간과된 월상골 전방 탈구로 인한 수근관 증후군과 수지 굴곡건 파열

정영율,장영재 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

월상골 전방 탈구는 비교적 드문 손상으로 진단이 지연되는 경우 정중신경 압박으로 인한 수근관 증후군과 마멸로 인한 굴곡건 파열이 발생할 수 있다. 저자들은 진단이 지연된 월상골 전방 탈구로 인하여 수근관 증후군과 제2수지 굴곡건 파열이 동시에 나타난 증례를 경험하였다. 이에 대하여 월상골 절제 및 정중신경 유리술, 장장근건을 이용한 제2수지 굴곡건 재건술을 시행한 후 1년 추시상 좋은 임상적 결과 및 방사선학적 결과를 얻은 바 있어 이에 대하여 보고하고자 한다. Anterior dislocation of lunate is rare, it can result in median nerve compression and attritional rupture of flexor tendon when delay diagnosed. We report a patient with second finger flexor tendon rupture and carpal tunnel syndrome caused by neglected anterior lunate dislocation. Patient underwent operative treatment for that excised lunate, released carpal tunnel and reconstructed second flexor tendon using palmaris longus tendon. One year after surgery, fucntional and neurologic symptom were recovered. Also carpal alignment was maintained on plain radiographs, even after excision of the lunate.

The Effect of Hydroxyapatite Coating on Long-term Results of Total Hip Arthroplasty with Hydroxyapatite-coated Anatomic Femoral Stem

정영율,임채현,김대희,허주영,장영재 대한고관절학회 2014 Hip and Pelvis Vol.26 No.3

Purpose: To evaluate the clinical and radiological results, as well as the survival rate, associated with total hiparthroplasty using a hydroxyapatite (HA)-coated anatomical femoral stem at a follow-up of ≥12 years. Materials and Methods: From April 1992 to May 1997, 86 patients (102 hips) underwent total hip arthroplastywith a HA-coated ABG I (Anatomical Benoist Giraud; Howmedica) hip prosthesis. The average age at the timeof surgery was 53.4 years and the mean duration of follow-up was 17.1 years (range, 12.1-21.0 years). TheHarris hip score (HHS) and radiographic assessments of thigh pain were used to evaluate the clinical results. Weobserved osteointegration, cortical hypertrophy, reactive line, calcar resorption and osteolysis around the femoralstems. The survival rate of the femoral stems was evaluated by using the span of time to a revision operation forany reasons was defined as the end point. Results: The mean HHS was 50.5 preoperatively and 84.2 at the time of last follow-up. Osteolysis only aroundthe HA-coated proximal portion of the femoral stem was observed in 72 hips, cortical hypertrophy all around thedistal portion of the femoral stem was observed in 38 hips, and calcar resorption was observed in 44 hips. Areactive line was observed in 13 hips, but was unrelated to component loosening. Stem revision operations wereperformed in 24 (23%) hips due to osteolysis (14 hips), fracture (5 hips) and infection (5 hips). The femoral stemsurvival rate was 75% over the mean duration of follow-up. Conclusion: Total hip arthroplasty using a HA-coated anatomical femoral stem showed necessitated a high rateof revision operations due to osteolysis around the femoral stem in this long term follow-up study.

인공 고관절 전치환술 후 발생한 하둔 동맥의 가성동맥류-증례보고-

정영율,정현균김기수 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

인공 고관절 치환술 후 가성 동맥류는 매우 드문 합병증으로 알려져 있다. 인공 고관절 치환술 후 발생한 가성 동맥류는 혈관에 대한 직접 손상이나 견인, 신장 등의 간접손상, 그리고 비구컵의 나사를 고정하는 과정에서 발생할 수 있다. 저자들은 인공 고관절 전치환술 후 발생한 하 둔 동맥의 가성 동맥류를 경피적 경도자 색전술로 효과적으로 치료하였기에 보고하는 바이다. Pseudoaneurysm after total hip arthroplasty (THA) is a rare and unusual complication. Pseudoaneurysm after THA results from direct vascular injury, indirect vascular injury including retraction, stretching and during acetabular screw fixation. We report a case of pseudoaneurysm of inferior gluteal artery after THA, which was successfully treated by percutaneous transcatheter embolization.

