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경골 근위부 종양에서 인공 삽입물 사용시 슬개골 전적출술이 관절기능 회복에 미치는 영향
박일형,김재도,인주철,전인호,Park, Il-Hyung,Kim, Jae-Do,Ihn, Joo-Chul,Chun, In-Ho 대한근골격종양학회 1996 대한골관절종양학회지 Vol.2 No.1
The purpose of this study is a comparative evaluation of range motion, especially extension deficit between the group of total patellectomy and that of intact patella, after reconstruction of the patellar tendon in the prosthetic replacement of a proximal tibia. Between 1990 and 1994, 15 patients who had a primary malignancy on proximal tibia were operated on. All patients were evaluated clinically and radiographically. Two patients were excluded because one had a deep infection treated with arthrodesis of the knee and the other was a composite allograft. The mean follow-up of the 13 patients was 27 months(15-47), including 10 osteosarcomas, 1 chondrosarcoma, 1 malignant fibrous histiocytoma and 1 malignant giant cell tumor. Eleven patients had a resection of the proximal tibia and 2 had an extracapsular total knee resection with distal femur. Reconstruction of the defect was done in 8 cases with a custom-made Link Endo-Model Total Rotation Knee Joint Prosthesis, and in 5 with How Medica Modular Resection System (HMRS). We used two methods to reconstruct the ligamentum patellae. Fixation of the patellar tendon to the prosthesis only with suturing and/or stapling(group SS) was done in 7. Transposition of gastrocnemius muscle to enhance fixation and to cover the prosthesis(group TG) was done in 6. Regardless of fixation methods, total patellectomy was done in 5 either to lengthen the patellar tendon or to make primary skin closure easier or for both. In 8 cases, patella was left intact or resurfaced with polyethylene prosthesis. Active extension was measured while the patient was in a sitting position. There is no statistically meaningful difference in terms of extension deficit (Wilcoxon rank test, p=0.8800) between patellectomy group and intact patella group, and between group of fixation only with suturing and that of gastrocnemius transposition. Two cases of extension deficit over 30 degree were seen in group SS and in the group of intact patella. Conclusively, total patellectomy could be an option without increasing the risk of extension deficit when primary skin closure is difficult or patellar tendon is a little bit short to be fixed. There is no rating in the Enneking system of functional evaluation that this finding into consideration.
전인호(In-Ho Jeon),김풍택(Poong-Taek Kim),경희수(Hee-Soo Kyung),오창욱(Chang-Wug Oh),인주철(Joo-Chul lhn),이지호(Ji-Ho Lee) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.2
목적: 척골 신경마비 증상이 동반된 주관절 관절염에서 후내방 도달법으로 척골 신경의 감압과 이전술, Outerbridge-Kashiwagi 술식을 동시에 시행하고 그 임상결과를 술식과 함께 보고하고자 한다. 대상 및 방법: 환자의 평균나이는 51세로, 9예가 남자, 2예가 여자였고 중노동직이 8예였고, 사무직, 상업, 가정주부가 각 1예였다. 최초 증상의 발현으로부터 수술까지의 평균 기간은 3년이었고, 10개월에서 5년까지 다양하였다. 척골 신경 증상은 McGowan grading으로 분류하였는데 1예의 McGowan grade Ⅰ, 4예의 grade Ⅱ, 6의 grade Ⅲ로 분류되었다. 결과: 수술 후 주관적 척골 신경 증상의 호전이 전례에서 관찰되었고, 수술 후 McGowan grade Ⅰ이 3예, Grade Ⅱ가 5예, Grade Ⅲ가 3예로 관찰되었다. 1예를 제외하고는 전례에서 수술 후 동통이 호전되었다. 평균 관절운동 범위는 수술 전 22.5-124°에서 수술 후 11.5-128.5°로 호전되었다. 결론: 주관절 후내방 접근법은 Outerbridge-Kashiwagi 술식과 척골 신경 감압이 동시에 가능한 술식으로, 만족할 만한 기능적 회복이 관찰되었다. Purpose: Elbow osteoarthritis with ulnar neuropathy was treated by a modified posteromedial approach, for decompression/transposition of the ulnar nerve and simultaneously with an Outerbridge-Kashiwagi procedure. The clinical result with these operative techniques is reported. Materials and Methods: Average age of the patients was 51, which including 9 male and 2 female. There were 8 manual workers and one each of a clerk, a merchant and a house wife. The ulnar neuropathy was evaluated by the McGowan grading; one grade Ⅰ, 4 grade Ⅱ and 6 grade Ⅲ. Results: The ulnar nerve symptoms were relieved in all patients; 3 McGowan grade Ⅰ, 5 grade Ⅱ and 3 grade Ⅲ, postoperatively. The pain subsided in all patients, with the exception of in one. The average range of motion was improved from 22.5-124° to 11.5-128.5°. Conclusion: A modified posteromedial approach is an effective method for both ulnar nerve decompression and the OK procedure, and provides an effective functional outcome.
