근위 대퇴정을 이용한 대퇴 전자부 골절의 치료

문영완,서동현,강신택,권덕주,지용남,이기병 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 근위 대퇴정을 이용한 고령 환자의 대퇴전자간 골절의 치료결과에 대해 보고하고자 한다. 대상 및 방법 : 2001년 4월부터 2002년 2월까지 대전자부에서 소전자에 이르는 횡선골절 및 소전자 주위 분쇄골절로 압박고 나사 고정이 용이하지 않은 전자간 골절, 일반적인 전자간 골절에 대해 근위 대퇴정을 사용해 치료한 80례 중 추시가 가능했던 71례를 대상으로 하였으며, 추시과정 중 골유합 시기, 대퇴경간각, 지연나사의 활강, 수술시간 및 출혈량, 술중 및 술후 합병증 수술시 주의사항을 조사하였다. 결 과 : 평균연령은 77.5세, 평균추시기간은 9개월이었다. Evans의 분류법으로 골절을 분류하여 안정성, 불안정성 골절은 30례, 41례였다. 평균 골 유합 시비는 13.8주였고, 대퇴경간각은 수술직후 131.9 ± 5.21˚, 129.9 ± 6.04˚ 였으며 평균지연나사의 활강은 4.21±4.13㎜였다. 수술시간은 평균 61분, 출혈량은 평균 0.67pint(134cc)였다. 술중 합병증으로는 정복 실패 1례, 원위고정나사 삽입시 피질골 골절 1례, drill bit 파손 1례가 있었으며, 술후 합병증으로는 대퇴 경간각 소실(5도이상) 12례, 경부골절의 발생이 2례, 지연나사의 관절내 돌출 1례였다. 결 론 : 대퇴골 전자부 골절의 치료로 근위 대퇴정은 정확한 삽입 위치, 삽입시의 조심스러운 확공, 지연나사의 연골하 골에 단단하게 고정시키는 등의 주의를 한다면 수술시간, 출혈량 감소 등의 술중 합병증을 줄이고, 견고한 내고정을 통한 조기 보행을 가능하게 하며, 좋은 골유합 등이 기대되므로, 특히 고령, 분쇄골절, 역행성 골절, 골다공증이 심한 경우에서 바람직한 수술방법으로 사료된다. Purpose : To evaluate the treatment results of geriatric intertochanteric fractures using a proximal femoral nail. Materials and Methods : From April 2001 to February 2002, 71 cases of the intertrochanteric fractures involving lesser trochanter, transverse or reverse oblique intertrochanteric fracture. We evaluated the bone union time, neck-shaft angle, lag screw sliding by follow up radiographs, operation time, blood loss and complications. Results : The average age was 77.5 years old, the mean duration of follow-up was 9 months and the mean duration of bone union was 13.8 weeks. The average neck-shaft angle on immediate postop. x-ray was 131.9 ± 5.21˚ and 129.9 ± 6.04˚ at last follow up and the average lag screw sliding was 4.21 ± 4.13㎜. The average operation time was 61 minutes and blood loss was 0.67 pints(134cc). Intraoperative complications were inadequate reduction in one case, difficulty in distal transfixing in one case and drill bit failure in one case and postoperative complications were loss of neck-shaft angle(more than 5 degree) in 12 cases, femur neck fracture in 2 cases and intraarticular cutting out of femur neck screw in one case. Conclusions : The use of the proximal femoral nail could be appropriate for the fixation of communited or reverse oblique intertrochanteric fracture in elderly, osteroporotic patients for early ambulation, preventing shortening and rotation deformity, and reducing operation time and blood loss.

임대차 법익균형을 통한 최소 주거권 접근에 관한 연구

문영완 전주대학교 비교법학연구소 2008 비교법학 Vol.8 No.-

Factors Correlated with the Reducibility of Varus Deformity in Knee Osteoarthritis: An Analysis Using Navigation Guided TKA

문영완,김재균,Jung Hoon Han,Kwan Hong Do,서재곤,임홍철 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.1

