주상골 불유합으로 인한 장무지 굴곡건 파열

강홍제,박정현 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

Flexor pollicis longus rupture due to scaphoid nonunion is very rare complication. It has never been reported in the Korean literatures. We reported a case of flexor pollicis longus rupture due to scaphoid non union that was treated by tendon graft with palmaris longus and osteosynthesis with bone graft. 주상골 불유합에 의한 장무지 굴곡건의 파열은 매우 드물며 아직 국내 문헌에 보고된 적은 없다. 이에 저자들은 45세 남자 환자에서 주상골 불유합을 동반한 장무지 굴곡건의 파열을 골 이식을 통한 골 유합술과 장장건을 이용한 건 이식술을 통해 좋은 결과를 얻었기에 문헌 고찰과 함께 보고 하고자 한다.

완관절과 수부에서 초음파 유도하 수술적 치료

강홍제,김세진 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.3

Ultrasonography is used commonly for diagnosis and treatment in orthopedic field, because of low cost and radiation free imaging. Especially, in hand and wrist, where anatomical structures are located superficially, ultrasonography is very useful. Furthermore, major structures could be seen real-time, increasing safety and accuracy in operation. Therefore, some authors are trying ultrasonography-guided surgery around wrist and hand. This article reviewed the ultrasonography-guided surgery around wrist and hand with its technique, indication, and contraindication. 초음파는 저비용이며 방사선 노출이 없으면서 진단과 치료를 함께 병행할 수 있는 장점이 있어 정형외과 영역에서 널리사용되고 있다. 특히 수부는 표층에 해부학적 구조물들이 위치하기 때문에 초음파를 통한 접근이 쉽고 비교적 좋은 해상도를 얻을 수 있어 주사 치료 등에 사용되고 있다. 뿐만 아니라 최근에는 신경과 혈관 등의 주요 구조물들을 실시간으로 볼 수 있어 조직 손상을 방지하여 수술의 안정성과 정확성을 높일 수 있어 여러 저자들에 의해 방아쇠 수지, 수근관증후군 등에서 초음파 유도하 수술이 시도되고 있으며 좋은 결과를 보고하고 있다. 이에 본 종설에서는 수부와 완관절주변에서 시행할 수 있는 초음파 유도하 수술의 종류와 각각의 적응증 및 술기, 주의 사항에 대하여 다루고자 한다.

상완골 간부에 발생한 Gorham씨 병

강홍제,배규환,전근철 대한견주관절의학회 2011 대한견주관절학회 학술대회논문집 Vol.2011 No.3

Epidermoid Cyst after Groin Flap Mimicking Malignancy

강홍제,우영하 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.3

Epidermoid cyst is a benign tumor containing a layer composed by stratified squamous epithelium and filled with keratin. The epidermoid cyst after soft tissue damage such as bite, laceration could be caused by implantation of epidermal cells. There are reports of epidermoid cyst rarely occurred after surgical procedures such as bone graft or spine puncture. However, the report of epidermoid cyst associated with flap in the hand is very rare. We experienced such epidermoid cyst after the groin flap mimicking malignancy in the distal phalanx of the thumb. We found calcified mass with bony erosions in radiologic findings and heterotrophic signals and partial necrosis in magnetic resonance imaging that suggested malignancy. However, it was pathologically diagnosed as an epidermoid cyst. Therefore, we report the case and literature review.

The Results of All-Inside Meniscus Repair Using the Viper Repair System Simultaneously with Anterior Cruciate Ligament Reconstruction

강홍제,전철홍,김광미,조항환,Johnsel C. Espinosa 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. Methods: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning’s classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. Results: The clinical success rate was 95.4% and the HSS scores were 93.9 ± 5.4 at the final follow-up. According to Henning’s classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. Conclusions: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.

