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 42.86 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 42.86 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 791-707, Korea Tel 054-288-2121 Fax 054-273-0049 Tel 82-54-288-2121 Fax 82-54-273-0049 E-mail yblood4@hanmail.net E-mail yblood4@hanmail.net 340
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 2 2.5 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.
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 0 10 13 Full Full 0 41 2. Varus 3 o Post. 10 o 0 8 10 Full Full 0 47 3. Valgus 7 o Ant. 5 o 0 10 12 Full Full 0 48 4. Varus 5 o Post. 5 o 0 13 13 Full Flexion con- 0 39 tracture (10 o ) 5. Valgus 10 o Ant. 8 o 10 mm 9 10 Full Full 0 44 6. Varus 7 o Post. 7 o 0 18 19 Nail displace Full Full 0 43 7. Valgus 3 o Post. 5 o 0 8 11 Full Full 0 38 8. Valgus 5 o Ant. 10 o 5 mm 12 12 Full Full 0 49 9. Varus 7 o Post. 7 o 0 10 11 Nail displace Full Full 0 46 10. Varus 3 o Post. 10 o 0 8 12 Full Full 0 42 11. Varus 5 o Ant. 8 o 0 10 12 Full Full 0 38 12. Valgus 5 o Post. 7 o 0 11 14 Full Full 0 46 13. Varus 5 o Ant. 5 o 0 9 10 Full Full 0 41 14. Valgus 7 o Post. 7 o 0 8 10 Nail displace Full Full 0 39 15. Valgus 3 o Post 5 o 0 12 14 Full Full 0 42 Mean 10.4 Mean 12.2 Mean 42.86 POD: Post-operative day, VAS: Visual analogue scale, ASES score: American Shoulder and Elbow Surgeon s score.
343 고 찰 결론
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