• Title/Summary/Keyword: 수술도달법

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Observation of Lateral Compartment through Posteromedial Trans-posterior Septal Portal in Knee Joints (슬관절 후내측 후격막 통과 도달법을 이용한 외측 구획의 관찰)

  • Lee, Ghun-Shik;Park, Han-Sung;Kim, Sang-Hyo
    • Journal of the Korean Arthroscopy Society
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    • v.9 no.1
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    • pp.56-59
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    • 2005
  • Trans-posterior septal posterior arthroscopic portals are useful in performing arthroscopic diagnosis and treatment of the lesions located in posterior aspect of knee joints. Except inferior surface of posterior horn of lateral meniscus, we easily observed entire lateral compartment, especially inferior surface of anterior horn and lateral tibial condyle by figure of 4 position through posteromedial trans-posterior septal arthroscopic portal. And it was possible to obtain visual field from posterior aspect and we could use anteromedial and anterolateral portals for instrumentation without clouding. So, this procedure may be useful in performing surgery of lateral compartment especially, anterior aspect in the knee joints.

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Thoracoscopic Anterior Release of the Spine in Total en Bloc Spondylectomy for Primary Thoracic Spinal Tumor -A case report- (원발성 흉추종양에 대한 전 척추 일괄 절제술 시 흉강경을 이용한 척추 전방 박리술 -1예 보고-)

  • Cho Deog Gon;Rhyu Kee Won;Kang Yong Koo;Cho Kyu Do;Jo Min Seop;Wang Young Pil
    • Journal of Chest Surgery
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    • v.39 no.1 s.258
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    • pp.80-84
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    • 2006
  • A combined anterolateral and posterior approach with thoracotomy has been recommended as the traditional surgical approach for the tumors of the thoracic spine. Recently, because of the morbidity associated with open thoracotomy, the thoracoscopically assisted surgical technique was introduced successfully in thoracic spinal surgery. Herein, we report a combined surgical technique for giant cell tumor of the thoracic spine (T10) consisting of bilateral thoracoscopic anterior release of the spine followed by a posterior on bloc spondylectomy and reconstruction by orthopedic surgeons. The thoracoscopic spinal surgery is safe and effective alternative for other open thoracotomic procedures in the approach to the anterior thoracic spine, avoiding the disadvantage inherent to thoracotomy.

Comparison of the Outcomes after Primary Total Hip Arthroplasty Using a Short Stem between the Modified Anterolateral Approach and Direct Anterior Approach with a Standard Operation Table (일반 수술 침대와 짧은 대퇴 주대를 이용한 인공 고관절 전 치환술의 직접 전방 도달법과 변형된 전 측방 도달법에 따른 결과 비교)

  • Park, Myung-Sik;Yoon, Sun-Jung;Choi, Seung-Min;Cho, Hong-Man;Chung, Woochull;Kang, Kyung-Rok
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.3
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    • pp.244-253
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    • 2019
  • Purpose: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. Materials and Methods: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. Results: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). Conclusion: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.

The Open Surgical Treatment for Stiff Elbow (주관절 구축의 관혈적 치료)

  • Lee, Ji-Ho;Ra, In-Hoo;Jeon, In-Ho
    • Clinics in Shoulder and Elbow
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    • v.13 no.2
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    • pp.293-298
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    • 2010
  • Purpose: Since an injured elbow joint can disturb the activity of daily life by limiting motion, especially if the motion is restricted over 40 degree of flexion contracture and under 105 degree of further flexion, it is imperative to select the best method and the timing of treatment of the elbow stiffness. Therefore this review will discuss open surgical techniques for stiff elbows based on the literature. Materials and Methods: It is important to take sufficient clinical examination of the patient, including history taking. And, a surgeon should select appropriate procedure after accurately understanding about the status and cause of the stiff elbow with radiographic methods. Surgical methods include arthroscopic release open release, distraction arthroplasty, total elbow replacement and there are four approachs in the open release - anterior approach, medial "over the top" approach, limited lateral approach: column procedure, posterior extensile approach-. Results and Conclusion: Although at present the arthroscopic technique is emphasized for the treatment of elbow stiffness, a surgeon should know conventional open techniques.