중수근 불안정성의 이해

강홍제 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.2

The midcarpal instability is the state with instability between the proximal and distal carpal rows, without dissociation between carpal bones. It can be divided into the intrinsic one that is caused by ligament hyperlaxity, and extrinsic one that is caused secondarily by the malunion of distal radius. The pathophysiology of the intrinsic one is still unknown, and the treatment is also controversial. On the other hand, the extrinsic one can be treated by corrective osteotomy of the radial malunion. This review investigated the comprehension, definition, classification, symptoms, diagnosis, and treatment of the midcarpal instability. 중수근 불안정은 수근골 사이의 해리 없이 근위 수근열과 원위 수근열 사이에 발생하는 불안정성을 말한다. 중수근 불안정은 과도한 인대 이완에 의해 발생하는 내재성 불안정과, 요골의 부정 유합에 의해 이차적으로 발생하는 외재성 불안정으로 크게 나눌 수 있다. 아직도 내재성 중수근 불안정을 유발하는 병태 생리가 정확하게 알려지지 않고 있으며 치료 역시 논란이 많다. 반면 외재성 중수근 불안정은 원인이 되는 요골의 부정 유합에 대해 교정 절골술을 시행하여 치료할 수 있다. 이에 수근 불안정의 기본 개념과 중수근 불안정의 정의, 분류, 증상, 진단, 치료에 대해 알아보고자 한다.

심부 종양 형태로 발생한 손목의 종양 석회증 1예

강홍제 ( Hong Je Kang ),김건록 ( Keon Rok Kim ),임보라 ( Bo Ra Lim ),박건 ( Kun Park ) 대한피부과학회 2021 大韓皮膚科學會誌 Vol.59 No.3

Tumoral calcinosis is an ectopic calcification syndrome characterized by an irregular soft tissue mass. It has been reported mainly in large joints such as the hip, shoulder, knee, and elbow, but rarely in the hands. When it occurs on the dorsal side of the wrist, there are no specific symptoms except for localized tenderness. Therefore, it is difficult to differentiate the calcification from other common hand tumors, especially ganglions. We report a case of tumoral calcinosis that occurred on the dorsal side of the wrist with magnetic resonance imaging findings. (Korean J Dermatol 2021;59(3):225∼228)

골 결손을 동반한 고령의 원위 요골 분쇄골절에서 동종 해면골 이식과 수장측 잠김 금속판을 이용한 치료

강홍제 ( Je Hong Kang ),신창현 ( Chang Hyun Shin ) 대한골절학회 2015 대한골절학회지 Vol.28 No.1

Purpose: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar Materials and Methods: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. Results: Using the MMWS, 13 cases were classified as ‘good’, 10 ‘fair’, and 5 ‘normal’. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow- up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p>0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as ‘good’, Conclusion: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.

슬관절 전치환술 후 발생한 대퇴골 과상부 골절의 치료

강홍제(Hong Je Kang),전철홍(Churl Hong Chun),김광미(Kwang Mee Kim),한상수(Sang Su Han) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.5

