날씨와 연계된 기침감기의 지리의학적 치유법 체험 소개

배서영,안소민,조기호 대한지리학회 2018 대한지리학회 학술대회논문집 Vol.2018 No.6

원위경비골인대 손상의 치료 동향: 대한족부족관절학회 회원 설문조사 분석

배서영,조재호,조병기,정비오,정진화 대한족부족관절학회 2022 대한족부족관절학회지 Vol.26 No.2

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the management of syndesmotic injuries over the last few decades. Materials and Methods: A web-based questionnaire containing 36 questions was sent to all KFAS members in September 2021. The questions were mainly related to the preferred techniques and clinical experiences in the treatment of patients with syndesmotic injuries. Answers with a prevalence ≥50% of respondents were considered a tendency. Results: Seventy-six (13.8%) of the 550 members responded to the survey. The results showed that the most preferred method to diagnose a syndesmotic injury was magnetic resonance imaging (MRI). Intraoperatively, the external rotation stress test and the Cotton test were most frequently used to confirm syndesmotic diastasis. The reduction was usually done by a reduction clamp. One 3.5-mm screw was used most frequently over three cortices at 2~4 cm above the ankle joint. The preferred ankle position during fixation was 0° dorsiflexion. Removal of the syndesmotic screw was routinely done by most surgeons, mainly because of the limitation of movement and risk of screw breakage. Factors that affect suture button selection included non-rigid fixation which enables adequate fixation, early weight-bearing, and an infrequent need to remove the hardware. Inadequate reduction was considered the main factor that affects poor prognosis. Conclusion: This study proposes updated information about the current trends in the management of syndesmotic injuries in Korea. Consensuses in both the diagnostic and therapeutic approach to patients with syndesmotic injury were identified in this survey study. This study may raise the awareness of the various possible approaches toward the injury and should be used to further establish a standard protocol for the management of syndesmotic injuries.

아킬레스건 봉합 후 초음파에서 보이는 섬유 배열 양상과 임상적 요인과의 관계

배서영,최영진,안수형 대한족부족관절학회 2022 대한족부족관절학회지 Vol.26 No.3

Purpose: To evaluate the correlation between the fibrillar pattern of the Achilles tendon on ultrasonography (US) and functional outcomes in patients who underwent open tendon repair after Achilles tendon rupture. Materials and Methods: Data of 44 patients who had been subjected to US at least 6 months after repair, during the period between July 2012 and July 2019 were reviewed. Those with bilateral tendon rupture, re-rupture, open injury, and chronic or insertional rupture, were excluded from the review. We divided them into two groups, the homogenous group (HoP) and the heterogenous group (HeP) based on the fibrillar pattern on US. We also divided the HoP into linear and wavy subgroups, and the HeP into no hypoechoic lesion and hypoechoic lesion subgroups. The rupture type of the Achilles tendon, radiographic factors including US and magnetic resonance images, patient-related, surgical factors, and clinical results at the last visit after repair were assessed retrospectively. Results: The tendon thickness was 11.4±1.7 mm in the HoP, and 14.5±3.0 mm in the HeP (p<0.001). A shredded pattern was observed in 17 cases (65.4%) in the HoP, and in 17 cases (94.4%) in the HeP (p=0.031). The mean value of the number of sutures used was 8.9±3.05 in the HoP and 11.39±1.75 in the HeP (p=0.001). The mean value of the difference in calf circumference was 0.9±0.67 cm in the HoP and 1.36±0.71 cm in the HeP (p=0.037). There were no statistically significant differences in the fibrillar patterns and patient-related factors. Conclusion: The fibrillar pattern observed after repair was correlated with the functional outcome and showed a significant relationship with the rupture pattern and the number of sutures used. Therefore, we suggest a careful individualized postoperative rehabilitation protocol to maximize functional outcomes by referring to the fibrillar pattern in US, especially in shredded ruptures.

