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고관절 전치환술에서 금속 대 금속 관절에 관한 추시 분석 : Midterm Follow up
고한석,김영용,박찬각,김문기 인제대학교 백병원 2001 仁濟醫學 Vol.22 No.2
Purposes: This study was attempted to evaluate early aseptic loosening and osteolysis clinically and radiologically, and to assess wear rate of metallic articulations using Co and Cr oncentrations as indirect tribologic marker. Materials and Methods: The Co, Cr concentrations were assayed as indirect tribologic marker for 23 subjects of normal control, 13 patients within 2 years after THRA, and 12 patients of 39 over 2 years after THRA using Neutron activation analysis and Atomic absorption spectry method respectively. Results: There is no aseptic loosening and no osteolysis radiologically and clinically. The concentrations of Co and Cr in patients after THRA were higher than control groups and concentrations of Co and Cr in patients over 2 years were not higher than patients within 2 years after THRA unlike theoretical initial run in period. Conclusions: It seems that metal bearings overcome early aseptic loosening which old made metal bearings showed and excessive wear of metal on metal bearings and body accumulation of metallic ions did not occur, but the more longitudinal and prospective follow up study about concentrations of Co and Cr and biologic effects of metallic ion are needed considering short follow up time and variable activity level before measurement of metal ion.
장관골의 골절 치료에 있어서 Cerclage wiring 후 발생한 합병증
서진수,김병직,고한석,서정국,주석규,김진구,박찬각,강영훈 인제대학교 2000 仁濟醫學 Vol.21 No.1
Introduction: There are a variety of long bone fracture teatment. Among them, it is the treatment of using cerclage wiring by individuality or compound in the long bone fracture treatment that is useful in the maintenance of its reduction. In a lot of research and study, it influences the periosteal circulation of long bone fracture, but it is also useful in keeping its reduction. Most of all, it is good for communited fracture having torsional fracture or butterfly fragment. In consequence of it, there is usually good for the union of fracture. Nevertheless, it is not known in the complication. In this study, it is stated about avascular change that is raised by the complication of cerclage wiring in long bone fracture treatment. Materials and Methods: In this paper, six cases are observed over a year by wiring exclusion or after the treatment in the examples of avascular change, nonunion and the fracture after the operation by cerclage wiring. In addition, the symptom and treatment of those complication are analyzed. The analysis is based on the nature of the complication, its treatment, its consequence and the follow up. The analysis of the consequence and the follow up are based on the data of radiography. There is one case using tomography. Results: The complication of avascular change and nonuion is appeared by the treatment of long bone fracture in these cases. Avascular change demanded the exclusion of bony fragment is observed twice after cerclage wiring and the time is a month after the operation. The finding of radiography is the change of radiolucency in reduced butterfly fragment. It is supposed that thining and osteoporosis of stangle in cortex of distal portion is occurred. Nonuion is happened in the part of the fracture. After the removal of bone fragment and wiring, union is obtained by the array. The management of the bony defect by ilizarov succeeds the length of the lower limbs. In conclusion avascular change appeared around wiring and bony fragment. Specially it raises change in the distal part of the wiring and it becomes the cause of the fracture of the distal part of the it. It is manifested that the symptom of recovery appears with the union after the exclusion of wire. Conclusion: In the treatment of the fracture by cerclage wiring, there is the danger of osteonecrosis by blood flow hindrance of cortex and membrane. Therefore, in the use of this operation, there is to be too much careful needed.