소아 대퇴골 골절에 대한 최소 침습적 금속판 고정술

국문 초록 (Abstract)

목적: 본 연구의 목적은 최소 침습적 금속판 고정술을 이용하여 소아 대퇴골 간부 골절을 치료하고 그 결과 및 장점을 알아보기 위함이다.
대상 및 방법: 14명의 환아(평균 나이 9.1세)에서 최소 침습적인 금속판 고정술을 시행하였고, 투시 가능한 수술대 위에서 도수 견인술 또는 유연성 골수정으로 임시 정복을 한 후, 근위 및 원위부에 2-3 ㎝의 절개를 하고, 형광투시경의 도움 하에 금속판을 경피적으로 삽입한 다음, 골절부를 개방치 않고 고정하였다. 골절부는 대퇴 중간부가 10예, 전자하부 2예, 근위부 1예, 원위부 1예 등이었으며, 분쇄성이 7예였고, 다른 부위의 골절 또는 외상을 동반한 경우가 9명이었다. 1년 이상(평균 2.1년)의 추시 후 Flynn 등의 방법에 따라 평가하였다.
결과: 모든 환자에서 골 이식 없이 골 유합을 얻었으며, 평균 골 유합 기간은 11.1주(범위, 10-14주)였다. 최종 추시상에서 10도 이상의 각형성 또는 5 ㎜ 이상의 하지 부동을 보인 환자는 없었다. 관절운동의 제한 또는 파행 등의 기능장애 소견이나, 내고정물에 관련된 문제를 나타낸 환자는 없었으며, 최종 임상적 결과에서 모든 환자가 우수의 결과를 보였다.
결론: 최소 침습적 금속판 고정술은 소아 대퇴골 골절에서 안전하고도 좋은 수술적 치료 방법이 될 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: To determine the efficacy of percutaneous plating for pediatric femoral fractures.
Materials and Methods: Fourteen children (mean age, 9.1 years-old) with a femoral fracture were treated with minimally invasive percutaneous plating. After a temporary reduction by manual traction or flexible nailing, a plate was inserted into the submuscular plane through proximal or distal incisions of 2-3 ㎝. Screws were then fixed with the control of the fracture alignment under fluoroscopic guidance. All procedures were carried out without opening the fracture site. The locations of the fracture are as follows: 10 in the middle, 2 in the subtrochanteric, 1 in the proximal, and 1 in the distal area. Seven had a comminution in the fracture, and nine had associated injuries or fractures. According to Flynns criteria, the patients were evaluated after a minimum of 1 year (mean, 2.1 years).
Results: All the fractures united without the need for a bone graft. The mean radiographic healing time was 11.1 weeks (range, 1014 weeks). No residual radiographic frontal or sagittal plane angulation ＞10 or a leg length discrepancy ＞5 ㎜ was observed in any patient. No patient showed any limitation in the joint, limping, or implant related problems. All the patients showed excellent final results.
Conclusion: Minimally invasive percutaneous plating is a safe and acceptable surgical option for the treatment of pediatric femoral fractures.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 결론
• 참고문헌
• 국문초록

참고문헌 (Reference)

1 RB Reeves, "nternal fixation versus traction and casting of adolescent femoral shaft fractures" 10 : 592-595, 1990

2 HR Song, "Treatment of femoral shaft fractures in young children: comparison between conservative treatment and retrograde flexible nailing" 13 : 275-280, 2004

3 JO Sanders, "Treatment of femoral fractures in children by pediatric orthopedists: results of a 1998 survey" 21 : 436-441, 2001

4 I Ziv, "Treatment of femoral fracture in the child with head injury" 65 : 76-278, 1983

5 JM Flynn, "Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications" 21 : 4-8, 2001

6 SD Heinrich, "The operative stabilization of pediatric diaphyseal femur fractures with flexible intramedullary nails: a prospective analysis" 14 : 501-507, 1994

7 J Greisberg, "Social and economic benefits of flexible intramedullary nails in he treatment of pediatric femoral shaft fractures" 25 : 1067-1070, 2002

8 DL Skaggs, "Secondary fractures associated with external fixation in pediatric femur fractures" 19 : 582-586, 1999

9 CW Oh, "Retrograde flexible intramedullary nailing in children's femoral fractures" 26 : 52-55, 2002

10 PJ Kregor, "Plate fixation of femoral shaft fractures in multiply injured children" 75 : 1774-1780, 1993

11 BF Hughes, "Pediatric femur fractures: effects of spica cast treatment on family and community" 15 : 457-460, 1995

12 OT Eren, "Open reduction and plate fixation of femoral shaft fractures in children aged 4 to 10" 23 : 190-193, 2003

13 CH Won, "Ninety-ninety skeletal traction for fractures of the femoral shaft in children" 25 : 1385-1390, 1990

14 CW Oh, "Minimally invasive plate osteosynthesis for periarticular tibial fractures" 36 : 449-453, 2001

15 WA Herndon, "Management of femoral shaft fractures in the adolescent" 9 : 29-32, 1989

16 RD Galpin, "Intramedullary nailing of pediatric femoral fractures" 14 : 184-189, 1994

17 JH Beaty, "Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications" 14 : 178-183, 1994

18 AG Martinez, "Femoral shaft fractures in children treated with early spica cast" 11 : 712-716, 1991

19 AA Stans, "Femoral shaft fracture treatment in patients age 6 to 16 years" 19 : 222-228, 1999

20 DE O'Malley, "Femoral head avascular necrosis associated with intramedullary nailing in adolescent" 15 : 21-23, 1995

21 J Aronson, "External fixation of femur fractures in children" 121 : 157-163, 1992

22 SM Perren, "Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology" 84 : 1093-1110, 2002

23 JN Ligier, "Elastic stable intramedullary nailing of femoral shaft fractures in children" 70 : 74-77, 1988

24 MS Caird, "Compression plating of pediatric femoral shaft fractures" 23 : 448-452, 2003

25 SJ Luhmann, "Complications of titanium elastic nails for pediatric femoral shaft fractures" 23 : 443-447, 2003

26 UG Narayanan, "Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them" 24 : 363-369, 2004

27 H Agus, "Biological internal fixation of comminuted femur shaft fractures by bridge plating in children" 23 : 184-189, 2003