무지 외반증 각변형에 대한 디지털영상의 전산화 계측: 100%와 150% 확대영상에서의 계측비교

성일훈,이두연,성창호,서우영,Sung, Il-Hoon,Lee, Doo-Yeon,Sung, Chang-Ho,Seo, Woo-Young 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.1

Purpose: To study computerized measurements of angular parameters on 100% and 150% resized digital radiography of hallux valgus deformity Materials and Methods: 30 digital radiography of standing foot anteroposterior view of hallux valgus patients were included. Two observers(A, B) independently measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) in two times on both 100%-size and 150% magnified images respectively, using computerized measurement software tools. The results were interpreted with the statistical software program, Statistical Analysis System, version 9.2. Results: In repeated measurements of each observer, measurements on 150% magnified image showed no differences of all three parameters and with 100%-size image, there were differences of HVA (observer A) and 1-2 IMA (observer B) (p>0.05). When testing interobserver reliability, both observers showed differences in measurement of HVA and DMAA (p<0.05), but no differences in measurement of 1-2 IMA in both images. Within the 95% confidence interval, limits of error of measurements between two observers on HVA, IMA and DMAA were $2.7^{\circ}$ $1.4^{\circ}$ and $5.0^{\circ}$ respectively in 100%-size images, and $2.6^{\circ}$, $1.6^{\circ}$ and $4.7^{\circ}$ respectively in 150% magnified images. Conclusion: In computerized measurements for angular parameters of hallux valgus with digital radiography, 150% magnified images showed intraobserver reliability. Both 100% and 150% magnified images failed to show interobserver reliability. Measurement of 1-2 IMA in both 100% and 150% images showed less interobserver error.

종골 결절부의 골절 : 부분 마취하의 관혈적 정복 - 1예 보고 -

성일훈,이봉근,Sung, Il-Hoon,Lee, Bong-Geun 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

We report a case of calcaneal tuberosity fracture, of which skin was at risk, treated urgently with limited open reduction and internal fixation, using 2 cannulated screws under local anesthesia.

부 주상골의 진구성 연골결합 손상과 동반된 편평족 변형 - 1예 보고 -

성일훈,김이석,Sung, Il-Hoon,Kim, Yee-Suk 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

We report a case, showing adult acquired flatfoot, associated with old synchodral diastasis of accessory navicular which was treated with surgical reconstruction.

무지 외반증의 근위 중족골 절골술에 있어서 수술 중 비체중부하와 수술 후 제중부하 방사선 소견에서의 제 1-2 종족골간 각의 차이

성일훈,김주학,황건성,Sung, Il-Hoon,Kim, Joo-Hak,Whang, Khun-Sung 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Purpose: To study the relationship of the 1st to 2nd intermetatarsal angle(1-2 IMA) between the intra-operative and weight bearing postoperative anterior-posterior(AP) radiography, and evaluate the intra-operative predictability for the postoperative 1-2 IMA after proximal metatarsal osteotomy(PMO) in the hallux valgus deformity. Materials and Methods: 20 cases of moderate to severe hallux valgus patients were included in this study. After the oblique PMO(Ludloff procedure) was performed and the osteotomy site was fixed temporarily, the AP view was taken intra-operatively. About 10 weeks after surgery, postoperative weight bearing AP view was taken. The pre -. intra -, and postoperative 1-2 IMAs were compared and ana lysed statistically. Results: The 1-2 IMAs of the weight bearing preoperative, non-weight bearing intra-operative and weight bearing postoperative AP view were $15.9^{\circ}{\pm}1.8^{\circ},\;4.7^{\circ}{\pm}2.1^{\circ}$, and $6.8^{\circ}{\pm}2.5^{\circ}$ (Mean${\pm}$SD) respectively. The postoperative 1-2 IMA was greater than intra-operative measurement by $2.1^{\circ}{\pm}1.8^{\circ}$ (range; $-1^{\circ}$ to $6^{\circ}$) which was stastistically significant(p<0.05). To get less than $9^{\circ}$ postoperatively as an average normal, intra-operative 1-2 IMA should be within $3.8^{\circ}$ to $5.2^{\circ}$ (95% confidence interval), and intra-operative 1-2 IMA should be within $3.4^{\circ}{\pm}$to $5.4^{\circ}$(95% confidence interval) to get more than $6^{\circ}$ difference between preoperative and postoperative 1-2 IMA, which is regarded as more than average correction by the distal metatarsal osteotomy. Conclusion: In hallux valgus surgery, it should be considered that intra-operative 1-2 IMA was less than the postoperative. To achieve postoperative 1-2 IMA less than $9^{\circ}$ and more than correction angle of $6^{\circ}$, it is suggested that the intra-operative 1-2 IMA should be measured less than about $5^{\circ}$.