만성 족관절 외측 불안정

배서영,Bae, Su-Young 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.1

Acute ankle sprain is the most common injury in the lower extremities, and approximately 10% to 40% of acute lateral ankle ligament injury causes chronic pain or instability. For chronic symptoms lasting after an acute sprain, the possibility of joint damage, such as bony structures, ligaments, cartilage, and nerves around the ankle joint, should be considered. Patients with chronic lateral ankle instability usually complain of repeated sprains or giving way sensations. There has been steady progress in the treatment options until recently, however new treatments are still being attempted. This paper describes the causes, diagnosis, and recent trends in the conservative and operative treatment of chronic lateral ankle instability.

족관절 삼과골절에서 후과골절편이 외상후 관절통증에 미치는 영향

배서영,신동훈 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 족관절 삼과골절에서 후과 골절편의 정복과 고정 여부에 관하여는 논란이 있으나 골절편의 크기가 관절면의 25~30% 이상을 차지하는 경우 고정이 필요하다는 주장이 일반적으로 받아들여지고 있다. 저자들은 후과 골절편의 크기 및 고정 여부가 실제로 임상결과에 영향을 주는 가장 중요한 인자인지 알아보고자 하였다. 대상 및 방법 : 본원에서 동반손상이 없는 족근관절 삼과골절로 치료받았으면서 내과 및 외과의 해부학적 정복이 이루어진 73명중 2년 이상 추시 가능하였던 30명을 대상으로 하였다. 수상 직후와 정복 직후의 측면사진에서 후과 골절편의 크기를 관절면을 차지하는 정도(%)로 측정하고 정복 직후 사진에서 잔존하는 전위 정도를 골편 간극과 관절면의 층짐으로 나누어 측정하였다. 또한 의무기록의 조사를 통해 후과의 고정 여부, 관절운동의 시작시기, 체중부하 시작시기를 조사하였다. 임상 결과는 AOFAS(American Orthopaedic Foot and Ankle Society)의 기준에 따라 통증, 기능, 정렬에 대해 점수를 매기고 추시상 관절의 통증이 남은 군과 통증이 없는 군으로 나누어 각 인자들 중 어떤 인자에 의해 좌우되는지 로지스틱 회귀분석과 Chi-square교차분석을 통해 유의수준 5%로 알아보았다. AOFAS 점수 중 기능이나 정렬 면에서는 차이가 없었으며 관절 불안정을 보이는 경우도 없었으며 운동범위의 제한을 보이는 경우가 1예 있었다. 관절통을 호소하는 군은 7명, 통증이 없는 군은 23명이었고 두 군간에 잔존하는 골절편의 간극과 관절면의 층짐 정도는 유의한 인자였으나 골편의 크기나 고정여부, 관절운동 시작시기, 체중부하 시작시기 등에서는 유의성을 검증할 수 없었다. 결 론 : 삼과골절에서 후과 골절편은 크기나 고정 여부보다도 정복 후 골절편의 간극이나 층짐이 임상결과, 특히 관절통증에 더 영향을 미치므로 고정 여부에 상관없이 정복후 정복 상태에 대한 정확한 평가가 필요하고 골편의 크기에 상관없이 해부학적 정복이 필요할 것으로 사료된다. 또한 후과의 부정위는 내외 양과의 골절이 해부학적으로 정복된다면 족관절 기능이나 불안정보다는 통증을 유발하는 것으로 사료된다. Purpose : There are some criticisms of indication for internal fixation of the posterior malleolar fragments in trimalleolar fractures. We tried to find out clinical and radiologic factors which affect on a clinical outcome of triballerolar fractures. Materials and Methods : Thirty three patients who were treated for trimalleolar fractures and given anatomical reduction of lateral and medial malleolus were included. We divided patients into two groups, a group without the pain and the other group with the pain. Preoperative and postoperative lateral plain radiographic films were used to estimate fragment size, post-reduction gap and step off. By reviewing the medical records, other factors such as the time of ankle motion, weight loading and whether posterior malleolus was fixed. Or not were studied. A clinical outcome was evaluated by ASFAS(American Orthopaedic Foot and Ankle Society) scaling system. We performed statistical analysis using Logistic regression analysis and Chi-square test on each factors. Results : There was no definite difference between two groups on the functional outcome. There was one case showing limited ankle motion. Seven patients were involved in the group with the pain and 23 in the group without the pain. The remnant fracture gap and step off of joint surface statistically showed the meaningful corellation with the pain but a fragment size and a surgical fixation, time of motion and weight loading did not show any significances. Conclusion : We doubt the significance of the size of posterior malleolar fragment. We concluded that anatomical reduction of posterior malleolus is the most significant factor of a clinical outcome regardless of the size or internal fixation, especially the pain after trimalleolar injuries.

