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종골 골절에서 Essex-Lopresti 술식 후 발생한 비복 신경 포착 -증례 보고-
문상호,서병호,김동준,공규민,김욱년,Moon, Sang-Ho,Suh, Byoung-Ho,Kim, Dong-Joon,Kong, Gyu-Min,Kim, Wook-Nyeon 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.2
Injuries to sural nerve through surgical incision or open wound in calcaneal fractures were reported as complications causing lateral hindfoot pain. But sural nerve entrapment by adhesive fibrous tissue after Essex-Lopresti axial fixation has not been reported. We report a case of sural nerve entrapment after Essex-Lopresti axial fixation which was successfully treated by nerve decompression.
한국인에서 족무지 지관절의 종자골에 대한 방사선학적 연구
문상호,김동준,서병호,Moon, Sang-Ho,Kim, Dong-Joon,Suh, Byoung-Ho 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2
Purpose: Frequency of sesamoid bone on hallucal interphalangeal joint has been described to be low probability in orthopaedic and anatomical literature. We have, however, experienced two cases of interphalangeal joint dislocation giving difficulty to usual manipulative reduction because of presence of sesamoid bone recently. In order to ascertain existence of sesamoid bone on interphalangeal joint of hallux in Korean adults, radiological study have been performed with feet of patients Materials and Methods: Between May 2003 and October 2006, 974 patients with 1098 radiographs of feet which were reached skeletal maturity over 18-year-old were examined. Unilateral or bilateral anteroposterior, lateral and oblique radiographs were observed by one same person and presence was recorded if there was sesamoid in films. Distance of long and short axes were measured in lateral view and cases of two sesamoids in interphalangeal joint were recorded. Statistical differences between left and right side or between men and women were evaluated by chi-square test. Results: Frequency of sesamoid was 980 cases (89.3%) and no occurrence in 118 cases (10.7%). Two sesamoids were observed in 3 cases. Average distance of long axis was 4.9 mm (range, 0.5-11.4) and average distance of short axis was 3.5 mm (range, 0.3-9.3). Unilateral sesamoid was observed in 7 patients (5.6%), bilateral absence was 7 patients (5.6%) and bilateral sesamoids in 110 patients (88.8%) out of 124 patients who took bilateral feet radiographs. Men has less frequency than women significantly (p=0.014) while there was no significant difference in frequency according to side(p>0.05). Conclusion: Sesamoid bone was seen in 980 feet (89.3%) out of 1098 normal Korean radiological studies of feet. We report 3 cases of two seamoids which was extremely rarely reported in literature. Korean frequency is similar with Japanese, but much higher than Caucasians and black Africans.
김동준,문상호,서병호,공규민,Kim, Dong-Joon,Moon, Sang-Ho,Suh, Byoung-Ho,Kong, Gyu-Min 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2
Irreducible dislocation of great toe interphalangeal joint with incarcerated sesamoid is a rare condition, with only a few cases reported in literature. We describe two cases of dislocation of interphalangeal joint which were diagnosed by plain radiographs and three dimensional computed tomography (3D-CT) and successfully treated with open reduction without excision of sesamoid through dorsal approach along with literature pertinent to this condition.
근위 경골 골절의 골수강 내 금속정을 이용한 고정술에서 삽입 방법에 따른 비교
문상호 ( Sang Ho Moon ),서병호 ( Byoung Ho Suh ),황정수 ( Chung Soo Hwang ),윤태현 ( Tae Hyun Yoon ) 대한골절학회 2006 대한골절학회지 Vol.19 No.1
