불안정 골반환 손상에서 천장관절 복합구조물의 수술적 고정
Surgical Fixation of Sacroiliac Joint Complex in Unstable Pelvic Ring Injuries
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목적: 불안정 골반환 손상에서 천장관절 복합구조물의 수술적 고정의 효용성과 치료 결과에 대해 알아보고자 하였다. 대상 및 방법: 2006년부터 2010년까지 본원에서 Tile 분류상 B와 C에 해당하는 불안정 골반환 손상에 수반되는 천장관절 복합 구조물에 대해 수술적 고정을 받고, 12개월 이상 추시가 가능하였던 16예를 대상으로 하였다. 수술적 치료의 방법으로 골반내 전방 접근법을 통한 금속판 고정술은 9예, 골반 외 후방 접근법을 통해서는 장력대 금속판 고정술은 2예, 장천골 나사못 고정술은 4예, 그리고 척추-골반 고정술은 1예에서 시행하였다. 치료 결과는 방사선학적 평가와 임상적 평가를 시행하였다. 결과: 수술적 고정을 시행한 모든 환자에게서 유합을 얻었으며, 방사선학적 결과는 Matta와 Saucedo에 의한 기준을 이용한 평가상에서 준 해부학적 정복 이상이 15예로 나타났다. 회전 전위는 분석을 시행한 10예 중 보통 이상이 9예로 나타났다. 임상적 결과는 모두 보통 이상이었다. 결론: 불안정 골반환 손상에서 천장관절 복합구조물의 해부학적 정복 및 견고한 내고정을 통해 만족할 만한 방사선학적 및 임상적 결과를 얻을 수 있었고 골절 형태상 C형 골절과 수직 전단 골절에서 상대적으로 나쁜 결과를 보였다.
Abstract
Purpose: To evaluate the effectiveness and clinical outcomes of surgical fixation of a sacroiliac joint complex in unstable pelvic ring injuries. Materials and Methods: We selected sixteen cases in our hospital from 2006 to 2010 that underwent surgical fixation of the sacroiliac joint complex and had unstable pelvis ring injuries corresponding to B and C of Tile classification. Plate fixation through an intra-pelvic anterior approach was performed for 9 cases, tension band plate fixation for 2 cases, iliosacral screw fixation for 4 cases, and spino-pelvic fixation through extra-pelvic posterior approach for 1 case. Radiological and clinical evaluations were implemented to determine the results of treatment. Results: Bone union was observed in all patients. For radiological evaluation using the Matta and Saucedo criteria, 15 cases were above the nearly-anatomic reduction. Out of 10 cases that performed rotational displacement analysis, 9 cases were above fair. All cases had above moderate clinical results as well. Conclusion: For unstable pelvic ring injuries, the satisfactory radiological and clinical results have been obtained through the anatomical reduction of the sacroiliac joint complex and firm internal fixation. And from the evaluation of fracture types, the Type C fracture and vertical shear type fractures showed relatively poor results.
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