전위된 관절 내 종골 골절에 대한 Essex-Lopresti 변형 정복술

곽경덕,조현오,임대환,안상민,장재호,Kwak, Kyoung-Duck,Cho, Hyoun-Oh,Lim, Dae-Hwan,Ahn, Sang-Min,Jang, Jae-Ho 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Purpose: The purpose of this study is to evaluate the effectiveness and indications of the modified Essex-Lopresti reduction in calcaneal fractures. Materials and Methods: We reviewed retrospectively 41 cases of displaced intraarticular calcaneal fractures. The fracture was reduced with Essex-Lopresti technique with modification in compression of the lateral wall with the specially designed compression device instead of the operator's hands. We evaluated the results of treatment by AOFAS scale and the radiographic parameters including the Bohler's angle, calcaneal width, calcaneofibular distance and the congruency of the posterior facet. Results: Boler's angle was restored from 11 to 29.6 degrees on average, heel width was reduced to 112% of contralateral value, the calcaneofibular gap was restored up to 87.9% of contralateral side, and the articular surface of the posterior facet was restored less than 2 mm of step off and less than 2 mm of gap. AOFAS scale averaged 87 points. The quality of reduction was best in Sander's type II fractures. Small sized fragments in type III fractures could not be reduced. The results were better when the reductions were performed within 24 hours of injury. Conclusion: The modified Essex-Lopresti reduction was less invasive, easy to perform, and the results of treatment were similar to those of open reduction; it seemed to be a reasonable alternative for the selected intraarticular calcaneal fractures.

관절경적 후내측 도달법을 이용한 슬와 낭종의 절삭 절제술

곽경덕,안상민,백승일,정찬종,노재수,Kwak, Kyoung-Duck,Ahn, Sang-Min,Baek, Seung-Il,Jung, Chan-Jong,Roh, Jae-Su 대한관절경학회 2006 대한관절경학회지 Vol.10 No.2

목적: 관절경적 후내측 도달법을 이용한 밸브기전의 교정을 통한 슬와 낭종의 절삭 절제술의 임상적 결과와 그 유용성을 보고 하고자 한다. 대상 및 방법: 2004년 4월부터 2005년 6월까지 변형된 관절경적 방법으로 슬와 낭종을 치료하였던 15례를 대상으로 하였다. 평균추시 기간은 15개월(범위: $12{\sim}28$) 이었다. Rauschning과 Lindgren의 평가 기준을 근거로 예후를 판정하였으며, 수술에 소요된 시간과, 슬관절의 통증이 없어지고 완전한 운동범위를 얻는데 걸린 기간을 측정하였다. 수술 후 12개월에 초음파를 시행하여 재발 여부를 관찰하였다. 결과: 기능평가는 Rauschning 과 Lindgren의 기준으로 최종 추시시 전례에서 Grade 0 또는 Grade 1 이었다. 수술 시간은 평균 45분(범위 $35{\sim}70$) 이었다. 전례에서 수술 후 5일 이내에 통증 없는 슬관절 운동범위의 완전한 회복을 얻을 수 있었으며, 1년 이상의 최종 추시에서도 운동범위는 모두 정상이었다. 재발한 예는 없었고, 통증과 보행 장애도 없었다. 결론: 후내측 도달법을 이용한 관절경술은 낭 주름의 밸브기전을 쉽게 교정할 수 있고, 슬와 낭종의 절삭술을 효과적으로 시행할 수 있는 대치방법으로 사료된다. Purpose: We evaluated the effectiveness of arthroscopic shaving cystectomy by using posteromedial portal for popliteal cyst with the correction of valvular mechanism. Materials and Methods: We had treated 15 cases of popliteal cyst with arthroscopic shaving cystectomy by using posteromedial portal from April 2004 to June 2005. The mean duration of follow up was 15 months (range: $12{\sim}28$). Functional results were based on the Rauschning and Lindgren criteria. We estimated operative time, time for regaining pain-free full range of motion and checked sonography for recurrence of the cyst at 12 months after the surgery. Results: The functional results by Rauschning and Lindgren criteria were rated Grade 0 or Grade 1 in all cases at last follow up. The average operation time was 45 minutes (range: $35{\sim}70$). All cases regained pain-free full range of motion within five days after surgery and range of motion was also normal at last follow up. There were no recurrence and no walking disturbance in all cases. Conclusion: Arthroscopic shaving cystectomy by using posteromedial portal is one of the effective alternative method of the treatment for popliteal cyst and it is also useful to correct the valvular mechanism.

