Bipolar Hemiarthroplasty in Unstable Intertrochanteric Fractures with an Effective Wiring Technique

( Jae-hwi Nho ),( Gi-won Seo ),( Tae Wook Kang ),( Byung-woong Jang ),( Jong-seok Park ),( You-sung Suh ) 대한고관절학회 2023 Hip and Pelvis Vol.35 No.2

Purpose: Bipolar hemiarthroplasty has recently been acknowledged as an effective option for treatment of unstable intertrochanteric fracture. Trochanteric fragment nonunion can cause postoperative weakness of the abductor muscle and dislocation; therefore, reduction and fixation of the fragment is essential. The purpose of this study was to perform an evaluation and analysis of the outcomes of bipolar hemiarthroplasty using a useful wiring technique for management of unstable intertrochanteric fractures. Materials and Methods: A total of 217 patients who underwent bipolar hemiarthroplasty using a cementless stem and a wiring technique for management of unstable intertrochanteric femoral fractures (AO/OTA classification 31-A2) at our hospital from January 2017 to December 2020 were included in this study. Evaluation of clinical outcomes was performed using the Harris hip score (HHS) and the ambulatory capacity reported by patients was classified according to Koval stage at six months postoperatively. Evaluation of radiologic outcomes for subsidence, breakage of wiring, and loosening was also performed using plain radiographs at six months postoperatively. Results: Among 217 patients, five patients died during the follow-up period as a result of problems unrelated to the operation. The mean HHS was 75±12 and the mean Koval category before the injury was 2.5±1.8. A broken wire was detected around the greater trochanter and lesser trochanter in 25 patients (11.5%). The mean distance of stem subsidence was 2.2±1.7 mm. Conclusion: Our wiring fixation technique can be regarded as an effective additional surgical option for fixation of trochanteric fracture fragments during performance of bipolar hemiarthroplasty.

투석을 시행하는 만성 신부전 환자의 인공 고관절 치환술 시 합병증에 대한 분석

노재휘(Jae-Hwi Nho),최형석(Hyung-Suk Choi),박강희(Kang-Hee Park),박종석(Jong-Seok Park),서유성(You-Sung Suh) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3

목적: 투석을 시행받는 만성 신부전 환자에 대한 수술적 치료는 결과 및 예후가 일반 환자군에 비해 불량하여, 인공 고관절 치환술을 시행받은 만성 신부전 환자의 수술과 관련된 합병증에 대한 결과적 차이를 분석하고자 하였다. 대상 및 방법: 투석 중인 만성신부전 환자에서 양극성 반치환술이나 고관절 전치환술을 시행한 38명의 환자, 총 40예를 대상으로 합병증의 종류와 빈도 및 연령, 성별, 투석 기간, 당뇨 합병 여부에 따라 환자군을 분류하여, 술 후 1년 내 수술과 관련된 합병증에 대해 분석하였다. 결과: 술 후 1년 내 총 15예에서 정형외과적 혹은 내과적 합병증이 발생하였고(37.5%), 사망은 전체 8예(20%)였다. 성별 및 투석 기간에 따른 분류에서는 합병증 발생 및 사망률에 있어 통계학적으로 유의한 차이점은 발견할 수 없었으나, 연령(p=0.014) 및 당뇨(p=0.026) 합병 여부에 따른 분류에서는 합병증 발생에 있어서 유의한 차이점을 발견할 수 있었다. 결론: 투석을 시행하는 만성 신부전 환자에서 시행한 인공 고관절 전치환술은 다양한 합병증이 발생할 수 있으며, 특히 고령 환자 및 당뇨가 동반된 경우 보다 세심하고 철저한 수술 전 치료 계획 및 술 후 관리를 통해 합병증을 줄이려는 노력이 필요하다. Purpose: In general, the results and prognosis of surgical treatment in dialysis patients are poor compared to patients with normal kidney function. This study analyzes the complications in chronic renal failure patients who underwent primary hip arthroplasty for hip fractures and arthropathy. Orthopaedic complications and medical complications were analyzed for a consequential difference. Materials and Methods: Between 2003 and 2008, 38 dialysis patients (40 cases) with chronic renal failure were enrolled with 24 cases of bipolar hemiarthroplasty and 16 cases of total hip arthroplasty. Types and rates of orthopaedic and medical complications were investigated. Patients were classified according to age, gender, duration of dialysis and diabetes mellitus status. Complications were analyzed for each group. Results: Complications occurred in 15 patients (overall complication rate: 37.5%). Eight patients were died within 1 year (mortality: 20%). Gender and duration of dialysis were not correlated to number of complications. However, there were significant differences according to age (p=0.014) and having diabetes (p=0.026). With regard to mortality, there was no significant difference according to the above classification. Conclusion: Patients on hemodialysis have a high risk of complications after primary hip arthroplasty, especially in elderly patients and diabetic patients. Therefore, we require a full disclosure before recommending hip arthroplasty surgery in dialysis patients, and close postoperative care in patients undergoing dialysis.

