성인에서 상완골 원위부의 T 또는 Y 자형의 관절내 골절에 대한 수술적 치료

김영규,엄기석 대한골절학회 2000 대한골절학회지 Vol.13 No.2

Purpose: To evaluate the results after rigid fixation for intraarticular distal humerus fractures and determine the prognostic factors influencing outcome. Materials and Methods: Twenty-two patients were managed with the rigid fixation using dual plate or one plate combined with cannulated screw. According to the Miiller's classification, eleven cases were classified as type C1; five, as type C2; and six, as type C3. Based on the age, the patients were divided into two groups as a guideline of 50 years of age so that the number of the patients was 11 cases respectively. Rusults: By the rating scale from Aitken and Rorabeck, excellent or good results were 90% in type Cl, 80% in type C2 and 66% in type C3. All patients who were under 50 years of age obtained excellent or good results, and group who were older than 50 showed 64% good results. Conclusion: Rigid fixation using dual plate and early mobilization using functional brace were considered to be a good method for intraarticular distal humerus fractures. And, this study revealed that comminution of fracture and age became an important factors in achieving the desired results.

심장이식 후 부신피질호르몬 투여로 인한 거골의 무혈성 괴사 - 1예 보고 -

박홍기,엄기석,Park, Hong-Gi,Eom, Gi-Serk 대한족부족관절학회 2000 대한족부족관절학회지 Vol.4 No.2

A vascular necrosis of the talus has frequently been reported following trauma because talus has no muscle insertions, sixty percent of the surface of the talus is covered by hyaline cartilage, takes only a small area for entrance of a blood supply. Osteonecrosis is also associated with a variety of nontraumatic disorders. There are many indications for steroid usage, patient with rheumatoid arthritis, systemic lupus erythematosus, chronic obstructive pulmonary disease, and status- post renal or cardiac transplantation may be on long- term steroid usage, osteonecrosis may develop. A vascular necrosis of the talus secondary to chronic steroid usage is an unusual case. Delay in detection of osteonecrosis may lead to fragmentation and collapse of the talar body. When pain on range of motion is present and conservative treatment have been exhausted, surgical treatment is indicated, that is, fusion of the ankle joint. However it is important that conservative treatment may prevent its various sequelae with early diagnosis because steroid - treated patients have a more operative risk and increased risk for postoperative infection. We report a rare case of corticosteroid induced avascular necrosis of talus after cardiac transplantation.

상완골 근위부 골절 또는 골절 및 탈구에서의 상완골 두 치환술

김영규,엄기석 대한견.주관절학회 2000 大韓肩.주關節學會誌 Vol.3 No.1

대퇴골 원위부 분쇄 골절에서 DCS를 이용한 MIPPO 수기

이범구(Beom Koo Lee),엄기석(Gi Serk Eom),심재앙(Jae Ang Sim) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.1

목적: 대퇴골 원위부 분쇄 골절의 치료에서 MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) 수기와 금속 내고정으로서 DCS (Dynamic Condylar Screw)의 유용성에 대해 알아 보고자 한다. 대상 및 방법: 1998년 2월부터 2000년 8월까지 본원에서 MIPPO 수기로 골간단부를 고정하고 관절내 골절이 함께 있는 경우 외측 슬개골 주위 관절 절개술로 수술한 대퇴골 원위부 골절 중 최소한 12개월 이상추시가 가능했던 23예를 대상으로 하였다. 수술 후 평가는 Neer 평가 방법, 방사선적 골 유합 및 대퇴-경골 각(tibiofemoral angle)으로 측정한 골 정열 상태의 방사선적 결과, 그리고 임상적 합병증으로 판정하였다. 결과: 임상 결과는 18예(78.3%)가 만족 이상, 5예(21.7%)가 불만족을 보였다. 방사선적 골 유합 기간은 평균 16주(11-20주)였으며, 대퇴-경골 각으로 측정한 골 정열 상태는 평균 외반 3°(0-7°)였고, 2예에서 8° 이상의 외반 변형을 보였으며, 10° 이상의 후방 각 형성은 없었다. 합병증으로는 1예에서 2cm의 하지 부동과 5예에서 지연 유합이 있었는데 이 경우 골절 부위에서 골편의 간격이 보였으나 골 이식은 필요하지 않았고 최종 추시에서 골유합을 얻었다. 결론: 대퇴골 원위부 분쇄 골절에서 MIPPO 수기와 DCS를 이용한 내고정이 불유합 및 감염 등의 합병증을 줄일 수 있는 유용한 술식이다. Purpose: To evaluate the advantages of transarticular reconstruction and fixation by MIPPO (Minimally Invasive Percutaneous Plate Osteosynthesis) using DCS in comminuted fractures of the distal femur. Materials and Methods: From February, 1998 to August, 2000, we experienced 23 cases of comminuted fractures of the distal femur, which were treated by MIPPO and lateral parapatellar arthrotomy in most cases. The follow up period was minimally 12 months. Clinical results were evaluated using Neer scores, radiographic results and the presence of clinical complications. Results: According to the Neer scores, 18 cases (78.3%) showed satisfactory results and 5 cases (21.7%) unsatisfactory results. The average period until radiographic union was 16 weeks (range 11-20 weeks). As for alignment measured using the tibiofemoral angle, 2 cases showed valgus deformity and no posterior angulation was present over 10°. As for complications, 1 case showed a leg length discrepancy of 2 cm and 5 cases showed delayed union, which showed a gap radiographically between the bone fragment at the site of the fracture, and callus formation on ultrasound, but which did not need a bone graft. The radio-graphic union was achieved at the final follow-up. Conclusion: In the case of comminuted fractures of the distal femur, transarticular reconstruction and fixation by the MIPPO technique using DCS could reduce complications including non-union and infection.

