금속판 및 나사못을 이용한 족근관절 외과 골절 치료의 문제점

하난경,백대현,손종민,김형관,장주해,현봉헌 대한골절학회 1998 대한골절학회지 Vol.11 No.4

The goal in treatment of ankle fracture is the restoration of normal ankle function. Although controversy still exists over the best method of treatment, recent ariticles emphasize importance of the anatomic reduction of fibula and the benefits of early mobilization when adequate fixation is accomplished. When we fix fracture of lateral malleolus with plate and screws, the distal screws should engage the medial cortex of the fibula but not protrude into the talofibular joint. Because the penetration of screws into ankle joint may be the cause of postoperative pain and post-traumatic arthritis. This article has reviewed a series of 36 ankle fractures, treated from March 1993 to January 1997, using plate and screws. In order to analyse the influence of the penetration of screws into the ankle joint, all fractures were classified according to the penetrating length of screw from medial cortex of lateral malleolus. Those with the end of the screw protnided more than 2mm into joint were clssified group I, those with less than 2mm group II, those with no engagement group III. The results obtained from this study were as follows: l. According to clinical and radiolgraphic assessment of the results of the treatment, open reduction and internal fixation using plate and screws in treatment of lateral malleous was a satisfactory method. The excellent or good results were achieved in 28 patients among the 36 patients (77.8 %). 2. Average time of bony union was not different significally among the three groups. 3. The gain of full range of motion was delayed in group I. 4. Patients of group I complained persistent pain and discomfort more frequently than the other groups. 5. In the treatment of lateral malleolar fracture, the distal screws should engage the medial cortex of fibula to gain firm fixation,but should not protrude more than 2mm into the ankle joint.

일 병원에서 통원병실을 이용한 수술적 치료의 경험

손종민,하난경 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.1

Background : in order to adapt to changes of the medical environm interests that is drawn in ambulatory surgery are increased as a method of approaching a patients’ satisfaction and cost-effective management. The purpose of this study is to a assess the operation which is able to perform through ambulatory care unit, to identify the problem in ambulatory surgery, and to increased the opportunity of ambulatory surgery with safety. Methods : Between May 13th, 1998 and June 30th, 2000, we performed surgical treatment through ambulatory care unit, and evaluate the results of them. The sorts of operation, duration of stay in the hospital, total cost of treatment, satisfaction of patients and safety if anesthesia were assessed. Results : We performed ambulatory surgery without serve complications and the patients were satisfied with surgical treatment through ambulatory care unit. In comparison of ambulatory and admission surgery, there was a reduction of cost to 16.7~25.3% in ambulatory surgery. Also, the duration of admission was 2 days shorter than admission surgery. Conclusions : According to our results, the surgical treatment through ambulatory care unit is safe and useful method that increase the quality of medical service, satisfaction of patients and reduce the cost of treatments.

장기간 방치된 상완골 외과부 골절의 불유합에 대한 수술적 치료

옥인영,하난경,최융섭 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.2

통원병실을 이용한 전신마취하 슬관절의 관절경 수술

송호경,하난경,백대현,손종민,김형관,이혁제 대한슬관절학회 2000 대한슬관절학회지 Vol.12 No.1

Purpose : Though many patients who visit ambulatory care unit are performed arthroscopic surgery under local anesthesia, it is difficult to do it in some patients. By selecting the anesthetic agents, educating the patients preoperatively and controlling the pain carefully, we gained the good results in arthroscopic surgery of knee through ambulatory care unit under general anesthesia without complications. Materials and Methods : From May 1998 to December 1999, arthroscapic surgery of the knee(meniscectomy, synovectomy, debridement, loose body removal, bursa excision) was carried out under general anesthesia in 91 patients through ambulatory care unit. The anesthetic agents used in operation were propofol(52 cases) and ethrane(39 cases), 10cc of 0.25% bupivacaine with 1% lidocaine was injected into knee joint after arthroscopic surgery for pain control. Results : The pain scores were improved from 12.5 points to 14.7 points at rest, from 9.5 points to 13 point at walking. Postoperatively, there were nausea(2 cases), chest pain(1 case), elevated blood pressure(2 case), redness(3 cases), pain(18 cases), effusion(27 cases). But these symptoms were improved without other complications. Conclusion : It is considered one of the comfortable, safe end reliable methods to perform arthroscopic surgery of knee through ambulatory care unit under general anesthesia.

