• Title/Summary/Keyword: 관절보존

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Phase-dependent Progress of Recalcitrant Calcific Tendinitis of the Shoulder after Removal (불응성 견관절 석회성 건염의 제거술 후 시기별 경과)

  • Moon, Young-Lae;Noh, Kyung-Hwan;Chang, Ji-Hoon
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.2
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    • pp.98-101
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    • 2008
  • Purpose: To evaluate the results of arthroscopic removal of calcific deposit depending on the phase-dependent progress of recalcitrant calcific tendinitis of the shoulder. Materials and Methods: From January, 2003 to September, 2007, arthroscopic treatment of calcific tendinitis of the shoulder joint, especially supraspinatus was performed in 27 consecutive patients who had had typical symptoms and failed with the conservative treatment and all patients could be followed up at least 6 months. We evaluated the visual analogue scale at preoperative, postoperative 2 weeks and 6 months. The results were compared according to the arthroscopic findings. Results: 11 cases were chalky calcium deposit of arthroscopic finding and 16 cases were toothpaste-like appearance. The VAS was 8.0 of the group with chalky deposit and 8.3 with toothpaste-like deposit preoperatively, which was not significantly different. However, at postoperative 2 weeks, it was 6.7 with chalky deposit and 2.7 with toothpaste-like, which is significantly different. At postoperative 6 months, the symptoms of all patients were resolved. Conclusion: Resorptive phase is well respond to surgical excision at early postoperative evaluation. The phase of calcific tendinitis is one of important factors for rapid resolution of the shoulder pain and functional improvement after arthroscopic treatment.

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A Study on Synovial Fluid Analysis of Chronic TMD and Effects of Pumping Technique (만성 악관절장애환자의 활액분석 및 악관절 도약술의 효과에 관한 연구)

  • 김용우;김영구;연태호
    • Journal of Oral Medicine and Pain
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    • v.22 no.2
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    • pp.241-252
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    • 1997
  • 본 연구는 임상검사 및 방사선 사진상 악관절장애로 진단된 환자중 물리치료,악관절 안정장치 등의 보존적 치료방법을 시행하였으나 증상의 개선이 별로 없는 퇴행성 관절질환이나 중등도의 개구제한을 가진 환자를 대상으로하여 aspirin을 이용한 활액성분 분석 및 악관절 도약술과 sodium hyaluronate의 주입을 시행한후 이에 따른 치료결과를 평가하기 위하여 시행되었다. 평균연령이 31.2세(21-42세)인 11명의 악관절 장애환자를 대상으로 하였다. 악관절 도약술과 sodium hyaluronate의 주입은 악관절의 동통과 개구제한의 해소를 위해 시행되었으며 그 결과를 시술전, 시술 즉시, 시술 1주후 및 4주후로 나누어 분석하였으며 활액 채취시 생리식염수의 희석에 의한 활액성분의 농도 변화에 따른 오차를 막고자 활액과 혈액내의 aspirin의 농도차를 이용하여 정확한 활액 성분농도를 측정하였다. 이상의 연구를 통하여 다음과 같은 결론을 얻었다. 1. 전체 환자의 생리식염수에 의한 악관절 활액의 희석계수는 1.4-12.9(5.5$\pm$4.2)로 상당히 넓은 범위를 나타내었다. 2. 만성 폐구성 과두걸림 환자군(n=7)의 생리식염수에 의한 활액의 희석계수 (6.2$\pm$3.5)는 퇴행성 관절질환을 갖는 환자군(4.4$\pm$5.7, n=4)과 유의한 차이가 없었다. 3. 만성폐구성 과두걸림군과 퇴행성 관절 질환군간의 활액성분의 농도는 유의한 차이가 없었으나 희석계수를 이용한 수정된 Hyaluronic acid와 총단백질의 농도는 만성 폐구성 과두걸림군의 경우에서 유의하게 더 높게 나타났다. 4. 악관절 도약술과 sodium hyaluronate의 주입 직후 만성 폐구성 과두걸림 환자군의 경우 평균 8.3mm의 추가적인 개구 증가로 유의한 차이가 관찰되었고 퇴행성 관절질환의 경우 평균 1.3mm의 추가적인 개구증가가 있었으나 유의한 차이가 관찰되지 못했다. 5. 시술전, 시술 1주후 및 4주후의 여러 검사항목을 비교한 결과 두 군에서 모두 시간의 경과에 따라 기능이상 및 동통 감소의 경향을 나타내었으나 유의하지는 않았으며 만성 폐구성 과두걸림의 경우 기능장애지수(dysfunction index) 와 최대개구시 동통의 정도는 시술전과 시술 4주후간에 유의한 차이가 관찰되었다.

