스포츠와 관련된 족부 및 족관절 손상에 대한 비수술적 치료

곽희철,서승석,김창완,Gwak Heui-Chul,Seo Seung-Suk,Kim Chang-Wan 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.2

The foot and ankle are one of the most common sites for acute musculoskeletal injuries related to sports activity. Foot and ankle injury includes ligament injury, tendon injury, bone and osteochondral injury, nerve injuy, heel pain syndrome, phalangeal injury. This is a article about nonoperative management of foot and ankle injury. Therefore, this article includes various exercise technique, range of motion, stretching for muscle relaxation, proprioception training for rehabilitation. We recommend that orthopedic surgeon should discuss with patient and specialist for treatment plan after foot and ankle injury

족근 관절 경비 인대 결합 손상

곽희철,권용욱,Gwak, Heui-Chul,Kwon, Young-Wook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Ankle injuries may involve the distal tibiofibular syndesmosis and can be associated with a variable degree of trauma to the soft tissue and osseous structures that play an important role in ankle joint stability. Ankle syndesmotic injury may occur solely as a soft tissue injury or in association with variable ankle fractures. Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. The prevalence of these injuries may be higher than previously reported. The diagnosis of syndesmotic injury as not always easy because isolated ankle sprains may be missed in the absence of a frank diastasis and syndesmotic instability may be unnoticed in the presence of bimalleolar ankle fractures. Controversies arise at almost every phase of treatment includings : type of fixation(screw size, type of implant), number of cortices required for fixation and of need for hardware removal. Regardless of controversies, the most important goal should be restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis.

중족통의 원인

곽희철,하동준,Gwak, Heui Chul,Ha, Dong Jun 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.3

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

거골하 관절에서 발생한 통풍성 관절염을 동반한 골연골종(1예 보고)

곽희철,김전교,Gwak, Heui Chul,Kim, Jeon Gyo 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.4

Osteochondroma, which is an osteocartilaginous exostosis, is essentially the most common primary bone tumor. These benign neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. Calcaneal osteochondroma is rare, furthermore osteochondroma accompanying with gouty arthritis is very rare. Also, the subtalar joint is not a classic site of acute gout. In this report, we report the case of a patient who experienced an unusual calcaneal osteochondroma with undiagnosed gouty arthritis of the subtalar joint.

거골의 연골 병변에 대한 관절경적 치료

곽희철(Heui Chul Gwak),김주용(Joo Yong Kim),최장석(Jang Seok Choi),김창완(Chang Wan Kim),김정한(Jung Han Kim),박대현(Dae Hyun Park) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.6