일 병원에서 통원병실을 이용한 수술적 치료의 경험

손종민,하난경,Sohn, Jong-Min,Ha, Nan-Kyung 한국의료질향상학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : in order to adapt to changes of the medical environm interests that is drawn in ambulatory surgery are increased as a method of approaching a patients' satisfaction and cost-effective management. The purpose of this study is to a assess the operation which is able to perform through ambulatory care unit, to identify the problem in ambulatory surgery, and to increased the opportunity of ambulatory surgery with safety. Methods : Between May 13th, 1998 and June 30th, 2000, we performed surgical treatment through ambulatory care unit, and evaluate the results of them. The sorts of operation, duration of stay in the hospital, total cost of treatment, satisfaction of patients and safety if anesthesia were assessed. Results : We performed ambulatory surgery without serve complications and the patients were satisfied with surgical treatment through ambulatory care unit. In comparison of ambulatory and admission surgery, there was a reduction of cost to 16.7~25.3% in ambulatory surgery. Also, the duration of admission was 2 days shorter than admission surgery. Conclusions : According to our results, the surgical treatment through ambulatory care unit is safe and useful method that increase the quality of medical service, satisfaction of patients and reduce the cost of treatments.

관절경 수술시 발견된 반월상 연골판 손상과 관절연골 결손과의 상관관계

손종민,하난경,조성태,서영환 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

목적: 반월상 연골판 손상진단하에 슬관절 관절경 수술시 발견된 관절연골 결손의 임상적 의의와 그 상관관계를 알아보고자 한다. 대상 및 방법: 1997년 5월부터 2001년 12월까지 반월상 연골판 손상으로 본원 통원병실을 이용하여 전신 마취하에서 관절경 수술을 시행받은 환자중 전반적인 퇴행성 관절염이 심하게 진행되거나 단순방사선 촬영상 퇴행성 변화가 보인 환자를 제외한 252예를 대상으로 하였다. 모든 환자에서 이학적 검사, 단순 방사선 촬영, 자기공명 영상촬영 및 관절경 사진 촬영을 시행하였고 그 결과를 환자의 연령, 수상후 수술까지의 기간, 반월상 연골판 소산의 형태에 따라 비교분석 하였다. 결과: 반월상 연골판 손상 환자중 관절연골 결손은 40예(15.9%)에서 발견되었으며, 그 중 대퇴부 18예(45%), 경골부 10예(25%), 대퇴부 및 경골부 양측 12예(30%)로 대퇴부 측의 이환율이 경골부보다 높았다. 발병율에 있어서는 40세 이상 및 증상 발현후 수술까지 6개월 증상을 호소하였던 환자에서 현저하게 높았다. 또한 반월상 연골 후각부의 손상환자에서 관절연골 결손의 발병율이 가장 높았으며, 증상발현기간이 갈수록 나이가 많을수록 관련성이 높았다. 결론: 슬관절의 반월상 연골판 손상환자에서 나이가 많을수록, 증상발현이 갈수록, 후각부의손상일수록 관절 연골 결손같은 퇴행성 변화의 발병율이 높기 때문에 각별한 주의를 요하며 연골판 손상의 조기치료등 적극적인 치료가 필요하다. Purpose: We studied to know the relationship between meniscal injury & defect of articular cartilage and its clinical importance. Materials & methods: 252 patients were selected, who undergone arthroscopic surgery for meniscal injury from May 1997 to December 2001. We excluded patients with severely progressed osteoarthritis of degenerative changes in simple X-ray. Physical examinations, simple X-rays, MRI & arthroscopic photographs were taken for all patients. And the results were analyzed according to age, duration from accident to operation and type of meniscal injury. Results: 40 cases (15.9%) showed defects of articular cartilage with meniscal injury. Among them, 18 cases (45%) in femur, 10 cases (25%) in tibia, and 12 cases (30%) in both. Incidence of articular cartilage defect was significantly higher in patients over the age of forty (p<0.01) and in those with a history longer than six months (p<0.05). Posterior horn tears were associated with the highest incidence of articular cartilage defect, but were also associated with a longer history and with older patients. Conclusion: In patients with meniscal injury, older age, long duration of symptom and tear at posterior horn have higher incidence of articular cartilage defect, especially femoral condyle. The reason for this is not entirely clear but these patients need close attention and early treatment.

