• Title/Summary/Keyword: 연부조직 손상

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Clinical Application of Radial Head Prosthesis (요골두 치환술의 임상적 적용)

  • Moon, Jun-Gyu
    • Clinics in Shoulder and Elbow
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    • v.14 no.1
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    • pp.140-145
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    • 2011
  • Purpose: Installing a radial head prosthesis has developed into a reliable procedure to replace the native radial head for treating unreconstructible radial head fracture when this is associated with an unstable elbow or forearm. A variety of implants have been developed and these are now commercially available. This article reviews the literature related to the indications, the available implants and the surgical techniques of radial head replacement arthroplasty. Materials and Methods: The main indication for a metallic radial head prosthesis is a comminuted fracture that is not amenable to reconstruction, and particularly if it is associated with complex elbow injuries. Excision of the radial head should be avoided in the presence of combined injured ligaments or interosseous membrane injury. Three different implants are available in Korea, including the bipolar, press fit monopolar and loose fit monopolar radial head prostheses. A primary technical goal of radial head arthroplasty is the insertion of an implant that closely replicates the native radial head. The major pitfall when using a metallic radial head prosthesis is the insertion of a longer implant, which results in overstuffing of the radiocapitellar joint. Results and Conclusion: Satisfactory clinical results can be anticipated when a radial head prosthesis is used for the correct indications and when a systemic approach is undertaken to ensure proper sizing. For the future studies, we need data regarding the long term outcomes and comparison of the various types of prostheses.

Stabilization of Short Juxta-articular Fractures Using a Circular External Skeletal Fixator System in Dogs (개에서 원형외고정장치를 이용한 관절주위 골절의 안정화)

  • Cheong, Hye-Yeon;Kim, Joo-Ho;Cha, Jae-Gwan;Seol, Jae-Won;Kim, Min-Su;Lee, Hae-Beom
    • Journal of Veterinary Clinics
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    • v.31 no.6
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    • pp.523-526
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    • 2014
  • Three dogs were admitted for repair of bone fracture. Case 1 (Maltese, 1.8 kg, intact female, 5-month-old) and case 2 (poodle, 3.0 kg, intact female, 6-month-old) had non-weight bearing lameness in the left pelvic limb, and case 3 (mixed, 3.3 kg, intact female, age unknown) had non-weight-bearing lameness in the left thoracic limb. On orthopedic examination, there was pain, crepitus, palpable instability and substantial soft tissue swelling on the affected side. No neurological deficits were identified. Radiographs revealed left proximal metaphyseal tibial and fibular fractures in cases 1 and 2, and left proximal metaphyseal radial and ulnar fractures in case 3. All cases had closed long-bone fractures with short juxta-articular fracture segments. Under fluoroscopic guidance, proper placement of the ring fixation elements was confirmed during surgery. Two or three rings were used to stabilize fractures with traditional circular external skeletal fixators (CESF). Postoperative radiographs showed acceptable alignment and apposition of the previously identified fracture. Time to radiographic union ranged from 5 to 14 weeks and there were no signs of implant failure or pin tract infection. Functional outcomes were excellent in all cases. CESF can be successfully used to reduce short juxta-articular fractures in which bone plates or external skeletal fixation cannot be applied.

A convergence study of the effects of asymmetric standing posture on knee joint position and lower extremity muscle activity in subjects with hyper-extended knee (무릎 과다 폄을 가진 대상자에게 비대칭 선 자세가 무릎 관절 위치와 근활성도에 미치는 영향에 대한 융합적 연구)

  • Jung, Sung-hoon;Ha, Sung-min
    • Journal of the Korea Convergence Society
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    • v.10 no.9
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    • pp.63-68
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    • 2019
  • The purpose of this study was to investigate the effect of hyper-extended knee and asymmetric standing posture on knee joint position and lower extremity muscle activity. Thirty-three voluntary participants participated and included sixty legs in the study. The sixty legs were divided into two groups: hyper-extended knee and normal group. The muscle activity and knee extension angle were measured. In the asymmetric standing posture, the knee joint extension angle and the muscle activity of the gastrocnemius were statistically significant between the normal group and the hyper-extended knee group. Based on the results, we confirmed that the asymmetric standing posture increases the hyper-extended knee. Therefore, it will contribute to the establishment of therapeutic guide for the subjects with hyper-extended knee to maintain the symmetrical standing posture, and future studies need to be conducted including the effects of the hip joint and ankle joints.

