건강코너 - "젊은 층으로 확대되고 있는 관절염 누구도 자유로울 수만은 없습니다.

심재앙,Sim, Jae-Ang 대한산업안전협회 2007 안전기술 Vol.119 No.-

이중 다발 전방십자 재건술 후 이식건의 자기공명영상 추시와 슬관절 안정성과의 관계

심재앙,곽지훈,이용석,김광희,남신우,전성수,이범구,Sim, Jae Ang,Kwak, Ji Hoon,Lee, Yong Seuk,Kim, Kwang Hui,Nam, Shin Woo,Jun, Sung Soo,Lee, Beom Koo 대한관절경학회 2012 대한관절경학회지 Vol.16 No.2

목적: 이중 다발 전방십자인대 재건술 후 이식건의 자기공명영상(magnetic resonance imaging, MRI) 추시 소견과 안정성과의 관계를 알아보고자 하였다. 대상 및 방법: 1.5 테슬라 자기공명영상을 이용하였으며, 이식건의 신호 강도는 Sonoda 등의 분류를 이용하여 1, 2, 3 등급으로 분류하였고, 주행은 직선과 곡선으로 분류하였다. 전방 안정성은 Lachman, KT 관절계, $30^{\circ}$ 전방 전위 방사선 검사로, 회전 안정성은 pivot shift 검사로 평가하였다. 이식건의 자기공명영상 소견과 안정성의 상관 관계를 평가하였다. 결과: 신호 강도는 전내측 다발이 1 등급 66.7%, 2 등급 26.7%, 3 등급 6.7%였고, 후외측 다발이 1 등급 63.3%, 2 등급 33.3%, 3 등급 3.3%였다. 주행은 전내측 다발이 직선 83.3%, 곡선 16.7%였고, 후외측 다발이 직선 86.7%, 곡선 13.3%였다. 전내측 다발의 주행은 전방 안정성과 관련이 있었고, 후외측 다발의 주행은 회전 안정성과 관련이 있었다. 신호 강도는 안정성과 관련이 없었다. 결론: 이중 다발 전방 십자 인대 재건술 후 이식건의 자기공명영상 추시 소견과 안정성과의 관계에서 전방 안정성 면에서는 전내측 다발의 주행이, 회전 안정성 면에서는 후외측 다발의 주행이 관련이 있었다. Purpose: This study examined the relationship between graft appearance on follow-up magnetic resonance imaging (MRI) and knee stability after double bundle anterior cruciate ligament (ACL) reconstruction. Materials and Methods: For each patient, 1.5 tesla MRI's were obtained. The signal intensity of grafts was divided into 3 grades by Sononda's classification. The course of grafts was divided into two patterns: straight and curved. We assessed Lachman test, KT 2000 arthrometer and anterior drawer stress radiograph using Telos$^{(R)}$ in $30^{\circ}$ knee flexion for anterior stability and evaluated pivot shift test for rotatory stability. The correlation between graft appearance on MRI and the results of knee stability tests was evaluated. Results: The anteromedial (AM) graft was evaluated as being grade 1 in 66.7%, grade 2 in 26.7%, and grade 3 in 6.7% of the cases and the posterolateal (PL) graft was assessed as being grade 1 in 63.3%, grade 2 in 33.3%, and grade 3 in 3.3% of the cases according to the signal intensity. The AM graft was evaluated as being straight in 83.3% and curved in 16.7% of the cases, and the PL graft was assessed as being straight in 86.7% and curved in 13.3% of the cases according to the course. The course of AM graft was correlated with the results of anterior stability tests and the course of PL graft was correlated with the result of rotatory stability test. However, the signal intensity of grafts was not correlated with the results of anterior stability and rotatory stability tests. Conclusion: The course of AM is correlated with anterior stability and the course of PL is correlated with rotatory stability on follow-up MRI after double bundle ACL reconstruction.

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using an Outside-in Technique: Two- to Six-Year Clinical and Radiological Follow-up

