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작성자자유시간 조회 0회 작성일 2021-06-10 20:55:02 댓글 0

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십분딥러닝_8_오토인코더(AE; AutoEncoder)

오토인코더(AutoEncoder)에 대한 설명입니다.
[PPT] https://www.slideshare.net/HyunKyuJeon3/8autoencoder
JW KIM : 좋은 강의 감사합니다
Junghoon Kim : 테마 좋네요 십분 딥러닝. 잘봤습니다. 여러 주제를 다뤄주시면 좋겠네요.
진교훈 : 늘 감사합니다
k song : 자료들 엄청나네요 감사합니다
불멸창식_ImmortalGgyu : 좋은 강의네요. 도움 많이 됬습니다.

Arthroscopic bankart repair

Arthroscopic bankart repair by
Joo Han, Oh M.D., Ph.D.

Seoul National University Bundang Hospital
Republic of Korea

■ Patient information
This patient was 22-year-old man. He had right shoulder anterior instability for 3 years. Three years ago, he had a trauma; abduction and external rotation injury during throwing. He like playing baseball, and his position is a pitcher. After initial subluxation, he had total ten times subluxation, and the last subluxation was 6 months ago during shoulder lift-up position.
The physical examinations of anterior instability were checked including anterior apprehension test, Jobe’s relocation test and anterior translation test, and they were positive. The physical examinations of posterior instability were checked also, and Jerk test, Kim’s test and post. apprehension test were all negative. He had not general laxity including sulcus sign. The physical examinations of SLAP lesion were checked, and biceps groove tenderness, Speed test and Yergason test were negative.
The total modified instability severity index score (mISIS)1) was 6 that was measured by patient’s information.
In the stress x-ray, the acromiohumeral interval was 16.9mm in the stress neutral position and 22.6mm in the stress external rotation position, and this meant that rotator interval was loose.
In the CT arthrography and MRI, the bony Bankart lesion (2-5 o'clock direction) with Hill-Sachs lesion whose width was 13.2 mm, depth was 3.1 mm and angle was 10 degrees. Using the best-fit circle method, glenoid bone defect was 16%. The value of the width of the glenoid track was more than the values of the Hill-Sachs interval, and it was an on-track lesion.
Therefore, we decided to do arthroscopic anterior capsulolabral reconstruction with rotator interval closure using knotless suture anchors.

■ Operative procedure
The patient underwent surgery in the lateral decubitus position under general anesthesia. Diagnostic arthroscopy with 30 degrees arthroscope was performed with a standard posterior viewing portal and anteroinferior portal as the primary working portal was made. Needle localization of anteroinferior portal for Bankart repair would be needed and it would be convenient if it locates just lateral side of the superior subscapularis tendon. The superior labrum complex was palpated with a probe to determine the type of SLAP lesion, and the lesion was diagnosed as a type V SLAP lesion with meniscoid labrum in this patient.
For Bankart repair and anterior capsular plication, the abnormally attached labrum and capsule was sufficiently detached from the glenoid neck using 70 degrees arthroscope, and then 2- to 3-mm wide subchondral bone was exposed using a motorized burr for the recipient bed. After overall examination of the glenohumeral joint and detaching procedure, the additional anterosuperior portal was used as the secondary working portal for procedures on the anterior labrum and capsule.
After 2.9 mm drill hole was made around 5 o’clock position, a suture hook loaded with No. 3 polydioxanone (PDS, Ethicon, Somerville, NJ) was introduced through the primary working portal and pierced the anteroinferior labrum and inferior capsule. Then, a strand of the PDS (blue strand) was retrieved through the secondary working portal. A FiberWire was passed into loop of PDS, and then PDS was retrieved through the main working portal with the shuttle relay technique. Knotless suture anchor (BIORAPTOR™ Knotless Suture Anchor; Smith \u0026 Nephew) with the FiberWire was inserted into the drilled hole. Additional second and third knotless suture anchor fixation was performed with the same method. To repair the rotator interval, the anterosuperior capsule and rotator interval together with the anterior labrum at 1- to 2 o’clock position were sutured.
After finishing the repair, we checked for firm reattachment of the labrum to the glenoid with a probe.

■ After operation
Immobilization in neutral rotation with an abduction pillow was maintained for 6 weeks. ROM exercises were initiated at 6 weeks after surgery and the brace was discontinued. The gaining of full range of motion was encouraged until 3 months after the operation except external rotation. Then muscle strengthening exercises and external rotation stretching exercise were started with the Theraband at 3 months after the operation. Sports activity was usually allowed 6 months after the operation.

■ Reference
1. Oh et al. Reliability of the Instability Severity Index Score as a Predictor of Recurrence after Arthroscopic Anterior Capsulolabral Reconstruction. CiOS. 2019;11:445-452
Geoffrey Yin : excellent live show
samaroj : English please
George TV : Master in shoulder surgery
Mohamed Attia : Very wonderful illustration

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