전방 십자 인대 파열후 자가 슬개건을 이용한 재건술군과 부분 손상후 보존적 치료군의 비교

이동철,이수호,김동한,Lee Dong Chul,Lee Su Ho,Kim Dong Han 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.2

목적: 전방십자인대부분파열후보존적치료군과완전파열후자가슬개건을이용한재건술군간의기능적평가, 활동도및전방안정성을비교평가하고자하였다.대상및방법: 전방십자인대손상으로진단되고관절경으로진단치료한38명의환자를대상으로2년이상추시하였으며전방십자인대50$\%$이하파열된부분손상군1 2명(평균연령: 38.3세), 완전파열후자가슬개건을이용한재건술군26명(평균연령: 25.3세)을대상으로하였다. 객관적인안정성은KT-2000 Arthrometer를이용하여15lb와20lb전방전위부하로측정하였으며,기능평가는Lysholm score, 활동도는Tegner activity score를이용하여분석하였다.결과: Lysholm의기능평가는부분손상군은88.5, 재건술군은89.3이었고, Tegner의활동도는부분손상군5.3, 재건술군5.1이었다( P<0.05 ) .전방안정성에서평균전방전위는20lb 부하하에부분손상군에서건측에비해1.7$\pm$1.4 mm, 재건술군에서는건측에비해2.3$\pm$1.9 mm였으며(P<0.05), 15lb 부하하에서는부분손상군은건측에비해1.2$\pm$1.0 mm, 재건술군에서는건측에비해1.4$\pm$1.5 mm였다(P<0.05). 합병증으로관절부종, 불안정성, 전방슬관절동통이었다. 불안정성은부분손상군에서흔한합병증이었다.결론: 양군에서임상결과들은비슷하였으며, Lysholm의기능평가는양호하였고, Tegner 활동도상태는양군에서평균적으로신체적인적당한활동(조깅, 규칙적인자전거타기)은유지되어50$\%$이하의부분손상군에대한보존적치료는양호한결과가나타난것으로사료되었다. Purpose: To evaluate and compare the functional results, activity status, and anterior stability between conservative group with partial ACL injury and reconstruction group with bone-patellar ten-don-bone autograft in ACL total rupture. Materials and Methods: Thirty-eight patients with ACL injury were diagnosed and treated with arthroscopy and followed for more than two years. The number of patients with partial injury was 12(mean age; 38.3) and reconstruction group was 26 (mean age; 25.3). Objective stability was estimated under anterior loading of 15 lb and 20 lb by KT-2000 Arthrometer (MED metric, USA). Functional evaluation using Lysholm score and Tegner activity score were performed. Results: Average functional score of Lysholm was 88.5 in partial injury group and 89.3 in reconstruction group. Average score of Tegner was 5.3 in partial injury group and 5.1 in reconstruction group(P<0.05).Average anterior displacement compared with normal side. Under loading of 20lb, 1.7$\pm$4.3 mm in partial injury group, 2.3$\pm$1.9 mm in reconstruction group were anterior displaced (P<0.05). Under loading of 15lb, 1.2$\pm$1.0 mm in partial injury group, 1.4$\pm$1.5 mm in reconstruction group were dis-placed (P<0.05). There were giving way, effusion, instability and anterior knee pain in complication. Giving way was the frequent complication in the partial injury group. Conclusions: Clinical results of both group were similar. Functional evaluation of Lysholm was good and status of Tegner activity was maintained to physical fitness activites (jogging, regular bik-ing) in both groups on average. The results of conservative treatment for the partial ACL injury (less than 50$\%$) was satisfactory and equivalent to that of reconstructive treatment for the total ACL injury.

