원위 경비인대 염좌의 치료

최귀연,이준영 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.4

High ankle sprain (distal tibiofibular syndesmosis injury) occurs from rotational injuries, specifically external rotation, and may be associated with ankle fractures. The prevalence of these injuries may be higher than previously reported because they may be missed in an initial examination. Syndesmosis injury can lead to significant complications in injured ankle joints, so a precise physical examination and radiological evaluation is necessary. The most important treatment goal is to have the tibia and fibula located in the correct position with respect to each other and to heal in that position. The methods to fix these injuries is controversial.

해부학에서 의사되기를 배우다

최귀연(Gwi-Yeon Choi),김정민(Jeong-Min Kim),서제훈(Jae-Hoon Seo),손현준(Hyun-Joon Sohn) 대한체질인류학회 2009 해부·생물인류학 (Anat Biol Anthropol) Vol.22 No.3

의학과정에 들어온 학생이 가장 먼저 배우게 되는 과목이 해부학이고 그 비중은 어느 과목보다 크다. 따라서 의학교육이 의사가 되는 과정이라고 볼 때 해부학 과정을 어떻게 거치는가는 어떤 의사로 되어 가는가에 매우 중요한 영향을 미친다. 이 연구에서는 내러티브 탐구 방법으로 의학교육과정의 여러 단계에 있는 학생들과 졸업생을 대상으로 해부학을 통하여 의사에게 필요한 어떤 자세와 가치를 배우고 느끼게 되는지를 면담하고 분석하였다. 해부학 과정이 학생들에게 미치는 영향은 다음과 같다. 첫째, 해부학을 통하여 학생들은 의사가 되는 길에 접어들었음을 실감하고 전문성에 접근하게 된다. 둘째, 학생들은 해부학을 통해 극도의 스트레스에 직면하게 되고 이를 극복하면서 성장하며, 스스로를 제어하는 방법을 터득한다. 셋째, 학생들은 해부학을 통해 자신만의 공부 방법을 습득하게 된다. 넷째, 해부학은 의사되는 과정에서 배우게 되는 모든 과목의 기반이 된다는 점에서도 중요성을 가진다. 다섯째 해부실습을 위하여 시신을 기증하신 분들에 대한 추모제를 통해 학생들은 감사하는 마음과 함께 이타적 치료자로서의 사명감을 느끼게 된다. 의료전문성(medical professionalism)의 핵심은 의사가 자신의 이익이 아닌 환자의 이익을 위하는 이타적 치료자로서의 자세이다. 이타적 치료자로서의 자세를 함양하는 데 해부학교육이 영향을 미치고 있지만 이것이 지속되기 위해서는 이어지는 다른 과목에서도 이러한 인식이 강조되어야 한다. 또한 의학교육을 수행하는 대학과 병원이 영리기관화 되어가는 현실적 압력에서 공공성을 확보하는 문제도 중요하게 거론되었다. Medical education is the process of transforming a layman into a medical professional. Anatomy is a major, primary subject for students entering medical school. How students learn anatomy is important for becoming a doctor. The object of this study is to determine what influences students to get their values and attitudes as an altruistic healer, and to develop professional competence from educational courses in the medical school. We focused on how the lessons and disciplines of the anatomy course guided medical students to become doctors. Interviews of narrative inquiry were conducted in which the students and graduates talked about the experience of learning in their course-work. Anatomy is an important subject for medical students, at both the cognitive and the emotional level. Through learning anatomy, students adapt their emotions and attitudes to the medical profession and become bona fide medical students. They face very stressful condition at first, but they learn how to adapt to their circumstances. They studied with passion, and could develop their own way of studying. Besides, they felt that they were gradually becoming health experts by learning medical terminology, and could enhance their professionalism by practicing anatomy. Indelible experiences in dissection laboratory and rite in memory of cadaver donors evoke deep reflection on thankfulness and altruism. This study addressing the issue of altruistic professionalism in anatomy will have to be continued by following students into the preclinical and clinical years. Public concerns with commercialism in teaching hospitals and schools are also emphasized.

