전자부 골절의 연성 골수강 금속정 고정시 Lowman 골감자를 이용한 피질골의 균열 방지

채인정,우경조,이홍건,고무경 대한골절학회 1989 대한골절학회지 Vol.2 No.2

Flexible intramedullary nailing has offered the many advantages in the treatment of the trochanteric fractures. But there has been many complications such as the knee joint pain, the deformity of external rotation of the femur, insufficient fixation of the fracture, peroneal nerve palsy, cortical breakage of insertion site of nailing and linear fracture of the femur. Of these complications, the cortical breakage and linear fractures of the femur was prevented by using the Lowman clamp on the proximal site of insertion hole during the nailing. The authors have treated 31 cases of the trochanteric fractures with this method from March 1985 to December 1988 and the results are as follows: 1. There was neither cortical breakage nor linear fracture at the site of insertion hole in all cases of 31. 2. Wide operation field was obtained with Lowman damp by traction of muscles near by. 3. The handle of Lowman clamp can be used as indicator to determine the grade of anteversion. 4. It is confirmed that intramedullary nailing with Lowman clamp is simpler than conventional methad and is highly recommended.

척추의 화농성 골수염에서의 경피적 배농술 및 세척술

채인정,박정호,권규호 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study Design : The authors analysed the recovery of clinical symptoms after percutaneous drainage and irrigation in pyogenic vertebral osteomyelitis. Objectives : To determine the role of percutaneous drainage and irrigation in pyogenic vertebral osteomyelitis. Summary of Literature Review : Pyogenic vertebral osteomyelitis is a relatively rare condition but its incidence is recently increasing due to common use of intravenous access devices and resultant nosocomial bacteremia. Management of the disease is not uniform and is controversial regarding the role of surgery and duration of use of antibiotics. At present, the role of percutaneous drainage of involved spines in treatment of pyogenic vertebral osteomyelitis is not well-known. Materials and Methods : We report 3 cases of pyogenic vertebral osteomyelitis which were treated by continuous drainage with automated percutaneous lumbar discectomy device(APLD device) and draining tube after they have failed to conservative treatment. APLD device, fluoroscopic guide, contrast media and continuous percutaneous draining tubes were used for this procedure. The percutaneous draining tubes were maintained for 7 to 11 days and each case was followed up for 6 to 10 weeks under admission. Results : Symptoms were relieved 3 to 5 weeks after this procedure. The patients were followed u p to 12 to 39 months and experienced no recurrence. Conclusions : Percutaneous drainage and irrigation with APLD device brought prompt and marked clinical recovery. It is indicated as a supplementary method to conservative treatment or in case of high operative risk patient due to poor general conditions. It has minimal invasiveness, short clinical course and low recurrence rate.

Steffee VSP 및 절단한 척추경 나사못을 이용한 요추 전방 전위증의 수술적 치료 : 새로운 수술방법 New Operative Technique

