견관절 유착성 관절낭염 환자에 동반된 회전근개 파열을 동시에 수술적 치료를 해야 하는가?

강석웅 대한스포츠의학회 2019 대한스포츠의학회지 Vol.37 No.1

Purpose: Retrospectively, the purpose of this study is to investigate the necessity for early operation for patients with rotator cuff tears and concomitant adhesive capsulitis. Methods: From March 2013 to March 2017, we conducted a retrospective study on patients with rotator cuff tears and concomitant adhesive capsulitis. We analyzed 32 cases out of 39 cases who have small to medium rotator cuff tears, excluding patients who were unable to follow up over 1 years. We evaluated range of motion, visual analog scale (VAS) score, and Constant score. We compared patients of non-symptom and symptomatic patients related to rotator cuff tear. Results: Among patients in the 32 cases, 21 cases of total patients improved without discomfort after recovering their range of motion and pain (group 1), and 11 cases were developed symptoms related to rotator cuff tear for the last 1 year (group 2). Average age of group 1 patients was 53.4 years old, and recovered from forward elevation 95.5o to 163.2o, external rotation from 8.5o to 68.7o, mean VAS score improved from 6.2 to 1.2. Average age of group 2 patients was 58.4 years old, and recovered from forward elevation 96.2o to 162.2o, external rotation from 8.1o to 67.8o, mean pain VAS score improved from 6.4 to 4.4. But there was statistically significant difference in pain reduction after restoration of motion compared to asymptomatic group. Conclusion: We do not need surgical treatment at the same time because the symptoms of rotator cuff tear may not be manifested in patients with rotator cuff tear associated with adhesive capsulitis. Sufficient follow-up should be considered after restoration of shoulder motion related to adhesive capsulitis.

무지외반증 수술에서 제 2족지의 외반 정도가 무지 외반각 교정소실에 미치는 영향

강석웅,유성호,송무호,김영준,오영광 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.4

Purpose: The purpose of this study is to determine the correlation between the correction loss of hallux valgus angle and the severity of valgus angle of the second toe. Materials and Methods: We selected 312 cases from 268 surgical patients with hallux valgus deformity receiving distal chevron osteoto『my. For a radiological evaluation, we analyzed the changes in the hallux valgus angles, first to second intermetatarsal angles, and valgus angle of the second toe post index operations. All patients were women; the mean age was 46 years. The mean follow-up period was 17 months. Results: The mean hallux valgus angle was 33.6° preoperatively (range, 25.7°∼44.8°), 13.1° (range, 8.4°∼16.4°) after 4 weeks of postop『erative period, and 17.1° (range, 9.4°∼28.5°) at their final follow-up. The mean valgus angle of the second toe was 8.4° preoperatively (range, 2.0°∼25.8°) and 8.3° (range, 1.7°∼24.9°) at the final follow-up. Preoperatively, there was a positive correlation between the valgus angle of the second toe and hallux valgus angle (r=0.747, p=0.001). The correction loss of hallux valgus angle had a significant correla『tion with the severity of valgus angle of the second toe (r=0.802, p=0.001). Conclusion: The existence of the second toe valgus deformity may present itself as a cause of correction loss of hallux valgus angle. The preoperative measurement of the second toe valgus angle may be a good predictor of correction loss; therefore, thorough preoperative warning on the possibility of correction loss should be conducted to maximize patient satisfaction after the procedure.

쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술의 수술적 결과

강석웅(sukwoong kang) 대한견주관절의학회 2018 대한견주관절학회 학술대회논문집 Vol.2018 No.3

쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술의수술적 결과

유성호,강석웅,서재승 대한골절학회 2019 대한골절학회지 Vol.32 No.1

Purpose: This study analyzed the results of the midclavicle fracture treatment using the minimally invasive percutaneous plate osteosynthesis (MIPO) technique in a retrospective manner. Materials and Methods: Between March 2013 and March 2017, this study analyzed 40 patients who received MIPO surgery. Excluding 1 patient who underwent surgery on another body part injury, and 4 patients who were lost to follow-up over 1 year, 40 patients were analyzed for their operation time, bone union, functional American Shoulder and Elbow Surgeons score, scar lengths, pain relief (visual analogue scale), and complications. Results: All patients over a 1 year of follow-up achieved bone union, and American Shoulder and Elbow Surgeons score 97.6 (94-100) on their shoulder functional scores. Their average operation time was 42.7 minutes, and the average scar length was 6.1 cm. Eighteen patients successfully received metal removal using the previous scar without additional incision. The clavicle length was similar in the normal and operated group. Conclusion: Despite its small sample size, clavicle fixation using the MIPO technique can be considered an effective treatment because of its limited number of complications, such as nonunion and rotational angulations. 목적: 쇄골 골절의 MIPO의 수술적 치료의 결과를 후향적 분석을 통해 분석하고자 하였다. 대상 및 방법: 2013년 3월부터 2017년 3월까지 쇄골 간부 골절로 최소 침습 고정술식을 시행받은 45명의 환자 중 1예는타 부위 동반 손상으로 수술적 치료를 시행하여 제외하였고, 연고지 관계로 1년 이상 추시되지 않은 환자 4명을 제외한 40 명의 환자에 대해 수술시간, 골 유합, 기능적 평가(American Shoulder and Elbow Surgeons score), 수술 반흔의 길이, 술후 통증 완화(visual analogue scale) 및 합병증에 대해 분석하였다. 결과: 1년 이상 추시 관찰 가능했던 40예에서 모두 골 유합이이루어졌으며, ASES score는 97.6점(94-100점)으로 양호한결과를 보였다. 평균 수술 시간 42.7분, 수술 반흔의 길이는6.1 cm였다. 18명의 환자에서 금속판 제거술을 시행하였으며, 수술 시 이전 절개를 통해 금속판 제거술이 가능하였고, 추가적인 절개는 가하지 않았다. 반대편의 정상 부위와의 쇄골 길이를 측정하였으며 통계적으로 차이를 보이지 않았다. 결론: 쇄골 간부골절에서 MIPO 술식은 임상적, 방사선적으로 모두 좋은 결과를 보임으로써 다른 수술 방법과 함께 고려해볼 만한 방법이라고 생각한다.

Coronal Alignment of the Lower Limb and the Incidence of Constitutional Varus Knee in Korean Females"

송무호,유승호,강석웅,김영준,박규택,편영선 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.3

Purpose In total knee arthroplasty (TKA), it is important to restore neutral mechanical alignment. The purpose of this study was to assess whether the lower limb alignment is neutral in healthy Korean females and investigate the incidence of constitutional varus knees among them. Materials and Methods Weight-bearing full-leg standing radiographs were obtained from 118 healthy females between the ages of 20 to 39 years. One radiologist and two orthopaedic surgeons measured the hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), and femoral anatomic mechanical angle (FAMA) on the radiographs and compared with the traditional gold standard HKAA of 0°, MPTA of 3° varus, and FAMA of 6°. Results The interobserver reliability of the three independent observers was high (p<0.001). The HKAA of the study subjects (1.35°±2.04°) was significantly different from the standard HKAA of 0° (p<0.001), but no statistically significant difference was observed in the MPTA (-3.18°±1.61°) and FAMA (5.99°±0.70°) from the standard values (p=0.083 and p=0.887, respectively). The incidence of constitutional varus alignment was 20.34%. Conclusions In Korean females, the mechanical axis of the lower limb was not neutral and the incidence of constitutional varus alignment was slightly higher than that in Western females. We believe that these findings should be taken into consideration in planning reconstructive surgery of the knee, such as TKA, unicompartmental knee arthroplasty, and high tibial osteotomy.

신세포암의 경막내 전이 - 1례 보고 -

안성준,송무호,이민수,강석웅,유성호,김병주 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.4

Most of intradural tumors are primary tumors and few of them are metastatic tumors. Especially, spinal intradural metastatic tumors which are derived from renal cell carcinoma are rarer. Even though such tumors occur, it accompany with brain metastasis in many cases. And there was no report regarding isolated intradural metastasis, without metastasizing on brain or other central nervous system organs, in domestic. The purpose of this research is to report the excellent clinical results regarding solitarily intradural metastasized renal cell carcinoma. Researchers found out renal cell carcinoma which was solitarily metastasized intradural of the third lumbar of 63 years old man who has renal cell carcinoma and underwent nephrectomy 2 years before. tumor extirpation was performed after total laminectomy. And after keeping watching it for 2 years, we could get favorable results and would like to report it with review of literature. 경막내 마미주변에 발생하는 종양은 대부분 신경교세포나, 신경초기원의 원발성 종양이며 중추신경계 외부로부터 전이는 매우 드물며, 있다 하더라도 뇌전이나 기타 중추신경계 전이를 동반하고 있는 경우가 대부분이다. 그러나 이 러한 중추신경계 전이 없이 신세포암 기원의 경막내 전이성 종양은 지극히 드물며 국내보고는 없다. 저자들은 신세포암으로 내원 2년전 신적출술을 시행한 63세 남자에서 발생한 제 3요추부 경막내에 고립성으로 전이 된 신세포암을 추궁판 절제술 후 종양 적출술을 시행 후 2년간 추시 결과 우수한 임상결과를 얻었기에 문헌고찰과 함께 보고하고자 한다.

쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술 비교

유성호(Seong-Ho Yoo),강석웅(Suk-Woong Kang),김부환(Bu-Hwan Kim),송무호(Moo-Ho Song),김영준(Yeong-Joon Kim),박규택(Gyu-Taek Park),곽창훈(Chang-Hun Kwack) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 쇄골 간부 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 고정술에 대한 후향적 분석을 통해 수술 결과를 비교하고자 한다. 대상 및 방법: 2011년 11월부터 2014년 5월까지 쇄골 간부 골절로 수술을 시행한 최소 1년 이상의 추시가 가능하였던 40예에서 최소 침습적 금속판고정술 20예를 A군, 관혈적 고정술 20예를 B군으로 나누어 두 군 간의 수술시간, 골유합, 기능적 평가(American Shoulder and Elbow Society score), 수술 반흔의 길이, 술 후 통증 완화(visual analogue scale) 및 합병증에 대해 비교 분석하였다. 결과: 모든 예에서 골유합이 이루어졌으며, 양 군에서 모두 양호한 결과를 보였다(p>0.05). 평균 수술 시간은 A군에서 47.5분, B군에서 58.7분이었고, 평균 절개의 길이는 A군에서 6.2 cm, B군 10.7 cm로 유의한 차이를 보였으며, 술 후 통증의 완화에서도 A군에서 초기 빠른 회복을 보였다. 합병증으로 A군에서 부정유합 1예, 피부 감각이상 2예를 보였으며, B군에서 피부 감각이상 6예 및 수술 반흔에 대한 미용상의 문제가 2예 있었다. 결론: 쇄골 간부 골절에서 A와 B 양 군에서 대체적으로 양호한 결과를 보였으나 A군이 B군에 비해 짧은 수술시간과 수술 절개, 초기 통증 완화 항목들에서 더 좋은 결과를 보였다. 하지만 부정유합, 방사선 노출 등의 합병증 및 장기 추시 결과에 대한 연구가 더 이루어져야 할 것으로 보인다. Purpose: To retrospectively compare minimally invasive percutaneous plate osteosynthesis (MIPPO) with open plate fixation for the treatment of clavicle midshaft fracture. Materials and Methods: Between November 2011 to May 2014, 40 cases that were followed for more than 1 year–among all cases of MIPPO and open plate fixation–were analyzed. The study population was divided into two groups: group A included 20 cases of MIPPO and group B included 20 open plate fixation cases. The comparative analysis between the two groups was based on the operative time, bone union, functional evaluation (American Shoulder and Elbow Society score), incision length, pain relief (visual analogue scale, VAS), and complication. Results: The bone union was successful for all the cases, and the functional evaluation scores of the shoulder joint were satisfactory for both groups (p>0.05). The operative time was 47.5 minutes and 58.7 minutes for group A and B, respectively (p<0.05). The incision length for group A was 6.2 cm and that for group B was 10.7 cm with statistical significance (p<0.05). Pain relief (VAS) after surgery for group A showed a quick recuperation in the early stages. For complications, there were 2 cases of dysesthesia and 1 case of malunion due to metal fixation failure in group A. There were 6 cases of dysesthesia and 2 cases of cosmetic problem due to hypertrophic scar in group B. Conclusion: Surgical results of clavicle shaft fracture were satisfactory for both groups, but group A had advantages of shorter operative time, minimal incision length, and better pain relief in the early stages compared with group B. However, we need further evaluations with long-term follow-up results and complications, such as malunion and exposure on radiation.

