• Title/Summary/Keyword: 재건

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Results of Anterior Cruciate Ligament Reconstruction with Unicondylar Arthroplasty for Medial Compartment Knee Osteoarthritis combined with Anterior Instability (전방 불안정성과 동반된 슬관절 내측 구획 진행성 관절염환자에서 전방십자인대 재건술 및 인공 관절 부분 치환술의 결과 - 3예 보고 -)

  • Lee, Chul Hyung;Song, In Soo;Ji, Jong Hun;Kim, Tae In
    • Journal of the Korean Arthroscopy Society
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    • v.17 no.1
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    • pp.88-94
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    • 2013
  • Three cases who had medial compartment osteoarthritis of the knee (Kellgrene-Laurence grade 3 and Outerbridge grade 4) and anterior instability of the knee due to rupture of the anterior cruciate ligament in relative young ages underwent staged anterior cruciate ligament reconstruction followed by medial unicondylar arthroplasty in 2 cases and simultaneous anterior cruciate ligament reconstruction and unicondylar arthroplasty. We evaluated clinical results some kinds of preoperative and postoperative International Knee Documentation Committee (IKDC), Lysholm score and last follow-up hospital for special surgery (HSS), knee society score (KSS). We consider that medial unicondylar arthroplasty with staged or simultaneous anterior cruciate ligament reconstruction is very good option of the treatment for the anterior instability and pain from advanced arthritis.

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Reconstruction of Sacral Pressure Sores Using Perforator-Based Island Skin Flaps (천공분지에 기저를 둔 도서형 피부피판을 이용한 천골부 욕창의 재건)

  • Moon, Ji Hyun;Lee, Nae Ho
    • Archives of Reconstructive Microsurgery
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    • v.9 no.1
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    • pp.62-67
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    • 2000
  • Recently, the incidence of pressure sore has been increased, due to increased number of patients with central nervous system injuries after traffic and industrial accidents or with long term loss of consciousness due to drug intoxication. The management of sacral pressure sore has been improved through the development of myocutaneous flap. However, sacrifice of the deep muscle cause some problems such as intraoperative bleeding, functional disabilities of donor site and further limitation of reconstruction for recurrent pressure sores in paraplegic patients. The development of perforator-based island skin flap introduce a new treatment modality for sacral pressure sores. We used perforator-based island skin flap in 15 cases with reasonable result from January 1998 to February 2000. This flap has a many advantages such as no significant sacrifice of the gluteus maximus muscle, wide rotation arc, reliable blood flow of the perforator, short elevation time for the flap, and no post-operative hindrance to walking in patients who are not paraplegic. There was no significant complication without significant sequelae and donor sites could be repaired primarily.

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Treatment of Posteolareral Rotatory Instability of the Knee (슬관절 후외방 불안정성의 치료)

  • Kim, Jin Goo
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.2
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    • pp.146-154
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    • 2011
  • Injury of posterolateral corner is unusual, but it can cause disability due to severe instability and cartilage damage. However, the anatomical structures, diagnosis and treatment have not defined clearly yet. Posterolateral corner injury is regarded as the one of main factor to the results of failure in cruciate ligament reconstcution if it was undiagnosed and untreated. Diagnosis of postetolateral corner injury is consists of physical exam, radiographic finding, MRI, and arthroscopic findings. The treatment method of of postetolateral corner injury depends on the time and severity of injury. Anatomical reconstruction of posterolateral corner shows the better clinical outcome than non anatomical reconstructions, but the clinical results of long term follow up is still needed. Therefore, the aim of this article is to review the recent literatures and to organize diagnosis and treatment of posterolateral corner injury.

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Cross-Pin and Interference Screw Femoral Fixation in Anterior Cruciate Ligament Reconstruction using Hamstring Tendon -Technical Note- (슬괵건을 이용한 전방십자인대 재건술시 횡고정 핀과 간섭나사를 이용한 대퇴터널 고정술 -수술 수기-)

  • In Yong;Bahk Won-Jong;Park Jong-Beom;Hong Seung-Hwan
    • Journal of the Korean Arthroscopy Society
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    • v.6 no.1
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    • pp.60-63
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    • 2002
  • Purpose : The purpose of this study was to introduce new femoral fixation technique using a cross-pin and a bioabsorbable interference screw in hamstring ACL reconstruction. Method : Semitendinosus and gracilis were harvested for quadrapled graft. After tibial tunnel had been made, femoral tunnel was made 35 mm in depth. Then the graft passed through the tunnels. Cross-pin was fixed through the drill hole which had been made through upper sleeve of the Rigidfix system. While pulling the graft, bioabsorbable interference screw was fixed through the anteromedial portal. Conclusion : We introduced the new femoral fixation technique using a cross-pin and a bioabsorbable interference screw as a good method with high fixation strength and tight graft-bone contact.

