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장세앙,조영호,변영수,구태회 대한고관절학회 2016 Hip and Pelvis Vol.28 No.3
Abductor deficiency in native hip joint may cause severe limping and pain. It is more serious situation in case of arthroplasty due to instability and recurrent dislocation. Well-known causes of abductor deficiency are repeated surgery, chronic trochanteric bursitis, superior gluteal nerve injury, failure of repair of abductor tendon insertion to the greater trochanter. Author had experienced primary abductor deficiency during total hip replacement and treated successfully with the transfer of gluteus maximus. We’d like to introduce the operation technique with the review of literature.
Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum
장세앙,조영호,변영수,정대근,한인호,김민국 대한고관절학회 2015 Hip and Pelvis Vol.27 No.1
Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn’t comment the primary bony abnormality especially acetabulum. We’d like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum.
관혈적 정복 및 내고정을 이용한 제 1미골 탈구의 치료
장세앙,유현승,김가람 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.1
Study Design: Case report. Objectives: To report the effectiveness of open reduction and internal (screw) fixation treatment performed to treat dislocation of the first coccygeal vertebra. Summary of Literature Review: Most treatment methods for coccygeal dislocation were conservative treatment for acute coccygodynia and coccygectomy for chronic coccygodynia. Materials and Methods: A 18-year-old female presented with severe coccygodynia due to a fall down the stairs. Computed tomography showed dislocation of the first coccygeal vertebra. We performed open reduction and internal fixation with a 4.0-mm shortthread cancellous screw with a washer, with no additional procedure for bone union. Results: Union was achieved 10 weeks postoperatively. Conclusions: Open reduction and internal (screw) fixation can be a useful method for coccygeal vertebra dislocation. Key words: Coccygeal vertebrae dislocation, Coccygodynia, Open reduction and internal fixation 연구 계획: 증례 보고목적: 제 1미골 탈구에 대한 수술적인 치료로 관혈적 정복 및 내고정술의 유용성에 대해 보고하고자 한다. 선행문헌의 요약: 미골 탈구에 대해 대부분 급성기에는 보존적 치료를 만성기에는 미골절제술을 시행하는 것으로 되어있다. 대상 및 방법: 18세 여자가 계단에서 넘어지면서 심한 미골통을 보였다. CT상 제 1미골 탈구가 관찰되었고, 골유합을 위한 추가적인 시술없이 관혈적 정복 및 4.0 mm 해면골 나사로 고정하였다. 결과: 수술 10주 후, 골유합을 얻었다. 결론: 관혈적 정복 및 내고정술을 이용한 미골 탈구 치료는 유용한 방법 중 하나라고 판단된다.
고령의 전자부 골절 환자에서 조기 수술 후의 유병률과 사망률
장세앙 ( Se Ang Jang ),조영호 ( Young Ho Cho ),변영수 ( Young Soo Byun ),박기홍 ( Ki Hong Park ),유현승 ( Hyun Seong Yoo ),정철 ( Chul Jung ) 대한골절학회 2013 대한골절학회지 Vol.26 No.3
목 적: 고령의 대퇴골 전자부 골절을 가진 환자들에서 병원 도착 후 24시간 이내에 수술을 시행 후 발생한 조기 합병증 및 사망률에 대해 알아보고자 하였다. 대상 및 방법: 2009년부터 2010년까지 본원에서 대퇴골 전자부 골절로 수술 받은 99명 가운데 10명을 제외하고 89 에 대해 수술 후 발생한 조기 합병증 및 사망률을 조사하였다. 남자 24명, 여자 65명이었고, 평균 연령은 79.8세(61 99세)였다. American Society of Anesthesiologists 분류에 따라 1그룹은 25명, 2그룹은 37명, 3그룹은 26명, 4그룹은 1명이었다. 모든 환자는 숙련된 전문의에 의해 골수 내 정을 이용하여 수술하였다. 결 과: 평균 수술 시간은 43분이었고, 수술 중 평균 출혈량은 165 ml였다. 섬망이 16명에서 발생하였으나 모두 호전 었고, 1개월째 폐렴이 1명에서 발생하였으며, 욕창이 1명 발생하였으나 보존적 치료로 호전되었고, 1개월째 폐색전증이 1명 발생 였다. 3개월 이내에 3명(3.4%)이 사망하였고, 3-6개월 사이에 1명(1.1%)이 사망하였으나, 그 후 사망한 환자가 없었다. 