짧은 아킬레스건의 의미

원성훈,천동일,Won, Sung Hun,Chun, Dong-Il 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.2

This review article attempts to describe several pathological conditions that can arise from the shortening of the Achilles tendon. The tension and tightening of the gastrocnemius-soleus-Achilles tendon complex (GSAC) can cause disharmony in the movement of the entire foot as well as the ankle joint when subjected to weight-bearing or walking. In addition, since these phenomena are observed in various lesions of the ankle joint, the dynamic shortening caused by the tension of GSAC may not be the primary cause of various ankle joint lesions, but is still considered to be a significant contributing factor.

일교차가 당뇨병성 창상의 치유에 미치는 영향: 동물 실험 연구

원성훈,천동일,조재호,박인근,이영,Won, Sung Hun,Chun, Dong-Il,Cho, Jaeho,Park, In Keun,Yi, Young 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.4

Purpose: Diabetic foot ulcers are closely related to body surface heat, which can be affected easily by temperature differences. This study examined the correlation between the healing process of diabetic wounds and abnormal diurnal temperature through an animal study. Materials and Methods: Rats in the abnormal diurnal temperature group and control group were given a 10 mm sized full-thickness skin ulcer. Wound size progression was observed in both groups. H&E and Masson's trichrome staining was performed at 14 days after wound formation, and the number of vessels per unit area and histology analysis were performed. The changes in the ulcer were measured through three dimensional cross-section area using INSIGHT^® devices. Results: The wound recovery period (granulation ingrowing) was 24 days in the abnormal diurnal temperature model and 20 days in the control group. The thickness of scar tissue was 402±23.19 ㎛ in the control group and 424.5±36.94 ㎛ in the diurnal temperature model. Neovascular formation was counted as 5.1±0.97 for the control group and 4.16±0.94 for the diurnal temperature model group. Conclusion: Delayed and inferior diabetic wound healing was observed in the abnormal diurnal temperature group, which was characterized by greater diurnal variations than the typical growth environment.

스포츠 손상에 의한 아킬레스건의 급성 분절 파열: 증례 보고

천동일,원성훈,이상현,조재호,Chun, Dong-Il,Won, Sung Hun,Lee, Sang Hyeon,Cho, Jaeho 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.2

Tendoachilles rupture has recently seen an increase in frequency, accounting for up to 40% of all tendon ruptures. However, an acute segmental rupture of the Achilles tendon is very rare with only one case caused by predisposing factors, such as steroid injection. In this report, we highlight an unusual clinical presentation of a segmental rupture of the Achilles tendon without any underling predisposing factor and without direct trauma. Herein, we discuss its mechanism. Twelve months after surgical repair with open technique, this patient became fully functional again in daily activity.

무수혈 환자에서 시행한 인공관절 치환술의 혈역학적 분석

서유성(You-Sung Suh),최형석(Hyung-Suk Choi),원성훈(Sung-Hun Won),김명회(Myoung-Hoe Kim),천동일(Dong-Il Chun),노재휘(Jae-Hwi Nho) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.6

