슬관절에 발생한 결핵성 관절염으로 오인한 활막성 연골종증

윤한국(Han-Kook Yoon),이진호(Jin-Ho Lee),박상훈(Sang-Hoon Park),하중원(Joong-Won Ha) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.1

활막성 연골종증은 관절 활액막으로부터 기원하는 증식성의 연골성 결절 양성 종양이다. 활막성 연골종증 환자의 진단에 있어서 영상의학적 소견이 중요한 부분을 차지하고 이는 다양한 모습으로 나타나는데 결핵성 관절염, 류마티스 관절염 등과 오인하게 되는 경우가 다수 있다. 자기공명영상 검사상 결핵성 관절염과 류마티스 관절염에서 흔히 보이게 되는 쌀소체(rice body)와 활액막성 연골종증의 소견이 유사하게 나타나는 경우가 많다. 영상소견상 결핵성 관절염 또는 류마티스 관절염으로 오인한 편측 무릎에 발생한 원발성 활막성 연골종증 1예에 대해서 보고한다. Synovial chondromatosis is a proliferative chondrogenic benign tumor originating from the synovial membrane of the joint. Radiological findings occupy an important part in the diagnosis of patients with synovial chondromatosis, which appear in various forms, and are often misunderstood such as tuberculous arthritis and rheumatoid arthritis. In many cases, the findings of rice body, which are common in tuberculous arthritis and rheumatoid arthritis, and synovial chondromatosis are similar on magnetic resonance imaging. A case of primary synovial chondromatosis that was mistaken for tuberculous arthritis or rheumatoid arthritis by imaging findings is reported.

급성 전방십자인대 손상의 진단에 있어 관절경 소견과의 비교분석을 통한 자기공명영상의 유용성

최종혁,윤한국,김보람,윤춘식,Choi, Chong-Hyuk,Yoon, Han-Kook,Kim, Bo-Ram,Yoon, Choon-Sik 대한관절경학회 2005 대한관절경학회지 Vol.9 No.1

목적 : 급성 전방십자인대의 손상에 있어 자기공명영상의 진단적 정확성 및 파열양상에 대한 유용성을 관절경 검사소견과의 비교연구를 통해 알아보았다. 대상 및 방법: 2002년 1월부터 2004년 6월까지 급성 슬관절 손상을 받고 임상적으로 전방십자인대 손상이 의심되어 자기공명영상검사를 시행한 후 이어서 관절경검사를 시행받은 환자 60례를 대상으로 하였다. 급성 전방십자인대의 손상에 있어 자기공명영상의 진단의 정확도, 파열양상에 대한 유용성에 대하여 관절경검사소견을 기준으로 양성예측도를 이용하여 분석하였다. 결과: 자기공명영상에서 불연속성을 보인 52례 모두에서 관절경검사상 전방십자인대 손상이 확인되었다. 파열양상에 있어서는 파열부위, 전반적인 부종, 국소 부종의 확인에 있어서는 관절경검사소견과 자기공명영상소견이 모두 일치한 결과를 보였고 원위부 허탈, 복합파열의 확인에 있어서는 정확도가 떨어지는 결과를 보였다. 결론: 급성 전방십자인대 손상의 자기공명영상의 소견은 관절경적 소견과 대체로 일치하였으며 특히 파열 양상에 있어서는 파열부위, 전반적인 부종, 국소부종의 확인에 있어서 매우 정확한 것을 갈 수 있었다. Purpose: The purpose of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute anterior cruciate ligament (ACL) injury and its tear pattern in comparison with arthroscopic finding. Materials and Methods: Sixty consecutive patients with acute ACL injury were taken NRI followed by arthroscopic examination between January 2002 and June 2004. MRI findings were reviewed according to the presence of ACL discontinuity, diffuse swelling or thickening, focal edema, collapse on distal end, and any combined tear. The pathologic findings were then confirmed arthroscopically. The diagnostic accuracy of MRI on ACL tear pattern was analyzed by obtaining its positive predictive value. Results: All fifty two cases with presence of discontinuity on MRI showed ACL rupture arthroscopically. The location of ACL tear, diffuse swelling and focal edema on MRI also corresponded with arthroscopic findings respectively. However, the diagnostic accuracy of MRI was relatively lower in the presence of other ACL patterns such as collapses and combined tear. Conclusion: Preoperative MRI findings seem to be in accordance with arthroscopic findings and is significantly accurate in detection of location and diffuse swelling and focal edema of ACL tear.

