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Hydroxyapatite 코팅 인공 고관절 전치환술 -임상적 및 방사선학적 결과 최소 2년 추시-
김신윤(Shin Yoon Kim),오승훈(Seung Hoon Oh) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1
We evaluated radiographic results of 42 hips & clinical results of 51 hips that had a hydroxyapatite coated primary THR from March 1993 to August 1996. The mean age of patients was 47(range, 23- 63). The primary diagnosis for THR was osteonecrosis in 23 hips(45%), osteoarthritis in 18 hips(35%), and miscellaneous in 10. Patients have been followed up for an average of 44 months(range 25-70 months). The average Harris hip score was 53 points preoperatively and 91 points at the most recent follow-up. Excellent clinical results were in 40 hips(78%), good in 9 hips(18%), fair in 1 hip and poor in 1 hip.Six patients(12%) complained of thigh pain. All patients who complained of thigh pain had no trouble in daily activity. In radiographic evaluation, endosteal bone formation at proximal and mid portion of stems was noted in 36 hips(86%), reactive lines were seen at the non-coated region of the distal stem in 23 hips(55%). Cortical hypertrophy was seen in 11 hips(26%), calcar change in 39 (93%), stem subsidence in one(2%). No femoral osteolysis was observed. Reactive lines around the acetabular cup were seen in 12 hips(28%). Pelvic osteolysis occured in 4 hips(10%) and 1 cup had migrated. The mean rate of polyethylene linear wear was 0.19 mm/year(range 0.03-0.51). The estimated volumetric wear rate was 118.2mm3/year. Complications were nonrecurrent dislocation in 3 hips, proximal femoral fractures during surgery in 2 hips, deep vein thrombosis in two hips and pelvic screw breakage in one hip. No revision was performed for any reason. Minimum 2 year follow up results of HA-coated THR revealed excellent clinical results including a relatively low incidence of thigh pain, and good radiographic results in the young patient group. Early linear polyethylene wear was compatible with the rate of other cementless THR. However, long term follow-up for osteolysis and third body wear will be necessary.
김신윤(Kim, Shin-Yoon),김병국(Kim, Byoung-Guk),유경무(Yoo, Kyoung-Mu),김형진(Kim, Hyeong-Jin),박재식(Park, Jae-Sik),황수관(Hwang, Soo-Kwan) 대한생리학회 1981 대한생리학회지 Vol.15 No.1
In the present study, an effort was directed to elucidate the effect of osmolality on the absorption of ethanol in rabbits. A single dose of 13.67 ml(2. 16 gm ethanol/kg BW) of hypo-, iso-hyphen and hypertonic ethanol per kg BW was administered into the stomach to albino rabbits and the experiment was performed at 30 th, 60 th and 120 th minute. The blood ethanol level was determined by the method of Williams et al, and hematocrit(Hct) was determined by the conventional Hct centrifuge and reader. The results are summarized as follow. The blood ethanol level showed the highest value at 60 min after the ethanol ingestion in the hypo- and isotonic groups, 171.3±13.3 mg% and 204.5±23.0 mg% , respectively, but in the hypertonic group, the highest value was observed at 120min after the ingestion. The absorption rate of ethanol between 0 to 30 min after the ingestion of hypo- and isotonic ethanol was 88.54±12.04 and 94.73±8.33 mg/min , respectively, but a decreased value of 44.72±6.69 mg/min was noted after hypertonic ethanol ingestion comparing with hypo- and isotonic groups, The Hct value after hypo- and isotonic ethanol ingestion was decreased at 30 min but returned to the control level at 120 min. In contrast with hypo- and isotonic ethanol ingestion, hypertonic ethanol ingestion produced an increase of the Hct value at 30 min and returned to the control level at 120 min. The heart rate was increased but the respiratory rate was decreased after ethanol ingestion regardless of the osmolality.
광범위한 대퇴골부 골괴사증에 대한 혈관부착 비골 이식술의 효과
김신윤 ( Shin Yoon Kim ),김도헌 ( Do Heon Kim ),조병채 ( Byung Chae Cho ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2
The authors reviewed 25 hips of 19 patients treated with free vascularized fibular graft for extensive osteonecrosis of the femoral head (C lesion by Steinberg classification) with a mean follow up of 36 months (ranging from 24 months to 57 months). Sixteen men and three women ranged in age from 15 to 47 years (mean, 33.4 years). Associated etiologic factors included alcohol abuse (15 hips), steroid treatment (5 hips), idiopathic (4 hips), and trauma (1 hip). Clinical and radiological results were assessed according to etiologic factors and the classification of Steinberg. According to Steinberg classification, there were 11 in stage IIC, 2 in stage IIIC and 12 in stage IVC. Clinical results were evaluated using Harris hip score (HHS). Excellent or good results by HHS were obtained in 19 hips (76%). In precollapse stages (Steinberg classification IIC, IIIC), clinical successes were obtained in 12 of 13 hips (92.3%). Radiological results were assessed according to collapse of the femoral head and degenerative change of the hip joint. Radiological successes were obtained in 18 hips (72%) in over all [12 of 13 hips (92.3%) in precollapse stages and 7 of 12 hips (58.3%) in stage IVC]. In precollapse stages, radiological success was higher than that in postcollapse stage (Steinberg classification IVC) (p<0.05). Three of 12 hips (25%) in postcollapse stage were converted to total hip replacement. The etiologic factors didnt affect the clinical and radiological results. In conclusion, free vascularized fibular graft chould be an effective method to get excellent or good results, to prevent further collapse in precollapse stage and to prolong the time until the conversion total hip arthro- plasty for postcollapse stage osteonecrosis of the femoral head with extensive involvement.