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Immediate Full Weight Bearing in Extension Brace Following Arthroscopic Primary Repair or Reconstruction of ACL (관절경하 전방십자인대 일차수복술 및 재건술후 신전보조기를 착용한 조기 완전체중부하)

  • Kim Jung Man;Chang Cheong Ho;Cho Woo-Shin
    • Journal of the Korean Arthroscopy Society
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    • v.1 no.1
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    • pp.128-131
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    • 1997
  • 전방십자인대의 일차수복술이나 재건술후에 장기간의 비체중부하가 필요한지를 결정하기 위해서 일차수복술을 시행한 96례와 재건술을 시행한 82례등 총 178례를 대상으로 술후 체중부하시기에따라 두군으로 나누어 비교분석 하였다. 모든 례에서 술후 보조기를 착용하였고 120례에서는 술후 첫6주간 점차적으로 관절운동범위를 증가를 시키고 다음 6주간은 완전운동범위 회복상태에서 유지후 술후 12주에 체중부하를 허용하였으며 나머지 58례에서 술후 완전신전상태에서 즉시 체중부하를 시켜서 정기적으로 Lachman검사, KT 2000을 이용하여 불안정성여부를 관찰하였다. 평균 추시기간은 4.2년(2년$\~$6년)이었고 불안정성에 대한 평가는 AMA 분류에 따랐다. 최종추시상 모든환자에서 1+이상의 불안정성은 발견되지 않았으며 술후 12주에 체중부하를 한군에서 1a+가 104례$(86.7\%)$, 1b+군이 16례$(13.3\%)$로 관찰되고 즉시 체중부하를 한 군에서 1a+가 51례$(87.9\%)$, 1b+가 7례$(12.1\%)$에서 보였으나 통계적으로 의미있는 차이는 없었다(P>0.05). 본연구의 결과로 전방십자인대 일차수복술이나 재건술후 신전보조기를 착용시키고 즉시 보행을 시키는 것이 술후 슬관절의 불안정성에 영향을 주지 않으며 안전한 재활방법으로 생각된다.

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Failure of Cross-Pin Femoral Fixation after Anterior Cruciate Ligament Reconstruction - A Case Report - (전방십자인대 재건술후 대퇴골 경골핀 고정의 실패 - 증례보고 -)

  • Lee Kee-Byoung;Kwon Duck-Joo;Ji Yong-Nam
    • Journal of the Korean Arthroscopy Society
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    • v.7 no.1
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    • pp.92-95
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    • 2003
  • A 34-year-old man with ACL total rupture due to slip down injury, had received ACL reconstruction using autogenous hamstrings tendon with cross-pin femoral fixation. Postoperative course was as usual. But postoperative 3 months later, he complained posterolateral knee pain, recurrent effusion and mild instability. He was managed repeatitive aspiration and nonsteroid antiinflammatory drugs but was failed to relieve symptoms & signs. In CT scans, perforation of posteromedial femoral cortex of lateral femoral condyle was found. In second look arthroscopy, two pieces of broken femoral cross pin were found in between tibiofemoral Joint which was badly injured cartilage. We considered malposition of pins was the main cause of failure. We propose that femoral tunnel must be made more acute angle and femoral cross-pin guide must be positioned more external rotation 10-20 degree than transepicondylar axis made confirm the cross-pin tunnel position in order to avoid posterior cortex perforation and early failure.

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Jejunal Free Graft for Complicated Corrosive Esophageal Stricture (유리공장이식편을 이용한 합병된 부식성 식도협착의 재건술)

  • I Hoseok;Lee Sungsoo;Shim Young Mog
    • Journal of Chest Surgery
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    • v.38 no.6 s.251
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    • pp.445-449
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    • 2005
  • The management of failure of colonic graft or corrosive stricture with impaired colonic circulation continues to be a challenge to surgeons. We present four cases of complicated corrosive esophageal stricture, which were successfully treated using jejunal free graft. As the initial surgical treatment, three patients underwent colonic interposition, and one underwent Whipple's procedure due to panperitonitis. Ore patient underwent transposition of jejunal free patch graft, two underwent interposition of jejunal free graft, and one underwent esophagojejunocolojejunostomy using jejunal free graft. All patients did not show dysphagia after long term follow-up. Complex esophageal reconstruction with jejunal free graft was performed successfully and long term functional outcome was good.

