고관절 비구순 파열의 관절경적 치료 : 2~7년 추시 결과 2 to 7 Year Follow Up

황득수,김영모,김경천,안성환 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1

Cam형 대퇴비구 충돌의 관절경적 치료: 단기 추시 결과

장세앙 ( Se Ang Jang ),조영호 ( Young Ho Cho ),변영수 ( Young Soo Byun ),박기홍 ( Ki Hong Park ),김한상 ( Han Sang Kim ),정정철 ( Chul Jung ) 대한고관절학회 2014 Hip and Pelvis Vol.26 No.1

목적: 증상이 있는 cam형 대퇴비구 충돌에 대해 관절경으로 치료한 환자들의 단기 추시 결과를 알아보고자 하였다. 대상 및 방법: 2010년 11월부터 2012년 12월까지 고관절 동통을 동반한 cam형 대퇴비구 충돌 중 보존적 치료에 실패하여 관절경 치료 후 최소 12개월 이상 추시 관찰된 환자들에 대해 임상적 및 방사선적 결과를 알아보고자 하였다. 남자는 19명, 여자는 6명, 평균 연령은 32.9세(19-57세), 평균 추시 기간은 17.2개월(13-31개월)이었다. 알파 각, offset, 변형된 Harris 고관절 점수 및 visual analogue scale (VAS)을 조사하였다. 결과: 알파 각은 평균 64.8°에서 39.9°, offset은 평균 0.8 mm에서 7.6 mm로 호전되었다. 비구순 파열은 전상방 구획에서 변연부 종파열 및 방사형 소섬유성 파열이 가장 많았다. 비구 연골 손상은 14예에서 확인되었다. VAS는 술 전 평균 6.3에서 0.9로, 변형된 Harris 고관절 점수는 51.7에서 73.6으로 호전되었다. 수술과 관련된 합병증으로 관절경 삽입 시 발생한 대퇴골 두 연골 손상이 3예, 회음부 신경 손상이 2예, 외측 대퇴피 신경 손상이 2예였다. 결론: 관절경을 이용한 cam형 대퇴 비구충돌의 단기 추시 결과는 만족할 만하였으나, 관절경 술식과 관련된 합병증을 줄이기 위해 좀 더 세심한 주의를 필요로 하며, 관절염 발생을 줄일 수 있는지에 대한 장기적인 연구가 필요하리라 생각된다. Purpose: We evaluated the short term results after treatment of cam type femoroacetabular impingement (FAI) by arthroscopy. Materials and Methods: We evaluated the clinical and radiological results of arthroscopic ally treated cam type FAI in patients who had failed conservative treatment with hip pain, with at least 12 months follow-up, from November 2010 to December 2012. There were 19 males and six females. Mean age of patients was 32.9 years (19-57 years) and mean follow up period was 17.2 months (13-31 months). We analyzed the alpha angle, head neck offset, visual analogue scale (VAS), and modified Harris hip score (MHHS). Results: Mean alpha angle improved from 64.8。to 39.9。and mean head neck offset also improved from 0.8 to 7.6 mm. Peripheral longitudinal and radial fibrillated labral tear was the most common in the anterosuperior quadrant. Damage to ace tabular cartilage was identified in 14 patients. Mean VAS improved from 6.3 to 0.9 and mean MHHS improved from 51.7 to 73.6. Complications associated with the operation included three cases of femoral head articular cartilage injury, two cases of pudendal nerve injury, and two cases of lateral femoral cutaneous nerve injury. Conclusion: Although the short term results for arthroscopic ally treated cam type FAI were satisfactory, care must be taken to reduce the complications associated with arthroscopy and long term follow is needed in order to determine whether or not it can reduce osteoarthritis of the hip.

