무지외반증 치료에서 근위 중족골 절골술과 원위 연부조직 교정술 후 종자골의 교정정도

정화재,신헌규,장일성,이종근,Jung, Hwa-Jae,Shin, Hun-Kyu,Chang, Il-Sung,Lee, Jong-Keun 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.

증세가 있는 비골하 부 골의 수술적 치료

정화재,신헌규,고천석,Jung, Hwa-Jae,Shin, Hun-Kyu,Ko, Chun-Suk 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.1

Purpose: To evaluate the clinical results of resection of os subfibulare and lateral ligament reattachment or modified Brostrom procedure in patients with symptomatic os subfibulare. Materials and Methods: This is a retrospective study on fourteen patients (14 ankles) who have symptoms associated with os subfibulare. Between August 1999 and July 2004, they underwent 4 resection of os subfibulare and lateral ligament reattachment for ankle pain due to os subfibulare or 10 resection of os subfibulare and modified Brostrom procedure available for ankle instability due to os subfibulare. Follow-up period is averaged for 17.6 months (12-24 months). Clinical results were graded according to the AOFAS clinical rating system. Results: Clinical results were rated as good in 4 ankles after resection of os subfibulare and lateral ligament reattachment, excellent in 5, good in 4, and fair in 1 ankle after the resection of os subfibulare and modified Brostrom procedure. In the last follow up period, 1 case of anterolateral ankle instability, 1 case of ankle pain and 1 case of inversion limitation were present postoperatively, but all symptoms were improved progressively. Conclusion: Resection of os subfibulare and modified Brostrom procedure is a good surgical technique for chronic ankle instability due to os subfibulare. But if just the ankle pain is present, resection of os subfibulare and lateral ligament reattachment is a sufficient procedure.

대퇴골두 무혈성 괴사 환자에 대한 양극성 인공고관절 반치환술

신헌규 ( Hun Kyu Shin ),정화재 ( Hwa Jae Jung ),최재열 ( Jae Yeol Chooi ),김홍균 ( Hong Kyun Kim ),김영훈 ( Young Hun Kim ),이종근 ( Jong Keun Lee ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.4

목적: AML 무시멘트 대퇴 스템을 이용한 양극성 인공 고관절 반치환술을 시행한 대퇴 골두 무혈성 괴사 환자들의 임상적, 방사선학적 치료 결과를 보고하고자 한다. 대상 및 방법: 1994년부터 1998년 까지 대퇴 골두 무혈성 괴사 환자에서 AML 무시멘트 대퇴스템을 이용한 양극성 인공고관절 반치환술을 시행 받은 환자 중 5년 이상 추시가 가능했던 환자 20명 22예를 대상으로 수술 후 임상적, 방사선적 결과를 분석하였다.결과: 총 20명중 남자 13명, 여자 7명 이었고, 평균 추시시간은 6년 2개월로 수술 당시 평균연령은 49세였고 Harris Hip score를 사용한 임상적 결과로는 술 전 53,5점에서 87.9점으로 향상된 결과를 얻었으며, 서혜부 및 대퇴 동통은 총 3예 (17%)에서 발생되었다. 방사선적 결과롤 비구의 근위부이동이 1 예에서 보였으며 대퇴 삽입물은 안정적인 고정을 보여주었다. 결론: 대퇴 골두 무혈성 괴사 환자의 치료로 시행한 AML 무시멘트 양극성 인공 고관절 반치환술은 비교적 낮은 합병증과 임상적, 방사선학적 안정성을 고려해 볼 때 만족스러운 치료 결과을 얻을 수 있을 것으로 사료된다. Purpose: We wished to analyze the clinical and radiological results of bipolar hip arthroplasty using AML cementless stems in patients with osteonecrosis of the femoral head. Materials and Methods: Between 1994 and 1998, 20 patients who underwent bipolar prosthetic replacement using AML cementless stems for osteonecrosis of the femoral head. We retrospectively reviewed and analyzed the clinical and radiological results of 22 hips of 20 patients, and the minimum follow-up period was 5 years. Results: The twenty patients included 13 men and 7 women. The mean duration of follow-up was 6 years and 2 months. The mean patient age was 49 years. The mean Harris hip score was improved from preoperative 53.5 points to 87.9 points at the latest follow up. Three patients (17%) had complaints about groin or thigh pain. One hip (5%) developed acetabulum migration. All the femoral stems remained stable. Conclusion: AML cementless bipolar hip arthroplasty for osteonecrosis of the femoral head produced satisfactory clinical and radiologic results on this follow-up study, and there was a relatively low rate of complications.

