• Title/Summary/Keyword: 관절보존

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Natural History of Rotator Cuff Disorders (회전근 개 질환의 자연경과)

  • Oh Jeong-Hwan;Park Jin-Young
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.3 no.2
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    • pp.93-97
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    • 2004
  • Continued research needs to be devoted to understanding the natural history of rotator cuff tears. Recent studies have shown progression of tear, symptomatic flare-ups and irreversible change in rotator cuffs managed nonsurgically. These data allow the grouping of patients with rotator cuff tears into three categories based on risk-benefit ratios. Nonsurgical care should be maximized for patients with impingement symptoms only, with partial-thickness tears, with chronic tears, and for the elderly patients. The proper selection of candidates for nonsurgical management should lead to the high success rate quoted by multiple authors. Even though conservative treatment is necessary, early surgery should be considered for tears that are acute, small or medium, associated with shoulder loss of function, or occur in a younger patient. Prolonged nonsurgical care in these patients risks tear propagation and irreversible changes to the cuff, which may complicate rotator cuff repair.

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ACL Reconstruction - Remnant Preserving Technique - (전방십자인대 재건술 - 잔류조직 보존술식 -)

  • Lee, Byung-Ill;Chun, Dong-Il
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.2
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    • pp.97-104
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    • 2009
  • Optimal treatment of the torn anterior cruciate ligament (ACL) remains controversial. The complexity of surgically reproducing the natural biomechanical and anatomical function of the ACL has led to a diversity of reconstructive procedures. Controversy continues to exist regarding the best reconstructive procedure for the ACL deficient knee, but currently, there is no ideal method. Because of the increased frequency of ACL injury and the functional impairment resulting from that, the role of mechanoreceptors in the ACL recently has attracted considerable attention. Proper reconstruction of the ruptured ACL does not always have good results. Success after operation may depend not only on the mechanical stability but also on the quality of recovery of proprioception. It is well known that most ACL are ruptured in proximal half and most mechanoreceptors have been reported to be located in the subsynovial layer and near the tibial insertion of the ACL. Expected roles of tibial remnant is to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to be able to acquire anatomical placement of the graft without roof impingement. The remnant of the ruptured ACL has been removed to clearly visualize the ACL footprint or decrease the risk of impingement and Cyclops lesion in most current techniques for ACL reconstruction. Therefore it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. In addition, it will facilitate the vascular ingrowth and ligamentization of the grafted ACL.

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Comparison between Surgical and Conservative Treatments in Isolated Lateral Compartment Syndrome of the Lower Leg: A Case Report (하지 외측 구획에 국한된 구획 증후군에서 수술적 치료와 보존적 치료 간에 비교: 증례 보고)

  • Gwak, Heui-Chul;Seo, Young-Chae;Jung, Soo-Hwan;Kim, Dae-Yoo
    • Journal of Korean Foot and Ankle Society
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    • v.26 no.3
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    • pp.136-142
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    • 2022
  • Lateral compartment syndrome of the lower leg is rarely observed. Hence, there may be difficulty in diagnosis as its clinical patterns are different and more complicated than usual. We report two rare cases of a 20-year-old and a 28-year-old diagnosed with isolated lateral compartment syndrome who had either a surgical or conservative treatment. The comparison was done by analyzing the progression of neurological manifestation, electromyography, and nerve conduction study for two years. In the final follow-up, the patient who underwent the surgical treatment showed a shorter recovery time. However, both patients showed a full recovery from neurologic deficits.

Arthroscopic Resection of Synovial Plica in Elbow (관절경을 이용한 주관절 활막 추벽의 제거)

  • Yoo, Yon-Sik
    • Clinics in Shoulder and Elbow
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    • v.10 no.1
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    • pp.50-58
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    • 2007
  • Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range $16{\sim}56$ years). All patients had a trial of conservative treatment at least six months (range $6{\sim}16$ months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average(range $12{\sim}24$). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.