채인정,서승우,임당재 대한척추외과학회 1999 대한척추외과학회지 Vol.6 No.3

연구 계획 : 저자들은 기능 분절을 보존하면서 만족스러운 정복을 얻기 위해 Steffee VSP 및 절단한 척추경 나사 못을 이용하여 수술적으로 치료한 요추 전방 전위증 환자의 임상적 결과를 고찰하였다. 목적 : 요추 전방 전위증 환자에서 Steffee VSP 및 절단한 척추경 나사못을 이용한 단일 분절 유합술의 우수성을 입증하고자 하였다. 대상 및 방법 : 1994년 3월부터 1996년 2월까지 Steffee VSP 및 절단한 척추경 나사못을 이용하여 Cork screw pulling back mechanism에 의해서 정복술 및 단일 분절 유합술을 시행한 29례의 환자를 대상으로 하였다. 추시 기간 은 1년 6개월에서 3년 1개월이었다. 결과 : 평균 전위율은 Taillard 방법에 의해 수술전 23.3 %에서 술후 3.7 %로 만족스런 정복을 얻었다. Gill’s criteria에 따른 임상적 평가에서도 90 %에서 양호 이상의 결과를 얻었다. 결론 : 저자들은 이 술식을 통해 비교적 만족스러운 결과를 얻었다. 또한 이러한 방법은 동일한 저자들에 의해 발표된 S-자형 금속판을 이용한 요추 전방 전위증의 수술적 치료와 비교할 때, 금속판을 이중으로 굴곡시켜야 하는 기술적인 어려움이 감소되었고, 응력 기점인 추궁판과의 접촉부를 술전에 미리 둥굴게 연마함으로써 접촉 면적을 증가시켜 추궁판 경화 등의 부작용을 감소시킬 수 있을 것으로 생각된다. 또한 향후 상위 후관절과 추궁판에 대한 절단된 척추경 나사못의 압박 효과와 골유합율 및 내고정물 제거술후 상부 분절의 보존 여부에 대한 장기 추시 관찰이 필요할 것으로 사료된다. Study Design : The authors have investigated the clinical results for the lumbar spondylolisthesis treated operatively using the Steffee VSP and cut pedicle screw for satisfactory reduction with saving of functioning segment. Objectives : To demonstrate the effectiveness of short segment fusion using the Steffee VSP and cut pedicle screw. Summary of literature review : Spondylolisthesis has been recognized as one of the leading cause of low back pain. Most are successfully managed with conservative treatment, but operative treatment is indicated if conservative treatment fails. Operative treatments are categorized into decompression, reduction and fusion. Especially, in the methods of fusion, there are some controversies between short segment fusion for saving of functioning segment and extended fusion for more amount of reduction. Materials and Methods : We report 29 cases of lumbar spondylolisthesis which were treated operatively using the Steffee VSP and cut pedicle screw from March 1994 to Feb. 1996. The reduction was done by cork screw pulling back mechanism and the short segment fusion was done. The each case was followed up for 1 year 6 months to 3 years 1 month. Results : Satisfactory reduction was obtained from preoperative 23.3% slippage to postoperative 3.7% by Taillard method. In the functional results, 90% was above good according to the Gill`s criteria without any serious complications. Conclusions : We had satisfactory results after this operation. When compared to operative treatment with S-shaped VSP reported by same authors, this procedure had following advantages ; ease to make and decrease of complication such as laminar sclerosis due to wider contact. It is necessary that long-term follow up about pressure effect of cut pedicle screw on above facet joint and lamina, fusion rate and saving of above functioning segment after implant removal.

Flexible drill bit를 이용한 척추경 고정시 안정성에 대한 내시경적 확인

채인정,박정호,서정대 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1

Among the numerous spinal instrumentation devices currently available,transpedicular screw fixa- tion has become one of the most popular methods of providing segmental stability. To avoid damage to surrounding dura, nerve roots, or vascular structures, proper placement of the screw is critical and it is influenced by anatomic consideration, such as pedicle size and location, spinal canal shape,ver- Having made screw holes using flexible drill bit, the authors confirmed that they were safely fixed within the pedicle using intraosseous endoscopy for 124 pedicle screws fixed patients from May. 1991 to July. 1994 at Korea University Anam Hospital. In result, every pedicle screws were located within the pedicle and no complications were observed. Therefore, pedicle screw fixation using flexible drill bit and direct visual confirmation of screw holes with intraosseous endoscopy are an efficient method to prevent the complications in pedicle screw fixation.

In Vivo Effect of Intra-Tendinous Thermal Shrinkage on the Rabbit Patellar Tendon

