수술술기 : 척골경상돌기 골절 고정을 위한 β-강선을 이용한 수술적 기법

김지형 ( Jee Hyoung Kim ),김진학 ( Jin Hak Kim ),이송 ( Song Lee ),양승진 ( Seung Jin Yang ),유창욱 ( Chang Wook Yoo ),전태환 ( Tae Hwan Chun ) 대한골절학회 2010 대한골절학회지 Vol.23 No.1

저자들은 척골경상돌기 골절을 고정하기 위해, 시술하기 쉽고 안전하며 골절부위에 압박력을 가할 수 있을 것으로 기대되는`β-강선 기법`을 소개하고자 한다. For the fixation of ulnar styloid process fracture, we want to introduce the `β-wire technique`, which is easy to learn and practice and thought to give a compressive force to the fracture site.

지혈대 압력에 따른 인공 슬관절 치환술 후 발생한 피하출혈양의 관계

김지형 ( Jee Hyoung Kim ),이송 ( Song Lee ),김경태 ( Kyung Tae Kim ),고동오 ( Dong Oh Ko ),양종화 ( Jong Hwa Yang ),이정수 ( Jung Soo Lee ),김대근 ( Dae Geun Kim ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.1

Purpose: We wanted to evaluate the post-operative amount of subcutaneous bleeding according to the tourniquet pressure during total knee replacement. Materials and Methods: We analyzed 136 patients who had undergone total knee replacement at our hospital from March 4th, 2010 to September 16th, 2010. A tourniquet pressure of 250 mm Hg was applied to 69 patients (group I) and a tourniquet pressure of 320 mm Hg was applied to the other 67 patients (group II). Subcutaneous bleeding was evaluated on the 3rd and 6th days after the operations. All of the total knee replacements were performed by a single surgeon. Results: Among the group I patients, subcutaneous bleeding was seen in just 2 patients, yet among the group II patients, there were 32 patients with subcutaneous bleeding on the 3rd day and 33 patients with subcutaneous bleeding on the 6th day. According to the multiple regression analysis, there were no significant differences in ages, the tourniquet time and the orders between the two groups. Group 1 had significantly less subcutaneous bleeding than did group II on the 3rd and 6th days after the operations (p=0.001). Conclusion: There was a significant difference of the amount of subcutaneous bleeding amount according to the tourniquet pressure. We were able to decrease the post-operative amount of subcutaneous bleeding after total knee replacement by lowering the tourniquet pressure to 250 mm Hg.

엑셀을 이용한 데이터 정리 및 함수 이용하기

김지형 ( Jee Hyoung Kim ) 대한간학회 2019 임상연구방법론워크숍 Vol.2019 No.1

슬관절 부분치환술 후 발생한 조기 실패의 원인과 치료

김경태 ( Kyung Tae Kim ),이송 ( Song Lee ),김지형 ( Jee Hyoung Kim ),김관수 ( Kwan Soo Kim ),김태우 ( Tae Woo Kim ),박순열 ( Soon Youl Park ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.3

Purpose: We wanted to evaluate the causes, treatments and preventive measures for early failure of unicompartmental knee arthroplasty (UKA) by performing an analysis of the cases. Materials and Methods: We retrospectively analyzed 687 cases of UKA that had been performed from January 2002 to December 2006. There are 622 cases of the meniscal bearing type, 31 cases of the tracked bearing type and 34 cases of the fixed bearing type. All of the cases were performed by minimally invasive surgery. Results: Early failures after UKA were seen in 36 cases, and these failures occurred from 4 months postoperatively to 5 years 7 months postoperatively. There were 20 mobile bearing dislocations, 18 femoral or tibial component loosenings, 4 infections, 1 medial tibial condylar fracture and 1 case of pain of unknown origin. The most common cause of the failed cases of the meniscal bearing type was bearing dislocation. All of the failed cases of the tracked and fixed types were from loosening of the component. Simple dislocations of bearing were treated by bearing change. All of the other cases were treated with revision TKA or UKA. Conclusion: Selection of an appropriate prosthesis and accurate surgical technique are needed to improve the clinical results and reduce failures. Open bearing change can be done for the cases of simple bearing dislocation, and revision TKA is needed if this is accompanied by other complications.

