금속 대 금속 고관절 전치환술 후 혈청 및 소변 코발트와 크롬 수치 중간 결과보고(5~10년)

김영창,곽희철 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Introduction : The purpose of this study is to evaluate the midterm(minimum 5years) results of THR with 2nd generation Metal on Metal prosthesis. Materials and Methods : The (52patients)60case of THR with End generation Metal on Metal prostheses was evaluated after an average duration of follow up of 784 months. The age of the patients at the time of operation had twenty five to seventy four years(average 54.7 years). Men was 33patients, women was 19patients. Preoperatively diagnosis was avascular necrosis 36case, osteoarthritis 18case, hip fracture 3case, ankylosing spondylitis 2case, tuberculosis 1case. Postoperative follow up was 6month, 1year 2year, 3year, 4year and last follow up. Physical examination, blood and urine was collected that were calculated by Atomic absorption spectroph otometry. Results : Harris hip score, Co-Cr concentration was evaluated. Harris hip score improved from 49.3point to 93.2point. Although Co-Cr concentration were elevated, but clinically definite toxicity was not detect. Conclusion : Conclusively the midterm(minimum 5years) results of THR with 2nd generation Metal on Metal prosthesis were excellent. Co-Cr concentration were elevated, but not detect continuous accumulation within body and definite toxicity. We need further long term evaluation of metal effect on human body.

후방십자인대 손상과 동반된 내측 측부 인대 손상의 치료 결과 : 내측부의 안정성은 후방 안정성에 의해 영향을 받는가 MCL Stability depends on PCL Status

서승석,곽희철 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

목적: 본 연구의 목적은 후방 십자 인대 손상과 동반된 내측 측부 인대 손상의 치료 결과를 분석하여 내측 측부 인대 손상의 치료 후 예후에 미치는 요소를 파악하고자 하는데 있다. 대상 및 방법: 1994년 12월부터 1999년 4월까지, 후방 십자 인대 손상과 내측 측부 인대 손상이 동시에 발생하여 본원에서 치료를 받았던 13예의 환자중에서 2년 이상 추시가 가능하였던 10에를 연구대상으로 하였다. 환자의 평균 나이는 33.6세이었고 손상 원인은 스포츠 손상이 2예, 교통사고가 8예였다. 후방 십자인대의 치료는 복원술이 3예, 재건술이 7예에서 시행되었고, 내측 측부 인대의 치료는 복원술이 8예, 보존적인 치료가 2예에서 시행되었다. 수술 후 5내지 6주간 석고고정을 한 후에 보조기 착용을 하고 재활 치료가 시행되었다. 결과: Lysholm 평가 점수에서 우수가 2예, 양호가 2예, 보통 3예, 불량 3예였다. IKDC 판정기준에 따르면 A등급 2예, B등급 2예, C등급 4예, D등급 2예였다. 술 후 스트레스 부하 방사선상에서 후방 십자 인대 이완 정도에 따라 이완이 5 mm 이내인 경우를 제 1군, 6 mm 경우를 제 2군으로 하였을 때 제1군이 4예, 제 2군이 6예였다. 후방 십자 인대 이완 정도에 따른 내측 측부 인대의 이완 정도는 제 1군에서 평균 1.6 mm였고 제 2군에서 평균 3.0 mm였다(P=0.05). 후방 십자 인대의 치료 방법에 따른 내측 측부인대의 이완 정도는 복원술을 시행한 군에서 평균 2.5 mm였고, 재건술을 시행한 군에서 평균 2.4 mm였다(P>0.05). 내측 측부 인대의 치료방법에 따른 내측 측부 인대 이완 정도는 보존적인 치료를 시행한 군에서 평균 2.8 mm였고, 복원술을 시행한 군에서 평균 2.4 mm였다(P>0.05). 결론: 내측 측부 인대 손상이 후방 십자 인대 손상과 동반되었을 때 내측 측부 인대의 이완 정도는 후방십자 인대나 내측 측부 인대의 치료 방법보다는 후방 십자 인대의 이완 정도와 관련이 있었다. 따라서 후방 십자 인대 손상과 동반된 내측 측부 인대 손상의 치료에 있어 우수한 외반 안정성을 얻기 위해서는 정확한 후방 십자 인대 손상의 치료가 필요할 것으로 사료된다. Purpose: The purpose of this study is to evaluate the results fo treatment of combined injury of PCL and MCL and to analysis the facotors affecting the MCL stability. Materials and Methods: The 10 patients of combined injury of posterior cruciate ligament and medial collateral ligament was evaluated after an average duration of follow up of 62.3 months. The age of the patients at the time of injury had twenty five to fifty five years (average 33.6 years) Posterior cruciate ligament were treated reconstructed (7case) or repaired (3case) Medial collateral ligament were treated repaired (8case) of nonoperatively (2case) of repaired (3case) Medial collateral ligament were treated repaired (8case) of nonoperatively (2 case) Postoperatively, all knees had been immobilized for 5~6weeks in 30degrees flexion with a plaster of cast. Results: Lysholm knee score were revealed Excellent (2), good (2). fair (3) poor (3). IKDC knee evaluation form were classified A (2), B (2), C (4), D(2). Materials were grouped according to posterior laxity on the stress x-ray. Group Ⅰ- less than 5 mm posterior translation (4 case), Group Ⅱ-more than 6 mm posterior translation (6case). MCL laxity were average 1.6 m in group Ⅰand 3.0 mm in group Ⅱ (P=0.05). The MCL laxity of PCL repair group was 2.5 mm and that of PCL reconstruction group was 2.4 mm (p>0.05). The MCL laxity of MCL non-operative group was 2.8 mm and that of MCL repair group was 2.4 mm (P>0.05). Conclusion: Lsxity of medial collateral ligament was more related to the PCL laxity than method of treatment PCL and MCL on combined injury of PCL and MCL. To obtain the excellent medial stability on the combined injury MCL and PCL needs a more sophisticated PCL reconstruction.

