거골 경부 골절 이후 발생한 부분적인 골괴사의 3차원 부피 분석

나웅채,이준영,박상하,박형석,Na, Woong Chae,Lee, Jun Young,Park, Sang Ha,Park, Hyung Seok 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

Purpose: The purpose of this study is to define the geographic patterns of partial avascular necrosis (AVN) of the talar body and to determine whether there were any predictors of both the location and occurrence of partial AVN. Materials and Methods: Nineteen patients with fracture of the talar neck treated by open reduction and internal fixation and followed up for more than 1 year were analyzed. The radiographs were examined 6 to 8 weeks after the operation for Hawkins sign and if it was not observed, magnetic resonance scans were performed. The three-dimensional analysis was performed using Mimics 17.0 (Materialise). The incidence of collapse and time to operative intervention was recorded. Results: Partial AVN of the talar body was observed in six out of 19 patients. The avascular segment of the talar body was located predominantly in the anterolateral portion. The average volume of the avascular segment was $289mm^3$, and it occupied 1% of total volume of the talus, and 10% of the talar dome. Collapse occurred in one patient in the area of the avascular process. There were no observable trends with regard to Hawkins classification, incidence of collapse, or time to operative intervention to the location of the avascular segment. Conclusion: Partial AVN can occur after fracture of the talar neck. The predominant location of the avascular segment was the anterolateral portion of the talar body. This information may be helpful to understanding the process of avascular necrosis of the talar body.

전위된 거골 경부 골절의 소형 금속판을 이용한 고정

나웅채 ( Woong Chae Na ),이상홍 ( Sang Hong Lee ),이준영 ( Jun Young Lee ),이상준 ( Sang Jun Lee ),김보선 ( Boseon Kim ) 대한골절학회 2015 대한골절학회지 Vol.28 No.4

목 적: 전위된 거골 경부 골절 환자를 대상으로 소형 금속판을 이용한 고정을 시행한 후 방사선 및 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2006년 5월부터 2011년 12월까지 수술을 시행한 20예 중 소형 금속판을 이용하고 2년 이상 추시 가능하였던 15예를 대상으로 후향적 분석을 시행하였다. Hawkin’s 분류상 2형은 7예, 3형은 8예였다. 자기공명영상 검사는 술 후 12-16주 사이에 시행하였으며 임상적 평가는 American Orthopaedic Foot and Ankle Society (AOFAS) 발목-후족부 점수를 이용하였다. 결 과: 유합 기간은 평균 11.6주(10-15주)였다. 불유합 및 부정유합은 발생하지 않았다. AOFAS 점수는 평균 88.2점(80-97점)이었다. 거골의 무혈성 괴사는 5예가 발생하였고, 그 중 체부의 붕괴는 3예, 외상 후 관절염은 4예에서 나타났다. 통계적분석 결과 나이, 성별, Hawkin’s 분류와 유합 기간이나 임상적 결과는 유의한 상관성을 보이지 않았다. 결 론: 전위된 거골 경부 골절 환자에서 관혈적 정복술 후 소형 금속판을 이용하여 내고정을 시행한 결과 부정유합 발생률이 낮고 방사선 및 임상적 평가에서 만족스러운 결과를 보여 좋은 치료 방법이 될 것으로 생각된다. Purpose: We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures. Materials and Methods: There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin’s classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results: Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin’s classification and union rates and clinical results. Conclusion: Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

전위된 관절 내 종골 골절의 치료

이준영,나웅채,Lee, Jun Young,Na, Woong Chae 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

Recently, open reduction and internal fixation has been the treatment of choice for displaced intra-articular calcaneal fractures for many orthopaedic surgeons. However controversy still surrounds the optimal treatment with regard to whether displaced intra-articular calcaneal fractures should be treated operatively or conservatively. Conservative treatments include use of splint, rest, leg elevation, icing, use of analgesics and early mobilization. Operative treatment is open reduction and internal fixation, performed through an extensile lateral approach with interfragmentary screws and application of a neutralization plate. We reviewed the question of whether operative treatment by open reduction and internal fixation provides a benefit compared with conservative treatment for displaced intra-articular calcaneal fractures.

골다공증성 고관절 골절 환자의 수술적 치료 후 정주용 Bisphosphonate의 효과

이상홍 ( Sang Hong Lee ),나웅채 ( Woong Chae Na ),박이규 ( Yi Kyu Park ) 대한고관절학회 2012 Hip and Pelvis Vol.24 No.2

