• Title/Summary/Keyword: 미세 골절술

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Autologous Chondrocyte Implantation (자가연골 세포이식)

  • Jeong, Hwa-Jae
    • Journal of the Korean Arthroscopy Society
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    • v.12 no.3
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    • pp.159-166
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    • 2008
  • Articular cartilage is a unique tissue with no vascular, nerve, or lymphatic supply. This uniqueness may be one of the reasons why chondral injuries will hardly heal and may progress to osteoarthritis over time. Currently, there are several surgical options for the treatment of articular cartilage lesions. Although there is some discrepancy as to which procedures work best in certain patients. The spectrum of treatment alternatives for articular cartilage defects can range from simple lavage and debridement, drilling, micro-fracturing, and abrasion to osteochondral grafting and autologous chondrocyte implantation. In 1984, for the first time, results of autologous chondrocyte implantation in a rabbit model were presented, showing hyaline cartilage repair. Clinical study using autologous cultured chondrocyte implantation in chondral defects of the human knee has been reported in 23 patients in 1994. In 14 out of 16 patients treated for chondral injuries on the femoral condyles, the results were good to excellent. It is important for the surgeon to understand the autologous chondrocyte implantation technique and to be aware on the postoperative management. Attention to surgical technique and selection of appropriate patient for the autologous chondrocyte implantation will provide with the best results.

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Autologous Osteochondral Transplantation as a Secondary Procedure after Failed Microfracture for Osteochondral Lesion of Talus (거골 골연골 병변에 대한 미세골절술 실패 후 2차 치료로서 자가 골연골 이식술)

  • Bae, Su-Young
    • Journal of Korean Foot and Ankle Society
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    • v.19 no.2
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    • pp.47-50
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    • 2015
  • Microfracture procedure has been widely recognized as the primary surgical treatment for an osteochondral lesion of the talus. However, if symptoms persist after initial surgery, selection of a secondary procedure can be difficult. The author desciribes the advantage and value of autologous osteochondral transplantation as a secondary procedure after failed microfracture for osteochondral lesion with a review of sevral previous published articles.

Operative Treatment of Osteochondral Lesion of the Talus: Arthroscopic Bone Marrow Stimulation (Multiple Drilling or Microfracture) (거골 골연골병변의 수술적 치료: 관절경적 골수 자극술(다발성 천공 또는 미세 골절술))

  • Gwak, Heui-Chul;Eun, Il-soo
    • Journal of Korean Foot and Ankle Society
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    • v.24 no.2
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    • pp.48-54
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    • 2020
  • Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician's preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.

Reconstruction of the Lower Extremities with the Gracilis Muscle Flap (박근 유리조직을 이용한 하지 재건술)

  • Lee, Jun-Mo;Lee, Ju-Hong
    • Archives of Reconstructive Microsurgery
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    • v.7 no.1
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    • pp.62-67
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    • 1998
  • The gracilis muscle is well suited to small and medium-sized soft tissue defects that cannot be adequately handled by simple rotational flaps and it will conform well to irregular contours, can be split longitudinally at both ends to allow cavities and awkwardly shaped spaces and can be transferred in part or in whole. The gracilis muscle used as a free muscle or musculocutaneous flap is small with a long, narrow contour and its vascular pedicle is a terminal branch of the medial femoral circumflex artery and vein. The aims of soft tissue reconstruction are to cover soft tissue defects, to clear up infection and to prepare for further surgical procedures. Authors have performed 12 gracilis muscle flaps in the lower extremities at Chonbuk National University Hospital from June 1994 through March 1998. The results were as follows. 1. 11 cases of 12(91.7%) were sustained from the crushing injury and secondary complications from the traffic accident. 2. The microsurgical anastomosis of one artery and two veins have performed in 6 cases(50%) of 12 and 11(91.7%) cases of 12 were successful at the third postoperative week and in the final result. 3. Gracilis muscle flap is the infetion-resistant and aesthetically acceptable performed in the lower leg 1/3 and the foot.

