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치료법에 따른 경골골절 치유에 관한 비교연구

Issue Date
1981
Description
의학과/석사
Abstract
[한글] 교통수단의 대형화와 각종 산업발달에 따른 산업재해의 빈발로 경골골절의 발생빈도는 점차 높아가고 있는 추세를 보이고 있으며 골절의 상태도 더욱 복잡해 가고 있는 실정이다. 특히 결골은 해부학적 구조상 그 전내측면이 거의 피부로만 덮혀있어 골절시 개방성인 경우가 많고 그 에 따라 골수염, 불유합등의 합병즈의 빈도가 높아 치료방법도 다양할 뿐 아니라 치료상 많은 문제점들을 내포하고 이TEk. 저자는 1972년 1월부터 1278 12월까지 만 7년간 원주기독병원 정형외과에 입원 가료한 경골골절환자 185명 중 원격추시가 가능했던 124명 총 130예에 대한 임상적 소견중 특히 치료법에 따른 골절치유를 중심으로 분석 검토하였던 바 다음과 같은 결론을 얻었다. 1. 골유합은 20세 이하에서 고연령층에 비하여 빨랐으며 지연유합, 불유합, 관절강직 등은 20세 이후의 고연령층에서 높은 빈도를 나타내었으나 부정유합의 빈도는 연령층에 따른 뚜렷한 차이가 없었다. 2. 골절부의 별로는 상1/3골절시 타부위 골절보다 평균 1주 정도 골유합 기간이 단축되었고 부정유합은 하 1/3골절에서 10.2%의 가장 높은 발생율을 보였다. 3. 골절형태 별로는 분쇄골절과 분절골절시 평균 골유합 기간의 각각 18.4주, 25.8주로 가장 길었고 불유합, 부정유합, 관절강직 등의 합병증도 다른 형태의 골절에 비하여 빈발하였다. 4. 경골골절과 동측 비골골절이 동반된 경우 골유합은 다소 늦어졌으며 그 밖의 부정유합, 불유합 등의 합벙증 역시 다소 증가하였다. 5. modified Ellis씨 분류에 의한 경골골절 분류에서 중증으로 갈수록 또한 개방성 골절일수록 골유합기간은 현저히 길었으며 그 밖의 합병증 역시 증가 증가됨을 보였다. 6. 대체로 조기에 체중부하를 시킬수록 골유합은 촉진되며 부정유합을 제외한 지연유합, 불유합, 관절강직 등의 빈도는 감소하는 경향을 보였다. 7. 대부분이 20세 이하의 환자인 전장하지석고붕대고정으로만 치료한 경우 평균 골유합기간이 13.7주 그 밖의 다른 비관혈적 치료로는 19.6주로 비관혈적 치로시 평균 17.4주의 골유합기간을 보였고, 관혈적 내고정 치료시는 평균 18.7주의 골유합기간을 보였다. 한편 불유합의 발생빈도는 관혈적 치로시 10%, 비관혈적 치료시 4.5%로 전자에서 높은 양상을 보였고 지연유합 및 감역 역시 전자에서 높은 경향을 나타내었으나 부정유합 및 관절강직은 후자에서 훨씬 높음을 나타내었다. A Clinical Study of Tibial Shaft Fractures Churl Soo Joo Department of Medical Science, The Graduate School Yonsei University (Directed by Prof. In Hee Chung, M.D.) One hundred and eighty five patients with a fracture of tibial shaft have been treated and managed in the Department of Orthipedic Surgert, Wonju Christian Hospital from January, 1972 to December, 1978. A clinical study was done on 130 cases(6 bilateral) that could be followed up among 185 patients. The results were as follows: 1. The rate of fracture union was accelerated under the age of 20 years but it was slow in older patients, and the rate of delayed union, nonunion, and joint stiffness except malunion was increased in aged group. 2. The union time of the tibial shaft fracture was more rapid by a week in the proximal one third of the tibia than the middle lower one thirds, but the rate of malunion was higher in the lower one third than in the proximal and middle thirds of the tidia. 3. The worse profnosis of fracture type was shown in segmental and comminuted fracture than any other. 4. There was a relatively decreasde rate of union in cases of associated fibular fracture. 5. Open fractures of the tibia united later than closed ones and the rate of delayed union, nonunion, malunion, infection, and joint stiffness was markedly increased in open fracture. 6. According to the modified Ellis' classification, the major severity group showed the worst prognosis. 7. Earlier weight bearing showed more rapid rate of fracture union, and more decreased rate of delayed union, nonunion, and joint stiffness except maluion. 8. The mean healing time of tibial fracture was 13.7 weeks in the most patients under the age of 20 years teated with a long leg cast only, 19.6 weeks in patients managed with the other conservative treatment, and 18.7 weeks in patients managed with operative treatment. The rate of delayed union, nonunion, and infection was higher in operative than conservative treatment, however, all the malunion and joint stiffness were observed in this treatment group.
[영문] One hundred and eighty five patients with a fracture of tibial shaft have been treated and managed in the Department of Orthipedic Surgert, Wonju Christian Hospital from January, 1972 to December, 1978. A clinical study was done on 130 cases(6 bilateral) that could be followed up among 185 patients. The results were as follows: 1. The rate of fracture union was accelerated under the age of 20 years but it was slow in older patients, and the rate of delayed union, nonunion, and joint stiffness except malunion was increased in aged group. 2. The union time of the tibial shaft fracture was more rapid by a week in the proximal one third of the tibia than the middle lower one thirds, but the rate of malunion was higher in the lower one third than in the proximal and middle thirds of the tidia. 3. The worse profnosis of fracture type was shown in segmental and comminuted fracture than any other. 4. There was a relatively decreasde rate of union in cases of associated fibular fracture. 5. Open fractures of the tibia united later than closed ones and the rate of delayed union, nonunion, malunion, infection, and joint stiffness was markedly increased in open fracture. 6. According to the modified Ellis' classification, the major severity group showed the worst prognosis. 7. Earlier weight bearing showed more rapid rate of fracture union, and more decreased rate of delayed union, nonunion, and joint stiffness except maluion. 8. The mean healing time of tibial fracture was 13.7 weeks in the most patients under the age of 20 years teated with a long leg cast only, 19.6 weeks in patients managed with the other conservative treatment, and 18.7 weeks in patients managed with operative treatment. The rate of delayed union, nonunion, and infection was higher in operative than conservative treatment, however, all the malunion and joint stiffness were observed in this treatment group.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117093
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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