목적: 무수혈 환자군을 대상으로 인공관절 치환술 시행함에 있어 수혈 대체 요법을 적용하고 혈역학적 변화를 분석하여 그 결과를 알아보고자 하였다. 대상 및 방법 : 인공슬관절 치환술 및 인공고관절 치환술을 시행 받은 48명의 환자 57예를 대상으로 하였다. 수술 당시 평균 연령은 70.9세 였다. 총 57예 중 인공 슬관절 치환술 15예, 인공 고관절 치환술은 42예에서 시행하였다. 술 전 혈색소 수치가 10g/dL 이상인 경우 재조합 에리스로포에틴 2,000 단위를 일주일, 경구철분제 일주일을 투여하였고 혈색소 수치가 10g/dL 이하인 경우 재조합 에리스로포에틴 4000단위를 일주일, 경구철분제나 베노페롬을 일주일 투여하였다. 술 중에는 술 전 혈색소치에 상관없이 자가수혈, 혈장증량제, 국소지혈제를 사용하였으며, 술 후에는 재조합 에리스로포에틴 4,000 단위, 베노페롬을 일주일 투여하였다. 결과: 내원 시 평균 혈색소 수치가 10g/dl 이상인 환자군은 수술 후 7일째 평균 혈색소 수치가 10.7g/dl로 평균 1.85g/dl의 감소율을 보였고, 내원 시 평균 혈색소 수치가 10g/dl 이하인 환자군은 수술 후 7일째 평균 혈색소 수치가 9.18g/dl이었다. 인공 슬관절 치환술을 시행한 환자군은 내원 시 혈색소 수치가 12.8g/dl에서 수술 후 7일째 혈색소 수치가 10.96g/dl, 인공 고관절 치환술을 시행한 환자군은 내원시 혈색소 수치가 13.4g/dl에서 수술 후 7일째 혈색소 수치가 11.8g/dl, 재치환술을 시행한 환자군은 내원 시 혈색소 수치가 13.8g/dl에서 수술 후 7일째 혈색소 수치가 12.75g/dl였다. 결론: 무수혈 환자에서 정형외과적 인공관절 치환술시 적절한 수혈대체 요법의 정립이 필요하며 저자들은 적극적인 수혈 대체 요법의 적용을 통해 혈역학적 관점에서 좋은 결과를 얻었다. Purpose: To analyze the hemodynamic changes in patients who underwent total joint arthroplasty and received alternative treatment to blood transfusion. Materials and Methods: Fifty-seven cases in 48 patients who received total knee and hip arthroplasty between 1998 September and 2008 February were enrolled. The mean age at the point of surgery was 709 years. The types of joint arthroplasty included 15 cases of total knee arthroplsty and 42 cases of total hip arthroplasy. Alternatives to blood transfusion entailed administration of 2,000 units of recombinant EPO and oral iron supplement for 1 week in patients with preoperative hemoglobin level higher than 10 g/dl, and 4,000 units of recombinant EPO with oral iron supplement or venoferrum for 1 week in patients with preoperative hemoglobin level lower than 10 g/dl. Intra-operatively, autotransfusion, plasma expander, topical hemostatic agents were used irrespective of the preoperative hemoglobin level. Postoperatively, 4,000 unit of recombinant EPO and venoferrum were administered for one week. Results: Patients with mean hemoglobin level higher than 10 g/dl exhibited mean hemoglobin level of 10.7 g/dl (a mean 1.85 g/dl decrease) 7 days after the operation. Patients with mean hemoglobin level lower than 10 g/dl exhibited increased mean hemoglobin level of 9.18 g/dl (a mean 0.38 g/dl decrease) 7 days after the operation Patients who underwent total knee arthroplasty exhibited reduction of hemoglobin from 12.8 g/dl to 10.96 g/dl (a mean decrease of 14 g/dl) 7 days after the operation Patients who underwent total hip arthroplasty exhibited a change of hemoglobin from 13.4 g/dl to 11.8 g/dl (a mean decrease of 1.84 g/dl) 7 days after the operation. Patients who underwent revision arhtroplasty exhibited a change of hemoglobin from 13.8 g/dl to 12.75 g/dl (a mean decrease of 1.05 g/dl) 7days after the operation. Conclusion: In patients who refuse blood transfusion, there is a need to establish an adequate alternative blood management plan for surgery, such as total joint arthroplasty. We obtained good results with the hemodynamic protocol adapted for the perioperative period.

골용해의 진단 및 치료

서유성 ( You Sung Suh ),원성훈 ( Sung Hun Won ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms cement disease. However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms particle disease. In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weightpolyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.