근육내 Diclofenac 주사 후 발생한 Nicolau 증후군

안성준(Seong Jun Ahn),강석웅(Suk Woong Kang),김부환(Bu Hwan Kim),송무호(Moo Ho Song),유성호(Seong Ho Yoo),김영준(Young Jun Kim),김동환(Dong Hwan Kim) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.4

Nicolau 증후군은 근육 주사 후 근육 주사 부위의 심한 압통과 조직괴사를 일으키는 아주 드문 질환이다. 국내에서도 피부과 학회에 12예가 보고되었으며, 심한 경우 수술적 치료가 필요한 경우도 있었다. 대부분의 환자가 정형외과적인 질환의 치료를 위해 사용한 비스테로이드성 항소염제(nonsteroidal anti-inflammatory drugs), corticosteroids, 항생제(antibiotics) 등 다양한 약물로 발현되었다. 이에 저자들은 전형적인 Nicolau 증후군 1예와 비전형적인 Nicolau 증후군 1예를 경험한 바 이를 보고하고자 한다. Nicolau syndrome is a rare complication causing severe pain and tissue necrosis after intramuscular injection. In Korea, the Korea Dermatological Association has reported 12 cases, and some severe cases required surgical treatment. Most cases have been related to the administration of a variety of drugs, including nonsteroidal anti-inflammatory drugs, corticosteroids, and antibiotics. We present two patients who developed this complication, 1 case of typical Nicolau syndrome and 1 case of atypical Nicolau syndrome.

원위 대퇴골 골절의 최소 침습적 경피적 금속판 고정술과 관혈적 수술비교

안성준 ( Seong Jun Ahn ),강석웅 ( Suk Woong Kang ),김부환 ( Bu Hwan Kim ),송무호 ( Moo Ho Song ),유성호 ( Seong Ho Yoo ),오관택 ( Kwan Taek Oh ) 대한골절학회 2013 대한골절학회지 Vol.26 No.4

목적: 대퇴 원위부 골절의 최소 침습적 금속판 고정술과 관혈적 고정술에 대해 후향적 분석을 통해 수술 결과를 비교하고자 한다. 대상 및 방법: 2002년 1월부터 2010년 12월까지 대퇴 원위부 골절로 수술을 시행한 최소 1년 이상의 추시가 가능하였던 31예중 최소 침습적 금속판 고정술 17예를 A군, 관혈적 고정술 14예를 B군으로 나누어 두 군 간의 수술시간, 수혈량, 골유합, C-반응성 단백, 술 후 재활 등의 결과를 비교하였다. 결과: 각 군의 수술 시간은 평균 86/135분, 평균 수혈량 0.8/1.9 단위로 A군에서 수술 시간과 수혈량이 유의하게 감소하였다. 술 후 3, 7일째 시행한 C-반응성 단백은 A군 평균 7.4/1.5 mg%, B군 10.3/2.4 mg%로 A군에서 조직손상이 적었다. Sanders 등에 의한 슬관절 기능 점수는 양 군에서 모두 양호한 결과를 보였다. 결론: 대퇴 원위부 골절에서 최소 침습적 금속판 고정술과 관혈적 고정술이 비교적 양호한 결과를 보였으나, 최소 침습적금속판 고정술에서 조직의 염증반응이 적고, 수술 시간의 단축과 수혈량의 감소를 보여 보다 효율적인 술식으로 생각한다. Purpose: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. Materials and Methods: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. Results: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. Conclusion: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.

Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty in Young Asian Patients Less than 60 Years of Age: A Minimum 5-Year Follow-up

김영준,김부환,유성호,강석웅,곽창훈,송무호 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

purpose: The purpose of this study was to evaluate the efficacy of unicompartmental knee arthroplasty (UKA) in young active Asian patients by analyzing clinical outcomes, complications and survival rates.Materials and Methods: Eighty­two knees were evaluated with a minimum follow­up of 5 years after Oxford phase 3 UKA in patients less than 60 years of age at the time of surgery. Their mean age was 54.7 years (range, 44 to 59 years). The mean follow­up period was 8.9 years (range, 5.3 to 12 years). Kaplan–Meier survivorship analysis was used to estimate implant survival.results: Including 3 bearing dislocations, 1 medial tibial collapse and 1 lateral osteoarthritis, the total complication rate was 6.1% (5/82). Of the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to total knee arthroplasty (TKA) due to repeated dislocation. The two knees with a medial tibial collapse and a lateral osteoarthritis were converted to TKA. The 10­year cumulative survival rate using Kaplan­Meier survival method was 94.7% (95% confidence interval: 88.7%–100%).conclusions: Oxford medial UKA was reliable and effective in young active Asian patients providing good clinical results and survival rate in the mid­term follow­up.