대퇴골 골절에 사용된 Huckstep 정

조세현(Se Hyun Cho),정순택(Soon Taek Chung),박형빈(Hyung Bin Park),하용찬(Yong Chan Ha),김병기(Byung Gi Kim),정재헌(Jae Heon Jeong),황선철(Sun Chul Hwang) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.1

목적: 대퇴골 골절과 대퇴골 불유합의 치료에 사용된 Huckstep 정의 임상적 및 방사선학적 결과를 분석하고, 저자들이 고안한 피질골 창을 만들어 방사선 투시장치 없이 시술한 교합 나사 삽입수기를 보고하고자 한다. 대상 및 방법: 1999년 1월부터 2004년 1월까지 Huckstep 정을 이용하여 지료한 급성 대퇴골 골절 6예(폐쇄성 골절 5, 개방성 골절 1), 불유합 9예(감염성 4, 비감염성 5)를 대상으로 분석하였으며, 수술 전 진단과 수술 횟수, Huckstep 정 시술 방법, 골유합까지의 기간, 합병증 등을 방사선 사진과 함께 분석하였다. 남자 10예, 여자 5예로서 Huckstep 정 수술 시의 평균 나이는 42세(18-70)였다. 모든 증례를 최소 16개월에서 6.4년까지 평균 26개월 간 추시하였다. 특히 7예에서 골절 상하 부위에 피질골 창을 내어 교합 나사를 삽입함으로써 방사선 투시장치의 도움 없이 쉽게 수술할 수 있었다. 결과: 급성 골절은 평균 15.3주에, 불유합은 24.6주에 방사선학적 골유합을 얻었다. 개방성 골절 1예는 일차 단측성 고정기로 고정하고 개방창이 치유되는 4주에 Huckstep 정을 시술하였다. 불유합 중 2예에서는 자가골을, 다른 3예에서는 수산화 인회석/삼중 칼슘 인산염 과립을 각각 이식하였다. 불유합은 외상 후 평균 1l.8개월 동안 타병원에서 평균 4.3회의 수술을 받고 내원하였고, 그 중 4예에서 최종 추시 상 슬관절 부분 강직을 보였다. 골절 근위부에 교합 나사를 삽입하지 않았던 급성 골절 1예에서 동력화로 인해 2 ㎝의 하지 단축이 발생하였다. 결론: Huckstep 정 술식으로 급성 골절과 불유합 모두에서 골유합을 얻었으며, 고정이 견고하여 조기 관절 운동과 체중 부하가 가능한 장점이 있었다. 골절 상하 부위에 만든 피질골 창을 이용한 교합 나사 삽입술로 방사선 투시장치의 도움 없이 쉽게 시술할 수 있었다. Purpose: To analyze the clinical and radiological results of Huckstep nailing in the treatment of acute femoral fractures and femoral nonunion, and to report the easy and non-fluoroscopic technique of targeting the locking screw holes by making double cortical windows. Materials and Methods: This study examined a total of fifteen femoral fractures treated with Huckstep nailing between January 1999 and January 2004. The fractures included six acute fractures (five closed and one open) and nine nonunions (four infective and five aseptic). The reoperative status, number of interventions, time to union and complications were analyzed. Ten male and 5 female patients with an average age of 42 years (range, 18-70) were followed up for a mean of 26 months (range, 16 months to 6.4 years). A new method of double cortical windows for targeting the screw holes were performed in seven cases without fluoroscopic aid. Results: Radiographic union was achieved after a mean of 15.3 weeks in those with an acute fracture and after a mean of 24.6 weeks in those with nonunion. One open fracture was fixed initially using a monofixator followed by Huckstep nail 4 weeks later when the open wound had healed. A bone graft was performed in two cases of nonunion, and Hydroxyapatite/Tricalcium phosphate granules were grafted in three cases of nonunion. Partial knee ankylosis resulted in 6 cases of nonunion at the final follow-up because the nonunion cases had undergone an average of 4.3 surgical procedures at other hospitals over an average of 11.8 months before performing Huckstep nailing. One acute case without proximal screw fixation resulted in dynamization and femoral shortening of 2 ㎝. Conclusion: Huckstep nailing provides stable fixation sufficient to enable early knee motion and weight bearing until the fracture heals in both acute fracture and nonunion. The new method of double cortical windows allows the easy targeting of screw holes without fluoroscopic aid.

