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고덕환,김형준,오성학,김병준,김성재 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.4
Background: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. Methods: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels – the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. Results: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients’ height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). Conclusions: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.
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한국인 성인 쇄골의 해부학적 계측 및 쇄골과 Pre-Contoured Anatomical Plate의 적합성에 대한 분석
김형준(Hyeungjune Kim),남경모(Kyoungmo Nam),강대명(Daemyung Kang),오성학(Sunghak Oh),고덕환(Dukhwan Kho) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.5
목적: 쇄골은 복잡한 해부학적 특성으로 인해 수술 시 금속판과 적합성이 맞지 않는 경우가 있다. 본 연구에서는 한국인 쇄골의 해부학적 자료를 분석하여 pre-contoured anatomical plate와의 형태학적 적합성을 조사하였다. 대상 및 방법: 2010년 7월부터 2011년 7월까지 건국대학교 충주병원 응급실로 내원하여 3차원 흉부 컴퓨터 단층촬영을 시행한 300명을 대상으로 쇄골의 길이, 너비, 두께, 내, 외측 만곡의 깊이, 상방극점을 Andermahr의 방법을 이용하여 계측하였다. Precontoured anatomical plate의 적합성은 Adobe Photoshop를 이용하여 쇄골의 50%, 60%-70% 구간을 기준으로 적절함, 보통, 부적함으로 나누어 조사하였다. 결과: 쇄골의 평균 길이는 146.21±4.98 mm, 평균 폭은 9.63±1.67 mm, 평균 두께는 9.54±1.67 mm로 나타났다. 쇄골 상방극점은 쇄골 외측단에서 내측으로 평균 36.17±0.60 mm, 평균 위치에서 5.88±0.62 mm로 측정되었으며, 쇄골의 내측 만곡의 깊이는 평균 15.89±1.33 mm, 외측 만곡의 깊이는 평균 11.73±1.66 mm로 측정되었다. Pre-contoured anatomical plate의 적합성은 50% 지점에서 보통(fair) 이상의 적합성이 79%로 나타났고 60%-70% 영역에서는 48%로 나타났다. 60%-70% 영역에서 금속판의 내, 외측을 반대로 적용시켰을 때, 보통 이상의 적합성은 67%로 증가하였다. 결론: 서양인의 쇄골에 맞게 제작된 pre-contoured anatomical plate는 한국인의 쇄골과 해부학적으로 맞지 않아 금속판 적용을 하기 힘든 경우가 많으므로 향후 한국인의 쇄골에 알맞은 pre-contoured anatomical plate의 개발이 필요하다고 생각한다. Purpose: Due to the complex anatomy of clavicles, clavicular plates are not always compatible with clavicular fractures. The purpose of this study was to analyze basic data on the anatomy of the clavicle in order to determine compatibility between clavicles of Korean adults and pre-contoured anatomical plates. Materials and Methods: We analyzed the anatomy of 600 clavicles of 300 patients who underwent three-dimensional (3D) computed tomography of clavicles in the emergency room of Konkuk University Chungju Hospital, between July 2010 and July 2011, using Andermahr"s method; in addition, the compatibility between 3D axial images of clavicles and sectional images of pre-contoured anatomical plates was also examined using Adobe Photoshop. Results: The mean length of the clavicle was 146.21±4.98 mm, the mean width was 9.63±1.67 mm, and the mean thickness was 9.54±1.67 mm. The location of the maximum superior bow was 36.17±0.60 mm from the lateral end of the clavicle and the mean magnitude was 5.88±0.62 mm. The mean depth of medial curvature was 15.89±1.33 mm, and the mean depth of the lateral curvature of the clavicle was 11.73±1.66 mm. The compatibility between clavicles and plates was 79% as above a fair compatibility in the 50% range of clavicles and 48% as above a fair compatibility in the 60% to 70% range of clavicles. On the contrary, in application of medial and lateral plates in the 60% to 70% range of clavicles, above a fair compatibility had increased to 67%. Conclusion: A more adequate pre-contoured anatomical plate is required for satisfactory improvement of the compatibility of clavicles of Korean adults.
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고령의 고관절부 골절 환자에서 인공 고관절 반치환술 후 사망률 분석
고덕환 ( Duk Hwan Kho ),남경모 ( Kyoung Mo Nam ),오성학 ( Sung Hak Oh ),김형준 ( Hyeung June Kim ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.4
목적: 고령의 고관절부 골절환자에서 인공 고관절 반치환술 시행 후 발생한 사망률과 관련된 인자를 분석하여 보고하고자 한다. 대상 및 방법: 1994년 3월부터 2010년 3월까지 고관절부 골절로 인공 고관절 반치환술을 시행한 75세 이상의 환자 246명 278예를 대상으로 하였으며 평균 연령은 83.7세(75-103세)였다. 연령, 성별, 골절 형태, 동반 질환, ASA 등급, 골밀도, 수술 시기, 보행능력, 거주형태를 조사하여 수술 후 1년 내사망과 관련이 있는 인자들을 사망군과 비사망군으로 나누어 분석하였다. 결과: 수술 후 1년 사망률은 17.2%(48예)였고, 술 후 3개월까지 9.7%(27예), 4개월에서 6개월까지 5.4%(15예), 7개월에서 1년까지 2.1%(6예)였다. 수술 후 1년 사망률은 지연된 수술, 높은 ASA 등급, 보행능력, 거주 형태 등의 영향을 받았으나 연령, 성별, 골밀도, 골절 형태 등과의 유의한 관계는 없었다. 결론: 고령의 고관절부 골절 환자에서 양극성 반치환술 후 사망률 연구에서 ASA 등급, 수술 시기, 보행 능력, 거주형태가 중요한 인자로 나타났다. Purpose: This study evaluated the rate of mortality and analyzed the associated risk factors in elderly patients treated with bipolar hemiarthroplaty for the hip fractures. Materials and Methods: Between March 1994 and March 2010, the clinical records of 246 patients(278 cases) older than 75 years of age who underwent bipolar hemiarthroplaty after hip fractures were reviewed. The mean age of the subjects was 83.7 years(75-103 years). The relationship between the postoperative one year mortality and the related factors (age, gender, type of hip fractures, the timing of surgery, the associated medical condition, ASA grade, osteoporosis, walking ability and residence type) were analyzed. The subjects were divided into the dead group and survivor group. Results: The mean postoperative mortality rate within 1 year was 17.2%(48 cases). The highest mortality rate was observed at postoperative 3 months(9.7%, 27 cases), followed in order by between 4 and 6 months(5.4%, 15 cases) and 7 and 12 months(2.1%, 6 cases). The postoperative mortality rate within 1 year was affected by the timing of the operation, ASA grade, patient`s walking ability, and residence type, but there were no significant difference of the other factors, such as age, gender, osteoporosis, and type of hip fractures. Conclusion: The ASA grade, timing of the operation, walking ability, and residence type are factors associated with the mortality rate in elderly patients with hip fractures.
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