심재앙,이용석,김경옥,김종근,이범구 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.1

Purpose: We evaluated the clinical and radiological outcomes of double-bundle anterior cruciate ligament (ACL) reconstruction using an outside-in technique with a follow-up of two- to six-years, especially in terms of the sports activity level and radiological degeneration.Materials and Methods: Sixty-seven patients who were available for a minimum two-year follow-up after double-bundle ACL reconstruction using an outside-in technique were retrospectively evaluated. The mean follow-up period was 43.7 months. The knee function and stability were evaluated before the operation, one year after the operation (short-term follow-up), and more than two years after the operation (last follow-up).Results: Regarding the knee function, the Lysholm score, International Knee Documentation Committee (IKDC) evaluation, and hop test showed significant improvement. Regarding the stability, the Lachman test, pivot shift test, KT-2000 arthrometer data, and anterior drawer radiographs using Telos showed significant improvement. Regarding the sports activity level, the patients who returned to pre-injury level activity was 68.7% according to the Tegner activity score and 76.1% according to the Cincinnati sports activity scale score. The incidence of aggravated degeneration or development of greater than IKDC grade A degeneration after surgery was 10.4%.Conclusions: Double-bundle ACL reconstruction using an outside-in technique showed favorable clinical and radiological outcomes with respect to the knee function and stability, joint degeneraion, and, especially, return to pre-injury sports activity.

자가 골-슬개건-골과 슬괵건을 이용한 관절경적 전방 십자 인대 재건술의 중기 추시 결과

심재앙,곽지훈,이범구,Sim, J.A.,Kwak, J.H.,Lee, B.K. 대한정형외과스포츠의학회 2006 대한정형외과스포츠의학회지 Vol.5 No.1

목적: 자가 골-슬개건-골과 슬괵건을 이용한 전방 십자 인대 재건술의 5년 중기 추시 결과를 비교 분석하고자 한다. 대상 및 방법: 전방 십자 인대 재건술을 시행한 후 5년 이상 추시 관찰이 가능한 65예를 대상으로 하였고, 골-슬개건-골이 38예, 슬괵건이 27예였다. 술 후 평가는 Lysholm 점수, 관절 운동 범위, 대퇴부 중간 부위 둘레 길이, Lachman 검사, 축 이동 검사, KT 2000 관절 계측기를 시행하였고, 술 후 합병증을 평가하였다. 결과: Lysholm 점수는 골-슬개건-골군과 슬괵건국에서 각각 평균 91점, 94.2점으로 슬괵건군이 우수하였고, 대퇴부 중간 부위 둘레 길이는 건측에 비해 각각 평균 1.7cm, 1.3cm의 차이를 보였다. 양 군간에 관절 운동 범위, Lachman 검사, 축 이동 검사 및 KT 2000 관절 계측 결과는 통계적으로 유의한 차이가 없었으나, 술 후 합병증은 과도한 보행이나 운동 후 슬관절 동통이 골-슬개건-골군에서 7예, 슬괵건 군에서 4예 관찰되었고, 전방 슬관절 동통이 골-슬개건-골군에서 4예 관찰되어, 골-슬개건-골군에서 더 많이 발생하였다. 결론: 5년 중기 추시에서 자가 슬괵건군이 우수한 슬관절 기능, 적은 합병증 등 임상적으로 우수하였으나 장기 추시가 요할 것으로 사료된다.

Comparison of Complete Distal Release of the Medial Collateral Ligament and Medial Epicondylar Osteotomy during Ligament Balancing in Varus Knee Total Knee Arthroplasty

심재앙,Yong Seuk Lee,곽지훈,Sang Hoon Yang,Kwang Hui Kim,이범구 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4

Background: During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. Methods: This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. Results: There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. Conclusions: Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique

슬개골 친화적인 ADVANTIM(R)을 이용한 슬관절 전치환술 후 결과

심재앙,이범구,기용철,최광운 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.1

Heterotrophic Ossification after Aggressive Rehabilitation in Patients with Trauma - A Case Report -

심재앙,윤용철,백승현 대한골절학회 2020 대한골절학회지 Vol.33 No.1

Heterotrophic ossification (HO) is a reactive disease presenting the formation of mature lamellar bone in soft tissues. It is known to occur following surgery, soft tissue injury, or central nervous system anomalies. However, a definite cause has not yet been clearly addressed. During the process of approach, reduction, and fixation while conducting surgeries, partial injury of soft tissue is inevitable. Additionally, secondary injuries may be caused during the active and passive range of motion exercises that should be done for the recovery of joint motion after surgery. The authors experienced cases of HO that may occur during surgery and rehabilitation after surgery. The authors recognized that special care is required for patients complaining of severe pain during the early stage of rehabilitation immediately after surgery. This study aimed to reaffirm the principles of fracture treatment by reviewing the cases and to investigate the occurrence of HO after fracture surgery.

