거골의 골연골 병변의 관절경적 치료

정비오(Bi O Jeong),정혁(Hyuk Jung) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.2

발목 손상은 가장 흔한 손상 중 하나로서 발목 염좌나 골절의 70%까지 거골의 골연골 병변(osteochondral lesion of the talus)이 발생한다고 알려져 있다. 여가 활동의 증가로 인해 스포츠 손상도 많아지고 연골의 상태를 확인할 수 있는 진단 기법이 발달하여 거골의 골연골 병변의 유병률도 높아지고 있다. 증상이 없는 거골의 골연골 병변은 비수술적 치료로도 좋은 결과가 보고되고 있지만 성인의 경우 비수술적 치료에 실패할 가능성이 높아 수술적 치료가 많이 시행된다. 우수한 결과를 위해서는 정상 연골로의 회복이 중요하지만 연골의 특성상 효과적으로 재생시키는 치료법은 현재까지 정립되지 않고 있다. 관절경적 미세 천공술(arthroscopic microfracture)과 같은 골수 자극 요법(bone marrow stimulation)이 많이 사용되는 수술 방법이며, 비수술적 치료에 반응하지 않고 크기가 너무 크지 않은 경우에 효과적인 치료법으로 알려져 있다. 또한 병변의 크기나 위치, 연골하 낭종의 유무, 이전 수술의 결과 등에 따라 자가 골연골 이식술이나 동종 골연골 이식술, 자가 연골 세포 이식술 등의 치료 방법이 있다. 여러 수술적 방법에서 단기·중기 추시에서 양호한 결과들이 보고되고 있으나 장기 추시 결과는 명확히 밝혀진 바 없다. 최근 여러 생물학적 제제의 개발로 인해 히알루론산(hyaluronan), 혈소판 풍부 혈장(platelet-rich plasma), 중간엽 줄기세포(mesenchymal stem cell), 골수 흡인 농축술(bone marrow aspirate concentrate)과 같은 다양한 치료 방법이 소개되고 있다. Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term followup have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.

동반 병변이 있는 자가 연골세포 이식술의 결과 분석

정비오(Bi O Jeong),윤경호(Kyoung Ho Yoon),배대경(Dae Kyung Bae),문지수(Jee Soo Moon),송상준(Sang Jun Song) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.2

