경골 분절 골절에서 골수강 내 금속정과 최소침습 금속판 고정술 병행의 임상적 결과 (Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis)

서지정보

· 발행기관 : 대한골절학회
· 수록지 정보 : Journal of Musculoskeletal Trauma / 33권 / 3호 / 142 ~ 147페이지
· 저자명 : 이준영, 박형석, 차동혁

초록

목적: 경골 분절 골절에서 골수강 내 금속정(IM nailing) 및최소침습 금속판 고정술(MIPO) 병행의 임상적 결과에 대해알아보고자 하였다.
대상 및 방법: 2012년 7월부터 2017년 12월까지 AO type 42 C2의 경골 분절 골절 32예 중 IM nailing 및 MIPO를 병행한 17예 중 추시 가능한 14예를 후향적으로 연구하였다. 방사선 사진 평가 및 술 후 임상적인 기능 평가를 하였다.
결과: 전 예에서 골유합을 얻었고 평균 26주였다. 수상 시 오염이 있던 1예에서의 감염을 제외한 합병증은 관찰되지 않았다. 평균 내반 2도, 평균 전방 각변형 3도, 건측 경골의scanogram과 비교하여 길이 단축은 평균 5 mm로 측정되었다. Modified Rasmussen’s system에 의한 슬관절 기능적 점수는 비교적 양호한 결과를 얻었으며, Molander와 Olerud의방법에 의한 족관절 기능적 점수도 양호한 결과를 얻었다.
결론: 경골 분절 골절에 대해 IM nailing 및 MIPO 병행은 골절 부위 간격을 효과적으로 줄일 수 있어 골유합 확률을 높이고, 만족할 만한 정렬을 얻어낼 수 있다. 따라서 연부조직의보존 및 경골의 정렬을 고려할 때, IM nailing 및 MIPO 병행은 유용한 치료라고 생각된다.

영어초록

Purpose: This study examined the clinical outcomes after the treatment of a tibia segmental fracture with intramedullary nailing (IM nailing) and minimal invasive plate osteosynthesis (MIPO).
Materials and Methods: From July 2012 to December 2017, 14 out of 17 cases from a treatment cohort of 32 cases of AO type 42 C2 tibia segmental fractures with IM nailing and MIPO were studied retrospectively. Periodic radiographs were used to evaluate the presence of union, union time, and radiographic evaluation of bony union (varus-valgus deformity, anteroposterior angular deformity, shortening). To evaluate the postoperative clinical function, modified Rasmussen’s system was used for proximal fractures, and the American Orthopaedic Foot and Ankle Society functional score was used for distal fractures.
Results: Bony union was achieved in all 14 cases, and the average union time was 26 weeks. In one case of soil contamination, there were no other complications other than simple debridement after a soft tissue infection. The mean varus was two degrees; the mean anteroposterior angular deformity was three degrees of anterior oblique; the mean length shortening was 5 mm (2-9 mm). The mean functional score of the knee joint with the Modified Rasmussen’s system measured for the postoperative clinical function was relatively good (excellent 9, good 4, fair 1, and poor 0). The results of the Molander and Olerud Functional scores of the ankle joints were also good (excellent 8, good 3, fair 2, poor 0).
Conclusion: The treatment of tibia segmental fractures with IM nailing and MIPO can effectively reduce the gap of fracture sites. Hence, it is possible to increase the bony union probability and obtain relatively satisfactory alignment. Overall, the treatment of tibia segmental fractures with IM nailing and minimally invasive plate osteosynthesis appears to be a useful treatment, considering the preservation of the soft tissue and the alignment of the tibia.

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