만성 족부 질환이 환측 하지의 골밀도에 미치는 영향

주인탁,유종민,강민구,정진화,Chu, In-Tak,Yoo, Jong-Min,Kang, Min-Gu,Chung, Jin-Wha 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.2

Purpose: Pain or discomfort caused by foot diseases may lead to abnormal gait, resulting in decreased bone mineral density (BMD) of the affected lower limb. We analyzed the effect of foot affection to BMD and its clinical significance. Materials and Methods: Bilateral hip BMD was evaluated in 93 patients with unilateral chronic foot disease. To minimize statistical errors, we excluded patients with medical histories that had influence on BMD. Analysis was based on the results of BMD tests at the first visit. All patients denied past medical intervention for osteoporosis. The difference in density between bilateral limbs was determined by comparing BMDs of the neck, upper neck, trochanter and total area of hip. Results: Test results revealed the decrease of BMD in the lower limb with the affected foot, compared to the unaffected side. This decrease was significant in the area of the trochanter (p <0.05). There was no marked difference of BMD in relation with duration of affection, underlying disease or age. Pertaining the location of foot affection, the hindfoot group showed significant decrease in BMD compared to the forefoot group. The group with affection in bone and joint also showed a marked decrease in BMD compared to the soft tissue group (p <0.05). Conclusion: Pain and discomfort caused by chronic foot diseases can lead to a decrease in the BMD of the affected lower limb. This may increase the risk of complications such as osteoporotic fracture and muscular atrophy.

족근관절 염좌시 동반된 신경 손상

주인탁,박현우,김찬규,Chu, In-Tak,Park, Hyun-Woo,Kim, Chan-Kyu 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: The neural injuries by the sprain around the ankle joint may contribute the chronic pain. Authors analyzed the incidence and the contributing factor of the neural injuries in ankle sprain. Materials and Methods: 52 patients (54 cases) were involved in this retrospective study. Patient with diabetes or spinal disease were excluded. Plain radiograph and MR image were evaluated. Treatments were consisted of cast immobilization for 4 weeks with weight bearing ambulation following bracing for 8 weeks. Neurologic evaluation were performed at 3 months, 6 months, 12 months post-injury period and each neural injury were confirmed by electromyography or lidocaine block test. Results: The average age was 39 years old and 34 cases were male and 20 cases were female. Rupture of the anterior talofibular ligament was observed in 48 cases, distal anterior tibiofibular ligament in 37 cases, calcaneofibular ligament in 6 cases. One cases revealed no injury of the ligament. Neural injuries around ankle was observed in 13 cases ; superficial peroneal nerve in 9 cases, sural nerve in 5 cases, saphanous nerve in 1 case. Neural injury was not influenced by the degree of ligament injuries but by the incidence numbers of ankle sprain. All cases were treated conservatively and symptom was subsided in all but 2 cases. Conclusion : Although the incidence is relatively low, the neural injuries in ankle sprain may occur in the recurrent ankle sprain and conservative treatment for neural injuries is satisfactory.

무지 외반증 환자의 원위 갈매기형 절골술 시 무지 내전건 절단술 병행의 유무에 따른 치료결과 비교

주인탁,박현우,김찬규,Chu, In-Tak,Park, Hyun-Woo,Kim, Chan-Kyu 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: Authors analyzed and compared the treatment result of distal chevron osteotomy between with and without adductor tenotomy. Materials and Methods: 36 patients (60 feet) with a minimum follow-up of one year were involved in this retrospective study. The chevron osteotomy without adductor tenotomy was performed for 20 patients (30 feet) and chevron osteotomy with adductor tenotomy was done for 16 patients (30 feet). The first metatarsophalangeal (MTP) angle and angle between first and second metatarsal longitudinal axis (IM) was measured. The difference of these angles were measured pre-and postoperatively and compared using Student's T-test. Results: In the group of chevron osteotomy with adductor tenotomy, the mean first MTP angle corrected $29^{\circ}$ pre-operatively to $9^{\circ}$ and the mean first IM angle corrected $16^{\circ}$ pre-operatively to $12^{\circ}$. In the group of chevron osteotomy without adductor tenotomy the mean first MTP angle corrected $31^{\circ}$ pre-operatively to $11^{\circ}$ (P>0.05) and the mean first IM angle corrected $13^{\circ}$ pre-operatively to $11^{\circ}$ (P>0.05). Deep peroneal neuroma were found in 3 cases of chevron osteotomy with adductor tenotomy. Conclusions: Adductor tenotomy should be performed in selected patient with chevron osteotomy to prevent deep peroneal neuroma.