벽매립형 중앙 흡인장치를 이용한 감염성 당뇨병성 족부 궤양의 밀봉 치료

배서영,이창욱,서인석,Bae, Su-Young,Lee, Chang-Wook,Seo, In-Seock 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.1

감염된 당뇨병성 족부궤양의 병실내 벽매립형 중앙 흡인 장치를 이용한 창상 밀봉관리로 빠른 창상의 호전을 얻을 수 있었다. 이 창상관리 방법은 빠른 창상의 호전 외에도 비용을 획기적으로 줄일 수 있으며 환자의 동통을 줄이고 병실내 세균 전파의 위험이 적으며 필요 인력 축소 등의 장점이 있으나 말기신장부전 환자에서의 적용은 추가의 연구가 필요할 것으로 사료된다. Purpose: The infected diabetic foot patients were reviewed to analyze the result of new dressing methods using a wall-suction instruments. Materials and Methods: Eighteen patients treated with wall-suction assisted vacuum dressing were included. After debridement under local anesthesia, a sponge pad, a drain, and a surgical drape were used to seal the wound. Negative pressure applied by the wall-suction at around 200 mmHg and dressing were repeated in every two to three days. The results of repeated wound cultures, growth of granulation tissues, and CRP level were closely observed on the regular basis. Results: Rapid growth of granulation tissues was noticed around the wound in 16 cases. No organism was obtained in an average 5 days and wound coverage was possible in an average 18 days. The CRP level returned to normal in an average 4 weeks. Two patients with end stage renal disease, who were regularly hemodialised, underwent major amputation. Conclusion: New dressing method has the following advantages: a rapid wound improvement in the patients with infected diabetic foot, less expensive, less painful, impediment of bacterial contamination in the hospital room. However, further study will be needed for the end stage renal disease patients.

유전성 연축성 양하지 마비 환자에서의 족부 진행성 동적 첨내반족 -1예 보고-

배서영,서인석,Bae, Su-Young,Seo, In-Seock 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.1

In neurogenic equinovarus deformity, surgical intervention such as tendon transfer or osteotomy can be expected to improve symptoms. However, in rare cases of hereditary spastic paraplegia, the deformity and paralysis gradually progress. So limited operation and early post-operative rehabilitation are preferred to aggressive operation. We would like to report our clinical experience with one case of hereditary spastic paraplegia patient with reference review. A 40 year-old male, given tendon transfer of ankle and foot and tendo achilles lengthening 10 years ago, complained about aggravated spastic paraplegia which resulted in dynamic equinovarus and limited walking ability since his operation. Family history showed limited walking ability of his father with gradually progressing spastic paralysis and he was diagnosed as hereditary spastic paraplegia type I. We had performed a limited operation such as tendo achilles and tibialis posterior lengthening to induce plantigrade standing and walking with crutch. As a result, the patient was able to maintain a stabilized standing posture and walk after the operation. Hereditary spastic paraplegia presents with a progressive paralysis which limits rehabilitation after tendon transfer, and the symptoms can be aggravated. Therefore, considering potential hereditary neurogenic disorders in paients with equinovarus deformity and performing limited operative procedures seem to be important.

