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- 저자 : 김바롬 ( Ba Rom Kim ) (검색결과 3 건)
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김바롬,이준영,차동혁,Kim, Ba Rom,Lee, Jun Young,Cha, Donghyuk 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.3
Purpose: This paper reports the surgical treatment results of open calcaneal fractures performed at the author's clinics focusing on open calcaneal fractures to help understand the appropriate treatment and realistic outcomes. Materials and Methods: This study was conducted on 22 cases out of 30 patients who visited the hospital from February 2009 to December 2019 and were followed up for more than one year. In open fractures, the fracture was classified using the Gustilo-Anderson classification and was evaluated using the soft tissue status at the time of visit. Intra-articular calcaneal fractures were classified using Sanders classification. The radiological parameters were measured for the Böhler angle, Gissane angle, calcaneal length, height, and width before and after surgery, and at the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and investigated complications. In addition, statistical analysis of the incidence and associated factors of posttraumatic arthritis was conducted. Results: In all cases, the surgical treatment was performed by minimally invasive surgery. The AOFAS ankle-hindfoot scale conducted for a clinical evaluation of the final follow-up was averaged 72.5 points. In the classification of open fractures, the Gustilo-Anderson classification type IIIA was the most common, and the Sanders type III was the most common. Of the 22 cases after surgery, 15 cases had complications, 11 cases had posttraumatic arthritis, eight cases had an infection, and 4 cases had both complications. Only the Sanders classification showed a statistically significant correlation with the incidence of posttraumatic osteoarthritis (p-value 0.032). Conclusion: In treating open calcaneal fractures, internal fixation by a minimally invasive approach showed relatively satisfactory results. However, follow-up research will be needed, including the results of a long-term follow-up through a large number of cases and comparative studies with other surgical methods.
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수술 방법에 따른 리스프랑 관절 손상의 결과 비교: 배부 가교 금속판, 관절 관통 나사 및 혼합 고정법
김바롬 ( Ba Rom Kim ),이준영 ( Jun Young Lee ),양성훈 ( Sung Hun Yang ),이승현 ( Seung Hyun Lee ) 대한골절학회 2023 대한골절학회지 Vol.36 No.1
목적: 리스프랑 관절 손상 시 관혈적 정복술 및 관절 관통 나사를 이용한 고정법이 흔한 방법으로 여겨졌으나, 관절면의 손상 등의 추가적인 합병증이 발생한다. 이에 본 연구는 리스프랑 관절 손상 시 배부 가교 금속판, 관절 관통 나사및 혼합 고정법에서의 임상적, 방사선학적 결과를 비교하고자 하였다. 대상 및 방법: 2015년 6월부터 2021년 3월까지 본원에서 리스프랑 관절 손상으로 수술 후 6개월 이상 추시가 가능하였던 43예의 환자 중, 추시가 되지 않은 1예와 합병증으로 절단술을 시행한 1예, 사망한 1예를 제외한 40예를 대상으로 후향적으로 진행하였다. 최종 추시 시 Wilppula 분류로 정복도를 평가하였고, AOFAS midfoot score를 평가하였다. 결과: 배부 가교 금속판 고정 시 AOFAS midfoot score와 정복도가 가장 높았다. 그리고 정복도가 좋을수록, 열 고정 개수가 적을수록 AOFAS midfoot score는 높았다. 합병증으로 는 배부 가교 금속판을 이용한 군에서 고정 나사의 파손 1예, 혼합 고정법을 이용한 군에서 창상부 괴사로 피부 결손이 발생하였고, 음압 폐쇄 드레싱 및 피부이식술 후 호전된 1예가 있었다. 결론: 리스프랑 관절 손상 환자의 수술 시 배부 가교 금속판을 이용한 고정은 리스프랑 관절 손상 시 시행할 만한 적절한 술식이다. Purpose: In Lisfranc joint injury, the traditional treatment has been open reduction and internal fixation with a transarticular screw. Despite this, additional complications, such as damage to the articular surface and breakage of the screw, have been reported. Therefore, this study compared the clinical and radiological outcomes of dorsal bridge plating with those of transarticular screws and combination treatment in Lisfranc joint injury. Materials and Methods: Among the 43 patients who underwent surgical treatment due to Lisfranc joint injury from June 2015 to March 2021, 40 cases followed for more than six months after surgery were analyzed, excluding three patients: one lost to follow-up, one had to amputate, and one expired. The radiological parameters were measured using the Wilppula classification in the last follow-up. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Results: The AOFAS midfoot score, according to the surgical method, was significantly higher in the dorsal bridge plating (p=0.003). The radiological outcomes showed significantly better anatomical reduction when dorsal bridge plating was used (p=0.040). According to the Wilppula classification, the AOFAS midfoot score improved as the quality of anatomical reduction improved (p=0.018). Finally, the AOFAS midfoot score decreased as the number of column fixations increased (p=0.002). There were two complications: screw breakage in dorsal bridge plating and superficial skin necrosis in the combination treatment. Skin defects caused by necrosis improved after negative pressure wound therapy and split-thickness skin graft. Conclusion: In treating Lisfranc joint injuries, open reduction and internal fixation by dorsal bridge plating can be an appropriate treatment option. Nevertheless, studies, such as long-term follow-up research, on complications, such as osteoarthritis, will be needed.
