한국인 사체에서의 정상 거골의 실측

하동준,곽희철,김전교,김정한,이창락,김영준,이정한,하병호,김의철,Ha, Dong-Jun,Gwak, Heui-Chul,Kim, Jeon-Gyo,Kim, Jung-Han,Lee, Chang-Rak,Kim, Young-Jun,Lee, Jeong-Han,Ha, Byung-Ho,Kim, Ui-Cheol 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.4

Purpose: To investigate the measured values of the talus in Koreans. Materials and Methods: We measured 88 tali from 44 cadavers that have been donated between December 2012 and December 2015. Of the cadavers, 27 were male and 17 were female. Their mean age was 73 years. The length and width of the talus were measured using a digital goniometer and vernier caliper. Results: The values of cadaveric measurement, mean maximal width and length, width and length of the dome anterior, width and length of the posterior facet, height and length of the trochlear medial facet, and height and length of the trochlear lateral facet were $43.6{\pm}2.6mm$, $56.5{\pm}3.3mm$, $32.5{\pm}2.0mm$, $42.2{\pm}2.7mm$, $22.2{\pm}2.2mm$, $34.7{\pm}2.0mm$, $15.3{\pm}1.3mm$, $33.3{\pm}2.9mm$, $25.3{\pm}3.3mm$, and $30.8{\pm}2.4mm$ for men and $38.9{\pm}1.6mm$, $53.6{\pm}2.4mm$, $27.9{\pm}2.1mm$, $37.4{\pm}3.2mm$, $20.6{\pm}0.8mm$, $31.9{\pm}1.2mm$, $13.6{\pm}2.6mm$, $28.4{\pm}2.5mm$, $24.9{\pm}2.1mm$, and $28.9{\pm}1.4mm$ for women, respectively. The size of the talus showed an accuracy of 86% when anteroposterior diameter was greater than 59 mm. A difference in the size of the right and left talus was not observed. The mean inclination and declination angles were $24.4^{\circ}{\pm}4.2^{\circ}$ and $28.2^{\circ}{\pm}5.4^{\circ}$ for men, and $24.6^{\circ}{\pm}3.6^{\circ}$ and $24.7^{\circ}{\pm}6.7^{\circ}$ for women (p=0.980, p=0.018), respectively, at least $15^{\circ}$, which showed a big difference for every object up to $37^{\circ}$. Conclusion: This paper, to the best of our knowledge, is the first study to measure the talus in Koreans. There were differences by gender and ethnicity in the in measured talus values. The measurements were smaller than European-Americans and greater than Japanese.

리스프랑 관절 골절 및 탈구: 나사와 Kirschner 강선을 이용한 치료

하동준,김전교,곽희철,장의찬,Ha, Dong-Jun,Kim, Jeon-Gyo,Gwak, Heui-Chul,Jang, Yue-Chan 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

Purpose: The purpose of this study is to retrospectively analyze the clinical results of screws and Kirschner wire (K-wire) fixation in patients with fracture dislocation of Lisfranc joint and the consequence of screw breakage. Materials and Methods: Sixty patients underwent Lisfranc joint open reduction and removal of internal fixators from January 2007 to December 2011. Forty-nine cases (81.7%) underwent operations with screw alone, and 11 cases (18.3%) underwent operations with both screws and K-wires. Type of internal fixators, duration of internal fixator removal, breakage of internal fixators and satisfaction with reduction were investigated. Additionally, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scales were analyzed. Results: The internal fixator was broken in 5 cases (8.3%). The average duration of instrument removal was 154 days in the non-broken screw group and 268.6 days in the broken screw group (p<0.05). The average AOFAS midfoot scale was 77.4 in the non-broken screw group and 74.2 in the broken screw group. The most commonly damaged portion was the first tarsometatarsal (Lisfranc) joint. Conclusion: Treatment with screws and K-wires was effective in patients with fracture dislocation of Lisfranc joint. The appropriate time for screw removal should be considered.

