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인공 고관절 전치환술 후 관절 주위 연부 조직에 주입한 Bupivacaine과 Morphine이 수술 후 통증에 미치는 영향: 전향적 연구
황규태 ( Kyu Tae Hwang ),조창민 ( Chang Min Cho ),김이석 ( Yee Suk Kim ),심재항 ( Jae Hang Shim ),김영호 ( Young Ho Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4
Purpose: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. Materials and Methods: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30˚) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. Results: Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05). Conclusion: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.
황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4
Recently, the incidence of revision total hip arthroplasty (THA) has increased following primary THA. Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The reasons for such acetabular defects include osteolysis, bone resportion following cup loosening, iatrogenic damage resulting from cup or cement removal during revision THA, and cup migration. The pre-operative assessment of acetabular bone stock, including the amount and location of pelvic osteolysis before revision surgery, is a critical preoperative preparation for the treatment of bone deficiency. In cases with mild acetabular defects, a variety of surgical options are available for treating. However, in cases with severe segmental, cavitary, or combined acetabular defects, controversies have existed so far about the most optimal treatment. Thereby, we tend to introduce the most commonly-adopted classification system of acetabular defects and management options using high hip center cups, oblong cups, structural allografts, morselized allografts with bipolar cups, morselized allografts with cementless cups, morselized allografts with acetabular reinforcement devices, and revisions with trabecular metal augmentations.
고관절 주위 골절 환자에서 알렌드로네이트 투여 후 복용 지속성 및 골밀도의 변화
황규태 ( Kyu Tae Hwang ),유병욱 ( Byeong Wook Yoo ),김이석 ( Yee Suk Kim ),최일용 ( Il Yong Choi ),김영호 ( Young Ho Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4
Purpose: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures. Materials and Methods: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation. Results: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores <-4.0, 6.3%(L) and 0.9%(F) for the T-scores -3.0~-4.0, and 3.8%(L) and -3.5%(F) for the T-scores >-3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate. Conclusion: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.
경전자 도달법을 이용한 일차성 인공 고관절 전치환술 후 고관절 탈구 발생의 위험 요인
황규태 ( Kyu Tae Hwang ),김영호 ( Young Ho Kim ),김이석 ( Yee Suk Kim ),봉현종 ( Hyun Jong Bong ),최일용 ( Il Yong Choi ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.1
Purpose: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. Materials and Methods: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. Results: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). Conclusion: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.
불안정성 천골 골절에서 척추-골반 고정술을 이용한 치료 - 증례 보고 -
최정환 ( Jung-hwan Choi ),황규태 ( Kyu-tae Hwang ),이승건 ( Seung Gun Lee ),강창남 ( Chang-nam Kang ) 대한골절학회 2018 대한골절학회지 Vol.31 No.4
22세 여환으로 음주 상태에서 보행자 교통사고를 당한 후 응급실로 내원하였다. 응급실에서 시행한 검사상 우측 천골 천골공 구역 골절, 좌측 하치골지 골절, 좌측 전방 비구 골절 및 우측 제1 천추의 상방 후관절 돌기의 골절이 확인되었으며 다른 신경학적 증상은 관찰되지 않았다. 환자는 척추-골반 고정술 및 경피적 장-천골 나사못 고정술을 시행하였고 이후 1년이 지나 골유합이 완료되어 내고정물을 제거하였으며 다른 합병증이 없이 치료가 완료되었다. 본 저자들은 불안정성 천추골 골절에 있어서 척추-골반 고정술 및 경피적 장-천골 나사못 고정술이 현존하는 다양한 천골 골절의 치료법 중 골반 후방의 안정성을 견고하게 얻을 수 있는 우수한 방법 중 하나이기에 추천하는 바이다. A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.
전현우 ( Hyun Woo Jun ),황규태 ( Kyu Tae Hwang ) 한국농공학회 1973 韓國農工學會誌 : 전원과 자원 Vol.15 No.2
The aggregate materials being scottored in districts of the country were investigated to provide the data to the Consturction worker who are working without quality tests of construction materials in the small scale land consolidation, farm building construction and new village Construction projects in the country. Also results of the survey will be helpful to those who want to devise a succerrful plan in concrete execution by means of specifying a standard and technical treatment of construction materials.