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고령의 대퇴골 경부 골절 환자에서 무시멘트 이극성 고관절 반치환술의 평가
한창동 ( Chang Dong Han ),최완섭 ( Wahn Sub Choe ),심동준 ( Dong Joon Shim ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.2
From January 1988 to March 1995, we performed 66 consecutive cementless bipolar hemiarthroplasties for displaced femoral neck fractures in elderly patients with serious medical illness and evaluated the clinical and radiological results. Only 41 patients (62. l%) were followed-up for more than two years and only 15 patients (22.7%) visited the hospital regularly. The mean age of the patients was 74.3 years (range, 62 to 92 years). Twelve patients were men and 54 were women. The hospital- ization period was less than 3 weeks for 80.3% of patients (mean period, 32.7 days). Walking with partial weight-bearing was begun at the mean of 4.7 days (range, 1-2l days) postoperatively. All patients acquired initial stability of their prostheses. Daily activity of life was excellent or good in 78.0% (32 patients) of the followed-up patients. For patients who visited regularly, Harris hip scores were higher than 80 points in 80.0% (12 patients) and all prostheses had stable fixation by bone ingrowth and no loosening. Acetabular protrusion was not detected. Early or late complications were insignificant. The postoperative mortality rate was 4.5%, and the follow-up mortality rate was 12.2% in the second year, 4.9% in the third year, and 2.4% in the fourth year. Cementless bipolar hemiarthroplasty in elderly patients with displaced femoral neck fracture and high surgical risk showed satisfactory results despite poor bone quality and osteoporosis.
강호정,권오룡,심동준,강응식,한수봉,Kang, Ho-Jung,Kwon, Oh-Ryong,Shim, Dong-Joon,Kang, Eung-Shick,Hahn, Soo-Bong 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.1
Purpose: The purpose of this study is to report four operative cases of recurrent peroneal tendon dislocation being effectively treated by superior peroneal retinaculum reconstructive operation and rerouting of calcaneofibular ligament. Materials and Methods: Four male adults with recurrent peroneal tendon dislocation including one of patient with redislocation after the treatment of plication of inferior peroneal retinaculum were followed up after being treated with superior peroneal retinaculum reconstructive operation using Achilles tendon and rerouting of calcaneofibular ligament. Results: All patients followed up for over one year revealed no pain and no redislocation. One patient who experienced redislocation after the treatment of plication of inferior peroneal retinaculum had no other complication after the treatment of superior peroneal retinaculum reconstructive operation using Achilles tendon. Conclusion: The reconstructive operation presumed to be effective for recurrent peroneal tendon dislocation.
최준원,최준철,나화엽,심동준,김영호,이상호,조형욱,Choi, Jun-Weon,Choi, Joon-Choil,Na, Hwa-Yeop,Shim, Dong-Joon,Kim, Young-Ho,Lee, Sang-Ho,Cho, Hyoung-Wook 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1
The midtarsal joint which consists of the talonavicular and calcaneocuboid joints lies transversely across the medial and lateral arches of the foot. Complete dislocation of this joint unassociated with fracture is extremely rare. A 36 year-old male who was injured by motor vehicle accident came to help for his left midfoot pain and deformity. We misdiagnosed as subtalar dislocation. Closed reduction was performed. We reviewed initial and post-reduction X-rays, and then we diagnosed as Chopart's dislocation. CT scan was taken; it showed fracture of the anterior process of the calcaneous.
