슬관절 동통에 대한 평가에 있어 Likert 척도와 Numeric Rating Scale과의 상관관계

최충혁 ( Choong Hyeok Choi ),김석환 ( Suk Hwan Kim ),이영석 ( Young Seok Lee ),강창남 ( Chang Nam Kang ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.1

Purpose: The Likert scale and the numeric rating scale (NRS) have been widely used to evaluate knee pain. The purpose of the present study is to compare the Likert scale and the NRS. Materials and Methods: The records of 350 patients who had painful knees were investigated from June 2008 to June 2009. The patients were divided into three groups. Group 1 included 98 patients who were admitted for total knee replacement, while group 2 consisted of 141 patients who underwent total knee replacement within a minimum of 1 year (range: 1 to 5 year), and group 3 included 111 patients who were treated with conservative methods. We simultaneously evaluated the Likert scale and the NRS and we analyzed the relationships between them using Pearson``s correlation test. Results: The correlation coefficients between the Likert scale and the NRS was -0.91. The correlation coefficients for each group was -0.75 (group 1), -0.78 (group 2), and -0.68 (group 3), respectively. Conclusion: The Likert scale was correlated with the NRS and there were no significant differences between these two scales for evaluating knee pain. It is believed that the Likert scale is another useful tool for expressing knee pain.

슬관절 재치환술 추시 결과

최충혁 ( Choong Hyeok Choi ),강석근 ( Suk Keun Kang ),이봉근 ( Bong Keun Lee ),정현기 ( Hyun Kee Chung ) 대한슬관절학회 2004 대한슬관절학회지 Vol.16 No.1

NexGen<SUP>®</SUP> 인공 슬관절 전치환술 후 결과

최충혁(Choong Hyeok Choi),김종헌(Jong Heon Kim),조용진(Yong Jin Cho),조재현(Jae Hyun Cho),정현기(Hyun Kee Chung) 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.4

슬관절 전치환술에서 외측 슬개지대 이완술의 빈도

최충혁 ( Choong Hyeok Choi ),성일훈 ( Il Hoon Sung ),정우성 ( Woo Sung Jung ),김동원 ( Dong Won Kim ) 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.1

표준형과 고도굴곡형 치환물을 이용한 후방십자인대 대치형 슬관절 전치환술의 술후 최대굴곡각 비교연구

최충혁(Choong-Hyeok Choi),구민회(Min-Hoi Koo),박용욱(Yong-Wook Park) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.6

목적: 표준형과 고도굴곡형을 사용한 후방십자인대 대치형 슬관절 전치환술의 술후 최대 굴곡각을 비교하였다. 대상 및 방법: 총 81명 133예의 슬관절을 대상으로 34명의 환자에게 일측에 표준형을, 반대측에 고도굴곡형 치환물을 이용한 슬관절 전치환술을 시행하였으며, 비교군으로 47명의 환자를 양측 모두 표준형, 양측 모두 고도굴곡형, 일측만 표준형, 그리고 일측만 고도굴곡형을 사용한 군으로 나누었고, 이에 대해 술전, 술후 1년 이상 경과 시 최대굴곡각, 슬관절점수, 그리고 기능점수를 비교하였다. 결과: 한 환자에 각각의 치환물을 사용한 34명의 환자에서 최대 굴곡각은 고도굴곡형에서 술후 평균 131.6±10.4°로, 표준형에서는 술후 131.6±9.5°로 통계적 유의한 차이를 보이지 않았다. 이를 47명의 다른 군과 비교시에도 각 군간의 통계적 차이는 없었다. 결론: 고도굴곡형 십자인대 대치형 치환물의 사용이 표준형과 비교하였을 때, 최대굴곡각의 증가를 초래하지 못한다고 사료된다. Purpose: This study was performed to compare the postoperative maximal flexion angle (MFA) of standard Pel-substituting (PS) prosthesis with that of high-flexion PS prosthesis after total knee arthro-plasty (TKA). Materials and Methods: A total of 81 patients (133 knees) were enrolled in this study. Sixty-eight primary bilateral TKAs were performed in 34 consecutive patients. The bilateral TKAs were performed in a staged sequential manner, with a standard PS prosthesis in one knee and a high-flexion PS prosthesis in the contralateral knee. We also analyzed the results of another 47 patients as several control groups, and this consisted of standard or high-flexion PS total knee prostheses in the bilateral TKAs, and standard or high-flexion PS total knee prostheses in the unilateral TKAs. The patients were clinically assessed with the Knee Society scoring system and the MFA was measured with a goniometer. Results: At the last follow up, the mean postoperative MFA of the 34 patients operated with the combination of different prostheses was 131.6±10.4° for high-flexion prosthesis side and 131.6±9.5° for standard prosthesis side respectively. There was no statistically significant difference. On comparing with the results of the 47 patients in the control group, no statistically significant difference in the mean postoperative MFA was found between the groups. Conclusion: We found no significant differences between the high-flexion PS prosthesis and the standard PS prosthesis in the postoperative MFA.

