대한골절학회지제 19 권, 제 4 호, 2006 년 10 월 Journal of the Korean Fractrure Society Vol. 19, N o. 4, October, 2006 팔씨름에의해발생한상완골간부및내상과골절 윤여헌 하종경 * 최경업 * 이관희 신상진 이화여자대학교의과대학목동병원정형외과, 서울적십자병원정형외과 * 목적 : 팔씨름중발생한상완골골절의발생기전및치료의결과를분석하였다. 대상및방법 : 팔씨름중유발된상완골골절 7예를대상으로하였으며, 이중상완골간부골절이 3예, 상완골내상과골절 4예였다. 문진및방사선사진을이용하여골절의기전과치료의결과를분석하였다. 결과 : 상완골간부골절은상완골의비틀림과축성압박력에의해유발되었다. 상완골내상과골절은굴곡근의과도한수축에의한견열골절이었으며, 내상과의골성장이끝나지않은어린나이에서유발되었다. 대상중 6예에서수술적치료를시행하였고, 전예 (7예 ) 에서합병증없이골유합을얻었다. 결론 : 팔씨름에의해유발된상완골골절은발생위치에따라연령과기전의차이가있고, 그에따른치료를시행할경우합병증없이만족할만한결과를얻을수있을것으로생각된다. 색인단어 : 상완골, 간부골절, 내상과골절, 팔씨름 The Fractures of Humerus Shaft and Medial Epicondyle by Arm Wrestling Yeo-Hun Yoon, M.D., Jong-Kyung Ha, M.D.*, Kyung-Eob Choi, M.D.*, Kwan-Hee Lee, M.D., Sang-Jin Shin, M.D. Department of Orthopedic Surgery, College of Medicine, Ewha Woman s University, Mok-Dong Hospital, Department of Orthopedic Surgery, Red-Cross Hospital*, Seoul, Korea Purpose: To evaluate the mechanism of the humeral fractures induced by arm wrestling and the clinical results of its treatment. Materials and Methods: We reviewed 7 humeral fractures induced by arm wrestling; 3 humeral shaft fractures, 4 humeral medial epicondyle fractures. The mechanism of the fractures and the clinical results were assessed by history and radiographs. Results: Shaft fractures were produced by twist and axial compression force. Humeral medial epicondyle fractures were the avulsion fractures by excessive contraction of flexor muscles and developed in young age. We operated 6 of them and in all cases, we could obtain fracture healings without complication. Conclusion: The humeral fractures induced by arm wrestling have the differences in the ages and mechanisms as to the locations of the fractures and if the proper treatment is performed, the clinical results are satisfactory. Key Words: Humerus, Shaft fracture, Medial epicondyle fracture, Arm wrestling 통신저자 신상진 Address reprint requests to Sang-Jin Shin, M.D. Department of Orthopeadic Surgery, School of Medicine, Ewha Woman s University, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel 02-2650-5143 Fax 02-2642-0349 E-mail sjshin622@ewha.ac.kr Tel 82-2-2650-5143 Fax 82-2-2642-0349 E-mail sjshin622@ewha.ac.kr 437
438 서론 결과 대상및방법 Table 1. Patient demographics Age/Sex BMI Dominant arm Injured arm Position in match Status in match Arm angle Type of injury 15/M 21.3 Right Right Sitting Even 60 o Med. epicondyle 18/M 18.7 Right Right Sitting Even 70 o Med. epicondyle 16/M 28.6 Right Left Sitting Losing 70 o Med. epicondyle 26/M 25.1 Right Left Sitting Even 70 o Shaft with butterfly frag 17/M 18.8 Right Right Sitting Even 60 o Proximal spiral 19/M 22.9 Right Right Sitting Even 70 o Distal spiral 17/M 22.4 Right Right Sitting Losing 70 o Med. epicondyle
439 팔씨름에 의해 발생한 상완골 간부 및 내 상과 골절 단순 방사선 사진상 골절선의 특징은 상완골 내측 피질 골에 서 골절선이 시작되어 나선형으로 이어지는 양상이었으며, 이 중 1명은 나비형 골절편이 동반되었다. 치료는 3명 모두 수술적 치료를 시행하였으며, 이 중 2명은 금속판을 이용한 관혈적 정복을 시행하였다. 상완골 근위부에 골절이 발생한 1명은 2개의 유연성 골수내 정 (flexible intramedullary nail) 을 이용한 도수 정복 및 내고정술을 시행하였다. 상완골 내 상과의 골절 4명 중 3명은 5 mm 이상 전이된 상태였으며, 이학적 검사상 주관절 외반 긴장 검사 양성 소견을 나타내어 관혈적 정복 및 K-강선을 이용한 고정술을 시행하였다. 나머 지 1명은 골절 전이가 없었으며 주관절 외반 긴장 검사상 음 성 소견을 보여 장상지 석고 부목을 이용한 보존적 치료를 시행하였다. 추시 결과 두 가지 양상의 골절 모두 지연 유합이나 불유 A B 합 소견은 보이지 않았다. 또한 요골신경 증상 및 주관절 강 직을 포함한 운동 제한도 보이지 않았으며, 화골성 근염도 발생하지 않았다. 1. 증례 1 26세 남자 환자로 우측 우세수로 앉은 자세에서 팔씨름 중 통증이 유발되어 응급실로 내원하였다. 팔씨름 처음 시작 후 바로 통증이 유발되었다. 이학적 검사상 요골신경 증상은 없었다. 내원 당시 시행한 방사선학적 검사상 우측 상완골 간부와 원위부 사이의 나선형 골절 및 나비형 골편이 보였다 (Fig. 1A, B). 골절에 대하여 LCDCP 금속판을 사용하여 내 고정을 시행하였다 (Fig. 1C). 술 후 12개월에 시행한 X-ray 상 골유합 소견을 보였고 (Fig. 1D), 통증을 호소하지 않았으 C D Fig. 1. Case 1. Mid to distal shaft fractures of the humerus with butterfly fragment by arm wrestling in a 26-year-old man. (A, B) Initial radiograph shows humerus shaft spiral fracture with butterfly fragment. (C) Postoperative radiograph shows precise reduction and stable fixation with LCDCP plate. (D) Follow-up radiograph 12 month after operation shows good fracture healing without complication. A B Fig. 2. Case 2. Proximal shaft fracture of the humerus by arm wrestling in a 17-year-old man. (A, B) Initial radiograph shows proximal humerus long spiral fracture without comminution. (C) Postoperative radiograph shows closed reduction and fixation with flexible IM nail. (D) Follow-up radiograph 6 month after operation shows good fracture healing without complication. C D
440 A B C D Fig. 3. Case 3. Avulsion fracture of the medial epicondyle of the humerus by arm wrestling in a 15-year-old-man. (A, B) Initial radiograph shows displaced humerus medial epicondyle fracture. (C) Postoperative radiograph shows open reduction with stable fixation with 2 K-wire fixation. (D) Follow-up radiograph 3 month after operation shows good fracture healing without complication after K-wires removal. 2. 증례 2 3. 증례 3 고 찰
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