류마토이드 관절염 환자의 족무지 외반증에 대한 제 1 중족 족지 관절 고정술 -지연 나사못과 배부 금속판을 이용한 치험-

성일훈,이형상,황건성,박기철,Sung, Il-Hoon,Lee, Hyung-Sang,Whang, Kuhn-Sung,Park, Kee-Cheol 대한족부족관절학회 2001 대한족부족관절학회지 Vol.5 No.2

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

원위 비골 길이의 방사선학적 고찰

성일훈,이종민 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 원위 비골 길이 계측에 대한 여러 가지 방법들을 재고찰하고 계측상의 오류를 최소화한 새로운 계측 방법을 고안하여 보고자 한다. 대상 및 방법: 18명의 족근 관절 외상의 기왕력이 없는 건강한 자원자로부터 검사한 36개의 정상 족근 관절의 격자 상 (mortise view)에 있어서 두 명의 독립된 관찰자가 각각 2회씩 비골 길이에 대하여 거각 각(Talocrural angle)과 양과 각(Bimalleolar angle)을 측정하였고, 또한 새로이 고안된 외과 각 (Lateral malleolar angle)을 이용한 각도 계측도 함께 시행하였으며, 모든 각도 계측치들은 양측을 서로 비교 분석하였다. 결 과: 거각 각의 평균은 78.4˚ (74˚~82˚)였고, 양과 각의 평균은 78.3˚ (73˚~86˚)였으며, 외과 각의 평균 계측치는 36.7˚(30˚~41˚)였다. 신뢰 구간에서 양측의 차이는 거각 각은 2.1˚, 양과 각은 3.0˚, 그리고 외과 각에 있어서는 1.2˚의 차이를 보였다. 관찰자내의 차이에 있어서 거각 각은 1.5˚, 양과 각은 1.6˚, 외과 각은 0.4 ˚의 차이를 보였고, 관찰자간의 차이에 있어서는 거각 각은 1.3˚, 양과 각은 2.4˚, 외과 각은 1.0˚의 차이를 보였다. 결 론: 원위 비골 길이 계측에 대한 여러 가지 방법들을 사용하는 경우에 계측상의 오차를 고려하여 원위 비골 길이를 판단하여야 할 것으로 사료되며, 외과 각은 비골 길이의 평가에 있어서 정확도와 신뢰도 면에서 보다 우월한 방법으로 사료된다. Purpose: This study was performed to reevaluate the radiological parameters for assessing the length of the distal fibula in the mortise view of the ankle and to introduce a more reliable method to lessen measurement error. Materials and Methods: Mortise view radiographs of 36 normal ankles from 18 healthy volunteers were obtained. The talocrural angle and bimalleolar angle were measured two times and compared bilaterally by two independent observers. Also, The lateral malleolar angle, newly devised in out department was measured and compared bilaterally. Results: The average of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 78.4 degree (range 74 to 83), 78.3 degrees (range 73 to 86), and 36.7 (range 30 to 41), respectively. The difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle between right and left was 2.1 degrees, 3.0 degrees, and 1.2 degrees (95% confidence limit), respectively. Intraobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.5 degrees, 1.6 degrees, and 0.4 degrees, respectively. Interobsever difference of the talocrural angle, bimalleolar angle, and lateral malleolar angle was 1.3 degrees, 2.4 degrees, and 1.0 degrees, respectively. Conclusion: When using various measurement methods to judge the length of the distal fibula, the measurement error should be considered. The proposed method, lateral malleolar angle, would be a good method for assessing the length of distal fibular in the mortise view of ankle.

전방 연부조직 충돌과 동반된 족관절 병변

성일훈,김석환,심규동,이준환,강창남,Sung, Il-Hoon,Kim, Suk-Hwan,Shim, Kyu-Dong,Lee, Jun-Hwan,Kang, Chang-Nam 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.2

