대퇴경부 골절에서 다발성 핀고정술

유총일,서근택,이택건 대한골절학회 1997 대한골절학회지 Vol.10 No.4

The incidence of femoral neck fracture has steadily increased with lengthening of the average life span. The end results of treatment have been improving with the development of internal fixation devices. However, the anatomic characteristics of femoral neck has made the complications of nonunion and avascular necrosis as a common result. Authors analysed 47 patients, with over 2 years follow-up on an average, who were more than twenty years old and treated with multiple Knowles pins or cannulated screws during the period from February 1988 to February 1994. Following results were obtained. 1. Among 47 patients, 23 cases(49%) were male and 24 cases(51%) were female. The highest incidence was found in the sixth decade. 2. The most common cause of femoral neck fracture was slip down (55%). 3. According to the Garden's 14) classification, the displaced fracture (Garden stage III and IV) was more common (68%), and according to the anatomic classification, transcervical type was the most common (40%). 4. Among 47 patients, there were 1 case of nonunion(7%) and 2 cases of avascular necrosis of femoral head(13%) in the nondisplaced fractures(15 cases), compared to 6 cases of nonunion(19%) and 8 cases of avascular necrosis of femoral head(25%) in the displaced fractures(32 cases). There were 4 cases of nonunion(15%) and 5 cases of avascular necrosis of femoral head(19%) among the 26 patients treated with multiple Knowles pins, compared to 3 cases of nonunion(I4 %) and 5 cases of avascular necrosis of femoral head(28%) among the 21 patients treated with cannulated screws. 3 cases of nonunion(10%) and 4 cases of avascular necrosis of femoral head(13%) were developed among 30 cases in which acceptable reduction was achieved after closed reduction. 4 cases of nonunion(24%) and 6 cases of avascular necrosis of femoral head(35%) were developed among 17 cases in which poor reduction was achieved. I 1 cases(42%) were complicated among 26 cases below Singh index grade 3 and 6 cases(29%) were complicated among 21 cases above Singh index grade 4. 5. Factors that may affect the success of treatment in femoral neck fracture are not the type of internal fixation device used, but rather anatomic site of fracture, the degree of displacement, degree of osteoporosis and accuracy of reduction.

경골과 골절의 수술적 치료 결과-임상적 결과에 영향을 주는 요인에 대한 분석-

성병년,박완수,신상열,우연기,이택건,박만제,이승기 대한골절학회 2002 대한골절학회지 Vol.15 No.1

목 적 : 경골과 골절의 수술적 치료에서 치료 결과에 영향을 미칠 수 있는 다양한 여러 요인 들에 대해 연구 분석하고자 하였다.대상 및 방법 : 1 9 9 1 년 1월부터 1 9 9 7 년 1 2월까지 수술적으로 치료한 2 9례를 대상으로 임상적 및 방사선학적 분석을 하였으며 추시 관찰 기간은 최소 1년이상이었다. 연령, 손상 원인, 골절의 분류, 동반 손상 유무 및 수술 방법에 따라 최종 치료 결과를 분석하였다.결 과 : 3 0대에서 5 0대까지가 1 9례중 1 8례로 Blokker 평가 기준에 의해 양호한 결과를 보였다. Schatzker분류 2형이 1 1례( 3 7 . 9 % ) 로 많았고, Ⅰ,Ⅱ,Ⅲ형이1 4례중 1 3례가 양호한 결과를 보였고, Ⅳ,Ⅴ,Ⅵ형이1 5례중 1 0례가 양호한 결과를 보였다. 동반손상은 1 8례중 1 2례가 양호한 결과를 보였다.

