Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Arthroscopic Transosseous Suture Repair for Bankart Lesion with a Flexible Drill Device - An Experimental and Preliminary Clinical Report -

유연성 천공기를 이용한 Bankart 병변의 골관통식 봉합 - 동물 실험 및 예비 임상 결과 보고 -

  • Park, Jin-Su (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Won, Ye-Yeon (Department of Orthopedic Surgery, Ajou University School of Medicine) ;
  • Yoo, Jung-Han (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Yong-Wook (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Noh, Kyu-Chul (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Chung, Kuk-Jin (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Hong-Kyun (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hwang, Ji-Hyo (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Young-Bum (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Suh, Il-Woo (Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine)
  • 박진수 (한림대학교 의과대학 정형외과학교실) ;
  • 원예연 (아주대학교 의과대학 정형외과학교실) ;
  • 유정한 (한림대학교 의과대학 정형외과학교실) ;
  • 박용욱 (한림대학교 의과대학 정형외과학교실) ;
  • 노규철 (한림대학교 의과대학 정형외과학교실) ;
  • 정국진 (한림대학교 의과대학 정형외과학교실) ;
  • 김홍균 (한림대학교 의과대학 정형외과학교실) ;
  • 황지효 (한림대학교 의과대학 정형외과학교실) ;
  • 이용범 (한림대학교 의과대학 정형외과학교실) ;
  • 서일우 (한림대학교 의과대학 정형외과학교실)
  • Received : 2010.04.30
  • Accepted : 2010.06.02
  • Published : 2010.06.15
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Abstract

Purpose: Too develop a flexible drill device that can be inserted into the shoulder joint so that arthroscopic transosseous suture repair for Bankart lesion is possible. Materials and Methods: We created a device composed of a flexible drill unit and a guide pipe unit. The flexible drill unit was made of flexible multifilament wires (1.2 mm in diameter) that was twisted into one cord so that it can flex in any direction and a drill bit (1.2 mm in diameter) that is attached onto one end of the flexible wire. The guide pipe unit was a 150 mm long metal pipe (2.0 mm in inner diameter and 3.0 mm in outer diameter), with one end bent to 30 degrees. The flexible drill set was inserted into the shoulder joint through the posterior portal of the joint. The guide pipe component was placed onto the medial wall of the glenoid so that the pipe was placed 5 mm posterior to the margin of the anterior glenoid rim. The flexible drill was driven through the glenoid by the power drill so that holes were made in the glenoid. A non- absorbable suture was passed through the hole. Tying of a sliding knot tying was accomplished over the capsule and labrum after making a stitch through the capsule and labrum with a suture hook loaded with suture passer. The same procedures were done at the 2 and 4 O'Clock positions of the glenoid. Results: Five cases with Bankart lesion received arthroscopic transosseous repair with our flexible drill device. There were no intraoperative problems. Neither redislocation nor subluxation was reported at final follow-up. Conclusion: Arthroscopic transosseous suture repair without suture anchors and easy tying of a sliding knot are possible with a flexible drill set.

목적: 견관절의 Bankart 병변에 대하여서 관절경적 수술하에서도 골경유 봉합이 가능하도록 유연성 골 천공기를 개발하였으며 이에 대한 동물 실험 및 임상 증례를 보고하는 바이다. 대상 및 방법: 유연성 천공기 세트는 유연성 천공기와 유도관으로 구성되어 있다. 유연성 천공기는 49개의 미세강선들이 단일 강선 (직경 1.2 mm)으로 꼬인 구조로 이루어져 유연성이 있으며 이러한 유연한 강선의 한 쪽 끝에는 천공기 (직경 1.2 mm)가 용접되어 있는 구조로 이루어져 있다. 유도관은 외경 3.0 mm, 내경 2.0 mm의 원통형 금속 도관으로 이루어져 있으며 한 쪽 끝은 30도 정도 굴곡되어 있다. 기기의 내구성 및 임상적 유용성을 시험하기 위하여 돼지의 견갑골 관절와에 골 천공을 실시하는 실험을 30회 이상 실시하였다. 유연성 강선 부위의 기계적 파단이나 골 천공의 실패 등은 발생하지 않았다. 일반적 견관절 관절경 술식대로 견관절의 후방 입구 및 전 상방, 전 후방 입구들을 확보한 후 관절경하에서 Bankart 병변이 확인이 되면 면도기를 이용하여 견갑와 내측면의 변연 절제를 실시하여 골 출혈을 유도한다. 이후 관절경을 전 상방 입구로 이전 시키고, 후방 입구를 통하여서 유연성 골천공기 세트의 유도 강관을 삽입하는데 유도 강관의 끝이 견갑와연에서 약 5 mm 정도 안쪽에 위치되도록 한다. 유도강관 내로 유연성 천공기를 삽입한 후 구동기를 이용하여서 견갑와의 골 천공을 실시한다. 골 천공 후에는 유연성 천공기만 유도강관에서 제거한 후에 유도 강관내로 봉합사를 삽입하여 천공된 골구로 통과시키도록 한다. 봉합 갈고리를 이용하여 관절와순에 유도봉합사를 통과시킨 후에 이 유도봉합사에 골 천공구를 통과한 봉합사를 끼워서 관절완순을 통과하도록 한 후 활주 결찰을 실시하여 골 관통 봉합을 이루도록 한다. 동일한 방식으로 견갑와의 2시, 4시 방향에 골 천공을 시행하여 견갑와순의 봉합을 실시한다. 결과: 외상성 견관절 탈구 환자 5예에서 유연성 골 천공기를 이용한 Bankart 병변의 봉합을 실시하였다. 수술 도중 또는 수술후의 신경이나 혈관 손상 등의 문제점이나 합병증 등은 발생하지 않았으며 기기 자체의 문제들도 발생하지 않았다. 평균 6개월간의 추시 결과 상에서는 재탈구 등의 증상은 나타나지 않았다. 결론: 유연성 골 천공기를 사용한 Bankart 병변의 봉합시 관절경적 수술이면서도 골 관통식 봉합이 가능하여 관절와순의 부착면적의 증대 효과 뿐 아니라 손쉬운 활주 결찰이 이루어 질 수 있음을 보여주었다.

Keywords

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