김신윤(Shin-Yoon Kim),노정호(Jung-Ho Noh) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3
목적: 폐쇄성 근위 대퇴 골수정을 이용한 대퇴골 전자부 골절의 치료에서 골절유합과 이에 영향을 미치는 요소들과의 상관성, 합병증 등을 알아보고자 하였다. 대상 및 방법: 2000년 11월부터 2004년 4월까지 근위 대퇴 골수정으로 치료받은 대퇴 전자부 골절 환자 91명 중 패혈성 쇼크 및 다발성 장기부전으로 사망한 3예를 제외하고, 12개월 이상 추시 관찰한 88명을 대상으로 하였다. 평균 연령은 73세(범위, 36-94세), 평균 추시기간은 16.4개월(범위, 12-36개월)이었다. 골절의 분류는 안정골절이 11예, 역사선 골절 및 전자하부 골절을 포함한 불안정골절이 77예였다. 정복상태, Singh 지수, 지연 나사못의 고정위치(Tip-Apex Distance, TAD)에 따른 골유합 기간의 차이를 살펴보았다. 결과: 수술시간은 평균 60분(범위, 42-90분)이었고 출혈량은 165 ㎖ (범위, 70-250 ㎖)이었다. 골유합 기간은 18.4주(범위, 12-40주)였고, 3예에서 불유합 소견을 보였다. 술 후 평균 HHS는 85.3 (범위, 23-99)을 보였다. 만족할 만한 정복이 이루어진 경우 평균 골유합 기간은 17.0주, 만족할 만한 정복이 이루어지지 않은 경우 26.7주였다(p<0.05). 불유합이 발생한 3예 모두 정복이 만족스럽지 못한 경우에서 발생하였다. Singh 지수가 3 이하인 경우 평균 골유합 기간은 19.2주이며, 4 이상인 경우는 16.7주였다. 지연나사못의 TAD가 25 ㎜ 이하인 경우 평균 골유합 기간은 16.8주이며, 25㎜보다 큰 경우 20주로 두 그룹 간의 차이가 있었다(p<0.05). 합병증으로는 회전방지 나사못의 파열 1예, 골수정 파열 1예, 지연나사못의 후퇴 1예, 대퇴골두 천공 1예가 발생하였다. 결론: 근위 대퇴 골수정을 이용하여 대퇴골 전자부 골절을 치료한 결과 96.6%에서 골유합을 얻을 수 있었으며 합병증은 4.5%에서 발생하였다. TAD와 정복상태가 골유합 기간과 유의한 상관관계가 있었다. Purpose: To evaluate the relationship between the bone union and the factors affecting the treatment of a peritrochanteric fracture of the femur with a proximal femoral nail along with the associated complications. Materials and Methods: From November 2000 to April 2004, 91 peritrochanteric fractures of the femur were treated with a proximal femoral nail. Three cases were excluded due to sepsis and multiorgan failure. The remaining 88 cases were followed up for mean period of 16.4 months (range, 12-36 months). The mean age was 73 years old (range, 36-94 years old). There were 11 stable fractures and 77 unstable fractures including reverse obliquity fractures and subtrochanteric extension. The relationship between the bone union and the potential associated factors such as reduction status, Singh index, and position of lag screw (tip apex index, TAD) was investigated. Results: The mean operation time was 60 minutes (range, 42-90 minutes), and the average amount of bleeding was 165 ㎖ (range, 70-250 ㎖). The mean period for union was 18.4 weeks (range, 12-40 weeks) and 3 cases showed nonunion. The mean Harris Hip Score at the final follow up was 85.3 (range, 23-99). The average union period was 17.0 weeks in the cases with an excellent or fair reduction and 26.7 weeks in those cases with a poor reduction. The average bone union period was 19.2 weeks in cases with a Singh index of 3 or less, and 16.7 weeks in the cases with a Singh index of 4 or more. The average bone union period was 16.8 weeks in the cases with a TAD 25 ㎜ or less, and 20.0 weeks in cases with a TAD more than 25 ㎜. Conclusion: The treatment of a peritrochanteric fracture using a proximal femoral nail produced bone union in 96.6% of cases with a 4.5% complication rate. The average bone union period cor-related with the reduction status and TAD significantly.