양측 슬관절 대퇴골 양과의 골괴사에 자가 장골 삼중 피질골 지주 이식 치료 - 증례 보고 -

남우동,김근우,한계영 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.2

Bone Union Rate Following Instrumented Posterolateral Lumbar Fusion: Comparison between Demineralized Bone Matrix versus Hydroxyapatite

남우동,이제민 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

Study Design: Retrospective study. Purpose: To compare the union rate of posterolateral lumbar fusion (PLF) using demineralized bone matrix (DBM) versus hydroxyapatite (HA) as bone graft extender. Overview of Literature: To our knowledge, there has been no clinical trial to compare the outcomes of DBM versus HA as a graft material for PLF. Methods: We analyzed prospectively collected data from consecutive 79 patients who underwent instrumented PLF. Patients who received DBM were assigned to group B (n=38), and patients who received HA were assigned into group C (n=41). The primary study outcome was fusion rate assessed with radiographs. The secondary outcomes included pain intensity using a visual analogue scale, functional outcome using Oswestry disability index score, laboratory tests of inflammatory profiles and infection rate. Results: One year postoperatively, bone fusion was achieved in 73% in group B and 58% in group C without significant difference between the groups (p =0.15). There were no differences between the groups with respect to secondary outcomes. Conclusions: DBM would provide noninferior outcomes compared to the HA as a fusion material for PLF, and could be a notable alternative.

Clinical and Radiological Predictive Factors to be Related with the Degree of Lumbar Back Muscle Degeneration: Difference by Gender

남우동,장봉순,이춘기,조재환 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3

Background: The prediction of lumbar back muscle degeneration is important because chronic low back pain and spino-pelvic imbalance have been known to be related to it. However, gender difference should be considered because there are different quality and volume of muscles between genders. The purpose of this study was to search for clinical and radiological factors to predict the degree of lumbar back muscle degeneration according to gender difference. Methods: We reviewed 112 patients (44 men and 68 women) with spinal stenosis who underwent a decompressive surgery between 1 January 2009 and 31 December 2011. Degrees of lumbar back muscle degeneration were classified into three categories by the fatty infiltration at each L3–4 disc level on the axial view of T1 magnetic resonance imaging (MRI). Age, sex, bone marrow density score, and body mass index (BMI) were obtained from chart reviews. Lumbar lordosis, sacral slope, pelvic tilt (PT), and pelvic incidence were calculated with lumbar spine standing lateral radiographs. The degrees of spinal stenosis and facet arthropathy were checked with MRI. Student t-test, chi-square test, or Fisher exact test were used to compare clinical and radiological parameters between genders. Analysis of variance (ANOVA) and linear regression analysis were used to search for a relationship between lumbar back muscle degeneration and possible predictive factors in each gender group. Results: Many clinical and radiological parameters were different according to gender. The age, BMI, and PT in the female group (p = 0.013, 0.001, and 0.019, respectively) and the PT in the men group (p = 0.018) were predictive factors to be correlated with lumbar back muscle degeneration. Conclusions: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only.

인공 슬관절 치환술시 경골고평부 중심의 변화 -사체 실험-

남우동,유기형,한계영 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.1

The Importance of Proximal Fusion Level Selection for Outcomes of Multi-Level Lumbar Posterolateral Fusion

남우동,조재환 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.1

Background: There are few studies about risk factors for poor outcomes from multi-level lumbar posterolateral fusion limited tothree or four level lumbar posterolateral fusions. The purpose of this study was to analyze the outcomes of multi-level lumbar posterolateralfusion and to search for possible risk factors for poor surgical outcomes. Methods: We retrospectively analyzed 37 consecutive patients who underwent multi-level lumbar or lumbosacral posterolateralfusion with posterior instrumentation. The outcomes were deemed either ‘good’ or ‘bad’ based on clinical and radiological results. Many demographic and radiological factors were analyzed to examine potential risk factors for poor outcomes. Student t-test,Fisher exact test, and the chi-square test were used based on the nature of the variables. Multiple logistic regression analysis wasused to exclude confounding factors. Results: Twenty cases showed a good outcome (group A, 54.1%) and 17 cases showed a bad outcome (group B, 45.9%). Theoverall fusion rate was 70.3%. The revision procedures (group A: 1/20, 5.0%; group B: 4/17, 23.5%), proximal fusion to L2 (groupA: 5/20, 25.0%; group B: 10/17, 58.8%), and severity of stenosis (group A: 12/19, 63.3%; group B: 3/11, 27.3%) were adopted aspossible related factors to the outcome in univariate analysis. Multiple logistic regression analysis revealed that only the proximalfusion level (superior instrumented vertebra, SIV) was a significant risk factor. The cases in which SIV was L2 showed inferior outcomesthan those in which SIV was L3. The odds ratio was 6.562 (95% confidence interval, 1.259 to 34.203). Conclusions: The overall outcome of multi-level lumbar or lumbosacral posterolateral fusion was not as high as we had hoped itwould be. Whether the SIV was L2 or L3 was the only significant risk factor identified for poor outcomes in multi-level lumbar orlumbosacral posterolateral fusion in the current study. Thus, the authors recommend that proximal fusion levels be carefully determinedwhen multi-level lumbar fusions are considered.