MIPO 수기를 이용한 경골 근위부 분쇄 골절의 치료

이범구,조현철,엄기석,김진원 대한골절학회 2002 대한골절학회지 Vol.15 No.2

목적 : 경골 근위부 분쇄 골절의 치료에서 최소침습적 금속판 고정술(minimally invasive plate osteosynthesis:MIPO)수기를 이용한 경골 전내측의 해부학적 금속판 고정술의 유용성에 대해 알아보고자 한다. 대상 및 방법 : 1997년 1월부터 2000년 2월까지 경골 근위부 분쇄 골절( AO 분류, A2, A3, C1, C2, C3형)로 수술을 시행한 18례를 대상으로 하였다. 방사선 영상 증폭 장치 감시하에 간접적인 골절 정복후 MIPO 수기를 사용하여 경골의 전내측에 해부학적 금속판을 사용한 내고정을 시행후, 수술기간, 골유합시기, 방사선학적 골정렬상태를 측정하였고, 슬관절 운동범위, Rasmussen 기준에 의한 기능적, 해부학적 결과에 대한 평가와 함께 합병증에 대하여 관찰하였으며, 최소 12개월 이상 추시 관찰하였다. 결과 : 수술시간은 평균 51 분(30-80분), 골유합기간은 평균 10.7주(9-14주)로 빠른 골유합을 보였으며, 골정력 상태는 5도 이하의 외반이 6례, 5도 이상의 외반은 1례였고, 11례에서 정상 골정렬 상태를 보였다. 슬관절 운동 범위는 0도는 140도 13례, 0-120도 3례, 0도에서90도 2례이었다. Rasmussen의 판정기준에 의한 기능적 평가는 매우 우수 14례(77.8%), 우수 4례(22.2%), 해부학적 평가는 매우 우수 7례(38.9%), 우수 11례(61.1%)로 18례 모두 우수 이상의 결과를 얻었고, 심부 감염, 불유합 등의 합병증은 없었다. 결론 : MIPO 수기를 이용한 경골 전내측 해부학적 금속판 고정술이 술후 골정렬 상태가 외반되는 경향이 있어 수술시 주의를 요하나 , 심부 감염이나 연부 조직 괴사, 불유합 등의 합병증을 줄이면서 빠른 슬관절 운동의 회복 및 골유합 시기와 수술시간의 단축 등의 장점이 있어 경골 근위부 분쇄 골절의 치료에 유용한 방법의 하나로 사료된다. Purpose: To evaluate the advantages of fixation of metaphysis by minimally invasive plate osteosynthesis(MIPO) technique for comminuted fractures of the proximal tibia. Materials & Methods: from January 1997 to February 2000, 18 cases of comminuted fracture of the proximal tibia were treated using MIPO technique. Operation time, union time, radiologic alignment, range of motion of the knee joint, functional and anatomical results according to Rassmusen' s grading criteria, complications were evaluated. Minimal follow-up time was 12 months. Results: Operation time was average 51 minutes (30-80 minutes). Time to bone healing was average 10.6 weeks (9-14 weeks) There was I case of valgus angular deformity greater than 5 degrees. 6 cases in acceptable bony alignment less than valgus 5 degrees and 11 cases were classified into normal bony alignment. Range of motion of the knee joint was 0-140 degrees in 13 cases, 0-120 degrees in 3 cases, 0-90 degrees in I case, 10-90 degree in 1 case. Rasmussen' s grading criteria for functional outcome revealed there were 14 cases(77.8%) excellent results, 4 cases(22.2%) good result. and grading criteria for anatomical outcome revealed there were 7 cases(38.9%) excellent results, 11 cases(61.l %) good result. Conclusion: MIPO technique for comminuted fracture of the proximal tibia seems to be a good techinque to obtain more rapid bony union with less complication.