견인강선을 이용한 경골극 견열 골절의 관절경적 치료

김현곤,김성재,한명훈,강용호,정환용,Kim, Hyun Kon,Kim, Sung Jae,Hahn, Myung Hoon,Kang, Yong Ho,Jung, Hwan Yong 대한관절경학회 1998 대한관절경학회지 Vol.2 No.1

Recently, a variety of arthroscopic techniques have been reported for the treatment of the displaced tibial eminence fracture. The purpose of this study was to describe details of arthroscopic technique using pull-out wire and to evaluate the results. Eleven patients with irreducible type II and type III tibial eminence fractures underwent the arthroscopic reduction and internal fixation using double strand pull-out wiring. The anterior cruciate ligament tibial drill guide was utilized for the reduction of fracture and passage of the guide pins. The tibial eminence fracture was firmly fixed with double strand 26-gauge pull-out wire(0.45mm diameter). Fracture union was achieved at 7.2 weeks (range, six to eight weeks) after operation. All cases were united at the last follow-up. Subjectively, nine patients had no pain and no restriction of daily activities. Two patients with combined injuries had limitation of knee motion(10 to 130 degrees, respectively) and one patient showed mild anterior laxity. Early rehabilitation was enabled without loss of reduction and breakage of pull-out wire. The arthroscopic reduction and internal fixation using pull-out wire showed good results including early rehabilitation, early fracture union, minimal morbidity, and no requirement of the second operation for hard ware removal.

견관절 전방 불안정에 대한 관절경적 최신 치료 경향

서재성 영남대학교 의과대학 2003 Yeungnam University Journal of Medicine Vol.20 No.1

In the past, the report of shoulder instability undergoing open shoulder stabilization had satisfactory outcomes of greater than 90%. However, the functional loss of open procedure is severe in abduction and external rotation especially. Current arthroscopic techniques for shoulder instability result in success rate equal to open surgical procedure when the labrum is properly fixed to the glenoid rim using suture anchors, the capsule is tightened, and associated bony and soft tissue pathology is addressed. The arthroscopic surgery facilitates the view within shoulder joint for more accurate diagnosis, reduces operating time, minimises postoperative pain, reduces operative morbidity, improves shoulder function, and provides the possibility to perform other procedure simultaneously. However, to accomplish a successful arthroscopic stabilization procedure and to prevent complications, numerous advanced arthroscopic skill must be mastered. Although the arthroscope provides means to visualize new lesions, the pathomechanism and biomechanical explanation is not clear yet. Further studies are necessary to develop for shoulder reconstruction.

Case Reports : Arthroscopic Treatment of Subchondral Bony Cyst in Early Osteoarthritis of the Hip Joint Using Allogeneic Bone Graft: A Report of Two Cases

( Gi Soo Lee ),( Deuk Soo Hwang ),( Chan Kang ),( Jung Bum Lee ),( Chang Kyun Noh ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.2

Subchondral bony cyst, large solitary or multiple cysts in acetabular dome usually exacerbate progression to degenerative osteoarthritis in the hip joint. But it can be treated through arthroscopic intervention. We report two cases that treated by arthroscopic curettage and bone graft for subchondral bony cysts in early osteoarthritis of the hip joint, and it may delay progression to moderate osteoarthritis.

감염성 슬관절염의 관절경적 치료 이후 예후 인자에 대한 분석

강상우(Sang-Woo Kang),최의성(Eui-Sung Choi),김동수(Dong-Soo Kim),정호승(Ho-Seung Jung),홍석현(Seok-Hyun Hong),고반석(Ban-Suk Go) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.1

