Comparison of Mechanical Axis and Dynamic Range Assessed with Weight Bearing Radiographs and Navigation System in Closed Wedge High Tibial Osteotomy

배대경,이종환,조성진,송상준 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.3

Purpose: To compare navigation and weight bearing radiographic measurements of mechanical axis (MA) before and after closed wedge high tibial osteotomy (HTO) and to evaluate post­osteotomy changes in MA assessed during application of external varus or valgus force.Materials and Methods: Data from 30 consecutive patients (30 knees) who underwent computer­assisted closed­wedge HTO were prospectively analyzed. Pre­ and postoperative weight bearing radiographic evaluation of MA was performed. Under navigation guidance, pre­ and post­osteotomy MA values were measured in an unloaded position. Any change in the post­osteotomy MA in response to external varus or valgus force, which was named as dynamic range, was evaluated with the navigation system. The navigation and weight bearing radiographic measurements were compared. Results: Although there was a positive correlation between navigation and radiographic measurements, the reliability of navigation measurements of coronal alignment was reduced after osteotomy and wedge closing. The mean post­osteotomy MA value measured with the navigation was 3.5°±0.8° valgus in an unloaded position. It was 1.3°±0.8° valgus under varus force and 5.8°±1.1° valgus under valgus force. The average dynamic range was >±2°.Conclusions: Poten tial differences between the postoperative MAs assessed by weight bearing radiographs and the navigation system in unloaded position should be con sidered during computer­assisted closed wedge HTO. Care should be taken to keep the dynamic range within the permissible range of alignment goal in HTO.

전방 십자 인대 파열시 손상된 대퇴골 외과 연골의 병리조직학적 연구

배대경,윤경호,김희선,Bae, Dae-Kyung,Yoon, Kyoung-Ho,Kim, Hee-Seon 대한관절경학회 2005 대한관절경학회지 Vol.9 No.2

목적: 급성 전방십자인대 파열 시 동반된 제 3형의 골멍의 조직학적 소견을 분석하였다. 대상 및 방법: 25례의 급성 전방십자인대 파열 환자에서 MRI상 대퇴골 외과에 제 3형의 골멍이 동반된 14례와 골멍이 동반되지 않은 11례를 대상으로 하였다. 남자가 22례, 여자가 3례였으며 평균 나이는 25세였다. 수상 후부터 MRI 검사까지의 기간은 최소 1일에서 최대 30일이였고 수상 후부터 전방십자인대 재건술까지의 기간은 평균 45일이었다. 전방십자인대 재건술 시 연골과 연골하 골에 trephine biopsy를 시행하여 조직학적 및 면역조직학적 소견을 비교 분석하였다. 결과: hematoxylin-eosin 염색시 세포에 대한 변화는 발견할 수 없었고, Masson's trichrome 염색에서 콜라겐의 분포차이는 보이지 않았다. 또한 면역화학염색으로 관찰된 제 1형 콜라겐과 제 2형 콜라겐의 분포에서 아무런 차이를 발견할 수 없었다(p>0.05). 그러나 Safranin-O를 이용한 글리코스아미노글리칸 염색에서 골멍군의 표층과 중간층의 글리코스아미노글리칸 염색 분포가 정상 대조군보다 떨어졌다(p<0.05). 또한 골멍군에서 석회화층에 지방세포들이 같이 발견되는 빈도가 높았다. 결론: 전방십자인대 파열시 동반되는 제 3형의 골임은 슬관절의 불안정성과 함께 추후 관절 연골의 손상을 유발하는 중요한 요인이 될 것으로 사료된다. Purpose: to describe the histologic appearance of the type III bone bruise in knees which had sustained an acute anterior cruciate ligament (ACL) rupture. Materials and Method: Twenty-five patients who sustained acute ACL rupture were prospectively enrolled in this study. On MRI, 14 patients demonstrated type III bone bruise on lateral femoral condyle, and 11 patients didn't demonstrated bone bruise. Arthroscopic evaluation and biopsy of the articular cartilage and subchondral bone wert performed before ACL reconstruction. Histologic and immunohistochemical evaluations were done. Results: There was no difference between the bone bruise and control group in the hematoxylin-eosin staining for cell distribution, Masson's trichrome staining for collagen and immunohistochemical staining for type I and type II collagen (p>0.05). But in the safranin-O staining for glycosaminoglycan distribution, the bone bruise group had an evidence of decreased staining at the superficial and middle layers, compared with the control group (p<0.05). We also found fatty change of bone marrow in calcified zone of the bone bruise group with safranin-O staining. Conclusion: We suggest that the type III bone bruise found on MRI indicates a substantial damage to normal articular cartilage homeostasis, and may induce further damage of the articular cartilage.

