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변형된 Sauve-Kapandji 술식을 이용한 부정유합된 Colles 골절의 치료
신현대,이광진,정제택,양준영,이준규 대한골절학회 1999 대한골절학회지 Vol.12 No.1
Distal radius fracture is one of the most common fracture of upper extremities including Colles' fracture. Since 1913, classic Darrach's technique which performed excision of the distal end of the ulna for distal radioulnar arthrosis have been introduced, many procedures have been described for the surgical management of painful disorders of the distal radioulnar joint. In 1936, Sauve and Kapandji first described the procedure that included an arthrodesis across the distal radioulnar joint and created a pseudarthrosis of the ulna, proximal to the fusion, to restore pronation and supination. The purpose of the present study is to evaluate clinical results of treatment for malunited Colles' fracture using modified Sauve-Kapandji procedure as an alternative salvage operation. From 1994 May, total nine patients were evaluated, average follow-up was twenty one months. There were four male patients and five female patients. Radiographic measurement, pain of radiocarpal and radioulnar joint, range of motion of the wrist, grip strength, instability of the distal radioulnar joint were foci of this present study. We used modified Sauve-Kapandji procedure. The purpose of modification is to preserve the pseudoarthrosis and stabilize the ulna, proximal ulnar stump was stabilized with a strip of flexor carpi ulnaris and pronator quadratus was sutured to sheath of extensor carpi ulnaris. According to Fernandez Point-Score System, results showed excellent 6, good 2 and fair 1. But two patients complained continuous pain at vigorous range of motion. All of the patient showed improvment of arc of motion and rotation, especially pronation-supination and did not develop any instability. But radiographic measurement was not correlated with clinical symptoms. In conclusion, modified Sauve-Kapandji procedure is effective procedure for treatment of the malunited Colles' fracture which have severe distal radioulnar disruption, ligament laxity, subluxation of the ulna, and ulnocarpal impingement. We should consider as alternative salvage operation options of maIunited Colles fracture.
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황득수,양준영,정제택 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2
The pilon fracture result from axial compression and rotational forces causing variable degrees of metaphyseal disruption, articular damage and malleolar displacement. It's managements are closed reduction and plaster immobilization, skeletal traction, fibular stabilization alone, limited open reduction and external fixation, open reduction and internal fixation, primary arthrodesis, and even immediate amputation. Recently limited open reduction and external fixation has been proved to provide good clinical results for the severely comminuted or open pilon fractures. Authors reviewed eighteen cases of the pilon fractures from March 1991 to February 1997. Among them eight cases were treated with limited open reduction and external fixation, and ten cases were treated with open reduction and internal fixation. In conclusion, limited open reduction and external fixation has shown better results than open reduction and internal fixation in severely comminuted or open pilon fractures for wound healing and preventing of other complications.
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윤승호,이광진,황득수,정제택,이준규 대한골절학회 1998 대한골절학회지 Vol.11 No.4
Generally it is known that the best clinical results in treatment of injuries of the ankle are obtained by anatomical restoration of the joint. For objective measurements of tibiotalar joint, some investigators used different criteria and defined the specific reference points under variable angle of internally rotated anteroposterior projection. But, occasionally we didn't acquire the accurate roentgenographic finding that was suggested by investigators. So, we check the variable angle of internal rotation film in addition to angle suggested by investigators and compare the criteria between them. The purpose of this study is to evaluate availability of internally rotated mortise view and its criteria in clinical practice. Following results was acquired. First, there was no significant difference in measuring the medical clear space on depand on variability of rotation angle. Second, the overlapping distance of tibiofibular syndesmosis decreased by increasing internal rotation angle, but was not under 1mm (ie, index of injury). A third, to measure the Weber' s 3 criteria, we need to check the variable internal rotation angle, if necessary. Finally, we acquired the normal range of measurement about Tile s 2 criteria by variable internal rotation angle.
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실패한 무시멘트형 양극성 고관절 반 치환술 및 고관절 전 치환술 주위조직으로부터 추출한 폴리에틸렌 마모세편의 비교 분석
황득수 ( Deuk Soo Hwang ),정제택 ( Je Taek Jeong ),이광진 ( Kwang Jin Rhee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2
Many researchers have been reported wear mechanism of bipolar hip endoprostheses. i.e. Persistent cyclic impingement of the stem neck on the rim of the polyethylene liner has been widely accepted main mechanism. Also some authors have been described larger amounts and sizes of polyethylene wear debris in the bipolar hemiarthroplasty than total hip arthroplasty. But the relative roles of particle shape, size and number and wear mechanisms remain unclear. The purpose of present study is to isolate and characterize polyethylene wear debris around periprosthetic tissues in both cementless bipolar and total hip arthroplasty and compare polyethylene particles(size, number and shape). From 1994 to 1997, revision of eleven hips performed and isolated polyethylene particles retrieved from periprosthetic tissues. Five hips of revised hips had underwent cementless bipolar hemiarthroplasty and six hips cementless total hip arthroplasty before revision surgery. Polyethylene particles were isolated by digestive enzymes(Papain buffer) and KOH and subsequentiy examined by scanning electron microscopy(SEM). The results were followings: 1) Total hip arthroplasty group showed larger amounts and sizes of the polyethylene particles than bipolar group, but not different in shapes. 2) All the revised hips showed more substantial wear of the bearing surface of the polyethylene liner than circumferential wear of the polyethylene insert rims. Indeed, bearing surface wear could be play an another important role in aseptic loosening as well as impingement in bipolar hemiarthroplasty. Therefore we should be consider implants design and other factors producing polyethylene wear debris.
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이준규,안재성,권순태,김환정,정제택 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2
This study was compared pre-operative MRI finding with operative finding on 36 cases with the failed back surgery syndrome (FBSS) retrospectively. The purpose of this study was to determine the accuracy of the MRI on the FBSS including early complications such as hematoma of infection. Of the 51 patients with FBSS, we analyzed pre-operative MRI finding compared with operative finding on 36 cases excluding nonunion, instability, metal failure and pseudoarthrosis who underwent an operation for the FBSS from December 1994 to June 1997. There were 25 men (69.4%) and 11 women (30.6%), aged from 16 to 68 years (average 43.6 years). These were divided into 5 sub-groups and calculated sensitivity, specificity and positive predictability. MRI accuracy in recurred disc was 84%, scar adhesion, recurred or developed stenosis, infection and hematoma 100% each and all, overall accuracy of the MRI 93%, respectively. Average interval of re-operation in FBSS WAS 4.3 years. In the 18 cases (50%), symptoms persist without pain-free interval after first operation. Early complications including hematoma and infection are easily detected with MRI. Especially if patient complains of severe leg pain or neurologic deficit, it is a good diagnostic procedure to check the MRI. The MRI is a useful method for evaluation of most cases of the FBSS, but it has limitations to evaluate recurred disc or scar adhesion only in T1, T2 weighted image. Therefore Gd-DTPA enhancement is necessary for the accurate diagnosis.
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