활강 압박 고나사를 이용한 대퇴 전자하 골절의 치료

이기행 ( Kee Haeng Lee ),김형민 ( Hyoung Min Kim ),김윤수 ( Youn Soo Kim ),정창훈 ( Chang Hoon Jeong ),박일중 ( Il Jung Park ),박일석 ( Ill Seok Park ),문찬웅 ( Chan Woong Moon ) 대한골절학회 2006 대한골절학회지 Vol.19 No.1

목적: 대퇴골 전자하 골절에 대하여 활강 압박 고나사를 이용한 관혈적 정복술 및 내고정술 후 치료 결과를 분석하고 그 유용성을 알아보고자 하였다. 대상 및 방법: 1997년 5월부터 2004년 6월까지 대퇴골 전자하 골절에 대해서 활강 압박 고나사를 이용한 내고정술을 시행 받고 12개월 이상 추시가 가능하였던 20예를 대상으로 하였다. 남자가 9예, 여자가 11예였으며, 평균 연령은 49.2세 (36∼80세)였다. Seinsheimer의 분류상 IIa형 1예, IIb형 4예, IIIa형 2예, IIIb형 2예, IV형 4예, V형 7예였다. 골유합 시기, 관절 운동범위, 보행상태 평가, 합병증의 발생 여부 등을 평가하고 분석하였다. 결과: 전 예에서 추가적인 수술적 치료 없이 골유합을 얻었으며 골유합 시기는 평균 19.8주 (16∼27주)였다. 최종 추시시 고관절과 슬관절의 심각한 관절 강직은 없었으며 17예 (85%)에서 술 전의 보행 상태를 회복하였다. 추시 중 내고정물 실패, 불유합, 부정유합, 심부 감염 등의 심각한 합병증은 없었다. 결론: 대퇴골 전자하 골절에서 활강 압박 고나사를 이용한 수술은 골수강 내 금속정의 삽입이 불가능할 정도의 협소한 골수강을 보인 경우, 근위 대퇴골의 변형이 있는 경우, 큰 나비형 골편을 갖는 분쇄 골절의 경우, 긴 나선상의 골절과 함께 내측의 피질골의 분쇄상을 보인 경우, 전자간 골절과 동반된 경우 등에 유용할 것으로 사료된다. Purpose: To evaluate the effectiveness of the compression hip screw, we reviewed the clinical results of cases of femoral subtrochanteric fracture which were treated with compression hip screw. Materials and Methods : From May 1997 to June 2004, 20 cases of femoral subtrochanteric fracture, which were treated with compression hip screw and followed up more than 12 months, were reviewed. By the Seinsheimer`s classification, there were 1 case of type IIa, 4 cases of type IIb, 2 cases of type IIIa and IIIb, 4 cases of type IV and 7 cases of V. We analyzed the treatment results by bony union time, range of motion, ambulation status and complications. Results: All 20 cases were gained bony union without serious complications and secondary operation. The average bony union time was 19.8 weeks. 17 of 20 cases were recovered pre-injury ambulatory status level. Conclusion: The compression hip screw may be effective in treatment of the femoral subtrochanteric fracture with very narrow intramedullary canal, proximal femoral deformity, comminuted fracture with large butterfly fragment, long spiral fracture with medial cortical comminution and combined intertrochanteric fracture.

골수강내 금속정 고정술 후 발생한 장관골의 불유합에 대한 부가적 금속판 고정술을 이용한 치료

이기행 ( Kee Haeng Lee ),김형민 ( Hyoung Min Kim ),문찬웅 ( Chan Woong Moon ),김윤수 ( Youn Soo Kim ),남원식 ( Won Sik Nam ) 대한골절학회 2004 대한골절학회지 Vol.17 No.3

골다공증의 진단

이기행 ( Kee Haeng Lee ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.3

신경섬유종증의 동반이 없는 총상 신경초종 - 2 례 보고 -

이기행,김윤수,정창훈,성미숙,김진아,최승욱,김형민,Lee, Kee-Haeng,Kim, Youn-Soo,Jeong, Chang-Hoon,Sung, Mi-Sook,Kim, Jean-A,Choi, Seung-Woog,Kim, Hyoung-Min 대한근골격종양학회 2005 대한골관절종양학회지 Vol.11 No.1

신경초 세포에서 기원하는 양성 종양에는 신경초종과 신경섬유종이 있다. 이 중 총상의 형태를 가지는 경우는 대부분 신경섬유종이며, 신경초종의 경우는 매우 드물다. 총상 신경초종은 신경섬유종증을 동반하지 않고, 악성화하지 않는다는 점에서 반드시 신경섬유종과 감별이 필요하다. 저자들은 각 각 좌측 상완부와 우측 족부에 발생한 총상 신경초종 2례를 치험하였기에 보고하는 바이다. Both neurilemmoma and neurofibroma are originated from Schwann cell. Plexiform tumor was mostly neurofibroma but Neurilemmoma which has plexiform is extremely rare. So it is important to differentiate plexiform neurilemmoma from plexiform neurofibroma, because plexiform neurilemmoma appears to have neither a significant association with neurofibromatosis nor a propensity for malignant transformation. We report two cases of plexiform neurilemmoma involving the left arm and right foot.