반월상 연골 후각부 파열의 치료에 영향을 미치는 요인

하동준,김창완,서승석,조일제,Ha, Dong-Jun,Kim, Chang-Wan,Seo, Seung-Suk,Cho, Il-Je 대한정형외과스포츠의학회 2009 대한정형외과스포츠의학회지 Vol.8 No.2

목적: 내측 반월상 연골판 후각부 파열 치료 결과에 영향을 미치는 요인들에 대해 알아보고자 한다. 대상 및 방법: 내측 반월상 연골 후각부 파열로 진단받고, 관절경적 시술을 받은 47명을 대상으로 하였다. 환자의 연령, 대퇴경골각, 골주사 검사 결과, 수술 방법 및 파열 양상에 따른 술후 임상적 결과를 Lysholm 및 Tegner 활동 점수를 이용하여 평가하였다. 결과: 환자의 나이는 수술 결과에 영향이 없으며, 술전 외반 4도 이상의 대퇴경골각을 가지거나, 술전 방사성 동위 원소 검사에서 정상 소견을 보이는 경우 좋은 예후를 기대할 수 있었다. 수술 방법의 차이, 즉 반월상 연골판 제거술 혹은 봉합술 여부에 따른 치료 결과의 통계적 차이는 없으며, 파열 양상에 따른 결과 차이 또한 통계적 의의는 없었다. 결론: 내측 반월상 연골판 파열의 치료에 있어 만족한 결과를 얻기 위해 다양한 요인들을 고려해야 하며, 특히 술전 시행한 골주사 검사는 반월상 연골판 파열부 및 그 주변 골, 연골의 상태를 반영하여 술후 예후를 예측할 수 있는 좋은 평가 방법으로 사료된다. Purpose: The purpose of this study was to evaluate the factors affecting the treatment results of medial meniscus posterior horn tear. Materials and Methods: Forty seven patients who had been performed the arthroscopic surgery for medial meniscus posterior horn tear were enrolled in this study. We analyzed the clinical outcomes with Lysholm score and Tegner activity score in accordance with the factors such as patients' age, tibiofemoral angle, uptake in bone scintigraphy, surgical methods and patterns of meniscal tears, respectively. Results: The patients' age didn't affect to the results, but the preoperative tibiofemoral angle over valgus $4^{\circ}$ and the preoperative normal uptake in scintigraphic assessment showed a positive influence on the clinical outcomes. The partial meniscectomy and repair in surgical methods had no statistically significance. In addition, the pattern of meniscal tear did not have an effect on the clinical results. Conclusion: We can conclude that many factors should be considered to get satisfactory results. Among them, preoperative bone scintigraphy may be a good assessment factor for the postoperative prognosis, reflecting the condition of meniscal tear and the periarticular bone and soft tissue.

후경골건 감입에 의한 족관절 골절-탈구의 정복 실패: 증례 보고

하동준,곽희철,정동우,노상명,Ha, Dong-Jun,Gwak, Heui-Chul,Jeong, Dong-Woo,Roh, Sang-Myung 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Fracture and fracture-dislocation of the ankle may be caused by a variety of mechanisms. In addition to the fracture, injury of soft tissue such as ligaments, tendons, nerves, and muscles may occur. Among these, tibialis posterior tendon injury is difficult to identify due to swelling and pain at the fracture site. There is no clear finding in radiological examination, therefore, it is found during surgery. In this case, irreducible fracture-dislocation of the ankle due to tibialis posterior tendon interposition was observed after the primary operation. The authors obtained satisfactory results in performance of a secondary operation assisted with arthroscopy.

컴퓨터 항법 장치를 이용한 인공 슬관절 치환술의 골절제 오차의 측정

하동준 ( Dong Jun Ha ),김영창 ( Young Chang Kim ),서승석 ( Seung Suk Seo ),김영복 ( Young Bok Kim ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.2