2세대 Metal-on-Metal Prosthesis를 사용한무시멘트 인공 고관절 전치환술 중간 결과 보고 (5-10년)

김영창,정경칠,곽희철,김주용 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

Heui-Chul Gwak,Jung-Han Kim 대한견주관절의학회 2016 대한견주관절학회지 Vol.19 No.2

Background: The first purpose of this study is to compare the clinical and radiological outcomes of surgical treatment for displaced midshaft clavicle fracture (Robinson type 2B1 vs. 2B2) with 3.5-mm low profile clavicular locking compression plate. The second purpose is to evaluate the difference of the results depending on the presence of accompanying injuries. Methods: Forty-nine patients who underwent an operation for the fractures were reviewed retrospectively. Fracture patterns were classified according to group 2B1 and 2B2 using Robinson’s classification. For radiological outcome, time to union after operation was evaluated and for clinical outcome, American Shoulder and Elbow Society (ASES) score, University of California in Los Angeles (UCLA) score, visual analogue scale (VAS), and range of motion (ROM) were evaluated from preoperative period to last follow-up period. Results: The mean time for union was not significantly different in the 2B1 group and 2B2 group (p=0.062). No statistically significant difference in ASES score, UCLA score, and VAS was observed between 2B1 and 2B2 (p=0.619, p=0.896, p=0.856, respectively). In ROM, significant higher mean forward flexion and abduction was observed in 2B2 (p=0.025, p=0.017, respectively) and there was no difference in external rotation and external rotation at shoulder 90o abduction position (p=0.130, p=0.180, respectively). There was no significant difference in clinical outcomes according to the accompanying injuries. Conclusions: There was no difference in clinical and radiological outcome between Robinson 2B1 and 2B2 type fracture after the operation. Accompanying injuries may not affect the clinical result of displaced midshaft clavicle fractures.

만성 족관절 불안정성을 가진 환자군에서 변형 브로스트롬 술식과 봉합 테이프를 추가한 술식 간의 결과 비교

Gwak Heui-Chul,Jung Soo-Hwan,Kim Jung-Han,Park Dae-Hyun,Choo Hye-Jung,Kim Dae-Yoo 대한족부족관절학회 2022 대한족부족관절학회지 Vol.26 No.1

Purpose: The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmenta- tion using suture tapes (ST). Materials and Methods: Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m2; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. Results: FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports ac- tivity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%) . There was significant improve- ment in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). Conclusion: The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

족부 족관절 분야에서의 관절경 술기

곽희철(Heui-Chul Gwak) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.2

관절경을 이용한 유합술기는 관절경 기술의 발달로 인하여 점차 많이 시행되고 있고, 그에 따라 술자들의 경험도 증가하면서 그 사용 범위가 증가하고 있다. 관절경을 이용한 술식은 연부조직 손상의 최소화, 환자 위험 감소, 빠른 회복, 병원 재원 일수 감소 및 빠른 유합 시간 등의 많은 장점을 가진다. For the arthroscopic fusion procedure, the development of arthroscopic techniques of joint preparation for fusion have made arthroscopic ankle arthrodesis popular, and foot and ankle surgeons also have gained considerable experience in arthroscopic techniques. Arthroscopic techniques offer minimized soft tissue disruption, lower morbidity and mortality, faster recovery, and shorter hospital stay and time to fusion. In addition, they may reduce the risk of wound complications for patients with a poor soft tissue envelope or relevant co-morbidities.

