장관골 골절의 감염성 불유합 치료에 대한 임상적 연구

Abstract

[영문]

[한글]

장관골 골절의 감염성 불유합은 감염을 치유하고 견고한 골유합을 얻기 위해 장시간의

치료를 요하는 어려운 문제이다.

1979년 7월부터 1988년 7월까지 연세대학교 의과대학 정형외과학교실에서 6개월이상 6

년까지 추구 관찰이 가능했던 21세이상 환자 35례의 장관골 골절의 감염성 불유합의 양상

과 유합기간에 관계하는 인자를 임상적으로 분석하여 다음과 같은 결론을 얻었다.

1. 35례의 감염성 불유합 중 22례(62.9 %)가 초기 손상시 개방성 골절이었고, 13례 (37

.1 %)는 수술후 감염에 의한 것이었다.

2. 감염성 불유합의 부위는 경골 19례(54.3 %), 대퇴골(37.1%), 상지골 3례 (8.6%)였고

, 개방성 골절에서는 경골 (63.6 %), 폐쇄성 골절에서는 대퇴골 (61.5%)이 많았다.

3. 감염성 불유합의 치료는 평균 3.3회의 소파술, 부골전제술등 골조작후에 외고정술 1

1례 (31.4 %), 감염전 시행된 고정의 유지 15례( 42.9%), 내고정술 9례(25.7 %)를 시행하

였고 골이식은 총 26례(74.3 %)에서 실시하였다.

4. 감염성 불유합의 진단후 유합기간은 초기고정이 안정된 경우 평균 7.1개월, 불안정

한 경우 21.7개월이었으며 대퇴골의 유합기간은 평균 10.8(4 - 29)개월, 경골은 7.0 (3 -

19)개월이었다.

5. 유합기간은 최종의 안정된 고정을 얻기전 시행한 수술이 많을수록 지연되었으며, 초

기고정을 유지하거나, 외고정과 함께 골이식술을 병행한 경우에서 가장 짧았다.

6. 골이식술은 자가해면골을 이용하였으며, 감염이 있는 상태에서도 osteoperiosteal d

ecortication과 골이식술을 병행하여 견고한 골유합을 얻었다.

A Clinical Analysis of the Treatment of Infected Non-union in the Fractures of Long

Bones

Seok Beom Lee

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Dae Yong Han, M.D.)

It is often difficult to achieve bony union and eradicate infection in treating

infected non-unions of the fractured long bones. The author carried out a clinical

analysis of the 35 infected non-union cases, all aged 21 years or older, treated

and followed for 6 months to 6 years from july 1979 to july 1988 in order to

determine the possible factors which might influence the time required for

attaining union.

The results were as follows :

1. In 22 of the 35 infected non-unions, the primary fracture site was open

(62.9%). The remaining 13 cases(37.1%) were the closed fractures associated with

postoperative infection.

2. The sites of infected non-union were tibia in 19 (54.3%), femur in 13 (37.1%),

and upper extremity in 3 (8.6%) cases. Tibia was more often involved in open

fractures (63.6%). Femur, on the other hand, was more involved in closed fractures

(61.5%).

3. After an average of 3.3 times of bony procedures, primary fixation was left in

place in 15 (42.9%), external fixation was required in 11 (31.4%), and internal

fixation was performed in 9 (25.7%). Bone graft was performed in 26 cases (74.3%).

4. Time required for achieving union was 7.1 months with stable primary fixation

and 21.7 months with unstable primary fixation. Femur and tibia united at 10.8

(mean; ranged from 4 to 29) and 7.0 (mean; ranged from 3 to 19) months,

respectively.

5. Bony union was delayed as the number of prior surgical procedures before

successful treatment increased; the time for union was significantly shorter when

either stable primary fixation or external fixation was combined with bone

grafting.

6. Firmer bony union was achieved after performing Osteoperiosteal decortication

with autogenous cancellous bone graft even in the presence of remaining infection

at the non-union site.