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Microcalcification Extraction by Wavelet Transform and Automatic Thresholding (웨이브렛 변환과 자동적인 임계치 설정에 의한 미세 석회화 검출)

  • Won, Chul-Ho;Seo, Yong-Su;Cho, Jin-Ho
    • Journal of Korea Multimedia Society
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    • v.8 no.4
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    • pp.482-491
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    • 2005
  • In this paper, we proposed the microcalcification detection algorithm which is based on wavelet transform and automatic thresholding method in the X-ray mammographic images. Digital X-ray imaging system is essential equipment in the field diagnosis and is widely used in the various fields such as chest, fracture of a bone, and dental correction. Especially, digital X-ray mammographic imaging is known as the most important method to diagnose the breast cancer, many researches to develop the imaging system are processing in country. In this paper, we proposed a microcalcifications detection algorithm necessary in the early phase of breast cancer diagnosis and showed that a algorithm could effectively detect microcalfication and could aid diagnosis-radiologist.

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Arthroscopic Reduction and Fixation of an Anterior Cruciate Ligament Avulsion Fracture From the Tibial Eminence Using Bioabsorbable Pins - Technical Note - (생흡수성 핀을 이용한 소아 경골 과간부 견열 골절의 관절경적 정복 및 고정 방법 - 수술 술기 -)

  • Lee, Su-Chan;Yang, Il-Soon;Seo, Hee-Soo
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.2
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    • pp.183-187
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    • 2009
  • Purpose: We describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence avulsion fracture using bioabsorbable pins in skeletally immature patients. Operative Technique: Diagnostic knee arthroscopy is performed using anterolateral and anteromedial portals. Fracture debris and blood clot are debrided to expose the injured site well. The fragment is reduced with the probe and fixed temporarily with a 1.1-mm diameter K-wire that is inserted percutaneously from the anterosuperior aspect of the knee joint. The drill guide is introduced into the joint and the fragment is secured by bioabsorbable, poly-p-dioxanone 1.3-mm pins inserted from different angles. The pins are 40 mm in length. The knee is placed in a long leg cast in extension for 4 weeks to assure that full extension is obtained. Conclusion: Arthroscopic fixation of an tibial intercondylar eminence avulsion fracture using bioabsorbable pins is not a technically demanding, suitable method that ensures fracture healing and restores the stability of the joint.

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Second-look Arthroscopy after Surgical Treatment for Osteochondral Lesion of Talus - Comparison of Mosaicplasty with Microfracture - (거골 골연골 병변의 수술적 치료 후 이차 관절경술 -자가 골연골 이식술과 미세 골절술의 결과 비교-)

  • Choi, Jin;Lee, Keun-Bae;Cho, Seong-Beom;Jung, Sung-Taek;Park, Gi-Heon
    • Journal of Korean Foot and Ankle Society
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    • v.10 no.2
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    • pp.133-139
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    • 2006
  • Purpose: To evaluate the results of mosaicplasty and microfracture after surgical treatments for symptomatic osteochondral lesion of talus (OLT) by second-look arthroscopy. Materials and Methods: 7 cases of mosaicplasty and 7 cases of microfracture were reviewed who undertook second-look arthroscopy at 6 months or one year after undertaking mosaicplasty or microfracture for OLT between December 2004 and October 2005. The mean age at first operation was 43.6 years (Range, 20-59) (Mosaicplasty; 43.9 years, Microfracture; 43.4 years). The mean size of cartilage defect was $15.0{\times}7.7\;mm$ in mosaicplasty and $7.1{\times}6.6\;mm$ in microfracture. Clinical outcomes were evaluated by Freiburg ankle score. Cartilage healing state was evaluated by Insall's classification for chondromalasia during second-look arthroscopy. Results: By the Freiburg ankle score, 9 ankles (6 in mosaicplasty, 3 in microfracture) had excellent and 5 (1 in mosaicplasty, 4 in microfracture) had good results at the times of second-look arthroscopy. By Insall's classification, consistency of the osteochondral grafts and congruity between grafts and native cartilage (Grade I) were shown in 9 (6 ankles in mosaicplasty, 3 ankles in microfracture), a fissuring (Grade II) in one ankle of mosaicplasty, a fasciculation (Grade III) in one ankle of microfracture, and partial exposure of subchondral bone (Grade IV) in 3 ankles of microfractures. Conclusion: Mosaicplasty was more excellent in consistency and hardness of cartilage than microfracture. In some cases of microfracture, cartilage healing was incomplete at 6 months postoperatively, so second-look arthroscopy is necessary to identify. If incomplete cartilage healing was shown, additional procedure such as microfracture or mosaicplasty was needed.

