반복적인 국소 스테로이드 주사의 위해: 수지 V 구역 신전 기전의 파열

남대철,박진성,이동영,황선철 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.3

Indicators for local steroid injection on the hands include trigger finger, De Quervain’s disease, carpal tunnel syndrome and trapeziometacarpal joint arthritis. Local steroid injection is an effective technique for rapid alleviation of symptoms and return to daily life. Complications following local steroid injection include depigmentation of the skin, subcutaneous fat atrophy, infection and tendon rupture. Tendon rupture and infection rarely occur as severe complications, and local steroid injection should not be abused or misused. The authors experienced a rupture of the extensor mechanism at extensor zone V after repeated local steroid injection to treat vague pain in the second metacarpophalangeal joint, followed by reconstruction of the extensor mechanism through tendon transfer and sagittal band reconstruction. We herein report a case with the literature review. 수부에서 국소 스테로이드 주사 요법의 적응증은 방아쇠 수지, De Quervain’s병, 수근관증후군 및 다각-제1 중수지 관절염 등이 있다. 국소 스테로이드 주사 요법은 빠른 증상의 완화와 일상으로의 복귀를 얻을 수 있어 환자나 의사에게 매력적인 치료 방법이다. 그러나, 국소 스테로이드의 주사 요법의 합병증으로는 국소의 피부 변색, 피하 지방 위축, 색소 침착 등이 있으며, 드물게 건 파열, 감염 등의 심각한 합병증도 발생할 수 있어서, 이의 남용이나 오용은 피해야 한다. 저자들은 29세 남성의 제2 중수지 관절의 모호한 동통을 치료하기 위해 사용된 반복적인 국소 스테로이드 주사 후 발생한 V 신전 구역의 신전 기전의 파열을 경험하였으며, 건 이식술과 시상대 재건술을 통해 신전기전의 재건을 시행하였으며, 문헌 고찰과 함께 증례 보고를 하고자 한다.

Effects of prunetin on the proteolytic activity, secretion and gene expression of MMP-3 in vitro and production of MMP-3 in vivo

남대철,김보건,이현재,신현대,이충재,황선철 대한약리학회 2016 The Korean Journal of Physiology & Pharmacology Vol.20 No.2

We investigated whether prunetin affects the proteolytic activity, secretion, and gene expression of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as in vivo production of MMP-3 in the rat knee joint to evaluate the potential chondroprotective effect of prunetin. Rabbit articular chondrocytes were cultured in a monolayer, and reverse transcriptionpolymerase chain reaction (RT-PCR) was used to measure interleukin-1β (IL-1β)- induced expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), and ADAMTS-5. In rabbit articular chondrocytes, the effects of prunetin on IL-1β-induced secretion and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The effect of prunetin on MMP-3 protein production was also examined in vivo. The results were as follows: (1) prunetin inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5; (2) prunetin inhibited the secretion and proteolytic activity of MMP-3; (3) prunetin suppressed the production of MMP-3 protein in vivo. These results suggest that prunetin can regulate the gene expression, secretion, and proteolytic activity of MMP-3, by directly acting on articular chondrocytes.

Cytoprotective Mechanism of Cyanidin and Delphinidin against Oxidative Stress-Induced Tenofibroblast Death

남대철,하영술,남정빈,김라정,박형빈 한국응용약물학회 2016 Biomolecules & Therapeutics(구 응용약물학회지) Vol.24 No.4

Age-related rotator cuff tendon degeneration is related to tenofibroblast apoptosis. Anthocyanins reduce oxidative stress-induced apoptotic cell death in tenofibroblasts. The current study investigated the presence of cell protective effects in cyanidin and delphinidin, the most common aglycon forms of anthocyanins. We determined whether these anthocyanidins have antiapoptotic and antinecrotic effects in tenofibroblasts exposed to H2O2, and evaluated their biomolecular mechanisms. Both cyanidin and delphinidin inhibited H2O2-induced apoptosis in a dose-dependent manner. However, at concentrations of 100 μg/ml or greater, delphinidin showed cytotoxicity against tenofibroblasts and a decreased antinecrotic effect. Cyanidin and delphinidin both showed inhibitory effects on the H2O2-induced increase in intracellular ROS formation and the activation of ERK1/2 and JNK. In conclusion, both cyanidin and delphinidin have cytoprotective effects on cultured tenofibroblasts exposed to H2O2. These results suggest that cyanidin and delphinidin are both beneficial for the treatment of oxidative stress-mediated tenofibroblast cell death, but their working concentrations are different.

