원위 대퇴골 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술비교

안성준 ( Seong Jun Ahn ),강석웅 ( Suk Woong Kang ),김부환 ( Bu Hwan Kim ),송무호 ( Moo Ho Song ),유성호 ( Seong Ho Yoo ),오관택 ( Kwan Taek Oh ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4

목적: 대퇴 원위부 골절의 최소 침습적 금속판 고정술과 관혈적 고정술에 대해 후향적 분석을 통해 수술 결과를 비교하고자 한다. 대상 및 방법: 2002년 1월부터 2010년 12월까지 대퇴 원위부 골절로 수술을 시행한 최소 1년 이상의 추시가 가능하였던 31예중 최소 침습적 금속판 고정술 17예를 A군, 관혈적 고정술 14예를 B군으로 나누어 두 군 간의 수술시간, 수혈량, 골유합, C-반응성 단백, 술 후 재활 등의 결과를 비교하였다. 결과: 각 군의 수술 시간은 평균 86/135분, 평균 수혈량 0.8/1.9 단위로 A군에서 수술 시간과 수혈량이 유의하게 감소하였다. 술 후 3, 7일째 시행한 C-반응성 단백은 A군 평균 7.4/1.5 mg%, B군 10.3/2.4 mg%로 A군에서 조직손상이 적었다. Sanders 등에 의한 슬관절 기능 점수는 양 군에서 모두 양호한 결과를 보였다. 결론: 대퇴 원위부 골절에서 최소 침습적 금속판 고정술과 관혈적 고정술이 비교적 양호한 결과를 보였으나, 최소 침습적금속판 고정술에서 조직의 염증반응이 적고, 수술 시간의 단축과 수혈량의 감소를 보여 보다 효율적인 술식으로 생각한다. Purpose: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. Materials and Methods: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. Results: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. Conclusion: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.

무지 외반증 환자에서 근위지골 기저부의 내측 돌출부 절제술 후 관절면을 통한 AKIN 절골술

안성준,김부환,송무호,강석웅,오관택,유성호,Ahn, Seong Jun,Kim, Bu Hwan,Song, Moo Ho,Kang, Suk Woong,Oh, Kwan Taek,Yoo, Seong Ho 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, it could lead to skin irritation and medial pain after the surgery. The purpose of this paper was to report our clinical and radiographic results with transarticular fixation of Akin osteotomy for the treatment of patients with hallux valgus after resection of the medial protrusion of base of the proximal phalanx. Materials and Methods: Our study is subject to 34 cases of 30 patients who went through proximal phalanx medial corticectomy among patients undergone both hallux valgus surgery and Akin osteotomy at our institution from March 2006 to March 2012. In all cases, we used absorbable suture material through the articular surface for Akin osteotomy after resection of the medial protrusion in proximal phalanx. Radiographs were reviewed to assess the union and displacement of osteotomy site at the time of postoperative 6 months. The clinical results were assessed by using AOFAS score and complication such as skin irritation and pain. Results: AOFAS score was improved from average 44 points(36-58), before operation and average 87 points(74-96), 12 months after operation. In two cases, partial union was suspected in radiological perspective, however, complete union on the osteotomy site was observed in all cases, 12 months after the operation. No patients was dissatisfied with pain, joint discomfort, skin irritation and inflammation from the knot. Conclusion: When medial protrusion in the base of proximal phalanx is severe from removing metatarsal bunion during the hallux valgus surgery, We have good results by transarticular fixation of Akin osteotomy using absorbable suture material.

상완골 원위부 AO-C형 골절의 수술적 치료는 초기 정형외과 의사에게 얼마나 어려운가?