Background: We hypothesized that a number of clinical and radiologic parameters could influence the reducibility of varus deformity in total knee arthroplasty. The aim of this study was to identify the factors correlated with reducibility of varus deformity and predict more accurately the amount of medial soft tissue release required in varus deformity total knee arthroplasty. Methods: One hundred forty-three knees with preoperative varus alignment and medial osteoarthritis were included in this retrospective study. The total knee arthroplasties were performed using a navigation system (OrthoPilot) by single surgeon. To assess varus deformity, the authors measured preoperative mechanical axis angles and valgus stress angles. Mechanical tibial angles, mechanical femoral angles, femoral osteophyte sizes, and tibial osteophyte sizes were measured. The Ahlbäck grading scale was applied for radiologic parameters, and clinical parameters (age, body mass index, sex, duration of pain, and preoperative range of motion) were documented. Correlations between these factors and preoperative valgus stress angle were analyzed. Results: A negative correlation was found between preoperative mechanical axis angle and preoperative valgus stress angle (p < 0.01, r = -0.38), and a positive correlation was found between the preoperative mechanical tibial angle and preoperative valgus stress angle (p = 0.01, r = 0.19). Conclusions: The present study shows that preoperative varus deformity and proximal tibial vara (measured by preoperative mechanical axis angle and mechanical tibial angle, respectively) are correlated with reducibility of varus deformity (measured by preoperative valgus stress angle), and clinical parameters (age, range of motion, duration of pain and body mass index) and other radiologic parameters (osteophyte size, severity of osteoarthritis and angulation of distal femoral joint surface) were not significantly correlated with reducibility of varus deformity.

Clinical Outcome of IM-Guided Total Knee Arthroplasty with Inappropriate Femoral Resection in Coronal Plane

문영완,한정훈,이근호,장성원,서재곤 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.1

Purpose: The purpose of this study was to evaluate clinical results and accuracy of femoral cutting in the coronal plane in total knee arthroplasty (TKA) using a fixed length intramedullary guide. Materials and Methods: From 2005 to 2008, 101 patients (154 knees) underwent TKA (NexGen LPS implant). The minimal follow-up period was 3 years (mean, 4.4 years). The patients were divided into two groups (group 1, 94≤α angle<98; group 2, 94>α, 98≤α). Mechanical axis deviation (MAD), patellar tilting angle (PTA), Knee Society Knee Score (KSKS), and Knee Society Function Score (KSFS) were measured in both groups. Results: There were 120 knees in group 1 and 34 knees in group 2. There was no significant intergroup difference in the postoperative MAD (group 1, 1.59o; group 2, 1.91o). The number of outliers with ≥2o MAD was 65 in group 1 and 24 in group 2. The mean PTA, KSKS, and KSFS were 10.17o, 96.0, and 96.6, respectively, in group 1 and 11.58o, 84.5, and 85.5, respectively, in group 2. Conclusions: The percentage of coronal alignment outliers was relatively high (34 in 154 cases, 22%) after TKA using a fixed length intramedullary guide. However, there was no statistically significant intergroup difference in clinical results (KSKS, p=0.67; KSFS, p=0.56).

Efficacy and Safety of Aceclofenac Controlled Release in Patients with Knee Osteoarthritis: A 4-week, Multicenter, Randomized, Comparative Clinical Study

문영완,강승백,김태균,이명철 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.1

Purpose: To evaluate the analgesic effect, efficacy and safety of aceclofenac controlled release (CR) in patients with chronic knee osteoarthritis (OA).Materials and Methods: A total of 125 subjects with chronic knee OA were randomly divided into two groups: one group (n=62) was administered aceclofenac CR once daily and the other (n=63), aceclofenac immediate release (IR) twice a day for 4 weeks. A 100-mm visual analogue scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS) and range of motoin (ROM) were evaluated as the outcome measures. To evaluate the safety of the drug, adverse events, vital signs, physical examination findings, clinical laboratory values and electrocardiographic findings were evaluated.Results: The VAS, KOOS and ROM were improved after 4 weeks of administration in both groups, but the differences between the two groups were not statistically significant. Significant differences between the two groups were not shown in the evaluation of the adverse events, vital sign, physical examination results, clinical laboratory values, and electrocardiography.Conclusions: The aceclofenac CR and aceclofenac IR were equally effective in patients with chronic knee OA and the clinical trial results didn’t show any significant difference in safety. The new aceclofenac CR formulation was found to be effective and safe with the practical advantage of once daily administration.