잔여 조직을 보존한 단일 다발 후방십자인대 보강재건술

이동철,김원호,Lee, Dong Chul,Kim, Won-Ho 대한관절경학회 2011 대한관절경학회지 Vol.15 No.2

후방십자인대 파열의 최선의 치료법은 논쟁의 대상이며, 후방십자인대 재건술시 고려해야할 사항들로는 경골 고정방법(transtibial vs inlay), 대퇴터널의 위치(central, eccentric or isometric), 재건다발의 수(single-bundle vs double-bundle)등이 있다. 후방십자인대는 중슬부 동맥의 분지와 가깝게 위치하고, 두꺼운 활액막에 싸여있어 손상시 전방십자인대보다 자연 치유력이 뛰어난 것으로 알려져 있다. 일반적으로 후방십자인대 재건술시, 이식물 통과를 용이하게 하고 터널 위치 선정을 위한 인대 부착부를 잘 보기 위해 남아 있는 후방십자인대 잔여 조직을 모두 제거한다. 그러나 잔여 조직을 보존하면 슬관절 후방 안정성에 기여하며, 이식물 치유를 빠르게 하고, 잔여 인대에 남아 있는 기계 수용체의 고유 수용 감각 기능을 살리게 된다. 수술 술기의 어려움과 터널 합병증이 발생될 수 있는 이중 다발 재건술에 비해, 대퇴부 인대 부착부를 보전하기 쉽고 합병증이 적은 단일 다발 재건술을 이용한 잔여 조직을 보존한 보강법이 유용한 수술 방법으로 사료된다. Optimal treatment of the torn posterior cruciate ligament (PCL) remains controversial. The type of tibial fixation (transtibial vs inlay), the femoral tunnel position within the femoral footprint (central, eccentric or isometric), and the number of bundles in the reconstruction (single-bundle vs double-bundle) are controversial issues. The PCL has a better chance of spontaneously healing than the anterior cruciate ligament (ACL) because of a rich blood supply (near the branch of the middle genicular artery) and coverage with a thicker synovium. In general, for easier passage of the graft and full visualization of the original ligament attachment site during the precise positioning of the tunnel, the remaining PCL fibers are usually debrided during reconstruction. However, the remaining remnant structures would significantly contribute to the posterior stability of the knee joint, the healing of the graft, preserving proprioceptive function of the mechanoreceptors in the PCL. Double bundle PCL reconstruction may result in some surgical complications because of increased complexity of making tunnel. Therefore, single bundle PCL reconstruction with remnant preservation seems to be an effective procedure.

대퇴골과 박리성 골연골염의 치료

이동철,권순,손욱진,Lee Dong-Chul,Kwon Soon,Son Wook-Jin 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.1

