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제 3형 급성 견봉-쇄골 관절 분리 환자의 수술적 치료 결과
한성호,양보규,이승림,정선욱,이동호,김민석 대한골절학회 2003 대한골절학회지 Vol.16 No.2
목적 : 본 연구를 통하여 Rockwood 제 3형 급성 견봉-쇄골 관절 분리 환자에서 Phemister 술식과 modified Phemister 술식의 치료 결과를 비교하고자 한다. 대상 및 방법 : 1992년 2월부터 2001년 8월까지 제 3형 급성 견봉-쇄골 관절 분리로 수술적 치료를 받고 1년 이상 추시 가능하였던 45명, 45예의 환자를 대상으로 하였다. 평균 연령은 28.1세였으며, 남자가 42명, 여자가 3명이었다. 진단은 이학적 검사와 단순 방사선 부하 촬영법을 이용하였으며, 수상일로부터 수술적 치료까지의 평균 기간은 7.8일이었다. 술장 소견상 오구-쇄골인대 봉합술이 어려운 15예에서는 Phemister 술식을 시행하였고 (Ⅰ군), 인대 봉합이 가능한 30예에서는 modified Phemister 술식을 시행하였다(Ⅱ군). 수술 후 추시 기간은 평균 16.2개월이었고, 결과 판정은 최종 추시 때의 임상 소견과 이학적 검사 및 방사선 촬영을 통해 UCLA shoulder scoring system과 acromio-clavicular separation scoring system을 이용하였다. 결과 : 술후 합병증은 Ⅱ군에만 표재성 감염이 2예, K-강선 이주가 1예에서 발생하였다. 최종 추시상 전예에서 동통, 관절 운동 범위의 제한은 없었고 , Ⅱ군에서만 방사선 촬영상 2예에서 아탈구가 관찰되었다. UCLA shoulder scoring system은 Ⅱ군에서 우수 93.3%, 양호 6.7%였고, acromio-clavicular shoulder scoring system은 Ⅱ군에서 우수 90%, 양호 10%였다. 결론 : 활동적인 연령에서 발생한 제 3형 급성 견봉-쇄골 관절 손상의 환자에서 Phemister 술식만으로도 좋은 결과를 보일 수 있을 것으로 사료된다. Purpose : The purpose of this study is to compare the Phemister technique with the modified Phemister technique for the patients with Rockwood type 3, acromio-clavicular separation. Materials and Methods : The 45 cases of 45 patients received surgical treatment for Rockwood type 3, acute acromio-clavicular separation in our hospital from Feb. 1992 to Aug. 2001 later with the follow-up study were selected as subjects. The average ages were 28.1 years old, male and female were 42, 3 persons, respectively. Physical examination and plain radiography were used for their diagnosis and the intervals between injury and surgical treatment were 7.8 days. In intraoperative finding, we performed Phemister technique in 15 cases according not to be able to repair coraco-clavicular ligament (groupⅠ), modified Phemister technique in 30 cases according to be able to repair that (groupⅡ). The average follow up period was 16.2 months, and the UCLA shoulder scoring system and the acromio-clavicular separation scoring system were used to obtain clinical results. Results : Only in Group Ⅱ, the complication after surgery were associated with superficial infection in two cases and K-wire migration in one case. At last follow up, there were no pain and limitation of range of motion in all cases, and two cases in Group Ⅱ were found to be subluxation in radiography. Clinical results revealed excellent was 93.3%, good was 6.7% in UCLA shoulder scoring system in both groups, and excellent was 90%, good was 10% for group Ⅱ in acromio-clavicular separation scoring system. Conclusion : The results are considered to be food with only Phemister technique in type 3, acute injury occurred in working ages.