노인과 청장년의 족근관절 골절에 대한 임상적 비교

이기행,문찬웅,김윤수,김형민,정상룡,Lee, Kee-Haeng,Moon, Chan-Woong,Kim, Youn-Soo,Kim, Hyoung-Min,Jung, Sang-Lyong 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: We compared the clinical features of the ankle fractures treated by operation between the elderly and the young, and reviewed the principles of treatment of the ankle fractures in the elderly. Materials and Methods: We reviewed 49 cases of the ankle fractures, which were treated by open reduction from August 1991 to July 2002. Patients aged more than 60 were designated as the elderly, and patients aged between 15 and 33 were designated as the young. The average follow-up period was 13.2 months. Using the Lauge-Hansen classification, We defined stage I or II fractures as low stage and stage III or IV fractures as high stage fractures. Results: There were 15 cases of high stage fractures (78.9%) in the elderly and 11 cases (36.7%) in the young. High stage fracture rate was significantly higher in the elderly (P=0.004). Hospital day, period between primary injury and operation, and union time were significantly longer in the elderly (P<0.001). However, there was no statistical difference in immobilization time between the two groups. The results of treatment were satisfactory clinically and radiologically by the Meyer's criteria in both groups. Conclusion: In the elderly, high stage fractures were more common and longer hospitalization and union time were needed than the young. However, the result of surgical treatment was satisfactory.

대퇴골두 무혈성 괴사에 대한 혈관부착 비골 이식술 후 디지털 감산 혈관조영술 소견

이기행,김윤수,이해규,옥지훈,김배균,김형민,Lee, Kee-Haeng,Kim, Youn-Soo,Lee, Hae-Giu,Ok, Ji-Hoon,Kim, Bae-Kyun,Kim, Hyoung-Min 대한미세수술학회 2004 Archives of reconstructive microsurgery Vol.13 No.2

Purpose : To observe the patency of anastomosis site and the findings of circulation of grafted fibula in osteonecrosis of femoral head treated with vascularized fibular graft by use of digital subtraction angiography. Materials and Methods : 17 cases of 11 patients who underwent vascularized fibula graft for osteonecrosis of femoral head. We performed digital subtraction angiography(DSA) for them at second week postoperatively in 12 cases, at sixth week in 1 case, at sixth month in 2 cases, at twelfth month in 1 case, and eighteenth month in 1 case which had been got DSA at second week before. We observe the patency of pedicle, and the circulation of grafted fibula such as periosteal and intraosseous vessels with time. Results : All cases except one which were thought failure of selective angiogram showed good passage of blood flow through anstomosed pedicle on DSA. We found the differences in appearance of circulation of grafted fibula with time. DSA at 2nd and 6th week postoperatively revealed both of periosteal and intraosseous vessels along the fibula and blood pooling at the tip of fibula. DSA at 6th month showed maintenance of periosteal and intraosseous vessels along the fibula but did not clearly reveal blood pooling at the tip of fibula. The findings of DSA at 12th and 18th month were similar each other. The periosteal vessels were not seen as the grafted fibular bone were incorporated into surrounding femoral bone but intraosseous vessels were still seen. Conclusion : It was thought that DSA could be used for evaluation of the status of pedicle including anastomsed site and vessels of grafted fibula with time. The periosteal vessels of fibula were decreased with time but intraosseous vessels were still seen until 18th month after vascularized fibula graft.

고관절 주위 연부 조직 질환

이기행 ( Kee Haeng Lee ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.2

Hip pain is a common but nonspecific symptom that has many etiologies. Due to the complex anatomy of the hip and pelvis, locating the exact origin of pain may be difficult. Soft tissue diseases around the hip are relatively rare and their clinical symptoms are often nonspecific. For such patients, it is necessary to understand various hip diseases, and do proper history taking and examination to correctly diagnose and treat soft tissue diseases of the hip. Advances in imaging studies such as MRI and ultrasonography can provide accurate information on soft tissues. This article reviews the soft tissue diseases of the hip that are experienced by clinics. It may be helpful in the differential diagnosis of hip pain arising from soft tissue structures and in the treatment of such diseases.

