동종 아킬레스건을 이용한 만성 족관절 불안정성의 외측인대 재건술 -2예 보고-

주석규,서진수,Choo, Suk-Kyu,Suh, Jin-Soo,Amendola, Annunziato 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.2

We performed lateral ankle ligament reconstructions using Achilles allograft on patients who had failed previous Brostrom repair. The bone plug is fixed with an interference screw into the calcaneus, the tendon graft is passed through a fibular tunnel, and then anchored into the talus with the biotenodesis screw. The graft is strong enough to maintain joint stability until graft incorporation and remodeling occurs. In patients with chronic failed lateral ankle instability requiring graft for ligament reconstruction, this technique allows anatomic reconstruction without the need to sacrifice autogenous peroneal tendons.

단순 골낭종에서 발생한 병적 골절

주석규,이희두,오형근,Choo, Suk-Kyu,Lee, Hee-Du,Oh, Hyoung-Keun 대한근골격종양학회 2011 대한골관절종양학회지 Vol.17 No.2

목적: 단순 골낭종의 병적 골절 환자를 대상으로 단순 골낭종의 관해에 미치는 예후 인자에 대하여 알아보고자 하였다. 대상 및 방법: 2001년부터 2010년까지 본원에 내원한 단순 골낭종을 동반한 병적 골절 환자 13명을 대상으로 하였으며, 평균 추시 기간은 26개월(3-90개월)이었다. 성별은 남자 11명, 여자 2명이었으며, 평균 나이는 10.2세(6-16세)였다. 발생 부위는 근위 상완골 9명, 상완골 간부 2명, 근위 대퇴골 1명, 근위 경골 1명이었다. 단순 골낭종의 병적 골절에 대하여 보존적 치료로 단순 석고 고정 후 골절 유합을 시도하였으며, 1명은 일차적으로 골이식 및 관헐적 정복술과 내고정술을 시행하였다. 5명의 환자에서 치료 경과 중 스테로이드 주사를 시행하였으며, 2명에서 골이식을 시행하였다. 병적 골절 치료 중의 단순 골낭종의 변화 및 연령, 낭종의 크기, 성장판 침범 정도에 따른 단순 골낭종의 예후 인자에 대해 분석하였다. 결과: 병적 골절 후 전례에서 평균 8.2개월에 골유합을 얻었으며, 13명의 환자 중 4명(31%)에서 골낭종의 완전 관해를 보였다. 발병 나이에 따른 단순 골낭종 관해의 통계적 차이는 없었지만(p=0.42), 낭종의 크기가 클수록, 성장판에 근접한 경우 관해를 얻기가 어려웠다(p=0.05, p=0.03). 결론: 단순 골낭종의 병적 골절에서 관해가 이루어질 수 있으나, 낭종의 크기가 크거나 성장판에 근접한 경우에는 좀 더 적극적인 치료가 필요할 것으로 보인다. Purpose: The purpose of this study is to observe unicameral bone cyst (UBC) outcome after the fracture has healed and if there is any identifiable prognostic factors. Materials and Methods: 13 UBC patients with pathologic fracture from 2001 to 2010 were reviewed. The mean follow up were 26 months (3-90 months). There were 11 male and 2 female patients and the mean age of the patients were 10.2 years old (6-16 years). 9 involved proximal humerusand 2 involved humerus shaft and 1 involved proximal femur and 1 involved proximal tibia. The treatment of UBC fracture was conservative cast application to heal the fracture initially, and 1 patient was treated with primary auto bone graft and open reduction with internal fixation. 5 patients were treated with steroid injection during follow up period and 2 patients with auto bone graft. We analyzed the change of UBC during pathologic fracture healing period and prognostic factor about age, the size of UBC, the involvement of physis. Results: The mean duration of the fracture healing was 8.2 months. Complete healing were occurred at 4 patients (31%). No statiscal difference was checked with age about UBC healing (p=0.42). But, more larger size about UBC and more closer to physis, the healing was difficult (p=0.05, p=0.03). Conclusion: While pathologic fracture of UBC was possibly healed, active treatment should be applied especially those cysts that involvescloser area of the physis or large size.

