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Total Knee Replacement Arthroplasty with Buechel and Pappas Knee: Minimum 2-Year Follow-up
문경호,홍승현,홍택호 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1
Background: Clinical and radiologic evaluation and analyses of the surgeries using Buechel and Pappas (B-P) knee implants. Methods: The study was conducted on 60 patients who underwent 94 total knee replacement arthroplasty with B-P knee implantsfrom May 2009 to December 2010. The results were compared to the results of 41 patients who underwent 60 knee joint surgeriesusing NexGen-LPS implants from January 2008 to August 2009. Results: The American Knee Society score of the B-P knee group increased from an average of 66.9 (clinical score) and 65.5(functional score) to 93.4 and 90.3, respectively; while those for the NexGen-LPS group increased from an average of 68.8 (clinicalscore) and 62.4 (functional score) to 86.3 and 76, respectively. The average ranges of motion of the B-P knee group and the Nex-Gen-LPS group were 119.1° and 114.8°, respectively, before surgery and improved to 121.0° and 123.0° at final follow-up after thesurgery. The visual analogue scale scores for the B-P knee group and the NexGen-LPS group improved from 4.7 and 4.6 to 1.4 and 1.8,respectively. The flexion contracture also improved from 5.1° and 6.3° to 0.64° and 1.72°. The tibio-femoral angle for the B-P kneegroup and the NexGen-LPS group also improved greatly after the surgery, from varus 0.34° and 0.73° each to valgus 6.7° and 6.9°,respectively. Conclusions: The evaluation of more than 2 years of total knee replacement arthroplasty using B-P knee implants showed goodresults. B-P knee implants showed a relatively higher degree of satisfaction in clinical knee score and less intraoperative bonemass removal than NexGen-LPS implants.
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이동주 ( Tong Joo Lee ),홍택호 ( Taek Ho Hong ),김낙철 ( Nak Chul Kim ) 대한골절학회 2015 대한골절학회지 Vol.28 No.3
목 적: 본 연구에서는 성인 주관절 복합 손상에서 관혈적 정복 및 내고정술 후 추가적인 경첩성 외고정술의 임상 결과를 분석하고자 한다. 대상 및 방법: 2007년부터 2013년까지 주관절 탈구, 요골두 골절 및 구상돌기 골절을 포함한 주관절 복합 손상 환자 중 내고정술후 외고정 장치를 시행받은 뒤 1년 이상 추시한 10예를 대상으로 하였다. 추가적 외고정 장치를 시행하는 기준은 내고정 이후에도 지속적인 주관절 불안정성이 관찰되는 경우로 하였다. 1년 추시 시 Cassebaum 분류와 Mayo elbow performance score(MEPS)를 측정하여 임상적 결과를 평가하였다. 결 과: 수술 후 1년 추시 시 평균 관절 운동 범위는 굴곡 구축 16도, 후속 굴곡 127도, 회내전 83도, 회외전 78도로 측정되었다. 임상적 평가상 Cassebaum 분류로 평가했을 때 우수 4예, 양호 4예, 불량 2예였고, MEPS상 평균 87점을 기록했다. 최종추시 시 주관절 불안정성이 관찰된 증례는 없었고 평균 골 유합 기간은 11.5주였으며, 불유합 증례는 없었다. 결 론: 성인 주관절 복합 손상 증례에서 경첩을 이용한 외고정 장치는 관절 안정성을 제공하면서 조기 관절 운동을 시행할수 있으며 1년 추시 관찰 시 우수한 임상 결과를 보였다. Purpose: The purpose of this study was to evaluate the use of hinged external fixation in management of complex elbow injury. Materials and Methods: We retrospectively reviewed clinical outcomes in 10 patients with elbow dislocation and associated fractures of both the radial head and the coronoid process from January 2007 to December 2013. All ten patients were treated by hinged external fixation after open reduction and internal fixation. The indication for use of a hinged external fixator was persistent instability after fixation of the fractures. Early mobilization was started at 1 week (6.5 days) after surgery. The external fixator was removed at 6 weeks after surgery. Cassebaum classification and Mayo elbow performance score were used for clinical and functional evaluation. The follow-up period was at least 1 year. Results: At the last follow-up, the average further flexion was 127o, and the average flexion contracture was 16o. The average pronation was 83o and the average supination was 78o. By the Cassebaum classification after 1 year follow-up, patients were classified as 4 excellent, 4 good, and 2 poor. According to the Mayo elbow performance score, the average score was 87 points (65-100 points) with 3 excellent, 6 good, and 1 fair. Stability was restored in all patients at the last follow-up. There was no case of nonunion and the average union period was 11.5 weeks. Conclusion: This study advocated the additional use of a hinged external fixator in the treatment of complex elbow instability, especially when fixation of fractures and repair of soft tissues were not sufficient. Providing adequate stability and allowing early motion, additional external fixation could improve the functional outcome.
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