상완골 과 상부 골절에서의 이중 긴장 대 기법을 이용한 수술적 치료
강호정,김홍희,심동준,한수봉,강응식 대한골절학회 2002 대한골절학회지 Vol.15 No.4
목 적 : 이중 긴장 대 기법을 이용한 상완골 과 상부 골절의 임상적 결과를 분석하여 그 유용성을 보고하고자 한다. 대상 및 방법 : 1992년 10월부터 2001년 9월까지 상완골 원 위부 골절로 치료한 환자 중 이중 긴장 대 기법을 시행한 14예를 대상으로 하였다. 골절의 원인으로서는 실족에 의한 단순 손상이 11예, 교통사고에 의한 손상이 2예, 직접 타격에 의한 손상이 1예가 있었다. AO/ASIF 분류 방법에 따라 분류하면 A2가 2예, A3이 1예,. C1이 6예, C2가 3예, C3이 2예였으며, 성별로는 남자가 5예, 여자가 9예였고, 평균 나이는 51.6 세 (최소 15세, 최대 88세)였다. 분쇄 골절이 심한 4예에서 주두 절골 술을 시행하였다. 술 후 고정기간은 평균 20.6일 이었고, 경화를 보인 시기는 술 후 평균 10.1주 였다. 65세 이상의 5예에 있어서는 술 전에 골 밀도 검사를 시행하였으며, 대퇴경부의 평균 T-score가 -3.65였고 요추부의 평균 T-score가 -2.97이였다. 평균 추 시 기간은 평균 16.4개월(최소 12개월, 최대 29개월) 이였다. 평가는 최종 외래 내원시 주관절의 운동 범위, 통증 유무, 환자의 만족도를 조사하였다. 결 과 : 최종 추후 결과를 분석하였으며, 운동범위는 Excellent군이 8예, Good군이 4예, Fair군이 2예 였으며, Poor군은 없었다. 10예에서는 술 후 통증이 전혀 없었으며, 4예에서는 가끔씩 통증을 호소하였다. 합병증으로는 1예에서 주두에 K-강선 삽입부위의 피부자극에 의한 통증으로 술 후 6개월째 조기 제거를 시행하였다. 척골신경 전방 전위 술을 8예에서 시행 하였으며, 시행하지 않은 6예 중에 2예에서 척골신경 자극증상이 있었다. 그 중 1예에서는 술 후 8개월째 척골신경 전방 전위 술을 시행 받았으나, 다른 1예에서는 대중적 치료로 증세가 호전되었다. 1예에서 K-강선 삽입부위에 부분적 피부괴사 소견이 보였으나 핀 제거 술 및 창상 치료 후 치유되었다. 결 론 : 이중 긴장 대 기법을 이용한 상완골 과 상부 골절의 치료가 수술이 간단하고 수술 시간을 단축시킬 수 있으며, 정복 시 골막의 박리 손상을 줄일 수 있어 골편의 탈활(devitalization)이 적으며, 골절부의 압축력을 얻을 수 있다. 특히 젊은 환자의 단순 과 상부 골절에서 과도한 술기를 피하고 조기 관절 운동을 하기위한 경우나, 술 전 골 밀도 검사상 골 다공 증을 동반한 분쇄가 심한 노령 환자의 과상부 및 과간 골절의 치료에 있어 이중 긴장 대 기법은 상완골 상부 골절의 치료에 유용한 방법이 될 수 있으리라 사료된다. PURPOSE : This study evaluated the clinical result of supracondylar fractures of the humans treated with double tension band osteosynthesis. MATERIALS AND METHODS : From October 1992 to September 2001, 14 patients with supracondylar fractures of the humerus were treated by method of double tension band osteosynthesis. eleven fractures were the results of slipped down injury and two traffic accidents and one direct trauma. All fractures were classified according to the AO fracture classification (A2; 2. A3; 1. C1; 6, C2; 3. C3; 2). There were 6 males and 9 females with average age of 51.6 age of 51.6 years (range 15 to 88). Olecranon osteotomy was performed in 4 patients with severe comminuted fractures. Postoperative immobiliza-tions were required for an average of 20.6 days and consolidations were noted after an average of 10.1 weeks. Before operation, bone marrow density studies were performed in five fractures above 65 years. Average T-score of the patients were -3.65 on femur neck and -2.97 on lumbar spine. All patients were re-examined after an average of 16.4 months. RESULTS : Union and consolidation was achieved in all 14 patients judged their results as excellent and four as good. Ten patients had no pain and four had only occasional discomfort. Early removal of K-wires was performed in one patient because irritation of one side K-wires were develop. Sensory change of the ulnar nerve was noted in two patients. Anterior transposition of ulnar nerve was performed in one patient and the other was improved spontaneously. Skin necrosis was developed in one patient but was healed after pin removal and conservative care. CONCLUSION : The advantages of double tension band wiring are an easier and faster procedure, less periosteal and muscle damage, and more symmetrical compression than double plating. Therefore, in the commiuted osteoporotic fracture with poor tolerance for internal fixation with the plate or the simple supracondylar fractures in young age, double tension band osteosynthesis can provide sufficient and secure stability to allow early functional exercise.