제5 중족골 기저부 골절의 유발인자 및 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

Should We Check the Routine Postoperative MRI for Hematoma in Spinal Decompression Surgery?

신헌규,정화재,김유진,박재형,박세진,조용운 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.2

Background: A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery. Methods: Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Results: Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant (p = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma (p = 0.562, p = 0.506, and p = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma (p = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score (p < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma (p = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different (p = 0.689). Conclusions: Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient’s status.

한국인에서 근위 대퇴부 골절 유형과 체질량 지수의 연관성

신헌규,정화재,김유진,박재형,고택수,최영민 대한골다공증학회 2014 Osteoporosis and Sarcopenia Vol.12 No.2

Objectives: The purpose of this analysis is to study whether the factors including bone mineral density (BMD) and age which influence fracture occurrence is involved in proximal femur fracture type. Any correlation of body mass index (BMI) and obesity to fractures of the proximal femur was investigated in particular. Methods: Two hundred fifty two patients hospitalized for femur neck fracture and intertrochanteric fracture over 60 under 90 years old were examined. Only simple fall down trauma for excluding pathologic fractures was included. About 225 patients, past medical, drug and social history were investigated and BMD and BMI (body mass index) were measured. Patients were classified into two groups (femoral neck fracture and intertrochanteric fracture). Significant differences in BMD and BMI between these two groups were investigated. Results: There was no statistically significant difference between two proximal femur fracture type with regard to age, sex and BMD. But two groups seem to have statistically significant different with BMI. Most patients had normal weight, thus no significant differences were found in degree of obesity between two groups. Conclusions: This study shows that the higher the patients have BMI, the more frequently intertrochanteric fracture is occurred. But, owing to normal obesity levels seen in most patients in this study, any definitive correlation between obesity and each type of proximal femur fracture could not be found.

Danis-Weber B형 족관절 외과 골절의 고정방법 비교연구 : Antiglide 금속판 고정술 대 외측 금속판 고정술

신헌규,최재열,강동호,Shin, Hun-Kyu,Choi, Jae-Yeol,Kang, Dong-Ho 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate the advantages of the antiglide plate fixation procedure for Danis-Weber type B lateral malleolar fractures of ankle compared to other methods of lateral plate fixation. Materials and Methods: We reviewed 70 cases that antiglide plate fixation and lateral plate fixation procedures were performed from Mar. 2001 through Mar. 2006. Of the total 70 cases, they were divided into two groups ; 22 cases were treated with the antiglide plate procedure (Group I) and 48 cases were treated with the lateral plate procedure (Group II). The results of the two groups were analyzed both radiographically and clinically using Ankle-Hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS). Results: All fractures were healed at average of 8 weeks both radiographically and clinically. According to the Ankle-Hindfoot scale, all cases of Group I and 48 cases of Group II were above 80 points. 2 cases (9%) in Group I complained of peroneal tendinitis, while 19 cases (39%) in Group II showed skin irritation resulting from the screw or the plate. A total of 6 cases (27%) in Group I and 27 cases (55%) in Group II complained cosmetic problems. Conclusion: we concluded that the antiglide plate fixation for Danis-Weber type B lateral malleolar fractures is one of the good methods. But, further analysis will be need to find a solution for the peroneal tendinitis.

경골 간부를 침범한 Pilon 골절에서 2단계 MIPO 수기를 이용한 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate surgical treatment using two-staged MIPO technique in tibial pilon fractures involving tibial shaft. Materials and Methods: Twelve patients, who underwent two-staged MIPO technique for pilon fractures involving tibial shaft between January 2003 and May 2005, were followed for more than one year. Radiographs were graded by the criteria of Anglen and ankle functions were graded by the criteria of Mast and Teipner. Ankle function, union time and postoperative complications were also analysed. Results: Clinically there were eight (67%) good results, three (25%) fair results and one (8%) poor result. At the last follow-up, the radiographic results showed seven (58%) excellent results, three (25%) good results, and two (17%) fair results. During the follow up, There was one case of nonunion Conclusion: Two-staged MIPO techinque is one of the good methods for the treatment of pilon fractures invloving tibial shaft.