Purpose: To evaluate clinical features of ankle lesions, associated with anterior soft tissue impingement. Materials and Methods: We retrospectively reviewed 21 patients who had chronic anterior ankle pain as initial symptom and associated ankle lesions with anterior soft tissue impingement. Based on preoperative radiologic findings, physical examination intra-operative findings, appropriate procedures were done for lesions by either arthroscopic or minimal open procedure or combined. Clinical evaluation was done using American Orthopedic Foot and Ankle Society, ankle-hind foot score (AOFAS score) and visual analog scale (VAS) on last follow up. Results: Associated lesion(s) to anterior soft tissue impingement of the ankle were 16 cases of osteochondral lesion of talus, 14 cases of bony impingement, 6 cases of ankle lateral instability, 5 cases of loose body, 4 cases of os subfibulare. AOFAS score was $58.9\;{\pm}\;5.1$ preoperatively and $74\;{\pm}\;9.1$ on last follow up. Clinical satisfaction score using VAS showed excellent in 3 cases, good in 11, fair in 3, poor in 4. Conclusion: The patients who had anterior soft tissue impingement would have various associated lesions on their ankle. In such cases, preoperative counseling for variety of postoperative results would be needed.

체조 선수의 상지관절에 대한 연구

성일훈,김태승,환건성,쵱일용,김성준 대한스포츠의학회 1991 대한스포츠의학회지 Vol.9 No.1

후 종골 절골술과 내측 연부 조직과의 관계 -해부학적 연구-

성일훈,최충혁,황규태,Jonathan T Deland 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.6

Dilemma in Severity Classification of Incongruent Hallux Valgus Deformity Using Radiological Measurements

성일훈,이경태,양기원,황건성,최충혁,정재홍,구민회 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.5

Purpose: To study the availability of the radiological classification for incongruent hallux valgus deformities, which has been used as the key to the algorithm for selecting surgical options. Materials and Methods: To determine radiological severity, 257 cases of incongruent hallux valgus deformities were studied. The hallux valgus angle (HVA) and the 1/2 intermetatarsal angle (IMA) were measured in each case. Following Mann,s radiological classification system, the HVA and IMA were compared to determine any similarity in severity. The distal metatarsal articular angle (DMAA) was also measured to observe the extent of its effect on the incongruent deformity. Results: The HVA was 36.1° on average (range, 16-60°) and the 1/2 IMA was 15.8° on average (range, 5-30°). In 126 cases (49.1%), the severity between the 1/2 IMA and HVA coincided with the index classification,whereas. 131 cases (50.9%) did not correspond. Overall, the severity of approximately half the cases,could not be graded. The DMAA was 15.6° on average (range, 0-40°) and 133 cases (51.8%) demonstrated a value above normal value (>15°). Conclusion: The radiological classification system used as a guide for surgical decision-making needs to be revised, due to the overt limits of correspondence between the severity of the 1/2 IMA and HVA. Because the HVA would be influenced by both the lateral subluxation and bony deformity around the first metatarsophalangeal joint, it is reasonable to consider these factors on the HVA as elements to be corrected individually, instead of the HVA alone. 목 적: 비상합성 무지 외반증의 수술 계획 수립을 위해 기존에 사용되던 각도 계측에 의한 분류법의 유용성을 재 고찰하고자 한다. 대상 및 방법: 비상합성 무지 외반증 257예를 연구 대상으로 하여 이들의 무지 외반각과 제1-2 중족골간 각을 측정하였다. Mann에 의한 방사선적 계측에 따른 분류 방법으로 무지 외반각과 제1-2 중족골간 각 사이의 중증도를 비교하였고, 이들의 중증도가 서로 일치하는지를 확인하였다. 비상합성 변형의 분포 정도를 관찰하기 위해 원위 중족 관절각 또한 계측하였다. 결 과: 무지 외반각은 평균 36.1° (범위, 16-60°)이었으며 제1-2 중족골간 각은 평균 15.8° (범위, 5-30°)이었다. 무지 외반각과 제1-2 중족골간 각의 중증도가 서로 일치하는 예는 126예(49.1%)이었고 131예(50.9%)에서는 중증도가 일치하지 않았다. 원위 중족 관절각은 평균 15.6° (범위, 0-40°)이었으며 133예(51.8%)에서 정상치 이상(>15)을 보였다. 결 론: 무지 외반각과 제1-2 중족골간 각의 중증도가 서로 일치하지 않는 한계가 있으므로, 수술 방법 결정을 위한 지침으로써 방사선학적 분류를 이용하기 위해서는 기존의 분류 체계가 보완되어야 할 것이다. 무지 외반각은 제1 중족족지 관절 주변의 골성 변형이나 외측방 아탈구 등에 의해 영향을 받으므로, 무지 외반각에 영향을 미치는 이러한 요소들을 세분하고 이를 교정해야 할 대상으로 고려하여야 할 것으로 사료된다.