대퇴골 전자간골절에 대한 항회전 근위 대퇴 골수정(PFNA) 고정술 후 중기 추시 결과

주석규 ( Suk Kyu Choo ),오형근 ( Hyoung Keun Oh ),우성종 ( Sung Jong Woo ) 대한고관절학회 2012 Hip and Pelvis Vol.24 No.2

목적: 대퇴골 전자간 골절로 항회전 근위대퇴 골수정(proximal femoral nail antirotation, PFNA)으로 수술을 시행했던 환자들을 대상으로 방사선적, 임상적 결과에 대한 중기 추시 결과를 보고하고자 한다. 대상 및 방법: 2008년 3월부터 2010년 2월까지 본원에서 대퇴골 전자간 골절로 PFNA 내고정술을 시행한 93명의 환자 중 1년 이상 방사선 추시가 가능하였던 43명의 환자를 대상으로 하였다. 평균 연령은 77.7세(62-93세), 남자 6명, 여자 37명이었으며, 평균 추시 기간은 19.1개월(12-33개월)이었다. 환자군은 AO/OTA 분류법에 따랐으며, A1군 14명, A2군 25명, A3군 4명이었다. 방사선학적으로 골유합 및 골절의 형태에 따른 나선 칼날의 활강 정도, 합병증 등을 조사하였으며, 임상적으로는 최종 추시상 동통 및 보행 정도, 일상 생활 능력(ADL) 등에 대한 평가를 시행하였다. 결과: 심부 감염이 발생한 1예를 제외한 전례에서 평균 3.5개월(2-6개월)에 골유합을 얻었다. 술 후 단순 방사선 검사상 43예 전 례에서 good 또는 acceptable한 정복 상태를 얻었다. 평균 나선 칼날의 활강은 6.1 mm (range, 0-21 mm)였으며, 골절 형태에 따른 통계적 차이는 없었다. 최종 추시상 Chanley 동통 점수는 평균 4.0점(0-6점)이었으며, 19명(44%)의 경우에서 술 전 보행 능력을 회복하였다. 일상생활 척도(ADL) 상 6개 항목 모두 만족하여 완전 일상 생활 자립이 가능하였던 경우는 22명(51.2%)이었다. 결론: PFNA는 다양한 형태의 대퇴골 전자간 골절에 효과적인 내고정물로 사용될 수 있으나, 술 후 임상적으로 보행 능력의 감소 및 일상 생활로의 복귀에 지장을 초래할 수 있어 이에 대한 전향적인 연구 및 기능적 회복과 재활 계획 수립이 필요할 것으로 생각된다. Purpose: To evaluate the mid-term results of patients with femoral intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA) in the elderly. Materials and Methods: Between March 2008 and February 2010, 93 patients with intertrochanteric femoral fractures were treated with PFNA. Of these patients, 43 could be followed for a mean of 19.1 months (range, 12- 33 months). The mean age was 77.3 years (range, 62-93 years) and there were 6 males and 37 females. According to the AO/OTA classification, there were 14 cases of A1, 25 cases of A2, and 4 cases of A3. Radiological outcomes were assessed at the union period along with the sliding distance of the antihelical blade according to fracture type. Functional outcomes were assessed according to the Chanley hip pain scoring system, walking ability, and the Activities of Daily Living (ADL) index. Results: All patients, except for one with a deep infection, had complete union at 3.5 months (range, 2-6 months). Postoperative X-rays showed a good or acceptable reduction in 43 cases (100%), and an ideal blade position without significant differences according to the fracture type. The mean sliding length of the blade was 6.1 mm (range, 0-21 mm) and mean Chanley hip pain score was 4.0 points (range, 0-6.0 points). 19 patients (44%) were restored to their preoperative walking ability. 22 patients (51.2%) were able to live independently without support. Conclusion: The PFNA is a very effective implant in the treatment of different patterns of intertrochanteric femoral fractures. But further studies are needed focusing on a functional recovery and rehabilitation to improve postoperative clinical outcomes.