목적 : 슬관절박리성골연골염환자에서나이, 병변의형태, 치료방법에따른임상결과를분석하고자하였다. 대상및방법 : 1991년3월부터2000년2월까지슬관절박리성골연골염으로치료받은환자중1년이상추시관찰가능한17명20예를대상으로 하였으며양측성이3명이었고, 스포츠손상(9예) 및 직접외상(3예) 병력을 가진 12예(60$\%$)에서 외상의 병력이 있었다. 증상은 동통, 탄발음, 잠김, 허약감 등의 순서였으며 동통이 전예에서 있었다. 임상평가는Hughston 평가와IKDC주관적만족도를사용하였다. 결과 : 17명의환자에서남자는1 2명, 여자5명, 평균연령은19.8세(11세$\~$50세)였다. 병변위치는대퇴골내과관절면이14예, 외과관절면이6예였고관절경을시행한 15예에서관절경소견상골연골편의조기분리6예, 부분분리4예, 완전분리5예로 나타났다. 치료는다발성천공술시행5예, Herbert 나사못고정5예, Herbert 나사못고정및골이식술을3예에서시행하였고, 보존적치료는진행초기인7예에서시행하였다. 임상평가는Hughston 평가에서우수6예(30$\%$), 양호9예(45$\%$)로75$\%$에서 양호한성적을보였으며IKDC 주관적평가상정상1예(5%$\%$, 비교적정상6예(30$\%$), 비정상10예(50$\%$)로나타났다. 결론 : 슬관절박리성골연골염에서외상이발병의중요요인이었으며, 나이가어린학동기군에서청소년기나성인에비해우수한 치료결과를보여가능한조기 진단이필요할것으로생각된다. 주관적기능 평가가Hughston 기능평가보다 낮았으며 이는청소년기때활동제한, 스포츠활동참여의제한으로인한것으로사료된다. Purpose : To analyze the clinical results of treatment for the osteochondritis dissecans of femoral condyle by age, the type of lesion and method of treatment. Methods : From March 1991 to February 2000, 17 patients (20 cases) with osteochondritis dissecans of the femoral condyle were followed up over 1 year. Three patients had bilateral lesion. There were 12 cases with trauma history (9 cases with sports injury and 3 cases with direct trauma). The initial symptoms were pain, clicking, locking, giving way in the order of frequency, pain was revealed in all cases. Clinical evaluation of IKDC and Hughston method were used for subjective and objective function. Results : The number of male patient was 12, and the mean age was 19.8 year old (11$\~$50). The location of the lesion was 14 cases in medial femoral condyle and 6 cases in lateral femoral condyle. The arthroscopic findings of the lesion in 15 cases were as follows, early separation in 6 cases, partially detachment in 4 cases, and crators and complete detachment in 5 cases. 5 cases were treated with mutiple drilling and 5 cases with Herbert screw fixation, 3 cases with Herbert screw fixation and bone graft. In early stage, 7 cases were treated with conservative method. In the grading of Hughston score, 6 cases were graded as excellent, 9 cases as good, 15 cases were graded as good to excellent. Based on the IKDC scale, 1 case was graded as normal, 6 as nearly normal, and 10 as abnormal. Conclusions : The trauma seemed to be important factor in occurrence of osteochondritis dissecans of the femoral condyle. The clinical results of juvenile period showed better than adolescence and adult period, it is necessary to detect the lesion as soon as possible. The result of subjective evaluation was worse than the Hughston evaluation. It was caused by limiting involvement of sports activity and limited activity in the adolescence.

축구경기시의 무릎손상

이동철,배상근,손욱진,Lee, Dong-Chul,Bae, Sang-Keun,Shon, Oog-Jin 대한정형외과스포츠의학회 2006 대한정형외과스포츠의학회지 Vol.5 No.2

목적: 축구 경기 시의 무릎 손상의 형태와 기전을 분석하고 치료 후 기능 회복 정도를 평가하고자 하였다. 대상 및 방법: 2002년 10월부터 2005년 1월까지 축구로 인해 무릎 손상을 받은 49명의 환자를 대상으로 하였으며, 환자의 평균 연령은 28.8$(14\sim45)$세였고, 평균 추시 기간은 14.9$(8\sim36)$개월이었으며, 손상 평가는 이학적 소견, 방사선적 검사, 진단적 관절경술을 통해서 이루어졌으며, 술 후 기능 평가는 기능도와 활동도를 이용하였다. 결과: 인대손상에 따른 분류는 전방 십자인대 단독 손상 27례로 가장 많았고 손상에 영향을 미치는 인자는 경기 중 후반부 계절 중 겨울, 경기 빈도가 1달에 5례 이하인 경우 등이었다. 손상의 기전은 turn & twisting이 20례로 가장 많았고, being tackle 순 이었다. 손상시 기능도와 활동도는 각각 45, 2이었으며, 최종 추시 시 86.7, 6이었으며, 다발성 인대 손상 군에서 가장 나쁜 결과를 보였다. 결론: 치료 후 기능도와 활동도의 회복은 양호했지만 스포츠 활동도에서 수상전과 뚜렷한 차이를 보여 적절한 정신적, 육체적 재활과 스포츠 복귀 프로그램이 필요할 것으로 사료된다. Purpose: This study was performed to analyze the mechanism and type of knee injury during soccer game and to evaluate the functional recovery after treatment. Materials and Methods: From October 2002 to January 2005, 49 patients were treated surgically. Mean age was 28.8 (8-36) years old, mean follow-up duration was 14.9 (8-36) months. Injury was evaluated by physical examination, radiography, and arthroscopic finding. Clinical results were evaluated with Lysholm score and Tegner activity score. Results: According to classification of the ligament injury, the incidence of single ACL injury was the most frequent and 27 cases. Injuries took place, in 2nd half of the games, and in the winter. Among the mechanism of injury, turn & twisting was 20 cases and the most frequent. The preoperative Lysholm score, Tegner activity score were 45, 2 and those of last follow-up were 87.6, 6, respectively. Conclusion: The recovery of Lysholm and Tegner activity score were good, but the sports activity was clearly decreased alter injury. It was suggested that appropriate physical & psychological rehabilitation and education were inevitable.