노인의 대퇴골 전자부 골절 치료에 대한 내고정물의 선택

곽경덕 ( Kyoung Duck Kwak ),고철언 ( Chul Un Ko ),안상민 ( Sang Min Ahn ),안기백 ( Kee Baek Ahn ) 대한골절학회 2005 대한골절학회지 Vol.18 No.4

요골 원위부 불안정성 골절에서 5개 핀을 이용한 외고정 치료

곽경덕 ( Kyoung Duck Kwak ),고철언 ( Cheol Eun Ko ),백승일 ( Seung Il Baek ),안상민 ( Sang Min Ahn ),정찬종 ( Chan Jong Jung ),안기백 ( Ki Baek Ahn ),노재수 ( Jae Su Roh ) 대한골절학회 2006 대한골절학회지 Vol.19 No.3

목적: 요골 원위부 불안정성 골절을 금속 외고정으로 치료할 때 원위 골편에도 핀을 추가해 5개 핀으로 외고정한 결과를 분석하고자 하였다. 대상 및 방법: 5개 핀으로 외고정한 20예 (5핀 군) 요골 원위부 골절을 대상으로 하였다. 제5핀은 요골 관절면 골편에 삽입하여 외고정 틀에 부착시켰다. 12예는 중수골 핀을 6주에, 8예는 3주에 제거하여 손목 관절 운동을 시작하였고, 요골측 핀은 모두 8∼9주에 제거하였다. 치료 결과를 4개 핀 외고정 20예 (4핀군) 결과와 방사선학적 계측치를 이용하여 비교하였다. 결과: 요골경사각은 술 후 5핀 군, 4핀 군에서 각각 23.1도, 22.2도였고 최종 추시에 각각 21.8도, 15.1도였다. 전방경사도는 5핀 군과 4핀 군에서 술 후 각각 8.5도, 7.3도였으며, 최종 추시에 각각 6.3도, 0.1도였다. 요골길이 단축은 술 후 5핀 군과 4핀 군 각각 0.3 mm, 0.4 mm였으나, 최종 추시에 각각 1.1 mm, 2.1 mm였다. 5핀 군 내에서 중수골 핀을 6주에 제거한 예들과 3주에 제거한 예들 사이에 의미있는 차이는 없었다. 결론: 요골 원위부 불안정성 골절을 금속 외고정으로 치료할 때 원위골편에 제5핀을 추가하여 외고정 틀에 고정함으로써 4개 핀만을 고정할 때보다 방사선학적으로 더 우수한 치료 결과를 얻을 수 있었다. Purpose: To evaluate the results of five-pin external fixation, with the fifth pin stabilizing the distal radius articular fragment, for unstable distal radial fractures. Materials and Methods: Twenty cases of unstable distal radial fractures were treated with five-pin external fixation (5-pin group). The fifth pin was inserted into the distal articular fragment and attached to the external fixation frame. Metacarpal pins were removed at sixth week in 12 cases and at third in 8 cases, and radial pins were removed at eighth or ninth week. The radiographic results of 5-pin group were compared with those of 20 cases of traditional four-pin external fixation (4-pin group). Results: The postoperative radial inclination was 23.1˚ in 5-pin group and 22.2˚ in 4-pin group; while at last follow-up 21.8˚ and 15.1˚ respectively. Postoperative volar tilt was 8.5˚ and 7.3˚; while at last follow-up 6.3˚ and 0.1˚ respectively. Postoperative radial shortening was 0.3 mm, 0.4 mm; while at last follow-up 1.1 mm and 2.1 mm respectively. In 5-pin group, there were no significant differences in results whether the metacarpal pins were removed at sixth or third week. Conclusion: Five-pin external fixation, with the fifth pin stabilizing the distal articular fragment, enhanced early motion of the wrist maintaining fracture stability in unstable fractures of the distal radius.

