쇄골 전위성 간부 골절에서 조기 고정술 군과 지연 재건술 군 간의 결과 비교

국문 초록 (Abstract)

목적: 기존의 연구들은 쇄골의 부정 유합 및 불유합에 대한 지연 재건술의 결과가 골절 후 조기 수술적 치료에 필적할 만한 우수한 결과들을 보고하여 왔으나 두 군을 직접적으로 비교한 연구는 드문 실정이다. 저자들은 쇄골 불유합과 부정 유합의 지연 재건술 군과 조기 고정술 군 간의 결과를 비교하였다.
대상 및 방법: 2000년 3월부터 2006년 2월까지 전위성 쇄골 간부 골절에 대해 조기 고정술을 시행한 18예(조기 고정술 군)와 보존적 치료 후 발생한 부정 유합 혹은 불유합에 대해 지연 재건술을 시행한 15예(지연 재건술 군)를 대상으로 하였다. 최종 결과 판정은 Constant 점수에 의한 임상적 결과와 방사선학적 골유합 소견을 비교하였다.
결과: Constant 점수는 지연 재건술 군이 조기 고정술 군에 비해 의미있게 낮았다(p=0.045). 통증 점수와 일상 생활 활동 점수는 두 군간 통계학적으로 유의한 차이를 보였으나(p<0.05) 관절 운동 범위 점수와 근력 점수는 두 군간 통계학적 유의성을 보이지 않았다(p>0.05). 방사선학적 골유합 소견은 조기 고정술 군 평균 8.8주, 지연 재건술 군 평균 9.8주에 관찰되었고 두 군 모두 전례에서 골유합 소견을 보였다.
결론: 지연 재건술 군 또한 임상적, 방사선학적으로 우수한 결과를 보였지만 조기 고정술 군에 비해 Constant 점수와 통증 점수, 일상 생활 활동 점수에서 유의하게 낮은 결과를 보였다. 쇄골 전위성 간부 골절의 초기 치료 선택에 있어 조기 수술과 지연 재건술의 장단점을 환자에게 충분히 설명하고 초기 치료를 결정하는 것이 중요하리라 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: Several authors have reported excellent results of delayed reconstruction of non-union & malunion in displaced mid-shaft fractures of the clavicle and these results were equal to that of immediate fixation. But direct comparison between these treatments is rare. We evaluated the results between the immediate fixation group and delayed reconstruction group for treating displaced mid-shaft fractures of the clavicle.
Materials and Methods: We studied the results of 18 cases with immediate fixation of displaced mid-shaft fractures of the clavicle and 15 cases with delayed reconstruction of non-union & malunion after conservative management, and these cases were seen from March 2000 to February, 2006. The final postoperative outcome was analyzed according to the clinical outcomes with using the Constant score and the radiological findings of bony union.
Results: The constant score was low in the delayed reconstruction group compare to that of the immediate fixation group (p value=0.045). For the pain score & the activities of daily living score, a statistically significant difference was seen between the two groups (p<0.05), but not for the range of motion score & the power score (p>0.05). Radiological findings of bony union were seen for both groups at an average of 8.8 weeks for the immediate fixation group and at an average of 9.8 weeks for the delayed reconstruction group.
Conclusion: Though the delayed reconstruction group was shown good clinical and radiological results, the immediate fixation group had a significantly better pain score, a better activities of daily living score and a better Constant score. It is important to choose the initial treatment option for displaced mid-shaft fractures of the clavicle after sufficient explanation to patients about the merits and demerits between these two treatment options.

목차 (Table of Contents)

• 서론
• 연구 대상 및 방법
• 결과
• 고찰
• 결론
• REFERENCES
• 초록

참고문헌 (Reference)

1 신현대, "다발성 손상에서 발생한 전위성 쇄골 간부 골절의 보존적 치료" 대한골절학회 17 (17): 333-337, 2004

2 Robinson CM, "Wakefield AE: Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture" 86 : 1359-1365, 2004

3 Nordqvist A, "The incidence of fractures of the clavicle" 300 : 127-132, 1994

4 Yoon HK, "Surgical Treatment of Symptomatic Clavicular Nonunion" 13 : 113-119, 2000

5 Nordqvist A, "Shortening of clavicle after fracture. Incidence and clinical significance, a 5-year follow-up of 85 patients. Acta Orthop Scand" 68 : 349-351, 1997

6 Lee KW, "Results of the Closed Treatment of Displaced Middle- Third Fractures of the Clavicle" 1 : 83-93, 1998

7 Poigenfurst J, "Plating of fresh clavicular fractures: results of 122 operations" 23 : 237-241, 1992

8 Canadian Orthopaedic Trauma Society, "Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial" 89 : 1-10, 2007

9 McKee MD, "Midshaft malunions of the clavicle" 85 : 790-797, 2003

10 Neer CS, "J Am Med Assoc" 171 : 1006-1011, 1960

11 Ko SH, "Internal Fixation with Plate and Bone Graft of Mid-shaft Clavicle Nonunion" 8 : 19-41, 2005

12 MD L, "Fractures of the clavicle. in: Rockwood and Green's fracture in adults, 5th Ed" JB Lippincott 1074-2001, 2001

13 AH C, "Fractures of shoulder, arm, and forearm. in: Cambell's operative orthopaedics" Mosby-Yearbook 989-1055, 1992

14 Allman FL Jr, "Fractures and ligamentous injuries of the clavicle and its articulation" 49 : 774-784, 1967

15 Potter JM, "Does delay matter? The restoration of objectively measured shoulder strength and patient-oriented outcome after immediate fixation versus delayed reconstruction of displaced midshaft fractures of the clavicle" 16 : 514-518, 2007

16 McKee MD, "Deficits following nonoperative treatment of displaced midshaft clavicular fractures" 88 : 35-40, 2006

17 Hill JM, "Closed treatment of displaced middle-third fractures of the clavicle gives poor results" 79 : 537-539, 1997

18 Chan KY, "Clavicle malunion" 8 : 287-290, 1999

19 Nowak J, "Can we predict long-term sequelae after fractures of the clavicle based on initial findings? A prospective study with nine to ten years of follow-up" 13 : 479-486, 2004

20 Jupiter JB, "A comparison of early and late reconstruction of malunited fractures of the distal end of the radius" 78 : 739-748, 1996