Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
권호 표지

Surgical Treatment of Nonunions of the Surgical Neck of the Humerus in Elderly Patients

노인의 상완골 경부 골절 불유합의 수술적 치료

Baek, Goo-Hyun;Chung, Moon-Sang;Lee, Sang-Hoon;Kwon, Bong-Cheol;Ha, Jeong-Hyun
백구현;정문상;이상훈;권봉철;하정현

  • Published : 20030000
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Abstract

Purpose : The purpose of this study was to evaluate the results of surgical treatment of nonunion of the surgical neck of the humerus in elderly patients. Materials and Methods : Seven patients over 60 years of age surgically treated for nonunion of the surgical neck of the humerus with follow-up over 1 year were investigated. Of the three patients with severe osteoporosis, multiple K-wires were used in 1 patient, and Ender nails were used in 2. The other 4 patients with relatively good bone quality were treated with plate and screws. Functional results were evaluated using the University of California, Los Angeles (UCLA) shoulder rating scale and statistical significance was tested using the Wilcoxon signed rank test. Results : Radiological union was obtained in six patients, and 1 patient had no evidence of union at a postoperative 5 years. Active elevation improved from an average of 73 (range, 20-100) degrees to 139 (range, 110-160) degrees. The UCLA score improved from 10.9 (range, 7-16) points to 27.3 (range, 10-33) points on the average. Conclusion : Open reduction with internal fixation and bone grafting for nonunion of the surgical neck of the humerus in elderly patients may result in significant functional improvement.

목 적 : 고령 환자의 상완골 외과적 경부 골절 불유합에 대한 수술적 치료 결과를 평가하고자 하였다. 대상 및 방법 : 상완골 외과적 경부골절의 불유합으로 수술받은 60세 이상 환자 중 1년 이상 추시 가능하였던 환자 7명을 대상으로 하였다. 심한 골다공증이 동반되었던 3예 중 1예에서 다발성 K-강선을 사용하였고, 2예에서 Ender정을 사용하였다. 골다공증이 심하지 않았던 4예에서는 금속판 및 나사를 이용하여 고정하였다. 기능적 평가는 University of California at Los Angeles (UCLA) 견관절 평가 지수를 이용하였다. 통계적 검정은 Wilcoxon signed ranked test를 이용하였다. 결 과 : 7예 중 6예에서 방사선적 유합을 얻었고, 1예에서는 5년 추시에서 골유합을 얻지 못하였다. 수술 전 견관절의 능동적 굴곡은 평균 73 (범위 20-110)$^{\circ}$였고 UCLA 견관절 평가 지수는 평균 10.9 (범위 7-16)점이었다. 수술 후 견관절의 능동적 굴곡은 평균 139 (범위 110-160)$^{\circ}C$, UCLA 견관절 평가 지수는 평균 27.3 (범위 10-33)점이었다. 결 론 : 상완골 외과적 경부 골절의 불유합으로 심한 동통과 기능 저하가 동반된 고령의 환자에서 관혈적 정복, 골이식 및 내고정술은 기능 향상에 유용한 방법으로 사료된다.

Keywords

References

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