정맥혈전 색전증 고위험군에서 시행한 혈전색전 예방요법(American College of Chest Physicians 지침 및 American College of Orthopedic Surgeons 지침)의 준수율 비교 연구

서유성(You-Sung Suh),노재휘(Jae-Hwi Nho),장병웅(Byung-Woong Jang),강덕원(Deokwon Kang),원성훈(Sung-Hun Won) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.4

목적: 인공관절 치환술 및 고관절 골절 환자에서 시행한 2가지 정맥혈전 색전증 예방요법의 준수율을 비교 분석하고자 하였다. 수술후 발생하는 정맥혈전 색전증은 인공 슬관절 치환술이나 인공 고관절 치환술 및 고관절 골절 수술 후 발생하는 가장 심각한 합병증이다. 이에 대한 적절한 예방이 무엇보다 중요하기 때문에 항응고제 사용의 필요성 또한 증가하고 있다. 대상 및 방법: 2009년 3월부터 2011년 2월, 2012년 3월부터 2014년 2월까지 순천향대학교 부속 서울병원에서 인공 슬관절 치환술, 고관절 전치환술 및 고관절 골절로 고관절 반치환술 및 내고정술을 시행받은 환자들을 의무 기록과 영상 검사를 검토하여 각각 American College of Chest Physicians (ACCP) 가이드라인과 American College of Orthopedic Surgeons (AAOS) 가이드라인에 따라 시행한 정맥혈전 색전증 예방요법의 준수율을 후향적으로 비교 분석하였다. 결과: 인공관절 치환술 및 고관절 골절 환자에서 정맥혈전 색전증 예방을 위한 가이드라인이 적용되고 있으며 실제로 ACCP 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 수술 전에 56.0%, 수술 후에는 67.0%, 물리적 요법에서는 80.5%의 준수율을 보였다. 또한 AAOS 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 74.1%, 물리적 요법에서는 88.3%의 준수율을 보이며 ACCP 가이드라인에 비해 높은 준수율을 보였다. ACCP 가이드라인의 수술 전 후 화학적 예방요법과 물리적 예방요법의 준수율과 AAOS 가이드라인의 화학적 예방요법과 물리적 예방요법의 준수율을 비교 분석하였으며, 인공 슬관절 치환술의 수술 전과 후, 고관절 골절 수술의 수술 전과 후, 전체 고위험군 수술에서 수술 전과 후 유의한 차이를 보였다(p<0.05). 결론: 정맥혈전 색전증 고위험군 수술에서 정맥혈전 색전증 예방요법의 가이드라인에 따른 준수율을 전반적으로 높여서 적절한 예방이 이루어지도록 해야 하며, 일선 정형외과의를 위한 통일된 방향의 가이드라인이 필요할 것이다. Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

인공관절 치환술 후 CRP 수치를 이용한 급성 감염의 예측

서유성(You-Sung Suh),최형석(Hyung-Suk Choi),노재휘(Jae-Hwi Nho),원성훈(Sung-Hun Won),최종원(Jong-Won Choi),이재철(Jae-Chul Lee),박종석(Jong-Seok Park) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.2

목적: 인공관절 치환술 후 4주 이내의 급성 감염에서 측정된 C-반응성 단백(C-reactive protein, CRP)의 변화 양상을, 감염이 없었던 인공관절 환자군과 비교하여 차이점을 분석하고자 하였다. 대상 및 방법: 하지 인공관절 치환술 후 4주 이내에 발생한 급성 술 후 감염 환자 33예(고관절: 26예, 슬관절: 7예)를 대상으로 하여, CRP를 측정하여 같은 기간 감염이 없었던 환자군 50예(고관절 25예, 슬관절 25예)의 CRP 변화 양상과 비교하고 분석하였다. 결과: 비감염군에서는 술 후 2-3일째 CRP의 급격한 상승 후 수술 3주째까지 지속적인 감소 추세를 나타내지만, 심부 감염군에서는 술 후 13일경, 천부 감염군에서는 술 후 10일경에 CRP의 상승이 나타나는 bimodal curve를 나타내었다. 결론: 인공관절 치환술 후 CRP가 재상승하는 양상(bimodal pattern)인 경우 급성 술 후 감염을 의심하여 적극적인 조기 검사 및 치료를 통해 효과적인 치료를 할 수 있었다. Purpose: C-reactive protein (CRP) has been shown to be useful in the diagnosis of periprosthetic infection. This study analyzed the serial CRP measurements in patients with acute postoperative infection by comparing with the serial CRP measurements in patients without postoperative infection. Materials and Methods: From 2004 to 2009, 33 patients with acute postoperative infection developed within 4 weeks of surgery were enrolled including 26 cases of hip arthroplasty and 7 cases of total knee arthroplasty. We measured the serial CRP levels in the groups with both deep infection and superficial infection. The CRP measurements in the group without postoperative infection were also analyzed based on the changing pattern of CRP. Results: In the non-infected group, CRP level sharply increased in 2-3 days postoperatively and it showed a continuing downward pattern till the third postoperative week. However, a bimodal curve pattern was obtained in the groups with both deep and superficial infection. The group with deep infection showed a second increase in CRP level around the 13th postoperative day and the group with superficial infection showed a second increase in CRP level around the 10th postoperative day. Conclusion: If there are bimodal patterns of CRP after arthroplasty, acute postoperative infections can be suspected. We can treat them effectively without delay by detection of bimodal increase in CRP.

