동종건과 종골 터널을 이용한 만성 아킬레스건 파열 환자의 아킬레스건 재건술의 수술적 결과

김갑래,홍성엽,조중현,윤동영 대한족부족관절학회 2024 대한족부족관절학회지 Vol.28 No.1

Purpose: Achilles tendon rupture is a frequently encountered ankle pathology associated with a substantial burden of intense pain and functional deficits. Chronic Achilles tendon ruptures with considerable defects pose intricate repair challenges that are often marred by complications such as re-rupture and persistent pain. Various treatment methods, including allograft transplantation, have been pro- posed, but the literature on this technique is limited. In this study, we propose a surgical approach utilizing allotendon transplantation and a calcaneal tunneling technique and provide clinical evaluation details. Materials and Methods: Fifteen patients with chronic Achilles tendon ruptures treated with allotendon between 2020 and 2022 were included in the study. Patients were evaluated at 1, 3, and 6 months postoperatively using Visual Analog Scale (VAS) scores and Achilles Tendon Total Rupture Scores (ATRSs). Complications were assessed postoperatively. Results: The average VAS score was 7 before surgery, 7.3 immediately after surgery, and 4.3 at 1 month, 2.5 at 3 months, and 1.3 at 6 months after surgery. Because the sample was limited to 15 individuals and distributions were non-normal, the analysis was conducted using the non-parametric Wilcoxon’s signed-rank test, and statistical significance was accepted for p-values<0.05. Results showed a sig- nificant improvement in ATRS and VAS scores versus preoperative and immediate postoperative values. VAS scores showed a decreas- ing trend after surgery, whereas average ATRS scores increased from 14 before surgery, 33.8 at 1 month, 82.7 at 3 months, and 93.9 at 6 months. Conclusion: This study suggests that allograft transplantation using the described calcaneal tunnel technique provides an effective treat- ment for chronic Achilles tendon ruptures. However, extensive research and long-term clinical trials are required to validate and better understand the technique’s efficacy

뒤꿈치 족저부에 발생한 무균 농양(1예 보고)

김갑래,신성일,김태화,박현진,Kim, Gab-Lae,Shin, Sung-Il,Kim, Tae-Hwa,Park, Hyun-Jin 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.2

Heel abscesses present as heel pain that progressively worsens, with associated tenderness and fullness a the heel pad. To our knowledge, there are fews reports in the literature describing a spontaneous heel pad abscess. A 48-years old woman presented spontaneously with pain, erythema, edema and increased warmth to this right foot. She has no underlying disease and steroid injection history. A radiologic examination was suggestive of an abscess. Follow incision and drainage, cultures that were taken during the surgical procedure did not produce any organism. The patient was discharged home and recovered from the abscess without recurrence or further surgical intervention.

경도-중등도 무지외반증 환자의 생체 흡수성 마그네슘 나사못과 티타늄 나사못을 사용한 수술의 단기 결과 비교

김갑래,홍성엽,한우솔 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.3

Purpose: Hallux valgus (HV) is a common foot deformity that causes pain in the first metatarsophalangeal joint. Distal metatarsal osteotomies are commonly performed as a treatment. This retrospective study compared the clinical and radiological results of bioabsorbable magnesium (Mg) versus titanium (Ti) screw fixation for modified distal chevron osteotomy in HV. Materials and Methods: Forty-nine patients, who underwent modified distal chevron osteotomy for HV in 2018 and 2019, were reviewed retrospectively. Bioabsorbable Mg screw fixation was applied in 20 patients (22 feet), and a traditional Ti compression screw was applied in 29 patients (40 feet). The patients were followed up for at least six months. The clinical results were evaluated using the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were measured before, after surgery, and at the six months follow-up. Results: The AOFAS-MTP-IP scale and VAS points were improved in both groups, with no significant difference between them. At the six-month follow-up, HVA, IMA, and DMAA were similar. Bone union was confirmed in both groups, and there were no significant major complications in both groups. Four people in the Ti screw group underwent implant removal surgery. Conclusion: Bioabsorbable Mg screws showed comparable clinical, radiologic results to Ti standard screws six months after distal modified chevron osteotomy. These screws are an alternative fixation material that can be used safely and avoid the need for implant removal operations.

