소아에서 발생한 전거비 인대 거골 부착부 견열 골절(1예 보고)

조형래,황태혁,왕태현,김근영,Cho, Hyung-Lae,Hwang, Tae-Hyok,Wang, Tae-Hyun,Kim, Keun-Young 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.3

Inversion injury of the lateral ankle ligaments is very common. Few studies, however, have focused on avulsion fracture of the lateral ankle ligaments. A fracture producing a small fragment usually avulsed from lateral malleolus and may be easily misdiagnosed as a sprain because the fragment is superimposed on the lateral malleolus and goes undetected on early radiographs, especially in skeletally immature patients. We present a case of isolated avulsion fracture of the talar attachment of the anterior talofibular ligament in 13-year-old male patient. Diagnosis was confirmed by computed tomography and avulsed fragment was fixed to original talar footprint with suture anchors. A high level of suspicion must be maintained to obtain an accurate diagnosis of avulsion fracture in inversion ankle injury because of the high incidence in children and to prevent recurrent instability.

야구 선수에서 발생한 제5요추의 비전형적 척추분리증: 2예 보고

조형래 ( Hyung Lae Cho ),김두열 ( Doo Yeol Kim ),진홍기 ( Hong Ki Jin ),김지훈 ( Ji Hoon Kim ) 대한스포츠의학회 2021 대한스포츠의학회지 Vol.39 No.4

Lumbar spondylolysis is a frequent cause of low back pain especially in adolescents involved in sporting activities. It is considered as a fatigue-type defect in the pars interarticularis or isthmus resulted from repetitive hyperextension and rotation on the spine; however, there is still confusion in regard to imaging findings of the location and direction of the defect. We report two unique cases of fifth lumbar spondylolysis in professional baseball hitter and adolescent pitcher; early-stage unilateral incomplete isthmus fracture and bilateral fracture in a different configuration, respectively. Computed tomography demonstrated vertical and more coronally oriented fracture lines compared with typical spondylolytic defect, and repetitive rotation in the same direction of pitching might cause a different type of fracture on the contralateral isthmus with the preexisting unilateral defect. Intriguingly, early-stage unilateral fracture in hitter was united after only 6 weeks of rest and rehabilitation and able to return to the game.

청소년기 야구 선수에서 자기 공명 영상 상의 견관절 후방 관절 와 병변

조형래(Hyung Lae Cho),김형민(Hyung Min Kim),김지언(Ji Un Kim) 대한견주관절의학회 2018 대한견주관절학회 학술대회논문집 Vol.2018 No.3

산후조리(産後調理) 과정에서 발생한 한포진(汗疱疹)에 관한 임상적(臨床的) 연구(硏究)

조형래 ( Cho Hyung-lae ),김동일 ( Kim Dong-il ),이태균 ( Lee Tae-kyun ),이경우 ( Lee Kyeong Woo ) 대한한방부인과학회 2001 大韓韓方婦人科學會誌 Vol.14 No.3

견관절 탈구의 도수 정복 중 생긴 의인성 골절 -2예 보고-

조형래 ( Hyung Lae Cho ),김형민 ( Hyoung Min Kim ),박기봉 ( Ki Bong Park ),왕태현 ( Tae Hyun Wang ),이동현 ( Dong Hyun Lee ) 대한골절학회 2016 대한골절학회지 Vol.29 No.1

견관절 탈구는 응급실에서 흔하게 접할 수 있는 급성 관절 외상 중 하나이며 도수 정복을 통해 대부분 정복된다. 그러나 고령환자의 경우는 무리한 도수 정복 시 의인성 골절이 발생할 수 있으므로 정복에 주의를 기울여야 한다. 저자들은 견관절 전방탈구로 인해 응급실로 내원한 70세 이상의 고령 환자에서 도수 정복 중 생긴 의인성 상완골 간부 골절 및 해부학적 경부 골절이 발생한 2예를 경험하였다. 1예는 최초 견관절 탈구 환자였으며 다른 1예는 재발성 견관절 탈구 환자였고 봉합 불가능한 광범위회전근 개 파열을 동반하고 있었다. 각각 골수강내 금속 정 및 역형성 견관절 전치환술을 시행하였다. Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

산욕기 과보온으로 야기된 산욕기 발한 과다에 대한 증례 보고

조형래 ( Hyung Lae Cho ) 대한한방부인과학회 2005 大韓韓方婦人科學會誌 Vol.18 No.4

Purpose: The keeping warm and avoidance of cold are one of important Korean traditional postpartum care, but sometimes overwarm for example over-bundling, an overheated room or a steam bath cause heavy sweats. I observed and treated three patients complained of heavy sweats, chills, fatigue, malaise, cold sensation and pain caused by keeping overwarm for postpartum care. Although the symptoms have aggravated, they have maintained keeping overwarm because of a belief of Korean traditional postpartum care. The purpose of these cases studies are to report postpartum hyperhidrosis caused by keeping overwarm and to make a point of keeping the appropriate room temperature and humidity during puerperium. Methods: I observed and treated three patients complained of heavy sweats, chills, fatigue, malaise, cold sensation and pain caused by keeping overwarm for postpartum care. I found that a cause of the symptoms was hyperhidrosis by keeping overwarm, and administered herbal medicine and was to keep the appropriate room temperature. Results: After medication of Herbal medicine(補中益氣湯加味方) and keeping the appropriate room temperature, they were improved. Conclusion: Postpartum care is not to keep overwarm but to keep the appropriate room temperature and humidity.

