젊은 당뇨 환자에서 신경병성 관절병증 종골 견열 골절의 자연 경과(1예보고)

고영철,은일수,정철용,김진완,최현수,김옥걸,Ko, Young-Chul,Eun, Il-Soo,Jung, Chul-Young,Kim, Jin-Wan,Choi, Hyeon-Soo,Kim, Ok-Gul 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.

수족한(手足汗)의 원인(原因)과 치료법(治療法)에 대한 동(東).서의학적(西醫學的) 고찰(考察)

고영철,신조영,Ko, Young-Chul,Shin, Jo-Young 대한한방내과학회 1997 大韓韓方內科學會誌 Vol.18 No.2

Sweating is natural phenomenon necessary for the regulation of an individual's body-temperature. The secretion of sweat is mediated by a portion of our vegetative nervous system(the sympathetic nervous system). In some people, this system is working at a very high activity level, far higher than needed to keep a constant temperature. This condition is referred to as hyperhidrosis. Especially excessive sweating of the hands and the feet is palmoplantar hyperhidrosis or volar hyperhidrosis. This is by far the most distressing condition. It was founded that the first important cause of this was emotional factor. The hands are much more exposed in social and prefessional activities than any other part of our body. Many individuals with palmoplantar hyperhidrosis are limited in their choice of proffession, because unable to manipulate materials sensitive to humidity or reluctant to shake hands; some patients arrive to the point to avoid social contact. The occidental medical treatments for palmoplantar hyperhidrosis include application of topical agents(chemical antiperspirants such as aluminum chloride), iontophoresis(treatment with electrical current), or surgery(thoracic sympathectomy). It was reported that the most effective treatment was thoracic sympathectomy. So this study was started to find the easy and effective oriental medical treatments against the occidental medical treatments through the oriental medical literature. The occidental medical idea for palmoplantar hyperhidrosis is only limited in neurologic system, so surgery is the best treatment. But the oriental medical idea for palmoplantar hyperhidrosis is much wider, so the oriental medical causes and treatments for this are able to be veriety. And the oriental medical teatment is freely in treating the patients of palmoplantar hyperhidrosis, because entire idea including pulse, facial color, mental condition, constitution and other symptom exists in the oriental medicine. The results of a bibliographic study of causes and treatments for palmoplantar are as follows; 1. The main causes of pa1moplantar hyperhidrosis are heat in the stomach, damp-heat in the spleen and the stomach, insufficiency of the spleen-qi and the stomach-qi, deficiency of the spleen-yin and the stomach-yin, and the others are the stomach-cold syndrome, stasis of blood and dyspepsia in the stomach, disorder of the liver-qi, deficiency of the heart-yin and the kidney-yin, deficiency of the heart-yang and the kidney-yang, stagnated heat in the liver and the spleen, the lung channel-heat etc. 2. The main methods of medical treatments for palmoplantar hyperhidrosis are clearing out the stomach-heat, eliminating dampness and heat in the spleen and the stomach, invigorating the spleen-qi and the stomach-qi, reinforcing the spleen-yin and the stomach-yin, warming the stomach, relaxing the liver and alleviating of mental depression and tonifying the heart and the kidney etc. 3. The main prescriptions of palmoplantar hyperhidrosis are Taesihotang, Palmultang-kakam, Samyeongbaechusan, Chongbisan, Sasammaekmundongtang, the others are Leejungtang, Hwangkikonjungtang, Seungkitang, Boyumtang, Baekhotang, Chongsimyonjayum, Moyrosan, etc. 4. Local medicine for external use are liquid after boiling alum in water for about 1 or 2 hours, liquid after boiling alum and pueraria root in water and liquid after boiling stragalus root, pueraria root, ledebouriella root and schizonepeta in water, etc. 5. The methods of acupuncture therapy include invigorating Bokyru, Yumkuk and purgating Hapkouk, or invigorating Bokyru, Kihae and purgating Hapkouk, or steadying Hapkouk, Nokung.

