슬관절 전치환술 후 발생한 인공삽입물 주위 골절

서정탁,백상대,최성종 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

목적: 슬관절 전치환술 후 발생하는 인공 삽입물 주위 골절은 흔하지는 않으나 발생시 습관절의 기능에 나쁜 영향을 미치는 합병증이다. 저자들은 인공 삽입물 주위 골절의 치료방법에 따른 그 결과를 분석하고자 하였다. 대상 및 방법 : 1991년 3월부터 2000년 12월까지 습관절 전치환술후 동측의 인공 삽입물 주위골절이 발생한 13례를 대상으로 하였다. 환자를 치료 방법에 따라 3개의 그룹으로 나누었으며, 제Ⅰ군은 골 견인 후 석고 또는 석고 보조기를 시행한 경우(4례), 제Ⅱ군은 금속판 고정술을 시행한 경우(4례), 제Ⅲ군은 역행적 골수강내 금속정을 시행한 경우(5례)였다. 골절의 유합은 방사선적으로 골소주가 골절면을 통과할 때, 임상적으로는 전 체중부하가 가능한 시기로 하였다. 결과: Hospital for Special Surgery의 Knee rating score는 술전 평균 87.1점에서 술후 74.5점으로 감소하였다. (Ⅰ군: 술전 85.0점, 술후 65.2점, Ⅱ군: 술전 89.3점, 술후 78.5점, Ⅲ군: 술전 87.4점, 술후 81.0점). 전례에서 골유합을 얻었고, 평균 골유합의 시기는 4.5개월로 각 군간에는 유의한 차이를 보이지 않았으며, 유합후의 대퇴 경골각에서도 유의한 차이가 없었다. 슬관절의 운동범위는 술전 평균 110도에서 술후 93도로 감소하였는데 (Ⅰ군: 술전 105도, 술후 65도, Ⅱ군: 술전 120도, 술후 110도, Ⅲ군: 술전 110도, 술후 105도), 제 Ⅰ군에서 현저하게 감소하였다. 결론: 슬관절 전치환술 후의 인공삽입물 주위골절의 치료시 보존적 요법은 장기간 고정과 지연된 관절 운동에 의한 운동범위의 감소가 현저했다. 이러한 측면에서 관혈적 정복 및 금속판 내고정술과 역행적 골수강내 금속정 삽입술은 견고한 고정후 조기 관절 운동이 가능하여 좋은 치료 방법으로 사료된다. Purpose: Periprosthetic fracture is known to be uncommon, but serious complication after total knee arthroplasty. We evaluated the clinical outcomes and radiological changes following treatment modality of periprosthetic fracture after total knee arthroplasty Materials and Methods: We reviewed 13 knees of the 13 patient with periprosthetic fracture after total knee arthroplasty between March 1991 and December 2000 The average follow up period was 27months. The patient were grouped according to the treatment methods; Group Ⅰ is the patients who were treated by skeletal traction followed by cast of cast brace. Group Ⅱ is the patients who were treated by open reduction and internal fixation with plate. Group Ⅲ is patients who were treated by retrograde intramedullary nails. We analyse time required for union, femorotibial angle after union, range of motion and Hospital for Special Surgery score of each group. Results: Time required for union was similliar within groups. Femorotibial angle after union was not significant change in all groups postoperatively. ROM was decreased in Group Ⅰbut there was not significant changes in group Ⅱ and Ⅲ. HSS score was decreased in Group Ⅰ, 85 preoperatively and 65.2 postoperatively. Conclusion: Skeletal traction followed by cast or cast brace only can be recommended for knees in which the initial alignment and stability of fracture were in acceptable range, but in has increased functional loss because of prolonged immobilization and delayed ROM execises. In knees with malaligned and unstable periprosthetic fracture, condylar plating and retrograde IM nails can be recommended for better clinical and radiological results.

Case Report : Total Knee Arthroplasty in a Patient with an Ankylosing Knee after Previous Patellectomy

( Jeung Tak Suh ),( Seung Joon Rhee ),( Shi Hwan Park ),( Sung Min Hong ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.3

Patellectomized patients may have less satisfactory clinical outcomes following total knee arthroplasty (TKA) due to a decreased extensor mechanism efficiency and potential instability. Furthermore, the existing literature does not provide concrete guidance on the expected results of TKA or the type of implant that should be used in patellectomized patients. We present a case of a patient with an ankylosing knee who had undergone patellectomy due to gunshot injury 45 years ago and was treated with primary TKA using a posterior stabilized prosthesis at our institution. TKA using this prosthesis in the ankylosed knee with a previous history of patellectomy yielded good results in terms of postoperative clinical scores, range of motion and joint stability.

