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거골 골연골병변에 대한 수술적 치료: 골수 흡인물 농축액 및 기질 유래 연골 형성
김범수,나엽,권원한 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.2
Bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) is an interesting treatment option for osteochondral lesions of the talus with promising short- to mid-term results. The various terminologies used to describe this surgical method need to be addressed. These include bone marrow-derived cell transplantation, matrix-induced bone marrow aspirate concentrate, and matrixassociated stem cell transplantation. BMIC is a one-stage, minimally invasive surgery performed arthroscopically or using a mini-open arthrotomy approach without a malleolar osteotomy in most cases. The lesion is replaced with hyaline-like cartilage, and treatmentrelated complications are rare. BMIC is a safe and effective treatment option and should be considered in large lesions or lesions with a prior treatment history.
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신은호,나엽,이동주 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.2
Purpose: A minimally invasive surgical technique has been introduced to treat carpal tunnel syndrome that causes less pain, minimal scaring, and a rapid recovery. This study was designed to evaluate the safety and effectiveness of the double minimal incision release compared with the open surgery technique. Methods: A study was performed on 175 cases in 111 patients who were operated on for carpal tunnel syndrome from January 2010 to December 2014. The patients were classified into 2 groups according to the type of surgical technique: 82 cases underwent standard open surgery in group A and 93 cases underwent double minimal incision release in group B. Grip strength and postoperative pain were evaluated 4 and 8 weeks and 6 and 12 months after surgery, and the period of numbness and time needed to resume normal activities were investigated. Results: Group B patients showed better outcomes during the 2 first months after surgery than those of group A patients in numbness, pain, stiffness (p<0.05), less scar pain and tenderness (p<0.001), and shorter time needed to resume normal activities. However, no differences in these parameters were observed between the 2 groups after 6 months (p>0.05). Conclusion: Double minimal incision release offered better clinical outcomes until 2 months after surgery compared to the standard open surgery technique and reduced incipient postoperative pain and allowed for earlier resumption of normal activities.
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요골 원위부 골절에서 외고정장치 후 신연에 따른 수근관절의 기능적 예후
노태훈,전윤문,나엽,이동주 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.3
Purpose: This study aimed to evaluate the relation between the degree of wrist joint distraction and postoperative restoration of joint function after performed external fixation with distraction of wrist joint in distal radius fracture. Methods: This study was conducted retrospectively on 55 patients who underwent reduction using external fixation for distal intra-articular radius fracture from January 2007 to December 2014. The degree of pre- and post-operative distraction was measured radiographically using the carpal height ratio (CHR). For postoperative functional assessment, range of motion of the wrist, Gartland Werley classification, grip strength, and pinch strength were measured. Results: In the functional assessment based on the Gartland Werley classification, excellent was reported by 31 patients, good; 16 patients, fair; 8 patients, and poor; 0 patients. The mean CHR was 0.519 preoperatively and 0.565 immediately after surgery. The mean postoperative CHR of excellent group was 0.581, demonstrating better clinical outcome in dis-traction than other groups. Eight case of joint stiffness was manifested when CHR value was lower than 0.54 and only 1 case of joint stiffness was manifested when CHR value was higher than 0.54, showing a tendency for lower incidence of joint stiffness when distracted over 0.54 of CHR. Conclusion: External fixation after sufficient distraction of the wrist joint produced an excellent outcome in the functional assessment. The better the prognosis in the Gartland Werley classification, the higher the CHR and the group with a CHR greater than 0.54 immediately after surgery showed less joint stiffness than the lower group. 목적: 요골 원위부 관절 내 골절에서 수근관절 신연 및 외고정술 시행 후, 신연 정도와 수술 후 관절 기능 회복의 연관성에 대해 알아보고자 하였다. 방법: 2007년 1월부터 2014년 12월까지 요골 원위부 골절 환자 중 외고정술을 시행한 55명을 대상으로 후향적 연구를 시행하였다. 신연 정도는 수근 높이 비를 측정하였고, 수근관절 운동 범위, Gartland Werley 분류, 악력, 핀치 강도 등을 조사하였다. 결과: Gartland Werley 평가 결과 우수 31명, 양호 16명, 보통 8명이었다. 수술 전 수근 높이 비 평균은 0.519였으며 수술 직후 0.565로 조사되었다. 우수군의 수술 후 평균 수근 높이 비는 0.581이었고, 양호군 0.553, 보통군 0.529로 임상적 예후가 좋을수록 수근 높이 비가 높았다. 수근 높이 비 0.54 이상인 환자군 중 수근관절 강직을 호소한 경우는 1명, 0.54 이하인 경우는 8명으로, 0.54 이상인 경우 수근관절 강직을 보이는 경우가 적었다. 결론: 요골 원위부 관절 내 골절 시 충분한 신연을 통한 비관혈적 외고정술은 좋은 임상적 결과를 보였으며 예후가 좋을수록 수근 높이 비가 큰 결과를 보였다. 수근 높이 비가 0.54보다 큰 경우가 낮은 경우와 비교하여 수술 후 관절강직이 나타날 확률이 낮은 결과를 보였다.
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