목적: 컴퓨터 항법 장치를 이용하여 인공 슬관절 치환술시 내재된 골절제 오차의 정도와 경향을 조사하고, 골절제 전계획치와 골절제 후의 실측치 와의 차이를 알아보고자 하였다. 대상 및 방법: 컴퓨터 항법 장치(Orthopilot(R), AESCULAP)를 이용해 인공 슬관절 전치환술을 시행을 받은 95명의 환자(남자 14명, 여자 81명), 95례의 슬관절을 대상으로 골절제 전 계획치와 골절제 후 실측치를 수집하여 비교하였고, 개별 골절제 면에서 두 값의 차이인 골절제 오차를 분석하여 각각의 통계적 유의성에 대해 검정하였다. 결과: 경골의 관상면과 시상면, 대퇴골의 시상면에서 계획치와 실제치의 차이는 통계적 유의성이 있었다(각각 p=0.0008, p=0.0002, p<0.0001). 그러나 대퇴골의 관상면에서 두 계측치 간의 차이는 유의성이 없었다(p=0.39). 대퇴골의 관상면 골절제 오차는 평균 0.05도(SD±0.66°)의 외반 편향, 시상면의 골절제 오차는 평균 0.47도(SD±0.91°)의 신전 경사 편향을 보였으며, 관상면과 시상면의 골절제 오차간에 유의한 차이를 보였다(p=0.012). 경골에 있어서 관상면상의 골절제 오차는 0.31도(SD±0.80)의 외반 편향, 시상면상의 골절제 오차는 0.21도(SD±2.09°)의 신전 경사 편향을 보였으며, 두 절제면의 골절제 오차의 차이는 유의하였다(p<0.0001). 결론: 슬관절 전치환술에서 골절제시 경골의 시상면 및 관상면, 대퇴골의 시상면에서 측정된 실측치는 계획치에 비해 의미 있게 차이가 있었다. 골절제의 오차는 대퇴골과 경골 모두에서 외반 편향과 신전경사의 경향을 보여 주었다. 골절제 오차는 관상면 보다 시상면에서 의미 있는 차이가 있었다. 이에 대한 시술자의 주의와 이를 개선하기 위한 술기를 요한다. Purpose: To investigate the degree of bone cutting errors and its deviation and to evaluate the differences between a planned value before sawing and an achieved value after sawing in total knee arthroplasty (TKA) with computer-assisted navigation system. Materials and Methods: 95 knees of 95 patients(81 females and 14 males) who underwent TKA with computer-assisted navigation (Orthopilot(R), AESCULAP) were studied. The planned value according to cutting block position and the achieved value according to achieved cutting planes were measured and compared. The bone cutting error which means a difference between the achieved value and the planned valued in each plane were statistically analysed. Results: On each cutting planes, there were significant differences between planned values and measured values in coronal and sagittal plane of tibia and sagittal plane of femur (respectively p=0.0008, p=0.0002, p<0.0001), but coronal plane of femur showed insignificant difference (p=0.39). There was significant difference between bone cutting errors with valgus 0.05° (SD±0.66) in coronal plane and extension 0.47° (SD±0.91) in sagittal plane of femur and valgus 0.31° (SD=±0.80) in coronal plane band extension 0.21° (SD±2.09) in sagittal plane of tibial cutting (respectively p=0.0012, p<0.0001). Conclusion: Achieved values of bone cutting in coronal and sagittal plane of tibia and sagittal plane of femur on TKA were significantly different from planned values. The deviation of bone cutting errors showed valgus and extension in both femur and tibia. The bone cutting errors in sagittal plane were more significant than the coronal plane. Surgeons should take this bone cutting errors into consideration on operation.

젊은 성인의 반월상 연골 수평파열 시 섬유소응괴를 이용한 봉합술 : 증례 보고

하동준 ( Dong Jun Ha ),김창완 ( Chang Wan Kim ),곽희철 ( Hee Chul Kwak ),심형남 ( Hyung Nam Shim ),서승석 ( Seung Suk Seo ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.1

슬관절 관절경 수술 후 발생한 심부 감염

김기용,하동준,심형남,서승석,Kim, Key-Yong,Ha, Dong-Jun,Shim, Hyung-Nam,Seo, Seung-Suk 대한관절경학회 2007 대한관절경학회지 Vol.11 No.1

목적: 슬관절의 외상 및 질환에 대한 관절경 수술 후 발생한 심부감염의 특성을 조사하고자 한다. 대상 및 방법: 1994년 2월부터 2006년 8월까지 슬관절의 관절경 수술을 시행 받은 총 894예의 슬관절을 대상으로 심부 감염의 빈도를 조사하였으며 감염으로 확진된 환자군에 관한 분석을 시행하였다. 결과: 총 894예의 슬관절 관절경 수술에서 7예의 심부 감염이 발생하여 0.9%의 발생율을 보였으며 419예의 절제와 봉합을 포함한 반월상 연골 수술에서 반월상 연골 봉합을 시행한 1예에서 감염이 발생하였다(1/419=0.2% 발생율). 십자인대 재건술 343예에서 6예의 감염 이 발생하였으며(6/343=2% 발생율) 전방 십자인대 단독 수술군에서 3예 (3/152), 후방 십자인대 단독 수술군에서 2예(2/70), 십자 인대에 부가하여 관절외 재건술을 시행한 25예의 환자 중에서 1예에서 감염이 발생하였다(1/26). 결론: 슬관절의 관절경 수술 후 감염 발생율은 비교적 낮았으나 이식물을 사용하여 관절강내 인대 재건술을 시행한 경우에서는 높게 발생 한 바 전후방 십자 인대 재건술 등의 수술시 이에 대한 주의를 요한다. Purpose: The purpose of this study is to evaluate characteristics of a deep infection after arthroscopic knee surgery. Materials and Methods: We selected 894 patients who underwent arthroscopic knee surgery between February 1994 and August 2006. We analyzed the results of the patients with definite infection. Results: Seven cases out of the 894 knee arthroscopic surgery which was performed by one surgeon during 12 years were diagnosed as postoperative deep infection (0.9%). Infection developed in one repair case among the meniscal surgeries (1419=0.2%). There were six infection cases in intraarticular ligament reconstruction (6/343=2%); 3 in ACL surgeries (3/152), 2 in PCL surgeries (2/70) and 1 in combined cruciate ligament surgery and extra-articular reconstruction (l/26). Conclusion: Postoperative infection rate of arthroscopic knee surgery was relatively low. However an attention for the prevention of postoperative deep infection should be paid in intraarticular ligament reconstruction because of its relatively high risk of infection.