고정된 골편 절제술로 치료한 요추 추간판 탈출증과 동반된 후방 연골단판 골절 - 증례 보고 -

남우동,조재환,이제민,이재우 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: A case report. Objectives: We report a case of posterior ring apophysis fracture (PRAF) with lumbar disc herniation treated by immobile bony fragment excision. Summary of Literature Review: PRAF causes severe radiculopathy, so treating with surgery is common. Materials and Methods: A 30-year-old male diagnosed with PRAF with lumbar disc herniation was treated with discectomy, but his clinical symptoms were not relieved. Consequently, bony fragment excision, extended laminectomy and interbody fusion were also done. Results: Radicular pain was relieved and showed good clinical outcome. Conclusions: When treating PRAF, bony fragment excision and extended laminectomy should be considered even if an immobile bony fragment exists. 연구 계획: 증례 보고적: 고정된 골편 절제술로 치료한 요추 추간판 탈출증과 동반된 연골단판 골절 1예를 보고하고자 한다. 선행 문헌의 요약: 후방 연골단판 골절은 심한 신경근 자극 증상을 일으켜 수술적 치료를 요하는 경우가 흔하다. 대상 및 방법: 요추 추간판 탈출증과 동반된 연골단판 골절을 진단받은 30세 남자에서 추간판 절제술을 하였으나 호전이 없어 골편 절제술, 광범위 후궁 절제술 및 추체간 유합술을 시행하였다. 결과: 술후 방사통이 호전되었으며 양호한 임상 결과를 얻었다. 결론: 연골단판 골절을 치료할 때 골편이 고정된 경우에도 골편 절제술 및 광범위 후궁 절제술을 고려해야 한다.

고관절 초음파의 정상 소견 및 고관절 주위 질환의 초음파 소견

남우동,남신우,한계영,Nam, Woo-Dong,Nam, Shin Woo,Han, Kye Young 대한정형외과초음파학회 2010 대한정형외과 초음파학회지 Vol.3 No.1

고관절에 위치한 골, 관절 및 주위 연부 조직의 병변은 고관절의 통증을 유발할 수 있다. 이를 진단하기 위해 기초적인 이학적 검사와 단순 방사선 검사를 시행하고, 경우에 따라 CT, MRI 등을 이용하였다. 그러나 건과 점액낭 등의 연부조직 병변 대해서는 초음파 검사가 비침습적이고 역동적인 검사가 가능하고, 고관절에 대한 수술 후 추시 검사 수단으로도 사용할 수 있다. 그러나 성인의 고관절은 심부에 위치하여 그 검사가 힘들고 비만인 환자에게는 적용하기 힘든 경우도 있다. 이에 고관절 주위의 구조물들의 정상적 초음파 소견과 고관절 질환의 병적 소견을 알아보고 또한 기타 활용 방안에 대해 설명하였다. The lesions around hip joint including bone, joint and soft tissue can cause the pain. For diagnosis of these lesions, physical examination and simple X-ray were accomplished primarily. Some special cases, CT or MRI was a useful tool. However ultrasonography could provide non-invasive and dynamic images for the lesions of tendon and bursa, and it could be a useful tool for follow up after hip surgery. Due to the deep location of hip joint, ultrasonography is not easy for physician to examine and its application was impossible in some obese patients. This article deals with the normal and pathologic ultrasonographic findings of the hip joint and various applications using ultrasonography.

대퇴 전자간 골절의 근위 대퇴 골수정 삽입술 후 발생한 전자부 통증의 초음파 소견 - 2예 보고 -

남우동,한계영,차성무,Nam, Woo Dong,Han, Kye Young,Cha, Seong Moo 대한정형외과초음파학회 2011 대한정형외과 초음파학회지 Vol.4 No.1

대퇴골 전자간 골절에서 근위 대퇴 골수정을 이용한 수술 후 고관절 외측부의 통증을 호소하는 환자들이 있다. 전자부 통증의 원인이 건병증임을 초음파 검사를 통해 확인할 수 있어 그 치험 예를 보고하고자 한다. After closed reduction and internal fixation with proximal femoral nail for intertrochanteric fracture, some patients complained lateral hip pain. We report two cases of lateral hip pain due to tendinopathy confirmed by ultrasonography.

대퇴골 전자간 골절의 치료에 이용한 타곤 근위 대퇴정

남우동 ( Woo Dong Nam ),안준환 ( Joon Hwan An ),김근우 ( Keun Woo Kim ),한계영 ( Kye Young Han ),어수익 ( Soo Ik Awe ),김성연 ( Soung Yon Kim ),김일영 ( Il Young Kim ),유기형 ( Kee Hyung Rhyu ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.1

90세 이상의 고령 환자에서 발생한 전자간 골절의 근위 대퇴정을 이용한 치료

남우동 ( Woo Dong Nam ),박일호 ( Ill Ho Park ),한계영 ( Kye Young Han ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.4

Purpose: This study examined the clinical and radiologic results of a proximal femoral nail (PFN) used to treat an intertrochanteric fracture of the femur in elderly people more than 90 years of age. Materials and Methods: Between January 2005 and December 2008, 20 patients over 90 years old with an intertrochanteric fracture were treated with a PFN. Among them, 16 patients (mean age, 93.9 years; 13 females and 3 males) were followed up for a minimum of 6 months. Clinically, the modified Koval index was evaluated. Radiological bony union and complications were evaluated from the plain X-ray film. Results: The average modified Koval index decreased from 3.1 before surgery to 1.8 after surgery. Only 5 cases could return to their pre-injury status. Radiologic bony union was achieved after an average of 8.2 weeks and there were no complications, such as non-union and femoral head perforations. Conclusion: Thirty one percent of patients older than 90 years and treated for an intertrochanteric fracture with a PFN had recovered to their pre-injury ambulatory status. However, all cases showed bony union and no complications. Overall, PFN might be a good treatment option for intertrochanteric fractures in elderly people older than 90 years.