비골건구를 깊게 하는 술식을 이용한 비골건 아탈구의 수술적 치료

유주형,이윤태,하중원,박융,신영석,Yoo, Ju-Hyung,Lee, Yun-Tae,Ha, Joong-Won,Park, Yung,Shin, Young-Seok 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.2

Purpose: To evaluate the efficiency of fibular groove deepening and superior retinacular reconstruction for peroneal tendon subluxation. Materials and Methods: Six patients who were treated by fibular groove deepening and superior retinacular reconstruction for peroneal tendon subluxation from March 2000 to August 2004 were reviewed retrospectively. Results: No recurrent subluxation of peroneal tendons had occurred. All patients were return to sports by 4 months after surgery and also gained nearly normal range of motion. Five patients were completely pain free, but one patient had mild occasional pain that limit his sports activities. Conclusion: Fibular groove deepening and superior retinacular reconstruction was believed to be a reliable procedure for peroneal tendon subluxation in spite of some minor complications.

관절경하 반월연골판 부분절제술 후 발생한 총장골정맥의 심부정맥 혈전증의 증례보고

유주형 ( Ju Hyung Yoo ),장기준 ( Ki Joon Jang ),이윤태 ( Yun Tae Lee ),박상훈 ( Sang Hoon Park ),심동우 ( Dong Woo Shim ) 대한스포츠의학회 2012 대한스포츠의학회지 Vol.30 No.2

Knee arthroscopy is generally considered a very safe operation with very high success rates. Few reported cases of complications arising from only arthroscopic partial meniscectomy include deep vein thrombosis and pulmonary embolism. In this study, we present the case of a 44-year-old female patient with complications of deep vein thrombosis arising after undergoing an arthroscopic partial meniscectomy. Eight days post-operation, the patient presented with pain and swelling of the lower limb and inguinal area of the same side as the operation and was diagnosed by computed tomography scan with deep vein thrombosis. Apart from obesity, the patient presented with no other risk factors for deep vein thrombosis. The patient was given heparin treatment and discharged once her symptoms were relieved.

최소 내측 광근 절개 도달법[Mini-Midvastus Approach]을 이용한 최소 침습 슬관절 전치환술의 단기 추시 결과

유주형(Ju Hyung Yoo),윤한국(Han Kook Yoon),한창동(Chang Dong Han),윤항섭(Hang Seob Yoon),이윤태(Yun Tae Lee),오현철(Hyun Cheol Oh),성승용(Seung Yong Sung),정현수(Hyun Soo Chung) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.2

목적: 최소 내측 광근 절개 도달법에 의한 최소 침습 슬관절 전치환술의 단기적인 임상적 결과를 분석하고자 한다. 대상 및 방법: 2005년 8월부터 2006년 2월까지 최소 내측 광근 절개법을 이용한 최소 침습 슬관절 전치환술을 시행하여 1년 이상 추시가 가능하였던 77예(61명)를 대상으로 하였다. 모든 예에서 대퇴사두근-보존형 최소 침습 기구와 Nexgen LPS-flex total knee system (Zimmer, Warsaw, IN)을 이용하였고, 수술 전 후 임상자료, 수술 결과, 방사선학적 결과를 분석하였다. 결과: 수술에 의한 합병증은 발생하지 않았으며, 피부 절개 길이는 평균 8.4±0.6 ㎝, 수술 시간은 평균 95.5±5.7분, 수술 후 출혈량은 평균 727.5±315.5 cc였다. 수술 후 경골 삽입물의 정렬 각도는 평균 0.2±1.3° 내반, 대퇴 경골간 각도는 평균 5.8±1.8° 외반이었다. 수술 후 8주와 1년째 관절 운동 범위와 HSS 슬관절 점수는 각각 평균 117±10°, 120±11°와 평균 88.9±7.1, 96.2±4.5였다. 결론: 최소 내측 광근 절개에 의한 최소 침습 슬관절 전치환술은 적절한 수술 수기와 기구를 사용한다면 수술 중에 합병증 발생 없이 양호한 삽입물의 정렬과 임상적 결과를 얻을 수 있는 최소 침습 방법의 하나로 생각된다. Purpose: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. Materials and Methods: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. Results: The length of skin incision was average 8.4±0.6 ㎝ and the operation time was average 95.5±15.7 minutes. The blood loss was average 727.5±315.5 cc. The tibial component alignment angles averaged 0.2±1.3° varus and the tibiofemoral angles averaged 5.8±1.8°. The mean ROM and the mean HSS score was 117±10° and 120±11°, 88.9±7.1 and 96.2±4.5 at eight weeks and one year after surgery respectively. Conclusion: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

