슬관절전치환술의 혈액손실

김정만,김용식,김성수,공준택,김기원 ( Jung Man Kim,Yong Sik Kim,Sung Soo Kim,Joon Taek Kong,Ki Won Kim ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.2

We reviewed the cases of two hundred twelve patients (three hundred twelve knees) who had a total knee arthroplasty between 1982 and 1991 at St. Marys Hospital, and we studied the relationship of the perioperative blood loss according to: 1. Type of disease (rheumatoid arthritis and osteoarthritis) 2, rehabilitation methods (simple ex- ercise, CPM, Alternate flexionuxtension splint) 3. Unilateral versus bilateral simultaneous group, The results were as follows; 1. The post-operative blood loss of the unilateral group was an average of 598.4 ml and of the bilateral group was 546.8 ml. 2. The post-operative blood loss of the CP54 group was 1014.4 ml and of the AFES group was 448.7 ml. 3. The patients who had rheumatoid arthritis had a significantly greater mean loss (616.3 ml) in comparison with osteoarf,hritis (513.9 ml), 4.. Persperative Hb difference was 1.3 gm/dl in the unilateral group, 1.5 gm/dl in the bilatera1 group, 0.7 gm/dl in rheumatoid arthritis 1.8 gm/dl in osteoarthritis, 2.3 gm/dl in the exercise group, 1.8 gm/d1 in the CPM group and 1.3 gm/dl in the AFES group. In conclusion, alternate flexion-extension splint was very effective in reducing the pest-operative blood loss. While normally blood loss is greater in rheumatoid arthritis versus osteoarthritis patients, we reduced the rheumatoid arthritis loss by intensive patient management. Thus, in our study, the perioperative Hb difference for osteoar- thritia was greater than rheumatoid arthritis.

내측 반월상 연골 파열의 진단에서 초음파의 의의

김정만,임동선,김태형,김종익,이규조,Kim, Jung-Man,Im, Dong-Sun,Kim, Tae-Hyung,Kim, Jong-Ick,Lee, Kyu-Jo 대한정형외과초음파학회 2011 대한정형외과 초음파학회지 Vol.4 No.1

목적: 자기 공명 영상 시행 전에 내측 반월상 연골의 파열 진단에서의 초음파 검사의 유용성을 알아보고자 하였다. 대상 및 방법: 2009년 4월부터 2010년 9월까지 본원 정형외과 외래를 방문하여 내측 반월상 연골 파열 의심 하에 초음파 검사를 시행한 341예 중 자기 공명 영상 검사를 시행한 147예를 대상으로 하였다. 초음파 검사상 이상 소견을 보이지 않는 16예, 비균질성(inhomogeneity)만을 보인 12예, 무리(cluster)를 보인 4예, 실질 내에 틈(cleavage)을 보인 60예, 5 mm 이상의 내측 탈출(extrusion)을 보인 55예를 자기 공명 영상 검사 결과와 비교 하였다. 통계학적으로 민감도와 특이도, 양성 예측률과 음성 예측률을 구하였다. 결과: 자기 공명 영상에서 파열을 보인 경우는 104예였다. 초음파 검사는 자기 공명 영상에 대하여 민감도가 94.2%, 특이도는 23.3%로 측정 되었다. 양성 예측률은 74.8%, 음성 예측률은 62.5%로 측정되었다. 초음파 영상에 따른 양성 예측률은 비균질성이 보이는 경우 58.3%, 무리를 보이는 경우에는 100%, 실질 내에 틈을 보이는 경우 75%, 내측 탈출을 보이는 경우 80%로 나타났다. 결론: 내측 반월상 연골 파열의 진단에 있어 고가의 자기 공명 영상을 시행하기 전 초음파 검사는 파열 가능성 여부를 사전에 아는데 유용하였다. Purpose: To evaluate the usefulness of ultrasonography in diagnosis of the medial meniscus tear as a screening tool before performing magnetic resonance imaging. Materials and Methods: From April 2009 to September 2010, magnetic resonance imaging (MRI) was taken in 147 knees out of 341 knees examined with ultrasonography (US) under the suspicion of medial meniscus tear. The sonographic findings were 16 without abnormality, 12 inhomogeneity, 4 cluster, 60 cleavage and 55 more than 5mm medial extrusion of medial meniscus. In Statistical analysis, sensitivity and specificity, positive predictive value and negative predictive values were calculated. Results: The MRI showed abnormality in 104 knees. Sensitivity and specificity of ultrasonography for MRI was 94.2% and 23.3%, respectively. Positive predictive value was 74.8%, negative predictive value was 62.5%. The positive predictive value of ultrasonography were 58.3% in heterogeneity, 100% in showing cluster, 75% in visible cleft and 80% in medial extrusion. Conclusion: The US is a useful tool in prediction of medial meniscus tear before confirming it in high-cost MRI.