Membranous PTEE Monocusp Vlave on the Right Ventricular Outflow Tract (막형 PTEE 단엽판막을 이용한 우심실 유출로 확장수술)

  • 박영환;홍유선;이현성;이종균;조범구
    • Journal of Chest Surgery
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    • v.34 no.4
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    • pp.322-328
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    • 2001
  • 배경: 우심실 유출로 재건술후에는 폐동맥판막부전이 우심실기능에 나쁜 영향을 미친다. 이를 막기 위해 여러 재료로 판막을 제조하여 사용하는데 가피 형성이 적은 막형 ePTEE(expanded polytetrafluoroethylene, Goretex) 단엽판막의 효과를 알아보고자 연구를 시행하였다. 대상 및 방법; 1996년 3월부터 1997년 2월까지 우심실유출로 재건술을 시행받고 수술 1일까지 우심실 압력을 측정할 수 있었던 47명중 막형 Goretex단엽판막을 사용한 환자(비교군) 19명, 사용하지 않은 환자(대조군) 28명에서 단엽판막의 유용성을 조사하였다. 두 군간에는 나이, 체중 그리고 McGoon ratio 등에는 통계학적 차이가 없었다.(p>0.05) 이전의 수술은 대조군에서 19번, 비교군에서 22번을 시행하였다. 우심실 유출로에 대한 수술은 대조군에서 REV수술 2예, 우심실폐동맥 연결수술 8예, 우심실 유출로 재개건술 2예, 우심실 유출로에 대한 수술은 대조군에서 16예였으며, 비교군에서는 REV 수술 5예, Rastelli 씨 수술 6예, 재우심실 유출로 재건술 5예, 그리고 우심실 재건술 3예였다. 결과: 대동맥 차단 시간이나 총심폐순환시간에는 두군간의 차이는 없었다. 또한 수술직후와 수술후 1일째 측정한 우심실 압력 및 좌심방압력의 차이도 두군간에는 차이가 없었으며 수술후 7일째 시행한 심에코도 결과 ejection fraction., 우심실/ 좌심실 압력비 , 그리고 우심실 유출로의 압력차, 강심제 투여일수, 호흡기 사용 기간 등에서도 두군간의 차이는 없었으나 흉관 삽입기간이 비교군에서 의미있게 짧았다. 추적 조사 기간 중 비교군 1예에서 사망을 하였으나. Goretex 단엽판막에 의한 것은 아니였으며 심초음파검사상 우심실 유출로 압력차이나 재수술은 두군간에 차이는 없었으나 폐동맥 폐쇄부전은 비교군에서 의미 있게 낮은 것을 보이고 있다. 결론; 막형 Goretex 단엽판막의 조기성적은 우수하였으며 폐동맥 폐쇄분전의 정도를 적게 하는 효과를 보이나 앞으로 이들이 성장함에 따라 우심실 유출로에 폐쇄를 일으키는지는 계속적인 추적관찰이 요구된다.

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A Clinical Study on Recent Causing Agents of Chemical Burns (화학 화상의 최근 원인 물질에 관한 임상적 연구)

  • Shin, Chi Ho;Yu, Sung Hoon;Kim, Ji Hoon;Kim, Dong Chul
    • Journal of the Korean Burn Society
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    • v.23 no.1
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    • pp.7-12
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    • 2020
  • Purpose: Due to rapid changes in the industrial structure in last decade, the wider various types of chemical agents were introduced. Burn surgeons should be well-informed with rapid changes of chemical burns. We present the recent incidence trends of causing agents of chemical burns. Methods: From 2010 to 2019, 92 chemical burn victims were included in this study. A retrospective study was made about the type, distribution and incidence of the causing agents of chemical burns. Initial treatments of most chemical burn wounds are copious saline irrigation by tap water, except hydrofluoric acid burn cases managed by 10% calcium gluconate injection. In alkali chemical burns on extremity, if thin eschars appear in postburn 2~3 days, acute early surgical escharectomy and split thickness skin graft were done. Results: More than 9 types of major chemicals causing chemical burns were surveyed, and the most common causing agent of chemical burns was Hydrofluoric acid (23.9%) followed by Acetic acid (19.6%) and Sodium hydroxide (8.7%). Conclusion: From 2010 to 2019, changes in the causing agent of chemical burns are that the types of major causing agents of chemical burns have increased and the distribution and incidence of causing agents have changed compared to previous reports. According to this study, more than 9 types of major chemicals causing chemical burns were surveyed, and the most common causing agent of chemical burns was Hydrofluoric acid (23.9%) followed by Acetic acid, Sodium hydroxide.

Long Term Result of Four Cases without a Staged Reconstruction of an Infected Achilles Tendon Following Repair (아킬레스건 봉합술 후 발생한 감염에서 이차적 건 재건을 시행하지 않고 치료한 4예의 장기 추시 결과)

  • Lee, Jaeyoung;Jeong, Changhoon;Jung, Sehoon;Park, Il-Jung
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.5
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    • pp.436-443
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    • 2020
  • The main treatment of infections following the repair of a ruptured Achilles tendon is debridement of the infected tissue and reconstruction of the Achilles tendon after controlling the infection. On the other hand, some studies recently reported excellent clinical results after the debridement of the infected Achilles tendon without a reconstruction of the tendon. This paper reports four cases of a competent result after the debridement of an infected Achilles tendon without reconstructing the tendon with a review of the relevant literature.