Biomechanical Properties of the Cervical Muscles Depending on Using of a Smartphone (스마트 폰 사용에 따른 경추부 근육의 생체역학성)

  • Kim, Yong-Woo;Kim, Maeng-Kyu
    • 한국체육학회지인문사회과학편
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    • v.55 no.3
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    • pp.543-551
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    • 2016
  • The study was aimed at investigating the relationship between biomechanical properties of cervical muscles and smartphone addiction score in fifty healthy males using smartphone more than 60 minutes each day. The usage of smartphone was evaluated by smartphone addiction survey developed from Korean International Society Agency. Biomechanical properties of three major cervical muscles; splenius capitis, sternocleidomastoid and upper trapezius, were measured by Myoton, and conducted five parameters; frequency, decrement, stiffness, creep, and relaxation time. As results, all parameters had less than 2% of coefficient of variation(CV) between measurement intervals. Also, intra-class correlation coefficient(ICC) indicated a high reliability(ICC>.9, p<.01). Moreover, the smartphone addiction score was significantly different in frequency(r=.353, p<.05) and stiffness(r=.346, p<.05) on upper trapezius; in addition, in decrement(r=-.284, p<.05) and creep(r=.288, p<.05) on sternocleidomastoid. Especially, splenius capitis was closely related with the overuse of smartphone(frequency, r=-.368, p<.01; decrement, r=-.405, p<.01; stiffness, r=-.424, p<.01). In conclusion, this study implied that the overuse of smartphone is significantly related with the damage of cervical muscles, cervical pain, and headache; furthermore, Myoton can be used as an effective device to assess mechanical properties of cervical muscles.

Arthroscopic assisted Core Decompression of Humeral Head Osteonecrosis - Technical Note - (상완 골두 골괴사증에서의 관절경하 핵심 감압술 - 수술 술기 -)

  • Cho, Chul-Hyun;Sohn, Sung-Won;Bae, Ki-Cheor;Kim, Dong-Hoo
    • Journal of the Korean Arthroscopy Society
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    • v.13 no.2
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    • pp.174-178
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    • 2009
  • Purpose: We introduce arthroscopic assisted core decompression for humeral head osteonecrosis. Operative technique: After diagnostic shoulder arthroscopy is performed using posterior and anterior portal, we make a 2 cm lateral skin incision approximately 3 cm distal to 1/3 of lateral margin of the acromion and place short gray cannula to prevent adjacent soft tissue injury when insert guide pin. Under C-arm fluoroscopic and arthroscopic guidance, 3 to 4 guide pins are inserted toward the necrotic area. Then we perform drilling using 7.0 mm reamer. Conclusion: We believe this technique is a less invasive approach and avoids the complications comparing to deltopectoral approach. Arthroscopic assisted core decompression is an effective procedure in management of early stage of the humeral head osteonecoris.

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Transplantation of the Neurosensory Free Flaps to the Hand (수부에 시행한 신경감각 유리 조직 이식술)

  • Lee, Jun-Mo;Lee, Ju-Hong
    • Archives of Reconstructive Microsurgery
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    • v.9 no.2
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    • pp.120-126
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    • 2000
  • Microsurgical reconstruction of the hand demands recovery of the sensation of the reconstructed free flap as well as microsurgeon's intelligence, technique and experience. Even with adequate soft tissue coverage and skeletal mobility, an insensate hand is prone to further injury and is unlikely to be useful to the patients. Authors have performed 8 cases of neurosensory free flaps in the hand, 4 cases of wrap around, 3 dorsalis pedis and 1 lateral arm flap, from July 1992 through June 1999 and followed up average 4 years and 4 months. Wrap around flap was performed for reconstruction of 4 cases of thumb, repairing deep peroneal nerve and superficial radial nerve by epineurial neurorrhaphy, and followed up for average 3 years and 10 months and calculated 9mm in the static 2 point discrimination test. Dorsalis pedis flap were 3 cases for reconstruction of the ray amputation, extensor tendon exposure and wrist exposure. Deep peroneal nerve and branch of the ulnar nerve was repaired by epineurial neurorrhaphy calculating 6mm and superficial peroneal nerve and superficial radial nerve averaging 18mm in the static 2 point discrimination test for follow up average 2 years and 9 months. Lateral arm flap was 1 case for reconstruction of the ray amputation in the hand repairing posterior cutaneous nerve to the arm to the superficial radial nerve calculating 20mm for follow up 6 years and 8 months.