저위험군 환자에게 동시에 시행한 양측 슬관절 전치환술의 안전성

유주형(Ju-Hyung Yoo),김성민(Seong-Min Kim),한창동(Chang-Dong Han),이윤태(Yeun-Tae Lee),오현철(Hyun-Cheol Oh),형지호(Jee-Ho Hyung) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

목적: 저위험군 환자에게 있어 한 번의 마취하에 시행한 양측 슬관절 전치환술의 안전성을 알아보고자 한다. 대상 및 방법: 양측에 인공슬관절 전치환술을 시행받은 310명(620예)을 대상으로 저위험군 환자이면서 한번의 마취하에 시행한 경우를 제 1군(179명), 2주 간격으로 시행한 경우를 제 2군(97명), 한쪽을 수술 후 재입원하여 반대측을 시행한 경우를 제 3군(34명)으로 구분하여 수술 후 합병증, 수술 후 총 출혈량, 평균 수혈량, 수술시간, 입원기간을 비교분석 하였다. 결과: 1,2,3군 모두에서 주요 합병증 발생은 없었고, 강한 합병증이 각각 5%, 7.2%, 5.8% 발생하였으나 통계적으로 유의한 차이는 없었다. 수술 후 총 평균 출혈양은 각각 1,442.9 ㎖, 1,567.4 ㎖, 1,616.6 ㎖로 각 군간에 유의한 차이는 없었으나(p>0.05), 평균 수혈량은 각각 1,220.3 ㎖, 680.1 ㎖, 692.2 ㎖로 1군에서 수혈의 양이 가장 많았다(p<0.05). 평균 수술시간은 각각 186분, 196분, 211분으로 1군에서 적게 소요되었으며(p<0.05), 총 평균 입원 기간은 각각 16.8일, 28.6일, 29.8일로 1군이 짧았다(p<0.05). 결론: 특별한 내과적 문제가 없는 저위험 환자에서는 한번의 마취하에 양측을 동시에 인공슬관절 전치환술을 시행할 수 있다고 생각된다. Purpose: To study the safety of sequential bilateral total knee arthroplasty in low risk patients. Materials and Methods: Those who had received the surgery all at once were grouped as the first group, those who had received the surgery over two weeks interval were the second group and the last group, third group were those who had received the first surgery on only one knee and they were gotten re-hospitalized for the second surgery on the rest of the knee. These groups were compared on the aspects of complication, postoperative bleeding amount, average transfusion amount, operation time and admission period. Results: There were no major complications found in all groups and the minor complication rate of occurrence was 3%, 4%, 6% in each, which did not constitute a significance difference. Each of the total blood loss was 1442.9 ㎖, 1567.4 ㎖, 1616.6 ㎖ and which did not constitute a significance difference, either. Each of the average volume of blood transfused was 1220.3 ㎖. 680.1 ㎖, 692.2 ㎖, and the first group had the largest volume transfused (p<0.05). The operation time was 186, 196, 211 minutes in each and the first group had the shortest duration (p<005) The average admission periods were 16.8, 28.6, 29.8 days and the first group had the shortest period (p<005). Conclusion: We suggest that when there are no medical diseases contracted on patients, the sequential bilateral total knee arthroplasty can be performed safely without definite increase in perioperative complications.

대퇴사두근-보존형[Quadriceps-Sparing] 최소 침습 슬관절 전치환술의 방사선학적 평가

유주형(Ju-Hyung Yoo),한대용(Dae-Yong Han),한창동(Chang-Dong Han),오현철(Heun-Cheul Oh),고일현(Il-Hyun Koh) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

