양악 악교정 수술에서 르포트 I형과 U-자형 복합 골절단술 후 상악골의 안정성에 관한 임상적 연구

김민근,박영욱,Kim, Min-Keun,Park, Young-Wook 대한악안면성형재건외과학회 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.6

Postoperative skeletal stability was evaluated in combination of Le Fort I and U-shaped osteotomies for superior repositioning of maxilla in bi-maxillary surgeries in 30 consecutive patients. The fifteen patients underwent Le Fort I osteotomy alone and the other fifteen patients underwent Le Fort I and U-shaped osteotomies. In all patients, the maxilla was first osteomized and fixed with absorbable plates system. A bilateral sagittal split ramus osteotomy (BSSRO) of the mandible was then carried out and fixation was performed using absorbable plates. Maxillo-mandibular fixation with rubber ring was used for two weeks post-operatively in all patients. Lateral cephalograms were obtained pre-operatively, 1 day post-operatively, 6 months after surgery. The changes in anterior nasal spine (ANS), point A, upper incisior (U1), and point of maxillary tuberosity (PMT) were examined. The maxillas in the fifteen patients of both examination group were repositioned nearly in their planned positions during surgery and no significant post-operative changes in the examined points of the maxilla were found. These results suggest that a combination of a Le Fort I and U-shaped osteotomy is a useful technique for reliable superior repositioning of the maxilla. The post-operative change in the maxilla using this combination osteotomy was comparatively stable.

퇴행성 요추 후만증의 수술적 치료 방법에 따른 결과 비교 분석

이재철,소재완,조주형,김연일,신병준 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.1

연구계획: 후향적 분석 연구목적: 퇴행성 요추 후만증으로 시상면 불균형을 초래한 환자에서 절골술을 시행한 경우와 절골술 없이 후방 전만 복원술만 시행한 경우, 전방 및 후방 전만 복원술을 같이 시행한 경우로 나누어 수술방법에 따른 방사선학적 및 임상적 차이를 비교하여 분석하였다. 대상 및 방법: 퇴행성 요추부 후만증으로 전만 복원술을 시행한 33명의 환자를 대상으로 하였다. 수술 당시 평균 연령은 61.2세였고, 33예 모두 여자였다. 추시 기간은 평균 34.7개월(12~125개월)이었다. 수술 방법에 따라 후방 절골술을 시행하여 전만 복원술을 시행한 7예를 A군, 절골술을 시행하지 않고 후방 전만 복원술만 시행한 15예를 B군, 전방 및 후방 전만 복원술을 모두 시행한 11예를 C군으로 분류하였다. 각 군은 방사선학적 계측으로 수술 전과 후, 최종 추시시 전체 요추부 전만각, 상위 요추부 전만각, 하위 요추부 전만각, 골반 경사각을 측정하고 임상결과를 평가하였다. 결과: 방사선학적 계측에서, 수술에 의한 교정 정도는 전체 요추부 전만각과 하부 요추부 전만각이 A군과 C군에서 B군보다 유의하게 컸고, 상위 요추부 전만각은 A군이 C군보다 유의하게 컸다. 최종 추시에서 교정 소실 정도는 세 군간에 통계학적으로 유의한 차이가 없었다. 임상적 결과는 A군, B군, C군간에 통계학적인 유의한 차이는 없었다. 합병증의 발생은 A군에서 4예(57%), B군에서 2예(13.3%), C군에서 2예(18.2%)로 A군에서 발생 빈도가 다소 높았으나, 통계적인 의미는 없었다. 재수술은 A군에서만 2예 시행하였다. 결론: 퇴행성 요추 후만증의 수술적 치료 방법 중 후방 절골술과 전방 및 후방 교정술을 시행한 경우가 후방 교정술만을 시행한 경우보다 요추부 후만각 교정에 효과적이었다. 임상적 결과는 각 군간에 유의한 차이가 없었으나, 합병증의 발생 빈도는 후방 절골술을 시행한 경우에 다소 높아서 주의를 요하며, 전후방 유합술이 선호될 수 있으리라 사료된다. Study Design: A retrospective study Objectives: To compare the radiological and clinical outcomes of three surgical methods Summary of literature Review: There were many proposed surgical treatments for lumbar degenerative kyphosis but the best treatment is still controversial. Materials and Methods: Thirty three patients (all female) had undergone surgery. The mean age at surgery was 61.2. The average follow-up period was 34.7 months. The patients were divided into three groups. Group A included 7 cases with a correction by a posterior osteotomy, Group B included 15 with a posterior correction without an osteotomy, and Group C included 11 with combined anterior-posterior surgery. The radiographic measurements of lumbar lordosis, upper lumbar lordosis, lower lumbar lordosis, and pelvic tilt were performed before surgery, after surgery, and at the final follow-up visit. The loss of correction, complication rates and the clinical results were also compared. Results: Postoperative correction of the lumbar and lower lumbar lordosis were significantly higher in group A and C than group B. The correction of upper lumbar lordosis was significantly higher in group A than group C. On the final follow-up, there was no significant difference in the loss of correction and clinical results between the three groups. The number of cases with complications in groups A, B and C was 4 (57%), 2 (13.3%) and 2 (18.2%), respectively. Two patients in group A required additional surgery. Conclusions: Groups A and C were more effective than posterior-only correction. There was no significant difference in the clinical results between the three groups but complication rate was higher in Group A than the other groups. Combined anterior and posterior surgery can be a safe and effective method for correction.