채인정,김상범,이석하,오광준 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.5

Purpose: In this vivo animal study, the authors evaluated the effect of thermal shrinkage on the rabbit patellar tendon using modified approaches involving intra-tendinous thermal treatment and protective immobilization. Methods and Measures: Of 30 New Zealand white rabbit patellar tendons, Twenty-five rabbits underwent tendon immobilization by fixation of the patella to the femur after thermal shrinkage of the right-side patellar tendon. Ten rabbits of those were sacrificed at 4 weeks and the other fifteen rabbits at 8 weeks. The left-side patellar tendon of twenty-five rabbits were underwent sham-control except thermal treatment. The rate of shrinkage and maximal peak stress and linear stiffness by unit area were assessed in these twenty-five rabbits. Differences between groups were statistically analyzed. Light and transmission electron microscopy examination were evaluated in all of thirty rabbits. Results: The shrinkage rate immediately after thermal treatment did not change significantly at 4 and 8 weeks. The mean maximal tensile stress and linear stiffness at 8 weeks (372.30±164.37 N/m2 and 214.60±142.52 N/mm) were significantly higher than those measured at 4 weeks (233.84±91.12 N/m2 and 196.70± 72.10 N/mm, respectively) allthough those were diminished when it compared with those of sham control group. Numerous collagen fibers with medium diameters and myofibroblasts indicative of a healing process were observed on histologic examination at 8 weeks. Conclusion: Intra-tendinous thermal shrinkage combined with a period of protective immobilization may be one of positive concern for prevention of re-stretching phenomenon as time goes by. 목 적: RF 에너지를 이용하여 슬개건막 혈관의 손상을 최소화 하기 위하여 토끼의 슬개건 내부에 열을 가하여 축화를 유발하고, 축화된 건을 고정하여 보호하는 방법으로 시간 경과에 따른 축화율, 인장 응력과 선상 강성의 변화를 알아보았다. 대상 및 방법: 30마리의 토끼 중 25마리의 우측 슬개건에 열 축화를 가하고 슬개골을 대퇴골에 고정시켜 축화된 슬개건을 보호하였다. 좌측 슬개건은 열 축화를 제외하고 동일한 수술을 시행하였다. 이후 10마리는 4주에 나머지 15마리는 8주에 희생시켜 축화율과 최대 인장 응력 및 선상 강성을 측정하고 통계적 분석을 시행하였다. 조직학적 변화를 관찰하기 위하여 나머지 5마리를 포함한 30마리 토끼의 슬개건 조직으로 광학 현미경 및 투시 전자 현미경 관찰을 시행하였다. 결 과: RF 에너지를 가한 직후의 축화율은 4주 및 8주 후의 축화율과 통계적으로 차이가 없었다. 4주와 8주 때 측정한 슬개건의 최대 인장 응력과 선상 강성은 축화를 시행하지 않은 대조군에 비하여 통계적으로 의미있게 감소하였으나, 8주 때의 최대인장 응력과 선상 강성(372.30±164.37 N/m2 and 214.60±142.52 N/mm)은 4주 때(233.84±91.12 N/m2 and 196.70±72.10 N/mm)와 비교하여 통계적으로 의미있게 컸다. 시간이 경과한 후 8주때의 조직학적 소견에서 중등도 굵기의 콜라겐섬유가 다시 관찰되면서 치유의 소견으로 보이는 근섬유모세포가 관찰되었다. 결 론: RF 에너지를 토끼의 슬개건 내부에 가하여 축화를 유발하고, 축화된 건을 일정기간 고정하여 보호함으로써 축화된조직이 시간이 경과함에 따라 발생하는 재이완 줄이고 최대 인장 응력과 선상 강성이 회복될 수 있음을 확인하여 인대나 건의 열 축화에 대한 긍정적 효과 기대할 수 있는 실험 결과를 얻었다.

대퇴과간절흔 성형술에서 유연성 연마기를 이용한 방법

채인정,이광석,백종륜,Chae, In-Jung,Lee, Kwang-Suk,Back, Jong-Ryoon 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

