$HINTEGRA^{(R)}$ 족관절 치환물을 이용한 족관절 전치환술의 단기 추시 결과

정홍근,배의정,박재용,김태훈,Jung, Hong-Geun,Bae, Eui-Jung,Park, Jae-Yong,Kim, Tae-Hoon 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: End-stage ankle arthritis is frequently combined with ankle-hindfoot deformity or ankle instability and therefore additional surgical procedures are often required when performing total ankle arthroplasty. We report the short term clinical and radiographic results of the total ankle arthroplasty with/without the combined adjunctive surgical procedures. Materials and Methods: The study is based on the 17 ankles (16 patients) of end-stage ankle arthritis that were treated with $HINTEGRA^{(R)}$ Total ankle prosthesis (Newdeal, Lyons, France) total ankle arthroplasty (TAA) from 2004 to 2007 with at least 12 months follow-up. The combined adjunctive procedures as well as the VAS pain score, AOFAS score, radiographic measurements and patient satisfactions were evaluated. Results: Average follow-up period was 29 months (13${\sim}$55 months), and the age was average 62 years (39${\sim}$75 years) old. Among total of 17 ankles, varus deformity and lateral ankle instability were found in 4 cases and 3 cases respectively. Twenty additional procedures such as Achilles triple hemisection (9), calcaneal displacement osteotomy (4) and lateral ankle ligament reconstruction (3) were performed in adjunct to TAA in 13 ankles. VAS pain score improved from preoperative average 8.4 (7${\sim}$10) to 2.0 (0${\sim}$5) and the AOFAS functional score improved from 41.8 points (13${\sim}$71 points) to 90.6 (77${\sim}$100 points) at final follow-up. Ninety-four percent of the patients were satisfied with the surgery. Conclusion: We confirmed that many adjunctive combined surgical procedures are often necessary in addressing the end-stage ankle arthritis (74%) with total ankle arthroplasty. We also achieved quite good clinical and radiographic short term results, although the long term follow-up study with larger number of cases are needed in the future.

근위 족저 근막염의 비수술적 치료 결과 : 족저 근막 두께에 따른 비교 분석

윤광섭,정홍근,배의정,김태훈,Yoon, Kwang-Sup,Jung, Hong-Geun,Bae, Eui-Jung,Kim, Tae-Hoon 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

Purpose: To evaluate the clinical outcome of proximal plantar fasciitis after nonoperative treatment, and also to find the correlation of the heel pain with the plantar fascia thickness measured by ultrasonography. Materials and Methods: The study is based on 41 patients, 46 feet of the proximal plantar fasciitis that were treated conservatively with at least 12 months follow-up. All were treated with heel pad, Achilles and plantar fascia stretching and pain medications for at least 3 months. Heel ultrasonography was performed at the beginning of the treatment to measure the plantar fascia (PF) thickness and the echogenicity. PF thickness over 4 mm and less were grouped in to group A and B respectively to compare the clinical outcome. Results: Average thickness of the PF at the calcaneal attach was 5.2 mm. Symptom duration before the treatment was average 13.2 month; group A being 14.6 months and group B being 9.0 months with no significant difference (p=0.09). As functional evaluation, Roles-Maudsley score improved from 3.4 initially to 2.3 at final follow-up, while morning heel pain also improved from average VAS pain score of 7.2 to 4.0. However Maudsley and VAS score both didn't show statistical difference between the 2 groups (p>0.05). Conclusion: Plantar fasciitis improved substantially with the nonoperative treatments. However, the 2 groups, divided according to 4 mm thickness by ultrasonography, didn't show significant difference in either symptom duration or in the clinical outcomes.

외상 후 족관절 연부조직 충돌증후군: 관절경적 및 영상의학적 분석

정홍근 ( Hong Geun Jung ),이성태 ( Sung Tae Lee ),박재용 ( Jae Yong Park ),배의정 ( Eui Jung Bae ),이호준 ( Ho Joon Lee ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.2