경추간공 요추 추체간 유합술 후 단일 케이지 후방이동의 위험인자에 대한 분석

고영철(Young-Chul Ko),하동준(Dong-Jun Ha),박만준(Man-Jun Park),허정욱(Jung-Wook Huh),박준형(Joon-Hyung Park),이우명(Woo-Myung Lee) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.3

목적: 경추간공 요추 추체간 유합술 후 단일 케이지의 후방이동의 위험인자들에 대해 알아보고자 한다. 대상 및 방법: 2015년 1월에서 2017년 1월까지 경추간공 요추간 유합술 시행한 환자들 중 1년 추시 가능한 48명(60개 추간판)의 환자들을 대상으로 후향적 연구를 시행하였다. 케이지의 후방이동이 있는 16명(17개 추간판)을 1군, 후방이동이 없는 32명(43개 추간판)을 2군으로 분류하였고, 의무기록과 방사선적 평가를 통해 인구학적 특징, 추간판 모양, 케이지 삽입된 요추 병변, 술 후 추간판 높이 변화, 추간판 내 케이지 삽입 위치 등을 분석하였다. 결과: 인구학적 인자 및 케이지 삽입된 요추 병변에 따른 각 군(1군 16명, 2군 32명) 간의 유의한 차이가 없었다. 1군에서 배(pear) 모양 추간판인 경우 9명으로 유의하게 더 많았고, 술 전, 후 추간판 높이 변화는 1.8 mm로 유의하게 낮았으며, 전후방 및 측면 사진상 케이지 위치가 각각 비 중앙(9명) 및 중앙(15명)인 경우 유의하게 더 많았다. 결론: 배모양 추간판, 적은 술 후 추간판 높이 변화, 전후방 및 측면 사진상 비중앙 부위 비전방 부위 케이지 삽입의 경우 후방이동의 발생 가능성이 높았다. 이를 토대로 술기에 참고하면 케이지 후방이동을 예방하는 데 도움이 될 것으로 생각된다. Purpose: To analyze the risk factors for posterior migration of a single cage after transforminal lumbar interbody fusion (TLIF). Materials and Methods: This study was conducted retrospectively on 48 patients (60 discs) who were followed-up for 1 year after TLIF from January 2015 to January 2017. The patients were divided into two groups: group 1 containing 16 patients (17 discs) with cage migration and group 2 containing 32 patients (43 discs) without it. Information related to cage migration, such as the demographic factors, shape of disc, level and location of the cage inserted, and disc height change, was acquired from the medical records and radiologic images, and the possibility for generating posterior migration of cage was evaluated statistically. Results: The demographic factors and cage-inserted level were similar in the two groups (16 patients in group 1, 32 patients in group 2). In the migration group, number of patients with a pear-type disc, 9 patients, was significantly larger; the disc height change, 1.8 mm, was significantly smaller; and the cage was located frequently on non-center in the anteriorposterior view and center in the lateral view in 9 and 15 out of 16 patients, respectively. Conclusion: A pear-type disc shape, small disc height change, cage with non-center on the anteriorposterior view and non-anterior on the lateral view are the risk factors for posterior migration. These factors are important for preventing posterior migration of the cage.

요추부 후측방 유합술 시 국소 자가골 및 골 이식 대체재 혼합 이식에 의한 골유합률의 비교

고영철(Young-Chul Ko),홍성확(Seong-Hwak Hong),박만준(Man-Jun Park),허정욱(Jung-Wook Huh),박준형(Joon-Hyung Park),이우명(Woo-Myung Lee) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.2

목적: 요추부 후측방 유합술 시 자가골과 혼합 이식하는 골대체재의 종류에 따른 골유합률을 비교하여 효과적인 혼합 이식 재료를 제시하고자 한다. 대상 및 방법: 본 연구는 후측방 유합술 시행 후 최소 2년 추시한 환자들을 대상으로 후향적으로 시행하였으며 유합술 시 국소자가골에 혼합하여 사용한 이식 재료에 따라 네 군으로 분류하였다. I군은 대퇴 골두 동종골을 사용한 48예, II군은 ß-tricalcium phosphate를 사용한 38예, III군은 이상인산칼슘을 사용한 92예, IV군은 이상인산칼슘 및 자가 골수를 사용한 38예를 대상으로 하였다. 술 후 2년째 단순 방사선 검사를 추시하여 유합 여부와 임상결과로 판단하였으며, 단순 방사선 소견상 양측 상하 횡돌기간에 뚜렷하게 형성된 골괴와 함께 굴신 방사선 소견상 각 운동 범위가 2도 미만이면서 전위 소견이 보이지 않을 때 유합으로 정의하였다. 결과: 술 후 2년째 단순 방사선을 추시한 결과 이상인산칼슘 및 자가골수를 국소 자가골과 혼합 이식한 IV군에서 가장 높은 유합률을 나타냈다. 결론: 생체흡수성이 높아지고 기계적 강도가 보완된 골전도성 대체재인 이상인산칼슘과 골유도 및 골형성이 가능한 자가 골수의 물질적 특성이 골유합률을 높일 수 있을 것이다. 따라서 요추부 후측방 유합술 시 이상인산칼슘, 자가 골수 및 국소 자가골의 혼합이식이 자가골 이식을 효과적으로 대체할 수 있는 방법으로 사용될 수 있으리라 생각된다. Purpose: To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft. Materials and Methods: The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using b-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs. Results: According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft. Conclusion: Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

