• Title/Summary/Keyword: 전방 불안정성

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Risk Factor Analysis for $SaO_2$ Instability after Systemic-pulmonary Shunt (전신-폐 단락술 후 산소포화도의 불안정성의 위험인자 분석)

  • Jung Sung-Ho;Yun Sok-Won;Park Jung-Jun;Seo Dong-Man;Kim Young-Hwue;Ko Jae-Kon;Park In-Sook;Yun Tae-Jin
    • Journal of Chest Surgery
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    • v.38 no.4 s.249
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    • pp.277-283
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    • 2005
  • Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

Arthroscopic Reconstrucion in Megafrequency of Recurrent Anterior Shoulder Dislocations (관절경을 이용한 고 빈도 재발성 전방 견관절 탈구의 재건술)

  • Ko, Sang-Hun;You, Chong-Il;Cho, Sung-Do;Choi, Chang-Hyuk;Cheon, In-Ho;Woo, Jong-Keun;Kwag, Chang-Yul;Yun, Dong-Jin;Choe, Seong-Won
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.2
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    • pp.194-200
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    • 2005
  • Purpose: To evaluate the short-term follow up outcome and the effectiveness of arthroscopic vertical shift of anteroinferior capsulolabral complex, plication of AIGHLC (anterior band of inferior glenohumeral ligament complex) and thermal capulorraphy, posteroinferior suture plication, rotator interval closure as an adjuncts in recurrent instability of megafrequency with night time dislocation. Materials & Methods: From March 1998 to February 2004, we have had 18 shoulders out of 156. All of the cases have been night time dislocation above more one time. The age were average 29.4$(21{\sim}37)$ year old. The average follow up were 21.1 $(12{\sim}45)$months We checked Rowe score and ROM at pre-operation, post-operation 6 months,1 year & last follow up period. Results: Above good results were 16 cases(88.9%). The excellent were 6 cases, good were 10, fair 1, poor 1. Conclusions: In recurrent anterior shoulder dislocation in greater than 50 frequency, arthroscopic stabilization can be an alternative technique for selected patients against open inferior capsular shift. But more long ter n follow up and large materials will be needed in the future study.

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Ligament Reconstruction for Subluxation of the Trapeziometacarpal Joint of the Thumb (무지의 대능형중수간 관절의 아탈구에 대한 인대 재건술)

  • Park Jin Soo;Chung Yung Khee;Yoo Jung Han;Na Kyong Soo
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.3 no.2
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    • pp.134-140
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    • 2004
  • Purpose: The reconstructive surgery of the anterior oblique ligament has been recommended for patients with unstable carpometacarpal joints. We reviewed retrospectively the functional results of two patients who had been treated by6 using a harvested portion of the tendon of flexor carpi radialis as a substitute for the anterior oblique ligament. Materials and Methods: In two patients with a instability of the trapeziometacarpal joint because of a rupture of the anterior oblique ligament, reconstruction was carried out using a slip of the tendon of flexor carpi radialis and the patients had been followed up for two years. Results: The results after a follow-up of two years that both of them had significant relief from pain and symptoms. The mean grip strength recovered to 90$\%$ of the controlateral side. patients felt that they had subjective improvement and would have undergone the operation again. Conclusion: Increased awareness of this lesion can lead to an early and clear diagnosis, so that the patient may be advised adequately.

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Transient Calcification of Autogenous Grafted Patellar Tendon in Anterior Cruciate Ligament Reconstruction - A Case Report - (슬관절 전방 십자 인대 재건술 후 발생한 이식 건의 일과성 석회화 - 증례 보고 -)

  • Chung, Hyun Kee;Choi, Choong Hyeok;Kim, Jong Heon;Kim, Jae Young
    • Journal of the Korean Arthroscopy Society
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    • v.3 no.1
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    • pp.30-34
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    • 1999
  • We report the case of a 30-year-old man who was presented with transient calcification on the graft shortly after anterior cruciate ligament(ACL) reconstruction using a autogenous bone patellar tendon. The patient underwent ACL reconstruction with two incisional technique and six month later, calcific density was seen radiologically around the graft. On postoperative 13 months follow-up radiographic films, the calcific density disappeared. After two months of operation, Lachman and pivot shift test were negative and one millimeter side to side difference was detected in KT-1000 with 20 Ibs strength. But 6 months after the reconstruction, mild anterior instability was detected with the calcific density around the grafted tendon. However the anterior stability was recovered according to the disappearance of calcific density.

