• Title, Summary, Keyword: 지연 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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The Delayed Inflammatory Reaction after Anterior Cruciate Lligament Reconstruction with a Bioabsorbable Interference Screw Fixation - A Case Report - (생분해성 간섭나사를 이용한 전방십자인대 재건술 후 발생한 지연성 염증반응 - 증례 보고 -)

  • Lim, Hong-Chul;Noh, Kyoung-Sun;Yang, Jae-Hyuk
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.1
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    • pp.87-90
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    • 2006
  • The complication caused by a bioabsorbable interference screw is rare after anterior cruciate ligament reconstruction. We report a case of delayed inflammatory reaction at the tibial tunnel and femoral tunnel where the graft tendon had been fixed with a bioabsorbable interference screw ($Bioscrew^{(R)}$) for anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.

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Visualization of Delayed Gastric Emptying Flows After Esophageal Reconstruction Using a Gastric Graft (위장 이식편을 이용한 식도 재건술에서 위장 배출 지연 현상의 가시화)

  • Jeon, Hye-Jin;Park, Hee-Jin;Sung, Jae-Yong;Lee, Jae-Ik
    • Journal of the Korean Society of Visualization
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    • v.7 no.2
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    • pp.22-27
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    • 2010
  • The delayed gastric emptying flows have been visualized in this study when a gastric graft replaced an esophagus after esophagectomy. To construct visualization models for gastric grafts, the path data of gastric graft were extracted from the CT images for real patients and then the experimental models were made from silicone tube by considering elasticity of real stomach. During experiments, 200 ml of water or glycerin was poured into the gastric graft model and the gastric emptying time for total volume of fluid to pass pylorus was measured from the successive images captured by a high speed CCD. The gastric emptying time was compared according to the change of diameter and path (front or rear path) of gastric graft, and pyloroplasty or not. In case that the pyloroplasty was not conducted, the smaller was the diameter of gastric graft, the shorter was the gastric emptying time. However, if the pyloroplasty was conducted, the larger diameter of gastric graft was better for the gastric emptying. Although the rear path gave rise to longer gastric emptying time than the front path, it did not matter, if the pyloroplasty was conducted.

Management of Multiple Ligament Injured Knee (슬관절 다발성 인대 손상의 치료)

  • Sim, Jae-Ang;Lee, Beom-Koo
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.12 no.1
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    • pp.16-23
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    • 2013
  • Multiple ligament knee injury is defined as rupture to at least two of the four major knee ligament structures. Three or four knee ligament injury results in knee dislocation as complete disruption of the integrity of the tibiofemoral articulation. In multiple ligament knee injury, vascular and neurologic assessment should be performed meticulously and systematically. Emergency surgery should be needed if arterial injury is suspected. Surgical treatment rather than conservative management should be done and early surgery might be better than delayed surgery. Reconstruction of ACL and PCL, repair or reconstruction of MCL, and reconstruction of posterolateral corner are recommended, although many debates have occurred. Multiple ligament knee injury requires more aggressive management than single ligament knee injury.

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Salvage with Reverse Total Shoulder Arthroplasty after the Failure of Proximal Humeral Tumor Treatment (근위 상완골 종양 치료 실패 후 역 견관절 전치환물을 이용한 구제술)

  • Jeon, Dae-Geun;Cho, Wan Hyeong;Kim, Bum Suk;Park, Hwanseong
    • Journal of the Korean Orthopaedic Association
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    • v.53 no.6
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    • pp.505-512
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    • 2018
  • Purpose: Many reconstruction methods have been attempted after an en-bloc resection of the proximal humerus. In particular, the introduction of reverse shoulder arthroplasty (RSA) has made a breakthrough in the functional recovery of the shoulder. Nevertheless, RSA has limitations when the humeral bone stock loss is significant. In addition, it is unclear if RSA is effective in patients showing failure with non-operative treatment of a proximal humeral tumor. Materials and Methods: A reconstruction was performed using an overlapping allograft-RSA composite for 11 patients with a failed proximal humeral construct. Delayed RSA was performed on 6 patients with failed non-operative treatment. The pre- and postoperative Musculoskeletal Tumor Society (MSTS) score and the complications were addressed. Results: Overlapping allograft-RSA composite afforded a stable construct in 11 failed proximal humeral reconstructions and the patient's chief complaints were resolved. The mean time to the union of overlapped allograft-host junction was 5.5 months. Average preoperative MSTS score of 20.3 point increased to 25.7 point, postoperatively. Four of the six patients who had RSA within 4 years from the index operation showed arm elevation of more than $90^{\circ}$ whereas the remaining 5 patients showed some disability. The complications include one case each of dislocation and aseptic infection, which were resolved by changing the polyethylene liner and scar revision, respectively. None of the 6 patients who underwent delayed RSA after the failure of non-operative treatment showed arm elevation more than $90^{\circ}$. Conclusion: An overlapping allograft-RSA composite is a simple and reliable reconstructive modality in patients with massive bone loss. In patients with metastatic cancer necessitating a surgical resection at presentation, early conversion to RSA is recommended to secure functional recovery.

