성인에서의 골반 절골술

조윤제(Yoon-Je Cho),고영완(Young-Wan Ko) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.6

골반 절골술이란 비구 이형성증과 같이 비구의 발육이 완전하지 못하여 비구가 대퇴골 두를 충분히 덮어주지 못하거나 생역학적으로 비정상적인 하중이 주어질 경우 이를 교정하기 위한 절골술이다. 골반 절골술은 크게 재형성(reconstructive) 혹은 재정렬(realignment) 절골술과 구제(salvage) 절골술로 구분될 수 있다. 재형성 절골술은 대개 관절의 조화(congruency)가 좋은 경우에 적응이 되며 Chiari 절골술을 제외한 대부분의 골반 절골술이 여기에 속하고, 중위 절골술인 Bernese 절골술과 근위 절골술인 비구 회전 절골술(rotational acetabular osteotomy), 비구 주위 회전 절골술(periacetabular rotational osteotomy)이 주로 사용되고 있다. 구제 절골술은 대퇴골 두와 비구에 변형이 심하여 관절면의 부조화(incongruency)가 있을 경우 또는 관절염이 진행되어 재형성 절골술을 시행하여도 건강한 관절 연골 간의 접촉을 얻을 수 없을 경우에 권장되는 술기로 Chiari 절골술이 대표적이다. 골반 절골술은 다소 수술이 크고 술기가 어려운 측면이 있으나 각 절골술의 특성과 장단점을 잘 알고 술자에게 익숙한 술기를 사용하면 성공률이 매우 높으며 관절을 보존할 수 있는 매우 중요한 수술 기법이다. Pelvic osteotomy is a surgery for correcting acetabular deformity, which causes incomplete coverage of the femoral head or biomechanically abnormal load to the hip joint. Pelvic osteotomy can be divided into two categories: reconstructive or realignment osteotomy and salvage osteotomy. Reconstructive osteotomy can be performed to correct the dysplastic hip with good congruency, and include most pelvic osteotomies, except Chiari osteotomy. Among these, Bernese osteotomy, rotational acetabular osteotomy, and periacetabular rotational osteotomy are commonly being used. Salvage osteotomy, which include Chiari osteotomy only, can be performed to increase the coverage of the femoral head of hip joint with joint incongruency due to the severely deformed femoral head and acetabulum or advanced osteoarthritis. Chiari osteotomy is a kind of arthroplasty reducing the pressure applied to the head, and increasing the bone coverage on the upper part of the femoral head. It is effective in reducing hip pain and slowing degenerative changes; however, as the surface is covered by fibrous cartilage, it is vulnerable to degenerative changes. The pelvic osteotomy is a very important and useful surgical technique to preserve joints, despite being a difficult procedure that is technically demanding.

내반주 변형에 대한 과상부 장방형 전위 절골술

안상로,오홍록 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Cubitus varus deformity is the late complication of the supracondylar fracture of humerus which is common in growing children. If the deformity is severe it cause functional problems as well as cosmetic ones necessitating corrective osteotomy. Though many authors devised different method of corrective osteotomy, the cosmetic results are not always satisfactory because of the development of "the lasy S" deformity by the lateral prominence. Technically, the initial stability of the osteotomy is also poor due to the poor contact of the osteotomy site. So we have devised a new quadrilateral displacement osteotomy to increase the initial stability of the osteotomy by creating a wedge on the osteotomy site and also to prevent the development of "the lasy S deformity" by elimination of the lateral prominence. We treated 3 cases of cubitus varus defomity with the new quadrilateral displacement osteotomy. The correction was not difficult and the initial stability of the osteotomy is rather good and the osteotomy is fixed by the convential methods, and the osteotomy were healed uneventfully. There developed no "the lasy S deformity" after osteotomy. We would like to report the details of the supracondylar quadrilateral displacement osteotomy.

