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원위 경골 골절에 대한 단계적 최소 침습적 금속판 고정술
박성기 ( Sung Ki Park ),오창욱 ( Chang Wug Oh ),오종건 ( Jong Keon Oh ),김경훈 ( Kyung Hoon Kim ),민우기 ( Woo Kie Min ),박병철 ( Byung Chul Park ),정원주 ( Won Ju Jeong ),인주철 ( Joo Chul Ihn ) 대한골절학회 2010 대한골절학회지 Vol.23 No.3
목적: 개방성 창상 또는 연부 조직 손상을 동반한 원위 경골 골절을 단계적 최소 침습적 금속판 고정술로 치료하고 결과를 평가하였다. 대상 및 방법: 원위 경골 골절 환자 20예 (평균 연령, 47.8세)를 대상으로 하였다. AO 분류상 A형 4예, C형 16예였고 8예의 개방성골절이 포함되었다. 가교 외 고정 후 평균 23.9일에 최소 침습적 금속판 고정술을 시행하였다. 최종 추시 때 골유합 및 정렬에 대한방사선적 평가를 하였고, 족관절 운동 범위 및 AOFAS (American Orthopedic Foot & Ankle Society) 점수로 기능적 평가를 하였다. 결과: 20예 중 17예 (85%)에서 평균 21.3주 (범위, 12∼28주)에 일차 골유합을 얻었고 3예의 불유합에서 골 이식이 필요하였다. AOFAS 점수는 평균 88.5점 (범위, 67∼92점이었고, 족관절 운동 범위는 평균 49.2도 (족저 굴곡 37.4도, 족배 굴곡 11.8도)였다. 합병증으로서 경도의 부정정렬 2예, 갈퀴 족 변형 1예, 비골 신경병증 1예가 있었다. 60세 이상의 환자에서 AOFAS 점수가 낮았으나, 골절 형태 등의 다른 인자들은 결과에 영향을 미치지 않았다. 결론: 개방성 골절을 포함한 연부 조직 손상을 동반한 원위 경골 골절에서 단계적 최소 침습적 금속판 고정술은 심부 감염과 연부조직 합병증을 감소시키고 만족스러운 결과를 얻을 수 있을 것으로 생각된다. Purpose: To assess the result of staged minimally invasive plate osteosynthesis (MIPO) for distal tibial fracture with an open wound or injured soft tissue. Materials and Methods: In 20 patients (mean age, 47.8 year-old) with distal tibial fractures, there were 4 type A fractures and 16 type C fractures based on the AO classification system. Eight of the 20 patients had open fractures. MIPO was performed on average 23.9 days after bridging external fixation. At the final follow-up, we assessed the radiological results of bone union and alignment. Functional results were also evaluated by measuring the degrees of ankle motion and the American Orthopedic Foot & Ankle Society (AOFAS) scores. Results: Seventeen of 20 cases (85%) achieved primary union at an average of 21.3 weeks. There were 3 cases of nonunion requiring a bone graft. The mean AOFAS score was 88.5 (range, 67∼92) and the average range of ankle motion was 49.2o (plantarflexion: 37.4o, dorsiflexion: 11.8o). Complication included 2 cases of minor mal-alignment, 1 case of claw toe and 1 case of peroneal neuropathy. Patients over the age of 60 had lower functional results. Additional factors did not affect the final results. Conclusion: Staged MIPO may achieve satisfactory results in distal tibial fractures with soft tissue compromise, decreasing deep infections and soft tissue complications.
비 확공성 골수강내 금속정을 이용한 대티골 간부 골절의 치료
이홍주,경희수,인주철,김풍택,오창욱,김신윤 대한골절학회 2000 대한골절학회지 Vol.13 No.4
Purpose: To evaluate the usefulness of unreamed nailing inthe treatment of femoral shaft fractures. Materials & Methods: Between March 1996 and June 1998, unreamed nailing with closed method was done for 74 patients with 82 femoral shaft fractures. The main indications for this treatment were multiple injury or isolated femoral fracture above Winquist type II. The influence of Winquist-Hansen classification, anatomical location, and open injury over bone union and the influence of injury severity score over general complication including fat embolism were investigated. Results: Primary union occurred in 76 cases(93%) with 6 cases of nonunion and 10(12%) of delayed union, and mean time to union was 27 weeks. In open fractures, the union time was delayed(32 weeks) rather than closed fracture. In Winquist classification, there was no stastical importance on time to union, but nonunion was most common in Winquist type IV. Anatomical location has no influence on time to union. In the view point of multiple injury, the group above 18 points(31 patients) in injury severity score had none of fat embolism, but the group below 18 points(43 patients) had 2 patients. Conclusion: The treatment of femoral shaft fractures by unreamed nailing had longer time to union with higher rate of delayed union, and we think that the theoretical ad vantage of decreasing pulmonary complications is controversial.