• Title/Summary/Keyword: 고정술

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Correction of Single Thoracic Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation: Comparison of Stainless Steel to Titanium Alloy Instruments (척추경 나사못 고정술을 이용한 단일 흉추 청소년기 특발성 척추 측만증의 치료: 스테인리스강과 티타늄 합금 기기의 비교)

  • Kim, Sung-Soo;Lim, Dong-Ju;Kim, Jung-Hoon;Choi, Byung-Wan;Kim, Hwi-Young;Lee, Jun-Seok
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.2
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    • pp.141-149
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    • 2019
  • Purpose: To compare the results of two different instruments made of stainless steel and titanium alloy for correction of single thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. Materials and Methods: A total of 141 patients with single thoracic AIS treated with pedicle screw instrumentation and selective thoracic fusion were retrospectively reviewed after a follow-up of 2 years. The patients had a main thoracic curve of 40° to 75° and were divided into two groups based on instrument materials; S group (stainless steel, n=90) and T group (titanium alloy, n=51). The diameter of the stainless steel rod used was 7.0 mm while that of the titanium alloy rod was 6.35 mm or 6.0 mm. Standing long-cassette radiographic measurements including various coronal and sagittal parameters for the preoperative, early postoperative and 2-year postoperative followup were analyzed. There were no significant differences in the preoperative curve characteristics between the two groups. Results: In the S group, the preoperative main thoracic curve of 51.3°±8.4° was improved to 19.0°±7.6° (63.1% correction) and the lumbar curve of 32.3°±8.4° spontaneously decreased to 12.7°±8.2° (62.9% correction) at 2 years postoperatively. In the T group, the preoperative main thoracic curve of 49.5°±8.4° and the lumbar curve of 30.3°±8.9° was improved to 18.8°±7.4° (62.2% correction) and 11.3°±5.4° (63.3% correction), respectively. The corrections of coronal curves were not statistically different between the two groups (p>0.05). The thoracic kyphosis was changed from 16.8°±8.5° to 24.3°±6.1° in the S group and from 19.6°±11.2° to 26.6°±8.5° in the T group. There were no significant differences in the changes of sagittal curves, coronal and sagittal balances at the 2-year follow-up and the number of fused segments and used screws between the two groups (p>0.05). Conclusion: When conducting surgery for single thoracic AIS using pedicles screw instrumentation, two different instruments made of stainless steel and titanium alloy showed similar corrections for coronal and sagittal curves.

Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation (근위 대퇴골에 발생한 전이성 골종양의 병적 골절의 수술적 치료: 종양대치 인공관절 치환술과 골절 고정술의 치료 성적 비교)

  • Shin, Duk-Seop;Kim, Ui-Sik;Kwak, Hae-Jun;Ko, Young-Jin
    • The Journal of the Korean bone and joint tumor society
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    • v.17 no.1
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    • pp.44-50
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    • 2011
  • Purpose: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. Materials and Methods: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. Results: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. Conclusion: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.

OVERDENTURES AND OSSEOINTEGRATED IMPANTS (오버덴춰와 골융합성 임프란트)

  • Shin Sang-Wan;Suh Kyu-Won
    • The Journal of Korean Academy of Prosthodontics
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    • v.29 no.3
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    • pp.197-203
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    • 1991
  • 저작압을 골에 직접 분산시키고 의치를 직접 골에 부착시켜 의치의 안정성을 증진시키는 가능성을 실현하는 것이 오랫동안 보철과의사들의 목표였다. 수십년 동안 골과 티타늄 임프란트가 결합(적합)되는 골융합성 술식이 발전되어 왔으며 이 임프란트의 상부구조물로 고정식 보철물이 받아들여져 왔다. 현재까지 가장 흔한 상부구조는 고정식 보철물이다. 요즈음 골융합성 임프란트에 지지를 받는 오버 덴춰의 술식이 고정식 보철물과 다른 하나의 방법으로 간주되어질 수 있게 되었다. 오버덴춰 술식이 심미적 경제적 이유 그리고 다양하게 적용할 수 있기 때문에 최근에 확대되는 경향이 있다. 골융합성 임프란트에 의한 고정식 보철물에 대한 광범위한 장기 결과들이 있는데 반하여 여러 어태치먼트를 이용한 오버덴춰 술식은 임상결과나 적용에 과한 지식들이 거의 발표되지 않았으며, 현재까지 임프란트 오버덴춰를 가진 환자의 구강기능에 대한 단지 몇개의 연구들만이 발표되었다. 우리는 장기 임상평가에 의해서 임프란트 오버덴춰를 아주 조심스럽게 평가해야 한다.

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Arthroscopic Stabilization Using Remplissage Technique In Recurrent Shoulder Instability with Large Hill-Sachs Lesion - Minimum Six Months Follow-Up Results - (광범위한 Hill-Sachs 병변에서 Remplissage 술기를 이용한 관절경적 재건술 - 최소 6개월 이상 추시 결과 -)

  • Ko, Sang-Hun;Jung, Kwang-Hwan;Jeon, Hyung-Min;Park, Han-Chang
    • Clinics in Shoulder and Elbow
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    • v.13 no.1
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    • pp.47-52
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    • 2010
  • Purpose: To evaluate shoulder stability, clinical, and functional results more than 6 months after utilizing the 'Remplissage' technique, consisting of an arthroscopic posterior capsulodesis and infraspinatus tenodesis, to fill Hill-Sachs lesions. Materials and Methods: Seven patients were followed-up more than 6 months after the 'Remplissage' procedures performed in our hospital from August 2008 to August 2009. The mean age of the patients was 28.6 years and the mean follow-up time was 10 months. Evaluations included ROM, ASES score, KSSI score, ROWE score, and postoperative MRI. Results: In a functional evaluation of the patients with an average postoperative time of 10 months, the ASES score improved from 51.4 preoperatively to 76.8 postoperatively, the KSSI score improved from 46.5 preoperatively to 76 postoperatively, and the ROWE score improved from 43.5 preoperatively to 76.3 postoperatively. After an average postoperative time of 10 months, the range of motion was nearly normal (>170 degrees in further flexion, and >45 degrees in external rotation). Conclusion: In recurrent shoulder instabilities with large Hill-Sachs lesions, the 'Remplissage' technique resulted in good outcomes in terms of shoulder stability, clinical, and functional results after postoperative times of more than 6 months.