중안모 기형의 교정을 위한 Le Fort II & I 복합골 절단술을 이용한 외과적 교정술의 개발

김명진(Myung Jin Kim),이안나(An Na Yi),김성곤(Sung Gon Kim),남일우(Il Woo Nam),김종원(Jong Won Kim) 대한구강악안면외과학회 1997 대한구강악안면외과학회지 Vol.23 No.4

Many authors reported the etiology of hypoplasia of the nasomaxillary complex as trauma, infection, underdevelopment. To correct these deformities, Le Fort II Osteotomy and its modification has been popularly applied. This method enabled total advancement of nasomaxillary complexes and acquirememt of midfacial esthetics. But it has some limitations such as various occlusal deviation or lateral shifting of nasomaxillary complex in case of nasomaxillary retrusion. We grouped these patients as follows : 1. Nasomaxillary retrusion without shifting of nasomaxillary complex (1) Anteroposterior deviation of occlusal plane (2) Lateral deviation of occlusal plane(including canting) (3) Supero-inferior deviation of occlusal plane (4) Combined disturbance of occlusal plane without shifting of nasamaxillary complex 2. Lateral shifting of nasomaxillary complex with or without deviation of occlusal plane We performed Le Fort II and I combined osteotomy on eleven cases of midfacial deformity from June 1994 to July 1997 and in most of the cases, followed up maximum 36 months and could acquire positional stability and improvement of facial eathetics.

Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction

Hong-Geun Jung,Jong-Soo Lee,Dong-Oh Lee,Sung-Wook Kim,Juan Agustin Coruña 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: Problems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS). Methods: Two groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured. Results: The mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280). Conclusions: We found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.

Major Surgical Treatment of Osteoporotic Vertebral Fractures in the Elderly: A Comparison of Anterior Spinal Fusion, Anterior-Posterior Combined Surgery and Posterior Closing Wedge Osteotomy

Shota Takenaka,Yoshihiro Mukai,Noboru Hosono,Takeshi Fuji 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.3

Study Design: A retrospective study. Purpose: To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results. Overview of Literature: Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures. Methods: The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison. Results: The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction. Conclusions: The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.

Comparison of Clinical Outcomes and Complications of Primary and Revision Surgery Using a Combined Anterior and Posterior Approach in Patients with Adult Spinal Deformity and Sagittal Imbalance

Whoan Jeang Kim,Hyun Min Shin,Dae Geon Song,Jae Won Lee,Kun Young Park,Shann Haw Chang,Jin Hyun Bae,Won Sik Choy 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.2

Background: The purpose of this study was to compare clinical outcomes and complications of primary and revision surgery in patients with adult spinal deformity (ASD) accompanied by sagittal imbalance. Revision surgery has been associated with poor clinical outcomes and increased risk of complications. Previous studies comparing primary versus revision surgery included data for a wide variety of diseases and ages, but few investigated patients with ASD with sagittal imbalance undergoing anterior and posterior combined surgery. Methods: Retrospective cohort analysis of prospectively collected data. We identified 60 consecutive patients with ASD combined with sagittal imbalance who underwent primary or revision surgery; of these, 6 patients were excluded for lack of a minimal 2-year follow-up. Patients’ surgical and radiological data, clinical outcomes, and complications were reviewed. Results: There were 30 patients in the primary group and 24 patients in the revision group. Patient characteristics, including the prevalence of sarcopenia, were similar between the two groups. Pedicle subtraction osteotomy was performed more frequently in the revision group although there was no statistically significant difference between groups. The primary group had more proximal junctional problems, whereas the revision group had more rod breakage (p < 0.05). There were significant improvements in clinical outcomes in both groups when the preoperative and 2-year postoperative values were compared. The Oswestry disability index and visual analog scale score were similar in both groups 2 years postoperatively. Conclusions: Considering the greater pain and disability at the time of the revision procedure, revision patients benefited more from surgery at the 2-year follow-up than the primary surgery patients. Complication rates were similar between the groups except for proximal junctional problems and rod breakage. Therefore, revision surgery should not be avoided in the treatment of ASD patients with sagittal imbalance.

Post-Operative Skeletal Stability of the Maxilla Treated with Le Fort 1 and U-Shaped Osteotomies in Simultaneous Maxillomandibular Orthognathic Surgery

Min Keun Kim,Young Wook Park 大韓顎顔面成形再建外科學會 2009 Maxillofacial Plastic Reconstructive Surgery Vol.31 No.2S

두개저 종양에 대한 확대 경기저 개두술

나형균,지철,최창락 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4

The extensive transbasal approach by Kawakami is a mOdifkation of the transbasal approach of Derome. This approach. an en bloc bilateral osteotomy of the orbital roofs and frontal sinus following an ordinary bifrontal craniotomy improves the exposure of midline lesions of the anterior and middle skull base. while minimizing the need for frontal lobe retraction. The authors present 5 cases operated on via this approach. The tumor diagnosis of 5 cases was 3 cases of tuberculum sellae meningioma 1 case of astrocytoma and 1 case of craniopharyngioma. In two patientdcases with localized lesions in the midline). the extensive transbasal approach was used alone, in the remaining three(cases with far lateral extension to the temporal base). it was combined with other skull base approachs. Our experience in 5 cases and the advantage of this approach are described.