자기공명영상으로 선택된 환자에서의 대퇴전자간 회전 내전 절골술을 이용한 대퇴골두 무혈성 괴사환자의 치료

양진원 ( Jin Won Yang ),구경회 ( Kyung Hoi Koo ),송해룡 ( Hae Ryong Song ),정순택 ( Soon Taek Jeong ),박형빈 ( Hyung Bin Park ),이승환 ( Seung Hwan Lee ),정운하 ( Oun Hwa Chung ),조세현 ( Se Hyun Cho ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

We used MR(magnetic resonance) image to formulate new selection criteria for the identification of suitable patients with femoral head osteonecrosis for transtrochanteric rotational varizational osteotomy. The selection criteria included: [1] an early post-collapse osteonecrotic hip(loss of congruity or crescent sign) without narrowing of joint space or acetabular involvement; [2] an age of less than 55 years and a painful hip; [3] an angle of more than 120 of intact portion of the femoral head on midsagittal MR image. Seventeen patients met predefined selection criteria and were treated with the osteotomy. The angle of rotation was determined preoperatively in midsagittal MR image. The osteotomy included 20 of intentional varization. Postoperative scintigraphy showed adequate perfusion of the femoral head. They were followed for a period of 36 to 67 months(mean, 50 months). Hip score by Merle dAubigne et al improved from a mean of 13.4 preoperatively to a mean of 17.6 at the latest follow- up. Collapse of the feporal head was arrested in all hips and no case required a total hip arthroplasty. Use of MR images(kstead of plain radiograph) in the patient selection and in the determination of rotational angle may improve the success rate of the transtrochanteric rotational varizational osteotomy.

