인공 슬관절 전치환술 시 압박대의 압력에 따른 대퇴부 동통과 실혈량에 대한 영향

서재성 ( Jae Seong Seo ),민학진 ( Hak Jin Min ),윤의성 ( Ui Seoung Yoon ),김진수 ( Jin Soo Kim ),조기현 ( Ki Hyun Jo ),김용훈 ( Yong Hoon Kim ),박철희 ( Cheol Hee Baak ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

목적: 인공 슬관절 전치환술에서 압박대의 압력에 따른 수술 후 대퇴부 동통 및 실혈량의 변화를 비교해 보고자 하였다. 대상 및 방법: 2003년 7월부터 2005년 2월까지 본원에서 인공 슬관절 전치환술을 시행한 161명의 환자를 대상으로 전향적 연구를 시행하였다. 압박대의 압력을 300 mmHg로 사용한 군(I군)과 수축기 혈압보다 100 mmHg 높은 압력을 사용한 군(II군)으로 나누어 술 후의 대퇴부 동통의 발생빈도, 동통의 강도 및 실혈량을 측정하여 비교 분석하였다. 결과: 술 후 대퇴부 통증의 빈도는 술 후 12시간째 I군(72.5%), II군(70.7%), 24시간째 I군(77.4%), II군(50.1%), 72시간째 I군(58.1%), II군(34.7%)으로 II군에서 통계적으로 유의하게 낮게 측정되었으며, 통증의 강도도 술 후 6시간(p=0.04)과 72시간(p=0.02)에서 II군에서 통계적으로 유의하게 낮게 나타났다. I군과 II군에서 수술 후 실혈량에는 통계적으로 유의한 차이가 없었다. 결론: 인공 슬관절 전치환술 시 수축기 혈압보다 100 mmHg 높은 압력의 압박대를 사용함으로써 술후 지혈대에 의한 대퇴부 동통을 감소시킬 수 있었으며, 300 mmHg의 압력을 사용하였을 때와 비교 시술후 실혈량에 영향을 미치지 않았음을 확인하였다. Purpose: We wanted to analyze the effects of tourniquet pressure on the postoperative thigh pain and blood loss of patients who undergo total knee arthroplasty. Materials and Methods: This prospective randomized study focused on one-hundred sixty-one unilateral total knee arthroplasties that were done with using a tourniquet. The tourniquet pressures were 300 mmHg in group I (seventy-four cases) and 100 mmHg higher than the systolic blood pressure in group II (eighty-seven cases). We analyzed the postoperative thigh pain with using a visual analog scale (VAS), and we assessed the hemoglobin levels and the hematocrits. Results: The incidence of postoperative thigh pain in group II was statistically lower than that of group I. The intensity of the postoperative thigh pain of group II was lower than that of group I at both 6 hours and 72 hours after surgery. There were no statistical differences in blood loss between the two groups. Conclusion: Using a tourniquet pressure of 100 mmHg above the systolic blood pressure during total knee arthroplasty can reduce the postoperative thigh pain. When comparing the above technique with a TKA using 300 mmHg of tourniquet pressure, there was no statistically significant difference of the postoperative blood loss.

Do Cementless Short Tapered Stems Reduce the Incidence of Thigh Pain After Hip Arthroplasty? Systematic Review and Meta-Analysis

Yoo Jun-Il,차용한,이영균,Ha Yong-Chan,Koo Kyung-Hoi 대한의학회 2022 Journal of Korean medical science Vol.37 No.6

Background: The purpose of this study was to determine whether short tapered stems reduce the rate of thigh pain through a systematic review and meta-analysis of comparative studies between short tapered stems and standard-length tapered stems. Methods: We conducted a meta-analysis of comparative studies: 1) retrospective studies and 2) randomized controlled trials (RCTs), on 2 stem designs: short tapered stem versus standard-length tapered stem. Studies were selected by means of the following criteria: 1) study design: retrospective comparative studies, prospective comparative studies, RCTs; 2) study population: patients with total hip arthroplasty or hemiarthroplasty for hip disease or hip fracture; 3) intervention: short tapered stem and standard tapered stem; and 4) outcomes; thigh pain, other clinical results. Results: Among the 250 articles that were identified at the initial search, 6 studies, 4 RCTs and 2 retrospective comparative studies, were included in this meta-analysis. In the analysis of retrospective studies, the short tapered stem reduced the risk of thigh pain compared to the standard tapered stem (risk ratio [RR] = 0.13; 95% confidence interval [CI], 0.02–0.09; Z = −2.07; P = 0.039). However, in the analysis of RCTs, the incidence of thigh pain was similar between the two stem designs (RR = 1.21; 95% CI, 0.76–1.93; Z = 0.82; P = 0.410). Overall meta-analysis including all studies showed that the short tapered stem did not reduce the incidence of thigh pain compared to the standard-length tapered stem (RR = 0.91; 95% CI, 0.59–1.40; Z = −0.44, P = 0.663). Conclusions: We did not find a significant difference in the incidence of thigh pain between short tapered stem and standard tapered stem in hip arthroplasty.