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Acute Shortening and Gradual Lengthening for a Comminuted Tibia Fracture with Massive Bone and Soft Tissue Defect - Case Report - (대량의 골 및 연부조직 결손을 동반한 분쇄 경골 골절에서의 급성 단축술과 점진적 연장술 - 증례 보고 -)

  • Han, Ho-Sung;Huh, Jung-Kyu;Song, Cheol-Ho;Baek, Goo-Hyun;Lee, Young-Ho;Gong, Hyun-Sik
    • Archives of Reconstructive Microsurgery
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    • v.20 no.1
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    • pp.68-73
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    • 2011
  • Traditional management of comminuted tibia fractures with massive bone and soft tissue defect includes soft tissue coverage and bone grafting. However, this method requires a large flap and a substantial amount of bone graft. Acute shortening can reduce the amount of required soft tissue and bone graft. We report a case of open tibia and fibula fracture with severe bone and soft tissue defect that was successfully treated by acute shortening of the tibia with immediate fibular strut bone graft and then by gradual lengthening of the tibia at its proximal metaphysis.

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Stiffness Analysis of External Fixation System with System Configuration Parameters (시스템 구성 인자를 고려한 외고정장치 시스템의 강성 해석)

  • Kim Yoon Hyuk;Lee Hyun Keun
    • Journal of Biomedical Engineering Research
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    • v.25 no.6
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    • pp.531-536
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    • 2004
  • In fracture treatment with external fixators, the inter-fragmentary movements at the fracture site affect the fracture healing process, and these movements are highly related to the stiffness of external fixation systems. Therefore, in order to provide the optimal fracture healing at the fracture site, it is essential to understand the relationship between the stiffness and the system configurations in external fixation system. In this study we investigated the influences of system configuration parameters on the stiffness in the finite element analysis of an external fixation system of a long bone. The system alignment, the geometric and the material non-linearity of the pin, the joint stiffness and the callus formation were considered in the finite element model. In the first, the system stiffness of the developed finite element model was compared with the experiment data for model validation. The consideration of the joint stiffness and nonlinearity of the model improved the system stiffness results. The joint stiffness, the non-alignment of the system decreased the system stiffness while the callus formation increased the system stiffness. The present results provided the biomechanical basis of rational guidelines for design improvements of external fixators and pre-op. planning to maximize the system stiffness in fracture surgery.

Results of the Autogenous Sural Nerve Graft for Ruptured Radial Nerve in the Closed Humerus Shaft Fracture (상완골 골절과 동반된 요골 신경 손상에서 자가 비복 신경 이식술의 결과)

  • Lee, Jun-Mo;Lim, Young-Jin;Park, Jong-Hyuk
    • Archives of Reconstructive Microsurgery
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    • v.14 no.2
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    • pp.138-143
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    • 2005
  • In the high radial nerve palsy caused by displaced humeral shaft fracture, radial nerve have to be explored in the fracture site. 5 cases of the ruptured radial nerve at the fracture site of the humerus from January 1993 through January 2005 were treated at first by open reduction and internal fixation with plates and screws fixation and then defective radial nerves were grafted with autogenous sural nerves by microsurgical epineurial and or perineurial neurorrhaphy. At average 30.4 months follow-up, 5 cases were recovered from motor and sensory deficit with solid bony union of the humerus shaft fracture. Authors have confirmed that ruptured radial nerve in the humerus shaft fracture grafted with autogenous sural nerve with microsurgical epineurial and or perineurial neurorrhaphy would be expected good motor and sensory recovery.

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