유골 골종의 경피적 고주파 파괴술 - 1례 보고-

서재곤,김지형,안중모,Seo, Jai-Gon,Kim, Jee-Hyoung,Ahn, Choong-Mo 대한근골격종양학회 2000 대한골관절종양학회지 Vol.6 No.1

유골 골종은 골의 양성 종양으로 대부분 30세 이하의 환자에 이환되며, 주로 하지의 장관골이 가장 흔히 이환된다. 주 증상으로 통증이 있으며, 밤에 심해지고, 아스피린에 특징적으로 반응하기도 한다. 수술적 제거술이 대부분의 일반적인 치료이며, 전산화 단층촬영하에 제거 술, 전산화 단층촬영하의 드릴을 이용한 파괴술 등을 통한 최소한의 침습적인 수술적 방법이나, 더욱 비침습적인 경피적 방법으로 레이저나 고주파를 발생하는 전극을 이용한 파괴술 등이 시도되고 있고, 수술적 제거술의 대체술로서 고려되고 있다. 이에 저자들은 경골 근위부의 유골 골종을 전산화 단층촬영 투시하에 고주파 치료술을 시행한 1례를 보고하며, 유골 골종의 새로운 치료법들을 고찰해 보고자 한다. We report the radio-frequency ablation technique applied on an osteoid osteoma under CT guide and review other new methods of treatment for the osteoid osteoma. An 18-year-old boy with an osteoid osteoma at the left proximal tibia, which was visible at plain film and MRI. He was treated by the percutaneous radio-frequency ablation technique under CT guide after a needle biopsy. He is free from any symptom and able to do daily activities. So, we proposed that the percutaneous radio-frequency ablation technique under CT guide is the effective and safe treatment method for an osteoid osteoma.

소아의 수부골에 전이된 신장의 투명세포육종 -1례 보고-

심종섭,김지형,서연림,Shim, Jong-Sup,Kim, Jee-Hyoung,Suh, Yeon-Lim 대한근골격종양학회 1998 대한골관절종양학회지 Vol.4 No.2

Clear cell sarcoma of the kidney (CCSK) is a rare malignant tumor of the renal origin in childhood, distinguished from Wilms tumor by its pathologic and clinical features. Bone metastasis is one of the characteristic clinical features. The common site of metastasis of the clear cell Sarcoma of the kidney is axial skeleton including skull, spines, ribs and femur. A cases of clear cell Sarcoma of the kidney presented to us, which solely metastasized to the hand bones without metastasizing to any other tissues including axial skeleton. We report this case with review of literatures.

슬관절 전치환술 후 발생한 감염에 시행한 관절경적 치료의 임상 결과

김경태,이송,김지형,김대근,신원식,Kim, Kyung Tae,Lee, Song,Kim, Jee Hyoung,Kim, Dae Geun,Shin, Won Shik 대한관절경학회 2013 대한관절경학회지 Vol.17 No.1

