대퇴 사두건을 이용한 관절경적 이중 다발 전방 십자 인대 재건술

김성재,정광암,송대흡,Kim, Sung-Jae,Jung, Kwang-Am,Song, Dae-Heup Korean Arthroscopy Society 2005 대한관절경학회지 Vol.9 No.2

Recently, the interest on anatomical ACL reconstruction with double bundle technique is increased to reproduce the original load distribution, and kinematics of the knee. We developed an arthroscopic double bundle ACL reconstruction technique using autogenous quadriceps tendon with 2 splitted graft and patellar bone plug. The anteromedial bundle and posteolateral bundle of the ACL is replicated with each splitted graft of quadriceps tendon and fixed with biodegradable interference screw on the 2 femoral tunnels. The patellar bone plug of quadriceps tendon is fixed with biodegradable interference screw within the 1 tibial tunnel. We suggest that our technique using quadriceps tendon may be an alternative in arthroscopic double bundle ACL reconstruction.

요추부에 발생한 경막외 유잉육종 - 증례 보고 -

안면환,신덕섭,정광암,하정옥,Ahn, Myun-Hwan,Shin, Duk-Seop,Jung, Kwang-Am,Hah, Jeong-Ok 대한근골격종양학회 1999 대한골관절종양학회지 Vol.5 No.3

Ewing's sarcoma is an uncommon malignant neoplasm of the long bone and it has a poor prognosis due to its early metastasis and aggressive local spread. It is mostly found before the age of 30 and it is rare in extraskeletal sites. Extraskeletal Ewing's sarcoma has been reported to occur in various sites including the larynx, scalp, nasal fossa, neck, chest wall, lung, pelvis, perineum, arm, finger, leg and toe, but it is extremely rare as a primary epidural tumor of the spine. We experienced a case of extraosseous epidural Ewing's sarcoma arising in the lumbar spinal canal at L3-L5 level in a 9-year-old boy. Following total laminectomy from L3 to L5 with a lumbar vertebrae and mass excision, he received chemotherapy with complete remission.

관절경을 이용한 반월상 연골 절제술 후 슬관절부 근육의 등속성 근력 평가 및 임상적 평가

이동철(Dong Chul Lee),이광희(Gwang Hee Lee),정광암(Kwang Am Jung),안상호(Sang Ho Ahn) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.5

퇴행성 슬관절 골관절염 환자에서 골다공증 치료의 국내 건강보험 심사평가원과 FRAX<SUP>®</SUP> 기준에 대한 비교 연구

이수찬(Su Chan Lee),남창현(Chang Hyun Nam),윤지열(Ji Yeol Yoon),정광암(Kwang Am Jung),황보현(Bo Hyun Hwang),안혜선(Hye Sun Ahn) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.5

목적: 고령의 퇴행성 슬관절 골관절염 환자를 대상으로 국내 건강보험 심사평가원(Health Insurance Review & Assessment Service, HIRA) 기준과 세계보건기구 fracture risk assessment tool (FRAX<SUP>®</SUP>, http://www.shef.ac.uk/FRAX/)에서의 골절 확률을 바탕으로 한 골다공증 치료 대상의 차이를 비교, 평가하고자 한다. 대상 및 방법: 2010년 6월부터 2011년 3월까지 퇴행성 슬관절 골관절염으로 인공관절 전치환술 시행예정인 65세 이상의 환자를 조사하였다. 치료 대상은 국내 HIRA 기준, T 점수 -2.5 이하이거나 FRAX<SUP>®</SUP> 기준의 10년 주요 골다공증 골절 확률 20% 및 대퇴골절 확률 3% 이상으로 정하였다. 결과: 929명 환자 중 골다공증 치료 대상은 국내 HIRA 기준 562명(60.5%), FRAX<SUP>®</SUP> 기준 372명(40.0%)이었다. 두 기준 모두 치료 대상으로 만족하는 경우는 339명(36.5%)으로, 비치료 대상 334명(36.0%)을 포함하여 673명(72.4%)의 낮은 진단 일치도를 보였다(κ값=0.471). 골감소증 319명 환자 중 33명(10.3%)은 FRAX<SUP>®</SUP> 기준의 치료 대상으로 분류되었다. 결론: 골다공증을 진단하고 치료함에 있어 국내 HIRA 기준에 FRAX<SUP>®</SUP>를 반영한 적정 치료 지침에 대한 보완이 필요하다. Purpose: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX<SUP>®</SUP>, http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. Materials and Methods: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of ≤?2.5 points, or the FRAX<SUP>®</SUP> criteria, defined as the 10-year probability of a major osteoporotic fracture and hip fracture of ≥20% or ≥3%, respectively. Results: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX<SUP>®</SUP> criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX<SUP>®</SUP> criteria. Conclusion: A combination of the HIRA and FRAX<SUP>®</SUP> criteria is required to improve the current guidelines for osteoporosis treatment.

