고관절 전 치환 성형술 후 탈구에 관한 치험 및 연구

서유성,김동진,박종석,임수재,나수균,최창욱 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.2

Dislocation is one of the serious complications in total hip replacement arthroplasties. The purpose of this study is to evaluate the risk factors of dislocation, including age, sex, preoperative diagnosis and bilaterality, history of previous hip surgery, positioning of component, soft tissue tension, treatment after dislocation or redislocation. Authors reviewed 190 patients of total hip replacement arthroplasty, which were performed from Jan. 1990 to Dec. 1996. 15 cases developed dislocation after surgery. Incidence of dislocation was 7.89%(15 of 190 cases). Dislocation after revision was not happened(0 of 18 cases). Inclination of acetabular cup was average 37.5° (range: 31° - 43° ). Average anteversion of the acetabular component was 18.1" by Woo and Morrey method, 11.4° by Hassan method. They were normal range except 3 cases. Dislocation was not prevented even though inclination and anteversion of acetabular cup were within normal range. Soft tissue tension is determined by change of limb and femoral neck length. Average limb length difference was -0.2mm(range; -l0mm - +10mm) and average offset difference was +1.7mm(range;-4mm - +18mm). Revision must be accomplished as soon as possible when limb shortening happen by upward migration of the acetabular component. In conclusion, anteversion of acetabular cup may be most important factor in our cases, so cup position must be fixed in proper position during operation.

제7회 연수강좌 : 총론 및 기초 ; 고관절 진단학

서유성 대한고관절학회 2005 Hip and Pelvis Vol.17 No.3

비확공성 골수강내 금속정을 이용한 경골 골절의 치료

서유성,조영일,정호원,김연일 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목적 : 비확공성 골수강내 금속정과 술후 2주째 조기 보행을 시행하여 치료한 경골 골절 46례를 대상으로 임상적 결과를 분석하여 그 유효성 및 금속정의 삽입 위치에 따른 부정 유합의 정도를 알아보고자 하였다. 대상 및 방법 : 비확공성 골수강내 교합정을 이용하여 치료한 경골 골절 46례를 대상으로 전항적 연구를 시행하여 술후 2주째 시행한 조기 보행의 결과와 유합 기간, 불유합등의 상관 관계를 분석하였으며 금속적의 삽입 위치를 방사선 사진을 이용하여 측정하고 부정 유합과의 상관 관계를 분석하였다. 결과 : 전례에서 불유합은 발생하지 않았으며 임상적 유합 기간은 182주가 소요되었고 방사선적 유합기간은 19.4주가 소요되었다. 슬관절과 족극관절에서 관절 강직은 발생하지 않았으며 최종 추시에서 시행한 방사선 검사상 중앙/내측/외측으로 삽입된 경우 최종 전후면 사진에서 2.45˚ ± 2.17/2.22˚ ± 1.84/1.73˚ ± 1.33(p; 0.705)였고 최종 측면 사진에서 1.81˚ ± 1.13/ 2.67˚ ± 1.62/2.00˚ ± 1.64(p; 0.320)로 금속정 삽입 위치에 따른 부정 유합의 정도에는 유의한 차이가 없었다. 결론 : 비확공성 골수강내 교합정을 이용하여 고정한 경골 골절 46례의 치료에서 금속정 삽입 위치와 변형각간의 유의성은 없는 것으로 보이며, 술후 2주째 슬개건 부하 보조기를 이용한 조기 보행으로 만족할 만한 결과를 얻을 수 있었다. Purpose : To evaluate of clinical results and malunion according to nail insertion site and early ambulation after undreamed interlocking intramedullary nailing for the treatment of tibial fractures, Materials and Methods : We reviewed 46 tibial fractures that were treated with undreamed static intramedullary nailing prospectively from March 1997 to May 2001. Nail insertion site and angulation of fracture site were reviewed by radiograph. All of 46 cases, ambulation was started at postoperative 2 weeks, and then clinical outcomes were reveiwed Results : In all 46 cases, union was achieved at average 18.2 weeks clinically and average 19.4 weeks radiographically. There is no significant difference in angulation according to nail insertion site, i,.e. after central/medial/lateral insertion, outcome was 2.45˚ ± 2.17/2.22˚ ± 1.84/1.73˚ ± 1.33(p; 0.705) in last follow up anterioposterior view, and 1.81˚ ± 1.13/2.67˚ ± 1.62/2.00˚ ± 1.64(p;0320) in last follow up lateral view. No breakage of intramedullay nails and no stiffness on adjacent joints. Conclusion : We confirmed that undreamed interlocking nailing in tibial fractures is one of the effective method for low recurrence of malunion and early ambulation