족근 관절 유합술 후 족부 잔여 운동범위

조현오,곽경덕,손수민,정우근,최종청,Cho, Hyoun-Oh,Kwak, Kyoung-Duck,Shon, Soo-Min,Jung, Woo-Keun,Choi, Jong-Cheong 대한족부족관절학회 1999 대한족부족관절학회지 Vol.3 No.1

The purpose of this study Is to assess the retained range of motion[RROM] of the foot after arthrodesis of the ankle joint, which might help designing the angle of arthrodesis. We reviewed the results including the RROM in 14 cases of ankle arthrodesis. Underlying causes included trauma group(six posttraumatic arthritis) and disease group(three osteoarthritis, three Charcot joints, one chronic synovitis and one pyogenic arthritis). We measured the RROM on the lateral roentgenograms of the ankle in full dorsiflexion and plantarflexion, The results were assessed by the AOFAS hindfoot scale[score]. The RROM in sagittal plane was $23.4{\pm}5.3$ degrees and the score was 71.5 points on average. The RROM and the score were $26.8^{\circ}{\pm}2.1$, 81.2 points respectively in trauma group and $20.8^{\circ}{\pm}5.6$, 64.3 points in disease group; $26.6^{\circ}{\pm}2.3$, 83.4 points in cases younger than 40 years of age and $21.6^{\circ}{\pm}5.7$, 64.9 points in the older. The mean score was 77.3 points in cases whose RROM were $24^{\circ}$ or more and 61 points in cases of less RROM; 69.6 and 73.4 points in cases with and without adjacent degenerative arthritis respectively. The score was 69.7, 73.3 and 71.5 points in cases whose angle of arthrodesis was in dorsiflexion, neutral, plantarflexion respectively. In conclusion, after ankle arthrodesis RROM of the foot was $23.4^{\circ}$, and the more the RROM, the higher the score. In cases with sufficient amount of RROM, the angle of fusion on sagittal plane might not influence the result significantly.

C형 경골천정 골절에 대한 일리자로브 외고정술

조헌오,곽경덕,조성도,김병용,오장호,Cho, Hyoun-Oh,Kwak, Kyoung-Duck,Cho, Sung-Do,Kim, Byung-Yong,Oh, Jang-Ho 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.1

The purpose of this study is to evalute the efficacy af the Ilizarov external fixation for the surgical treatment. of the tibial plafond fractures. We reviewed retrospectively fourteen cases of tibial plafond fractures with moderate to severe soft. tissue damage, which were fixed with Ilizarov external fixator. Using the AO Muler classification, there were four Type C1 fractures, six Type C2 and four Type C3. In most, of the cases, the ankles were operated on with other associated fractures within a few days after injury. We reduced the fracture indirectly by soft issue taxis and fixed externally across the ankle joint. using the circular external fixator with tensioned wires and ankle hinge. In cases of inadequate closed reduction, we applied limited open reduction and internal fixation. Range of motion exercise began immediately. Postoperative follow-up averaged fourteen months (ranges, 8-30 months). Overall clinical results rated good or excellent in 7 cases, fair in 4 and poor in 3. There were three cases of pin tract infection which were resolved with short-term antibiotics and local care; one delayed wound closure in a patient. whose fracture was associated with Type III open wound; one wound slough in a patient associated with Type II open wound, which was closed later by skin graft; and one osteoarthritis. From this review, we concluded that cross-ankle circular external fixation with tensioned wires with or without. limited open reduction is a reasonable alternative for the treatment of the tibial plafond fractures with severe soft tissue damage.