태권도수련이 스트레스와 생활만족에 미치는 영향

고영철 ( Young Chul Ko ) 대한무도학회 2002 대한무도학회지 Vol.4 No.1

슬관절 골관절염 환자에서 발생한 Streptococcus sanguis에 의한 화농성 슬관절염

정철용(Chul-Young Jung),은일수(Il-Soo Eun),김진완(Jin-Wan Kim),고영철(Young-Chul Ko),김창규(Chang-Kyu Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.1

Streptococcus sanguis (S. sanguis)는 정상인의 구강, 상기도의 정상 세균총인 Viridans streptococci 분류의 그람 양성 연쇄구균으로 병원성은 낮으나, 치석 제거나 구강의 외과적 처치 시 혈행성 전파를 통해 세균성 심내막염을 일으킬 수 있는 균이다. S. sanguis에 의한 화농성 관절염은 국외에서 흉쇄관절과 슬관절에 발생한 증례가 보고되었으나 국내에서는 보고된 예가 없는 매우 드문 감염증이다. 이에 저자들은 치주염의 과거력이 있는 슬관절 골관절염 환자에서 발생한 S. sanguis에 의한 화농성 슬관절염을 경험하였기에 보고하는 바이다. Streptococcus sanguis (S. sanguis ) is a gram positive streptococcus bacteria which is found in the normal bacterial fl ora of the oral cavity and the upper respiratory tract. It has low virulence, but it can cause bacterial endocarditis through the blood circulation when dental calculus are removed from the teeth or during surgical treatment. Septic arthritis caused by S. sanguis has been reported as infecting the sternoclavicular joint and the knee joint, but it is a quite rare infectious disease that has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by S. sanguis in a patient with osteoarthritis of the knee, who has the history of periodontitis.

상부 견갑 현수 복합체의 3중 골절에 대한 치료

정철용(Chul-Young Jung),은일수(Il-Soo Eun),김진완(Jin-Wan Kim),고영철(Young-Chul Ko),김영준(Young-June Kim),김창규(Chang-kyu Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

상부 견갑골 현수 복합체(SSSC, Superior Shoulder Suspensory Complex)는 견갑골의 관절와, 오구돌기, 오구 쇄골 인대, 원위 쇄골, 견봉 쇄골 관절, 견봉으로 구성된 골 또는 연부조직의 고리로 하나의 기능적 단위를 이루는 복합체를 형성하며, 상완 및 견갑부의 정상적인 안정성을 유지하는 역할을 한다. 상부 견갑골 현수복합체의 손상은 주로 교통사고나 낙상 등에 의한 고에너지 손상에 의해 이루어지며, 단독 분리는 빈번히 일어나는 것으로 알려져 있다. 그러나 외상에 의한 이중 분리 즉, 복합체의 두 부위 이상의 손상은 드물며, 이리한 복합체의 이중 분리는 수술적 치료를 요하는 것으로 알려져 있다. 복합체 이중 분리 중 오구돌기와 견봉 및 원위 쇄골의 동시 골절인 삼중 골절은 국외에서 단 1례만 보고되고 있으며, 국내에서는 보고된 바가 없는 실정이다. 저자들은 47세 남자 환자에서 발생한 상부 견갑 현수 복합체의 삼중 골절을 경험하였기에 문헌고찰과 함께 보고하고자 한다. The Superior Shoulder Suspensory Complex (SSSC) is a bony and soft tissue ring comprising the glenoid process, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromion. The SSSC maintains a normal stable relationship between the upper extremity and the axial skeleton. High-energy injury, such as traffic accident or a fall, can cause disruption of the SSSC. Single traumatic disruption of the SSSC is common. However, double disruption of the SSSC is infrequent and surgical management is generally necessary. We have experienced a case of triple fracture involving the coracoid process, the acromion, and the distal end of the clavicle. Such disruption of the SSSC has not been previously reported in our country and only one case has been reported in the Western literature; the authors obtained positive clinical results with surgical treatment. We report here on this case and include a review of the relevant literature.