내반 요족 변형에서 시행한 제1중족골 및 종골에 대한 절골술

주인탁,박종민,유종민,정진화,Chu, In-Tak,Park, Jong-Min,Yoo, Jong-Min,Chung, Jin-Wha 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.2

Purpose: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. Materials and Methods: We performed a dorsal closing wedge $1^{st}$ metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-$1^{st}$ metatarsal, calcaneus-$1^{st}$ metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. Results: Talo-$1^{st}$ metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of $21^{\circ}$ and $25^{\circ}$ to $12^{\circ}$ and $19^{\circ}$, respectively, at last followup. Also, calcaneus-$1^{st}$ metatarsal angle was increased from the mean $114^{\circ}$ to $114^{\circ}$. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. Conclusion: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.

삼각 인대 파열을 동반한 족근 관절 내과 골절 - 1예 보고 -

주인탁,박성진,김양수,김영훈,이준석,Chu, In-Tak,Park, Seong-Jin,Kim, Yang-Soo,Kim, Young-Hoon,Lee, Jun-Seok 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

Authors report one patient of concurrent fracture of medial malleolus and rupture of deltoid ligament. To the author's knowledge, combined failure of both structures has not been previously reported in Korea. Injury mechanism was classified into pronation -abduction type according to Lauge-Hansen classification. Plain radiograph revealed trimalleolar fracture and posterior ankle dislocation. MRI showed complete rupture of both deep and superficial layer of the deltoid ligament. In conclusion, therefore, concurrent rupture of deltoid ligament should be considered for the surgical treatment in trimalleolar ankle fracture with posterior ankle dislocation resulted from pronation-adduction injury.

The Incidences and Locations of Osteochondral Lesions of the Talus in Ankle Fracture

In-Tak Chu(주인탁),Yang-Soo Kim(김양수),Soung-Ho Yoo(유성호),In-Soo Oh(오인수) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.5

목적: 족근관절 골절에서 발생하는 거골의 골연골병변은 외상성 관절염을 속발할 수 있으므로 적절한 치료가 필요하다. 족근관절 골절시 거골의 골연골병변의 빈도가 높다고 알려져 있으나 골절의 관혈적 정복시 사용하는 수술적 도달법으로는 거골의 골연골병변의 유무를 확인하기가 어려워 이에 대한 치료가 지연될 수 있다. 저자들은 족근관절 골절시 발생하는 거골의 골연골병변의 빈도와 위치를 알아보기 위하여 수술 전 검사한 자기공명영상을 후향적으로 분석하였다. 대상 및 방법: 족근관절 골절 환자 40명의 자기공명영상을 분석하였다. 골연골병변의 위치는 9구획으로 분류하였는데 거골 체부 관절면을 전후 그리고 내외측으로 3등분하여 내측, 중심부, 외측, 그리고 전방부, 중심부, 후방부로 나누어 각 부위의 발생 빈도를 조사하였다. 손상기전은 회외기전, 회내기전으로 나누었다. 결과: 족근관절 골절 40명의 환자 중 28명의 환자(70%)가 거골의 골연골병변이 있었고, 13명의 환자(46%)가 회외기전에 의해, 15명의 환자(54%)가 회내기전에 의해 발생하였다. 회외기전 손상군에서 7명은 외측부에, 1명은 중심부에, 5명은 내측부에 발생하였고, 8명은 후방부에, 3명은 중심부에, 2명은 전방부에 발생하였다. 회내기전 손상군에서는 13명은 외측부에, 1명은 중심부에, 1명은 내측부에 발생하였고, 9명은 후방부에 5명은 중심부에 1명은 전방부에 발생하였다. 외상 후 거골의 골연골병변의 빈도는 통계적으로 회내, 회외기전 손상군에서 모두 외측과 후방에 높은 발병률을 보였다. 결론: 족근관절 골절에서 발생하는 거골의 골연골병변의 조기 진단을 위하여 족근관절 골절 치료시 거골의 후방 혹은 외측부의 정밀한 관찰이 요구되며, 이에 대한 추가적인 치료가 필요하다. Purpose: An osteochondral lesion of the talus in ankle fracture needs appropriate treatment to prevent traumatic arthritis. Despite the high incidence of an osteochondral lesion in cases of ankle fracture, it is difficult to identify the location of the lesion during open fracture reduction due to limitation of the surgical approach. Therefore, we reviewed retrospectively the MRIs of ankle fractures to determine the incidences and locations of osteochondral lesions of the talus according to ankle fracture injury mechanism. Materials and Methods: The MRIs of forty patients with ankle fractures were reviewed. Locations of osteochondral lesions were divided into nine areas; i.e., medial, central, lateral and anterior, central, posterior. Injury mechanisms were divided into supination and pronation groups. Results: Twenty eight (70%) out of 40 patients with ankle fractures had an osteochondral lesion of the talus. Thirteen (46%) patients were allocated to the supination group and 15 (54%) to the pronation group. Lesion locations were; 7 cases of lateral, 1 central, 5 medial and 8 posterior, 3 central, and 2 anterior for supination injury. In cases of pronation injury, 13 were lateral, 1 each central and medial, and 9 posterior, 5 central, and 1 anterior. The incidences of osteochondral lesions were significantly different at the lateral and central areas, and also between the posterior and anterior areas in both the supination and pronation groups. Conclusion: For osteochondral lesion in cases of ankle fracture, careful observation of the posterior and lateral areas of the talar dome should be performed and additional treatment should be added for the lesion if required.

