슬관절 탈구와 동반된 다발성 슬관절 인대 손상의 접근과 치료

김광미 ( Kwang Mee Kim ),전철홍 ( Churl Hong Chun ) 대한스포츠의학회 2012 대한스포츠의학회지 Vol.30 No.1

Multiple ligament injuries of the knee means more than two ligament injuries, using as an analogue of the knee dislocation. The first priority in the early diagnosis and treatment of the knee dislocation is a vascular evaluation of extremity and careful neurovascular examination should be done firstly. It is common opinion in the treatment of multiple ligament injuries that surgical treatment is superior to conservative treatment. Especially, early ligament repair or reconstruction and aggressive rehabilitation are recommended in young active patients.

동종 반월상 연골 이식술 후 임상적 결과 및 운동력 회복

김광미 ( Kwang Mee Kim ),전철홍 ( Churl Hong Chun ),정기준 ( Ki Joon Jeong ) 대한스포츠의학회 2011 대한스포츠의학회지 Vol.29 No.1

The purpose of this study was to evaluate the clinical results and recovery of sports activity in patients who received meniscal allograft transplantation. From December 1999 to May 2009, we selected 36 cases out of 38 cases who received meniscal transplantation using fresh frozen allograft. The mean age was 33.8 years (range: 17-50 years) and the mean follow up was 68.8 months (range: 12-142 months). Clinical results were evaluated with knee assessment scoring system (KASS), Lysholm knee score and International knee Documentation Committee. The information of quadriceps and hamstrings strength recovery was obtained using Tegner activity scale, Tegner activity score and Biodex system 2 (Biodex, USA), and it was used to evaluate the recovery of sports activity. The average KASS score was increased from 61.7 preoperatively to 83.8 postoperatively. The average Lysholm score was increased from 77.7 preoperatively to 87.7 postoperatively. Also, Tegner activity scale, Tegner activity score and the recovery of quadriceps and hamstrings increased at 1year after surgery. In knee joint position sense, the proprioception increased compared to preoperational count. We propose the meniscal allograft transplantation is one of a proper treatment after subtotal or total meniscectomy, which can significantly relieve pain and improve function of the knee joint.

사람의 슬관절 전방십자인대에서 감각신경의 조직학적 분포

김광미 ( Kwang Mee Kim ),전철홍 ( Churl Hong Chun ),김봉규 ( Bong Gyu Kim ) 대한스포츠의학회 2012 대한스포츠의학회지 Vol.30 No.2

P.F.C(R) Sigma(TM) RP-F Knee System을 이용한 고도 굴곡 회전형 슬관절 전치환술 후 결과 -술 전 슬관절 운동범위 90˚ 미만 군과 90˚ 이상 군의 비교-

김광미 ( Kwang Mee Kim ),전철홍 ( Churl Hong Chun ),임재창 ( Jae Chang Im ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.4

Purpose: The purpose of this study was to evaluate the clinical and radiological results of using the P.F.C(R) Sigma(TM) RP-F Knee System for high flex rotating platform-flexion total knee arthroplasty in 2 groups of patients with a preoperative range of motion (ROM) less than 90 degrees or more than 90 degrees, respectively. Materials and Methods: From January 2005 to November 2006, eighty-two patients received the P.F.C(R) Sigma(TM) RP-F Knee System for high flex rotating platform total knee arthroplasty, and they were evaluated for a minimum of 3 years. We subdivided the patients into two groups: the preoperative ROM less than 90˚ group and the more than 90˚ group. The clinical results were assessed using the ROM, the Hospital for Special Surgery (HSS) score, the Knee Society Score (KSS) and the Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) score. The radiological results were evaluated using the tibio-femoral angle and the presence of loosening or osteolysis of the components. Results: The ROM increased in the two groups at the last follow-up. The mean ROM range at the last follow up was significantly increased more in the less than 90˚ group compared to that in the more than 90˚ group. The HSS score, KSS, and WOMAC score significantly increased in the two groups, but there was no statistical difference between the two groups. The tibio-femoral angle improved in the two groups. There was no aseptic loosening or osteolysis. Conclusion: The postoperative clinical and radiological measures were significantly improved using the P.F.C(R) Sigma(TM) RP-F Knee System on the short term follow-up, and especially for the patients whose preoperative ROM was poor.

고도 굴곡형 슬관절 전치환술의 중기 결과

김광미(Kwang Mee Kim),전철홍(Churl Hong Chun),강홍제(Hong Je Kang),노성현(Sung Hyun No) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.4

