내측 반월상 연골판 후방 부착부 파열의 관절경적 견인 봉합술 - 최소 5년 추시결과 -

사공협,신홍관,이영국,배기철,조철현,이경재,손은석,김두한,SaKong, Hyub,Shin, Hong Kwan,Lee, Young-Kook,Bae, Ki Cheor,Cho, Chul Hyun,Lee, Kyung Jae,Son, Eun-Seok,Kim, Doo Han 대한관절경학회 2012 대한관절경학회지 Vol.16 No.2

목적: 본 연구의 목적은 슬관절 내측 반월상 연골판 후방 부착부 파열 환자에 대해 관절경적 견인 봉합술을 시행한 후 임상적 및 방사선학적 5년 추시 결과를 보고하고자 한다. 대상 및 방법: 2001년 1월부터 2005년 5월까지 본원에서 내측 반월상 연골판 후방 부착부 파열로 진단받고 관절경적 견인 봉합술을 시행한 환자 중 5년 이상 추적 관찰이 가능하였던 30예를 대상으로 하였다. 평균 추시 기간은 76개월(60-90개월)이었다. 임상적 결과는 Lysholm knee score로 확인하였고 방사선학적 결과는 단순 방사선 사진을 이용한 Kellgren-Lawrence 분류를 이용하였으며, 전예에서 2차 관절경 수술을 시행하였다. 외상, 비만, 내반 변형 및 수술 시기 등과 임상적 결과를 비교 분석하였다. 결과: 임상적 결과는 수술 전 Lysholm knee score 평균 55점에서 5년 추시 시 평균 86점으로 호전을 보였고, 방사선학적 추시 검사 결과 23예에서 관절 간격의 유지 및 호전 소견 보였으며, 7예에서 관절 간격이 감소되는 등의 퇴행성 변화가 있었고, 그 중 1예에서 골 관절염의 진행 소견으로 추후 인공 관절 치환술을 시행하였다. 결론: 관절경적 견인 봉합술을 시행하여 최소 5년 추시에서 27예(90%)에서 양호 이상의 좋은 결과를 얻었으며 내반 각도가 클수록 임상적으로 호전되는 정도는 유의하게 낮았다. Purpose: This study aims at evaluating our results with a 5-year follow up of arthroscopic pull-out suture repair of posterior root tear of the medial meniscus. Materials and Methods: This study enrolled 30 cases who underwent a arthroscopic pull-out suture repair to treat the posterior root tear of the medial meniscus from January 2001 to May 2005 and followed up at least 5 years. The average follow-up period was 76 months (range, 60-90 months). Clinical results by use of the Lysholm knee score and radiographic grade by use of the Kellgren-Lawrence classification were evaluated and second-look arthroscopy was done in all cases. The clinical results were compared with trauma history, obesity, varus deformity and time to operation. Results: At the last follow up, the Lysholm knee score improved from 55 points to 86 points. For the radiological results, 23 cases displayed maintenance or improvement of the medial joint space on the follow up X-ray, but 7 cases displayed decrease of the medial joint space, and 1 case was lately performed total knee replacement due to progressive osteoarthritic change. Conclusion: Arthroscopic pull-out suture repair has a good result at 27 cases (90%) in minimum 5 years follow-up. The clinical improvement was significantly reduced in more severe varus angle.

A Simple Way to Improve Visualization and Increase Working Space in Arthroscopy

조철현,이영국,신홍관 대한견주관절의학회 2011 대한견주관절학회 학술대회논문집 Vol.2011 No.3

장 내전근 파열 -3예 보고-

강철형,송광순,신홍관,배기철,Kang, Chul-Hyung,Song, Kwang-Soon,Shin, Hong-Kwan,Bae, Ki-Chul 대한정형외과스포츠의학회 2005 대한정형외과스포츠의학회지 Vol.4 No.1

