급성 전방십자인대 손상 시 자기공명영상에서 나타나는 골멍과 전방십자인대 손상 정도의 관계

정화재,신헌규,고천석,김장환,Jeong, Hwa-Jae,Shin, Hun-Kyu,Ko, Chun-Suk,Kim, Jang-Hwan 대한관절경학회 2012 대한관절경학회지 Vol.16 No.1

목적: 급성 전방십자인대 손상 환자의 자기공명영상(magnetic resonance imaging, MRI)에서 나타난 골멍의 형태 및 크기와 전방십자인대의 손상 정도와의 관계를 알아보고 골멍의 발자취(footprint)를 조사해 손상기전을 알아보고자 하였다. 대상 및 방법: 급성 전방십자인대 손상 6주 이내의 급성기에 자기공명영상을 촬영하여 골멍이 나타나는 65명을 대상으로 하였다. 골멍의 형태는 Costa-Paz 분류에 따라, 골멍의 크기는 Kornaat의 방식으로 측정하였다. 자기공명영상의 전방십자인대 관상사면영상(anterior cruciate ligament [ACL] oblique coronal view)에서 손상 정도를 등급화 하였다. 결과: Costa-Paz 분류에 따른 대퇴골 외과의 골멍 형태와 전방십자인대 손상 정도의 관계를 알아본 결과, 부분 파열군(1, 2 등급)에서 제2형이 많고, 완전 파열군(3 등급)에서 제3형이 많았다(P=0.037). Kornaat 총 골멍 점수는 전방십자인대 손상 등급에 따라 차이를 보였으며(P=0.014), 손상기전은 축회전 손상(pivot shift injury)이 가장 많았고 편타 외반 손상 (clip valgus injury) 등이 뒤를 이었다. 결론: 급성 전방십자인대 손상 시 골멍의 형태와 크기는 전방십자인대의 손상 정도와 관련이 있었고, 골멍의 발자취를 통해 손상기전을 유추할 수 있어 급성 전방십자인대 손상의 진단 및 치료에 도움이 되리라 사료된다. Purpose: The aim of this retrospective study was to evaluate the relationship between appearance and size of bone bruise and severity of anterior cruciate ligament (ACL) injury with magnetic resonance imaging (MRI), furthermore, to identify the mechanism of ACL injury by analyzing the footprint of bone bruise. Materials and Methods: Sixty-five subjects who was taken an MRI within 6 weeks after acute ACL injury were studied. All MRI showed ACL injury and associated bone bruises. Bone bruises were analyzed using Costa-Paz classification based on appearance and location and also scored using Kornaat bone bruise grading system based on size and location. The severity of the ACL injury was graded using a 4-point system (ie, grade 0-3) with oblique coronal MRI. Results: There was statistically significant correlation between Costa-Paz classification of bone bruises in lateral femoral condyle and grade of ACL injury. There were more type 2 lesions in partial tear group (grade 1, 2), however, type 3 lesions of Costa-Paz classification in complete tear group (P=0.037). Significant positive correlations were observed between Kornaat total bone bruise score and grade of ACL injury (P=0.014). Most common ACL injury mechanism was pivot shift injury. Other mechanisms were clip valgus injury, phantom foot injury, and hyperextension injury. Conclusion: It is highly suggested that appearance and size of bone bruise is related to severity of ACL injury after acute ACL injury. The foot print of bone bruise provides valuable clues to identify ACL injury mechanism.

증세가 있는 비골하 부 골의 수술적 치료

정화재,신헌규,고천석,Jung, Hwa-Jae,Shin, Hun-Kyu,Ko, Chun-Suk 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.1

Purpose: To evaluate the clinical results of resection of os subfibulare and lateral ligament reattachment or modified Brostrom procedure in patients with symptomatic os subfibulare. Materials and Methods: This is a retrospective study on fourteen patients (14 ankles) who have symptoms associated with os subfibulare. Between August 1999 and July 2004, they underwent 4 resection of os subfibulare and lateral ligament reattachment for ankle pain due to os subfibulare or 10 resection of os subfibulare and modified Brostrom procedure available for ankle instability due to os subfibulare. Follow-up period is averaged for 17.6 months (12-24 months). Clinical results were graded according to the AOFAS clinical rating system. Results: Clinical results were rated as good in 4 ankles after resection of os subfibulare and lateral ligament reattachment, excellent in 5, good in 4, and fair in 1 ankle after the resection of os subfibulare and modified Brostrom procedure. In the last follow up period, 1 case of anterolateral ankle instability, 1 case of ankle pain and 1 case of inversion limitation were present postoperatively, but all symptoms were improved progressively. Conclusion: Resection of os subfibulare and modified Brostrom procedure is a good surgical technique for chronic ankle instability due to os subfibulare. But if just the ankle pain is present, resection of os subfibulare and lateral ligament reattachment is a sufficient procedure.