Arthroscopic anterior cruciate ligament reconstructions using bone-patella tendon-bone have been considered the best method by which others are compared. The notchyplasty is one of the important steps of this procedure and it is emphasized recently to prevent retear of the reconstructed ACL caused by impingement. However, until now, there is controversy about adequate amount of notchyplasty. Also, it is hard to examine the adequacy of notchyplasty even in the arthroscopic field, The purpose of this paper is to describe the surgical technique of notchyplasty, using the flexible reamer and preliminary result of its operation. In this study the results of ACL reconstruction with notchyplasty which is made by us were analized from January. 1994 to December, 1995. The results were as follows: 1. The notchyplasty with flexible reamer is the method that can be obtained adequate amount of removal, perfectly smooth notchyplasty. 2. The range of motion of the affected knee joint was normal ROM after post operation 6 month. 3. In the last follow up, 2 cases were positive in anterior drawer test 4 cases were positive in Lachmann's test and 1 knee was positive in Pivot shift test 4. Average Lysholm knee scoring scale was 70 points at preoperative and 92 points at the last follow up.

학술대회 : 성인에서 골절경을 이용한 슬와낭종의 관절내 동반병변에 대한 분석

채인정,이기홍,김태하 대한슬관절학회 1999 정기학술대회 Vol.- No.-

슬개골전 점액낭염의 관절경적 절제술

채인정,한승범,이병택,Chae In-Jung,Han Seung-Beom,Lee Byung-Taek 대한관절경학회 2000 대한관절경학회지 Vol.4 No.1

목적 : 보존적 치료에 반응하지 않는 슬개골전 점액낭염에 대하여 점액낭 내벽의 염색후 관절경을 이용한 절제술을 시행하여 고무적인 결과를 얻었기에 그 임상적 결과를 보고하고자 한다. 대상 및 방법 : 1996년 1월부터 1998년 10월까지 본 교실에서 치료받은 20세 이상의 슬개골전 점액낭염의 환자중 관절경적 절제술을 시행받은 환자 11명을 대상으로 하였다. 수술방법은 앙와위에서 점액낭내로 관절경을 삽입후 메틸렌 블루를 이용하여 내벽의 염색을 시도한후 shaver를 이용하여 내벽을 제거후 지속적 폐쇄 흡입기를 설치한후 압박 드레싱한후 보행을 허용하였다. 결과 : 모든 환자에서 동통을 수반한 반흔은 없었으며 수술 직후부터 보행이 가능하였으며, 추시 관찰중 1례에서 지연 감염이 있었다. 결론 : 관절경을 이용한 슬개골전 점액낭염의 치료는 합병증을 최소화 할 수 있으며, 특히 시술시 점액낭 내벽을 염색함으로써 병변 조직의 구별이 용이하여 슬개골전 점액낭염의 치료에 있어 좋은 술식으로 생각된다. Purpose : We report a result of arthroscopic resection after inner-wall staining for treatment of prepatellar bursitis which was not treated conservatively. Materials and Methods : Between January 1996 and October 1998, We treated arthroscopically 11 patients with prepatellar bursitis. Arthroscopic resection was performed with shaver after inner-wall staining using Methylene Blue and then placed continuous suction drainage and compressive dressing. Results : All patients had no tender scars and were able to walk immediately after procedure. We found one case of late infection during follow-up. Conclusion : Arthroscopic bursectomy minimizes the complication of open bursectomy such as pain or large scar. Skin perforation would be prevented by inner-wall staining.

요천추부 추간판탈출증에 시행한 경피적 수핵제거술

채인정,우경조,정대철 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.2

To compair the results of the automated percutaneous lumbar discectomy between the cases of ruptured disc case of unruptured in preoperative discography, retrospective evaluation of 91 patients was done those were operated from Feburuary 1989 to Feburuary 1994 in Korea University Hospital. The results were obtained as follows. 1. The patients range in age from 17 to 41 years (mean age : 24 years), and number of male patients was 54 and female 37. 2. Among the 91 patients, ruptured case were 27(29.7%) and unruptured case were 64(70.3%) according to discographic study. 3. Satisfactory results were obtained 82.5% in unruptured case and 58.5% in ruptured case according to the Mcnab's criteria.