경골근위부 골육종의 사지구제 수술시 대퇴사두근 기능의 보존 - 2례 보고 -

김정만,김용식,김성수,배수경 ( Jung Man Kim,Yong Sik Kim,Sung Soo Kim,Soo Kyung Bae ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.1

Reattachment of the patellar tendon to the implant following limb salvage operation in cases of ma ' ncy of the proxima1 tibia is a challenging problem and there is no report of success. In two young patients of 13 and 15 years old authors performed osteotomy of the fibula at distal 1/3 and the bone was angulated. The fibular head was moved to the site of the previous tibial tuberosity following wide marginal resection of the osteosarcoma of the proximal tibia. The pateUar tendon with a piece of bone intact was fixed to the fibular head with sorew. Quadriceps setting exercise was encouraged following operation. In 6 weeks after operation the patients could extend the knee against gravity. In 12 weeks they could walk with crutches and partial weight bearing was allowed. In 6 months one patient could walk without support. The other patient could waRc with crutches and the muscle power was good. He was lost to follow up because of metastasis of the tumor to the medial femoral condyle. In conclusion anteromedial transposition of the fibula and reattachment of the patellar tendon is useful in restoring the quadriceps muscle function following limb salvage operation of the osteosarcoma of the tibia.

슬개골대퇴골간 골성관절염과 슬개골압통

김정만,김성수,권순용,김형관,이화성 ( Jung Man Kim,Sung Soo Kim,Soon Yong Kwon,Hyung Kwan Kim,Hwa Sung Lee ) 대한슬관절학회 1992 대한슬관절학회지 Vol.4 No.1

To clarify the meaning the patellar tenderness for the patellofemoral osteoarthritis we compared intraoperative findings of the wear pattern of the articular cartilage of the patella and corresponding femoral trochlea with preoperative patellar tenderness in cases of total knee arthroplasty. The tenderness was observed according to the divi- ded area such as inferior pole, lateral facet, central ridge, medial facet and superior pole. The wear pattern of the articular cartilage was also observed on the aforemen- tioned divided area. One hundred and twelve knees of 73 patients were involved in this study. The average age of the patients was 61.8 years ranging from 30 to 80. The sex was predominently female (67 patients, 91.8 %). Position of the pate0a was measured with Insall-Salvati measurement and Black- burae-Peel meaaurernent. From a Merchants view sulcus angle and congruence angle were measured. The relationship of those findings and the wear pattern was analyzed statistically with chi-square test. 1. Wear of the cartilage was near or at the central ridge, from which it was extended medially, laterally and distally. No case showed isolated wear of inferior pole or superior pole. 2. Patellar tenderness was most frequently observed at inferior pole followed by lateral facet and then central ridge. Hawever, there was no isolated tenderness on central ridge where wear of the articular cartilage was seen. Tenderness an the proximal pole was frequently observed independently. The tender point was not coincided with the wear area at all. 3. There was no sigpificant relationship between congruence angle and patellar tenderness or wear of cartilage (P > 0.05). 4. Wear of the articular cartilage of the trochlea could occur without wear of the cartilage of the patella, however there was no statistical relationship between the two (P > 0.05). Radiological subchondral sclerosis was not significantly related with the findings of wear of the cartilage (P > 0.05), whereas subchondral cyst was seen more frequently in case of worn cartilage than in case of intact cartilage (P < 0.05). From these results it was suggested that the patellar tenderness could not be a index of the severity of tbe wear of articular cartilage of the patella. The patellar ten- derness may be caused by other facfors other than cartilage wear, such as synovial impingement or spur.