전신성 홍반성 루푸스 환자에서 발생된 Group B Salmonella 균에 의한 감염성 슬관절염

최충혁(Choong-Hyeok Choi),이래형(Rae-Hyung Lee),이진규(Jin-Kyu Lee) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.4

전신성 홍반성 루푸스 환자에게 감염은 가장 중요한 사망 원인이며, 박테리아에 의한 감염이 대부분을 차지하고 있다. 살모넬라는 세망내 피기관의 부전, 면역 억제 제재의 사용 등으로 면역이 저하된 전신성 홍반성 루푸스 환자에서 균혈증을 유발하는 흔한 균주 증 하나이나 화농성 관절염을 일으키는 경우는 극히 드문 것으로 보고되어 있다. 저자들은 전신성 홍반성 루프스 환자에서 B군 살모넬라균에 의한 화농성 슬관절염을 경험하였으며, 관절경하 세척술과 항생제로 치료한 증례를 보고하는 바이다. Infection is a leading cause of death in patients with systemic lupus erythematosus (SLE). Insufficiency of the reticuloendothelial system, immunosuppressive therapy and inadequate opsonization are the main predisposing factors for infection. Salmonella infection is one of the most common opportunistic bacterial infections in patients with SLE and it can provoke a bacteremia or a localized infection. We report here on a rare case of septic knee arthritis caused by Group B Salmonella in a SLE patient, and this was treated with arthroscopic irrigation and antibiotics.

Distal Metatarsal Chevron Osteotomy with Trans-Articular Lateral Soft Tissue Release in Moderate to Severe Hallux Valgus

Choong-Hyeok Choi(최충혁),Il-Hoon Sung(성일훈),Jin-Woo Choe(최진우) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.8

목적: 중등도 또는 고도의 무지 외반 변형에 있어 제1 중족골 원위 갈매기형 절골술과 제1 중족 족지 관절을 통한 외측 연부 조직 유리술의 임상적 및 방사선학적 결과에 대해 알아보았다. 대상 및 방법: 총 20예를 대상으로 하였으며 방사선학적으로 수술 전 및 수술 후 1년 추시시 무지 외반각 및 제1, 2 중족골간 각을 측정하여 비교하였다. 임상적 평가는 미국정형외과족부족관절(AOFAS) 평가법을 이용하였다. 결과: 수술시 원위 골편의 외측 전이는 평균 6.9 ㎜ (5-8 ㎜)였다. 수술 전 무지 외반각 및 제1, 2 중족골간 각은 각각 평균 31.2° (29-36°)와 15.0° (13-18°)였으며, 수술 후 1년 추시 결과 각각 평균 8.4° (1-17°)와 6.6° (3-11°)로 향상되었다. AOFAS수치 또한 평균 47.0 (32-65)점에서 91.0 (72-100)점으로 향상되었다. 4명의 환자는 수술 후 발 모양에 대해 불만족 하였다. 2명의 환자는 수술 후 제1 중족 족지 관절의 현저한 족배 굴곡 장애를 보였으며 1명의 환자는 K-강선 제거 후 신경통을 호소하였다. 결론: 제1 중족골 원위 갈매기형 절골술과 제1 중족 족지 관절을 통한 연부 조직 유리술을 함께 시행한 경우, 평가 항목상 모든 예에서 만족 이상의 결과를 보여 주었으나, 심한 무지 외반증에서 이 술식을 적용시킬 경우 수술 후 내측 발 모양에 의해 주관적인 불만족을 보일 수 있으므로 이에 대한 고려가 있어야 할 것으로 사료된다. Purpose: To assess the clinical and radiographic results of distal metatarsal chevron osteotomy (DMCO) and transarticular release of lateral soft tissue for moderate to severe hallux valgus deformities. Materials and Methods: 20 cases were studied. Hallux valgus angle (HVA) and first-second intermetatarsal angle (1, 2 IMA) were measured preoperatively and at 1 year after surgery. The clinical evaluation was performed with the American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarso-phalangeal-interphalangeal scale. Results: The average lateral shift of the distal segment was 6.9 ㎜ (range: 5 to 8 ㎜). The average preoperative HVAs and 1, 2 IMAs were 31.2° (range: 29 to 36°) and 15.0° (range: 13 to 18°) respectively, which improved 1 year after surgery to 8.4° (ange: 1 to 17°) and 6.6° (range: 3 to 11°), respectively. The average AOFAS score improved from 47.0 points (range: 32 to 65 points) to 91.0 points (range: 72 to 100 points). Four patients were dissatisfied with the profiles of their feet, two patients had significant limitations in dorsiflexion of the first metatarsophalangeal joints, and one patient had neuralgic pain after removal of a K-wire. Conclusion: The overall outcomes were good with DMCO and transarticular release of the lateral soft-tissue. However, these procedures alone, in some advanced deformities, would result in subjectively unsatisfactory medial foot contours.