유성호 ( Seong Ho Yoo ),강석웅 ( Suk Woong Kang ),송무호 ( Moo Ho Song ),김영준 ( Young Jun Kim ),배혁 ( Hyuck Bae ) 대한골절학회 2018 대한골절학회지 Vol.31 No.2

목적: 초기 정형외과 의사로서 상완골 원위부 C형 골절의 수술적 치료에서 초기 20예를 분석해 보고자 한다. 대상 및 방법: 상완골 원위부 AO-C형 골절 환자에서 수술적 치료를 시행한 초기 20예의 결과를 분석하였다. 2013년 3월부터 2015년 5월까지 최소 1년 이상 추시가 가능하였던 환자를 대상으로 하였다. 수술 시간, 골유합 시기, 주관절 운동 범위를 측정하였고, Mayo 주관절 수행 점수를 이용하여 기능적 평가를 하였다. 수술 직후부터 발생한 주, 부 합병증에 대해 분석하였다. 결과: 모든 환자에서 골유합을 얻었으며, 평균 골유합 기간은 16.4주, 평균 수술 시간은 112분이었다. Mayo 주관절 기능평가 점수는 우수 6예, 양호 10예, 보통 4예였으며, 평균 주관절 운동 범위는 굴곡 구축 14.5도, 후속 굴곡 120.7도였다. 총 6명에 대해 9회의 재수술을 시행하였다. 2예에서 재고정술을, 1예에서 척골신경 전위술을 시행하였다. 이외 척골 절골부위 전이, 표재성 감염, 고정핀의 이완 등으로 재수술을 시행하였다. 결론: 상완골 원위부 AO-C형의 경우 초기 정형외과 의사의 수술적 치료 시 수술 기법과 경험 부족으로 다양한 합병증을 일으킬 수 있어 수술 전, 후 철저한 준비로 좋은 결과를 얻을 수 있도록 해야겠다. Purpose: Twenty early surgical management cases of distal humerus type-C fractures were analyzed. Materials and Methods: This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo’s functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed. Results: All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5° with a follow-up improvement averaging 120.7°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening. Conclusion: Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.

쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술 비교

유성호(Seong-Ho Yoo),강석웅(Suk-Woong Kang),김부환(Bu-Hwan Kim),송무호(Moo-Ho Song),김영준(Yeong-Joon Kim),박규택(Gyu-Taek Park),곽창훈(Chang-Hun Kwack) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 고정술에 대한 후향적 분석을 통해 수술 결과를 비교하고자 한다. 대상 및 방법: 2011년 11월부터 2014년 5월까지 쇄골 간부 골절로 수술을 시행한 최소 1년 이상의 추시가 가능하였던 40예에서 최소 침습적 금속판고정술 20예를 A군, 관혈적 고정술 20예를 B군으로 나누어 두 군 간의 수술시간, 골유합, 기능적 평가(American Shoulder and Elbow Society score), 수술 반흔의 길이, 술 후 통증 완화(visual analogue scale) 및 합병증에 대해 비교 분석하였다. 결과: 모든 예에서 골유합이 이루어졌으며, 양 군에서 모두 양호한 결과를 보였다(p>0.05). 평균 수술 시간은 A군에서 47.5분, B군에서 58.7분이었고, 평균 절개의 길이는 A군에서 6.2 cm, B군 10.7 cm로 유의한 차이를 보였으며, 술 후 통증의 완화에서도 A군에서 초기 빠른 회복을 보였다. 합병증으로 A군에서 부정유합 1예, 피부 감각이상 2예를 보였으며, B군에서 피부 감각이상 6예 및 수술 반흔에 대한 미용상의 문제가 2예 있었다. 결론: 쇄골 간부 골절에서 A와 B 양 군에서 대체적으로 양호한 결과를 보였으나 A군이 B군에 비해 짧은 수술시간과 수술 절개, 초기 통증 완화 항목들에서 더 좋은 결과를 보였다. 하지만 부정유합, 방사선 노출 등의 합병증 및 장기 추시 결과에 대한 연구가 더 이루어져야 할 것으로 보인다. Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year–among all cases of MIPPO and open plate fixation–were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

근육내 Diclofenac 주사 후 발생한 Nicolau 증후군

안성준(Seong Jun Ahn),강석웅(Suk Woong Kang),김부환(Bu Hwan Kim),송무호(Moo Ho Song),유성호(Seong Ho Yoo),김영준(Young Jun Kim),김동환(Dong Hwan Kim) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.4

