인공 슬관절 단일구획 치환술 후 폴리에틸렌 마모의 관절경적 진단 - 증례 보고 -

강규복,윤정로,박성철,송승엽,양재혁,Kang, Kyu-Bok,Yoon, Jung-Ro,Park, Sung-Chul,Song, Seungyeop,Yang, Jae-Hyuk 대한관절경학회 2012 대한관절경학회지 Vol.16 No.2

인공 슬관절 전치환술 후 발생한 폴리에틸렌 마모를 관절경을 통한 진단은 이전에 보고된 바 있다. 이번 논문에서 저자들은 인공 슬관절 단일구획 치환술 후 발생된 폴리에틸렌 마모와 재발성 아탈구를 관절경을 통해 진단하여 폴리에틸렌의 교환만으로 치료된 증례에 대해 보고하는 바이다. 인공 슬관절 단일구획 치환술 후 발생된 폴리에틸렌 마모와 탈구의 진단에 관절내시경이 도움이 되며 문제의 원인, 진단 및 치료 방침을 정하는데 유용한 것으로 사료된다. The role of arthroscopy for the diagnosis of polyethylene wear after total knee arthroplasty has been reported previously. In this report, we demonstrate a case of wear of meniscal bearing in unicompartmental knee arthroplasty (UKA) and recurrent meniscal bearing subluxation which was diagnosed by arthroscopy. Arthroscopic examination has its role in diagnosing the wear and subluxation of polyethylene bearing after UKA.

족관절 인공관절 치환술: 반 구속형과 자유형 치환물의 단기 추시 결과 비교

강규복,최재혁,김택선,김학준,권제호,Kang, Kyu-Bok,Choi, Jae-Hyuck,Kim, Taik-Sun,Kim, Hak-Jun,Kwon, Jae-Ho 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: The purpose of this study is to compare the two prosthesis that used for total ankle arthroplasty. Materials and Methods: From Sept. 2003 to Jun 2006, 13 patients and 14 ankles that could be follow up more than 1 months. Semiconstrained type (Group I, 7 cases) and Unconstrained type (Group II, 7 cases) were used for total ankle arthroplasty. Mean age was 63.2 year-old, 12 ankles are men and 2 ankles were women. Mean follow up periods were 29 months. The criteria to compare the clinical result were postoperative range of motion, AOFAS score and residual bone stock of medial malleolus. Results: Postoperative range of motion of group I was $43.6{\pm}9.4$ degrees and of group II was $50.7{\pm}7.3$ degrees (p=0.115). Postoperative AOFAS score of group I was $77.1{\pm}13.0$ points and of group II was $86.0{\pm}5.7$ points (p=0.094). Resected bone stock in medial malleolus of group I was $10.7{\pm}2.5\;mm$ and of group II was $5.1{\pm}1.2\;mm$ (p=0.003). Total number of complication in our study was 9 cases. 3 cases were a malleolar fracture, two occurred at intra-operation, the other at follow-up period. Re-operation was done in 6 cases, 3 cases were calcaneal corrective osteotomy, 2 cases were resection of a heterotopic bone and one case was pedicular flap operation for skin problem. Conclusion: In our hospital, mobile bearing type prosthesis shows good result than a semiconstrained type in respect of residual bone stock in medial malleolus. Postoperative range of motion and AOFAS score between two groups shows no significant difference. But small number of patients and short term follow up period is a defect in our study, afterward more population and long term follow up period are needed.

대한정형외과학회지에서 통제어로 작성된 저자 키워드

강규복(Kyu-Bok Kang),김지형(Ji-Hyung Kim),김영배(Young Bae Kim),김진각(Jin-Kak Kim),신상미(Sang-Mi Shin) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.4