슬관절 주위 골절이 동반된 슬관절 치환술의 Klebsiella pneumoniae 단일균에 의한 후기 감염

정철용(Chul-Young Jung),은일수(Il-Soo Eun),고영철(Young-Chul Ko),박만준(Man-Jun Park),김민우(Min-Woo Kim),황금민(Keum-Min Hwang) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.6

Klebsiella pneumoniae에 의해 발생한 화농성 관절염은 성인에서 매우 드물며, 인공관절 치환술 후 발생한 경우는 더욱 드물다. 인공관절 치환술 후 발생한 K. pneumoniae에 의한 화농성 관절염은 급성 또는 수술 후 초기에 발생한 예는 있으나 후기 감염으로 보고된 예는 국내에서 아직 보고된 바 없으며, 다균성 감염이 대부분으로 K. pneumoniae 단일균에 의한 감염 역시 매우 드물다. 이에 저자들은 내원 11년 전 슬관절 인공관절 치환술을 받은 85세 여자 환자에서 후기 감염으로 K. pneumoniae 단일균에 의한 화농성 관절염이 슬관절 치환물 주위 골절과 동반된 1예를 치험하였기에 보고하고자 한다. Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.

중등도 이상의 무지 외반증에서 최소 절개를 이용한 원위 중족골 절골술의 결과

허정욱,은일수,고영철,박만준,박숙현,Huh, Jung-Wook,Eun, Il-Soo,Ko, Young-Chul,Park, Man-Jun,Park, Sook-Hyun 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.2

Purpose: Minimal incision distal metatarsal osteotomy (MIDMO) is known to be an effective surgical procedure for mild to moderate hallux valgus. However, the result of MIDMO on moderate to severe hallux valgus is controversial; therefore, we investigated the radiological and clinical results of MIDMO on moderate to severe hallux valgus. Materials and Methods: We reviewed 51 feet (48 patients) with moderate to severe hallux valgus. The mean age was 67.0 years and the mean follow-up period was 32.2 months. Radiological data of hallux valgus angle, first intermetatarsal angle, and distal metatarsal articular angle on plain radiographs were analyzed. Recurrence, union, lateral translation of distal fragment and angulation were also analyzed. The clinical data were obtained using American Orthopaedic Foot and Ankle Society (AOFAS) score of preoperation and last follow-up. Receiver operating characteristic (ROC) curve was used to determine a cut-off value. Results: The mean hallux valgus angle measured at preoperation was $37.7^{\circ}$ and $15.9^{\circ}$ at last follow-up. The mean first intermetatarsal angle of preoperation and last follow-up were $15.2^{\circ}$ and $8.3^{\circ}$. The mean distal metatarsal articular angle changed from $12.6^{\circ}$ at preoperation to $7.8^{\circ}$ at last follow-up. Preoperative hallux valgus angle (p=0.0051) and distal metatarsal articular angle (p=0.0078) were statistically significant factors affecting postoperative AOFAS score. Cut-off value of each was $37^{\circ}$ and 13o, respectively. Lateral translation of distal fragment in 5 recurrent cases was 23.0% compared to 45.3% of 46 non-recurrent cases. The result was statistically significant and the cut-off value was 38%. Conclusion: Sufficient lateral translation over 38% in MIDMO on moderate to severe hallux valgus patients with preoperative hallux valgus angle under $37^{\circ}$ and distal metatarsal articular angle under $13^{\circ}$ can lead to good clinical results without recurrence.

삼소음(蔘蘇飮)이 백서(白鼠)의 국소뇌혈류량(局所腦血流量)과 혈압(血壓)에 미치는 영향(影響)

박병민,홍재의,고영철,신조영,이시형,Park, Byong-Min,Hong, Jae-Eui,Ko, Young-Chul,Shin, Jo-Young,Lee, Si-Hyeong 대한한방내과학회 2002 大韓韓方內科學會誌 Vol.23 No.1

Objective : The objective of this study is to measure the changes of regional cerebral blood flow(rCBF) and blood pressure(BP) in rats with the following injection. Methods : The measurement was continually monitored by laser-doppler flowmeter-Transonic Instrument, USA- and pressure tranducer(Grass, USA) in anesthetized adult Sprague-Dawley rats about for two hour to two hour and a half hours through the data acquisition system composed of Maclab and Macintosh computer. Result : This experiment with Samso-eum increased the changes of rCBF in rats, significantly, but did not change the blood pressure. The rCBF of Samso-eum decreased by pretreated propranolol, and was not changed by pretreated L-NNA and ODQ. Conclusion : It is considered that the dosage-dependent increase on rCBF is mediated by adrenegic ${\beta}$-receptor.