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양보규,한성호,정선욱,이승림,박양희,고동오 대한골절학회 2001 대한골절학회지 Vol.14 No.2
Purpose : The goal of our study was to evaluate diagnosis and management of stress fracture in long bones using MRI findings. Material & Method: Between May 1995 to May 1999, 40 patients( 45 cases ) were confirmed to have a stress fracture by clinical and radiological findings. All patients were evaluated with clinical, X-ray, bone scan, and MRI findings. The patient was 21 years in average( range from 18 to 23 years ). All were males and soldiers. The evaluation was made by comparison of MRI and plain radiograph, and duration of symptom was evaluated with MRI grading by Fredericson et al. Result: The locations of stress fracture of long bones were tibia(n=25), fibula(n=14), and femur(n=6). MRI findings were bone marrow edema in 38(84.4%)cases, intramedullary low signal intensity band in 19(42.2%)cases which was continuous with cortex and cortical fracture line. Periosteal reaction was seen in 45(100%)cases and surrounding soft tissue edema in 20(44.4%)cases. Plain X-ray findings were peristeal reaction in 31( 68.9%)cases, medullary sclerosis in 10(22.2%)cases, and cortical fracture line in 8(17.8%) cases. Duration of symptom was longer in higher MRI grade. Conclusion: MRI was more useful in early diagnosis and differential diagnosis of stress fracture, showing various findings than plain radiograph. MRI grading was helpful in planning tlhe therapy of stress fracture.
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배대경,정선욱,권현섭 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1
The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.
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배대경,정선욱,권현섭 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1
Ligament injuries of the knee joint are very common among competitive athletes. Acrurate assessment of the nature of these injuries is a prerequisite for appropriate therapy. The purpose of this study is to evaluate the significance of MRI findings in assesing the status of ACL tear and associated injuries. 31 cases of ACL injuries were examined and reconstructed arthroscopically from Jan. 1997 to Sep. 1997 at Kyung Hee University Hospital. 1n all cases, we reviewed preoperative physical and MRI findings and performed postoperative radiologic assessments. Results were as follows; 1. Lachman test and Pivot shift test were positive in all 31 cases but anterior drawer test was positive in 29 cases. 2. In MRI findings, 24 cases were interpretated as complete ACL tear and 7 cases as inccomplete ACL tear. But these 7 cases were confirmed as complete tear in arthroscopic examination with careful probing of ACL fiher. 3. MRI showed associated meniscal injuries in 19 cases(61%)-14 cases(74%) at medial meniscus, 5 cases(26%) at lateral meniscus. All cases were confirmed arthroscopically. In conc1usion, physical findings are more reliable than MRI findings in diagnosing the complete ACL tear and deciding the ACL reconstruction. But MRI findings are very helpful to assess the associated injuries and plan the treatments.
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전위된 양동이 손잡이형 파열의 치료 - 내측과 외측 반월상 연골의 비교 -
정선욱,한성호,양보규,이승림,하정현,김민석,여용범,Chung Shun Wook,Hahn Sung Ho,Yang Bo Kyu,Yi Seung Rim,Ha Jeong Hyun,Kim Min Seok,Yeo Yong Beom 대한관절경학회 2003 대한관절경학회지 Vol.7 No.2
목적 : 내측 및 외측 반월상연골의 전위된 양동이 손잡이형 파열의 양상과 동반손상에 따른 치료원칙과 결과를 비교하고자 하였다. 대상 및 방법 : 1998년 9월부터 2002년 12월까지 본원에서 내측 반월상 연골의 전위된 양동이 손잡이형 파열(이하 I군)로 진단받은 52명 52예와 외측 반월상 연골의 전위된 양동이 손잡이형 파열(이하 II군)로 진단받은 31명 32예를 대상으로 하였으며, 평균연령은 I군 25세($16\~66$세), II군 29세($18\~63$세)였고, 평균 추시기간은 I군 18개월 ($12\~50$개월), II군 13개월($6\~46$개월)이었다. 술중 관절경 검사를 통하여 연골 파열의 부위, 동반손상 여부를 확인하였으며, 외측의 경우 추가적으로 원판형 연골인 경우를 조사하였다 술 후 최종 추시 시 이학적 검사와 임상양상에 따라 치료 판정을 하였으며, 두 군 전체에서 전방십자인대 파열이 동반되었던 경우 추시 관절경을 19례$(23\%)$에서 시행하였다. 결과 : 전방십자인대 파열이 동반된 경우는 I군 38예$(73\%)$, II군 5예$(16\%)$였으며, 원판형 연골이었던 경우는 II군에서 19예$(59\%)$였다. 최종 추시 시 봉합술을 시행한 예에서 I군의 경우 26예 중 22예$(85\%)$는 성공 판정을 받았으며, II군의 경우 3예 중 2예$(67\%)$에서 성공 판정을 받았고, 절제술을 시행한 예에서는 I군의 경우 26예 중 전예에서 II군의 경우 28예 중 26예$(93\%)$에서 성공 판정을 받았다. 