Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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고령의 상완골 원위부 관절내 분쇄골절의 수술적 치료: 관혈적 정복술 및 내고정술과 일차적 주관절 전치환술의 임상적 결과

Clinical Outcome after Surgical Treatment of Intra-articular Comminuted Fracture of the Distal Humerus in the Elderly: Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty

  • 김두섭 (연세대학교 원주기독병원 정형외과학교실) ;
  • 윤여승 (연세대학교 원주기독병원 정형외과학교실) ;
  • 이창호 (연세대학교 원주기독병원 정형외과학교실) ;
  • 우주형 (연세대학교 원주기독병원 정형외과학교실) ;
  • 나중호 (연세대학교 원주기독병원 정형외과학교실)
  • Kim, Doo-Sup (Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University) ;
  • Yoon, Yeu-Seung (Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University) ;
  • Yi, Chang-Ho (Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University) ;
  • Woo, Ju-Hyung (Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University) ;
  • Rah, Jung-Ho (Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University)
  • 투고 : 2012.05.21
  • 심사 : 2012.11.08
  • 발행 : 2012.12.31
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초록

목적: 골다공증이 있는 노인환자에서 상완골 원위부 관절부위 골절로 관혈적 정복술 및 내고정술과 주관절 전치환술 시행 후 기능적 결과에 대해서 평가 보고하였다. 대상 및 방법: 2007년1월부터 2009년 10월까지 상완골 원위부 관절내 골절을 주소로 내원한 65세 이상의 환자 24명을 대상으로 하였으며 18명은 후방 도달법을 이용하여 관혈적 정복술 및 내고정술을 시행하고 (Fig. 1), 6명은 주관절 전치환술을 시행하였다 (Fig. 2). 평균 추시 기간은 16.3 개월 이였으며 골절형태는 AO 분류로 8명이 C2, 16명이 C3 형태의 골절이였다. 추시 시 모든 환자들은 방사선촬영 및 신체검사를 시행하였고, Mayo 주관절 수행점수, 및 DASH 점수를 이용하여 임상적 결과를 측정하였다. 결과: Group I 18예 모두 골유합 되었으며 골절부터 골유합까지 평균 기간은 14주였다. 합병증으로 2예에서 주두골 절골부위에 불유합이 관찰되었으며 척골신경증상을 보였던 2예 중 1예는 전방이전술에도 불구하고 개선되지 않았다. Mayo 주관절 수행점수는 평균 87.0점이였으며, DASH 점수는 평균 32.4점이였다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 121.0도 (95~145도), 굴곡구축은 평균 12도 (0~35)이였다. Group II 6예 모두 추시 기간내 합병증은 없었으며, Mayo 주관절 수행점수는 평균 89.1점 이였으며, DASH 점수는 평균 44.3점이었다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 125.1도 (100~145도), 굴곡 구축은 평균 12.6도 (0~30)이였다. 결론: 골다공증을 동반한 고령의 상완골 원위부 관절내 골절 환자에서 적절한 환자 선택시 내고정술 뿐만 아니라 전치환술에서도 단기 추시 시 만족할만한 결과를 보임을 확인할 수 있었다.

Purpose: To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. Materials and Methods: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. Results: The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was $121.0^{\circ}$ (range, $95{\sim}145^{\circ}$) with mean flexion-contracture of $12.0^{\circ}$ (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was $125.1^{\circ}$ (range, $100{\sim}145^{\circ}$) with mean flexion-contracture of $12.6^{\circ}$ (range, 0 to 30). Conclusions: With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.

키워드

참고문헌

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