대퇴골 간부 골절에 관한 임상적 연구

Abstract

[한글]

대퇴골은 체중 부하에 관여하는 인체 골격중에서 가장 큰 장관골로서, 기계 문명의 발달과 교통양의 증가로써 그 빈도는 증가하고 있는 실정이다. 대퇴골 간부골절은 수상후 다량의 출혈 및 여러가지 합병증을 수반하며, 그 골절에 대한 치료는 연령, 골절부위 및

형태 치료 방법등에 따라 다르며, 부적당한 치료는 많은 장애를 초래할 수 있으므로 매우 중요하다 하겠다.

본 저자는 1967년 9월부터 1976년 9월말까지 연세대학교 의과대학부속 세브란스병원 정형외과학 교실에서 입원 가료한 211예의 소아 및 성인 대퇴골 간부골절에 대한 임상적 소

견 및 치료 결과를 분석하여 다음과 같은 결론을 얻었다.

1. 발생 빈도는 소아에서는 6-10세 ( 41.2%)에 호발하였으며 성인에서는 활동성이 많은 21-40세(54.2%) 연령층에 많았으며 남자가 67.6%를 차지하였다.

2. 비개방성 골절(87.7%)이 많았으며, 소아와 성인 모두에서 분쇄골절이 가장 높은 비율을 나타내고, 부위는 중위 1/3부에 많았다.

3 .골절의 원인은 교통 사고(71.5%), 특히 보행자 손상이 많았으며, 그외 산업시설의 미비로 인한 손상의 빈도도 높았다.

4. 수상후 24시간이내에 내원한 경우가 72.8%를 차지하였다..

5. 수반 손상은 특히 젊은층에서 많았으며 종류별로 보면 비골 및 경골골절, 두개골골절 순이었다.

6. 소아에서는 비수술절 요법으로 치료하여 양호한 결과를 얻었고, 성인에서는 수술적 치료를 시행한 예에서 좋은 결과를 나타내었다.

7. 성인에서 수술적 치료에 따른 골유합 기간은 압박형 금속관 고정술 13.0주, 금속정 고정술 16.2주, 금속관 고정술 17.2주, 골격 전인 20.1주 순이었다.

8. 금속판 고정술은 골수정 삽입이 적응되지 않은 골절예에서 사용되었으며, 합병된 관절 강직의 정도는 일반적으로 비수술적 요법을 시행한 환자에서 보다 양호하였으나, 골수정 고정술보다는 심한 편이었으며 압박형 금속관 고정술예에서 가장 좋은 결과를 나타내었다.

9. 합병증은 소아에서 훨씬 적었으며, 관절 강직도 적게 발생하였고, 이에 따른 치료 결과도 양호하였다.

10. 술후 감염율은 4.4%로써 보존적으로 치료되었다.

11. 소아에서의 90° - 90°골격 견인법 및 성인에서의 압박형 금속판 고정술 및 석고붕대 보조기 (Cast-brace)의 사용은 권장될만 하였다.

Clinical study on the Femoral Shaft Fracture

Moon Ki Hong

Department of Medical Science The Graduate School Yonsei University

(Directed by Prof. In Hee Chung, M.D.)

The femur is the largest long bone in the body which is related to weight

bearing.

As a result of rapid increase in traffic accidents and industrial injuries, the

incidence of femoral shaft fractures has risen also.

The methods of treatment in children and adults are different, therefore

inadequate treatment can cause permanent disability.

The author has reviewed 211 cases of femoral shaft fractures in 204 persons

(children and adults) from September 1967 to September 1976 who were admitted and

treated in Severance Hospital Orthopedic Department.

The results were as follows :

1. The factures occured commonly in the 6-10 yr. age group (41.2%) in children

and in the 21-40 yr. group (54.52) in adults. Males comprised 138 cases (67.6%).

2. Closed fractures were 185 cases (87.7%) and comminuted fractures were the most

common type, 94 cases (44.5%) in all. The fracture site was mid 1/3 in 116 cases

(55%).

3. Causes were mainly car accidents, 146 cases (71.5%) and industrial injuries.

Pedestrian injuries are particularly common in Korea. Many industrial accidents

occur due to inadequate working facilities in factories.

4. Associated injuries were common in young adults and in order of frequency

these were : fractures of the tibia and fibula; skull; pubic bone.

5. In the early and delayed operation groups, primary bony union rate was better

(92%) in the early than the late operation group (78.3%).

6. The period of bony union was 13 weeks with compression plate and screw

fixation; 16 weeks with Kuntscher nailing; 17.5 weeks with plate and screw

fixation; and 20 weeks with skeletal traction in adults.

7. Knee joint motion was most limited with skeletal traction (33.5%), less with

plate and screw fixation (14.7%) and Kuntscher nailing (1.7%), but none with

compression plate and screw fixation.

8. Good results were obtained with conservative treatment in children and

operative treatment fn adults.

9. Complications were much less frequent in children than in adults and were

treated well.

1O. Post-op. infection rate was 4.4% and infection was treated well with

conservative measures.

11. The 90°- 90° skeletal traction in children and compression plate and screw

fixation along with cast brace in adults were recommended.

[영문]

The femur is the largest long bone in the body which is related to weight bearing.

As a result of rapid increase in traffic accidents and industrial injuries, the incidence of femoral shaft fractures has risen also.

The methods of treatment in children and adults are different, therefore inadequate treatment can cause permanent disability.

The author has reviewed 211 cases of femoral shaft fractures in 204 persons (children and adults) from September 1967 to September 1976 who were admitted and treated in Severance Hospital Orthopedic Department.

The results were as follows :

1. The factures occured commonly in the 6-10 yr. age group (41.2%) in children and in the 21-40 yr. group (54.52) in adults. Males comprised 138 cases (67.6%).

2. Closed fractures were 185 cases (87.7%) and comminuted fractures were the most common type, 94 cases (44.5%) in all. The fracture site was mid 1/3 in 116 cases (55%).

3. Causes were mainly car accidents, 146 cases (71.5%) and industrial injuries.

Pedestrian injuries are particularly common in Korea. Many industrial accidents occur due to inadequate working facilities in factories.

4. Associated injuries were common in young adults and in order of frequency these were : fractures of the tibia and fibula; skull; pubic bone.

5. In the early and delayed operation groups, primary bony union rate was better (92%) in the early than the late operation group (78.3%).

6. The period of bony union was 13 weeks with compression plate and screw fixation; 16 weeks with Kuntscher nailing; 17.5 weeks with plate and screw fixation; and 20 weeks with skeletal traction in adults.

7. Knee joint motion was most limited with skeletal traction (33.5%), less with plate and screw fixation (14.7%) and Kuntscher nailing (1.7%), but none with compression plate and screw fixation.

8. Good results were obtained with conservative treatment in children and operative treatment fn adults.

9. Complications were much less frequent in children than in adults and were treated well.

1O. Post-op. infection rate was 4.4% and infection was treated well with conservative measures.

11. The 90°- 90° skeletal traction in children and compression plate and screw fixation along with cast brace in adults were recommended.