Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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65세 이상의 상완골 근위부 골절 환자에서 다축 각안정 잠김 압박 금속판을 이용한 내고정술

Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years

  • 이기원 (울산대학교 강릉아산병원 정형외과) ;
  • 최영준 (울산대학교 강릉아산병원 정형외과) ;
  • 안형선 (울산대학교 강릉아산병원 정형외과) ;
  • 김정환 (울산대학교 강릉아산병원 정형외과) ;
  • 황재광 (울산대학교 강릉아산병원 정형외과) ;
  • 강정호 (울산대학교 강릉아산병원 정형외과) ;
  • 추한호 (울산대학교 강릉아산병원 정형외과) ;
  • 박준석 (울산대학교 강릉아산병원 정형외과) ;
  • 김태경 (울산대학교 강릉아산병원 정형외과)
  • Lee, Ki-Won (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Choi, Young-Joon (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Ahn, Hyung-Sun (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Kim, Chung-Hwan (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Hwang, Jae-Kwang (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Kang, Jeong-Ho (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Choo, Han-Ho (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Park, Jun-Seok (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine) ;
  • Kim, Tae-Kyung (Department of Orthopedic Surgery, Gangneung Asan hospital, University of Ulsan College of Medicine)
  • 투고 : 2012.04.29
  • 심사 : 2012.06.05
  • 발행 : 2012.06.30
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초록

목적: 65세 이상의 상완골 근위부 골절 환자에 대하여 다축 각안정 잠김 압박 금속판 (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB)을 이용하여 내고정술을 시행하고 그 임상적, 방사선적 결과를 알아보고자 하였다. 대상 및 방법: 2007년 8월부터 2011년 1월까지 65세 이상의 상완골 근위부 골절 환자 중 NCB 금속판을 이용하여 내고정술을 시행한 32명의 환자를 대상으로 하였다. 평균 연령은 71세 였으며 평균 추시 기간은 11.5개월이였다. 골절의 분류는 2분 골절이 14예, 3분 골절이 18예였다. 임상적 평가는 VAS 점수와 Constant 점수를 이용하였으며, 방사선학적 평가는 골유합 시기와 Paavolainen 방법으로 경간각을 평가하였다. 결과: 최종 추시 시 VAS 점수는 평균 3점, Constant 점수는 평균 64.5점이었으며 모든 예에서 수술 후 평균 16.2주에 골유합을 얻었다. 방사선학적 평가 결과 최종 추시 시 경간각은 평균 125.9도로 우수 24예, 양호 8예이었다. 강선 파열 1예 및 지연유합 1예, 경미한 금속판의 견봉하 충돌로 인한 통증 호소 3예 등의 합병증이 관찰되었으며 정복소실, 나사 이완, 불유합, 상완골 골두의 무혈성 괴사 등은 없었다. 결론: NCB 금속판을 이용한 내고정술은 골절의 고정 및 정복의 유지가 어려운 고령의 상완골 근위부 골절 환자의 치료에 효과적인 수술 방법 중 하나로 생각된다.

Purpose: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated. Materials and Methods: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle. Results: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head. Conclusion: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.

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참고문헌

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피인용 문헌

  1. Conformity of Proximal Humerus Internal Locking Plate System (PHILOS) and Anatomic Features of Proximal Locking Screws: Cadaveric Study vol.49, pp.2, 2014, https://doi.org/10.4055/jkoa.2014.49.2.140
  2. Accurate application of a precontoured-locking plate for proximal humeral fractures in Asians: a cadaveric study vol.136, pp.10, 2016, https://doi.org/10.1007/s00402-016-2538-1