목적: 근위 경골 골절에서 정복 유지와 부정 정렬을 개선하기 위해 고안된 semiextended 삽입 방법과 기존의 금속정 삽입 방법의 임상적 및 방사선학적 수술 후 결과를 비교 분석하였다. 대상 및 방법: 2000년 5월부터 2004년 2월까지 근위 경골 골절로 골수강 내 금속정으로 치료하였던 환자 중 1년 이상 추시가 가능하였던 24예를 대상으로 하였으며 개방성 골절이 12예, 분절 골절이 4예, 나비형 골편이 있는 경우가 3예, 분쇄 골절이 17예였고, 남자가 18예, 여자가 6예였으며 평균연령은 50세였다. 이 중 semiextended 삽입 방법으로 시행하였던 10예와 기존의 방법대로 경골 결절 상방에서 삽입하였던 14예를 분석하여 임상적으로 동반손상의 정도, 합병증 등을 평가하였고 방사선학적으로 전후면 및 측면에서의 수술 후 각 형성과 전위 정도를 비교하였다. 이들 결과의 통계학적 분석은 t-test를 사용하였다. 결과: Semiextended 군에서 전후면에서의 각 형성은 평균 2.3˚, 측면에서의 각 형성은 평균 2.8˚, 전후면에서의 전위는 평균 4.5 mm, 측면에서의 전위는 평균 5.3 mm였으며 기존 방법 군은 전후면에서의 각 형성은 평균 5.1˚, 측면에서의 각 형성은 평균 7.4˚, 전후면에서의 전위는 평균 6.1 mm, 측면에서의 전위는 평균 5.3 mm였다. 전후면에서의 각 형성 (p=0.006)과 측면에서의 각 형성 (p=0.001)은 유의하게 semiextended 군에서 적었으나 전후면에서의 전위 (p=0.344)와 측면에서의 전위 (p=0.99)는 양 군 간에 유의한 차이가 없었다. 양 군 모두 주로 전방 및 외반 각 형성을 보였고 전위 방향은 후외측이었다. 전체 환자 중 14예에서 동반 손상이 있었고 기존 방법 군 1예에서 불유합 소견 보여 금속정 교체술 및 자가골 이식술을 시행하였다. 결론: 근위 경골 골절에서 골수강 내 금속정을 이용한 치료에 있어 semiextended 삽입 방법은 기존의 삽입 방법에 비해 골절부 전위 면에서는 유의한 차이가 없으나 전후면과 측면 각 형성을 줄이는 데 효과적인 술식으로 생각한다. Purpose: To compare clinical and radiological results between standard insertion method and semiextended method which was designed to improve proximal fixation and alignment in proximal tibia fracture. Materials and Methods: A retrospective review from May 2000 to February 2004, identified 24 extraarticular fractures in proximal tibia, initially treated with locked intramedullary nails at least 1 year follow up. There were 12 open injuries, 4 segmental, 3 butterfly fragments and 17 comminuted. Semiextended method was used in 10 fratures and standard insertion method which is cephalad to tibial tubercle in 14. Follow up clinical assessment consisted of review of associated injuries and complications and these two methods were compared by postoperative angulation and displacement in anteroposterior and lateral radiographs. Data were analysed by t-tests. Results: In semiextended group, average angulation was 2.3˚ in coronal and 2.8˚ in sagittal plane and average displacement was 4.5 mm in coronal and 5.3 mm in sagittal. In ordinary group, average angulation was 5.1˚ in coronal and 7.4˚ in sagittal plane and average displacement was 6.1 mm in coronal and 5.3 mm in sagittal. In semiextended group, there were significant reduction in coronal angulation (p=0.006) and sagittal angulation (p=0.001), but there was no significant difference in coronal (p=0.344) and sagittal (p=0.99) displacement. Both groups showed anterior, valgus angulation and posterolateral displacement in most cases. There were 14 associated injuries and one patient developed nonunion and was treated by nail exchange with autogenous bone graft. Conclusion: Our retrospective analysis demonstrated that semiextended method is effective for reducing coronal and sagittal angulation, but is not helpful for reducing displacement in both planes.
Essex-Lopresti 축성 핀 고정법을 이용한 관절 함몰형 종골 골절의 치료
공규민 ( Gyu Min Kong ),서병호 ( Byoung Ho Suh ),김동준 ( Dong Joon Kim ) 대한골절학회 2007 대한골절학회지 Vol.20 No.2
목 적: 관절 함몰형 종골 골절을 치료할 때 관혈적 정복술을 대체할 수 있는 방법으로서Eseex-Lopresti 축성 핀 고정법의 유용성을 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2005년 2월까지 관절 내 종골 골절로 Essex-Lopresti 술식을 시행받은 환자 중 1년 이상 추시가 가능하였던 32예를 대상으로 치료 결과를 방사선적 및 임상적으로 분석하였다. 결 과: 수술 후 Creighton-Nebraska Health Foundation Assessment Score를 이용한 임상적 평가 결과 우수가 5예, 양호가 11예, 보통이 6예, 불량이 10예였으며 Sanders 분류 제IV형을 제외했을 때 68.2%에서 양호 이상의 결과를 얻었다. B?hler 각의 평균은 수술 전10.3도에서 최종 추시상 24.5도로 관찰되었다. 임상적 평가 점수와 함몰된 골편의 크기 사이에 통계적으로 유의한 상관관계가 있었다 (상관계수0.672, p<0.01). 결 론: Essex-Lopresti 축성 핀 고정법은 함몰된 골편의 크기가 비교적 크고 분쇄가 심하지 않은 관절 함몰형 종골 골절의 치료에 관혈적 정복술 대신 사용하여 좋은 결과를 얻을 수 있는 방법으로 생각한다. Purpose: To evaluate the result of joint depression type of intraarticular calcaneal fractures treated with Essex-Lopresti method. Materials and Methods: From March 2001 to February 2005, Thirty two patients` joint depression type of intraarticular calcaneal fractures which treated with Essex-Lopresti method were clinically and radiograph ically evaluated retrospectively. Results: According to Creighton-Nebraska Health Foundation Assessment Score (C -N score), there were 5 excellent, 11 good, 6 fair and 10 poor results. B hler angle was corrected from 10.3 degrees to 24.5 degrees. There was a positive correlation between size of depressed fragment and C-N score (p<0.01). Conclusion: Essex-Lopresti method can substitute open reduction methods in joint depression type of intraarticular calcaneal fractures which have relatively large depressed joint fragments.