Rapid Loc 기기를 이용한 관절경적 반월상 연골판 봉합술

권덕주,이기병,정웅교,이병택,박상욱,Kwon, Duck-Joo,Lee, Kee-Byung,Joeng, Woong-Kyo,Lee, Byung-Taek,Park, Sang-Wook 대한관절경학회 2005 대한관절경학회지 Vol.9 No.2

목적: 본 논문의 목적은 Rapid Loc 기기를 이용한 관절경적 연골판 봉합술의 임상적, 방사선학적 결과를 평가하고자 하였다. 대상 및 방법: 44례를 대상으로 후향적으로 결과를 분석하였다. 퇴행성 병변이 동반되지 않은 단순 종파열로 진단되어 관절내시경하에서 Rapid Loc 기기를 이용하여 연골판을 봉합한후 평균 6개월이상의 추시가 가능하였던 환자 군을 대상으로 하였다. Orthopaedische Arbeitsgemeinschaft Knie (OAK) 평가 지표와 자기 공명 영상 촬영을 이용하여 임상적 방사선학적 결과를 평가하였다. 관절연 압통, 관절내 부종, McMurray 검사에서 양성인 경우는 임상적 실패로 간주하였다. 결과: 평균 연령은 33.4세 평균 추시기간은 15개월이었다. 임상결과는 우수 15례(34.1%), 좋음 20례 (45.5%), 양호 7례(15.9%), 불량 2례(4.5%) 였다. MRI상 Reicher 분류를 이용한 방사선학적 평가에서 grade 1 15례(33.3%), grade II 21례(50%), grade III 7례(16.7%)였으며, 임상적 실패는 8례(18%)였다. 술후 합병증은 1례에서 발생되었다. 결론: Rapid Loc 기기는 연골판 봉합술에 있어서 매우 우수한 결과를 보였으며, 삽입물이 유연하여 연골 손상이 적고, 사용이 간편하고 파열 부위의 압박 정도를 조절 할 수 있는 등 많은 장점이 있는 기법이라 사료된다. Purpose: To purpose of this study is to evaluate the clinical and radiological results of arthroscopic meniscus repair using Rapid Loc device. Materials and Methods: A retrospective study was performed on 44 cases which had been turned out longitudinal tear without degeneration. We repaired all cases with Rapid Loc device. Patients were evaluated using clinical examination, Orthopaedische Arbeitsgemeinschaft Knie (OAK) scheme, and MRI. We regarded patients with joint line tenderness, swelling or McMurray positive test as clinical failure. Results: A mean age was 33.3 years and follow-up period was average 15 months. Clinical results were excellent 15 cases(34.1%), good 20 cases(45.5%), fair 7 cases(15.9%), poor 2 cases(4.5%). MRI showed grade 115 cases(33.3%), grade II 22 cases(50%), grade III 7 cases(16.7%). Clinical failures were 8 cases and only one complication was developed. Conclusion: Rapid Loc device showed the excellent results in meniscus repair. We regard it has a lot of advantages in safety, softness, ease, ability to control tension at repair site.

생체 흡수성 판과 나사못을 이용한 족근 관절 골절의 치료

권덕주,이용범,신준,Kwon, Duck-Joo,Lee, Yong-Beom,Shin, Jun 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: The purpose of this article is to assess the efficacy of a bioabsorbable polylactide (PLA) plate and screw for treating injuries of ankle fractures. Materials and Methods: 24 patients who underwent an open reduction and internal fixation operation for ankle fractures from July 2005 to March 2007 were enrolled into the study. There were 15 men and 9 women. The average age of the patients was 44 years and the average follow-up period was 16 years and two months (16.2 months). All cases were divided into low grade fracture patient (11) who belongs in type A and B of Danis-Weber classification and high grade fracture patient (13) who belongs in type C1, C2 of Danis-Weber classification, and each groups were analyzed by clinical (Meyer score) and radiological finding at the time of their last follow-up evaluation. Results: The clinical results according to Meyer scoring system, showed that all patient with low grade fracture had good to excellent result, but only 54% of patient with high grade fracture had good to excellent result. According to Cedell's radiologic finding, there were 91% cases above fair in low grade fracture. But there were 62% of patient above fair result in high grade fracture, the reduction losses were seen in 38% of patient with high grade fracture. Conclusion: Bioabsorbable PLA plate and screw is good internal fixation device which doesn't have additional operation for removal of implant because of slow absorption within the human body. It showed sufficient strength for acquisition and maintenance of reduction in low grade fracture, but need attention to use because of many cases of reduction loss in high grade fracture. So, it seems to be safe and effective when used in heeling of low grade fracture under considering about type of fracture sufficiently.

