흉요추 골다공증성 압박 골절에서의 후만 변형의 진행과 자기공명영상 소견 사이의 관계

전득수(Deuk Soo Jun),백종민(Jong-Min Baik),권혁민(Hyuk Min Kwon) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.4

목적: 자기공명영상(magnetic resonance imaging, MRI)을 이용하여 보존적 치료를 시행한 흉요추부 골다공증성 압박 골절 환자에서 후만 변형의 예측 인자를 조사하고자 하였다. 대상 및 방법: 2007년 1월부터 2016년 3월까지 흉요추 압박 골절 의심하에 진료를 본 환자들 중 보존적 치료를 시행한 환자를 따로 분류하였고 그들 중 골밀도 -2.0 미만의 골감소증 및 골다공증, 단일 분절 골절을 가진 환자 89명을 대상으로 후향적 연구를 시행하였다. 골절된 척추체에서 전·후종 인대 손상, 상부 또는 하부 종판 파열, 상부 또는 하부 추간판 손상, T2 강조 영상에서 저 신호 강도의 존재, 척추체의 골 부종 정도를 MRI를 통해 확인하였다. 결과: 상부 종판이 파열된 사례나 척추체 골 부종 수준이 높은 사례의 경우 후만각, 설상각, 전방 척추 압박이 현저하게 진행되었다. 전종 인대 손상이나 상부 추간판 손상이 있는 경우에는 후만각만 현저하게 진행되었다. T2 강조 영상에서 저 신호 강도의 병변을 보인 경우 설상각과 전방 척추 압박이 높게 나타났다. 그러나 후종 인대 손상과 하부 종판 파열 및 하부 추간판 손상의 경우는 후만 변형 및 척추 압박의 진행과 유의미한 상관관계는 없었다. 후만각이 5° 이상 증가될 위험 요인으로는 전종 인대의 손상 유무, 상부 종판 파열, 상부 추간판 손상이 있는데 손상 받지 않은 사례에 비해 각각 21.3, 5.1, 8.5배 위험했고 골 부종 수준에 따라 각각 위험도가 달랐다. 결론: 골감소증 및 흉요추부 골다공증성 압박 골절일지라도 전종 인대 손상, 상부 종판 및 추간판 손상 또는 MRI상 높은 수준의 부종이 있을 경우 후만 변형의 위험도가 증가한다. Purpose: To examine the relationship between the progression of a kyphotic deformity and the magnetic resonance imaging (MRI) findings in conservatively treated osteoporotic thoracolumbar compression fracture patients. Materials and Methods: This study categorized the patients who underwent conservative treatment among those patients who underwent treatment under the suspicion of a thoracolumbar compression fracture from January 2007 to March 2016. Among them, this retrospective study included eighty-nine patients with osteoporosis and osteopenia with a bone density of less than -2.0 and single vertebral body fracture. This study examined the MRI of anterior longitudinal ligament or posterior longitudinal ligament injury, superior or inferior endplate disruption, superior of inferior intravertebral disc injury, the presence of low signal intensity on T2-weighted images, and bone edema of intravertebral bodies in fractured intravertebral bodies. Results: In cases where the superior endplate was disrupted or the level of bone edema of the intravertebral bodies was high, the kyphotic angle, wedge angle, and anterior vertebral compression showed remarkably progression. In the case of damage to the anterior longitudinal ligament or the superior disc, only the kyphotic angle was markedly prominent. On the T2-weighted images, low signal intensity lesions showed a high wedge angle and high anterior vertebral compression. On the other hand, there were no significant correlations among the posterior longitudinal ligament injury, inferior endplate disruption, inferior disc injury, and the progression of kyphotic deformity and vertebral compression. The risk factors that increase the kyphotic angle by more than 5° include the presence of injuries to the anterior longitudinal ligament, superior endplate disruption, and superior disc injury, and the risk factors were 21.3, 5.1, and 8.5 times higher than those of the uninjured case, and the risk differed according to the level of bone edema. Conclusion: An osteoporotic thoracolumbar compression fracture in osteoporotic or osteopenic patients, anterior longitudinal ligament injury, superior endplate and intravertebral disc injury, and high level of edema in the MRI were critical factors that increases the risk of kyphotic deformity.