골프에서 척추 및 하지의 손상

이동철,손욱진,Lee Dong Chul,Sohn Oog Jin 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.1

Golf has become an increasingly a popular sports for young and older ages. It has benefits of walking exercise and enjoyment of sports . However, golf is considered to be a moderate risk activity for sports injury due to traumatic origin and overuse. Golf injuries primarily affect the dorsolumbar sites , upper extremity(elbow, shoulder, wrist) and lower extremity (knee, hip, ankle). Ajustment of golf swing and conditioning programmes for preventing injuries which include muscular strengthening, flexibility and a short pregame warm up help to reduce the incidence of injury.

후방 및 후외측 불안정성 슬관절

이동철,Lee, Dong-Chul 대한관절경학회 2003 대한관절경학회지 Vol.7 No.2

슬관절 후외측방 불안정성은 전방 및 후방 십자인대 손상과 흔히 동반되며 이 동반된 손상은 심각한 기능적 불안정성 및 관절 연골의 변성을 초래하게된다. 슬관절의 후외측 구조물 손상이 있는 경우 적절한 치료 없이 전방 및 후방 십자인대 재건술만 시행할 경우 십자인대 재건술이 실패하게된다. 이를 방지하기 위해 자세한 이학적 검사, 방사선 검사를 시행하여야하며 하지정열축 및 보행 형태를 평가하여야 한다. 급성 후외측방 구조물의 3등급 단독 손상이나 동반 손상에서는 3주이내에 일차 봉합을 하거나, 봉합이 어려울 경우 보강수술이나 재건수술을 시행하는 것이 좋다. 후방 및 후외측방 재건술에서 다양한 수술 방법 중 적절한 방법을 선택하여 동시에 시행하거나 2단계 재건수술을 가능한 빨리 시행하여야 한다. 만약 만성 후외측 불안정성 슬관절에서 내반 정열이 있으면서 varus thrust gait가 있는 경우 외측 연부조직 재건술로는 해결하기가 어려우므로 먼저 외반 절골술을 시행하여야 하고 약 6개월 뒤에 후외측 불안정성을 재평가하여 이후 연부조직 재건술을 시행할 수도 있다. Posterolateral instability of the knee occurs more commonly in association with an injury to anterior and posterior cruciate ligament and combined injuries are severe injuries that result in significant functional instability and articular cartilage degeneration. Reconstruction of the anterior and posterior cruciate ligament without an appropriate treatment of posterolateral corner injury result in failure of the reconstructed cruciate ligaments. Meticulous physical examinations, imaging studies, lower limb alignment and gait pattern should be evaluated. Acute grade III isolated or combined injury of the posterolateral corner is best treated within three weeks by direct repair, or augumentation, or reconstruction. The appropriate surgical method or combined methods are selected among the several methods of posterior and posterolateal reconstruction, and all injuried posterolateral and cruciate ligament structures are anatomically reconstructed simultaneously or by stages. If a varus alignment and varus thrust is disclosed in chronic posterolateral instability of knee, soft tissue reconstructions laterally are highly unlikely to be able to correct tile problem. It is appropriate that valgus osteotomy should be done before soft tissue reconstruction and reevaluate the posterolateral instability about 6 months later.