We evaluated the arthroscopic and MRI findings of the post-traumatic ankle soft tissue impingement (ASTI) and the clinical outcome of arthroscopic debridement. Thirty-one ASTI patients were treated with arthroscopic debridement from 2006 to 2008 and 24 patients were followed-up for at least 6 months. Mean age at surgery was 33.0 year-old and mean follow-up period was 16 months. Twenty-nine cases had past trauma history of ankle sprain. The locations of the soft tissue lesions were 42% at anterolateral, 19% anteromedial and 3% medial gutter of the ankle joint. Synovitis was 58% while fibrotic lesion was 32%. VAS pain score decreased from mean 6.8 to 2.2 and American Orthopedic Foot and Ankle Society (AOFAS) functional score also improved from mean 64 to 89 after surgery (p<0.05). Twenty-two patients (92%) were satisfied with the surgery. We found that the diagnostic rate of the ASTI was 75% by MRI and the soft tissue impingement lesions were more common with synovitis than fibrosis. We also achieved favorable clinical outcome with arthroscopic debridement.

족관절 외측 인대 불안정증에 대한 동종 반건양건과 간섭 나사를 이용한 해부학적 재건술

정홍근(Hong-Geun Jung),박재용(Jae-Yong Park),배의정(Eui-Jung Bae),김태훈(Tae-Hoon Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

목적: 족관절 외측 인대 불안정증에 대해 동종 빈건양건과 간섭나사를 이용하여 해부학적 재건술을 시행한 후 단기 추시 결과를 예비 보고하고자 한다. 대상 및 방법: 족관절 외측인대 불안정증 진단 하에 2007년부터 2008년까지 본원에서 동종 반건양건과 간섭나사를 이용하여 전방거비인대 및 종비인대의 해부학적 재건술을 시행한 12족 중 1년 이상 추시가 가능하였던 11명, 11족을 대상으로 하였다. 평균 추시 기간은 14개월(12-22)이었고, 평균 연령은 25.9세(19-57)이었으며, 술 전 재발성 염좌 기간은 평균 31.4개월(2-120)이었다. 평균 두께 4.0㎜ (3.5-4.5)의 동종 반건양건을 사용하였으며, 거골과 종골의 건 고정에는 간섭나사를 사용하였다. 수술 전후의 VAS 통증 지수와 American orthopaedic foot and ankle society (AOFAS) 족관절-후족부 기능 점수 및 Karlsson-Peterson 족관절 점수를 비교하였으며, 환자의 주관적 만족도를 조사하였다. 방사선학적으로는 수술 전 후 스트레스 검사상 거골 경사각 및 전방 전위 정도를 측정, 비교 분석하였다. 결과: VAS 통증 점수는 술 전 평균 6.0점(3-8점)에서 술 후 1.1점(0-4점)으로 유의하게 감소하였다(p<0.05). AOFPS 점수 또한 술 전 70.4점(41-84점)에서 술 후 90.4점(85-100점)으로, Karlsson-Peterson 족관절 점수는 54.6점(32-77점)에서 술 후 92.4점(85-100점)으로 유의하게 향상되었다(p<0.05). 수술에 대해 82%의 환자가 만족 이상의 결과를 나타내었다. 내반 스트레스시 거골 경사각은 술 전 15.7°(10.2-25.0°)에서 3.2°(0.3-13.0°)로 유의하게 감소하였다(p<0.05). 술 후 직업 복귀에는 평균 3.7개월이 소요되었다. 결론: 본 연구를 통해서 동종 반건양건과 간섭나사를 이용한 해부학적 외측 인대 재건술은 육체적 활동량이 많거나 심한 족관절 외측 인대 불안정증에 대해서 만족스러운 결과를 기대할 수 있는 매우 효과적인 수술 방법으로 생각된다. Purpose: To evaluate the clinical outcome of the anatomic reconstruction of the lateral ankle instability using the semitendinosus allograft tendon and the interference screws. Materials and Methods: This study is based on the 12 feet of lateral ankle instability that had been treated with anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using the semitendinosus allograft tendon and the interference screws. The majority of patients were young and physically active. We evaluated the patients' VAS pain scores, AOFAS scores and Karlsson-Peterson ankle scores for the 11 feet involved with at least 12 months follow up, both pre- and postoperative. In addition, we evaluated patient satisfaction. We measured the talar tilt angles and the talar anterior translations from ankle stress views. Results: The average age at surgery was 25.9 years old (19-57 years); patients had symptoms of recurrent sprain for average 31.4 months before surgery. The average follow up period was 14 months. For reconstruction, we used 4.0㎜ thick allograft semitendinosus tendon and interference screws. VAS pain scores decreased from 6.0 to 1.1 (p<0.05) and AOFAS scores improved from 70.4 to 90.4 postoperatively (p<005) Karlsson-Peterson ankle scores improved significantly from 546 to 92.4 (p<0.05). Radiographic talar tilt decreased from 15.7° to 3.2° postoperatively (p<0.05). Eighy-two percent of the patients were satisfied with the results and the patients had returned to their jobs by 3. 7 months after surgery. Conclusion: Anatomic reconstruction of the ATFL and the CFL in the lateral ankle instability patients using the semitendinosus tendon and the interference screws is an ideal surgical option especially for young athletes with high grade instabilities.