목적: 슬관절 전치환술 후 발생한 대퇴골 과상부 골절 치료에 금속판 내고정술과 역행적 골수강 내 금속정 삽입술을 시행한 후 그 결과를 임상적 및 방사선학적으로 분석하고자 한다. 대상 및 방법: 1998년 8월부터 2010년 5월까지 본원에서 슬관절 전치환술을 시행한 1,658예에서 대퇴골 과상부의 인공 삽입물 주위 골절이 발생한 24예 중 인공 슬관절의 해리가 없는 안정성 골절로 수술적 치료를 시행한 18예를 대상으로 하였다. 수술 당시 평균 연령은 69.1세(55-83)였고, 평균 추시 기간은 42.8개월(14-142)이었다. 전체 18예 중 금속판 내고정술을 시행한 8예를 A군, 역행적 골수강 내 금속정 삽입술을 시행한 10예를 B군으로 분류하였으며 각 군의 골유합 기간 및 골절 전 마지막 추시와 최종 추시시 슬관절의 운동 범위, Hospital for Special Surgery score (HSS), 대퇴 경골각을 분석하였다. 결과: 전 예에서 골유합을 얻을 수 있었으며, 골유합 평균 기간은 A군과 B군에서 각각 5개월과 4.8개월이었으며, 글관절 운동범위는 A군에서 골절 전 마지막 추시시 평균 120도에서 최종 추시시 평균 93도, B군은 평균 124.5도에서 최종 추시시 평균 96.8도로 통계학적으로 술 전에 비해 의미있게 감소하였으나(p<0.001), 두 구간의 차이는 없었다(p>0.05). HSS 점수는 A군에서 골절 마지막 추시시 평균 87점에서 최종 추시시 79.8점, B군은 평균 85점에서 최종 추시시 81점으로 감소되었으나 술 전과 비교하여 통계학적인 의미는 없었으며(p>0.05), 두 군간의 치이도 없었다(p>0.05). 대퇴 경골각의 경우 A군은 골절 마지막 추시시 평균 외반 6.2도에서 최종 추시시 평균 외반 4.4도였고, B군은 골절 전 평균 외반 6도에서 최종 추시시 평균 외반 5.2도로 측정되어 술 전에 비해 통계학적인 차이는 없었으며(p>0.05), 두 군간의 차이 역시 없었다(p<0.05). 결론: 슬관절 전치환술 후 발생한 대퇴골 과성불 골절에 대해 골절 양상에 따라 관혈적 정복 및 금속판 내고정술과 역행적 골수강 내 금속정 삽입술을 시행하여 임상적 및 방사선학적으로 좋은 결과를 얻을 수 있었다. Purpose: This study examined the outcomes of treatment in periprosthetic supracondylar fractures of the femur after total knee arthroplasty with the plates of internal fixation and retrograde intramedullary nailing using clinical and radiological methods. Materials and Methods: Between August 1998 to May 2010, 24 cases of periprosthetic supracondylar fractures of the femur around the stem were selected and 18 cases of a stabled fracture without a loosening of the stem were chosen. The mean age was 69.1 (range 55-83) years and the mean follow period was 42.8 (range 14-142) months. In 18 cases, 8 cases who used a plate to gain anatomical alignment were categorized as group A and 10 cases who used retrograde intramedullary nailing were called group B. The union period, range of motion before fracture and last follow up, HSS score and tibiofemoral angle in both groups were compared. Results: Radiographic union was obtained in all cases. The mean union period was 5 and 4.8 month in group A and B, respectively. In group A, the range of motion just before fracture was 120° and the last follow up was 93° In group B, the range of motion before fracture was 124.5° and the last follow up was 96.8°. Although the range of motion in both groups had decreased appreciably (p<0.001), there was no significant difference between them (p>0.05). The HSS score in group A was 87 just before the fracture and decreased to 79.8. The HSS score in group B was 85 before fracture and decreased to 81. The final HSS score at the last follow up decreased in both groups but the decrease and difference between the two groups was not significant (p>0.05). The coronal alignment in group A was 6.2 valgus just before the fracture and 4.4 valgus at the last follow up. The coronal alignment in group B was 6 valgus before the fracture and 5.2 va lgus at the last follow up (p>0.05). Conclusion: In the treatment of periprosthetic supracondylar fractures of the femur after total knee arthroplasty, both an open reduction with internal fixation of the plates and retrograde intramedullary nailing showed good results in the clinical and radiological fields.

정중신경에 발생한 지방 섬유종성 과오종의 수술 전후자기공명영상 변화

최상수,강홍제,김정우,김광미 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.4

Lipofibromatous hamartoma is a very uncommon, benign tumor that involves diffuse infiltration of peripheral nerves by normal-appearing fibrous and adipose tissues. We repost a rare case of secondary carpal tunnel syndrome due to a lipofibromatous hamartoma of the median nerve with preoperative and postoperative magnetic resonance images. 지방 섬유종성 과오종은 섬유지방 조직이 미만성으로 말초 신경을 침범하는 매우 드문 종양이다. 저자들은 21세 남자환자에서 원위 전완부에서 원위 수근관의 정중신경에 발생한 지방 섬유종성 과오종을 증례 보고와 함께 수술 전과 후의자기공명영상 소견의 변화를 문헌 고찰을 통해 알아보고자 하였다.