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외상성 중심성 척수 증후군 후 신경학적 및 기능적 결과
송경철(Kyoung-Chul Song),유재원(Jae-Won You),김현학(Hyun-Hak Kim),손홍문(Hong-Moon Sohn) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.1
목적: 외상성 중심성 척수 증후군에서 수술적 치료와 보존적 치료의 신경적 및 기능적 결과를 비교하여 치료의 방향을 결정하고 호전에 영향을 미치는 요소들을 알아보고자 하였다. 대상 및 방법: 2005년 1월부터 2008년 12월까지 중심성 척수 증후군으로 진단받고, 최소 1년 이상 추시 관찰이 가능했던 28예를 후향적으로 분석하였다. 수술적 치료군(group 1)이 15예, 보존적 치료군(group 2)이 13예였으며, 방사선적 평가는 maximum canal compromise (MCC), maximum spinal cord compression (MSCC), 기능적 결과는 American Spinal Injury Association motor score (AMS), Japanese Orthopaedic Association (JOA) score, neck disability index (NDI)를 사용하였다. 결과: MCC는 평균 47.2%, MSCC는 평균 20.0%였으며, 최종 AMS는 평균 92.0 (group 1: 92.9, group 2: 90.9), JOA score는 평균 12.8 (group 1: 14.0, group 2: 11.4), NDI는 평균 25.0 (group 1: 25.7, group 2: 24.3)이었다. 결론: 외상성 중심성 척수 증후군 치료에서 연령이 젊고, 골절이 동반된 고 에너지 손상이면서 척수 압박은 심하나 초기 신경적 결손이 심하지 않은 경우 조기에 수술적 치료를 시행하는 것이 좋을 것으로 생각된다. Purpose: The purpose of this study was to determine the direction for treatment and to evaluate factors influencing improvement by comparison of neurologic and functional outcomes of surgical treatment and conservative treatment for traumatic central cord syndrome. Materials and Methods: A total of 28 patients, who were available for follow-up for at least more than one year from January 2005 to December 2008, who were diagnosed as traumatic central cord syndrome were analyzed retrospectively. Fifteen patients underwent surgical treatment (group 1), and 13 patients received conservative treatment (group 2). Maximum canal compromise (MCC), and maximum spinal cord compression (MSCC) were used for radiologic assessment, and American Spinal Injury Association (ASIA) motor score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used for assessment of functional outcomes. Results: The mean MCC was 47.2%, mean MSCC was 20.0%, and mean ASIA motor scale was 92.0 (group 1: 92.9, group 2: 90.9) at the final follow-up. The mean JOA score was 12.8 (group 1: 14.0, group 2: 11.4) and mean NDI was 25.0 (group 1: 25.7, group 2: 24.3) at the final follow-up. Conclusion: It is concluded that if a patient with traumatic central cord syndrome is young, with a high energy injury combined with fractures, and has severe spinal compression and mild initial neurologic defect, early surgical treatment would be needed as soon as possible.
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관혈적 정복술 및 내고정술 후 군인에게 발생한 경비골 원위부 골결합증(1예 보고)
이준영,남기영,송경철,Lee, Jun-Young,Nam, Ki-Young,Song, Kyoung-Chul 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1
The scanty literature on distal tibiofibular synostosis includes descriptions of relatively few specific complaints. Here we report a case of a 24-year-old young soldier who sustained a left ankle lateral malleolar fracture about 6 months ago and was initially treated by the open reduction and internal fixation with plate & screw. But 6 months later, he suffered from an vague ankle pain, each time the symptoms occurred right after an active ambulation, ankle dorsiflexion, especially when he had exercised aggressively. The radiographs revealed that there was a mature distal tibiofibular synostosis. We treated the patient with surgical excision of synostosis. Post-operative condition was satisfied to all concern and the result was found to be excellent during one-year follow-up.
