체중 부하 후 전족부 배열의 방사선적 변화: 무지 외반각 및 중족골간 각과 내측 종자골의 위치

노성만,이근배,최진,천승영,허창익,Rowe, Sung-Man,Lee, Keun-Bae,Choi, Jin,Cheon, Seung-Young,Hur, Chang-Ich 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: To determine the radiographic changes in forefoot geometry with weight-bearing. Materials and Methods: The forefoot radiographs of 100 normal Korean adults, 50 male and 50 female volunteers, were evaluated both in nonweight-bearing and weight-bearing. The mean age was 27 years with range of 21-39 years. Those with normal feet were selected from volunteers having no history of foot problems or other musculoskeletal diseases. Results: The changes of measured angle between phalanges and metatarsals with weight-bearing were as follows; Hallux valgus angle was noted to increase in 20% of the feet, decrease in 59%, and remained unchange in 21%. Intermetatarsal angle $1{\sim}2$ was noted to increase in 76% of the feet, decrease in 3%, and remained unchange in 21%. Intermetatarsal angle $1{\sim}5$ was noted to increase in 95% and remained unchange in 5%. Shift in medial sesamoid on weight-bearing was also not consistent. Lateral shift was noted in 27%, no shift in 66%, medial shift in 7%. Conclusion: The generalized concept that the angles between bones and shift of medial sesamoid in the forefoot will change consistently with weightbearing was not found.

요골 원위부 관절내 불안정 골절의 치료

문은선(Eun-Sun Moon),이근배(Keun-Bae Lee),천승영(Seung-Young Cheon) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.5

Mortality Following Hip Fracture

Sung Man Rowe(노성만),Bong Hyun Bae(배봉현),Yu Bok Park(박유복),Seung Young Cheon(천승영),Kyung Do Kang(강경도) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.8

목적: 고관절 골절 후 발생하는 사망률을 확인하고, 이에 영향을 미치는 주요 인자들을 규명하고자 하였다. 대상 및 방법: 2001년 호남지역에 거주하는 50세 이상 864,966명 중 1,152명에서 고관절 골절이 발생하였다. 이들 골절 환자 중 수상 후 1년 이내의 사망 환자는 총 172명이었으며, 평균 연령은 79세(51-96세)였고, 남자가 69명, 여자가 103명이었다. 결과: 고관절 골절 환자 1,152명 중 172명이 1년 이내에 사망하여 사망률은 14.9%였다. 수상 후 기간별 사망률은 3개월에 6.9%, 6개월 9.6%, 9개월 13.2%, 그리고 12개월에 14.9%였다. 고관절 골절 후 1년 사망률(l4.9%)은 일반인의 사망률(5.8%) 보다 2.6배 높았다. 사망률을 증가시킬 수 있는 관련 요소로는 고령, 활동력 저하, 비수술적 치료, 병원 방문의 지연, 불안정성 대퇴전자간 골절, 그리고 여름에 발생한 골절이었으며, 다중회귀분석 결과 환자의 활동력 저하와 비수술적 치료가 사망률 증가에 있어 가장 중요한 요인임을 알 수 있었다. 결론: 고관절 골절 환자에서 활동력 저하와 비수술적 치료의 시행이 환자의 사망률 증가에 가장 큰 영향을 주었다. Purpose: To determine mortality levels following hip fracture in Korea, and to identify the factors responsible. Materials and Methods: Hip fracture occurred in 1,152 of 864,966 persons (13.3/10,000 per year) aged 50 years or more in South Honam, Korea in 2001. Of these 1,152 patients, 172 died within 12 months of injury. Mean age of these mortalities was 79 years with range of 51 to 96 years. 103 were females and 69 were males. Results: Mortality rates were 6.9% within 3 months of injury, 9.6% within 6 months, 13.2% within 9 months, and 14.9% within 12 months. The annual mortality rate of fracture patients (14.9%) was 2.6 times higher than the age and sex adjusted mortality rate of the general population (5.8%). The factors found to increase the probability of death were; an advanced age, poor daily activity level, nonoperative treatment, delayed visit to hospital, an unstable intertrochanteric fracture, and a fracture during the summer. Multivariate analysis identified poor daily activity level and nonoperative treatment as the most significant variables. Conclusion: The poor daily activity level and nonoperative treatment were found to have greatest effect on mortality rates following hip fracture in the elderly.

경골 근위부 절골술 비교

이준엽(Jun Yub Lee),선종근(Jong Keun Seon),송은규(Eun Kyoo Song),윤택림(Taek Rim Yoon),천승영(Seung Young Cheon),임근영(Keun Young Lim) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.7

