapatite bone graft substitute. Hand Surg, 16: 29-37, ) Geissler WB, Fernandez DL: Percutaneous and limited open reduction of the articular surface of the distal radius. J Orthop Trauma, 5: , ) Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA: Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res, (329): , ) Mjöberg B, Pettersson H, Rosenqvist R, Rydholm A: Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand, 55: , ) Zimmermann R, Gabl M, Lutz M, Angermann P, Gschwentner M, Pechlaner S: Injectable calcium phosphate bone cement Norian SRS for the treatment of intra-articular compression fractures of the distal radius in osteoporotic women. Arch Orthop Trauma Surg, 123: 22-27, ) Enneking WF, Mindell ER: Observations on massive retrieved human allografts. J Bone Joint Surg Am, 73: , ) Kim JY, Kang HJ, Yi Y: Multiple flexor tendon injuries after volar plate fixation for distal radius fracture: two cases report. J Korean Soc Surg Hand, 17: 47-51, 2012.

9 ISSN (Print) ISSN (Online) 대한골절학회지제 28 권, 제 1 호, 2015 년 1 월 J Korean Fract Soc 2015;28(1): Original Article 골결손을동반한고령의원위요골분쇄골절에서동종해면골이식과수장측잠김금속판을이용한치료 강홍제 신창현 원광대학교의과대학정형외과교실, 원광의과학연구소 목적 : 골결손을동반한고령의원위요골분쇄골절에서동종해면골이식과수장측잠김금속판을이용한치료의결과에대해알아보고자한다. 대상및방법 : 2009년 4월부터 2013년 4월까지동종해면골이식과수장측잠김금속판으로치료한 29예를대상으로하였다. 골절형태는 AO/OTA 분류를이용하였다. 임상적결과는최종추시시관절운동범위, modified Mayo wrist scoring system (MMWS), visual analogue pain scale (VAS) 를이용하고, 방사선적결과는수술직후와최종추시시요골길이, 요골경사각, 수장측경사각, Sarmiento criteria를이용하였다. 결과 : MMWS에서우수 13예, 양호 10예, 보통 5예였다. 평균관절운동범위는굴곡 88.5%, 신전 92.2%, 회내전 90.5%, 회외전 94.0% 였다. VAS는평균 1.7점이었다. 최종추시시평균요골길이, 요골경사각, 수장측경사각은수술후와통계적의미있는변화는없었으며 (p>0.05), Sarmiento criteria는우수 5예, 양호 14예, 보통 7예였다. 결론 : 골결손을동반한고령의원위요골분쇄골절에서동종해면골이식과수장측잠김금속판을이용한치료는양호한결과를보이는효과적인치료방법이다. 색인단어 : 원위요골골절, 동종해면골이식, 수장측잠김금속판 접수일 수정일 게재확정 교신저자강홍제익산시익산대로 460 원광대학교의과대학정형외과학교실 Tel , Fax , kanghongje@hanmail.net Copyright c 2015 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 16

ORIGINAL ARTICLE J Korean Fract Soc 2018;31(1):1-8 ISSN (Print) ㆍ ISSN (Online) 벽돌쌓기기법을이

ORIGINAL ARTICLE J Korean Fract Soc 2018;31(1):1-8 ISSN 1225-1682 (Print) ㆍ ISSN 2287-9293 (Online) https://doi.org/10.12671/jkfs.2018.31.1.1 벽돌쌓기기법을이용한원위요골관절내분쇄골절의해부학적정복술 김형민ㆍ조형래ㆍ채종우ㆍ신명지 좋은삼선병원정형외과 Anatomical