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급성 아킬레스건 파열의 수술적 치료: 경피적 봉합술과 관혈적 봉합술의 비교
김도연,김상범,허윤무,이정범,임재우,오형탁,Kim, Do-Yeon,Kim, Sang-Bum,Heo, Youn-Moo,Lee, Jung-Bum,Lim, Jae-Woo,Oh, Hyeong-Tak 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.2
Purpose: The purpose of the present study was to compare and analyze the clinical outcomes of the percutaneous and open repair of acute Achilles tendon ruptures. Materials and Methods: We performed a retrospective study on 24 patients (group 1) managed with percutaneous repair, and 21 patients (group 2) managed with open repair for acute Achilles tendon rupture. The postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. Postoperative overall satisfaction and cosmetic satisfaction were also evaluated. Results: By Arner-Lindholm scale and AOFAS score, there was no difference between two groups (p<0.05). As for postoperative overall satisfaction, 5 cases were very satisfied, 16 cases were satisfied and 3 cases were fair in group 1. In group 2, 12 cases were very satisfied, 9 cases were satisfied. For postoperative cosmetic satisfaction, 13 cases were satisfied, 11 cases were fair in group 1. In group 2, 9 cases were very satisfied, 12 cases satisfied. In open repair group, a case of deep wound infection and three cases of skin necrosis were reported as complication. 2 cases of sural nerve injury were seen in percutaneous repair group and were recovered within 3 months. Conclusion: Percutaneous repair of acute Achilles tendon ruptures have high level of cosmetic satisfaction compared with open repair without any significant difference in clinical outcomes.
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네비게이션을 이용한 슬관절 전치환술 시 압박대의 감압 시기에 따른 실혈량에 대한 영향
김광균(Kwang Kyoun Kim),원예연(Ye Yeon Won),오형탁(Hyeong Tak Oh),이대희(Dae Hee Lee) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.1
목적: 컴퓨터 네비게이션을 이용한 슬관절 전치환술에서 압박대의 감압시기에 따른 실혈량의 변화를 비교하고자 하였다. 대상 및 방법: 1군은 31예로 피부 봉합 및 압박 소독을 시행한 후 압박대를 감압하였으며, 2군은 32예로 치환물을 삽입하기 전 압박대 감압 및 지혈을 시행하였다. 술 전 및 술 후 24, 48시간의 혈색소량 및 적혈구 용적률을 조사하였고, 양 군 간의 총실혈량, 술 후 배액관을 통한 실혈량, 감춰진 실혈량, 가시적 실혈량 및 수술 시간을 비교하였다. 결과: 술 후 24, 48시간의 혈색소(p=0.371, p=0.247) 및 적혈구 용적률의 변화량(p=0.428, p=0.125)은 양 군 간 통계적으로 유의하지 않았다. 술 후 24시간의 흡입 배액된 실혈량(p=0.381)과 총실혈량(p=0.126)은 양 군 간에 유의한 차이가 없었고, 가시적인 실혈량(p=0.023), 감춰진 실혈량(p=0.045) 및 수술시간(p=0.005)은 유의한 차이를 보였다. 결론: 네비게이션을 이용한 슬관절 전치환술에서 압박대의 감압 시기에 따른 총실혈량 및 술 후 배액되는 실혈량의 차이가 없으며, 수술 후 압박대를 감압하는 방법은 수술 중 압박대를 감압하는 방법에 비해 시야 확보 및 수술 시간을 단축하는 측면에서 유용한 방법이라고 생각한다. Purpose: The aim of this study is to evaluate the effects of timing of tourniquet release on blood loss in navigation assisted total knee arthroplasty. Materials and Methods: A total of 63 consecutive patients, who underwent navigation assisted total knee arthroplasty, were divided into two groups; 31 patients (31 knees, group I) were operated with tourniquet release after wound closure and applied compression dressing, and another 32 patients (32 knees, group II) were operated with tourniquet release and hemostasis before implantation of the polyethylene insert. We examined hemoglobin concentration and hematocrit at three points in time, preoperatively, 24 hours and 48 hours postoperatively. We compared the two groups of patients in terms of total blood loss, postoperative drained blood loss, hidden blood loss, visible blood loss and operation time. Results: There were no significant differences between the two groups in the hemoglobin concentration at 24 hours and 48 hours postoperatively (p=0.371, p=0.247), and hematocrit at 24 hours and 48 hours postoperatively(p=0.428, p=0.125). No statistically significant differences between the two groups in the postoperative drained blood loss (p=0.381) and total blood loss (p=0.126) were found. We found statistically significant differences in the visible blood loss (p=0.023), hidden blood loss (p=0.045) and operation time (p=0.005). Conclusion: The releasing time of tourniquet have no effect on the actual total blood loss, and postoperative drained blood loss in navigation assisted total knee arthroplasty. We concluded that compared with intraoperative tourniquet release, postoperative tourniquet release are useful for making the broader operation field and less operation time.
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