Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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주관절 강직의 병태 생리

Pathophysiology of Stiff Elbow

  • 송현석 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실) ;
  • 윤형문 (가톨릭대학교 의과대학 성바오로병원 정형외과학교실)
  • Song, Hyun-Seok (Department of Orthopedic Surgery, St. Paul's Hospital, the Catholic University of Korea) ;
  • Yoon, Hyung-Moon (Department of Orthopedic Surgery, St. Paul's Hospital, the Catholic University of Korea)
  • 투고 : 2010.12.07
  • 심사 : 2010.12.07
  • 발행 : 2010.12.15
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초록

목적: 관절의 적절한 기능을 위해서는 관절의 안정성과 운동 범위의 유지가 필요하다. 주관절과 연관된 환자의 주소의 대부분이 주관절의 강직이다. 최근 보고들에서 주관적의 강직에 대한 치료에서 우수한 결과가 보고되고 있다. 그러나 어떠한 술식을 선택하여야 하는 것은 결정하기 어렵다. 대상 및 방법: Morrey 등은 기능적인 운동 범위를 30-130도의 굴곡-신전 범위, 50도 회내전 및 50도 회외전이라고 하였다. 이 범위에서 일상 생활의 약 90%가 이루어 진다. 주관절 강직은 원인이 되는 외상과 주 병변의 위치에 따라서 분류할 수 있다. 관절 내 원인으로는 심각한 관절 내 불일치, 관절 내 유착 또는 관절 내 연골의 소실, 골극 형성에 의한 기계적 제한, 관절 내 유리체, 활액막의 과다 증식이 해당된다. 관절 외 원인으로는 외상 또는 탈구에 의한 심한 관절막의 유착, 측부 인대 또는 근육의 구축이 해당된다. 결과 및 결론: 신전 제한의 주 원인은 전방 관절막의 섬유화에 의한 구축이다. 이러한 병변은 전방 관절막 절제술이 도움이 된다. 굴곡 제한의 주 원인은 내측부 인대의 후방대의 구축이다.

Purpose: Stability of joints and maintenance of range of motion are needed for optimum function. The most common complaint about the elbow joint is joint stiffness. Recent articles have reported good outcomes in the treatment of stiff elbow joints. However, deciding which procedure to use is always difficult. Materials and Methods: Morrey et al. reported that the functional range of motion of the elbow joint is $30-130^{\circ}$ of flexion-extension and $50^{\circ}C$ of supination and pronation. About 90% of daily activities are done using this range of motion. Stiff elbow joints can be classified according to the traumatic events that caused the problem or the location of the main pathology. Intraarticular pathology includes severe articular mismatch, intraarticular adhesions, loss of articular cartilage, mechanical blockade by osteophytes, loose bodies, and hypertrophied synovium. Extraarticular pathology includes severe capsular adhesion due to the trauma or to dislocation, contracture of the collateral ligaments or muscles, bony bridge. Results and Conclusions: The main pathology underlying the loss of extension is the fibrous contracture of the anterior capsule. In this pathology, an anterior capsulectomy would be helpful. The main pathology underlying the loss of flexion is the contracture of the posterior band of medial collateral ligament.

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참고문헌

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피인용 문헌

  1. Relationship of Trochlear Medial Facet Osteophyte to Elbow Flexion in Elbow Joint without Trauma History vol.16, pp.2, 2013, https://doi.org/10.5397/CiSE.2013.16.2.100