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관절와 상완 관절 병태 생리, 분류 및 치료 방침 결정

  • Sin, Sang-Jin
    • The Academic Congress of Korean Shoulder and Elbow Society
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    • 2008.11a
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    • pp.99-108
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    • 2008
  • 견관절 전방 탈구의 치료 방법을 결정하는데 있어서 중요한 점은 탈구를 유발한 병태 생리에 대한 충분한 숙지와 함께 적절한 환자의 선택과 치료 결과에 대한 환자의 기대치를 파악하여 그에 맞는 치료를 선택하는 것이 중요하다. 탈구의 횟수에 있어서 첫 탈구이거나 아주 적은 횟수의 탈구로 환자가 일상 생활에 어려움을 호소하지 않는다면 보존적 치료를 시행해야 할 것이며, 수술적 치료의 경우에 환자의 병변 상태나 그 원인 인자에 대한 평가가 정확히 이루어진 후 시행되어야 한다. 환자의 기대치는 일반인의 경우 수상 이전의 활동도의 회복보다는 안정성이 중요할 것이며, 운동 선수인 경우에는 안정성이 회복 되었더라도 운동에 다시 복귀하지 못한다면 만족도는 매우 떨어질 것이다. 이렇듯 의사의 능력이나 욕망 보다는 환자의 활동 정도와 견관절의 병적 상태, 환자의 요구에 맞는 치료방법을 선택해야 할 것이다.

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상완 이두 건 장 두의 부분 파열

  • 김영규
    • Clinics in Shoulder and Elbow
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    • v.7 no.2
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    • pp.83-89
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    • 2004
  • 상완 이두 건 부분 파열은 관절경 검사를 시행하지 않는 한 진단이 매우 어렵다. 이학적 검사는 대체적으로 비특이적이나 이두 구 근처에서 압통의 유무를 확인하는 것이 중요하며 이두 구에 마취제 국소 주사가 진단에 도움이 될 수 있다. 치료로는 보존적 치료를 중요시하여야 하나 지속적인 동통이 존재할 경우에는 동통으로 인한 일상생활의 제한 및 견관절 기능의 소실을 고려하여 적극적인 수술적 치료가 요할 것으로 사료되며. 특히 고령의 경우 이두 구 근처에서의 상완 이두 건 부분 파열은 건 유리술이 도움이 될 것으로 생각된다.

Anterior Cruciate Ligament Augmentation Using Autogenous Semitendinosus Tendon (자가 반건양건을 이용한 전방 십자 인대 보강술)

  • Choi, Nam-Yong;Han, Chang-Hwan;In, Yong;Moon, Chan-Woong;Choi, Seung-Woog;Jin, Sung-Ki
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.1
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    • pp.12-17
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    • 2008
  • Purpose: This study presents clinical results of anterior cruciate ligament(ACL) augmentation using autogenous two-strand semitendinosus tendon in the treatment of partial ACL tears with preservation of residual portion. Materials and Methods: From January 2004 to June 2006, twenty two patients who had an ACL injury underwent ACL augmentation using autogenous two-strand semitendinosus tendon were enrolled in this study. We evaluated the clinical results with regard to clinical findings(range of motion, Lachman test, pivot shift test), standard knee scales(Lysholm, Modified Feagin Scoring System), and KT-1000 arthrometer testing. Results: At minimum one year postoperatively, there was no limitation of range of motion. Lachman and pivot shift tests were negative in all knees. On instrumented anterior laxity test by KT-1000 arthrometer, mean side to side difference was improved from 4.6mm preoperatively to 1.7mm postoperatively. Average Lysholm score was improved from 70 to 92. Ninety one percent of cases were rated as good or excellent in Modified Feagin Scoring System. Conclusion: Augmentation using autogenous two-strand semitendinosus tendon with preservation of residual portion of the ACL seems to be an acceptable method for restoring knee stability and proprioceptive function.

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Treatment of Acromioclavicular Joint Injury (견봉 쇄골인대 손상의 치료)

  • Noh, Kyu-Cheol;Lee, Jae-Won;Yoo, Yon-Sik
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.1
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    • pp.58-68
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    • 2011
  • Acromioclavicular (AC) joint dislocations are common injuries in active individuals secondary to direct force on the lateral aspect of the adducted shoulder. Complete disruption of the acromioclavicular and coracoclavicular (CC) ligaments may occur, depending on the magnitude of the insulting force. Most of these injuries are successfully treated without surgery. However, for the treatment of cases in which surgical management is warranted, there are more than 100 surgical techniques available without a gold standard technique. We review the anatomy of the acromioclavicular joint, the diagnosis of disorders of this joint, and the different treatment options in this article.