골다공증성 척추골절 역학 및 중요성

신헌규,박종현 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

연구 계획: 골다공증성 척추골절의 역학 및 중요성에 대한 문헌 고찰. 목적: 골다공증성 척추골절의 역학 및 중요성에 대해 알아보고자 한다. 선행 문헌의 요약: 골다공증성 척추골절의 빈도는 증가하고 있다. 대상 및 방법: 문헌 고찰. 결과: 골다공증성 척추골절의 빈도는 고령화 사회와 더불어 증가하고 있으며 이는 삶의 질 저하와 기대 수명 저하를 가지고 올 수 있다. 또 이는 척추의재골절이나 이차 골절을 발생시킬 수 있다. 결론: 고령화 사회에서 골다공증성 척추골절은 중요한 사회적 문제이다. 따라서 그 예방을 위한 노력이 필요하다. Study Design: Review of the literature on the epidemiology and importance of osteoporotic spinal fractures. Objectives: To determine the epidemiology and importance of osteoporotic spinal fractures. Summary of Literature Review: Osteoporotic spinal fractures have been increasing in recent years. Materials and Methods: Review of the literature. Results: Osteoporotic spinal fractures can lead to a reduced quality of life and reduced life expectancy with increasing morbidity. They can also be a major cause of additional spinal fractures or secondary fractures. Conclusions: In an aging society, osteoporotic spinal fractures are considered a social problem. Preventive care should be emphasized.

척추 질환 환자의 비암성 만성 통증 관리 현황 조사

신헌규,남우동,김동수,김진환,김성규,안태근,김성수 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.3

연구 계획: 단면연구, 다기관 설문연구목적: 만성 비암성 통증 환자의 통증, 치료 방법 및 치료 후 통증 경험에 대해 조사하였다. 선행 연구문헌의 요약: 척추 질환으로 인한 만성 비암성 통증 환자의 최근 관리 현황에 대한 조사는 드물다. 대상 및 방법: 척추 질환 진료를 위해 내원한 만성 비암성 통증 환자 330명에게 설문조사를 실시하였다. 결과: 통증 치료 전에는 중증 통증 환자가 86.7% 였으며, 99.4%가 경구 진통제를 복용하였다. 치료 후, 중증 통증 환자는 42.1%로 줄었으나, 52.4% 가 간헐적인 통증이 있다고 응답하였다. End of dose failure (EDF)를 경험한 환자는 29.1% 였고, 41.7%가 약물 복용 3~6시간 이후 통증을 다시 느꼈다. 8.2%가 돌발 통증, 29.1%가 수면 방해 통증을 경험하였다. 결론: 다수의 만성 통증 환자들이 약물치료 후에도 EDF로 인한 통증을 경험하였다. 만성 통증은 원인이 복합적이므로, 효과적인 통증 관리를 위해 적절한 진통제 선택이 필요할 것으로 보인다. 약칭 제목: 비암성 만성 통증 관리 현황 Study Design: Cross-sectional, multi-center survey study. Objectives: The objective of this study was to investigate the pain status, pain management methods, and pain experience after treatment among patients suffering from chronic non-cancer pain due to spinal disease. Summary of the Literature Review: No thorough investigation of the current status of chronic non-cancer pain management in patients with spinal disease has recently been reported. Materials and Methods: We surveyed 330 patients with chronic non-cancer pain who visited spine clinics in Korea. Results: Prior to treatment, 86.7% of the patients had severe pain and 99.4% of the patients had taken oral analgesics for pain control. After treatment, the percent of patients with severe pain was reduced to 42.1%, and 52.4% of patients responded that they experienced intermittent pain. End of dose failure was experienced by 29.1% of patients, and 41.7% of patients experienced pain again 3-6 hours after taking analgesics. Furthermore, 8.2% of patients experienced breakthrough pain, and 29.1% of patients experienced pain that interfered with sleeping. Conclusions: Many patients with chronic pain reported experiencing pain due to end of dose failure after medication. As the causes of chronic pain are complex, appropriate analgesics should be considered and selected for effective pain management.

요추부 추간공 협착증을 동반한 척추관 협착증 환자에서 관상형 견인기를 이용한최소 침습적 감압술의 유용성

신헌규,최재열,정화재,김유진,박세진,이승희,서동석 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.1