변형 마우 절골 술기의 유용성과 한계점 (30예 추시 보고)

배서영,김병민,남희태,최희준,Bae, Su-Young,Kim, Byoung-Min,Nam, Hee-Tae,Choi, Hee-Joon 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: To evaluate the value and limitation of modified Mau osteotomy through the review of 30 feet treated by this procedure. Materials and Methods: We retrospectively analyzed 30 cases treated with modified Mau osteotomy since 2002. The mean duration of follow-up was 10 months. We reviewed medical records to describe each case and select several clinical factors which related with surgical procedure and could influence on final results. We measured radiographic parameters such as hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position and also assessed clinical outcomes by AOFAS score and satisfaction degrees. Results: The mean preoperative HVA and IMA were $40.4^{\circ}$, $17.4^{\circ}$ and the mean amounts of correction were $31.2^{\circ}$ and $11.5^{\circ}$. Amounts of delayed loss of correction were 16.8% in HVA and 19.2% in IMA. Initial HVA, rotational angle and translation distance of the distal fragment, stability of fixation, first ray instability were revealed as significant factors for the final result from this procedure. DMAA was increased by rotation of the distal fragment and decreased by adding translation on the rotation. Conclusion: Modified Mau osteotomy is an effective procedure to get enough correction. But, it is important to try to avoid excessive rotation of the distal fragment because it may worse joint congruity. It may be worthwhile to pay close attention to the direction of saw and stability of fixation.

족부의 말초 신경 병변으로 인한 통증에서 피리독신의 사용

배서영,정의엽,오수찬,Bae, Su-Young,Jung, Eui Yub,Oh, Su Chan 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: We analyzed retrospectively the effect of pyridoxine in the treatment of peripheral nerve related foot pain because we have seen favorable clinical results from it as a monotherapy. Materials and Methods: We analyzed the clinical results of 200 cases of peripheral nerve related foot pain, treated with pyridoxine from March 2009 to February 2012. We devided them into three groups, peripheral neuritis, Morton's neuroma and posttraumatic neuralgia and recorded percentage of improvement of pain, compared to initial pain level at 2 weeks and 6 weeks. Results: There were 127 peripheral neuritis cases, 22 Morton's neuroma and 51 posttraumatic neuralgia. At 2 weeks after treatment, 135 cases(67.5%) showed pain relief. At 6 weeks, 36 cases(21%) showed complete improvement of pain, 81 cases(47%) showed more than 50 % of improvement, 22 cases(13%) showed less than 50% of improvement and 33 cases(19%) showed no improvement. There are 4 cases of gastrointestinal discomfort and 2 cases of aggravation of nervy pain. Conclusion: Pyridoxine was effective drug in the treatment of peripheral neuropathic pain in terms of pain relief, safety and cost effectiveness. So it can be an available first line drug before adding other drugs.

소건막류에서 경피적 절골술의 전위 정도가 임상 결과에 미치는 영향

배서영,이승주,정형진,Bae, Su-Young,Lee, Seung-Joo,Chung, Hyung-Jin 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.2

Purpose: The purpose of this study was to report impacts of the amount of displacement of percutaneous osteotomy on the clinical and radiologic results in the treatment of bunionette deformities. Materials and Methods: We retrospectively reviewed 36 cases of bunionette deformities treated with percutaneous modified Kramer osteotomies from 2009 to 2013. We measured amounts of displacement on anteroposterior and lateral plain radiographs as well as multiple parameters which represent degrees of the bunionette deformities. We also recorded radiological healing time, clinical healing time, residual symptoms, and the time of returning to daily activity. Results: No meaningful correlation was found between severity of preoperative deformity and amount of displacement of the osteotomy. The amount of displacement on a horizontal plane did not affect the healing time, duration of symptoms, or time of returning to daily activity. However, large sagittal displacement was related to duration of postoperative symptoms. Conclusion: Findings of this study suggest that the displacement in percutaneous osteotomy for bunionette deformity does not affect clinical results and healing time. We believe that we do not need to be excessively cautious about how large the displacement we make during the percutaneous modified Kramer osteotomy for the bunionette deformity.