임신말기 자궁내 발육상태와 자궁적출 시기가 특정질병 제어 형질전환 복제동물 생후 생존에 미치는 영향

우제석(Jae-Seok Woo),황성수(Seongsoo Hwang),오건봉(Keon Bong Oh),이휘철(Hwi-Cheul Lee),양병철(Byoung-Chul Yang),임기순(Gi-Sun Im),이명식(Myeung Sik Lee),김민규(Minkyu Kim),노환국(Whangook Nho),박수봉(Soo-Bong Park),홍성구(Sunggoo Hon 충남대학교 농업과학연구소 2011 농업과학연구 Vol.38 No.4

Bioorgan transgenic cloned mini pig has a problem of growth retardation in uterus during end of pregnancy so that survival rate is very low in newborn piglet. In order to support their life after birth, cesarean section of fetus with sufficient growth in uterus was tested in this study. First of all, fetus growth measured using a ultrasound scanner during pregnancy in transgenic mini pig, comparing normal pig. After 113 days for delivering, fetus was removed out of uterus. Fetus growth for normal pig was 1.8 cm at 4weeks and 14.4 cm at end of pregnancy (15 weeks). At 113 days, fetus growth was 15.9±4 cm in ultrasound scanner and real growth measurement from fetus removal out of uterus was 16.0±2 cm. It is very a similar result between measurement of ultrasound scanner and real measurement. Therefore, using ultrasound scanner for measuring fetus growth will be useful to predict fetus growth in uterus.

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

( You Sung Suh ),( Jae Hwi Nho ),( Seong Min Kim ),( Sijohn Hong ),( Hyung Suk Choi ),( Jong Seok Park ) 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).

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

You-Sung Suh,Jae-Hwi Nho,Jonghyeon Seo,Byung-Woong Jang,Jong-Seok Park 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: Hip fracture surgery is associated with blood loss, which may lead to adverse patient outcomes. The hemoglobin level declines gradually in most hip fracture cases involving femoral neck fractures and intertrochanteric fractures. It decreases further after hip fracture surgery due to perioperative bleeding. We developed a protocol, which avoids transfusion in hip fracture surgery, and reviewed the hemodynamic outcomes of patients with hemoglobin less than 10 g/dL without transfusion. Methods: From 2014 to 2019, we retrospectively recruited 34 patients with hip fractures and a hemoglobin level less than 10 g/dL, who refused to undergo transfusion. There were 19 patients with femoral neck fractures and 15 patients with intertrochanteric fractures. Our patient blood management (PBM) protocol involving 4,000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) was applied to all included patients. Intraoperatively, a cell saver and tranexamic acid were used. Postoperatively, the protocol was maintained until the patients’ hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications, and hemodynamic changes. Results: Nineteen patients with femoral neck fractures underwent bipolar hemiarthroplasty and 15 patients with intertrochanteric fractures underwent internal fixation with a cephalomedullary nail. The mean hemoglobin level was 8.9 g/dL (range, 7.3–9.9 g/dL) preoperatively, 7.9 g/dL (range, 6.5–9.3 g/dL) immediately postoperatively, 7.7 g/dL (range, 4.3–9.5 g/dL) on postoperative day 1, 7.4 g/dL (range, 4.2–9.4 g/dL) on postoperative day 3, 8.1 g/dL (range, 4.4–9.7 g/dL) on postoperative day 5, 8.5 g/dL (range, 4.5–9.9 g/dL) on postoperative day 7, and 9.9 g/dL (range, 5.7–11.1 g/dL) on postoperative day 14. The average intraoperative bleeding was 206.2 ± 78.7 mL. There was no case associated with complications of anemia. Conclusions: Hip fracture surgery in patients with hemoglobin less than 10 g/dL was feasible without the need for transfusion using our PBM protocol in 34 patients. Using this protocol, the operation was conducted safely despite the anemic condition of patients with fractures whose hemoglobin was less than 10 g/dL.