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Using the Arthroscopic Remplissage of Anterior Shoulder Instability with Hill-Sachs Lesion (전방 견관절 불안정성에서 Hill-sachs 병변의 관절경적 Remplissage)

  • Ko, Sang-Hun;Jung, Kwang-Hwan;Shin, Seung-Myeong;Park, Han-Chang
    • Clinics in Shoulder and Elbow
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    • v.14 no.1
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    • pp.53-58
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    • 2011
  • Purpose: We evaluated the minimal 1 year follow-up results (shoulder stability and the clinical and functional results) for the Remplissage technique to fill a Hill-Sachs lesion. Materials and Methods: The subjects were 12 patients who could be followed up for more than 12 months after the "Remplissage" procedures in our hospital from December 2008 to November 2009. Their mean age was 27.9 years old and the mean follow-up was 19 months. The evaluations included the ROM, the ASES score, the KSSI score, the ROWE score and postoperative MRI. Results: On the postoperative functional evaluation after an average of 16 months, the ASES score improved from 50.8 preoperatively to 78.3 postoperatively, the KSSI score improved form 44.5 preoperatively to 81.0 postoperatively and the ROWE score improved from 40.2 preoperatively to 84.3 postoperatively. After an average 14 months for all the cases, the range of movement was nearly in the normal range, which is 178.6${\pm}$18.6 (165~180) degrees for forward flexion and 49.3${\pm}$10 (43~60) degrees for external rotation. Conclusion: For recurrent shoulder instability with a large Hill-Sachs lesion, the Remplissage technique has a good outcome after more than 1 year follow-up in terms of the shoulder stability and the clinical and functional results.

Arthroscopic Bankart Repair using Suture Anchors (봉합나사를 이용한 Bankart 병변의 관절경적 봉합술)

  • Kim, Kyung-Taek;Kim, Chul-Hong;Shin, Sang-Howa;Kwak, Jong-Ill
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.2
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    • pp.173-177
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    • 2006
  • Purpose: To evaluate the efficacy of arthroscopic Bankart repair using suture anchors for treatment of traumatic anterior instability of shoulder joint. Materials and Methods: We performed arthroscopic Bankart repair using suture anchor in 90 cases and evaluated the results with the functional grading system of Rows and Zarins after patients were followed up for more than 24 months. Results: Combined pathologies identified under arthroscopy were Hill-sachs lesion in 46 cases, SLAP lesion in 12 cases, Rotate cuff lesion in 7 cases. The results were excellent or good in 82(91.1%) cases and redislocation was happened only 3 cases. Conclusion: We concluded that arthroscopic Bankart repair with suture anchors is one of the reliable and effective method for recurrent shoulder dislocation with Bankart lesion.

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Simultaneous Acute Rupture of Anterior Cruciate Ligament and Patellar Tendon - A Case Report - (전방십자인대 및 슬개건 급성 동시 파열 - 1예 보고 -)

  • Kim, Yeung-Jin;Kim, Tae-Kyun;Yang, Hwan-Deok;Kim, Hyoung-Jun;Park, Jin-Young;Seo, Kwang-Ho
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.103-107
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    • 2006
  • Simultaneous acute rupture of the anterior cruciate ligament (ACL) and the patellar tendon is a very unusual injury. That is difficult to diagnose in initial evaluation of knee injury, because the patellar tendon rupture is often missed. We report a 26 year-old male patient who was treated with ACL reconstruction using achilles allograft and direct patellar tendon repair with achilles allograft augmentation. The patient had the stable knee and full range of motion. It's clinical results were excellent(Lysholm score 93, Tegner activity score 6).

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Conservative Treatment for Injured Anterior Cruciate Ligament - Two Cases Report - (손상된 전방십자인대의 보존적 치료 - 증례 보고 -)

  • Jung Young Bok;Tae Suk Ki;Yum Jae Kwang;Kim Jin Soo
    • Journal of the Korean Arthroscopy Society
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    • v.1 no.1
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    • pp.112-115
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    • 1997
  • While the cruciate ligament has a profuse vascular response following injury, spontaneous repair does not occur. This may result from the fact that synovial fluid dilution of the hematoma following injury prevents the formation of a fibrin clot and thus the initiation of the healing mechanism. Another theory suggests that the dynamic nature of the fascicles of the anterior cruciate ligament(ACL) through even small ranges of motion prohibits spontaneous union to these fibers. But we experienced two cases of spontaneous healing of partially injured ACL. Initially they showed more than grade II anterior instability. 6 mm difference by stress roentgenographs(pull view) and difference of 8 mm by KT 1000TM arthrometer between the ACL injured knee and normal side knee. Lax, nearly complete tear of ACL and synovial bleeding were noted during arthroscopic examination but the continuity of synovial membrane was seemed to be intact. These cases were treated by conservative management rather than reconstructive procedure. Postoperatively they showed excellent clinical results, no anterior instability and unlimited athletic activity. Based on our clinical experience. we think that cruciate ligament has the spontaneous healing potential in acute stage and middle aged patient. We consider the microfracture technique and initial immobilization for accelleration of healing response of the ACL.