제5 중족골 제1, 2 구역 골절의 조기 체중부하의 비수술적 치료 결과

곽희철(Heui-Chul Gwak),박대현(Dae-Hyun Park),김정한(Jung-Han Kim),이창락(Chang-Rack Lee),권용욱(Yong-Uk Kwon),김동석(Dong-Seok Kim) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.2

목적: 제5 중족골 기저부 골절의 위치와 전위, 관절 침범, 분쇄 등의 특징이 조기 체중부하 치료의 결과에 어떤 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 2013년 1월부터 2017년 7월까지 인제대학교 부산백병원에 내원하여 제5 중족골 기저부 제1, 2 구역 골절로 진단받은 총 34명의 34예를 대상으로 하였다. 평균 추시 기간은 13개월(6–15개월)이었다. 동 기간 동안 수술적 치료를 시행한 경우는 없었고 1명의 경우 추시 기간 중 이전 골절 부위와 다른 부위의 재골절로 제외되었으며 총 33예 모두 보존적 치료를 시행하였다. 족부의 전후면, 측면 및 경사 방사선 촬영 및 컴퓨터 단층 촬영을 시행하여 골절의 위치와 전위, 관절 침범, 분쇄의 정도를 평가하였다. 33명의 모든 환자에게 있어서 수상 직후부터 단하지 석고고정 혹은 탈착 가능한 부츠형 보조기를 선택하여 착용 후 통증이 허용되는 범위 내에서 부분적인 체중부하를 허용한 뒤 통증이 소실되면 일반 신발 또는 수술 후 신발을 착용 후 전 체중부하를 시행하게 하였다. 임상적 결과로 최종 추시 시에 American Orthopedic Foot and Ankle Society (AOFAS) score를 평가하였다. 외래 추시 시 족부의 단순 방사선 촬영을 하여 방사선적 골유합 시기와 업무로의 복귀 시기를 확인하였다. 결과: 총 33명의 환자가 본 연구에 참여하였고(남자 9명, 여자 24명), 환자들의 평균 나이는 48.7세(16–80세)였다. 제1 구역이 24명, 제2 구역이 9명이었고 전체 33명의 환자 중 22명에서 2 mm 이상의 골절 전위가 관찰되었고 관절 침범은 9명, 분쇄 골절은 5명에서 관찰되었다. 제1 구역에서 제2 구역에 비하여 통계적 의미 있는 업무로의 복귀를 보였고 최종 추시 시 AOFAS score는 우수한 결과를 보였고 통계적 차이는 없었다. 골절의 전위 정도, 관절 침범 여부, 분쇄 정도를 분류, 비교하였을 때 방사선적 유합 시기, 업무 복귀 시기에 있어 통계적 차이는 없었으며 모든 경우에 있어 최종 추시 시 만족할 만한 결과를 보였다. 결론: 제5 중족골 기저부 골절에서 골절의 위치, 전위, 관절 침범, 분쇄 여부에 관계없이 조기 체중부하를 허용하여도 만족할 만한 임상적 결과를 얻을 수 있다. 제5 중족골 기저부 골절에서 조기 체중부하하 보존적 치료는 우수한 임상 결과를 얻을 수 있는 좋은 치료 방법이라 생각된다. Purpose: To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment. Materials and Methods: From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6–15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work. Results: Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up. Conclusion: Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

거골의 연골 병변에 대한 관절경적 치료

곽희철(Heui Chul Gwak),김주용(Joo Yong Kim),최장석(Jang Seok Choi),김창완(Chang Wan Kim),김정한(Jung Han Kim),박대현(Dae Hyun Park) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.6