급성 전방 십자 인대 파열의 관절경적 봉합술

최종혁,윤한국,김형식,Choi, Chong-Hyuk,Yoon, Han-Kook,Kim, Hyung-Sik 대한관절경학회 2005 대한관절경학회지 Vol.9 No.2

Purpose: The purpose of this study is to evaluate the results of arthroscopic anterior cruciate ligament(ACL) repair with minimal incision and to review prognostic factors according to ACL tear patterns and the presence of associated injury Materials and Methods: Thirty eight patients (thirty nine knees) with acute ACL tear were given arthroscopic ACL repair between January 2001 and December 2002 and were followed up at least over six months. Intraoperative findings such as ACL tear pattern and the presence of synovial or concomitant medial collateral ligament injuries were recorded. Each knee was then postoperatively re-evaluated with aid of KT-1000 arthrometer and Lachman test and Lysholm score. Results: Postoperative limitation of motion was significant when combined typed ACL tear was present with concurrent medial collateral ligament(MCL) injury. In contrast, in the case where there were sole proximal ACL tear or no evidence of synovial injury, the limitation of motion was not significant. Anterior laxity was significantly associated with the presence of combined typed ACL tear or concurrent synovial injury, but was not significant when there were sole proximal ACL tear. Conclusion: In the case where there is sole proximal ACL tear without concurrent synovial injury, arthroscopic ACL repair can be considered as a treatment modality for the treatment of acute ACL injury. 목적: 급성 전방 십자 인대 파열 환자에서 관절경을 이용한 최소한의 절개에 의한 봉합술 후 조기 운동을 시행하여 그 결과를 알아보는데 있다. 대상 및 방법: 2001년 1월부터 2002년 12월까지 슬관절의 급성 전방 십자 인대 파열로 내원하여 인대 봉합술로 치료받은 환자 중 최소 6개월 이상 추시 관찰되었던 38명(39례)를 대상으로 하였으며, 환자의 평가는 이학적 검사, KT-10000을 이용한 전방 전위 검사 및 Lysholm평가를 이용하여 수술결과를 파열양상, 활막의 상태, 내측 측부 인대 손상 여부등에 따라 분석하였다. 결과: 수술후 운동장해는 근위부 및 원위부의 복합파열과 내측 측부 인대 동반손상시 빈도가 의미있게 높았으며 근위부 단독파열과 활막의 파열이 없는 경우 의미있게 낮은 결과를 보였다. 전방 불안정성은 근위부 파열만 있는 경우 의미있게 적었으며 복합파열과 활막의 손상이 심할수록 전방 전위가 의미있게 증가하는 결과를 보였다. 결론: 급성 전방 십자 인대 손상의 치료로 관절경적 봉합술은 근위부 단독파열이면서 활막손상이 없는 경우에 있어서 결과가 좋은것을 알 수 있었다.

종골의 관절 내 골절에서 외측 광범위 도달법을 이용한 F형 금속판 고정술과 잠김 금속판 고정술의 비교

이윤태,오현철,윤한국,장재원,장기준,Lee, Yun-Tae,Oh, Hyun-Cheol,Yoon, Han-Kook,Jang, Jae-Won,Jang, Ki-Jun 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.3

Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

중등도 이상의 무지 외반증에서 근위 초승달형 절골술의 효과

이윤태,김형복,윤한국,Lee, Yoon-Tae,Kim, Hyoung-Bok,Yoon, Han-Kook 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1

Purpose: The purpose of this study was to retrospectively analyze the clinical and radiologic results of the proximal crescentic osteotomy for moderate to severe hallux valgus deformity. Materials and Methods: Between March 2001 and March 2008, 55 patients (71 feet) who had undergone crescentic osteotomy and distal soft tissue procedure for hallux valgus were followed up for more than one year. The average follow-up period was 15.8 months (12~28 months) and the average age at the time of surgery was 49.8 years (20~69 years). We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA), the length of 1st metatarsal bone and the position of medial sesamoid in preoperative and the last follow-up radiographs. The American Othopeaedic Foot and Ankle Society (AOFAS) score and patient satisfaction were measured by modifying Johnson's method which were used for clinical outcome assessments. Results: The HVA and the IMA were 36.2 and 15.8 degrees preoperatively, and 10.8 and 3.9 degrees at the last follow-up, respectively. The amount of shortening of 1st metatarsal bone averaged $2.3{\pm}1.1$ rum postoperatively. The medial sesamoid position improved from a preoperative average of grade 6.6 to the last follow-up average of grade 1.9. The AOFAS score improved from a preoperative average of 45.3 points to an average 90.6 points at the last follow-up. The patient's satisfaction was completely satisfied in 61 cases (85.9%), satisfied with minor reservations in 6 cases (8.5%), satisfied with major reservations in 2 cases (2.8%), and dissatisfied in 2 cases (2.8%). Conclusion: Proximal crescentic osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

