회전근 개 파열에 대한 관절경적 봉합술과 소 절개 봉합술의 비교

박지강,박경진,김용민,김동수,최의성,손현철,조병기,임세혁,Park, Ji-Kang,Park, Kyoung-Jin,Kim, Yong-Min,Kim, Dong-Soo,Choi, Eui-Sung,Shon, Hyun-Chul,Cho, Byung-Ki,Im, Se-Hyuk 대한정형외과스포츠의학회 2010 대한정형외과스포츠의학회지 Vol.9 No.1

목적: 관절경적 회전근 개 봉합술과 소 절개를 이용한 봉합술의 결과를 비교 분석하고자 한다. 대상 및 방법: 회전근 개 파열이 확인된 44명의 환자를 대상으로 하였다. 23예에서는 관절경적 봉합술을, 21예에서는 소 절개를 이용한 봉합술을 시행하였다. 수술 시 평균연령은 관절경적 봉합술군이 50.4세, 소 절개를 이용한 봉합술군이 56.7세였다. 평균 추시 기간은 관절경적 봉합술군이 24.1개월, 소 절개를 이용한 봉합술군이 26.1개월이었다. 양 군의 결과를 견관절 운동범위, VAS (Visual Analogue Scale), ASES (American Shoulder and Elbow Society), UCLA (University of California LA) 점수를 비교했으며 이를 통계적으로 검정하였다. 결과: 파열의 크기는 관절경적 봉합술군에서 소파열이 2예, 중파열이 10예, 대파열이 11예였으며, 소 절개를 이용한 봉합술군에서는 각각 1예, 8예, 12예 였다. 평균파열의 크기는 관절경적 봉합술군은 3.8 cm이었고, 소 절개 봉합술군이 4.2 cm이었다. 최종 추시 시에 양 군에서 동통과 기능점수가 향상되었으나 양 군간의 차이는 없었다. 양 군의 견관절 운동범위 (p=0.7493), VAS (p=0.9677), ASES (p=0.8032), UCLA (p=0.2289) 점수의 통계적 차이는 없었다. 결론: 관절경적 회전근 개 봉합술군은 파열의 크기가 최종 추시 시 임상 결과와 유의한 상관 관계를 보이지 않았으나, 소절개 봉합술군은 파열의 크기가 클수록 결과가 좋지 않았다. 회전근 개 전층파열에서 관절경적 봉합술군과 소 절개를 이용한 봉합술군 간에 임상 결과의 차이는 보이지 않았다. Purpose: To compare the outcome of patients who underwent rotator cuff repair using all-arthroscopic mini-open repair techniques. Materials and Methods: We retrospectively reviewed 44 patients who underwent either arthroscopic (group I) or mini-open (group II) rotator cuff repair. 23 patients underwent an arthroscopic repair and 21 patients had a mini-open repair. The mean age was 50.4 years in the arthroscopic group and 56.7 years in the mini-open group. The outcomes for the 2 groups were evaluated using ROM, VAS, ASES, UCLA scale. Statistical analysis was performed using correlations, T-test, Paired T-test. The mean follow-up period in the arthroscopic and mini-open groups were 24.1months and 26.1months, respectively. Results: The group I (arthroscopic group) had 2 small-sized tears, 10 medium sized tears, and 11 large sized tears (3~5 cm). The group II (mini-open group) had 1 small sized tears, 8 medium sized tears, and 12 large sized tears. The mean cuff tear size of the group I and Group II were 3.8 cm and 4.2 cm, respectively. At last follow-up periods, ROM and functional scores were improved. In the group I and group II, there were no significant difference in ROM, VAS, ASES, UCLA score. Conclusion: The size of the tear did not produce different results at arthroscopic repair group but larger tear size was associated with a worse outcome in mini-open group. There were no significant clinical results between the arthroscopic and mini-open group.