외상성 삼각섬유연골 복합체 손상과 원위부 요척 관절의 불안정성

김병성(Byungsung Kim),노재휘(Jae-Hwi Nho),정기진(Ki Jin Jung),윤건희(Keonhee Yun),김영환(Young Hwan Kim),윤홍기(Hong-Kee Yoon) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.2

삼각섬유연골 복합체(triangular fibrocartilage complex, TFCC) 외상성 병변은 원위부 요척 관절(distal radioulnar joint, DRUJ)의 불안정을 유발할 수 있어 파열의 위치와 정도에 따라 적절한 치료방법을 설정하는 것이 중요하다. TFCC의 손상은 DRUJ 불안정성을 유발할 수 있는 불안정형 병변과 DRUJ 불안정을 유발하지 않는 안정형 병변으로 구분된다. 병변의 위치와 손상 정도에 따라 관절경적 변연절제술, 관절경적 봉합술 등이 고려될 수 있다. DRUJ 불안정을 유발할 수 있는 척측부 견열 손상의 경우는 관절경적인 변연절제술 후 손상이 있는 부위를 정확히 확인한 다음 suture anchor를 이용한 고정이나 끌어내기 봉합이 유용하다. 척측 견열 손상에 대한 TFCC의 봉합술은 다양한 방법과 술기가 보고되어 손상 위치 및 정도에 따라 적절한 선택이 필수적이다. 척골 양성변이와 동반된 TFCC 파열 역시 파열의 위치와 DRUJ의 불안정성 여부에 따라 수술 방법을 결정하게 되고, DRUJ 불안정성을 해결하기 위해서는 TFCC의 봉합이 중요하며, 경우에 따라 척골단축술을 고려할 수 있다. 단 TFCC 변연부 심부 파열인 경우 척골충돌증후군과 DRUJ 불안정성이 동반되어 있을 때에는 척골단축술만으로는 DRUJ 불안정성을 해결할 수 없기 때문에 척골단축술과 TFCC 봉합을 동시에 시행을 할 수 있다. Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

정맥혈전 색전증 고위험군에서 시행한 혈전색전 예방요법(American College of Chest Physicians 지침 및 American College of Orthopedic Surgeons 지침)의 준수율 비교 연구

서유성(You-Sung Suh),노재휘(Jae-Hwi Nho),장병웅(Byung-Woong Jang),강덕원(Deokwon Kang),원성훈(Sung-Hun Won) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.4

