• Title/Summary/Keyword: 재건 방법

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Reconstruction of Chronic Ankle Instability with the Toe Extensor Tendon (족지 신전건을 이용한 만성 족관절 불안정성의 재건)

  • Ahn, Jae-Hoon
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.6 no.2
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    • pp.88-91
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    • 2007
  • Persistent instability following an acute lateral ankle sprain eventually require ligamentous reconstruction in some cases. Over 50 surgical procedures have been described to reestablish lateral ankle stability varying from direct in situ repair of the anterior talofibular ligament and the calcaneofibular ligament to augmented reconstructions with either autograft or allograft tissue. The author describes the rationale and the technique of anatomic ankle ligament reconstruction with the 4th extensor digitorum longus tendon.

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A Comparison of Outcomes after Early and Delayed Reconstruction in the Acute Posterior Cruciate Ligament Injuries (급성 후방십자인대 손상 환자에서 조기 재건군과 지연 재건군의 결과 비교)

  • Lee, Yong Sik;Lee, Soo Won;Seo, Byung Ho;Kim, Yoon Gi
    • Journal of the Korean Arthroscopy Society
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    • v.17 no.1
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    • pp.31-37
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    • 2013
  • Purpose: This study performed to compare degree of joint stiffness and clinical results between early and delayed reconstruction of acute posterior cruciate ligament (PCL) injuries. Materials and Methods: Thirty-two Patients who underwent PCL reconstruction between March 2008 and October 2011 enrolled this study. We performed transtibial single bundle reconstruction using the allo-achilles tendon in all cases. We divided the patient into two groups, early reconstruction group underwent surgery before a week, delayed reconstruction group underwent surgery after 3 weeks, before 6 weeks. All the patients underwent aggressive joint motion exercise till surgery and enrolled post operative rehabilitation program. We checked posterior drawer stress radiography, range of motion, the Lysholm score, the International Knee Documentation Committee (IKDC) score and the Tegner score to evaluate the results. Results: At the final follow up the Lysholm score was 92.1 in the early group and 93.8 in the delayed group. All the cases were rated above B (near normal) on IKDC score (p=0.808, p=0.722). The Tegner score was 6.6 in the early reconstruction group and 6.2 in the delayed group (p=0.480), The average of maximum flexion and extension angle was $133.9^{\circ}$, $1.4^{\circ}$ in the early group and $133.6^{\circ}$, $1.1^{\circ}$ in the delayed group (p=0.560, p=0.581), no complication such as deep vein thrombosis or infection, no difference in posterior drawer stress radiography (p=0.750). Conclusion: We could obtain satisfactory clinical results in both the early and delayed reconstruction groups of acute PCL injuries. Therefore, the early reconstruction of PCL performed before a week could be one of the treatment options for acute PCL injury.

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Reconstruction of the Defect after Resection of Tonsillar Carcinoma Using Pectoralis Major Myocutaneous Flap (편도암 수술후 대흉근피판을 이용한 결손부위의 재건)

  • Choi Eun-Chang;Lee Jeong-Joon;Hong Won-Pyo
    • Korean Journal of Head & Neck Oncology
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    • v.11 no.1
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    • pp.41-46
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    • 1995
  • The pectoralis major myocutaneous flap represents a major contribution to head and neck cancer reconstruction. Its advantages are improved viability, one-stage reconstruction, and carotid protection. The oropharyngeal defect especially tonsillar area reveals valley shaped one with loss of a wide mucosal area. Using pectoralis major myocutaneous flap to this defect is sometimes difficult due to its natural figure of bulkiness. This article reviews our experience with patients undergoing 14 pectoralis major myocutaneous flap in carcinoma of the tonsillar area. Complications and their incidences were I total loss, 3 marginal loss, 2 minor seperation of suture, I wound infection and 2 hematoma. Most of the complications did not require a second procedure for reconstruction. Bulkiness of the flap and gravity force to the upper suture line were thought to be causes of the complications. Modification of the flap design with bilobular figure was useful to reduce its bulkiness at the folding area. More stable suture around hard palate was needed to overcome seperation of the suture.