목적 : 거골의 연골 병변에 대하여 관절정적 연골 성형술, 미세 골절술 및 자가 골연골 이식술을 시행 후 임상 결과 비교 및 결과에 영향을 미치는 인지를 평가하고자 하였다. 대상 및 방법 : 1998년 3월부터 2007년 12월까지 거골의 연골 병변으로 진단받은 환자들 중 관절경적 연골 성형술, 미세 골절술 또는 자가 골연골 이식술 시행 후 12개월 이상 추시가 가능했던 35명(36예)을 대상으로 하였다. 연골 성형술이 14예(13명), 미세 골절술이 12예(12명), 자가 골연골 이식술이 10예(10명)에서 시행되었다. 병변의 단계는 단순 방사선 산진 상 Berndt와 Harty 분류 및 Anderson 자기 공명 영상 분류를 사용하였다. 전 예에서 술 전 및 최종 추시에서 VAS score 및 AOFAS score를 측정하여 각각의 술식에 따른 임상적 결과를 평가 및 비교하였다. 병변의 위치, 크기, 단계 및 나이에 따른 임상적 결과를 평가하였다. 결과: 연골 병변 위치는 외측이 13예, 내측이 23예였으며 연골 병변의 평균 크기는 1.9 ㎠(1-4㎠)였다. 병변의 단계는 Berndt와 Harty 분류 및 Anderson 분류 2단계가 8예, 3단계가 21예, 4단계가 7예였다. 평균 추시관찰 기간은 15개월(12-30개월)이었으며, 전체 환자에서 VAS score 및 AOFAS score의 유의한 호전이 관찰되었으나, 각 술식 간의 의미있는 차이는 없었다. 병변 위치, 크기, 단계 및 나이에 따른 환자 군의 비교에서 유의한 차이는 나타나지 않았다. 결론: 관절경을 이용한 연골 성형술, 미세 골절술 및 자가 골연골 이식술 모두 거골의 연골 병변에서 유용한 치료 방법으로 사료되며, 병변 위치, 크기, 단계 및 나이에 따른 분류에서는 각 군별로 유의한 차이가 나나나지 않았다. Purpose: To compare clinical results and to evaluate the factors affecting the clinical results after performing arthroscopic chondroplasty, microfracture, and osteochondral autologus transplantation (OAT) due to a chondral defect of the talus. Materials and Methods: This study enrolled 35 patients (36 cases) diagnosed with a chondral defect of the talus and who could be followed over 12 months after arthroscopic chondroplasty, microfracture, or OAT between March 1998 and December 2007. The arthroscopic chondroplasties were carried out in 14 cases (13 patients), the microfractures were carried out in 12 cases (12 patients) and OAT was carried out in 10 cases (10 patients). The lesion staging used Berndt and Harty classification on simple radiographs and Anderson's classification on magnetic resonance images. Clinical results were evaluated and compared by measuring VAS and AOFAS scores at the time of operation, before the operation, and at the time of follow up Clinical evaluation included location, size, and stage of each lesion as well as the age of individual patient. Results: There were 13 medial and 23 lateral lesions. The average size of the chondral defects were 1.9 ㎠ (range 1-4 ㎠). According to the classification of Berndt and Harty and Anderson, there were 8 stage Ⅱ, 21 stage Ⅲ, and 7 stage Ⅳ cases. The average follow up period was 15 months (range: 12-30 months). VAS and AOFAS scores showed significant improvement in all treatment groups. However, clinical results according to the operative methods did not show any differences. Lesion size, stage and location, as well as of age of patient had no significant impact on clinical results. Conclusion: We concluded that all three procedures, arthroscopic chondroplasty, microtracture. and OAT, are useful for treating a chondral defect of talus. Location of lesion, size, stage and age of patient did not make a significant difference.

회전근 개 층간 분리 파열과 비 분리 파열 간의 임상적 결과 및 조직의 치유정도에 대한 비교

곽희철(Heui Chul Gwak),김창완(Chang Wan Kim),Kim junghan 대한견주관절의학회 2016 대한견주관절학회 학술대회논문집 Vol.2016 No.7

제5 중족골 제1, 2 구역 골절의 조기 체중부하의 비수술적 치료 결과

곽희철(Heui-Chul Gwak),박대현(Dae-Hyun Park),김정한(Jung-Han Kim),이창락(Chang-Rack Lee),권용욱(Yong-Uk Kwon),김동석(Dong-Seok Kim) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.2

목적: 제5 중족골 기저부 골절의 위치와 전위, 관절 침범, 분쇄 등의 특징이 조기 체중부하 치료의 결과에 어떤 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 2013년 1월부터 2017년 7월까지 인제대학교 부산백병원에 내원하여 제5 중족골 기저부 제1, 2 구역 골절로 진단받은 총 34명의 34예를 대상으로 하였다. 평균 추시 기간은 13개월(6–15개월)이었다. 동 기간 동안 수술적 치료를 시행한 경우는 없었고 1명의 경우 추시 기간 중 이전 골절 부위와 다른 부위의 재골절로 제외되었으며 총 33예 모두 보존적 치료를 시행하였다. 족부의 전후면, 측면 및 경사 방사선 촬영 및 컴퓨터 단층 촬영을 시행하여 골절의 위치와 전위, 관절 침범, 분쇄의 정도를 평가하였다. 33명의 모든 환자에게 있어서 수상 직후부터 단하지 석고고정 혹은 탈착 가능한 부츠형 보조기를 선택하여 착용 후 통증이 허용되는 범위 내에서 부분적인 체중부하를 허용한 뒤 통증이 소실되면 일반 신발 또는 수술 후 신발을 착용 후 전 체중부하를 시행하게 하였다. 임상적 결과로 최종 추시 시에 American Orthopedic Foot and Ankle Society (AOFAS) score를 평가하였다. 외래 추시 시 족부의 단순 방사선 촬영을 하여 방사선적 골유합 시기와 업무로의 복귀 시기를 확인하였다. 결과: 총 33명의 환자가 본 연구에 참여하였고(남자 9명, 여자 24명), 환자들의 평균 나이는 48.7세(16–80세)였다. 제1 구역이 24명, 제2 구역이 9명이었고 전체 33명의 환자 중 22명에서 2 mm 이상의 골절 전위가 관찰되었고 관절 침범은 9명, 분쇄 골절은 5명에서 관찰되었다. 제1 구역에서 제2 구역에 비하여 통계적 의미 있는 업무로의 복귀를 보였고 최종 추시 시 AOFAS score는 우수한 결과를 보였고 통계적 차이는 없었다. 골절의 전위 정도, 관절 침범 여부, 분쇄 정도를 분류, 비교하였을 때 방사선적 유합 시기, 업무 복귀 시기에 있어 통계적 차이는 없었으며 모든 경우에 있어 최종 추시 시 만족할 만한 결과를 보였다. 결론: 제5 중족골 기저부 골절에서 골절의 위치, 전위, 관절 침범, 분쇄 여부에 관계없이 조기 체중부하를 허용하여도 만족할 만한 임상적 결과를 얻을 수 있다. 제5 중족골 기저부 골절에서 조기 체중부하하 보존적 치료는 우수한 임상 결과를 얻을 수 있는 좋은 치료 방법이라 생각된다. Purpose: To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment. Materials and Methods: From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6–15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work. Results: Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up. Conclusion: Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