성인 여성에서 체중 부하에 따른 발 크기 변화

조현오,곽경덕,손수민,강철호,서대석,임대환,Cho, Hyoun-Oh,Kwak, Kyoung-Duck,Sohn, Soo-Min,Kang, Chul-Ho,Suh, Dae-Seok,Lim, Dai-Hwan 대한족부족관절학회 2000 대한족부족관절학회지 Vol.4 No.1

Purpose: The purpose of this study is to assess the amount of changes in the foot size on weight bearing in adult women, which might help in choosing an appropriate size of the shoes. Materials and Methods: The authors measured the length and width of the feet of 200 healthy women on weight bearing and non-weight bearing, and the size of the shoes they wore. Results: Foot length and width differences between right and left sides were 2.53 mm and 2.16 mm respectively on non-weight bearing, and 2.47 mm and 1.77 mm respectively on weight bearing. Foot length and width increased by 2.89% and 7.50% respectively on weight bearing than those on non-weight bearing. Shoe width was 6.82% longer and 9.54% narrower than the weight bearing foot size. There were 25 women who had shoe-related foot pain, all of them wore shoes that were 13.01 % or more narrower than the weight bearing foot width. Foot pain was significantly correlated with the shoe-foot width difference(p=0.0001). Conclusion: The foot size was increased by 2.89% in length and 7.50% in width with weight bearing. The width of their shoes was narrower. than the weight bearing foot width. Shoe-related foot pain was correlated with the foot-shoe width difference.

족부측방촬영을 통한 정상 아동의 족근골 및 중족골간 각도 계측 결과

고철언,조현오,곽경덕,김병용,손수민,문진경,오필환,Ko, Cheol-Eon,Cho, Hyoun-Oh,Kwak, Kyoung-Duck,Kim, Byeong-Yong,Son, Soo-Min,Moon, Jin-Kyoung,Oh, Pil-Hwan 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.2

정상 아동 124명에서 족부 단순방사선촬영 소견에서 편평족과 관련하여 방사선학적 계측치를 나이에 따라 비교한 결과 나이가 어릴수록 대부분이 편평족 소견을 보였고 나이가 많아짐에 따가 차츰 발아치가 형성되어 13세 이후에는 대부분의 예에서 성인과 비슷한 소견을 보였다. 따라서 아동에서는 방사선학적 계측에서 편평족 소견을 보이더라도 이를 치료할 필요가 있을지 결정하는데는 임상 소견이 더 중요할 것으로 사료된다. 본 연구는 정상아동에 대한 횡적 조사연구이므로 향후 종적 조사를 시행하면 나이에 따른 발아치의 변화를 좀 더 정확하게 파악할 수 있을 것으로 사료된다. Radiographs were made of the feet of one hundred and twenty four normal children who were ranged in age from 1 to 13 years. On lateral radiographs that were made with the feet in standing, the talo-first metatarsal, calcaneal pitch and calcaneo-fifth metatarsal angles and arch ratio were measured. Most of the children in this study revealed flattened feet in earlier ages and the mean values were changed with age up to normal range later in the early school ages. These data might provide one of the standard for assessment of the flatfoot in children. However, the diagnosis and treatment of the flatfoot should be based on clinical assessment and radiographic values should not determine clinical management even if the values are beyond the normal range.

정적 교합성 골수강내 금속정 삽입후 역동화의 필요성

조현오(Hyoun Oh Cho),곽경덕(Kyoung Duck Kwak),조성도(Sung Do Cho),기병용(Byoung Young Kim) 대한정형외과학회 1996 대한정형외과학회지 Vol.31 No.5

연부조직 종양에서 초음파 검사의 유용성

조현오(Hyoun-Oh Cho),곽경덕(Kyoung-Duck Kwak),조성도(Sung-Do Cho),류철수(Cheol-Soo Ryoo),이법재(Bab-Jae Lee) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.3