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Arthroscopic Posterior Cruciate Ligament Reconstruction without Tourniquet (지혈대 없이 시행한 관절경하 후방십자인대 재건술)

  • Kim, Sang-Bum;Lee, Young-Goo;Son, Jung-Hwan
    • Journal of the Korean Arthroscopy Society
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    • v.8 no.2
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    • pp.94-97
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    • 2004
  • Purpose: To report the results of arthroscope assisted posterior cruciate ligament reconstruction without tourniquet, which has not yet been reported in documents within the country. Materials and Methods: Out of the 75 cases of arthroscope assisted posterior cruciate ligament reconstruction on patients with posterior cruciate ligament damage from January, 1998 to May,2003 in this hospital, study was done on 49 cases of patients with isolated posterior cruciate ligament damage, excluding 16 cases of patients who were applied tourniquet in extraarticular operation due to combined damage such as in lateral collateral ligament and posterolateral collateral ligament, and 10 cases where the postoperative observation period was less than 12 months. There were 13 cases where reconstruction was done using autogenous bone-patella tendon-bone, 19 cases using allogenous bone-patella tendon-bone, and 17 cases using allogenous achilles tendon. For assessment, the 49 cases were compared using Lysholm knee scoring scale. Results: The average duration of operation was 105 minutes. There were no severe complications such as swelling, bleeding, infection etc . Assessment results attained by Lysholm knee scoring scale was 74(fair) for cases where autogenous bone-patella ten-don-bone was used,75(fair) for cases where allogenous achilles tendon was used, and 76(fair) for cases where allogenous bone-patella tendon-bone was used. Conclusion: There are no difficulties to perform the arthroscopic assisted posterior cruciate ligament reconstruction. Reconstruction without tourniquet can be thought to prevent complications that could follow when using it.

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Single Bundle PCL Reconstruction with Remnant Preservation (잔여 조직을 보존한 단일 다발 후방십자인대 보강재건술)

  • Lee, Dong Chul;Kim, Won-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.15 no.2
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    • pp.125-131
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    • 2011
  • Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.

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Effect of High-temperature Redrying on Drying Characteristics of CCA-treated Lodgepole Pine Dimension Lumber (고온 재건조가 CCA 처리 Lodgepole Pine 각재의 건조 특성에 미치는 영향)

  • Kim, Gyu-Hyeok
    • Journal of the Korean Wood Science and Technology
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    • v.18 no.3
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    • pp.34-41
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    • 1990
  • 본 연구는 CCA로 방부(防腐)처리된 Lodgepole pine 각재(角材)의 재건조(再乾燥)시 고온건조법(高溫乾燥法)의 적용이 건조속도(乾燥速度) 및 건조결함(乾燥缺陷)의 발생에 어떻게 영향하는가를 고찰하고자 수행되었다. 고온건조시 건조속도는 통당(通常) 열기건조(熱氣乾燥)시보다 약(約) 2.5배 증가되었으며, 방부처리재의 재건조 속도는 처리전(前)의 전건조속도보다 약간 감소됨을 보였다. 표면할열(表面割裂)의 발생정도(程度)은 전건조시의 경우, 고온건조시 보다 심(甚)하였으나 재건조시에는 건조방법간에 큰 차이가 없었다. 방부제의 침투(浸透)를 도모(圖謀)하기 위하여 자상(自傷)처리(Incising)된 각재의 경우에는 재건조시 절개부(切開部)의 연장(延長)에 의해 할렬의 정도가 증가됨을 보였다. 뒤틀림(Warping)의 발생정도는 고온건조시가 통상 열기건조에 비해 심하지 않았으며, 전(全) 건조과정을 통하여 발생된 뒤틀림은 WWPA가 정(定)해놓은 Lodgepole pine 2등급(等級)(No. 2 grade)의 뒤틀림 허용치(許容値)의 범위내(範圍內)에 있음을 보였다. 결론적(結論的)으로, 고온건조시 증가되는 건조속도와 건조재의 질(質)에 큰 영향을 주지않는 범위내에서 발생되는 건조결함을 고려할 때, Lodgepole pine의 전건조및 CCA 처리후 재건조를 위해 큰 문제없이 고온건조법이 적용될 수 있음을 보였다.

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욕창의 외과적 치료

  • Lee, Dae-Hun;Jeong, Yeong-Sik;Choe, Si-Ho;Seol, Jeong-Hyeon
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.31-37
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    • 1985
  • 욕창의 발생부위에 따른 수술방법 중 천골부 욕창의 치료에는 천골절골이 필요한 깊은 경우에는 대둔근피판술이, 갚지는 앓으나 광범위한 욕창일 경우에는 하둔대퇴피판술이 가장 성적이 좋았다. 대전자부 욕창의 치료에는 대퇴근막장근근피판술이 가장 성적이 좋았으며, 슬관절부 욕창의 치료에는 비복근판술 후 피부이식방법이 좋은 결과를 초래하였으며, 종골부 창상치료에는 발꿈치의 외후면 재건시는 lateral calcaneal flap이 좋으며, 종골절골이 필요치 않은 heel pad 재건시는 족저부 근막피판술이, 종골절골이 필요한 heel pad 재건에는 족지단골근근판술이 가장 좋은 성적을 가져 왔기에 문헌고찰과 함께 보고하는 바이다.