요추 경막외 지방종증 : 2례 보고 Two Cases Report

성병년,박찬지,박승준,김상욱,이택건 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.2

Study Design : We report two cases of symptomatic spinal epidural lipomatosis (SEL) associated with long-term use of steroid medication Objectives : The purpose of this study was to assess the clinical characteristics, diagnosis and treatment of symptomatic spinal epidural lipomatosis. Summary of literature review : Spinal epidural lipomatosis is a condition in which excess adipose tissue is deposited circumferentially about the spinal cord in the epidural space. It can present neurologic symptoms including back pain, radiculopathy or cauda equina. Magnetic resonance imaging is the most helpful dignostic means and should be used initially if suspected. Treatment is decompressive laminectomy and debulking of fat. Materials and methods : Two cases of lumbar epidural lipomatosis with neurologic symptoms were discussed and evaluated by physical examination , postmyelography CT and MRI. Results : Two cases were treated with decompressive laminectomy and debulking of fat. Increased accumulation of the fatty tissue was seen predominently in posterior and posterolateral epidural space of the spinal canal, displacing and compressing the lumbar spinal cord anteriorly. Both gross and histologic evaluation revealed overgrowth of unencapsulated normal appearing fat consistent with spinal epidural lipomatosis. One case was demonstrated gradual improvement in symtoms after operation but the other was died due to medical problems. Conclusion : The authors reviewed the literature and reported the results of operative treatment of patients with lumbago, radicular pain and intermitent claudication caused by epidural lipomatosis of lumbar spine and degenerative spinal stenosis.

경골과 골절의 수술적 치료 결과 : 임상적 결과에 영향을 주는 요인에 대한 분석 Analysis of the factors affecting to the clincal results

박완수,이승기,성병년,이택건,신상열,박만제,우연기 대한골절학회 2002 대한골절학회지 Vol.15 No.1

목적: 경골과 골절의 수술적 치료에서 치료 결과에 영향을 미칠 수 있는 다양한 여러 요인 들에 대해 연구 분석하고자 하였다. 대상 및 방법: 1991년 1월부터 1997년 12월까지 수술적으로 치료한 29례를 대상으로 임상적 및 방사선학적 분석을 하였으며 추시 관찰 기간은 최소 1년이상이었다. 연령, 손상 원인, 골절의 분류, 동반 손상 유무 및 수술 방법에 따라 최종 치료 결과를 분석하였다. 결과: 30대에서 50대까지가 19례중 18례로 Blokker 평가 기준에 의해 양호한 결과를 보였다. Schatzker 분류 2형이 11례(37.9%)로 많았고, Ⅰ,Ⅱ,Ⅲ,형이 14례중 13례가 양호한 결과를 보였고, Ⅳ,Ⅴ,Ⅵ,형이 15례중 10례가 양호한 결과를 보였다. 동반손상은 18례중 12례가 양호한 결과를 보였다. 결론: 관혈적 정복술 및 견고한 금속 내고정술로 슬관절의 운동 범위를 조기에 얻을 수 있어야 양호한 임상적 결과를 기대할 수 있었다. 임상결과에 영향을 주는 요인으로서 연령, 골절분류, 동반 손상이 있다. 불량한 결과와 관련있는 요인으로는 30대 이전의 연령층과 60대이후의 연령층, 고 에너지 손상의 Schatzker 분류 Ⅳ형 이상의 골절, 전방 십자 인대 손상과 반월상 연골 손상등 심한 동반 손상이 있는 경우였다.

AO C3 형의 경골 Pilon 골절의치료 : 제한적 내고정 및 hybrid 형 외고정 장치의 병합치료 결과 Limited Internal Fixation and Hybird External Fixation

박승준,박동성,성병년,이택건 대한골절학회 1998 대한골절학회지 Vol.11 No.3

The intraarticular fractures of the distal tibia has been the most difficult problem due to severe comminution of itself, little bone mass and poor circulation of soft tissue. Recently limited internal fixation with hybrid external fixation has been reported to provide a good clinical results for the severely comminuted or open pilon fractures as a AO type C3. From February 1994 to February 1996, the authors analyzed the clinical and radiological results of 2 year follow-up in 7 cases of the AO type C3 pilon fractures who were treated with combination of limited internal fixation and hybrid external fixation. 6 cases had good or excellent clinical and radiological results without any serious complications such as skin sloughs, .skin infection, malunion and nonunion, but one case had a nonunion who were treated with internal fixation and autogenous iliac bone graft. We believe that the combination of limited internal fixation and hybrid external fixation that does not cross the ankle joint, provides the good clinical results in AO type C3 pilon fractures by early ankle joint motion.