Rupture of the adductor longus muscle of the thigh is a rare muscular injury. It is produced by several causes, such as trauma. Ultrasonography and magnetic resonance imaging need to differential diagnosis to other disease. Successful results by conservative management, surgical repair is indicated in the fresh rupture. 18-year-old, 17-year-old, and 20-year-old male patient were diagnosed as having a adductor longus rupture by means of physical examination, ultrasonography, and magnetic resonance imaging. One patient was treated by physical treatment, the other patients were treated by surgical excision. We report three cases of adductor longus rupture with a brief review of literature. 장 내전근 파열은 비교적 드물게 발생하는 근육 파열 질환으로 여러 원인으로 발생하나 외상등의 병력이 선행되어 발생하는 경우가 많다. 초음파 및 자기 공명 영상 촬영 등을 이용하여 여러 질환 과의 감별이 필요하며 보존적 요법으로도 좋은 효과를 얻을 수 있으나 간혹 수술적 치료가 요구되기도 한다. 저자들은 서혜부 종창을 주소로 내원한 17세와 18세, 20세 남자 3예에서 이학적 검사와 초음파 검사 및 자기 공명 영상 검사를 이용하여 장 내전근 파열을 진단하여 1예에서는 보존적 요법으로 치료하였고 2예는 수술적 요법으로 치료하였다. 이에 드문 장 내전근 파열 3예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Effect of a Sleep Aid in Analgesia after Arthroscopic Rotator Cuff Repair

조철현,이시욱,이영국,신홍관,황일선 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.3

Purpose: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. Materials and Methods: Seventy-eight patients were prospectively assigned to eitherthe zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the controlgroup (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic,duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. Results: The mean number of times that additional rescue analgesicwas required during 5 days after surgery was 2.1±2.0 in the zolpidem group and 3.3±2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the controlgroup. Additionally, there were no significant differences in duration of functionalrecovery and adverse effects between the two groups. Conclusion: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless,mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.

불안정성 골반 골절시 수술적 치료의 합병증

민병우 ( Byung Woo Min ),강철형 ( Chul Hyung Kang ),신홍관 ( Hong Kwan Shin ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.3

불안정성 쇄골 원위부 골절에서의 Endobutton을 이용한 오구 쇄골 인대 보강술

조철현(Chul-Hyun Cho),정구희(Gu-Hee Jung),신홍관(Hong-Kwan Sin),이영국(Young-Kuk Lee),박진현(Jin-Hyun Park) 대한견주관절의학회 2011 대한견주관절학회지 Vol.14 No.1

목적: 불안정성 쇄골 원위부 골절에서 Endobutton을 이용한 오구 쇄골 인대 보강술을 시행하고 그 방사선학적 및 임상적 결과를 알아보고자 하였다. 대상 및 방법: 2007년 10월부터 2009년 9월까지 오구 쇄골 인대 손상이 동반된 Neer 제 2형 불안정성 쇄골 원위부 골절로 TightRope<SUP>®</SUP> 고정술을 시행하고 1년 이상 추시 관찰이 가능하였던 연속적 9예를 대상으로 하였다. 방사선적 평가는 단순 방사선 사진을 이용하여 오구 쇄골 간격 측정 및 골유합을 판단하였고, 임상적 평가는 ASES 평가 점수를 이용하였다. 결과: 8예 (88.9%)에서 골유합을 얻을 수 있었으며, 평균 골유합 기간은 12.9 (9~16)주였다. 술 후 및 최종 추시 평균 오구 쇄골 간격은 5.6 mm, 6.2 mm로 통계학적으로 의미있는 정복의 소실은 없었다 (p>0.05). ASES 점수는 평균 90.3 (78~96)점으로 우수 6예, 양호 2예, 보통 1예였으며, 8예 (88.9%)에서 만족할 만한 결과를 나타내었다. 합병증으로 1예에서 초기 정복 소실로 인하여 불유합이 발생하였으며, 보통의 임상적 결과를 보였다. 그 외 고정물의 파손 및 감염등의 합병증은 없었다. 결론: 불안정성 쇄골 원위부 골절에서 TightRope<SUP>®</SUP> 고정술은 고정물의 제거가 필요하지 않다는 장점이 있으며, 원위 골편의 고정이 어려운 골절에서 안정된 고정을 얻을 수 있는 하나의 대안이 될 수 있을 것으로 생각된다. Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after operative treatment using endobuttons for unstable distal clavicle fractures. Materials and Methods: Between October 2007 and September 2009, 9 consecutive patients who were followed up for at least more than 12 months after operative treatment using a TightRope<SUP>®</SUP> were studied. The radiologic results on the serial plain radiographs and the clinical results according to the American Shoulder Elbow Surgeons (ASES) score were analyzed. Result: Bony union was shown in 8 cases (88.9%) and the average time to union was 12.9 (range: 9~16) weeks. The average coracoclavicular distances at the postoperative and final follow-up were 5.6 mm and 6.2 mm, respectively, with no statistically significant difference (p>0.05). The average ASES score was 90.3 (range: 78~96) and the clinical outcomes were 6 excellent, 2 good and one fair. There were no complications such as implant failure or infection except for one case of nonunion due to loss of the initial reduction. Conclusion: A major advantage of TightRope<SUP>®</SUP> fixation for unstable distal clavicle fractures is that no further surgery is needed to remove the implant. We suggest that this technique provides an alternative for fracture with a distal fragment, which is difficult to fix.