목적: 슬관절 전치환술 후 발생한 감염에 대해서 시행한 관절경적 치료의 효용성과 치료 결과에 영향을 미치는 인자들에 대하여 알아보고자 하였다. 대상 및 방법: 슬관절 전치환술 후 발생한 감염에 대하여 관절경적 치료를 시행한 17예를 연구 대상으로 하였다. 혈액검사와 관절액 천자를 통해 감염을 확인한 후 관절경을 이용하여 변연 절제술과 활액막 제거술을 시행하고 항생제를 혼합한 생리 식염수를 사용하여 세척술을 시행하였다. 수술 후 정기적인 검사를 통해 치료의 실패 또는 재발 여부를 확인하고 수술 후 2년까지 감염의 재발이 없는 경우를 치료의 성공이라 판단하였다. 결과: 슬관절 전치환술 후 발생한 감염에 대하여 관절경적 수술로 치료받은 17예 중 13예에서는 1회의 관절경적 치료만으로 감염이 치료되었으나 4예는 감염이 지속 또는 재발되어 재수술을 시행하였다. 치료 결과에 영향을 미치는 인자들에 대해 분석해 본 결과 재수술을 시행한 군에서 관절경적 수술만으로 치료된 군보다 감염 증상 발현 후 수술까지의 기간이 더 길었다(p<0.05). 결론: 관절경적 수술을 이용한 슬관절 전치환술 후 발생한 감염의 치료는 적절한 환자의 선택, 철저한 변연 절제술과 세척술 및 적합한 항생제의 사용 등을 통해서 성공적인 결과를 기대할 수 있으나 감염이 의심된다면 가능한 빨리 수술을 시행해야 할 것으로 사료된다. Purpose: To evaluate the efficiency of arthroscopic treatment for infected total knee arthroplasty (TKA), and to investigate the factors affecting the outcomes. Materials and Methods: We analyzed 17 cases which underwent arthroscopic treatment to treat infection after TKA. After confirming infection by hematologic examination and analysis of joint fluid, we performed arthroscopic debridement, synovectomy and irrigation with normal saline mixed with antibiotics. Through routine examination after operation, we checked failure of treatment or recurrence of infection. If there is no recurrence until 2 years after the operation, we considered it as a success of treatment. Results: Of the 17 cases taken arthroscopic treatment, 13 cases were treated successfully with primary arthroscopic treatment only, but 4 cases had to undergo re-operation because of persistence or recurrence of infection. Analyzing the factors affecting the results, we found that symptom duration of the re-operation group is longer than the treated group after arthroscopy (p<0.05). Conclusion: Arthroscopic treatment can be effective when we performed appropriate selection of patients, careful and extensive arthroscopic irrigation and debridement, and suitable use of antibiotics. However, we have to do early arthroscopic surgery as soon as possible when infection after TKA is suspected.

슬관절 전치환술 후 발생한 과상부 대퇴 삽입물 주위골절의 치료 -역행성 골수강 내 금속정 고정술과 잠김 금속판 고정술 간의 비교-

김진학 ( Jin Hak Kim ),김지형 ( Jee Hyoung Kim ),양승진 ( Seung Jin Yang ),유창욱 ( Chang Wook Yoo ),전태환 ( Tae Hwan Chun ),양종화 ( Jong Hwa Yang ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.4

Purpose: The purpose of this research is to compare the clinical and radiological results of retrograde intramedullary nailing and locking compression plate fixation. Both of these are surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee arthroplasty. Materials and Methods: The subject population consisted of 23 cases: there were 10 cases that underwent retrograde intramedullary nailing fixation (group 1) and 13 cases that underwent use of a locking compression plate (group 2), and in both groups supracondylar femur fracture subsequent to total knee replacement occurred during the period between January 2004 and December 2008. The range of joint motion, the Hospital for Special Surgery (HSS) knee score, the tibio-femoral angle and the time to achieve bone union in each group were comparatively analyzed. Results: The mean range of the knee joint motion decreased from 124.5˚ to 116.2˚ in group 1, and from 118.2˚ to 110.1˚ in group 2. The mean HSS knee score declined from 84.4 points to 75.8 points in group 1, and from 82.3 points to 79.0 points in group 2. The mean tibio-femoral angle changed from 6.3˚ eversion to 5.8˚ in group 1, and from 6.1˚ to 7.2˚ in group 2. The mean time to achieving bone union was 2.7 months in group 1 and 3 months in group 2. Conclusion: Both retrograde intramedullary nailing and locking compression plate fixation, as surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee replacement, allow solid fixation and early resumption of joint movement without any statistically significant differences between the two procedures. So, both procedures appear to be good methods of treatment.

