벤치프레스 도중 발생한 대흉근 파열 -증례 보고-

이병일,이현욱,최호림,최형석,김준범,민경대,권세원,Lee, Byung-Ill,Lee, Hyun-Uk,Choi, Ho-Rim,Choi, Hyung-Suk,Kim, Jun-Bum,Min, Kyoung-Dae,Kwon, Sai-Won 대한정형외과스포츠의학회 2007 대한정형외과스포츠의학회지 Vol.6 No.2

대흉근 파열은 주로 활동적인 젊은 성인이나 격렬한 경기와 관련된 운동선수에게서 발생하고, 특히 웨이트 트레이닝 도중에 발생하는 경우가 많다고 알려져 있다. 흔치 않은 손상이 나 최근 스포츠 활동 인구의 증가로 대흉근 파열의 발생은 증가 추세에 있으며 이에 따라 기능적 및 미용적 회복을 위한 다양한 수술적 치료 방법이 소개되고 있다. 저자들은 벤치프레스 도중 발생하였으나 진단이 불명확하여 적절한 치료를 시행하지 못하고 수상 후 5개월 만에 진단된 대흉근 파열에 대하여 골경유 봉합 및 봉합나사를 이용한 봉합술을 시행한 1례를 경험하였기에 문헌고찰과 함께 보고하고자 한다. Rupture of the pectoralis major muscle may occur in youngers or athletes associated with extreme sports, especially during the weight training. It is uncommon, but the incidence is increased by the recent growth of athletic population, According to the drift, variable methods of operative treatment for the functional and cosmetic recovery are introduced. We report a case of pectoralis major muscle rupture which was successfully repaired using transosseous repair and suture anchors five months after the initial injury during the bench-pressing.

슬개골전 점액낭염의 관절경적 치료 - 경피적 연차봉합술 3례 보고 -

이병일,민경대,최근선,Lee, Byung-Ill,Min, Kyung-Dae,Choi, Keun-Sun 대한관절경학회 1999 대한관절경학회지 Vol.3 No.1

The authors introduce an operative technique which is simple and effective for the treatment of the large prepatellar bursitis, avoiding problems by the conventional open technique such as tender scar, infection and recurrence. We treated three cases of the large refractory prepatellar bursitis caused by acute direct trauma. Bursectomies were performed by using an arthroscope and percutaneous multiple sutures were applied to the overlying skin with mattress fashion. There were no complications after treatment over one year follow-up. We suggest that this technique is very useful, greatly minimizes the chance of recurrence and reduces the possibility of post-operative infection. 급성 외상에 의해 발생한 슬개골전 점액낭염 중 그 크기가 거대하고 보존적 요법에 반응하지 않는 3례에 대하여 관절경을 통해 점액낭을 절제하고 경피적 다발성 연차봉합을 시행한 바, 그 술기를 소개하고 1년이상 추시상 모든예에서 합병증이나 재발없이 만족할 만한 결과를 얻었기에 그 증례를 보고하고자 한다. 본 술기는 통상적인 절개방법에서의 피부 반흔에 따른 문제와 감염 및 재발 등의 합병증을 최소화하기 위한 보완적 술기로 고안되었으며 얇고 손상받기 쉬운 피부를 보호할 수 있는 장점이 있고 점액낭이 제거된 공간에 부가적인 연차봉합을 통해 사강(dead space)을 배제하고 분리된 조직간의 견고한 접촉을 유지해 줌 으로써 술후 조기 운동을 가능케하고 재발의 가능성을 줄일 수 있어 선택적으로 적용할만한 유용한 술기라 사료된다.

전방십자인대의 고유수용 감각

이병일,유재응,Lee, Byung-Ill,Yoo, Jae-Eung 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

In the present paper the current clinical knowledge about proprioception is given for the shoulder, knee, ankle, elbow and the radiocarpal joint. Proprioceptive capabilities are decreased after knee joint injury such as anterior cruciate ligament. Joint position sense is significantly improved by cruciate reconstruction. Thus, we review of the articles for the proprioception of the anterior cruciate ligament of the knee joint. The present information on proprioception will influence our clinical practice in the future. We should choose surgical procedures that not only reconstruct the anatomy, but also the neurophysiologic feed-back mechanism.

전방십자인대 재건술 - 잔류조직 보존술식 -

이병일,천동일,Lee, Byung-Ill,Chun, Dong-Il 대한관절경학회 2009 대한관절경학회지 Vol.13 No.2

Optimal treatment of the torn anterior cruciate ligament (ACL) remains controversial. The complexity of surgically reproducing the natural biomechanical and anatomical function of the ACL has led to a diversity of reconstructive procedures. Controversy continues to exist regarding the best reconstructive procedure for the ACL deficient knee, but currently, there is no ideal method. Because of the increased frequency of ACL injury and the functional impairment resulting from that, the role of mechanoreceptors in the ACL recently has attracted considerable attention. Proper reconstruction of the ruptured ACL does not always have good results. Success after operation may depend not only on the mechanical stability but also on the quality of recovery of proprioception. It is well known that most ACL are ruptured in proximal half and most mechanoreceptors have been reported to be located in the subsynovial layer and near the tibial insertion of the ACL. Expected roles of tibial remnant is to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to be able to acquire anatomical placement of the graft without roof impingement. The remnant of the ruptured ACL has been removed to clearly visualize the ACL footprint or decrease the risk of impingement and Cyclops lesion in most current techniques for ACL reconstruction. Therefore it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. In addition, it will facilitate the vascular ingrowth and ligamentization of the grafted ACL.