경피적 척추성형술, 또는 경피적 풍선 척추성형술 시행 후 발생한 추체의 재압박과 시멘트 형상과의 상관관계 및 재압박 유발 위험인자에 대한 분석

전득수(Deuk Soo Jun),백종민(Jong Min Baik),윤영현(Young Hyun Yoon) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.3

목적: 척추 압박골절 환자에서 척추성형술 이후 척추체의 재압박이 발생하는 경우가 증가하고 있다. 이에 척추성형술 시 주입된 시멘트의 형상, 무혈성괴사(쿰멜씨병) 여부, 수술의 종류, 골밀도, 성별, 나이 등을 포함한 재압박을 유발 가능한 여러 인자들의 영향을 분석해 보았다. 대상 및 방법: 본 연구는 2005년부터 2015년까지 본원에서 척추 압박골절로 척추성형술 또는 풍선 척추성형술을 시행한 환자를 대상으로 단순 방사선 사진 분석을 통해 시멘트의 형상 및 추간판 내 시멘트 유출여부에 대하여 분석하였다. 주입된 시멘트 형상을 척추체 상부 종판에만 또는 하부 종판에만 걸쳐 시멘트가 주입된 경우, 상부 및 하부 종판 모두에 걸쳐 주입되어 있는 경우 및 척추체의 가운데에만 주입되어 있는 경우의 총 4가지로 분류하여 각 형상과 재압박골절과의 관계를 분석하였다. 결과: 척추성형술을 시행한 환자 238명 중 59명(24.8%)에서 척추체의 재압박골절이 발생하였다. 압박 골절 당시 무혈성괴사가 동반되어 있던 군에서 그렇지 않은 군에 비해 척추성형술을 시행했음에도 재압박골절이 더 잘 발생하는 것으로 나타났다(p<0.05). 시술 시 시멘트가 상부 및 하부 종판에 모두에 접촉하며 주입된 경우 재압박골절 발생을 감소시키는 것으로 나타났으며(p=0.008), 풍선 척추성형술을 시행했을 경우 단순 척추성형술을 시행했을 경우보다 척추체 재압박골절 발생이 유의미하게 감소하는 것으로 나타났다(p=0.02). 이외에 추간판 시멘트 유출 여부, 시멘트 용량, 성별, 골밀도 등의 인자들은 재압박골절 발생에 영향이 없었다. 결론: 수술 전 무혈성괴사가 확인되었던 경우 척추성형술 후 추시 과정 중에 재압박골절의 발생 여부에 대해 면밀히 평가해야 할 것으로 보인다. 또한 주입된 시멘트가 상부 및 하부 종판에 모두 접촉되지 않은 경우 추시 과정 중 재압박골절 발생 여부에 대해 세심한 관찰이 필요하며, 시멘트 주입 시 상부 및 하부 종판 모두에 접촉될 수 있게 하기 위한 추가 연구도 필요할 것으로 보인다. Purpose: With the increasing incidence of recompression fractures after vertebroplasty or kyphoplasty, this study analyzed the risk factors that affect the occurrence of recompression vertebral fractures, such as cement distribution, existence of avascular necrosis (Kummell’s disease), type of procedures, bone mineral density, sex, and age. Materials and Methods: Two hundred and thirty-eight patients who underwent vertebroplasty or kyphoplasty at the author’s clinic from 2005 to 2015 were enrolled in this study. The patients were divided into four groups according to the distribution of injected cement. The patients were classified as type 1 and type 2 when injected cement was contacted only to the upper or lower endplate of the body respectively. They were classified as type 3 when both the upper and lower endplates were contacted by injected cement. When neither the upper nor the lower endplate was contacted, the patients were called type 4. This study statistically evaluated the effects of the risk factors, including the cement distribution on the incidence of recompression vertebral fracture after vertebroplasty or kyphoplasty. Results: There were 59 cases (24.8%) of recompression fracture after vertebroplasty or kyphoplasty, among the 238 cases. According to the analysis, the recompression of the vertebral body after vertebroplasty or kyphoplasty occurred more often when the compression fracture was accompanied by osteonecrosis at the body (p<0.05). The patients who had injected cement distributed at both upper and lower plate simultaneously (type 3) had a lower incidence of recompression fracture of the vertebral body after vertebroplasty or kyphoplasty (p=0.008). In addition, the kyphoplasty group had a lower incidence of recompression after the procedure than vertebroplasty group (p=0.02). Conclusion: Careful attention should be given to these patients with osteonecrosis at the compression fracture level through a preoperative evaluation. In addition, if the injected cement does not contact both the upper and lower endplates, careful observation is required during the follow-up period based on the high incidence of vertebral recompression fractures proven through this study. Further technical and biomechanical research and efforts will be needed to make the cement contact both endplates.