자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술의 단기 추시 결과

심재앙(Jae-Ang Sim),양상훈(Sang-Hoon Yang),안병근(Byoung-Keun Ahn),이범구(Beom-Koo Lee) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.3

목적: 자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술 후 최소 1년 이상 단기 추시 결과를 보고하고자 하였다. 대상 및 방법: 50예를 대상으로 하였으며, 전내측 다발로 반건양건, 후외측 다발로 박건을 이용하였다. 대퇴부 전내측 다발은 Ligament Plate<SUP>®</SUP>에 현수 고정, 후외측 다발은 Mersilene tape<SUP>®</SUP>을 이용 고정, 경골부는 이중 post-tie 고정을 시행하였다. 평균 추시 기간은 16.5개월이었고, 임상적, 방사선학적으로 평가하였다. 결과: Lysholm 점수는 92.4±6.8점, IKDC 점수는 A 등급 35예, B 등급 14예, C 등급이 1예로 호전되었다. Lachman 검사는 음성 40예, 경도 9예, 중등도 1예, pivot shift 검사는 음성 45예, 경도 5예로 호전되었다. KT 관절계 검사는 건측에 비해 1.3±1.6 ㎜, 전방 전위 방사선 사진은 1.3±1.3 ㎜로 호전되었다. 터널 확장 정도는 대퇴부가 전내측 1.7±0.6 ㎜, 후외측 1.6±0.7 ㎜, 경골부가 전내측 1.2±0.4 ㎜, 후외측 1.4±0.5 ㎜였다. 결론: 자가 슬건과 Ligament Plate<SUP>®</SUP>를 이용한 이중 다발 전방 십자 인대 재건술은 충분한 조기 고정력과 outside-in 등의 술기를 통한 해부학적 재건으로 우수한 임상 결과를 얻을 수 있었다. Purpose: We wanted to evaluate the clinical outcomes at a minimum 1-year following anatomic double bundle ACL reconstruction with using autogenous hamstring tendons fixed with Ligament Plate<SUP>®</SUP>. Materials and Methods: We evaluated a total of 50 patients. Semitendinosus tendon was used for the reconstruction of the anteromedial bundle and the gracilis tendon was used for the reconstruction of the posterolateral bundle. For femoral fixation, we used an anteromedial bundle that was suspended in Ligament Plate<SUP>®</SUP> and a posterolateral bundle linked with Mersilene tape<SUP>®</SUP>. For tibial fixation, we used double post-tie. The average follow-up period was 16.5 months. We analyzed the clinical and radiographic results. Results: At the last follow-up, the Lysholm score was 92.4±6.8 points. For the IKDC score, there were 35 cases of grade A, 14 cases of grade Band 1 case of grade C. The Lachman test was negative for 40 cases, it was grade 1 for 9 cases and it was grade 2 for 1 case and the pivot shift test was negative for 45 cases and it was grade 1 for 5 cases. The side-to-side differences with the KT-2000 and the anterior drawer radiogram were 1.3±1.6 ㎜ and 1.3±1.3 ㎜, respectively. The femoral tunnel enlarged to 1.7±0.6 ㎜ in the anteromedial aspect and 1.6±0.7 ㎜ in the posterolateral aspect, and the tibial tunnel enlarged to 1.2±0.4 ㎜ in the anteromedial aspect and 1.4±0.5 ㎜ in the posterolateral aspect. Conclusion: Anatomic ACL reconstruction using autogenous hamstring tendons that are fixed with Ligament Plate<SUP>®</SUP> showed good clinical results due to the strong strength of early fixation and the anatomic restoration of the ACL.

외측 반월상 연골에서 발생한 외상성 완전 방사상 파열 자가 치유의 자연 경과: 증례 보고

심재앙 ( Jae Ang Sim ),윤용철 ( Yong Cheol Yoon ),이신우 ( Sheen Woo Lee ),이범구 ( Beom Koo Lee ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Complete radial tears of the lateral meniscus are relatively rare. Once torn, the injury can be debilitating due to disruption of the circumferential fibers of the meniscus. We experienced a case of a lateral meniscus with a complete radial tear at the midbody, where the two torn ends were displaced more than 1 cm and could not be approximated during arthroscopy. Thirteen months after surgery, follow-up MRI and second-look arthroscopic findings showed that the complete radial tear has healed spontaneously. However, twenty nine months after the second-look arthroscopy, the patient complained of severe knee pain during exercise. On follow-up MRI, increased sclerosis and newly developed bone marrow edema were observed in the lateral femoral condyle, compared with previous MR images. Finally, we performed meniscal allograft transplantation due to the defective properties of the completely healed lateral meniscus. [ J Trauma Inj 2015; 28: 21-26 ]

Ligament Plate(R)과 슬근건을 이용한 전방십자인대 재건술의 단기 추시 결과

심재앙 ( Jae Ang Sim ),이범구 ( Beom Koo Lee ),곽지훈 ( Ji Hoon Kwak ),이경찬 ( Kyung Chan Lee ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.2