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- 저자 : 강승백(Seung Baik Kang) (검색결과 47 건)
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당뇨병이 있는 환자에게 시행한 인공 슬관절 전치환술의 결과
강승백(Seung-Baik Kang),조영재(Young-Jae Cho),윤강섭(Kang-Sup Yoon),이지호(Ji Ho Lee),조현철(HyunChul Jo),이재협(Jae-Hyup Lee),한혁수(Hyuk Soo Han) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.6
목적: 당뇨병을 앓고 있는 환자에게 시행한 인공 슬관절 전치환술(TKA)의 임상결과를 알아보고자 하였다. 대상 및 방법: 1996년 3월부터 2001년 10월까지 본원에서 슬관절의 골관절염으로 TKA를 시행 받은 373명 601예 중 당뇨가 있었던 45명(74예)를 대상군으로 하였다. 대상군은 모두 제2형 당뇨에 이환되어 있었다. 평균추시 기간은 49개월(6-108개월)이었으며, 평균연령은 68.6세(54-83세)였다. 대상군과 대조군의 HSS 점수 및 KSS 점수, 방사선적 해리소견, 표재성 창상문제 및 심부 감염 여부, 내과적 합병증발생 여부를 평가, 비교하였고, 당뇨군에서 수술 전과 추시 시에 혈장 당화혈색소 수치를 검사했다. 결과: 최종 추시 시 KSS 임상점수와 통증 점수는 당뇨군이 비당뇨군에 비해 높았으며(각각 p=0.040, 0.039), HSS 점수와 기능점수는 비당뇨군이 높았다(각각 p=0.021, 0.016). 표재성 창상 합병증은 당뇨군에서 6예(8.1%), 비당뇨군에서 8예(2.4%) 관찰되어 당뇨군에서 유의하게 많았다(p=0.032). 심부 감염은 당뇨군에서 2예(2.7%), 비당뇨군에서 3예(0.9%) 관찰되었고 두 군 간에 유의한 차이는 없었다(p=0.224). 대상군 중 표재성 창상 합병증과 심부 감염이 발생한 환자들의 당화혈색소수치가 감염증이 발생할 당시 평균 8.4% (7.9-8.7%)였고, 이는 대상군 중 감염이 발생하지 않은 환자들의 평균치인 5.7% (4.0-8.1%)에 비해 유의하게 높았다(p=0.033). 결론: 당뇨병을 동반한 골관절염 환자에서 TKA의 임상 결과는 비당뇨병 환자와 비교하여 큰 차이가 없었지만, 감염 및 창상 합병증에 대하여 철저한 주의가 요구된다. 당화혈색소수치는 TKA와 연관된 창상문제 및 감염예방 을 위한 지표로써 가치가 있다. Purpose: To analyze the results of total knee arthroplasty (TKA) in patients with diabetes mellitus (DM). Materials and Methods: Between 1996 and 2001, 601 TKAs in 373 patients were performed by a single surgeon. From this series, 45 patients (74 knees) were diagnosed as type Il DM and osteoarthritis of the knee. The mean follow-up was 49 months (6-108 months), and the mean age was 68.6 years (54-83 years). The clinical outcome of the diabetic and non diabetic group was compared using the Hospital for special surgery score (HSS) and the Knee society clinical and radiological scoring system. The radiological loosening and perioperative complications were evaluated. The plasma Hemoglobin A1c (HbA1c) level of the diabetes patients was examined pre and postoperatively. Results: The knee and pain scores were higher in the diabetes group postoperatively (p=0.040, p=0.039, respectively), whereas the HSS scores and overall function scores were lower in the diabetes group postoperatively (p=0.021, p=0.016, respectively). The rate of superficial wound problems was greater in the diabetes group (8.1 % versus 2.4%, p=0.032). However the incidence of a deep infection was similar in the diabetic and non diabetic group (2.7% versus 0.9%). The mean HbA1c level was significantly higher in the diabetic patients with a superficial and deep infection than in the remaining diabetic patients (p=0.033). Conclusion: The HbA1c level might be a valuable predictor of superficial wound complications and deep infection. Although the clinical results were similar in the diabetes and non diabetes groups, special precautions should be taken for diabetic patients undergoing TKA to minimize complications.
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강승백 ( Seung Baik Kang ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.4
In the current age of technological advances, reproducing the knee kinematics for minimizing wear and increasing the range of motion, together with obtaining proper alignment and stability, have become the major goals of total joint replacement. The kinetics of total knee arthroplasty (TKA) have a complex influence on its performance, and differing abnormal patterns have been shown after TKA by using gait analysis, fluoroscopy and radiostereometry. In the sagittal plane, it is now understood that the femoral condyles roll and glide simultaneously on the tibial plateau during flexion. The kinematics of the knee and the shape of the condyles and the tibial plateau are closely interrelated with the functions of the cruciate ligaments. The kinematics result from the combined actions of the surface geometry of the joint and the soft tissues attached to it. To a variable extent in the mid-range, these factors cause tibial internal rotation to occur with flexion around a medial axis. From 120_ to full flexion, both condyles roll back onto the posterior horn so that the tibio-femoral joint subluxes. In TKA, it has been demonstrated that substituting a cam-and-post mechanism for the PCL (posterior cruciate ligament) shows consistent posterior femoral rollback during flexion. Restoration of the posterior condylar offset is important since it allows a greater degree of flexion before impingement occurs.