슬관절 전치환술에서 대퇴 삽입물의 정렬을 위한 초음파 유도 골수강외 정렬 방식과 골수강내 정렬 방식의 정확도 비교

이송 ( Song Lee ),김지형 ( Jee Hyoung Kim ),김진학 ( Jin Hak Kim ),양승진 ( Seung Jin Yang ),류창욱 ( Chang Wook Ryu ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.1

Purpose: We wanted to compare the accuracy between a newly suggested sonography-guided extramedullary alignment guide system and an ordinary intramedullary alignment guide system for the femoral component alignment in Total Knee Arthroplasty (TKA). Materials and Methods: Among the patients who underwent TKA from December 2006 to May 2007, an intramedullary technique was applied in 50 cases (the IM group) and an extramedullary technique was used in 50 cases (the EM group). The femoral component alignment angle was measured and compared postoperatively by using an anteroposterior (AP) radiograph of the knee. Results: The average femoral component alignment angle was 94.96° (92∼98°) in the IM group and 95.36° (90∼99°) in the EM group. Both groups didn`t show a significant difference. 45 cases (90%) in the IM group and 43 cases (86%) in the EM group were included in the optimal range of the femoral coronal angle (95°±2). Conclusion: There was no significant difference regarding the accuracy of the sonography-guided extramedullary and intramedullary femoral component alignment guide systems for performing Total Knee Arthroplasty.

골절 내고정용 금속판 모양에 따른 응력과 변형의 유한요소 해석

문준희(Jun-Hee Moon),김지형(Jee Hyoung Kim),이봉구(Bong-Gu Lee),이송(Song Lee),김대근(Dae Geun Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.4

목적: 골절 시 사용되는 금속판을 개선하기 위해 동일한 부피와 무게를 가지면서도 모양이 다른 금속판을 유한요소 해석을 통해 변형과 응력을 비교하였다. 대상 및 방법: 길이 100 mm, 외경 20 mm 및 내경 12 mm인 피질골을 가진 뼈에 장축과 직각인 가상의 골절선을 만든 뒤 두 조각의 뼈를 금속판으로 고정한다고 가정하였다. 이 때 금속은 Titanium 재질이며, 12 mm 간격으로 6개의 구멍이 있고 이 구멍에 지름 2 mm, 길이 25mm의 나사못이 삽입된 것으로 가정하였다. 금속판의 모양은 A형은 표준형, B와 C형은 중심부 두께가 두꺼운 형태, D와 E형은 중심부 폭이 넓은 형태로 총 5개로 구분하였다. 각 형태에 인장, 압축, 전방, 후방 및 측방 굽힘, 비틀림의 6 종류의 힘이 주어졌고 그에 따른 최대 응력 및 변형을 비교하였다. 결과: 인장력, 굽힘 그리고 비틀림이 작용하는 환경에서는 B, C, D나 E형의 금속판이 A형보다 낮은 최대 응력 및 적은 최대 변형을 보여주었으며 특히 전방 굽힘에서 가장 월등한 결과를 보였다. 하지만 압축력에 대해서는 상대적으로 큰 향상을 보이지는 않았다. 결론: 동일한 부피의 금속판은 가운데 부분의 두께가 두껍거나 폭이 넓을수록 낮은 최대 응력 및 적은 최대 변형을 보여주었다. Purpose: To determine the metal plate that has almost the same volume and weight as the conventional plate, but has improved properties by changing the shape using finite element analysis. Materials and Methods: The bone is assumed to be of 100 mm length, 20 mm outer diameter and 12 mm inner diameter, respectively. There is a fracture line that is perpendicular to the major axis of the bone at the center. The two pieces of bone are joined together using a metallic plate that is made of titanium. Six holes are located, with an interval of 12 mm. We suppose that screws of 2 mm diameter and 25 mm length are inserted in six holes. The metallic plates are of 5 shapes (A, B, C, D and E) in total. Shape A is the standard or nominal type. Shape B and C are thicker at the center of the plate, respectively. Shape D and E are wider at the center. Six types of load are applied to each of those plates: tension, compression, anterior flexion, posterior flexion, lateral flexion and torsion. We compared stress, deformation, maximal stress and maximal deformation, according to the six types of load. Results: Our deliberate investigation using finite element analysis showed that increasing the thickness or width at the center of metallic plates lowered the maximum stress and deformation. In particular, maximal stress and deformation could be reduced by 33.5% and 38.6%, respectively, in the anterior bending situation. Compression showed lower stress and deformation in type C or D, but the absolute quantity was much smaller than others, for example 0.01-0.001 times. Conclusion: As for the internal bone fixation plates with the same volume, the wider or thicker in the middle the plate become, the less deformation and yielding it bears.