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조기대퇴골두무혈성괴사에서 괴사범위와 대퇴골두함몰과의 관계
구경회 ( Kyung Hoi Koo ),송해룡 ( Hae Ryong Song ),정순택 ( Soon Taek Jeong ),김지연 ( Ji Yeon Kim ),양진원 ( Jin Won Yang ),하용찬 ( Yong Chan ),조세현 ( Se Hyun Cho ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.2
In a randomized trial conducted to compare the core decompression to the conservative treatment, we tested the hypothesis that the extent of necrosis at the intial magnetic resonance(MR) study predicts the subsequent risk of collapse of the femoral head. After the initial clinical evaluation incluing plain roentgenography and MR imaging, thirty-seven hips of early-stage osteonecrosis(ON) in thirtythree patients were randomly assigned to core decompression group or conservative treatment group. All the patients were regularly followed by clinical evaluation, plain roentgenography and MR imag- ing at three-month intervals. The extent of ON was estimated on the basis of the percentage of abnormal signal intensity in the weight-bearing portion of the femoral head as determined on a combination in coronal and sagittal MR images. The angle of necrotic portion in mid-coronal image(A) and that in mid-sagittal image(B) were used to quantify the extent of necrotic portion by the formular;(A/180)x(B/180)x100%. A strong correlation was observed between the percentage of necrotic portion and the development of collapse. We concluded that the extent of necrotic portion is a major risk factor of the collapse and proposed a systematic method of classifying the percentage of necrotic portion which might be useful as a predictive index for that fate of early-stage ON.
구경회 ( Kyung Hoi Koo ),조세현 ( Se Hyun Cho ),이종서 ( Chong Suh Lee ),송해룡 ( Hae Ryong Song ),박형빈 ( Hyung Bin Park ),정연천 ( Yeon Chun Jung ),황선철 ( Sun Chul Whang ) 대한고관절학회 1992 Hip and Pelvis Vol.4 No.2
The shape of the proximal femoral endosteal canal is so different with age, sex and individual variation that any one contemporary stem cannot afford adequate fitting for all cases. Therefore the accurate knowledge of variability of proximal femoral canal and its chronological change is essential for the selection of the most adequate stem design and prediction of the fate of stem after hip replacement arthroplasty. Total 300 radiographs of proximlal femur (50 cases for each decade, from 3rd decade to 8th) were reviewed for the chronological anthropometric study of proximal femoral geometry and the below results were obtained. 1. The maximum cortical thickness at isthmic level was observed in the 5th decade (9.8+- 1.5mm), with gradual decreament, after then(8.9+-1.9mm in the 8th decad). 2. The endosteal canal ratio at the isthmic level revealed continuous increament from the 3rd decade (0.38+-0.08 in the 3rd decade, 0.44+-0.08 in the 8th decade). 3. About the canal flare index and the stem space flare index, their maximum values were in the 4th decade(4.5+-0.9 and 3.2+-0.6)and decreased gradually(3.5+-0.6 and 2.5+- 0.5 in the 8th decade).
자기공명영상이 정상인 대퇴골두무혈성괴사 위험군의 혈관조영술, 골주사, 골수압 및 조직학적 소견
구경회 ( Kyung Hoi Koo ),조세현 ( Se Hyun Cho ),송해룡 ( Hae Ryong Song ),민영식 ( Young Sik Min ),김재수 ( Jae Soo Kim ),김지연 ( Ji Youn Kim ) 대한고관절학회 1994 Hip and Pelvis Vol.6 No.1
Twenty-eight hips(22 Patients), at high-risk of osteonecrosis(ON) of the femoral head, with negative magnetie resonance(MR) images, underwent superselective angiography of the medial femoral circumflex artery. Six patients(seven hips) suffered groin pain since one to 12 weeks prior to this study. Superselective angiography showed the interruption of the superior retinacular aiteries(SRAs) in 13 hips(12 patients), including six of seven symptomatic hips. bone scan was performed on eight out of 13 angiographically positive hips. Decrease of radionuclide uptake(cold lesions) was observed in all of the eight femoral heads. Thufeen femoral heads with interruption of SRAs, underwent intraosseous pressure(IOP) measurement and core biopsy. IOPs were elevated in 11 femoral heads. Histologic study showed evidence of early necrosis in ten femoral heads. But the remaining three were negative for ON. This study indicates that there exists a considerable number of highrisk femoral heads, even with negative MR images, which has positive findings on angiography, scintigraphy(cold lesions), and IOP measurement, which reflects the interruption of SRAs, decreased perfusion, and marrow edema, and that among those patients, a large portion shows positive findings for early necrosis on histologic study.