목적: 슬관절 내측 구획에 국한된 골관절염 환자에서 경골 근위부 개방형 설상 절골술을 시행하고 그 임상적 및 방사선학적 결과를 폐쇄형 설상 절골술과 비교하였다. 대상 및 방법: 골관절염으로 경골 근위부 개방형 절골술 후 2년 이상 추시가 가능하였던 27병 29예(A군), 비교군으로는 폐쇄형 절골술을 시행했던 30명 30예의 환자(B군)를 대상으로 하였다. 방사선학적으로 Ahlback에 의한 관절염의 정도, 대퇴-경골각, 경골의 관상면 정열 및 후방 경사도와 Insall-Salvati 방법에 의한 슬개골의 높이의 변화를 측정하여 비교하였으며, 임상적으로는 HSS 점수를 측정하였다. 결과: 개방형 군에서 수술 전에 측정한 대퇴-경골각은 내반 4.2°, 경골의 정열은 5.3° 내반 및 7.9°의 후방 경사, Insall-Salvati ratio는 0.93이었으며 폐쇄형 군에서도 유사한 수치를 보였다. 개방형 군에서 2년 추시 대퇴-경골각은 외반 7.7°, 경골의 정열은 1.3°의 외반으로 수술 전에 비해 의의있는 교정을 보였으며, Insall-Salvati ratio는 0.92로 수술 전에 비해 변화가 없었다. 그러나, 경골의 후방 경사도는 2년 추시상 10.7°로 수술 전에 비해 약 3° 이상의 증가를 보였다. 폐쇄형 군의 2년 추시에서는 개방형 군과 의의 있는 차이는 없었으나, 경골의 후방 경사도는 수술 전 8.7°에서 2년 추시상 3.7°로 의의있는 감소를 보였다. HSS 점수는 개방형 군에서 수술 전 74점에서 2년 추시 93점으로 향상되었으며, 폐쇄군의 변화와 의미 있는 차이는 없었다. 합병증으로는 개방형 군에서는 자연유합 1예 외에 다른 합병증은 관찰되지 않았으나, 폐쇄형 군에서 천 비골 신경 손상 3예, 지연유합 1예가 발생하였다. 결론: 개방형 설상 절골술은 신경 혈관 합병증이 없이 폐쇄형과 비슷한 방사선학적 및 임상적 결과를 얻을 수 있는 비교적 간단하며 안전한 술식으로 생각되나 후방 경사도의 증가의 방지를 위하여 동일한 정도의 전ㆍ후방 개방에 유의해야 할 것으로 생각된다. Purpose: To evaluate the clinical and radiological results of an opening wedge osteotomy for an osteoarthritic knee, and compared these results with those of a closing wedge osteotomy. Materials and Methods: The study included 27 patients (29 cases) with an opening wedge osteotomy (Group A) and 30 patients (30 cases) with a closing wedge osteotomy (Group B). The radiological results obtained regarding the degree of osteoarthritis, femur-tibia angle, tibial alignment, posterior tibial slope and patellar height using the Insall-Salvati s method were analyzed. HSS score was used for evaluation of the clinical results. Results: Preoperatively, there were no significant differences between the two groups regarding the degree of osteoarthritis, the femur-tibia angle, tibial alignment, posterior tibial slope, and patellar height. Two years after surgery, the femur-tibia angle and tibial alignment were significantly improved to 7.7° valgus and 1.3° valgus, respectively, and the patellar height was not changed significantly in group A. Similar results were obtained in group B. The tibial posterior slope increased from 3° to 10.7° in group A and decreased from 4° to 3.7° in group B. Clinically, the HSS score was improved from 74 points preoperatively to 93 points 2 years postoperatively in the opening group, and was similar to the improvement observed in the closing group. The complications included 1 delayed union in the opening group, and 3 cases of superficial peroneal nerve palsy and 1 delayed union in the closing group. Conclusion: An opening wedge osteotomy is a relatively simple and safe procedure that gives similar radiological and clinical outcomes to a closing wedge osteotomy, without peroneal nerve palsy. However, surgeons should take care in preventing an increase in the tibial posterior slope.

4분 척추에 의한 선천성 후측만증의 수술적 치료 결과

정재윤,김형석,천승영 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.2

Study design : Sixteen patients with congenital kyphoscoliosis were evaluated the clinical and radiological results according to the treatment method. Objectives : To provide a guideline for surgical treatment of congenital kyphoscoliosis Summary of literature review : Congenital kyphoscoliosis is an abnormal coronal and sagittal curvature of spine that is caused by the presence of vertebral anomalies, which causes a significant deformity and disability. Correction of the deformity is challenging and accompanied by high risk of complications. Many methods of operative treatment were recommanded with various results. Materials & methods : We reviewed 16 patients of congenital kyphoscoliosis who were operated from 1984 to 1997, and follow-up periods were over 1.2 months in all. The average age of surgery was 12 years (ranged from 4 to 20 years). Nine cases were operated by excision of quadrant hemivertebra through combined anterior & posterior approach and 6 cases were treated only by posterior instrumentation and one underwent posterior en bloc spondylectomy. Results : The type of curves were thoracic in 5, thoracolumbar in 9, lumbar area in 2 patients. Average angle of kyphosis was 55 degree preoperatively, 25 degree postoperatively, and 39 degree at the follow up study. Average angle of scoliosis was 48 degree, 22 degree, and 27 degree, respectively. In 9 cases corrected by excision of quadrant hemivertebra; kyphotic angle was changed from 62 preoperatively, to 22° postoperatively and to 36 degree at the end of follow up study, while scoliotic angle was changed from 47° to 12° and to 21°, respectively. In 6 cases corrected by posterior instrumentation ; kyphotic angle was changed from 52° preoperatively, to 33° postoperatively and to 48° degree at the follow up study, while scoliotic angle was changed from 53° to 33° and to 37° respectively. Conclusion : Excision of quadrant hemivertebra through combined anterior and posterior approach or posterior instrumentation were resulted in significant loss of correction during the remaining growth period due to the secondary change of adjacent vertebrae. So, to obtain better correction and to reduce the recurrence of deformity, more aggressive approach including the concept of three dimentional osteotomy involving the upper and lower adjacent curve may be considered.