최소 감압술에 의한 요추 퇴행성 척추관 협착증의 치료

최장석,최호,신능철 인제대학교 2000 仁濟醫學 Vol.21 No.1

Objectives: In the operative treatment of lumbar spinal stenosis, wide decompression and fusion method has many problems such as long operative time, large amount of blood loss, postoperative back pain and limited operative indication. To avoid these disadvantages, we have tried minimal decompression method minimizing the resection of laminae and facet joints. Materials and Methods: 26 cases of degenerative lumbar stenosis, who had neither segmental instability nor spondylolisthesis, received minimal decompressive surgery without instrumentation. We reviewed mean operative time, blood loss and evaluated clinical results by Kim's criteria and postoperative segmental instablity by Dupuis method. Average follow-up period was 33 months. Results: Transfusion was not needed in all cases. Mean operative time was 1 hour 5 minutes, 1 hour 46 minutes in one and two levels decompression respectively. According to Kim's criteria for clinical results, we observed 17 cases showed excellent results and 7 cases good results. Radiographs at postoperative 33 months show no dynamic instability in lumbar spine. Conclusion: In degenerative lumbar stenosis without segmental instability or spondylolisthesis, minimal decompression is an effective treatment method.

골수강내 교합정과 금속판을 이용한 경골 간부골절 치료의 비교 분석

최장석,이재익,손명환,박재홍,남궁성현 인제대학교 1997 仁濟醫學 Vol.18 No.3

경골 간부 골절의 치료로 많은 방법들이 제시되었고 그중 골수강내 교합정과 금속판을 이용한 내고정술이 많이 사용되어 왔다. 이 두가지 방법으로 치료받은 환자들에 대하여 골절 유합 및 빠른 생활로의 복귀 그리고 합병증 등을 비교 분석하여 좀더 유용한 치료법이 무엇인가를 알아보기 위해 본 연구를 시행하였다. The numerous procedures were introduced for treatment of tibial shaft fractures. Among them, interlocking intramedullary nailing and plate fixation are used most commonly for this fracture. The authors analysed 64 cases of the tibial shaft fracture which were treated with interlocking intramedullary nails or plate and screw fixation (33 patients were treated with interlocking intramedullary nails and 31 patients were treated with plate and screw) and average follow up was 16.7 months(from 12 to 26 months). The purpose of this study is to reduce the union time and complication of fracture cases by analyzing the comparison between interlocking intramedullary nailing and plate and screw fixation. The results obtained are as follows ; 1.According to the mean period of the fracture union, the union period was 15.2 weeks in cases treaded with interlocking intramedullary nails and interlocking intramedullary group acheived union earlier than plate and screw group. 2.There were more superficial infection in plate and screw group than interlocking intramedullary nail group but there were no difference in incidence of nonunion or delayed union. 3.The patients treated with interlocking intramedullary nails returned to their previous job earlier than the patients treated with plate and screws.

백서 좌골 신경 결손에서 이식복원술에 따른 신경전달 검사

최장석,김영창,서승석,안기찬,유성진 인제대학교 1999 仁濟醫學 Vol.20 No.1

자가신경이식과 실리콘관을 이용한 신경봉합술의 신경재생을 비교 관찰하기 위해 Sprague-Dawley계 30마리의 백서를 이용하여 좌골신경 절제 후 미세수술법을 이용하여 반대측 좌골신경을 자가이식하고 그 신경간극에는 실리콘관을 연결하여 술후 2주, 4주, 8주, 12주, 16주에 자가신경 이식군과 실리콘관을 이용한 군의 신경재생의 양상과 근전도 소견을 비교 관찰하였다. 자가신경 이식군이나 실리콘관 이식군 모두 4주 이상이면 신경전달 검사상 비슷한 정도의 진폭을 보였다. 유수신경섬유 수는 술후 4주에서는 실리콘관 이식군에서 더 의미있는 증가를 보였으나 12주 이상에서는 평행을 이루면서 큰 차이를 볼 수 없었다. To compare the result of autogenous nerve graft with that of silicone tubing method in segmental defect of sciatic nerve, the experiments were carried out on adult rats with autogenous nerve graft in the left side and silicone tubing in the right side using microsurgical technique. Similar amount of amplitude in NCT after postoperative 4 weeks in both groups. The numbers of myelinated nerve fibers were more significantly abundant in silicone tube group at postoperative 4 weeks, but there were no difference between 2 groups in postoperative 12 weeks.

