대한정형외과학회지 : 제 40 권제 3 호 2005 J Korean Orthop ssoc 2005; 40: 252-9 관절내원위요골골절치료후원위요척관절의불안정에대한 CT를이용한임상적평가 김종필 * ㆍ박민종 단국대학교의과대학정형외과학교실 *, 성균관대학교의과대학삼성서울병원정형외과학교실 목적 : 관절내원위요골골절환자를대상으로정상쪽을포함한양측컴퓨터단층촬영 (CT) 을하여원위요척관절의불안정에대한임상적평가를하고자하였다. 대상및방법 : 수술적으로치료받고반대쪽이정상인관절내원위요골골절환자 27 명을대상으로하였으며, 추시기간은평균 17.9 개월 (10-36 개월 ) 이었다. 최종추시시정상쪽을포함하여원위요척관절에대한임상적검사와단순방사선촬영을하고, 전완의위치를 70 회내전, 중립및 70 회외전상태에서 CT 촬영을하여 radioulnar ratio 와 radioulnar line 을변형한 subluxation ratio 를이용하여분석하였다. 결과 :CT 측정치를기준으로저자들이원위요척관절의불안정으로판정한환자는 8 명이었다. 임상적검사에서불안정이의심되었던환자 9 명중 4 명에서 CT 촬영에서불안정이확인되었다. 척골경상돌기골절의불유합이나원위요골의부정유합은원위요척관절의불안정과통계학적관련은없었다 (p>0.05). 결론 : 원위요골골절후임상적으로원위요척관절의불안정이의심되는경우회내전, 중립및회외전상태에서양측 CT 촬영을한후정상쪽과비교하는방법이원위요척관절의불안정을보다객관적으로평가하는데도움을줄수있을것으로사료된다. 색인단어 : 원위요골, 골절, 원위요척관절, 불안정, 컴퓨터단층촬영 Clinical ssessment of the Distal Radioulnar Joint Instability fter Treatment of Intra-articular Fractures of the Distal Radius using Computed Tomography Jong-Pil Kim, M.D.*, and Min-Jong Park, M.D. Department of Orthopaedic Surgery, Dankook University College of Medicine*, Chonan; Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea Purpose: The purpose of this study was to make an assessment of distal radioulnar joint (DRUJ) instability after the treatment of intra-articular fractures of the distal radius using computed tomography (CT) including contralateral normal wrist. Materials and Methods: Twenty-seven intra-articular fractures of the distal radius in twenty-seven patients who had had the surgical treatment were evaluated at follow-up of mean 17.9 months (range, 10-36 months). The DRUJ was assessed with clinical examination, plain radiography, and bilateral CT. CT scans were obtained in 70 pronation, neutral, and 70 supination. The radioulnar ratio and the subluxation ratio which was modified radioulnar line method were used to measure DRUJ instability. Results: Eight patients were diagnosed as DRUJ instability based on CT assessment. Nine patients were considered to have DRUJ instability in clinical examination, but 4 patients of them were confirmed to have DRUJ instability based on CT measurements. Nonunions of ulnar styloid or malunions of the distal radius were not found to have statistical correlation with DRUJ instability (p>0.05). Conclusion: In patient with suspicious DRUJ instability following distal radius fractures, we recommend 통신저자 : 박민종서울시강남구일원동 50 성균관대학교의과대학삼성서울병원정형외과학교실 TEL: 02-3410-3506 FX: 02-3410-0061 E-mail: mjp@smc.samsung.co.kr * 본논문은삼성생명과학연구소의연구비지원 ( 과제번호 C-1-018-1) 에의해이루어졌음. ddress reprint requests to Min-Jong Park, M.D. Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea Tel: +82.2-3410-3506, Fax: +82.2-3410-0061 E-mail: mjp@smc.samsung.co.kr 252
원위요골골절후 CT 를이용한원위요척관절불안정평가 253 computed tomography scans of both the injured and uninjured wrists in pronation, neutral, and supination position for objective assessment. Key Words: Distal radius, Fracture, Distal radioulnar joint, Instability, Computed tomography 원위요골골절은전체골절의 10-12% 를차지하는매우흔한골절중의하나로합병증또한높은것으로보고되고있다 4,17,23). 원위요골골절치료후관찰되는원위요척관절 (distal radioulnar joint) 의기능성장애의기전은크게두가지로나눌수있다. 첫째는골절의부정유합및요골의 S형절흔 (sigmoid notch) 관절면의간격 (gap) 과층형성 (step off) 등으로원위요척관절면의부조화와운동역학의이상을가져오는것이며 1,2,9), 둘째는삼각섬유연골복합체 (TFCC) 로대표되는연부조직의손상에기인한원위요척관절의불안정이다 10,15,25). 저자들에따라다르지만원위요골골절후약19-37% 에서원위요척관절의불안정이동반되는것으로알려져있다 5-7,15,18). 또한원위요골골절과함께척골의경상돌기 (styloid process) 골절은 51-71% 에서동반하는것으로보고되고있으나원위요척관절의기능에미치는영향과그에따른치료원칙에대해서는논란이많다 12,15,18,27). 이렇듯원위요골골절에서발생하는원위요척관절의동반손상의중요성이계속지적되고있으나골절치료와임상평가시요수근관절에관심을많이기울이는반면원위요척관절에대해서는소홀히취급하는경향이있다. 이러한경향의가장큰이유는원위요척관절병변을일반방사선촬영으로는정확하게관찰하기어려우며동반된연부조직의손상을확인하기가어렵기때문이다. 특히원위요척관절의불안정을정확하게진단하기는더욱어려움이있으며, 현재까지도이학적검사에많이의존하고있지만원위요척관절의기능을객관적으로판정하기에는한계가있다 15). 최근에여러저자들이원위요척관절의이상특히불안정을알아보는데가장유용한검사로컴퓨터단층촬영을사용하고있다 11,16,20,22,26,30). 그러나원위요골골절후원위요척관절의변형이동반되어있는경우에이방법을적용한연구는없었다. 이에저자들은관절내원위요골골절을치료한환자를대상으로정상쪽을포함하여양측손목관절에대한컴퓨터단층촬영을시행하여원위요척관절의불안정을객관적으로평가하고자하였으며아울러원위요골 골절의부정유합및척골경상돌기불유합이원위요척관절의불안정에미치는영향을분석하고자하였다. 대상및방법 1. 연구대상 1998년 7월부터 2003년 3월까지관절내원위요골골절로수술적으로치료를받고외래추시가가능하였던환자중전완부의회내전및회외전을각각 70 까지회복하지못한환자와, 반사성교감신경이영양증등특이적반응으로골절치료와재활이불량하였던환자를제외한총 41 명의환자를대상으로, 이환부및이환되지않은반대측에대해원위요척관절의불안정검사를포함한이학적검사, 일반방사선촬영, 전완부의위치를 70 회내전, 중립및 70 회외전상태에서의컴퓨터단층촬영을시행하였다. 이중양측이골절된 3명, 반대쪽이치유된골절이었거나의심되는 6명및컴퓨터단층촬영사진상회전위치가부적절하게촬영된 5명을제외하였다. 최종연구대상인환자는 27명으로남자가 18명, 여자가 9명이었으며평균연령은 39.1세 (19-64세) 였다. 원위요골골절의분류는 O/SIF 분류방법 21) 을사용하였으며 type C3 (14명) 이가장많았고 type C1 (5명), type C2 (4명), type 1 (2명), type 2 (1명), type 3 (1 명 ) 순이었다. 동반된원위요척관절병변은 Geissler 등 7) 이제시한방법을사용하여분류하였다 (Table 1). 원위요골골절의수술적치료로서 19명의환자에대하여관절경적정복술및내고정술을시행하였으며, 나머지 8 Table 1. Classification of associated distal radioulnar joint lesions in 27 intra-articular fractures of the distal radius Types* Number of patients Normal 2 I 8 I 1 II 1 II 10 III 3 III 2 Total 27 *From Geissler et al. 7)