반월상 연골 파열의 치료에서 meniscal arrow의 역할

배대경,임창무,정기웅,Bae, Dae Kyung,Yim, Chang Moo,Jeong, Ki Woong 대한관절경학회 1999 대한관절경학회지 Vol.3 No.1

목적 : 본 논문의 목적은 반월상 연골 파열의 치료에서 meniscal arrow의 역할을 분석하는데 있다. 대상 및 방법 : 1997년 5월부터 1998년 8월까지 반월상 연골이 파열되어 meniscal arrow를 사용하여 봉합한 22명 22례를 대상으로 하였다. 추시 기간은 평균 14.7개월(7~22개월)이었으며, 평균 연령은 27세(18~51세)였다. 성별은 남자 19명, 여자 3명이었고 우측이 12례, 좌측이 10례였다. 동반손상은 전방십자인대 파열이 16례, 내측 측부인대 손상이 1례였으며, 파열위치는 후각부가 19례, 중앙부가 3례였다. 연골판의 파열 형태는 종파열이 14례, bucket handle형 파열이 7례, 수평 파열은 1례였고, 환자 1례당 봉합을 위하여 사용된 meniscal arrow는 평균 2.5개(1-4개)였다. 임상적 결과의 판정은 Tapper와 Hoover의 분류를 기준으로 하였고, 술 후 운동범위를 측정하였으며, 동통, 잠김, 불안정 등의 주관적 증상의 변화를 관찰하였다. 또한 수술시 연골 봉합술에 소요된 시간을 측정하였다. 결과 : 임상적 결과는 우수가 16례, 양호가 4례 그리고 보통이 2례 였다. 최종 추시시 운동 범위는 평균 135도(120~140도)였으며 1례를 제외한 모든 환자에서 동통, 잠김, 불안정 등을 호소한 례는 없었다. 수술시 연골의 봉합술에 소요된 시간은 평균 25분(15-40분)이었다. 22례 중 이차 관절경을 시행한 환자 3례 모두에서 파열 부위는 완전 치유되어 있음을 관찰할 수 있었다. 결론 : Meniscal arrow는 반월상 연골 파열에 대하여 동반손상이나 파열부위에 따라 선택적으로 사용하는 것이 바람직할 것으로 사료된다. Purpose : The purpose of this paper is to analyze the clinical results after meniscal repair using meniscal arrow. Materials and Methods : Between May 1997 and Aug 1998, we repaired 22 tom menisci in 22 patients using meniscal arrows. There were nineteen males and three females with an average age of 27 years. There were longitudinal tear in 14 cases, Bucket-handle tear were 7 cases and horizontal tear was in 1 case. In 22 meniscus tears, 16 cases were associated with anterior cruciate ligament tear. Average number of meniscal arrow that was used were 2.5(ranged 1 to 4). Average follow-up period was 14.7 months(ranged 6 to 22 months). We evaluated the clinical results by the Tapper and Hoover's grading system. Results : There were excellent in 16 cases, good in 4 cases and fair in 2 cases on the clinical results. At the last follow up, the range of the motion of the knee joint were average 135 degrees(ranged 125 to 140 degrees). Mean time elapsed for meniscal repair were 25 minutes(ranged 15 to 40 minutes). Conclusion : Meniscal arrow has many advantages such as short operative time, easy fixation technique, and less neurovascular injury. We think that arthroscopic meniscal repair using meniscal arrow is effective treatment method in selected patient who have longitudinal, bucket-handle tear at the posterior hom associated with anterior cruciate ligament tear.

