제 3형 급성 견봉-쇄골 관절 분리 환자의 수술적 치료 결과

한성호,양보규,이승림,정선욱,이동호,김민석 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목적 : 본 연구를 통하여 Rockwood 제 3형 급성 견봉-쇄골 관절 분리 환자에서 Phemister 술식과 modified Phemister 술식의 치료 결과를 비교하고자 한다. 대상 및 방법 : 1992년 2월부터 2001년 8월까지 제 3형 급성 견봉-쇄골 관절 분리로 수술적 치료를 받고 1년 이상 추시 가능하였던 45명, 45예의 환자를 대상으로 하였다. 평균 연령은 28.1세였으며, 남자가 42명, 여자가 3명이었다. 진단은 이학적 검사와 단순 방사선 부하 촬영법을 이용하였으며, 수상일로부터 수술적 치료까지의 평균 기간은 7.8일이었다. 술장 소견상 오구-쇄골인대 봉합술이 어려운 15예에서는 Phemister 술식을 시행하였고 (Ⅰ군), 인대 봉합이 가능한 30예에서는 modified Phemister 술식을 시행하였다(Ⅱ군). 수술 후 추시 기간은 평균 16.2개월이었고, 결과 판정은 최종 추시 때의 임상 소견과 이학적 검사 및 방사선 촬영을 통해 UCLA shoulder scoring system과 acromio-clavicular separation scoring system을 이용하였다. 결과 : 술후 합병증은 Ⅱ군에만 표재성 감염이 2예, K-강선 이주가 1예에서 발생하였다. 최종 추시상 전예에서 동통, 관절 운동 범위의 제한은 없었고 , Ⅱ군에서만 방사선 촬영상 2예에서 아탈구가 관찰되었다. UCLA shoulder scoring system은 Ⅱ군에서 우수 93.3%, 양호 6.7%였고, acromio-clavicular shoulder scoring system은 Ⅱ군에서 우수 90%, 양호 10%였다. 결론 : 활동적인 연령에서 발생한 제 3형 급성 견봉-쇄골 관절 손상의 환자에서 Phemister 술식만으로도 좋은 결과를 보일 수 있을 것으로 사료된다. Purpose : The purpose of this study is to compare the Phemister technique with the modified Phemister technique for the patients with Rockwood type 3, acromio-clavicular separation. Materials and Methods : The 45 cases of 45 patients received surgical treatment for Rockwood type 3, acute acromio-clavicular separation in our hospital from Feb. 1992 to Aug. 2001 later with the follow-up study were selected as subjects. The average ages were 28.1 years old, male and female were 42, 3 persons, respectively. Physical examination and plain radiography were used for their diagnosis and the intervals between injury and surgical treatment were 7.8 days. In intraoperative finding, we performed Phemister technique in 15 cases according not to be able to repair coraco-clavicular ligament (groupⅠ), modified Phemister technique in 30 cases according to be able to repair that (groupⅡ). The average follow up period was 16.2 months, and the UCLA shoulder scoring system and the acromio-clavicular separation scoring system were used to obtain clinical results. Results : Only in Group Ⅱ, the complication after surgery were associated with superficial infection in two cases and K-wire migration in one case. At last follow up, there were no pain and limitation of range of motion in all cases, and two cases in Group Ⅱ were found to be subluxation in radiography. Clinical results revealed excellent was 93.3%, good was 6.7% in UCLA shoulder scoring system in both groups, and excellent was 90%, good was 10% for group Ⅱ in acromio-clavicular separation scoring system. Conclusion : The results are considered to be food with only Phemister technique in type 3, acute injury occurred in working ages.

Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip

( Seung Rim Yi ),( Min Ho Lee ),( Bo Kyu Yang ),( Young Joon Ahn ),( Jieun Kwon ),( Se Hyuk Im ),( Ye Hyun Lee ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.4

Purpose: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. Materials and Methods: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1±0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0±19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. Results: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; P<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). Conclusion: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.

CASE REPORT : Bilateral Bone Marrow Edema Syndrome of the Femoral Head with a Unique Onset: A Case Report

( Seung Rim Yi ),( Ye Hyun Lee ),( Hae Min Kim ) 대한고관절학회 2015 Hip and Pelvis Vol.27 No.4

Bone marrow edema syndrome (BMES) is a rare condition which mainly affects the hip area. The etiology and pathogenesis of BMES is still unclear. Pain near the affected area, regional osteoporosis, bone marrow edema (identified using magnetic resonance imaging) and spontaneous regression within 6-12 months are the main characteristics of BMES. In this case, a 52-year-old male was diagnosed with BMES of the right hip followed by spontaneous subsiding of symptoms. After 3 years, and under nearly the same social and physical conditions, he was admitted again with newly developed left hip pain and again diagnosed with BMES. We report this rare case since a similar one has not been previously reported in the domestic literature and may be considered valuable for basic research relating to the pathogenesis of BMES.

