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Limb Lengthening in the Osteoporotic Bone
Hui Taek Kim(김휘택),Seong Ho Whang(황성호),Jeong Han Kang(강정한),Jong Seo Lee(이종서),Sang Jin Cheon(천상진),Chong Il Yoo(유총일),Hee Kyung Chang(장희경) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.8
목적: 스테로이드로 골 다공증을 유도한 가토에서 신연 골형성을 연구하였다. 대상 및 방법: 성숙한 가토에서 스테로이드 투여 용량에 따라 1군(스테로이드를 투여하지 않은 군), 2군(0.4 ㎎/㎏/day 2주간 투여한 군), 3군(0.4㎎/㎏/day 4주간 투여한 군), 4군(0.8 ㎎/㎏/day 2주간 투여한 군), 5군(0.8 ㎎/㎏ 4주간 투여 한 군)으로 나누었다. 스테로이드 투여 후 경골 간부에 외고정 기구를 고정한 후 절골술을 시행하였으며 4주간 골신연술을 시행하였다. 1주마다 단순 방사선 사진 촬영과 골밀도 및 퍼센티지 골밀도를 측정하고, 최종 신생골 형성 정도에 따라 3개의 군으로 나누어 조직학적 분석을 하였다. 결과: 양호한 가골을 형성한 가토는 모두 1군이었다. 그들의 요추 골밀도는 평균 5.1% 감소되었으며, 신연 1주 후 신연부 퍼센티지 골밀도는 50 이상이었다. 결론: 성숙한 가토에서 요추 골밀도가 10% 이상 감소되었거나, 신연 1주 후 퍼센티지 골밀도가 50 미만인 경우 사지 연장술 중 문제점의 발생이 예상된다. 인체에 있어서도 유사한 수치가 적용될 수 있으리라 생각된다. Purpose: This study investigated the results of distraction osteogenesis in steroid-induced osteoporotic rabbits. Materials and Methods: Mature rabbits were assigned to the following five steroid dosage groups: Ⅰ (none); Ⅱ (0.4 ㎎/㎏/day for 2 weeks); Ⅲ (0.4 ㎎/㎏/day for 4 weeks); Ⅳ (0.8 ㎎/㎏/day for 2 weeks); Ⅴ (0.8 ㎎/㎏/day for 4 weeks). After the steroid injection, the tibias were osteotomized and distracted for 4 weeks. The rabbits were classified radiographically into three groups according to the quality of new bone formed, and the Bone mineral density (BMD) and percentage BMD for these groups were then compared. The microscopic results supported the radiographic groupings. Results: The rabbits that formed good calluses were all from group Ⅰ, and their average lumbar BMD remained high (mean decrement, 5.1%). These rabbits had a percentage BMD ≥50 after 1 week of the distraction. Conclusion: Problems can be expected during limb lengthening in mature rabbits that shows a lumbar BMD decrease ≥10%, or a percentage BMD <50 after 1 week of the distraction. Similar guidelines may be indicated for humans.
Reconstruction of Acetabular Posterior Wall Fractures
Hui Taek Kim,Jae-Min Ahn,Jun-Oh Hur,Jong-Seo Lee,Sang-Jin Cheon 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.2
Background: The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction. Methods: Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D’aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated. Results: The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome. Conclusions: This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.
김휘택(Hui Taek Kim),박건보(Kunbo Park),서창효(Chang Hyo Seo),안태영(Tae Young Ahn),김인희(In Hee Kim) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.4
목적: 소아청소년기에 발생한 거골 박리성 골연골염 환자들의 보존적 치료와 수술적 치료의 결과를 비교하였다. 대상 및 방법: 18세 이하 24명(31예)의 환자를 대상으로 하였다. 1군은 14예(평균 13.0세)로 모두 보존적 치료를 받았다. 2군은 17 예(평균 15.1세)로 모두 수술적 치료를 받았다. Berndt와 Harty 분류에 의하면 1군에서 I단계 6예, II단계 4예, III단계 3예, IV단계 1예가 있었고, 2군에서는 I단계 1예, II단계 9예, III단계 7예였다. 병변은 1군은 1예를 제외한 13예에서 내측에 발생하였고, 2군은 3예에서 외측, 14예에서 내측에 발생하였다. 평균 추시 기간은 1군은 31.9개월, 2군은 28.9개월이었다. 임상적 및 방사선적 결과는 American Orthopaedic Foot and Ankle Society (AOFAS) 점수와 Higuera 등의 분류를 이용하였다. 결과: AOFAS 임상적 평균 점수는 1군에서 91.4점, 2군에서는 87.5점이었다. Higuera 등의 임상적 평가는 1군에서 매우 우수 6예, 우수 7예, 보통 1예가 있었고, 2군에서 매우 우수 5예, 우수 2예, 보통이 10예였으며, 방사선적 평가는 1군에서 우수 13예, 보통 1예였고, 2군에서 우수 10예, 보통 7예였다. 양 군 간 치료 결과의 통계적 차이는 없었다. 결론: 소아 및 청소년기에 발생한 거골의 박리성 골연골염의 경우 일차 보존적 치료로 만족할 만한 결과를 얻을 수 있었다. Purpose: We compared the results between conservative and surgical treatment methods in a group of children and adolescents with osteochondritis dissecans of the talus. Materials and Methods: A total of 24 patients (31 ankles), who were younger than 18 years old, were included in this study. Group 1 consisted of 14 ankles (mean age at the time of treatment was 13.0 years) treated conservatively. Group 2 consisted 17 ankles (mean age at the time of treatment was 15.1 years) treated surgically. According to the Berndt and Harty classification, there were 6 ankles in class I, 4 in class II, 3 in class III, and 1 in class IV in group 1; 1 ankle in class I, 9 in class II, and 7 in class III in group 2. In group 1, there were 13 medial lesions and 1 lateral lesion; and in group 2, there were 14 medial lesions and 3 lateral lesions. The mean follow-up period was 31.9 months for group 1 and 28.9 months for group 2. Clinical and radiologic results were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the classification by Higuera et al. Results: The mean AOFAS clinical score was 91.4 in group 1 and 87.5 in group 2. According to the classification by Higuera et al., regarding clinical results, there were 6 excellent, 7 good, and 1 fair in group 1, and 5 excellent, 2 good, and 10 fair in group 2. As for radiological results, there were 13 good and 1 fair in group 1, and 10 good and 7 fair in group 2. There was no statistical difference between the two groups. Conclusion: Conservative treatment provided satisfactory results for osteochondritis dissecans of the talus in children and adolescents.