목적: 고도 굴곡형 인공관절을 사용하여 슬관절 전치환술을 시행한 환자의 중기 추시 결과를 보고한다. 대상 및 방법: 2004년 11월부터 2006년 6월까지 고도 굴곡형 치환물을 사용하여 슬관절 전치환술을 시행한 77명, 119예를 대상으로 하였다. 평균 연령은 67.3세, 평균 추시 기간은 71.1개월이었다. 평가는 관절운동범위, Hospital for Special Surgery (HSS) score를 조사하였으며 기능적 평가를 시행하였고, 방사선학적으로 평가를 하였다. 결과: 평균 관절운동범위는 104.7o에서 129.8o로, 평균 HSS score는 42.7점에서 93.5점으로 호전되었다. 쪼그려 앉기 33명(42.8%), 양반다리 앉기 75명(97.4%), 무릎 꿇기 27명(35.0%), 바닥 및 의자에서 일어나기는 각각 45명(58.4%), 73명(94.8%)에서 가능하였다. 6예에서 슬관절 강직으로 도수 조작술을 시행하였고, 1 mm 정도의 방사선 투과성 선을 보이는 경우는 5예였으나 진행하지 않았으며 의미 있는 해리는 없었다. 결론: 대퇴 치환물의 조기해리는 치환물 자체의 문제가 아닌 것으로 생각되나 조기해리의 원인에 대한 연구 및 장기 추시가 필요할 것으로 생각한다. Purpose: The purpose of this study was to evaluate the mid-term results of high-flexion total knee arthroplasty. Materials and Methods: We retrospectively reviewed 77 patients who underwent 119 total knee arthroplastys using high-flexion implants (LPS-flex<SUP>®</SUP>, Zimmer, Warsaw, IN, USA) from November 2004 to June 2006. The mean age was 67.3 years (range, 54-83 years), and the average follow-up duration was 71.1 months. We assessed preoperative and last follow-up functional outcomes with ranges of motion (ROM) and the Hospital for Special Surgery (HSS) score and investigated their ability to squat, sit cross-legged knee, kneel, or stand up from the floor or a chair at the final follow-up. The Knee Society Radiographic evaluation and scoring system was used for radiologic evaluation. Results: The mean ROM increased from 104.7o preoperatively to 129.8o postoperatively at the final follow-up. The average HSS score improved from 42.7 points preoperatively to 93.5 points postoperatively. At the final follow-up, 33 patients (42.8%) were able to squat; 75 patients (97.4%) were able to sit cross-legged; 27 patients (35.0%) were able to kneel; 45 patients (58.4%) were able to stand up from the floor and 73 patients (94.8%) were able to stand up from a chair. Six cases encountered stiff knees as a complications, and were treated with manipulation procedures. 1 mm radiolucent lines were detected in 5 cases, but none of them were progressive. Conclusion: We believe that the hyperflexion implant itself is not a cause of early loosening. Research on reasons regarding early loosening and long-term follow-ups will be needed.

아킬레스 동종건을 이용한 전방십자인대 재건술에서 잔류조직 보존술과 비보존술의 고유수용감각 비교 및 보행운동형태 분석

김광미 ( Kwang Mee Kim ),한정규 ( Joung Kyue Han ),이영 ( Young Yi ),전철홍 ( Churl Hong Chun ) 대한스포츠의학회 2012 대한스포츠의학회지 Vol.30 No.2

슬관절 연골 결손에 대한 Fibrin Matrix 자가 연골 세포 이식술 후 임상적 결과와 자기공명영상 소견 및 운동력 회복

전철홍 ( Churl Hong Chun ),김광미 ( Kwang Mee Kim ),정기준 ( Ki Joon Jeong ),한정규 ( Joung Kyue Han ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.2

The purpose of this study was to evaluate the clinical results, MRI findings and recovery of sports activity in 11 patients with cartilage defects of the knee who received fibrin matrix autologous chondrocyte implantation (ACI) from December 2005 to February 2008. Their mean age at the time of surgery was 37.8 years and the mean follow-up was 24.1 months. The average size of defect was 6.27 cm2. The site of defect was located in medial femoral condyle or lateral tibial condyle. Clinical results were assessed using the Lysholm score, VAS score, modified Cincinnati knee score, Tegner activity scores. MRI was examined at 12 months postimplantation. The quadriceps and hamstrings strength were measured using Biodex System. Mean modified Cincinnati score, VAS score, Lysholm score and Tegner activity scores were showed significant improvement. MRI studies also were showed significant improvement. Peak torque and total work at postoperative period were significantly greater than at preoperative period. The treatment of chondral lesions of the knee using ACI brought positive clinical results. It has been shown that ACI is an effective means of managing focal chondral lesions of the knee. The clinical, MRI findings and recovery of sports activity reflect the good outcome obtained with the procedure.

신선 아킬레스 동종건을 이용한 전방십자인대 재건술 후 이차적 관절경 소견과 임상적 결과 및 스포츠 회복 평가

전철홍 ( Churl Hong Chun ),김정우 ( Jeong Woo Kim ),김광미 ( Kwang Mee Kim ),전근철 ( Keun Churl Chun ),한정규 ( Joung Kyue Han ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.2

The purpose of this study was to analyze recovery of sports activity and the relation between clinical results and arthroscopic findings after anterior cruciate ligament (ACL) reconstruction. From May 1995 to March 2007, 85 patients (85 knees) who underwent arthroscopic ACL reconstruction with fresh frozen Achilles allograft were evaluated with 2nd-look arthroscopy over a year (average 20.6 months). The mean age at the time of surgery was 31.6 years. The findings of 2nd-look arthroscopy were evaluated on graft tension, extension of synovial coverage and revascularization. The graft tension, synovial coverage and revascularization showed significant correlation on each of anterior translation, IKDC score and Lachman test. However, range of motion showed correlation only on graft tension (p<0.05). Mean-while, Lysholm knee score showed correlation on graft tension and synovial coverage (p<0.05). Tegner activity scores showed satisfying recovery of sports activity and 2nd-look arthroscopic findings showed highly significant correlation with clinical findings. So, it needs to study about improving formation of synovium and revascularization, and graft tension.