슬관절 전치환술

배대경 대한류마티스 건강전문학회 2003 근관절건강학회지 Vol.10 No.2

거대세포종의 치료시 관절 기능의 보존

배대경,한정수,선승덕,백창희,이재훈,Bae, Dae-Kyung,Han, Chung-Soo,Sun, Seung-Deok,Baek, Chang-Hee,Rhee, Jae-Hoon 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.2

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

슬관절 주위 거대세포종의 치료

배대경,Bae, Dae-Kyung 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1

Giant cell tumors are primary bone tumors originating from non-osteoblastic connective tissue. The sites of involvement were commonly distal femur, proximal tibia, proximal humerus, distal radius and others (including os calcis, ilium and sacrum). Giant cell tumor located around knee joint has been difficult to treat because of local recurrence following curettage with or without bone graft. Although primary resections reduce recurrence of the lesion, the joint function will be markedly impaired. Marginal excision was very often complicated by a loss of joint integrity since all the giant cell tumors occupy juxtaarticular positions. Techniques involving physical adjuncts(high speed burr and electric cauterization) have been used in the hope of decreasing the rate of local recurrence and avoiding the morbidity of primary resection. A meticulous clinical, radiological and histological evaluation is needed to choose the correct treatment, keeping in mind the possibility of recurrence after each treatment modality.

슬관절 재치활술후 임상적 결과

배대경,이상권,김병설,김형구 慶熙大學校 醫科大學 1993 慶熙 醫大 論文集 Vol.18 No.1

전십자인대 손상 환자에서 자기공명영상 촬영의 효용성

배대경,정선욱,권현섭 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1

Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment of the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 cases. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and 7 cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in arthroscopic examination with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.

경골 근위부 절골술의 결과 및 생존율 분석

배대경,윤경호,권오수,김용찬,신동준 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.3

361 였고, 제 2실패 기준에서의 각각의 생존율은 1993년 Coventry 등6)은 87%와 66%, 1988년 Ritter와 Fechtman20)은 80%와 58%, 저자는 96.4%와 74.6%로 약간의 차이를 보였다. 경골 근 위부 절골술을 시행한 환자에서 본 저자의 생존율 결과가 양호 했던 이유로써는 실패에 대한 기준의 차이, 상대적으로 낮은 연 령과 적은 체중, 동통에 대한 환자 개인의 차이 및 경제적, 사회 적 요인이 관여하리라 추정되며 또한 수술 기법상 내측 피질골 과 골막을 보존하는 원칙을 지키기 위한 노력과 본 저자가 고안 한 miniplate staple (Johnson & Johnson Orthopaedics, New Milton, UK)을 고정물로 사용함으로써 Coventry staple 사용 후 석고 고정으로 인한 상대적으로 늦은 체중 부하의 단점을 보 완하였기 때문인 것으로 사료된다2). 경골 근위부 절골술은 장기 추시의 만족도에서는 시간의 경과 에 따른 임상 성적의 악화가 보고 되고 있고 수술 후 시간의 경 과에 따른 병변의 진행과 교정각의 소실로 인한 동통의 재발로 슬관절 전치환술을 시행하여야 하는 경우가 있다. 그러나 슬관 절 전치환술에 비해 수술기법이 간단하고, 저렴한 수술비용, 수 술 후 굴곡 운동에 제한이 없어 활동 범위가 넓으며, 특히 최근 전치환술 후 야기되는 문제점으로 골용해(osteolysis) 및 마모 (wear) 등의 심각한 합병증을 고려할 때, 경골 근위부 절골술 의 적응과 과교정을 엄격히 하면 여전히 퇴행성 슬관절염의 치 료에 있어 유용한 술식이라 사료된다3).

제19차 대한슬관절학회 정기학술대회 / Free Paper Session / TKRA - 2 : 슬관절 전 치환술에서 한국인 대퇴골의 해부학적 계측 및 대퇴골과 대퇴삽입물의 적합성에 대한 분석

배대경,이영호,정선욱,권창혁 대한슬관절학회 2001 정기학술대회 Vol.- No.-