흉추 및 요추 골절의 장분절 척추 고정술 및 단분절 척추 고정술의 비교분석

정순택,조세현,송해룡,구경회,박형빈,정운화 대한척추외과학회 1999 대한척추외과학회지 Vol.6 No.1

연구계획 : 척추골절의 치료를 위한 내고정시 사용되는 장분절 고정과 단분절 고정의 임상적 결과 및 차이점을 알아보고자 후향적 연구를 계획하였다. 연구목적 : 장분절 고정술과 단분절 고정술 사이에 역학적 견고성과 골절의 정복력, 신경학적 회복 정도와 임상적 결과를 비교, 분석하고자 하였다. 대상 및 방법 : 1989년부터 1997년까지 척추의 외상 환자중 후방도달법에 의한 척추경나사못 고정술을 시행한 54명 을 대상으로 장분절 고정군과 단분절 고정군으로 구분하였고 단분절 고정술의 경우 골절된 추체에도 척추경 나사 못을 삽입하였다. 단분절 고정군은 35례로 평균 1년 8개월 추시하였고 장분절 고정군은 19례였으며 평균 2년 7개월까지 추시하였다. 결과는 단순 방사선사진에서 전방추체 높이의 변화, sagittal index, 및 신경학적 회복정도를 비교하여 평가하였다. 결과 : 장분절 고정군에서 전방추체 높이는 술전 50.7%, 술후 78.7%, 최종 추시상 74.9 %이었고, 단분절 고정군에서 는 각각 59.7%, 79.3%, 및 77.7 %로 통계학적 차이가 없었다. Sagittal index는 장분절 고정군에서 술전 17.5。, 술후 6.7。, 최종 추시상 8。였으며 단분절 고정군은 19.9。, 10.4。, 및 12.1。로 차이가 없었다. 다른 임상결과도 양군간의 차이 는 없었다. 신경증상이 발생한 36례중 22례에서 Frankel분류에서 1등급 이상의 회복이 있었다. 결론 : 흉요추 및 요추 골절의 수술적 치료시, 골절된 추체를 포함하여 상하위 1추체씩 고정하는 추경나사못 사용 단분절 고정술이 권장할 만한 수술방법으로 사료된다. Study design : A retrospective study was designed to evaluate the clinical result and difference between short segment and long segment fixation, which was undertaken by posterior approach for thoracic and lumbar spine fractures. Objective : To determine and compare the mechanical maintenance and ability of correction, and clinical and neurologic recovery between short segment and long segment fusion group. Summary of Background Data : The long segment instrumentation is a cause of decrease of motion segment in thoracic and lumbar spine. In short segment fusion, screw failures were reported. Materials and Methods : From 1989 thorough 1997, 54 patients who had been operated on by the posterior approach with transpedicular screw fixation for spine injuries were divided into two groups. The authors applied the short segment transpedicular instrumentation including fractured vertebra. Short segment group included 35 cases, and long segment group, 19 cases. The mean follow-up period was one year and eight months for short segment group, two years and seven months for long segment one. The results were evaluated by comparing the anterior vertebral height, sagittal index in simple roentgenogram and neurologic recovery. Results : The average of anterior vertebral height which was 50.7% at preoperation, became 78.7% after the operation and measured 74.9% at final follow-up in long segment fusion group, while in short segment fusion group it was 59.7%, 79.3% and 77.7%, respectively. The average of sagittal index of 17.5°at preoperation became 6.7°after the operation, and measured 8。 at final follow-up in long segment fusion group, while in short segment fusion group it was 19.9。, 10.4。, and 12.1。, respectively. Overall clinical results had no statistical significant difference between two groups. Of the thirty-six patients with neurologic deficits, twentytwo improved by over the one Frankel grade. Conclusions : The authors conclude that the short segment transpedicular instrumentation including fractured vertebra is a successful method of thoracolumbar and lumbar burst fractures.

요추와 흉요추의 특발성 척추 측만증의 치료에 있어 Zielke Ventral Derotation System과 Cotrel-Dubousset기 기술의 비교

석세일,이춘기,정성수,정순택,김진혁,오주한 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.1

There has been much controversy, in the surgical treatment of idiopathic thora- columbar and lumbar scoliosis, about whether anterior or posterior instrumentation produced a better result. The purpose of this study was to compare the Zielke ven- tral derotation system and Cotrel-Dubousset instrumentation in the correction of frontal, sagittal, and rotational deformity. and to define the advantage and disad vantage of each instrument in idiopathic thoracolumbar and lumbar scoliosis. The ventral derotation system was used in 20 patients (VDS group) and Cotrel-Dubousset instrumentation was used in 20 patients (CDI group). The average age of VDS group patients at the time of surgery was 16.7 years, and that of CDI group patients was 18.5 years. The average length of follow up was 48 and 25 months, respectively. In frontal curve correction, the VDS group showed a 77% correction, and the CDI group a 63% correction(P>0.05). In rotational deformity correction, the VDS group showed a 42% correction, and the CDI group a 16% correction (p<0.05). There were six decompensations in the VDS group, and three in the CDI group. Two decompen- sations of the VDS group were corrected with posterior CDI. There was one pseu- doarthrosis in the VDS group, with no significant symptoms. There were two instru- mentation problems in each group, with no daverse effects on curve correction and maintenance. In conclusion, the ventral derotation system showed more powerful frontal and rotational correction, and can be effective even in more rigid or larger curves. Cotrel-Dubousset instrumentation, however, maintained physiologic sagittal alignment, was performed using a less invasive posterior approach, and had broader indication because it could be extended upward or downward to the compensatory curves.