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M. chelonae Soft Tissue Infection Spreading to Osteomyelitis
김려섭,김준식,최동훈,권도승,정재훈 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.1
A previously healthy, 54-year-old woman presented with Mycobacterium chelonae soft tissue infection and osteomyelitis of her left lower leg. The infection had started from soft tissue emerging at the medial aspect of the distal femur and had spread through the bone because of delayed diagnosis. The largely indolent, 8-month course to diagnosis was attributable to unremarkable clinical manifestations combined with a low index of suspicion such as immunocompetent patient and/or inadequate finding of acid-fast bacilli in a lesion smear, characteristic histopathological features, and culture techniques. Soft tissue infection and osteomyelitis were successfully treated without surgical intervention and with a 6-month course of chemotherapy.
김려섭,강준순,김영태,김범수,Kim, Ryuh-Sup,Kang, Joon-Soon,Kim, Young-Tae,Kim, Bom-Soo 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4
Purpose: This study was designed to analyze the usefulness of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in diagnosing symptomatic accessory tarsal bones. Materials and Methods: Twenty four feet (16 patients) with symptomatic accessory navicular and/or os trigonum, who agreed to take SPECT/CT, were included in this study. Fifteen feet had accessory navicular, five had os trigonum, and four had both. According to the uptake in the SPECT/CT, 11 feet were classified into high and 13 into low uptake groups. The low uptake group was treated non-operatively, while the high uptake group received operations when initial conservative management failed. A modified Kidner procedure was performed for accessory navicular and arthroscopic excision was done for os trigonum. After a mean follow-up of 6.8 (range, 3~13) months, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS) for pain were compared. Results: Patients in the high uptake group had a higher initial mean VAS score ($7.0{\pm}0.8$ vs $2.2{\pm}0.9$, p<0.05) and a lower initial mean AOFAS score ($45.9{\pm}9.2$ vs $83.9{\pm}4.2$, p<0.05) compared to the low uptake group. All patients in the low uptake group improved after non-operative treatment. Seven patients underwent operations and had a decreased VAS ($1.6{\pm}0.5$) and an increased AOFAS score ($88.3{\pm}1.8$) at the last follow-up. Four patients in the high uptake group demonstrated erratic symptoms. Conclusion: SPECT/CT can be a useful diagnostic tool and helpful in designing treatment plans for symptomatic accessory navicular and os trigonum.
전위된 상완골 과간 골절의 재건판을 이용한 수술적 치료
김려섭 ( Ryuh Sup Kim ),이동주 ( Tong Joo Lee ),문경호 ( Kyoung Ho Moon ),박승림 ( Seung Rim Park ),이문 ( Moon Lee ) 대한골절학회 2007 대한골절학회지 Vol.20 No.2
목 적: 상완골 원위부 과간 골절의 수술적 치료로 주두 갈매기 절골술과 양측 재건판을 이용한 방법의 치료 결과를 분석하였다. 대상 및 방법: 1997년 6월부터 2005년 10월까지 본원에서 상완골 원위부 과간 골절로 수술적 치료를 받은 환자 중 1년 이상 추시 가능한 26예를 대상으로 하였고, 평균 추시기간은 15개월이었다. 주두 절골은 모두 갈매기 절골을 시행하였고, 상완골 원위부 내외측에 재건판을 이용한 내고정술을 시행하였다. 척골신경은 수술 중 모두 확인하였고, 환자의 상완골 원위부의 해부학적 양상상, 재건판을 고정할 때 척골신경을 자극할 것으로 사료되는 3예는 척골 신경 전방 이동술을 시행하였다. 술 후 기능적 평가와 운동범위 평가는 추시 3개월, 6개월, 1년에 Cassebaum의 분류와 Mayo elbow performance score를 이용하였다. 결 과: 평균 골유합 기간은 11.7주였으며, 기능적 평가는 우수 9예, 양호 11예, 보통 4예였다. 운동범위는 평균 굴곡구축 11˚, 후속굴곡 126˚이었다. 결 론: 갈매기 주두 절골 및 재건판을 이용한 양측 내고정술은 타 고정방법에 비하여 비교적 견고한 내고정을 얻을수 있어, 조기 재활치료가 가능하며, 좋은 임상적 결과를 얻을 수 있다. Purpose: To evaluate the therapeutic effects of chevron olecranon osteotomy and bilateral reconstruction plate as operative treatment for distal hum erus intercondylar fracture. Materials and Methods: Among patients operated for distal hum erus intercondylar fracture in our hospital from June, 1997 to October, 2005, 26 patients were selected who could be follow ed-up form ore than one year. The average follow-up period was 15 months. All olecranon osteotom ies were chevron osteotomy and all fractures were treated with internal fixation using bilateral reconstruction plate. The ulnar nerve was checked in all cases. Three patients in which case the plate might irritate the ulnar nerve, received with ulnar nerve anterior transposition. Cassebaum`s classification and Mayo elbow performance score were used to evaluate at three, six and twelve months. Results: Mean bone union period was 11.7 weeks. There were 9 excellent cases, 11 good cases, 4 fair cases and 2 poor cases. Mean flexion contracture was 11˚ and further flexion was 126˚ at last follow-up. Conclusion: Bilateral reconstruction plate internal fixation using chevron olecranon osteotomy showed strong fixation and good clinical results and it is possible for early rehabilitation treatment.