소건막류의 원위부 역위 사형 절골술 후 체중부하의 효과

김갑래,현윤석,신재혁,최상민,김권,박준식,Kim, Gab-Lae,Hyun, Yoonsuk,Shin, Jae-Hyuk,Choi, Sangmin,Kim, Kwon,Park, Junsik 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.4

Purpose: To evaluate the radiological and clinical effects of early weightbearing after distal reverse oblique osteotomy of bunionette. Materials and Methods: Between 2009 and 2015, 52 patients who underwent surgical treatment at our hospital for bunionette deformity with a minimum follow up of one year were included in the study. Postoperatively, foot cast was applied and full weightbearing was permitted in 28 patients. And short leg splint was applied with only partial weightbearing using crutches allowed in 24 patients. Clinical scores were evaluated. Radiologically, the 4th~5th intermetatarsal angle (IMA), and 5th metatarsophalangeal angle (MPA) were analyzed preoperatively and at the final follow up visit. Results: The visual analogue scale and American Orthopaedic Foot and Ankle Society scores improved in the partial weightbearing group and full weightbearing group, but without significant differences. The average 4th~5th IMA and average 5th MPA correction also did not showed significant differences between the partial weightbearing group and full weightbearing group. Moreover, the full weightbearing group did not encourage non-union rate compared with the partial weightbearing group. Conclusion: Effective bone union may be achieved through early weightbearing, resulting in better clinical outcomes. It is considered that early weightbearing did not have any effect on the changes of IMA and bone union.

아킬레스건을 포함한 뒷발굽 접촉성 피부 화상에 대해 시행한전외측 대퇴피부 피판술 및 아킬레스건 재건술: 증례 보고-기능적 회복을 위한 수술적 치료법-

김갑래,박준식,백승하 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.3

A 3rd degree burn on the heel including the Achilles tendon is vulnerable and requires active treatment to improve the functional outcomes. Previously, there have been a few treatments on severe burns, such as amputation, debridement or simple skin graft. The cooperative technique of an anterior lateral thigh flap with Achilles tendon reconstruction can be an innovative procedure that preserves the major arteries. The authors review a case and report the clinical outcome.

족관절 골절 수술에서의 유착방지제(Guardix^®)의 효과 연구

김갑래,권환진,Kim, Gab Lae,Kwon, Hwan Jin 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.4

Purpose: Reducing tenderness or pain on the ankle joint and improving the range of motion are thought to be possible using hyaluronate-based anti-adhesive agents. On the other hand, there are more aspects to be studied regarding the incidence of complications, such as resting pain, tenderness, and stiffness, after surgery. Therefore, the aim of this study was to prove the effectiveness of the agents after ankle fracture surgery. Materials and Methods: Patients, who underwent open reduction and internal fixation surgery due to ankle joint fractures from June 2015 to May 2016, were studied prospectively. Thirty patients of them received a $Guardix^{(R)}$ injection during their surgeries and were included in the injection group. The other 30 patients were included in the control group. Postoperatively, tenderness on the scar, a delay in wound healing, and the active range of motion were evaluated at 2, 6, and 12 weeks after surgery. Results: A significant difference in tenderness on the scar was observed 2 weeks after surgery. On the other hand, there was no significant difference at 6 and 12 weeks after the surgery. The agent-using group showed a 6.7% delay in wound healing and a 93.3% nondelaying. In the non-using group, the delay was 63.3%, while non-delay was 36.7% (p<0.001). The group that underwent $Guardix^{(R)}$ usage showed an effective result in the visual analogue scale, which was statistically significant (p<0.001). The result at 6 and 12 weeks after surgery showed a significant difference. Conclusion: Improvement was observed in the patients who underwent a $Guardix^{(R)}$ injection, regarding the range of motion, visual analog scale, and healing of the wound postoperatively.

