슬관절 골관절염 환자에서 발생한 Streptococcus sanguis에 의한 화농성 슬관절염

정철용(Chul-Young Jung),은일수(Il-Soo Eun),김진완(Jin-Wan Kim),고영철(Young-Chul Ko),김창규(Chang-Kyu Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.1

Streptococcus sanguis (S. sanguis)는 정상인의 구강, 상기도의 정상 세균총인 Viridans streptococci 분류의 그람 양성 연쇄구균으로 병원성은 낮으나, 치석 제거나 구강의 외과적 처치 시 혈행성 전파를 통해 세균성 심내막염을 일으킬 수 있는 균이다. S. sanguis에 의한 화농성 관절염은 국외에서 흉쇄관절과 슬관절에 발생한 증례가 보고되었으나 국내에서는 보고된 예가 없는 매우 드문 감염증이다. 이에 저자들은 치주염의 과거력이 있는 슬관절 골관절염 환자에서 발생한 S. sanguis에 의한 화농성 슬관절염을 경험하였기에 보고하는 바이다. Streptococcus sanguis (S. sanguis ) is a gram positive streptococcus bacteria which is found in the normal bacterial fl ora of the oral cavity and the upper respiratory tract. It has low virulence, but it can cause bacterial endocarditis through the blood circulation when dental calculus are removed from the teeth or during surgical treatment. Septic arthritis caused by S. sanguis has been reported as infecting the sternoclavicular joint and the knee joint, but it is a quite rare infectious disease that has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by S. sanguis in a patient with osteoarthritis of the knee, who has the history of periodontitis.

상부 견갑 현수 복합체의 3중 골절에 대한 치료

정철용(Chul-Young Jung),은일수(Il-Soo Eun),김진완(Jin-Wan Kim),고영철(Young-Chul Ko),김영준(Young-June Kim),김창규(Chang-kyu Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

상부 견갑골 현수 복합체(SSSC, Superior Shoulder Suspensory Complex)는 견갑골의 관절와, 오구돌기, 오구 쇄골 인대, 원위 쇄골, 견봉 쇄골 관절, 견봉으로 구성된 골 또는 연부조직의 고리로 하나의 기능적 단위를 이루는 복합체를 형성하며, 상완 및 견갑부의 정상적인 안정성을 유지하는 역할을 한다. 상부 견갑골 현수복합체의 손상은 주로 교통사고나 낙상 등에 의한 고에너지 손상에 의해 이루어지며, 단독 분리는 빈번히 일어나는 것으로 알려져 있다. 그러나 외상에 의한 이중 분리 즉, 복합체의 두 부위 이상의 손상은 드물며, 이리한 복합체의 이중 분리는 수술적 치료를 요하는 것으로 알려져 있다. 복합체 이중 분리 중 오구돌기와 견봉 및 원위 쇄골의 동시 골절인 삼중 골절은 국외에서 단 1례만 보고되고 있으며, 국내에서는 보고된 바가 없는 실정이다. 저자들은 47세 남자 환자에서 발생한 상부 견갑 현수 복합체의 삼중 골절을 경험하였기에 문헌고찰과 함께 보고하고자 한다. The Superior Shoulder Suspensory Complex (SSSC) is a bony and soft tissue ring comprising the glenoid process, the coracoid process, the coracoclavicular ligaments, the distal clavicle, the acromioclavicular joint, and the acromion. The SSSC maintains a normal stable relationship between the upper extremity and the axial skeleton. High-energy injury, such as traffic accident or a fall, can cause disruption of the SSSC. Single traumatic disruption of the SSSC is common. However, double disruption of the SSSC is infrequent and surgical management is generally necessary. We have experienced a case of triple fracture involving the coracoid process, the acromion, and the distal end of the clavicle. Such disruption of the SSSC has not been previously reported in our country and only one case has been reported in the Western literature; the authors obtained positive clinical results with surgical treatment. We report here on this case and include a review of the relevant literature.

슬관절 주위 골절이 동반된 슬관절 치환술의 Klebsiella pneumoniae 단일균에 의한 후기 감염

정철용(Chul-Young Jung),은일수(Il-Soo Eun),고영철(Young-Chul Ko),박만준(Man-Jun Park),김민우(Min-Woo Kim),황금민(Keum-Min Hwang) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.6

Klebsiella pneumoniae에 의해 발생한 화농성 관절염은 성인에서 매우 드물며, 인공관절 치환술 후 발생한 경우는 더욱 드물다. 인공관절 치환술 후 발생한 K. pneumoniae에 의한 화농성 관절염은 급성 또는 수술 후 초기에 발생한 예는 있으나 후기 감염으로 보고된 예는 국내에서 아직 보고된 바 없으며, 다균성 감염이 대부분으로 K. pneumoniae 단일균에 의한 감염 역시 매우 드물다. 이에 저자들은 내원 11년 전 슬관절 인공관절 치환술을 받은 85세 여자 환자에서 후기 감염으로 K. pneumoniae 단일균에 의한 화농성 관절염이 슬관절 치환물 주위 골절과 동반된 1예를 치험하였기에 보고하고자 한다. Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.

