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조우신,박종희,김정민,오세관 대한슬관절학회 2003 대한슬관절학회지 Vol.15 No.1
목적: 강직이 동반된 슬관절염 환자에서 슬관절 전치활술의 문제점, 결과 및 합병증을 분석하고자 하였다. 대상 및 방법: 1994년 1월부터 2000년 12월까지 슬관절 강직(운동 범위 50도이하)이 있는 환자에게 슬관절 전치환술을 시행하여 2년 이상 추시가 가능하였던 16례를 대상으로 하였다. 수술은 관절 강직이 발생한지 평균 12.2년(1~40년)에 시행하였으며, 추시기간은 평균 3.3년(2~6년)이었다. 16례 중 남자 3례, 여자 13례였고, 평균 나이는 55.8세(34세~75세)였다. 감염에 의한 후유증 6례로 가장 많았고 그 외 퇴행성 관절염 4례, 외상 후 관절염 3례, 류마티스성 관절염 3례의 순이었다. 술 후 평가는 추시기간 중의 운동 범위와 HSS score 및 합병증을 분석하였다. 결과: 관절 운동 범위는 술 전 평균 31.6도(0~50도)에서 추시시 평균 95.4도(80~120도)로 증가하였으며, 1례에서만 5도의 굴곡 구축이 있었다. HSS score는 술 전 평균 59.6점(43~76점)에서 추시시 평균 84.6점(76~92점)으로 향상되었다. 1례에서 수술 중 슬개건 부분파열이 있었으나 보조기 착용과 적극적 재활로 술 후 1년째 90°의 관절 운동이 가능했다. 표재성 감염 1례는 창상의 변연절제술 후 피부이식으로 치유되었고, 심부 감염된 3례는 추후 관절 유합술을 시행하였다. 결론: 슬관절 전지환슬은 강직된 슬관절의 기능을 회복시킬 수 있는 좋은 술기이지만 감염등의 합병증을 고려해서 시행되어야 한다. Purpose: To evlauate the results of TKRA (Total knee replacement arthroplasty) for the treatment of stiff knee. Methods & Materials : TRKA has been performed for 18 cases of stiff knee ( ROM < 50° ) between January 1994 and December 2000. 16 cases which have been followed up for more than 2 years were analysed. Average follow-up was 3.3 years(2~6 years). 3 were male and 13 female. The average age was 55.8 years(34~75 years). Sequales of infection were most with 6 cases and followed by osteoarthritis (4 cases, 2 cases had been performed arthroscopic debridement) and rheumatoid arthritis (3 cases) and traumatic arthritis (3 cases) in order. TKRA was performed on average 12.2 years (1~40 years) after knee stiffness has been developed. We evaluate the results with ROM, HSS score and complications. Results : Average ROM was increased from 31.6°(0°~50°) preoperatively to 95.4°(80°~120°) postoperatively. 5° of flexion contracture was present in only 1 cases. Average HSS score was improved from 59.6 points preoperatively to 84.6 points postoperatively. The patella tendon was partially ruptured in 1 case surgery, but by brace application and rehabilitative exercise, ROM was improved to 90°, 1 year post operatively. There were 1 superficial skin infection which was resolved by revision of wound and skin graft, and deep infection in 3 cases, which needed knee fusion finally. Conclusion : TKRA is a good method for improving function in knee stiffness although infection risk is high.
김정재,박종희,김기용,조우신 대한골절학회 1997 대한골절학회지 Vol.10 No.3
The intraarticular fractures of the distal tibia, so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B l 5 cases, type B2 7 cases, type B3 5 cases, type Cl 3 cases, type C2 4 cases, type C3 10 cases. The authors analyzed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow: 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of fibula fracture. 2. Good results in fracture reduction was obtained at 26 cases( 76.5 9b) and good functional results was obtained at 26 cases( 76.5 %). 3. The most common postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.