급성 골다공증성 요추 골절 환자에서 척추 기립근 및 다열근의 지방침투율과 후만각 변형의 연관 관계

전득수(Deuk Soo Jun),백종민(Jong-Min Baik),백승현(Seung Hyun Baek) 대한정형외과학회 2021 대한정형외과학회지 Vol.56 No.3

목적: 급성 골다공증성 요추 골절 환자에서 척추 변형의 진행을 예측할 수 있는 여러 인자들 중 척추의 자기공명영상 촬영에서 척추 주변 근육의 정량적 분석을 통해 척추 기립근 및 다열근의 감소와 후만각의 변형의 상관관계를 알아보고자 한다. 대상 및 방법: 이 연구는 2007년 1월부터 2018년 3월까지 단일 분절의 급성 요추 골절로 진단되어 보존적 치료 중인 환자를 대상으로 하였다. 다열근 및 척추 기립근의 감소는 지방으로 변성된 비율을 통해 확인하였고 이는 진단 당시 촬영한 요추 자기공명영상 촬영을 사용하여 측정되었으며, 지방으로 변성된 비율은 총 지방 침윤율로 정의하였다. 1년 추적 관찰에서 요추의 측면 방사선 사진에 기초하여 추체 압박률, 콥스각 및 쐐기각을 측정하였다. 피어슨 상관 계수를 분석하여 통계적 유의성을 확인하였다. 결과: 연구 대상은 129명으로 30명은 남자, 99명은 여자를 대상으로 하였다. 평균 연령은 71.28±9.55세, 평균 BMD 점수는 -3.53±0.79 g/cm², 평균 지방 침윤율은 15.20%±11.99%였다. 지방침투율은 수상 당시 나이(R=0.373, p<0.001)와 양의 상관관계가 있었지만, BMD 점수(R=-0.252, p=0.004)와는 음의 상관 관계를 보였다. 1년 후 추적관찰하여 확인한 결과에서 지방 침윤율은 추체 압박률(R=0.369, p<0.001) 및 콥스각(R=0.386, p<0.001)과 양의 상관 관계를 보였다. 요추 골절이 아래 분절로 내려 갈수록 추체 압박률(R=-0.191, p=0.030) 및 후만각(R=-0.428, p<0.001)은 감소하는 경향이 있었다. 결론: 급성 골다공증 요추 골절 환자에서 지방 침윤율은 보존적 치료를 위한 중요한 예측 인자가 될 수 있다. 지방 침윤율이 높은 환자의 예후는 환자 교육 과정에서 설명을 해야 하며 단기 외래 환자 후속 조치를 통해 환자를 면밀한 모니터링이 필요하다. Purpose: Verifying a reliable predictor of the progression of vertebral deformity in patients with acute osteoporotic fractures of the lumbar spine may be useful. A qualitative analysis of the muscle near the spine was performed using magnetic resonance imaging (MRI), and its correlation with a spinal deformity was determined under the hypothesis that the causes of the kyphotic deformity are associated with muscle reduction in the multifidus and erector spinae. Materials and Methods: The study was performed in a retrospective manner using the electronic medical records of patients who presented to the author’s institution between January 2007 and March 2018, and were diagnosed with an acute lumbar fracture. The fat infiltration rates of the multifidus and erector spinae were measured using MRI taken at the time of injury, and the mean value was defined as the total fat infiltration rate (TFI). Based on lateral radiographs of the lumbar spine at the one-year follow-up, the loss of height of the vertebral body, the kyphotic angle and the wedge angle were measured. The statistical significance was confirmed by calculating the Pearson correlation coefficient. Results: One hundred twenty-nine patients, of which 30 were male and 99 were female, were examined. The mean age was 71.28 years. The mean T-score was -3.53±0.79 g/cm², and the mean fat infiltration was 15.20%±11.99%. TFI was positively correlated with age (R=0.373, p<0.001), compression rate (R=0.369, p<0.001), and Cobb’s angle (R=0.386, p<0.001) after a one year follow-up, but negatively correlated with the BMD score (R=-0.252, p=0.004). As the fracture progressed to the lower lumbar level, the compression rate (R=-0191, p=0.030) and wedge angle (R=-0.428, p<0.001) at the time of injury tended to decrease. Conclusion: In patients with osteoporotic vertebral fractures, the fat infiltration rate may be an important predictor of conservative treatment. The prognosis of patients with a high-fat infiltration rate should be explained during patient education, and the patients must be monitored closely through short-term outpatient follow-up.