결 론: 고령의 대퇴골 전자부 골절 환자에서 사망률과 조기 합병증을 줄이기 위해 환자의 상태가 수술을 위해 최적화 된다면 병원 도착 후 조기에 수술을 시행하는 것이 고려되어야 한다. Purpose: To find out the effect of early closed reduction and internal fixation (within 24 hours after admission to hospital) on the morbidity and mortality in the elderly with intertrochanteric fractures of the femur. Materials and Methods: Retrospectively, we analyzed 99 patients with intertrochanteric fracture of the femur who underwent surgery from January, 2009 to December, 2010. We reviewed 89 of the 99 patients and checked for early complications and reviewed the mortality rates 3 months, 6 months and 1 year after surgery. There were 24 males and 65 females. The average age was 79.8 years (61-99 years). According to the American Society of Anesthesiologists classification, 25 patients were class 1, 37 patients were class 2, 26 patients were class 3, and 1 patient was class 4. All patients were operated on by one surgeon, who was skilled in inserting intramedullary nail. Results: The average surgical time was 43 minutes and the average intraoperative blood loss was 165 ml. Sixteen patients experienced delirium but all of them recovered. One patient had pneumonia at one month after surgery. Pressure sores developed in one patient but improved with conservative treatment. Pulmonary thromboembolism developed in some patients one month after surgery. Three patients (3.4%) died within three months and one patient (1.1%) died between three and six months after surgery, but no patient died between six months and one year after surgery. Conclusion: If patients are optimized for the operation, early internal fixation of trochanteric fracture in elderly patients after arrival at the hospital should be considered to reduce early complications and mortality.
항회전 근위 대퇴 골수정의 특별한 합병증 1예보고 칼날의 고관절 내로의 관통
장세앙 ( Se Ang Jang ),조영호 ( Young Ho Cho ),변영수 ( Young Soo Byun ),조훈식 ( Hun Sik Cho ),최성 ( Sung Choi ),유현승 ( Hyun Seong Yoo ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4
항회전 근위 대퇴 골수정은 근위 대퇴골의 전자부 골절 시 고정에 사용될 수 있는 유용한 기구이다. 저자들은 골절부의 내반 혹은 회전 불안정성이 없이 나선형 칼날이 대퇴골 두를 통하여 고관절 내로 관통한 증례를 보고하고자 한다. The proximal femoral nail anti-rotation (PFNA) is a useful device to fix trochanteric fractures of the proximal femur. We report a case of postoperative penetration of the helical blade through the femoral head into the hip joint without any sign of rotational or varus instability in the fracture.
항회전 근위 대퇴 골수정(PFNA)을 이용한 대퇴전자부 골절의 치료(PFNA를 이용한 대퇴전자부 골절의 치료)
장세앙 ( Se Ang Chang ),조영호 ( Young Ho Cho ),변영수 ( Young Soo Byun ),한재휘 ( Jae Hui Han ),박재영 ( Jae Young Park ),이충열 ( Chung Yeol Lee ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.3
Purpose: This study was performed to evaluate the usefulness of proximal femoral nail antirotation (PFNA) for internal fixation of femur trochanteric fractures. Materials and Methods: We operated on 36 femur trochanteric fracture patients with performing PFNA from September, 2006 to November, 2008 and we analyzed the operation time, the blood loss, the union time, the tip apex distance (TAD), the Cleveland index, the sliding distance of the blade and the complications. We also evaluated the clinical results according to the recovery of ambulatory function and the functional recovery score. Results: The mean operation time was 54 minutes and the mean amount of blood loss amount was 119cc. Thirty two cases progressed to union within 4 months and 4 cases also progressed to union within 6 months without a further operation. The mean TAD was 16mm and the mean sliding distance was 3.8 mm. Clinically, the mean loss of ambulation ability was 1.2 grades and the Jensen functional recovery score was 1.8. There was one case of back out of the blade, but there was no skin problem. There were no significant complications. Conclusion: The findings from this study indicate that PFNA is a useful and reliable choice for the treatment of trochanteric fracture of the femur.