Radiographic Progression of Osteoarthritis after Rotational Acetabular Osteotomy: Minimum 10-Year Follow-up Outcome According to the Tönnis Grade

Byung-Woo Min,강창수,Kyung-Jae Lee,Ki-Cheor Bae,Chul-Hyun Cho,최정훈,손혁준,신홍관 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.3

Background: Although satisfactory mid- to long-term results of rotational acetabular osteotomy for early osteoarthritis secondary to acetabular dysplasia have been reported, there is still controversy about the long-term effects of this surgery in more advanced osteoarthritis. The purpose of this study was to investigate the radiographic progression of osteoarthritic changes after rotational acetabular osteotomy in acetabular dysplasia according to the preoperative Tönnis grade and evaluate its effects after minimum 10-year follow-up. Methods: We performed 71 consecutive rotational acetabular osteotomies in 64 patients with symptomatic acetabular dysplasia between November 1984 and April 2005. Of these, 46 hips (four hips with Tönnis grade 0, 30 with grade 1, and 12 with grade 2) whose clinical and radiographic findings were available after minimum 10-year follow-up were evaluated in this study. The mean age at the time of surgery was 39.0 years (range, 18 to 62 years) and the average follow-up duration was 17.3 years (range, 10.0 to 27.7 years). Clinical and radiographic evaluations were performed according to the preoperative Tönnis grade. Results: The average Harris hip score improved from 71.8 (range, 58 to 89) to 85.1 (range, 62 to 98). The radiographic parameters also improved in all Tönnis grades after the index surgery. Although the improvement of radiographic parameters was not different between preoperative Tönnis grades, the incidence of osteoarthritic progression was significantly different between grades (zero in Tönnis grade 0, four in Tönnis grade 1, and 10 in Tönnis grade 2; p < 0.001). The mean age at the time of surgery was also significantly older in osteoarthritic progression patients (p < 0.002). Kaplan-Meier survivorship analysis, with radiographic progression of osteoarthritis as the endpoint, predicted a 10-year survival rate of 100% in Tönnis grade 0, 85.7% in Tönnis grade 1, and 14.3% in Tönnis grade 2 (p < 0.001). Conclusions: The outcome of rotational acetabular osteotomy in most hips with Tönnis grade 0 and 1 was satisfactory after an average of 17 years of follow-up. The incidence of osteoarthritic progression was higher in Tönnis grade 2 and older age. Our results support that early joint preserving procedure is essential in the case of symptomatic dysplastic hips.