254 김종필ㆍ박민종 명을관혈적정복술및내고정술로치료를하였다. 내고정은경피적핀고정, 관혈적핀고정, 전방 T형금속판고정등의방법을사용하였다. 이중수술후정복부위의불안정이우려되는 5명에대하여추가로 Stableloc TM (cumed, Oregon, US) 를이용한외고정술을시행하였다. 삼각섬유연골복합체손상은모두 14명에서동반되었으며 Palmer 분류 24) 상 1로원위요척관절의불안정과관련이있을것으로추정되는 4명중 2명에대하여삼각섬유연골복합체의 outside-in technique 을이용한관절경적봉합술을시행하였다. 척골경상돌기골절은 27명중 20명 (74%) 에서관찰되었다. 이중골절부위가기저부인경우는 11명이었으며 5명에서원위요골골절을고정한직후시행한원위요척관절의불안정검사에서양성으로나타나정복후관혈적핀고정과경피적핀고정방법을이용하여내고정하였다. 최종추시기간은최소 10개월에서최대 36개월로평균추시기간은 17.9개월이었다. 2. 연구방법원위요척관절의불안정을평가하기위한이학적검사로원위요척관절부에서의압통, 전완부의회전범위및전완부의회전시동통이나탄발음유발유무등을검사하였다. 특히원위요척관절의불안정을유발하는이학적검사로서전 후방스트레스검사를하였다. 전 후방스트레스검사는전완부를중립위치에서양손으로척골과요골을각각고정한후원위척골두에힘을가하여요골에대해전 후방으로이동시키는것으로반대쪽과비교하였을때심하게전위되면불안정이있다고판단하였다 15). 방사선학적분석을위하여최종추시에서반대쪽이정상인손목관절을포함하여전후면및측면단순방사선촬영을시행한후요측관절면경사각 (radial inclination angle), 요골단축 (radial shortening) 및전방경사각 (volar tilt angle) 을측정하였다. 수술전단순방사선사진에서척골경상돌기골절이관찰된경우최종추시사진에서골절유합유무를조사하였다. 컴퓨터단층촬영은 General Electronic Hi-Speed dvantage TM (General Electronic Corp, Milwaukee, US) 를사용하였으며, 특수하게제작된방사선투과성고정기구에전완부와손목관절을위치시킨후 70 회내전, 중립및 70 회외전상태에서정상쪽과이환된손목관절부위를같은조건하에서 3 mm 간격으로촬영하였다. 이때환자의자세는기립상태에서요부를측굴곡하여견관절이가능한외전되지않도록한상태에서주관절이 90 에가깝게굴곡이되도록하였다. 그리고 70 회내전과회외전상태에서의촬영은위치를정하는손잡이용봉을능동적힘으로꽉쥐고유지하게함으로써가능한동적인상태에서의영상자료를얻고자하였다 (Fig. 1). 양측손목관절부위를세가지위치에서촬영한컴퓨터단층사진중요골의 S형절흔과척골두의크기가가장크게보이는컴퓨터단층사진을각각선택하여 (Fig. 2) Lo 등 16) 이제시한 radioulnar ratio (RUR) 와저자들이 Mino 등 19) 이제시한 radioulnar line 방법을변형시킨 subluxation ratio 의두가지측정방법을사용하여요골에대하여척골두의전위또는아탈구되는정도를측정하였다. Fig. 1. custom designed positioning device including a handgrip bar to allow reproducible positioning in () 70 pronation and () 70 supination.
원위요골골절후 CT 를이용한원위요척관절불안정평가 255 Volar D Dorsal C RUR (%)=D/ 100 Volar UD Dorsal Subluxation ratio (%)=UD/ 100 Fig. 3. Two methods for quantifying DRUJ subluxation in this study. () The RUR method: The center of the ulnar head is found using concentric circles. From this point C, a line perpendicular to the line which connecting the volar and dorsal margins of the sigmoid notch is drawn. The ratio of length D: is calculated. () The subluxation ratio method: line connecting the volar and dorsal margins of the sigmoid notch (line ) is drawn. Two perpendicular lines are drawn in the