Comparison of the Incidence and Risk Factors for Developing Osteoarthritis after ACL Reconstruction - Patellar Versus a Hamstring Autograft - (전방 십자 인대 재건술 후 골관절염의 발생 빈도 및 위험 인자들에 대한 비교 - 자가 슬개건과 자가 슬괴건을 이용한 방법 -)

  • Song, Eun-Kyoo;Seon, Jong-Keun;Kim, Hyung-Soon;Kang, Kyung-Do;Byun, Jae-Wook
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.9 no.1
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    • pp.48-57
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    • 2010
  • Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p<0.001; HT p=0.091), intervals from the injury to reconstruction of > 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.

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Do the Rotating Hinge-Flexible Intramedullary Nail Composites Alleviate Junctional Osteolysis in Megaprothesis Reconstruction for Bone Tumor? (탄력성 있는 골수강 내고정물과 회전경첩형 슬관절 전치환물을 조합한 종양인공관절로 자가골의 골 용해를 감소시킬 수 있는가?)

  • Song, Won-Seok;Cho, Wan-Hyeong;Cho, Sang-Hyun;Jeon, Dae-Geun
    • The Journal of the Korean bone and joint tumor society
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    • v.13 no.2
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    • pp.96-104
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    • 2007
  • Purpose: The authors investigated whether 35 flexible nail-rotating hinge composite reconstructions around knee joint minimize junctional osteolysis of host bone. Material and Method: The reconstructive technique was as follows: 1) en bloc tumor resection, 2) filling of the host bone marrow cavity with multiple Ender nails, 3) assembling the Ender nails and an Endo-Link type total knee component with wire and bone cement. Result: Mean follow-up was 53 months (ranged 30~79). At final follow-up, 29 patients retained a mobile joint. Resection of more than 40% of bone showed a positive relationship with junctional hypertrophy (p=0.028). Eight patients showed nail breakage and eight prostheses were removed due to early or late infection. The cumulative prosthetic survival rate was 33% at 6 year. Average functional score according to the MSTS criteria was 26.8. Conclusion: Mid-term evaluations showed that results were fair. The revision process was straightforward. Junctional hypertrophy observed appears to give some clues as to how to minimize osteolysis at the prosthesis-host junction after modular prosthesis fixation.

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When do we use the Recycling Autograft in Limb Salvage Surgery? (사지구제술에서 언제 재활용 자가골 이식술이 유용한가?)

  • Kim, Jae-Do;Jang, Jae-Ho;Cho, Yool;Kim, Ji-Youn;Chung, So-Hak
    • The Journal of the Korean bone and joint tumor society
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    • v.14 no.2
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    • pp.95-105
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    • 2008
  • Purpose: To identify which is the best procedure in recycling autograft according to the resection & reconstruction type and recycling methods, and so when the recycling autograft is used in limb salvage surgery. Materials and Methods: We have treated fifty-eight patients (34 male, 24 female; age range 5 to 74 years, mean age 36.5 years), who had the malignant musculoskeletal tumors, with recycling autograft (47 patients with extracoporeal irradiation, 11 patients with pasteurization) from December 1995 to February 2006. The resection and reconstruction type was 3 cases with fragmentary, 8 intercalary, 23 rAPC (recycling-Autograft-Prosthesis composite), 18 osteoarticular, 5 total joint and 1 soft tissue (achilles tendon). The result was evaluated by the radiologic union at junctional site, the functional score by musculoskeletal tumor society score and complications according to the resection & reconstruction type and recycling methods. Results: The junctional union was obtained at 15.0 months in extracoporeal irradiation and 12.6 months in pasteurization. Also the mean radiologic union was shown at 6.0 months in fragmentary, 12.8 months in intercalary, 10 months in rAPC, 23.3 months in osteoarticular and 15.6 months in total joint. The functional score was 65.5% in fragmentary, 60.8% in intercalary, 62.8% in APC (except pelvis), 66.0% in osteoarticular and 66.6% in total joint. We have experienced 1 infection, 1 prutrusio acetabuli in pasteurization (18.1%) and other 22 complications (3 deep infections, 8 nonunions, 2 fractures, 2 epiphyseal problems, 5 joint instabilities, 2 local recurrence) in extracoporeal irradiation (46.8%). Also we have experienced 3 complications (3 nonunions) in intercalary (37.5%), 9 complications (4 nonunions, 1 deep infection, 1 periprosthetic fracture, 1 epiphyseal problem, 1 local recurrence, 1 protrusio acetabuli) in rAPC (50.0%), 6 complications (2 deep infections, 2 nonunions, 1 epiphyseal problem, 1 pathologic fracture) in osteoarticular (33.3%), 5 complications (5 joint instabilities) in total joint (100%) and 1 complication(1 local recurrence) in soft tissue (100%). Conclusion: In our experience, according to the resection & reconstruction type fragmentary and intercalary may have several advantages such as good radiologic and functional result and low rate of complication. And it seems that rAPC was available in case which have no sufficient residual bone stock. Also the pasteurization may have more advantages than that of the extracorporeal irradiation.

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