목적: 대퇴사두근-보존형(Quadriceps-Sparing) 최소 침습 슬관절 전치환술의 방사선학적인 결과를 기존 수술 방법과 비교 분석하고자 한다. 대상 및 방법: 2004년 3월부터 1년간 전향적으로 대퇴사두근-보존형 최소 침습 슬관절 전치환술을 시행한 50예 (제1군)와 기존의 수술방법으로 시행된 50예(제2군)를 대상으로 하였으며, 모든 예에서 Nexgen LPS-flex Total Knee System (Zimmer, Warsw, IN)을 사용하였다. 각 군에 대하여 수술 전후 대퇴 경골각, 경골 삽입물의 각도, 경골 절단면과 경골 삽입물 크기의 비를 측정하여 경골 삽입물 크기의 적정성을 비교 분석하였다. 결과: 양 군에서 수술 후 경골 삽입물의 정렬 각도 및 후방 경사각, 경골 삽입물의 크기, 출혈량에는 차이가 없었으며(p>0,05), 수술 후 8주 후에 측정한 슬관절 운동범위, 슬관절 점수는 제1군이 제2군에 비하여 양호하였다(p<0.05). 수술 후 대퇴 경골각은 제l군에서 6.9±1.3° 외반, 제2군에서 7.7±1.4° 외반으로 의미 있는 차이가 있었다(p<0.05). 결론: 대퇴사두근-보존형 최소 침습 슬관절 전치환술이 기존의 수술 방법에 비하여 경골 삽입물의 정렬 및 크기 선택은 차이가 없었으나, 대퇴골 원위부의 외반 절골각이 감소하는 경향이 있는 것으로 생각된다. Purpose: The purpose of this study was to evaluate the radiological results of quadriceps-sparing total knee arthroplasty. Materials and Methods: 50 consecutive total knee arthroplasties with a quadriceps-sparing surgical technique and 50 consecutive total knee arthroplasties with conventional surgical techniques were performed. The same surgeon performed all the operations with the same type of prosthesis (Nexgen LPS-flex Total Knee System). We compared the differences between these groups in terms of preoperative and postoperative femorotibial angles, tibial component alignment angles, tibial component inclinations, and ratios of size of the tibia component to tibial cutting size. Results: There were no differences in preoperative femorotibal angles, tibial component alignment angles, tibial component inclinations, ratios of sizes of tibia tray to tibial cutting size, and blood loss between the two groups (p>0.05). The average ranges of motion and HSS scores at 8 weeks postoperatively in the quadriceps-sparing total knee arthroplasty group were greater than those in the conventional surgical technique (p < 0.05). The mean postoperative femorotibial angle in the quadriceps-sparing total knee arthroplasty group was a valgus of 6.9±1.3° compared with a valgus of 7.7±1.4° in the standard arthroplasty group (p < 0.05). Conclusion: A quadriceps-sparing total knee arthroplasty offers predictable results in terms of radiological comparison with the conventional arthroplasty technique. But this technique has the tendency of producing a decreased valgus angle at the distal femur.

Versys Fiber Metal Midcoat 대퇴스템을 이용한 무시멘트 인공 고관절 전치환술 후 최소 3년 추시 결과

유주형 ( Ju Hyung Yoo ),김성국 ( Sung Guk Kim ),한창동 ( Chang Dong Han ),오현철 ( Hyun Chul Oh ),윤한국 ( Han Kook Yoon ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.1

Purpose: The purpose of this study was to retrospectively evaluate the results of cementless total hip arthroplasties that used a Versys fiber metal midcoat femoral stem. Materials and Methods: From March 2000 to June 2005, 28 cases in 23 patients were followed up for a minimum of three years. The average follow up period was 5.1 years. Clinical results were evaluated by Harris hip scores. Radiographic analysis was done by evaluating fixation stability, osteolysis, stress shielding, and cortical hypertrophy. Results: The mean Harris hip score improved from 43.1 to 93.8 at the last follow up. In radiographic analyses of the stem, there was no evidence of positional changes or vertical subsidence. There was heterotopic ossification in four, distal cortical hypertrophy in two, proximal stress shielding in twenty, and femoral osteolysis in five cases. The femoral stem revealed a stable bony ingrowth in all. The acetabular cup revealed a stable bony ingrowth in all. There was no evidence of horizontal or vertical migration or of a change of inclination angle of the acetabular cup. Conclusion: Cementless total hip arthroplasty using a Versys fiber metal midcoat femoral stem showed good clinical and radiologic results, but long term follow up is needed.

슬관절 전치환술시 후방십자인대 보존 및 절제에 따른 관절선의 변화

유주형(Ju-Hyung Yoo),이윤태(Yun-Tae Lee),오현철(Hyun-Cheol Oh),하중원(Joong-Won Ha),고일현(Il-Hyun Koh) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.3

