분만 손상

강군순(Koon Soon Kang),박병문(Byeong Mun Park),장준섭(Jun Seop Jahng),강준순(Joon Soon Kang) 대한정형외과학회 1987 대한정형외과학회지 Vol.22 No.1

대퇴 전자부 골절의 수술적 치료

강준순(Joon Soon Kang),박승림(Seung Rim Park),김형수(Hyung Soo Kim),이우형(Woo Hyeong Lee),김기욱(Ki Wook Kim),이준희(Jun Hee Lee) 대한정형외과학회 2001 대한정형외과학회지 Vol.36 No.5

고관절 반치환술 후 비구 연골의 퇴화

문경호(Kyoung Ho Moon),강준순(Jun Soon Kang),조규정(Kyu Jung Cho),이동주(Tong Joo Lee),권대규(Dae Gyu Kwon) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

목적: 기간에 따른 인공 금속 골두가 비구 관절 연골을 퇴화시키는 정도를 알아보고, 어떤 임상적 인자들이 비구 관절 연골의 퇴화에 영향을 미치는지 알아보고자 하였다. 대상 및 방법: 1996년 8월부터 2002년 8월까지 고관절 반치환술을 시행 받은 192명(226 고관절) 중 최소 2년이상 추시가 가능하고, 탈구, 감염 및 기능상의 문제를 보이지 않은 61명(65 고관절)을 대상으로 하였다. Computer assisted vector wear analysis program을 변형하여 비구 관절 연골의 퇴화 정도를 측정하였으며 퇴화의 정도가 평균값보다 많은 군과 적은 군으로 나누어 퇴화에 영향을 미치리라 생각되는 인자들을 통계학적으로 분석하였다. 결과: 고관절 반치환술 후 측정된 비구 관절 연골의 선상 퇴화 변화는 평균 0.23±0.107 ㎜/yr, 부피 퇴화 변화는 평균 114±47.2㎣/yr로 측정되었다. 평균 이상 및 이하의 군으로 나누어 비교 분석한 결과 활동력 및 Harris hip score(HHS)는 통계학적으로 의미 있는 차이를 보였다. 퇴화에 미치는 기여도에 있어서는 선상 및 부피 퇴화 변화에 대해 HHS가 역상관관계각 있었고 활동력은 상관관계에 있었다. 결론: 비구 관절 연골의 퇴화는 환자의 활동이 활발할수록 빠르며, HHS가 높을수록 느렸다. 고관절 치환술시 환자의 여명 및 활동력에 따라 반치환술 혹은 전치환술의 선택을 선별하여 시행하는 것이 좋으리라 생각된다. Purpose: This study examined the rate of degeneration of the acetabular cartilage by the bipolar head according to time, and which clinical factors are related to the degeneration of the acetabular cartilage. Materials and Methods: Among 192 patients (226 hip joint) who were received bipolar hemi-arthroplasty from August 1996 to August 2002, 61 patients (65 hip joint), who were followed up for more than 2 years and showed no signs of dislocation, infection and functional problems, were enrolled in this study. A modified form of a computer assisted vector wear analysis program was used to measure the rate of degeneration of the acetabular cartilage. The subjects were divided into two groups, those whose amount of degeneration of the acetabular cartilage was less than average and those whose amount of degeneration was more than average. The factors that appeared to affect the level of acetabular degeneration in the two groups were evaluated. Results: After a bipolar hemiarthroplasty, the average linear degenerative change in the acetabular cartilage and the volumetric degenerative change was 0.23±0.107 ㎣/yr and 114±47.2 ㎣/yr, respectively. The result showed significant differences with activity and the HHS between the two groups. The HHS showed a reverse relationship with the linear degeneration and volumetric degeneration, the activity showed a correlation with the linear and volumetric degeneration. Conclusion: The acetabular cartilage degenerates faster as the patient's activity increases, and slower with a higher HHS. When surgeons perform hip joint arthroplasty, it is strongly recommended that the life expectancy and the level of activity be considered when deciding between a hemiarthroplasty or total hip arthroplasty.

화골성 섬유종

박병문(Byeong Mun Park),장준섭(Jun Seop Jahng),강응식(Eung Shick Hang),한수봉(Soo Bong Hahn),강준순(Joon Soon Kang) 대한정형외과학회 1986 대한정형외과학회지 Vol.21 No.4