당뇨병성 족부 궤양 환자의 진단 1년 내의 절단율 및 위험 인자의 분석

천동일,전민철,최성우,김용범,노재휘,원성훈,Chun, Dong-Il,Jeon, Min Chul,Choi, Sung-Woo,Kim, Yong-Beom,Nho, Jae-Hwi,Won, Sung Hun 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.3

Purpose: This study investigates the amputation rate within 1 year after the diagnosis of diabetic foot ulcer and its associated risk factors. Materials and Methods: This study enrolled 60 patients with diabetic foot ulcer. The mean and standard deviation age was $64.4{\pm}12.8years$ (range, 32~89 years); the mean and standard deviation prevalence period for diabetes mellitus was $21.0{\pm}7.5years$ (range, 0.5~36 years). The amputation rate was evaluated by dividing the subjects into two groups - the major and minor amputation groups - within 1 year following the initial diagnosis of diabetic foot ulcer. Multivariate Cox proportional hazards regression analysis was used to identify the risk factors for amputation. Results: The total amputation rate of 38.3% (n=23) was comprised of the amputation rate for the major amputation group (10.0%) and rate for the minor amputation group (23.8%). There was a high correlation between peripheral artery disease (toe brachial pressure index <0.7) and amputation (hazard ratio [HR] 5.81, confidence interval [CI] 2.09~16.1, p<0.01). Nephropathy was significantly correlated with the amputation rate (HR 3.53, CI 1.29~9.64, p=0.01). Conclusion: Clinicians who treat patients with diabetic foot complications must understand the fact that the amputation rate within 1 year is significant, and that the amputation rate of patients with peripheral artery disease or nephropathy is especially high.

종골 길이와 너비의 상관관계를 이용한 종골 너비 추정에 관한 연구

천동일,황수강,조재호,최성우,김용범,원성훈,Chun, Dong-il,Hwang, Shu Chiang,Cho, Jae-ho,Choi, Sung-Woo,Kim, Yong Beom,Won, Sung Hun 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.2

Purpose: The purpose of this study was to determine the correlation and ratio between the calcaneal length and width for predicting the width of calcaneus. Materials and Methods: A total of 190 feet (190 patients) were included based on computed tomography scans. The length of calcaneus (CL) was measured on the line connecting the center of a circle tangent to the cortical margin in the anterior and posterior parts of the calcaneus in a sagittal plane (W1, W2). The width of the calcaneus was defined as the horizontal line of each part (W1, W2, W3) on the same axial plane. The relationship between the measurement was determined through a correlation analysis. The reliability was assessed based on intraclass correlation coefficients. Results: The CL and widths of calcaneus (W1, W2, W3) had a good positive correlation (r=0.848 [W1/CL], r=0.738 [W2/CL], r=0.769 [W3/CL]; p<0.001). The mean CL and widths ratios were 0.33 (W1/CL), 0.37 (W2/CL), and 0.37 (W3/CL). Using these ratios to estimate the widths by multiplying each ratio by the measured calcaneal length, we found a difference between the estimated calcaneal widths and the actual measured calcaneal widths values was 0.25 mm, 0.43 mm, and 0.16 mm. All measurements showed good-to-excellent inter- and intraobserver reliability. Conclusion: This study analyzed the correlation and ratio between the length and width of the calcaneus. The results will help orthopedic surgeons fixate screws in a stable manner to prevent iatrogenic injuries to the medial neurovascular structures of the calcaneus.