골수강내 금속정 삽입 후 외 고정 장치를 이용한 대퇴골 연장술
송해룡(Hae-Ryong Song),오창욱(Chang-Wug Oh),Rakesh Mattoo,김성중(Sung-Jung Kim),경희수(Hee-Soo Kyung),박일형(Il-Hyung Park),전인호(In-Ho Jeon),인주철(Joo-Chul Ihn),박성기(Sung-Ki Park) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.7
목적: 하지 부동 환자들에서 골수강 내 금속 정 삽입 후 외 고정 장치를 이용한 대퇴골 연장술을 시행하고 그 결과 및 합병증을 후향적으로 평가하였다. 대상 및 방법: 22명의 환자들에서 수술을 시행하였고, 평균 3.2년(범위, 2-5.2년) 추시하였으며, 수술 당시의 나이는 평균 22.2세(범위, 13-35세)였다. 연장된 대퇴골의 길이는 평균 5cm(범위, 2.7-8.1 cm)였으며, 외 고정 장치는 수술 후 평균 135.9일(범위, 59-210일)에 제거하였다. 외 고정 장치의 장착률은 평균 23.8일/cm(범위, 11.1-34.7일/cm)이었다. 결과: 22명 중 19명에서 수술 전 목표치만큼 대퇴골 연장이 가능하였으나, 골수염의 발생으로 조기에 골수강 내 금속 정을 제거하여 실패한 경우가 3예 있었으며, 이들은 기존 대퇴골 단축의 원인으로 골수염 또는 개방성 골절 후의 감염 처치 술 등의 병력이 있던 환자들이었다. 대퇴골의 연장률이 20% 이상인 환자 중에서 슬관절의 합병증이 발생한 경우가 4예 있었는데, 이는 슬개골의 아탈구 3예, 후방 아탈구 1예 등이었다. 그 외 다른 합병증으로 연장 골의 함몰과 함께, 교합 나사의 파손이 발생한 경우가 1예 있었다. 결론: 골수강 내 금속 정 삽입 후 외 고정 장치를 이용한 대퇴골 연장술은 외 고정 기간을 단축할 수 있으나, 합병증의 발생에 유의하여야 한다. Purpose: The results and complications of femoral lengthening over an intramedullary nail with a external fixator in patients with limb length discrepancy were retrospectively reviewed. Materials and Methods: After lengthening 22 femoral segments, all patients were followed-up for a mean of 3.2 years (range, 2 to 5.2 years). They ranged in age from 13 to 35 years (average age, 22.2 years) at the time of the index procedure. The mean lengthening was 5 cm (2.7 to 8.1 cm), and the external fixator was removed after a median 135.9 days (range, 59 to 210 days). The mean external fixation index was 23.8 days/cm of lengthening (range, 11.1 to 34.7 days/cm of lengthening). Results: Nineteen patients achieved the length of their pre-operative goal. However, there were 3 failures with osteomyelitis and the removal of the nail, which had a past history of infection or open trauma. There were 4 knee joint complications when the lengthening was over 20%. These included three cases of a patella subluxation and one case of a posterior knee subluxation. In the other complications, there was one case of a collapse in the lengthened segment with a breakage of the locking screws. Conclusion: Although lengthening over a nail can reduce the duration of external fixation, caution is needed in order to prevent complications.