목적: 인공관절 치환술 및 고관절 골절 환자에서 시행한 2가지 정맥혈전 색전증 예방요법의 준수율을 비교 분석하고자 하였다. 수술후 발생하는 정맥혈전 색전증은 인공 슬관절 치환술이나 인공 고관절 치환술 및 고관절 골절 수술 후 발생하는 가장 심각한 합병증이다. 이에 대한 적절한 예방이 무엇보다 중요하기 때문에 항응고제 사용의 필요성 또한 증가하고 있다. 대상 및 방법: 2009년 3월부터 2011년 2월, 2012년 3월부터 2014년 2월까지 순천향대학교 부속 서울병원에서 인공 슬관절 치환술, 고관절 전치환술 및 고관절 골절로 고관절 반치환술 및 내고정술을 시행받은 환자들을 의무 기록과 영상 검사를 검토하여 각각 American College of Chest Physicians (ACCP) 가이드라인과 American College of Orthopedic Surgeons (AAOS) 가이드라인에 따라 시행한 정맥혈전 색전증 예방요법의 준수율을 후향적으로 비교 분석하였다. 결과: 인공관절 치환술 및 고관절 골절 환자에서 정맥혈전 색전증 예방을 위한 가이드라인이 적용되고 있으며 실제로 ACCP 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 수술 전에 56.0%, 수술 후에는 67.0%, 물리적 요법에서는 80.5%의 준수율을 보였다. 또한 AAOS 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 74.1%, 물리적 요법에서는 88.3%의 준수율을 보이며 ACCP 가이드라인에 비해 높은 준수율을 보였다. ACCP 가이드라인의 수술 전 후 화학적 예방요법과 물리적 예방요법의 준수율과 AAOS 가이드라인의 화학적 예방요법과 물리적 예방요법의 준수율을 비교 분석하였으며, 인공 슬관절 치환술의 수술 전과 후, 고관절 골절 수술의 수술 전과 후, 전체 고위험군 수술에서 수술 전과 후 유의한 차이를 보였다(p<0.05). 결론: 정맥혈전 색전증 고위험군 수술에서 정맥혈전 색전증 예방요법의 가이드라인에 따른 준수율을 전반적으로 높여서 적절한 예방이 이루어지도록 해야 하며, 일선 정형외과의를 위한 통일된 방향의 가이드라인이 필요할 것이다. Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

허브형 구동모듈 기반의 가변접지 기능을 갖는 전방향 이동로봇

김효중(Hyo-Joong Kim),조창노(Chang-Nho Cho),김휘수(Hwi-Su Kim),송재복(Jae-Bok Song) 대한기계학회 2012 大韓機械學會論文集A Vol.36 No.3

최근에 들어 서비스 로봇의 효율성 향상을 위한 이동로봇에 대한 연구가 활발하다. 이동로봇은 서비스 로봇의 이동성을 향상시킴으로써, 다양한 공간에서 작업을 할 수 있도록 한다. 그러나 기존의 서비스 로봇은 높은 무게중심으로 인하여 작업 중 전복의 가능성이 높다. 또한, 이동로봇에 사용되는 바퀴는 작고 가벼우며, 환경에 따라 바퀴의 종류를 바꿔야 하므로 기존의 허브형 모터는 한계가 있다. 이를 해결하기 위하여 본 연구에서는 이동로봇에 적합한 허브형 구동모듈과 가변접지면 메커니즘을 개발하였으며, 전방향 이동로봇에 적용하였다. 이를 통해 이동성 및 안정성을 향상과 다양한 작업공간에서의 효율성 향상시켰다. 또한 다양한 시험을 통하여 제안한 메커니즘의 성능을 검증하였다. In recent years, an increased amount of research has been carried out on mobile robots to improve the performance of service robots. Mobile robots maximize the mobility of service robots, thus allowing them to work in different areas. However, conventional service robots have their center of mass placed high above the ground, which may cause them to fall when moving at high speed. Furthermore, hub-type actuators, which are often used for mobile robots, are large and expensive. In this study, we propose a mobile robot with a hub-type actuator unit and a variable footprint mechanism. The proposed variable footprint mechanism greatly improves the stability and mobility of the robot, allowing it to move freely in a narrow space and carry out various tasks. The performance of the proposed robot is verified experimentally.

Hip Fractures in Centenarians: Functional Outcomes, Mortality, and Risk Factors from a Multicenter Cohort Study

Byung-Woong Jang,Jin-Woo Kim,Jae-Hwi Nho,Young-Kyun Lee,Jung-Wee Park,Yong-Han Cha,Ki-Choul Kim,Jun-Il Yoo,Jung-Taek Kim,Kyung-Hoi Koo,You-Sung Suh 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.6

