Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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Polarus 골수정을 이용한 상완골 경부 불유합의 수술적 치료

Polarus Intramedullary Nail for Nonunion of Humerus neck

  • 강호정 (연세대학교 의과대학 정형외과학교실) ;
  • 김슬기 (연세대학교 의과대학 정형외과학교실) ;
  • 윤홍기 (순천향대학교 의과대학 정형외과학교실) ;
  • 한수봉 (연세대학교 의과대학 정형외과학교실) ;
  • 김성재 (연세대학교 의과대학 정형외과학교실)
  • Kang, Ho-Jung (Department of Orthopaedic Surgery Yonsei University, College of Medicine) ;
  • Kim, Sul-Gee (Department of Orthopaedic Surgery Yonsei University, College of Medicine) ;
  • Yoon, Hong-Kee (Department of Orthopaedic Surgery Soonchunhyang, College of Medicine) ;
  • Hahn, Soo-Bong (Department of Orthopaedic Surgery Yonsei University, College of Medicine) ;
  • Kim, Sung-Jae (Department of Orthopaedic Surgery Yonsei University, College of Medicine)
  • 발행 : 2007.06.15
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초록

목적: 상완골 경부의 불유합에 대한 치료로 Polarus 골수정을 이용한 수술적 치료 방법의 임상적, 방사선학적 치료 결과를 알아보고자 하였다. 대상 및 방법: 상완골 외과적 경부골절의 불유합으로 수술적 치료를 받은 환자 8명을 대상으로 하였다. 모두 여성 환자였으며, 평균 연령은 65세였다. 8예 중 5예는 1차 수술적 치료후 불유합 환자로 1차적 치료로는 관혈적 정복술 후 금속판 내고정 1예, Ender 정 삽입 2예, 외고정 1예 및 도수 정복술 후 경피적 핀 고정 1예였으며, 3예는 보존적 치료 후의 불유합 환자였다. 불유합 기간은 1차적 수술을 받은 환자군에서 약 9개월(범위 $3.5{\sim}14.8$개월), 수술을 받지 않았던 환자군에서 6.2개월(범위 $3{\sim}7.8$개월)이었다. 수술적 치료로는 8예 모두에서 Polarus 골수정을 이용한 내고정 및 자가장골 이식술을 시행하였다. 골유합은 방사선학적 소견으로 판정하였으며, 기능적 평가는 University of california at Los Angeles(UCLA) 견관절 평가 지수를 사용하였다. 결과: 8례 모두에서 방사선학적 골유합을 얻었다. 골유합까지의 평균 기간은 3.5개월이었으며, 평균 추시 기간은 27개월이었다. UCLA 견관절 평가지수는 수술 전 평균 7.6(범위 $6{\sim}9$)점에서 수술 후 평균 26.3(범위 $10{\sim}33$)점으로 향상되었으며, 견관절의 능동적 굴곡은 수술 전 40.7도(범위 $20{\sim}60$도)에서 수술 후 104도(범위 $50{\sim}160$도)로 증가하였으며, 견관절의 능동적 외전은 수술 전 32.9도(범위 $20{\sim}60$도)에서 수술 후 96.3도(범위 $60{\sim}120$도)로 역시 증가하였다. UCLA functional criteria는 양호(Good) 5예, 보통(Fair) 3예였으며, 불량(poor)에 해당하는 환자는 없었다. 결론: 고령 환자의 상완골 경부 불유합의 치료로서 Polarus 골수정 및 자가장골 이식술을 이용한 내고정술은 골유합과 기능의 향상에 있어 유용한 치료방법으로 생각된다.

