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역행성 골수강 내 금속정을 이용한 상완골 간부 골절의 치료
최기범 ( Ki Bum Choi ),강수환 ( Soo Hwan Kang ),이윤민 ( Yoon Min Lee ),송석환 ( Seok Whan Song ),김연준 ( Youn Jun Kim ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4
목적: 상완골 간부 골절에서 주두와의 삽입부를 이용한 역행적 교합성 골수강 내고정술의 결과에 대하여 보고하고자 한다. 대상 및 방법: 2005년 4월부터 2012년 9월까지 가톨릭대학교 여의도성모병원 정형외과에서 상완골 간부 골절에서 역행적 교합성 골수내정을 이용하여 치료한 22예를 대상으로 임상적 및 방사선학적 결과를 분석하였다. 결과: 평균 골유합기간은 5.8개월(4-11개월)이었다. 1예에서 수술 도중 외과의 골절이 발생하여 강선술 등의 추가적인 내고정을 시행하였고 수술 후 2예에서 상완골 간부의 지연유합이 발생하였으나 골이식술을 시행하여 골유합을 얻었으며, 2예에서 불유합이 발생하였다. 술 후 견관절의 운동제한 및 통증은 없었으며 주관절은 8예에서 평균 6.5도의 굴곡 강직과 평균 약 131도의 운동 범위를 보였다. 결론: 동반된 신경 및 혈관 손상이 없는 상완골 간부 골절에서 보다 안전한 원위 골수강 삽입부를 통한 역행적 교합성 골수강 내고정술은 과상부 골절 및 삽입부 주위 피질골 골절의 위험을 줄일 수 있고 술 후 좋은 결과를 얻을 수 있는 술식이라 생각한다. Purpose: The purpose of this study was to report the outcome of treatment of humeral shaft fracture with retrograde intramedullary nail of advanced insertion opening. Materials and Methods: From April 2005 and August 2012, 22 patients with a humeral shaft fracture were treated by a single surgeon using the technique of retrograde intramedullary nail at Department of Orthopedic Surgery, Yeouido St. Mary`s Hospital (Seoul, Korea). To avoid causing fractures at the insertion site, the entry point was more distally located than conventionally, and was extended proximally to include the proximal marginal cortex of the olecranon fossa. The outcome was evaluated clinically and radiologically. Results: The mean period of achievement of bony was 5.8 months (4-11 months). Additional fixations were needed in one patient with intraoperative lateral condylar fracture and 2 patients with postoperative nonunion. There were no limitations of movement or pain in the shoulder joint, and 8 cases had a 6.5o flexion contracture on average. Conclusion: This retrograde intramedullary fixation technique using a distal entry portal near the olecranon fossa is particularly useful in humeral shaft fractures without a neurovascular injury. The risk of an intraoperative fracture (supracondylar fracture or fracture around the entry portal) can be decreased using this treatment. We recommend this technique because of the safety and the satisfactory outcome.
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이윤민,송석환,최기범,이승구,Lee, Yoon-Min,Song, Seok-Whan,Choi, Ki-Bum,Rhee, Seung-Koo 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.2
Purpose: As clinical manifestations of thoracic outlet syndrome are vague pain or symptoms in upper extremity, the diagnosis of the disease is delayed or misdiagnosed as cervical HNP, shoulder pathologies, or peripheral neuropathies. In that reason, many patients spend time for unnecessary or ineffective treatments. We report the results of our thoracic outlet syndrome cases, which were treated by conservative care or surgical treatment. Materials & Methods: Twenty five cases, diagnosed as thoracic outlet syndrome since 1999, were reviewed retrospectively. Physical examinations including Adson's and reverse Adson's test, hyperabduction test, costoclavicular maneuver, and Roo's test, plain radiography of shoulder and cervical spine, MRI of neck or brachial plexus, and EMG were checked. If subjective symptoms were not improved after conservative treatments over three months, surgical treatment were performed. Nine patients were performed operative treatment and the others had conservative treatment in outpatient clinic. Postoperative improvement of symptoms and the follow up period, and the results of conservative care were reviewed. Results: Among five physical examinations, mean 1.75 tests were positive, and EMG has little diagnostic value. MRI were performed in twenty cases and compression of brachial plexus were found in 6 cases (30%). Ten patients out of 16 conservative treatment group had excellent improvement of symptoms, and 5 had good results. Eight patients out of 9 operative treatment group had excellent improvement with mean 5.1 months of follow-up period. Conclusion: Diagnosis of thoracic outlet syndrome is difficult due to bizarre and vague symptoms. However if the diagnosis is suspected by careful physical examinations, radiologic studies, or nerve conduction studies, conservative care should be done as initial treatment and at least after three months, reassess the patient's condition. If the results of conservative treatment is not satisfactory and still the thoracic outlet syndrome is suspected, surgical treatment should be considered. Conservative treatment and operative technique are the valuable for the treatment of this disease.
