족근 관절 관절염에서 족관절 유합술의 결과: 전방 도달법과 경비골 도달법 비교

박치형,이준영,정연주,Pak, Chi Hyoung,Lee, Jun Young,Jeong, Yeon Joo 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Purpose: The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods: There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively. Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion: After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.

수평내전에 의해 악화되는 견관절 후방 통증 환자에서 초음파하 극하근 주사요법의 효과

박치형,문영래,이현준,Pak, Chi Hyoung,Moon, Young Lae,Lee, Hyeon Jun 대한정형외과초음파학회 2015 대한정형외과 초음파학회지 Vol.8 No.1

목적: 본 연구는 수평 내전 검사로 인해 견관절 후방부 동통의 악화를 보이는 환자에 대해서 초음파 유도 하에 스테로이드를 이용한 극하근 주사 치료 후 그 유용성에 대하여 평가하고자 하였다. 대상 및 방법: 2013년 5월부터 2014년 5월까지 견관절 후방부 통증을 주소로 내원한 환자 중 수평 내전 검사 시 동통의 악화를 보이는 21명을 대상으로 하였다. 외래에서 초음파 유도하에 극하근에 스테로이드 주사 치료를 시행하였으며 시술 전, 시술 후 3개월, 6개월로 나누어 VAS 통증 점수, UCLA 점수를 평가하였다. 결과: 스테로이드를 이용한 극하근 주사 치료 3개월 경과 시 환자들의 VAS 점수, UCLA 점수에서 임상적으로 유의하게 향상되었다(p<0.05). 시술 후 3개월과 6개월을 비교하면 VAS 점수와 UCLA 점수는 유의한 차이는 없었다(p>0.05). 6개월 추시 후 증상의 호전이 있는 완쾌 및 호전은 14예(67%)이었고, 호전이 없는 비호전 및 악화는 7예(33%)이었다. 결론: 초음파 유도 하에 스테로이드를 이용한 극하근 주사요법은 견관절 후방 통증이 있으며 수평 내전 시 통증이 악화되는 증상이 있는 환자들에게 유용한 시술이라고 생각된다. Purpose: The purpose of this study was to analyze the effectiveness of local steroid injection for infraspinatus under ultrasonographic guidance in patients with posterior shoulder pain during horizontal adduction test. Materials and Methods: Twenty one cases of patients, from May 2013 to May 2014, showed positive horizontal adduction test were retrospectively analyzed. We performed ultrasonography-guided infraspinatus injection using steroid to these patients in the outpatient clinics. We evalulated results for visual analogue score (VAS) for pain, UCLA score for these patients before injection, following 3 months and 6 months after injection. Results: After ultrasonography-guided infraspinatus injection using steroid, there were clinically significant improvements in VAS and UCLA score at 3 month's follow-up period (p<0.05). But there were no significant differences in VAS and UCLA score between 3 months and 6 months (p>0.05). Fourteen of 21 (67%) cases showed much improved and improved satisfaction. Respectively, seven of 21 (33%) cases showed not improved and aggravation satisfaction. Conclusion: Ultrasonography-guided infraspinatus injection using steroid is an effective treatment method for the patients with exacerbated posterior shoulder pain during horizontal adduction test.

항회전 근위 대퇴 골수정을 이용한 대퇴골 전자하 골절의 치료

박치형 ( Chi Hyoung Pak ),이상홍 ( Sang Hong Lee ),하상호 ( Sang Ho Ha ),이광철 ( Gwang Chul Lee ),송경철 ( Kyoung Chul Song ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4

목적: 대퇴 전자하 골절에 대해 항회전 근위 대퇴 골수정을 이용하여 치료한 결과를 분석하여 유용성을 평가하고자 하였다. 대상 및 방법: 최소 12개월 이상 추시 가능하였던 25예를 대상으로 하였고, 남자가 17명, 여자가 8명으로 평균 연령은 53.4세였다. Seinsheimer 분류상 IIA형 2예, IIB형 9예, IIIA형 2예, IV형 3예, V형 9예였다. 폐쇄적 도수 정복은 16예, 최소 절개를 시행한 경우는 9예였으며 Cleveland index, tip apex distance (TAD), 대퇴 경간각 변화, 골유합 시기 및 골수정 활강 정도 그리고 합병증 등을 평가하였다. 결과: 23예에서 골유합을 얻었으며 골유합 기간은 약 17주였다. Blade의 골두 내 위치는 Cleveland index상 5, 6, 8, 9영역이 80%였고, TAD는 평균 19.6 mm였으며 골수정 활강은 평균 4.4 mm, 대퇴 경간각 변화는 3도였다. 합병증으로 지연유합 3예, 불유합 2예 발생했다. 결론: 비교적 빠른 골유합 기간과 조기 보행 및 재활, 합병증의 감소를 보여 유용한 치료로 생각되며 폐쇄적 정복으로 해부학적 정복이 어려운 경우 최소 절개법을 이용한 정복 및 부가적 고정이 더 유용할 것으로 생각한다. Purpose: The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). Materials and Methods: Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer`s classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. Results: Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion. Conclusion: With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.