volar and dorsal margins of the sigmoid notch. The ratio of length UD: is calculated. Fig. 2. The DRUJ CT scans of patients with healed distal radius fracture. () Pronation position, () neutral position, and (C) supination position. Note volar subluxation of the ulnar head respect to the radius in supination scan. RUR 은요골의 S형절흔의전방과후방끝점을잡고직선 을그린후투명한동심원자를이용하여척골두의중심점 (C) 을찾아이점에서직선 에수직으로직선 CD를그려서직선 에대한직선 D의비를백분율로환산한것이다 (Fig. 3). Subluxation ratio 는요골의 S형절흔의전 후방끝점을잡고직선 를그 C 린후각끝점에서이직선에대하여수직인선을그어이수직선에대하여척골두의전방또는후방전위정도 (UD) 를측정하여직선 에대한비율을백분율로환산한것이다 (Fig. 3). 저자들은정상측과비교하여다음세가지기준을정하여원위요척관절의불안정을판정하였다. 첫번째기준은정상측과비교하여측정오차와정상적인차이를감안하여비율이 10% 이상차이가나는것을일단의미있는비정상소견으로정의하였다. 그리고정상요척관절에비해 10% 이상차이를보이는경우가 RUR 과 subluxation ratio 둘중하나의측정방법에서회내전, 중립및회외전의세위치중두위치이상에서관찰되고,
256 김종필ㆍ박민종 Volar Volar Dorsal Dorsal Fig. 4. Type instability of the DRUJ. CT scan demonstrates abnormal dorsal subluxation of the ulnar head in supination. 나머지방법에서적어도하나이상의위치에서관찰되는경우를양성이라고진단하였다 (Type ). 두번째기준은정상적으로척골두는회내전시후방전위되고회외전시전방전위됨 11,22) 에비하여회전방향과전위방향이이와다르게나타난경우비정상이있다고판단하였다. 즉, 정상측과달리 70 회내전하여촬영한사진에서척골두가전방전위되거나 70 회외전하여촬영한사진에서척골두가후방전위되면서관절면의불일치가명확한경우를양성으로정의하였다 (Type ) (Fig. 4). 세번째기준은한위치에서두가지방법모두정상측과비교하여 50% 이상현격한차이를보이는경우불안정이있다고판정하였다 (Type C)(Fig. 5). 단, 전 후방불안정의양상이두방법에서다르게나타나전위방향이모호한경우는제외하였다. 양측컴퓨터단층촬영으로확인된원위요척관절의불안정과일반방사선촬영으로측정한변수들, 즉전방경사각, 요측관절면경사각및요골단축과의관련성을 Mann-Whitney U test로검증하였다. 또한척골경상돌기골절유합유무와원위요척관절의불안정의관련유무를 Fisher s exact test로검증하였다. 각통계적처리는 SPSS version 11.5 (SPSS Inc, Chicago, US) 를이용하였으며유의수준은 5% 이하로하였다. 결과원위요척관절의전 후방스트레스검사시 9명에서반대쪽정상보다전위의증가가관찰되었으며, 이중 2 명에서통증이동반되었다. 그리고전 후방스트레스검사시원위요척관절의전위가관찰되지않은환자중 2 Fig. 5. Type C instability of the DRUJ. CT scan demonstrates severe volar subluxation of the ulnar head in supination. 명에서척측부위의통증을호소하였다. 방사선학적결과를보면이환부의수술후요측관절면경사각은평균 24.8 로정상부위에비해평균 2.9 감소되었으며, 요골단축의경우정상쪽보다평균 1.7 mm 단축되었고, 요골의전방경사각은이환부위가평균 4.1 로정상측평균 12.2 보다감소되었다. 원위요골골절시 20명에서관찰되었던척골경상돌기골절은정복및내고정을받은 5명은모두골유합소견을보였으나치료를받지않은 15명중 10명에서불유합소견이관찰되었다. 컴퓨터단층촬영후 subluxation ratio 방법과 RUR 방법으로측정하여저자들이제시한기준에맞춰이환부의원위요척관절의불안정을조사한결과 Type 불안정이 6명, Type 불안정이 1명그리고 Type C 불안정이 1명으로총 8명에서불안정이관찰되었다. 이중전방불안정과후방불안정이각각 6명과 2명에서관찰되었다. 임상적으로원위요척관절의이완이관찰되었던 9명중 4명이컴퓨터단층촬영을이용한방법에서불안정이있는것으로확인되었다. 컴퓨터단층촬영으로원위요척관절의불안정이있다고확인된군과없는군으로나누어최종추시한단순방사선촬영사진에서요측관절면경사각, 전방경사각및요골단축을비교한결과두군사이에통계적유의성이발견되지않았다 (Table 2). 불안정으로진단된 8명의수술소견상삼각섬유연골복합체손상이관찰된경우는중심부파열 1명과요골의 S형절흔에서의부분파열 1명으로모두관절경적변연절제술을받았었다. 또한수상당시척골경상돌기골절