중족통의 원인

곽희철,하동준,Gwak, Heui Chul,Ha, Dong Jun 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.3

Metatarsalgia is one of the most common causes of patients complaining of pain in their feet. This pain is the plantar forefoot, including the second to fourth metatarsal heads and arises from either mechanical or iatrogenic causes. On the other hand, it is frequently accompanied by a deformity of the toes as well as of the first and fifth rays. The pain has a variety of causes, and sometimes the cause is difficult to distinguish. The variability of possible causative factors necessitates an individualized approach to treatment. To determine these causes, this paper presents an overview of the gait mechanics, plantar pressure, and the classification according to the etiology.

자가 슬괵근을 이용한 전방 십자 인대 재건술 후 발생한 전경골 낭종 - 증례 보고 -

서승석,김창완,하동준,정훈재,Seo, Seung-Suk,Kim, Chang-Wan,Ha, Dong-Jun,Jung, Hun-Jae 대한관절경학회 2009 대한관절경학회지 Vol.13 No.1

The pretibial cyst is a very rare complication after anterior cruciate ligament (ACL) reconstruction. It occurs whatever kind of graft choice or kind of graft fixation method at tibial side. It have been known such as graft necrosis at tibial side, extra-articular leakage of joint fluid through tibial tunnel, foreign body reaction due to breakdown of the bioabsorbable screw and incomplete incorporation of graft to bony tunnel as the cause of pretibial cyst. We experienced one case of pretibial cyst which had undergone ACL reconstruction with autogenous hamstring graft fixed with biodegradable interference screw. We report a rare case of pretibial cyst with literature review.

한 면에 ∧/∨형 리브가 있는 2벽면 수축 사각채널의 열전달 증가

이명성,유지의,정희재,최동근,하동준,고진수,안수환,Lee, Myung-Sung,Yu, Ji-Ui,Jeong, Hee-Jae,Choi, Dong-Geun,Ha, Dong-Jun,Go, Jin-Su,Ahn, Soo-Whan 한국마린엔지니어링학회 2016 한국마린엔지니어링학회지 Vol.40 No.4

양 벽면이 수축되는 채널에서 ${\vee}/{\wedge}$형 리브의 각도가 열전달에 미치는 효과를 실험적으로 조사하였다. 한 벽면에만 설치된 ${\vee}/{\wedge}$형 리브의 충돌 각은 각각 $30^{\circ}$, $45^{\circ}$, $60^{\circ}$ 그리고 $90^{\circ}$이다. 리브의 높이(e)는 10 mm 그리고 리브 간격(p)과 높이(e)비는 10으로 제작하였다. 길이가 1,000 mm인 시험 부는 입구의 단면적은 $100mm{\times}100mm$, 출구는 $50mm{\times}100mm$으로 제작하였다. 레이놀즈수가 22,000에서 75,000까지의 범위에서 실험을 수행하였다. 연구결과 전체적으로 레이놀즈 수가 높을수록 누셀트 수가 컸고, ${\wedge}$형 $45^{\circ}$ 리브가 가장 누셀트 수가 컸다. The effect of the rib angle-of-attack on heat transfer in the convergent channel with ${\vee}/{\wedge}$-shaped ribs was examined experimentally. Four differently angled ribs (a = $30^{\circ}$, $45^{\circ}$, $60^{\circ}$, and $90^{\circ}$) were placed to only the one sided wall. The ribbed wall was manufactured with a fixed rib height (e) of 10 mm and rib spacing (p)-to-height (e) ratio of 10. The convergent channel had a length of 1,000 mm and a cross-sectional areas of $100mm{\times}100mm$ at inlet and $50mm{\times}100mm$ at exit. The measurement was conducted for the Reynolds numbers ranging from 22,000 to 75,000. The results show that the Nusselt number is generally higher at higher Reynolds number and that an angle-of-attack of $45^{\circ}$ at the ${\wedge}$-shaped rib produces the greatest Nusselt number.