경피적 추체 성형술을 이용한 골다공증성 추체 압박 골절 치료 (99명, 171추체)

김정환 ( Chung Hwan Kim ),안형선 ( Hyung Sun Ahn ),황재광 ( Jae Kwang Hwang ),송정석 ( Jung Suk Song ),배의정 ( Eui Jung Bae ) 대한골절학회 2006 대한골절학회지 Vol.19 No.2

목적: 골다공증성 추체 압박 골절에 대해 경피적 추체 성형술을 시행 받은 환자 중 2년 이상 연속 추시가 가능했던 환자들의 임상 증상과 방사선 결과를 분석하고 이를 추시기간과 골밀도 측정치에 따라 비교 분석하고자 하였다. 대상 및 방법: 2000년 1월부터 2003년 9월까지 골다공증성 추체 압박골절에 대해 경피적 추체 성형술을 시행 받은 환자 중 2년 이상 연속 추시가 가능했던 99명, 171추체를 대상으로 추시 기간에 따라 2~3년, 3~4년, 4년 이상의 3개의 군으로 나누었으며, 골밀도 측정치에 따라 BMD -3.0 이상, -3.0 이하의 2개의 군으로 분류하여 각 군의 입상 증상과 방사선 결과를 비교, 분석하였다. 임상 증상 분석은 대상 환자를 개체로 하였으며 방사선 결과 분석은 대상 추체를 개체로 하였다. 임상 결과는 우수, 양호, 보통, 저하, 불량으로 나누어 평가하였으며 방사선 결과는 추시 기간에 따른 추체 높이의 변화를 측정하고 회복률과 상실률을 비교 평가하였다. 통계는 Chi-squire test와 Independent-Samples T test들 이용하였다. 결과: 추시 기간에 따른 분류에서 임상 증상은 각 군 간에 유의한 차이가 없었으며 (p>0.05) 추체 높이 회복 상실률은 I군 (2~3년 추시)과 III군 (4년 이상 추시) 간에 유의한 차이가 있었으나 (p<0.05) 그 외에는 유의한 차이가 없었다 (p>0.05). 골밀도 측정치에 따른 분류에서는 각 군 간에 임상 증상과 추체 높이 회복 상실률에 유의한 차이가 없었다 (p>0.05). 결론: 골시멘트를 이용한 경피적 추체 성형술은 골다공증성 추체 압박골절 환자의 치료에서 추시 기간이나 골밀도 측정치에 관계없이 만족스러운 임상 결과와 방사선 결과를 기대할 수 있는 치료법으로 사료된다. Purpose: This study was designed to compare the clinical and radiologic outcome of the patients who underwent percutaneous vertebroplasty among the groups based on follow-up period and BMD. Materials and Methods: A total of 99 patients (171 vertebral bodies) underwent percutaneous vertebroplasty from January 2001 to September 2003. The patients were divided into 3 groups by follow-up periods, and also divided into 2 groups by BMD. We investigated the difference of radiologic & clinical effects among the groups. Radiologic findings was assessed as vertebral height restoration rate and rate of reduction loss by measurement of the height of vertebral body. The clinical outcomes were graded into 5. The statistical analysis was done using Chi-squire test and Independent-samples T test. Results: Among the groups divided by follow-up period, there was no statistically significant difference of clinical & radiologic results except the rate of reduction loss between group I and group III (p>0.05). Between the groups divided by BMD, there was no statistically significant difference of clinical and radiologic results. Conclusion: Percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture is an efficient procedure and considered as technique producing pleasurable clinical and radiologic results regardless of follow up-period and BMD.