목적: 인공 슬관절 치환술에서 후방십자인대 보존형과, 굴곡간격을 증가시킬 목적으로 시행한 후방십자인대 절제형간의 관절선과 슬개골의 높이 차이를 비교 분석하고자 한다. 대상 및 방법: 2001년 8월부터 2003년 1월까지 인공슬관절 치환술을 시행 받은 환자를 대상으로 하였으며, 수술 시 골절제 후에 신전간격과 굴독간격의 균형이 맞아 후방십자인대 보존형을 시행한 50예와, 굴곡간격이 상대적으로 작아 굴곡 간격을 늘일 목적으로 시행한 후방십자인대 절제형 50예를 대상으로 하여, PACS를 이용한 수술 전 및 수술 후 측면 방사선 사진에서 대퇴경골간 관절선, 대퇴경골간 관절선으로부터의 슬개골선, 대퇴경골간 관절선으로부터의 슬개골 관절선, 경골 결절로부터의 슬개골선, 경골 결절로부터의 슬개골 관절선을 비교 측정하였다. 결과: 후방십자 인대 보존형과 후방십자 인대 절제형 간에 수술 후 관절선과 슬개골의 높이의 통계학적인 차이점은 없었다(p>0.05). 결론: 인공 슬관절 치환술에서 후방십자 인대의 절제는 굴곡간격을 넓힐 수 있으면서, 관절선과 슬개골의 높이에는 영향이 없으므로, 굴곡간격이 신전간격에 비하여 작을 경우에 후방십자 인대의 절제가 관절간격의 균형을 이룰 수 있는 유효한 방법의 하나로 사료된다. Purpose: The purpose of this study is to compare the change of joint line and patellar position between posterior crucate ligament-retained and posterior cruciate ligament-sacrificed total knee arthroplasty. Materials and Methods: Fifty posterior crucate ligament-retained and fifty posterior cruciate-sacrificed total knee arthroplasties were evaluated to compare the joint line height from tibial tuberosity, patella bone height from joint line, patella articular height from joint line, patella bone height from tibial tuberosity and patella articular height from tibial tuberosity. The measurements were assessed preoperatively and postoperatively. Results: No difference in joint line height from tibial tuberosity, patellar bone height from joint line, patellar articualr height from joint line, patellar bone height from tibial tuberosity and patellar articular height from tibial tuberosity were found with either design (p>O.05). Conclusion: This study demonstrates that the resection of the posterior cruciate ligament can be one of the preferable method to increase the flexion gap without influencing the joint line in Total knee arthroplasty.

인공 슬관절 전치환술 이후에 반복적으로 발생하는 자발성 급성 혈관절증의 치료

유주형 ( Ju Hyung Yoo ),양희철 ( Hee Cheul Yang ),이윤태 ( Yun Tae Lee ),오현철 ( Hyun Chul Oh ),하중원 ( Joong Won Ha ),김진영 ( Jin Young Kim ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

A 67-year-old woman presented with six acute recurrent hemorrhagic episodes sixteen months after primary total knee arthroplasty. Femoral angiography demonstrated a prominent vascular blush on the superolateral side of the knee joint. The patient underwent therapeutic embolization of the superior lateral geniculate artery and a muscular branch from the popliteal artery. However, neglected embolization to the lateral inferior artery induced another episode of acute hemarthrosis. Finally, open arthrotomy allowed for identification and coagulation of the focus of acute bleeding in the lateral inferior geniculate artery.

미세혈관 수술법을 이용한 결손사지의 재건술

한수봉,유주형,Hahn, Soo-Bong,Yoo, Ju-Hyung 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1

From Fabuary 1982 to May 1995, 396 patients had undergone reconstructive surgery of the upper and lower limb with microsurgical technique at department of orthopaedic surgery, Yonsei University of Medicine. The results were as follows; 1. Average age at the time of operation was 23.4years(2-64 years), and there were 277 male and 119 female patients. 2. Among 324 patients of soft tissue flap(87 inguinal flap, 132 scapular flap, 38 latissimus dorsi flap, 11 latissimus dorsi and scapular combind flap, 6 gracilis flap, 12 deltoid flap, 3 tensor facia lata flap, 11 dorsalis pedis flap, 6 lateral thigh flap, 12 wrap around flap, 1 lateral arm flap, 5 musculocutaneous flap), 274 cases(85.5%) were succeed. 3. Among 37 patients of vascularized bone graft(18 fibular bone graft, 11 iliac bone graft, 7 toe to finger transplantation,1 vascular pedicle rib graft), 30 cases(80.1%) were succeed. 4. In 26 cases of segmental resection and rotationplasty at lower extremity, 23 cases were succeed. 5. In 7 cases of Tikhoff-Linberg procedure and in 2 case of segmental resection and replantation, all case was succeed. Overall success rate of microscopic reconstructive surgery was 85.6%. In conclusion, microsurgical technigue is valuable for reconstruction of tissue defect or function loss of the limb.

50세 이상 연령층에서 발생한 고관절 주위골절과 골밀도와의 상관관계

장준섭(Jun-Suop Jahng),유주형(Ju-Hyung Yoo),손준석(Joon-Seok Sohn) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.1