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關節結核의 治療와 關節의 可動性 <第1報>

Treatment of Tuberculosis of Joint(The 1st Report)

대한외과학회지 1964년 6권 4호 p.213 ~ 219
鄭仁熙, 朴炳文,
소속 상세정보
鄭仁熙 (  ) - 延世大學校 醫科大學 整形外科學敎室
朴炳文 (  ) - 延世大學校 醫科大學 整形外科學敎室

Abstract


It has been well known that the use of anti-tuberculosis chemotherapy in orthopedics has recently developed since its introduction and great progress has been made in the treatment of bone and joint tuberculosis, especially in the field of operative procedures.
And many studies have been attempted in recent year by various surgeons to treat tuberculosis of joint while retaining motion under the afore-mentioned favorable conditions, but before anti-tuberculosis agents became available there was general agreement the results were disappointing and the objective of treatment was to achieve permanent arrest of the disease by arthrodesis of the involved joint.
Sacrifice of movement was accepted because of the fear of reactivation of the disease if motion was retained.
It is important to solve the urgent problems of how the function of a joint can be restored and also how ankyosis or fusion can be mad unnecessary as well as further reactivation or other compications being prevented.
The purpose of this paper is to attempt to assess how far the possibibility of realizing these hopes has been established and to find indications to retain motion in tuberculosis of the joints.
Our policy of treatment is to select the patients with in the group between children in growing age and young adults, and to use combined anti-tuberculosis chemotheraphy and operative measures, such as partial synovectomy, joint clearance(namely partial synovectomy and radical curettage of the involved tissues) and joint resection operation respectively.
There after the joint is put at rest by immobilization(with cast or Buck´s traction) for 6-12 weeks duration and then followed by physiotherapy.
Clinical studies consists of 23 follow-up cases out of the selected 30 cases of tuberculosis of various joints(hip 11, knee 6, ankle 3, shoulder 1, and elbow 2) who were admitted to the Dept. of Orthopedic surgery, Severance Hospital, Yonsei University, College of Medicine from August 1, 1959 to July 31, 1962.
Of the 23 cases, tte results stowed Exellent in 17.4%(4 cases), Good 30.4%(7 cases), Fair 17.4%(4 cases) and Poor or Failed 30.8%(8 cases) respectively.
There might be an apparent close relationship between preoperative clin!cal and roentgenclogical findings, the total area of the destroyed cartilage surfaces of joint at operation and prognosis of function of joint.
So, on the basig of only the preoperative clinical and reentgenological findings we may to a certain extent, anticipate the postoperative prognosis of joint function.
A good functional range of joint motion has been obtained more in children than in adults, with little pain or minimal residual stiffness.
It has been shown that the earlier the diagnosis can be made and treatment started, the better the result obtained.
In cases of joint by immobilization, better functional results may be observed in the use of Buck´s traction than cast immobilization, and a shorter period of immobilization was found to be more effective than a longer period.
It has been no tendency toward reactivation of the disease clinically or roentgenologically during our follow-up study.

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