Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Compression Plate Fixation with Autogenous Bone Graft for Humerus Shaft Nonunion

상완골 간부 불유합에 대한 금속판 고정 및 자가골 이식술

  • Cho, Chul-Hyun (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Song, Kwang-Soon (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Bae, Ki-Cheor (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Kim, In-Kyoo (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Kwon, Doo-Hyun (Department of Orthopedic Surgery, School of Medicine, Keimyung University)
  • 조철현 (계명대학교 의과대학 정형외과학교실) ;
  • 송광순 (계명대학교 의과대학 정형외과학교실) ;
  • 배기철 (계명대학교 의과대학 정형외과학교실) ;
  • 김인규 (계명대학교 의과대학 정형외과학교실) ;
  • 권두현 (계명대학교 의과대학 정형외과학교실)
  • Published : 2009.06.15
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Abstract

Purpose: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. Materials and Methods: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. Results: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. Conclusion: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results.

목적: 상완골 간부 골절의 불유합에 대해 그 원인을 분석하고, 금속판 고정 및 자가골 이식술을 통한 수술적 치료의 결과를 평가하고자 하였다. 대상 및 방법: 총 18예를 대상으로 하였으며, 평균 추시 기간은 28개월이었다. 불유합에 대해 금속판 고정 및 자가골 이식술을 시행하였고, 골결손이 심한 경우 골단축술을 병행하였다. 술후 추시 단순 방사선 검사로 골유합을 확인하였고, ASES 점수 평가법을 이용하여 임상적 평가를 시행하였다. 결과: 불유합의 원인은 처음 수술시 금속판을 시행한 12예의 경우에서는 불충분한 금속판 길이가 6예, 금속판의 파손 2예, 나사못의 이완이나 파손이 2예, 감염이 1예, 정신과적 문제로 인한 환자의 불응성이 1예였고, 금속정 고정술을 시행한 3예에서는 전 예에서 골절 부위의 신연이 원인이었으며, 외고정을 시행한 3예에서는 불충분한 고정이 원인이었다. 전 예에서 골유합을 얻을 수 있었으며, 골유합까지의 기간은 평균 24주였다. 임상적 결과는 우수가 11예, 양호가 6예, 보통이 1예였다. 결론: 불유합에 대한 수술 시 불유합 부위에 존재하는 섬유조직이나 괴사된 골조직을 철저하게 제거한 후, 충분한 길이의 금속판 내고정술 및 자가골 이식술을 이용하면 만족스러운 결과를 얻을 수 있을 것으로 사료된다.

Keywords

References

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