Mortality after Hip Fractures in Nonagenarians

강번중,이영균,이기웅,원성훈,하용찬,구경회 대한골대사학회 2012 대한골대사학회지 Vol.19 No.2

Objectives: Nonagenarians with hip fractures represent a special group of people because of their advanced age and co-morbidities. We evaluated mortality after hip fractures in nonagenarians. Methods: Fifty-one patients were studied over a 2-year period. There were 39 female and 12 male patients. Twenty seven patients sustained an intertrochanteric fracture of the femur, 24 suffered from femoral neck fracture. The American Society of Anaesthetists (ASA) score of II was the most frequent among 51. Forty-one of them had one or more co-morbidities. Patient review was done 2 years after the fracture. Results: The mortality rate at one year was 53.4% in men, and 15.7% in women. After multivariate analysis, the type of fracture (intertrochanteric fracture) was identified as a risk factor for one-year mortality (P = 0.025). Conclusion: The outcome in nonagenarians with hip fractures is poor due to the high rates of mortality, especially in men, and this could be informed to patients and their families before hip fracture surgery.

대퇴골두 골괴사를 가진 환자에서의 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술 -금속 금속 관절면과 세라믹 세라믹 관절면의 비교-

강번중 ( Bun Jung Kang ),이주희 ( Jue Hee Lee ),정영복 ( Young Bok Jung ),김진홍 ( Jin Hong Kim ),한용문 ( Yong Moon Han ),장의찬 ( Eui Chan Jang ),김경운 ( Kyoung Woon Kim ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

목적: 진행된 대퇴골두 골괴사증 환자에서 무시멘트형 조립식 대퇴주대를 이용한 고관절 치환술의 임상적 및 방사선학적 결과를 평가하였으며, 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한 군 간, 결과에 차이가 있는지를 확인하고자 하였다. 대상 및 방법: 2001년 1월부터 2004년 12월 까지 대퇴골두 골괴사증으로 조립식 대퇴주대를 이용하여 무시멘트형 고관절 치환술을 시행 받았으며, 5년 이상 추시관찰이 가능하였던 66명(78예)을 대상으로 하였고, 술 후 평균 추시 기간은 평균 77개월(60~122개월) 이었다. 결과: 임상적 평가로 술 전 평균 Harris 고관절 점수는 53점에서 최종 추시 시 88.5점으로 향상되었다. 방사선학적 검사 결과에서 대퇴주대의 안정도는 68예에서 골성고정을 얻었으며, 9예에서 섬유성 안정고정, 1예에서 불안정고정을 나타내었다. 재치환술은 3예에서 시행하였으며, 122개월 간 대퇴 스템의 생존율은 95.7%인 것으로 조사되었다. 결론: 진행된 대퇴골두 골괴사증에서 시행한 조립식 대퇴주대를 이용한 무시멘트형 고관절 전치환술은 5년 이상 추시 결과 금속-금속 관절면을 사용한 군과 세라믹-세라믹 관절면을 사용한군, 모두 만족한 만한 임상적 및 방사선학적 결과를 얻었다. Purpose: The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation. Materials and Methods: Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years. Results: The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months. Conclusion: Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.

대퇴골두 무혈성 괴사에서 근위 대퇴골 절골술

강번중 ( Bun Jung Kang ),하용찬 ( Yong Chan Ha ),정재효 ( Jae Hyo Jung ),김연호 ( Yeun Ho Kim ),구경회 ( Kyung Hoi Koo ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.3

