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자가 슬괵건을 이용한 전방 십자 인대 재건술 - 새로운 대퇴부 현수고정법인 Cross Pin과 일정한 긴장력 유지를 위한 Graft Tensioner 사용의 단기 추시 결과 -
서승석,김창완,김진석,최상영,Seo, Seung-Suk,Kim, Chang-Wan,Kim, Jin-Seok,Choi, Sang-Yeong 대한정형외과스포츠의학회 2011 대한정형외과스포츠의학회지 Vol.10 No.1
목적: 자가 슬괵건을 이용한 전방 십자 인대 재건술에서 Cross pin 및 Graft Tensioner를 이용한 수술의 단기 추시 결과를 보고하고 조기 경험에서 발견된 수술 술기상의 문제점과 그 해결방안을 모색하고자 한다. 대상 및 방법: 2008년 1월부터 2009년 3월까지 자가 슬괵건을 이용한 전방 십자인대 재건술 후 최소 18개월이상 추시가 가능하였던 35예를 대상으로 하였다. 이식건의 대퇴골측 고정을 위해 Cross pin을, 경골측의 고정을 위해 Intrafix와 Post-tie를 사용하였다. 이식건은 Graft Tensioner을 이용하여 80N의 힘으로 고정하였다. 결과는 임상적, 방사선학적 결과와 합병증으로 평가하였다. 결과: IKDC 주관적 점수 및 Lysholm 점수는 술 후 89.1점 및 91.4점로 호전되었으며 축이동 검사 및 One-leg hop 검사도 술후 양호한 소견을 보였다. KT-1000 관절계 검사 및 Telos 부하 방사선 검사상 최종 추시시 건측에 비해 평균 $2.8{\pm}1.6$ mm, $2.6{\pm}1.3$ mm로 호전을 보였으며 대퇴골 터널은 평균 $2.3{\pm}1.1$ mm로 확장되었다. 수술 술기상 문제점으로 대퇴골 터널과 횡고정 터널의 불일치, 대퇴골 터널과 Graft Harness의 길이 불일치 그리고 연부 조직 자극이 관찰되었다. 결론: Cross pin 및 Graft Tensioner를 이용한 전방 십자인대 재건술은 단기 추시 상 좋은 안정성을 보여주는 수술 방법 중의 하나로 사료된다. 그러나 술기상 문제로 대퇴 터널-cross pin 불일치를 줄이기 위해 대퇴 터널을 짧게 만들거나 cross pin 터널을 피질골에 가능한 수직으로 만들어야 하며 대퇴 터널 형성시 위치 막대를 3 mm가량 더 진행시켜야 대퇴 터널-graft harness 불일치를 줄일 수 있을 것으로 생각된다. Purpose: To evaluate the short term clinical result of ACL reconstruction with autologous hamstring tendon using Cross pin and Graft Tensioner and to seek way to resolve the experienced technical problems. Materials and Methods: From January 2008 to March 2009, 35 patients who had been treated arthroscopic ACL reconstruction were enrolled. The femoral side of ACL graft was fixed with Cross pin. The tibial side of graft was fixed with Intrafix and post-tie. The graft was tensioned with Graft Tensioner at 80N. We analyzed the clinical, radiographic results and complications. Results: IKDC subjective score and Lysholm score improved to 89.1 and 91.4 points. Also, Pivot shift test and One-leg hop test showed good results postoperatively. Side to side difference using KT-1000 arthrometer and Telos stress radiography improved compared with normal limb to $2.8{\pm}1.6$ mm and $2.6{\pm}1.3$ mm, respectively. The femoral tunnel enlarged to $2.3{\pm}1.1$ mm. Soft tissue irritation and femoral tunnel-graft harness length mismatch, femoral tunnel-cross pin tunnel mismatch were happened as peri-operative complications. Conclusion: Using of Cross pin and Graft Tensioner for ACL reconstruction with hamstring tendon is one of the good method for obtaining stability in short-term clinical result. But to reduce femoral tunnel-cross pin mismatch, it needs to shorten femoral bone tunnel and to create cross pin tunnel as vertical as possible. And to reduce femoral tunnel-graft harness mismatch, it needs to advance position rod further 3 mm when to create femoral tunnel.
자가 슬괵건을 이용한 전방 십자 인대 재건술에서 생체 흡수성 간섭 나사와 피질 골편을 이용한 대퇴 터널내 고정
서승석(Seung Suk Seo),유성진(Sung Jin You),최장석(Jang Seok Choi),김영창(Young Chang Kim) 대한슬관절학회 2001 대한슬관절학회지 Vol.13 No.1
Purpose: The purpose of this study is to report the postoperative clinical results after arthroscopic ACL reconstruction using quadrupled hamstring autograft fixed with biodegradable interference screw and bone block in the femoral tunnel. Meterials and Method: Between January and December 1997, we performed an arthroscopic ACL reconstruction with quadrupled hamstring autograft in twenty one patients. To enhance the mechanical stability in the femoral tunnel the graft was fixed with a biodegradable interference screw and cortical bone block which was harvested from the proximal tibial metaphysis. The tibial side of graft was tied at the post of an AO cortical screw. Postoperatively the patients were permitted an accelerated rehabilitation with motion brace. The results were evaluated with IKDC form, complications and radiologic findings. The average follow-up was 36 months. Results: Patient subjective assessment was graded normal in 4, nearly normal in 8, abnormal in 7, severe abnormal in 2. Ligament evaluation was graded normal in 16, nearly normal in 3, abnormal in 1, severe abnormal in 1. Harvest site pathology was graded normal in 16, nearly normal in 4, abnormal in 1. Functional test was graded normal in 6, nearly normal in 8, abnormal in 4, severe abnormal in 3. Radiologic findings showed an average 22% increase in the tibial tunnel diameter. Postoperative complications were one recurrent patholaxity, deep infection and arthrofibrosis required operation in each. Conclusion: Arthroscopic ACL reconstruction using quadrupled hamstring autograft fixed with biodegradable interference screw and bone block in the femoral tunnel provided with excellent ligament stability and permitted the early accelerated rehabilitation.