26개월 여아에서 발생한 슬관절 외측 원판형 연골 파열의관절경적 치험례 -증례보고-

이병일,최형석,민경대,조영일,Lee Byung-Ill,Choi Hyung-Suk,Min Kyung-Dae,Cho Young-Il 대한관절경학회 2002 대한관절경학회지 Vol.6 No.1

소아에서의 슬관절 탄발음은 주로 원판형 연골에 의해서 발생되며 슬관절의 신전제한은 원판형연골의 파열을 강력히 시사하는 소견으로 알려져 있으며, 특히 3세미만 소아에서의 보고는 극히 적은 실정이다. 또한 3세 미만의 증상이 있는 원판형 연골의 치료방법에 있어서는 정설이 없고 기술적으로도 어려운 점이 있을 것으로 예상된다. 저자들은 신전제한을 주소로 내원한 25개월 여아에서 자기 공명영상검사상 외측 원판형 연골 파열을 확인하고 관절경하 부분 절제술 시행 후 2년 9개월간 추시 한 바 합병증이나 증상의 재발없이 임상적 및 기능적으로 만족할만한 결과를 보여 이에 대한 증례를 문헌 고찰과 함께 이를 보고하는 바이다. In children, the snapping-knee syndrome is strongly suggestive of a diagnosis of discoid menisci. Furthermore the loss of extension of the knee suggests a diagnosis of torn lateral discoid meniscus. Symptomatic lateral discoid meniscus tear in a very young child, especially under the 3-year-old, was very rarely reported and the treatment protocol has not been established. Some therapeutic advancement was achieved in symptomatic lateral discoid meniscus but still technical difficulties exist. We undergone arthroscopic meniscal reshaping in a 26-month-old girl. At the time of postoperatively 2-year 9-month follow up, excellent result has achieved in clinical and functional outcome according to the scale of Ikeuchi without recurrence of symptom or postoperative complication. We reported out experience and results that arthroscopic reshaping procedure was done for management of symptomatic lateral discoid meniscus in a 26-month-old girl.

슬개골 탈구에 동반된 골연골 골절의 관절경적 치료

이병일,민경대,최형석,Lee Byung-Ill,Min Kyung-Dae,Choi Hyung-Suk 대한관절경학회 2001 대한관절경학회지 Vol.5 No.2

목적 : 슬개골 탈구에 동반된 골연골 골절의 양상을 분석하고 관절경적 치료에 따른 임상결과를 평가하고자 한다. 대상 및 방법 : 1989년 3월부터 1998년 4월까지 경험한 슬개골 탈구 환자 중 골연골 골절을 동반하여 관절경적으로 치료한 14례를 대상으로 평균 32개월 추시하였다. 전례에서 관절경적 시술을 하였으며 수술시 골절편의 위치와 크기를 기록하였다. 결과는 Larsen과 Lauridson의 방법으로 평가하였다. 결과 : 골연골 골절의 위치는 슬개골의 내측면이 8례, 외측면이 1례, 대퇴외과의 외측면이 5례였다. 각 골연골 골편의 최대 직경의 범위는 1cm에서 4.2cm이었고 치료는 절제술만 시행한 경우가 6례, 절제술과 내측지대 봉합술을 병행한 경우가 2례, 절제술과 내측지대 봉합술, 외측지대 이완술을 같이 한 경우가 3례, 고정술만 시행한 경우가 3례 있었다. 기능적 결과는 우수 5례, 양호 6례 보통 1례, 그리고 불량이 2례였다. 결론 : 슬개골 탈구에 동반된 골연골 골절에 대한 관절경적 치료는 최소한의 절개와 철저한 관절내 병변의 파악을 통한 적절한 치료 방법의 선택으로 합병증을 최소화할 수 있는 좋은 방법이 라 사료된다. Purpose : To analyze the patterns of osteochondral fracture associated with patellar dislocation and to assess the results of arthroscopic treatment. Materials and Methods : Fourteen patients were treated from March, 1989 to April, 1998 for patellar dislocations with osteochondral fracture. The average follow-up was 32 months. All were treated by arthroscopic procedures. The location and size of the fracture fragments were recorded. To assess the functional results, we used Larsen & Lauridson's score system. Results : Osteochondral fractures were found 8 cases in medial side of patella, 1 case in lateral side of patella, 5 cases in lateral margin of lateral femoral condyle. The range of maximal diameter of osteochondral fragment was from 1cm to 4.2cm. Treatments include fragment excision only in 6 cases, excision and medial retinacular repair in 2 cases, excision and medial retinacular repair and lateral retinacular release in 3 cases, and internal fixation only in 3 cases. The functional results were excellent in 5 cases$(36\%)$. good in 6 cases$(43\%)$, fair in 1 case$(7\%)$ and poor in 2 cases$(14\%)$. Conclusion : In osteochondral fractures associated with patellar dislocation, arthroscopic treatment is useful to diagnose precisely, to determine proper treatment modality, and to minimize the complications.

