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골수강내 교합정을 이용한 경골 간부 골절의 치료에 있어서 Reaming type 과 Unreaming type의 비교
김수곤,김철현,김재혁,김익곤 대한골절학회 1995 대한골절학회지 Vol.8 No.3
The authors analyzed 41 cases of fresh diaphyseal fracture of tibia who were treated with intramedullary interlocking nail between Oct. 1991 to Oct. 1993. in Hae-Dong hospital and followed up for 12 months or more. Among 41 cases, 18 cases were treated with reamed nailing method, and the others with unreamed method. The authors compared the results of 2 type of nailing method and obtained the following results. 1. Most of the cases(63%) had injury in their third and forth decade. Male was 31 cases. 2. The most common cause of injury was traffic accident(61%). 3. The mean bony union time was 16.5 weeks in reamed case, and 15.6 weeks in unreamed case. 4. The patients were judged to have good or excellent result in 89% of reamed cases and 87% of unreamed cases according to functional result by Klemm and Borner13) The merits of unreamed intramedullary interlocking nail were relatively easier in procedure, short operation time, and less bleeding. So the authors concluded that unreamed intramedullary interlocking nail is useful method to treat the tibial diaphyseal fractures, especially in open fracture, elder patient and complicated patient
김철현,김재혁,김익곤,황룡 대한골절학회 1998 대한골절학회지 Vol.11 No.1
The bone is the dynamic living tissue which is always maintained bone mineral content by bone resorption and formation. Osteoporosis is most common metabolic bone disease which is characterized by decrease of bone matrix, resulting in generally reduced bone mass. For measurement of the degree of osteoporosis, various methods have been used. The Singh' s index and the cortical shaft index of the proximal femur anteroposterior X-ray film are very simple methods to measure degree of osteoporosis. Authors compared Singh s index and cortical shaft index with Dual Energy X-ray Absorptiometry(DEXA) and studied the correlation and clinical usefulness of two indices. We took Singh s index and cortical shaft index in proximal femur A-P view in 103 patients and also performed DEXA, then analyzed and compared each two indices with DEXA. The cortical shaft index had less interpersonal difference and intrapersonal difference than those of Singh s index. The correlation coefficient of CSI(0.660-0.669) was larger than that of Singh s index(0.530-0.590) (p$lt;0.05). We think CSI is more useful method in the diagnosis and grading of osteoporosis than Singh s index.
요추부 골절 환자군과 정상군의 골밀도와 골절 역치 비교
김재혁,김익곤,홍영일,김정일 대한골절학회 2001 대한골절학회지 Vol.14 No.2
Purpose : The purpose of this study was to show how bone mineral densities of the lumbar spine decrease with aging, to investigate the relationship between the bone mineral densities of the control and fracture group, and to obtain fracture threshold values. Materials and Method: From January 1995 to December 1999, we measured and evaluated BMD of L3 by DXA in 239 normal volunteers(96 men and 143 women), and in 218 patients with lumbar spine fracture(91 men and 127 women) above 50 years. The Chi-Square test was used for statistical analysis. Results: 1. The average BMD of L3 in control group and lumbar spine fracture group were 0.772±0.030 g/㎠ in male and 0.732±0.089g/㎠ in female and 0.720±0.031g/㎠ in male and 0.692±0.002g/㎠ in female, respectively. 2. The BMD of the control group and fracture group decreased with aging(p$lt;0.05) and were higher in men than in women. There were statistically significant difference(p$lt;0.001). 3. There were statistically significant difference between BMD of the control group and BMD of the lumbar spine fracture group(p$lt;0.05). The BMD were higher in the control group than fracture group. 4. Fracture threshold of the lumbar spine fracture group were 0.867g/㎠ (male:0.898g/㎠, female:0.836g/㎠) according to 90 percentile.
김철현,김재혁,김익곤,황룡 대한골절학회 1998 대한골절학회지 Vol.11 No.2
Clavicle fracture is one of the most common fracture, which had been managed via conservative methods with some exceptions such as nonunion. Operative treatment had been regarded as an important cause of nonunion and poor outcome. Nowadays, however, the goal of fracture treatment has become anatomical reduction, rigid fixation and early rehabilitation for better final results. We managed 43 clavicular shaft fracture which was displaced above 11 mm, with conservative treatment (23 cases) and operative treatment (20 cases) since 1990 to 1995. All patients achieved good union in both group, except 5 nonunions of conservative treatment and no significant difference in union time. By functional evaluation of shoulder by Weitzman 23), final results were excellent in 17, good in 2 case., fair in 1 case with operative treatment and excellent in 12, good in 4, fair in 3 and poor in 4 cases with conservative treatment. It was concluded that early operative treatment of clavicular shaft fracture showed better result than conserative treatment, especially in displaced and comminuted ones.
수지골 골절의 수술적 치료에 대한 Miniplate 의 유용성
김철현,박철홍,김재혁,김익곤 대한골절학회 1997 대한골절학회지 Vol.10 No.1
Before the introduction of internal fixation, the healing of a fracture was an unpredictable event. Internal fixation provides stability, and fractures heal predictably. The miniplate is used for unstable metacarpal and phalangeal fractures of the hand to provide stability and to allow early motion. We analysed 32 patients, 41 cases of metacarpal and phalangeal fractures of the hand which were treated with miniplates from Jan. 1990 to June 1995. The following results were obtained. l. Mean age was 35 years and the male was predominent (81.3%). The most common fracture site was the metacarpal(51.2%). 2. TAM(total active motion) was 2240 in average and the best result was obtained in the metacarpal fractures(TAM = 239). The roentgenographic union was l6.8 weeks in average. 3. There were 6 complications(complication rate 14.6%) which were 3 cases of joint stiffness, a case of wound infection, a case of loss of reduction, and a case of delayed union. 4. Miniplate fixation is considered to be an useful method to get fracture union and goad range of motion with low complication rate in the treatment of metacarpal and phalangeal fractures of the hand.