시멘트 성형법으로 제작한 PROSTALAC의 장점

남대철(Dae-Cheol Nam),황득수(Deuk-Soo Hwang),이호진(Ho-Jin Lee) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.1

목적: 인공 고관절 감염의 치료에서 저자들이 고안한 변형된 시멘트 성형법으로 제작한 PROSTALAC의 장점 확인 및 치료 성적을 분석학고자 하였다. 대상 및 방법: 인공 고관절 감염 진단 후 PROSTALAC을 받은 27예를 대상으로 하였고, 평균 연령은 57세였다. 수술 시 항생제가 섞인 시멘트를 감마 방사선 조사로 멸균 처리된 재활용 주대에 입힌 후 대퇴 골수강 내로 피스톤 운동하여 골수강과 형태가 일치되도록 했다. 양극성 반치환술에 쓰이는 폴리에틸렌 라이너의 잠김 기전을 비구컵에 이용하였다. 임상적 평가로 적혈구 침강 속도, C-반응단백, 조기 보행 가능 여부, 하지 단축 및 고관절 굴곡 정도를 조사했다. 결과: C-반응단백은 평균 42주에 정상화됐고, 목발 체중 부하는 수술 2주 후 가능했으며, 하지 단축 및 고관절 굴곡 범위는 평균 14 ㎝와 63.5도이었다. PROSTALAC 기능에 대해 만족도가 높은 5예는 최종 치환술 없이 추시 관찰 중이고, 최종 치환술한 22예 중 재감염률은 18.2% (4예)였으며, 수술 후 탈구나 치환물 주위 골절은 없었다. 결론: PROSTALAC 2단계 치료법은 효과적 감염 조절 수단이며, 삽입물에 대한 멸균처리와 안정성 유지가 병행된다면 최종 치환술 전에도 제한적 일상 생활의 영위가 가능하다고 사료된다. Purpose: To report the clinical advantage and effect of our modified cement-coating method of PROSTALAC for the treatment of infected hip arthroplasty. Materials and Methods: Twenty seven patients (mean age, 57), who had been treated with PROSTALAC after an infected hip arthroplasty, were enrolled in this study. Before surgery, the femoral stem was sterilized with gamma-radiation. During the operation, the stem was coated with antibiotics-impregnated cement and introduced into the femoral canal by several repeats of an insertion and removal procedure, just like a piston movement, to fit the stem into the intramedullary canal space. A bipolar hemiarthroplastic polyethylene liner was used for acetabular cup cement-fixation. A periodic hematologic test, such as ESR and CRP, the ability of early ambulation, leg length discrepancy and hip flexion, were checked for the clinical evaluation. Results: CRP was normalized by an average of 4.2 weeks after the PROSTALAC operation. Partial weight bearing was possible 2 weeks after surgery, and mean leg length discrepancy and flexion of hip was 1.4 ㎝ and 63.5°, respectively. PROSTALAC was still retained in 5 cases with satisfactory function. Reinfection after final reimplantation (22 cases) was noted in 4 cases (18.2%). Neither dislocation nor peri prosthetic fracture occurred after reimplantation. Conclusion: The 2 phase treatment with PROSTALAC is an effective method for infected hip arthroplasty. PROSTALAC has considerable benefit for providing daily acting ability before the final reimplantation provided the appropriate surgical technique and strict sterilization of the inserted implements are combined.

후외측 거골 골연골 병변을 동반한 삼각골 증후군 (1예 보고)

조세현,남대철,정순택,김동희,문동규,Cho, Se-Hyun,Nam, Dae-Cheol,Jeong, Soon-Taek,Kim, Dong-Hee,Moon, Dong-Kyu 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.2

Both os trigonum syndrome and osteochondral lesion of talus (OLT) are common causes of ankle pain and usually affect ballet dancers or athletes. Lateral osteochondral lesions, which usually result from traumatic event, are mostly located anterolateral talar dome but rare central or posterolateral. Moreover, there are technical difficulties such as position of patient or additional posterior portal to address posterolateral lesion by arthroscopy. Meanwhile, treatment of os trigonum syndrome using arthroscopic approach has been reported in many literatures recently. However, it has not been reported to diagnose both os trigonum syndrome and posterolateral OLT together and treat arthroscopically at one stage. The authors report a case of male patient who was diagnosed as os trigonum syndrome with posterolateral OLT and treated simultaneously by hindfoot arthroscopy. Symptom was improved immediately after the operation, and radiological findings at postoperative 16 months verified remarkable healing.