One-Unit Osteotomy to Correct Deviated Bony Dorsum

김병길,김효열,허유진,박송이,홍상덕,정용기 대한이비인후과학회 2023 Clinical and Experimental Otorhinolaryngology Vol.16 No.1

Objectives. A crooked nose is frequently caused by nasal bony vault deviation, and proper management of the bony vaultis an integral part of rhinoplasty. Conventional osteotomy to correct a deviated nose favors simultaneous medial andlateral osteotomies, which allows the free independent movement of each nasal bone. However, patient satisfactionwith deviated nose surgery is sometimes low. In the present study, we introduce a one-unit osteotomy procedure thatcombines bilateral and root osteotomies with unilateral triangular bony wedge resection to allow symmetry of bothnasal bones. Methods. Twenty consecutive patients who presented with bony vault deviation and underwent one-unit osteotomy wereenrolled in this retrospective single-center study. The Nasal Obstruction Symptom Evaluation (NOSE) questionnairewas used to evaluate each patient’s functional outcome. The angle of bony vault deviation before and after one-unitosteotomy was measured using a protractor and compared with the results of 14 patients who had undergone con-ventional osteotomy. The improvement in dorsal deviation was evaluated using facial photography preoperatively and3 months postoperatively. Results. NOSE values improved from 8.4±6.4 to 4.1±4.2 (P =0.021). The angle of bony vault deviation improved from6.9°±2.2° to 2.1°±1.2° (P <0.001) in one-unit osteotomy and from 7.3°±4.0° to 2.7°±1.2° (P =0.001) in conven-tional osteotomy. The preoperative deviation angle improved by 70.3% in one-unit osteotomy compared with 56.6%in conventional osteotomy, which was a significant difference (P =0.033). The mean grade of the postoperative esthet-ic outcomes for the remaining deviation was 1.6±0.5, which was similar to that in the conventional osteotomy group. Conclusion. One-unit osteotomy is a relatively simple procedure that balances the width of both lateral walls by removingexcessive bony fragments from the wider bony wall and providing better structural integrity. This technique improvesfunctional outcomes and has equivalent esthetic results to those of the traditional procedure.

Green-stick osteotomy를 이용한 비성형술

유원민,류창우,박병윤,이원재 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.5

Lateral osteotomy has been chosen as a part of rhinoplasty for modification of the nasal bony vault, alteration of the base width of the lateral walls, establishment of a new profile line of the nasal dorsum and lateral profile line, and closure of the open roof. Various methods of lateral osteotomy may be employed, however Orientals have characteristically broad and flat noses Compared to caucasians and for an esthetically satisfactory result, it is important to correct both in rhinoplasty. In this study, the authors performed their devised method of lateral osteotomy in 12 patients for the correction of broad, flat nasal dorsum and deviated noses. The operations could be broadly categorized into two groups: 1) short lateral osteotomy in which the lateral osteotomy line was incomplete and short, extending to the infraorbital rim; and 2) green-stick transverse osteotomy which was induced by in-siturotation fracture by osteotomy and, if considered necessary, augmentation rhinoplasty and nasal tip plasty were also performed simultaneously. Our nasal osteotomy has limited mobilization, where as the previous method has total mobilization, and it has the advantages of repositioning the broad and deviated nose in a preferable direction and shape, as well as the capability of narrowing the preferable area selectively. Especially if there is a necessity to correct both broad and flat noses such as in Orientals, our osteotomy methods have a synergistic effect in esthetic outcome when performed with augmentation rhinoplasty with a silastic implant. There were no complications such as relapse or air-way obstruction during the 4.5-month follow-up period. However, a long-term follow-up period is needed to evaluate the complications considering the physiologic aspect of the nose.