원위 비골 골절의 수술 후 발생한 불유합의 관련 인자

이준영,최귀연,강신욱,고강열 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.3

Purpose: The purpose of this study was to evaluate the radiologic outcomes of distal fibular fractures and to analyze the risk factors associated with nonunion. Materials and Methods: Between January 2009 and March 2016, 13 patients who had final nonunion with ankle fracture were included. In the control group, 370 patients who had undergone bony union and removed metal implants were included. All patients underwent the same surgical procedure and had the same treatment method, ultimately achieving satisfactory open reduction results with less than 2 mm fracture gap. Surgical treatment of fracture was considered to have the same effect on nonunion, and factors that might be associated with nonunion were evaluated. SPSS ver. 13.0 (SPSS Inc., USA) was used for all statistical analyses. Pearson’s chi-square test and multi-variate regression analysis were performed to determine the factors affecting nonunion of distal fibular fracture. A p-value less than 0.05 was considered statistically significant, and relative risk was assessed. Results: The mean age of 13 patients was 46.9 years (range, 16∼57 years); there were 8 men and 5 women. Among the 13 patients with nonunion, atrophic was the most common (12 cases). The association between the injury mechanism and the Lauge-Hansen classification and diabetes mellitus was not statistically significant. Distal fibular fractures with tibia shaft fracture (p=0.015) and Danis-Weber type C fracture (p=0.023), open fracture (p=0.011), and smoking (p=0.023) were significantly associated with nonunion. Conclusion: In this study, the combined injury of the ipsilateral tibia shaft fracture, open fracture, and Danis-Weber type C fracture may increase the possibility of nonunion. Therefore, caution is advised to prevent nonunion.

분쇄가 심한 Ruedi-Allgower II, III형의 개방성 경골 천정 골절에서 단계적 수술의 결과

이준영,최귀연,장현웅,김영욱 대한족부족관절학회 2019 대한족부족관절학회지 Vol.23 No.3

Purpose: This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation. Materials and Methods: From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed. Results: The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases. Conclusion: Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

Effect of Spine-Pelvis Relationship in Total Hip Arthroplasty

이상홍,임채원,최귀연,조승환 대한고관절학회 2019 Hip and Pelvis Vol.31 No.1

When spine-pelvic motion is normally coordinated, the pelvis may tilt posteriorly and acetabular anteversion may increase as the patient’s position changes from standing to sitting; this scenario allows for improved clearance of the femoral head and neck during hip flexion. However, changes in the mobility of the spine and pelvis may result in impingement after total hip arthroplasty (THA), with the most obvious complication being dislocation. Understanding the spinal-pelvic relationship in the sagittal plane is essential for planning THA in patients with spinal fusion or a known spine disease. Careful attention should be payed to the cup position when performing THA on patients with an increased risk of dynamic impingement.

AO 분류 43에 해당하는 극원위부 경골 골절에서 교합성 골수강 내 금속정 고정술

이준영(Jun Young Lee),이상준(Sang-Joon Lee),하상호(Sang Ho Ha),최귀연(Kwi Youn Choi) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.4