족근골 결합에 의한 족근관 증후군의 수술적 치료

권덕주,박상욱,Kwon, Duck-Joo,Park, Sang-Wook 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: Study was to evaluate the operative results for tarsal coalition with tarsal tunnel syndrome. Materials and Methods: From Jan. 2005 to Mar. 2006, among a number of patients who were diagnosed with tarsal tunnel syndrome caused by tarsal coalition and treated surgically, 5 patients were closely observed for more than 12 months. All cases were talocalcaneal coalition and there were two male and three female patients with a mean age of 36 years (22-50 years). We used the Takakura rating scale as clinical evaluation. Results: All five patients had a burning pain in the sole or extended to toes and showed positive Tinel's sign. Sensory disturbances were observed in the distribution of the medial plantar nerves in four patients and in the area of the medial and lateral plantar nerves in one. Atrophy and weakness of the plantar muscles were seen in two patients. The mean Takakura scale in preoperative and postoperative was 3.4 points (1 to 5 points), 8.6 point (6 to 10 points). The mean follow up was 14.4 months (12 to 16 months). The postoperative results were excellent in two patients, good in two and fair in one. As postoperative complications, there were persistent swelling in one patient and a flexion disturbance of Hallux in one. Conclusion: The coalition resection performed on tarsal tunnel syndrome caused by tarsal coalition could improve a level of pains and neurological symptoms significantly. However, since there were some undesirable complications, a detailed explanation to patients is required prior to surgical treatment and study of such complications may be required.

중증도 이상의 무지 외반증에서 Ludloff 절골술의 결과

권덕주,송시영,이기병,이남규,최준하,Kwon, Duck-Joo,Song, Si-Young,Lee, Kee-Byung,Rhee, Nam-Kyou,Choi, Jun-Ha 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: To evaluate the clinical and radiologic results of the Ludloff osteotomy for moderate to severe hallux valgus deformity retrospectively. Materials and Methods: Between January 2003 and October 2006, 33 patients (42 feet) who had undergone with Ludloff osteotomy combined with distal soft tissue procedure were followed up for more than one year. The average follow-up period was 14.6 months and the average age at the time of surgery was 47.7 years (26-70 years). The American Othopeaedic Foot and Ankle Society (AOFAS) score was used for clinical outcome assessments. We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA) and the degrees of the tibial sesamoid subluxation in preoperative and the last follow-up radiographs. Results: The AOFAS score improved from a preoperative average of 45.6 points to an average 84.3 points at the last follow-up. HVA and IMA were 34.8 and 14.5 degrees preoperatively, 17.2 and 5.9 degrees at the last follow-up. The tibial sesamoid position improved from a preoperative average of grade 2.5 to the last follow-up average of grade 1.2. Conclusion: Ludloff osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

변형된 Outside-In 기법을 이용한 반월상 연골판 봉합술 - 수술 수기 -

이기병,권덕주,이영건,송영준,Lee Kee-Byoung,Kwon Duck-Joo,Lee Young-Gyun,Song Young-Joon 대한관절경학회 2003 대한관절경학회지 Vol.7 No.1

관절경술의 발달과 반월상 연골판의 기능적 중요성이 강조됨에 따라 반월상 연골판 봉합술은 나날이 발전 되어왔다. 그러나 종래의 기법들은 특별한 기구뿐 아니라 신경, 혈관, 연부조직의 손상을 방지하기 위하여 과다한 피부 절개가 필요하거나, 봉합사 매듭이 관절면에 존재하므로 잠재적인 연골손상의 위험성을 가지고 있었다. 이에 저자들은 spinal needle과 nylon loop를 이용한 변형된 outside-in 기법을 소개하고자 하며, 변형된 outside-in 기법은 안정적이고 간단한 봉합이 가능하면서도 별 도의 피부절개가 필요 없는 장점을 가지고 있다. As arthroscopy is more advanced and the importance of meniscal function is more emphasized, there have been more advanced en meniscal repair technique. However conventional technique require the use of special instruments and extensive skin incision to protect the neurovasculatures and soft tissues. Also these have the potential problem of damage in articular surfaces by the knot. So, we develop a modified outside-in technique using spinal needles and nylon loops. Our method have many advantages not only in stability but simplicity, and there is no need of additional skin incision.