Arthroscopic Rotator Cuff Repair For Partial Articular-Surface Tendon Avulsion (PASTA) Lesion (회전근 개 관절내 부분 파열 환자의 관절경적 봉합술)

  • Lee, Bong-Gun;Cho, Nam-Su;Park, Keun-Ho;Moon, Seong-Cheol;Rhee, Yong-Girl
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.3
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    • pp.242-248
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    • 2009
  • Purpose: To evaluate the clinical and radiologic results of the arthroscopic rotator cuff repair for partial articular surface tendon avulsion lesion. Materials and Methods: Twelve patients with symptomatic, partial articular surface tendon avulsion underwent arthroscopic rotator cuff repair between Mar. 2006 and Sep. 2008. The mean follow-up period was 18.3 months(12~36 months), and the mean age at the time of surgery was 46.9-year-old(19~64 years). Three cases had underwent rotator cuff repair after conversion to full-thickness tear and nine cases had transtendon repair with preserving bursal side cuff. Results: The mean VAS during motion was 6.2 before treatment and 2.0 at final follow-up (p<0.001). The passive forward flexion improved from $163.3^{\circ}$ preoperatively to $169.8^{\circ}$ postoperatively (p=0.038). The mean UCLA score improved from 18.4 preoperatively to 30.1 with 2 excellent, 8 good and 2 fair results at final follow-up. The mean KSS improved from 61.8 preoperatively to 76.8 at final follow-up. By examining the postoperative MR images of 5 patients, complete healing was observed in all of them. Conclusion: Arthroscopic rotator cuff repair may be an effective procedure for partial articular surface tendon avulsion in pain relief and improvement of the range of motion. If the remaining bursal side cuff fibers are intact, transtendon repair procedure with preserving the intact bursal layer of the tendon can be considered. If the remaining bursal side cuff fibers are friable or little, completion from partial-thickness to full-thickness tears with subsequent cuff repair can be considered.

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Synovial Sarcoma with Femoral Vein Invasion (대퇴정맥을 침 범한 활액막육종 1예보고)

  • Seo, Jae-Jeong;Park, Seung-Il;Kim, Eun-Gi
    • Journal of Chest Surgery
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    • v.29 no.4
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    • pp.454-457
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    • 1996
  • The Incidence of synovial sarcoma Is very low but sarcoma Is a well-defined entity, which occurs primarily around large Joints and usually in association with tendon sheaths, bursae or the capsule. Recently we experienced a case of synovial sarcoma which invaded the right femoral vein of 433 5-year-old man. The tumor was widely excised incl ding the invaded femoral vein, and vein reconstruction was done using saphenous vein graft. The postoperative course was uneventful without intractable edema nor disability.

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Dynamics Analysis for Flexible Systems using Finite Elements and Algebraic Quaternions (4원법과 유한요소를 이용한 유연체 동역학의 해석기법)

  • Lee, Dong-Hyun;Yun, Seong-Ho
    • Journal of the Computational Structural Engineering Institute of Korea
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    • v.18 no.2
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    • pp.141-149
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    • 2005
  • This paper deals with formulations of the energy equilibrium equation by an introduction of the algebraic description, quarternion, which meets conservations of system energy for the equation of motion. Then the equation is discretized to analyze the dynamits analysis of flexible multibody systems in such a way that the work done by the constrained force completely is eliminated. Meanwhile, Rodrigues parameters we used to express the finite rotation lot the proposed method. This method lot the initial essential step to a guarantee of developments of the 3D dynamical problem provides unconditionally stable conditions for the nonlinear problems through the numerical examples.

A CLINICAL STUDY ON TRACHEAL STENOSIS (기관협착증에 관한 임상적 고찰)

  • 정무권;조진생;안회영;차창일;유세영;박주철
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1987.05a
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    • pp.13.1-13
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    • 1987
  • 저자들은 1984년 12월 17일부터 1987년 2월 26일까지 경희대학교 의과대학 부속병원 이비인후과 및 흉부외과에서 경험한 9례의 기관협착증환자를 대상으로 임상적 고찰을 하여 다음과 같은 결과를 얻었다. 1) 연령 및 성별분포는 여자 3례, 남자 6례이었고, 10세이하 3례, 10대 2례, 20대 2례, 40대 이상이 2례 이었다. 2) 원인은 지속적 기관내삽입관에 의한 경우가 4례이었고 1례는 선천성 혈관기형인 double aortic arch에 의해 기관이 눌리어 기도협착증상이 있었던 경우이었다. 상기관절개술에 의한 경우가 2례, 경부외상 1례, 기관내 종양 2례이었다. 3) 협착부위의 길이는 1.5cm에서 2cm까지가 4례로 가장 많았고 3cm이내가 2례, 4cm이내 1례, 6cm이내 1례이었다. 4) 치료는 보존적인 방법으로 내시경하에서 육아조직 및 반흔조직을 laser를 이용하여 제거한 후 silastic stent 혹은 Montgomery T-tube 삽입후 4주에서 6주후 제거하여 치료한 경우가 2례이었고 협착부위절제 및 단단문합술을 시행한 경우가 6례이었다. 1례에서는 aortic arch division을 시행하였다. 5) 예후는 9례중 단단문합술을 시행한 6례 그리고 보존적 방법으로 laser를 이용한 육아조직의 제거 및 지지물삽입을 시행한 3례에서 모두 현재까지 재발은 보이지 않고 있다. 6) 기관협착의 길이가 1.5cm에서 4cm까지의 경우에는 supralaryngeal release procedure없이 단단문합술을 시행하였고 협착길이가 6cm인 1례에서는 supralaryngeal release를 하여 tension없이 문합술을 시행할 수 있었다.