진행 양상을 보인 압박형 대퇴 경부 피로 골절: -2예 보고-

이승림 ( Seung Rim Yi ),제민수 ( Min Soo Je ),이승원 ( Seung Won Lee ),김석진 ( Seok Jin Kim ) 대한스포츠의학회 2010 대한스포츠의학회지 Vol.28 No.2

The stress fracture of the femoral neck is an uncommon injury and delay in diagnosis occurs occasionally. It is generally classified as the compression type and the tension type. The compression type fracture of the femoral neck is stable, and could be treated nonoperatively. Tension type fracture is potentially unstable, and could require operative stabilization. The displacement of the femoral neck stress fractures has potential complications such as osteonecrosis of femoral head, malunion and nonunion. We have experienced two cases of compression type fractures that progressed to entire femoral neck despite conservative treatment with avoidance of weight bearing. These two cases shows even compression type of femoral neck fracture could further progress to entire femoral neck after conservative treatment, which could require operative treatment.

발음성 고관절에 대한 변형된 장경대 연장술의 치료

이승림 ( Seung Rim Yi ),김성완 ( Seong Wan Kim ),송중원 ( Joong Won Song ) 대한스포츠의학회 2012 대한스포츠의학회지 Vol.30 No.2

전체 대퇴골에 발생한 골괴사 환자에서 인공 고관절 전치환술

이승림(Seung Rim Yi),임세혁(Se Hyuk Im),박상훈(Sang Hoon Park) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.3

무혈성 골괴사는 골조직 및 골수 조직의 허혈성 상태로 인한 괴사로 정의될 수 있으며, 외상성 및 비외상성으로 구분할 수 있다. 무혈성 골괴사는 대퇴골 골두, 상완골 골두와 같이 장골의 골단 부위에서 주로 발생한다. 기존의 무혈성 골괴사는 대부분 대퇴골 골두에 한정된 증례에 대한 보고 및 연구가 이루어져 왔다. 근위 대퇴골의 무혈성 괴사의 존재는 인공 고관절 전치환술 이후 생물학적 고정 실패의 원인이 된다. 본 저자들은 대퇴골 골두로부터 대퇴골 경부, 간단부 간부 및 원위부에 이르는 골수강내 부위의 대퇴골 전 영역의 무혈성 골괴사가 관찰된 56세 남자 환자에서 인공 고관절 전치환술을 시행하고 2년 추시 결과를 문헌 고찰과 함께 보고하고자 한다. Avascular necrosis (AVN) is defined as the cellular death of bone and bone marrow components due to the loss of blood supply, and associated with post-traumatic or non-traumatic events. AVN usually involves the epiphysis of a long bone, such as the femoral and humeral heads, which are susceptible to osteonecrosis. Many studies have been conducted but they were restricted to investigations of femoral head avascular necrosis. The presence of osteonecrosis in the proximal femur may impair biological fixation after total hip arthroplasty. We report a 56-year-old male patient with avascular necrosis located not only at the femoral head, but also in the entire femur, including the medullary cavity, who underwent total hip arthroplasty 2 years earlier along with a review of the relevant literature.

골성 추지에서 변형된 신전 차단 수기에 의한 치료 결과

이승림 ( Seung Rim Yi ),한성호 ( Sung Ho Hahn ),양보규 ( Bo Kyu Yang ),안영준 ( Yang Joon Ahn ),유재호 ( Jae Hoo Yoo ),여용범 ( Yong Beom Yeo ),빈성우 ( Sung Woo Bin ) 대한골절학회 2006 대한골절학회지 Vol.19 No.2

목적: 골성 추지에서 변형된 신전 차단 수기를 이용한 치료 결과를 알아보고자 하였다. 대상 및 방법: 2002년 12월부터 2004년 1월까지 골성 추지로 진단 받고 변형된 신전 차단 수기 (modified extension block technique)를 이용한 수술적 치료를 받은 16명, 16예를 대상으로 하였다. 평균 추시 기간은 13개월 이었다. 수술 적응증은 골절편이 원위 지관절면을 1/3 이상 침범했거나 원위 지관절의 아탈구가 있는 경우로 하였다. 결과: 원위 지관절 평균 신전 소실은 2.3˚, 평균 운동 범위는 68.8˚였다. 단순 방사선 촬영상 모든 예에서 골절 유합 소견을 보였다. Crawford 평가 기준에서는 12예(75%)에서 good 이상의 결과를 보였다. 합병증으로 술 후 2주 내의 정복 소실이 2예, 운동 시 경미한 통증이 1예 있었다. 결론: 변형된 신전 차단 수기는 수술 방법이 쉽고 간편하며 피부 절개로 인한 합병증이 없이 만족할 만한 결과를 얻을 수 있어 골성 추지의 치료로 유용한 방법이라 생각한다. Purpose: To evaluate the treatment outcomes of the modified extension block technique for bony mallet finger. Materials and Methods: This study included 16 patients who had been treated with the modified extension block technique for bony mallet finger from December 2002 to January 2004. The average duration of follow up was 13 (12~17) months. The indication of operation was the presence of a large bony fragment invading more than 1/3 of the articular surface or the palmar subluxation in the distal interphalangeal joint. Results: The average extension lag was 2.3˚, and the range of motion of the distal interphalangeal joint was 68.8˚. Radiograph showed bony union state in all cases. By the Crawford`s evaluation criteria, 12 cases (75%) was excellent or good. Postoperative complications occurred in 3 cases, which were reduction loss within postoperative 2 weeks in 2 cases and mild pain with motion in 1 case. Conclusion: The modified extension block technique is a easy and simple method. It shows a good result without complications from skin incision. So, it seems a useful method for bony mallet finger.