전방십자인대 재건술후 대퇴골 경골핀 고정의 실패 - 증례보고 -

이기병,권덕주,지용남,Lee Kee-Byoung,Kwon Duck-Joo,Ji Yong-Nam 대한관절경학회 2003 대한관절경학회지 Vol.7 No.1

34세 남자 환자로 등산중 실족으로 발생한 전방십자인대의 완전파열로 자가 슬괵건을 이용한 경핀 고정법으로 전방십자인대 재건술을 시행하였다. 술후 경과는 양호하였으나 술후 3개월째 굴신 신전 운동 시 슬부 후측면의 동통과 지속적인 관절내 부종 소견을 보였으며 수차례의 관절천자와 약물투여에도 반응이 없었다. 컴퓨터 단층 촬영 상후방 피질 골의 천공이 관찰되어 술후 6개월째 이차관절내시경 수술을 시행하였다. 내시경 소견상 경핀고정물의 전방부 1/3에 일치되는 투명한 이물질과 대퇴경골관절면의 연골의 손상이 관찰되었으며 이물 제거 후 증세는 호전되었다. 경핀 터널의 잘못된 위치가 실패의 원인이라고 생각되었으며 경핀고정법을 이용한 전방십자인대 재건술시, 슬관절 과굴곡 상태에서 예각의 대퇴 터널을 만들어 후방 피질 골을 두껍게 남기고, 핀 홀을 만들 때 경핀가이드를 횡상과축보다 $10\~20$도 외회전시켜야 대퇴골 후방피질골의 천공을 방지할 수 있어 조기 실패를 예방할 수 있다고 생각된다. A 34-year-old man with ACL total rupture due to slip down injury, had received ACL reconstruction using autogenous hamstrings tendon with cross-pin femoral fixation. Postoperative course was as usual. But postoperative 3 months later, he complained posterolateral knee pain, recurrent effusion and mild instability. He was managed repeatitive aspiration and nonsteroid antiinflammatory drugs but was failed to relieve symptoms & signs. In CT scans, perforation of posteromedial femoral cortex of lateral femoral condyle was found. In second look arthroscopy, two pieces of broken femoral cross pin were found in between tibiofemoral Joint which was badly injured cartilage. We considered malposition of pins was the main cause of failure. We propose that femoral tunnel must be made more acute angle and femoral cross-pin guide must be positioned more external rotation 10-20 degree than transepicondylar axis made confirm the cross-pin tunnel position in order to avoid posterior cortex perforation and early failure.

종골 골절의 나사못 고정 후 발생한 내측 족저 신경 손상

권봉철 ( Bong Cheol Kwon ),신용운 ( Yong Woon Shin ),권덕주 ( Duck Joo Kwon ),이남규 ( Nam Kyou Rhee ) 대한골절학회 2006 대한골절학회지 Vol.19 No.2

We present a case of medial plantar nerve injury by screw tip after open reduction and internal fixation of intraarticular calcaneus fracture. We reviewed the risk and prevention technique of medial plantar nerve injury in fixing the calcaneus fracture.

체외충격파를 이용한 테니스 엘보우의 치료

이석범(Seok-Beom Lee),권덕주(Duck-Joo Kwon),송영준(Young-Joon Song),이기병(Kee-Byung Lee) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.2

