성인 족부의 거대지 치료 (1예 보고)

안재훈,김병성,강종원,김동훈,최원식,Ahn, Jae-Hoon,Kim, Byung-Sung,Kang, Jong-Won,Kim, Dong-Hoon,Choy, Won-Sik 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Macrodactyly is a rare congenital anomaly characterized by the overgrowth of some or all tissue elements of a digit or digits in the hand or foot. We report of a case of macrodactyly in a foot of an adult female, which was treated successfully with the staged foot narrowing operations.

골간부 사형 절골술을 이용한 소건막류의 치료

안재훈,김하용,강종원,최원식,김용인,Ahn, Jae-Hoon,Kim, Ha-Yong,Kang, Jong-Won,Choy, Won-Sik,Kim, Yong-In 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: The authors intended to evaluate the results of symptomatic bunionette treated with a diaphyseal oblique osteotomy. Materials and Methods: Nine patients were followed for more than 1 year after diaphyseal oblique osteotomy for a bunionette deformity with plantar callosity. The mean age was 43 years (23-69 years), and the mean follow-up period was 27 months (12-70 months). As a combined disorder, 7 patients had hallux valgus, for which 3 distal metatarsal oteotomies, 3 proximal osteotomies, and 1 double osteotomy were performed. Clinically, preoperative and postoperative AOFAS MP-IP scale, patient's satisfaction, postoperative complications were analyzed. Radiologically, the 4th intermetatarsal angle and the 5th metatarso-phalangeal angle were analyzed. Results: Clinically, AOFAS MP-IP scale was increased from 59 points preoperatively to 93 points postoperatively, and all patients were satisfied with the results. The plantar callosity had all disappeared at the final follow up. The 4th intermetatarsal angle was decreased from $12.6^{\circ}$ preoperatively to $4.3^{\circ}$ postoperatively, and the 5th metatarsophalangeal angle was decreased from $21.9^{\circ}$ preoperatively to $2.4^{\circ}$ postoperatively. There were no significant postoperative complications. Conclusion: Diaphyseal oblique osteotomy of the 5th metatarsal appears to be safe and satisfactory procedure for the treatment of a symptomatic bunionette with plantar callosity.

중족지 관절경을 이용한 Freiberg 병의 치료 -1예 보고-

안재훈,이승훈,이광원,최원식,감병섭,Ahn, Jae-Hoon,Lee, Seung-Hun,Lee, Kwang-Won,Choy, Won-Sik,Kam, Byoung-Sup 대한관절경학회 2007 대한관절경학회지 Vol.11 No.1

Freiberg 병은 비교적 드문 골연골증으로 주로 사춘기 여자의 제2 중족골 두에서 발생한다. 그 치료는 다양하여 관절내 유리체 제거술, 골두 절골술 또는 골두 절제술 등의 수술이 시도되고 있다. 관절경을 이용한 치료는 회복 기간을 단축시키는 동시에 술후 발생하는 강직을 감소시키는 장점이 있다. 저자들은 초기의 Freiberg 병에 대해 중족지 관절경을 이용하여 유리체 제거술 및 변연절제술을 시행하고 그 결과를 보고하고자 한다. Freiberg disease is a relatively rare osteochondrosis of metatarsal head, which usually involves the 2nd metatarsal of adolescent females. Various open surgical treatments have been recommended; arthrotomy and removal of loose body, dorsiflexion osteotomy and resection of the metatarsal head. Arthroscopic treatment for Freiberg disease has a merit of shortening the recovery period and reducing the postoperative stiffness. We report a case of early stage Freiberg disease treated with metatarsophalangeal arthroscopic excision of loose body and debridement of the 2nd metatarsophalangeal joint.

전위된 거골 경부 골절의 수술적 치료

안재훈,백창현,최원식,김용인,Ahn, Jae-Hoon,Baek, Chang-Hyun,Choy, Won-Sik,Kim, Yong-In 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate the results of open reduction and internal fixation for displaced talar neck fracture. Materials and Methods: Fourteen patients were followed for more than 1 year after open reduction and internal fixation of displaced talar neck fracture. The mean age was 41.5 years, and the mean follow-up period was 3.8 years. There were 10 type II, 3 type III and 1 type IV fractures per Hawkins. There were 3 open fractures. Clinically AOFAS ankle-hindfoot scale and Hawkins criteria were utilized. Radiologically quality of reduction, duration of bony union, avascular necrosis and posttraumatic arthritis were evaluated. Results: At last follow-up, AOFAS scale was mean 89.1 points. There were 8 excellent, 4 good, and 2 fair results according to Hawkins criteria. Radiologically anatomical reduction was obtained in 13 cases. Mean duration of bony union was 11.8 weeks. There were 3 avascular necrosis and 2 post-traumatic arthritis. There was no significant difference in the incidence of avascular necrosis between early operation group and surgically delayed group. Conclusion: Accurate open reduction and rigid internal fixation seem to be prerequisites for satisfactory treatment of a displaced talar neck fracture.