上顎骨 前方部 部分 骨折斷術後 齒髓 神經纖維 再生에 關한 組織學的 硏究

안중진(Jung Jin An),조병욱(Byoung Ouck Cho) 대한구강악안면외과학회 1995 대한구강악안면외과학회지 Vol.21 No.3

The segmental osteotomy is one of the commonly used surgical procedure for the treatment of various dentofacial deformities involving the maxilla. Common complication after osteotomy was stabilization, inflamation, relapse, paresthesia, necrotic change of fragment and pulpal degeneration. The condition of the pulp after segmental maxillary osteotomics in human has only been studied in a few clinical investigations. Many investiga+ors believe that subsequent reinnervation and vascularization is accomplished, however, few clinical studies have been directed at evaluating this phenomonen. Conflicting results have also been reported of tooth response after segmental osteotomy procedures in the maxilla. Studies in patients show the incidence of non-responsive teeth to electrical stimulation varying from 6 to 43%. Animal studies have also reported wide variation in the effect on the pulp, varying from nil to marked cellular changes by 13e11(1969), Poswillo(1972), Ohzeki & Takahashi(1980) and Nanda(1982). The purpose of the present study was to determine the degeneration and reinnervation of pulpal nerve fiber after the segmental maxillary anterior osteotomy. The reinnervation of anterior maxillary teeth (]enervated by segmental osteotomy has been investigated in clogs by using light and electron microscopy, The extracted teeth from segmental fragment were cut off at right angle to the long axis of the tooth at the apical 1 mm portion on 1, 2, 4, 8, 24 weeks after osteotomy. The following observation were made : 1. One week after osteotomy, most pulpal axon showed sign of degeneration and decreased the number about 74% axons compare with control group. 2. Two weeks after osteotomy, only alomost intact two myelinated fibers and few degenerated unmyelinated fibers were presented. 3. Four weeks after osteotomy, all axons were disappeared. 4. Eight weeks after osteotomy, a myelinated and unmyelinated axon were presented. 5. Twenty four weeks after osteotomy, numerous myelinated and unmyelinated axons were presented. The total axons were about 33% of control group. The ratio of unmyelinate axon was about 45%.

Medial Structures of the Posterior Calcaneal Osteotomy

Il-Hoon Sung(성일훈),Choong-Hyeok Choi(최충혁),Kyu-Tae Hwang(황규태),Jonathan T Deland 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.5

목적: 후 종골 절골술을 시행할 때 절골선의 위치와 후족부 내측 연부 조직과의 관계를 연구하였다. 대상 및 방법: 12개의 신선냉동 성인 사체를 이용하였다. 종골의 외측면에서 종골 후조면의 후상방 모서리의 약 10 ㎜ 전방으로부터 시작하여 족저면에 대하여 약 45° 사선 방향을 절골면의 시작 위치로 하였다. 검체 군을 무작위로 양분하였고 각각 절골면의 방향을 10° 전내측과 10° 후내측으로 향하게 하여 절골선의 다양한 변이를 감안하였다. 미세 절골 톱을 이용하여 절골술을 시행한 후에 K-강선으로 절골부를 고정하고 후족부를 해부하였다. 결과: 내측 부위에서 절골선의 원위부는 하 결절의 전방 평균 8.1 ㎜에서 관찰되었고 방형 족저 근과 외측 족저 신경의 분지들이 내측의 절골선 상에 있었다. 절골선을 가로지르는 신경은 제5 소족지 외전근 신경과 내측 종골 신경이었다. 이들 신경과 내측 절골선 사이의 연부 조직 두께는 각각 평균 2.3 ㎜와 5.9 ㎜이었고 절골선의 원외부로 갈수록 얇은 양상이었다. 내 외측 외측 족저 신경이나 동맥과 같은 중요 연부 조직은 절골선 상에서 관찰되지 않았다. 결론: 후 종골 절골술 시 절골선의 근위부를 종골 후조면의 후상방 모서리로부터 약 10 ㎜ 전방 내에서 시작하여 약 45° 사선 방향으로 절골하는 경우에, 절골선은 방형 족저 근, 제5 소족지 외전근 신경과 내측 종골 신경을 가로지르며 절골선의 원위부로 갈수록 내측 절골선 사이의 연부 조직 두께가 얇으므로 이들 신경 손상에 주의하여야 하겠다. 그러나 내측의 중요 신경혈관 다발은 절골선의 후방에서 관찰되므로 비교적 안전하게 후 종골 절골술을 시행할 수 있을 것으로 사료된다. Purpose: The proximity of the medial soft tissue structures to a posterior calcaneal osteotomy (PCO) was examined to determine which structures are at risk of injury. Materials and Methods: A PCO was performed on 12 adult frozen cadaver feet. At the lateral side of each specimen, the inclination of the osteotomy line was 45° to the plantar aspect of the foot and its proximal end was began approximately 10 mm anterior to the posterosuperior corner of the calcaneus. Two different PCOs were made in order to include any variations in the osteotomy. Using a guide device to direct the osteotomy, the PCOs were performed 10° anteromedially in half of the specimens and 10° posteromedially in the other half. The medial side of the hindfoot was carefully dissected after the PCO had been fixated with K-wires. Results: The most inferior portion of the osteotomy was 8.1 ㎜ anterior to the inferior tubercle. The structures found closest to the osteotomy on the medial side were the medial head of the quadratus plantae (QP) and the branches of the lateral plantar nerve (LPN). In both osteotomies, the nerve to the abductor digiti quinti (ADQ) and calcaneal branch of the LPN crossed the osteotomy site. The thickness of the soft tissue coverage at the crossing site medially averaged 2.3 ㎜ at the nerve to the ADQ and 5.9 ㎜ for the calcaneal branch. In all specimens, the soft tissue coverage was thinner at the more inferior aspect of the osteotomy. No major neurovascular structures, such as the medial and lateral plantar arteries and nerves, crossed the osteotomy site. Conclusion: In the PCO, the structure most at risk is the medial head of the QP and the nerve to the ADQ, which is followed by the calcaneal branch of the LPN. Care should be taken for these nerve injuries, particularly at the inferior portion of the osteotomy due to the thinner coverage of the intervening soft tissue. The PCO can be safely carried out without involving the major neurovascular bundle of the foot, when the inclination of osteotomy line is 45° to the plantar aspect and its proximal end begins within 10 ㎜ anterior to the posterosuperior corner of the lateral side of the calcaneus.