목적: 본 연구는 주관절 외 상과염에 대한 체외충격파 치료의 효과를 알아보고자 시행되었다. 대상 및 방법: 불응성 외 상과염을 가진 24병의 환자에게 체외충격파 치료를 하였다. 치료효과 판정을 위해 visual analog scale (VAS)을 이용한 통증 평가와 simple elbow test (SET)를 이용하였다. 전체적인 평가를 위해 추시 1년에는 Roles와 Maudsley의 평가방법을 이용하였다. 결과: 추시 1년뒤 Roles와 Maudsley 평가결과 20명(83%) 환자들에게서 만족한 결과를 볼 수 있었고 SET와 VAS의 평균 점수는 체외충격파 치료후 통계학적으로 의미있게 호전되었다(p<0.05). 결론: 본 연구는 주관절의 불응성 외 상과염에 대한 체외충격파의 치료가 비침습적이면서도 효과적인 치료 수단이 될 수 있음을 시사하고 있다. Purpose: The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) an lateral epicondylitis of the elbow. Materials and Methods: Twenty-four patients with refractory lateral epicondylitis were treated with shock waves. The patients were evaluated by assessing of pain using visual analog scale (VAS) and a simple elbow test (SET). Overall clinical outcomes were evaluated using Roles and Maudsley scores at 12 months after ESWT. Results: Significant symptom improvement were observed in 20 (83%) patients at the 12 months follow up according to the Roles and Maudesley scores. Average SET and VAS scores were also significantly improved after ESWT (p<0.05). Conclusion: This study suggests that shock waves therapy could be considered as an effective and noninvasive treatment modality for refractory lateral epicondylitis of the elbow.

슬관절 연골 병변에 대한 관절경과 일상적 MRI의 비교

이기병 ( Kee Byoung Lee ),고성혜 ( Sung Hye Koh ),권덕주 ( Duck Joo Kwon ),서규남 ( Kyu Nam Seo ),이남규 ( Nam Kyou Rhee ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.2

목적: 연골을 평가하기 위한 MRI 촬영 기법이 포함되지 않은 일상적 슬관절 MRI가 연골 병변에 대하여 어느 정도 예측 가능 한지 관절경과 비교하고 분석하여, 발견된 연골 병변에 대하여 적절한 치료 계획을 세우는데 도움이 되고자 하였다. 대상 및 방법: 2003년 11월부터 2006년 1월까지 무릎 관절경을 시행한 환자 중 대퇴골 내측과에 연골 병변을 가진 53명의 환자를 대상으로 관절경과 일상적 MRI가 연골 병변에 대하여 어느 정도 일치 하는지 변형된 Outerbridge 등급을 이용하여 비교 분석하였다. 결과: 변형된 Outerbridge 등급 I~IV에 해당하는 경우는 각각 관절경에서 3, 4, 24, 22례, MRI에서 3, 10, 12, 23례, 정상이 5례였다. 연골 병변 유무에 대한 민감도(sensitivity)는 90.6%로 높았으나 일치도는 낮았다(K=0.24). MRI와 관절경의 등급이 일치하는 경우는 24례(45.2%), 일치하지 않는 경우는 29례(54.7%) 였다. 결론: 연골을 평가하기 위한 MRI 촬영 기법이 포함되지 않은 일상적 MRI에서도 연골 표면을 세밀하게 관찰하는 것이 중요하며, 일상적 MRI에서의 연골 병변은 실제 더 높은 등급의 병변으로 고려하여야 한다. Purpose: The cartilage lesions of routine MRI (no cartilage-specific image sequences) compared with those of arthroscopy for detecting how much we can predict. Materials and Methods: We made a retrospective study of 53 patients with cartilage lesions of medial femoral condyle in the knee arthroscopy from Nov. 2003 to Jan. 2006. We analyzed the extent of agreement in cartilage lesions between arthroscopy and routine MRI using modified Outerbridge classification. Results: All patients were categorized by modified Outerbridge Grade I~IV. In arthroscopy, 3, 4, 24, 22 cases were reported in each category: on routine MRI, 3, 10, 12, 23 cases were reported in each category and there were 5 normal cases. The sensitivity of cartilage lesions on MRI was high (90.6%), however, the agreement of those was low (K=0.24). We found 24 cases (45.2%) that MRI levels and arthroscopy levels were matched. We found 29 cases (54.7%) that those two levels were not matched. Conclusion: It is important to make a close inspection of chondral surfaces even in routine MRI. And cartilage lesions in routine MRI should be considered as those of higher grade in arthroscopy.

랫드 슬관절의 내측 및 외측 측부인대와 슬개건을 지배하는 척수신경절의 분포

신성일(Sung Il Shin),박인헌(In Heon Park),송경원(Gyung Won Song),이진영(Jin Young Lee),박성진(Sung Jin Park),권덕주(Duck Joo Kwon),안준호(Jun Ho Ahn),현윤석(Yun Seok Hyun) 대한정형외과학회 2001 대한정형외과학회지 Vol.36 No.5