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항회전 근위 대퇴 골수정을 이용한 대퇴골 전자하 골절의 치료
박치형 ( Chi Hyoung Pak ),이상홍 ( Sang Hong Lee ),하상호 ( Sang Ho Ha ),이광철 ( Gwang Chul Lee ),송경철 ( Kyoung Chul Song ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4
목적: 대퇴 전자하 골절에 대해 항회전 근위 대퇴 골수정을 이용하여 치료한 결과를 분석하여 유용성을 평가하고자 하였다. 대상 및 방법: 최소 12개월 이상 추시 가능하였던 25예를 대상으로 하였고, 남자가 17명, 여자가 8명으로 평균 연령은 53.4세였다. Seinsheimer 분류상 IIA형 2예, IIB형 9예, IIIA형 2예, IV형 3예, V형 9예였다. 폐쇄적 도수 정복은 16예, 최소 절개를 시행한 경우는 9예였으며 Cleveland index, tip apex distance (TAD), 대퇴 경간각 변화, 골유합 시기 및 골수정 활강 정도 그리고 합병증 등을 평가하였다. 결과: 23예에서 골유합을 얻었으며 골유합 기간은 약 17주였다. Blade의 골두 내 위치는 Cleveland index상 5, 6, 8, 9영역이 80%였고, TAD는 평균 19.6 mm였으며 골수정 활강은 평균 4.4 mm, 대퇴 경간각 변화는 3도였다. 합병증으로 지연유합 3예, 불유합 2예 발생했다. 결론: 비교적 빠른 골유합 기간과 조기 보행 및 재활, 합병증의 감소를 보여 유용한 치료로 생각되며 폐쇄적 정복으로 해부학적 정복이 어려운 경우 최소 절개법을 이용한 정복 및 부가적 고정이 더 유용할 것으로 생각한다. Purpose: The purpose of this study was to analyze the results of treating subtrochanteric femoral fractures with proximal femoral nail antirotation (PFNA). Materials and Methods: Twenty five consecutive patients diagnosed with subtrochanteric femoral fractures underwent intramedullary fixation using PFNA and followed-up for over 12 months. According to the Seinsheimer`s classification, there were 2 type IIA, 9 type IIB, 2 type IIIA, 3 type IV and 9 type V. According to the AO classification, there were 10 type A, 9 type B and 6 type C. There were 16 cases of closed reduction group and 9 cases of limited open reduction group. Retrospectively, radiological outcomes were assessed at the union period, change of neck shaft angle, tip-apex distance, Cleveland index, sliding of lag screw and complication. Results: Union was achieved in 23 of 25 cases, over an average of 17 weeks. Limb length shortening below 2 cm occurred in 7 patients. The Cleveland index was shown in 80% of 5, 6, 8 and 9 zone; the tip apex distance was 19.6 mm; the mean sliding distance was 4.4 mm; and the mean change of femur neck and shaft angle was varus 3 degree at the final follow-up. Complications included 3 cases of delayed union and 2 cases of nonunion. Conclusion: With its early bony union, ambulation, rehabilitation and low complication, PFNA is a useful and reliable choice for the treatment of subtrochanteric fractures of the femur. Limited open reduction and additional fixation such as cable grip are recommended if it is difficult to obtain anatomical reduction by closed reduction.
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운동 선수에게 발생한 제5 중족골 근위부 피로골절에 대한 경피적 유관나사 고정술
이준영 ( Jun Young Lee ),하상호 ( Sang Ho Ha ),유재원 ( Jae Won Yu ),이상홍 ( Sang Hong Lee ),남기영 ( Ki Young Nam ),송경철 ( Kyoung Chul Song ) 대한스포츠의학회 2011 대한스포츠의학회지 Vol.29 No.1
The purpose of this study was to know utility of percutaneous cannulated screw fixation of fifth proximal metatarsal stress fractures in athletes by assessment of radiological and clinical outcome. This study examined clinical and radiological union time of eleven cases of percutaneous screw fixation, which used the 4.0 mm cannulated screw, of fifth proximal metatarsal stress fracture in athletes. Type 1 of Torg classification is 7 cases, type 2 is 3 cases and type 3 is 1 case. All the cases showed fracture union, and all the patients resumed their athletics at the final follow-up. None of the cases complained of refracture or pain around where they had surgery, and visual analogue scale of pain, and American Orthopedic Foot and Ankle Society score was 0.73 and 93.4. The results of the study confirm that percutaneous screw fixation, which used the cannulated screw, of fifth proximal metatarsal stress fracture would help athletes resume their athletics in early stages.
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