종골의 관절내 골절 후 발생한 불유합의 수술적 치료

은일수,정철용,김진완,고영철,허정욱,Eun, Il-Soo,Jung, Chul-Young,Kim, Jin-Wan,Ko, Young-Chul,Huh, Jung-Wook 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: Nonunion of intra-articular fractures of calcaneus is rarely reported complication. We present our experiences with 4 patients (5 cases) treated operatively for nonunion after intra-articular fracture of calcaneus. Materials and Methods: 4 patients (5 cases) with nonunion of intra-articular fracture of calcaneus after operative treatment were followed for 4 years (from 2002 to 2006). For assessment, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS) were assessed for clinical outcome and the union of fracture site, the talocalcaneal height and the angle of talar declination were determined for radiologic outcome. Results: The mean talocalcaneal height was 6.94 cm (range, 5.9${\sim}$7.6 cm) preoperatively and 7.34 cm (range, 6.0${\sim}$8.3 cm) at last follow-up. The mean angle of talar declination was 5.68 degrees (range, 4.6${\sim}$8 degrees) preoperatively and 13.1 degrees (range, 5.7${\sim}$21 degrees) at last follow-up. The mean preoperative AOFAS score and VAS were 20.4 (range, 14${\sim}$36) and 4 (range, 3${\sim}$6), respectively. At last follow-up, these scores improved to a mean of 59.6 (range, 54${\sim}$68) and 3 (range, 2${\sim}$4), respectively. Unions of previous nonunion site of intra-articular fracture of calcaneus were achieved in all 4 patients (5 cases). Conclusion: The reconstructive procedure for nonunion of intra-articular fracture of calcaneus showed good results in terms of bone union, radiologic results and functional improvement than preoperative state. Because the plantar pain for the inferior angular formation in nonunion site may happen, we will pay attention to reduction of fragment.

젊은 당뇨 환자에서 신경병성 관절병증 종골 견열 골절의 자연 경과(1예보고)

고영철,은일수,정철용,김진완,최현수,김옥걸,Ko, Young-Chul,Eun, Il-Soo,Jung, Chul-Young,Kim, Jin-Wan,Choi, Hyeon-Soo,Kim, Ok-Gul 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.2

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.

실패한 족관절 인공관절 치환술 후 큰 골결손에서 내고정 없이 시행한 족관절 구제술: 증례 보고

박만준,은일수,정철용,고영철,류총일,김민우,황금민,Park, Man-Jun,Eun, Il-Soo,Jung, Chul-Young,Ko, Young-Chul,Yoo, Chong-Il,Kim, Min-Woo,Hwang, Keum-Min 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.2

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

국내 금융거래전자화를 위한 하부구조 구축

김병연(Byung-Yeon Kim),정철용(Chul-Young Jung) 한국전자거래학회 1997 한국전자거래학회지 Vol.2 No.1

고령의 대퇴골 전자간부 분쇄골절에서 대전자부 재부착 기구를 이용한 양극성 고관절 반치환술

김진완 ( Jin Wan Kim ),고영철 ( Young Chul Ko ),정철용 ( Chul Young Jung ),은일수 ( Il Soo Eun ),최현수 ( Hyeon Soo Choi ),김옥걸 ( Ok Gul Kim ),김영준 ( Young June Kim ) 대한골절학회 2009 대한골절학회지 Vol.22 No.4

