관절 내 종골 골절에서 금속판 고정을 이용한 수술적 치료

홍기도,김재영,하성식,심재천,강정호,박광희,Hong, Ki-Do,Kim, Jae-Young,Ha, Sung-Sik,Sim, Jae-Chun,Kang, Jung-Ho,Park, Kwang-Hee 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: We evaluated the results of operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures. Materials and Methods: From August 2003 to July 2006, twenty intraarticular calcaneal fractures which were operated with open reduction and internal fixation with F or H plates and screws were evaluated retrospectively. According to the Essex-Lopresti classification, 3 cases were tongue type and 16 were joint depression type. With the Sanders classification, 2 cases were IIA type, 7 were IIB, 5 were IIIAB, 2 were IIIAC and 3 were IV. We have analysed the $B{\ddot{o}}hler$ angle, Gissane angle, and calcaneal width in radiologic evaluation, and evaluated clinical result according to the Creighton-Nebraska Health Foundation Score. Results: Radiologic changes showed as follows: $B{\ddot{o}}hler$ angle improved from $5.8^{\circ}$ to $25.9^{\circ}$, Gissane angle from $119.0^{\circ}$ to $113.3^{\circ}$, and calcaneal width from 50.4 mm to 37.8 mm. In the clinical results, excellent cases were noted in 8 cases, good in 8 cases, fair in 2 cases, poor in 1 case. Conclusion: Operative treatment with F or H plates and screws using extensile lateral approach in intraarticular calcaneal fractures was thought to be a useful operative method allowing anatomical reduction.

소아 대퇴골 간부 골절에대한 Nancy정 고정술

홍기도,하성식,정남식,심재천,김재영 대한골절학회 2003 대한골절학회지 Vol.16 No.4

슬관절 관절내 발생한 양성 섬유성 조직구종: 증례 보고

홍기도,하성식,심재천,김태호,이종성,성민철,Hong, Ki-Do,Ha, Sung-Sik,Sim, Jae-Cheon,Kim, Tae-Ho,Lee, Jong-Seong,Sung, Min-Chul 대한근골격종양학회 2012 대한골관절종양학회지 Vol.18 No.2

슬관절에서의 양성 섬유성 조직구증은 매우 드문 질환으로 대부분의 경우 통증 등의 특별한 증상을 유발하지 않고 심부에 위치하고 있어 진단을 놓치기 쉬우며 우연히 발견되는 경우가 많다. 저자들은 슬관절의 운동제한과 동통을 주소로 내원한 53세 여자 환자에 대해서 외관상 촉지 되지 않았다가 MRI 검사에서 슬개건 하부의 종물을 발견하였고, 진단적 관절경 검사 후 절제 및 조직 생검 결과 양성 섬유성 조직구종으로 밝혀진 1예를 경험하게 되었다. 심부 양성 섬유성 조직구증은 모든 양성 섬유성 조직구증의 5% 이하로 흔하지 않은 것으로 알려져 있는 가운데 슬관절에서 발생한 1예에 대해서 문헌고찰과 함께 보고하고자 한다. Benign fibrous hitiocytoma of the infrapatella fat pad is very rare. It has usually do not induced a pain or a symptom because it was located deep tissue. So it was very difficult to be diagnosed. We experienced a case of deep benign fibrous histiocytoma in a 53-year-old woman. It was diagnosed by MRI. Diagnostic arthroscopic procedure was performed and the lesion was completely resected by open excision. We report a rare case of benign fibrous hitiocytoma presenting as an intra-articular tumor in the joint causing pain and limitation of movement.

악성 증식성 모낭 종양 - 증례 보고 -

홍기도,김재영,하성식,심재천,조혜제,최윤호,Hong, Ki-Do,Kim, Jae-Young,Ha, Sung-Sik,Sim, Jae-Chun,Cho, Hye-Jae,Choi, Yoon-Ho 대한근골격종양학회 2009 대한골관절종양학회지 Vol.15 No.1

증식성 모낭 종양은 모낭 말단부위의 외근모초에서 기원하는 드문 종양이다. 악성 변화는 드물지만 갑작스러운 크기의 증가, 침윤성 성장 및 두피 이외에서 종양의 발생 등은 악성 증식성 모낭 종양을 시사한다. 병리조직학적으로 핵의 이형성, 다형성 및 유사분열 소견은 악성증식성 모낭 종양의 특징이다. 악성 증식성 모낭 종양은 재발 및 전이가 보고되고 있어 정상조직을 포함한 충분한 절제와 추적관찰이 요구된다. 53세 남자 환자의 우측 제 5수지 원위 지골에 7년전 발생한 종양을 중위 지이하 절제술 후 병리조직검사상 악성 증식성 모낭 종양으로 진단되었고, 환자가 외래로 더 이상 방문하지 않아 재발과 전이를 확인할 수 없었다. Proliferating trichilemmal tumor(PTT) is a rare neoplasm derived from the outer root sheath of the hair follicle. Malignant transformation is rare, but abrupt enlargement of size, infiltrative growth, and non-scalp location are suggestive of malignant PTT. Histopathologic characteristics of malignant PTT are nuclear atypia, pleomorphism, and mitotic figures. Recurrence and metastasis have been documented in malignant PTT. Wide resection of the tumor with the normal tissue and accurate follow-up is the treatment of choice of the both malignant and benign PTT. We report a 51-year-old man with the mass on right 5th finger distal phalanx for 7 years. The tumor was excised with middle phalangiectomy, and based on the histopathologic findings of the tumor, this case was diagnosed as mailignant PTT. We cannot detect recurrence and metastasis because the patient was lost to follow-up.

