Monteggia 골절에 대한 임상적 고찰

Abstract

[한글]

요골골두의 탈구를 동반한 척골의 골절을 Monteggia 골절이라고 하며, 요골골두의 탈구방향 및 척골의 골절부위에 따라 여러 유형으로 분류할 수 있으며, 각 유형에 따른 수상기전, 연령 및 치료에 차이를 보인다.

1980년 1월부터 1985년 12월까지 연세의료원 정형외과에 입원 치료하였던 63례의 Monteggia골절환자를 대상으로 연구 분석하여 다음과 같은 결론을 얻었다.

1. 총63례중 소아22례, 성인 41례로 성인에서 약2배의 빈도를 보였다.

2. 성별 분포는 남자 49례, 여자14례로 남자에서 3.5배 높은 빈도를 보였다.

3. 수상원인으로는 소아의 경우 낙상과 실족에 의한 경우가 19례로 86%를 차지하였으나, 성인의 경우 교통사고와 기계손상에 의한 수상이 39례(78%)였다.

4. Bado분류에 의한 각 유형별 빈도는 제Ⅰ형이 43례(68%), 제Ⅱ형이 7례(112%), 제Ⅲ형이 11례(18%), 제Ⅲ형이 2례(3%)였다.

5. 수상시 14례(22%)에서 요골신경의 부분신경손상 소견을 보였으나, 모두 자연회복되었다.

6. 요골 골두의 탈구방향은 전방탈구가 24례(38%), 전외방 탈구가 26례(41%), 외방탈구 5례(8%), 후방탈구 6례(10%) 후외방탈구가 2례(3%)였으며, 성인의 경ㅇ 전외방탈구가 49%였으며, 소아에서 전방탈구가 64%로 가장 많았다.

7. 척골 골절의 부위는 골간단부 골절 14례, 상1/3부 15례 상중1/3접합부 9례, 중1/3부 9례, 하1/3부 1례였으며, 상중1/3접합부의 골절빈도가 가장 많았다.

8. 척골골절은 소아에서 23례중 18례에서 도수정복이 가능하였으나, 성인의 경우 41례중 31례에서 관혈적 정복술을 시행하였다.

요골골두 탈구의 정복은 척골골절 관혈적 정복에 겸하여 요골골두 관혈적 정복을 시행한 예는 7례 였으며, 소아의 경우 3례에서 관혈적 정복술이 필요하였다. 총 63례중 45례에서 도수정복으로 요골골두 탈구의 정복을 시행하였으며, 성인 6례에서 요골골두 제거술을 시행하였다.

9. 6개월이상 추시관찰이 가능하였던 소아 14례중 13례(93%)에서, 성인 28례중 20례(71%)에서 Bruce방법에 의하여 치료성적을 검토한후, 만족스러운 결과를 얻었다.

Clinical study on Monteggia fracture

Chong Hyuk Choi

Department of Medical Science, The graduate School, Yonsei University

(Directed by Professor Eung Shick Kang, M.D.)

Monteggia fracture-dislocation was described as a fracture of proximal one third

of the ulnar with a dislocation of radial head by G.B. Monteggia in 1814. Bado

named Monteggia lesion as a fracture of ulnar at any level and a dislocation of

radial head.

The author reviewed sixty-three patients of Monteggia fracture who were treated

at Department of Orthopedic Surgery, Yonsei University College of Medicine form

1980.1. to 1985.12. The study was emphasized especially on cause of injury,

fracture classification, direction of radial head dislocation, level of ulnar

fracture site, treatment and results.

The result were as follows:

1. There were 22 children and 41 adults among 63 patients.

2. The male was affected more frequently that female (49:14).

The ratio between male and female was 3.5:1.

3. The most common cause of injury was falling down (54%) in children and car

accident (51%) in adult.

4. According to Bado classification type Ⅰ was 68%, type Ⅱ 11%, type Ⅲ 18% and

type Ⅳ 3%.

5. The partial posterior interosseous nerve injury was noticed in 11 cases and

the superficial radial sensory nerve injury was in 3 cases. The nerve injury was

recovered spontaneously in all cases.

6. Dislocation of radial head was as follows: Anterior dislocation was 38%,

anterolateral 41%, lateral 8%, posterior 10% and posterolateral 3%.

7. Location of ulnar fracture site was as follows: Metaphysis 22%. upper 1/3 24%,

junction of upper and mid 1/3 38%, middle 1/3 14% and lower 1/3 2%.

8. Closed reduction of radial head dislocation was done in 45 cases, open

reduction in 10 cases and radial head excision in 6 cases.

9. Closed reduction of ulnar fracture was done in 26 cases and open reduction in

35 cases.

10. The follow-up period was between 6 months and 5 years.

The results were excellent in 18 cases, good in 15 cases, fair in 4 cases and

poor in 5 cases.

[영문]

Monteggia fracture-dislocation was described as a fracture of proximal one third of the ulnar with a dislocation of radial head by G.B. Monteggia in 1814. Bado named Monteggia lesion as a fracture of ulnar at any level and a dislocation of radial head.

The author reviewed sixty-three patients of Monteggia fracture who were treated at Department of Orthopedic Surgery, Yonsei University College of Medicine form 1980.1. to 1985.12. The study was emphasized especially on cause of injury, fracture classification, direction of radial head dislocation, level of ulnar fracture site, treatment and results.

The result were as follows:

1. There were 22 children and 41 adults among 63 patients.

2. The male was affected more frequently that female (49:14).

The ratio between male and female was 3.5:1.

3. The most common cause of injury was falling down (54%) in children and car accident (51%) in adult.

4. According to Bado classification type Ⅰ was 68%, type Ⅱ 11%, type Ⅲ 18% and type Ⅳ 3%.

5. The partial posterior interosseous nerve injury was noticed in 11 cases and the superficial radial sensory nerve injury was in 3 cases. The nerve injury was recovered spontaneously in all cases.

6. Dislocation of radial head was as follows: Anterior dislocation was 38%, anterolateral 41%, lateral 8%, posterior 10% and posterolateral 3%.

7. Location of ulnar fracture site was as follows: Metaphysis 22%. upper 1/3 24%, junction of upper and mid 1/3 38%, middle 1/3 14% and lower 1/3 2%.

8. Closed reduction of radial head dislocation was done in 45 cases, open reduction in 10 cases and radial head excision in 6 cases.

9. Closed reduction of ulnar fracture was done in 26 cases and open reduction in 35 cases.

10. The follow-up period was between 6 months and 5 years.

The results were excellent in 18 cases, good in 15 cases, fair in 4 cases and poor in 5 cases.