Nicolau 증후군은 근육 주사 후 근육 주사 부위의 심한 압통과 조직괴사를 일으키는 아주 드문 질환이다. 국내에서도 피부과 학회에 12예가 보고되었으며, 심한 경우 수술적 치료가 필요한 경우도 있었다. 대부분의 환자가 정형외과적인 질환의 치료를 위해 사용한 비스테로이드성 항소염제(nonsteroidal anti-inflammatory drugs), corticosteroids, 항생제(antibiotics) 등 다양한 약물로 발현되었다. 이에 저자들은 전형적인 Nicolau 증후군 1예와 비전형적인 Nicolau 증후군 1예를 경험한 바 이를 보고하고자 한다. Nicolau syndrome is a rare complication causing severe pain and tissue necrosis after intramuscular injection. In Korea, the Korea Dermatological Association has reported 12 cases, and some severe cases required surgical treatment. Most cases have been related to the administration of a variety of drugs, including nonsteroidal anti-inflammatory drugs, corticosteroids, and antibiotics. We present two patients who developed this complication, 1 case of typical Nicolau syndrome and 1 case of atypical Nicolau syndrome.

역행성 압박 골수내 금속정을 이용한 경골거골종골 관절 유합술

송무호,김부환,안성준,강석웅,김영준,김동환,유성호,Song, Moo Ho,Kim, Bu Hwan,Ahn, Seong Jun,Kang, Suk Woong,Kim, Young Jun,Kim, Dong Hwan,Yoo, Seong Ho 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of talus, combined arthritis of the ankle and subtalar joint, failure of previous ankle arthrodesis, and failed total ankle arthroplasty. Materials and Methods: Eighteen consecutive patients (10 men and 8 women) with an average age of 54 years (range, 42~72 years) underwent tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail fixation. The mean duration of follow-up was 16 months (range, 12~23 months). Radiological evaluation included assessment of the union status of ankle and subtalar joints. Clinical evaluations included visual analogue scale (VAS) for pain and patient satisfaction, and postoperative complications were analyzed. Results: Radiological union was achieved in 14 ankle joints (77%) and 16 subtalar joints (88%) at an average of 16 weeks (range, 14~40 weeks) and 14 weeks (range, 12~24 weeks), respectively. The preoperative VAS were 4.6 (range, 4~8) at rest and 8.2 (range, 7~10) during walking, and the postoperative VAS were 2.2 (range, 0~3) and 4.6 (range, 4~6), respectively (p<0.05). There were 6 nonunions (4 ankle joints and 2 subtalar joints), 3 tibia fractures, 2 delayed union of ankle joints, and 2 breakage of the implant. Conclusion: Tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail may be considered as a viable option in patients with complex hindfoot problems.

배면 갈매기형 절골술을 이용한 족저각화증의 수술적 치료

유성호,김부환,송무호,안성준,이민수,강석웅,Yoo, Seong-Ho,Kim, Bu-Hwan,Song, Mu-Ho,Ahn, Seong-Jun,Lee, Min-Su,Kang, Suk-Woong 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1

Purpose: Painful plantar callosities under the second, third or fourth metatarsal head have been controverted about its treatment mordalities. We performed the vertical chevron osteotomy in patients with painful callosities on the second and third metatarsal head, and evaluated the outcome clinically. Materials and Methods: Fourteen cases from 10 patients who had plantar keratosis were operated by vertical chevron osteotomy from March 2005 to October 2008. We used K-wire fixation for all cases. We evaluated the clinical results by the patients' satisfaction and disappearance of plantar lesion. Results: The plantar keratosis was completely disappeared in 8 cases and partially in 5 cases. In 2 cases, patients expresses their pain caused by constant metatarsalgia that was suspected to be dorsal incisional pain and joint capsulitis. Transmetatarsalgia was not appeared. Conclusion: We consider vertical chevron osteotomy as a good surgical method for treatment of plantar keratosis.