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Schwannoma of the Extremities (사지에 발생한 신경초종)

  • Bahk, Won-Jong;Rhee, Seung-Koo;Kang, Yong-Koo;Lee, An-Hi
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.2
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    • pp.148-154
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    • 2003
  • Purpose: To correlate the significant MRI findings and histologic features of the Schwannoma of the extremities and to review the clinical characteristic and the result of the surgical enucleation. Materials and Methods: 67 patients with pathologically proven Schwannoma of the extremities, who were surgically treated at our institutes between January 1996 and June 2002, were selected for this study. The clinical records, EMG, MRI and histologic findings were reviewed. Age of the patients ranged from 8 to 75 years with average of 44.7 years. Mean follow-up period was 9.7 months with raging from 3 months to 46 months. Results: On MRI, Schwannoma shows a well-demarcated fusiform mass with a low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images, which is connected to parent nerve. A target pattern with peripheral hyperintensive rim and central low intensity on T2-weighted images was seen in 6 cases (15%), and fasciculation pattern with inhomogenous intensity in the hyperintensity on T2-weighted images was observed in 24 cases (62%). Various degree of cystic degeneration was discovered in 25 cases (64%). Postoperative complications include tingling sense or radiating pain in 5 patients, paresthesia in 2 patients, nerve palsy in 2 patients, but all of the complications were recovered during followup period. There were no local recurrence or malignant change. Conclusion: MRI demonstrates characteristic findings of Schwannoma, and very useful tool for preoperative diagnosis and planning of surgery. Exact preoperative diagnosis and meticulous enucleation are enough option of treatment.

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Reirradiation in Rcurrent Cervical Cancer Following Definite Radiation Therapy (근치적 방사선치료 후 재발한 자궁경부암의 재 방사선치료)

  • Kim, Jin-Hee;Choi, Tae-Jin;Kim, Ok-Bae
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.230-236
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    • 2001
  • Purpose : To evaluate treatment results in terms of local control, complications and survival after reirraidiation in recurrent cervical cancer following definite radiation therapy. Material and methods : From November 1987 through March 1998, eighteen patients with recurrent cervical cancer following definite radiation therapy were subsequently treated with reirradiation at Keimyung University Dongsan Medical Center. In regard to the initial FIGO stage, one patient was stage la, five were stage IIa, three were IIb, two were IIb and two were IVa. The age range was 37 to 79 years old with median age of 57. The time interval from initial definite radiation therapy to recurrence ranged from 6 to 122 months with a median of 58 months. The recurrent sites were the uterine cervix in seven patients, vagina in ten and pelvic lymph node in one. Reirradiation was peformed with external radiation and intracavitary radiation in twelve patients, external radiation and implantation in four and external radiation alone in two. The range of external radiation dose was $2,100\~5,400\;cGy$ and the range of the total radiation dose was $3,780\~8,550\;cGy$. The follow-up periods ranged from 8 to 20 months with median of 25 following reirradiation. Results : Fourteen of eighteen patients $(78\%)$ had local control just after reirradiation. The two year disease free survival (2YDFS) rate was $53.6\%$. There were statistically significant differences in the 2YDFS according to both recurrent site (2YDFS $28.5\%$ in uterine cervix, $71.4\%$ in vagina, (p=0.03)) and the total dose (2YDFS $71.8\%$ in >6,000 cGy , $25\%$ in $\leq6,000$ cGy, p=0.007). Seven of ten patients who were followed for more than 20 months remain alive and disease free (7/18, $39\%$). Patients treated with external radiation and intracavitary radiation had a higher rate of 2YDFS. Seven patients including 4 patients with no local control experienced local failure in the uterus or vagina and two patients died with distant metastasis. Complications included rectal bleeding in 3 patients, bowel obstruction treated with surgery in two, hematuria in one, radiation cystitis in two, soft tissue swelling in two and vaginal necrosis spontaneously healed in one. There was no statistical difference in complications according to the total dose or the time to recurrence from initial radiation. Conclusion : In patients with recurrence following definite radiation therapy in the uterine cervical cancer, reirradiation may be effective but requires an effort to reduce radiation induced severe complications.

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