목적: 관절경적 수술을 시행받은 감염성 슬관절염 환자들에서 성별, 나이, 기저질환, 증상 발생 후 수술까지 걸린 기간, 발병 전 침습적 시술의 시행 여부, 관절 천자액의 세균 배양, Gächter 분류를 통한 세균 감염의 정도가 치료 예후에 미치는 영향에 대해 알아보고자 한다. 대상 및 방법: 2014년 6월부터 2016년 12월까지 감염성 슬관절염으로 관절경적 수술을 시행받은 51명의 환자를 대상으로 하였으며, 평균 추시 기간은 14.2±2.1개월(12-20개월)이었다. 남자가 27명(52.9%), 여자가 24명(47.1%)이며, 평균 나이는 55.1±17.6세(13-84세)였다. 수술 전 시행한 관절 천자검사상 백혈구 수가 50,000개 이상, 다형핵 백혈구 수의 비율이 95% 이상인 환자를 감염성 슬관절염으로 진단하고 수술을 시행하였다. 모든 환자에서 관절경적 수술과 수술 후 지속적인 관절 세척을 시행하였다. 결과: C-반응 단백의 초기 평균 수치는 9.55±6.76 mg/dl (1.51-31.06 mg/dl)에서 최종 평균 수치는 0.74±1.26 mg/dl (0.08-6.77 mg/dl)로 감소하였으며, 평균 C-반응 단백의 정상화 기간은 27.6±18.9일(8-93일)이었다. 관절경적 수술과 항생제 사용 후 발열, 동통, 부종 등의 임상증상이 호전되고 C-반응 단백의 수치가 0.5 mg/dl 이하로 감소하여 감염성 슬관절염의 완치 판정을 받은 환자는 51예 중 44예(86.3%)이며, 최종적으로 두 번 이상의 관절경적 수술을 시행한 환자가 5예, prosthesis of antibiotic-loaded acrylic cement 후 인공관절 치환술로 전환한 환자가 2예이다. 결론: 지금까지 문헌들에서 알려진 것처럼 증상 발생 후 수술까지 걸린 기간과 Gächter 분류에 따른 병기는 감염성 슬관절염의 치료 성공 여부에 유의하게 영향을 주었다. 하지만 이외의 인자들은 통계적으로 유의한 상관관계가 없었다. 단 관절 천자액에서 세균이 배양된 환자군은 대조군보다 유의하게 C-반응 단백의 정상화 기간이 짧아 치료 기간을 반영하는 것으로 보인다. Purpose: This study examined the effects of gender, age, underlying disease, duration after onset of symptoms, preoperative invasive procedures, bacterial culture of joint fluid, and stage of infection by the Gächter classification on the prognosis of patients with infectious knee arthritis who underwent arthroscopic surgery. Materials and Methods: From June 2014 to December 2016, 51 patients who underwent arthroscopic surgery for infective knee arthritis were enrolled in this study. The average follow-up period was 14.2±2.1 months (range, 12-20 months). The subjects were 27 men (52.9%) and 24 women (47.1%), with an average age of 55.1±17.6 years (range, 13-84 years). A preoperative evaluation of the joint aspiration with a count of more than 50,000 leukocytes and a polymorphonuclear leukocyte count of 95% or more was performed. All patients underwent arthroscopic surgery and postoperative continuous joint irrigation. Results: The initial mean value of the C-reactive protein decreased from 9.55±6.76 mg/dl (range, 1.51-31.06 mg/dl) to a final mean of 0.74±1.26 mg/dl (range, 0.08-6.77 mg/dl); the mean duration of C-reactive protein normalization was 27.6±18.9 days (range, 8-93 days). Among the 51 patients who received arthroscopic surgery and antibiotics, 44 patients (86.3%) with infectious knee arthritis completed treatment with improved clinical symptoms, such as fever, pain, and edema, and the C-reactive protein decreased to less than 0.5 mg/dl. Finally, 5 cases were treated with two or more arthroscopic operations, and 2 cases were converted to arthroplasty after prosthesis of antibiotic-loaded acrylic cement. Conclusion: The duration of surgery after the onset of symptoms and the stage according to the Gächter classification are important prognostic factors for predicting the successful treatment of infectious knee arthritis. On the other hand, the other factors were not statistically significant. Nevertheless, patients with bacteria cultured from the joint fluids appear to reflect the treatment period because the period of normalization of the C-reactive protein is shorter than that of the control group.

Arthroscopic Treatment of Partial-thickness Rotator Cuff Tear

Kim Seung-Ho,Ha Kwon-Ick Korean Shoulder and Elbow Society 1998 대한견주관절의학회지 Vol.1 No.2