갑상선기능저하증을 동반한 티록신 결합글로불린 결핍증 1례

이동철,리선희,유재홍,Lee, Dong-Chul,Lee, Sun-Hee,Yu, Jae-Hong 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.6

티록신 결합글로불린 결핍증은 대부분 갑상선기능저하증을 동반하지 않으므로 갑상선 호르몬 보충 요법이 필요 없으나 드문 예에서 유리 티록신 농도가 정상치 보다 낮게 유지되고, 중추 신경계에 대한 갑상선 호르몬의 부족에 의해 갑상선 자극호르몬이 정상치 보다 증가하는 경우가 있다. 이런 경우는 티록신 결합글로불린의 결핍 정도가 갑상선기능저하증을 유발할 수 있을 정도로 갑상선 호르몬의 이동과 갑상선 밖의 호르몬 저장에 영향을 주는 것이므로 갑상선호르몬의 보충요법이 필요하게 된다. 저자들은 갑상선기능저하증을 동반하여 갑상선 호르몬의 투여가 필요한 중증의 티록신 결합글로불린 결핍증 1례를 보고하는 바이다. A child diagnosed with congenital hypothyroidism after newborn screening and follow up thyroid function test at 1 month of life in another general hospital demonstrated euthyroid state with thyroxine( $T_4$) supplementation until the age of 22 months of life, when he was transferred to our hospital, where he was diagnosed as thyroxine binding globulin(TBG) deficiency with low $T_4$ and TBG. Withdrawal of $T_4$ at age of 26 months was associated with hyperthyrotropinemic hypothyroidism. This patient is a case of TBG deficiency associated with hypothyroidism, and in rare instances, TBG deficiency may lead to hypothyroidism requiring hormone supplementation.

하퇴부 손상 및 통증

이동철,Lee Dong Chul 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.2

스포츠 활동 중 하퇴부 손상 및 동통은 과도한 훈련활동 및 강도 증가, 잘못된 훈련 방법, 훈련 환경의 적용 잘못으로 발생하는 경우가 많으며 주로 달리기, 축구, 롤러브레이드 등 하지를 많이 사용하는 종목에서 발생된다. 급성 손상으로는 급성 구획 증후군, 근육 손상 및 좌상, 근 경련 등이 있으며 만성 손상으로는 만성 활동성 구획 증후군, shin splints, 피로골절, 아킬레스 건염 등이 발생된다. 이러한 손상이 발생되는 원인과 치료 방법에 대해 알아보고 적절한 훈련 방법, 보조구 장착을 하여 하퇴부 손상을 예방할 수 있는 방법이 중요할 것으로 생각된다. Clinical conditions causing the lower leg injury and pain in athletes include acute injuries which are acute compartment syndrome, acute strain injury, contusion, muscle cramps, and chronic injuries which are chronic exertional compartment syndrome, achilles tendinitis, shin splints and stress fractures. Most injuries occur during running, jumping and playing soccer. Many of these conditions relate to overuse, increased strength, training errors and environment. It is necessary to know the cause of injuries and treatment methods to prevent the sports related lower leg injuries.

스키에 의한 슬관절 인대 손상

이동철,고진혁,김동한,Lee Dong Chul,Ko Jin Hyeok,Kim Dong Han 대한정형외과스포츠의학회 2003 대한정형외과스포츠의학회지 Vol.2 No.1

