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내반주 및 외반주 변형에 대한 교정 절골술 후 효과적인 내고정물의 선택
이영구,김영창,최장석,서승석,안기찬,류청창 대한골절학회 1997 대한골절학회지 Vol.10 No.2
There are several methods of fixation after corrective ostetomy for cubitus varus and cubis valgus deformities. In patients yonger than 15 years whose growth has not completed, the results are sastisfactory in most patients regardless of methods of fixation. When corrective osteotomy is done in adolescent or adults, the results are not satisfactory according to methods of fixation. If the fixation of the osteotomy site is not rigid in patients older than 16 years, nonunion, delayed union, displacement of osteotomy site and the limitation of elbow motion occur frequently due to long duration of immobilization. We performed suprachondylar corrective osteotomy in 39 pateints for cubitus varus or cubitus valgus from January 1986 to January 1995, at Inje University Pack Hospital. The results were as follows: 1. The osteotomy were lateral closing wedge osteotomy for cubitus varus, medial closing wedge ostetomy, open wedge displacement osteotomy, step cut osteotomy for cubitus valgus. 2. For the fixation, we used K-wire, Steinmann pin in 23 cases, 2 screws and wire loop in 3. In the group of patients younger than 15 years old, good results were obtained due to bone growth and there was no difference among the results according to methods of fixation 4. In the group of patients older than 16 years old, excellent results were obtained by rigid fixation with plate and early mobilization of elbow.
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비구골 결손시에 지주골 및 파쇄골 이식을 이용한 고관절 전치환술
최장석,안기찬,남우동,서승석,김영창,류청창 인제대학교 1998 仁濟醫學 Vol.19 No.2
인공 고관절 치환술 시는 고관절의 회전 중심이 해부학적으로 회복되어야 하고, 비구컵이 비구부에 충분히 유치되어야 만족할 만한 결과를 얻을 수 있다. 비구 이형성이나 인공 고관절 재치환술 시 동반되는 비구부 결손은 고관절 회전 중심의 해부학적 회복과 비구골에 대한 유치를 어렵게 한다. 이에 비구부 결손에 대하여 자가골이나 동종골, 이종골 등의 골 이식을 시행하고 나서 방사선학적 및 임상적으로 분석한 바, 지주 이식골의 유치율이 45%를 넘지 않을 경우와 자가골 이식을 시행하였을 경우, 그 결과는 양호할 것으로 사료된다. The insufficient acetabular bone stock is a major problem in patients with dysplastic hip caused by septic hip sequelae, CDH sequale who required total hip replacement and with required revision total hip replacement. The restoration of the anatomical center of relation and adequate acetabular containment is important to obtain long-term sucess. Many alternative operations were introduced by several authors using small acetabular components, widening the ilium by inserting a graft between the inner and outer tables, or acetabular augmentation by bone graft from femoral head and neck. According to Harris(1986), Autogenous femoral head bone grafting is a useful technique with a good potential for long-term success when amount of coverage by graft is limited to less than 40% of the surface of the acetabular component. Authors analysed 41 patients 45 hips with acetabular deficiency treated with primary or revision total hip replacement using acetabular bone graft and cementless acetabular component at Inje University, Pusan Paik Hospital from Sep. 1983 to Jan. 1995. The 45 hips in 41 patients were available for review with a minimum follow-up of 24 months (mean 5.2 year, maximum 8.7 year). The results obtained were as follows. 1.Strut bone graft to acetabular segmental deficiency combined with cancellous bone graft to cavitary deficiency are useful procedure with a good potential for long term success when amount of strut bone graft is less than 45% of cup coverage. 2.Autogenous bone graft and metal-backed acetabular component with press-fitting are favorable for good result.
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