슬관절 외측 측부 인대 복합체 급성 손상의 수술적 치료
최재상(Jae Sang Choi),서승석(Seung Suk Seo),김영창(Young Chang Kim),최장석(Jang Seok Choi) 대한슬관절학회 2001 대한슬관절학회지 Vol.13 No.1
Purpose: The purpose of this study is to elucidate the clinical features of the acute lateral ligamentous complex injuries and evaluate the postoperative results. Materials and Methods: Between 1991 and 1997, 27 patients (28 cases) were treated surgically for acute lateral ligament complex injuries. All cases showed 2+ or more varus instability and were treated within 6 weeks after trauma. 20 cases combined other ligamentous injuries and 8 cases had isolated injuries. Among the lateral ligament complex the lateral collateral ligament was ruptured in all cases. Meniscal injuries were associated in 12 cases and 5 cases showed common peroneal nerve injury but no cases showed vascular injuries. Result: On Telos stress X-ray, the varus stability was improved from 2,12+(mean 8.6mm) to 0.50+(mean 2.8mm) in isolated injuries and from 2.95+(mean 9.5mm) to 1.10+(4.5mm) in combined injuries. Cases with isolated injury showed no C and D grade on IKDC subjective evaluation, ligament evaluation and range of motion evaluation. Cases of combined injuries showed 5C and 3D on subjective evaluation, 3C and 2D on ligament evaluation, 3C and 1D on range of motion evaluation. Most common postoperative complication was joint stiffness, of which 2 cases were treated with arthroscopic adhesiolysis. Conclusion: Prognosis in isolated cases was good and the results were influenced with combined injuries. To reduce postoperative complications a secure fixation and early rehabilitation was recommended. Our study supports the notion that operation performed at an early stage in fresh injuries with a varus instability of 2+ or more gives improved stability as a final result.
Diclofenac Diethylammonium 플라스터제 (류마스탑${\circledR})$의 경피흡수에 따른 임상약동학적 특성의 분석
윤영란,차인준,손지홍,김경아,김민정,박성욱,서승석,최장석,이형기,신재국,Yoon, Young-Ran,Cha, In-June,Shon, Ji-Hong,Kim, Kyoung-Ah,Kim, Min-Jung,Park, Sung-Wook,Seo, Seung-Seok,Choi, Jang-Seok,Lee, Hyeong-Ki,Shin, Jae-Gook 대한임상약리학회 2000 臨床藥理學會誌 Vol.8 No.1
Background: Transdermal absorption pharmacokinetics of diclofenac diethylammonium(DEA) plaster $(Rheumastop{\circledR})$ were estimated after single and multiple application in normal healthy subjects. Methods : Single plaster of 120 mg diclofenac DEA was applied to upper arm of 14 healthy male subjects for 24 hours and replaced with new plaster every 24 hours for following 14 days. Serial blood samples were drawn after the first dose and the last dose of the plaster and intermittent blood samples were drawn at 3, 5, 7 and 10 days of the study. Diclofenac concentrations in plasma, urine and plaster were determined by high performance liquid chromatography method. Pharmacokinetic parameters were estimated by both noncompartmental analysis and compartmental analysis of 2-compartment, 2-segment simultaneous input model with using $(NONMEM{\circledR})$ Results : The amount of diclofenac absorbed during 24 hour application of each diclofenac DEA plaster was estimated to $6.6{\pm}3.5$ mg and was corresponded to 6.9 % of total amount of diclofenac measured in the in tact plaster(average 95.17 mg). After the first dose of a diclofenac plaster, the average peak plasma concentration was reached to maximum concentration $(7.4{\pm}3.6 ng/ml)$ at $12.4{\pm}9.2$ hour. After multiple doses of diclofenac DEA plaster, the plasma concentration reached to peak level $(15.9{\pm}11.7 ng/ml)$ at $7.9{\pm}7.4$ hours, then concentrations were declined very slowly to $(10.0{\pm}5.1 ng/ml)$ at the time of next application. The mean AUC of diclofenac at steady state was estimated to $273{\pm}205 ng/ml$ h. From the compartmental model for the transdermal absorption of diclofenac DEA plaster, $75{\pm}14$ % of diclofenac dose was described by the burst zero order input model and the remained was by slow first order input model. The estimated volume of distribution (Vd/F) was estimated to $2.2{\pm}0.8$ L/kg and half life was $3.4{\pm}0.8$ hour. Conclusions : The diclofenac DEA plaster which shows initial burst and slow continuous input absorption kinetics appears to be able to maintain constant plasma level during 24 hour application. The measured plasma concentration-time profiles at steady-state are expected to be adequate for therapeutic effect, taking into account the comparable results to those from twice a day application of 185 mg diclofenac HEP plaster of which clinical effect has been well established. However, further clinical trials in patients are remained to document the clinical effects of this new diclofenac plaster.