Background: Increasing longevity has caused the very old population to become the fastest-growing segment. The number of centenarians (over 100 years old) is increasing rapidly. Fractures in the elderly lead to excessive medical costs and decreased quality of life with socioeconomic burdens. However, little research has thoroughly examined the functional outcomes and mortality of hip fractures in centenarians. Methods: This is a retrospective observational study. Sixty-eight centenarian hip fracture patients were admitted to the 10 institutions from February 2004 to December 2019. Fifty-six patients with 1-year follow-up were finally included. The following data were obtained: sex, age, body mass index, Charlson comorbidity index value on the operation day, Koval’s classification for ambulatory ability, type of fracture, the time interval from trauma to surgery, American Society of Anesthesiologists grade, surgery-related complications, and duration of hospital stay. Postoperative Koval’s classification (at 1 year after surgery) and information about death were also collected. Multivariate analysis was performed to analyze the risk factors affecting mortality 1 year after surgery. Results: Mortality rates were 26.8% at 6 months and 39.3% at 1 year. The 90-day mortality was 19.6%, and one of them (2.1%) died in the hospital. The 1-year mortality rates for the community ambulatory and non-community ambulatory groups were 29% and 52%, respectively. Only 9 (16.1%) were able to walk outdoors 1 year after surgery. The remaining 47 patients (83.9%) had to stay indoors after surgery. Multivariate analysis demonstrated that the pre-injury ambulatory level (adjusted hazard ratio, 2.884; p = 0.034) was associated with the risk of mortality. Conclusions: We report a 1-year mortality rate of 39.3% in centenarian patients with hip fractures. The risk factor for mortality was the pre-injury ambulatory status. This could be an important consideration in the planning of treatment for centenarian hip fracture patients.

인공관절 치환술 후 CRP 수치를 이용한 급성 감염의 예측

서유성(You-Sung Suh),최형석(Hyung-Suk Choi),노재휘(Jae-Hwi Nho),원성훈(Sung-Hun Won),최종원(Jong-Won Choi),이재철(Jae-Chul Lee),박종석(Jong-Seok Park) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.2

목적: 인공관절 치환술 후 4주 이내의 급성 감염에서 측정된 C-반응성 단백(C-reactive protein, CRP)의 변화 양상을, 감염이 없었던 인공관절 환자군과 비교하여 차이점을 분석하고자 하였다. 대상 및 방법: 하지 인공관절 치환술 후 4주 이내에 발생한 급성 술 후 감염 환자 33예(고관절: 26예, 슬관절: 7예)를 대상으로 하여, CRP를 측정하여 같은 기간 감염이 없었던 환자군 50예(고관절 25예, 슬관절 25예)의 CRP 변화 양상과 비교하고 분석하였다. 결과: 비감염군에서는 술 후 2-3일째 CRP의 급격한 상승 후 수술 3주째까지 지속적인 감소 추세를 나타내지만, 심부 감염군에서는 술 후 13일경, 천부 감염군에서는 술 후 10일경에 CRP의 상승이 나타나는 bimodal curve를 나타내었다. 결론: 인공관절 치환술 후 CRP가 재상승하는 양상(bimodal pattern)인 경우 급성 술 후 감염을 의심하여 적극적인 조기 검사 및 치료를 통해 효과적인 치료를 할 수 있었다. Purpose: C-reactive protein (CRP) has been shown to be useful in the diagnosis of periprosthetic infection. This study analyzed the serial CRP measurements in patients with acute postoperative infection by comparing with the serial CRP measurements in patients without postoperative infection. Materials and Methods: From 2004 to 2009, 33 patients with acute postoperative infection developed within 4 weeks of surgery were enrolled including 26 cases of hip arthroplasty and 7 cases of total knee arthroplasty. We measured the serial CRP levels in the groups with both deep infection and superficial infection. The CRP measurements in the group without postoperative infection were also analyzed based on the changing pattern of CRP. Results: In the non-infected group, CRP level sharply increased in 2-3 days postoperatively and it showed a continuing downward pattern till the third postoperative week. However, a bimodal curve pattern was obtained in the groups with both deep and superficial infection. The group with deep infection showed a second increase in CRP level around the 13th postoperative day and the group with superficial infection showed a second increase in CRP level around the 10th postoperative day. Conclusion: If there are bimodal patterns of CRP after arthroplasty, acute postoperative infections can be suspected. We can treat them effectively without delay by detection of bimodal increase in CRP.