Study Design: Retrospective study. Objectives: The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression usingtubular retractor with minimally invasive technique. Summary of Literature Review: Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminalstenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because itmay have several complications. Materials and Methods: Clinical results were obtained from 12 patients who underwent posterior foraminotomy and centraldecompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and theProlo outcome scale. Results: Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible,and no surgically related complication was noted. During the follow-up period, the Oswestry disability index decreased from24.25±2.89(pre-op) to 19.33±3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients. Conclusions: A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for thetreatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal ofarthrodesis. 연구계획: 최소 침습적 후방 추간공 확장술을 시행한 12명의 요추부 추간공부 협착증을 동반한 척추관 협착증 환자의 임상 및 수술 결과에 대해 후향적분석을 시행하였다. 목적: 요추부의 추간공 협착증을 동반한 척추관 협착증 환자에서 최소 침습적 요추부 후방 추간공 확장술 및 척추관 감압술의 유용성에 대하여 살펴보고자 하였다. 선행문헌의 요약: 요추부의 추간공 협착증을 동반한 척추관 협착증 환자에서 흔히 사용되는 수술법은 고식적인 후방 감압술 및 유합술이다. 이는 수술시간이 길고, 오랜 입원기간, 술 후 요추부 통증, 유합술로 인한 인접 척추분절 장애 등이 남을 수 있어 고령의 기저질환이 많은 환자에서는 위험할 수 있고, 큰 수술을 원치 않는 환자군에서는 적절치 못한 수술법이다. 대상 및 방법: 2009년 1월부터 2011년 4월까지 후방 추간공 확장술 및 척추관 감압술을 시행한 12명의 환자를 대상으로 하였으며 통증 정도는 VASscore를 이용하였다. 술 후 예후는 Oswestry Disability Index (ODI)와 Prolo Outcome Scale (POS)로 평가하였다. 결과: 12명 중 6명에서 수술 후 하지 방사통의 즉각적인 호전이 관찰되었다. 수술 후 요추부 통증은 미미한 정도였으며, 수술과 관련된 합병증은 관찰되지 않았다. 관찰기간 동안 8명에서 ODI는 수술 전 평균 24.25±2.89에서 수술 후 최종 추시 결과 평균 19.33±3.02으로 감소하였다(p=0.28, pairedt-test). 결론: 최소 침습적 후방 추간공 확장술은 고령의 기저질환이 많은 환자나 유합술을 원하지 않는 환자에 대안적 수술법으로 선택적으로 사용할 수 있을것으로 사료된다.

족관절 골절의 임상적 고찰

김기용,윤준오,이수호,신헌규 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

The ankle joint is a modified complex hinge joint which plays an important role in weight bearing, walking and standing. So, the goals of treatment of ankle fracture are anatomical positioning of the talus in the mortise and regaining a smooth articular surface. The Lauge-Hansen classification of ankle fracture is useful because it characterized the mechanism and sequence of injury and in particular, emphasizes the associated ligamentous injuries. But, it is more complex and all fractures do not conform exactly to one of the described pattern. The Danis-Weber classification of ankle fracture is simpler, emphasized the importance of the lateral side of the ankle, and is usuful in planning surgical treatment. Initially this system did not distinguish the extent of involvement and was too inclusive. The problem has been addressed in the AO classification. The system proposed by Tile is easy to remember and emphasized the importance of assessing and relating stability to the structures that are injured. We analyzed 124 cases of ankle fracture, most of which were treated surgically by AO methods, in the Orthopedic Department, University of Ulsan Medical College, Asan Medical Center from July 1989 to March 1992. The results obtained from this study were as follows : 1. The most common victim was 3rd-5th decade's man. 2. The most common type of Danis-Weber classification was type C(36.3%) and most common type of AO classification was type C1(15.3%), C2(15.3%). According to the classification of Lauge-Hansen, the most common type was pronation-external rotation (42.7%). 3. In Danis-Weber type B and C, satisfactory results were obtained by operative treatment. 4. Danis-Weber's classification and A-O classification were very practical criteria for treatment of the ankle fracture.

환추축 불안정성이 없는 치상돌기 후방부의 가성 종양을 동반한 경추 척수증

신헌규(Hun-Kyu Shin),홍석우(Seok Woo Hong),박진훈(Jin Hun Park),손동욱(Dong-Wook Son) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.1

82세 남자 환자로 경부 통증, 양측 상지 위약감 및 보행장애를 주소로 내원하였다. 환자는 류마티스 관절염이나 다른 특이 과거력은 없던 분이었고 타 병원에서 시행한 경추부 자기공명영상에서 치상돌기 후방의 가성 종양 소견을 확인할 수 있었다. 단순 방사선 검사상에서 환축추 불안정성은 보이지 않았으며 이에 후방 유합술은 시행하지 않고 환추의 후궁 절제술만 시행하였다. 수술 직후 통증은 감소하였고 신경학적 증상도 호전되는 경과를 확인할 수 있었다. 환축추 불안정성이 없는 치상돌기 후방 가성 종양의 경우 환추의 후궁절제술만으로 증상 호전을 기대해 볼 수 있을 것으로 생각한다. An 82-year-old male patient was admitted for neck pain, motor weakness in both upper extremities, and gait disorder. The patient had no history of rheumatoid arthritis or other specific histories, and the findings of cervical myelopathy with retro-odontoid pseudotumor were confirmed by cervical magnetic resonance imaging. On cervical radiography, there was no evidence of atlantoaxial instability or subluxation. Therefore, posterior fusion was not performed; only a C1 laminectomy was performed. Immediately after surgery, the pain decreased, and neurological symptoms were also improved. In the case of a retro-odontoid pseudotumor without atlantoaxial instability, it is believed that the symptoms can be improved only with C1 laminectomy.