봉합나사 및 금속강선 고정술을 이용한 월상골 주위 탈구에 대한 치료

김갑래,현윤석,신성일,박정섭,한결,홍성엽 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.4

Chronic lunate dislocations are very rare injuries comprising of less than 10% of all wrist injuries. Volar lunate dislocations account for less than 3% of perilunate dislocations. We present a case of a missed volar lunate dislocation for 6months after initial injury. He fell down and had hyperextension injury during his sports activity. When the patient visit in our hospital, neurologic symptom was devel- oped in distribution of median nerve. Tingling sensation and radiation symp- tom was found in affected hand. A plain radiograph revealed a volar lunate dis- location. Nerve conduction studies confirmed compression of the median nerve at the wrist, carpal tunnel level. Operation was performed with open reduction of lunate, fixation with K-wires and anchor suture. The outcome was excellent in relieving pain, function, range of motion, grip strength. There was improve- ment in Mayo wrist score and disabilities of the arm, shoulder and hand score. So we report a patient and a operation technique which can be considered in similar cases. 만성적 월상골 탈구는 매우 드문 손상이며 모든 완관절 손상의 10% 미만을 차지한다. 그 중 배측 월상골 탈구는 월상골탈구 중 3% 미만에서 발생한다. 환자는 과신전 상태로 넘어지며 수상하였으며 초기 손상 이후 6개월이 지난 상태였다. 내원시 제2-4 수지의 저리는 증상과 이상감각증이 동반되어 있었으며, 방사선 사진상 배측 월상골 탈구를 확인하였다. 이에 본 저자는 관혈적으로 탈구를 정복하고, 주상골-월상골-삼각골간의 근위부위를 봉합나사 및 금속강선을 이용하여 고정하였다. 수술 후 완관절의 통증완화, 운동범위 회복, 수술전의 기능회복 및 Mayo wrist score와 disabilities of the arm, shoulder and hand score상에서 좋은 결과를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

미국 연방증권법상 금융투자업자 규제의 새로운 경향

김갑래(Kab Lae Kim) 한국증권법학회 2009 증권법연구 Vol.10 No.2

미국의 금융투자업자 규제는 전통적으로 브로커?딜러를 규제하는 1934년 증권거래법 규제체제와 1940년 투자자문업자법 규제체제로 나누어져 있었다. 그러나 금융투자산업 및 금융상품이 다양화?비전형화되고, 금융위기의 극복과정에서 금융소비자 보호가 강조됨에 따라 전통적인 미국의 브로커?딜러와 투자자문업자에 대한 규제체제에 변화가 생기기 시작했다. 미국 금융산업의 고도화와 경쟁 격화로 인하여 수수료중심 브로커?딜러와 같은 1934년 증권거래법 규제범위와 1940년 투자자문업자법 규제범위의 중간영역에 존재하는 새로운 유형의 금융투자업자들이 등장함에 따라 기존의 이원화된 금융업자 규제체제의 적용범위 문제를 해결할 필요성이 증대되었다. 또한, 최근의 금융규제개혁안은 금융소비자 보호를 위해 전통적으로 투자자문업자에게만 적용하던 신인의무를 자문서비스를 제공하는 브로커?딜러에게도 확대 적용함으로써 브로커?딜러 규제체제와 투자자문업자 규제체제를 조화시키려 한다. 미국 연방증권법상 브로커?딜러와 투자자문업자에 관한 규제체제 변화는 2009년 2월 새롭게 출범한 우리 자본시장법 체제의 규제공백과 규제차익의 문제를 해결하며 동 체제를 발전시켜 나가는데 있어 큰 시사점을 준다. 미국의 브로커?딜러 규제체제와 투자자문업자 규제체제는 각각 고유한 법 원리를 발전시키며 균형 있게 발전하여 왔음에 반하여, 우리 투자자문업(투자자문?일임업) 규제체제는 투자판매업(투자매매?중개업 등) 규제체제에 비해 상대적으로 법적 정비가 덜 되어 있다. 현행자본시장법 체제는 자생적으로 태동하여 성장 초기단계에 있는 재무설계를 올바르게 규율하고 건전하게 육성할 법적 인프라를 갖추지 못하고 있다. 고령화?저임금이 세계적인 추세가 되고 금융위기와 메이도프 폰지 사건이 전 세계 금융시스템의 신뢰를 훼손하였던 최근의 금융시장 상황을 놓고 볼 때 우리 자본시장법하의 투자자문업 규제체제를 정비하고 규제공백을 메워야 할 필요성은 커진다. 자문서비스를 제공하는 금융투자업자에 대한 신인의무를 확대하여 규제차익을 해소하는 것을 내용으로 하는 미국 금융투자업자 규제체제의 변화는 우리 자본시장법 발전방향을 논의하는데 있어서 실질적 금융소비자 보호라는 화두를 던진다. 자문서비스제공 금융업자에 대한 신인의무 적용 논의의 핵심은 금융소비자는 투자자문업자가 제공하는 자문서비스와 브로커?딜러가 판매업무에 부수하여 제공하는 자문서비스간의 차이를 잘 인식하지 못하며, 양자에 대해 비슷한 수준의 신뢰감을 갖는다는 연구결과에 바탕을 둔 것으로서, 결국 금융소비자의 인식을 바탕으로 금융소비자의 신뢰를 실질적으로 보호하자는 것이다. 우리 자본시장법도 금융소비자보호중심적 금융투자업자 규제체제를 확립함으로써 금융시장의 신뢰성을 높이고, 결국 높은 시장신뢰가 금융시장을 활성화시킬 수 있는 방향으로 발전해야 할 것이다. In the U.S., the regulatory systems for financial professionals have been respectively developed under the two laws, the Securities Exchange Act of 1934 for broker?dealers (“BDs”) and the Investment Advisers Act of 1940 for investment advisers (“IAs”). However, to develop the financial products industry and overcome the recent financial crisis, the regulatory systems has to change. The fierce competition and innovation in the financial industry has produced new types of financial professionals and has blurred the boundary between the BD and IA regulatory systems. Therefore, it is necessary to clarify the scope of the application of each regulatory system on financial professionals. In addition, the investor protection measures in the financial regulatory reform include the harmonization of BD and IA regulatory systems. The study on the demarcation and harmonization of the U.S. regulatory systems for BDs and IAs will help develop the regulatory structure under the Financial Investment Services and Capital Market Act in Korea. While the BD and IA regulatory systems in the U.S. have been respectively evolved and have mutually affected each other’s development, the IA regulatory system in Korea is underdeveloped compared to the BD regulatory system. The regulation system for IAs under the Financial Investment Services and Capital Market Act does not provide the legal infrastructure necessary for nurturing the financial planning industry, which is at the early stage of its development. Given the trend of aging society and low interest rates, it is necessary to improve the Korean regulatory system for IAs and financial planners by closing the regulatory loopholes in the Financial Investment Services and Capital Market Act. In developing the Financial Investment Services and Capital Market Act in Korea, the U.S. trend for applying fiduciary duty to all financial advice providers can be considered as desirable to substantially protect financial consumers. The argument to expand the fiduciary duty to BDs is based on the RAND research that shows that retail investors do not understand differences between IAs and BDs when they provide advisory services. The argument is aimed to address the consumer confidence in the financial advice industry, where the traditional distinction between BDs and IAs is blurred. The efficient financial consumer protection will restore confidence in the financial products industry and will consequently activate the financial market.