전내측 도달법을 이용한 Bifurcate Ridge 중심의 해부학적 전방십자인대 재건술 후 대퇴 터널 위치에 대한 평가

박치형(Chi-Hyoung Pak),김동휘(Dong Hwi Kim),정성(Sung Jung),양성훈(Sung Hun Yang) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.3

목적: 전내측 도달법을 이용한 해부학적 전방십자인대 재건술 시 이분 융기선을 대퇴 터널의 중심으로 터널을 만든 후 3차원 computed tomography (CT)를 이용하여 위치의 적정성을 평가하고자 하였다. 대상 및 방법: 2012년 3월부터 2013년 2월까지 해부학적 전방십자인대 재건술을 시행하였던 35예 중 후향적인 방법으로 수술 후 3차원 CT를 측정하였던 32예에 대해 Mimics을 이용하여 대퇴골 외과의 내측연을 재건한 후 Bernard의 quadrant 방법을 이용하여 터널의 위치를 평가하였다. 결과: 대퇴 터널의 중심은 대퇴 외과의 심부에서 표층으로 32.2% (27.4-37.6%), Blumensaat’s line에 수직인 선을 따라 상위에서 하위로 46.7% (43.5-51.1%)에 위치하였고, 이는 기존의 대퇴 부착부 위치를 분석한 문헌과 비교하여 대퇴 부착부 안에 존재하였으나 부착부의 중심보다는 약간 표층 및 하위에 위치하였다. 결론: 4자 모양 하지 위치에서 전내측 도달법을 이용하여 해부학적 전방십자인대 재건술을 시행하는 경우 이분 융기선은 좋은 해부학적 지표가 될 수 있으며 대퇴골 외과 후방 피질골 등의 손상 없이 해부학적 단일 대퇴 터널을 만드는 데 유용한 방법으로 생각된다. Purpose: The purpose of this study is to analyze the position of the 10-mm-sized femur tunnel drilled aiming for the bifurcate ridge using anteromedial portal technique with ‘Figure of 4 position’ by 3-dimensional computed tomography (3D-CT) reconstruction images after anatomic anterior cruciate ligament (ACL) reconstruction and to evaluate it’s propriety. Materials and Methods: Out of 35 patients who underwent anatomic ACL reconstruction from March 2012 to February 2013, 32 patients who undergone postoperative 3D-CT scans were included in this study retrospectively. Medial surface of the lateral femoral condyle was reconstructed using Mimics, and then the position of the femoral tunnel was evaluated using the Bernard quadrant method and the results were compared with those of published literatures. The mean age of the patients was 32.6 years old. There were 25 cases of double-bundle ACL reconstruction with one femoral-two tibial tunnel. There were 7 cases of single bundle ACL reconstruction with one femoral-one tibial tunnel. Results: The mean distance of the femoral tunnel center was 32.2%±2.9% (range, 27.4%-37.6%) along the line parallel to the Blumensaat’s line from the posterior condylar surface and 46.7%±2.3% (range, 43.5%-51.1%) along the line perpendicular to the Blumensaat’s line from the roof of the notch. In comparison with the results of published literature, although the center of the femoral tunnel was presented in the femoral footprint, it was located slightly more shallow and inferior than the center of the ACL footprints. Conclusion: The bifurcate ridge may be a good anatomic landmark when making a 10-mm-sized single femoral tunnel in ‘Figure of 4 position’ using the anteromedial portal technique.

가골 신연술을 이용한 제4 단중족증 치료 중 발생한 제4 중족골 골두의 무혈성 괴사(1예 보고)

이준영,조성원,박치형,Lee, Jun-Young,Cho, Sung-Won,Pak, Chi-Hyoung 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.3

Callotasis has been widely used to treat brachymetatarsia. But various complications have been reported. Avascular necrosis of the $4^{th}$ brachymetatarsia treated by callotasis has not been frequently addressed in the literature. We report 1 cases of avascular necrosis of the $4^{th}$ brachymetatarsia treated by callotasis with a review of the literature.

탈구를 동반한 족관절 골절에서 수술적 치료 후 최소 2년 추시 결과

조승환,이준영,조성원,박치형,Jo, Sueng-Hwan,Lee, Jun-Young,Cho, Sung-Won,Pak, Chi-Hyoung 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.1

Purpose: In previous study, the frequency of osteoarthritis and discomfort were high in ankle fracture-dislocation but detail results about ankle fracture-dislocation has rarely been investigated. In this study, we retrospectively analyze the outcome of the operative treatment of ankle fracture with dislocation for over-2 years follow up. Materials and Methods: There were 47 cases of ankle fracture-dislocation in our hospital from March 2007 to May 2010. We investigated 20 patients who underwent operation and were possible for over-2 years follow up. The result was estimated with the direction of dislocation, fracture type, the time of bone union and post-traumatic osteoarthritis with plain radiologic images. In clinical assessment, we statistically evaluated the function and pain through AOFAS score and Olerud & Molander scoring system. Results: By Lauge-Hansen classification, there were 13 cases(65%) of pronation-external rotation and 6 cases(30%) of supination-external rotation, 1 case(5%) of supination-adduction. AOFAS score was 85.5, and Olerud & Molander score was "excellent" in 8 cases, "good" in 5 cases, "fair" in 3 cases and "poor" in 4 cases. Postoperative complications in 4 cases revealed post-traumatic arthritis. All kinds of lateral dislocation of ankle fracture was 15 cases and the most common. Of these, all 3 cases, anterolateral dislocation showed post-traumatic osteoarthritis. Conclusion: In ankle fracture-dislocation, post-traumatic osteoarthritis occurred in 4 of 20 patient(20%). Especially, the possibility of post-traumatic osteoarthritis was more in cases of anterolateral or lateral dislocation. So, it must be needed that deliberate examination, for example, preoperative MRI and sufficient explanation to patient. Also, we have to follow up the patients carefully.