상완골 과상부 골절의 임상적 연구

Abstract

[한글]

상완골 과상부 골절은 소아의 골절중 가장 많은 골절이며 이에 대한 많은 연구가 보고되었다. 그러나 상완골 과상부 골절의 치료는 매우 까다로우며 그 합병증인 볼크만 저혈성괴사(Volkmann's ischemic contracture)및 신경손상의 예방과 치료는 용이하지 않으며

해결하여야 할 많은 문제점을 내포하고 있는 골절의 하나이다.

저자는 1975년 1월부터 1979년 12월까지 만5년 간 연세대학교 의과대학부속 세브란스병원 정형외과에서 치험한 상완골 과상부 골절 환자 110예를 중심으로 골절의 형태와 치료 및 합병증을 동반한 증예들을 세밀히 분석 검토하고 각기 그에 따른 적합한 치료를 시행

후 그 결과를 임상적으로 관찰하여 다음과 같은 결론을 얻었다.

1. 성별로는 남자가 83예 (75.5%), 연령별로는 4세에서 11세까지 88예(80.0%), 좌우 발생빈도 별로는 좌측이 79예(71.8%)였다.

2. 신전형이 104예(94.5%)로 굴곡형 6예 (5.5%)에 비하여 대부분을 차지하였다.

3. 합병증은 내반주변형이 21예(19.1%)로 가장 많았다.

4. 내반주변형은 percutaneous pinning 한 증예들에서와 관혈적정복 및 내고정술을 시행한 증예들에서 가장 적었다.

5. 주관절의 운동범위의 감소는 관혈적정복 및 내고정술을 시행한 증예들에서 가장 많았다.

6. 내반주변형을 일으킨 경우는 모두 골절 당시 원위골편이 내측 전위된 경우였다.

7. 요골실경마비는 모두 골절 당시 원위골편이 원위골편이 내측 후방으로 전위된 경우였고 정중신경마비는 외측 후방으로 전위된 경우였다.

8. 볼크만 저혈성괴사는 조기 적절한 치료로 발생되지 않았다.

Clinical Studies on the Supracondylar Fractures of the Humerus

Jae Yung Hyun

Department of Medical Science The Graduate School, Yonsei University

(Directed by Prof. Byeong Mun Park. M.D.)

Supracondylar fractures of the humerus is the most common elbow fractures in

children. Many papers has been published about the treatment of the supracondylar

fractures of the humerus in children and prevention of both Volkmann's ischemic

contractures and nerve injuries associated with these fractures, however,

unfortunately it is still one of the most difficult fractures to manage.

After successful reduction, the late complications of loss of elbow motion, the

change in carring angle, myositis ossificans, and progressive ulnar nerve palsy

still lie ahead.

For the period of 5 years from January 1975 to December 1979, 110 patients who

had been treated for supracondylar fractures of the humerua at Severance Hospital,

Yonsei university, College of Medicine were studied and analyzed retrospictively

and the re-sults are summerized as follows:

1. The age of the patients varied from 1 to 26 years, the majority(80.0%) being

between 4 to 11 years and the fractures were on the left side in 71.8% and males

comprised 75.55.

2. The extention type comprized 94.5%.

3. Most common complications were cubitus varus deformities.

4. Percutaneous pinning and open reduction and internal fixation elicited rare

cubitus varus deformities.

5. Limitation of motion was most frequent complication after open reduction and

internal fixation.

6. All cases which showed cubitus varus deformities were initially medially

displaced fractures.

7. Four median nerve injuries were associated with posteromedial displacement and

one radial nerve injury was associated with postermedial displacement.

8. Finally with prompt and adequate treatment there were no Volkmann's ischemic

contractures seen in this study.

[영문]

Supracondylar fractures of the humerus is the most common elbow fractures in children. Many papers has been published about the treatment of the supracondylar fractures of the humerus in children and prevention of both Volkmann's ischemic contractures and nerve injuries associated with these fractures, however,

unfortunately it is still one of the most difficult fractures to manage.

After successful reduction, the late complications of loss of elbow motion, the change in carring angle, myositis ossificans, and progressive ulnar nerve palsy still lie ahead.

For the period of 5 years from January 1975 to December 1979, 110 patients who had been treated for supracondylar fractures of the humerua at Severance Hospital, Yonsei university, College of Medicine were studied and analyzed retrospictively and the re-sults are summerized as follows:

1. The age of the patients varied from 1 to 26 years, the majority(80.0%) being between 4 to 11 years and the fractures were on the left side in 71.8% and males comprised 75.55.

2. The extention type comprized 94.5%.

3. Most common complications were cubitus varus deformities.

4. Percutaneous pinning and open reduction and internal fixation elicited rare cubitus varus deformities.

5. Limitation of motion was most frequent complication after open reduction and internal fixation.

6. All cases which showed cubitus varus deformities were initially medially displaced fractures.

7. Four median nerve injuries were associated with posteromedial displacement and one radial nerve injury was associated with postermedial displacement.

8. Finally with prompt and adequate treatment there were no Volkmann's ischemic contractures seen in this study.