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Arthroscopic Treatment of Metallic Suture Anchor Failures after Bankart Repair (Bankart 수술 후 발생한 금속 봉합 나사못 합병증의 관절경적 치료)

  • Shin, Sang-Jin;Jung, Jae-Hoon;Kim, Sung-Jae;Yoo, Jae-Doo
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.70-76
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    • 2006
  • Purpose: This study presents 5 patients who had metallic anchor protrusion on glenoid after Bankart repair in anterior shoulder instability and reviewed the cause, clinical feature and arthroscopic removal technique. Method and Materials: 5 male with average age of 22 years (range 19 to 25 years) were included. 4 patients had arthroscopic Bankart repair and 1 patient had open repair for anterior shoulder instability. They had protruded metallic suture anchors on glenoid and the protruded suture anchors were removed arthroscopically using larger suture anchor empty inserter. Results: 4 patients had painful clicking sound with motion of abduction and external rotation and 1 patient showed shoulder instability. The ROM showed normal except mild degrees loss of external rotation. The position of protruded metallic anchor was 2, 3 and 5 O'clock in three patients and 4 O'clock in 2 patients. In 2 patients, the metallic suture anchor was malpositioned about 5mm off on the medial side from the anterior glenoid edge. All had Outerbrige classification Grade II-III chondral damage on humeral head and 1 patient showed glenoid cartilage destruction. None had shoulder instability after 2 years of follow-up. Constant score was 65 preoperatively and 89 postoperatively. ASES score was 67 preoperatively and 88 postoperatively. Conclusion: Symptoms of protruded suture anchor are not combined with instability. Most of symptoms were revealed from the rehabilitation period and confused with postoperative pain. Prompt diagnosis and early arthroscopic removal or impaction of protruded metallic suture anchor is recommended because of serious glenohumeral cartilage destruction. This is easy and simple and reproducible method to remove protruded metallic suture anchor arthroscopically.

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Comparison between Conservative Treatment of partial ACL Rupture and Reconstructive Surgery with BPTB Autograft in ACL Rupture (전방 십자 인대 파열후 자가 슬개건을 이용한 재건술군과 부분 손상후 보존적 치료군의 비교)

  • Lee Dong Chul;Lee Su Ho;Kim Dong Han
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.1 no.2
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    • pp.131-137
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    • 2002
  • Purpose: To evaluate and compare the functional results, activity status, and anterior stability between conservative group with partial ACL injury and reconstruction group with bone-patellar ten-don-bone autograft in ACL total rupture. Materials and Methods: Thirty-eight patients with ACL injury were diagnosed and treated with arthroscopy and followed for more than two years. The number of patients with partial injury was 12(mean age; 38.3) and reconstruction group was 26 (mean age; 25.3). Objective stability was estimated under anterior loading of 15 lb and 20 lb by KT-2000 Arthrometer (MED metric, USA). Functional evaluation using Lysholm score and Tegner activity score were performed. Results: Average functional score of Lysholm was 88.5 in partial injury group and 89.3 in reconstruction group. Average score of Tegner was 5.3 in partial injury group and 5.1 in reconstruction group(P<0.05).Average anterior displacement compared with normal side. Under loading of 20lb, 1.7$\pm$4.3 mm in partial injury group, 2.3$\pm$1.9 mm in reconstruction group were anterior displaced (P<0.05). Under loading of 15lb, 1.2$\pm$1.0 mm in partial injury group, 1.4$\pm$1.5 mm in reconstruction group were dis-placed (P<0.05). There were giving way, effusion, instability and anterior knee pain in complication. Giving way was the frequent complication in the partial injury group. Conclusions: Clinical results of both group were similar. Functional evaluation of Lysholm was good and status of Tegner activity was maintained to physical fitness activites (jogging, regular bik-ing) in both groups on average. The results of conservative treatment for the partial ACL injury (less than 50$\%$) was satisfactory and equivalent to that of reconstructive treatment for the total ACL injury.

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