A Useful MRI Classification for Symptomatic Discoid Lateral Meniscus

( Eui Yub Jung ),( Seongmin Jeong ),( Sun-kyu Kim ),( Sung-sahn Lee ),( Dong Jin Ryu ),( Joon Ho Wang ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Purpose: The purpose of this study is to classify the discoid lateral meniscus (DLM) according to the signal and shape in magnetic resonance imaging (MRI), and to provide information not only in diagnosis but also in treatment. Materials and Methods: We reviewed 162 cases who diagnosed with DLM by MRI and underwent arthroscopic procedures from April 2010 to March 2018. Three observers reviewed MRI findings of all cases and predicted arthroscopic tear using three MRI criteria (criterion 1,2 and 3). Among three criteria, the criterion that most accurately predicts arthroscopic tear was selected. Using this criterion, the cases of predicted tear were named group 1. In addition, group 1 was divided into three subgroups (group 1a, 1b and 1c) by deformation or displacement on MRI and arthroscopic type of tear and procedures were analyzed according to these subgroups. Results: The intra-meniscal signal change itself (criterion 3) on MRI showed the highest agreement with the arthroscopic tear. No meniscal deformation and displacement on MRI (group 1a) showed no specific type of tear and more cases of meniscal saucerization. The meniscal deformation on MRI (group 1b) showed more simple horizontal tears and more cases of meniscal saucerization. The meniscal displacement on MRI (group 1c) showed more peripheral tears and more cases of meniscal repair and subtotal meniscectomy. Comparing arthroscopic type of tear and type of arthroscopic procedure between three subgroups, there were significant differences in three groups (P < .05). Conclusions: Intra-meniscal signal change itself on MRI is the most accurate finding to predict arthroscopic tear in symptomatic DLM. In addition, subgroup analysis by deformation or displacement on MRI is helpful to predict the type of arthroscopic tear and procedures.

The Effect of Valgus Reduction on the Position of the Blade of the Proximal Femoral Nail Antirotation in Intertrochanteric Hip Fractures

Eui Yub Jung,In Taek Oh,Sang Yeup Shim,Byung-Ho Yoon,성열보 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.1

Background: The purpose of this study was to evaluate the quantitative association between the degree of reduction and the position of the blade of the proximal femoral nail antirotation (PFNA) in intertrochanteric hip fractures. Methods: From March 2009 to April 2015, 530 patients treated with PFNA for intertrochanteric hip fractures were retrospectively reviewed. Patients were divided into a valgus reduced group (group 1) and a non-valgus reduced group (group 2), and the “valgus reduced” was defined as valgus reduction over 5°. We compared the calcar referenced tip-apex distance (calTAD) and the area between the blade of PFNA and the medial cortex of the femoral neck between the two groups. Results: The calTAD was measured as 22.5 ± 4.1 mm in group 1 and 24.8 ± 3.8 mm in group 2 (p < 0.05). The area between the blade and the medial femoral neck was measured as 135.5 ± 49.8 mm2 in group 1 and 145.1 ± 54.8 mm2 in group 2 (p = 0.074). The area corrected for the length difference in the femoral neck was 0.55 ± 0.16 in group 1 and 0.79 ± 0.19 in group 2 (p < 0.05). Conclusions: Valgus reduction resulted in less calTAD and inferior position of the blade at the femoral neck in the treatment of intertrochanteric hip fractures with PFNA.

무릎 내측 구획 골관절염에서 초음파 유도하 경 반월상 연골 주사의 임상적 효과

정의엽(Eui Yub Jung),왕준호(Joon Ho Wang),이의섭(Eui-Sub Lee),이성산(Sung-Sahn Lee),소상연(Sang-Yeon So) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.5