척추성형술 또는 풍선 척추성형술 시행 후 발생하는 추체의 재압박

전득수 ( Deuk Soo Jun ),문도현 ( Do Hyun Moon ),고영규 ( Young Kyu Ko ),최장석 ( Jang Seok Choi ),안병근 ( Byoung Keun An ),백제원 ( Je Won Paik ),박민호 ( Min Ho Park ) 대한골절학회 2015 대한골절학회지 Vol.28 No.2

Purpose: The purpose of this study was to examine incidence of recompression and risk factors in the patients with osteoporotic vertebral compression fracture (OVCF) after vertebroplasty or kyphoplasty. Materials and Methods: This study was conducted on 179 vertebral bodies of 126 patients who underwent vertebroplasty or kyphoplasty on OVCF from January 2004 to August 2013. Results: When anterior vertebral height of fractured vertebrae declined by more than 3 mm from the height immediately after vertebroplasty or kyphoplasty, it was judged that recompression had occurred. Recompression was observed in a total of 58 vertebrae (32.4%). Recompression occurrences were found to be decreasing significantly when fractured vertebrae were the thoracic spine. In addition, osteonecrosis occurred in the preoperative vertebrae and restoration degree of anterior vertebral height immediately after vertebroplasty or kyphoplasty affected recompression occurrences significantly. The other factors (age, sex, bone mineral density, steroid medication history, follow-up duration, cement volume, vertebroplasty or kyphoplasty, and approach method) were compared, but no statistical significance was found. Conclusion: The risk of vertebral recompression is more common, especially when osteonecrosis occurred in preoperative vertebrae or when vertebroplasty or kyphoplasty achieved remarkable restoration of anterior vertebra height. When performing vertebroplasty or kyphoplasty, such conditions should be considered carefully.

골다공증성 척추 압박 골절 환자에서 다열근과 척추기립근의 지방 침투율과 골다공증 관련 인자의 상관 관계 분석

전득수(Deuk Soo Jun),백종민(Jong-Min Baik),최지욱(Ji Uk Choi) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.4