응급센터를 내원한 대퇴골 골절 환자에서 골밀도와 생화학적 표지자들의 의의

이경미 ( Kyoung Mi Lee ),한승백 ( Seung Baik Han ),김준식 ( Jun Sig Kim ),백광제 ( Kwang Je Baek ),홍성빈 ( Seong Bin Hong ),문경호 ( Kyoung Ho Moon ),강준순 ( Joon Soon Kang ),윤승환 ( Seong Hwan Yoon ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Backgound: The most frequent fracture seen at the emergency department (ED) in the elderly is a femur fracture whereas they do not know the degree of osteoporosis. We analyzed the degree of osteoporosis in patients with femur fractures and compared patients with only femur fractures (FX) to patients with femur and vertebral fractures (VX) by examining the clinical features, the bone mineral density (BMD), and biochemical markers. Methods: From January 2004 to December 2004, we enrolled prospectively 30 femur fracture patients who visited the ED. The bone mineral densities of the lumbar spine and the femur were examined. Total calcium, phosphate, alkaline phosphatase, osteocalcin, and serum C-terminal telopeptide (s-CTx) were measured. The patients with femur fractures were divided into two subgroups according to the presence of vertebral fracture. Results: All BMDs of the FX group showed osteoporosis. The s-CTx levels were higher than normal. The patients in the FX with VX were older than those in the FX only group, and had lower BMDs. There were no significant differences in markers between the subgroups, but the incidence of trochanteric fractures was higher in FX with VX group than in the FX only group. Conclusion: Femur fractures in the elderly were associated with osteoporosis. In our study, despite a considerable difference in BMD between patients with femur fractures and those with femur fractures combined with vertebral fractures, there was no difference in biochemical markers on bone formation nor in the those of bone resorption. We will further investigate the biochemical markers and BMD in the population of osteoporotic fractures. So those indicators should be helpful for planning treatment and for prevention of FX in the elderly.

견고한 내고정 및 조기 관절 운동을 통한 원위 상완골 분쇄골절의 치료

박승준,김형수,이주형,박승림,이우형,강준순 대한골절학회 1998 대한골절학회지 Vol.11 No.1

$quot;Comminuted fractures of distal humerus are difficult fractures to treat because of their rarity and associated significant comminution. The results of managing theses fractures non- operatively are limited by failure to get anantomical reduction and early mobilization, which often results in painful stiff elbow and/or psedoarthrosis. The goals of open reduction are to preserve articular surface and restore elbow function. Hence an operative management with anatomical reduction of fragments becomes the treatment of choice for these fractures. Authors analyzed 17 patients, with 30 months follow-up on an average, who were treated with open reduction and rigid internal fixation followed early mobilization during the period from Jan. 1991 to Dec. 1996. Following results were obtained. l. According to the Muller' s classification, type A was 4 cases(23.5%), type B was 4 (23.5%), and type C was 9(53%). 2. Excellent or good results were obtained in 12 cases(71%) by the criteria of Aitken and Rorabeck. 3. There were limitation of full extension over 5 in all cases and no other severe complications causing disability of elbow.$quot;

요추부 척추관 협착증과 당뇨병 : 수술적 치료의 결과 Comparison of Surgical Outcome

박승림,김형수,강준순,이우형,이주형,박승준 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study Design : This retrograde study was designed to compare the clinical features and postoperative clinical results of diabetic and non-diabetic patients who had undergone decompression and postero-lateral fusion with instrumentation. Objective : To determine whether diabetes affected the outcome of surgery and to identify the clinical features associated with a poor outcome Summary of Background Data : Symptoms of peripheral angiopathy and neuropathy as longterm complications of diabetes closely mimic those of lumbar stenosis and there may be a risk of inappropriate surgical intervention in patients with both diabetes and spinal stenosis. In the presence of diabetes, a poor surgical outcome might be expected. But only a few literatures have been documented. Materials and Methods : We reviewed 21 diabetic(mean age 58.2 years) and 21 non-diabetic patients(mean age 61.3 years) who had undergone decompression and postero-lateral fusion with instrumentation for lumbar spinal stenosis at a mean of 32 months after operation by reviewing the medical records such as clinical symptoms and results of objective examination(including electrophysiologic study) Results : The preoperative symptoms were similar in the two groups except that abrupt onset of symptoms, the presence of night pain and the absence of any posture-related pain relief were recorded only by diabetic patients. The level of decompression, co-morbidity rate, and intra-operative blood loss were similar in two groups, too. Nerve-conduction velocity was lowered in 66.7% of the diabetic and in 25% of the non-diabetic patients. Polyneuropathy, which are highly suspicious of diabetic neuropathy was detected 46.7% in only diabetic group. The long-term result was excellent or good for thirteen(61.9%) of the twenty-one diabetic patients and for nineteen(90.5%) of the twenty-one nondiabetic patients. Conclusions : Thus diabetic patients who have spinal stenosis cannot be expected to have same clinical outcome as non-diabetic patients, which is consistent with the general belief or impression. Therefore, the selection of patient according to clinical and electrophysiologic findings would be the most important factor i n determining the rate of success of surgical treatment.