목적: 슬관절의 동반 병변이 있는 연골결손 환자에서 시행한 자가 연골 이식술의 결과를 보고하고자 한다. 재료 및 방법: 자가 연골세포 이식술을 시행한 슬관절 연골결손 환자 36명, 39예, 67 연골결손을 대상으로 하였다. 단일 연골결손의 4예를 Ⅰ군, 다발성 연골결손의 3예를 Ⅱ군, 박리성 골 연골염으로 인한 골병변이 있는 5예를 Ⅲ군, 단일 연골결손 및 동반 손상의 9예를 Ⅳ군, 다발성 연골결손 및 동반손상의 18예를 V군으로 하여 최소 2년 이상 추시하였다. IKDC 주관적, 객관적 평가와 ICRS 기능적 평가를 사용하였으며 12예, 21 연골결손에서 이차적 관절경술을 시행하였다. 결과: IKDC 주관적 평가점수는 평균 39.8점에서 64.1점으로 증가되었고, IKDC 객관적 평가에는 C 54%, D 46%에서 A 74%, B 23%, C 3%로 호전되었다(p<0.001). ICRS 기능적 평가에서는 Ⅲ 82%, Ⅳ 18%에서 Ⅰ 15%, Ⅱ 85%로 향상되었다. 이차적 관절경술 시 ICRS 연골평가에서는 Ⅰ 9%, Ⅱ 67%, Ⅲ 24%의 결과를 보였으며 단독 연골결손의 경우와 동반 병변이 있는 경우에서의 결과의 차이는 없었다(p>0.05). 결론: 동반 병변을 가진 다발성 연골결손의 경우에도 자가 연골세포 이식술과 동반 병변에 대하여 치료를 동시에 시행하여 단독 연골결손의 경우와 마찬가지로 우수한 결과를 얻을 수 있었다. Purpose: To evaluate the results of autologous chondrocyte implantation with a concomitant injury. Materials and Methods: Sixty-seven chondral defects (39 cases, 36 patients), which were treated with autologous chondrocyte implantation, were analyzed with a minimum follow-up of 2 years. The cases were divided into the following five groups: 4 cases of a single chondral defect (group Ⅰ), 3 cases of multiple chondral defects (group Ⅱ), 5 cases of osteochondritis dissecans (group Ⅲ), 9 cases of a single chondral defect with a concomitant injury (group Ⅳ), and 18 cases of multiple chondral defects with a concomitant injury (group Ⅴ). The clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores and the International Cartilage Repair Society (ICRS) functional evaluation system. Arthroscopic examinations were performed on 12 cases and 21 chondral defects. Results: The mean IKDC subjective score was 39.8 preoperatively, which improved to 64.1 postoperatively, and the IKDC objective score was C in 54% and D in 46%, which improved to A in 74%, B in 23% and C in 3%. The ICRS functional evaluation system was Ⅲ in 82% of cases, and Ⅳ in 18% preoperatively, which improved to Ⅰ in 15% and Ⅱ in 85%, postoperatively. At the arthroscopic evaluation, the results of the ICRS system were Ⅰ in 9%, Ⅱ in 67%, and Ⅲ in 24%. There was no significant difference between the single chondral defect and chondral defects with a concomitant injury. Conclusion: In the treatment of the multiple chondral defects with a concomitant injury, autologous chondrocyte implantation produced similar excellent clinical results to those of a single chondral defect.

동종 골-슬개건-골과 동종 전경골건을 이용한 관절경적 전방십자인대 재건술의 결과 비교

정비오 ( Bi O Jeong ),윤경호 ( Kyoung Ho Yoon ),배대경 ( Dae Kyung Bae ),오훈 ( Hoon Oh ),김정원 ( Jeong Weon Kim ),박수연 ( Soo Yeon Park ) 대한스포츠의학회 2007 대한스포츠의학회지 Vol.25 No.2

관절경적 반월상 연골 전 절제술 후 퇴행성 슬관절염의 발생에 관한 연구

정비오(Bi O Jeong),윤경호(Kyoung Ho Yoon),배대경(Dae Kyung Bae),이동훈(Dong Hun Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.1

목적: 슬관절 반월상 연골 전 절제술을 시행한 후 임상적 및 방사선학적 방법으로 퇴행성 관절염의 발생률을 조사하고 절제 부위에 따른 퇴행성 관절염의 발생률을 비교하고자 하였다. 대상 및 방법: 반월상 연골 전 절제술 시행 후, 5년 이상 추시가 가능하였던 78예를 대상으로 하였다. 내측 절제(I군) 16예, 외측 절제(II군) 17예, 원판형 연골(III군) 29예 및 전방십자인대 재건술과 동반 된 내측절제(IV군)가 16예였다. 관절염 발생은 관절 간격이 50% 이상 감소하는 Ahlback Grade II 이상으로 규정하고 Kaplan-Meyer의 생존분석법을 이용하였다. 결과: 술 후 5년 및 7년 경과 시 17% 및 36%에서 퇴행성 관절염이 발생하였다. I군의 경우 5년에 9%, 7년에 18% 이었으며, II군 각각 14%, 29%, III군 25%, 46%, IV군 28%, 55%이었다. 각 군 간의 차이는 통계적으로 유의하였다(p<0.05). 결론: 반월상 연골이 결여된 슬관절은 그 손상형태에 따라 다르지만 높은 빈도의 퇴행성 관절염의 발생을 보였다. 그러므로 가능한 한 전 절제술을 피하기 위한 노력이 필요할 것으로 생각한다. Purpose: This study compared the clinical and radiological incidence of osteoarthritis after a total meniscectomy. Materials and Methods: Seventy eight patients, who underwent a total meniscectomy, were evaluated after a minimum follow up of five years. The operations were a medial meniscectomy (group I) in 16 cases, a lateral meniscectomy (group II) in 17 cases, a discoid meniscus (group III) in 29 cases and medial meniscectomy with an anterior cruciate ligament reconstruction (group IV) in 16 cases. The development of degenerative osteoarthritis was analyzed using the Kaplan-Meyer survivorship. Results: At postoperative 5 years and 7 years, degenerative osteoarthritis developed in 17% and 36% of patients, respectively. The incidence of degenerative osteoarthritis at postoperative 5 years and 7 years in groups I, II, III and IV was 9% and 18%, 14% and 29%, 25% and 46%, and 28% and 55%, respectively. The difference was statistically significant. Conclusion: The meniscus deficient knee joint which varies according to the patterns of a meniscal injury, had a higher incidence of degenerative osteoarthritis. Careful attention should be paid to the treatment of meniscal tears.

