불안정 원위 쇄골 골절의 치료에서 Hook 금속판을 이용한 전향적 연구

국문 초록 (Abstract)

목적: 불안정 원위 골절에 대해 전향적으로 잠김 압박 Hook 금속판을 사용하여 최소 2년의 추시를 통해 방사선학적 및 임상적 결과를 분석하고 그 결과를 보고하고자 한다.
대상 및 방법: 2008년부터 2009년까지 전향적으로 Hook 금속판 고정술을 시행받은 20예 중 17예를 추시하였다. 술 후 2주, 6주, 3개월, 6개월, 12개월, 18개월, 24개월에 방사선학적 추시를 하였고, 임상적 결과는 술 후 12개월, 24개월에 평가하였다.
결과: 평균 골 유합기간은 14.5주, 금속판 제거 시기는 20.2주였다. 1년 및 2년 추시상 평균 VAS 통증 점수는 0.7, 0.8, UCLA 점수는 33.5, 33.3, ASES 점수는 92.8, 92.5, Constant-Murley 점수는 81.5, 77.0, KSS 점수는 92.5, 94.3, 견관절 운동 범위는 굴곡 173.3°, 173.7°, 외회전 56.0°, 54.5°내회전 62.3°, 63.5°, 외전 172.0°, 172.6°, 신전 43.3°, 42.9° 였다. 임상적 결과 및 관절 운동 범위 모두 1년 및 2년 추시상 통계학적 의미있는 차이는 없었다 (p>0.05). 1예의 지연 유합 이외에는 다른 합병증은 없었다.
결론: Hook 금속판을 이용하여 내고정 후 2년 추시 상 우수한 임상 결과를 얻을 수 있었다.

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to analyze and report on the radiologic and clinical results of prospective Hook plate fixation for unstable distal clavicle fractures after a minimum of 2 years follow up.
Materials and Methods: We followed up 17 out of 20 cases that underwent prospective Hook plate fixation from 2008 to 2009. We performed radiologic follow up at 2 weeks, 6 weeks, 3 months, 6 months, 18 months and 24 months postoperatively. The clinical results were evaluated at 12 months and 24 months postoperatively.
Results: The mean period for bony fusion was 14.5 weeks and the plate was removed after an average of 20.2 weeks. The VAS pain scores were 0.7 and 0.8, the UCLA scores were 33.5 and 33.3, the ASES scores were 92.8 and 92.5, the Constant-Murley scores were 81.5 and 77.0, the KSS scores were 92.5 and 94.3 and the ranges of motion were 173.3° and 173.7° of flexion, 56.0° and 54.5° of external rotation, 62.3° and 63.5° of the internal rotation, 172.0° and 172.6° of abduction and 43.3°, and 42.9° of extension at 1 and 2 years follow-up, respectively. There was no statistically significant difference of clinical outcomes and the range of motion at 1 year and 2 year postoperatively (p>0.05). There was no other complication except 1 case of delayed union.
Conclusion: For Hook plate fixation at 2 years postoperatively, the complications will be decreased and excellent clinical results should occur.

목차 (Table of Contents)

• 서론
• 연구 대상 및 방법
• 결과
• 고찰
• 결론
• REFERENCES
• 초록

참고문헌 (Reference)

1 박철현, "불안정 원위 쇄골 골절의 치료에서 장력대 강선 고정술과 Hook 금속판 고정술의 결과의 비교" 대한골절학회 24 (24): 55-59, 2011

2 Levy O, "minimally invasive surgical technique for treatment of type 2 fractures of the distal clavicle" 12 : 24-28, 2003

3 Muramatsu K, "Use of the AO hook-plate for treatment of unstable fractures of the distal clavicle" 127 : 191-194, 2007

4 Kona J, "Type II distal clavicle fractures: a retrospective review of surgical treatment" 4 : 115-120, 1990

5 Tambe AD, "Turner SM. Fractures of the distal third of the clavicle treated by hook plating" 30 : 7-10, 2006

6 Hessmann M, "Treatment of unstable distal clavicular fractures with and without lesions of the acromioclavicular joint" 27 : 47-52, 1996

7 Kao FC, "Treatment of distal clavicle fracture using Kirschner wires and tension-band wires" 51 : 522-525, 2001

8 Salem KH, "Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture" 23 : 565-569, 2009

9 Fann CY, "Transacromial Knowles pin in the treatment of Neer type 2 distal clavicle fractures. A prospective evaluation of 32 cases" 56 : 1102-1105, 2004

10 Ko SH, "The use of hook plate on the management of unstable Neer II lateral end fracture of the clavicle" 6 : 131-137, 2003

11 Faraj AA, "The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases" 67 : 448-451, 2001

12 Renger RJ, "The clavicle hook plate for Neer type II lateral clavicle fractures" 23 : 570-574, 2009

13 Flinkkila¨ T, "Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation" 73 : 50-53, 2002

14 Mall JW, "Surgical treatment of fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis" 7 : 535-537, 2002

15 Chen CH, "Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption" 52 : 72-78, 2002

16 M Kashii, "Surgical Treatment of Distal Clavicle Fractures using the Clavicular Hook Plate" 447 : 158-164, 2006

17 Herrmann S, "Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors" 40 : 236-239, 2009

18 Sim E, "Repair of complete acromioclavicular separations using the acromioclavicular-hook plate" 314 : 134-142, 1995

19 Kim JH, "Percutaneus cerclage wiring in distal clavicle fracture type 2a-one case report" 9 : 124-129, 2006

20 Neer CS 2nd, "Nonunion of the clavicle" 172 : 1006-1111, 1960

21 Neviaser RJ, "Injuries to the clavicle and acromioclavicular joint" 18 : 433-438, 1987

22 Haidar SG, "Hook plate fixation for type II fractures of the lateral end of the clavicle" 15 : 419-423, 2006

23 Neer CS 2nd, "Fracture of the distal clavicle with detachment of coracoclavicular ligaments in adults" 3 : 99-110, 1963

24 Charity RM, "Fixation failure of the clavicular hook plate: a report of three cases" 14 : 333-335, 2006

25 Wilkie WN, "Distal clavicle fractures and acute acromioclavicular joint injuries" 15 : 20-24, 2010

26 Ballmer FT, "Coracoclavicular screw fixation for unstable fractures of the distal clavicle. A report of five cases" 73 : 291-294, 1991

27 Meda PV, "Clavicular hook plate for lateral end fractures:- a prospective study" 37 : 277-283, 2006