성인에서의 병적 위치 변형이 없는 아킬레스건 종골 후방 부착부의 특징: 자기공명영상 계측 연구

곽희철,정대원,박형택,하동준,곽재용,김의철,Gwak, Heuichul,Jung, Daewon,Park, Hyungtaek,Ha, Dongjun,Kwak, Jaeyong,Kim, Uicheol 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.3

Purpose: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. Materials and Methods: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. Results: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group ($1.47{\pm}0.25cm$) than in the middle insertion group ($1.27{\pm}0.35cm$). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). Conclusion: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

족근 관절 경비 인대 결합 손상

곽희철,권용욱,Gwak, Heui-Chul,Kwon, Young-Wook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Ankle injuries may involve the distal tibiofibular syndesmosis and can be associated with a variable degree of trauma to the soft tissue and osseous structures that play an important role in ankle joint stability. Ankle syndesmotic injury may occur solely as a soft tissue injury or in association with variable ankle fractures. Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. The prevalence of these injuries may be higher than previously reported. The diagnosis of syndesmotic injury as not always easy because isolated ankle sprains may be missed in the absence of a frank diastasis and syndesmotic instability may be unnoticed in the presence of bimalleolar ankle fractures. Controversies arise at almost every phase of treatment includings : type of fixation(screw size, type of implant), number of cortices required for fixation and of need for hardware removal. Regardless of controversies, the most important goal should be restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis.

Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment

곽희철,김전교,김정한,노상명 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.4

Background: To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. Methods: We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. Results: In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. Conclusions: Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants.

운동 후 발생한 제5족지의 괴사가 동반한 조기 말초동맥질환: 증례 보고

곽희철,윤준민,김대유 대한스포츠의학회 2022 대한스포츠의학회지 Vol.40 No.4

Premature peripheral arterial disease is characterized by onset of peripheral arterial occlusion before age of 50 years. Its prevalence is rare. To the best of the authors’ knowledge, there is rare research of premature peripheral arterial disease in Korea. The authors encountered a case of necrotic toe caused by premature peripheral arterial disease after soccer workout. This paper reports this case with a review of the relevant literature.

스포츠와 관련된 족부 및 족관절 손상에 대한 비수술적 치료

곽희철,서승석,김창완,Gwak Heui-Chul,Seo Seung-Suk,Kim Chang-Wan 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.2

The foot and ankle are one of the most common sites for acute musculoskeletal injuries related to sports activity. Foot and ankle injury includes ligament injury, tendon injury, bone and osteochondral injury, nerve injuy, heel pain syndrome, phalangeal injury. This is a article about nonoperative management of foot and ankle injury. Therefore, this article includes various exercise technique, range of motion, stretching for muscle relaxation, proprioception training for rehabilitation. We recommend that orthopedic surgeon should discuss with patient and specialist for treatment plan after foot and ankle injury

중족통의 원인

곽희철,하동준,Gwak, Heui Chul,Ha, Dong Jun 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.3

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

거골 골연골병변의 수술적 치료: 관절경적 골수 자극술(다발성 천공 또는 미세 골절술)

곽희철,은일수 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.2

Osteochondral lesion of the talus (OLT) is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone. Various terms are used to describe this clinical entity, including osteochondritis dissecans, osteochondral fractures, and osteochondral defects. Several treatment options are available; the choice of treatment is based on the type and size of the defect and the treating clinician’s preference. Arthroscopic microfracture (a bone marrow stimulation technique) is a common and effective surgical strategy in patients with small lesions or in those in whom non-operative treatment has failed. This study had the following aims: 1) to review the historical background, etiology, and classification systems of OLT; 2) to describe a systematic approach to arthroscopic bone marrow stimulation for OLT; and 3) to determine the characteristics that are useful for assessing osteochondral lesions, including age, size, type (chondral, subchondral, cystic), stability, displacement, location, and containment of the lesion.

당뇨발 환자에서 Syme 절단술의 위험 인자

곽희철,김전교,김영준,이정한,이운성,Gwak, Heuichul,Kim, Jeongyo,Kim, Youngjun,Lee, Jeonghan,Lee, Woonseong 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.2

Purpose: This study examined the factors affecting the treatment of diabetes mellitus foot patients who had undergone a Syme amputation. Materials and Methods: This study included 17 patients diagnosed with a diabetes mellitus foot and who had undergone a Syme amputation from January 2010 to January 2014. Some of the risk factors (age, body mass index [BMI], disease duration, smoking, ankle brachial index [ABI], HbA1c, serum albumin, total lymphocyte, C-reactive protein [CRP], and serum creatine) that affect the successful Syme amputation were analyzed. Results: The healing rate of a Syme amputation was significantly higher when the lymphocyte count was above $1,500mm^3$ (p=0.029). The factors affecting the surgical outcome according to multivariate analysis were HbA1c and the BMI (p=0.014, p=0.013). Regarding reamputation, there was a significant difference with HbA1c, lymphocyte, and BMI (p=0.01, p=0.03, and p=0.01). No significant differences were observed with age, disease duration of diabetes mellitus, smoking, ABI, serum albumin, CRP, and serum creatine. Conclusion: The HbA1c level, BMI and total lymphocyte count are risk factors that must be considered for successful Syme amputation in patients with diabetic foot disease.

족부족관절 질환 환자를 위한 아텔로콜라겐 주사의 이해

곽희철,Yoon Jun-Min,Kim Dae-Yoo 대한족부족관절학회 2023 대한족부족관절학회지 Vol.27 No.4

Collagen is the most common structural protein in the connective tissues of vertebrates, playing a crucial role in maintaining the tissue structure and wound healing. Atelocollagen retains the original properties of collagen but does not induce inflammatory cytokines. At- elocollagen is extracted from various animals and humans, with bovine-derived collagen being the most commonly used. The safety and efficacy of atelocollagen have been demonstrated through multiple studies, but further research will be needed in the field of orthopedics regarding its range of use and effects. Foot and ankle diseases have attracted little research attention, highlighting the need for further studies.

거골하 관절에서 발생한 통풍성 관절염을 동반한 골연골종(1예 보고)

곽희철,김전교,Gwak, Heui Chul,Kim, Jeon Gyo 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.4

Osteochondroma, which is an osteocartilaginous exostosis, is essentially the most common primary bone tumor. These benign neoplasms are generally asymptomatic and have a relatively small potential for adverse effects. Calcaneal osteochondroma is rare, furthermore osteochondroma accompanying with gouty arthritis is very rare. Also, the subtalar joint is not a classic site of acute gout. In this report, we report the case of a patient who experienced an unusual calcaneal osteochondroma with undiagnosed gouty arthritis of the subtalar joint.