다발성 유관나사를 이용한 경골-거골-종골간 관절 유합술

정홍근,박신형,유현열,유문집,Jung, Hong-Geun,Park, Shin-Hyung,Yoo, Hyun-Yul,Yoo, Moon-Jib 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. Materials and Methods: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. Results: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. Conclusion: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

도서형 복재 신경피부 피판술을 이용한 하지 연부 조직 결손의 재건

서중배,박희곤,유현열,김종필,Seo, Joong-Bae,Park, Hee-Gon,Yoo, Hyun-Yul,Kim, Jong-Pil 대한미세수술학회 2006 Archives of reconstructive microsurgery Vol.15 No.2

Purpose: We present clinical usefulness of saphenous neurocutaneous island flap for reconstruction of soft tissue defect of the lower leg, especially anteromedial aspect, including foot and ankle. Materials and Methods: Thirteen cases of soft tissue defects in the lower leg including foot and ankle which were 6 cases of pretibial area, 2 cases of anteromedial aspect of distal two third, 2 cases of ankle, and 3 cases of foot were treated saphenous neurocutaneous island flap. They were proximally based flap 3 cases and distally based flap 10 cases. Clinically the flaps ranged in size from $4{\times}5\;cm$ to $6{\times}12\;cm$. Results: All of the flaps except 1 case survived completely. Three cases, however, had marginal necrosis. One case of flap failure was proximal tibia fracture accompanied with injury of the flap pedicle which was difficult in flap elevation, subsequently. Conclusion: The saphenous neurocutaneous island flap is a simple, reliable procedure with a versatility for soft tissue coverage of the lower leg, especially anteomedial aspect, including foot and ankle. In case of another injuries accompanied near the saphenous nerve, careful attention should be made.

무지 중수지 관절의 종자골하 관절염의 치료 : 종자골 절제 후 전방판 보강술

김종필(Jong-Pil Kim),유현열(Hyun-Yul Yoo),민병권(Byoung Kwon Min) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.2

목적: 무지 중수지 관절의 종자골하 관절염에 대한 치료로 종자골 절제 후 건 이식을 이용한 전방판 보강술의 임상적 결과를 보고하고자 한다. 대상 및 방법: 종자골 절제 후 장장건 이식을 이용하여 무지 중수지 관절의 전방판 보강술을 시행 받은 11예를 대상으로 하였으며 남자 7명, 여자 4명이었으며 평균 연령은 46세(30-56세)이었다. 무지 중수지 관절의 과신전 손상 후 발생한 관절염 9예 및 특발성 관절염 2예였다. 수술 전후 객관적 및 주관적 기능 평가를 하였으며 최종 추시 기간은 평균 19개월(12-35개월)이었다. 결과: 최종 추시 시 1명을 제외하고 대부분 만족의 결과를 보였다(우수 3명, 양호 7명 및 불량 1명). 악력과 집기력은 반대쪽에 비교하여 수술 전 각각 평균 63.0%와 51.3%에서 수술 후 각각 평균 84.9%와 88.9%로 향상되었다. 술 후 무지 중수지 관절의 평균 운동범위는 신전 -5.9도, 굴곡 50.9도였으며 평균 DASH 및 MHQ 점수도 수술 전 보다 의미 있게 향상되었다. 결론: 무지 중수지 관절의 종자골하 관절염에 대한 치료로서 종자골 절제 후 건 이식을 이용한 전방판 보강술은 통증을 감소시키고 악력과 집기력을 향상시키는 등 무지의 기능에 필요한 안정성을 유지시킬 수 있는 유용한 술식이라고 사료된다. Purpose: To report the clinical outcomes of a volar plate reinforcing technique with free tendon grafts after sesamoid excision for the surgical treatment of subsesamoid arthritis of the metacarpophalangeal (MCP) joint of the thumb. Materials and Methods: Eleven consecutive patients that underwent sesamoid excision and volar plate reinforcement using a palmaris longus free tendon graft were enrolled. There were 7 males and 4 females, with an average age of 46 (range, 30-56 years). Post-traumatic arthritis after a hyperextension injury of the thumb was present in 9 patients. Two patients had idiopathic arthritis. All patients were evaluated by objective and subjective criteria, the mean follow-up duration was 19 months (range, 12-35 months). Results: The results were satisfactory overall (3 excellent, 7 good, 1 poor). The mean grip strength and pinch strength significantly improved from 63.0% and 51.3%, respectively, preoperatively, to 84.9% and 88.9%, postoperatively. The mean range of motion for the MCP joint was -5.9/50.9 degrees. The mean DASH and MHO scores showed significant improvement compared to the preoperative scores. Conclusion: The early clinical results suggest that the described technique is a safe and effective option for subsesamoid arthritis of the MCP joint of the thumb.