목적: 고관절 골절 후 수술적 치료를 받은 환자에서 골 교체율을 감소시키고 골밀도를 증진시키는 정주용 zoledronic acid의 효과로써 골밀도 및 생화학적 골 대사 표지자 변화에 대하여 알아보고자 하였다. 대상 및 방법: 2009년 1월부터 2010년 6월까지 고관절 주위 골절에 대해 수술적 치료를 받고 zoledronic acid를 정주한 환자중 1년 이상의 추시가 가능하였던 34명을 대상으로 후향적 연구를 시행하였다. 수술 전, 수술 1년 후 DXA의 T 점수 및 생화학적 골 대사 표지자를 비교 평가 하였다. 결과: 수술 전 T 점수는 평균 -4.2, 1년 뒤 -3.3으로 호전되었으며 통계학적 유의성을 보였다 (P<0.05). 두가지 생화학적 골 대사 표지자는 대부분의 환자에서 감소하는 소견을 보였다. 약물 투여 후 3일 이내에 총 7명(20.6%)에서 경미한 부작용이 관찰되었으나, 심방세동 등의 심각한 합병증은 발생하지 않았다. 결론: 고관절 골절 후 수술적 치료를 받은 환자에서 골다공증성 골절의 예방을 위해 정주한 zoledronic acid의 효과는 경미한 부작용 이외에 심각한 부작용은 발견되지 않았다고, 골 밀도 및 생화학적 골대사 표지자 변화 등 긍정적인 효과를 1년 추시로 확인할 수 있었다. Purpose: We evaluated changes in bone mineral density and biochemical bone turn over markers resulting from intravenous administration of zoledronic acid for the purpose of increasing bone mineral density and decreasing bone turnover rate in patients who had received operative treatment after hip fracture. Materials and Methods: We carried out a retrospective study of 34 patients who had received injections of zoledronic acid after surgical treatment for hip fracture from January 2009 to June 2010, with a follow up period of more than one year. We evaluated pre and post T-scores of DXA in spine, proximal femur and femoral neck along with biochemical bone metabolic markers, and we then analyzed each factor. Results: T score was enhanced in all cases with pre T-score -4.2 and post T-score -3.3 revealing statistical significance (P<0.05). In addition, two biochemical bone turnover markers were observed to decrease in most patients. Three days after drug administration, 7 patients (20.6%) had minor adverse effects. There were no serious complications such as atrial fibrillation. Conclusion: No major adverse effects were observed, only minor ones in patients who had been injected with zoledronic acid for the prevention of osteoporotic fracture after surgical treatment for hip fracture. We confirmed the affirmative effects on changes in bone mineral density and biochemical bone turn over markers associated with the use of this drug.

외상 후 발생한 심한 족관절 첨족 변형의 2단계 수술적 치료방법 - 예비보고 -

김정호,이준영,하상호,유재원,이상홍,나웅채,Kim, Jung-Ho,Lee, Jun-Young,Ha, Sang-Ho,You, Jae-Won,Lee, Sang-Hong,Na, Woong-Chae 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.2

Purpose: To evaluate the effectiveness as well as correct the post-traumatic severe ankle equinus deformity by conducting the treatment surgery, which is divided into 2 stages, soft tissue adhesiolysis and ankle arthrodesis. Materials and Methods: We have conducted the methods, which are Z-plasty Achilles tendon lengthening, multiple capsulotomy and tendon lengthening (flexor hallucis longus muscle, flexor digitorum longus, posterior tibialis tendon) for 10 patients who has shown equinus deformity after post-traumatic compartment syndrome due to the injury. The average age of patients was 33.7 year-old; there were 8 men and 2 women, and the follow up period was 13 months (6~31 mon). Outcomes were rated based on American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Visual Analogue Scale (VAS) and patient's satisfaction after operation. Results: The average degree of preoperative equinus deformity was 64 degree (-60~-70), and we've obtained AOFAS anklehindfoot score that was evaluated after 4 months of 2nd operation which was 76.7 score on average. We've also checked the decreased pain score from all of the patients according to the fact that the average VAS before the surgery was 6 (4~8), but it reduced to 3 (1~4). The patient's satisfaction showed generally great satisfactions which was 5 cases were excellent, 2 cases were good, and 3 cases were fair. Conclusion: The two staged surgical treatment of post -traumatic severe ankle equinus deformity, which was conducted of soft tissue adhesiolysis and arthrodesis, could be one of the effective methods to improve patients walking ability.

증례: 슬개하 지방대에 발생한 국소형 건초 거대세포종

김동휘 ( Dong Hui Kim ),유재원 ( Jae Won You ),이광철 ( Kwang Chul Lee ),나웅채 ( Woong Chae Na ),이미자 ( Mi Ja Lee ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.2

국소형의 건초 거대세포종(giant cell tumor of tendon sheath)은 주로 수지나 족지의 신전건 활막에 흔히 발생하며, 슬부의 지방대에서 관찰되는 경우는 매우 드물다. 저자들은 슬개하 지방대(infrapatella fat pad) 에 발생하여 외측 대퇴 경골 관절로 감입, 충돌을 일으켜 신전제한과 슬부 통증을 유발하였던 2.5x3x4cm 크기의 주변 조직과 경계가 명확한 종물에 대해 전동 절삭기를 이용한 관절경적 절제술을 시행하였다. 병리조직검사상 건초 거대세포종(tenosynovial giant cell tumor)으로 진단되었으며 임상적으로 좋은 결과를 보였기에 문헌 고찰과 함께 보고하고자 한다. Localized giant cell tumor of the tendon sheath (GCTTS) usually occurs in extensor an tendon sheath of the fingers and toes. It has rarely been observed in the fat pad of the knee joint. We treated a case of a 2.5×3×4 cm mass arising from the infrapatellar fat pad, which presented with extension limitation and knee pain due to lateral femorotibial joint impingement. The tumor was successfully treated using arthroscopic excision with a motorized shaver. Histologic findings were diagnosed as localized GCTTS. Herein we report this case with a literature review.