목적: 통제어를 이용한 저자 키워드를 사용하면 정확한 검색이 가능하여 해당 논문의 피인용 지수를 높일 수 있다. 대한정형외과학 회지는 키워드로 통제어인 medical subject headings (MeSH) 용어의 사용을 권장하고 있다. 이에 사용 경향을 분석하고 개선안을 제 시하고자 하였다. 대상 및 방법: 2009년부터 2012년까지 학회지에서 발표된 논문 320편에서 사용된 1,058개의 영문 키워드를 대상으로 하였다. 기술 분석 후, MeSH browser를 이용해 일치, 부분 일치, 불일치로 구분하였고, 부분 일치의 경우 기입어, 전후방 일치, 부주제어 등으로 세분하였다. 이를 토대로 MeSH 용어와의 구조적인 차이와 투고자들이 실수하기 쉬운 유형들을 분석하였다. 결과: 일치율은 평균 23.5%, 부분 일치율은 평균 34.8%, 불일치율은 41.7%였다. 부분 일치로 전후방 일치 205예, 기입어의 사용 147예, 복수 미사용 10예, 부주제어 사용 6예 순이었다. 최빈어들은 knee 및 total knee arthroplasty (17회), osteoarthritis (9회) 등 의 순이었다. 결론: 논문들의 정확한 검색과 재인용을 위하여 저자 키워드들을 MeSH 용어와 같은 통제어로 사용하는 것이 권장되어야 할 것이다. Purpose: The purpose of this study was to analyze the equality between author key words used in the Journal of the Korean Orthopaedic Association and controlled vocabulary or medical subject headings (MeSH). Materials and Methods: A total of 1,058 English key words in 320 papers (average 3.3 words in a paper) from 2009 to 2012 were eligible for this study. We classified them according to matched, partially matched, and non-matched terms. The partially matched terms were further dissected into entry terms, qualifiers, anteriorly or posteriorly matched, abbreviations, and pleurals. After descriptive analysis, we assayed patterns of errors in using MeSH, and reviewed frequently used non-MeSH terms. Results: The rate of matched terms was 23.5% for an average of four years, and 34.8% for 2013, which is on the rise by year. The rate of partially matched terms was 34.8%, and that of non-matched terms was 41.7% for an average of four years. The most frequently used key words were Knee and Total knee arthroplasty (17 times), followed by Osteoarthritis (9), Femur, Hip, and Total hip arthroplasty (8). Conclusion: Use of proper keywords aligned with the international standards such as MeSH is important to be properly cited. The authors should pay attention and be educated on correct use of MeSH as key words.

골다공증성 흉요추부 압박 골절에서의 보존적 치료

강규복 ( Kyu Bok Kang ),고영도 ( Young Do Koh ) 대한외상학회 2005 大韓外傷學會誌 Vol.18 No.2

Backgrounds: To evaluate the effectiveness of conservative treatment in osteoporotic thoraco-lumbar compression fractures and to identify the factors influencing the progression of compression. Materials and Methods: From January 2003 to October 2004, Patients who were admitted to our hospital for osteoporotic thoraco-lumbar compression fractures were reviewed retrospectively with follow-up more than 12 months (ave. 14.6 months). With simple x-ray lateral view, we evaluate wedge compression ratio (WCR) and kyphotic angle (KA) at initial and final follow-up. We separate the patients into two groups baesed on the amount of progression of vertebral compression and evaluate a relation with BMD, vertebral fracture level, initial WCR, initial KA. All datas were statistically analyzed. Results: An average of T-score was -3.5 and the changes of KA between initial and final follow-up were average 3.5°. Compression of anterior column were progressed to 8.5%. The changes between initial and final WCR in Group I (N=24) was 17.8%, and Group II (N=18) was 3.3%. T-score in group I was -3.4 and group II was -3.8 (p=0.228). vertebral fracture level were 10 T12, 12 L1, 2 L2 in group I; 6 T12, 6 L1, 6 L2 in group II (p=0.156). Initail WCR was 0.74 in group I, 0.63 in group II, and there was statistical difference between two groups(p=0002). Initial kyphotic angle was 13.9°in group I, 16.2° in group II repectively (p=0.392). Conclusion: The conservative treatment with short-term bed rest and early embulation is effective and valuable method to patients who have osteoporotic thoraco-lumbar compression fractures. There was no statistical difference between two groups according to BMD, vertebral fracture level, KA. But in comparison with initial WCR between two groups, there was statistical difference. That means, in the case of small initial compression of anterior column, the progression of compression was bigger than else. In these patients, more strict use of appropriate brace and careful follow-up should be needed.