연성골수정을 이용한 소아 대퇴골 간부골절의 치료[예비보고]

주석규 ( Suk Kyu Choo ),김병직 ( Byung Jik Kim ),정현욱 ( Hyun Wook Chung ) 대한골절학회 2005 대한골절학회지 Vol.18 No.1

교합성 골수강내 고정술로 치료한 대퇴골 분쇄골절에서 분쇄골편의 방사선학적 추시

주석규(Suk Kyu Choo),김병직(Byung Jik Kim),고한석(Han Suk Ko),서정국(Jeong Gook Seo),김진구(Jin Goo Kim),서진수(Jin Soo Suh),신동환(Dong Hwan Shin),조진태(Jin Tae Cho) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.3

65세 이상 연령층의 대퇴골 전자주위골절의 수술후 합병증

주석규(suk-Kyu Choo),서정국(Jeong-Gook Seo),고한석(Han-Suk Ko),김병직(Byung-Jik Kim),최일규(Il-Kyu Choi),신재기(Jae-Kie Shin) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.7

대퇴 전자간 골절에서 항회전 근위 대퇴 골수정과 근위 대퇴 골수정 -활강의 비교-

주석규 ( Suk Kyu Choo ),오형근 ( Hyoung Keun Oh ),최준영 ( Jun Young Choi ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.1

Purpose: This study compared sliding between (a) lag screws of PFN (Proximal Femoral Nail, AO synthes) and (b) the helical blade of PFNA (Proximal Femoral Nail Antirotation, AO synthes) for femoral intertrochanteric fractures. Materials and Methods: We include in our study thirty seven cases who were classified as AO/OTA type A1 femoral intertrochanteric fractures and who underwent hip operations between October 2006 and December 2008. There were 19 patients in the PFN group and 18 in the PFNA group. Degrees of sliding were also measured with postoperative radiology on last follow up compared with immediate postoperative radiology. Both groups were also compared with regard too walking ability using the method of Koval. Results: Average sliding was 5.0±2.3 mm for lag screws of the PFN group and 2.8±1.3 mm for the helical blade of the PFNA group. The difference was statistically significant (p=0.04). Ambulatory abilities were not statistically different (p=0.33). Conclusion: Patients in the PFNA group have less sliding of the implant, but their walking abilities are similar to patients in the PFN group.

다발성 외상 환자의 대퇴골 간부 골절에서 임시 외고정술 후 내고정술로의 전환

주석규 ( Suk Kyu Choo ),강경운 ( Kyung Woon Kang ),김영우 ( Young Woo Kim ),오형근 ( Hyoung Keun Oh ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

Purpose: We report the surgical outcomes for femoral shaft fractures in polytrauma patients who were temporarily treated with external fixation and subsequently converted to internal fixation. Methods: From August 2008 to April 2012, we enrolled 13 patients with multiple traumas due to high-energy injuries and concurrent femoral shaft fractures in which temporary external fixation was carried out. The mean age was 39 years, with a range from 18 to 55 years. Ten were men and 3 were women. According to the AO/OTA classification of fractures, type A was found in 5 patients, type B in 6, and type C in 2, with open fractures being found in 6 patients and femoral artery rupture occurring in 2. For internal fixation, intramedullary nailing was performed in 7 patients, and minimally-invasive fixation of locking compression plates was used in 6. Results: Of the 7 patients converted to intramedullary nailing, 1 experienced delayed union. Of the 6 patients treated with minimally-invasive plate fixation, delayed union occurred in 5, and an auto-bone graft was performed within, on average, 8 months (range: 5~10 months), leading to bone union in all cases in the final follow-up. None of the patients experienced infections or complications involving other organs after having been converted to internal fixation. During the mean follow-up of 19 months, patients achieved satisfactory functional outcomes. Conclusion: In polytrauma patients with a femoral shaft fracture who have been treated with temporary external fixation and who may need internal fixation due to the occurrence of delayed union, an appropriate internal fixation method needs to be selected based on the patient’s physical status, and the fracture type. [ J Trauma Inj 2014; 27: 151-7 ]

원위 요골 2.4 mm 수장측 잠김 압박 금속판을 이용한 불안정성 원위 쇄골 골절의 수술적 치료 결과

주석규 ( Suk Kyu Choo ),남지호 ( Ji Ho Nam ),김영우 ( Young Woo Kim ),오형근 ( Hyoung Keun Oh ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