외상성 견갑하건 파열의 관절경하 봉합술

조수현,조형래,구정회,황태혁,박만준,최재혁,Cho, Su-Hyun,Cho, Hyung-Lae,Ku, Jung-Hoei,Hwang, Tae-Hyok,Park, Man-Jun,Choi, Jae-Hyuk 대한관절경학회 2010 대한관절경학회지 Vol.14 No.3

목적: 회전근 개 파열 중 견갑하건의 파열은 극상건이나 극하건의 파열 보다는 드물다. 저자들은 외상 후 발생한 견갑하 건의 단독 파열에 대해 관절경하 봉합술 후 기능적 결과 및 구조적 연속성에 대해 보고하고자 한다. 대상 및 방법: 2003년 2월부터 2008년 10월까지 외상 후에 발생한 편측 견갑하건 파열로 관절경하 봉합술을 시행한 15예(남자 13예, 여자 2예, 평균 연령 46.2세, 범위: 35~52세)를 후향적으로 분석하였다. 전 예에서 견갑하건 이외의 다른 회전근 개의 손상의 동반은 없었고 견갑하건의 완전 파열이 9예, 상부 2/3의 파열이 6예였으며 술 후 최소한 2년간 추시 하였다(평균 28개월, 범위: 25~38개월). 술 후 최종 추시 상에서 기능적 평가는 Constant 점수와 미국 견주관절 학회 점수(ASES index)로 판정하였고 자기 공명 영상을 이용하여 봉합부의 연속성을 판정하였다. 결과: 최종 추시 결과 평균 기능적 결과 지수와 근력에 있어서 유의한 호전을 보였으며 Constant 점수는 술 전 41.5점에서 술 후 81.3점으로(P<0.05) ASES 점수는 술 전 46.4점에서 89.6점으로 향상되었다(P<0.05). 13예(87%)에서 술 후 결과에 만족하였으며 완전 파열의 경우가 부분 파열보다 기능적 점수가 높은 경향을 보였다. 술 후 평균 13개월에 촬영한 자기공명영상 검사에서 15예 중 12예(80%)에서 봉합부가 치유된 것으로 판정되었고 봉합부의 연속성이 있는 경우보다 재파열된 예에서 술 후 견관절 기능적 점수가 의미 있게 감소되었다(P<0.05). 결론: 외상성 견갑하건 단독 파열환자에서 관절경하 봉합술을 시행한 결과 동통, 견관절 운동역 및 근력의 유의한 향상 을 보였다. 술 후 봉합부의 연속성은 견관절의 기능과 연관되어 있으며, 비록 완전파열의 경우가 부분파열보다 기능적 점수가 높은 경향을 보였으나 이에 대한 추가적 연구가 필요할 것으로 사료된다. Purpose: Rotator cuff tears involving the subscapularis are less common than those involving the superior and posterior rotator cuff. The purpose of the present study was to report the clinical results of repair of isolated traumatic tears of the subscapularis tendon. Materials and Methods: Fifteen patients (13 males, 2 females; mean age 46.2 years; range 35 to 52) with unilateral ruptures of the subscapularis tendon after trauma who underwent arthroscopic repair between February 2003 and October 2008 were reviewed retrospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon and were followed for at least two years (mean 28 months). The entire subscapularis was involved in 9 cases and the tear was localized to the upper two thirds in 6 cases. The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index) and postoperative integrity was determined through magnetic resonance imaging. Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up. The constant shoulder score improved from 41.5 to 81.3 points (P<0.05) compared to before surgery and ASES index improved from 46.4 to 89.6 points (P<0.05) postoperatively. Thirteen patients (87%) were satisfied with the result of the treatment. The total tears were significantly more improved by surgery than the partial tears. In 12 of 15 patients (80%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 13 months postoperatively. The postoperative score was significantly lower for the patients with a failed repair than it was for those with an intact repair (P<0.05). Conclusion: Repair of traumatic isolated subscapularis tears through arthroscopic techniques effectively restores patient function with regard to pain, mobility, strength and postoperative tendon integrity. The postoperative integrity of the repair correlates with the functional results and the total tears were more improved by surgery than the partial tears, but future studies may be needed.