목적: 무릎 내측 구획 골관절염 환자에서 초음파 유도하 무릎 관절강내 경 반월상 연골 주사를 소개하고 그 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2019년 3월부터 2019년 7월까지 3개월 이상 무릎 통증이 지속되었던 무릎 내측 구획 골관절염 환자 중 초음파 유도하 경 반월상 연골 주사를 시행한 36명의 환자에 대해서 후향적으로 분석하였다. 초음파 유도하 척추 바늘을 이용하여 무릎관절강내 내측 구획에 corticosteroid와 국소마취제를 주사하였다. 시술 전, 1주, 4주, 8주째 신체진찰을 하였고 numeric pain rating scale (NRS), Lequesne index, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) 점수를 측정하였다. 시간에 따른 NRS, Lequesne index, WOMAC 점수를 분석하였으며 상당한 호전이 있었던 환자들의 비율을 분석하였다. 또한 내측 구획 골관절염의 단계에 따른 NRS, Lequesne index, 상당한 호전이 있었던 환자들의 비율을 분석하였다. 결과: 시술 전과 비교하여 1주, 4주, 8주째 NRS와 Lequesne index는 감소하였고 8주째까지 통증 감소 효과는 차이 없이 지속되었다. 상당한 호전이 있었던 환자들의 비율은 1주, 4주, 8주째 각각 50.0%, 47.2%, 52.8%였으며 8주째까지 통증 감소 효과는 차이 없이 지속되었다. 시술 전과 비교하여 1주, 4주, 8주째 WOMAC 점수는 감소하였고 8주째까지 차이 없이 감소가 지속되었다. 골관절염 1, 2단계 환자들에서 상당한 호전이 있었던 환자들의 비율이 골관절염 3, 4단계 환자들보다 1주, 4주, 8주째 유의하게 많았다(p<0.05). 결론: 무릎 내측 구획 골관절염 환자에서 초음파 유도하 무릎 관절강내 경 반월상 연골 주사는 평균 8주 이상의 통증 감소 및 기능개선 효과를 보였다. 특히 내측 구획 골관절염 1, 2단계 환자에서는 통증 감소 효과가 더 컸다. Purpose: The purpose of this study was to introduce the ultrasound-guided transmeniscal injection in medial compartment knee osteoarthritis and analyze the clinical outcomes. Materials and Methods: The electronic medical records of 36 patients with medial compartment knee osteoarthritis who were treated with an ultrasound-guided transmeniscal injection from March 2019 to July 2019 were accessed for this retrospective review. Using an ultrasound guided spinal needle, the patients received an intra-articular steroid injection at the medial compartment of the knee. A physical examination was conducted at the initial visit (pre-injection), and at one week, four weeks, and eight weeks after the injection. The numeric pain rating scale (NRS), Lequesne index, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score were measured at each visit and analyzed over time. The percentage change of the patients who revealed substantial improvement was analyzed. The NRS, Lequesne index, and percentage of patients, who revealed substantial improvement over time classified by osteoarthritis grade, were analyzed. Results: The NRS and Lequesne index decreased at one week, four weeks, and eight weeks after the injection compared to the initial baseline, and the pain-relief effect continued without change until eight weeks. The percentage of patients who showed substantial improvement at one, four, and eight weeks was 50.0%, 47.2%, and 52.8%, respectively. The WOMAC scores decreased at one, four, and eight weeks compared to the initial baseline, and the decrease was continued without any difference until eight weeks. The percentage of patients with osteoarthritis stage 1 or 2 who revealed more than substantial improvement was significantly higher at one, four, and eight weeks than those with osteoarthritis stages 3 or 4 (p<0.05). Conclusion: In patients with medial compartment knee osteoarthritis, the pain reduction and functional improvement persisted for at least eight weeks after the ultrasound-guided transmeniscal injection at the medial compartment. In particular, patients with medial compartment osteoarthritis stage 1 or 2 showed more effective pain reduction.

상완골 간부 골절에서 교합성 골수강 내 금속정 고정 후 잔존한 골절부위의 전위의 정도와 골절유합에 대한 임상적, 방사선학적 분석

Jae-Kwang Yum(염재광),Eui-Yub Jung 대한견주관절의학회 2015 대한견주관절학회 학술대회논문집 Vol.2015 No.4

다른 수지의 중수수지 관절에서의 Stener 유사 병변

이상림(Sanglim Lee),정의엽(Eui Yub Jung),이지혜(Jihae Lee),전숙하(Suk Ha Jeon) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.6

