경골 원위 골단부에 발생한 삼면골절

옥재철,소재근,안진환 대한골절학회 1995 대한골절학회지 Vol.8 No.4

The triplane fracture of the distal end of the tibia in adolescents is considered uncommon injuries, but recently it has received considerable attention in the orthopaedic literature. We reviewed five patients who had been treated at Kyung Hee University Hospital for triplane fractures and followed- up at least one year. The purposes of this paper were to determine the configuration of the fracture and the results of treatment. The cause of injury was slip down in three patients, fall down in one patients and sports injury in one patient. The mechanism of injury was supination-external rotation in four patients and unknown in one patient. The plain x-ray and CT were evaluated in all patients, On radiological evaluation, the initial displacement more than 2mm observed in four patients, but displaced fractures were reduced less than 2mm after treatment. The two fragment fractures were seen in two patients, three fragments in three patients. At last follow-up, complete union with anatomical position occurred without degenerative change of ankle joint and any deformity. We treated operatively in two patients, one with arthroscopic reduction and percutaneous pinning, the other with open reduction and internal fixation. Also we treated conservatively in one minimal displaced fracture and two displaced fractures. The results were graded using a modification of the Weber protocol. Points were assigned for pain, walking, activity, radiographic findings, function of the ankle joint, and deformity. The results was classified as excellent in 5 patients and good, fair and poor results was none. The complications was not developed in all patients. The initial displacement, No. of fragments and treatment method were not significantly affect the results of treatment. Finally, we had excellent results in triplane fracture if the reduction less than 2mm regardless initial displacement can obtained.

Allegretto Component 를 이용한 슬관절 부분 치환술

배대경,소재근,손용락,김병순 ( Dae Kyung Bae,Jae Keun So,Young Lak Son,Byung Soon Kim ) 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.2

There is some controversy regarding long term suvivorship of unicompartmental knee arthroplasty compared to total knee arthroplasty. In unicompartmcntal knee arthroplasty, wear and loosening may shorten the survivorship due to stress lacalized to the small area of components. For that reason exact central tracking of femoral component relative to the tibial component is important for preventing wear and loosening of the components. Twenty seven unicompartmental knee arthroplasties using Aregretto components were performed in nineteen patients between June 1992 and July 1993 at the Department of Orthopaedic Surgery, Kyung Hee University, The purpose of this paper is to analyze the preliminary clinical results and to evaluate the tracking of camponents radiologically. The average age at the time of operation was 59,1 years and follow-up period was from one to two years. Functional assessments including rating by Hospital for Special Surgery knee score were conducted. Radiologically we measured the distance from center of the tibial component to center of the femorai component on anteroposterior roentgenogram. 1. The preoperative diagnosis was osteoarthritis in 16 patients, osteonecrosis in two patients and rheumatoid arthritis in one patient. Twenty six knees had undergone medial compartment arthreplasty and one knee had undergone latera1 compartment arthroplasty. 2. The average preoperative range of motion was 127.0 degress and the average postoperative range of motion was 136.1 degrees. 3. The average preoperative knee rating score was 61.1 points and postoperaively average score improved to 89.0 points. 4. The center of femoral component was displaced medially from the center of tibia1 component in 16 knees, laterally in seven knees and was not displaced in four knees. The average displacement of central tracking was 2.3mm (range, 0-6mm). 5, Regarding eentral tracking, there was no significant difference of clinical results depending on the amount of displacement in our cases.

Miniplate Staple 을 이용한 경골 근위부 절골술후 재활치료

배대경,소재근,김병순 ( Dae Kyung Bae,Jae Keun So,Byung Soon Kim ) 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.2

The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnonnal tibiofemoral axis in the coronal plane. But postoperative rehabilitation has often been long azd difficult. The mothods of fixation are cast, staple, plate and external fixation etc., among them conventional Coventry staple has been used most widely. But conventional Coventry staple has some disadvantages such as inadequate fixation, need of cast immobilization for 6 weeks, and readmission for rehabilitation. The purpose of this paper is to demonstrate the superior performance of rehabilitation of the newly designed Miniplate staple over the conventional Coventry staple. We have analyzed the changes of rehabibtation of 15 patients, 21 cases which had used newly designed Miniplate staple in proximal tibial osteotomy. Preoperative diagnosis was osteoarthritis in 15 cases(71.49o), physiologic genu varum in 6 cases(28.6%). 1. The range of motion was average 129.4 degrees preoperatively, 135.3 degrees postoperatively. 2. HSS knee score was average 81.9 points preoperatively, 89.4 points postoperatively. 3. The tibiofemoral angle was average varus 3.8 degrees preoperatively, valgus 8.4 degrees postoperatively. 4. The ROM excrcise started at 8 days, standing at 15 days, crutch ambulation at 22 days and ambulation without crutch at 53 days postoperatively. 5. The radiological bone union observed at average 5 weeks 4 days postoperatively. In conclusion, early range of motion exercise could be started without appiication of long leg cast. The newly designed Miniplate staple can provide better postoperative fixation in high tibial osteotomy.