슬관절 전치환술에서 경골 골결손시 골쐐기를 이용한 자가골 이식술

홍기도,하성식,정남식,심재천,서세익 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

목적: 심한 내반 변형에 따른 경골 내과 골결손의 슬관절염 환자에게 골쐐기를 이용한 자가골 이식술 방법으로 슬관절 전치환술을 시행한 후 임상적 및 방사선학적 결과를 분석하여 이 수술방법의 유용성을 알아보았다. 대상 및 방법 : 1998년 7월부터 2000년 12월까지 내과 골결손이 있어 골이식과 시멘트성 슬관절 전치환술을 시해안 15예를 대상으로 하였다. 경골 근위부를 절제한 후 골결손부위를 대퇴 원위부와 경골 상단부의 절제되어진 골을 전후면 사진상에서 쐐기모양으로 만들어 결손 부위에 압축 고정을 시켰다. 초기 안정성을 위해 나사못이나 K-강선을 사용하는 대신에 골결손부의 처리시 외곽의 경화성 골조직을 그대로 유지하고 골쐐기와 정확한 모양으로 디자인하여 압축 고정만을 하는 방식을 택하였다. 평가 방법으로 HSS Knee rating scale을 이용하였고 방사선 사진상의 변화를 관찰하였다. 결과: HSS 슬관절 점수는 술전 평균 52.4점에서 술후 1년에 84.7점으로 향상되었고 대퇴경골각은 평균 17.8˚ 내반에서 수술 후 추시 1년에 5.8˚ 외반을 보였다. 이식골의 평균 유합 기간은 5개월이었으며 자가 이식된 골편의 전위나 삽입물의 해리는 보이지 않았다. 결론: 골쐐기를 이용한 자가골 이식술은 나사못이나 K-강선 사용 없이도 비교적 견고하게 고정하여 안정성을 얻을 수 있는 수술 방법으로 생각된다. Purpose: The aim of this study is to report the usability of autogenous bone graft with bone peg in total knee arthroplasty in the patients with tibial medial bone defect from osteoarthritis due to severe varus deformity. Materials and Methods: From July 1998 to December 2000, fifteen total knee arthroplsties with autogenous bon graft were performed for the medial tibial bone defects. The proximal tibia was resected and then bone pegs which were prepared from resected portion of distal femur and proximal tibia were inserted into the defect site with the shape of peg in the anterior posterior view using press fitting method. Instead of applying screw of K-wire, we performed press-fitting method for early stability. For attaining the stability, we preserved the sclerotic rim and designed precisely the bony defect site, We reviewed the result using the HSS Knee Rating Scale and observed the radiologic change. Results: In HSS Knee Rating Scale review, 52.4 of preoperative score was improved to 84.7 at postoperative 1 year. Tibio-femoral angle, the average 17.8˚ of varus was improved to the average 5.8˚ of valgus at 1 year postoperatively. The average union period was 5 months, and there was no evidence of the displacement of grafted bone and loosening of the inserted implants. Conclusion: The method of autogenous bone graft applied with bone peg could be supposed as the stable fixation method without using screws of K-wires.

경골 Pilon 골절의 치료후 발생한 합병증

홍기도,하성식,차현종 대한골절학회 2001 대한골절학회지 Vol.14 No.4

Purpose: Aim of this study was to find the treatment and preventive method of the complication occurred after treatment of tibial pilon fracture. Material and Methods: 10 cases of complication, which has required the unplanned operative treatment among 25 cases of tibial pilon fracture from 1994 to 1999 were analyzed rertrospectively according to the Ruedi-Allgower classification, open or closed fracture, isolated or polytrauma, type of complication, type of procedure, primary or delayed wound closure. Results: There were 1 type 1, 3 type 2, and 6 type 3 Ruedi-Allgower fracture type, 3 open fracture, 7 isolated and 3 polytrauma. 6 required plastic surgery procedure such as pedicle flap or full thickness skin graft and 7 required orthpaedic procedure such as osteotomy, cancellous bone graft, metal removal and currettage, debridement of ankle. Conclusion: The complications after treatment of tibial pilon fracture are classified to intraoperative, early and late postoperative complication. Intraoperative complication include penetration of the joint by screw and inadequate reconstitution of the articular surface which can be avoided by taking intraoperative roetgenograms, early complication include wound necrosis which can be minimized by good soft tissue technique, late complication include nonunion, joint stiffness and posttraumatic arthritis can be treated by osteotomy, cancellous bone graft and anatomic reduction with early motion.