편측 및 양측 슬관절 전치환술후 C-반응성 단백 수치의 변화 양상

이수찬(Su-Chan Lee),윤지열(Ji-Yeol Yoon),정광암(Kwang-Am Jung),남창현(Chang-Hyun Nam),정숭현(Soong-Hyun Jung) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.4

목적: 슬관절 전치환술 후 C-반응성 단백(C-reactive protein, CRP) 수치의 술 후 기간에 따른 변화 양상을 조사하였다. 또한 감염과 관련되어 CRP값이 의미 있게 차이를 보이는 술 후 기간을 조사하였다. 대상 및 방법: 편측 혹은 양측 동시 슬관절 전치환술을 시행 받은 2,315예에 대해 술 후 6개월까지 CRP 변화 양상을 기간 별로 나누어 후향적으로 분석하였다. 배제된 심부감염 19예의 CRP 변화 양상을 전체 조사군과 비교하였다. 결과: 슬관절 전치환술 후 CRP값은 술 후 3일 이내 최고값을 보이고 이후 감소하여 술후 15-28일 구간에서 정상화 되었다. 술 후 14일까지 편측군보다 양측 동시 수술군에서 CRP가 의미있게 증가되어 있었다(p<0.01). 그 이후의 CRP는 두 군 간의 차이가 없었다. 심부감염 증례군과 비교 시 술 후 8일 이후 CRP 차이가 통계적 의의를 보였다. 결론: 슬관절 전치환술 후 구간별 CRP 변화 양상은 감염에 대한 추시 관찰에 유용하며, 술 후 8일 이후 큰 차이를 보이거나 술 후 4주 이후도 CRP가 증가되어 있는 증례에서는 염증성 관절염이 아닌 경우 감염 가능성에 대해 유의해야 한다. Purpose: The objective of this study was to determine the patterns of C-reactive protein (CRP) changes during the postoperative period after total knee replacement (TKR), and to determine the CRP changes associated with infection after TKR. Materials and Methods: A retrospective analysis of the pattern of CRP changes during the first 6 postoperative months was conducted on 2,315 patients who underwent unilateral or simultaneous bilateral TKR. This data was also compared with the pattern of CRP changes which occurred in 19 patients with a deep prosthesis infection who were not enrolled in the main study. Results: The CRP levels peaked 3 days postoperatively, and then decreased to baseline levels at 15-28 days postoperatively. Within 14 days postoperatively, the CRP levels were significantly higher in the simultaneous bilateral TKA group than in the unilateral group (p<0.01). Thereafter, no significant difference in CRP levels existed between two groups. After the 8<SUP>th</SUP> postoperative day, a significant difference in CRP level existed between patients with and without deep prosthesis infections. Conclusion: CRP changes post-TKR provide an effective means of monitoring of infections. In cases of non-inflammatory arthritis in which the CRP levels are significantly difference after the 8<SUP>th</SUP> postoperative day or are elevated after the 4<SUP>th</SUP> postoperative week, an infection should be suspected.

Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty

Su Chan Lee(이수찬),Chang Hyun Nam(남창현),Il Seok Park(박일석),Ji Yeol Yoon(윤지열),Kwang Am Jung(정광암),Seung Hyun Hwang(황승현) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.5

Achromobacter xylosoxidans는 기회 균주로 주로 투석 환자 등의 면역저하 환자에서 감염을 일으킨다. 그러나 슬관절 전치환술 후, A. xylosoxidans 감염에 관한 보고는 매우 드물며, 정상 면역 환자에서 이 균주의 슬관절 전치환술 감염의 관한 보고는 없었다. 이에 우리는 면역저하 병력이 없는 슬관절 전치환술 환자의 A. xylosoxidans에 의한 감염 증례를 보고하고자 한다. Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

인공 슬관절 및 고관절 전치환술후 ESR , CRP 의 변화

김세동,이동철,정광암,백승희 대한슬관절학회 2001 대한슬관절학회지 Vol.13 No.1

Purpose: To study the changes of ESR and CRP after total hip arthroplasty(THA) and total knee arthroplasty(TKA). Material and Methods: We tested the values of ESR and CRP of total 61 patients, who received THA or TKA. The levels of ESR and CRP were compared before operation, on the 2nd, 4th post-op. Day, 1st, 2nd, 3rd week after operations. Results: The peak level of ESR was reached on the 4th post-op day(70.7mm/hr) in unilateral TKA group, but on the 7th day(53.2mm/hr) in bilateral group. The peak level of ESR was reached on the 4th day in unilateral THA group(71.5mm/hr), as was in bilateral group(50.6mm/hr). The values of ESR were declined to the normal range until the 3rd week except 9 cases(15%). The peak level of the CRP of TKA(14.0mg/dL, 15.0mg/dL) and THA(12.7mg/dL, 17.7mg/dL) in unilateral and bilateral group were reached on the 2nd day after operations. After the peak level, the values of CRP were abruptly declined to the normal and pre-op level until the 3rd week. Conclusion: The highest value of the CRP revealed on the 2nd post op day in bilateral group and declined to the normal range at 2nd week. The peak value of the ESR showed on the 4th post-op day, but the peak value of the bilateral group was low and the range of increase was narrow when compared with the unilateral group. The value of CRP after post-op 2 weeks could be used as the index of normal and infection in TKA or THA.