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반월상 연골 파열의 치료에서 meniscal arrow의 역할
배대경,임창무,정기웅,Bae, Dae Kyung,Yim, Chang Moo,Jeong, Ki Woong 대한관절경학회 1999 대한관절경학회지 Vol.3 No.1
목적 : 본 논문의 목적은 반월상 연골 파열의 치료에서 meniscal arrow의 역할을 분석하는데 있다. 대상 및 방법 : 1997년 5월부터 1998년 8월까지 반월상 연골이 파열되어 meniscal arrow를 사용하여 봉합한 22명 22례를 대상으로 하였다. 추시 기간은 평균 14.7개월(7~22개월)이었으며, 평균 연령은 27세(18~51세)였다. 성별은 남자 19명, 여자 3명이었고 우측이 12례, 좌측이 10례였다. 동반손상은 전방십자인대 파열이 16례, 내측 측부인대 손상이 1례였으며, 파열위치는 후각부가 19례, 중앙부가 3례였다. 연골판의 파열 형태는 종파열이 14례, bucket handle형 파열이 7례, 수평 파열은 1례였고, 환자 1례당 봉합을 위하여 사용된 meniscal arrow는 평균 2.5개(1-4개)였다. 임상적 결과의 판정은 Tapper와 Hoover의 분류를 기준으로 하였고, 술 후 운동범위를 측정하였으며, 동통, 잠김, 불안정 등의 주관적 증상의 변화를 관찰하였다. 또한 수술시 연골 봉합술에 소요된 시간을 측정하였다. 결과 : 임상적 결과는 우수가 16례, 양호가 4례 그리고 보통이 2례 였다. 최종 추시시 운동 범위는 평균 135도(120~140도)였으며 1례를 제외한 모든 환자에서 동통, 잠김, 불안정 등을 호소한 례는 없었다. 수술시 연골의 봉합술에 소요된 시간은 평균 25분(15-40분)이었다. 22례 중 이차 관절경을 시행한 환자 3례 모두에서 파열 부위는 완전 치유되어 있음을 관찰할 수 있었다. 결론 : Meniscal arrow는 반월상 연골 파열에 대하여 동반손상이나 파열부위에 따라 선택적으로 사용하는 것이 바람직할 것으로 사료된다. Purpose : The purpose of this paper is to analyze the clinical results after meniscal repair using meniscal arrow. Materials and Methods : Between May 1997 and Aug 1998, we repaired 22 tom menisci in 22 patients using meniscal arrows. There were nineteen males and three females with an average age of 27 years. There were longitudinal tear in 14 cases, Bucket-handle tear were 7 cases and horizontal tear was in 1 case. In 22 meniscus tears, 16 cases were associated with anterior cruciate ligament tear. Average number of meniscal arrow that was used were 2.5(ranged 1 to 4). Average follow-up period was 14.7 months(ranged 6 to 22 months). We evaluated the clinical results by the Tapper and Hoover's grading system. Results : There were excellent in 16 cases, good in 4 cases and fair in 2 cases on the clinical results. At the last follow up, the range of the motion of the knee joint were average 135 degrees(ranged 125 to 140 degrees). Mean time elapsed for meniscal repair were 25 minutes(ranged 15 to 40 minutes). Conclusion : Meniscal arrow has many advantages such as short operative time, easy fixation technique, and less neurovascular injury. We think that arthroscopic meniscal repair using meniscal arrow is effective treatment method in selected patient who have longitudinal, bucket-handle tear at the posterior hom associated with anterior cruciate ligament tear.
배대경,임창무,전영수,Bae, Dae Kyung,Yim, Chang Moo,Chun, Young Soo 대한관절경학회 1998 대한관절경학회지 Vol.2 No.2
Discoid meniscus is an uncommon cause of internal derangement of the knee joint. The discoid medial meniscus is much less common than the discoid lateral meniscus. A 15-year-old male student had a incomplete discoid medial meniscus of right knee combined with a horizontal tear. This was confirmed by magnetic resonance imaging(MRI) and arthroscopic procedure. Partial meniscectomy was performed arthroscopically. An unevenful recovery followed. We report a case of discoid medial meniscus with brief review of literature.
정덕환,한정수,임창무,Chung, Duke-Whan,Han, Chung-Soo,Yim, Chang-Moo 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1
There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.