Dodd-Frank 개혁과 미국 연방 법제하의 사모펀드 제도 연구

김갑래 ( Gyu Lim Kim ),김규림 ( Kab Lae Kim ),김상수 ( Sang Su Kim ),빈기범 ( Ki Beom Binh ) 한국재무관리학회 2013 財務管理硏究 Vol.30 No.1

본 고에서는 사모펀드(private investment pool)가 탄생하고 발달한 미국의 사모펀드 법제를 조사·연구하고, 이를 바탕으로 국내 사모펀드 제도에 관한 시사점을 제시한다. 미국 법제는 한국 제도 도입과 개선에 있어 항상 중요한 벤치마크가 되므로, 미국 사모펀드 법제를 정확히 이해하는 것은 매우 중요하다. 미국 시장에서 사모펀드는 다수의 연방증권법률과 관련되어 있다. 미국 사모펀드의 주요 법제적 특성을 살펴보기 위해서는 1933년 증권법, 1934년 증권거래법, 1940년 투자회사법, 1940년 투자자문사법, 상품거래법 등 이상의 5개 법률에서 사모펀드와의 관련 조항을 분석해야 한다. 나아가, ``도드-프랭크 개혁``에 의해 다수의 연방증권법률의 큰 변화가 있었기에 변화된 사모펀드 관련 조항을 파악해야 한다. 본 고에서는 상기 5개 연방증권법률에서 예외나 면제 조항을 두어 자유로운 사모펀드의 결성과 운영을 가능하게 하는 법제적 요소에 집중하여 연구하였다. 사모펀드에 관한 미국 법제에 있어 두 가지 사항을 주목해야 한다. 첫째, 펀드와 운용자를 구분하여 펀드 자체에 대한 규제는 거의 없거나 최소화되어 있다는 것이다. 둘째, 도드-프랭크법을 통한 규제 강화에도 불구하고 벤처캐피탈 펀드나 PEF 및 운용자에 대한 규제에 있어서는 매우 보수적이라는 것이다. 미국 사모펀드 법제 특성은 한국 사모펀드 제도의 개선에 관하여 시사하는 바가 크다. 첫째, 사모펀드의 경제적 의의와 기능을 투자자, 금융당국, 국회 모두 이해할 필요가 있다. 둘째, 펀드와 운용자를 구분하여 펀드에 대한 규제는 크게 완화할 필요가 있다. 셋째, 상품시장(commodity market)을 육성할 필요가 있다. In this paper, we survey U.S. federal securities laws related the private funds and provide the implications for Korean private funds scheme. It is necessary to comprehend U.S. securities regulations because Korean policymakers and legislators frequently use them as a benchmark. To do this, we analyze private funds-related regulations based on the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Company Act of 1940, the Investment Advisers Act of 1940, and the Commodity Exchange Act and reflect on changes brought about by Dodd-Frank Wall Street Reform and Consumer Protection Act. The Dodd-Frank Act reforms and tightens significant regulations of investment advisers for the purpose of investor protection and systemic risk control. However, noteworthy is the separate regulatory scheme for funds and that for investment advisers. This means that there are some registration exemption provisions for private funds and for their investment advisers. Moreover, the regulations for venture capital funds or private equity funds and their investment advisers are very conservative. The U.S. regulations on private funds have policy implications for the Korean capital market. First, investors, regulators, and legislators in Korea could better understand the positive role and significance of private funds. Second, a review of the U.S. regulations can facilitate the process of reducing Korean fund-level regulations, which should be reduced by separating those on fund managers and those on the funds that they manage. Third, Korean policymakers should consider and implement measures to develop the commodity market.

