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견관절 불안정성의 견갑하근 및 관절 낭 수평 분할을 이용한 하방 관절 낭 이동술
박진영,임수택,유문집,유석주,Park Jin-Young,Lim Soo-Taek,Yoo Moon-Jib,Lyu Suk-Joo 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.1
목적 : 견관절 불안정성의 관절경적 수술로 재발의 가능성이 높은 환자에 대해견갑하근 및 관절낭 수평 분할을 이용한 하방관절낭이동술을시행하고이에대한결과를분석하고자하였다. 대상및방법 : 1994년부터 1999년까지수술을시행한환자중1년이상추시(평균: 2년, 범위: 1$\~$3년)가가능한 15례를대상으로하였다. 남자가13례여자가2례이었으며평균연령은27 이었다. 질환은다방향성불안정성4례, 수의성불안정성3례, 골성Bankart 병변이있는전방불안정성2례, 접촉성운동선수의전방불안정성6례였다. 13례는관혈적봉합술과하방관절낭이동술을 동시에 시행하였고, Bankart 병변이없던2례는하방관절낭이동술만 시행하였다. 관절낭중첩 정도는평균 19 mm (범위: 10$\~$5 mm)였다. 결과 : 14례에서우수혹은양호의결과를보였으며술후1례에서아탈구되었고, 1례에서전방염려검사에양성소견을보였다. 술후전방거상과팔을체간에붙인외회전, 90$^{\circ}$ 외전에서의외회전의운동범위는술전과통계학적인차이가없었다. 결론 : 견갑하근및관절낭수평분할을이용한하방관절낭이동술은관절운동범위의감소없이과잉관절낭과Bankart 병변을치료할수있어관절경적치료로재발의가능성높은환자에서권장될치료법으로사료되었다. Purpose: The aim of this retrospective study were to report the short-term results of inferior capsular shift procedure using splitting subscapularis and capsule for the patients who had shoulder instability and were apt to recur after arthroscopic stabilization procedure. Materials & Methods : Fifteen cases of instability of the shoulder were included with an average follow-up of 2 years (range: 1$\~$3 years). There were 13 men and 2 women with an average age of 27years. Multidirectional instability was found in 4 cases, voluntary instability in 3 cases, bony Bankarte lesion in 2 cases and 6 cases were contact sportmen. Thirteen shoulders underwent the inferior capsular shifts and Bankart repairs and 2 shoulders without Bankart lesion underwent the inferior capsular shift only. Average 19 mm of shift (range: 10$\~$25 mm) was done. Results : Fourteen patients showed good and excellent results with one subluxation and one positive apprehension test. Postoperative ranges of motions did not change in forward elevation, external rotation at side and external rotation at 90$^{\circ}$ abduction (p>0.05). Conclusion : Inferior capsular shift procedure using splitting subscapularis and capsule can be helpful in shoulder instability patients who were high-risk group of recurrence with arthroscopic procedure.
결핵성 흉추 후만 환자에서 발생한 척수연화증에 의한 지연성 하지마비 - 증례 보고 -
김용민,허윤무,임수택 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.1
Many cases of tardy paraplegia after bony fusion have been reported among well-treated tuberculous spondylitis patients. In most cases, the cause of the paraplegia is known to be spinal cord compression caused by kyphosis, and in these patients cord decompression and kyphotic deformity correction have been commonly performed. A 44 year-old-male patient presenting with thoracic kyphosis and tardy paraplegia was admitted to our department. The cause of his paraplegia was considered to be a compression of the spinal cord by progressive kyphosis. The initial therapeutic plan involved decompression of the spinal cord and surgical correction of kyphotic deformity. However an MRI of the thoracic spine revealed a myelomalacia of the whole thoracic cord associated with severe cord atrophy. Myelomalacia is known to be an irreversible condition with no surgical remedy. Although this condition is very rare, an unnecessary decompressive surgical procedure may be performed if this possiblity is not considered. Because of its rarity and the importance of planning a therapeutic treatment modality, the authors report this case and include a review of the literature. 결핵성 척추염이 치유되어 골유합이 이루어진 후 지연성 하지마비에 관한 많은 기술이 있어왔으나 그 원인은 대개가 후 만변형의 진행에 따른 척수 압박에 의한 것으로 규정되어 왔다. 따라서 이에 대한 치료로 척수의 감압술 및 후만변형의 교정이 흔히 적용되고 있다. 저자들은 20년 전 제 9, 10흉추의 결핵성 척추염에 대해 약물 치료후 후만 변형이 남은 상태로 완전한 골유합을 얻었으나, 내원 약 5년전부터 서서히 진행된 양측 하지마비로 내원한 44세 남자환자를 진료하게 되었다.