Hip & pelvis

  • 제21권4호
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  • Pages.334-338
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  • 2009
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  • 2287-3260(pISSN)
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  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지

양지주 비구골절에서 장서혜 도달법을 이용한 후방 골주의 간접 정복

Indirect Reduction of Posterior Column through Ilioinguinal Approach in Case of Both Column Fractures

  • 강철형 (계명대학교 의과대학 정형외과학교실) ;
  • 이경재 (계명대학교 의과대학 정형외과학교실) ;
  • 민병우 (계명대학교 의과대학 정형외과학교실) ;
  • 정재훈 (계명대학교 의과대학 정형외과학교실)
  • Kang,Chul-Hyung (Department of Orthopedic Surgery, College of Medicine, Keimyung University) ;
  • Lee, Kyung-Jae (Department of Orthopedic Surgery, College of Medicine, Keimyung University) ;
  • Min, Byung-Woo (Department of Orthopedic Surgery, College of Medicine, Keimyung University) ;
  • Jung, Jae-Hun (Department of Orthopedic Surgery, College of Medicine, Keimyung University)
  • 발행 : 2009.12.31

⟨ 이전 논문 다음 논문 ⟩

초록

목적: 양지주 비구골절에서 장서혜 도달법(ilioinguinal approach)을 이용하여 후방 골주를 간접 정복하고 그 효용성과 치료 결과를 알아보고자 하였다. 대상 및 방법: 2000년 2월부터 2008년 1월까지 양지주 비구골절로 본원에 내원하여 장서혜 도달법을 이용하여 후방 골주를 간접 정복한 26예의 환자 중 1년 이상 추시 관찰이 가능하였던 18예의 환자를 대상으로 하였다. 평균 추시 기간은 52.7(14~85) 개월이었다. 골절의 정복 상태, 임상적 및 방사선학적 치료결과는 Matta의 기준에 따라 평가하였으며 합병증의 발생 유무를 조사하였다. 결과: 골절 정복 상태는 해부학적 정복 13예(72.2%), 불완전 정복 2예(11.1%), 불량 정복 3예 (16.7%)였다. 해부학적 정복을 얻었던 13예 중 임상적으로 12예, 방사선학적으로 9예에서 우수(excellent)한 치료 결과를 얻을 수 있었으며 불량한 정복을 보였던 3예 중 2예에서 임상적 및 방사선학적으로 불량한 결과를 보였다. 술후 합병증으로 외측 대퇴 피신경(lateral femoral cutaneous nerve)의 부분 손상이 3예에서 발생하였으나 추시 도중 모두 회복되었고 상둔 동맥의 손상이 1예 있었다. 결론: 양지주 비구골절에서 장서혜 도달법을 통한 후방 골주의 간접 정복은 단기 추시 결과 만족할만한 임상적 및 방사선학적 결과를 보였으나 술중 과도한 견인 등으로 인한 외측 대퇴 피신경 손상에 유의하여야 하겠다.

Purpose: To evaluate the efficacy and results of indirect reduction of the posterior column through the ilioinguinal approach in cases of both column fractures. Materials and Methods: Between February 2000 and January 2008, 18 patients, who underwent indirect reduction of the posterior column through the ilioinguinal approach, were evaluated clinically and radiographically after a minimum follow-up of one year. The mean follow-up duration was 52.7 months. The reduction quality, clinical results, and radiographic results were analyzed according to the criteria reported by Matta. The complications were also recorded. Results: There were 13 cases (72.2%) of an anatomical reduction, 2 cases (11.1%) of an imperfect reduction, and 3 cases (16.7%) of a poor reduction. Out of 13 anatomically reduced fractures, excellent results were graded in 12 cases clinically and 9 cases radiographically. Poor clinical and radiographic results were graded in 2 of the 3 poorly reduced fractures. Complications included 3 cases with transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with an injury to the superior gluteal artery. Conclusion: Indirect reduction of the posterior column through the ilioinguinal approach is effective for both column fractures. During surgery, care should be taken to reduce the risk of iatrogenic lateral femoral cutaneous nerve injury.

키워드

참고문헌

  1. Chiu FY, Chen CM, Lo WH. Surgical treatment of displaced acetabular fractures - 72 cases followed for 10(6-14) years. Injury, 31: 181-185, 2000. https://doi.org/10.1016/S0020-1383(99)00277-6
  2. Helfet DL, Borrelli J Jr, DiPasquale T, Sanders R. Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg, 74-A: 753-765, 1992.
  3. Lee SH, Shin MK, Jo SH. Clinical results of surgical treatment of acetabular fractures according to quality of reduction. J Korean Orthop Assoc, 42: 153-161, 2007. https://doi.org/10.4055/jkoa.2007.42.2.153
  4. Letournel E. Acetabular fracture: classification and management. Clin Orthop Relat Res, 151: 81-106, 1980.
  5. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res, 292: 62-67, 1993.
  6. Letournel E, Judet R. Fractures of the acetabulum, 2nd ed. Berlin, Germany, Springer-verlag, 1993.
  7. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in the patients managed operatively within three weeks after injury. J Bone Joint Surg, 78-A: 1632-1645, 1996.
  8. Matta JM. Operative treatment of acetabular fracture through the ilioinguinal approach. A 10-year perspective. J Ortho Relat Res, 305: 10-19, 1994.
  9. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res, 205: 230-240, 1986.
  10. Min BW, Kang CS. Central acetabular fracture dislocation. J Korean Hip Soc, 5: 54-60, 1993
  11. Min BW, Kang CS, Pyun YS, Song KS, Kang CH, Lee SH. Surgical treatment for posterior fracture dislocations of the hip with fracture of acetabulum. J Korean Fracture Soc, 7: 530-537, 1994.
  12. Min BW, Nam SY, Kang CS. Complications of surgical treatment in patients with acetabular fractures. J Korean Hip Soc, 12: 253-260, 2000.
  13. Pennal GF, Davidson J, Garside H, Plewes J. Result of treatment of acetabular fractures. Clin Orthop Relat Res, 151: 115-123, 1980.
  14. Rowe CR, Lowell JD. Prognosis of fractures of the acetabulum. J Bone Joint Surg, 43-A: 30-59, 1961
  15. Tile M. Fractures of the acetabulum. Orthop. Clin North Am, 11: 481-506, 1980.