원위요골골절후 CT 를이용한원위요척관절불안정평가 257 Table 2. Radial variables in patients with or without distal radioulnar joint instability, which was diagnosed by computed tomographic measuring methods Variables DRUJ instability (-) DRUJ instability (+) Mean (95% confidence Mean (95% confi- p-value interval) dence interval) Volar tilt angle ( )* 3.5 (16.8~-11.8) 5.7 (14.9~-1.9) 0.56 Radial inclination 24.7 (15.4~33.8) 25.2 (20.5~28.7) 0.98 angle ( ) Radial shortening 2.3 (5.9~-1.3) 2.1 (6.0~-1.4) 0.85 (mm) *Negative values indicate dorsal tilt, Negative values indicate radial lengthening (negative ulnar variance) and positive values indicate radial shortening (positive ulnar variance). 이 6명에서관찰되었고그중기저부골절이 3명에서발견되어 1명은관혈적정복술후내고정술을받았으며, 2 명은관절경검사상삼각섬유연골복합체가정상긴장을유지하고있었고원위요척관절의안정성이유지되어내고정을받지않았던경우였다. 척골경상돌기의불유합유무와원위요척관절의불안정과의관련성을분석하기위하여척골의경상돌기골절이없었거나있어도유합된군 (17 명 ) 과척골경상돌기골절후유합이되지않았던군 (10 명 ) 에서원위요척관절불안정의빈도를확인해본결과경상돌기골절후불유합된경우 4명 (40%) 에서원위요척관절의불안정이관찰되었고, 경상돌기골절이없었거나유합된경우 4명 (23%) 에서불안정이관찰되었으나통계적차이는없었다 (p=0.42). 고 원위요척관절의불안정을진단하는임상적검사는원위요척관절에전 후스트레스를주어반대쪽과비교하여전위정도와통증유무를관찰하여판단하는것으로검사자간의오류가많은주관적인방법이므로신뢰성에대한임상적연구가더필요하다는지적이있다 15,30). 원위요척관절의불안정을진단하기위해단순방사선촬영을이용할수있으나 8,19,20), 촬영시정측면사진을얻기가쉽지가않을뿐더러중립위치에서관찰되지않고회내전이나회외전시나타날수있는동적불안정을확인하는데에는부적절하다 22,26,30). 또한원위요골골절과같이요골이변형되어있는경우에는더욱부정확하다는단점이있다. 컴퓨터단층촬영은원위요척관절의단면을볼수있어관절면부조화를확인할수있고, 회내전, 중립및회 찰 외전에서각각촬영하여원위요척관절을동적으로관찰할수있어원위요척관절병변을확인하는데정확하고유용한검사로제시되고있다 3,13,16,19,20,22,30). 컴퓨터단층촬영후아탈구여부를판단하는기준이여러저자들에의해제시되고있지만아직표준화되어사용하는방법이없다. Mino 등 19,20) 은 radioulnar line 방법을제시하여요골의전 후방경계선을그어척골두가이경계선안에있는경우정상이라고판독하고선을벗어난경우불안정이있다고진단하였다. 그러나정상적으로척골두가요골에대하여회내전시후방전위되며회외전시전방전위된다는점을감안하면원위요척관절의불안정을진단하는방법으로서신뢰도가떨어진다고할수있다 11,16,30). Wechsler 등 14) 은이러한문제점을보안하기위하여 congruity 방법과 epicenter 방법을제시하였으나, congruity 방법은전완부회전시요골의 S 형절흔과척골두의관절면의부조화여부를단순판단하는것으로매우주관적이어서평가방법으로는적절치못하다 16,22). Epicenter 방법은원위요척관절에대한회전의중심을척골두의중심과척골경상돌기의중심사이의중간점으로정의하여사용하였다는데의의는있으나경상돌기골절이있었던경우나척골골두골절을동반한경우에중심점을정확하게잡을수없다. Lo 등 19) 은이러한척골경상돌기및요골변수를최대한감소시키기위하여척골두의중심을기준점으로하는 RUR 방법을제시하여정상인의회내전, 중립및회외전에서측정한평균값과비교하여불안정을평가하였다. 저자들은원위요골골절후변형으로인하여기준점이모호해지는점을고려하여가장변수가적은 RUR 방법과 Mino 등 19,20) 이제시한 radioulnar line 방법을변형하여컴퓨터단층촬영에서가장잘보이는요골의 S형절흔과척골두의두변수만으로단순화한 subluxation ratio 방법으로불안정을평가하였다. 저자들은컴퓨터단층촬영후두가지방법으로측정한값을바탕으로정상측과비교해서비정상의판단기준을나름대로정의하였다. 이에대해서는근거자료가전혀없어자의적인기준이될수있다는것은인정하지만최대한합리적인기준을찾고자노력하였다. 우선중립위치를포함하여두위치이상에서측정한값이 10% 이상차이가날때불안정이있다고판정하였다. 여기서불안정의방향은중립위치에서정상측과비교하여전 후방어느
