Clinical Outcome and Arthroscopic Evaluation of Double-Bundle Anterior Cruciate Ligament Reconstruction

송은규,선종근,이경재,김형순,Song, Eun-Kyoo,Seon, Jong-Keun,Lee, Kyoung-Jai,Kim, Hyung-Soon Korean Orthopaedic Society for Sports Medicine 2010 대한정형외과스포츠의학회지 Vol.9 No.1

목적: 본 연구는 이중 다발 전방십자인대 재건술 후의 단기 임상결과와 이차적 관절경 소견을 알아보았다. 대상 및 방법: 이중 다발 전방십자인대 재건술 후에 최소 24개월 이상 추시가 가능하였던 49 예(환자)를 대상으로 하였다. 임상적 결과로 Lysholm 슬관절 점수, Tegner 활동 점수, 도수 및 기계적 전방 안정성 검사를 시행하였다. 15 예에서 스테플 제거와 함께 이차적 관절경 수술을 시행하여, 재건된 전방십자인대의 파열 유무와 이식건의 주관적인 긴장 정도 및 활액막 형성 정도를 검사하였다. 결과: Lysholm 슬관절 및 Tegner 활동 점수는 각각 술전 67.4, 2.0에서 최종 추시에 96.1, 6.1로 호전되었다 (p<0.01). Lachman 및 pivot-shift 검사에서 39예, 36예가 정상범위로 호전되었다. 스트레스 방사선 검사의 양측 차이 정도는 10.8 mm 에서 3.3 mm로 의미있게 호전되었다 (p<0.01). 이차적 관절경 소견상 모든 환자에서 전내측 다발이 정상 및 정상에 가까운 소견이 관찰되었으나, 8예 (53.3%) 에서 후외측 다발의 부분 및 완전 파열이 관찰되었다. 결론: 이중 다발 전방십자인대 재건술이 임상적으로 슬관절의 회전 및 전, 후방 안정성을 복원하는 효과적인 수술법이라도, 이차적 관절경 수술을 시행한 증례의 몇 예에서 후 외측 다발의 파열이 관찰되었다. Purpose: The aim of this study was to evaluate short-term clinical results and second-look arthroscopic findings after double-bundle anterior cruciate ligament (DB ACL) reconstruction. Materials and Methods: Forty-nine patients, who were followed up for at least 24 months after DB ACL reconstruction, were included. Clinical results, such as, Lysholm knee and Tegner activity scores, and manual laxity and instrumented anterior laxity test results were evaluated. In fifteen patients (15 knees), second-look arthroscopy with staple removal was performed. At second-look arthroscopy, the authors assessed about reconstructed ACL rupture, subjective graft tension and extent of synovial coverage. Results: Lysholm knee scores significantly improved from 67.4 preoperatively to 96.1 at last follow-up (p<0.01). Tegner activity scale improved from 2.0 to 6.1. The Lachman test, at last follow-up, showed normal laxity in 39 (of 49) patients, and the pivot-shift test showed normal laxity in 36 (of 49) patients. Mean side-to-side differences improved significantly from 10.8 mm to 3.3 mm (p<0.01). Second-look arthroscopic findings showed that all patients had a normal or a near normal anteromedial bundle. However, 8 patients (53.3%) were found to have partial or complete posterolateral bundle rupture. Conclusion: Even though double-bundle ACL reconstruction was clinically effective means of restoring knee rotational and anteroposterior stabilities, there were some ruptured posterolateral bundles observed in cases under arthroscopy after double-bundle ACL reconstruction.

나노기술 개발동향 : 세라믹 나노분말의 합성 및 정보분석

강상규 ( Sang Kyu Kang ),이호신 ( Ho Shin Lee ),소대섭 ( Dae Sup So ),이경재 ( Kyoung Jai Lee ) 한국공업화학회 2005 공업화학전망 Vol.8 No.5

슬관절 전치환술에서 다중 통증조절 프로토콜 하에서 대퇴신경 차단술의 통증조절 효과

정문수(Mun Su Jeong),송은규(Eun Kyoo Song),선종근(Jong Keun Seon),변재욱(Jae Wook Byun),이경재(Kyoung Jai Lee),정영우(Young Woo Jung) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3