Staged surgical management of multiple ligament injury of the knee

Jeung Tak Suh,Jae Min Ahn,Ji Min Lee,Nu Ri Kim 대한정형외과 스포츠의학회 2014 Arthroscopy and Orthopedic Sports Medicine Vol.1 No.2

Background: We evaluated the clinical outcomes of staged surgical management of patients with multiple ligament injury of the knee after a follow-up period of at least one year. Methods: A staged surgical management of 20 cases of multiple ligament injury of the knee in 18 patients was carried out between January 2005 and December 2010 and followed up for a minimum of 1 year. All multi-ligament injuries were either KD-II or above injuries according to the modified Scheneck classification system. As the first stage of management, repair or reconstruction were performed for all cases of posterolateral ligament complex injuries; conservative treatment for 5 cases of medial collateral ligament injuries with low grade (grade 1 or 2), and suturing for 6 cases with high grade (grade 3). If instability persisted even when the patient’s range of motion returned to normal levels, as a second stage of management, the fresh-frozen Achilles allograft was used for trans-tibial single bundle reconstruction by arthroscopy. Results: The mean Lysholm score improved from 52.1 ± 5.53 (range, 43-62) preoperatively to 88.3 ± 5.61 (range, 78-95) at the last follow-up. The Lysholm score was above 80 points in 90.0% of the knees (18 out of 20). The mean International Knee Documentation Committee (IKDC) subjective score also improved from 45.3 ± 11.52 (range, 29.1-67.3) preoperatively to 86.4 ± 10.33 (range, 66.5-99.5) at the last follow-up. The overall IKDC grading was above B in 70% of the knees (14 out of 20). Lastly, the Tegener activity score improved from 2.9 ± 0.62 (range, 2-4) preoperatively to 4.6 ± 0.86 (range, 3-6) at the last follow-up. Conclusion: We obtained satisfactory clinical results after a staged surgical management of multiple ligament injury of the knee. Therefore, we suggest staged surgical management as one of the treatment options for multiple ligament injury of the knee.

Tibial Inlay법과 Tibial Tunnel법을 이용한 관절경적 후방 십자 인대 재건술의 평가

서정탁(Jeung Tak Suh),천상진(Sang Jin Cheon),김정일(Jeung Il Kim),이춘기(Choon Key Lee),박원로(Won Ro Park) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.5

목적: 후방 불안정성의 치료로 이용되고 있는 tibial tunnel법과 tibial inlay법을 이용한 후방 십자 인대 재건술의 치료 결과를 비교 및 분석하고자 하였다. 대상 및 방법: 보존적 치료에도 불구하고 통증과 불안정성을 호소하고 등급 2 이상의 후방 전위를 보인 31명의 환자들을 대상으로 하였으며 평가는 수술 전 및 최종 추시 관찰 시의 후방 전위 검사, 후방 전위 스트레스 방사선 사진 촬영, Lysholm knee score와 Tegner activity score로 하였다. 결과: 후방 전위 검사에서 최종 추시 시 tibial tunnel 군은 등급 1이 7예(58.3%), 등급 2가 4예(33.3%), 등급 3이 1예(8.3%)였고, tibial inlay 군은 등급 1이 14예(73.7%), 등급 2가 5예(26.3%)였다. 후방 전위 스트레스 방사선 사진상 건측과의 차이는 tibial tunnel 군에서는 수술 전 평균 12.4 mm, tibial inlay 군에서는 평균 11.8 mm였고, 최종 추시 시에는 각각 평균 4.0 mm 및 2.9 mm로 향상되었다. 최종 추시 시 Lysholm knee score는 tibial tunnel 군에서 86.8점으로, tibial inlay 군에서 88.2점으로 향상되었으며, Tegner activity score는 각각 5.83점, 5.84점으로 향상되었다. 결론: 최종 수시 시 후방 안정성은 tibial inlay법에 의한 후방십자인대 재건술이 비교적 잘 유지되는 경향을 보였으나 통계적 유의성은 없었으며 더 많은 증례와 더 긴 추시 기간을 통한 연구가 필요하리라 생각된다. Purpose: To compare the results of posterior cruciate ligament reconstructions by tibial inlay and tibial tunnel techniques. Materials and Methods: Despite of conservative treatment, all patients (31 cases) had pain and grade 2 or more posterior instability. Posterior drawer test and posterior drawer stress radiography were performed. Clinically, Lysholm knee score and Tegner activity score were evaluated. Results: In the tibial tunnel group, posterior drawer test demonstrated grade 1 instability in 7 cases, grade 2 in 4 cases, and grade 3 in 1 case at the last follow-up. In the tibial inlay group, there was grade 1 instability in 14 cases and grade 2 in 5 cases. On posterior drawer stress radiography, the mean side-to-side difference in measurement of the tibial tunnel group improved from 12.4 mm preoperatively to 4.0 mm at follow-up, and that of the tibial inlay group improved from 11.8 mm to 2.9 mm. Lysholm knee score and Tegner activity score improved to 86.8 points and 5.83 points, respectively, in the tibial tunnel group, and to 88.2 points and 5.84 points, in the tibial inlay group. Conclusion: PCL reconstruction with the tibial inlay technique tends to maintain better posterior stability, but there is no statistically significant difference between the two techniques. Further study may be required.