상완골 근위부 골절의 치료 결과

박만제,성병년,이승기,이택건,신상렬,김형수 대한골절학회 2002 대한골절학회지 Vol.15 No.2

목 적 : 수술적 방법 및 보존적 방법 으로 치료한 상완골 근위부 골절에서 견관절의 해부학적 정복 및 기능적 회복 정도와 치료 방법에 따른 결과의 차이를 알아 보고자 하였다. 대상 및 방법 : 12개월 이상 추시 된 42예를 보존적 치료군(1군, 20예), 도수정복후 Rush pin 또는 경피적 핀 삽입군(2군, 11예), 근위 골수강내 교합정 고정군(3군, 11예)으로 나누었다. 기능적 평가 에는 설문지를 이용한 modified neer 방법을 이용하였고 방사선 사진상 경간각을 이용한 Paavolainen 방법으로 해부학적 정복 정도를 분석 하였다.각 군의 결과를 비교한 통계 처리는 Generalized Liner Model을 이용한 분산분석과 Fisher's exact test을 이용하였다. 결 과 : 방사선사진에 의한 해부학적 정복정도의 결과는 3군에서 가장 우수하였다.(p<0.05). 골 유합 시기는 평균 10.33 주였다. 기능 점수 또한 3군에서 가장 높았으며 합병증도 9례 에서 발견되었는데 3군에는 1례만 존재하였다. 전체적 결과에서 3군이 다른군과 비교하여 우수한 결과를 보였다. 결 론 : 근위 골수강내 교합정 고정술은 전위형 상완골 근위부 골절에서 여러방향 으로 고정 나사의 삽입이 가능하여 골편의 정복이 용이하므로 해부학적 정복 정도가 다른 방법에 비해 좋고(p<0.05) 합병증을 최소화하면서 조기 재활 및 골 유합에 충분한 고정력을 얻을 수 있는 좋은 방법으로 사료 된다. Purpose : To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods. Materials and Methods : Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test. Result : Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups. Conclusion : Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

고도의 분쇄상 및 전위된 슬개골 골절의 슬개골적출술

김부환,박원욱,이규열,류총일,서근택,이택건 대한골절학회 1997 대한골절학회지 Vol.10 No.4

The results of partial and total patellectomy as a treatment for severe comminuted and displaced patellar fracture were assessed retrospectively with the use of clinical criteria and radiologic findings. Sixteen patients treated with patellectomy (four total and twelve partial patellectomies) were followed up for an average of 3 years 4 months and evaluated. According to the Bostman s fracture classification, there were type I in 5 cases(31%), type II in 7 cases(44%), and type III in 4 cases(25 % ). The results of the patellectomy were relatively good since excellent result was shown in 11(69%) among 16 cases. The comparison between partial and total patellectomy was difficult because the fracture patterns treated by these techniques were different. In this study, the result of the partial patellectomy was better than that of the total patellectomy, but their difference was not statistically significant(P$gt;0.05). The results of the study indicated that partial or total patellectomy could be one of the effective treatment methods for severe comminuted and displaced patellar fracture. However total patellectomy should be recommended only when the entire patella was too severely comminuted to function as a part of the extensor mechanism of the knee.

인공고관절 전치환술 후 발생한 동측대퇴골 불안정성 골절의 치료

서근택(Kuen-Tak Suh),이창범(Chang-Bum Lee),이택건(Taek-Geon Lee) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.2