• 대한정형외과학회지
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• 제56권6호
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• pp.461-471
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• 2021

Kienböck 질환을 완관절의 월상골에 발생한 무혈성 괴사로 정의하고 있지만 원인과 자연경과, 적정한 치료 방법에 대해서는 정확하게 밝혀져 있지 않다. 교과서적으로는 병의 진행 단계를 나누고 단계에 따라 치료 방법을 제시하고 있지만 과연 원칙에 맞는 올바른 치료 방법인지에 대한 충분한 검증 없이 따르고 있는 것은 아닌가 하는 의문이 드는 것도 사실이다. 저자는 그동안 많은 Kienböck 질환을 진단하고 치료를 하면서 교과서에 기술된 내용 중에서 의문이 드는 부분이 많았으며, 자료 분석과 경험을 토대로 나름대로의 적정한 치료 접근을 정립하고자 하였다. 본 종설에서는 기존의 지식이 과연 정확한 근거를 바탕으로 한 것인지 검토해 보면서 합리적인 치료 방법에 대한 저자의 의견을 제시해 보고자 한다.

• Journal of Acupuncture Research
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• 제30권5호
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• pp.203-209
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• 2013

Objectives : The purpose of this study is to report the clinical effects of Korean medical treatment for Kienb$\ddot{o}$ck's disease. Methods : The patient was treated using acupuncture, electroacupuncture, herbal medicine, pharmacopuncture treatment, and other treatments including moxibustion, physical rehabilitation for 6 weeks. And we evaluated the patient through verbal rating scale(VRS), disability of the arm, shoulder and hand(DASH), range of motion(ROM). Results : After treatment, VRS is changed from 7 to 3, DASH is changed from 37.93 to 20.69. And ROM is changed from $60^{\circ}$ to $70^{\circ}$ in wrist flexion, and from $10^{\circ}$ to $15^{\circ}$ in radial deviation. Conclusion : These results suggest that Korean medical treatment is effective to the patient complaining pain and dysfunction.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.101-106
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• 2006

The purpose of this study was to analyze the mid to long-term clinical and radiological outcome of vascularized pronator quadratus-wrapped radial bone flap arthroplasty for symptomatic advanced $Kienb{\ddot{o}}ck's$ disease. Between 1982 and 2000, 41 cases of advanced $Kienb{\ddot{o}}ck's$ disease were treated with vascularized pronator quadratus wrapped radial bone flap arthroplasty. There were 17 men and 24 women, with a mean age of 39 years at the time of operation. According to Lichtman's classification, there were 13 stage IIIb and 28 stage IV patients. The duration of follow-up averaged 6.1 ($3{\sim}22$) years. We assessed the clinical outcome by subjective pain and active range of motion of the wrist, and evaluated the radiologic outcome by using carpal height ratio and radioscaphoid angle. Postoperatively, all patient reported an improvement in their symptoms. The mean active extension and flexion were improved by $9^{\circ}$ and $6^{\circ}$, respectively (p<0.05). The carpal height ratio was decreased from a mean of 0.52 to 0.48, and the radioscahpoid angle was increased from a mean of $61^{\circ}$ to $66^{\circ}$, but the differences were not significant statistically. Vascularized pronator quadratus-wrapped radial bone flap arthroplasty improves the wrist motion and may prevent serious carpal collapse in advanced $Kienb{\ddot{o}}ck's$ Disease.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.108-114
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• 2008

Purpose: There are many controversies concerning therapeutic guidelines for the treatment of Kienb$\ddot{o}$ck's disease. The purpose of this study is to evaluate the clinical and radiological result of lunate replacement by vascularized os pisiform transfer in advanced Kienb$\ddot{o}$ck's disease. Materials & Methods: There were two men and three women. The mean age was 55 years, ranging from 41 to 70. According to Lichtman's classification, three cases were stage IIIb and two cases were stage IV. Results: At the period of follow up, pain during motion was markedly diminished in all patients, the arc of motion ranged on average from 49 degrees of flexion to 53 degrees of extension and the grip power of the affected hand reached on average 83% compared with the contralateral side. Clinical results assessed by DASH and modified Mayo score showed 8 and 90. On plain X-rays, carpal height ratio and radioscaphoid angle were not changed postoperatively. Conclusion: Lunate excision and vascularized os pisiform transfer is a reliable alternative method for the treatment of advanced Kienb$\ddot{o}$ck's disease.