• Title, Summary, Keyword: 조기 재건술

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A Comparison of Outcomes after Early and Delayed Reconstruction in the Acute Anterior Cruciate Ligament Injuries (급성 전방십자인대 손상 환자에서 조기 재건군과 지연 재건군의 결과 비교)

  • Lee, Soo Won;Kim, Sung Hwan;Kim, Yoon Gi
    • Journal of the Korean Arthroscopy Society
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    • v.16 no.1
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    • pp.34-39
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    • 2012
  • Purpose: This study performed to compare degree of joint stiffness and clinical results between early and delayed reconstruction of acute anterior cruciate ligament (ACL) injuries. Materials and Methods: Thirty-four Patients who underwent ACL reconstruction between March 2008 and October 2010 enrolled this study. We divided the patient into 2 groups, early reconstruction group underwent surgery before a week, delayed reconstruction group underwent surgery after 3 weeks, before 6 weeks. All the patients underwent aggressive joint motion exercise till surgery and enrolled post operative rehabilitation program including self exercise. We checked range of motion, the Lachman test, the pivot shift test, the Lysholm score, the International Knee Documentation Committee (IKDC) score and the Tegner score to evaluate the results. Results: At the final follow up. The Lysholm score was 91.82 in the early group and 94.83 in the delayed group. All the cases were rated above B (near normal) on IKDC score (P=0.217, P=0.845). The Tegner score was 6.7 in the early reconstruction group and 7.1 in the delayed group (P=0.840), there was no difference between the groups for the range of motion (P=0.873, P=0.873), no complication such as deep vein thrombosis or infection, no difference in the Lachman test, pivot shift test (P=0.606, P=0.118). Conclusion: We could obtain satisfactory clinical results in both the early and delayed reconstruction groups of acute ACL injuries. Therefore, the early reconstruction of ACL performed before a week could be one of the treatment options for acute ACL injury.

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Comparison of Results Between Immediate Fixation Group and Delayed Reconstruction Group in Displaced Mid-shaft Fractures of the Clavicle (쇄골 전위성 간부 골절에서 조기 고정술 군과 지연 재건술 군 간의 결과 비교)

  • Kim, Doo-Sub;Rah, Jung-Ho;Yoon, Yeo-Seung;Lee, Chang-Ho
    • Clinics in Shoulder and Elbow
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    • v.12 no.1
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    • pp.61-66
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    • 2009
  • Purpose: Several authors have reported excellent results of delayed reconstruction of non-union & malunion in displaced mid-shaft fractures of the clavicle and these results were equal to that of immediate fixation. But direct comparison between these treatments is rare. We evaluated the results between the immediate fixation group and delayed reconstruction group for treating displaced mid-shaft fractures of the clavicle. Materials and Methods: We studied the results of 18 cases with immediate fixation of displaced mid-shaft fractures of the clavicle and 15 cases with delayed reconstruction of non-union & malunion after conservative management, and these cases were seen from March 2000 to February, 2006. The final postoperative outcome was analyzed according to the clinical outcomes with using the Constant score and the radiological findings of bony union. Results: The constant score was low in the delayed reconstruction group compare to that of the immediate fixation group (p value=0.045). For the pain score & the activities of daily living score, a statistically significant difference was seen between the two groups (p<0.05), but not for the range of motion score & the power score (p>0.05). Radiological findings of bony union were seen for both groups at an average of 8.8 weeks for the immediate fixation group and at an average of 9.8 weeks for the delayed reconstruction group. Conclusion: Though the delayed reconstruction group was shown good clinical and radiological results, the immediate fixation group had a significantly better pain score, a better activities of daily living score and a better Constant score. It is important to choose the initial treatment option for displaced mid-shaft fractures of the clavicle after sufficient explanation to patients about the merits and demerits between these two treatment options.