관절내 종골 골절의 치료 : 전산화 단층촬영에 따른 분류 및 치료법간의 비교 Based on CT Classification and Comparison of Treatments

김형수,박주식,박승림,이우형,강준순 대한골절학회 1999 대한골절학회지 Vol.12 No.1

The treatment modality of the displaced intraarticular calcaneal fractures is still controversial. The objectives of this study are to classify intraarticular fractures based on computed tomography and to compare the treatment results according to the classification and to consider the influence of Bohler angle to the prognosis of this injuries. From October 1989 to March 1997, 62 fractures(58 patients) who had been treated after calcaneal CT(computed tomography) were selected. The interval between the trauma and the last follw-up was mean 3.3 years(1.1-5.2 years). They had been treated with one of the three methods, that is, open reduction and internal fixation(OR/IF), Essex Lopresti or simple cast immobilization. The fracture was classified as type I (non-displced), type II (two part or split), type III (three part or split depression), type 1V (four part or highly comminuted) based on CT according to Sanders et. al. The calcaneal scoring system proposed by Kerr et. al. was applied to the assessment of the treatment results, which may be more appropriate for non-parametric statistical test. Thc type I fractures had been treated only with cast immobilization with or without manual reduction and all of the 4 cases(100%) have shown favorable(excellent or good) results. The OR/IF group(favorable results for 15 of 18 cases(83.3%) in type II and for 11 of 13(84.6%) in type g ) have shown better results than those of other two group(p ( 0.05). The results between other two groups, that is, Essex-Lopresti operation group(favorable results for 4 of 8 cases(50%) in type II and for 1 of 3(33.3%) in type III)and cast immobization (2 of 5 cases(40%) in type II and for 0 of 2(0%) in type III) have made no significant differences(p ) 0.5). In type 1V, there were no significant differences among the results of the three methods(p ) 0.1) and worse results than type II, g (p ( 0.05) probably due to difficulty in reduction of highly comminuted articular facets. The Bohler angle has given no significant influence to the final results(p ) 0.1). In conclusion, OR/IF has shown better results than closed modalities in the treatment of displaced intraarticular calcaneal fractures and may be the primary choice of treatment for these fractures. We have used Kruskal-Wallis H test and its approximation to chi-square distribution for comparison of three groups and Mann-Whitney U test and its approximation to normal distribution for two groups and have been aided by the computor program, SPSS in statistical calculations. The p-value was 0.05.

소아 상완골 과상부 골절에 대한 정복평가 : 운반각, 바우만각, 골간단-골간각의 비교 Comparison of Clinicla carrying angle, Baumann`s angle and Metaphyseal-diaphyseal angle

김형수,김성환,박승림,이우형,강준순 대한골절학회 1999 대한골절학회지 Vol.12 No.3

Purpose: The object of this retrospective study is to verify Baumann's angle as assessment methods of reduction for supracondylar fracture of the humerus in children and to confirm what is the more accurate assessment methods of supracondylar fracture of the humerus between Baumann's and metaphyseal-diaplyseal angle. Marerials and Methods: 34 cases of more than 1years follow up after closed reduction and pinning were reviewed. Simple linear regression has been used for statistical analysis and Pearson's correlation coefficient(rho) has been used for comparison of Baumann's angle and metaphyseal-diaphyseal angle. Results: The results form simple linear regression, about a 10° change in Baumann's angle contributes to a change in the carrying angle of approximately 3.7° on the uninjured(=-0.372, r=-0.750, p$lt;0.001) and injured( =-0.365, r=-0.759, p$lt;0.001) arms. In comparison of Baumann's angle and metaphyseal-diaphyseal angle to predict final carrying angle, the correlation coefficient between Baumann's angle and carrying angle(r=-0.759) was higher than that between metaphyseal-diaphyseal angle and carrying angle(r=-0.495) with statistical significant using Fisher's rho(p$lt;0.05). Conclusion: The Baumann's angle after reduction can be reliably used to predict accurately the final carrying angle and is more accurate than the metaphyseal-diaphyseal angle to predict the final carrying angle.

소아 대퇴골 간부 골절 치료시 과도성장 및 재형성

김형수,박승림,이우형,강준순,전현양 대한골절학회 1997 대한골절학회지 Vol.10 No.1

Fifty-two femoral shaft fractures in children, treated conservatively, were studied clinically and radiographically to access the overgrowth and it's related factors. Among them, we reviewed fourteen children(16 cases), who had angular deformities over l0 after union for the spontaneous correction of the angular deformity. They had an average follow-up of 40.5 months and 32.4 months. The results were as follows: 1. The average of the overgrowth was 9.9 mm. 2. The overgrowth was influenced by the age, but was not promoted by other factors. 3. The average overgrowth of the age group between 4 and 9 was 10.8±2.7 mm. 4. The average correction was 78% of the initial angular deformity, 77% had occurred at the physes and 23% at the fracture site 5. There was no close relation between the remodelling rate and degrees of initial deformity