65세 이상 노년층에서 고관절부 골절 유무 및 형태에 따른 골밀도의 비교

김명호 ( Myung Ho Kim ),유문집 ( Moon Jib Yoo ),서중배 ( Joong Bae Seo ),유현열 ( Hyun Yul Yoo ),문상영 ( Sang Young Moon ) 대한골절학회 2010 대한골절학회지 Vol.23 No.3

목적: 노년층에서 고관절부 골절 환자에서 대퇴 근위부와 요추부의 부위별 골밀도를 측정하여 고관절부 골절의 발생 및 형태 사이의 상관관계 및 골다공증 약물치료 기준점을 제시하고자 하였다. 대상 및 방법: 2007년 7월부터 2010년 2월까지 65세 이상의 골다공증성 고관절부 골절 환자 총 147명을 대상으로 하였고, 65세 이상의 골절이 없는 80명의 환자를 대조군으로 하여 각 군의 골밀도 및 골절 한계치를 비교 분석하였다. 결과: 대퇴 전자간 골절군에서 경부 골절군에 비해 대퇴 경부와 전자부 및 제2, 3 요추부의 골밀도가 유의하게 낮게 측정되었다. 또한, 대퇴 전자간 골절군 중 불안정 골절군에서 안정 골절군에 비해 전자간부와 Ward 삼각 부위의 골밀도가 유의하게 낮게 측정되었다. 고관절 골절 위험 한계치는 대퇴 전자간 골절군과 경부 골절군에서 각각 대퇴 근위부 합계 T-score -1.10, -1.36, 요추부 합계 T-score -1.40, -1.40로 측정되었다. 결론: 골밀도 검사 시 대퇴근위부와 요추부를 함께 측정하는 것이 골절의 발생 및 형태 예측에 도움이 되며 또한, 골절 위험 한계치의 분석 결과 65세 이상 노년층 고관절부 골절 위험 한계치인 T-score -1.40 이하부터는 골절 예방을 위하여 적극적인 치료가 필요할 것으로 생각된다. Purpose: We measured the BMD of elderly patients with osteoporotic hip fracture in order to understand the relationship between BMD of each sites and hip fracture occurrence or the types, and also to suggest a reference point for starting an osteoporosis treatment program. Materials and Methods: From July 2007 to February 2010, we investigated total 147 elderly osteoporotic hip fracture patients over 65 years. For control group, 80 patients who were over 65-year-old and did not have any fracture were selected. BMD was compared at each site between each groups statistically. Results: In the comparison of femur intertrochanter and neck fracture groups, BMD of femur neck and trochanter areas and L2, L3 areas were significantly less in intertrochanteric fracture group. In the analysis according to the classification of intertrochanteric fracture, BMD of intertrochanter and Ward`s triangle area were significantly less in unstable fracture group than stable one. Each of the fracture threshold of intertrochanteric and neck fracture group was -1.10 and -1.36 of the T-score in proximal femur, and -1.40 and -1.40 of the T-score in lumbar vertebrae. Conclusion: To examine the BMD of both proximal femur and lumbar vertebrae areas is helpful to predict the hip fracture occurrence and the type of hip fracture. And for the prevention of hip fracture in elderly patients over 65 years, we propose that the aggressive treatment of osteoporosis should be started to prevent fracture for patients with a T-score less than -1.40.

자가 슬건과 동종 전경골건을 이용한 전방십자인대 재건술 후 시행한 이차 관절경의 결과 비교

김명호 ( Myung Ho Kim ),유문집 ( Moon Jib Yoo ),박희곤 ( Hee Gon Park ),유현열 ( Hyun Yul Yoo ),이대희 ( Dae Hee Lee ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.1

Purpose: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. Materials and Methods: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. Results: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. Conclusion: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

LCS mobile bearing system을 이용한 슬관절 전치환술 후 장기 추시 결과

민상혁 ( Sang Hyuk Min ),유석주 ( Suk Joo Lyu ),유문집 ( Moon Jib Yoo ),김명호 ( Myung Ho Kim ),박희곤 ( Hee Gon Park ),김유진 ( You Jin Kim ),유현열 ( Hyun Yul Yoo ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.1

Clinical Article : 주관절의 외반 신전 과부하 증후군 야구선수에서 시행한 관절경하 주두 골극절제술

박진영 ( Jin Young Park ),윤형문 ( Hyung Moon Yoon ),오경수 ( Kyung Soo Oh ),유현열 ( Hyun Yul Yoo ),방진영 ( Jin Young Bang ),강대명 ( Dae Myung Kang ) 대한스포츠의학회 2013 대한스포츠의학회지 Vol.31 No.2

We evaluated the clinical outcome after arthroscopic olecranon osteophyte resection without ligament operation in the elite baseball players who had valgus extension overload syndrome without moderate or severe medial collateral ligament injury. From January 2007 to December 2011, twelve patients underwent arthroscopic osteophyte resection without ligament operation and they were followed for more than 12 months. The mean age was 19.2 years and mean follow-up period was 26 months. The clinical results were evaluated using range of motion, visual analogue scale (VAS) and Mayo elbow performance score (MEPS). After checking osteophyte size and location through 3-dimensional computed tomography, arthroscopic osteophyte resection was performed. Average preoperative extension, flexion, pronation and supination were 2.3o, 138.2o, 76.4o, and 69.1o. Average postoperative extension, flexion, pronation and supination had been changed into 0.7o, 137.3o, 79.1o, and 77.3o. Average preoperative pain VAS and MEPS were 5.5 and 67.5. Average postoperative pain VAS and MEPS had been changed into 0.4 (p <0.001) and 97.5 (p<0.001). Eleven patients returned to play. Ten cases returned to their own position. No patients were performed other operation for elbow pain. The arthroscopic osteophyte resection in valgus extension overload syndrome with low grade medial ulnar collateral ligament (MUCL) injury or without MUCL injury was a one of the ideal treatment option for early return to pre-injury levels and relief of pain.

외반 신전 과부하 증후군 야구선수에서 주두 골극 제거술

박진영(Jin-Young Park),윤형문(Hyung-Moon Yoon),고덕환(Duk-Hwan Kho),오경수(Kyung-soo Oh),유현열(Hyun-Yul Yoo) 대한견주관절의학회 2013 대한견주관절학회 학술대회논문집 Vol.2013 No.3