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제 3형 급성 견봉-쇄골 관절 분리 환자의 수술적 치료 결과
한성호,양보규,이승림,정선욱,이동호,김민석 대한골절학회 2003 대한골절학회지 Vol.16 No.2
목적 : 본 연구를 통하여 Rockwood 제 3형 급성 견봉-쇄골 관절 분리 환자에서 Phemister 술식과 modified Phemister 술식의 치료 결과를 비교하고자 한다. 대상 및 방법 : 1992년 2월부터 2001년 8월까지 제 3형 급성 견봉-쇄골 관절 분리로 수술적 치료를 받고 1년 이상 추시 가능하였던 45명, 45예의 환자를 대상으로 하였다. 평균 연령은 28.1세였으며, 남자가 42명, 여자가 3명이었다. 진단은 이학적 검사와 단순 방사선 부하 촬영법을 이용하였으며, 수상일로부터 수술적 치료까지의 평균 기간은 7.8일이었다. 술장 소견상 오구-쇄골인대 봉합술이 어려운 15예에서는 Phemister 술식을 시행하였고 (Ⅰ군), 인대 봉합이 가능한 30예에서는 modified Phemister 술식을 시행하였다(Ⅱ군). 수술 후 추시 기간은 평균 16.2개월이었고, 결과 판정은 최종 추시 때의 임상 소견과 이학적 검사 및 방사선 촬영을 통해 UCLA shoulder scoring system과 acromio-clavicular separation scoring system을 이용하였다. 결과 : 술후 합병증은 Ⅱ군에만 표재성 감염이 2예, K-강선 이주가 1예에서 발생하였다. 최종 추시상 전예에서 동통, 관절 운동 범위의 제한은 없었고 , Ⅱ군에서만 방사선 촬영상 2예에서 아탈구가 관찰되었다. UCLA shoulder scoring system은 Ⅱ군에서 우수 93.3%, 양호 6.7%였고, acromio-clavicular shoulder scoring system은 Ⅱ군에서 우수 90%, 양호 10%였다. 결론 : 활동적인 연령에서 발생한 제 3형 급성 견봉-쇄골 관절 손상의 환자에서 Phemister 술식만으로도 좋은 결과를 보일 수 있을 것으로 사료된다. Purpose : The purpose of this study is to compare the Phemister technique with the modified Phemister technique for the patients with Rockwood type 3, acromio-clavicular separation. Materials and Methods : The 45 cases of 45 patients received surgical treatment for Rockwood type 3, acute acromio-clavicular separation in our hospital from Feb. 1992 to Aug. 2001 later with the follow-up study were selected as subjects. The average ages were 28.1 years old, male and female were 42, 3 persons, respectively. Physical examination and plain radiography were used for their diagnosis and the intervals between injury and surgical treatment were 7.8 days. In intraoperative finding, we performed Phemister technique in 15 cases according not to be able to repair coraco-clavicular ligament (groupⅠ), modified Phemister technique in 30 cases according to be able to repair that (groupⅡ). The average follow up period was 16.2 months, and the UCLA shoulder scoring system and the acromio-clavicular separation scoring system were used to obtain clinical results. Results : Only in Group Ⅱ, the complication after surgery were associated with superficial infection in two cases and K-wire migration in one case. At last follow up, there were no pain and limitation of range of motion in all cases, and two cases in Group Ⅱ were found to be subluxation in radiography. Clinical results revealed excellent was 93.3%, good was 6.7% in UCLA shoulder scoring system in both groups, and excellent was 90%, good was 10% for group Ⅱ in acromio-clavicular separation scoring system. Conclusion : The results are considered to be food with only Phemister technique in type 3, acute injury occurred in working ages.
양보규,한성호,정선욱,이승림,박양희,고동오 대한골절학회 2001 대한골절학회지 Vol.14 No.2
Purpose : The goal of our study was to evaluate diagnosis and management of stress fracture in long bones using MRI findings. Material & Method: Between May 1995 to May 1999, 40 patients( 45 cases ) were confirmed to have a stress fracture by clinical and radiological findings. All patients were evaluated with clinical, X-ray, bone scan, and MRI findings. The patient was 21 years in average( range from 18 to 23 years ). All were males and soldiers. The evaluation was made by comparison of MRI and plain radiograph, and duration of symptom was evaluated with MRI grading by Fredericson et al. Result: The locations of stress fracture of long bones were tibia(n=25), fibula(n=14), and femur(n=6). MRI findings were bone marrow edema in 38(84.4%)cases, intramedullary low signal intensity band in 19(42.2%)cases which was continuous with cortex and cortical fracture line. Periosteal reaction was seen in 45(100%)cases and surrounding soft tissue edema in 20(44.4%)cases. Plain X-ray findings were peristeal reaction in 31( 68.9%)cases, medullary sclerosis in 10(22.2%)cases, and cortical fracture line in 8(17.8%) cases. Duration of symptom was longer in higher MRI grade. Conclusion: MRI was more useful in early diagnosis and differential diagnosis of stress fracture, showing various findings than plain radiograph. MRI grading was helpful in planning tlhe therapy of stress fracture.
배대경,정선욱,권현섭 ( Dae Kyung Bae,Shun Wook Chung,Hyun Sub Kwon ) 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1
The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.
배대경,정선욱,권현섭 ( Dae Kyung Bae,Shun Wook Chung Hyun Sub Kwon ) 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1
Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment ot the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 case,s. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and / cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in mthroscopic exanunation with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.
양보규,한성호,정선욱,이승림,이제오 대한골절학회 2000 대한골절학회지 Vol.13 No.2
Purpose: In this paper, we have intended to evaluate the types of fracture of the distal femur treated with anatomical bone plate, simple and user' s friendly apparatus and to assess their clinical results. Materials and Methods: We retrospectively reviewed 21 cases in 20 patients who were followed up over I year among the patients that had distal femoral fractures treated with anatomical bone plate. We analysed their fracture types in AO classification and assessed clinical results according to Neer system. The average duration of follow-up was 30 months(range, 14 months to 49 months). Results: Out of twenty-one cases, twelve were A type(A 1, 3 cases: A2, 4 cases: A3. 5 cases) and nine were C type(C1, 2 cases; C2, 4 cases; C3, 3 cases). But B type was none. Conclusions: This study demonstrate that the operation with anatomical bone plate is not only simple and user s friendly technique but also widely applicable method to treat A and C types of the distal femoral fractures.