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유소년기 감염성 고관절염으로 인한 골관절염의 외전근 활주를 이용한 2단계 고관절 전 치환술
윤강섭 ( Kang Sup Yoon ),강승백 ( Seung Baik Kang ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2
Total hip arthroplasty for adults with the sequelae of pediatric hip infection presents a series of difficult problems because of soft tissue contractures, hypoplasia of acetabulum, distorted femur, suboptimal abductor function, leg-length discrepancy and recurrence of infection. During the past 5 years, two stage total hip arthroplasty using abductor slide has been performed for the twenty one patients with the sequelae of pediatric hip infection and followed up for average 29.1 months. No trochanteric osteotomy was done and the aMuctor was released subperiosteally and aUowed to slide distally over the wing of the ilium. The mean Harris hip score and the Enghs radiographic assessment score were 84.4 and 22.7 respectively. One hip, which showed migration of the acetabular cup, rated as poor and the revision of the acetabular cup seemed to be impending. The frequency of the pain was 19.0% and limping was seen in 47.6%. The average correction of leg length discrepancy was 3.3 cm and there was no sciatic and common peroneal nerve palsy except one case of temporary femoral nerve palsy which recovered completely 4 months after operation. Vascular injury, postoperative dislocation, deep infection were not detected in all cases and heterotopic ossification occurred in 1 1 hips(52.4%). Two stage total hip arthroplasty for adults with the sequelae of pediatric hip infection would be a safe technique, having many advantages such as safe, sufficient correction of leg length discrepancy, avoidance of nerve palsy and trochanteric problem, restoration of abductor function, detection of latent bone infection and measurement of true leg length in the presence of severe joint contracture and so on. Gentle tissue handling to avoid heterotopic ossfication and longer follow-up will be needed to uncover any hidden advantages or disadvantages of this technique.
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정성수,원중희,강승백,신건 ( Sung Soo Chung,Choohg Hee Won,Seung Baik Kang,Geon Shin ) 대한슬관절학회 1995 대한슬관절학회지 Vol.7 No.1
Degenerative arthritis and functional instability have been reported in knees with chronic posterior cruciate ligament injury treated conservatively. Surgical treatment for the posterior instability seems to be necessary, however, problerns of rupture or stretch of the reconstructed ligarnent may occur according as force to the knee joint increases. We have attemped to correct posterior knee instability due to chronic posterior cruciate ligament injury with a procedure that employs a free autograft of one-third of the patellar tendon augmented with PROLAD (Protek ligarnent augmentation device - Protek, Bern, Switezrland) using hot-dog techique. The purpose of this paper is to report our experience and to evaluate early result of the reconstructive surgical procedure. This procedure was done for 6 knees in 6 patients during the period of 1992 to 1994. They were all males and had pain and instability. Average age was 28 years, ranging from 17 to 46 years. The interval between injury and ligarnent reconstruction was minimum 3 rnonths. Postoperatively, motion of the joint begun on second to fifth day. The average follow-up was 18months, ranging from 14 months to 26 months. There were two complications, one superficial wound infection and tendemess on the protruded screw head, which were treated by wound care and transfer of screw, respectively. According to the OAK evaluation chart, one patient shows excellent, five patients show good result and in Lysholm scoring, five excellent and one good. On posterior stress roentgenograms, posterior displacernent improved from 16mm ( range, 1 Imm to 20mm ) to 4mm( range, 3mm to Srnm ). This early results indicate that synthetic augrnentation enables patients to move their joint earlier and protects the autograft to regain its sufficient strength and that this procedure seems to be effective for achieving static and functional stability of the knee.
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이명철,성상철,강승백 ( Myung Chul Lee,Sang Cheol Seong,Seung Baik Kang ) 대한슬관절학회 1993 대한슬관절학회지 Vol.5 No.1
Over the past few years the arthroscope has played a major role in the evaluation and treatment of the chondral and osteochondral lesions of ankle joint. But its tech- nique is very difficult and require considerable expertise with instrument. We reviewed 10 ankles in 10 patients who underwent arthroseopic treatment of the osteochondral lesion of ankle at Seoul National University Hospital from 1986 to 1991. The mean age at the time of surgery was 30 years (re,nge,16 to 49 years). There were eight males and two females, All patients had history of trauma and conservative treat- ment under the diagnosis of ankle sprain. The mean follow-up was 2 years and 9 months (range, 1 year and 2 months to 6 years and 7 months). Preoperative diagnosis were osteochondritis dissecans in 7 ankles, loose osteochondral body in one and degenerative arthritis in two through CT or MRI. Arthroscopic diagnosis were osteo- chondritis dissecans with crater and loose body in 6 ankles, loose osteochondral body with no osteochondral defect in one and posttraumatic degenerative arthritis in three. Six ankles with crater and loose body were treated with arthrosopic abrasion and loose body removal. Dne aknle with loose osteochondral body was treated with loose body removal and 3 ankles with degenerative arthritis were treated with resection of body spur and osteochondral ridge. At last follow up, 8 ankles showed excellent and two showed good result. Postoperatively one patient complained transient dorsal numbness and there were no permanent complications. Arthroscope would play a definite role in the diagnosis and treatment of the osteochondral lesions of ankle.
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