샌드위치 세라믹 라이너의 골절 : 1예 보고 One Case Report

서유성,임강철 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

In Alumina-Alumina Artificial Hip joints with a sandwich ceramic liner, liner fracture and dissociation is rare. In December 2001, a 58-year-old man underwent a right total hip arthroplasty because of avascular necrosis of femoral head. 3.8 years after surgery, he felt click and squeak in the groin and had thigh and inguinal pain. Radiographs shows a fracture of the ceramic acetabular insert. At sergery, we found the fracture of the insert, which had become detached from the polyethylene backing, the greatly worn polyethylene backing and the ceramic head that was discolored from contact with the metal shell. The patient was treated by revisional total hip arthroplasty and a new polyethylene liner and a metal head were fitted. We describe this one rare case and review the literature.

Survivorship and Complications after Hip Fracture Surgery in Patients with Chronic Kidney Disease

서유성,원성훈,최형석,이재철,천동일,노재휘,이환웅,김진형 대한의학회 2017 Journal of Korean medical science Vol.32 No.12

The aim of this study was to investigate survival rate, complications and associated risk factors after hip fracture surgery in patients with chronic kidney disease (CKD) by comparing to non-CKD patients. A total of 119 patients (130 hips, 63 hips CKD group, 67 hips non-CKD) who underwent hip fracture surgery were included. We assessed variables including age, gender, CKD, comorbidities, operation delay and operation time as risk factors for survival and complications after hip fracture surgery. The survival rate was 55.8% at 1-year, 45.8% at 3-year, and 31.4% at 5-year in CKD group, whereas 82.1%, 60.7%, and 36.8%, respectively in non-CKD. Age (more than 85) (hazard ratio [HR], 3.238; 95% confidence interval [CI], 1.736–6.042; P < 0.001), stages 4, 5 of CKD (HR, 2.004; 95% CI, 1.170–3.433; P = 0.001), cerebrovascular disease (HR, 2.213; 95% CI, 1.196–4.095; P = 0.001), and malignancy (HR, 3.086; 95% CI, 1.553–6.129; P = 0.001) were significant risk factors. Complications occurred in 17 hips of CKD group and 8 hips of non-CKD. Stage 4–5 of CKD (odds ratio [OR], 3.401; 95% CI, 1.354–8.540; P = 0.001), malignancy (OR, 3.184; 95% CI, 0.984–10.301; P = 0.050) were significant risk factor. When performing hip fracture surgery in patients with CKD, surgeons should consider age, severity of CKD, and presence of other comorbid disease, such as cerebrovascular disease and malignancy, as patients with these risk factors will need more intensive preoperative and postoperative care.

다소성 골괴사

서유성,박형근,최형석,김연일,이병일 순천향의학연구소 2002 Journal of Soonchunhyang Medical Science Vol.8 No.2

In case of the occurrence of osteonecrosis at three or more anatomical location, it is defined as multifocal osteonecrosis, but still any king of study with references hasn't been reported in Korea. The patient who had admitted due to the pain in both knee joints, both hip joints and left ankle joint and we diagnosed as multifocal osteonecrosis by using bone scan and magnetic resonance imaging. To relieve right knee joint and left hip joint pain, we perfomed arthroplasty. Here we present one case report of multifocal osteonecrosis through analysis by patient's history and hematologic examination and provide a review of the literature.