이중 I군에서 재수술을 시행한 경우가 봉합술을 시행한 2예에서 있었고, 재수술 당시 1예에서는 봉합부위의 재파열과 다른 1예에서는 새로운 부위의 파열을 발견하였다. II군에서는 원판형 연골의 모양을 보였던 19예 중 2예에서 절제술 후 남아있는 연골에서 새로운 파열이 발견되었다. 결론 : 내측과 외측 반월상연골의 전위된 양동이 손잡이형 파열에 있어 동반 손상이 현저히 다르며, 그 차이를 고려하는 것이 적절한 치료 원칙을 정하는데 도움이 되리라 사료된다. Purpose : The purpose of this study was to compare the pattern of displaced bucket-handle tear of lateral and medial menisci and the treatment modality and results from accompanying injury. Materials and Methods : Patients who were diagnosed for displaced bucket-handle tear of medial meniscus (group I: 52patients, 52cases) and lateral meniscus (group II: 31patients, 32cases) from September 1998 to December 2002. The mean ages were 25years $(16\~66)$ for Group I and 29years $(18\~63)$ for Group II, and the average follow-up period were 18months $(12\~44)$ and 13months $(6\~46)$, respectively. The zone of meniscus tear and the existence of accompanying injury were verified through intraoperative arthroscopy and discoid type meniscus was additionally examined for group II. The assessment was made according to the physical examination and clinical pattern at the postoperative last follow-up, and the 2nd look arthroscopy was performed in 19cases $(23\%)$ for the cases accompanying anterior cruciate ligament (ACL) injury in both groups. Results : There were 38cases $(73\%)$ in group I, 5cases $(16\%)$ in group II for associating ACL injury. We observed discoid type meniscus (19cases, $59\%$) in group II. At last follow-up clinical success in repair cases of group I and II are 22cases $(85\%)$, 2cases $(67\%)$, in resection cases are 26cases $(100\%)$, 26cases $(93\%)$ respectively. Reoperation is performed 2cases in repair cases of group I. One case is re-rupture, the other case is newly developed tear in white-white zone. Reoperation is performed 2cases due to remnant meniscal tear in resection cases of group II. All of 2cases are discoid type menisci. Conclusion : Displaced bucket-handle tear of medial & lateral menisci would be substantially different an aspect, considering on difference would help to select proper treatment modality.
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옥재철,배대경,정선욱,안동기 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2
The PFC(Press Fit Condylar) knee was first implanted clinically in 1984 with retention of posterior cruciate ligament. Thereafter PFC modular version had been developed at 1988 with option of posterior cruciate ligament substitution and minor design changes. We classified the 170 patients, 252 knees which underwent the PFC total knee arthroplasty in the period from January 1988 to May 1995 into three groups. In group I, 62 patients had 93 total knee arthroplasties with insertion of the original PFC total knee prosthesis with retention of posterior cruciate ligament from January 1988 to October 1991. In group IIa, 51 patients had 74 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with retention of posterior cruciate ligament from November 1991 to May 1995. In group III, 57 patients had 85 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with substitution of posterior cruciate ligament from November 1991 to May 1995. Average follow-up periods were 7 years 5 months in group I and 3 years 2 months in group IIa and IIb. Clinical and radiographic results were similar among the group I, IIa and IIb except slight better scores in group IIa and IIb than group I, even though group IIa and IIb had short follow-up periods. Postoperative implant wear was developed at 5 knees in group I, 1 knee in group IIa and not developed in group IIb. Implant loosening was developed at 1 knee only in group I. Revisional arthroplasty was performed to 7 knees in group I, 1 knee in group IIa and not in group IIb. In conclusion, posterior cruciate ligament substitution group had no difference in functional results with the retention group. In the problem of implant wear, posterior cruciate ligament substitution group was superior to the retention group but similar in loosening.
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