목적: 스키손상에서슬관절인대손상의형태와영향을줄수있는인자를분석하고, 수상전후의슬관절기능평가및스포츠활동도변화를알고자하였다. 대상및방법: 슬관절인대손상환자30명을대상으로설문및이학적검사, X선및MRI 촬영을통한평가를하였고, 기능평가는Lysholm Knee Scoring Scale, 스포츠활동도는Tegner activity score로평가하였다. 결과: 내측측부인대손상을동반한전방십자인대손상이11명으로가장많았고, 내측측부인대손상이9명으로그다음이었다. 수상기전은유령발현상(phantom foot phenomenon)과외전-외회전기전이각각13례와12례로83 $\%$를차지했다. 최종추시에서평균Lysholm score는93.4점으로매우양호하였으며, 활동도는수상전Tegner activity score 6.1점에서수상후4.2점으로감소되었다. 기능과활동도평가에서내측측부인대단독손상군이경과가가장양호하였으며, 내측측부인대손상을동반한전방십자인대손상군이경과가불량하였다. 스키손상에영향을미칠수있는요인으로는스키를지속적으로2시간이상탄경우, 바인딩이풀리지않는경우, 적절한스키강습프로그램을받지않은경우였다. 결론: 환자들의수상후Lysholm score는매우양호했지만, 수상후스포츠활동도에서는수상전과뚜렷한차이를보여적극적이고체계적인스포츠복귀프로그램이필요함을알수있었다. Purpose: This study is to analyse the injury patterns of knee ligament and the factors influencing ligament injuries of knee, and to evaluate the changes of knee function and activity after ski injury. Materials and Methods: Thirty cases of ligament injuries of knee were studied with a questionaire, stress radiographs, magnetic resolution imaging, and physical examination. Mean age was 28.6 years old and mean follow up was 29.6 months. Clinical evaluation of Lysholm knee scoring scale was used for knee function and Tegner activity score was used for activity change after ski injury. Results: The anterior cruciate ligament (ACL) injury accompanied with medial collateral ligament(MCL) injury was most in 11 cases and isolated MCL injury was the next in 9 cases. The common types of injury mechanism were Phantom foot phenomenon (13 cases, 43$\%$) and valgus external rotation injury (12 cases, 40$\%$), which constitute 83$\%$ of all case. At the last follow up, the mean Lysholm score was 93.4 and mean Tegner activity score was 4.2. The reduced Tegner activity score after injury was 1.9. Among several injury groups, the evaluation of knee function and activity was best in the isolated MCL injury group and worst in the ACL injury accompanied with MCL injury group. The factors to influence ski injury were participation to ski class, release of binding, and skiing long time more than 2 hours. Conclusions: Lysholm score at last follow up revealed good grading, but sports activity after ski injury was reduced when compared with pre-injury state. It seems to need a active, systemic sports rehabilitation program after sports injury.

GMDH를 이용한 전력 수요 예측 알고리즘 개발

이동철,홍연찬,Lee, Dong-Chul,Hong, Yeon-Chan 한국지능시스템학회 2003 한국지능시스템학회논문지 Vol.15 No.2

In this paper, GMDH(Croup Method of Data Handling) algorithm which is proved to be more excellent in efficiency and accuracy of practical use of data is applied to electric power demand forecasting. As a result, it became much easier to make a choice of input data and make an exact prediction based on a lot of data. Also, we considered both economy factors(GDP, export, import, number of employee, number of economically active population and consumption of oil) and climate factors(average temperature) when forecasting. We assumed target forecast period from first quarter 1999 to first quarter 2001, and suggested more accurate forecasting method of electric power demand by using 3-step computer simulation processes(first process for selecting optimum input period, second for analyzing time relation of input data and forecast value, and third for optimizing input data) for improvement of forecast precision. The proposed method can get 0.96 percent of mean error rate at target forecast period. 본 논문에서는 데이터의 효율적인 활용과 정확성에서 보다 우수한 특성을 보이는 GMDH(Croup Method of Data Handling) 알고리즘을 전력수요예측에 적용함으로써 입력 데이터의 선정을 용이하게 하였고, 다양한 데이터를 기반으로 보다 정확한 예측을 할 수 있게 하였다. 그리고, 예측 시에 경제적인 요인(GDP, 수출, 수입, 취업자 수, 경제활동인구, 석유소비량)과 기후적인 요인(평균기온)을 모두 고려하였다. 또한 목표 예측 기간을 1999년 1/4분기에서 2001년 1/4분기까지 9개의 분기로 가정하고, 가정한 목표 기간의 예측 정확도를 높이기 위해 3단계의 시뮬레이션 과정(최적 입력 분기 수를 결정하는 과정, 입력 데이터와 예측값의 시간적 연관성을 분석하는 과정, 입력 데이터의 최적화 과정)을 이용함으로써 더 정확한 전력수요예측 방법을 제시하였고, 제안된 기법으로 목표한 예측 기간에서 0.96%의 평균 에러율을 얻을 수 있었다.