족부 족관절 분야에서의 관절경 술기

곽희철(Heui-Chul Gwak) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.2

관절경을 이용한 유합술기는 관절경 기술의 발달로 인하여 점차 많이 시행되고 있고, 그에 따라 술자들의 경험도 증가하면서 그 사용 범위가 증가하고 있다. 관절경을 이용한 술식은 연부조직 손상의 최소화, 환자 위험 감소, 빠른 회복, 병원 재원 일수 감소 및 빠른 유합 시간 등의 많은 장점을 가진다. For the arthroscopic fusion procedure, the development of arthroscopic techniques of joint preparation for fusion have made arthroscopic ankle arthrodesis popular, and foot and ankle surgeons also have gained considerable experience in arthroscopic techniques. Arthroscopic techniques offer minimized soft tissue disruption, lower morbidity and mortality, faster recovery, and shorter hospital stay and time to fusion. In addition, they may reduce the risk of wound complications for patients with a poor soft tissue envelope or relevant co-morbidities.

아킬레스건 파열의 수술적 치료 비교: 최소 절개 봉합술과 관혈적 봉합술

공규민,곽희철,김전교,Kong, Gyu-Min,Gwak, Heui-Chul,Kim, Jeon-Gyo 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.3

Purpose: The purpose of this study was to compare and analyse the clinical outcomes of minimal incision repair and open repair in ruptured Achilles tendon. Materials and Methods: We retrospectively analyzed the outcomes of 10 patients with minimal incision repair (group 1) and 19 patients with open repair (group 2) from February 2007 to June 2011. The postoperative clinical evaluations were done by Arner-Lindholm scale, AOFAS score, overall patient's satisfaction and cosmetic satisfaction of scar. Results: There was no statistical difference between two groups in Arner-Lindholm scale, AOFAS score, overall patient's satisfaction (p=1.21, 0.87, 1.07). There was statistically high rate of cosmetic satisfaction in group 1(p<0.001). There were no complications in group 1. Complications occurred in three patients (deep infection, rerupture, deep vein thrombosis) of group 2. Conclusion: Treatment of minimal incision repair in Achilles's tendon ruptures showed high rate of cosmetic satisfaction and low rate of complication's, but there were no significant differences with open repair in other clinical outcomes. The minimal incision repair could be recommended as one of the effective treatment for the Achilles's tendon ruptures.

족무지 종자골에 발생한 무혈성 골괴사증(3예 보고)

김영창,곽희철,김정한,문상원,Kim, Young-Chang,Gwak, Heui-Chul,Kim, Jung-Han,Moon, Sang-Won 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.2

Although avascular necrosis of the hallucal sesamoid has not been frequently addressed in the literature, it should be considered in the differential diagnosis of persistent forefoot pain. We experienced 3 cases of avascular necrosis of the hallucal sesamoid with sclerosis of the sesamoid bone on radiograghs and computed tomograghy images. T1 and T2-weighted MRI images in 2 patients showed low signal intensity in the sesamoid bone, which suggested osteonecrosis and confirmed by histology. We report 3 cases of avascular necrosis of sesamoid with a review of the literature.