대퇴골 경부 골절 치료 후 발생한 합병증에서 후방피질골 분쇄 의의

서유성,정석봉,박종석,임수재,이병일 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목적 : 대퇴골 경부 골절이 발생하여 수술적 치료를 결정하고 시행하려 할 때 일차적으로 단순 내고정으로 할 것인가, 적극적 치료를 시행할 것인가는 명확한 객관적 기준보다는 다소간의 수술자의 경험과 선호도에 따라 결정되는 실정이기에 일차적 내고정을 시행하여 수술법 선택시 중요성을 부과할 수 있는 지침 일부를 마련 하고자 한다. 대상 및 방법 : 내고정 후 발생한 불유합과 무혈성 괴사, 내고정의 소실 등의 발현이 있는 환자를 대상으로 후향적으로 발생 가능한 인자를 분석하였다. 결과 : 대퇴 경부 골절을 내고정 시행하였을 경우에 합병증의 발생은 견고한 내고정의 유지에 비중을 두고 있고 다른 인자로 골절의 형태, 골다공증, 고정의 위치를 중요하게 생각하고 있지만 고정의 소실이 없어도 합병증이 발생하는 경우 골절의 형태는 후방 피질골 분쇄 골절이 동반되고 있었다. 결론 : 저자들이 시행한 환자의 분석 결과는 대퇴골 경부 골절을 일차적으로 치료시 단순 내고정과 다른 적극적 치료와의 선택의 경우에 대퇴골 후방 피질골 분쇄 유무에 비중을 두어 결정해야 할 것으로 사료된다. Purpose : When a surgeon carries out an operative treatment on a patient who has fractures of the femoral neck, he decides to do either the internal fixation for bony union of the aggressive treatment according to his experience and preparation, not according to the objective standard. The aim of this retrospective study is to prepare a guideline for the operative method. Materials and Methods : We analyse possible factors of the patient who has nonunion, avascular necrosis and loss of fixation after doing internal fixation in femoral neck fractures. Results : In this treated case of femoral neck, the appearance of complications are influenced by the maintenance of internal fixation, shape of fractures, osteoporosis, and the position of fixations; but in the complicated cases without the loss of fixation, the shape of fractures always have posterior cortical communition. Conclusion : When we choose between simple fixation and aggressive treatments in cases of fractures of the femoral neck, we must treat according to the patient’s condition, displacement of the fracture, operative technique and existence of a posterior cortical comminuted fracture.

역동적 고나사를 이용한 대퇴골 전자하부 분쇄 골절의 치료

서유성,이재상,윤홍기,신병준 순천향대학교 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.2

Background : To evaluate the effectiveness of dynamic hip screw fixation in managing comminuted subtrochanteric fractures of the femur Methods : We performed a retrospective chart review of 23 cases of Seinsheimer’s Type IV and V (below Fielding Type 2) comminuted subtrochanteric fractures of femur, treated with dynamic hip screw, and followed for over a year. The postoperative clinical courses were examined, including bone union time and adverse events. Results : Bone union was achieved in 22 of 23 patients, with a mean time of 21 weeks (range 15-28 weeks). There were 3 adverse events: 1 nonunion of fracture site, 1 nonunion, and 1 malunion of lesser trochanter fracture. Mean follow-up duration was 27 months (range 13-84). At the most recent follow-up, except for one case of fracture nonunion, no shortening, limitation of motion, pain of fracture site, or limping gait was observed. Conclusions : Using dynamic hip screw procedure is thought to be one of effective treatments in severe communited intertrochanteric fracture and relatively mild communited subtrochanteric fracture.

Multilock 대퇴삽입물을 이용한 고관절 치환술의 단기결과

서유성,황재영,나수균,최창욱 최신의학사 1995 最新醫學 Vol.38 No.8

Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures

서유성,노재휘,김성민,홍시전,최형석,박종석 대한고관절학회 2015 Hip and Pelvis Vol.27 No.1

Purpose: In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23])Materials and Methods: We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). Results: There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). Conclusion: There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH<PFNA<CHS).