Osteochondral Lesion of the Talus (거골의 골연골 병변)

  • Lee, K.B.
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.6 no.1
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    • pp.19-26
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    • 2007
  • 최근에 스포츠 손상이 증가하고 관절경을 이용한 치료가 발전하면서 조기에 더 적극적인 치료를 하는 추세이다. 또한 방사선 소견에 비하여 관절경하에서는 연골이 불안정하거나 분리되어 있는 경우도 있으므로 기존의 수술 적응증보다는 좀 더 광범위하게 관절경 검사 및 수술적 치료가 요구된다고 생각한다. 치료 방법을 하면 $1.5cm^2$ 이하의 병변을 가진 50세 이하의 환자는 관절경을 이용하여 변연 절제술, 연골하 천공, 연마, 미세 골절술, 소파술 등의 방법으로 치료할 수 있다. 같은 방법으로 50세 이상의 $3cm^2$ 이하의 병변을 가진 환자 중 mosaicplasty와 자가 연골 세포 이식술을 적용할 수 없는 환자에서 시도해볼 수 있다. $1.5\sim3cm^2$의 병변을 가진 50세 이하의 환자, 그전의 관절경적 치료로 실패한 경우에는 자가골 연골 이식 또는 자가 연골 세포 이식술을 이용하여 치료해야 한다. $3cm^2$ 이상의 병변을 가진 50세 이하의 환자는 자가 연골 세포 이식술이나 동종 골 연골 이식을 이용하여 치료하며, 50세 이상의 환자는 관절 고정술이나 족근 관절 인공치환술을 고려하는 것이 바람직하다.

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Clinical Results of Arthroscopic Biceps Long Head Tenodesis Above the Pectoralis Major Using an Interference Screw (간섭나사를 이용한 관절경적 상완 이두건 대흉근 상부 건 고정술의 임상적 결과)

  • Choi, Sang Su;Kang, Hong Je;Kim, Jeong Woo;Kim, Jong Yun;Kim, Dong Moon;Kim, Kwang Mee
    • Clinics in Shoulder and Elbow
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    • v.16 no.2
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    • pp.94-99
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    • 2013
  • Purpose: The purpose of this study is to evaluate the clinical results of arthroscopic biceps long head suprapectoral tenodesis using an interference screw. Materials and Methods: We reviewed the cases of 30 patients who underwent arthroscopic biceps long head suprapectoral tenodesis using an interference screw between January 2008 and January 2010. The minimum follow up period was one year. Twenty patients had rotator cuff tears. The results were analyzed by VAS, ASES, tenderness in the bicipital groove, fixation failure, and the degree of deformity. Results: VAS, ASES scores showed a statistically significant increase during the final observation in all patients, compared with those before surgery. However, five patients (17%) had anterior shoulder pain and tenderness in the biceps groove, and three patients (10%) had Popeye deformity. Better results were achieved in patients without rotator cuff tear than in patients with rotator cuff tear (p<0.05). Conclusion: Arthroscopic biceps long head tenodesis above the pectoralis major using an interference screw in patients with a pathologic lesion of the proximal biceps tendon showed good results at the last follow up. However, further study for tenderness in the biceps groove in 17% of patients is needed.

A Comparison between Minimally Invasive Percutaneous Plate Osteosynthesis and Plate Fixation in the Treatment of Clavicle Midshaft Fracture (쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술 비교)

  • Yoo, Seong-Ho;Kang, Suk-Woong;Kim, Bu-Hwan;Song, Moo-Ho;Kim, Yeong-Joon;Park, Gyu-Taek;Kwack, Chang-Hun
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.1-6
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    • 2017
  • Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year-among all cases of MIPPO and open plate fixation-were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

The Volar Plating of Fracture of the Coronoid Process - Report of Two Cases - (구상돌기 골절에서 내측 접근법을 통한 전방 금속판 고정술 - 2예 보고 -)

  • Jung, Gu-Hee;Cho, Chul-Hyun;Jang, Jae-Ho;Kim, Jae-Do
    • Clinics in Shoulder and Elbow
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    • v.13 no.2
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    • pp.260-265
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    • 2010
  • Purpose: To report the clinical results of two cases of coronoid process fractures that were treated with volar plating through a medial approach. Materials and Methods: Two fractures of the coronoid process that needed to be fixed were managed with open reduction and internal fixation through a medial approach using 2.4 mm locking compression plates (Compact Hand set$^{(R)}$, Synthes, Switzerland). The patients were followed up for 14 months and 17 months and were evaluated using the Mayo Elbow Performance Score (MEPS). Results: The MEPS was 95 for Case 1 and 100 for Case 2. Active elbow joint motions were $5^{\circ}-120^{\circ}$ (Case 1) and $0^{\circ}-130^{\circ}$ (Case 2). Supination and pronation fully recovered. Conclusion: Satisfactory results can be obtained in cases of coronoid process fractures because volar plating through a medial approach allows sound fixation and early mobilization of the elbow joint.