척추 수술 후 감염에 대한 위험인자: 당뇨병을 중심으로

정화재,신헌규,박종근,김유진,박재형,박세진,하상훈 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.3

Study Design: Retrospective study. Objectives: To identify risk factors for infection after spinal surgery. Summary of the Literature Review: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity. Materials and Methods: From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients’ age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type. Results: Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups. Conclusions: Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery. 연구 계획: 후향적 연구. 목적: 척추 수술 후 발생 가능한 감염에 대한 위험 인자의 규명. 선행 연구문헌의 요약: 척추 수술 후 감염은 비교적 흔하지 않으나 한번 발생하면 심각한 결과 및 비용의 증가와 후유증이 발생한다. 척추 수술 후 감염발생의 위험 인자로는 후방 접근술, 기기 사용, 동종골 이식, 수혈, 긴 수술 시간이 알려져 있으며, 환자 측 요인으로 당뇨, 비만 등이 있다. 대상 및 방법: 2009년 1월부터 2013년 12월까지 본원 정형외과에서 척추 질환으로 수술을 시행한 환자들을 조사하였으며 심부 감염으로 진단받은 10 명과 감염 소견이 없었던 환자들에 대해 비교 분석을 시행하였다. 본 연구에서는 수술 당시 환자들의 당뇨 이환 여부, 성별, 체질량 지수, 수술 범위, 수술접근 방법, 수술 부위, 기기 사용 여부, 수술 방법에 대해 조사하였다. 결과: 5년간 척추 수술을 시행하였던 환자 중 추시 관찰이 가능하였던 350명의 환자를 대상으로 하였으며, 그 중 10명의 척추 감염 사례가 발생하였다. 감염 군에서 당뇨 환자의 비율은 비감염군에 비해 높았으나 통계적으로 유의한 차이를 보이지는 않았다. 그러나 당뇨 환자에서 시행한 혈색소 수치가7.0% 이상인 환자 비율이 감염 군에서 높게 나타났다. 수술시간, 수술 접근법, 배액관 삽입 여부, 수혈 여부, 동종골 이식술 시행 여부는 감염군과 비감염군에 따른 차이를 보이지 않았다. 결론: 조절되지 않는 당뇨는 척추 수술 후 감염 발생에 있어서 가장 중요한 위험 인자로 생각된다. 따라서, 수술 후 감염 예방을 위해 수술 전 환자의 혈당조절을 해야 한다. 약칭 제목: 당뇨병과 척추 수술 후 감염 간의 관계

테니스 엘보우(외측 상괴염)

정화재 한림대학교의료원 1991 人間科學 Vol.15 No.4

건강한 한국인의 액와신경의 신경전도에 관한 연구

정화재,오정희 한림대학교의료원 1984 人間科學 Vol.8 No.12

관절강 내에서 모든 수술 과정을 시행하는 관절경적 전방십자인대 재건술

정화재,Jeong, Hwa-Jae 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

The all inside anterior cruciate ligament reconstruction technique places an anterior ligament substitutes within two bony sockets rather than hone tunnel. This approach is accomplished through arthroscopic three portal which avoids the surgical exposure and morbidity associated with creating traditional bone tunnel. This technique has several distinct advantages when compared with the traditional ACL reconstruction through the bone tunnels. It offers the surgeon a less morbid method for ACL reconstruction that positions an ACL substitute at the anatomic attachment sites of the original ACL with two bone sockets, obviating the need for traditional bone tunnels. Graft fixation at or near the anatomic attachment points of the original ACL minimizes creep with early range of motion and reduces the abrasive 'wind-shield wipe' motion of the graft which occur with bone plugs positioned inside bone tunnels. The sagittal posterior angle to the tibial socket increases fixation strength to pullout with anterior translation force for the tibia on the femur. This technique is not graft specific and can accomodate any graft in which graft length can be customized to the intraarticular native ACL length.

의학교육과 교육평가

정화재 한림대학교의료원 1994 人間科學 Vol.18 No.3

소아 대퇴골 간부 골절에 대한 고찰

정화재,김도영,신주호,정선균 한림대학교의료원 1994 人間科學 Vol.18 No.6

운동이Prednisolone 투여 골격근에 미치는 영향에 관한 조직화적 및 미세구조적 연구

정화재,오정희 大韓再活醫學會 1991 Annals of Rehabilitation Medicine Vol.15 No.2

무지외반증 치료에서 근위 중족골 절골술과 원위 연부조직 교정술 후 종자골의 교정정도

정화재,신헌규,장일성,이종근,Jung, Hwa-Jae,Shin, Hun-Kyu,Chang, Il-Sung,Lee, Jong-Keun 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.