• Title/Summary/Keyword: 관절경적 미세 골절술

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Arthroscopic Treatment of Symptomatic Shoulders with Minimally Displaced Greater Thberosity Fracture (상완골 대결절의 미세전위골절의 관절경적치료)

  • Kim Seung-Ho;Ha Kwon-Ick
    • Clinics in Shoulder and Elbow
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    • v.2 no.2
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    • pp.178-186
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    • 1999
  • Twenty-three patients with chronic shoulder pain beyond 6 months after the fracture of the greater tuberosity underwent arthroscopic treatment and were retrospectively assessed after an average of 29 months(range, 22 to 40 months). There were 18 men and 5 women with the average age of 39 years(range, 24 to 61 years). Fourteen were isolated fractures and nine were related to acute anterior instability episode. The average displacement of the fracture was 2.3mm(range, 0 to 4mm) on the anteroposterior view of the plane radiographs. At the time of arthroscopy, all patients had partial thickness rotator cuff tears in the articular surface. The cuff tears were located on the tuberosity fracture area and were an Ellman's grade I to n in depth. With the arthroscopic debridement or repair of the tear depending on the condition of the tear itself, as well as the subacromial decompression, the UCLA score revealed good to excellent results in 20 and fair in 3 patients. Nineteen of the patients had returned to the previous level of activities. The patient with a higher activity demand revealed a lower level of activity return(p=0.034). The partial thickness rotator cuff tear should be considered in patients with chronic shoulder pain after the minimally displaced fracture of the greater tuberosity, and arthroscopic debridement or repair is an appropriate procedure.

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Arthroscopic Osteochondroplasty of Osteochondral Lesion of the Talus (거골 골연골 병변에 대한 관절경적 골연골성형술)

  • Lee, Myung Jin;Kim, Sung Soo;Wang, Lih;Lee, Chul Won;You, Sung Gon;Hwang, Jin Soo
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.134-139
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    • 2012
  • Purpose: To report the treatment results of arthroscopic osteochondroplasty in osteochondral lesion of the talus. Materials and Methods: This study included 32 patients who had osteochondral lesion of the talus treated with arthroscopic osteochondroplasty and were able to be followed up over 3 years from 1999 to 2007. The mean follow up period was 48 (38-108) months, and 22 male patients and 10 female patients with a mean age of 34 (20-56) years were included. Locations of lesion were evaluated with simple X-ray and magnetic resonance imaging (MRI), and severities of lesions were classified by Berndt and Harty classification. All cases were treated by arthroscopic debridement or microfracture. The treatment results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and subjective and functional score of Kailkkonen. The group treated by arthroscopic microfracture was compared with the group treated by arthroscopic debridement. Results: The mean AOFAS ankle-hindfoot scale was significantly improved 53 (${\pm}7$) points preoperatively to 84 (${\pm}8$) points postoperatively (P<0.001). The mean subjective and functional score was also improved 55 (${\pm}8$) points preoperatively to 88 (${\pm}8$) points postoperatively with statistical significant (P<0.001). There were no relations between the severity of lesions and the postoperative functional score of ankle (P>0.05). There were no significant differences in the clinical results between the group treated with arthroscopic microfracture and the group treated with arthroscopic debridement (P>0.05). Conclusion: Arthroscopic osteochondroplasty of osteochondral lesion of the talus shows excellent result in terms of patients' satisfaction. There were no significant differences in the clinical results between arthroscopic microfracture group and debridement group.

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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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Arthroscopic Reduction and Fixation of an Anterior Cruciate Ligament Avulsion Fracture From the Tibial Eminence Using Bioabsorbable Pins - Technical Note - (생흡수성 핀을 이용한 소아 경골 과간부 견열 골절의 관절경적 정복 및 고정 방법 - 수술 술기 -)

  • Lee, Su-Chan;Yang, Il-Soon;Seo, Hee-Soo
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.2
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    • pp.183-187
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    • 2009
  • Purpose: We describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fracture using bioabsorbable pins in skeletally immature patients. Operative Technique: Diagnostic knee arthroscopy is performed using anterolateral and anteromedial portals. Fracture debris and blood clot are debrided to expose the injured site well. The fragment is reduced with the probe and fixed temporarily with a 1.1-mm diameter K-wire that is inserted percutaneously from the anterosuperior aspect of the knee joint. The drill guide is introduced into the joint and the fragment is secured by bioabsorbable, poly-p-dioxanone 1.3-mm pins inserted from different angles. The pins are 40 mm in length. The knee is placed in a long leg cast in extension for 4 weeks to assure that full extension is obtained. Conclusion: Arthroscopic fixation of an tibial intercondylar eminence avulsion fracture using bioabsorbable pins is not a technically demanding, suitable method that ensures fracture healing and restores the stability of the joint.

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Operative Treatment of Osteochondral Lesion of the Talus: Arthroscopic Bone Marrow Stimulation (Multiple Drilling or Microfracture) (거골 골연골병변의 수술적 치료: 관절경적 골수 자극술(다발성 천공 또는 미세 골절술))

  • Gwak, Heui-Chul;Eun, Il-soo
    • Journal of Korean Foot and Ankle Society
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    • v.24 no.2
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    • pp.48-54
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    • 2020
  • Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.