258 김종필ㆍ박민종 쪽으로전위되는지와어느위치에서어느방향으로아탈구소견을보이느냐에따라결정된다. 나머지기술한두기준은방향성이뚜렷하고정상측과차이가현격한것으로불안정으로판정하는데이의가없을것으로사료된다. 저자들은제시한기준에따라최종적으로 6명에서전방불안정이, 나머지 2명에서후방불안정이있음을진단하였는데, 전방불안정이많은이유는원위요골골절의손상기전이대부분과신전으로요골이후방으로전위되고상대적으로척골이전방전위되는것과관련이있을것으로사료된다. 임상적검사상전 후방스트레스검사에서양성인환자 9명중컴퓨터단층촬영을이용한방법에서불안정이판명된환자는 4명이었지만원위요척관절의불안정진단시컴퓨터단층촬영을이용한검사방법과임상적검사방법을비교한연구는없어컴퓨터단층촬영을이용한방법이더정확하다고는할수없다. 그러나임상적검사시원위요척관절의불안정이의심된환자를대상으로양측컴퓨터단층촬영을이용한방법을적용한다면더욱정확하게원위요척관절의불안정을진단할수있을것으로사료된다. 원위요골골절시동반되는척골경상돌기골절의빈도는저자들에따라다르지만약 51-71% 정도로보고하고있다 12,18,28). 이중척골경상돌기의기저부골절은원위요척관절의안정성에가장중요한삼각섬유연골복합체의전 후방인대가부착하는부분을포함하므로원위요골골절치료시반드시해부학적정복과고정을해야만성적원위요척관절의불안정을예방할수있다고알려져있다 7,28). May 등은척골경상돌기골절이기저부를침범하고 2 mm 이상전위되는경우가원위요척관절의불안정을유발하는위험인자라고하였다 18). 비슷한맥락에서여러저자들도척골경상돌기의불유합이있는경우원위요척관절의불안정이나타날수있다고보고한바있다 12,29). 이와반대로 Lindau 등은원위요골골절치료후척골경상돌기불유합을보인 17 예중단 5예만이원위요척관절의불안정을동반하였음을보고하였고, 모든척골경상돌기기저부골절이삼각섬유연골복합체파열을의미하지않으며인대손상이불안정을일으키는가장중요한요인이라고하였다 14,15). 그러나대부분의저자들이원위요척관절의불안정을판단시단순히전 후방스트레스검사나정측면단순 방사선촬영으로판단하여객관성과신뢰도에많은문제가있다고하겠다. 저자들의연구에서는수술전척골경상돌기골절이없었거나있어도유합된군과척골경상돌기골절후유합되지않았던군에서나타난불안정사이에통계적으로의미있는차이를보이지않아척골경상돌기불유합이원위요척관절의불안정에미치는영향이크지않은것으로판단되었다. 또한원위요척관절의불안정이있는군과없는군으로나누어요측관절면경사각, 전방경사각및요골단축을비교해보았으나두군사이의큰차이를발견하지못해원위요척관절의불안정이요골의부정유합보다는연부조직과의관계가깊다는것을짐작할수있었다. 결론원위요골골절치료후합병증으로나타나는원위요척관절의불안정은임상적검사나단순방사선촬영으로객관적판단이어려워그동안임상적결과평가에서제대로분석되지않았다. 이에저자들은원위요척관절에대한보다객관적인평가를위해양측컴퓨터단층촬영을시행하여불안정을측정하고분석하고자하였다. 원위요골골절후임상적으로원위요척관절의불안정이의심되는경우회내전, 중립및회외전상태에서양측컴퓨터단층촬영을하여정상부위와비교하는방법이원위요척관절의불안정을객관적으로진단하는데도움을줄수있을것으로사료된다. 참고문헌 1. dams D: Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg, 18-: 492-498, 1993. 2. ronstein J, Trumble TE and Tencer F: The effects of distal radius fracture malalignment on forearm rotation: a cadaveric study. J Hand Surg, 22-: 258-262, 1997. 3. urk DL Jr, Karasick D and Wechsler RJ: Imaging of the distal radioulnar joint. Hand Clin, 7: 263-275, 1991. 4. Cooney WP 3rd, Dobyns JH and Linscheid RL: Complications of Colles fractures. J one Joint Surg, 62-: 613-619, 1980. 5. Fernandez DL: Fractures of the distal radius: operative treatment. Instr Course Lect, 42: 73-88, 1993. 6. Frykman G: Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar
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