목적: 저자들은 슬관절 전치환술과 관련된 급성기의 극심한 통증에 다중 통증조절 프로토콜 하에서 대퇴신경 차단의 통증조절 효과에 대하여 알아보고자 하였다. 대상 및 방법: 일차성 퇴행성 관절염으로 편측 슬관절 전치환술을 시행한 76 슬관절을 대상으로 전향적 연구를 시행하였다. 전 예에서 전신 마취를 시행하였으며, 수술 직전 선제 약물 투여 후 수술 중 관절주변 주사요법 및 정맥 자가 통증조절 장치를 시행하였다. 43명은 실험군으로 33명은 대조군으로 무작위 배정을 하였으며 단일 맹검으로 진행하였다. 실험군은 수술 후 신경 자극기 및 0.5% Bupivacaine 20 ㎖, 1% lidocaine 10 ㎖를 이용하여 일회 약물 주입을 통한 대퇴신경차단술을 한 술자에 의해 시행하였다. 통증 정도는 pain scale로 수술 후 6시간, 12시간, 24시간, 48시간, 72시간, 수술 후 7일째에 측정하였다. 또한 Ⅳ-PCA (intravenous patient controlled anesthesia) 소비량 및 급성 통증 진통제(acute pain rescuer) 사용 횟수, 하지 직거상 및 관절 운동범위, 첫 보행 시간, 약물에 의한 부작용과 합병증의 발생 빈도를 비교 분석하였다. 결과: 실험군에서 평균 pain scale 및 Ⅳ-PCA 소비량은 48시간까지 대조군에 비해 유의하게 낮았고(p=0.04, 0.03), 관절운동의 범위는 실험군에서 술 후 6, 12, 24, 48시간에 각각 19.6°, 29.7°, 20°, 4.1°가 더 많았다(p=0.002, 0.001, 0.003, 0.02). 급성 통증 진통제의 사용회수는 첫 3일간은 실험군에서 유의하게 적었다(1.36 vs 2.58). 하지 직거상은 대조군에서 더 일찍 가능하였다(술 후 12시간 vs 27.9시간, p=0.02). 첫 보행 시간, 합병증 및 부작용 발생 빈도는 두 군 간의 차이가 없었다. 결론: 대퇴신경 차단술은 다중 통증조절 프로토콜 하에서 슬관절 전치환술과 관련된 급성기의 극심한 통증을 경감시키며, 관절 운동 범위의 증가, Ⅳ-PCA 소비량 및 급성 진통제의 사용 횟수를 감소시키는 좋은 효과를 나타내었다. Purpose: Authors evaluated the effectiveness of pain relief of the femoral nerve block in multimodal pain control protocols for patients with total knee arthroplasty in early postoperative period. Materials and Methods: Seventy-six patients who underwent TKA under general anesthesia were enrolled in this study. Preemptive analgesic medication, periarticular multimodal drug injection, and Ⅳ-PCA were used for pain control in all patients. This single-blind, randomized controlled trial included 43 patients in the nerve block group and 33 patients in the control group. In the former group, the femoral nerve block was done by one author with a nerve stimulator set using 0.5% bupivacaine 20 ㎖ and 1% lidocaine 10 ㎖. Pain scale was measured at 6, 12, 24, 48, 72 hours and 7 days postoperatively. In addition, amount of Ⅳ-PCA consumption, numbers of using acute pain rescuer, range of motion, straight leg raising, first ambulation time, and complications related with drugs were evaluated. Results: Pain scale and the amount of Ⅳ-PCA consumption were significantly lower innerve block group until 48 hours (p=0.04, 0.03), and the range of motion was better compared to the control group (p≤0.02). The number of pain rescue medicines was significantly low ill nerve block group within the first 3 days postoperatively (1.36 vs 2.58). The ability to raise a straightened leg was recovered more rapidly in the control group than ill the nerve block group; this difference was statistically significant (12 vs 27.9 hours, p=0.02). There were no differences in first ambulation time and incidence of complications between the 2 groups. Conclusion: Femoral nerve block in the early period after TKA under multi modal pain control protocols showed significant improvement in pain relief and in range of motion, as well as a significant decrease in the requirement of Ⅳ PCA and acute pain rescuers.

국방개혁에 부합하는 군사력 건설 방향

이경재 원광대학교 2008 圓光軍事論壇 Vol.- No.4

The success or failure of the build up of military force makes a significant impact on the survival strategy of an individual country. As the ROK has made every effort to reinforce the weapon system and equipment by investing a couple of billion won so far since 1947, it obtains a remarkable success in various fields. Above all, in addition to deterring NK's military threats in a substantive manner, this investment contributes, to a great degree, to acquiring some state of the art technology and personnel with expertise, vitalizing national economy, developing dual use technology and so forth. However, if we look into the whole process in detail, its substantial efficiency falls down. in comparison with investment cost since the most portion of the military force reinforcement is in conjunction with direct introduction of foreign weapon systems and technology-import production. In particular, if we examine 'Defense Reform 2020' which is now under controversy, it is certain that key weapon systems are primarily dependent upon foreign introduction. In a few words, it makes acquisition of key technologies be merely ideal and only deepens the degree subject to the advanced country in the defense industry. Thus it is of my view that we should set up, even now, general acquisition policy which is to invest the budget intensively on domestic R&D in the long term, and also invest more than one third of defense investment budget in R&D in addition to seeking for the policy centered on not threat-based but capabilities-based acquisition. Further, the Defense Ministry should take advantage of the ROK-US alliance as much as necessary to minimize the security instability that might be caused by the lack of force. Although it results in the occurrence of some difficulties thereby, the Defense Ministry should proceed with aforementioned proposition. Unless doing it, we are not able to enter the circle of advanced defense industry nations forever, leading to falling behind the others in national defense science & technology. It is the right time that we have to change our way of thinking so as to make such an astronomical budget investment give birth to more positive impact to national development.