원위 요골 골절후 발생한 불유합의 수술적 치료

강호정(Ho Jung Kang),윤한국(Han Kook Yoon),윤홍기(Hong Kee Yoon),한창욱(Chang Wook Han),정성훈(Sung Hoon Jung),한수봉(Soo Bong Han) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.3

목적: 원위 요골 골절 후 불유합된 7예의 임상적 치료 경험을 문헌고찰과 함께 보고하고자 한다. 대상 및 방법: 자가 장골 이식술 및 금속판 내고정술로 치료한 7예에 대하여 수상원인, 발생요인, 방사선 소견, 치료방법, 합병증 등을 후향적으로 분석하였다. 골유합 여부를 평가하였고 요골 길이와 척골 변위를 Kreder 등의 방법을 사용하여 측정하고 수술 전후를 비교하였다. 술 후 기능 및 임상적 평가는 Anderson씨 평가기준을 이용하였다. 결과: 전 예에서 골유합을 얻었으며 골유합까지의 기간은 평균 19주였다. 최종 추시시의 기능적 결과는 우수 4예, 양호 3예였다. 불유합의 발생 요인은 견고한 고정의 실패로 인한 골절부의 불안정성이 3예, Gustilo & Anderson 분류 Ⅱ형 이상의 심한 개방성 골절이 2예, 술 후 감염에 의한 것이 1예, 특별한 원인을 찾을 수 없는 경우가 1예였다. 결론: 심한 개방성 골절과 수술 후 감염, 불안정한 정복유지, 원위 척골의 동반손상 등에서 발생한 원위 요골 불유합을 단계적 수술을 통한 감염조절과 골이식술과 금속판을 이용한 견고한 내고정으로 만족할만한 결과를 얻을 수 있었다. Purpose: To report the treatment results of 7 cases of distal radius nonunion with a review of the relevant literature. Materials and Methods: Seven patients treated with an autoiliac bone graft and rigid internal fixation for nonunion of the distal radius were analyzed retrospectively for the cause of injury, the factors affecting nonunion, radiological findings, treatment method and complications. The results were analyzed radiologically using Kreder's method and functionally using the Anderson' protocols. Results: Union was achieved in all cases after a mean period of 19 weeks. The functional result of treatment at the last follow-up was excellent in 4 cases and satisfactory in 3 cases. The probable factors of nonunion were instability of the fracture site in three cases, type Ⅱ or Ⅲ open fracture in 2 cases, postoperative infection in one case and idiopathic in one case. Conclusion: Infection control using a stepwise operation, rigid internal fixation and autogenous iliac bone graft showed satisfactory results in distal radius nonunion, which had developed in those with severe open fractures, postoperative infection, instability on the fracture site and associated distal ulnar fracture.

최소 내측 광근 절개 도달법[Mini-Midvastus Approach]을 이용한 최소 침습 슬관절 전치환술의 단기 추시 결과

유주형(Ju Hyung Yoo),윤한국(Han Kook Yoon),한창동(Chang Dong Han),윤항섭(Hang Seob Yoon),이윤태(Yun Tae Lee),오현철(Hyun Cheol Oh),성승용(Seung Yong Sung),정현수(Hyun Soo Chung) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.2

목적: 최소 내측 광근 절개 도달법에 의한 최소 침습 슬관절 전치환술의 단기적인 임상적 결과를 분석하고자 한다. 대상 및 방법: 2005년 8월부터 2006년 2월까지 최소 내측 광근 절개법을 이용한 최소 침습 슬관절 전치환술을 시행하여 1년 이상 추시가 가능하였던 77예(61명)를 대상으로 하였다. 모든 예에서 대퇴사두근-보존형 최소 침습 기구와 Nexgen LPS-flex total knee system (Zimmer, Warsaw, IN)을 이용하였고, 수술 전 후 임상자료, 수술 결과, 방사선학적 결과를 분석하였다. 결과: 수술에 의한 합병증은 발생하지 않았으며, 피부 절개 길이는 평균 8.4±0.6 ㎝, 수술 시간은 평균 95.5±5.7분, 수술 후 출혈량은 평균 727.5±315.5 cc였다. 수술 후 경골 삽입물의 정렬 각도는 평균 0.2±1.3° 내반, 대퇴 경골간 각도는 평균 5.8±1.8° 외반이었다. 수술 후 8주와 1년째 관절 운동 범위와 HSS 슬관절 점수는 각각 평균 117±10°, 120±11°와 평균 88.9±7.1, 96.2±4.5였다. 결론: 최소 내측 광근 절개에 의한 최소 침습 슬관절 전치환술은 적절한 수술 수기와 기구를 사용한다면 수술 중에 합병증 발생 없이 양호한 삽입물의 정렬과 임상적 결과를 얻을 수 있는 최소 침습 방법의 하나로 생각된다. Purpose: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. Materials and Methods: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. Results: The length of skin incision was average 8.4±0.6 ㎝ and the operation time was average 95.5±15.7 minutes. The blood loss was average 727.5±315.5 cc. The tibial component alignment angles averaged 0.2±1.3° varus and the tibiofemoral angles averaged 5.8±1.8°. The mean ROM and the mean HSS score was 117±10° and 120±11°, 88.9±7.1 and 96.2±4.5 at eight weeks and one year after surgery respectively. Conclusion: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

