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Proximal Tibia Fracture after Proximal Tibia Autograft Harvest
( Jin-kak Kim ),( Jong-hyeop Song ),( Kyungbum Lee ),( Jae-woo Cho ),( Ki-ho Moon ),( Do-hyun Yeo ),( Beom-soo Kim ),( Jong-keon Oh ) 대한외상학회 2017 大韓外傷學會誌 Vol.30 No.4
Bone-grafting procedures are common in orthopedic trauma surgeries. There are only few reports on the morbidity after proximal tibia harvesting. Here, we report an experience of complication after proximal tibia harvesting while treating subtrochanteric femoral osteomyelitis.
김진각 ( Jin-kak Kim ),김수현 ( Soo-hyun Kim ),조재우 ( Jae-woo Cho ),오종건 ( Jong-keon Oh ) 대한골절학회 2017 대한골절학회지 Vol.30 No.2
골결손을 동반한 비감염성 불유합의 치료에서 골이식은 많은 경우 모퉁이돌(cornerstone)과 같은 중요한 역할을 하는데 이식골이 들어가야 할 부위를 정확히 파악하고 준비(preparation)하여 이식골을 제위치에 삽입하는 것이 중요하다. 이식골은 흡수되어 초기 이식한 양보다 줄어드는 것을 감안하여 인접 피질골의 테두리보다 더 돌출되게 충분한 양을 넣어야하고 주골편과 결손부위가 이행하는 곳에서는 onlay방식을 이용하여 소위 junctional problem이 생기는것을 막는 것이 필요하다. 분쇄가 심한 대퇴골 간부, 관절 주위 골절을 도수 정복하고 골수강내 금속정 혹은 MIPO로 치료한 후 발생한 불유합의 치료에서 골이식을 해야 할 부위가 내측을 포함하여 여러 곳에 산재해 있을 경우에는 확공 후 골수내정으로 고정하는 방법을 시도하는 것도 유용한 방법이 될 수 있을 것으로 보인다. 저자들이 본 종설에서 소개한 증례들은 환자의 전신적인 상태가 모두 양호하였으며, 오로지 골결손만을 동반한 비감염 불유합 환자들을 예로 들었다. 하지만 실제치료에 임할 때는 불유합 부위의 국소적인 문제뿐만 아니라 환자의 전신상태도 면밀히 검토하여 불유합의 원인을 밝혀내고 치료에 접근한다면 성공적인 치료 결과를 얻을 것이라 생각한다. The management of nonunion with severe bone loss is a challenging task to both surgeons and patients. It often requires prolonged and potentially painful treatments. Moreover, it also represents serious socioeconomic issues for patients. Inadequate fracture stability, disrupted biology, such as blood supply and soft tissue, as well as severe bone loss or presence of infection are possible reasons for nonunion. Several different treatment modalities are available, including nail dynamization, plate osteosynthesis, exchange nailing, and adjuvant alternatives, such as electrical or ultrasound stimulation. Autogenous bone graft remains the standard method to reconstruct small defects. Distraction osteogenesis and induced membrane techniques are contemporary strategies of choice for the reconstruction of larger bony defects. Herein, we attempt to describe the key techniques that may be employed in treating nonunion with severe bone loss.
( Seung Kak Shin ),( Oh Sang Kwon ),( Chang Hwi Yoon ),( Young-joo Jin ),( Jin-woo Lee ),( Sangheun Lee ),( Ki Jun Han ),( Young Nam Kim ),( Tae Hun Kim ),( Yun Soo Kim ),( Duck Joo Choi ),( Ju Hyun K 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Combination of daclatasvir (DCV) and asunaprevir (ASV) has been approved in Korea for the treatment of genotype 1b (GT1b) hepatitis C virus (HCV) infected patients. The efficacy in virologic response, improvement of liver function and non-invasive fibrosis marker in liver cirrhosis (LC) were investigated. Methods: All HCV GT1b patients who were treated with DCV and ASV for at least 4 weeks from August 2015 to January 2017, were retrospectively enrolled. Virologic response was measured at 4 weeks (rapid virologic response, RVR), at 24 weeks (end of treatment response, ETR), and at 12 weeks after the end of treatment (sustained virologic response, SVR12). Liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, and fibrosis index (FI) were compared between before and after treatment (SVR12). Results: Patients with GT1b patients (n=474) were examined for resistance associated variants (RAVs). Sixty-seven patients had RAV. A total of 290 RAV-negative patients were treated with DCV and ASV for at least 4 weeks. Baseline characteristics were obtained: age (54±11 years), gender (male: 50.3%), LC (29.0%), treatment-naïve (74.8%), ALT (58.5±49.2 IU/L), HCV RNA (1,915,001±4,969,456 IU/mL). RVR (255/277, 92.1%), ETR (190/195, 97.4%), and SVR (146/152, 96.1%) rates were obtained. SVR rates were not significantly different between non-LC (102/104, 98.1%) and LC patients (44/48, 91.7%) (p=0.080). SVR rates were not significantly different between treatment- naïve (103/106, 97.2%) and treatment-experienced patients (43/46, 93.5%) (p=0.368). In LC patients (n=48), there were significant changes of albumin (3.8±0.8 to 4.0±0.5 g/dL, p=0.036), platelet count (109.6±52.6 to 120.3±58.5 x103/mm3, p=0.004), APRI (2.6±3.1 to 0.8±0.6, p=0.001), FIB-4 (7.6±6.5 to 2.9±1.6, p<0.001), and FI (3.1±1.1 to 2.9±1.2, p=0.058) after treatment. Conclusions: DCV and ASV treatment for HCV GT1b infected Korean subjects without RAV achieved high SVR rates. In addition, improvement of liver function and non-invasive fibrosis marker were noted in patients with LC.