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Larsen 술식을 이용한 만성 족관절 외측부 인대 손상의 치료
건국대학교 민중병원 정형외과와 한국보훈병원 정형외과에서 1991년 3월부터 1993년 2월까지 만성 족관절 분안정성 환자 11명을 대상으로 Larsen 술식을 시행하여 다음과 같은 결론을 얻었다. (1) 남자가 9명, 여자가 2명 이었고 연령은 18세에서 41세까지로 평한 31세이었다. (2) 수술 적응증은 족관절 불안정을 호소하는 환자로 스트레스 방사선 검사상 거골경사각이 Cox와 Hewes의 기준에 의거 건측에 비해 10˚이상, 전방전위정도가 Seligson등의 기준에 의해 3mm 이상의 차이를 보인 경우로 하였다. (3) 수술후 Excellent 5례(45%), Good 4례(36%)로 9례에서 양호한 경과를 얻었다. (4) 합병증은 표재성 감염 1례, 족관절의 지속적인 불안정성 1례, 그리고 1례에서 경한 퇴행성 변화 등이었다. (5) Larsen 술식은 간단하면서도 보다 해부학적인 위치에서 족관절과 거골하관절 모두를 안정화 시키며, 불안정성의 유형에 따라서 건의 종골부착부위를 적당히 변동시킬 수 있다는 점에서 족관절 만성 불안정성 환자에게 우수한 수술방법으로 사료된다. Injury of the ankle ligaments is one of the most common sports-related injuries. Although there is some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using Peroneus brevis tendon from March, 1991 to February, 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indications of surgical treatment were in cases of ankle instability which had differences over 10˚ in talar tilting angle or over 3 mm in anterior displacement compared with the uninjuried site. 2. The postoperative results were 5 cases in excellent and 4 cases in good. 3. The Larsen procedure was considered good method in according to stabilize both the ankle and subtalar joint anatomically and simply and fix tendon depending on the type of instability.
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활성산소가 골아세포내 Ca^(2) 활성도에 미치는 영향
Physiological activity of osteoblast is known to be closely related to the increase of intracellular Ca^(2+) activity ([Ca^(2+)]_(i)) in osteoblast. Reactive oxygen species such as H_(2)O_(2) plays an important role in regulation of cellular functions such as transcription, growth factor action and ion transport. In this study, the effects of reactive oxygen species on the intracellular Ca^(2+) regulation in osteoblast-like cells (OLCs) were investigated by measuring Ca^(2+) activities with cell imaging techniques. OLCs were isolated from femur and tabia of neonatal rats, and cultured for 7 days. The cultured OLCs were loaded with a Ca^(2+)-sensitive fluorescent dye, Fura-2, and fluorescence images were monitored with a cooled CCD camera and analyzed with an image analyzing software. The results are as follows: (1) [Ca^(2+)]_(i) of OLC increased as the H_(2)O_(2) concentration in superfusing Tyrode solution was raised, in two fashions. The OLCs with lower basal Ca^(2=) activities yielded a transient Ca^(2+) increase, the Ca^(2+) spike, while OLCs with higher basal Ca^(2+) activities showed continuous increase in [Ca^(2+)]_(i) leading to the cell death. (2) tBHP did not have a significant effect on Ca^(2+)-dependence of [Ca^(2+)]_(i). (3) Ca^(2+) spikes, generated when Na^(+) in the supefusing solutions was removed, were blocked by tBHP and H_(2)O_(2). However, H_(2)O_(2) induced a continuous Ca^(2+) release from the internal Ca^(2+) stores under the extracellular Na^(+) and Ca^(2+)-free condition. (4) Ca^(2+) efflux generated by Na^(+)-Ca^(2+) exchange was not affected by H_(2)O_(2). These results suggest that H_(2)O_(2) modulates the intracellular Ca^(2+) activity in osteoblast by the modifications of the Ca^(2+) transport across the cell membrane and Ca^(2+) release from the internal stores. Further studies with histochemical and biochemical techniques will enrich the findings of the study.
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