Anterior Thigh Pain Following Minimally Invasive Oblique Lateral Interbody Fusion: Multivariate Analysis from a Prospective Case Series

Sam Yeol Chang,Woo Seok Lee,Sujung Mok,Sung Cheol Park,Hyoungmin Kim,Bong-Soon Chang 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.3

Background: Oblique lateral interbody fusion (OLIF) involves the antepsoas approach and psoas major muscle (PMM) retraction to insert the interbody cage orthogonally. Therefore, OLIF is often associated with postoperative anterior thigh pain (ATP) on the approach side. However, there is limited evidence on the nature and risk factors of ATP following OLIF. Methods: Consecutive patients who planned to undergo minimally invasive OLIF and percutaneous pedicle screw instrumentation for lumbar degenerative diseases were prospectively enrolled. The visual analog scale (VAS) for ATP was recorded, and a pain map was drawn daily from the operation day to postoperative day 7 in all patients. We also prospectively collected the preoperative and intraoperative data to identify the risk factors associated with ATP. Radiologically, the total cross-sectional area (CSA), retraction length, and retraction CSA of PMM were measured from the preoperative T2-weighted axial magnetic resonance imaging scans at the L4–5 intervertebral disc level. The patients were stratified into two groups based on the experience of ATP with a VAS score of ≥ 7 at any time point. Additionally, a binary logistic regression analysis was performed to identify the associated factors. Results: The current prospective study included 92 patients (31 men, 61 women) with a mean age of 70.4 years (range, 56–86 years), who underwent OLIF at our institution. The left-side approach was used in 73 patients (79.3%), while 19 (20.7%) underwent a right-side approach. Sixty-five of the total patients (70.6%) experienced approach-side ATP to any extent during postoperative 0–7 days following OLIF. The mean pain VAS (4.4 ± 2.1) and the prevalence (57.6%) were highest at postoperative 2 days. On postoperative day 7, there were 19 patients (20.7%) who complained of residual ATP with a mean VAS of 2.6 ± 1.8. In the multivariate analysis, the PMM retraction length was significantly associated with ATP of VAS ≥ 7 (adjusted odds ratio, 2.316; p = 0.044). Conclusions: In this study, we prospectively collected and analyzed the ATP and associated factors following OLIF and identified the PMM retraction length as a potential independent risk factor for severe ATP in the immediate postoperative period following OLIF.

무시멘트 고관절 치환술후 대퇴 통증에 관한 연구

김영호 ( YH Kim ),박재민 ( JM Park ),최창옥 ( CU Choi ) 대한고관절학회 1993 Hip and Pelvis Vol.5 No.1

Fibrous dysplasia very commonly involves the proximal femur. Fibrous dysplasia of the proximal end of the femur is a serious clinical problem because structural stabilty is destroyed and function of the hip joint is impaired due to the pathologic fracture and angulation deformity which influenced by biomechanical structure of the femur. So, the stability and functional reconstruction of the hip joint must considered at the treatment of the fibrous dysplasia of the proximal end of the femur. Authors have reviewed a series of 14 patients of fibrous dysplasia which were treated at the Department of Orthopedic Surgery, School of Medicine, Kyung Hee University. The follow-up period ranged from January 1981 to December 1990, the average being 3 years and 6 months. The average age was 21.8 years. Among 14 patients, the nine patients were monostotic type and the five patients were polyostotic type. And one polyostotic type showed bilateral involvement. The characteristics of the fibrous dysplasia around the hip joint were pain of the hip, coxa vara, angulation deformity, pathologic fracture of the femur was not delayed. Ten patients (7196) revealed satisfactory result, and four patients marked unsatisfactory result by the Stephensons classification. Simple curettage and bone graft couldnt prevent the progression of deformity or pathologic fracture in widely expanded lesion. The pro-phylactic rigid internal fixation with massive bone graft was mandatory to prevent the progression of deformity or pathologic fracture.