금속판을 이용한 경골 골절의 치료시 발생한 지연성 국소감염

이기행(Kee Haeng Lee),김윤수(Youn Soo Kim),최문구(Moon Gu Choi),정창훈(Chang Hoon Jeong),김형민(Hyoung Min Kim),임기현(Ki Hyeon Lim) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.1

족부에 발생한 조갑하 외골증에 대한 수술적 치료

이기행,김형민,문찬웅,이범성,김윤수,Lee, Kee-Haeng,Kim, Hyoung-Min,Moon, Chan-Woong,Lee, Bum-Seong,Kim, Youn-Soo 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.2

목적: 저자들은 족부에 발생한 조갑하 외골증에서 병변부위 및 크기에 따라 다른 수술방법을 시도하여 좋은 결과를 얻었기에 이에 대한 경험을 보고하고자 한다. 대상 및 방법: 1995년 10월부터 2003년 5월까지 1년 이상 추시가 가능하였던 12례를 대상으로 하였다. 여자가 9례, 남자가 3례였다. 수술 당시 평균나이는 13.4세였으며, 증상 발현기간은 평균 20.3개월 이었다. 무지에 발생한 경우가 9례였으며, 제 2, 3, 5족지에 발생한 경우가 각각 1례였다. 무지에 발생한 9례 중 8례가 원위지골의 배내측에 위치하였으며, 1례에서 배외측에 발생하였다. 제 2, 3, 5족지의 경우 모두 중앙부에 발생하였다. 무지에 발생한 경우 조갑을 절제하지 않고 보존하는 방법으로 외골증에 대한 수술적 접근을 시도하였고, 다른 족지에 생긴경우 조갑의 완전절제를 시도하였으나 가능한 조상은 보존하도록 노력하였다. 술후 판정은 조갑의 모양이 거의 정상이고, 임상적 및 방사선적으로 재발이 없는 경우 우수, 재발은 없으나 조갑의 융기와 같은 약간의 변형이 있는 경우 양호, 확실한 조갑의 변형 또는 방사선적으로만 발견되는 무증상의 경미한 재발이 있는 경우 보통, 임상적 및 방사선적으로 확실한 증상이 있는 재발의 경우 불량으로 하였다. 결과: 무지의 경우 6례에서 우수, 2례에서 양호, 1례에서 재발하여 불량으로 판정되었으며 기타 족지에 발생한 경우 3례 모두에서 양호 소견을 보였다. 결론: 족부에 발생한 조갑하 외골증에서 병변의 부위와 크기에 따라 다른 수술방법으로 치료하여 만족할 만한 결과를 얻었기에 저자들의 수술법은 권장할 만한 치료법으로 생각된다. Purpose: We described our experience with subungual exostosis in the foot for which we used different surgical technique according as location and size of lesion and revealed excellent results. Materials and Methods: We experienced 12 cases of subungual exostosis that were treated surgically and followed them more than one year between October 1995 and July 2003. There were nine females and three males. The average age of patients at surgery was 13.4 years. Duration of symptoms was 20.3 months on average. The lesion involved the hallux in nine cases; eight dorsomedial and one dorsolateral aspect of distal phalangeal bone. It involved the second, the third, and the fifth toe in one each; all central aspect of dorsum of distal phalanx. We used surgical technique that involves approaching the exostosis under the nail to preserve nail coverage for lesion in the hallux. The nails were extracted totally but preserved nail bed as much as possible in other toes. Results were based on appearance of the regenerated nail and presence of recurrence. Excellent results were those in which the nail appeared nearly normal and there was no clinical or radiographic evidence of recurrence. Good results were associated with a minor nail deformity such as ridging, and no evidence of recurrence. Fair results had obvious nail deformity or a minimal asymptomatic recurrence that was discernable only on radiograph. Poor results were associated with a clinically evident symptomatic recurrence. Results: When the lesion involved hallux, there were six excellent and two good results, and one poor result. All cases that involved other toes revealed good results. Conclusion: We suggest that different surgical technique might be applied according as location and size of the lesion to achieve satisfactory results for subungual exostosis in the foot.

중수골 두부에 발생한 관절내 골연골종 - 1례 보고-

이기행,정창훈,문찬웅,김형민,최정근,김영실,김윤수,Lee, Kee-Haeng,Jeong, Chan-Woong,Moon, Chan-Woong,Kim, Hyoung-Min,Choi, Jung-Keun,Kim, Young-Sill,Kim, Youn-Soo 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.2

골연골종은 가장 흔한 양성골종양으로 대부분 장관골의 골간단에 주로 발생한다. 수부에 발생하는 골연골종은 드물며 그 중 관절내 골연골종은 매우 드문 것으로 되어 있다. 저자들은 53세 여자 환자에서 제 3 중수골 두부에 발생된 관절내 골연종을 보고하고자 한다. 적출된 종물은 $10{\times}8{\times}5$ mm 크기로 명확한 연골모를 가지고 있었다. The osteochondroma is the most common benign bone tumor which arise in the metaphyseal or metaphysiodiaphyseal portion of long bone. Osteochondroma is rare in hand and extremely rare in the intraarticular location of the hand. We report a case of intraarticular osteochondroma which occurred at the third metacarpal head of the hand in a 53 year old female patient. The size of the excised mass was $10{\times}8{\times}5$ mm with definite cartilage cap.