책상다리 자세에 국한된 증상을 호소하는 환자에서 자기공명영상의 유용성

이승림 ( Seung Rim Yi ),정현석 ( Hyun Seok Chung ),양보규 ( Bo Kyu Yang ),안영준 ( Young Joon Ahn ),김성완 ( Seong Wan Kim ),임세혁 ( Se Hyuk Im ),이예현 ( Ye Hyun Lee ) 대한스포츠의학회 2014 대한스포츠의학회지 Vol.32 No.2

This study was conducted to evaluate the diagnostic utility of magnetic resonance imaging (MRI) for the patients having problems confined to cross-legged posture. The study subjects were 128 cases (male 87.5%) and 120 patients from October 2008 to June 2013. Average age of male patients was 50 years old (range, 21.72 years old), and female 45 years old (range, 18.76 years old). The rate of positive MRI findings was compared according to abnormal physical findings. The average duration of symptoms was 11.7 months. The most frequent complains was on the back (41.9% at rest, 57% when taking the posture). Patrick test was positive for 33.6% of cases, simple radiography was abnormal only for 20% of cases. Bone scan was normal for all 98 cases. Only 21.9% of 128 cases showed abnormal MRI findings which were managed with conservative treatment. Limitation in the range of hip joint motion was not statistically associated with abnormal findings of MRI (p=0.148). Normal Patrick test was associated with normal MRI finding (p=0.001). Among normal cases on both physical and simple bone X-ray film, 88.6% were normal at MRI. In conclusion, for patients with physical complaints from the cross-legged posture, diagnostic utility of MRI is relatively low when they show normal on both physical examination and simple radiography.

책상다리 자세에 국한된 증상을 호소하는 환자에서 자기공명영상의 유용성

이승림 ( Seung Rim Yi ),정현석 ( Hyun Seok Chung ),양보규 ( Bo Kyu Yang ),안영준 ( Young Joon Ahn ),김성완 ( Seong Wan Kim ),임세혁 ( Se Hyuk Im ),이예현 ( Ye Hyun Lee ) 한국정책학회 2014 The KAPS Vol.39 No.-

This study was conducted to evaluate the diagnostic utility of magnetic resonance imaging (MRI) for the patients having problems confined to cross-legged posture. The study subjects were 128 cases (male 87.5%) and 120 patients from October 2008 to June 2013. Average age of male patients was 50 years old (range, 21.72 years old), and female 45 years old (range, 18.76 years old). The rate of positive MRI findings was compared according to abnormal physical findings. The average duration of symptoms was 11.7 months. The most frequent complains was on the back (41.9% at rest, 57% when taking the posture). Patrick test was positive for 33.6% of cases, simple radiography was abnormal only for 20% of cases. Bone scan was normal for all 98 cases. Only 21.9% of 128 cases showed abnormal MRI findings which were managed with conservative treatment. Limitation in the range of hip joint motion was not statistically associated with abnormal findings of MRI (p=0.148). Normal Patrick test was associated with normal MRI finding (p=0.001). Among normal cases on both physical and simple bone X-ray film, 88.6% were normal at MRI. In conclusion, for patients with physical complaints from the cross-legged posture, diagnostic utility of MRI is relatively low when they show normal on both physical examination and simple radiography.

젊은 남성에서 팔씨름에 의해 발생한 상완골 간부 골절

이승림 ( Seung Rim Yi ),권지은 ( Jieun Kwon ),이예현 ( Ye Hyun Lee ),양보규 ( Bo Kyu Yang ),안영준 ( Young Joon Ahn ),임세혁 ( Se Hyuk Im ),조준희 ( Joon Hee Cho ),박상훈 ( Sang Hoon Park ) 대한스포츠의학회 2017 대한스포츠의학회지 Vol.35 No.3

Humeral shaft fracture sustaining arm wrestling is rare, but occurs intermittently. We treated 15 cases of humeral shaft spiral fractures occurred during arm wrestling for fun since 2007. Average age was 22.47±2.69 years, average body mass index was 22.67±2.06 kg/m². There was no prominent tendency for the fractures to occur at a certain phase of the match. Fractured level and length of each case were measured in the plain radiographs and compared with those of previous reports. Eight cases (53.3%) had an associating medial butterfly fragment, and the time taken until the fracture occurred was longer than that of simple spiral fracture (15.62±9.03 seconds vs. 7.85±2.67 seconds, p=0.048). Fractures were distributed mid to distal one third of humerus, the length of fracture was 7.93±2.69 cm and involved 25.43%±8.24% of humeral length. All cases except one treated surgically using plate and screws and returned their full activities within postoperative 3 months. Although arm wrestling is a simple and joyful sport, participants should be aware of the risks of injury during arm wrestling, especially for the amateur players.