Arthroscopic Repair of the Postero-medial or Postero-lateral Capsule Tear in the Knee Joint - Technical Note - (슬관절 후내측 혹은 후외측 관절막 파열의 관절경적 봉합술 - 수술 수기 -)

  • Ahn Jin-Hwan;Cho Yang-Bum;Lee Yong-Seuk
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.2
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    • pp.135-139
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    • 2001
  • Purpose : Repair of the posterior capsule tear at the time of the operation for the chronic postero-lateral or postero-medial rotary instability has not been reported. We describe the arthroscopic repair of the posterior capsule tear using the posterior trans-septal portal. Method : After conducting basic arthroscopic examination of the knee, postero-medial and postero-lateral portals are secure to make the posterior trans-septal portal, through which the postero-medial and postero-lateral capsule tears are repaired using the suture hook under the arthroscopic guidance. Conclusion : When arthroscopic reconstruction of PCL insufficiency or postero-lateral rotaty instability that accompanies postero-medial or postero-lateral capsular tears. rising the posterior traits-septal portal could ensure better visualization of the capsule and a subsequent more accurate repair of the capsule. Since it significantly lessened instability, it could contribute to an achievement of successful clinical results.

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The Optimal Surgical Approach and Complications in Resecting Osteochondroma around the Lesser Trochanter (소전자부 주위의 골연골종 절제 시 적절한 외과적 접근법과 합병증)

  • Jeon, Dae-Geun;Cho, Wan Hyeong;Song, Won Seok;Kong, Chang-Bae;Lee, Seung Yong;Kim, Do Yup
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.33-39
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    • 2017
  • Purpose: Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed. Materials and Methods: Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach. Results: Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2-72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration. Conclusion: For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.

Comparison Study of Different Approach (Deltoid Splitting Approach and Delto-pectoral Interval Approach) for Proximal Humeral Fractures (근위 상완골 골절의 수술적 치료에서 삼각근 분할 도달법과 삼각 대흉간 도달법의 임상적, 방사선학적 추시 결과 비교)

  • Kim, Seung-Hee;Dan, Jinmyoung;Kim, Byoung-Kook;Lee, Yun-Seok;Kim, Hyoeng-Jung;Ryu, Keun-Jeong;Lee, Jin-Hyun;Kim, Jae-Hwa
    • Clinics in Shoulder and Elbow
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    • v.16 no.1
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    • pp.17-26
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    • 2013
  • Purpose: A comparison of the radiographic and the clinical outcomes between two different surgical approaches-Deltoid splitting and Delto-pectoral interval-on the proximal humerus fractures treated by locking compressive plate (LCP), is done. Materials and Methods: Medical records and pre- and postoperative radiographs were reviewed retrospectively for 75 adult patients who underwent surgical fixations with locking compressive plates from May 2005 to December 2011. Patients were divided into two groups according to the surgical methods. Differences in the neck-shaft angle between immediate postoperative period and final follow-up were compared between the two groups. Differences in constant score and Korean shoulder score (KSS) between affected arms and contralateral arms at final follow-up were also compared. Results: The differences in the neck-shaft angle between immediate postoperative period and at final follow-up was 12.04 degrees on average in Deltoid splitting approach and 10.20 degrees in Delto-pectoral interval approach, which was not statistically significant. Differences in constant score/KSS between the affected arm and the contralateral arm were 13.78/22.74 points in deltoid-splitting approach on average and 19.41/31.13 points in Delto-pectoral interval approach, showing that deltoid-splitting approach is significantly superior. Conclusion: Deltoid-splitting approach showed better functional outcomes in the fracture reduction and internal fixation using LCP for the treatment of unstable proximal humerus fractures.