슬관절 전치환술에 대하여 환자가 지적하는 좋은 점과 아쉬운 점에 대한 분석

최충혁 ( Choong Hyeok Choi ),김강욱 ( Kang Wook Kim ),성일훈 ( Il Hoon Sung ),박예수 ( Ye Soo Park ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.1

Purpose: To determine the priority for the instrumental development of Total knee replacement arthroplasty(TKA) by assessment of patient interviews after TKA in Korea. Materials and Methods: We assessed the responses of 168 patients with primary TKA a minimum of one year after surgery. In order not to limit their choices by using a survey, interviewees responded to two open-ended questions, What was the best result achieved after TKA? and What was the result you most wished for but was not achieved after TKA? Results: All the patients expressed satisfaction with TKA except for 12 patients (7.1%) and for the question of the best result after TKA, 118 patients (70.2%) pointed out that pain relief was the most satisfactory. For the question of the most wished for function still to be restored after TKA, 59 patients (35.1%) answered No inconvenience and no need and the greatest proportion among the others who had a wish, 61 patients (36.3%) pointed to discomfort related to the degree of knee flexion with the response Not easy to stand from the ground and to have deep knee flexion. The average knee flexion degree was 120.7˚ in the group who had a wish related to knee flexion but 127.5˚ in the No need group, and the difference was significant (P=0.004). Conclusion: Although there was a 93% satisfaction rate after TKA, the remaining function most wished for after TKA was to stand up from the ground easily, which is related to knee flexion degree. Therefore, we propose that the improvement of knee flexion after TKA should be the priority for instrumental development in Korea.

슬관절 전치환술의 내측 이완술 중 내측측부인대가 분리된 예에 대한 임상적 , 방사선학적인 평가 - 비교 연구 -

최충혁(Choong Hyeok Choi),김종헌(Jong Heon Kim),정현기(Hyun Kee Chung),김주학(Joo Hak Kim) 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.1

Purpose: On performing TKA in severe varus deformity, sometimes processing medial release, we can not get well balanced knee without completely detaching the MCL in tibial attached site. In these cases, we analyzed the clinical and radiological results. Materials and Methods: We evaluated 20 TKA patients with completely detached MCL (Group I) comparing to 20 TKA patients without MCL detached using CR type (Group II), 20 TKA patients without MCL detaches using PS type (Group III). The clinical evaluation was done by the American Knee Society evaluation system. The radiographic examination in valgus stress were done with Telos device under control of fluoroscopic guide 0 degree and 30 degree flexion. Results: The mean knee score of each group was improved from 43, 45, and 41 points preoperatively to 89, 90, and 91, then mean functional score also improved from 52, 54, and 57 points preoperatively to 88, 91 and 94 points at the latest follow-up respectively. On the radiographs in valgus stress at 0 degree flexion and 30 degree flexion, the mean angle were; in group I 4.5 and 6.0 degree, in group II 3.1 and 4.2 degree, in group III 3.4 and 4.7 degree. There was no patients to complain the subjective medial instability of the knee Conclusion: On performing TKA in severe varus deformity, in releasing MCL, it might be detached completely from tibial side. In this situation, this resulted in good function and there was no need to reattach the ligament and use constrained type prosthesis.

원위 비골 골절에 이용한 후방 금속판 고정술

최충혁 ( Choong Hyeok Choi ),조영아 ( Young A Cho ),김재훈 ( Jae Hoon Kim ),성일훈 ( Il Hoon Sung ) 대한골절학회 2007 대한골절학회지 Vol.20 No.2

목 적: 원위 비골 골절에서 후방 금속판 고정술의 기술적 경험을 보고하고자 한다. 대상 및방법: 원위 비골 골절에 후방 금속판 고정술을 시행하였던 20예를 연구 대상으로 하였다. 1/3반원형 금속판을 사용하여 나사못의 고정은 금속판에 직각이 되도록 하였고 수술장 내에서 고정의 안정성과 정복의 유지 여부를 확인하였다. 수술 후 최소 1년 시점에서AOFAS 점수로 임상적 결과를 평가하였다. 결 과: 5예에서 지연 나사못 고정 및 원위 골편의 고정 없이 골절부의 정복과 안정적인 고정이 가능하였다. 골절부의 추가적 정복과 안정성의 확보가 필요하였던 14예에서 금속판을 경유한 후전방 지연 나사못 고정을 하였다. 후방 금속판이 정복을 방해하였던 3예에서는 금속판의 윤곽 변형을 하였고 이 중 1예에서는 금속판 고정 전에 전후방으로 나사못을 고정하였다. 모든 예에서 가장 원위부 나사 구멍의 고정 없이안정적으로 고정되었다. 술 후 중대한 합병증은 발생하지 않았다. 수술 후 최소 1년 시점에서 AOFAS 점수는 평균 95.5점 (범위; 78∼100)이었다. 결 론: 원위 비골 골절에서 후방 금속판 고정은 대부분 안정적인 고정을 얻을 수 있었으나 일부 예에서 적절한 정복이나 견고한 고정이 가능하지 않은 경우도 있었으며, 추가적인 나사못 삽입이나 금속판의 윤곽변형이 필요하였다. Purpose: To report the technical experience of posterior plating for the distal fibular fracture. Materials and Methods: 20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFO AS) Ankle-Hindfoot score. Results: 5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior inter-fragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFO AS score was 95.5±5.2. Conclusion: The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.