일반인에서 스포츠 손상으로 인한 제2형 단독 Superior Labral Anterior and Posterior 병변의 관절경적 봉합술의 임상적 결과 및 삶의 질 평가

노성현 ( Sung Hyun No ),김정우 ( Jeong Woo Kim ),강홍제 ( Hong Je Kang ),김종윤 ( Jong Yun Kim ),김광미 ( Kwang Mee Kim ) 대한스포츠의학회 2014 대한스포츠의학회지 Vol.32 No.1

The purpose of this study was to morphologically classify the superior labral anterior and posterior (SLAP) lesion in people with athletic injuries and further research into the clinical result of arthroscopic repair of type II SLAP lesions. January 2005 to June 2012 occurred after sports activity in patients with shoulder pain diagnosed with isolated SLAP lesion by magnetic resonance imaging and arthroscopy were classified according to the tear type. Of these patients, 40 cases of type II SLAP patients were evaluated using American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Also satisfaction of surgery was evaluated by following up through phone calls using translated short form-36 (SF-36). At average of 35 months postoperatively, external rotation decreased slightly from 60.4 degrees to 56.2 degrees, forward elevation and internal rotation were both recovered to a range of pre-surgery but no significant changes were noticed statistically (p>0.05). Visual analogue scale, ASES scores, physical component summary, and mental component summary of SF-36 improved from 5, 1 to 1.2 (p=0.01), from 65.4 to 91.5 (p=0.017), 42.6 to 52.5 (p=0.047), and from 48.5 52.6 to (p=0.036), respectively. In comparison of a group of patients over forty years and less than forty, both groups showed good results, but group of patients less than forty years showed more improvement in pain relief, functional test, and postoperational satisfaction (p=0.004). Arthroscopic repair showed good results in patients with type II SLAP lesion due to athletic injuries especially when they were less than 40 years and it can be regarded as a good treatment with high satisfaction.

P.F.C. 인공 슬관절을 이용한 슬관절 전치환술에서 후방십자인대 보존유무에 따른 비교

전철홍(Churl Hong Chun),김정우(Jeong Woo Kim),김현준(Hyun Jun Kim),임철민(Chul Min Lim),김광미(Kwang Mee Kim) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5

목적: 퇴행성 관절염 환자에게 슬관절 전치환술을 시행함에 있어, 후방십자인대 보존 여부에 따른 임상적, 방사선학적 결과에 대해 비교하파 하였다. 대상 및 방법: 퇴행성 관절염 환자 193명(223예) 중 P.F.C. 형의 슬관절 전치환술을 시행하고 6년 이상 경과 관찰이 가능하였던 퇴행성 관절염 환자 168명(188예)을 후방십자인대 보존군 96예, 대치군은 92예로 나누어 분석하였다. 결과: 술 전 Knee Society 슬관절 점수와 HSS 평가지수 및 굴곡 구축, 방사선학적 정렬은 두군 모두에서 통계학적으로 호전되었지만 양군간의 차이는 통계학적 의의가 없었다. 반면에 평균 후속 굴곡각은 술 전 보존군 114.7도, 대치군 119.3도였으나, 추시상 각각 121.2도와 131.3도로 증가되어, 술 후 평균 후속 굴곡각은 대치군에서 더 증가되었다(p<0.05) 결론: 보존군과 대치군 사이에 술 후 슬관절 점수등의 임상적인 결과 및 방사선적 결과에 차이는 없었으나, 후속 굴곡각은 대치군에서 보존군보다 더 향상되었다. Purpose: To compare the functional results of posterior cruciate-retaining (PCR) and posterior substituting (PS) replacement in patients undergoing primary total knee arthroplasty (TKA) for osteoarthritis. Materials and Methods: A randomized controlled study was carried out to compare the clinical and radiological outcomes of PCR and PS primary P.F.C.<SUP>®</SUP> TKA. One hundred and sixty eight patients (188 cases), who had a primary diagnosis of osteoarthritis, and an intact functioning posterior cruciate ligament, were enrolled in this study. The patients were randomized regardless of the level of posterior cruciate ligament preservation. One hundred and eighty eight cases had a minimum 6-year follow-up, which included 96 and 92 cases in the PCR and PS groups, respectively. Results: The Knee Society Score, the Hospital for Special Surgery (HSS) knee rating scores, average flexion contracture and radiologic alignment improved significantly, but there were no significant difference between the two groups. On the other hand, the mean postoperative flexion angles in the PCR and PS knees increased from 114.7° to 121.2° and 119.3° to 131.3°, respectively (p<0.05). Conclusion: There were no significant differences between PCR and PS TKA in the follow-up knee scores. However, the level of postoperative improvement in further flexion was better in the PS group.