목적: 근감소증에 중요한 요소인 척추 주변 근육 감소를 수치화한 총 지방 침윤율(total fat infiltration rate, TFI rate)과 골다공증성 척추 압박 골절(osteoporotic vertebral compression fracture) 및 관련 수치와의 상관 관계를 찾는 것을 목표로 하였다. 대상 및 방법: 2012년 1월부터 2016년 12월까지 요추의 압박 골절 진료를 본 환자들 중 1) 골밀도(bone mineral density, BMD) T score -2.5 g/㎠ 미만으로 골다공증을 진단받고, 2) 요추 골절로 경피적 척추성형술(vertebroplasty) 또는 경피적 풍선척추성형술(kyphoplasty)을 받았으며, 3) 요추의 한 분절만 골절된 4) 1년 이상 추시한 환자 98명을 대상으로 후향적 연구를 시행하였다. TFI는 Image J 프로그램으로 자기공명영상을 분석하여 확인하였다. 이를 바탕으로 다열근(multifidus) 및 척추기립근(erector spinae)의 TFI와 골다공증 요소들과의 연관성을 분석하였다. 결과: 다열근및 척추기립근의 평균 TFI는 14.66±10.16이었다. 척추 BMD는 고관절 BMD와 통계적으로 유의한양 의 상관 관계를 보였으나 TFI와 음의 상관 관계를 보였다. 고관절 BMD는 체질량지수(body mass index)와 유의한 양의 상관 관계를 보였다. 또한 비타민 D 수치는 척추 BMD와 고관절 BMD에서 모두 양의 상관 관계를 보였으나, TFI와는 음의 상관 관계를 보였다. 결론: 근육량은 근감소증 환자뿐만 아니라 골다공증 환자의 치료에 있어서도 도움이 되므로 주의깊게 보아야 할 것이다. 또한 비타민 D를 증가시키는 것은 근육 위축의 진행을 늦출 수 있으므로 이로써 골절을 예방하는 효과를 가져올 수 있다. Purpose: To examine the relationship between total fat infiltration (TFI) rate, which quantifies the reduction of muscles around the spine and is an important factor for sarcopenia, and the factors affecting osteoporotic vertebral compression fracture. Materials and Methods: Patients treated for osteoporotic compression fractures of the lumber spine from January 2012 to December 2016 were analyzed retrospectively. Among them, this study included ninety-eight patients who were 1) diagnosed with osteoporosis with a bone mineral density (BMD) T score of less than 2.5 g/㎠, 2) received vertebroplasty or kyphoplasty for lumbar fractures, 3) involved one segment of the lumbar spine, and 4) were followed-up for more than one year. The TFI rate confirmed by analyzing magnetic resonance imagings with the Image J program was studied. Based on this, the relationship between the TFI of the multifidus and erector spinae muscles and the factors of osteoporosis were analyzed. Results: The mean TFI of the multifidus and erector spinae was 14.66±10.16. The spine BMD showed a positive correlation with the hip BMD, but a negative correlation with the TFI. A positive correlation was observed between the hip BMD and body mass index. In addition, vitamin D was positively correlated with both the hip and spine BMD but negatively correlated with the TFI rate. Conclusion: Muscle growth helps treat osteoporosis, and can prevent fractures that occur frequently in osteoporosis patients. Increasing the vitamin intake can also slow the progression of muscle atrophy.

흉요추부 골다공증성 척추 압박 골절의 수술적 치료 : 골시멘트 보강술을 이용한 척추경 나사 고정

전득수(Deuk Soo Jun),백종민(Jong-Min Baik),박지현(Ji Hyeon Park) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.4