대퇴골 간부의 분쇄 골절에서 교합성 골수강내 금속정 고정술을 이용한 치료 - 환상 철사 고정술을 부가한 개방적 골수강내 금속정 고정술과 폐쇄적 골수강내 금속정 고정술의 비교 분석 -

서정탁 ( Jeung Tak Suh ),노형록 ( Hyoung Lok Roh ),김정일 ( Jeung Il Kim ),유총일 ( Chong Il Yoo ) 대한골절학회 2005 대한골절학회지 Vol.18 No.1

경골과 골절에 대한 임상적 고찰

서정탁(Jeung Tak Suh),김휘택(Hui Taeg Kim),장재원(Jae Won Chang),유총일(Chong Il Yoo) 대한정형외과학회 1992 대한정형외과학회지 Vol.27 No.2

슬와부의 경골 신경에 발생한 신경 내 결절종

서정탁 ( Jeung Tak Suh ),문규필 ( Kyu Pill Moon ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.2

Intraneural ganglion is a relatively rare clinical entity that is commonly found in the peripheral nerves in the upper and lower extremities. It is commonly manifested by motor deficits, pain and sensory changes due to nerve entrapment and compression of the involved nerve. An intraneural ganglion of the tibial nerve is very rare. We present here a rare case of intraneural ganglion of the tibial nerve in the popliteal fossa and the patient had a neurologic deficit, and this was all treated successfully. We review the clinical course of the patient and the relevant issues are discussed together with a thorough review of the relevant literature.

65세 이상의 연령층에서 원위 요골 골절의 수술적 치료

서정탁 ( Jeung Tak Suh ),김대웅 ( Dae Woong Kim ),유총일 ( Chong Il Yoo ) 대한골절학회 2003 대한골절학회지 Vol.16 No.4

고도굴곡형 슬관절 인공관절 전치환술에서 가동형과 고정형 삽입물의 비교

서정탁 ( Jeung Tak Suh ),김태완 ( Tae Wan Kim ),안태영 ( Tae Young Ahn ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.3

목적: 고도굴곡형 슬관절 인공관절 전치환술에서 가동형과 고정형 삽입물을 이용한 치료 결과를 비교 분석하였다. 대상 및 방법: 2003년 12월부터 2007년 12월까지 고도굴곡형 슬관절 인공관절 전치환술을 시행받은 환자 중 가동형 삽입물을 이용한 65예와 고정형 삽입물을 이용한 65예를 대상으로 최소 2년 이상 추시관찰하였다. 결과: 슬관절 점수 및 기능점수는 가동형군에서 술 전 53.2점, 49.7점에서 술 후 95.6점, 96.1점으로, 고정형군에서 술 전 54.1점, 50.9점에서 술 후 94.5, 95.1점으로 향상되었다. 슬관절 운동 범위 및 최대 굴곡 각도는 가동형군에서 술 전 122.3o, 125.8o에서 술 후 129.1o, 131.4o로, 고정형군에서 술 전 122.2o, 123.9o에서 술 후 128.3o, 129.3o로 향상되었으며, 양군간에 유의한 차이는 없었다. 꿇어 앉는 자세와 양반다리 자세 가능 여부에 있어서도 양 군에서 유의한 차이는 없었으나, 가동형군에서 양반다리 자세 시 더 용이 하였다. 결론: 임상적 평가지수, 슬관절 운동 범위, 최대 굴곡 각도는 양 군에서 큰 차이는 없었으나, 양반다리 자세 시 편안함을 느끼는 정도는 가동형 삽입물을 이용한 군에서 더 높았다. Purpose: We compared and analyzed the follow-up results of high flexion total knee arthroplasty (TKA) with using the mobile-bearing and fixed-bearing designs. Materials and Methods: We studied 130 patients who had undergone high-flexion TKA from December 2003 to December 2007 and who were followed up for at least 2 years. Of all the 130 patients, 65 patients had undergone TKA using a mobile-bearing design, and the other 65 patients had undergone TKA using the fixed-bearing design. Results: The post-operative Knee Society Knee Score (KSKS) and Knee Society Functional Score (KSFS) of the mobile-bearing group were 95.6 and 96.1 points, which were 53.2 and 49.7 points, respectively, preoperatively, and the post-operative KSKS and KSFS of the fixed-bearing group were 94.5 and 95.1 points, which were 54.1 and 50.9 points, respectively, preoperatively. The range of motion (ROM) and maximal flexion angle (MFA) of the knee joints of the mobile-bearing group were 129.1o and 131.4o, which were 122.3o and 125.8o, respectively, preoperatively, and those of the fixed-bearing group were 128.3o and 129.3o, which were 122.2o and 123.9o, respectively, preoperatively. There were no significant differences between the two groups. Crossed-legged sitting and attaining a kneeling position also showed no significant differences between the two groups, but the mobile-bearing group could easily take a crossed-legged sitting position. Conclusion: The clinical parameters and the ROM and MFA of the knee joint showed no significant differences between both groups, but the mobile-bearing group felt more comfortable in the crossed-legged sitting position

경골 분절 골절의 폐쇄성 교합성 골수강내 금속정 고정술 후 결과

서정탁 ( Jeung Tak Suh ),천상진 ( Sang Jin Cheon ),김영균 ( Young Gyun Kim ),이정섭 ( Jung Sub Lee ),이춘기 ( Choon Key Lee ) 대한골절학회 2005 대한골절학회지 Vol.18 No.3