Purpose: This study evaluated the surgical outcomes of unstable distal clavicular fractures treated with a 2.4 mm volar distal radius locking plate. Materials and Methods: From August 2009 to August 2012, 16 patients with distal clavicle fractures underwent surgical treatment. Mean age was 36 years (18-62 years) and mean follow-up period was 12.9 months (6-32 months). Two cases were Neer type I, six cases IIa, three cases IIb, three cases III, and two cases V. For the radiologic assessment, union time and metal failure were evaluated, and coracoidiologic assessment, union time and metal failure were evaluatethe acromioclavicular joint. The clinical results were evaluated by range of motion, postoperative complication, and University of California at Los Angeles (UCLA) score. Results: Mean time to fracture union was 7.4 weeks (6-14 weeks) in all cases. No statistical difference in coracoid-clavicle distance was observed between immediate post-operation group and contra-lateral group (p=0.6), but an increase of 2.1 mm was observed in the last follow up group compared with the contra-lateral group (p<0.01). The UCLA scoring system showed excellent results in 15 cases and good results in one case. Acromial-clavicle instability occurred in one case so that metal removal and distal clavicle resection were performed. Conclusion: A 2.4 mm volar distal radius locking plate can provide rigid fixation through several screw fixation in the short distal fragment and lead to satisfactory clinical outcomes in unstable distal clavicular fractures.

36 mm 골두를 사용한 Ceramic - Ceramic 무시멘트 인공 고관절 전치환술 -3년 이상 추시 결과-

주석규 ( Suk Kyu Choo ),오형근 ( Hyoung Keun Oh ),유시훈 ( Si Hoon Yoo ),남지호 ( Ji Ho Nam ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.2

목적: 36 mm 대퇴골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술을 시행하고 임상적 및 방사선학적 결과를 분석 하였다. 대상 및 방법: 36 mm 대퇴 골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술을 시행 받은 40명, 43예를 대상으로 하였다. 평균 연령은 56세(28-82세)였으며 평균 추시 기간은 5.3년(3-7.5년)이었다. 임상적 추시로서 Harris 고관절 점수와 통증의 정도, 운동범위를 수술 후 3년에 확인 하였고, 방사선학적 추시 및 합병증을 확인하였다. 결과: Harris 고관절 점수는 수술 전 43.4점(21-57점)에서 수술 후 3년에 88.1점(81-95점)으로 상승하였다. 고관절 운동범위는 평균 굴곡 113°, 외전 30°, 내전 24°, 외회전 36°, 내회전 12°였다. 주관적 통증은 전례에서 없거나 미미한 정도였다. 합병증으로 낙상으로 인한 탈구가 발생된 경우는 1예가 있었으며 비관혈적 정복술을 시행하였다. 이외 세라믹의 골절은 없었으며 1예에서 감염이 발생하였다. 결론: 36 mm 대퇴골두를 사용한 무시멘트 세라믹-세라믹 관절면 고관절 전치환술은 최소 3년 추시에서는 임상적, 방사선학적으로 만족한 결과를 보였으며 장기적인 경과관찰이 필요할 것으로 판단된다. Purpose: The purpose of this study was to analyze the results for clinical outcome and radiologic assessment of ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. Materials and Methods: This study included a group of 40 patients of 43 cases who underwent ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head. The age range of this group was 28 to 82(mean 56); we monitored them over a period of 5.3 years(3-7.5 years). This clinical evaluation process included monitoring the degree of pain, range of motion, and the Harris hip score after three years since the surgery was performed. Radiographic evaluation and complication were confirmed as well. Results: The preoperative Harris hip score increased from 43.4(21-57) to 88.1(81-95) after the surgery. The average motion range of hip was 113° flexion, 30° abduction, 24° adduction, 36° external rotation, and 12° internal rotation. Subjective pain was zero or minimal in all cases. Among the complications, dislocation occurred in only one case by a fall from a height and was reduced by closed reduction. There was no occurrence of ceramic fracture, even though infection occurred in one hip. Conclusion: The clinical outcome and radiologic assessment of the ceramic on ceramic cementless total hip arthroplasty using a 36 mm diameter femoral head showed a satisfactory result at three-year follow-up. Longerterm follow up is needed for further assessment.