고령 환자에서 대퇴골 전자간 골절 후 발생한 섬망

강규복 ( Kyu Bok Kang ),서동훈 ( Dong Hun Suh ),오성록 ( Seong Rok Oh ) 대한골절학회 2011 대한골절학회지 Vol.24 No.2

목 적: 대퇴골 전자간 골절 진단하에 수술적 치료를 시행받은 환자들을 대상으로 하여 섬망의 발병율 및 위험인자를 확인해 보고자 하였다. 대상 및 방법: 2005년 7월부터 2009년 1월까지 대퇴골 전자간 골절 진단하에 수술적 치료를 시행받은 162예를 대상으로 후향적 연구를 시행하였다. 섬망은 confusion assessment method (CAM)을 적용하여 진단하였으며 환자의 의무기록을 조사하였고, 수상 전 보행상태는 Palisano 등의 Gross Motor Function Classification System을 이용하여 평가하였다. 통계적인 분석은 단변량 분석과 다변량 분석을 시행하였다. 결 과: 162예 중 2예 (1.2%)는 술 전 내원 시부터 섬망의 증세를 보였으며 39예 (24.1%)에서 술 후 섬망이 발병하였다. 나이, 적혈구 용적률, 치매, 마약성 진통제 사용기간, 호흡기 합병증 여부는 단변량 분석 및 다변량 분석상 섬망의 발생과 유의한 상관관계를 보였다(p<0.05). 섬망이 발생한 군에서 입원기간이 더 길었으며, 퇴원 시 보행 상태가 더 떨어졌다 (p<0.05). 결 론: 고관절 주위 골절 후 섬망은 높은 빈도로 발병하며 발병 시 안 좋은 예후를 보이므로 수술 전 후 환자의 평가 시 환자의 기질적인 상태에 대한 평가뿐만 아니라 인지능력에 대한 평가도 함께 시행해야 하며 다른 합병증과 같이 적극적인 예방과 치료가 필요하다. Purpose: To evaluate the incidence, risk factors and prognosis of delirium in elderly patients with intertrochanteric fractures of femur. Materials and Methods: 162 patients who underwent operation for intertrochanteric fracture of femur from July 2005 to January 2007 were reviewed retrospectively. Delirium was diagnosed by using Confusion Assessment Method (CAM). Medical records were reviewed for the information of the patients, Gross motor function classification of Palisano et al. was used for the evaluation of ambulatory status. Univariate analysis and multivariate analysis were done to find out the risk factors. Results: 2 cases out of 162 (1.2%) met the criteria of delirium at admission, and 39 cases (24.1%) after surgery. Univariate analysis and multivariate analysis identified age, hematocrit, dementia, the duration of opiate use, and pulmonary complication as risk factors. Hospital stay was longer and postoperative ambulatory status was worse in the patients with delirium. Conclusion: Delirium is a frequent complication of intertrochanteric fractures of old age and associated with worse results. Cognitive function as well as physical status should be evaluated before and after surgery. Delirium needs more active prevention and treatment for better results.

무지 외반증의 근위 갈매기형 절골술 후 고정 방법에 따른 결과 차이

김택선,강규복,강종우,김학준,Kim, Taik-Seon,Kang, Kyu-Bok,Kang, Jong-Woo,Kim, Hak-Jun 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was $3.21{\pm}1.7$ and group B $1.76{\pm}1.0$. Preoperative mean AOFAS score of group A was $45.61{\pm}8.3$, group B $44.41{\pm}8.9$, the final mean score of group A was $88.87{\pm}8.3$ and group B $92.47{\pm}4.4$. Preoperative mean HVA was $30.82{\pm}6.6$ degrees in group A and $32.88{\pm}14.5$ degrees in group B, the final mean angle of group A was $14.89{\pm}8.3$ degrees and group B $17{\pm}4.4$ degrees. The preoperative mean IMA of group A was $13.69{\pm}3.6 $degrees and group B $12.35{\pm}5.2$, the final mean angle of group A was $9.26{\pm}3.6$ degrees and group B $12.35{\pm}5.8$ degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.