Sirus® 골수정을 이용한 대퇴골 골절의 치료: 삽입점에 따른 합병증 비교

정영율 ( Young Yool Chung ),최동혁 ( Dong Hyuk Choi ),윤대현 ( Dae Hyun Yoon ),이정호 ( Jung Ho Lee ),박지훈 ( Ji Hun Park ) 대한골절학회 2015 대한골절학회지 Vol.28 No.2

Purpose: The purpose of this study is to analyze the clinical results of fixation using Sirus® nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal. Materials and Methods: From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus® nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared. Results: The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment. Conclusion: Using Sirus® nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

골반환 손상의 진단과 치료

정영율 ( Young Yool Chung ),김희동 ( Hee Dong Kim ) 대한고관절학회 2007 Hip and Pelvis Vol.19 No.3

선택적 수술기법 : Two-Incision 최소 절개 인공 고관절 전치환술

정영율 ( Young Yool Chung ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.4

인공 고관절 전치환술 후 발생한 하 둔 동맥의 가성 동맥류 -증례 보고-

정영율 ( Young Yool Chung ),정현균 ( Heun Guyn Jung ),김기수 ( Ki Soo Kim ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

인공 고관절 치환술 후 가성 동맥류는 매우 드문 합병증으로 알려져 있다. 인공 고관절 치환술 후 발생한 가성 동맥류는 혈관에 대한 직접 손상이나 견인, 신장 등의 간접손상, 그리고 비구컵의 나사를 고정하는 과정에서 발생할 수 있다. 저자들은 인공 고관절 전치환술 후 발생한 하 둔 동맥의 가성 동맥류를 경피적 경도자 색전술로 효과적으로 치료하였기에 보고하는 바이다. Pseudoaneurysm after total hip arthroplasty (THA) is a rare and unusual complication. Pseudoaneurysm after THA results from direct vascular injury, indirect vascular injury including retraction, stretching and during acetabular screw fixation. We report a case of pseudoaneurysm of inferior gluteal artery after THA, which was successfully treated by percutaneous transcatheter embolization.

Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

김민욱,정영율,이정호,박지훈 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

Purpose: We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). Materials and Methods: From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. Results: Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. Conclusion: Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type.

Measuring the Impact of Femoral Head Size on Dislocation Rates Following Total Hip Arthroplasty

김민욱,정영율,이지원,김철환 대한고관절학회 2017 Hip and Pelvis Vol.29 No.2

Purpose: The purpose of this study was to evaluate if the femoral head’s size has an impact on dislocation rates following total hip arthroplasty (THA). Materials and Methods: Five hundreds forty-three THA performed using a posterolateral approach in our hospital and followed up more than 6 months were included in this study. We evaluated dislocation rates based on the size of femoral head (28 mm vs. over 32 mm) and further investigated the dislocation rates classified into primary and revision surgery. Patient-related and surgical factors were reviewed to evaluate risk factors impacting dislocation rates. Results: Dislocation occurred in 9.6% of cases (n=52; 32 males and 20 females). Of this dislocation group, 36 were treated with femoral heads 28 mm in diameter (9.8% of all patients treated with 28 mm femoral heads) and 16 were treated with femoral heads 32 mm and over (9.1% of all patients treated with femoral heads of at least 32 mm). The percentages of patients experiencing dislocation were not significantly different among the two groups (i.e., 28 mm vs. ≥32 mm). However, after revision surgery, the dislocation rate in the 28-mm group was significantly higher than the ≥32-mm group (P<0.05). In a case-control study comparing dislocation and nondislocation groups, the risk of dislocation was 6 times higher in patients with habitual alcohol intake, and 9.2 times higher in patients with a neuropsychiatric disorder (P<0.05). Conclusion: Patient factors are considered to have a more significant impact on dislocation rates following THA than the size of femoral head.

Total Hip Arthroplasty Using Metal Head on a Highly Cross-linked Polyethylene Liner

김민욱,정영율,박지훈,이정호 대한고관절학회 2015 Hip and Pelvis Vol.27 No.4

Purpose: This retrospective study was performed to evaluate the clinical results and measure polyethylene liner wear in total hip arthroplasty (THA) with highly cross-linked polyethylene. Materials and Methods: Except for patients who had died or were unable to have follow-up at least 2 years, 60 of 78 hips that underwent THA were included this study. The mean age was 64.5 years (range, 25-81 years) and the mean body mass index (BMI) was 23.0 kg/m2 (18.1-32.3 kg/m2). Diagnosis at the time of the operation was osteonecrois of the femoral head in 28 hips, primary osteoarthritis in 14, hip fracture in 13, and other diseases in 5. The mean follow-up period was 3.8 years (2.1-7.1 years). Harris hip score (HHS) was reviewed before THA and at the last follow-up. On the anteroposterior pelvic radiographs, acetabular cup inclination and ante-version were also measured. The annual linear wear rate was measured using Livermore’s method on the radiographs. Results: The mean HHS was 60.1 (28-94) before operation and 90.4 (47-100) at the last follow-up. In the immediate post-operation, the average inclination and anteversion angles of the acetabular cups were 46.3。(standard deviation, ±6.7。) and, 21.4。(±10.1。) respectively. The mean of the annual linear polyethylene wear was 0.079 mm/year (0.001-0.291 mm/year). Age, gender and BMI were not statistically related to linear polyethylene wear but the period of follow-up and the acetabular cup’s inclination showed significant negative and positive correlation respectively. Conclusion: The wear rate of a highly cross-linked polyethylene was shown to correlate negatively with duration of follow-up. However, our study was based on a short-term follow-up, so a long-term follow-up study is necessary in the future.