60세 이상의 고령에서의 중족골 절골술을 이용한 무지 외반증 치료

정비오,이상현,Jeong, Bi O,Lee, Sang Hyeon 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.4

Purpose: To treat hallux valgus in old age patients with chevron metatarsal osteotomy and to see the subsequent clinical and radiological outcomes. Materials and Methods: 23 cases of 18 hallux valgus patients of age 60 years or older who received proximal or distal corrective osteotomy from April 2007 to August 2009 and were followed up for at least 1 year were included in the study. The mean age at operation was 65 years (range, 60~81 years), and the mean follow-up period was 2 years and 6 months (range, 1 year~3 years 6 months). Clinical outcome was assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, complications, satisfaction rate, as well as measurements and comparison of pre- and postoperative hallux valgus angles, the 1st~2nd intermetatarsal angle, and the position of hallucal medial sesamoid bone. Results: The AOFAS score was improved from preoperative average of 35.1 (range, 13-47) to average 85.1 at last follow-up (range, 75-100). Patients were satisfied about the operation in 21 cases (91.3%). Preoperative hallux valgus angle was $31.7^{\circ}$ on average (range, $19.1^{\circ}-48.9^{\circ}$), and $4.9^{\circ}$ on average at last follow-up (range, $0.3^{\circ}-21.2^{\circ}$). The 1st~2nd intermetatarsal angle was $14.4^{\circ}$on average (range, $8.7^{\circ}-25.7^{\circ}$) and $3.1^{\circ}$ on average at last follow-up (range, $0.6^{\circ}-7.5^{\circ}$). The hallucal medial sesamoid bone position was improved from preoperative average 3.5 (range, 3-4) to postoperative average 1.0 (range, 0-2). Conclusion: Proximal and distal metatarsal osteotomy treatment yielded good clinical and radiological outcomes in old age hallux valgus patients.

고관절 결핵

정비연,Jeong, Bi-Yeon 대한결핵협회 2007 보건세계 Vol.55 No.11

족관절 불안정성의 인대 봉합술: Broström 술식의 효과 및 술기

정비오,황역구,Jeong, Bi O,Hwang, Yeok Gu 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.3

Chronic lateral ankle instability occurs in 10% to 20% of individuals after acute ankle sprain. The management of chronic lateral ankle instability is traditionally conservative treatment in the acute phase. On the other hand, surgical intervention is considered if conservative treatment fails and the symptoms are ongoing. This review focuses on the surgical approaches to treatment of chronic lateral ankle instability, including $Brostr{\ddot{o}}m$ surgical techniques, with a review of the traditional procedure and newer techniques.