목적: 골다공증성 척추 압박 골절 환자에서 척추경 나사못을 이용한 고정술을 시행 시 골시멘트(polymethylmethacrylate) 보강의 방사선적 효용성에 대해 조사하고자 하였다. 대상 및 방법: 골다공증성 압박 골절에서 골시멘트 보강술을 이용한 척추경 나사 고정을 시행한 20예의 환자가 연구에 포함되었다. 평균 추시 기간은 15.6개월이었으며, 인구학적인 자료, 골밀도(bone mineral density, BMD), 유합 분절, 척추경 나사의 사용 개수 및 골시멘트 주입량은 의무기록을 통하여 검토되었다. 방사선적인 결과를 산출하기 위하여 시간 순차적(수술 전, 수술 직후, 술 후 6주, 술 후 3, 6개월 및 술 후 1년) 추시를 통해 방사선적 지표를 측정하였다. 결과: 본 연구에 총 20명의 환자(여자 16예[80.0%]; 평균 나이, 69.1±8.9세)가 포함되었다. 평균 BMD는 -2.5±0.9 g/cm², 각각의 추체당 평균 골시멘트 주입량은 6.3 ml였다. 술 전 측정한 후만각(Cobb angle)은 32.7°±7.0°였으며, 술 후 측정값은 8.7°±6.9° (p<0.001)로 큰 호전을 나타내었고, 교정은 술 후 시간 순차적인 추시에서도 유지됨을 보였다. 기구 고정 후 후만각, 설상각, 시상지표 또한 유사한 호전 양상을 나타내었다. 또한 골절된 추체의 전방 높이 또한 수술 전 11.0±5.0 mm에서 수술 후 18.5±5.7mm (p=0.006)로 호전되었고 3, 6개월 및 1년간의 추시 간에도 유지됨이 확인되었다. 결론: 골다공증성 압박 골절에서 골시멘트 보강술을 이용한 척추경 나사 고정은 효과적인 치료법이라 생각되며, 이 술식을 통해 국소 흉요추부 후만의 충분한 교정을 얻을 수 있고 술 후에도 잘 유지할 수 있는 방법으로 골다공증 척추 압박 골절 환자에서 유용한 술식으로 생각된다. Purpose: To investigate the radiological efficacy of polymethylmethacrylate (PMMA) augmentation of pedicle screw operation in osteoporotic vertebral compression fractures (OVCF) patients. Materials and Methods: Twenty OVCF patients, who underwent only posterior fusion using pedicle screws with PMMA augmentation, were included in the study. The mean follow-up period was 15.6 months. The demographic data, bone mineral density (BMD), fusion segments, number of pedicle screws, and amount of PMMA were reviewed as medical records. To analyze the radiological outcomes, the radiologic parameters were measured as the time serial follow-up (preoperation, immediately postoperation, postoperation 6 weeks, 3, 6 months, and 1 year follow-up). Results: A total of 20 patients were examined (16 females [80.0%]; mean age, 69.1±8.9 years). The average BMD was -2.5±0.9 g/cm². The average cement volume per vertebral body was 6.3 ml. The mean preoperative Cobb angle of focal kyphosis was 32.7°±7.0° and was improved significantly to 8.7°±6.9° postoperatively (p<0.001), with maintenance of the correction at the serial follow-up, postoperatively. The Cobb angle of instrumented kyphosis, wedge angle, and sagittal index showed similar patterns. In addition, the anterior part of fractured vertebral body height averaged 11.0±5.0 mm and was improved to 18.5±5.7 mm postoperatively (p=0.006), with maintenance of the improvement at the 3-month, 6-month, and 1-year follow-up. Conclusion: The reinforcement of pedicle screws using PMMA augmentation may be a feasible surgical technique for OVCF. Moreover, it appears to be appropriate for improving the focal thoracolumbar/lumbar kyphosis and is maintained well after surgery.

중수골 부위 절단상(transmetacarpal amputation)에 시행한 재접합술

김주성,송금영,전득수,김희오,백구현,정문상,Kim, Joo-Sung,Song, Keum-Young,Jun, Deuk-Soo,Kim, Hye-Oh,Baek, Goo-Hyun,Chung, Moon-Sang 대한미세수술학회 1998 Archives of reconstructive microsurgery Vol.7 No.2

From march 1993 to march 1998, twenty consecutive transmetacarpal replantations and revascularizations were reviewed retrospectively. Nine patients sustained severe and diffuse crush injuries, four patients had local crush injuries, and seven suffered guillotine type amputation. Six replantations and fourteen revascularizations were performed. 76 of 81 replantable digits(93%) were salvaged. 15 patients required secondary surgery, 10 patients for tendon and joint scarring and 5 for nonunions or malunions. Intrinsic muscle function and pinch and grip strengths were weak or absent. According to Chen's grading system of functional return, 2(10%) were grade I, 6(30%) were grade II, 10(50%) were grade III, and 2(10%) grade IV. The follow-up period ranged from 6months to 46 months. Only 3 patients resumed his prior occupation(one as a supervisor); 2 were permanently disabled, 4 pursued new occupations as a manual worker, 1 were still in therapy. Only two of the manual laborers were able to return to their preinjury occupation. Despite these unacceptable functional results, all patients were satisfied with the surgery.