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

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참고문헌

  1. Agel J, Jones CB, Sanzone AG, Camuso M, Henley MB: Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg, 13: 191-195, 2004. https://doi.org/10.1016/j.jse.2003.12.005
  2. Ajmal M, O'Sullivan M, McCabe J, Curtin W: Ante-grade locked intramedullary nailing in humeral shaft fractures. Injury, 32: 692-694, 2001. https://doi.org/10.1016/S0020-1383(01)00076-6
  3. Bengner U, Johnell O, Redlund-Johnell I: Changes in the incidence of fracture of the upper end of the humerus during a 30-year period. Clin Orthop Relat Res, 231: 179-182, 1988.
  4. Bigliani LU, Flatow EL and Pollock RG: Fractures of the proximal humerus. In: Rockwood CA and Matsen FA, The shoulder 2nd ed, Philadelphia, WB Saunders Co: 337-389, 1998.
  5. Brooks CH, Revel WJ, Heatley FW: Vascularity of the humeral head after proximal humeral fractures. An anatomic cadaver study. J Bone Joint Surg Br, 75: 132-136, 1993.
  6. Cofield RH: Comminuted fractures of the proximal humerus. Clin Orthop Relat Res, 230: 49-57, 1988.
  7. Coventry MB and Laurnen EL: Ununited fractures of the middle and upper humerus. Special problems in treatment. Clin Orthop Relat Res, 69: 192-198, 1970.
  8. Crolla RMPH, et al: Locked intramedullary nailing of humeral fractures. Injury, 6: 403-406, 1993.
  9. Duralde XA, Flatow EL, Pollock RG, Nicholson GP, Self EB, Bigliani LU: Operative treatment of nonunions of the surgical neck of the humerus. J Sholder Elbow Surg, 5: 169-180, 1996. https://doi.org/10.1016/S1058-2746(05)80002-3
  10. Ellman H, Hanker G, Bayer M: Repair of the rotator cuff : End-result studyof factors influencing reconstruction. J Bone Joint Surg Am, 68: 1136-1144, 1986.
  11. Fleischmann W, Kinzl L: Philosophy of osteosynthesis in shoulder fractures. Orthropedics, 16: 59-63, 1993.
  12. Galatz LM and Iannotti JP: Management of surgical neck nonunions. Orthop Clin North Am, 31: 51-61, 2000. https://doi.org/10.1016/S0030-5898(05)70127-9
  13. Baek GH, Chung MS, Lee BC, Kwon JH : Surgical Treatment of Nonunins of the Surgical Neck of the Humerus in Elderly Patients. J Korean Orthop. Assoc, 38: 149-153, 2003
  14. Wang GJ, Reger S, Stamp W: Nonunion of Fractures of the Proximal Humerus. Southern Medical Journal, 7: 818-821, 1977.
  15. Hawkins RJ, Angelo RL: Displaced proximal humeral fractures: selecting treatment, avoiding pifalls. Orthop Clin North Am, 18: 421-431, 1987.
  16. Healy WL, Jupiter JB, Kristiansen TK, White RR: Nonunion of the proximal humerus, a review of 25 cases. J Orthop Trauma, 4: 424-431, 1990. https://doi.org/10.1097/00005131-199012000-00011
  17. Kang HJ, Lee DY, Sung SY, Hahn SB: Intramedullary Nailing for the Fracture of Proximal Humerus. J. Korean Orthop. Assoc, 17: 271-276, 2004.
  18. Ikpeme JO, et al: Intramedullary interlocking nailing for humeral fractures experience with Russel-Tayllor humeral nail. Injury, 25: 447-455, 1994. https://doi.org/10.1016/0020-1383(94)90271-2
  19. Ingman AM, Waters DA: Locked intramedullary nailing of humeral shaft fractures. J Bone Joint Surg Br, 76: 23-29, 1994.
  20. Jaberg H, Warner JP, Jakob RP: Percutaneous stabilization of unstable fractures of the humerus. J Bone Joint Surg Br, 194: 508-515, 1992.
  21. Kesemenli CC, Subasi M, Arslan M, Necmioglu S, Kapukaya A: Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting. Acta Orthopaedica Belgica, 68: 471-475, 2002.