경골 근위부에 발생한 Brodie 농양에서 내시경을 이용한 소파술 - 증례 보고 -

구정회,조형래,박만준,최승현,Ku, Jung-Hoei,Cho, Hyung-Lae,Park, Man-Jun,Choi, Seung-Hyun 대한관절경학회 2007 대한관절경학회지 Vol.11 No.2

Brodie 농양은 빈도가 흔하지 않고, 독성이 적은 원인균에 의해 발생하는 아급성 혹은 만성 골수염의 국소형으로 소아나 청소년의 하지 장골 특히 경골의 골간단과 골단 부위에 호발하나 성인에서도 발생할 수 있다. 수술적 치료시 병변의 위치가 근위 경골 골간단 후방에 위치한 경우 개방적 소파술로는 병소 접근이 어렵고 신경 혈관 손상 및 주위 조직 오염의 위험성이 있다. 본원 정형외과에서 48세 남자에서 발생한 경골 근위부 골간단 후방부의 Brodie 농양을 전방 십자 인대 재건술시 사용하는 표적 기구(Rigid fix system, Mitek, Johnson & Johnson, Norwood, MA)를 이용하여 병소에 손쉽고 정확하게 삽입구를 만들어 내시경 시야 하에서 염증 및 육아 조직을 제거하여 치료한 경험이 있어 이를 문헌 고찰과 함께 보고하고자 한다. Brodie abscess is a localized form of subacute or chronic osteomyelitis which is common in children but may also occur in adulthood. When Brodie abscess is located in the posterior metaphysis of the proximal tibia, open biopsy and curettage have a difficulty in approach to the lesion and can cause neurovascular injury or soft tissue contamination. We report a case wherein a novel surgical technique was used to treat a Brodie abscess in the posterior proximal tibial metaphysis in 48 year-old-male with endoscopic-assisted curettage by commercial anterior cruciate ligament targeting device(Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). Two portals were created toward the abscess site and, through each portal interchangeably, the granulation tissue and sclerotic bone could be excised. We believe that endoscopic-assisted curettage presents safe technique, decreased morbidity, accurate assessment of the extent of the abscess and possible improvement in long-term outcomes.

견관절 오구돌기 골절의 고정 후 발생한 오구돌기하 충돌증후군 - 증례 보고 -

구정회,조형래,조수현,황태혁,박만준,최재혁,Ku, Jung-Hoei,Cho, Hyung-Lae,Cho, Su-Hyun,Hwang, Tae-Hyok,Park, Man-Jun,Choi, Jae-Hyuk 대한관절경학회 2010 대한관절경학회지 Vol.14 No.3

상완골두의 전상방부와 전방 오구견봉 궁 사이의 비정상적인 접촉으로 인해 발생되는 오구돌기하 충돌증후군은 견관절 전방부 동통을 유발하는 비교적 드문 질환이다. 이는 견관절부의 수술적 치료로 인해 오구돌기와 소결절 사이의 해부학적 관계가 변형되어 견갑하근과 점액낭을 포함한 주변 연부조직의 충돌을 유발 하게 된다. 저자들은 오구돌기 골절을 유관나사를 이용해 고정한 환자에서 오구돌기하 공간의 협소화로 인해 견갑하건 파열을 동반하는 오구돌기하 충돌증후군을 경험하였다. 관절경하에서 유관나사 제거 및 견갑하건 봉합 시행 후 술전 환자의 증상은 소실되었다. 오구돌기하 충돌증후군은 견관절 수술 후 지속적 견관절 동통을 유발하는 원인 중의 하나가 될 수 있다. Subcoracoid impingement resulting from abnormal contact between the anterosuperior humerus and the anterior coracoacromial arch represents an uncommon source of anterior shoulder pain. Certain operative procedures can also alter the relationship between the coracoid and the lesser tuberosity, leading to impingement of the interventing soft tissue, including the subscapularis and the bursa. We describe an unique case of subcoracoid impingement with the tear of subscapularis tendon after the internal fixation of the fractured coracoid process with cannulated screw due to crowding of the coracohumeral space. Arthroscopic removal of the screw and repair of the subscapularis in our patient resulted in successful resolution of his symptoms. Although subcoracoid impingement is a rare cause of shoulder pain, failure to diagnose and treat this condition may represent a significant cause of failed shoulder surgery.

Haglund씨 병에서 시행한 내시경적 감압술의 결과

안수한,조형래,홍성확,왕태현,Ahn, Su-Han,Cho, Hyung-Lae,Hong, Seong-Hwak,Wang, Tae-Hyun 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

Purpose: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. Materials and Methods: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than $75^{\circ}$ and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). Results: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and $82^{\circ}$ to postoperative 2.3 and $57^{\circ}$, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. Conclusion: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.