거골하 관절경을 이용한 Os Trigonum Syndrome의 치료(1예 보고)

안재훈,백창현,이광원,김승권,최원식,Ahn, Jae-Hoon,Baek, Chang-Hyun,Lee, Kwang-Won,Kim, Seung-Kwon,Choy, Won-Sik 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Os trigonum syndrome is a clinical disorder characterized by posterior ankle pain which occurs in excessive plantar flexion. The pain is elicited by the impingement of os trigonum between the calcaneus and the posterior edge of tibial plafond. Mostly, symptoms can be improved with nonsurgical management, however surgery is required for refractory cases. We report of a case of os trigonum syndrome in a female ballet dancer, which was successfully treated with subtalar arthroscopic excision of os trigonum.

발 및 발목 관절 부위의 결절종

안재훈,이항호,최원식,Ahn, Jae-Hoon,Lee, Hang-Ho,Choy, Won-Sik 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Purpose: To analyze the clinical results of excision of the symptomatic or recurred ganglion cysts of the foot and ankle. Materials and Methods: Twenty-one cases of the ganglions located in the foot and ankle area were followed for more than 12 months postoperatively. There were 9 males and 12 females, and the mean age was 42.3 years (range, 11-71 years). The mean duration of follow-up was 2.3 years (range, 1.1-4.1 years). Clinically previous treatment, size and location of the cyst, preoperative and postoperative AOFAS foot score, postoperative complication and satisfaction of patients were evaluated. Results: As a previous treatment, 7 patients received mean 1.3 bouts of aspirations, and 6 patients were recurred after mean 1.5 bouts of operations. The size of cyst ranged from 1.4 cm to 5.1 cm with the mean size of 2.7 cm. The cyst was most common in the dorsum of the foot and ankle, where 14 cases were found. Preoperative mean AOFAS foot. scores were low in the cysts associated with the tarsal tunnel syndrome, which was 71 points, and in the cyst of the plantar aspect of the 1st toe, which was 79 points. Postoperative mean AOFAS foot scores were significantly increased to 91 points and 92 points in preceding two groups. There were 2 cases (9.5%) of recurrence, both of which had satellite mass along the tendon sheath. Conclusion: Care should be taken in the diagnosis and treatment of ganglions in the tarsal tunnel and in the plantar aspect of the 1st toe. In case of ganglion cysts originated from the tendon sheath, consideration should be given for possible satellite mass.

거골하 관절의 관절경술

안재훈,Ahn, Jae-Hoon 대한관절경학회 2009 대한관절경학회지 Vol.13 No.3

The development of good quality small-diametered arthroscopes and refined arthroscopic techniques has contributed to the improvement of the subtalar arthroscopy. The therapeutic indications are synovectomy, removal of loose bodies, debridement and drilling of osteochondritis dissecans, excision of subtalar impingement lesions and osteophytes, lysis of adhesions for post-traumatic arthrofibrosis, removal of a symptomatic os trigonum, calcaneal fracture assessment and reduction, and arthroscopic arthrodesis of the subtalar joint. The subtalar arthroscopy can be done in supine position using thigh holder or in lateral decubitus position. The arthroscope generally used is a 2.7-mm 30 degrees short arthroscope. Noninvasive distraction with a strap around the hindfoot can be helpful. Usually anterolateral, middle and posterolateral portals are utilized for inspection and instrumentation within the joint. Twoportal posterior subtalar arthroscopy in prone position can be performed as well with 4.0-mm 30 degrees arthroscope, depending on the type and location of the subtalar pathology. The subtalar arthroscopy is a technically demanding procedure, which requires proper instrumentation and careful operative technique. Possible complications are nerve damage and persistent wound drainage.