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A Simple Arthroscopic Resection Technique for Inferior Leaf of the Deep Horizontal Tear in the Anterior Meniscal Horn - Technical Note - (반월상 연골 전각의 깊은 수평 파열에서의 간단한 관절경 하부 연골편 절제술 - 수술술기 -)

  • Lee, Kee-Byoung;Lee, Seok-Beom;Chang, Ho-Guen;Moon, Young-Wan;Kang, Ki-Hoon;Kim, Kye-Won
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.1
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    • pp.62-65
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    • 1999
  • A new method for arthroscopic resection of the inferior leaf for the horizontal tear in the anterior horn of the meniscus extending deep toward the capsule was developed. Resection of this tear is difficult-perhaps more so than any other meniscal tear. At arthroscopy, a small incision on the meniscotibial ligament of the anterior horn was made after the deep horizontal tear was carefully debrided. A retrograde punch was introduced through the incision and underneath the inferior leaf of the anterior meniscus. The inferior leaf of the anterior horn was resected by the punch without difficulty. This simple technique minimizes the risk of superior leaf injury and can be used for a horizontal tear in the anterior horn as well as the mid horn with sweeping motion of the retrograde punch.

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Arthroscopic Release of the Extensor Carpi Radialis Brevis Tendon for Chronic Recalcitrant Lateral Epicondylitis (만성 불응성 외 상과염에서 시행한 관절경적 단 요 수근 신건 유리술)

  • Ku, Jung Hoei;Hwang, Tae Hyok;Lee, Jung Su;Cho, Hyung Lae;Kim, Jung Woo
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.2
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    • pp.140-146
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    • 2012
  • Purpose: The objective of this study was to assess the clinical outcome of arthroscopic release of the extensor carpi radialis brevis (ECRB) tendon in chronic recalcitrant lateral epicondylitis and tried to determine any prognostic factors. Materials and Methods: A retrospective review of 24 patients with lateral epicondylitis treated by arthroscopic ECRB release was performed. Outcome measures included a patient self rating and visual analog scale (VAS). Functional evaluation was made with Quick-disabilities of the arm, shoulder and hand (DASH) score system to identify preoperative factors that might be associated with the outcomes. Results: Twenty one (88%) elbows received benefit from the procedure. A mean preoperative VAS pain score and the mean Quick-DASH were significantly improved at final follow up. Age, sex, dominant arm and duration of symptom, presence of capsular tear or calcification did not correlate significantly with the clinical outcome. Three of four patients without T2-weighted high signal focus of the ECRB origin on preoperative magnetic resonance imaging (MRI) showed higher Quick-DASH score. Conclusion: Arthroscopic release of the ECRB is an effective option for chronic recalcitrant lateral epicondylitis. Lack of high signal focus on preoperative MRI is significantly associated with a poor surgical outcome and a considerable factor for the proper surgical indication.

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Treatment of Infection after Anterior Cruciate Ligament Reconstruction: Graft Retention (전방 십자 인대 재건술 후 감염의 치료: 이식건의 보존)

  • Kim, Hyoung-Jun;Koh, Hae-Seok;Moon, Chan-Woong;Choi, Nam-Yong;In, Yong;Kim, Min-Woo
    • Journal of the Korean Arthroscopy Society
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    • v.11 no.2
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    • pp.99-103
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    • 2007
  • Purpose: To report the results of graft retention treatment for infection cases after anterior cruciate ligament(ACL) reconstruction. Materials and Methods: From a group of 511 consecutive ACL reconstruction patients, we report 5 who sustained septic arthritis. All patients underwent arthroscopic lavage, debridement, synovectomy with graft retention, and treatment with intravenous antibiotics. Results: All patients were evaluated at an average of 34 months after operation. The infection was successfully eradicated. No patient showed instability with KT-2000 arthrometer testing. The clinical outcome was inferior to normal ACL reconstruction patients. Two patients were graded as nearly normal and 3 patients were graded as abnormal with International Knee Documentation Committee evaluation form. Conclusion: There were no recurrences of septic arthritis or bone infection with graft retention treatment for infection patients after ACL reconstruction.

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