상완골 간부 골절의 금속판 내고정술과 Ender 정 고정술과의 치료 비교
김철현,김재혁,김익곤,백수동 대한골절학회 1996 대한골절학회지 Vol.9 No.1
The humerus is anatomically and physiologically unique bone: firstly, it is a non-weight bearing bone; secondly, it has greatest range of motion; thirdly, while the person is standing, the axis of bone hangs vertically and is influenced by gravity, and conservative methods are usually used in treatment. However, in the cases of closed reduction failure, open fracture, multiple fracture, and old age etc, operative methods may be employed. This decision should be based on the type, location of fracture, the presence of concomittent injuries, the age, and the general condition of the patient. When open reduction and internal fixation is carried out, the periosteum and soft tissue attachment is stripped off and operative time is longer. Flexible Ender nailing is a simple procedure which does not disrupt or strip off periosteum and soft tissue at the fracture site, and decreases the chance of infection and allows early exercise. Authors carried out fixation in 28 patients and Ender nailing in 24 patients having humeral shaft fractures who were treated at the orthopedic department, Hae Dong hospital from March, 1990 to February, 1994.
Reconstruction plate 릉 이용한 성인 전위성 쇄골 간부 골절의 수술적 치료
김재혁,김익곤,황룡,홍영일 대한골절학회 2000 대한골절학회지 Vol.13 No.4
Purpose: The purpose of this study was to know the usefulness of bony union and faster recovery of shoulder motions by the open reduction and internal fixation with the reconstruction plate for the displaced clavicle shaft fracture of adults. Material and method: From January 1993 to December 1997, for 5 years, we analyzed 28 cases which underwent for a year of displaced clavicular shaft fracture over 11mm after open reduction and internal fixation with the reconstruction plate and supplementary iliac bone graft. Result: At all 28 cases, there were united without delayed union for average 7.2 weeks after operation. Motion of the shoulder joint were returned to normal within 1.8 weeks except two cases who had combined humerus fracture and partial gastrectomy for peptic ulcer. Conclusion: It seems that operative treatment with the reconstruction plate and supplementary bone graft for the displaced clavicle shaft fracture of adults showed effective union and faster recovery of shoulder motions.
고관절부 골절환자군과 정상군의 골 밀도와 골절 역치 비교
김철현,김종석,김재혁,김익곤 대한골절학회 1999 대한골절학회지 Vol.12 No.2
Osteoporosis represents reduced amount of bone mass per unit volume as compared with controls of the same age and sex. In this condition, bone mineral density decreases and the skeleton becomes more prone to fracture. The purpose of this study was to show how bone mineral densities of the femoral neck area decrease with aging, to in vestigate the relationship between the bone mineral densities of the control and fracture group, and to obtain fracture threshold values. This report observed BMD of femoral neck region in femoral neck and intertrochanteric fracture group was less than that of control group and the differences were significant. We measured and evaluated BMD of femoral neck region by DEXA in 234 normal volunteers(99 men and 135 women), in 105 patients with femoral neck fracture(41 men and 64 women) and in 103 patients with intertrochanteric fracture(40 men and 63 women) above 50 years-old. Following results were obtained: 1. The average BMD of femoral neck region in control group, femoral neck fracture group and intertrochanteric fracture group were 0.751±0.030 g/cm in male and 0.661±0.089g/cm in female, 0.660±0.031g/cm in male and 0.557±0.002g/cm in female and 0.661±0.008g/cm in male and 0.562±0.005g/cm in 2. The BMD of the control group and fracture group decreased with aging and were higher in men than in women and there were statistically significant difference(p$lt;0.001). 3. There were statistically significant difference between BMD of the control group and BMD of the hip fracture group(p$lt;0.005) but no significant differences between BMD of the femoral neck fracture group and intertrochanteric fracture group. 4. Fracture threshold of the hip fracture group were 0.815g/cm(male:0.832g/cm2, female:0.733g/cm2) according to 95 percentile.
김철현,김종석,김재혁,김익곤 대한골절학회 1998 대한골절학회지 Vol.11 No.2
Forty-six patients who had had forty-nine calcaneal fractures were managed with closed reduction and a cast, closed reduction and axial pin fixation, and open reduction and internal fixation. The results were reviewed retrospectively, between twelve months and twenty-six months after the treatment, with criteria usued in assesssment of result by Salama30) and with plain radiographs. The purpose of this study were to analyze the relationship between the prognostic factors and post-treatment results. The results of treatment and prognostic factors obtained from this study were as follows. 1. The negative prognostic factors that were associated with an unsatisfactory out come were an age of more than fifty years, a greater body weight, work involving strenuous labor, subtalar incongruity, a decreased fibulocalcaneal space, and a decreased B hler-angle ratio of the fractured to the normal side. 2. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. 3. The length of the Achilles-tendon fulcrum, which is directly related to the calcaneal length, was not related to the outcome.