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TFNA (Trochanteric Fixation Nail-Advanced)를 이용한 대퇴골 전자간 골절의 임상적, 방사선학적 치료 결과
이현준 ( Hyeon Joon Lee ),최현배 ( Hyun Bai Choi ),김바롬 ( Ba Rom Kim ),조승환 ( Seung Hwan Jo ),이상홍 ( Sang Hong Lee ) 대한골절학회 2021 대한골절학회지 Vol.34 No.3
목적: 근위 대퇴 골수정인 TFNA (DePuy Synthes)를 이용한 대퇴골 전자간 골절의 치료 후 임상적, 방사선학적 결과에 대하여 후향적으로 분석해 보고자 한다. 대상 및 방법: 2019년 1월부터 2019년 11월까지 대퇴골 전자간 단독 골절로 TFNA를 이용해 수술을 시행한 64명을 대상으로 하였다. 술 전ㆍ후 Koval 등급, mHHS를 통해 환자의 전신 상태와 보행 정도, 삶의 질(EQ-5D)을 평가했으며, 방사선 검사에서 정복 정도, 칼날의 위치, 전진, 돌출 정도를 측정하였다. 또한 방사선학적 골유합 시기와 합병증을 조사하였다. 결과: 50예의 환자가 조사 기준을 만족하였으며 술 전, 최종 추시 비교시 Koval 등급, EQ-5D는 통계적으로 유의하게 감소하였다. mHHS 역시 감소하였으나, 통계적으로 유의하지는 않았다. 47예(94.0%)에서 6개월 이내 골유합을 얻었으며, 골유합까지의 기간은 평균 16.60±3.96주였다. 합병증은 7예에서 발생하였다. 결론: TFNA는 최소 1년의 추시 결과상 대퇴골 전자간 골절의 치료에서 선택할 수 있는 적절한 삽입물로 생각된다. Purpose: This study evaluated the clinical and radiological outcomes of TFNA (Trochanteric Fixation Nail-Advanced; Depuy Synthes) for the treatment of proximal femur fractures. Materials and Methods: This was a retrospective study of 64 patients diagnosed with a proximal femur fracture from January 2019 to November 2019. The patient’s demographic data, preoperatively and postoperatively Koval grade, modified Harris hip score, EQ-5D (Euro-Qol-5 Dimension), sliding and advancement of the blade, radiologic outcome, and complications were investigated. Results: Fifty patients were available for evaluation at one year postoperatively. The patients reported the following: the Koval grade decreased after surgery; the modified Harris hip score decreased from 78.56±8.88 to 72.74±6.59 (p=0.149); the mean EQ-5D decreased from 0.75±0.09 to 0.72±0.06 (p=0.000). Satisfactory reduction was achieved on a postoperative radiographic examination in 47 patients in six months. Complications occurred in seven cases. Conclusion: TFNA is considered an appropriate implant for treating intertrochanteric fractures of the femur with a minimum follow-up of one year.
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