무시멘트 인공고관절 전치환술 후 대퇴부 동통

김영호 ( Young Ho Kim ),박기철 ( Kee Cheol Park ),김윤재 ( Yoon Jae Kim ),최일용 ( Il Young Choi ) 대한고관절학회 2003 Hip and Pelvis Vol.15 No.2

New insight into the vasto-adductor membrane for safer adductor canal blockade

Yanguk Heo,Miyoung Yang,Sung Min Nam,Hyun Seung Lee,Yeon-Dong Kim,Hyung-Sun Won 대한통증학회 2024 The Korean Journal of Pain Vol.37 No.2

Background: This study aimed to identify exact anatomical landmarks and ideal injection volumes for safe adductor canal blocks (ACB). Methods: Fifty thighs from 25 embalmed adult Korean cadavers were used. The measurement baseline was the line connecting the anterior superior iliac spine (ASIS) to the midpoint of the patellar base. All target points were measured perpendicular to the baseline. The relevant cadaveric structures were observed using ultrasound (US) and confirmed in living individuals. US-guided dye injection was performed to determine the ideal volume. Results: The apex of the femoral triangle was 25.3 ± 2.2 cm distal to the ASIS on the baseline and 5.3 ± 1.0 cm perpendicular to that point. The midpoint of the superior border of the vasto-adductor membrane (VAM) was 27.4 ± 2.0 cm distal to the ASIS on the baseline and 5.0 ± 1.1 cm perpendicular to that point. The VAM had a trapezoidal shape and was connected as an aponeurosis between the medial edge of the vastus medialis muscle and lateral edge of the adductor magnus muscle. The nerve to the vastus medialis penetrated the muscle proximal to the superior border of the VAM in 70% of specimens. The VAM appeared on US as a hyperechoic area connecting the vastus medialis and adductor magnus muscles between the sartorius muscle and femoral artery. Conclusions: Confirming the crucial landmark, the VAM, is beneficial when performing ACB. It is advisable to insert the needle obliquely below the superior VAM border, and a 5 mL injection is considered sufficient.

대퇴골 전자간 골절 환자에서 125도와 130도의 각도를 가진 제2형 항회전 근위 대퇴 골수정을 이용한 수술의 임상적, 방사선학적 결과 비교

임수재,박용복,김현권,박신형 대한골절학회 2020 대한골절학회지 Vol.33 No.4

Purpose: This study compared the clinical and radiographic results of two proximal femoral nail antirotation II (PFNA-II) angled by 125° and 130° in patients with intertrochanteric fractures. Materials and Methods: From March in 2015 to September in 2016, 65 patients who underwent a closed reduction and internal fixation with PFNA-II for a femoral intertrochanteric fracture were evaluated retrospectively. The minimum follow-up period was two years. Of those, 30 and 35 patients underwent 125° angled PFNA-II and 130° angled PFNA-II, respectively. The clinical performance was evaluated using the Harris hip score, WOMAC (Western Ontario and McMaster Universities Osteoarthrtis Index), and UCLA (University of California Los Angeles) score. Radiographic analyses were performed using standardized anteroposterior and lateral radiographs to assess the implant position and quality of reduction. The blade length, distance between the blade tip and the tip of the greater trochanter, and distance between the blade tip and the most lateral protrusion point of the greater trochanter in the two groups were measured and compared. Results: The clinical results, including the Harris hip score, WOMAC, and UCLA, were similar in the two groups at the last follow-up postoperatively. In the radiography evaluation, the implant position, quality of reduction, and the blade length were similar in the two groups. The distances between the blade tip and the tip of the greater trochanter were 52.60±3.53 mm and 58.07±5.54 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The distance between the blade tip and the most lateral protrusion point of greater trochanter were 16.48±2.54 mm and 21.19±4.43 mm in the 125° angled PFNA-II and 130° angled PFNA-II groups, respectively. The differences were significant (p=0.031, p=0.012). Conclusion: The operation with the 125° angled PFNA-II showed a more superior and lateral position of the blade than that with the 130° angled PFNA-II. Nevertheless, lateral thigh pain can occur when the blade is positioned superolaterally. 목적: 대퇴골 전자간 골절 환자에서 125도, 130도의 제2형항회전 근위 대퇴 골수정(PFNA-II)을 이용한 수술의 결과를분석하였다. 대상 및 방법: 대퇴골 전자간 골절로 PFNA-II를 이용한 수술을 시행 받은 환자 65예를 후향적으로 분석하였다. 이 중 30 예는 125도 PFNA-II를 사용하였고, 35예는 130도 PFNA-II 를 사용하였다. 수술 후 대퇴부 동통 외 임상적 점수를 조사하였고 삽입물의 위치 및 정복 정도, 추가적으로 대전자 끝에서 나선형 칼날 삽입구까지의 거리, vastus ridge 끝에서 나선형 칼날 삽입구까지의 거리를 측정하여 비교하였다. 결과: 대전자 끝에서 나선형 칼날 삽입구까지의 거리는 125 도 PFNA-II 집단에서는 52.60±3.53 mm였고, 130도 PFNA- II 집단에서는 58.07±5.54 mm였다. Vastus ridge 끝에서 나선형 칼날 삽입구까지의 거리는 125도 PFNA-II 집단에서는 16.48±2.54 mm였고(p=0.031), 130도 PFNA-II 집단에서는 21.19±4.43 mm였다(p=0.012). 결론: 125도 PFNA-II 집단이 130도 PFNA-II 집단보다 나선형 칼날의 위치가 좀 더 상방, 외측에 위치하였다.