신경 차단 마취를 이용한 족부 및 족근 관절 수술

박용욱,정영기,유정한,전득수,전진호,Park, Yong-Wook,Chung, Yung-Khee,Yoo, Jung-Han,Jun, Deuk-Soo,Chun, Jin-Ho 대한족부족관절학회 1999 대한족부족관절학회지 Vol.3 No.1

We present our experience with the use of nerve block anesthesia in 212 of 484(43.8% ) surgical procedures of the foot and ankle between 1995 and 1997. Nerve block anesthesia was used for surgical procedures of the forefoot, midfoot, hindfoot, and ankle in the setting of elective surgery and trauma. From the viewpoint of the surgeon, nerve block anesthesia was completely successful in 99.5% of the procedures performed. We confirmed that 80% of patients were satisfied with the use of nerve block anesthesia for their operative procedure. There were only one(0.5%) miner complication being toxic neuritis of posterior tibial nerve. With increasing experience, the expanded indications and uses of nerve block anesthesia for foot and ankle surgery are proving to be simple, safe, reliable, and well tolerated by the patient.

종골 골절후 발생한 족부 구획 증후군의 치료

박용욱,정영기,유정한,전득수,황필성,Park, Yong-Wook,Chung, Yung-Khee,Yoo, Jung-Han,Jun, Deuk-Soo,Hwang, Pil-Sung 대한족부족관절학회 2000 대한족부족관절학회지 Vol.4 No.2

Eleven patients with calcaneal fracture had 2 acute compartment syndrome of the feet and 9 late complication of the compartment syndrome of the feet. An interstitial pressure of more than 30 mmHg in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy performed medially. Rigid claw toe deformity was treated by excision of the head and neck of the proximal phalanx, dorsal capsular release of the metatarsophalangeal joint, and lengthening of the extensor tendon. Patients were evaluated at a mean of 35 months(range, 21 - 44 months) after operation, and the examination was directed specifically toward symptoms and signs of myoneural ischemia, and walking pain. At follow-up, 2 patients with acute compartment syndrome of the foot had no evidence of myoneural ischemia, 9 patients with claw toe deformity had no pain with walking. Based on our clinical observations, we concluded that compartment syndrome of the foot may occur after the calcaneal fracture and fasciotomy is effective treatment for the prevention of the long term sequelae of this debilitating condition.

종골 골절후 발생한 족부 구획 증후군의 치료

박용욱,정영기,유정한,전득수,황필성,Park, Yong-Wook,Chung, Yung-Khee,Yoo, Jung-Han,Jun, Deuk-Soo,Whang, Pil-Sung 대한족부족관절학회 1999 대한족부족관절학회지 Vol.3 No.1

Eleven patients with calcaneal fracture had 2 acute compartment syndrome of the feet and 9 late complication of the compartment syndrome of the feet. An interstitial pressure of more than 30 mmHg in either the central or interosseous compartment was considered pathologic and was treated by fasciotomy performed medially. Rigid claw toe deformity was treated by excision of the head and neck of the proximal phalanx, dorsal capsular release of the metatarsophalangeal joint, and lengthening of the extensor tendon. Patients were evaluated at a mean of 35 months(range, 21 - 44 months) after operation, and the examination was directed specifically toward symptoms and signs of myoneural ischemia, and walking pain. At follow -up, 2 patients with acute compartment syndrome of the foot had no evidence of myoneural ischemla, 9 patients with claw toe deformity had no pain with walking. Based on our clinical observations, we concluded that compartment syndrome of the foot may occur after the calcaneal fracture and fasciotomy is effective treatment for the prevention of the long term sequelae of this debilitating condition.