전방 정복술 및 경피적 후방 압박나사 내고정술을 이용한 전위성 거골 경부 골절의 치료 결과

박지강,김용민,최의성,손현철,조병기,차정권,Park, Ji-Kang,Kim, Yong-Min,Choi, Eui-Sung,Shon, Hyun-Chul,Cho, Byung-Ki,Cha, Jung-Kwan 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.2

Purpose: Posteroanterior screw fixation is biomechanically stronger than anteroposterior screw fixation. However, there are few literature about the correlation between clinical results and more strength by posteroanterior fixation. This study was performed to evaluate the clinical outcomes of the accelerated rehabilitation following anterior open reduction and posterior percutaneous screw fixation for displaced talar neck fractures. Materials and Methods: Eighteen cases were followed up for more than 1 year after posteroanterior fixation using headless compression screw for talar neck fractures. The clinical evaluation was performed according to American Orthopaedic Foot and Ankle Society (AOFAS) score and Hawkins criteria. As radiographic evaluation, the degree of fracture displacement, period to union, and occurrence rate of complications such as avascular necrosis through MRI were measured. Results: The AOFAS score was average 90.4 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the Hawkins criteria. Therefore, 16 cases(88.8%) achieved satisfactory results. The degree of fracture displacement had improved significantly from preoperative average 5.6 mm to 1.2 mm immediate postoperatively, and maintained to 1.1mm at the last follow-up. All cases achieved bone union, and the period to union was average 12.4 weeks. There were 3 cases of avascular necrosis of talar body and 2 cases of post-traumatic arthritis. Conclusion: Anterior open reduction and posterior percutaneous headless screw fixation seems to be an effective surgical method for displaced talar neck fractures, because of the possibility of accurate restoration of articular surface, fixation strength enough to early rehabilitation, and needlessness of hardware removal.

운동선수의 만성 발목관절 불안정성에서 교량형 봉합술을 이용한 변형 Brostrom 술식 후의 기능평가

박지강,박경진,조병기,임채욱,Park, Ji-Kang,Park, Kyoung-Jin,Cho, Byung-Ki,Im, Chae-Wook 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.3

Purpose: Ligament reattachment technique using a suture anchor appears to show satisfactory functional outcomes and mechanical stability compared with conventional bone tunnel technique. This study was prospectively conducted in order to evaluate functional outcomes of modified Brostrom procedures using the suture bridge technique for chronic ankle instability in athletes. Materials and Methods: Twenty eight athletes under 30 years of age were followed for more than two years after undergoing the modified Brostrom procedure using the suture bridge technique. Functional evaluation consisted of the foot and ankle outcome score (FAOS), foot and ankle ability measure (FAAM) score. Range of motion and time to return to exercise were evaluated using a periodic questionnaire. Talar tilt angle and anterior talar translation were measured through stress radiographs for evaluation of mechanical stability. Results: FAOS improved significantly from preoperative mean 59.4 points to 91.4 points (p<0.001). Daily living and sport activity scores of FAAM improved significantly from preoperative mean 50.5, 32.5 points to 94.8, 87.3 points, respectively (p<0.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean $16.8^{\circ}$, 13.5 mm to $4.2^{\circ}$, 4.1 mm at final follow-up (p<0.001). Times to return to exercise were as follows: mean 10.2 weeks in jogging, 15.4 weeks in spurt running, 13.1 weeks in jumping, 11.5 weeks in walking on uneven ground, 9.1 weeks in standing on one leg, 7.2 weeks in tip-toeing gait, 8.4 weeks in squatting, and 10.6 weeks in descending stairs. Conclusion: Modified Brostrom procedure using the suture bridge technique showed satisfactory functional outcomes for chronic ankle instability in athletes. Optimal indication and cost-effectiveness of the suture bridge technique will be studied in the future.

무지 외반증과 동반된 소족지 기형에 대한 수술적 교정치료가 임상 결과에 미치는 영향

박지강,김용민,김동수,박경진,조병기,정호승,Park, Ji-Kang,Kim, Yong-Min,Kim, Dong-Soo,Park, Kyoung-Jin,Cho, Byung-Ki,Jeong, Ho-Seung 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.3

Purpose: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. Materials and Methods: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. Results: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. Conclusion: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

분산 실시간 객체 TMO를 위한 MicroC / OS - II 실시간 스케줄러의 설계 및 구현

박지강(Ji Kang Park),서한석(Han Seok Seo),김정국(Jung Guk Kim) 한국정보과학회 2005 한국정보과학회 학술발표논문집 Vol.32 No.1

컴퓨터 산업의 빠른 발전과 더불어 근래에는 임베디드 시스템 분야가 빠르게 성장하고 있다. 이전에 작고 단순하던 임베디드 시스템이 산업의 발전과 사용자의 다양한 요구로 운영체제의 필요성이 높아지고 운영체제하에서 관리하는 실시간 프로세스들의 크기와 복잡도가 빠르게 증가하고 있다. 본 논문에서는 분산 실시간 객체 모델인 TMO-MicroC/OS-II의 실시간 스케줄러의 설계와 구현 방법을 기술하였다. TMO-MicroC/OS-II는 Micrium™에서 개발한 임베디드 OS인 MicroC/OS-II에 분산실시간 객체 모델인 TMO를 적용시킨 것이다. TMO (Time-triggered Message-triggered Object)는 시간조건에 의해 구동되는 객체 내의 실시간 스레드들의 동적 맴버들로 구성되는 프로그래밍 페러다임으로 본 논문에서는 TMO모델 적용을 위한 Deadline-driven 스케줄러 구현에 대해서 기술한다.

항회전 근위 대퇴 골수정을 이용한 대퇴골 전자간 골절치료에서 외반정복술의 유용성

박지강(Ji-Kang Park),손현철(Hyun-Chul Shon),김용민(Yong-Min Kim),최의성(Eui-Sung Choi),김동수(Dong-Soo Kim),박경진(Kyoung-Jin Park),조병기(Byung-Ki Cho),차정권(Jung-Kwon Cha),강상우(Sang-Woo Kang) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.6

목적: 대퇴골 전자간 골절에서 외전 정복 후, 항회전 근위 대퇴 골수정으로 치료한 후의 임상적, 방사선적 결과에 대해 알아보고자 하였다. 대상 및 방법: 2008년 3월부터 2012년 8월까지 충북대학교병원에서 항회전 근위 대퇴 골수정으로 치료한 65세 이상의 대퇴전자간 골절 환자 중에서 1년 이상 추시가 가능하였던 51예를 대상으로 하였다. 추시 기간은 평균 15.6개월이었으며 연령은 평균 78.6세였다. 초기 골절의 AO/OTA 분류, 수술 후 대퇴 경부 전염각과 대퇴 경간각, 나선 검의 위치, 외전 정복 여부와 첨단-정점 거리 값, 합병증 발생 여부, 수상 전과 골유합 후의 Koval의 보행능력정도를 비교, 분석하였다. 결과: 49예에서 외전 정복(42예)과 해부적 정복(7예)이 되었으며 골유합은 술 후 평균 15.3주에 얻었다. 나선 검의 평균 활강은 3.5mm였다. 첨단-정점 거리는 평균 18.7 mm였고 합병증의 발생은 없었다. 수상 전에 보행이 가능하였던 42예 중 31예는 수상 전 보행능력을 회복하였고, 11예는 보행능력을 회복하였지만 다른 보행보조수단에 좀 더 의존하게 되었다. 결론: 대퇴골 전자간 골절에 있어서 외전 정복을 통한 항회전 근위 대퇴 골수정을 이용한 수술법은 합병증이 거의 없고 골유합에 매우 유용한 치료 방법이라 판단된다. Purpose: The purpose of this study is to investigate the functional and radiologic results of treatment of the old with intertrochanteric fractures by implementation of the proximal femoral nail antirotation (PFNA) with Valgus reduction. Materials and Methods: A retrospective review of patients (over 65 years old) with intertrochanteric fractures undergoing PFNA, during the period March 2008 to August 2012 at Chungbuk National University Hospital, with follow-up for at least 12 months, was conducted. Fifty-one patients were identified. The mean observation period was 15.6 months and the mean age of patients was 78.6 years old. In this study, AO foundation and Orthopaedic Trauma Association (AO/OTA) classification of initial fractures, post operative neck shaft angle, location of the blade tip (Cleveland index), tip-apex distance (TAD), incidence of complication, Wayne-County reduction, and Koval walking ability were analyzed. Results: Satisfactory reduced status was achieved by significant (p<0.05) valgus reduction in 49 out of 51 cases and the mean period for radiologic bony union was 15.3 weeks. The mean blade sliding distance was 3.5 mm and the mean TAD was 18.7 mm; however, the blade location did not affect the results. No complications, including surgical site infection, delayed union, nonunion, rotational angulation, and cutting out of the blade tip were found. Thirty-one patients out of 42 who maintained their pre-fracture ambulatory ability, 11 patients (out of 42) remained ambulatory but became more dependent on assistive devices. Conclusion: It is expected that the Wayne-County reduction followed by internal fixation with PFNA is a useful treatment option for intertrochanteric fractures in elderly patients because it shows few complications with good functional and radiologic results.

경주두 도달법과 이중 잠김 금속판을 이용한 상완골 과간 골절의 치료

박지강 ( Ji Kang Park ),김용민 ( Yong Min Kim ),김동수 ( Dong Soo Kim ),최의성 ( Eui Sung Choi ),손현철 ( Hyun Chul Shon ),박경진 ( Kyoung Jin Park ),조병기 ( Byung Ki Cho ) 대한골절학회 2012 대한골절학회지 Vol.25 No.2

목 적: 불안정성 상완골 원위부 과간 골절 환자에 대한 경주두 도달법 및 이중 잠김 금속판을 이용한 수술적 치료 후의 임상적, 기능적결과를 알아보고자 하였다. 대상 및 방법: 불안정성 상완골 원위부 과간 골절 진단하에 수술적 치료를 시행 받은 환자들 중 최소 1년 이상 추시가 가능하였던 18예를 대상으로 하였다. 모든 예에서 척골신경의 전방 전위술을 시행했으며, 수술 후 1주째부터 관절운동을 허용하는 조기 재활프로그램을 적용하였다. 임상적 결과의 평가는 Mayo 주관절 수행 점수를 이용하였고, Cassebaum의 평가 척도를 이용해 술 후 주관절의 기능을 평가하였다. 결 과: 최종 추시 시 주관절의 운동 범위는 굴곡 구축 평균 12.8도, 후속 굴곡 평균 119.3도였다. 방사선 검사상 술 후 골유합까지의 기간은 평균 14.2주였으며, 모든 예에서 골유합을 얻었다. Mayo 주관절 수행 점수는 최종 추시 시 평균 88.5점으로 총 18예 중 15예 (83.3%)에서 만족스러운 결과를 보였으며, 14예 (77.7%)에서 120도 이상의 주관절 굴곡이 가능하였다. 결 론: 경주두 도달법 및 이중 잠김 금속판을 이용한 내고정술은 불안정성 상완골 원위부 과간 골절에서 견고한 고정을 통해 조기관절재활을 가능하게 하는 효과적인 치료 방법 중의 하나라고 생각한다. Purpose: To evaluate the clinical outcomes of operative treatment using a transolecranon approach with a dual locking plate for unstable intercondylar fractures of the distal humerus. Materials and Methods: Eighteen patients were followed for more than 1 year after surgical treatment for unstable intercondylar fractures of the humerus. Anterior transpositioning of the ulnar nerve and an early rehabilitation program to allow range of motion (ROM) exercise from postoperative week 1 were used for all cases. The clinical and functional evaluation was performed according to the Mayo Elbow Performance Index and Cassebaum`s classification of ROM. Results: The range of elbow joint motion was a flexion contracture mean of 12.8 degrees to a further flexion mean of 119.3 degrees at the final follow-up. The Mayo Elbow Performance Index was an average of 88.5 points. Among the results, 6 were excellent, 9 good, 2 fair, and 1 poor. Therefore, 15 cases (83.3%) achieved satisfactory results. Fourteen cases (77.7%) achieved a satisfactory ROM according to Cassebaum`s classification. All cases achieved bone union, and the interval to union was an average of 14.2 weeks. Conclusion: Dual locking plate fixation through the transolecranon approach seems to be one of the effective treatment methods for unstable intercondylar fractures of the humerus because it enables the anatomical reduction and rigid fixation of articulation, and early rehabilitation exercise.

비골 동맥 천공지 기저 프로펠러 피판술을 이용한 족관절 주위 연부조직 결손의 재건술: 4예 보고

조병기,박지강,박경진,정수리,Cho, Byung-Ki,Park, Ji-Kang,Park, Kyoung-Jin,Chong, Suri 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Four patients with soft tissue defects around the ankle joint were covered with peroneal artery perforator-based propeller flaps. Using color Doppler sonography, the flap was designed by considering the location of the perforator and soft tissue defects. The procedure was then performed by rotating the flap by $180^{\circ}$. Additional skin graft was required in a patient due to partial necrosis, and delayed wound repair was performed in another patient with poor blood circulation at the distal part of the flap. The remaining patients did not have any complications and results were considered excellent. Good outcomes were eventually obtained for all patients.

등속성 운동검사를 이용한 정상 한국인 성인에서의 발목관절 근력 측정

최승명,박지강,하윤원,조병기,Choi, Seung-Myung,Park, Ji-Kang,Ha, Yoon-Won,Cho, Byung-Ki 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

Purpose: Restoration of ankle stability through the strengthening exercise of peroneus muscles is considered an important factor for achievement of successful outcomes, in the rehabilitation program following ankle ligament injuries. However, there were few definitive data on normal muscle strength, including eversion power by peroneus muscles. This study was conducted to evaluate the muscle strength of ankle joint measured using an isokinetic dynamometer in normal Koreans. Materials and Methods: Sixty adults (120 ankles) were recruited and divided into three groups (20 in their twenties, 20 in thirties, and 20 in forties). Each group consisted of 10 males and 10 females. The selection criteria were no history of ankle injury and no evidence of instability. The peak torque, total work, and deficit ratio were measured using the Biodex$^{TM}$ (Biodex Medical Systems). Differences in muscle strength by age, gender and dominant versus non-dominant side were analyzed. Results: The peak torque of dorsiflexion was average 31.5 Nm at $30^{\circ}/s$ of angular velocity and 18.8 Nm at $90^{\circ}/s$; average 69.3 Nm ($30^{\circ}/s$) and 42.4 Nm ($90^{\circ}/s$) on plantarflexion; average 19.6 Nm ($30^{\circ}/s$) and 10.8 Nm ($90^{\circ}/s$) on inversion; average 12.9 Nm ($30^{\circ}/s$) and 8.0 Nm ($90^{\circ}/s$) on eversion. The deficit ratio of strength in women was average 61.1% of men on dorsiflexion; average 66.2% on plantarflexion; average 48.5% on inversion; average 55.4% on eversion. The deficit ratio in non-dominant foot was average 88.6% of dominant foot on dorsiflexion; average 90.1% on plantarflexion; average 85.1% on inversion; average 85.6% on eversion. Conclusion: The muscle strength of the ankle joint showed a tendency to weaken with age. There were significant differences in muscle strength by gender and dominancy. Further studies for comparison of patients with ankle instability, a comparison between before and after surgery for instability, the correlation between clinical outcomes and the recovery in muscle strength will be needed.

이소성 골형성으로 인한 주관절 강직에서 12개월 이내에 시행한 수술적 치료의 효과

김용민(Yong-Min Kim),박지강(Ji-Kang Park),정수리(Suri Chong) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.6

이소성 골형성으로 인해 주관절 운동 제한이 발생한 5예에 대해 1년 이내에 수술적 치료를 시행하였다. 수상 시로부터 평균 10개월에 수술적 치료로 이소성 골제거술 및 관절 유리술을 시행하였고 방사선 요법은 700 cGy로 1회 시행하였다. 비스테로이드성 소염제는 평균 4주간 사용하였다. 평균 21개월의 추적관찰 기간 중 이소성 골형성의 재발은 발생하지 않았다. 최종 추시에는 굴곡-신전 운동의 범위가 평균 64도에서 133도로 증가하였다. 이소성 골형성으로 인한 주관절의 운동제한이 발생한 경우 수상 시로부터 수술 시점은 기존에 제시되던 12-18개월보다 적은 1년 이내라도 방사선 치료 및 비스테로이드성 소염제를 동반한 수술적 치료로 효과적인 결과를 얻을 수 있었다. Five patients presented with a limited range of motion in their elbow associated with heterotopic ossification. All of these patients underwent surgery within one year. Removal of heterotopic ossification and a posterior capsular release was performed within ten months on average after the initial injury. Each patient postoperatively received prophylaxis consisting of a single-shot radiation of 700 cGY and administration of nonsteroidal anti-inflammatory drugs (NSAIDs) for four weeks on average. With a median follow up period of 21 months, five patients had no radiographic evidence of recurrence. The arc of flexion-extension increased from an average of 64 degrees preoperatively to 133 degrees at the latest follow up. A 12- to 18-month period is generally recommended as necessary for an operation on an ankylosed elbow associated with heterotopic ossification. However, the operative treatment, together with radiation therapy and NSAIDs administration, showed good results within 12 months.