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Treatment of Distal Clavicular Fracture by Reconstruction Plate and Wire Fixation (쇄골 원위부 골절에 대한 재건 금속판과 강선 고정술을 이용한 치료)

  • Suh, Mu-Sam;Kim, Sang-Hyo;Park, Hyeong-Taek
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.5 no.1
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    • pp.58-62
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    • 2006
  • Purpose: To evaluate the result of operative treatment with plate and wire fixation for fractures of the distal clavicle. Materials and Methods: We assessed 9 cases of fractures of the distal clavicle that were treated by plate and wire fixation from March 2001 to July 2003 and followed up over 1year. We used the reconstruction plate as a buttress and performed cerclage wiring to fix comminuted fracture site. The functional result of shoulder was evaluated by the scoring system of Rowe. Results: The average periods of bony union was 9 weeks in all cases. According to Rowe scoring system, the functional result was exellent in 7 cases and good in 2 cases. There was no LOM of shoulder and traumatic arthritis in AC joint. But there was skin irritation in 1 case. Conclusion : The operative method by reconstruction plate and wire fixation for distal clavicular fracture was useful when there were comminuted fracture. This method seems to be simple and satisfactory in terms of improvement of range of motion of shoulder, restoration of function and rare complication.

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Proper Surgical Methods of Posterolateral Rotatory Instability of the Knee (슬관절 후외측 회전 불안정성의 적합한 수술적 방법)

  • Jung Young Bok;Lee Yong Seuk;Song Kwang Sup;Jin Ho Sun;Lee Jong Seok
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.3 no.1
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    • pp.49-55
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    • 2004
  • Purpose: we would like to suggest the proper surgical methods according to the severity of instability by analyzing the results. Materials and Methods: Between January 1998 and August 2002, eighty five patients have been operated on because of posterolateral rotatory instability (PLRI). The materials were included the patients who had followed-ups for over 2 years in sixty one patients and the patient's assessments were done by clinical score (OAK, IKDC) and posterolateral drawer and dial test. Results: Through our results, the fibular tunnel turned out to be superior compared to the tibia tunnel method in rotational stability. Hughston-Jacobson methods and biceps tenodesis showed poor results. Fibula head tunnel was superior to tibia tunnel in rotational stabiliaty Conclusion: The surgical technique that passes the modified posterolateral corner sling through the fibula head tunnel may provide good clinical results in grade II PLRI. It is necessary to reconstruct both tibia and fibula tunnel in grade III PLRI. When there is combined varus instability, a positive result may be obtained if an additional LCL reconstruction is performed.

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Arthroscopic Double-Bundle Reconstruction of Anterior Cruciate Ligament (관절경을 이용한 전방 십자 인대의 이중 다발 재건술)

  • Jung, Young-Bok;Park, Se-Jin;Jung, Ho-Joong;Yoo, Jae-Hyun
    • Journal of the Korean Arthroscopy Society
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    • v.11 no.2
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    • pp.92-98
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    • 2007
  • Purposes: The purpose of this study was to report surgical technique of double bundle anterior cruciate ligament(ACL) reconstruction and to compare the short-term clinical results between arthroscopic single-bundle and double-bundle ACL reconstruction. Materials and Methods: From May 2005 to May 2006, ninety-eight patients were underwent ACL reconstruction. We designed prospective study with sixty-one patients who were revealed isolated ACL injury. We serially checked clinical and radiologic data preoperatively and postoperatively. We compared single-bundle with double-bundle ACL reconstruction patients with preoperative datas and postoperatively 1-year data. There were 30 single bundle reconstruction and 31 double bundle reconstruction. Stability was assessed objectively by anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer. The clinical results were assessed by IKDC(International Knee Documentation Committee) and OAK(Orthopadische Arbeitsgruppe Knie) scores. Also, we evaluated postoperative thigh circumference and range of motion. All of operations were done by only one surgeon. Results: At single-bundle reconstruction group, preoperative AP instability which was checked by $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer was $7.9{\pm}3.3$ and $7.4{\pm}2.0$, respectively. At double-bundle reconstruction group, it was $8.3{\pm}3.5$ and $7.9{\pm}3.2$, respectively. Residual AP laxity checked at 1 year after operation was $1.9{\pm}1.2$ and $2.2{\pm}1.6$ in single-bundle reconstruction group, and $1.1{\pm}0.9$ and $1.0{\pm}1.0$ in double-bundle reconstruction group. So, double-bundle reconstruction had better results in both anterior stress radiographs with the $Telos^{(R)}$ device and the maximal manual test with the KT-2000 arthrometer, and there were significant differences in statistics. But, clinical results such as IKDC(International Knee Documentation Committee) scores, OAK(Orthopadische Arbeitsgruppe Knie) scores, thigh circumference and range of motion had no significant difference between two groups. Conclusions: On the basis of stability, the side-to-side anterior laxity of double-bundle ACL reconstruction was significantly better than that of single-bundle reconstruction, although there were no significant differences in the other clinical measures among them.

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