경골 근위부 전골술을 이용한 슬관절 골성 관절염의 치료

정영기(Yung Khee Chung),정화재(Hwa Jae Jeong),정선균(Sun Kyun Jung) 대한정형외과학회 1992 대한정형외과학회지 Vol.27 No.4

대퇴 전자간 골절의 금속정을 이용한 내고정술 후 실혈량: 위험 인자 분석

박재형 ( Jai Hyung Park ),정화재 ( Hwa Jae Jung ),신헌규 ( Hun Kyu Shin ),김유진 ( Eugene Kim ),박세진 ( Se Jin Park ),고택수 ( Taeg Su Ko ),박종현 ( Jong Hyon Park ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

Purpose: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evansclassification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. Results: Total calculated blood loss (2,100±1,632 ml) differed significantly from visible blood loss (564±319 ml). In addition, the blood loss of unstable fracture patient was 2,496±1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.

소아 대퇴골 간부 골절에 대한 고찰

정화재,김도영,신주호,정선균 한림대학교의료원 1994 人間科學 Vol.18 No.6

T-형 금속판을 이용한 요골 원위부 골절의 치료

최재열,정화재,김홍균,이종근,장일성 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적: 금속판을 이용한 원위부 요골 골절의 치료 결과를 분석하여 기존의 다른 보고들과 비교하여 치료 방침 설정에 도움이 되고자 하였다. 대상 및 방법: 본원에서 1999년 1월 1일부터 2002년 12월 31일까지 T-금속판을 이용한 내고정술을 시행하고 1년 이상 추시 가능하였던 52례의 요골 원위부 골절을 대상으로, 골절의 분류는 Fernandez 분류 (1형 18례, 2형 4례, 3형 22례, 4형 2례, 5형 6례)를 이용하였다. 평가는 Scheck의 방사선 검사 방법을, 임상적 평가는 Sarmiento 등의 Demerit Point System을 사용했다. T-금속판을 이용한 관혈적 정복을 한 군과 비관혈적 정복술 및 강선 고정술을 시행한 대조군과 결과를 비교하기 위해 비관혈적 정복술 및 강선 고정술을 시행한 경우 중 1형 골절 16례, 3형 골절 21례에 대해 무작위로 대조군을 설정하였다. 결과: 방사선학적 평가 상 우수 12례 (23%), 양호 27례 (52%), 보통 10례 (19%), 불량 3례 (6%)였으며, 임상적 평가에 의한 결과는 우수 11례 (21%), 양호 27례 (52%), 보통 11례 (21%), 불량 3례 (6%)였다. 합병증은 6례에서 관절염성 변화가 관찰되었는데, 5형 골절에서 4례가 관찰되었다. Fernandez 분류 중 1형과 3형에 대한 치료 방법을 비교해 보면, 1형에서는 관혈적 정복과 K-강선을 이용한 군에서 임상적, 방사선학적인 결과에 있어서 통계적으로 차이가 없었으며 (p>0.05), 3형은 관혈적 정복에서 우수한 결과를 보였다 (p<0.05). 결론: 저자들은 T-금속판을 이용한 내고정술을 시행한 결과 방사선학적 및 임상적으로 만족할 만한 결과를 얻었으며, 특히 요골 원위부 골절의 Fernandez 3형의 치료로 T-금속판을 이용한 내고정술은 유용한 치료법으로 사료된다. Purpose: To review the result of fractures of distal radius treated with the T-plate fixation and to recommend guideline for treatment of fracture of distal radius. Materials and Methods: Between January 1999 and December 2002, among the patients with fractures of distal radius underwent T-plate fixation, we retrospectively reviewed 52 cases that had a minimum follow-up of 12 months. According to the Femandez classification of distal radius fractures, 18 cases were type Ⅰ, 4 cases were type Ⅱ, 22 cases were type Ⅲ, 2 cases were type Ⅳ and 6 cases were type Ⅴ. To assess the clinical result, we used the Demerit Point System and for the radiologic result, we used the Point system by Scheck. We Compare the result of treatment in fractures of distal radius by T-plate fixation and K-wire fixation in Type Ⅰ and Ⅲ. Results: Excellent to good results were obtained in 38 cases (73%) in clinical result and 39 cases (75%) in radiological results. Radiologic evidence of arthritis was presented 6 cases at follow-up examination. There was no evidence of statistical difference between Type Ⅰ using T-plate and K-wire fixation (p>0.05). However in type Ⅲ, result in the group of T-plate fixation were better than in pinning group (p<0.05). Conclusion: We obtained good result for type Ⅲ with T-plate but only T-plate fiaxtion for type Ⅴ was not satisfactory.