A Comparison of Outcomes after Early and Delayed Reconstruction in the Acute Posterior Cruciate Ligament Injuries (급성 후방십자인대 손상 환자에서 조기 재건군과 지연 재건군의 결과 비교)

  • Lee, Yong Sik;Lee, Soo Won;Seo, Byung Ho;Kim, Yoon Gi
    • Journal of the Korean Arthroscopy Society
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    • v.17 no.1
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    • pp.31-37
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    • 2013
  • Purpose: This study performed to compare degree of joint stiffness and clinical results between early and delayed reconstruction of acute posterior cruciate ligament (PCL) injuries. Materials and Methods: Thirty-two Patients who underwent PCL reconstruction between March 2008 and October 2011 enrolled this study. We performed transtibial single bundle reconstruction using the allo-achilles tendon in all cases. We divided the patient into two groups, early reconstruction group underwent surgery before a week, delayed reconstruction group underwent surgery after 3 weeks, before 6 weeks. All the patients underwent aggressive joint motion exercise till surgery and enrolled post operative rehabilitation program. We checked posterior drawer stress radiography, range of motion, the Lysholm score, the International Knee Documentation Committee (IKDC) score and the Tegner score to evaluate the results. Results: At the final follow up the Lysholm score was 92.1 in the early group and 93.8 in the delayed group. All the cases were rated above B (near normal) on IKDC score (p=0.808, p=0.722). The Tegner score was 6.6 in the early reconstruction group and 6.2 in the delayed group (p=0.480), The average of maximum flexion and extension angle was $133.9^{\circ}$, $1.4^{\circ}$ in the early group and $133.6^{\circ}$, $1.1^{\circ}$ in the delayed group (p=0.560, p=0.581), no complication such as deep vein thrombosis or infection, no difference in posterior drawer stress radiography (p=0.750). Conclusion: We could obtain satisfactory clinical results in both the early and delayed reconstruction groups of acute PCL injuries. Therefore, the early reconstruction of PCL performed before a week could be one of the treatment options for acute PCL injury.

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Mitral Valve Reconstruction in Mitral Insufficiency : Intermediate-Term Results (승모판 폐쇄부전증에서 승모판 재건술의 중기평가)

  • 김석기;김경화;김공수;조중구;신동근
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.35 no.10
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    • pp.705-711
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    • 2002
  • The advantages of mitral valve reconstruction have been well established and so mitral valve reconstruction is now considered as the procedure of choice to correct mitral valve disease. This is the report of intermediate-term results of 38 cases that performed mitral valve reconstruction for valve insufficiency(the total number of mitral valve reconstruction were 49 cases, but 11 cases that performed mitral valve replacement due to incomplete reconstruction were excluded). Material and Method : From March 1991 to March 2001, 38 patients underwent mitral valve repair due to mitral valve regurgitation with or without stenosis. Mean age was 47.6$\pm$14.7 years(range 15 to 70 years) : 11 were men and 27 were women. The causes of mitral valve regurgitation were degenerative in 14, rheumatic in 21, infective in 2 and the other was congenital. Result : According to the Carpentier's pathologic classification of mitral valve regurgitation, 3 were type 1 , 16 were type II and 19 were type III. Surgical procedures were annuloplasty 15, commissurotomy 19, leaflet resection and annular plication 9, chordae shortening 11, chordae transfer 5, new chordae formation 2, papillary muscle splitting 2 and vegetectomy 2. These procedures were combined in most patients. There were 2 early death and the causes of death were respiratory failure, renal failure and sepsis. There was no late death. Valve replacement was done in 6 patients after repair due to valve insufficiency or stenosis 3 weeks, 1, 3, 51, 69, 84months later respectively. These patients have been followed up from 1 to 116 months(mean 43.0 months). The mean functional class(NYHA) was 2.36 pre-operatively and improved to 1.70. Conclusion : In most cases of mitral valve regurgitation, mitral valve reconstruction when technically feasible is effective operation that can achieve stable functional results and low surgical and late mortality.

