Dorsal Translation of Ulnar Head after the Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

윤건희,정기진,노재휘,조휘제,김병성 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.4

Purpose: The purpose of this study was to evaluate the results of the arthroscopic wafer procedure (AWP) for ulnar im-paction syndrome (UIS) and identify preoperative factors and degree of distal radioulnar joint (DRUJ) translation that could assist in predicting outcomes. Methods: We retrospectively reviewed the medical records of 9 patients (11 wrists) who underwent AWP for UIS. Among these, 5 cases were converted to secondary ulnar shortening osteotomy and were categorized to group A and the remaining 6 cases were categorized to group B. The ulnar variance (UV), radioulnar ratio (RUR) by computed tomog-raphy or magnetic resonance imaging (MRI), MRI evidence of mechanical impaction in the ulnar or lunate, grip power, Disability of Shoulder, Arm and Hand (DASH) score, and Mayo wrist score were examined before and after AWP. Results: The MRI evidence did not differ significantly between groups A and B (p>0.05). The average UV and RUR changed from 1.6±0.7 mm and 0.68±0.17 before AWP to –1.5±0.9 mm and 0.54±0.10 after AWP, respectively. The differ-ence between the preoperative RUR (0.65) and postoperative RUR in group B (0.49) was significant (p=0.027, Pearson correlation coefficient=0.862). The grip strength, DASH score, and Mayo wrist score improved from 77.1%, 47.6, and 69.1 to 85.2%, 16.8, and 85.5, respectively. Conclusion: If patients have persisting pain and DRUJ dorsal translation is not reduced after wafer procedure, secondary ulnar shortening osteotom may be required.

후방 추체간 유합술 시 금속 케이지를 이용한 자가 국소골 이식과 케이지 주변 동종골과 자가 국소골의 유합양상: 전산화 단층 촬영 분석

박찬호,김응하,윤건희 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.2

Study Design: Retrospective study. Objectives: To conduct an analysis of the union rate and union patterns of local autogenous bone grafts using metal cages, allogenic bone, and local autogenous bone around the cages in posterior lumbar interbody fusion (PLIF). Summary of Literature Review: Local autologous bone grafting using metal cages is regarded as an effective method for union during PLIF without iliac bone harvesting. There are few studies about the additional bone grafting except using metal cages. Materials and Methods: Thirty-nine patients (68 segments) with postoperative computed tomography (CT) results from 6 to 18 months after PLIF were included. We used 2 metal cages filled with local autogenous bone intraoperatively (region C). We also grafted allogenic bone between 2 cages (region A) and local autogenous bone at the side of the cages (region B). Retrospective analyses of the coronal CT sections were performed using the modified Bridwell criteria for assessing the presence of union. A quantitative evaluation was performed using a scoring system that assessed the proportion of radiopaque parts of the union mass. Results: Among the 68 segments, union was observed in 64 segments, resulting in a union rate of 95.6%. The union rates in regions A, B, and C were 86.8%, 89.7%, and 94.1%, respectively. Trabeculation and the quantitative evaluation of union bone showed a statistically significant trend for improvement from regions A to C (p<0.001). Conclusions: In this study, the complementary effect of additional bone grafting other than local bone grafting was not proven, but it was effective in increasing the fusion area at around 90%. Keeping the height of disc space with the cages, additional bone grafting using local autogenous and allogenous bone may be used as an effective method for stable union. 연구 계획: 후향적 연구목적: 후방 추체간 유합술 시 금속 케이지를 이용한 자가 국소골 이식과 케이지 주변에 이식한 자가 국소골 및 동종골의 유합률 및 유합 양상에 대하여 분석하고자 한다. 선행문헌의 요약: 금속 케이지를 이용한 자가 국소골 이식은 후방 추체간 유합술 시 장골능의 골채취 없이 골유합을 얻는데 효과적인 방법으로 생각된다. 국소골 케이지 외 추가적 골 이식이 유합율을 높이는지에 대한 연구는 별로 없다. 대상 및 방법: 요추부 질환으로 후방 추체간 유합술을 시행 받은 환자 중 술 후 6개월에서 18개월 사이에 CT (computed tomography)를 촬영한 환자 39 명, 68분절을 대상으로 하였다. 후방 추체간 유합술 시 2개의 금속 케이지(C 구역)에 후궁절제술로 얻은 자가 국소골을 채운 후 사용하였다. 두 개의 케이지 사이에는 동결 건조 동종골(A 구역)을 이식하였고, 케이지 측면에도 자가 국소골(B 구역)을 이식하였다. CT 관상면을 분석하여 케이지 내부 및 주변 추체와의 골소주 형성 정도를 modified Bridwell criteria를 이용하여 분석하였고, 유합골괴의 정량적 분석을 위해 전체 크기 중 방사선 비투과성 부분의 크기를 점수화하여 분석하였다. 결과: 전체 68분절 중에 64분절에서 유합되어 94.1%의 높은 유합률을 보였으며, A, B, C 구역 각각의 유합률은 86.8%, 89.7%, 94.1%로 나타났다. 골소주 형성과 유합골괴의 정량적 분석 모두 케이지 사이 동종골 이식부위(A 구역)에서 케이지 외측 자가 국소골 이식 부위(B 구역), 케이지를 내부 자가 국소골 이식 부위(C 구역) 로 갈수록 우수한 경향을 보였다(p<0.001). 결론: 본 연구를 통해 케이지를 이용한 자가 국소골 이식 이외의 추가적 골 이식이 전체 유합율을 높이는 보완적 효과는 입증되지 않았으나 90% 내외에서 유합을 보여 유합 면적을 높이는 효과가 있었다. 케이지로 추간판 간격을 유지한 채로 추가적인 자가골과 동종골 이식은 안정적인 유합을 얻기 위한효과적인 방법으로 사용될 수 있겠다. 약칭 제목: 후방 추체간 유합술 시 이식골의 유합 양상

