상완골 대결절 단독 골절의 스프링 금속판을 이용한 수술적 치료 결과 = The Surgical Outcomes of Isolated Greater Tuberosity Fractures of the Proximal Humerus Fixed with the Spring Plate

국문 초록 (Abstract)

목적: 상완골 대결절 단독 골절에 대한 스프링 금속판을 이용한 수술적 치료결과를 분석해 보고자 하였다. 대상 및 방법: 대결절 단독 골절에 대한 수술적 치료를 시행받은 환자 중에서 1년 이상 추시가 가능하였던 14명을 대상으로 하였다. 평균연령은 51세 (범위, 25∼73세)였다. 모든 예에서 삼각 흉근 도달법으로 접근하여 스프링 금속판을 이용하여 고정하였으며, 골편의 분쇄 정도 및 위치에 따라 회전근개를 통한 봉합, 골편간 나사나 긴장대 고정을 추가하였다. 임상적 결과는 UCLA (The University of California at Los Angeles) scoring 및 KSS (Korean Shoulder Score)를 이용하였다. 결과: UCLA 점수는 평균 29.8이었으며, KSS는 평균 89.4이었다. 금속 내고정물 실패로 재수술을 했던 1예를 포함하여, 골유합은 전례에서 술 후 평균 10.2주 (범위, 7∼14주)에 얻을 수 있었다. 관절 강직이 4예, 창상치료로 치유된 감염이 1예 있었다. 결론: 스프링 금속판을 이용한 상완골 대결절 단독 골절의 치료는 신뢰할 만한 임상결과를 제공하는 좋은 치료방법이라 생각한다.

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to evaluate the surgical outcomes of isolated greater tuberosity fractures of the proximal humerus fixed with the spring plates. Materials and Methods: Fourteen patients who could be followed up at least 1 year after the surgical treatment of isolated greater tuberosity fracture were evaluated. Their mean age was 51 years (range, 25∼73 years). The deltopectoral approach and fixation with the spring plate were performed in all cases. The spring plate was used in all cases. In some circumstances, sutures incorporating the rotator cuff, interfragmentary screw or tension band wire were added. We evaluated the clinical outcomes using UCLA scoring system and KSS (Korean Shoulder Score). Results: The mean UCLA score was 29.8 and the mean KSS was 89.4. The average time of bony union was 10.2 weeks (range, 7∼14 weeks) after the surgery, including 1 case that was performed the secondary operation due to metal failure. The shoulder stiffness were observed in 4 cases and one case of infection was treated well without operation. Conclusion: In the treatment of isolated greater tuberosity fractures of the proximal humerus, the spring plates fixation can be a good surgical option providing reliable functional results.

참고문헌 (Reference)

1 한승범, "스프링 금속판을 이용한 비구 후벽 골절의 수술적 치료" 대한고관절학회 17 (17): 217-222, 2005

2 문은선, "상완골 대결절 단독 골절의 수술적 치료 결과" 대한골절학회 20 (20): 239-245, 2007

3 Keen WW, "Ⅰ. Fracture of the greater tuberosity of the humerus, with dislocation of the humerus into the axilla. Immediate reduction of dislocation. On seventh day nailing of fragment of tuberosity in place" 45 : 938-944, 1907

4 Park MC, "Two-part and three-part fractures of the proximal humerus treated with suture fixation" 17 : 319-325, 2003

5 Park TS, "The treatment of one-part fractures of the greater tuberosity of the proximal humerus" 2 : 21-27, 1999

6 Iannotti JP, "The normal glenohumeral relationships. An anatoimical study of on hundred and forty shoulders" 74 : 491-500, 1992

7 Lee KJ, "The Shoulder and elbow. 1st ed" 290-291, 2007

8 Lee KJ, "The Shoulder and elbow. 1st ed" Young-Chang 676-679, 2007

9 Brien WW, "Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus" 72 : 1208-1210, 1990

10 Green A, "Isolated fractures of the greater tuberosity of the proximal humerus" 12 : 641-649, 2003

11 Ihn JC, "Hooked spring plate: its uses in posterior wall acetabular fracture fixation" 7 : 606-615, 1994

12 Olivier H, "Fractures of the greater tuberosity of the humerus" 10 : 223-, 1986

13 Santee HE, "Fractrues about the upper end of humerus" 80 : 103-114, 1924

14 Bono CM, "Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder" 83 : 1056-1062, 2001

15 Neer CS 2nd, "Displaced proximal humeral fractures. Ⅰ Classification and evaluation" 52 : 1077-1089, 1970

16 Neer CS 2nd, "Displaced humeral fractures. Ⅱ. Treatment of three-part and four-part displacement" 52 : 1090-1103, 1970

17 McLaughlin HL, "Dislocation of the shoulder with tuberosity fracture" 43 : 1615-1620, 1963

18 Renn JC, "Depression in orthopaedic trauma patients. Prevalence and severity" 88 : 1927-1933, 2006

19 Chun JM, "Deltopectoral approach for the operative treatment of fracture of the greater tuberosity of the proximal humerus" 8 : 28-32, 2003

20 Haryman DT II, "Common surgical approaches to the shoulder In instructional course lectures. The America academy of orthopaedic surgeons. 3rd ed" Harper Row 309-, 1982

21 Kim E, "Characteristics of an isolated greater tuberosity fracture of the humerus" 10 : 441-444, 2005

22 Flatow EL, "Bigliani LU: Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus" 73 : 1213-1218, 1991

23 Ji JH, "Arthroscopic treatment of greater tuberosity fracture- Preliminary Report-" 6 : 57-65, 2007

24 Park TS, "A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus" 56 : 171-176, 1997

25 Constant CR, "A Clinical method of functional assessment of the shoulder" 214 : 160-164, 1987