Anterior Cruciate Ligament Reconstruction Using Autologous Bone-patellar Tendon-bone (자가 골-슬개건-골을 이용한 전방십자인대 재건술)

  • Kyung, Hee-Soo
    • Journal of the Korean Arthroscopy Society
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    • v.14 no.2
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    • pp.88-91
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    • 2010
  • 전방십자인대 재건술시 자가건 선택에 대해서는 많은 논쟁의 소지가 존재하며 많은 보고들이 나오고 있으나, 현 시점에서 이식건으로써 자가 골-슬개건-골이 표준(gold standard)라는 주장은 이제 변화하고 있으며, 골-건 고정방법의 개선에 따른 조기 슬관절 안정성의 호전으로 자가 슬괵건의 사용이 점점 증가되고 있는 추세이다. 자가 골-슬개건-골은 이식건으로써 강한 물성, 튼튼한 고정, 장기 추시에서 높은 성공률 등으로 젊고, 강한 활동을 요하는 운동선수에서 종종 선택되고 있으며 조기에 강한 활동으로의 운동 복귀를 할 수 있다. 그러나 슬관절 전방 통증, 무릎을 꿇을 때의 통증, 슬개골골절, 슬개-대퇴 관절의 염발음 및 대퇴사두근력의 감소 등 이식물 채취로 인한 공여부 이환이 문제가 되었다. 그래서 자가 골-슬개건-골의 이식건으로서의 문제점 및 문헌상 고찰을 하여 논하고자 한다.

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The Early Experience with a Laparoscopy-assisted Pylorus-preserving Gastrectomy: A Comparison with a Laparoscopy-assisted Distal Gastrectomy with Billroth-I Reconstruction (복강경 보조 유문부보존 위절제술의 초기 경험: 복강경 보조 원위부 위절제술 후 Billroth-I 재건술과의 비교)

  • Park, Jong-Ik;Jin, Sung-Ho;Bang, Ho-Yoon;Chae, Gi-Bong;Paik, Nam-Sun;Moon, Nan-Mo;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.20-26
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    • 2008
  • Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+$\beta$ lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a $2.5{\sim}3.0\;cm$ pyloric cuff and maintaining a $3.0{\sim}4.0\;cm$ distal margin for the resection. Results: The mean age for patients who underwent LAPPG and LADGBI were $59.9{\pm}9.4$ year-old and $64.1{\pm}10.0$ year-old, respectively. The sex ratio was 1.3 : 1.0 (male 5, female 4) in the LAPPG group and 2.6 : 1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes ($28.3{\pm}11.9$ versus $28.1{\pm}8.9$), operation time ($269.0{\pm}34.4$ versus $236.3{\pm}39.6$ minutes), estimated blood loss ($191.1{\pm}85.7$ versus $218.3{\pm}150.6\;ml$), time to first flatus ($3.6{\pm}0.9$ versus $3.5{\pm}0.8$ days), time to start of diet ($5.1{\pm}0.9$ versus $5.1{\pm}1.7$ days), and postoperative hospital stay ($10.1{\pm}4.0$ versus $9.2{\pm}3.0$ days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. Conclusion: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

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Short Term and Midterm Surgical Results for Infective Endocarditis - Does Wide Debridement and Reconstruction Affect the Post Operative Mortality and Morbidity? (90년대 중반 이후 시행한 감염성 심내막염의 중단기 수술 성적)

  • Yie, Kil-Soo;Oh, Sam-Sae;Kim, Jae-Hyun;Shinn, Sung-Ho;Kim, Jong-Hwan;Kim, Soo-Cheol;Na, Chan-Young
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.40 no.5
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    • pp.341-350
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    • 2007
  • Background: We present here the early and midterm surgical results for infective endocarditis and we especially focus on the effect of aggressive reconstruction or root implantation after wide debridement. Material and Method: Between January 1995 and Jun 2006, we enrolled 79 adult infective endocarditis patients who underwent surgical treatment. There were 63 and 16 native and prosthetic valve endocarditis cases, respectively. They included 27 cases of culture negative endocarditis. With performing valve replacement or repair, 28 of the patient underwent a more aggressive surgical option, for example, aortic root replacement or reconstruction, or heart base reconstruction etc. Result: There were statistical relationships between the in-hospital mortality and staphylococcal infection, urgent-based operation and operation during the active phase of endocarditis. Wide debridement and aggressive reconstruction were not related to either the post operative mortality or the early morbidity. Culture negative endocarditis was not related to the postoperative mortality and morbidity. Conclusion: Physicians must pay attention to patients' medical treatment during the preoperative period of the infective endocarditis. If surgery is considered for treating infective endocarditis, it should be performed before the downhill course of the disease so that the surgical outcome is improved. Wide debridement and more aggressive reconstruction are also warranted.