NexGen CR-Flex(R)를 이용한 슬관절 전치환술의 단기 추기 결과

임수재 ( Soo Jae Yim ),유재호 ( Jae Ho Yoo ),서유석 ( Yu Seok Seo ),원성훈 ( Sung Hun Won ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

목적: 고도 굴곡 후방십자인대 보존형 고안의 NexGen CR-Flex(R) (Zimmer, Warsaw, IN, USA)을 사용하여 슬관절 전치환술을 시행한 환자의 최소 2년 추시에서 관절 운동 범위를 포함한 임상적 결과를 조사하였다. 대상 및 방법: 2005년 8월부터 2006년 5월까지 단일 술자에 의해 NexGen CR-Flex(R)를 사용하여 슬관절 전치환술을 시행한 환자 63명 98예를 대상으로 하였다. 수술 시 평균 연령은 67.4세(52~81세)였으며, 평균 추시 기간은 28개월이었다. 임상적 결과의 평가는 HSS(Hospital for Special Surgery) 점수와 슬관절 운동 범위를 측정하였고, 최종 추시상 쪼그려 앉거나, 무릎을 꿇는 자세가 가능한지 조사하였다. 방사선학적으로 대퇴경골각, 방사선 투과선의 여부와 대퇴 후과 옵셋(posterior condylar offset)을 측정하였다. 결과: 평균 HSS 점수는 수술 전 58.3점(43~71)에서 최종 추시상 91.1점(81~96)으로 호전을 보였다. 관절 운동 범위는 수술 전 평균 123.2°에서 최종 추시상 137.1°로 호전되었으며, 최종 추시상 49명(78%)에서 쪼그려 앉을 수 있었으며 24명(38%)에서 무릎 꿇는 자세가 가능하였다. 대퇴경골각은 수술 전 평균 내반 6°에서 수술 후 외반 7°였으며, 방사선 투과선은 한 예에서도 발견되지 않았다. 대퇴 후과 옵셋은 수술 전 평균 26.1 mm (22~35 mm)에서 수술 후 27.2 mm로 측정되었다. 결론: NexGen CR-Flex(R)를 이용한 슬관절 전치환술은 평균 28개월(24~33개월) 추시상 만족할 만한 결과를 얻었다. 우수한 관절 운동 범위를 얻기 위해서는 적절한 환자를 선정하고, 수술 중 대퇴 후과 옵셋을 잘 복원하고, 대퇴 후과의 골극을 세심히 제거하는 술기를 사용하는 것이 중요할 것으로 판단된다. Purpose: The purpose of this study is to evaluate the result of primary total knee arthroplasty(TKA) with using NexGen CR-Flex(R) (Zimmer, Warsaw, IN, USA) after a follow-up of at least 2 years. Materials and Methods: A total of 63 patients (98 knees) were included in this study. The same surgeon performed all the TKAs between August 2005 and May 2006 with using NexGen CR-Flex(R). The patients` age ranged from 52 to 81 years, and the mean follow-up period was 28 months. The patients were assessed clinically and radiographically with using the HSS score, the possibility that they could squat or kneel, the tibiofemoral angle, the radiolucency and the posterior condylar offset. Results: The mean HSS score was 58.3 points preoperatively, and it was 91.1 points at the last follow-up. The mean range of motion improved from 123.2° preoperatively to 137.1° postoperatively. Forty-nine patients (78%) were able to squat and 24 patients (38%) could kneel down at the last follow-up. The mean tibiofemoral angle was 6° of varus preoperatively, and 7° of valgus postoperatively. And there was no radiolucency in any case. The mean posterior condylar offset was 26.1mm preoperatively and 27.2 mm postoperatively. Conclusion: TKA with using NexGen CR-Flex(R) showed favorable results at a mean follow-up of 28 months. Adequate patient selection, restoration of the posterior condylar offset and thorough clearing of posterior condylar osteophytes are thought to be the key elements to achieve a satisfactory range of motion after TKAs.