요골두 분쇄 골절에 대한 관혈적 정복 및 내고정술 (Open Reduction and Internal Fixation in Comminuted Radial Head Fracture)

서지정보

· 발행기관 : 대한골절학회
· 수록지 정보 : Journal of Musculoskeletal Trauma / 32권 / 4호 / 173 ~ 180페이지
· 저자명 : 이준구, 김태호, 김충기, 한수홍

초록

목적: 요골두 분쇄 골절에 있어서 금속판을 이용한 관혈적 정복술 및 내고정술을 시행한 경우들을 대상으로 결과를 분석하였다.
대상 및 방법: Modified Mason 3형의 요골두 골절에 대해 관혈적 정복술 및 내고정술을 시행한 33예를 후향적 분석하였다. 술 전 요골두 분쇄 위치 및 골편수, 최종 추시 영상 자료에서 골유합, 관절면 일치, 관절염 발생을 확인하였고, 임상적결과 분석으로 운동 범위, 통증 정도(VAS), modified Mayo elbow 점수를 조사하였다.
결과: 33예 중 남자 14명, 여자 19명이었으며, 평균 나이는41.8세를 보였다. 요골두 분쇄 골편수에 따른 기능적 운동 범위는 골편수 3개인 경우(1군, 20명) 141.2°±9.3°, 4개인 경우(2군, 7명) 123.8°±18.5°, 5개 이상인 경우(3군, 6명) 100.7°± 24.4°였고, 각각의 modified Mayo elbow 점수는 88.2±2.9 점, 83.7±4.3점, 77.3±8.4점이었다. 골절의 주된 위치가 척측에 있는 경우 요측에 비하여 결과가 좋지 않았다.
결론: 본 연구에서 modified Mason 3형에 대해 관혈적 정복및 내고정술을 시행하여 비교적 양호한 결과를 얻었지만, 분쇄 정도가 결과에 관여하고 있음을 확인하였다.

영어초록

Purpose: Radial head fractures, which account for 33% of all fractures, are treated depending on the Mason classification. In comminuted type 3 fractures, open reduction internal fixation (ORIF), and radial head arthroplasty are the treatment options. This study examined the clinical outcome of modified Mason type 3 radial head fractures using ORIF with a plate.
Materials and Methods: The medical records and image of 33 patients, who underwent ORIF for modified Mason type 3 radial head fractures, were reviewed retrospectively. The preoperative plain radiographs and computed tomography images were used to examine the location of the fracture of the radial head, the number of fragments, union, joint alignment, and traumatic arthritis at the final followup.
The range of motion (ROM) of the elbow at the last follow-up, pain score (visual analogue scale), modified Mayo elbow score (MMES), and complications were analyzed for the clinical outcome.
Results: Of the 33 cases, 14 were men and 19 were women. The mean age was 41.8 years and the average follow-up period was 19 months. The functional ROM was divided into three groups according to the number of bone fragments: 141.2°±9.3° of 3 (n=20), 123.8°±18.5° of 4 (n=7), 100.7°±24.4° of more than 4 (n=6). Furthermore, the MMES were 88.2±2.9, 83.7±4.3, and 77.3±8.4, respectively (p=0.027). Depending on the radial head fracture location, the ROM and MMES were 130.7°±7.5° and 82.1±4.7, respectively, with poor outcomes on the ulnar aspect compared to 143.1°±3.8° and 89.9±3.2 on the radial aspect.
Conclusion: Various factors, such as the degree of crushing and location involved in the clinical outcome.
In particular, the result was poor in the case of more than four comminuted fragments or chief position located in the ulnar aspect. In this case, radial head arthroplasty may be considered in the early stages.

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