제 18 차 정기학술대회 초록집 : 42. 슬관절내에 십자인대에 생긴 결절증 - 증례 보고 -

손종민,하난경,백대현,김형관,장주해,고해석 대한슬관절학회 2000 정기학술대회 Vol.- No.-

고령에 발생한 대퇴 전자부 불안정 골절에 대한 일차성 고관절 반치환술

손종민,장주해,하난경,조성태,최광영 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 고령의 골 조송증이 심한 불안정 대퇴전자간 골절의 치료에 있어서 일차성 고관절 반치환술을 시행한 집단과 압박고 나사못 고정술을 시행한 집단의 결과를 비교분석하고 그 결과를 바탕으로 일차성 고관절 반치환술의 임상적 유용성을 알아보고자 한다. 대상 및 방법 : 1992년 1월부터 2000년 12월까지 가톨릭대학교 성모자애병원 정형외과에서 대퇴골 전자간부 불안정 골절 진단하에 수술을 시행 받은 환자중 1년 이상 추시가 가능하였던 93례를 대상으로 하여, 70세 이상으로 Singh's Index 3.0이하의 골 조송증이 동반된 경우 또는 동반질환이 있거나 전신상태가 불량한 경우에서 일차성 고관절 반치환술을 시행한 34례(Group Ⅰ), Group Ⅰ과 동일한 조건에서 압박고 나사못 고정술을 시행한 20례(Group Ⅱ), 70세 이상이면서 Singh's Index 4 이상인 경우에서 압박고 나사못 고정술을 시행한 39례(Group Ⅲ)를 대상으로 하여 치료 결과를 비교분석하였다. 결 과 : Group Ⅰ(n=34) 및 Group Ⅱ는 대퇴 골두 천공 4례, 불유합 10 례, 금속판 및 나사못 이완 2 례 등 19 례, Group Ⅲ는 경도의 내반고 변형 1 례, 지연유합 2 례 등 총 8 례에서 합병증을 보였다. 결 론 : 70세 이상 고령의 불안정성 대퇴 전자간 골절 환자에서 특히 골 조송증이 심한 경우, 70세 미만이지만 동반질환이 존재하거나 전신상태가 불량한 경우에서 장기간의 침상안정으로 발생할 수 있는 술후 합병증을 감소시키고 조기보행을 가능하게 할 수 있는 양극성 고관절 반 치환술이 일차적 치료법으로 제시될 수 있을 것으로 사료된다. Purpose : The purpose of this study was to evaluate the effectiveness and advantage of bipolar hemiarthroplasty in treatment of unstable femoral intertrochanteric fracture in elderly parients. Materials and Methods : We reviewed 93 patients and followed up more than one year. Group Ⅰ(n=34, Singh indexⅡ<3 with more than 70 year old) were treated by bipolar hemiarthroplasty. GroupⅡ(n=20) with same condition were treated by compression hip screw. Group Ⅲ (n=39, Singh index >4 with more than 70 year old) were treated by compression hip screw. Results : Group Ⅰ and Ⅲ patients showed satisfactory result over than good by merle D' Aubigne hip rating scale. Among Group Ⅱ(n=20), 16 cases showed under 'poor' according to dunctional scale. Complication was 1 cases in group Ⅰ, 19 cases in group Ⅱ and 8 cases in group Ⅲ. Conclusion : We suggest bipolar hemiarthroplasty as first choice of treatment for osteoporotic elderly patients with unstable intertrochanteric fracture, especially who have combined medical problems or poor general condition.

이중 내측 활막추벽 증후군 - 1예 보고 -

손종민,장주해,하난경,조성태,황정택,Sohn, Jong-Min,Jang, Ju-Hae,Ha, Nan-Kyoung,Cho, Seong-Tae,Hwang, Jung-Taek 대한관절경학회 2006 대한관절경학회지 Vol.10 No.1

저자들은 우 슬관절에 발생한 이중 내측 활막추벽 증후군 환자를 경험하였기에 보고한다. 일반적으로 활막추벽 증후군은 전형적인 증상이나 통증이 없을수 있으며, 다양한 골관절 증상을 유발하는 다른 슬내장증의 원인들과 감별진단이 요구된다. 결정적인 진단에는 MRI와 관절경술이 필요하며, 증상이 있는 경우 관절경적 제거술에 의해 증상의 호전이 이루어진다고 보고된다. 본 환자는 앉거나 계단을 오를 때, 우 슬관절 동통을 호소하였고, MRI상 전형적인 이중 내측 활막추벽이 관찰되어 관절경적 절제술을 시행하였다. 술후 환자는 만족스러운 임상호전을 보였다. We present a case of double medial plica that developed on right knee joint. There has been no documented case of double medial plica of the knee joint. In a general way, double medial plica syndrome is very difficult to diagnose because it does rarely develop and symptoms are non-specific or not present. It is difficult to distinguish between pain originating from the medial plica and from other internal derangement of the knee. This patient had symptoms including aggravating right knee pain with sitting position or knee flexion for 3 months. We performed MRI and arthroscopy for more accurate diagnosis. MRI T1, T2 images showed typical double medial plica and we had performed arthroscopic excision of symptomatic medial plica in right knee joint. Arthroscopic resection provided satisfactory relief of symptom.lasting and satisfactory relieve of symptom.

선천성 근성 사경에 대한 흉쇄유돌근 부분절제술

이한용,정창훈,하난경,서상일,옥인영 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.3