목적: AO 분류 43에 해당하는 극원위부 경골 골절에 대하여 교합성 골수강 내 금속정을 시행한 환자들을 대상으로 후향적 연구를 통 하여 술 후 결과를 평가하였다. 대상 및 방법: 2008년 5월부터 2012년 4월까지 AO 분류상 43의 경골 골절 중 교합성 골수강 내 금속정 고정술을 시행하고 1년 이상 추시 가능하였던 17예를 대상으로 하였다. 술 전 골절의 형태, 동반 손상 및 합병증에 대하여 분석하였고 전 예에서 최소 2개 이상 의 원위 교합나사를 사용하였다. 술 후 주기적인 영상학적 검사를 시행하였으며 Iowa 족관절 평가 지수 시스템을 이용하여 족관절 기능평가를 하였다. 결과: 골유합 시기는 평균 18주에 이루어졌으며 Iowa 족관절 평가 지수에서 14예에서 양호 이상의 결과를 보였다. 술 후 마지막 추 시상 내외반 각형성은 평균 1.9도, 전후방 각형성은 평균 1.1도로 전체 예에서 부정유합은 없었으며 합병증으로 1예에서 비후성 불유합과 1예에서 원위 교합나사의 파절 및 지연유합이 발생하였다. 결론: 교합성 골수강 내 금속정 고정술은 AO 분류 43에 해당하는 극원위부 경골 골절의 치료 시 심한 개방성 창상이 동반되는 등의 금속판을 이용할 수 없는 경우 고려해 볼 수 있는 술식으로 생각되며 좋은 결과를 위해서는 정확한 술기와 술자의 경험이 요구된다. Purpose: This retrospective study was conducted in order to evaluate the results of interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43. Materials and Methods: Seventy patients with far distal tibia fractures in AO classification 43 treated with interlocking intramedullary nailing from May 2008 to April 2012 were evaluated. The minimum follow-up period was 12 months. We analyzed preoperative fracture pattern, associated injury, and complication. All cases were treated with use of either two or three distal interlocking screws during intramedullary nailing. Patients received regular post-operative radiographic check-up and ankle function was evaluated using the Iowa ankle-evaluation rating system. Results: The fractures healed completely within an average of 18 weeks. None of the patients showed malaligment on the final radiographic evaluation. Average of varus-valgus aligment was 1.9 degrees and average of anterior-posterior alignment was 1.1 degrees. According to the Iowa ankle-evaluation rating system, we obtained satisfactory clinical results in 14 cases. Complication occurred in two cases. There was one case of hypertrophic nonunion and one breakage of the distal locking screw with delayed union. Conclusion: We consider that interlocking intramedullary nailing of far distal tibia fractures located within AO classification 43 is a considerable method when a plate is not used due to accompanying severe open wound, etc. For satisfactory results, accurate technique and experience of the operator were required.

경골 고평부 골절에서 관절경을 이용한 관절강 내 정복술 및 내고정술

김동휘 ( Dong Hwi Kim ),이광철 ( Gwang Chul Lee ),최귀연 ( Kwi Youn Choi ),조성원 ( Sung Won Cho ),하상호 ( Sang Ho Ha ) 대한골절학회 2013 대한골절학회지 Vol.26 No.3

목 적: 경골 고평부 골절 시 관절경하 골절부를 조작하여 별도의 피질골 창을 내지 않고 골이식술 없이 내고정술 후과를 평가하였다. 대상 및 방법: 2006년 3월부터 2009년 3월까지 3차원 컴퓨터 단층 촬영(computed tomography, CT)상 관절면의 함몰 및 전위가 5 mm 이상인 경골 고평부 골절에 대해 관절경적 정복술 및 내고정술을 시행한 12예를 대상으로 하였다. 경골 피질 에 별도의 창을 내지 않고 골막거상기를 이용하여 감입되어 있는 골편을 정복하거나 제거하여 관절면 정복을 얻은 후 유관 나사를 용하여 내고정을 시행하였고, 전예에서 골 이식은 하지 않았다. 임상적, 방사선학적인 결과 평가로 Rasmussen의 방법을 이용하였다. 결 과: 유합 기간은 평균 9주(7-12주)였으며 Rasmussen 기준에 따라 임상적 결과로 우수 8예, 양호 3예, 보통 1예였고 방사선학적 결과로 우수 7예, 양호 5예로 만족스러운 결과를 보였다. 결 론: 경골 고평부 골절에서 정복을 방해하는 골편을 별도의 창을 내지 않고 관절경을 이용하여 제거 또는 관절강 서 정복하는 술기는 추가적인 골이식 없이 임상적으로 양호한 결과를 얻을 수 있는 방법으로 생각한다. Purpose: We evaluated the results of arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window along with any additional bone grafts. Materials and Methods: From March 2006 to March 2009, twelve patients with arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures over 5 mm in depression and displacement on the articular surface in computed tomography (CT) were enrolled in this study. We reduced or removed the depressed fracture fragment using freer without making a cortical window. Then, we accomplished internal fixation by a cannulated screw. All cases have not received bone graft. Both the postoperative clinical and radiological results were evaluated by the Rasmussen system. Results: The fractures were healed completely in an average of 9 (range from 7 to 12) weeks. According to Rasmussen classification, we obtained satisfactory clinical results as excellent in 8 cases, good in 3 cases, and fair in 1 case; and radiological results were excellent in 7 cases and good in 5 cases. Conclusion: We consider that arthroscopic intra-articular reduction and internal fixation of tibial plateau fractures without cortical window and any additional bone grafts is are a useful methods for attaining satisfactory results.