상완골 근위부 골절 또는 골절 및 탈구에서의 상완골 두 치환술

김영규(Young Kyu Kim),엄기석(Gi Serk Eom) 대한견주관절의학회 2000 대한견주관절학회지 Vol.3 No.1

만성 골수염의 내시경적 처치 - 증례 보고 2예 -

이범구,엄기석,기용철,조현이,Lee Beom Koo,Eom Gi Serk,Ki Yong Chul,Cho Hyun Yee 대한관절경학회 2002 대한관절경학회지 Vol.6 No.2

만성 골수염의 치료는 육아 조직이나 반흔 조직, 사골(Sequestrum) 및 경화된 골 조직의 완전한 절제와 병소의 만성적인 허혈 상태를 제거해 혈액 순환을 원활하게 만들어 주어야 한다. 기존의 배상성형술(saucerization)로도 사골 등 병소의 확인과 병소의 적절한 제거가 충분히 가능하지만, 병소의 광범위한 절제로 인하여 혈관 손상을 줄 가능성이 있다. 본 정형외과학 교실에서는 만성 골수염 환자의 처치에 있어서 관절경을 이용한 골수강 내시경술(medulloscopy)을 시행한 결과, 관절경 사용시 비정상적 조직 및 사골의 직접적인 확인이 보다 용이하고, 혈관 손상도 줄이며 수술할 수 있는 장점이 있어 이의 증례를 보고하고자 한다. The goal of surgery of chronic osteomyelitis is removal of dead bone and achieving a viable and vascular environment. During saucerization, the sequestrum could be checked and resected completely. But it can causes vascular injury by massive soft tissue dissection in saucerization of chronic osteomyelitis. Recently, we experienced medulloscopy in the treatment of chronic osteomyelitis and it is possible for us to visualize the sequestrum, to do complete resection of dead bone and to reduce vascular injury during operation.

남아있는 후방 십자 인대 다발을 보존하고 슬괵건을 이용한 후방 십자 인대 재건술

이범구 ( Beom Koo Lee ),엄기석 ( Gi Serk Eom ),이장열 ( Jang Yeol Lee ),차종훈 ( Jong Hun Cha ) 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

Purpose: The purpose of study is to evaluate the clinical results of posterior cruciate ligament (PCL) reconstruction using the quadruple hamstring tendon with preservation of the PCL remnant. Subjects and Methods: Twenty PCL reconstructions have been performed by one surgeon. The average follow-up period were at 31 months. There were 11 isolated injuries and 9 associated injuries. The clinical outcome was assessed by preoperative and postoperative posterior displacement at stress radiograph, Lysholm knee score and complications. Results: At last follow up Lysholm knee scores improved from 60 preoperatively to 92 postoperatively. The average preoperative posterior displacement at stress radiograph was 14 mm and postoperatively it was 3.2 mm. The average postoperative posterior displacement at stress radiograph was 2.6 mm in isolate injury and 3.7 mm in associated injury. The average postoperative posterior displacement at stress radiograph was 2.6 mm in case of reconstruction within three weeks and 3.7 mm in case of reconstruction after three weeks. Conclusion: Good stability and function of knee could be obtained by PCL reconstruction using hamstring tendon with preserving the PCL remnant and non-aggressive rehabilitation.

급성 후방 십자 인대 파열의 보존적 치료 후 슬관절 후방 불안정성

이범구 ( Beom Koo Lee ),엄기석 ( Gi Serk Eom ),기용철 ( Yong Cheol ) 대한슬관절학회 2003 대한슬관절학회지 Vol.15 No.2

급성 슬개골 탈구의 수술적 치료

조현철(Hyun Chul Jo),이범구(Beom Koo Lee),엄기석(Gi Serk Eom),김신웅(Shin Woong Kim) 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.1

Purpose: To analyze factors related with patellar dislocation and evaluate clinical results after early surgical treatment in acute patellar dislocation. Materials and Methods: The study was done in 11 patients who underwent surgery due to acute patellar dislocation from February 1997 to January 2000. patients who had history of previous patella dislocation were excluded in this study. The average follow up period was 23 months. Radiographs were antero-posterior, lateral at 30 degree of flexion, and Merchant view. We looked for of patella alta, trochlear dys-plasia, intraarticular loose body and measured sulcus angle, congruence angle, Q-angle. We checked the location of injured medial retinaculum and ostochondral lesions, and associated intraarticular lesions from MRI, arthrosopic and operative findings. We performed the 3 operative methods: Upon the completion of the arthroscopic evaluation, medial retinacular repair (5cases), medial retinacular repair and lateral release (3cases). augmented repair and plication of medial retinaculum ie, modified Madigan technique (3cases). Results: patella alta was present in 7cases (63.6%), trochlear dysplasia (crossing sign) in 5cases (45.5%), and increased sulcus angle in 5 cases (45.5%). one or more predisposing factors contributing to patella dislocation were seen in 9 of 11 cases (81.8%). Medial retinacular tear was present in the adductor tubercle in 5 cases and midportion (parapatellar tear) in 4 cases, and relaxed without tear in 2cases. The clinical results showed that the average Kujala score was 91 points. The congruence angle became normal in 10 cases and patella subluxation was seen in 1 case postoperatively. Conclusions : Acute patellar dislocation was related in those cases with trochlear dysplasia and patella alta and increased sulcus angle. During the 23 months follow up preiods, Excellent clinical results were obtained with early surgical treatment.