저자들은 다른 수지의 중수수지 관절에서 발견된 Stener 유사 병변 3예와 제2 수지에서 이와 유사한 임상 소견을 나타냈던 제1 배측 골간근 파열 1예를 보고하고자 한다. 제5 수지에서 발생한 2예는 Stener 병변이었고 제2 수지의 1예는 파열된 측부 인대가 전위되었으나 파열되지 않은 시상대가 아래에 위치하여 있었으며, 이는 수술 전 자기공명영상(magnetic resonance imaging, MRI) 검사에서도 관찰되었다. 수술 전 초음파에서 제2 수지의 Stener 병변으로 판단되었던 1예는 제1 골간근의 파열이었다. MRI는 수지의 중수수지 관절의 측부 인대 파열의 진단에서 필수적인 감별 진단 검사라고 판단된다. Three Stener-like lesions of the metacarpophalangeal joint of the fingers and a rupture of the first dorsal interosseous muscle mimicking the lesion in the index finger were observed. Two cases in the little fingers had a true Stener’s lesion. In one case in the index finger, the ruptured ligament was retracted and located under the intact sagittal band, which was also observed by preoperative magnetic resonance imaging (MRI). Rupture of the first dorsal interosseous muscle was misdiagnosed preoperatively as a Stener’s lesion in the index finger by ultrasonography. MRI should be an essential differential diagnostic exam for collateral ligament ruptures of the metacarpophalangeal joint of the fingers.

Risk Factors for Neck Shortening in Patients with Valgus Impacted Femoral Neck Fractures Treated with Three Parallel Screws: Is Bone Density an Affecting Factor?

( Yerl-bo Sung ),( Eui-yub Jung ),( Kyung-il Kim ),( Soo-yeon Kim ) 대한고관절학회 2017 Hip and Pelvis Vol.29 No.4

Purpose: The purpose of this study is to analyze the relationship between significant femoral neck shortening (SFNS) and bone density after three parallel screw fixation in valgus impacted femoral neck fracture, and to analyze the risk factors for SFNS. Materials and Methods: This is retrospective study of 83 patients. We performed univariate analysis for patient information, bone density, fracture configuration and screw position divided into SFNS group (n=13) and non-SFNS group (n=70) and performed multivariate analysis using logistic regression model. We also analyzed the relationship between SFNS and complications such as osteonecrosis of femoral head and nonunion. Results: There was a significant difference in age, screw non-parallelism and bone mineral density of intertrochanteric and total hip area in the univariate analysis between the two groups (P<0.05). In multivariate analysis, old age (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.21) and screw non-parallelism (OR, 2.95; 95% CI, 1.44-6.59) were significant risk factors for SFNS. The incidence of SFNS was significantly higher in the complication group (P=0.027). Conclusion: Bone density did not significantly affect SFNS in valgus impacted femoral neck fractures treated with three parallel screws. The risk factors of SFNS were old age and screw non-parallelism. Therefore, we recommend using other fixation method to prevent SFNS in older ages and making the screw position as parallel as possible when performing screw fixation in valgus impacted femoral neck fracture.

국내.외 우수관거 시설기준 비교 및 분석에 관한 연구

김정수,곽상호,김성엽,윤세의,Kim. Jung Soo,Kwak. Sang Ho,Kim. Sung Yub,Yoon. Sei Eui 한국방재학회 2014 한국방재학회 학술발표대회논문집 Vol.2014 No.1