지간 신경종의 자기 공명 영상을 이용한 진단

홍기도,하성식,심재천,김재영,Hong, Ki-Do,Ha, Sung-Sik,Sim, Jae-Cheon,Kim, Jae-Young 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Most interdigital neuroma can be diagnosed clinically. But, diagnostic local injection method, sonography and magnetic resonance image(MRI) have been used as secondary tests for clinical confirmation or surgery. Recently, there have been active discussions on the method of interdigital neuroma diagnosis for which sonography or MRI is used. For finding out the location or the number of interdigital neuroma particularly in non-typical clinical manifestation or surgery, MRIs, which are exellent in tissue contrast, may be quite helpful. This case had an interdigital neuroma showing non-typical manifestation. MRIs were used for clinical diagnostic confirmation and finding out the location and the number of interdigital neuroma. Thus, the validity along with literary consideration is being reported.

경피적 겸자 정복 및 골수강내 금속핀 고정을 이용한 쇄골 골절의 치료

홍기도,하성식,정남식,심재천,김경호 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적 : 경피적 겸자 정복 및 골수강내 금속판 고정술을 이용한 쇄골 간부 골절의 치료에 대해 유용성을 규명해 보고자 하였다. 대상 및 방법 : 2002년 1월부터 2003년 7월까지 본원에서 쇄골 간부 골절 환자 중 신경 및 혈관 손상이 없었고, 골절의 분쇄상이 비교적 적었던 총 16례를 대상으로 겸자를 이용한 경피적 정복 후에 골수강에 금속판을 삽입하여 고정하였다. 술 후 유합 정도 및 결과를 임상적, 방사선학적으로 분석하였다. 결과 : 방사선학적으로 골유합을 보인 경우가 총 15례였으며, 술 후 평균 9.1주에 유합 소견을 관찰하였다, 임상적으로 강 등의 기준에 따라 구분한 결과, 우수 이상이 14례로 나타났다. 1례에서 1주 만에 K-강선의 내측전위로 골절부위가 재전위되어 관혈적 정복 및 금속판 내 고정을 시행한 이외에 다른 주요 합병증은 없었다. 결론 : 저자들의 방법은 수술시간이 짧고 간단하며, 연부조직의 추가적 손상이 적어 골유합율이 높고, 수술 반흔을 남기지 않아 수술적 적응을 신중히 고려한다면 쇄골 간부 골절의 치료법의 하나로 유용할 것으로 사료된다. Purpose: To investigate the utility of surgical treatment of clavicle shan fracture using a percutaneous towel clip reduction and intramedullary fixation. Materials and Methods : This study was conducted for total 16 case of patients who had no neurovascular injury and a few comminuted bone fragment among patients with clavicle shaft fracture from January 2002 to July 2003. The method of operation was percutaneous towel clip reduction and intramedullary fixation. The clinical and radiological results were evaluated. Results : Radiologically, 15 cases showed bone unions and the avenge time was 9.1 weeks. According to Kang's criteria clinically, there were 14 cases which were more than an excellence. One case substituted open reduction and nailing fixation due to a medial migration of K-wire and re-displacement of fracture even in 1 week. However, there wasn't any other major complication. Conclusion : Due to its having no additional injury to soft tissues, no scar formations, and its short operation time, percutaneous towel clip reduction and intramedullary fixation will be very useful as one of the treatments of clavicular shaft fracture if it follows correct surgical indications.

13세 환자의 종골에 발생한 연골육종 - 증례 보고 -

홍기도,하성식,박영근,이효진,차현종,Hong, Ki-Do,Ha, Sung-Sik,Park, Young-Keun,Lee, Hyo-Jin,Cha, Hyun-Jong 대한근골격종양학회 2001 대한골관절종양학회지 Vol.7 No.2

연골육종이 소아의 종골에 발생한 경우는 매우 드물다. 13세 환자가 수개월간 지속된 우측종골 부위의 통증으로 내원하여 시행한 방사선 검사상 우측 종골의 골밀도의 증가 및 석회화와 피질골 파괴, 그리고 종골 주위 조직의 석회화 침범 소견이 관찰되었고, 조직검사상 원발성 연골육종으로 진단되어 슬하부 절단술 및 술후 항암요법을 시행하였으며 12개월째 경과 관찰중이며 재발이나 원격전이는 발견되지 않았다. Chondosarcoma of the calcaneus in young child is extremely rare. A thirteen-year old male patient has suffered from right heel pain for several months before. Dominant gross feature was hard mass and swelling on one entire right heel, and increased density and calcification on entire calcaneus with cortical destruction, and calcific densities on soft tissues around calcaneus were seen on roentgenogram of right ankle. It was diagnosed to be chondrosarcoma by bone biopsy. It was treated by below knee amputation and chemotherapy, and no recur and distant metastsis during 12 months after operation.

Infantile Cortical Hyperostosis 2례 보고

홍기도(Ki Do Hong),홍기성(Ki Sung Hong),김형석(Hyung Seok Kim) 대한정형외과학회 1981 대한정형외과학회지 Vol.16 No.4