기업의 사회적 책임에 관한 미국 판례 분석

김갑래(Kim, Kab Lae) 한국증권법학회 2012 증권법연구 Vol.13 No.1

오늘날 세계적 금융위기를 거치면서 경제양극화와 빈부격차가 심화됨에 따라 기업의 사회적 책임(CSR)에 대한 사회적 요구가 증대되고 있다. 또한 기업이 주변 생태계의 건전한 발전 없이 지속가능성을 유지하기 어렵다는 현실로 인해 최근 공유가치경영에 관한 사회적 관심이 고조되고 있다. 이러한 시점에서 본질적으로 영리추구를 목적으로 하는 회사의 사회적 성격과 CSR 관련 이사의 선관의무에 대해 법적으로 고찰하는 것은 의미 있는 작업으로 사료된다. 본 논문에서 분석한 미국 CSR 관련 판례와 입법례는 우리 상법상 기업의 사회적 책임에 관한 법해석론적·입법정책적 관점에서 시사하는 바가 크다. 정부 주도의 경제개발계획을 토대로 대기업 위주로 성장한 우리 경제는 주주중심주의적 기업문화와 이해관계자중심주의적 기업문화를 모두 경험하지 못하였다. 이로 인해 우리 경제는 주주중심주의와 이해관계자중심주의를 동시에 균형 있게 발전시켜야 하는 이중 과제를 안고 있다. 미국의 CSR 관련 판례 및 입법례는 회사의 장기적 수익성과 관련성이 있는 범위에서 경영판단의 원칙에 입각한 회사의 사회공헌 활동을 인정한다는 점에서 주주중심주의와 이해관계자중심주의가 균형을 이루는 법적 접근방법을 제시한다. 본 논문은 우리 경제가 기업과 주변 생태계간의 동반성장을 통해 지속가능한 발전을 이루기 위한 법적 인프라 구축에 필요한 기초 연구자료로 활용됨을 연구목적으로 하였다. 여기서 분석한 미국 CSR 관련 판례 및 입법례는 경제 현실이 다른 우리회사법제에 그대로 적용되기 어려울 수 있다. 그러나 미국의 CSR 법적 모델은 기업의 영리성과 사회성의 균형점을 지향하고 있다는 점에서 의미 있는 법적 접근방법을 제시하고 있다. 이러한 접근방법은 오늘날 기업가치(기업이익극대화)와 사회가치(사회발전)가 교차하는 공유가치를 창출하려는 혁신적 회사기업에게 유용한 법적 인프라로서 기능할 것을 기대한다. The demand for corporate social responsibility (CSR) is increasing in Korea as the economy becomes increasingly polarized. The Korean economy experienced rapid government-driven growth and did not have enough time to embed shareholder primacy or stakeholder approach in the corporate culture. Corporations’ social roles are confused in Korea. At a crossroads of whether the Korean economy develops into an advanced one, it should balance shareholder primacy and stakeholder protection in CSR-related issues. This article was written to help create a legal infrastructure where CSR activities increase both profitability and social value thereby meeting corporate directors’ fiduciary duties and social demands for CSR. The case studies on CSR in the U.S. show that corporate directors have discretion in CSR decisions under the business judgment rule. However, the studies, suggest that CSR decisions should not sacrifice a corporation’s long-term interests and sustainability. This article argues that the legal policy and interpretation regarding CSR should focus on long-term profitability and sustainability. The argument is suitable for the current business environment where CSR is incorporated into innovative management strategies such as Creating Shared Value (CSV).