최근 들어 빈번히 발생하는 국지성 집중호우로 인해 내수배제 불량에 따른 도시지역의 내수침수 피해가 빈번하게 발생하고 있으며, 도시지역의 노후화된 우수관거 교체 및 설치 계획이 이루어지고 있다. 그러나 국내 대도시의 경우 우수관거 교체를 위한 예산확보가 부족한 실정이고 우수관거 특성상 시공 후 개선이 어려우므로 도시지역에서의 홍수피해를 저감하기 위한 우수관거의 합리적이고 효율적인 설계 기준이 필요한 상황이다. 또한 도시에서의 강우유출은 상당부분 우수관거시설에 의해서 이루어지고 있어 도심지 우수관거시설기준의 중요성은 더욱 부각된다. 이에 따라 도시지역에서의 홍수피해 저감을 목적으로 우수 관거 시설의 합리적이고 효율적인 설계 기준을 위해 국내 외 우수관거 시설기준을 분석하였다. 본 연구에서는 문헌조사를 중심으로 국내 외 우수관거 시설기준에 대하여 분석을 실시하였다. 국내 문헌으로는 도로배수시설 설계 및 유지관리 지침(2003), 하수도 관거의 계획과 설계계산(2003), 하수도공사 시공관리요령(2006), 하수관거공사 표준시방서(2010), 하수도시설기준(2011), 도시부 도로배수시설 설계 잠정 지침(2012)을 중심으로 시설기준을 분석하였으며 국외 문헌으로는 Drainage and Construction of Urban Stormwater Management Systems(1992), Urban Storm Drainage Criteria Manual(2001), Stormwater Collection Systems Design Handbook(2001), Urban Drainage Design Manual(2005)을 활용한 분석을 실시하였다. 우수관거 설계를 위한 계획우수량의 경우 국내의 설계기준에서는 최대계획우수유출량의 산정을 합리식에 의하는 것을 원칙으로 하되, 필요에 의해서 다양한 우수유출산정 방법들이 사용 가능하다 제시하였으며 국외의 경우 지속강우강도, 우량분포도 및 강우자료의 합성 중 설계자 판단에 따라 사용가능하도록 제시하였다. 빗물받이의 경우, 국내 설계기준은 빗물받이 간격을 도로폭 및 경사별 설치기준을 제시하여 노면배수를 유도하였고, 국외의 경우 속도별, sag별 최소 설계 빈도와 확산정도를 제시하여 수막현상을 방지하며 보행자 및 자전거의 안전에 대하여 유입구 모양을 제시하였다. 국내의 맨홀 설계기준은 관경별 최대간격을 제시하고 접합관경에 따라 합류맨홀의 선정을 가능하게 하였다. 국외의 경우도 마찬가지로 관경별 맨홀 간격을 제시하였지만 맨홀의 각도별 손실계수 또한 제시하여 흐름계산시 흐름의 저하를 고려하도록 지침하고 있다. 이에 따라 국내의 설계기준에도 빗물받이의 설계빈도 상향과 수막현상 방지를 위한 유입구 모양 및 간격의 제시가 요구되며 맨홀에서도 흐름저하를 고려한 다방향 합류맨홀의 설계기준 및 손실계수 산정을 통해 도시유역의 원활한 내수배제가 필요하다 판단된다.

Predictive Factors for Patellofemoral Degenerative Progression After Opening-Wedge High Tibial Osteotomy

Lee, Sung-Sahn,So, Sang-Yeon,Jung, Eui-Yub,Kim, Hyun-Jun,Lee, Byung Hoon,Wang, Joon Ho Elsevier 2019 Arthroscopy Vol.35 No.6

<P><B>Purpose</B></P> <P>To identify risk factors for patellofemoral degenerative progression after opening-wedge high tibial osteotomy (HTO) and to investigate the effect of patellofemoral degeneration on the patellofemoral specific patient-reported outcomes.</P> <P><B>Methods</B></P> <P>Between March 2010 and June 2016, 94 knees (86 patients) underwent hardware removal with second-look arthroscopy at 21.4 months after opening-wedge HTO with first-look arthroscopy (mean follow-up duration, 49.8 months). Predictive factors for patellofemoral degeneration, including demographics, preoperative and postoperative mechanical axis (MA) of the lower limb (positive and negative MA indicating varus and valgus, respectively), tibial slope, and modified Blackburne-Peel ratio, were evaluated. Patients were divided into the progression and nonprogression groups according to their patellofemoral degenerative progression from first to second arthroscopy. Clinical outcomes, including the Kujala score and Knee Injury and Osteoarthritis Outcome Score, and radiographic outcomes were compared between the 2 groups.</P> <P><B>Results</B></P> <P>Postoperative MA (adjusted odd ratio, 0.62; <I>P</I> < .001) was the most significant predictive factor for progressive change in the patellofemoral joint (<I>R</I> <SUB>n</SUB> <SUP>2</SUP> = 0.31). Twenty-eight knees (30%) showed patellofemoral degenerative progression. Mean postoperative Kujala score (progression group 60.5 vs nonprogression group, 72.3; <I>P</I> = .005) and Knee Injury and Osteoarthritis Outcome Score scales (except for the symptom subscale) were lower in the progression group. Postoperative MA was significantly more corrected in the progression group (progression group –5.1° ± 2.7° vs nonprogression group –2.4° ± 2.3°; <I>P</I> < .001).</P> <P><B>Conclusions</B></P> <P>Postoperative MA, which might be related to overcorrection, is correlated with patellofemoral degenerative progression after opening-wedge HTO. Patients with patellofemoral degenerative progression showed inferior patient-reported outcomes.</P> <P><B>Level of Evidence</B></P> <P>Level IV, case series with subgroup analysis.</P>