대퇴골 하부골단과 대측 슬개골에 동시에 발생한 골연골증 1례

이병일,박승규 ( Byung Ill Lee,Seung Kyu Park ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.1

Osteochondrosis is an abnormality of an epiphysis in which normal growth or ossification is disturbed by degeneration or necrosis. Fifty-three anatomic sites has been described in the literature since first detailed description was that published at the capital femoral epiphysis in 1883. Also, concomitant osteochondrosis more than two anatomic sites was extremely rare. Breck(1971) reviewed literature and reported that literatures contain only forty-six reported cases proving the relative of this condition. But our case has not been reported. The authors experienced a case of concomitant osteochondrosis in the dista1 femoral epiphysis and the contralateral patella, and valgus deformity was developed in the distal femoral condyle during long-term follow up period(10 years), which has been corrected surgically.

슬관절의 외상성질환에서 자기공명영상과 관절경검사와의 비교 연구

이병일,김홍섭 ( Byung Ill Lee,Hong Surp Kim ) 대한슬관절학회 1991 대한슬관절학회지 Vol.3 No.1

During the period of 19 months from May 1989 to Dec. 1990, 140 cases of 136 patients with traumatic injury on the knee, who underwent magnetic resonance imag- ing, were used in a consecutive series of 51 cases together with arthroscopy to diagnose knee injuries at Soonchunhyang University Hospital, revealing the following results; 1. The accuracy for ligaments was 88.8 /o (Sensitivity; 92.3 %, Specificity; 88.4 %.) 2. The accuracy for menisci was 88.8 % (sensitivity; 83.4%, specificity; 77.4 %.) 3. The overall result of the ligaments and menisci was 89.5 k of accuracy. 4. The MRI was especially useful in determining PCL injuries and peripheral meni- scal tears of posterior horn of medial meniscus. 5. The MRI provided good information in the MCL and LCL tears and occult fracture of condyle.

관절경하에 Herbert Screw 를 이용한 슬관절 박리성 골연골염의 치료

이병일,최창욱 ( Byung Ill Lee,Chang Uk Choi ) 대한슬관절학회 1992 대한슬관절학회지 Vol.4 No.2

Between 1983 and 1991, we treated 10 knees of 8 patients with osteochondritis dissecans of the knee with arthroscopic Herbert screw fixation. The patients average age at the time of surgery was 20 and the average follow-up was 2 years and 3 months. The location of lesions were medial condyle in 7 knees, lateral condyle in 2 knees, and patella in I, The types of lesion were intact articular cartilage in 2 knees, detached articular cartilage in 7 knees, and 1oose fragment in 1. A second-look arthroseopy was performed on 4 knees to remove the Herbert screw. 3 of the 4 kaees had a sobd osteochondral fragment to probing after screw removal, and 1 demonstrated minimal fragment motion to probing after screw removal, 1 knee showed depression of fragment. Juxtaarticular tibial surface was not eroded in all 8 patients. Roentgenograms demonstrated 6 of the 10 lesions had complete union, 2 lesions, articular incongruity, 1 lesion, radiolucent line, and 1 lesion, mild degenerative changes. The average healing time was 10.2 weeks (8 - 16 weeks). According to the criteria of the Hughston rating scale for Osteochondritis Dissecans, there were 3 excellent, 5 good, 2 fair, no poor, and no failure. The results suggest that arthroscopic Herbert screw fixation is a useful and effective procedure for osteochondritis dissecans of the knee.

전십자인대 재건술 후 고식적 재활과 적극적 재활의 결과

이병일,민경대,최중근,유재응,손치수,Lee, Byung-Ill,Min, Kyung-Dae,Choi, Joong-Keun,You, Jae-Eung,Son, Chi-Soo 대한관절경학회 1997 대한관절경학회지 Vol.1 No.1

The purpose of this study is to compare the results between conventional and accelerated rehabilitation program following ACL reconstruction using bone-patellar tendon-bone. Conventional rehabilitation focused on protecting the new ligament by blocking terminal extension and avoiding active quadriceps function in the terminal degrees of extension. But there is current trend toward early postoperative mobilization and intensive. so called 'accelerated', rehabilitation stressing hyperextension of the knee. The results of intraarticular ACL reconstruction with conventional and accelerated rehabilitation were prospectively compared for one year postoperatively in a series of 27 patients. Range of motion and thigh circumference were checked preoperatively, and weekly up to 8 weeks, 3 months. 6 months, and 1 year postoperatively. Stress radiologic test, KT-1000 arthrometer. Cybex II dynamometer were checked in preoperatively, and 3 months, 6 months, and 1 year postoperatively. There were no differences of objective stability and restoration of muscle power. But the accelerated group had a low incidence of extension loss. excellent range of motion, and less difference of thigh circumference. We concluded that accelerated rehabilitation program is recommendable due to superiority in terms of range of motion, especially less extension loss without increasing laxity of knee joint.