한국인의 연, 망간, 알루미늄 및 실리콘의 혈중 농도

김정만,안정모,김원술,김정일,신해림,정갑열,김준연,Kim, Jung-Man,Ahn, Jung-Mo,Kim, Won-Sul,Kim, Jung-Il,Shin, Hai-Rim,Jung, Kap-Yeol,Kim, Joon-Youn 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.2

연, 망간, 알루미늄 및 실리콘에 대하여 직업적 노출이 없는 성인 132명(남성 67명, 여성 65명)을 대상으로 혈중 농도를 정량분석하여 다음과 같은 결과를 얻었다. 평균 혈중 연량(기하평근, 기하표준편차)은 남자군 (3.49, 1.70) ${\mu}g/dL$와 여자군 (3.04, 1.65) ${\mu}g/dL$로서 남자군에서 높았으나 유의한 차이는 없었고, 연령군별로는 남, 여 모두 차이가 없었다. 평균 혈중 망간량은 $0.99{\pm}0.41\;{\mu}g/dL$이었으며, 성별, 연령군별 유의한 차이는 관찰되지 않았다. 평균 혈중 알루미늄량은 $0.59{\pm}0.35\;{\mu}g/dL$이었으며, 성별, 연령군별 유의한 차이는 관찰되지 않았다. 평균 혈중 실리콘량은 남자군 $54.11{\pm}27.64\;{\mu}g/dL$, 여자군 $43.34{\pm}23.51\;{\mu}g/dL$로서 남자군에서 유의하게 높았고(p<0.05), 남자군의 경우 연령이 증가함에 따라 유의한 증가가 관찰되었으나(p<0.05), 여자군의 경우에는 연령군별로 차이가 없었다. 본 연구는 몇 가지 금속의 참고치 설정을 위한 기초 연구의 일환으로 앞으로의 연구에 자료로서 활용함으로써 이들 물질에 의한 인체장해의 평가와 예방관리에 일조 할 수 있을 것으로 생각된다. Objectives : This study was peformed to determine the reference values of blood lead, manganese, aluminium, and silicon in healthy adults. Methods : The subjects were 132 (67 male and 65 female), and classified to three age groups $(\leq39,\;40\sim49,\;and\;50\leq)$. Blood lead, manganese and aluminium were analyzed by atomic absorption spectrophotometer, and blood silicon was analyzed by direct current plasma optical emission spectrometer. Results : Blood lead levels(geometric mean, S.D) were (3.49, 1.70) ${\mu}g/dL$ in male and (3.04, 1.65) ${\mu}g/dL$ in female, but the difference is not significant, and there was no significant difference between age groups. Mean blood manganese level was $0.99{\pm}0.41{\mu}g/dL$, and there was no significant difference between sex or age groups. Mean blood aluminium level was $0.59{\pm}0.35{\mu}g/dL$, and there was no significant difference between sex or age groups. Mean blood silicon level was $54.41{\pm}27.64{\mu}g/dL$ in male and $43.34{\pm}23.51{\mu}g/dL$ in female, and the level in male was significantly higher than that in female (p<0.05). There was significant difference between age groups, and the oldest showed the highest level in male (p<0.05), but no significant difference between age groups in female. Conclusions : Authors hope that this study would provide basic data for determining reference values and evaluating health effects.

