The Treatment of Angiofibromas Using Multiple-Drilling Method by Carbon Dioxide Laser / 대한피부과학회지

No abstract available.

Effects of Multiple Drilling on the Ischemic Capital Femoral Epiphysis of Immature Piglets

PURPOSE: This study investigated the effects of multiple drilling on the immature capital femoral epiphysis following ischemic injury in a piglet model. MATERIALS AND METHODS: Ischemic necrosis of capital femoral epiphysis was induced bilaterally in 12 piglets using a cervical ligation method. Three weeks later, medial, central, and lateral 3 drill holes were made on the left femoral head using 0.062" K-wire. At 3, 6, 9, and 12 weeks following the multiple drilling, femoral heads were harvested from each three piglets. On histologic examination, percent of revascularization, percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height were evaluated. Untreated right femoral heads served as control. RESULTS: While percent of revascularization of left capital femoral epiphysis with multiple drilling was significantly higher than untreated control side (p<0.001), percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height showed no significant difference. CONCLUSION: This study indicates that multiple drilling could promote revascularization of ischemic capital femoral epiphysis, and multiple drilling does not appear to produce bony physeal bars at short-term, if using small diameter drill. However, multiple drilling alone does not seem to prevent femoral head deformity or to promote new bone formation.

Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Case Report

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.

Clinical Results of the Multiple Drilling for Osteochondral Lesion of the Medial Talar Dome / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment outcomes of transmalleolar multiple drilling with a K-wire for an osteochondral lesion of the medial talar dome after an mean follow-up period of 77 months. MATERIALS AND METHODS: Among patients treated surgically for a symptomatic osteochondral lesion of the talus between March 1997 and December 2002, sixteen ankles (fifteen patients) with a medial talar dome lesion were treated by transmalleolar multiple drilling and followed-up for at least 3 years. The average age at the time of surgery was 34.4 years (range, 19-58 years). The mean follow-up period was 77 months (range, 41-107 months). RESULTS: At the latest follow-up, the average VAS at motion decreased from 6.8 to 2.1 (p=0.004). The AOFAS score improved from 64 points to 86.2 points (p=0.001). The 8 ankles in those less than thirty years of age at that time of surgery showed a VAS at motion of 1.8 and an AOFAS score of 91.1 points. In contrast, 8 ankles in those who older than thirty one years of age had a VAS at motion of 2.4 and an AOFAS score of 81.2 points. The younger group showed a significantly better AOFAS score than the older group (p=0.001). However, there was no significant difference in the VAS score (p=0.22). CONCLUSION: Multiple drilling has a good effect in pain control and ankle function for patients with an osteochondral lesion of the medial talar dome 10 mm. The procedure is particularly effective and useful in younger patients.

Comparative Study of the Clinical Results between Arthroscopic Multiple Drilling and Autologous Osteochondral Grafting for Osteochondral Lesions of the Talus / 대한정형외과학회잡지

PURPOSE: We compared the clinical results between arthroscopic multiple drilling and autologous osteochondral grafting for osteochondral lesions of the talus. MATERIALS AND METHODS: Twelve patients underwent arthroscopic multiple drilling that left the remaining cartilage at the lesions, and ten patients underwent autologous osteochondral grafting for detached cartilage lesions. We performed a modified Brostrom procedure for 9 of the cases with combined lateral ankle instability in both groups. The average follow-up period was 12.4 months. The mean ages were 31 and 28 years old, respectively. The results were compared between the two groups by assessing the AOFAS scores and patient satisfaction, based on subjective symptoms. RESULTS: The mean pre-operative AOFAS scores were 70 in the arthroscopic multiple drilling group and 70.3 in the autologous osteochondral grafting group. The post-operative AOFAS scores were 78.8 in the arthroscopic multiple drilling group and 93.5 in the autologous osteochondral grafting group (p<0.05). Patient satisfaction after multiple drilling was good in 3 cases, fair in 4 cases, poor in 5 cases, and pre-operative symptoms were not improved at all in 4 cases. After autologous osteochondral grafting, 7 cases were good and 3 were fair. CONCLUSION: The study demonstrated that in the treatment of osteochondral lesions of the talar dome, the results of autologous osteochondral grafting were superior to those of arthroscopic multiple drilling.

The Effects of Arthroscopic Lavage Combined with Percutaneous multiple Drilling in Patients with Degenerative arthritis of knee

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.

Result of Multiple Frilling for the Early Stage Nontraumatic Osetonecrosis of the Femoral Head / 대한정형외과학회잡지

Sixty-six cases of nontraumatic osteonecrosis of the femoral head were treated with multiple drilling using 9/64 inch Steinmann pin from May, 1992 to March, 1996. In this study, the results of the cases that were followed more than 2 years were analyzed. Thirty-three hips of 32 patients were included in this study. One case was lost to follow after the last follow-up at postop 19 months. Diagnosis was made by simple x-ray and MRI in all cases. The stage was classified according to the modified Fic.t classification. The extent of lesion was evaluated on coronal and sagittal images of MRI. Multiple drilling was performed with the patients on fracture table under C-arm control using 9/64 Steinmann pin held on a low speed power drill. Depending on the size of lesions, 4 to 13 holes were drilled into head from the lateral cortex of proximal femur. The average duration of follow-up was 30 months (range, 8-48 months). When a head collapsed or was converted to THRA for any reason, the case was determined to be a failure. There were 14 Ficat stage I, 16 stage IIA, I stage IIB and 2 stage III hips. The extent of lesion was ranging from 10 to 88% with an average of 49%. There were 7 cases of failure (overall success rate, 78%). In 4 cases, collapse of head was detected at postop 12, 14, 14 and 19 months and 3 of them were converted to THRA. Three cases were converted to THRA at postop 8, 21 and 41 months because of recurred pain without collapse on x-ray. Ectopic ossification around drill entry site was the only complication and was detected in 9 cases. Even though the follow-up period is short, multiple drilling of small diameter is very simple procedure and the short-term results were encouraging in early stage osteonectosis.