결핵성 삼각근하 점액낭염 - 증례 보고 -

이우승,윤정로,강규복,양재혁,임형태,Lee, Woo-Seung,Yoon, Jung-Ro,Kang, Kyu-Bok,Yang, Jae-Hyuk,Lim, Hyung-Tae 대한관절경학회 2010 대한관절경학회지 Vol.14 No.1

We report a case of an 85-year-old woman with tuberculous subdeltoid bursitis. Tubeculous bursitis without adjacent joint tuberculosis may occur any site but it is rare. It is common in bursae subjected to trauma like trochanteric, prepatellar, olecranon and so on. Because the clinical findings or physical examination of tuberculous subdeltoid bursitis are similar to rotator cuff disorder and the MRI or arthroscopic findings are similar to synovial diseases, careful differential diagnosis is necessary. 85세 여자 환자에서 발생한 결핵성 삼각근하 점액낭염을 경험하였기에 보고하고자 한다. 인접 관절의 침범 없이 발생하는 결핵성 점액낭염은 드물며 외상을 받기 쉬운 대전자, 슬개전 및 주두 점액낭 등에 주로 발생하지만 어느 곳에나 발생 할 수 있다. 결핵성 삼각근하 점액낭염에서 견관절 전외측부 통증, 압통 및 충돌 징후 양성 등 임상 증상 및 이학적 검사는 회전근 개 질환과 유사하며 자기공명영상 검사 및 관절경 소견에서 관찰되는 활액막의 비후 및 다발성의 미립체의 소견등은 류마토이드 관절염 등과 같은 활액막 침범 질환과 유사한 소견을 보일 수 있으므로 이러한 질환들과 감별을 요한다.

내측 및 외측 반월상 연골에 동시 발생한 양동이 손잡이형 파열 - 증례 보고 -

윤정로,김택선,양재혁,강규복,김영찬,Yoon, Jung-Ro,Kim, Taik-Sun,Yang, Jai-Hyuk,Kang, Kyu-Bok,Kim, Young-Chan 대한관절경학회 2010 대한관절경학회지 Vol.14 No.1

대부분의 반월상 연골의 양동이 손잡이형 파열은 전방 십자인대와 동반하여 발생하며, 전방십자 인대의 급성 손상 시는 외측 반월상 연골의 양동이 손잡이형 파열이 흔한 반면 만성 전방 십자인대 손상 시는 내측에서 흔히 발생한다고 보고된다. 저자들은 전방십자 인대의 불안정성과 동반 된 내,외측 반월상 연골의 동시적 양동이 손잡이형 파열에 대해 보고하고자 한다.저자들은 전방십자 인대의 불안정성과 동반 된 내,외측 반월상 연골의 동시적 양동이 손잡이형 파열의 발생 가능성에 대한 인식을 높이고자 하였으며, 추가적으로 본 손상의 발생기전, 임상증상, 자기공명영상 검사상 특이 소견 및 치료에 대해 문헌 고찰과 함께 보고하고자 한다. Most of bucket handle meniscal tears are associated with anterior cruciate ligament (ACL) deficiency. Lateral meniscus lesions are more common with acute ACL deficiency, where medial meniscus lesions are more associated with chronic ACL deficiency. We reported an ACL deficient knee with bucket handle tears of medial and lateral meniscus of the same knee. The report suggests the need for increased awareness of the possible presence of this. Additionally, we discuss injury mechanism, clinical symptoms, specific signs on Magnetic Resonance Imaging (MRI), and treatment options.

대퇴골 전자하 골절 후 발생한 깊은 다리 혈관 손상 -증례 보고-

양재혁 ( Jae Hyuk Yang ),윤정로 ( Jung Ro Yoon ),강규복 ( Kyu Bok Kang ),윤호현 ( Ho Hyun Yun ),신영수 ( Young Soo Shin ),조윤구 ( Yun Ku Cho ) 대한골절학회 2012 대한골절학회지 Vol.25 No.1

Arterial trauma associated with hip fracture treatment is still a rare complication. We present a case in which an arterial injury was discovered during closed reduction and intramedullary nail fixation of a subtrochanteric hip fracture. The preoperative thigh circumference was increased due to severe swelling, and the vascular injury was located substantially proximal to the fracture and the instrumentation area. An interventional angiogram revealed a damaged vessel originating from one of the minor proximal branches of the right deep femoral artery while filling a 2 cm-sized pseudoaneurysm. Embolization was performed without further complications.