내측 반월상 연골 초음파 상 고에코성 '무리'의 임상적 의의

김정만,오세관,유종민,김필성,김인보,Kim, Jung-Man,Oh, Se-Kwan,Yu, Jong-Min,Kim, Pil-Sung,Kim, In-Bo 대한정형외과초음파학회 2011 대한정형외과 초음파학회지 Vol.4 No.2

목적: 내측 반월상 연골 파열의 초음파적 진단은 매우 어려운 것으로 알려져 있다. 저자들은 내측 반월상 연골의 초음파 영상에서 고에코성 '무리'가 보일 때 어떤 임상적 의의가 있는지 알고자 하였다. 대상 및 방법: 내측 반월상 연골의 초음파 상 고에코성 '무리'가 보이는 28예에서 자기 공명 영상과 수술 소견을 비교하여 그 의의를 찾고자 하였다. 전례 여성이었으며 년령은 55~75세 사이였다. 결과: 고에코성 '무리'의 생성 부위는 수술 소견상 정확히 반월상 연골의 파열된 조각이 모조직과 중첩되는 부위와 일치 하였다. 결론: 고에코성 '무리'가 내측 반월상 연골에 보일 때 이는 연골 파열 파편이 모조직과 중첩된 것을 나타낸다. Purpose: To verify the sinificance of the hyperechoic cluster formation in medial meniscal tear on the sonography. Materials and Methods: The formation of hyperechoic cluster of the medial meniscus on the sonography were compared with the MRI and arthroscopic findings in 28 knees. Results: The cluster formation area coincided with the overlapped torn fragment of the meniscus in all cases. Conclusion: The hyperechoic cluster on the sonography reveals the position of the overlapped torn fragment.

슬관절내 발생한 Clear Cell Sarcoma - 1예 보고 -

김정만,김용식,김성수,조재영 ( Jung Man Kim,Yong Sik Kim,Sung Soo Kim,Jae Young Cho ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.1

Clear cell sarcoma arising from tendons and aponeuroses is very rare, especially in the knee joint. This was first1y decribed as a new type of tumor by Enzinger in 1965. Although the histogenesis of clear cell sarcoma remains uncertain, it may be expected the melanoqrtic origin. The microscopic pattern of nests, fascicles, or clusters of fusiform to polygonal cells with a typical reticular pattern, clear cytoplasm, and clear nucleoi with prominent nucleoli is a consistent observation. We report a case of ineidentaQy founded clear cell sarcoma in the knee joint mimic to chronic synovitis with review of literature.

탄소 섬유로 유발된 활액막염

김정만,김용식,김성수,공준택,김기원 ( Jung Man Kim,Yong Sik Kim,Sung Soo Kim,Joon Taek Kong,Ki Won Kim ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.2

Total joint replacement components of ultra-high molecular weight polyethylene that is reinforced by the addition of randomly oriented carbon fibers have been com- mercially available for several years. The use of carbon-fiber reinforced polyethylene in these components was advo- cated on the basis of improved resistance to creep, improved wear properties and in- creased strength as compared with plain (non-reinforced) polyethylene. Recently, we have encountered three notable failures of carbon fiber reinforced polyethylene components of the total knee replacement prostheses. All failures (two cases of loosening, one case of patellar subluxation) were caused by defect in the molded carbon fiber reinforced polyethy}ene: at exploration, the sy- novial tissue throughout the knee had a blackened appearance and extreme wear of articular components were found in all cases. In conclusion, the cases of our three patients demonstrate the potential for early and catastrophic failure due to poor molding of carbon fiber reinforced polyethylene. Although many components have been used clinically, this potential for failure must be considered as another disadvantage of its use in total joint replacement.

물리적 유해인자의 허용량(5)

김정만,Kim, Jeong-Man 대한산업보건협회 1985 산업보건소식 Vol.16 No.-

물리적 유해인자의 허용량(4)

김정만,Kim, Jeong-Man 대한산업보건협회 1985 산업보건소식 Vol.15 No.-