임대차계약의 법리구조와 법익균형제고에 관한 연구

문영완 전주대학교 비교법학연구소 2007 비교법학 Vol.7 No.-

70세 이상의 전위된 대퇴골 경부 골절 환자에서 무시멘트형 조립식 대퇴 스템을 이용한 고관절 치환술

문영완 ( Young Wan Moon ),박윤수 ( Youn Soo Park ),임승재 ( Seung Jae Lim ),임경섭 ( Kyung Sub Lim ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.2

목적: 70세 이상의 전위된 대퇴골 경부 골절 환자에서 무시멘트형 조립식 대퇴 스템을 이용한 고관절 치환술의 임상적 결과 및 방사선학적 추시 결과를 평가하였다. 대상 및 방법: 2002년 1월부터 2005년 5월까지 전위된 대퇴골 경부 골절로 무시멘트-조립형 대퇴 스템을 이용하여 고관절 치환술을 시행 받았으며, 술 후 2년 이상 추시가 가능하였던 70세 이상의 환자 66명, 67예를 대상으로 하였다. 수술 당시 평균 연령은 77세(70~92세)였으며, 술 후 추시 기간은 평균 31(24~41)개월 이었다. 임상적 평가는 수술 전후의 일상생활 보행 능력 (ADL) 및 술 후 합병증 등을 평가하였고, 방사선학적 평가는 술 후 정기적으로 시행한 고관절 단순 방사선 사진을 이용하여 대퇴 스템 주변의 골용해와 해리 정도, 양측 하지 길이를 측정하였다. 결과: 임상적인 평가로 수술 전 일상생활 보행 능력 정도(ADL)는 1, 2, 3, 4, 5 등급에서 각각 31예(46%), 21예(31.5%), 14예 (21%), 1예(1.5%), 0예(0%) 였으며, 수술 후 ADL은 각각 25예(37.5%), 18예(27%), 21예(31%), 3예(4.5%), 0예(0%)였다. 이 중 수술 전 ADL 이상으로 회복된 환자는 48예(71.5%) 였다. 수술과 관련한 심각한 합병증은 없었다. 방사선학적 결과로 1예의 수직 침강을 보인 경우를 제외한 모든 예에서 스템의 안정 골성삽입을 보였으며, 술 후 양측 하지 길이 차이는 5예(7.5%)에서 나타났는데 모두 1 cm 미만이었다. 결론: 고령의 전위된 대퇴골 경부 골절 환자에서 무시멘트형 조립식 대퇴 스템을 이용한 고관절 치환술의 2년 이상 추시 결과 수술과 관련한 합병증을 최소화 하면서 만족할 만한 임상적 및 방사선학적 결과를 얻을 수 있었다. Purpose: To evaluate the clinical and radiological results of hip arthroplasty using a cementless modular femoral stem in patients older than 70 years with a femoral neck fracture. Materials and Methods: From January 2002 to May 2005, 67 hip arthroplasty procedures (66 patients) using a cementless modular femoral stem for displaced femoral neck fractures in patients older than 70 years of age were evaluated. All the patients were followed up for more than 2 years. The mean age at surgery was 77 (70~92) years. There were 22 men and 44 women. The mean follow up period was 31 months (24~41). The clinical evaluation was performed by examining the perioperative Activities of Daily Living (ADL) and postoperative complications. The radiological evaluation for femoral stem loosening and osteolysis was performed using the serial postoperative radiographs. The radiological evaluation for leg length discrepancies was performed using the immediate postoperative radiograph. Results: In preoperative ADL, 31 cases (46%) were in grade 1, 21 (31.5%) in grade 2, 14 (21%) in grade 3, 1 (1.5%) in grade 4 and none in grade 5. A review of the postoperative ADL revealed 25 cases (37.5%) in grade 1, 18 (27%) in grade 2, 21 (31%) in grade 3, 3(4.5%) in grade 4 and none in grade 5. Postoperative restoration of the ADL was observed in 48 cases (71.5%). There were no significant complications. Radiographically, all cases showed stable bony fixation of the femoral stem with the exception of 1 case, who showed subsidence and a pedestal reaction. Postoperative leg length discrepancy was observed in 5 cases (7.5%) but was < 1 cm in all cases. Conclusion: In elderly patients older than 70 years of age with a displaced femoral neck fracture, cementless hip arthroplasty using a modular femoral stem provides good initial stability and subsequent secure bony fixation with minimal complications.

고관절부위에서 골다공증 : 골다공증의 진단

문영완 ( Young Wan Moon ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.4

외측 원판형 연골

문영완(Young-Wan Moon),이명철(Myung Chul Lee),정홍근(Hong Geun Jung),성상철(Sang Cheol Seong) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.2

링커 기기와 네비게이션을 이용한 슬관절 전치환술의 방사선학적 결과 비교

문영완 ( Young Wan Moon ),서재곤 ( Jai Gon Seo ),강홍제 ( Hong Je Kang ),김융성 ( Yung Sung Kim ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.1