유관 나사와 분쇄 골이식을 사용한 거골하 관절 유합술

안재훈,김갑중,최원식,나규현,Ahn, Jae-Hoon,Kim, Kap-Jung,Choy, Won-Sik,Na, Kyu-Hyun 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.1

Purpose: To analyze the clinical and radiological outcome of subtalar arthrodesis using cannulated screws and morselized bone graft. Materials and Methods: Twenty one patients with follow-up of more than 1 year after subtalar arthrodesis were included in this study. Mean age was 40.8 years, and mean follow-up duration was 38 months. Underlying diseases were 19 cases of posttraumatic arthritis (18 calcaneal fractures and 1 talar fracture) and 2 cases of tarsal coalition. Clinically AOFAS ankle-hindfoot score, operation time, complication and satisfaction of patients were analyzed. Radiologically time to union, arthritis of surrounding joints, preoperative and postoperative talar declination angle were analyzed. Results: AOFAS ankle-hindfoot score was improved from preoperative 33 points to postooperative 79 points. Eighteen patients (86%) were satisfied with the results. Mean operation time was 91 minutes. All cases were fixed with 1-2 cannulated screws and morselized bone graft. Mean time to radiologic union was 12.1 weeks. There was 1 case of delayed union. There was no significant perioperative changes in talar declination angles. Conclusion: Subtalar arthrodesis using cannulated screws and morselized bone graft seems to be relatively simple and effective treatment method for subtalar arthritis.

원위부 중족골 쉐브론 절골술을 이용한 무지 외반증의 치료

안재훈,최원식,김하용,이도현,배경완,Ahn, Jae-Hoon,Choy, Won-Sik,Kim, Ha-Yong,Lee, Do-Hyun,Bae, Kyoung-Wan 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.2

Purpose: The authors intended to analyze the operative results of mild to moderate hallux valgus treated with distal chevron metatarsal osteotomy. Materials and Methods: Twenty six feet of twenty three patients were followed for more than 1 year after the distal chevron metatarsal osteotomy. Biplanar osteotomy with wedge resection was done when the distal metatarsal articular angle (DMAA) was increased. The mean age was 39 years, and the mean follow up period was 27 months. Clinically preoperative and postoperative AOFAS hallux MP-IP scale and satisfaction after the surgery were analyzed. Radiologically hallux valgus angle, the 1st intermetatarsal angle, DMAA and sesamoid position before and after the operation were analyzed. Results: Distal chevron osteotomy was done in 15 cases and biplanar osteotomy was done in 11 cases. Clinically AOFAS scale was increased from 65.3 points preoperatively to 92.2 points postoperatively. Two patients were not satisfied with the results. Radiologically hallux valgus angle was decreased from $21.9^{\circ}$ preoperatively to $8.5^{\circ}$ postoperatively. The first intermetatarsal angle was decreased from $11.8^{\circ}$ preoperatively to $6.7^{\circ}$ postoperatively. DMAA was decreased from $11.8^{\circ}$ preoperatively to $5.5^{\circ}$ postoperatively. There was one case of minor wound infection. Conclusion: Distal chevron metatarsal osteotomy appears to be safe and satisfactory procedure for mild to moderate hallux valgus.

족근관 증후군의 수술적 치료

안재훈,김갑중,김하용,최원식,양대석,Ahn, Jae-Hoon,Kim, Kap-Jung,Kim, Ha-Yong,Choy, Won-Sik,Yang, Dae-Suk 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: The authors intended to analyze the operative results of tarsal tunnel syndrome. Materials and Methods: Twenty-one patients with tarsal tunnel syndrome were followed for more than 1 year after operation. The mean age was 44 years, and the mean follow up period was 2 years and 9 months. Clinically preoperative and postoperative AOFAS ankle-hindfoot score and visual analogue scale for pain were analyzed. Radiologically the cause of disease was investigated, and the size of mass was measured, if possible. The duration of symptom, the presence of space occupying lesion (SOL), the effect of epineurolysis were statistically analyzed to see the relation with the operative results. Results: Operative release of tarsal tunnel was done in all cases, and epineurolysis was done in 11 cases. The causes of the disease were 10 soft tissue masses, 7 talocalcaneal coalitions, 1 nonunion of medial talar process fracture, and 1 pes planovalgus, and 3 idiopathic cases. The masses were subdivided into 7 ganglions, 2 neurilemmomas, and 1 lipoma. There was 1 case of combined talocalcaneal coalition and ganglion. Clinically AOFAS ankle-hindfoot score was increased from 62.7 points preoperatively to 84.3 points postoperatively. Visual analogue scale was improved from 6.5 preoperatively to 2.2 postoperatively. Two cases were graded as unsatisfactory. One was severe pes planovalgus, and the other was idiopathic case. The duration of symptom and the epineurolysis were not related with the results. However the presence of space occupying lesion was significantly related with the good results. Conclusion: Early operative release of tarsal tunnel appears to be important for the improvement of symptom. However the prognosis is limited in case that there is no SOL.