목적: 대퇴골 전자간부의 불안정성 분쇄골절이 있는 고령 환자에 대하여 양극성 고관절 반치환술을 시행 시 전위된 대전자부 골절편을 대전자부 재부착 기구 (GTRD)로 견고하게 고정한 임상 및 방사선학적 결과를 보고하고자 한다. 대상 및 방법: 2006년 1월부터 2008년 1월까지 70세 이상 대퇴골 전자간부 분쇄골절에 대해 양극성 반치환술을 시행하고 1 cm 이상 전위된 대전자부 골절편을 GTRD로 고정한 환자들 중 1년 이상 추시가 가능했던 32예를 대상으로 하였다. 술 후 임상적으로는 Harris 고관절 점수와 Johnston의 일상 생활 기능 평가를 사용하였고, 방사선학적으로는 술 후 골절편과 GTRD의 전위 유무 등을 확인하였다. 결과: 술 후 Harris 고관절 점수는 평균 71.6점 (53~82점)이었고 일상 생활 기능 평가에서는 보통 이상의 결과가 27예 (84.4%)였으며, 골절편의 1 cm 이상의 전위는 2예 (6.3%)에서 발생하였다. 1예에서 심부 감염이 발생하여 양극성 치환물을 제거하고 항생제 함유 골시멘트를 삽입하여 감염을 조절한 후 인공 관절 전치환술을 시행하였다. 결론: 고령의 대퇴골 전자간부 분쇄골절에서 양극성 고관절 반치환술을 시행할 경우 전위가 심한 대전자부 골절편을 GTRD로 고정하여 양호한 결과와 조기 재활을 얻을 수 있었다. Purpose: To evaluate the clinical and radiological outcome of the greater trochanter reattachment device (GTRD) as firm fixation method for displaced greater trochanter fragment in bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture in elderly patients. Materials and Methods: From January 2006 to January 2008, 32 patients above 70 years old treated with bipolar hemiarthroplasty using the GTRD as fixation method for comminuted intertrochanteric femur fracture with greater trochanter bone fragment displaced above 1 cm. They were followed up for more than one year. Clinically, the postoperative Harris hip score (HHS) and daily activities of life of Johnston et al were evaluated, and radiological, any displacement of greater trocharter bone fragments and/or GTRD. Results: The mean postoperative HHS was 71.6 (range, 53~82) points. In rating the daily activity of life, twenty seven (84.4%) patients` postoperative results were above fair. Two patients (6.3%) had displacement of the greater trochanter bone fragment above 1 cm. One patient had a deep infection, so we removed the bipolar head and inserted antibiotics-loaded cement block instead, and after the infection was controlled, conversion to total hip arthroplasty was done. Conclusion: In bipolar hemiarthroplasty for comminuted intertrochanteric femur fracture with displaced greater trochanter bone fragment, GTRD produced satisfactory results and early rehabilitation.

강직성 척추염에서 불완전 마미증후군을 동반한 제3요추 전이성 손상의 치료 -증례 보고-

김진완 ( Jin Wan Kim ),고영철 ( Young Chul Ko ),정철용 ( Chul Young Jung ),은일수 ( Il Soo Eun ),김영준 ( Young June Kim ),김창규 ( Chang Kyu Kim ) 대한골절학회 2012 대한골절학회지 Vol.25 No.1

Ankylosing spondylitis is a rheumatic disease in which mainly the spinal and sacroiliac joints are affected. Patients with ankylosing spondylitis are at significant risk for spinal fracture when exposed to even minor trauma. Most spinal fractures with ankylosing spondylitis occur in the cervical spine, whereas spinal fractures in thoracic or lumbar spine are rare, especially in the lower lumbar spine. Furthermore, neurologic symptoms in cases of lower lumbar spine fracture are rarer than in cases of cervical and thoracic spinal fracture. We have experienced a case of translation injury of the 3rd lumbar vertebra accompanied by incomplete cauda equine syndrome in ankylosing spondylitis and the authors gained good clinical results with surgical treatment. We have reported here on this case and have included a review of the relevant literature.

주관절 후내측 탈구를 동반한 동측 원위 요골 및 주상골 골절 -증례 보고-

김진완 ( Jin Wan Kim ),고영철 ( Young Chul Ko ),정철용 ( Chul Young Jung ),은일수 ( Il Soo Eun ),김영준 ( Young Jun Kim ),김창규 ( Chang Kyu Kim ) 대한골절학회 2012 대한골절학회지 Vol.25 No.2

낙상이나 교통사고와 같은 고에너지에 의한 상지의 수상은 수근관절과 주관절의 손상을 동시에 일으킬 수 있다. 이러한 손상으로는 몬테지아 (Monteggia) 골절, 갈레아찌 (Galeazzi) 골절, 에섹스-로프레스티 (Essex-Lopresti) 골절 탈구 등이 알려져 있다. 하지만 주상골 골절과 동반된 원위 요골 골절에서 발생한 주관절 탈구는 보고된 증례가 없으며 그 예후에 대해서도 알려진 바가 없다. 이에 저자들은 42세 남자 환자에서 발생한 주상골 골절과 원위 요골 골절의 동반손상에서 동측 주관절의 후내측 탈구가 발생한 사례에 대한치료 및 결과를 문헌고찰과 함께 보고하고자 한다. Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.