백서의 아킬레스 건 봉합 후 Hyaluronate-Carboxymethyl cellulose가 조직 유착에 미치는 영향

이정희,정비오,김교영,Lee, Jung-Hee,Jeong, Bi-O,Kim, Gou-Young 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: The purpose of this study was to evaluate the effect of Sodium hyaluronate-Sodium carboxymethyl cellulose (HA-CMC) on tissue adhesion after tenorrhapy in tenotomized Achilles tendon of the Sprague-Dawley rat. Materials and Methods: Twenty-eight legs of 14 Sprague-Dawley rat were used in study. After tenotomy of the Achilles tendons, tenorrhaphies were performed. Simple tenorrhaphy without any other procedures were performed on the left Achilles tendons (control group), and additional HA-CMC injections were done prior to the tenorrhaphy on the right Achilles tendons (HA-CMC group). Gross and histological examinations were made to identify differences between the two groups, 1, 2, 6, 8, 10, 12 and 14 weeks respectively. Results: Distinct decrease in granulation tissues and adhesions were seen in the HA-CMC group during gross inspection at 6 and 8 week after the operation. On histological analysis of the HA-CMC group, although increased infiltrations of inflammation cells were observed during 1 week, less adhesion were seen at 6, 8 and 10 weeks after the operation. In HA-CMC group, superior healing processes were seen at 6, 8 and 10 weeks and less fibrotic changes, compared to control group, were seen at 2 and 6 weeks. Conclusion: Prevention of adjacent tissue adhesion was made possible through decrease in collagen deposition and fibrosis by injecting HA-CMC before tenorrhaphy of Achilles tendon. Also, histologically faster healing process of the collagen fibers within the Achilles tendon was observed.

생비골 이식술을 통한 대퇴골의 난치성 감염성 불유합의 치료 - 3예 보고 -

정덕환,정비오,소동혁,한정수,Chung, Duke-Whan,Jeong, Bi-O,So, Dong-Hyuk,Han, Chung-Soo 대한미세수술학회 2007 Archives of reconstructive microsurgery Vol.16 No.1

Purpose: To report the clinical results of the vascularized fibular graft in the treatment of intractable infected nonunion of femur. Materials and Methods: We reviewed 3 patients who were performed vascularized fibular graft in treated for intractable infected nonunion of femur. They had received an average of 5.6 times($4{\sim}8\;times$) surgical treatment at different hospitals. 1 case was of a infected nonunion in a fracture treated with internal fixation, the fracture having occurred after resection of a malignant tumor and transplantation of pasteurized autologous bone. 2 cases occurred after internal fixation in closed fractures. Surgical treatment was performed an average of 4 times($3{\sim}5\;times$) at our hospital and in all of the cases debridement of necrotic tissue and sequestrectomy. And vascularized fibular graft was performed. In all cases unilateral external fixation devices were used, of these, 1 case was changed into internal fixation. The final conclusion was made by assessment of functional outcomes and complications according to the standards of Paley. Results: As a result, in all of the cases bone union was achieved, and in the last follow up the functional results were excellent in 2 cases and good in 1 case. There were not presented leg length discrepancy of more than 2 cm, and further loss of knee joint motion. After previous treatment, average 23.3 months($16{\sim}30\;months$) was taken to eliminate infection and achieve complete bone union via vascularized fibular graft in our hospital. Conclusion: In treatment of intractable infected nonunion of femur, fairly good results can be expected after firm fixation, through debridement and vascularized fibular graft.

만성 발목 불안정증의 치료에서 관절경 수술

이호진,정비오,Lee, Ho Jin,Jeong, Bi O 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.1

The open Broström procedure is considered the surgery of choice for treating chronic lateral ankle instability. The role of arthroscopy has gained popularity in the surgical treatment of chronic lateral ankle instability, partly for the ability to manage the intra-articular pathology combined with ankle instability. Arthroscopic techniques can be divided broadly into the arthroscopic-assisted Broström technique and arthroscopic all-inside ligament repair. The clinical results of these arthroscopic techniques are similar to open procedures. The arthroscopic technique may be an excellent alternative to the open Broström procedure in treating chronic lateral ankle instability when applying the appropriate indications.