골성 추지의 치료 : 신전 차단 K-강선을 이용한 비관혈적 정복술 Closed Reduction Using Extension Block K-wire

최재열,정화재,이호진,송경모,김영훈 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적: 신전 차단 K-강선을 이용한 비관혈적 정복술로 치료한 골성 추지 환자들의 치료 결과를 보고하고자 한다. 대상 및 방법: 2001년 1월부터 2002년 11월까지 골성 추지로 신전 차단 K-강선을 이용한 비관혈적 정복술로 수술적 치료를 받았던 환자 중 최소 1년 이상 추시가 가능했던 14례를 대상으로 하여 후향적 연구를 시행하였다. 결과: 총 14례 중 남자가 10례, 여자가 4례였고, 평균 추시 기간은 15.7개월 (최소 12개월, 최대 23개월)이었다. Crawford의 기준에 따른 임상적 평가에서 7례에서 excellent를 보였으며, 5례에서 good, 2례에서 fair의 결과를 보였고, 전례에서 술 후 동통을 호소하는 경우는 없었으며 골성 유합을 얻었다. 관절 운동범위도 양호하여 수술 후 12개월째 평균 약 67도의 운동범위를 얻었다. 합병증으로 강선 주위 감염은 발생하지 않았으며 조갑변형과 원위 지간 관절에 경도의 퇴행성 변화를 보인 경우가 각각 한 례씩 있었다. 결론: 골성 추지의 수술적 치료방법으로 신전 차단 K-강선을 이용한 비관혈적 정복술은 기존의 수술적 치료방법에 비해 덜 침습적이고 합병증의 빈도가 낮으며 비교적 정복조작이 간단하며 결과가 우수하여 유용한 치료방법으로 사료된다. Purpose: To review the result of bony mallet finger treated with a closed reduction using extension block K-wire. Materials and Methods: Between January 2001 and November 2002, among the patients with bony mallet finger underwent closed reduction using extension block K-wire, we retrospectively reviewed 14 patients with 14 fractures who had a minimum follow-up of 12 months. Result: There were 10 men and 4 women, with a average follow-up for all cases 15.7 months (range, 12 months~18 months). According to Crawford's evaluation criteria, we obtained 7 excellent, 5 good, 2 fair. We obtained bony union in all patients, with no remained pain. The average ROM was 67 degrees at postoperative 12 months. Postoperative complications occurred in two cases, which were nail deformity and mild osteoarthritis at the distal interphalangeal joint. There was no pin site infection. Conclusion: This technique is not only easier but also less invasive than other techniques for reduction of mallet finger. Also, it shows excellent result withe lower complication rate. So, it seems a reliable treatment for bony mallet finger.

골수강내 교합정을 이용한 경골 골절치료시 발생하는 각 변형

김경철,오정희,정화재,구본섭,최재열 대한골절학회 2000 대한골절학회지 Vol.13 No.4

Purpose; We studied the relationship between angular deformity and possibly contributing factors in the treatment of tibial fractures with interlocking nailing. Materials and Methods: Intramedullary nailing of the tibia was performed on 49 cases and were followed for the minimum of 12 months. We analyzed relationship between angular deformity and postoperative tibial alignment, operative technique and other factors. Results: Of the 49 cases, 19(38%) were angulated. Angular deformity was seen in 60%, 51.8% and 11.8% in the proximal, distal and middle third of tibial fractures respectively. With AO classification, Group AJ3,C were angulated in 32.4%, 55.6%, 66.7%. In group A, 43.8% of spiral fractures, 28.6% of oblique fractures and 14.3% of transverse fractures were angulated. The cases combined with fibular fracture showed higher incidence of angular deformity than the cases with intact fibula. The opening of fracture and the nail insertion site were not significant to angular deformity. Conclusion: Angular deformity of interlocking nailing in tibial fractures were more common in proximal, comminuted and spiral fractures. Precise attentions to operative technique i. e. accurate anatomical reduction and centromedullary nail orientation are recommended to prevent angular deformity. In proximal third tibial shaft fractures where muscles and patellar tendon has deforming force on fracture fragment, authors believe that use of interlocking nailing must be limited with fracture pattern.