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

김병성,노재휘,정기진,윤건희,박은석,박성용 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.4

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford’s criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a sig-nificant relationship between gap or step-off and extension lag. Using Crawford’s evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

복강내 온열 관류 요법이 술후 간기능에 미치는 영향

권오경,최종호,심재용,박철주,문동언,김의숙,김성년,윤건희 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.5

N/ABackground : Intraperitoneal hyperthermic perfusion (IPHP) has been introduced in clinical practice to improve the survival of cancer patients. But despite of this advantage, postoperative hepatic dysfunction may occur more severely after IPHP than general anesthesia. The protective mechanism of liver is destroyed by hyperthermia as the result. The purpose of this study is to evaluate the effect of intraperitoneal hyperthermic perfusion on the postoperative liver function in cancer patients. Methods : Sixty patients with ovarian cancer were divided into two groups; 30 patients undergone only radical hysterectomy(control group), and 30 patients undergone radical hysterectomy combined with IPHP(IPHP group). Anesthesia was performed with enflurane-N2O-O2 in both groups. Serum glutamic oxaloacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT) and albumin levels were evaluated before anesthesia, 1, 3, 5, 7, 10 and 14th days after surgery on both groups. Results : Postoperative SGOT levels were increased on 1, 3, 5, 7, 10 and 14th days in both groups, and on 1, 3 and 5 days postoperatively were increased more significantly in IPHP group than control group, but there were no significant difference between both groups after post-operative 7 days. SGPT levels were increased more significantly on 1, 3 and 5 days postoperatively in IPHP group than control group. Albumin levels were decreased more significantly on 1 and 3 days postoperatively in IPHP group than control group. Conclusion : We consider that postoperative liver function in cancer patients is influenced by the intraperitoneal hyperthermic perfusion. (Korean J Anesthesiol 1998; 34: 1014∼1020)

전화 상담원 보호를 위한 언어폭력 탐지 방법 연구

금소현(SoHyun Keum),김관중(GwanJung Kim),윤건희(GeonHui Yun),이민수(MinSoo Lee),정준호(Junho Jeong) 한국통신학회 2023 한국통신학회 학술대회논문집 Vol.2023 No.6

외상성 삼각섬유연골 복합체 손상과 원위부 요척 관절의 불안정성

김병성(Byungsung Kim),노재휘(Jae-Hwi Nho),정기진(Ki Jin Jung),윤건희(Keonhee Yun),김영환(Young Hwan Kim),윤홍기(Hong-Kee Yoon) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.2

삼각섬유연골 복합체(triangular fibrocartilage complex, TFCC) 외상성 병변은 원위부 요척 관절(distal radioulnar joint, DRUJ)의 불안정을 유발할 수 있어 파열의 위치와 정도에 따라 적절한 치료방법을 설정하는 것이 중요하다. TFCC의 손상은 DRUJ 불안정성을 유발할 수 있는 불안정형 병변과 DRUJ 불안정을 유발하지 않는 안정형 병변으로 구분된다. 병변의 위치와 손상 정도에 따라 관절경적 변연절제술, 관절경적 봉합술 등이 고려될 수 있다. DRUJ 불안정을 유발할 수 있는 척측부 견열 손상의 경우는 관절경적인 변연절제술 후 손상이 있는 부위를 정확히 확인한 다음 suture anchor를 이용한 고정이나 끌어내기 봉합이 유용하다. 척측 견열 손상에 대한 TFCC의 봉합술은 다양한 방법과 술기가 보고되어 손상 위치 및 정도에 따라 적절한 선택이 필수적이다. 척골 양성변이와 동반된 TFCC 파열 역시 파열의 위치와 DRUJ의 불안정성 여부에 따라 수술 방법을 결정하게 되고, DRUJ 불안정성을 해결하기 위해서는 TFCC의 봉합이 중요하며, 경우에 따라 척골단축술을 고려할 수 있다. 단 TFCC 변연부 심부 파열인 경우 척골충돌증후군과 DRUJ 불안정성이 동반되어 있을 때에는 척골단축술만으로는 DRUJ 불안정성을 해결할 수 없기 때문에 척골단축술과 TFCC 봉합을 동시에 시행을 할 수 있다. Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.