  22. Koval KJ, Sanders R, Zuckerman JD, Helfet DL, Kummer F, DiPasquale T: Modifiedtension band wiring of displaced surgical neckfractures of the humerus. J Shoulder Elbow Surg, 2: 85-92, 1993. https://doi.org/10.1016/1058-2746(93)90005-2
  23. Max Scheck: Surgical treatment of nonunions of the surgical neck of the humerus. Clin Orthop Relat Res, 167: 255-259, 1982.
  24. Nayak NK, Schickendantz MS, Regan WD, Hawkins RJ: Operative treatment of nonunion of surgical neck fractures of the humerus. Clin Orthop Relat Res, 200-205, 1995.
  25. Neer, C.S. I: Displaced Proximal Humeral Fractures, Part I. Classification and Evaluation. J. Bone Joint Surg Am, 52.
  26. Neer CS II: Displaced proximal humeral fractures. Part II. Treatment of three part and fourpart displacement. J Bone Joint Surg Am, 52: 1090-1103, 1970.
  27. Norris TR, Green A, McGuigan FX: Late prosthesis shoulder arthroplasty for displaced proximal humerus fractures. J Shoulder Elbow Surg, 4: 271-290, 1995. https://doi.org/10.1016/S1058-2746(05)80020-5
  28. Norris TR, Turner JA, Bovill D: Nonunion of the upper humerus. An analysis of the ethiology and treatment in 28 cases. In : Post M, Hawkins RJ, Morrey BF eds. Surgery of the shoulder. St Louis, Mosby-Year Book Inc: 63-67, 1990.
  29. Ogiwara N, Aoki M, Okamura K, Fukushima S: Ender nailing for unstable surgical neck fractures of the humerus in elderly patients. Clin Orthop Relat Res, 330: 173-180, 1996. https://doi.org/10.1097/00003086-199609000-00021
  30. Paul CS, Richard DP, Edward RC, James N, Patrick MC, James FK: Biomechanical Analysis of Blade Plate Versus Locking Plate Fixation for a Proximal Humerus Fracture: Comparison Using Cadaveric and Synthetic Humeri. J Orthop Trauma, 20: 8: 547-554, 2006. https://doi.org/10.1097/01.bot.0000244997.52751.58
  31. Rajasekhar C, Ray PS, Bhamra MS: Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg, 10: 7-10, 2001. https://doi.org/10.1067/mse.2001.109556
  32. Robinson CM, Christie J: The two-part proximal humeral fracture; a review of operative treatment using two techniques. Injury, 24: 123-125, 1993. https://doi.org/10.1016/0020-1383(93)90204-J
  33. Rockwood CA, Pearce JC: Management of proximal humerus non-unions. Orthop Trans, 13: 644, 1989.
  34. Richard. J, Hawkins, FRCS, Gerhard NK: Internal Fixation Technique for proximal humeral fracture. Clin Orthop Relat Res, 223: 77-85, 1987.
  35. Richard. J. Hawkins MD, RL Angelo: Displaced Proximal Humeral Fractures. Orthop. Clin. Am, 18: 421-431, 1987.
  36. RockWood CA, Greec CP: Fracture in Adult. 3rd ED. Philadelphia, JP Lippincott Company, 871-927, 1984.
  37. Sara LE, Nicole AW, Li-qun Z, Steven F, Bradley RM: Two-Part Surgical Neck Fractures of the Proximal Part of the Humerus. A BIOMECHANICAL EVALUATION OF TWO FIXATION TECHNIQUES. J Bone Joint Surg Am, 88: 2258-2264, 2006. https://doi.org/10.2106/JBJS.E.00757
  38. Sorensen KH: Pseudoarthrosis of the surgical neck of the humerus. Two cases. Acta Orthop Scand, 34: 132-138, 1964. https://doi.org/10.3109/17453676408989312
  39. William, LH, Jesse BJ, ThomaskK, Raymond RW: Nonunion of the Proximal Humerus. Journal of Orthopaedic Trauma, 4: 424-431, 1990. https://doi.org/10.1097/00005131-199012000-00011
  40. Wu CC, Shih CH: Treatment for nonunion of the shaft of the humerus. Comparison of plates and Seidel interlocking nails. Can J Surg, 35: 661-665, 1992.

피인용 문헌

  1. Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion vol.12, pp.1, 2009, https://doi.org/10.5397/CiSE.2009.12.1.033