노령에서 고관절 골절에 영향을 주는 수상전 요인

김종오,윤여헌,고영도,유재두,정준모,방한천,강규복 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 노령에서 고관절골절의 여러 원인적 요인들과 상관관계를 분석, 그 연관성에 대해 알아 보고자 하였다. 대상 및 방법 : 2001년 1월부터 2002년 5월까지 대퇴 고관절 골절로 본원에서 치료받은 환자중 60세 이상이고 골밀도 검사를 시행받은 158례를 대상으로, 수상전 요인을 나이, 성별, 흡연여부, 비만정도, 골절종류, 수상장소, 다른 이환 질환, 골절전 활동도, 골밀도 검사, 수상당시 바닥의 경도, 수상당시 넘어진 방향, 수상에너지에 따라 대퇴 경부골절과 전자간 골절, 전자간 골절중 안정골절과 불안정 골절로 나눠 비교하였다. 결 과 : 80세 이상의 군에서 대퇴 전자간 골절이 대퇴 경부 골절에 비해 의미있게 많이 발생했음을 알 수 잇었으며(p<0.001) 환자의 수상전 활동정도의 비교에서도 활동정도가 낮았던 군에서 대퇴 전자간 골절이 의미있게 많이 발생하였다(p<0.001). 골밀도 검사에 따른 비교에서는 T-score -3.0 이하인 군에서 대퇴 전자간 골절이 많았으며(p<0.005), 수상에너지에 따른 비교에서는 적은 에너지에 의한 골절이 전자간 골절에서 많았다(p<0.05). 대퇴 전자간 골절은 안정 골절과 비안정 골절로 나눈 비교에서는 사회 활동이 어려운 ADL C이하의 군과(p<0.05), 골밀도 T-score -3.0 이하인군에서는 의미있는 차이를 보였다(p<0.001). 결 론 : 노령에서의 고관절 골절 중 80세 이상의 고령에서, 골밀도 T-score -3.0 이하인 경우, 일상생활 활동정도가 낮은 경우에, 비교적 적은 에너지에 의한 충격시에 대퇴 전자간 골절의 발생이 대퇴 경부 골절에 비해 의미있게 많았고 전자간 골절에서 불안정 골절은 사회활동이 적고 골밀도 T-score -3.0 이하인 경우 많음을 알수 있었다. Purpose : We studied the co-relation on the causes of the hip fracture through the analysis of a relevance on the etiological factors as increased incidence according increasing old age. Materials and Methods : Total 158 cases that treated on the hip fracture from 2001 Jan. to 2002 May were studied. The parameters were age, gender, smoking, obesity, type of fracture, place of fracture, other comorbidity, activity of daily living, bone marrow densitometry, hardness of floor, orientation, injury energy. And then, we analysis of difference between femur neck fracture and femur intretrochanter fracture and between stable femur intertrochanter fracture and unstable femur intertrochanter fracture. Results : The incidence of the femoral intertrochanteric fracture was larger significantly than that of the femoral neck fracture in the older then 80(p<0.001). On the comparison of the pre-fractural activity of daily living, the group revealed lower activity had larger incidence of femoral intertrochateric fracture(p<0.001). Also, the femoral intertrochanteric fracture was more larger osteoporosis patient group(p<0.005), and lower energy trauma(p<0.05). In a unstable femoral intertrochanteric fracture, 21 cases(77.7%) of total 27 cases were belong to the group of the activity of daily living scale below C(p<0.05), 24 cases pf 27 cases were belong to the osteoporosis patient who was estimated below -3.0 on T-score(p<0.001). Conclusion : In the hip fracture of the elderly patients, the femoral intertrochanteric fracture is more prevalance ratherthe femoral neck fracture on the cases of older patient more than 80 year-old, lower activity of daily living scale, lower T-score less than -3.0 on BMD, lower energy trauma. Also, in femur intertrochanter fracture, unstable fracture is more common in low daily activity and owteoporosis.