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후방-후방 이중 금속판 고정을 이용한 원위 상완골 골절의 치료
이윤민 ( Yoon Min Lee ),송석환 ( Seok Whan Song ),최기범 ( Ki Bum Choi ),서유준 ( Yoo Joon Sur ),김성은 ( Sung Eun Kim ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4
목 적: 원위 상완골 골절은 복잡한 해부학적 구조와 흔히 동반되는 분쇄로 치료가 어렵다. 이중 금속판을 90도 직각으로 혹은 평행하게 배열하여 수술을 시행하고 있으나 어느 방법이 더 좋은지는 논란이 있다. 본 연구에서는 또 다른 수술방법인 일반 역동적 압박 금속판을 이용한 후방-후방 이중 금속판 고정을 통하여 치료한 원위 상완골 골절의 임상 결과에 대해 보고하고자 한다. 대상 및 방법: 2003년 3월부터 2012년 3월까지 가톨릭대학교 의과대학 여의도성모병원에서 후방-후방 이중 금속판 고정으로 치료한 원위 상완골 골절 환자 20명을 후향적으로 연구하였다. 환자의 평균 나이는 45세(26-78세)였다. 초기 단순 방사선사진을 원위 상완골 골절의 AO 분류에 따라 골절을 분류하였다. 결과: 완전한 골유합을 얻은 시기는 수술 후 평균 7.1주(4-11주)였으며, 평균 9개월에 금속판을 제거하였다. 마지막 추시시 주관절의 굴신 관절 운동 범위는 116.2도였다. 신경병증이나 불유합 등의 합병증을 보인 예는 없었다. 결론: 후방-후방 이중 금속판 고정법은 대부분의 나사 구멍에서 이중 피질골 고정이 가능하며 수술자의 의도에 따라 삽입 방향을 달리하여 나사 간의 간섭현상을 줄일 수 있고, 상완골 후면과 금속판의 접촉 면적을 높이면서 동시에 근위 및 원위부에서 골절면을 압박할 수 있는 장점이 있다. Purpose: Fractures of the distal humerus are one of the challenging injuries due to its complex anatomy and accompanied comminution. For dual plate fixation, orthogonal or parallel plating is widely used, but the better of the two is debatable. The purpose of this study was to report another fixation technique that yielded good clinical results with early bone union of distal humerus fracture, namely, posterior-posterior plate fixation. Materials and Methods: From March 2003 to March 2012, 20 patients with distal humerus fractures were treated by posterior- posterior plate fixation. The triceps reflecting approach was used with anterior transposition of the ulnar nerve. The mean age at the time of injury was 45 years (range, 26 to 78 years). By AO classification of distal humerus fractures, there were one case of A2 and B3 respectively, two cases of each A3, C1 and C3, and twelve cases of C2. Results: The mean period of complete bone union was 7.1 weeks (range, 4 to 11 weeks). The mean flexion-extension range of motion of the elbow joint at last follow-up was 116.2 degrees. The mean pronation was 81.2 degrees and supination was 83.1 degrees. Plates and screws were removed at about nine months after the initial surgery. No cases showed complications or required additional operation. Conclusion: Posterior-posterior dual plates fixation resulted in stable bicortical screw fixation, and insertion of lag screws were possible without interference. Posterior-posterior plating could be an easy and stable fixation method that provides good clinical results.
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