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김진영 ( Jin Young Kim ),박정민 ( Jeong Min Park ),임군일 ( Gun Il Lim ) 대한류마티스학회 2010 대한류마티스학회지 Vol.17 No.1
The wrist joint is often involved in the early stages of the rheumatoid arthritis (RA) and is regarded as a main target of the disease. Since the wrist plays a key role in the articulations of the upper extremities, appropriate treatment of this joint will preserve the patient`s work ability and independence. When surgical intervention is considered, determining the disease extent is as important as the type of rheumatoid involvement. This can be achieved by performing an extensive clinical and functional assessment of the extremities. In addition, understanding radiological findings also helps to determine the type of rheumatoid destruction, and the subsequent treatment algorithms. Success of surgical management depends on a well-considered strategy in the timing of different procedures. Prophylactic surgery, such as a synovectomy of the joint or tendon could be performed in the early stages to prevent further destruction and deformation. As destruction at the radiocarpal level progresses in the later stages of the disease, reconstructive surgery such as partial joint fusion combined with ulnar head resection, total wrist fusion or wrist arthroplasty could be considered. In the event of severe destruction, definitive stabilization by total wrist fusion is indicated. A pain-free, stable wrist joint often outweighs immobility.
젊은 여성에서 K-강선을 이용한 쇄골간부 골절의 내고정술
김도영,박용욱,임군일,임창균,이상수,박현철 대한골절학회 2002 대한골절학회지 Vol.15 No.4
젊은 여성의 쇄골간부 골절의 수술 방법은 K-강선을 이용한 내고정술의 결과를 분석하여 이수기의 장단점을 알아보고자 하였다. 대상 및 방법 : 수술 후 1년 이상 추시된 12예를 대상으로 하였으며 모두 여성으로 평균 연령을 28세, 평균 추시 기간은 14개월이었다. 전 예에서 전위된 쇄골 간부 중 1/3 골절로 골편의 피하 돌출이 있었으며 2예는 제 1형 개방성 골절이었다. 수술 후 최종 추시 까지 골유합 시기, K-강선의 변화, 수술 반흔 및 단점 등을 주기적으로 조사하였다. 결 과 : 골유합기간은 평균 11.8주 )분포 : 8주 - 20주)였으며, 불유합은 없었다. K-강선의 변화는 11예에서는 없었으나,1예에서 전이 및 굽음이 나타났다. 수술반흔은 약 4㎝ 이었으며 K-강선은 국소 마취하에 쉽게 제거할 수 있었으나, 전 예에서 잦은 방사선 검사, 비교적 긴 고정 기간 및 쇄골 내측 K-강선 끝의 돌출에 따른 피하 자극은 단점으로 나타났다. 결 론 : 젊은 여성의 쇄골 간부 골절의 치료로 K-강선을 이용한 내고정은 수술 방법 중의 하나로 생각된다. Purpose : To know the advantages and disadvantages of this procedure by analyzing the results of internal fixation with K-wire for clavicular shaft fractures in young women. Materials and Methods : Twelve patients were followed for more than 1 year after the operation. All patients were female and average age was 28 years with average follow-up of 14 months. All cases were displaced fractures of the middle third with tenting of the skin and 2 cases were type 1 open fractures. After the operation, we investigated time to union, changes of K-wire, scar and disadvantages periodically. Results : There was no nonunion and time to union averaged 11.8 weeks. Migration and bending of the K-wires occured in one case. The length of surgical scar was about 4㎝ and the K-wires were easily removed under local anesthesia. But all patients complained of frequent radiographic evaluation, relatively long period of immobilization and irritation of the K-wires on medial part of the clavicle. Conclusion : We think that internal fixation with the K-wires is one of the effective treatment options for the clavicular shaft fractures in young women.