자가골막 이식을 이용한 관절연골의 재생에 관한 실험적 연구 : An Experimental Investigation the Rabbit

최장석,김영창,김기훈 인제대학교 1999 仁濟醫學 Vol.20 No.2

The articular cartilage can be damaged by trauma or disease. Because of the limited potential of damaged articular cartilage for either repair or regeneration, there is a need for biological resurfacing of large articualr cartilage defects in diseased or damage joints by transplantation of a tissue with significant chondrogenic potential. The purpose of this study was to investigate the use of free periosteum in articular defects and to characterize the newly formed cartilage. The periosteum was used for repair of articular cartilage defect in femoral condyle. The process of repair was evaluated grossly or histologically at from 2, 4, 6 and 8 weeks after grafted process. The results were follows : 1. At 2 weeks after operation, neochondrogenesis was rarely seen and the defects was potentially filled with some fibrous tissue. 2. At 4 weeks, the hyaline cartilage appeared focally 75% in grafted group and 25% in control group. 3. At 6 weeks, the defects were filled with more dove loped hyaline cartilage cells in all grafted group, but only 38% (6weeks), 44% (8weets) of the control group. 4. The articular cartilage defect can be repaired by autogenous periosteal chondro-genesis cartilage and the newly formed tissue 8 were originated from the cambium layer of periosteal grafts.

동결 동종골의 구조적 삽입을 이용한 거골하 신연 유합술

최장석,곽지훈,전성수,박홍기,Choi, Jang-Seok,Kwak, Ji-Hoon,Jun, Sung-Soo,Park, Hong-Gi 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

고환 절제 백서에서 남성 호르몬 결핍과 이로 인한 골 감소가 골절 유합에 미치는 영향

최장석,이창섭,신정욱,장유권,유성진,최종문 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.6

골막 및 골내막이 골절 치유에 미치는 영향

최장석,한문성,손찬모,변만호 인제대학교 1995 仁濟醫學 Vol.16 No.4

골절의 치유과정 중 가골형성 시기에 골막 및 골내막의 간엽세포들이 분화의 과정을 거쳐서 섬유성 연골의 가골을 형성하기 시작한다. 저자들은 성장기에 있는 36마리의 백색 가토의 경골 간부에 절골술을 시행한 후 절골술 부위의 고정은 pin and resin으로 외고정을 실시한 후 새로운 골형성 과정을 관찰하기 위하여 술후 1주일 간격으로 방사선 촬영을 실시한 후 새로운 골형성 과정을 평가하였다. 저자의 실험에 의하면 수술시 골막을 제거한 경우에는 골절의 치유가 지연되었으며 골내막을 제거한 경우에는 큰 영향을 미치지 못하였다. 이상의 소견으로 골절유합에 있어 골막이 골내막보다 더 중요한 역할을 하는 것으로 사료된다 In callus formation stage of fracture heating, periosteal and endosteal mesenchymal cells begin to differentiate and form the fibrocartilaginous callus. But a long standing controversy exists as to the osteogenic potential of periosteum and endosteum. Our study was designed to determine the role of periosteum and endosteum in fracture healing of rabbits. Transverse osteotomy was performed in the tibia diaphysis and the osteotomized bone was stabilized with a pin and resin external fixation. The rabbits were divided into four experimental groups; Group 1-The periosteum and endosteum were not removed. Group 2-The endosteum was removed. Group 3-The periosteum was removed. Group 4-The periosteum and endosteum were removed. Following operation, the process of new bone formation was monitored by radiographs weekly. The appearance of fracture callus on conventional radiographs is an important finding in the assessment of fracture healing. The fracture healing was delayed in the group that the periosteum had been removed at operation but was not largely influenced in the group that the of scrapig of endosteum. This result suggests that the periosteum plays a more important role in fracture healing than the endosteum does.