A safe, stable, and convenient three-dimensional device for high Le Fort I osteotomy

Sugahara, Keisuke,Koyachi, Masahide,Odaka, Kento,Matsunaga, Satoru,Katakura, Akira Korean Association of Maxillofacial Plastic and Re 2020 Maxillofacial Plastic Reconstructive Surgery Vol.42 No.-

Background: Le Fort I osteotomy is a highly effective treatment for skeletal jaw deformities and is commonly performed. High Le Fort I osteotomy is a modified surgical procedure performed for improving the depression of the cheeks by setting the osteotomy higher than the conventional Le Fort I osteotomy. Developments in three-dimensional (3D) technology have popularized the use of 3D printers in various institutions, especially in orthognathic surgeries. In this study, we report a safe and inexpensive method of performing a high Le Fort I osteotomy using a novel 3D device and piezosurgery, which prevent tooth root injury without disturbing the operation field for patients with a short midface and long tooth roots. Results: A 17-year-old woman presented with facial asymmetry, mandibular protrusion, a short midface, and long tooth roots. We planned high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy. Prevention of damage to the roots of the teeth and the infraorbital nerve and accurate determination of the posterior osteotomy line were crucial for clinical success. Le Fort I osteotomy using 3D devices has been reported previously but were particularly large in size for this case. Additionally, setting the fixing screw of the device was difficult, because of the risk of damage to the roots of the teeth. Therefore, a different surgical technique, other than the conventional Le Fort I osteotomy and 3D device, was required. The left and right parts of the 3D device were fabricated separately, to prevent any interference in the surgical field. Further, the 3D device was designed to accurately cover the bone surface from the piriform aperture to the infra-zygomatic crest with two fixation points (the anterior nasal spine and the piriform aperture), which ensured stabilization of the 3D device. The device is thin and does not interfere with the surgical field. Safe and accurate surgical performance is possible using this device and piezosurgery. The roots of the teeth and the infraorbital nerve were unharmed during the surgery. Conclusions: This device is considerably smaller than conventional devices and is a simple, low-cost, and efficient method for performing accurate high Le Fort I osteotomy.