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Osteosarcoma in an 8 Month-Old Infant treated with Limb Sparing Operation (8개월된 유아 골육종 환자에서의 사지 보존술)

  • Kim, Jae-Do;Kwon, Young-Ho;Kang, Myung-Soo
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.1
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    • pp.100-104
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    • 2005
  • Osteosarcoma is the most common tumor in malignant bone tumors. The peak age incidence in osteosarcoma is between 10 to 14 years of age. This tumor rarely develops under 6 years of age and the youngest patient in the previous literature was a 13 months old girl who had an osteosarcoma involving the second metacarpal bone. We report a case of an 8 month old male infant, who had an osteosarcoma involving the right proximal tibia. This patient was treated by wide excision with transepiphyseal resection and reconstruction with allograft. At 20 months after operation, the varus deformity was developed at the proximal junctional site of allograft. Thereafter, the revision was performed with correction of deformity and augmentation with the proximal fibula transfer. At 51 months after operation, he has been remained as free of disease, and he has recovered the knee motion ranged from 15 degree to 75 degree. The osteosarcoma in infant is very rare but it should be considered the osteosarcoma in the differential diagnosis of any bone lesion. Instead of amputation, the limb sparing operation and the solutions for limb length inequility in growing period should be carefully considered in the infantile osteosarcoma.

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Comparison of Rotational Strength in Shoulders with Anterior Instability and Normal Shoulders Using Isokinetic Testing (등속성 검사를 통한 견관절 전방 불안정 환자와 정상인의 회전력 비교)

  • Lee, Dong-Ki;Kim, Tae-Kwon;Lee, Jin-Hyuck;Lee, Dae-Hee;Jung, Woong-Kyo
    • Clinics in Shoulder and Elbow
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    • v.15 no.2
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    • pp.79-85
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    • 2012
  • Objective: It has been expected that patient with posttraumatic recurrent anterior shoulder dislocation might have limited daily life activity because of pain and apprehension of dislocation. But there have been only a small number of investigations regarding the rotator strength in this patient. The aim of this study is to find the characteristics about rotator strength of patient with posttraumatic recurrent anterior shoulder dislocation using an isokinetic testing. Method: We enrolled thirteen patients with posttraumatic recurrent anterior shoulder dislocation and fifteen sex, age-matched healthy nonathletic subjects in this controlled study. All participants were male and there were no significant differences between the two groups in age, height, weight, BMI. Isokinetic internal rotator and external rotator strength was evaluated with a Biodex Isokinetic Testing machine (Biodex Medical Systems, Shirley, NY, USA), tests were performed at 60 deg/sec and 180 deg/sec for both sides. Peak torque normalized to body weight, external rotator to internal rotator ratio, total work and fatigue were calculated for each angular velocity. The association between internal rotator and external rotator strength and shoulder instability was analyzed by comparisons with a control group. Results: Any notable differences could not be found between the two groups given all data from no symptomatic left shoulder. There were no significant differences between the two groups statistically in internal rotation strength of right shoulder. However, there has been a tendency that at all angular velocities, external rotator peak torque to body weight, total work and external rotator to internal rotator ratio were significantly lower in the anterior instability group than the control group at all angular velocities. There was no substantial difference between those groups with respect to the fatigue of external rotator and internal rotator in our study. Conclusion: The prominent characteristics of posttraumatic recurrent anterior shoulder dislocation are external rotator weakness and loss of balance with external rotator and internal rotator. Therefore selective training using this information rotator might be helpful in conservative treatment and rehabilitation.