대퇴골두 무혈성 괴사에서 핵시감압술의 효과(무작위 선정에 의한 임상 실험)
구경회 ( Kyung Hoi Koo ),조세현 ( Se Hyun Cho ),소해룡 ( Hae Ryong Song ),정순택 ( Soon Taek Jeong ),김재수 ( Jae Soo Kim ),양진원 ( Jin Won Yang ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.1
A randomized trial was conducted on 33 patients' 37 hips with early-stage osteonecrosis (ON). After the initial clinical evaluation including plain roentgenography aad magnetic resonance (MR) imaging, hips were randomly assigned to a core decompression group or conservative treatment group. All the patients were regularly followed by clinical evaluation, plain roentgenography and MR imaging at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core decompression group, while pain persisted in three out of four initially painfol hips in the conservatively treated group on the second evaluation (p<0.05). At a minimum follow-up of 24 months, 14 of the 1S eore decompressed hips (78%) and 15 of the 19 nonoperated hips (79%) devel- oped collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log rank test p=0.79). Core decompression may be effective in symptomatic relief, but it may not provide additional benefit in preserving femoral head as compared to the conservative management in early-stage ON of the femoral head.
무혈성괴사에서 근위 대퇴골 간단부의 지방화의 평가 : T1 강조영상을 이용한 방법
구경회 ( Kyung Hoi Koo ),송해룡 ( Hae Ryong Song ),정순택 ( Soon Taek Jeong ),정재혁 ( Jae Hyuck Jeong ),한영찬 ( Young Chan Han ),조세현 ( Se Hyun Cho ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.2
To determine whether fatty marrow conversion of the proximal femoral metaphysis is related to osteonecrosis of the femoral head, a case-control study was conducted on 42 osteonecrotic hips in 28 patients using Tl-weighted MRls. The 42 hips with osteonecrosis were matched with 84 normal control hips as for gender, age (5-year range), and time of presentation (1-year range). The signal intensities of the proximal femoral metaphysis (SM) and the greater trochanter (ST) were measured in each hip studied. We derived a marrow conversion index (%) using the formula: (SM/ST) x IOO (%). The index was 90.2% (SD, 8.2) in osteonecrotic hips, and 75.1% (SD, 9.1) in matched controls (p = 0.000). By conditional logistic regression, a 5% increase in the index above our control group value of 75% was associated with 3.6 times higher risk for osteonecrosis (95% CI = 1.9-6.7, p = 0.000) and a 10% increase with 12.9 times higher risk (95% CI = 3.7-44.8, p = 0.000). The marrow conversion index, which reflects the ratio of fatty marrow conversion of the proximal femoral metaphysis to that of the greater trochanter measured on Tl-weighted MRI, has a strong association with an increased risk for osteonecrosis.
감염성 인공슬관절의 항생제 시멘트를 이용한 이단계 재치환술
조세현,송해룡,구경회,정순택,박영준,박형빈,정재혁,하용찬 ( Se Hyun Cho,Hae Ryong Song,Kyung Hoi Koo,Soon Taek Jeong,Young June Park,Hyung Bin Park,Jae Hyuck Jung,Yong Chan Ha ) 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2
Purpose of the study. The purpose of this study was to evaluate the result of treatment of the infected total knee arthroplasty by two-stage revision. Material. Out of twenty eight total knee arthroplasty revisions, 13 revisions were performed for infected total knee arthroplasties between 1985 and l.996. Two cases of infected total knee arthroplasties were treated by immediate replacement and four cases by arthrodesis. Seven infected total knee arthroplasties had been revised by two-stage revision and followed-up for 38.6 months in average(range, 18-105 months). They were one male and six female patients of 61.6 years old in average. The primary cause of arthroplasty was osteoarthritis in all. Infection was diagnosed by preoperative aspiration, culture of the pus from draining sinus and culture of surgical specimen. Five cases revealed positive growth of causative bacteria, while two were not identified. Method. The protocol for two-stage revision began with tbe removal of infected implants and cement. The surrounding bony and soft tissue were thoroughly debrided and cleaned. The dead space between femur and tibia was filled with antibiotics-impregnated cement spacer and beads. Wound was closed and the leg was placed in soft knee brace. Patients received intravenous antibiotic therapy based on culture results for 4-6 weeks. Reimplantation was followed using total condylar prosthesis of posterior stabilizing type in five and semiconstrained type in two cases. Result. Two-stage revision was successful in six cases. One case revealed the recurrence of infection eleven months after reimplantation and underwent the repetition of the same two-stage procedure. At the final follow-up, the average Hospital for Special Surgery score was 81.l points, the average Knee Society knee score was 78.6 points and the average functional score was 76.7 points. Patients could regain average 100 degrees of knee flexion. Conclusion. The result of two-stage revision for infected total knee arthroplasty was satisfactory, showing that this can be the method of choice for infection treatment and functional restoration. This procedure using antibiotics-impregnated cement spacer and beads can control infection and improve functional results.