Forty-nine partial thickness rotator cuff tears underwent arthroscopic debridement or repair, and were followed up for a minimum of two years. Follow-up evaluations of the results were completed using a detailed functional questionnaire which was comprised of a rating of the UCLA shoulder scale and return to the previous sports activity and job. The average age of the 49 study patients was 46.5 years(range, 14 to 67 years). The patients were divided into four groups on the basis of the onset of the patient's symptoms. Thirty-five patients(72%) had partial tearing only on the articular surface, six(12%) on the bursal surface, and eight(16%) on both surfaces. Group I consisted of 21 patients with an average age of 56.7. Partial tearing in group I was attributed to the impingement syndrome. In group II, partial tearing of the rotator cuff was related to the anterior instability of the shoulder. This group included 9 patients with an average age of 27.9. In group III, all of the 8 patients were overhead athletes with an average age of 21.8. In this group, no isolated instances of significant trauma were related to the development of the shoulder pain. In group IV, 11 patients noted that a significant traumatic event preceded the onset of their pain. The average age of the patients was 34.9. Overall, 82% of the patients demonstrated satisfactory results and 18% revealed unsatisfactory results. The worst UCLA score and rate of return to the prior activity was noted in group III. In conclusion, partial thickness rotator cuff tear can be caused by subacromial impingement, instability, repetitive microtrauma, and macrotrauma. Arthroscopic debridement of partial tear of the rotator cuff provides a favorable outcome except in overhead athletes.

좌골 신경의 주막 낭종에 의한 이차성 이상근 증후군의 관절경적 치료

강찬 ( Chan Kang ),황득수 ( Deuk Soo Hwang ),차수민 ( Soo Min Cha ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.4

Secondary piriformis syndrome may develop under several conditions. We report on the method and usefulness of arthroscopic treatment of the piriformis muscle and benign perineural cyst of the sciatic nerve. Arthroscopic assessment was performed to a perineural cyst on the sciatic nerve seen through EMG and hip MRI. Through the posterior and posteroinferior portal, the lesion below the piriformis muscle was confirmed following release of the tendon. The incision and drainage of the perineural cyst was done so as to achieve decompression. The excision of the lesion was not carried out so as to avoid injury to the sciatic nerve. Symptoms did not recur during 10 months of follow up appointments.

좌골 신경의 주막 낭종에 의한 이차성 이상근 증후군의 관절경적 치료 -증례 보고-

강찬,황득수,차수민 대한고관절학회 2008 Hip and Pelvis Vol.20 No.4

Secondary piriformis syndrome may develop under several conditions. We report on the method and usefulness of arthroscopic treatment of the piriformis muscle and benign perineural cyst of the sciatic nerve. Arthroscopic assessment was performed to a perineural cyst on the sciatic nerve seen through EMG and hip MRI. Through the posterior and posteroinferior portal, the lesion below the piriformis muscle was confirmed following release of the tendon. The incision and drainage of the perineural cyst was done so as to achieve decompression. The excision of the lesion was not carried out so as to avoid injury to the sciatic nerve. Symptoms did not recur during 10 months of follow up appointments. 이차성 이상근 증후군을 유발하는 원인들은 다양하다. 저자들은 이상근 및 좌골 신경 주위의 양성 낭종에 적용할 수 있는 관절 경적 치료의 수술 방법 및 효과에 대하여 보고하고자 한다. 근전도 검사 및 고관절 MRI 검사에서 좌골 신경의 주막 낭종이 관찰 된 증례에 대하여 관절경적 접근을 시행하였다. 후방 및 후하방의 관절경 삽입구를 통하여 이상근 건 유리술 후 이상근 아래 위 치한 좌골 신경에서 병변을 확인하고 절개 및 배액술을 시행하였다. 좌골 신경 손상을 피하기 위해 주막 낭종을 절제하지 않고, 절개 및 감압술 만을 시행하였다. 술 후 10개월 단기 추시에서 증상 재발은 관찰되지 않았다.

Arthroscopic treatment of soft tissue impingement caused by extruded and a detached cement following total knee replacement arthroplasty

Shin Woo Nam,Yong Seuk Lee,Jun Sung Won,Beom Koo Lee 대한정형외과 스포츠의학회 2014 Arthroscopy and Orthopedic Sports Medicine Vol.1 No.2

The clinical outcome to total knee arthroplasty of arthritic knees has been satisfactory, however the complications associated with this approach has continued to evolve. Soft tissue impingement is one of the complications, which can cause pain and limit range of motion. But it can be treated satisfactorily through arthroscopic intervention. We report a patient who suffered from a rare case of impingement caused by irritation of extruded and a detached cement mantle between the femoral component and the polyethylene insert in the medial compartment. In this particular case, arthroscopic treatment successfully treated the complication of impingement after total knee arthroplasty