유연성 연마기를 이용한 관절경적 전방 십자 인대 재건술의 추시 결과

채인정,왕준호,최기원,송동익,Chae, In-Jung,Wang, Joon-Ho,Choi, Gi-Won,Song, Dong-Ik 대한관절경학회 2008 대한관절경학회지 Vol.12 No.1

목적: 유연성 연마기를 이용한 전방십자인대 재건술을 시행 받은 환자에서 슬관절의 기능 및 안정성에 대한 임상적 결과를 보고하고자 한다. 대상 및 방법: 1999년 3월부터 2004년 5월까지 유연성 연마기를 이용하여 전방 십자 인대 재건술을 시행받고 1년 이상 추시가 가능 하였던 98례를 대상으로 하였다. 임상적 평가를 위해 주관적 검사로는 Lysholm knee score 및 2000 International Knee Documentation Committee(IKDC) subjective knee score를 이용하였으며, 객관적 검사로는 전방 전위 검사와 Lachman 검사, pivot shift 검사 그리고 KT-2000 arthrometer를 이용하였다. 결과: 관절 운동 범위는 5도 이상의 신전 소실이 술 전에는 8례에서 술 후 1례로 감소 하였으며 5도 이상의 최대 굴곡 소실은 술 전 12례에서 술 후 2례로 감소 하였다. 주관적 검사 중, Lysholm 점수는 술 전에 평균 61.3점(${\pm}3.5$ SD)에서 술 후에 87.7점(${\pm}2.0$ SD)으로 향상되었고, IKDC subjective knee score도 술 전 평균 49점(${\pm}3.3$ SD)에서 술 후 84점(${\pm}2.2$ SD)으로 향상되었다. 객관적 검사 중, Lachman 검사상 grade II 이상의 전방 전위를 보인 경우는 술 전 93례에서 술 후 5례로 감소하였으며 pivot shift 검사상 술 전 71례에서 grade II 이상의 양성 소견을 보였으나 술 후 음성인 경우가 89례였다. 또한 KT-2000 arthrometer 검사상 환측과 건측의 최대 전방 전위 차이는 술 전 평균 6.8 mm(${\pm}1.9$ SD)에서 술 후 평균 1.8 mm(${\pm}0.8$ SD)로 향상되었다. 결론: 유연성 연마기를 이용한 전방십자인대 재건술로 술 후 양호한 결과를 얻었으며, 특히 슬관절의 회전 안정성을 얻을 수 있었던 바 이는 이식물을 보다 해부학적인 위치에 이식시킬 수 있었기 때문일 것으로 사료된다. Purpose: The purpose of this study is to evaluate the clinical results of the function and stability of ACL reconstruction using the flexible reamer. Materials and Methods: We reviewed 98 patients who taken ACL reconstruction using the flexible reamer from March, 1999 to May, 2004. And the follow-up period was more than 12 months in all cases. We used the subjective tests including Lysholm knee score and 2000 International Knee Documentation Committee(IKDC) subjective knee score, and the objective tests such as anterior drawer test, Lachman test, pivot shift test, and KT-2000 arthrometer to evaluate the clinical results. Results: In the range of motion of the affected knee, the extension deficit more than 5 degree was 8 cases preoperatively and 1 case postoperatively. The flexion deficit more than 5 degree was 12 cases preoperatively and 2 cases postoperatively. The mean Lysholm knee score was 61.3 point(${\pm}3.5$ SD) preoperatively and 87.7 point(${\pm}2.0$ SD) postoperatively. The mean 2000 International Knee Documentation Committee(IKDC) subjective knee score was 49 point(${\pm}3.3$ SD) preoperatively and 84 point (${\pm}2.2$ SD) postoperatively. 93 cases were more than grade II in Lachman test preoperatively and 5 cases postoperatively. 71 cases were more than grade II in pivot shift test preoperatively but 89 cases were negative postoperatively. The mean maximal manual difference by KT-2000 arthrometer was 6.8 mm(${\pm}1.9$ SD) preoperatively and 1.8 mm(${\pm}0.8$ SD) postoperatively. Conclusion: ACL reconstruction using the flexible reamer achieved the ideal isometric point of femur and anatomic graft placement, so we could obtain good results, especially in rotational stability.