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역행성 골수강내 금속정 고정술로 치료한 성인 대퇴골골절의 장기추시 결과
성열보,박수철,안종국,염재광,정형진,김진호,송승택,한용택 대한골절학회 2002 대한골절학회지 Vol.15 No.3
목 적 : 순행성 골수강내 금속정 고정술은 성인 대퇴골 골절의 효과적인 수술적 요법으로서 많이 쓰이고 있다. 동측의 대퇴골 경부 골절, 전자간 골절, 비구 골절 그리고 다발성 골절이 동반된 대퇴간부 골절의 경우 사용된 역행성 골수강내 금속정 고정술은 매우 효과적인 수술적 방법이며 임산부, 비만, 외상성 슬관절 절개, 양측 하지 외상인 경우도 적응증이 된다. 저자들은 대퇴골 골절 후 역행성 골수강내 금속정 고정술을 시행 받은 환자의 장기간(2년이상) 추시를 통하여 그 결과와 합병증에 대하여 보고하고자 한다. 대상 및 방법 : 1994년 3월부터 1999년 3월까지 인제 대학교 의과대학 상계백병원에서 역행성 골수강내 금속정 고정술을 시행받고 2년이상 추시가 가능 했던 37예의 환자를 대상으로 연구하였다. 원위부 나사못 부전, 금속정의 이동, 불유합 등은 방사선 소견으로 슬관절 운동 제한, 기타 합병증은 임상적 소견으로 그 결과를 파악하였다. 결 과 : 1) 골유합기간은 평균 17주였다. 2) 술후 슬관절운동은 대부분 정상 범위로 회복되었으나(33/37), 4예에서 관절 운동범위가 제한(굴곡< 100도)되었다. 그러나 수상 당시 손상 정도가 심하였던 경우였고 역행성 금속정 내고정 때문은 아닌것으로 판단되었다. 3) 불유합과 부정유합이 각각 1예가 있었다. 4) 술후 감염이나 대퇴골 단축을 없었다. 4예에서 원위 나사목 부전이 있었으나 금속정의 이동은 없었다. 결 론 : 역행성 골수강내 금속정 고정술은 대퇴골 간부 골절에서 선택할 수 있는 효과적인 수술적 방법이다. 동측 대퇴 골절, 경골 간부골절, 슬관절 전치환술후 대퇴 골절 등이 이에 속한다. 역행성 골수강내 금속정 고정술은 대퇴골 간부 골절에서 올바른 적응증과 숙련된 술자에 의해 시행되어질 경우, 골유합률과 부정유합, 불유합, 술후 감염은 순행성 골수강내 금속정 고정술과 유의한 차이가 없으며, 수술 시간 및 수술 중 혈액 소실은 적었다. 술관절 합병증은 2년이상의 추시 관찰동안에 순행성 골수강내 금속정 고정술과의 의미있는 차이를 보이지 않았다. Purpose : Antegrade intramedullary nailing of the femur is effective method of treatment for patients with femoral shaft fractures. But retrograde IM nailing is another effective method, especially in femoral shaft fractures concomitant with ipsilateral femoral neck, intertrochanteric fractures, acetabular fracture, multiple fracture and obesity, pregnancy, traumatic arthrotomy of the knee joint, bilateral femur fractures, and floating knee injuries are also indicated. The purpose of this study is to verify the effectiveness of retrograde IM nailing after long-term follow-up by retrospective evaluation. Materials and Methods : A retrospective review of the medical charts and X-rays about 37 patients who were operated by retrograde nailing and all patients were minimally followed up about 2 years. Results were evaluated radiologically for screw breakage, nail migration, nonunion and clinically for knee ROM limitation, infection. Results : The results were as follows; 1) union was achieved at on average of 17 weeks. 2) Full range of knee motion was gained in 33/37 cases. Knee-stiffness occurred in 4 cases, Severity of initial trauma might affect such results but not, retrograde nailing 3) 2 complications, were found nonunion and delayed union. 4) There were not postoperative infection and femoral shortening. There were distal screw breakage in 4 cases but, the others were not migrated. Conclusion : Retrograde IM nailing of femoral fracture is an effective method in selected cases such as ipsilateral femoral neck fractures, floating knees, post-TKRA femoral fracture and so on. If retrograde IM nailing is operated by skillful surgeon and appled to absolute indication, the result is no significant difference of antegrade IM nail such as bone union, nonunion and postoperative infection. Nevertheless, operation time is shorter and blood loss lesser. Significant knee problems related to this technique could not be identified for 2 years followed up,
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성열보,정의엽,김경일,김수연 대한고관절학회 2017 Hip and Pelvis Vol.29 No.4
Purpose: The purpose of this study is to analyze the relationship between significant femoral neck shortening (SFNS) and bone density after three parallel screw fixation in valgus impacted femoral neck fracture, and to analyze the risk factors for SFNS. Materials and Methods: This is retrospective study of 83 patients. We performed univariate analysis for patient information, bone density, fracture configuration and screw position divided into SFNS group (n=13) and non-SFNS group (n=70) and performed multivariate analysis using logistic regression model. We also analyzed the relationship between SFNS and complications such as osteonecrosis of femoral head and nonunion. Results: There was a significant difference in age, screw non-parallelism and bone mineral density of intertrochanteric and total hip area in the univariate analysis between the two groups (P<0.05). In multivariate analysis, old age (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.21) and screw non-parallelism (OR, 2.95; 95% CI, 1.44-6.59) were significant risk factors for SFNS. The incidence of SFNS was significantly higher in the complication group (P=0.027). Conclusion: Bone density did not significantly affect SFNS in valgus impacted femoral neck fractures treated with three parallel screws. The risk factors of SFNS were old age and screw non-parallelism. Therefore, we recommend using other fixation method to prevent SFNS in older ages and making the screw position as parallel as possible when performing screw fixation in valgus impacted femoral neck fracture.
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장측으로 전위된제 2 중수골 기저 골절 - 1례 보고 -
성열보,김성수 대한골절학회 1997 대한골절학회지 Vol.10 No.4
Fracture of the base of the second metacarpal bone is usually undisplaced or minimally displaced. There were some reports of traumatic avulsion fracture of the extensor carpi radialis longus from the base of the second metacarpal. In most cases, the fragments were displaced into dorsal side. However, there is noreport of displaced fracture of the base of the second metacarpal into volar side in English papers. We are reporting a case in which the fragment was displaced into volar side.
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고관절 전치환술 후 발생한 재발성 탈구에 대한 대전자 부분 후하내방 이동술
성열보,한용택 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5
In spite of great advancement in total hip arthroplasty, recurrent dislocation is stlll one of the most common complication after THA. There are two main treatment options for this complication. One is the component change and the other is soft tissue tightening which gives stability around the hip joint. For a case of recurrent dislocation after THA in a 68 year-old man, we tried partial postero-infero-medial transfer of greater trochanter-abductor unit which had an excellent result.
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무시멘트형 비구 컵에서 polyethylene liner의 분리 후 발생한 Metallosis 1예
성열보,김덕규 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1
In 1971, Harris introduced a metal backed cementless acetabular cup to allow replacement of worn polyethylene liner and it has been popularly used now. But it has the additional potential for dissociation between metal shell and polyethylene liner. A case is described of catastrophic failure of the polyethylene liner of an cementless total hip arthroplasty with metal baked acetabular cup, 10 years 5months after implantation. At revision, the polyethylene liner was partialy dislocated in its metal shell, resulting in the femoral head was found to be articulating directly with the metal shell, There was gross metallosis in hip and severe osteolysis and cavitary bone defect of the pelvis.
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