경골 골수정 고정술후 교합나사의 파단

박형빈,강번중,송해룡,구경회,정순택,조세현 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 경골 골절에서 골수정 고정술후 발생하는 교합나사 파단의 빈도와 발생 원인을 밝히고자한다. 대상 및 방법 : 1995년 3월부터 2000년 10월까지 골수정으로 치료하였던 경골 간부골절 82예중 내고정물 파단이 발생하거나 골유합이 이루질 때까지 추시 가능하였던 75예를 대상으로 하였다. 내고정물 파단 빈도와 위치, 골절의 양상, 술후 골절부 신연 및 골유합 이상 여부를 조사하였다. 결 과 : 교합나사 파단은 7예였고 (9.3%), 근위부 두 번째 나사의 파단이 가장 흔하였다. 교합나사으 ㅣ파단은 AO분류 B형과 C형 골절, 술후 골절부가 신연된 경우, 개발성골절, 자연유합 및 불유합의 경우 발생하였다. 결 론 : 교합나사 파단의 주된 요인은 골절부의 골과 골 접촉이 불안정하기 때문이며, 개방성 골절, 지연유합 및 불유합도 교합나사 파단의 위험인자라고 생각한다. 교합나사 파단을 예방하기 위해서는 수술시 골절부 신연을 피해야하며 골절부 골접촉이 불안정한 경우 완전 체중부하를 골유합시까지 제한하여야할 것으로 생각한다. Purpose : The aims of this study were to investigate the prevalence and the causes of crew breakage in tibia nailing. Materials and Methods : Between 1995 and 2000, eighty-two tibial diaphyseal fracture were treated with interlocking nails. The loss of follow-up was 7 cases. We retrospectively reviewed seventy-five cases. We investigated the rate and location of metal failure and evaluated the fracture pattern, the presence of distraction after nailing and union abnormality. Results : Screw breakage was identified in seven cases (9.3%) and most frequently occurred on the second proximal locking screw. Screw breakage occurred in AO type B or C type fractures, fracture site distraction after nailing, open fracture, delayed union and nonunion. Conclusion : The main cause of screw breakage is unstable bone to bone contact on the fracture site caused by comminution of distraction. The open fracture, delayed union, and nonunion also contributing factors for screw breakage. For preventing screw breakage, it is necessary to avoid fracture site distraction and delay full weight bearing in cases having unstable fracture site contact.

추체 성형술 후 발생한 화농성 척추추간판염과 동반된 광범위 경막외 농양과 요근 농양 - 증례 보고 -

박진성,김동희,강번중,정순택 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.2

Study Design: Case report. Objective: To report a case of extensive spinal epidural abscess and bilateral psoas abscesses combined with pyogenic spondylodiscitisafter a L3 vertebroplasty. Summary of Literature Review: Infection after vertebroplasty or kyphoplasty is a rare medical complication. Few reports on spinalepidural abscess and bilateral psoas abscesses, coupled with pyogenic spondylodiscitis after vertebroplasty, are available in the Englishmedical literature. Materials and Methods: The authors performed a clinical and radiographic case review. Results: A 74-year-old woman, without any existing medical illness, presented with a history of three weeks of lower back pain, fever,and neurologic deficits of both legs after vertebroplasty performed in another hospital. Magnetic resonance imaging demonstratedan extensive spinal epidural abscess from T10 to S1 and huge bilateral psoas abscesses combined with spondylodiscitis at L3-4. Urgent limited laminectomies and abscess drainage were performed from L1 to S1. The day after the operation, ultrasound-guidedpercutaneous drainage was performed to manage bilateral psoas abscesses. Methicillin-resistant Staphylococcus aureus was identifiedby intraoperative culture. Antibiotic therapy during hospitalization was maintained for six weeks with vancomycin and rifampicin. Theinfection was successfully treated without any neurologic deficit and spinal deformity. Conclusions: Vertebroplasty is relative safe and simple procedure; however, the procedure also may cause severe spinal infection. Aseptic techniques under sterile environment was required during surgery. It is important that early diagnosis and prompt surgicaldecompression in spinal epidural abscess with neurologic deficit. Limited surgery and antibiotic therapy could be a good treatment optionin spinal epidural abscess combined with pyogenic spondylodiscitis. Key Words: spinal epidural abscess, psoas abscess, pyogenic spondylodiscitis, vertebroplasty, complication 연구 계획: 증례보고목적: 제 3요추 추체 성형술 후 광범위 경막외 농양과 요근 농양이 동반된 화농성 척추추간판염에 대해 증례 보고를 하고자 한다. 선행문헌의 요약: 추체 성형술과 경피적 풍선 척추 성형술 후 감염이 발생하는 경우는 매우 드문 합병증이다. 추체 성형술 후 광범위 경막외 농약과 양측 요근 농양이 동반된 척추추간판염에 대해 적은 증례가 보고되어 있다. 대상 및 방법: 이학적, 임상 및 영상학적 검사를 토대로 증 례보고 시행하였다. 결과: 특이 질환없는 74세 여자환자로 내원 3주 전 하부 요통으로 추체 성형술을 타병원에서 시행 후, 양측 하지 신경학적 결손 및 발열로 내원하였다. 자기공명영상에서 제 10흉추에서 제 1천추까지 광범위 경막외 농양과 양측 요근 농양이 동반되어 있는 제 3-4요추 척추추간판염이 관찰되었다. 제 1요추에서 제 1천추까지 제한적 후궁절제술과 배농술을 시행하였다. 양측 요근 농양에 대해서는 수술 이후 초음파 감시 하 경피적 배농술을 시행하였다. 수술장에서 시행한 배양 검사 상 메티실린 내성 황색 포도상구균이 배양되었으며, 6주간 반코마이신(vancomycin) 정맥 주사와 리팜피신(rifampicin)을경구 투여하였다. 신경학적 결손 및 요추 변형 없이 감염은 성공적으로 치료되었다. 결론: 추체 성형술은 비교적 안전하고 간단한 시술이지만, 종종 심각한 감염을 일으킬 수 있다. 따라서, 반드시 수술은 멸균된 환경에서 무균적 처치가필요하다. 신경학적 증상이 동반된 경막외 농양은 빠른 진단이 필수적이며, 즉각적인 감압술과 적절한 장기간의 항생제 치료가 필요하다. 또한, 경막외농양과 동반된 화농성 척추추간판염은 제한적 수술과 적절한 항생제의 투여가 좋은 치료 옵션이 될 수 있다.

Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?

강수용,백지훈,강번중,김민규,이한준 대한골대사학회 2012 대한골대사학회지 Vol.19 No.2

A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ,USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.

Effect of Anteromedial Portal Entrance Drilling Angle during Anterior Cruciate Ligament Reconstruction: A Three-Dimensional Computer Simulation

문동규,황선철,윤철호,박진성,강번중,조성희,조호승 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: The object of this study was to evaluate entrance angle effects on femoral tunnel length and cartilage damage during anteromedial portal drilling using three-dimensional computer simulation. Materials and Methods: Data was obtained from an anatomic study performed using 16 cadaveric knees. The anterior cruciate ligament femoral insertion was dissected and the knees were scanned by computer tomography. Tunnels with different of three-dimensional entrance angles were identifiedusing a computer simulation. The effects of different entrance angles on the femoral tunnel length and medial femoral cartilage damage were evaluated. Specifically,tunnel length and distance from the medial femoral condyle to a virtual cylinderof the femoral tunnel were measured. Results: In tunnels drilled at a coronal angleof 45°, an axial angle of 45°, and a sagittal angle of 45°, the mean femoral tunnel length was 39.5±3.7 mm and the distance between the virtual cylinder of the femoral tunnel and the medial femoral condyle was 9.4±2.6 mm. The tunnel length at a coronalangle of 30°, an axial angle of 60°, and a sagittal angle of 45°, was 34.0±2.9 mm and the distance between the virtual cylinder of the tunnel and the medial femoral condyle was 0.7±1.3 mm, which was significantly shorter than the standard angle (p<0.001). Conclusion: Extremely low and high entrance angles in both of axial plane and coronal plane produced inappropriate tunnel angles, lengths and higher incidenceof cartilage damage. We recommend that angles in proximity to standard anglesbe chosen during femoral tunnel drilling through the anteromedial portal.

Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

조우람,이영균,하용찬,이경민,강번중,구경회 대한의학회 2016 Journal of Korean medical science Vol.31 No.8

Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea.

Incidence and Risk Factors of Symptomatic Peripartum Diastasis of Pubic Symphysis

유정준,하용찬,이영균,홍준석,강번중,구경회 대한의학회 2014 Journal of Korean medical science Vol.29 No.2

This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P=0.010) and twin gestation (P=0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P=0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis.

Correlation between Femoral Guidewire Position and Tunnel Communication in Double Bundle Anterior Cruciate Ligament Reconstruction

이상혁,황선철,최준영,김동희,강번중,남대철,윤홍권 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions requiredto prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. Materials and Methods: The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. Results: In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. Conclusion: The techniquefor double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.