족부의 말초 신경 병변으로 인한 통증에서 피리독신의 사용

배서영,정의엽,오수찬,Bae, Su-Young,Jung, Eui Yub,Oh, Su Chan 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: We analyzed retrospectively the effect of pyridoxine in the treatment of peripheral nerve related foot pain because we have seen favorable clinical results from it as a monotherapy. Materials and Methods: We analyzed the clinical results of 200 cases of peripheral nerve related foot pain, treated with pyridoxine from March 2009 to February 2012. We devided them into three groups, peripheral neuritis, Morton's neuroma and posttraumatic neuralgia and recorded percentage of improvement of pain, compared to initial pain level at 2 weeks and 6 weeks. Results: There were 127 peripheral neuritis cases, 22 Morton's neuroma and 51 posttraumatic neuralgia. At 2 weeks after treatment, 135 cases(67.5%) showed pain relief. At 6 weeks, 36 cases(21%) showed complete improvement of pain, 81 cases(47%) showed more than 50 % of improvement, 22 cases(13%) showed less than 50% of improvement and 33 cases(19%) showed no improvement. There are 4 cases of gastrointestinal discomfort and 2 cases of aggravation of nervy pain. Conclusion: Pyridoxine was effective drug in the treatment of peripheral neuropathic pain in terms of pain relief, safety and cost effectiveness. So it can be an available first line drug before adding other drugs.

대퇴골 전자간 역사상 및 횡골절에서 골수강 내고정과 골수강 외 고정의 치료 결과 비교

성열보 ( Yert Bo Sung ),최정윤 ( Jung Yun Choi ),정의엽 ( Eui Yub Jung ) 대한고관절학회 2012 Hip and Pelvis Vol.24 No.2

목적: 대퇴골 전자간 역사상 및 횡골절에서 골수강 내 고정과 골수강 외 고정을 이용한 임상적, 방사선학적 치료 결과를 비교 분석하고자 하였다. 대상 및 방법: 2001년 9월부터 2010년 12월까지 대퇴골 전자간 역사상 및 횡골절로 수술 받은 39예를 대상으로 하였다. 골수강 내 고정으로 치료한 20예(I군)와 골수강 외 고정으로 치료한 19예(II군)를, 두 군간의 수술 시간, 수술 중 출혈 및 총 수혈량, 재원 기간, 골유합 기간을 비교하였고, 방사선학적 지표 및 합병증을 조사하였다. 결과: 수술 시간은 I군에서 평균 87.8분, II군에서 평균 153.8분이 소요 되었고, 수술 중 출혈량은 I군에서 평균 375.0 ml, II군에서 평균 1,015.8 ml로 측정 되었으며, 총 수혈량은 I군에서 평균 555.5ml, II군에서 평균 801.6 ml로 측정 되었다. 골유합 기간은 I군에서 평균 12.1주, II군에서 평균 18.1주로 측정 되었다. 그 밖에 변수들은 두 군간의 통계학적으로 유의한 차이가 없었다. 결론: 대퇴골 전자간 역사상 및 횡골절의 치료에 있어서 골수강 내 고정법은 골수강 외 고정법에 비해 덜 침습적이며, 골유합 기간이 짧아 유용한 방법이라고 생각된다. Purpose: This study was designed to compare the clinical and radiological results of intramedullary fixation to those of extramedullary fixation in patients with reverse oblique or transverse intertrochanteric femoral fractures. Materials and Methods: We retrospectively reviewed 39 cases of reverse oblique or transverse intertrochanteric femoral fractures between September 2001 and December 2010. There were 20 cases treated with intramedullary fixation (Group I) and 19 cases treated with extramedullary fixation (Group II). The operative time, intraoperative blood loss, amount of blood transfused, hospital day, and time to bone union were compared between the two groups. Radiologically, the position and sliding length of the lag screw or blade, change of femoral neck-shaft angle, and medialization of distal fragment were compared. Also, complications were assessed. Results: The mean operative time was 87.8 minutes with Group I and 153.8 minutes with Group II. The mean intraoperative blood loss was 375.0 ml with Group I and 1,015.8 ml with Group II. The mean amount of transfusion was 555.5 ml with Group I and 801.6 ml with Group II. The mean time to bone union was 12.1 weeks with Group I and 18.1 weeks with Group II. There were no statistical differences in other parameters between the two groups. Conclusion: The intramedullary fixation group revealed better results in the aspects of invasiveness and time to bone union in comparison with the extramedullary fixation group for the treatment of reverse oblique or transverse intertrochanteric femoral fractures.