목적 : 거골의 연골 병변에 대하여 관절정적 연골 성형술, 미세 골절술 및 자가 골연골 이식술을 시행 후 임상 결과 비교 및 결과에 영향을 미치는 인지를 평가하고자 하였다. 대상 및 방법 : 1998년 3월부터 2007년 12월까지 거골의 연골 병변으로 진단받은 환자들 중 관절경적 연골 성형술, 미세 골절술 또는 자가 골연골 이식술 시행 후 12개월 이상 추시가 가능했던 35명(36예)을 대상으로 하였다. 연골 성형술이 14예(13명), 미세 골절술이 12예(12명), 자가 골연골 이식술이 10예(10명)에서 시행되었다. 병변의 단계는 단순 방사선 산진 상 Berndt와 Harty 분류 및 Anderson 자기 공명 영상 분류를 사용하였다. 전 예에서 술 전 및 최종 추시에서 VAS score 및 AOFAS score를 측정하여 각각의 술식에 따른 임상적 결과를 평가 및 비교하였다. 병변의 위치, 크기, 단계 및 나이에 따른 임상적 결과를 평가하였다. 결과: 연골 병변 위치는 외측이 13예, 내측이 23예였으며 연골 병변의 평균 크기는 1.9 ㎠(1-4㎠)였다. 병변의 단계는 Berndt와 Harty 분류 및 Anderson 분류 2단계가 8예, 3단계가 21예, 4단계가 7예였다. 평균 추시관찰 기간은 15개월(12-30개월)이었으며, 전체 환자에서 VAS score 및 AOFAS score의 유의한 호전이 관찰되었으나, 각 술식 간의 의미있는 차이는 없었다. 병변 위치, 크기, 단계 및 나이에 따른 환자 군의 비교에서 유의한 차이는 나타나지 않았다. 결론: 관절경을 이용한 연골 성형술, 미세 골절술 및 자가 골연골 이식술 모두 거골의 연골 병변에서 유용한 치료 방법으로 사료되며, 병변 위치, 크기, 단계 및 나이에 따른 분류에서는 각 군별로 유의한 차이가 나나나지 않았다. Purpose: To compare clinical results and to evaluate the factors affecting the clinical results after performing arthroscopic chondroplasty, microfracture, and osteochondral autologus transplantation (OAT) due to a chondral defect of the talus. Materials and Methods: This study enrolled 35 patients (36 cases) diagnosed with a chondral defect of the talus and who could be followed over 12 months after arthroscopic chondroplasty, microfracture, or OAT between March 1998 and December 2007. The arthroscopic chondroplasties were carried out in 14 cases (13 patients), the microfractures were carried out in 12 cases (12 patients) and OAT was carried out in 10 cases (10 patients). The lesion staging used Berndt and Harty classification on simple radiographs and Anderson's classification on magnetic resonance images. Clinical results were evaluated and compared by measuring VAS and AOFAS scores at the time of operation, before the operation, and at the time of follow up Clinical evaluation included location, size, and stage of each lesion as well as the age of individual patient. Results: There were 13 medial and 23 lateral lesions. The average size of the chondral defects were 1.9 ㎠ (range 1-4 ㎠). According to the classification of Berndt and Harty and Anderson, there were 8 stage Ⅱ, 21 stage Ⅲ, and 7 stage Ⅳ cases. The average follow up period was 15 months (range: 12-30 months). VAS and AOFAS scores showed significant improvement in all treatment groups. However, clinical results according to the operative methods did not show any differences. Lesion size, stage and location, as well as of age of patient had no significant impact on clinical results. Conclusion: We concluded that all three procedures, arthroscopic chondroplasty, microtracture. and OAT, are useful for treating a chondral defect of talus. Location of lesion, size, stage and age of patient did not make a significant difference.

회전근 개 층간 분리 파열과 비 분리 파열 간의 임상적 결과 및 조직의 치유정도에 대한 비교

곽희철(Heui Chul Gwak),김창완(Chang Wan Kim),Kim junghan 대한견주관절의학회 2016 대한견주관절학회 학술대회논문집 Vol.2016 No.7

족근 관절 경비 인대 결합 손상

곽희철,권용욱,Gwak, Heui-Chul,Kwon, Young-Wook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Ankle injuries may involve the distal tibiofibular syndesmosis and can be associated with a variable degree of trauma to the soft tissue and osseous structures that play an important role in ankle joint stability. Ankle syndesmotic injury may occur solely as a soft tissue injury or in association with variable ankle fractures. Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. The prevalence of these injuries may be higher than previously reported. The diagnosis of syndesmotic injury as not always easy because isolated ankle sprains may be missed in the absence of a frank diastasis and syndesmotic instability may be unnoticed in the presence of bimalleolar ankle fractures. Controversies arise at almost every phase of treatment includings : type of fixation(screw size, type of implant), number of cortices required for fixation and of need for hardware removal. Regardless of controversies, the most important goal should be restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis.