수술 후 컴퓨터 단층촬영을 이용한 관절 내 종골 골절의 정복과 임상 결과 간의 연관성 분석

엄준상,주영득,김성준,신민호,이동오,정홍근,Eom, Joon-Sang,Joo, Young-Deuk,Kim, Seong-Jun,Shin, Min-Ho,Lee, Dong-Oh,Jung, Hong-Geun 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, B${\ddot{O}}$hler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was $84.1{\pm}8.5$ and $2.2{\pm}2.2$. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average B${\ddot{O}}$hler angle was restored from $11.1^{\circ}$ to $24.7^{\circ}$(p<0.05), Gissane angle was changed from $121.0^{\circ}$ to $119.0^{\circ}$ (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, B${\ddot{O}}$hler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with B${\ddot{O}}$hler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.

요내반족 변형에 대한 재건수술의 임상적 및 방사선학적 결과 분석

정홍근,박재용,이동오,엄준상,정승희,Jung, Hong-Geun,Park, Jae-Yong,Lee, Dong-Oh,Eom, Joon-Sang,Chung, Seung-Hee 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.2

Purpose: Reconstructive surgeries for equinocavovarus foot deformities are quite variable, including hind-midfoot osteotomy or arthrodesis, soft tissue procedure, tendon transfers, etc. Comprehensive evaluation of the deformity and its etiology is mandatory for achievement of successful deformity correction. Few studies in this field have been reported. We report on the clinical and radiographic outcome of reconstruction for cavovarus foot deformities. Materials and Methods: The study is based on 16 feet with cavovarus foot deformities that underwent bony and soft tissue reconstructive surgery from 2004 to 2008. We evaluated the etiologies, varieties of surgical procedures performed, pain score, functional scores, and patient satisfaction and measured the radiographic parameters. Results: The average age at the time of surgery was 39.4 years old, with a male/female ratio of 9/4 and an average follow-up period of 23.9 months (range, 12~49 months). The etiologies of the cavovarus deformity were idiopathic 7 feet, residual poliomyelitis 5 feet, Charcot-Marie-Tooth disease 2 feet, and Guillain-Barre syndrome and hemiplegia due to cerebrovascular accident sequela 1 foot each. Lateral sliding calcaneal osteotomies were performed in 12 feet (75%), followed by Achilles tendon lengthening and plantar fascia release in 11 feet (69%), and first metatarsal dorsiflexion osteotomy/arthrodesis and tendon transfer in 10 feet (63%). Visual analogue scale pain score showed improvement, from an average of 4.2 to 0.5 points. American Orthopaedic Foot and Ankle Society ankle-hindfoot score showed significant improvement, from 47.8 to 90.0 points (p<0.05). All patients were satisfied. Ankle range of motion improved from $27.5^{\circ}$ to $46.7^{\circ}$. In radiographic measurements, calcaneal pitch angle improved from $19.1^{\circ}$ to $15.8^{\circ}$, Meary angle from $13.0^{\circ}$ to $9.3^{\circ}$, Hibb's angle from $44.3^{\circ}$ to $37.0^{\circ}$, and tibio-calcaneal axis angle from varus $17.5^{\circ}$ to varus $1.5^{\circ}$ Conclusion: We achieved successful correction of cavovarus foot deformities by performing appropriate comprehensive reconstructive procedures with improved functional, radiographic measures and high patient satisfaction.

소아 유연성 편평족에서 Kalix<SUP>®</SUP> 족근동 기구를 이용한 거골하 관절 제동술

황석민(Seok-Min Hwang),엄준상(Joon-Sang Eom),이동오(Dong-Oh Lee),이종수(Jong-Soo Lee),김성욱(Sung-Wook Kim),원태구(Tae-Gu Won),정홍근(Hong-Geun Jung) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.6

목적: 소아의 유연성 편평족에 대한 거골하 관절 제동술의 방사선적 및 임상적 결과를 평가하고자 하였다. 대상 및 방법: 2007년 3월부터 2012년 6월까지 건국대학교병원에서 편평족으로 진단 후 거골하 관절 제동술을 시행받은 10명, 14예의 환자를 대상으로 하였다. 방사선적으로는 측면 방사선 사진을 통하여 거골-제1 중족골 간 각, 거골 수평면각 및 종골 경사각을 측정하였다. 전후면 방사선 사진을 통하여 거주상골 피복각 및 거골-제1 중족골 간 각을 측정하였고, 후족부 정렬 사진을 통하여 경골-종골각을 측정하였다. 임상적 평가로는 수술 전후의 visual analogue scale (VAS) 통증 지수와 미국 정형외과 족부족관절학회(American Orthopaedic Foot and Ankle Society, AOFAS) 기능 점수를 조사하였다. 결과: 평균 추시 기간은 48.7개월(16-98개월)이었으며, 평균 연령은 11.6세(6-19세)였다. 방사선적 측면 족부 방사선 사진상에서 거골-제1 중족골 간 각은 술 전 평균 -25.1도에서 술 후 평균 -7.5도, 거골 수평면각은 술 전 평균 37.4도에서 술 후 평균 23.2도 및 종골 경사각은 술 전 평균 8.3도에서 술 후 평균 15.0도로 각각 향상 측정되었다. 전후면 방사선 사진에서 측정한 거주상골 피복각은 술 전 평균 23.0도에서 술 후 평균 11.9도로, 거골-제1 중족골 간 각은 술 전 평균 17.2에서 술 후 평균 9.0도로 감소하였다. 또한 후족부 정렬상 경골-종골 각은 술 전 평균 외반 17.4도에서 술 후 평균 외반 4.5도로 호전되었다. 임상적으로는 VAS 통증 점수는 술 전 5.8점에서 술 후 1.5점으로, AOFAS 점수는 술 전 61.8점에서 술 후 90.4점으로 향상되었다. 합병증으로는 족근동 통증이 5예(35.7%)에서 발생하였다. 결론: 소아의 유연성 편평족 환자에서 족근동 삽입물을 이용한 거골하 관절 제동술을 시행하여 방사선적 및 임상적으로 우수한 결과를 얻었고, 편평족 변형에 대해 만족스러운 교정을 얻을 수 있었다. 하지만 수술 후 체중 부하 시 족근동 통증의 높은 발생 가능성에 대해서는 유념하여야 할 것이다. Purpose: The purpose of this study was to evaluate the radiographic and clinical outcomes of subtalar arthroereisis as a method of treatment for pediatric flexible flatfoot. Materials and Methods: We retrospectively investigated 14 feet among 10 patients with flexible flatfoot, who were treated with a subtalar arthroereisis using a sinus tarsi implant between March 2007 and June 2012. Radiographically, the talo-1st metatarsal angle, talar declination, and calcaneal pitch angle have all been measured on lateral radiographs. The talo-navicular coverage angle and talo-1st metatarsal angle was measured on anteroposterior (AP) radiographs and tibio-calcaneal angle was assessed by hindfoot alignment view. Visual analogue scale (VAS) pain scores and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were used for clinical evaluation. Results: The mean follow-up was 48.7 months (16–98 months), and the mean age was 11.6 years (6–19 years). Radiographically, the mean pre-operative and postoperative values measured by the lateral foot radiograph were -25.1° and -7.5° for talo-1st metatarsal angle, 37.4° and 23.2° for talar declination, and 8.3° and 15.0° for calcaneal pitch angle, respectively. The mean preoperative and postoperative values measured by foot AP radiograph were 23.0° and 11.9° for talo-navicular coverage angle and 17.2° and 9.0° for talo-1st metatarsal angle, respectively. Moreover, tibio-calcaneal angle improved from valgus 17.4° on average to 4.5° on average. Clinically, the VAS score and AOFAS score was improved from 5.8 to 1.5 and from 61.8 to 90.4, respectively. Complication was sinus tarsi pain that occurred in 5 cases (35.7%). Conclusion: We achieved a satisfactory correction of pediatric flexible flatfoot deformities via subtalar arthroereisis, using a sinus tarsi implant with favorable radiographic and clinical measures. However, high potential complication rate of postoperative sinus tarsi pain on weight-bearing should carefully be considered.

내측부 족관절염에 대한 과상부 경골 절골술

박종태(Jong-Tae Park),엄준상(Joon-Sang Eom),정홍근(Hong-Geun Jung) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.2

목적: 족관절 내측부에 국한된 골관절염에서 과상부 경골 절골술의 임상적, 방사선학적 결과를 통해 과상부 경골 절골술의 유용성을 알아보고하고자 하였다. 대상 및 방법: 2007년 8월부터 2011년 6월까지 내측부 족관절염 진단하에 과상부 경골 절골술을 시행하고 1년 이상 추시가 가능하였던 9명의 환자를 대상으로 하였다. 임상적 평가로는 수술 전후의 visual analogue scale (VAS) 통증 지수와 미국 정형외과 족부족관절학회(American Orthopaedic Foot and Ankle Society, AOFAS) 기능 점수 등을 조사하였다. 방사선학적으로는 tibial anterior surface (TAS) 각과 tibial lateral surface 각, Takakura 족관절염 분류를 이용하여 조사하였다. 결과: VAS 통증 점수는 0.6점으로 유의하게 감소하였으며, AOFAS 점수 또한 89.3점으로 유의하게 향상되었다. TAS 각은 술 후 93.5도의 경도의 외반 변형으로 유의하게 증가하였으며, Takakura 분류상 IIIa였던 7예가 술 후 등급 II로 향상되었다. 결론: 내측부에 국한된 내반형 족관절염 환자에서 과상부 경골 절골술을 시행하여 만족할 만한 결과를 얻을 수 있었으며, 특히 Takakura IIIa 단계에서 추천할 만한 수술 기법임을 확인할 수 있었다. Purpose: The aim of this study is to evaluate the clinical and radiologic outcomes of supramalleolar tibial osteotomy for medial compartment ankle osteoarthritis (OA) and to verify the efficacy of the supramalleolar osteotomy. Materials and Methods: This study is based on 9 ankles of the medial compartment ankle OA treated with supramalleolar tibial osteotomy from August 2007 to June 2011 with at least 1 year follow-up. As for the functional evaluation, visual analogue scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were evaluated. On radiographs, tibial anterior surface (TAS) angles, tibial lateral surface angles were measured. The severity of ankle OA was classified by the Takaura staging system. Results: The mean VAS pain scores improved to 0.6 and AOFAS scores improved to 89.3. Radiographically, TAS angle increased to 93.5o postoperatively. Seven ankles showed improvement of the ankle arthritis grading from IIIa to II according to Takakura’s staging. Conclusion: Supramalleolar tibial osteotomy for patients with medial compartment varus ankle OA showed satisfactory clinical and radiological outcome. We confirmed that the procedure is recommendable for medial compartment varus ankle OA especially for Takakura stage IIIa.

Mobility 족관절 치환물을 이용한 족관절 전치환술의 단기 추시 결과

정홍근(Hong-Geun Jung),이동오(Dong-Oh Lee),이상헌(Sang-Hun Lee),엄준상(Joon-Sang Eom) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.2

목적: 최근 인공관절 치환술은 고무적인 임상 결과로 고정술을 대신해 말기 족관절염의 수술적 치료로 주목받고 있다. 이에 저자들은 Mobility 치환물을 이용한 임상적 및 방사선학적 단기 추시 결과 및 동반 수술에 대해서 보고하고자 한다. 대상 및 방법: 2008년부터 2013년까지 말기 족관절염 환자에 대해 Mobility 치환물을 이용한 족관절 인공관절 치환술 40예, 39명을 대상으로 하였다. 평균 추시 기간은 20.8개월이었고 수술 시 평균 연령은 63.7세였다. 26예(65%)는 외상 후 관절염이었다. 동반 시행한 술기 및 수술 전, 후 visual analogue scale (VAS) 동통 점수, American Orthopaedic Foot and Ankle Society (AOFAS) 기능 평가, 방사선학적 계측과 환자 만족도 등을 조사하였다. 결과: VAS 동통 점수는 술 전 7.7점에서 2.8점으로 감소하였고, AOFAS 점수는 술 전 46.8점에서 82.4점으로 향상되었다. 만족도는 81%에서 만족 이상이었다. 21예에서 동반 수술을 시행하였고 합병증이 28예, 그 중 12예에서 재수술을 시행였하다. 결론: 본 연구로 족관절 전치환술에 대한 단기 추시상 임상적으로 만족할 만한 결과를 얻었으며, 상당한 경우에서 보조적 동반 수술이 필요함을 확인할 수 있었다. 그러나 향후 보다 많은 증례에 대한 장기 추시가 필요할 것으로 생각된다. Purpose: Recently, minimally constrained 3-component total ankle systems have been often performed to address painful ankle arthritis. We report early clinical and radiographic outcome of the total ankle arthroplasty with Mobility system for end-stage ankle arthritis. Materials and Methods: Total ankle arthroplasty was performed with Mobility total ankle system in 40 ankles (39 patients) from November 2008 to January 2013. The mean age at surgery was 63.7 years (range, 50-78 years). The mean follow-up duration was 20.8 months (range, 12-56 months). The primary etiology for ankle arthritis was post-traumatic arthritis (26 ankles, 65%). The outcome was assessed based on visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot function score, patient satisfaction and radiographic measurements. Results: There was a significant reduction in VAS pain score from an initial average of 7.7 points (range, 5-10 points) to 2.8 points at the final follow-up (range, 0-7) (p<0.05). The mean AOFAS score improved significantly from 46.8 (range, 15-68) preoperatively to postoperatively 82.4 (range, 63-100) (p<0.05). Eighty-one percent of patients were satisfied with the result. Combined surgeries, such as Achilles tendon percutaneous lengthening, were performed in twenty-one cases of 40 ankles. Conclusion: The current short term results of Mobility total ankle arthroplasty showed a quite favorable functional and radiographical outcome with few major complications. However, the long term follow-up study with larger number of cases is needed in the future.

고령 환자에서 관찰되는 족관절 외과 골절 양상 및 잠김 압박 금속판 고정술의 임상 결과

황석민(Seok-Min Hwang),정홍근(Hong-Geun Jung),정형진(Hyung-Jin Chung),엄준상(Joon-Sang Eom),이동오(Dong-Oh Lee),조정현(Jung-Hyun Cho),박종태(Jong-Tae Park) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.1

목적: 외과 골절의 치료에 있어 잠김 금속판의 이점에 관한 여러 연구 결과가 있었으나 고령의 외과 골절에 대한 연구는 많지 않았다. 따라서 고령의 외과 골절 양상과 잠김 금속판을 이용한 후 그 임상 결과에 대하여 고찰하였다. 대상 및 방법: 65세 이상의 외과 골절을 잠김 압박 금속판을 이용하여 수술 시행 후 1년 이상 추시가 가능했던 21명을 대상으로 연구를 시행하였다. Lauge-Hansen 및 Danis-Weber 골절 분류법을 사용하였으며, 임상적 평가는 최종 visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) 점수, 만족도, 족관절 운동 범위를 평가하였고, 골 유합 및 내고정물 이완 등을 방사선적으로 평가하였다. 결과: 평균 나이는 71.2세, 최종 추시 평균 VAS는 1.6점, AOFAS는 94.2점이었으며, 18예(85.7%)에서 만족 이상의 만족도를 보였다. 분쇄 골절이 8예, 지연 나사 삽입이 가능한 군은 7예였다. 평균 골 유합 시기는 3.6개월이었다. 부정 유합은 5예 관찰되었고, 불유합, 정복 소실이나 내고정물 해리는 없었다. 결론: 본 연구에서 고령의 족관절 외과 골절은 술 후 만족도와 통증만이 유의한 관련이 있었으며, 잠김 압박 금속판은 자극 증상을 일으키는 경우가 있었으나 그 외 의미있는 합병증 없이 치료에 유용하였다. Purpose: Several studies have reported on the biomechanical advantages of a locking compression plate (LCP) for treatment of lateral malleolar fracture. However, few studies have reported clinical outcome after treatment of lateral malleolar fracture using a LCP in elderly patients. Thus, this study investigated the trends of lateral malleolar fractures in elderly patients and evaluated the clinical and radiological outcome of treating them using a ‘locking compression distal fibula plate’. Materials and Methods: Twenty-one patients (male: 3, female: 18) over 65 years old, who were followed-up for at least one year were enrolled in this study. They were treated surgically with open reduction and internal fixation using a LCP for lateral malleolar fracture from 2011 to 2014. Lauge-Hansen and Danis-Weber classification were used for preoperative classification of fractures. Visual analog scale (VAS) pain scores, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, 4-graded subjective satisfaction and post-operative range of motion were used for the clinical evaluation. Time to bone union, non-union, mal-union, metal failure and implant loosening were assessed for radiographic outcomes. Results: The mean age of patients was 71.2 years old, pain VAS and AOFAS score was 1.6 points and 94.2 points, respectively and 18 cases (85.7%) showed more than satisfaction in subjective satisfaction. Comminuted fracture was observed in 8 cases (38.1%) and lag screw insertion was performed in 7 ankles (33.3%). The mean bony union period was 3.6 months. There were 5 cases of mal-union, no case of non-union and metal failure. Conclusion: Satisfaction level of elderly patients with lateral malleolar fracture was significantly associated with only pain at the final follow-up. Fixation with a LCP distal fibula plate can sometimes lead to metal irritation but largely resulted in good clinical outcome without serious complication.