족저 근막염의 초음파 영상학적 형태

홍승환,주인탁,정현우,Hong, Seung-Hwan,Chu, In-Tak,Chung, Hyun-Woo 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: This retrospective study was designed to evaluate the appearances of plantar fasciitis by ultrasonography. Materials and Methods: 48 cases of unilateral plantar fasciitis were enrolled in this study. Plain radiograph and realtime sonography of both feet were perfomred and the results were compared between the affected feet and controlateral symptomless feet. Calcaneal spur were observed on plain radiograph and thickness of plantar fascia, hypoechogenecity, blurring of border of plantar fascia, perifascial effusion, wavy plantar fascia were observed on sonography. Results: Women (35 cases) and left feet (30 cases) were more frequent than men and right feet. Thickness of plantar fascia in affected site was thicker than normal site (p<0.01). Hypoechogenecity was observed only in 39 cases (81%) affected site, blurring of border of plantar fascia in affected site was 30 cases (62%) and 7 cases (15%) in normal site, perifascial effusion was observed only in 38 cases (79%) affected site, wavy plantar fascia in affected site was 43 cases (90%) and 2 cases (4%) in normal site. Calcaneal spur in affected site was 36 cases (75%) and 33 cases (69%) in normal site. Conclusion: Sonography is a useful diagnostic procedure for the plantar fasciitis especially in the unilateral plantar fasciitis.

Lindholm 방법을 이용한 진구성 아킬레스 건 파열의 치료

이호진,주인탁,최성필,Lee, Ho-Jin,Chu, In-Tak,Choi, Seong-Pil 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: This retrospective study was designed to evaluate the treatment results of chronic Achilles tendon rupture by Lindholm method. Materials and Methods: Between 2002 and 2006, we performed the reconstruction of the Achilles tendon by using of the gatrocnemius-sloeus fascia known as Lindholm method. Ten cases of ten patients were enrolled in this study (8 men and 2 women). The mean age of the patients at the time of operation was 49 years (range, 32${\sim}$66 years). The mean follow-up duration was 15.2 months (range, 12${\sim}$19 months). The retrospective review of the clinical history, physical examination, the American Orthopedic Foot and Ankle Society (AOFAS) score were conducted. Results: The mean AOFAS score before surgery was 74.10${\pm}$2.56 and that of the latest follow-up was 90.60${\pm}$5.72. The excellent results were six and good results were four patients. Eight patients were normal triceps power and the others were good. The average of heel to floor distance was 4.5 mm less in the operated legs than the contralateral ones in each patient, but there was no significant difference (p>0.05). The average of calf muscle circumference in the mid-leg was 7.5 mm less in the operated legs than the contralateral ones and there was significant difference (p<0.05). The active range of motion of the ankles, mean plantarflexion was 40 degrees and dorsiflexion was 16.8 degrees in operated side. The contralateral side was 43 degrees in plantarflexion and 19 degrees in dorsiflexion. No case showed rerupture of the reconstructed Achilles tendon. One patient had the superficial wound infection which was treated successfully by antibiotic therapy. Conclusion: It was suggested that the overall results of Lindholm method for the chronic Achilles tendon rupture indicated satisfactory outcomes.

발레, 현대 및 고전 무용수들의 무지 외반각의 차이

주인탁(In-Tak Chu),송현준(Hyun-Jun Song) 대한정형외과학회 1996 대한정형외과학회지 Vol.31 No.5

족관절 내가 골절 치료를 위한 금속나사고정술과 긴장대고정술의 비교

주인탁(In Tak Chu),정창훈(Chang Hoon Jeong),장정호(Cheog Ho Chang),하주현(Joo Hyun Ha) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.3