족부와 족관절에서의 신경내 결절종

최장석,김광희,곽지훈,박홍기,이신우,Choi, Jang-Seok,Kim, Kwang-Hee,Kwak, Ji-Hoon,Park, Hong-Gi,Lee, Shin-Woo 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Purpose: Pathogenesis of intraneural ganglion is controversial, however, the synovial theory that the intraarticular region is the origination of disease has come into the spotlight nowadays. But there are a few researches about intraneural ganglion in foot and ankle. We studied 7cases of intraneural ganglion. We are going to prove the synovial theory by indentifying articular branch of intraneural ganglion. Materials and Methods: From August 2003 to May 2011, we evaluated 7 ouf of 8 patients diagnosed as a intraneural ganglion in foot and ankle. The gender ratio were 4 male and 3 female, and the mean age at the time of surgery was 52.9 years. Clinically, we checked pre and post operative symptom, muscle tone and whether loss of muscle tone and sensation exists. We analyzed surgical records and preoperative MRI and compared those with intra-operative finding. Results: In MRI analysis of 7cases, the connection around the joints were confirmed, and 1 case was confirmed in the retrospective analysis of MRI. Intraneural ganglions occurred in medial plantar nerve 3 cases, lateral plantar nerve 1 case, superficial peroneal nerve 1 case and sural nerve 1 case. We could not found recurrence during the follow up periods. Most patients relieved pain after operation, but recovery of sensation was unsatisfactory. We could find some cases pathological finding of the nerve intraoperatively, and clinical result of that cases was poor. Conclusion: Intraneural ganglion can occur in various parts in foot and ankle. We concluded that the intranneural ganglion originated from joint by identifying the artichlar branch of ganglion. Due to its small size, it is difficult to find articular branch in operation field. But we do our best to find and remove articular branch. Currently, considering the small amount of research in foot and ankle, more research about articular brach is needed.

대퇴 경부와 요추부 골밀도에 의한 골다공증 진단의 일치도

최장석,안기찬,이창섭,최종문,김주용,신동렬 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.2

족부, 족관절 결핵

최장석,곽희철,김정한,정훈재,Choi, Jang-Seok,Gwak,, Heui-Chul,Kim, Jung-Han,Chung, Hoon-Jae 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

Purpose: To emphasize the importance of considering tuberculosis in atypical cases of foot and ankle by reporting clinical results of those cases. Materials and Methods: Seven cases which were diagnosed as tuberculosis around foot and ankle from March 1996 to June 2007 were included. We reviewed initial impressions, the time to be diagnosed, clinical symptoms, laboratory findings, radiological findings and the clinical results and complications. Results: We followed up at least 6 months ($6{\sim}24$ months) after surgery in all cases. Initially 2 cases had been diagnosed as cellulitis, 4 cases as chronic osteomyelitis, and 1 case as an ankle instability. Tuberculosis was diagnosed after biopsy in all cases. Mean duration of symptom was 15 months ($6{\sim}36$ months) except in infants. There were various radiologic manifestations such as osteopenia, bony erosion or destruction and cystic changes. Symptoms were relieved in all cases within 4 months with chemotherapy followed by surgical biopsy, except one ankle which had been misdiagnosed as ankle instability and joint destruction was developed after modified Brostrom surgery. Conclusion: It is important to perform a surgical biopsy for diagnosis and proper management even with a faint suspicion on tuberculosis in foot and ankle. And in case of need, when surgical biopsy is performed, curettage procedure may help to improve clinical result.