상완골 원위 골절에서 주두 절골 시사전 천공 후 유관나사못 및 강선 고정

한수홍 ( Soo Hong Han ),이호재 ( Ho Jae Lee ),김우현 ( Woo Hyun Kim ),조용길 ( Yong Gil Jo ),송원태 ( Won Tae Song ) 대한골절학회 2015 대한골절학회지 Vol.28 No.2

Purpose: The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus. Materials and Methods: This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated. Results: All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem. Conclusion: Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra- articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.

Biomechanical Properties of a New Anatomical Locking Metal Block Plate for Opening Wedge High Tibial Osteotomy: Uniplane Osteotomy

( Seung Beom Han ),( Ji Hoon Bae ),( Sung Jae Lee ),( Tae Gon Jung ),( Kang Hee Kim ),( Jae Ho Kwon ),( Kyung Wook Nha ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.3

Purpose: The purpose of this study was to evaluate the biomechanical properties of a new anatomical locking metal block plate by comparing the initial biomechanical stability of three different fixation constructs for open wedge high tibial osteotomy (HTO). Materials and Methods: Sawbones composite tibiae were used to make a 10-mm opening osteotomy model with uniplane technique. The osteotomy was secured with three different types of plates: Group I, new osteotomy plate without a metal block (n=5); Group II, new osteotomy plate with a 10- mm metal block (n=5); and Group III, two short metal block plates (n=5). Single load to failure test and staircase load-controlled cyclical failure test were performed. In the single load to failure test, the yield load, maximum failure load, and the displacement of the osteotomy gap were measured. In the staircase cyclical load to failure test, the total number of cycles to failure was recorded. Failure modes were observed during both single and cyclic load tests.Results: Group II showed the highest yield and ultimate loads (1829±319 N, 3493±1250 N) compared to Group I (1512±157 N, 2422±769 N) and Group III (1369±378 N, 2157±210 N, p<0.05). The displacement of the opening gap in Group II (0.34±0.35 mm) was significantly lesser than the other groups (p<0.05). In the staircase cyclical load to failure test, the total number of cycles to failure was 12,860 at 950 N in Group III, 20,280 at 1,140 N in Group I, and 42,816 at 1,330 N in Group II (p<0.05). All the specimens showed complete fracture of the intact lateral sawbones area and slight displacement of the distal fragment of the specimens in the single load to test. None of the specimens showed deformed or broken screws and plates during the single load to test. During the fatigue test with staircase cyclic loading, no fracture of the lateral sawbones area was observed.Conclusions: This study demonstrated that the new anatomical locking metal block plate could provide sufficient primary stability for open wedge HTO. The addition of a metal block to this new plate can increase the stability of the osteotomy compared to the one without a metal block.

Analysis of changes in tibial torsion angle on open-wedge high tibial osteotomy depending on the osteotomy level

( In-soo Song ),( Junhan Kwon ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Purpose: This study evaluated the tibial torsional angle changes of 72 knees before and after open-wedge high tibial osteotomy (OWHTO) and compared the results according to the osteotomy level. Materials and methods: Seventy patients (72 knees) with Kellgren-Lawrence grade 3 underwent OWHTO. Demographic data, operation procedures, and measurement of mechanical tibiofemoral angle (mTFA), anatomical tibiofemoral angle (aTFA), tibial torsional angle (TTA), and pre- and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores were obtained. The authors analyzed TTA changes between 30 knees with high-level osteotomy (group A) and 42 knees with low-level osteotomy (group B). Results: The changes of TTAs in the subjects of 72 knees went from 29.26 ± 5.6° preoperative mean to 25.36 ± 6.4° postoperative mean (p = 0.032). The postoperative TTAs of group A (mean 27.4 ± 4.8°) and B (mean 25.7 ± 4.9°) were statistically significant (p < 0.01). Preoperative Lysholm and IKDC scores of 72 knees had means of 49.1 ± 3.5 and 49.0 ± 15.2, respectively, and postoperative means of 85.7 ± 8.56 and 78.0 ± 17.6, respectively, which were statistically significant (p < 0.01). Conclusions: Changes of TTA with internal rotation of distal tibia were observed following OWHTO. High-level osteotomy on the proximal tibia’s lateral cortex had less internal rotation of the distal tibia than low-level osteotomy.