족관절 외과의 Danis-Weber B형 단독 골절에 있어서 활주 방지 금속판고정술과 외측 금속판고정술의 비교

하중원,김형복,고민석,윤한국,Ha, Joong-Won,Kim, Hyoung-Bok,Ko, Min-Suk,Yoon, Han-Kook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.3

Purpose: This study was performed retrospectively and to compare the clinical outcomes of the surgical management using Antiglide plating and lateral plating for Danis-Weber type B isolated lateral malleolar fractures. Materials and Methods: Between March 2004 and March 2009, 92 patients were followed up for more than 6 months after surgical treatment. 49 patients were treated with Antiglide plating, whereas the remaining 43 patients underwent lateral plating. The results of the two groups were analyzed both radiographically and clinically using Ankle scoring system. Results: Both groups were comparable for age, sex distribution, time to surgery, and operation time. Bone union was noted at average of 8 weeks in all fractures. The mean ankle score was similar in both groups (94% versus 93%). Conclusion: Antiglide plating for Danis-Weber type B isolated lateral malleolar fracture is one of the good methods which has some advantages such as early ankle motion, ambulation and smaller operative incision.

Corynebacterium striatum에 의한 화농성 슬관절염

박상훈(Sang-Hoon Park),윤한국(Han-Kook Yoon),김현교(Hyunkyo Kim),최호준(Ho-Jun Choi) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.2

Corynebacterium striatum (C. striatum)은 호기성 그람 양성 막대균으로 호흡기, 피부의 상재균이다. 병독성이 낮아 배양 검사에 나와도 대개 오염균으로 생각되지만 심내막염, 호흡기 감염을 일으킬 수 있으며 드물게 뇌수막염, 관절염을 유발할 수 있다. 면역력이 저하된 환자뿐만 아니라 도관을 유치하고 있거나 피부장벽이 파괴된 환자에서 C. striatum 에 의한 감염이 보고된다. C. striatum 감염 증례로 화농성 슬관절염이 보고된 예는 드물며 이전 septic arthritis로 관절경하 변연절제술을 시행받은 환자에서 C. striatum 에 의한 감염에 대해 보고된 바는 더욱 드물다. 이에 C. striatum 에 의한 화농성 슬관절염을 조기 발견과 관절경적 치료로 호전된 1예를 보고하고자 한다. Corynebacterium striatum (C. striatum) is an aerobic Gram-positive rod, which is an organism of the respiratory tract and skin. Because of its low virulence, it is usually thought to be a contaminant even if it is shown in culture tests, but it can cause endocarditis and respiratory infections, and rarely meningitis and arthritis. Infection with C. striatum has been reported in patients with reduced immunity, as well as in patients with catheter or broken skin barriers. Septic knee arthritis caused by C. striatum infection is rarely reported, and knee joint infection by C. striatum in patients who underwent arthroscopic debridement for previous septic arthritis is even more rare. Therefore, we report a case of septic knee arthritis caused by C. striatum that was improved by early diagnosis and arthroscopic treatment.

종골 골절 시 골절편에 의해 발생한 비복 신경의 포착(1예 보고)

이윤태,이태진,김성환,윤한국,Lee, Yun-Tae,Lee, Tae-Jin,Kim, Sung-Hwan,Yoon, Han-Kook 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.1

Sural nerve is a sensory nerve that innervates the lateral side of ankle and foot, and the injury of this nerve can be usually caused by surgical approch of calaneal fracture or achilles tendon injury. Entrapment neuropahty of sural nerve caused by bony fragment after calcaneal fracture is not reported, yet. Authors experienced one case that sural nerve injury due to bony fragment after calcaneal fracture and we regard that it is a rare case, so we report this case after reviewing literatures.