퇴행성 슬관절염에서 미세 천공술후 재생된 연골의 임상 및 병리조직학적 연구

배대경,윤경호,소재근,Bae, Dae-Kyung,Yoon, Kyoung-Ho,So, Jae-Keun 대한정형외과스포츠의학회 2005 대한정형외과스포츠의학회지 Vol.4 No.1

목적: 퇴행성 슬관절염 환자에서 관절경을 이용한 미세 천공술 후 재생된 연골의 임상적, 방사선학적 그리고 조직병리학적 결과를 분석하고자 한다. 대상 및 방법: 1997년 10월부터 1998년 12월까지 관절경을 이용한 미세 천공술로 치료한 퇴행성 슬관절염 환자 46명, 48례를 대상으로 하였으며, 평균 연령은 56세이었고 평균 추시기간은 1년이었다. 이차관절경술은 수술 후 6개월에 22명, 24례에서 시행하였다. 임상적 평가는 최종추시 시에 Baumgaertner의 슬관절 기능 평가 방법에 의해 시행하였다. 이차관절경술을 시행한 24례에서 일반 조직학적 검사를 시행하였고 제2형 교원질의 존재를 확인하기 위하여 18례에서는 면역 조직화학적 검사를 시행하였으며 12례에서는 Western blotting test를 시행하였다. 정량화된 제2형 교원질의 양에 따라 세군으로 나누고 임상적, 방사선학적, 이차관절경 소견, 환자의 나이 그리고 체중과의 상관관계를 분석하였다. 결과: 임상적 결과는 43례(90%)에서 우수, 5례(10%)에서 양호의 결과를 보였다. 이차관절경술을 시행한 24례중 21례에서 연골결손 부위의 80%이상이 재생된 연골로 덮혀 있는 것을 확인할 수 있었으며, 재생된 연골은 조직학적으로 초자연골과 섬유연골로 이루어진 혼합형 연골이었다. 면역 조직화학적 검사 및 Western blotting test결과상 정도의 차이는 있었지만 전례에서 제2형 교원질의 존재를 확인할 수 있었다. 정량화된 제2형 교원질의 양이 많을수록 수술 전 내반변형의 정도는 적었고 이차관절경소견상 재생된 연골의 범위가 넓었으며 이는 통계학적으로 유의한 차이를 보였다. 요약 및 결론: 퇴행성 슬관절염 환자에서 관절경을 이용한 미세 천공술은 연골 결손 치료에 있어 유용한 치료방법으로 사료되며 이러한 재생된 연골이 지속적인 체중 부하에 의해서 생역학적인 변화를 일으키지 않고 얼마나 유지 할 수 있는지는 보다 장기적인 추시 관찰이 필요할 것으로 사료된다. Purpose: The purpose of this study is to evaluate the clinical, radiological and histopathological results after microfracture surgery for degenerative arthritis of the knee. Materials and Methods: From Oct. 1997 to Dec. 1998, 48 knees in 46 patients were treated by microfracture technique. Their mean age at the time of operation was 56 years(range, 40-75 years) and mean period of follow-up study was one year(range, 7-20 months). For 24 knees in 22 patients, 'second-look' arthroscopies and biopsies were performed at 6 months following microfracture. At the last follow up clinical results were evaluated with Baumgaertner's scale. The specimens of 24 cases were stained with H-E, Safranin-O, and Masson's trichrome. Eighteen of 24 cases were stained immunohistochemically and the Western blotting test was performed on 12 cases for type II collagen. We analyzed the relationship of the Western blotting for type II collagen with clinical score, preoperative varus deformity, joint space widening in radiological result, extent of repaired articular cartilage in '2nd-look' arthroscopic findings, patient's age and weight. Results: Clinical results were excellent in 90% and good in 10%. Among the 24 knees, more than 80% of areas of chondral defect were covered with regenerated cartilage in 21 knees Histologically, the repaired tissue appears to be a hybrid of hyaline cartilage and fibrocartilage. Repaired cartilage contains variable amounts of type II collagen with immunohistochemical staining. The results of the Western blotting test were similar. The amounts of type II collagen formation had positive correlation with the extent of repaired cartilage and preoperative varus deformity. Conclusion: 'Second-look' showed that the chondral defect areas were covered with newly grown grayish white tissue. Articular cartilage repair was confirmed with histological and immunohisto-chemical study qualitatively, and the amount of type II collagen was calculated with the Western blotting test quantitatively. The exact nature and fate of repaired cartilagenous tissues need further long term follow-up study. The results of this study provide the rationale to select osteoarthritic patients indicated for microfracture surgery.

슬관절 반월상 연골의 자가및 동종 이식술

안진환(Jin-Whan Ahn),변상윤(Sang-Yoon Byun),조윤제(Yoon-Je Cho),소재근(Jae-Keun So),김용재(Yong-Jae Kim) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.4