Measurement of Knee Morphometrics Using MRI: A Comparative Study between ACL-Injured and Non-Injured Knees

박진성,황선철,남대철,김동희,김형간 대한슬관절학회 2012 대한슬관절학회지 Vol.24 No.3

Purpose: The purpose of this study is to find out the differences of distal femur morphology between the anterior cruciate ligament (ACL)-injured and the non-ACL injured on an magnetic resonance imaging (MRI), and the difference of bone structure by gender. Materials and Methods: MRI Measurements of notch width (NW), bicondylar width (BCW), medial condyle width (MCW), lateral condyle width (LCW), medial-to-lateral condyle ratio (M:L ratio), and notch entrance width (NE) were taken from 120 subjects with ACL injury and the other 106 subjects without ACL injury, by three independent observers, at two different times. The measured values from MRI figures between the ACL-injured and the non-ACL-injured were compared and analyzed, with consideration of the differences by gender. Both intra and inter-observer reliability were calculated. Results: There were significant differences of NW, BCW, MCW, LCW and NE by gender (p<0.001). While NW and MCW in male group were different (p<0.001), NW, MCW, M:L ratio and NW index (NWI) in female group were significantly different (p<0.001) in the bone morphology between the ACL-injured and non-ACL-injured. The intra- and inter-observer reliability was satisfying. Conclusions: If necessary to take an MRI, female patients with small NWI and NW injury should be carefully treated because of possibility of ACL injuries.

족관절 유합술 후 발생한 거주상 관절염의 전경골 건 개재 관절성형술: 증례 보고

조성희,서민석,이은창,남대철,Cho, Seong-Hee,Seo, Min-Seok,Lee, Eun-Chang,Nam, Dae-Cheol 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.1

Ankle arthrodesis has been used frequently for end-stage ankle arthritis that does not respond to conservative treatment. On the other hand, there are concerns regarding the degenerative changes to the adjacent joint, such as the subtalar or talonavicular joint, due to the altered biomechanics after the loss of ankle motion. Because the arthrodesis for these midtarsal joints may overload stress on another contiguous joint, a salvage procedure should be considered rather than joint sacrificing. This paper reports a case of talonavicular arthritis after malunited ankle arthrodesis that was treated with interpositional arthroplasty using the tibialis anterior tendon.

외측 족근중족관절에 발생한 류마토이드 관절염의 건 개재 관절성형술을 이용한 치료 (증례 보고)

김현옥,박진성,이동영,남대철,Kim, Hyun-Ok,Park, Jin-Sung,Lee, Dong-Yeong,Nam, Dae-Cheol 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.4

Controversies exist regarding the treatment options for the end-stage arthritic change in the lateral tarsometatarsal joints. Arthrodesis has been frequently performed, but has a disadvantage of sacrificing a mobile joint. Resection arthroplasty also gained its popularity, especially in the patients with Rheumatoid arthritis, but possible hypermobility can lead to deformity. We report a successful clinical outcome of a patient with Rheumatoid arthritis in the 4th, 5th tarsometatarsal joints treated with tendon interpositional arthroplasties.

젊은 성인에서 발생한 자발성 흉추 경막외 혈종 - 증례 보고 -

정순택,김동희,조세현,남대철 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

A spontaneous spinal epidural hematoma (SSEH) of the thoracic spine is a rare space-occupying disease that accompanied with severe axial pain in the spine. Because there is the possibility of a significant neurological injury such as paraplegia, SSEH requires careful diagnosis and management. A SSEH is mainly caused by a coagulating disorder or anticoagulant medication, while certain cases have shown that this disease is related with spinal inflammatory conditions. A SSEH tends to occur in patients who have risk factors for hemorrhage. However, the incidence of SSEH is quite low, and there are few domestic reports of a SSEH in young adults who are without the risk factors for hemorrhage. We encountered a 25 years old young male without a prior significant medical history and he was suffering from severe back pain and paraplegia due to a SSEH at the thoracic spine. The early diagnosis was made via MRI. We report here on a favorable clinical outcome that was achieved with immediate operative treatment, and we include a review of the relevant literature.

퇴행성 요추부 질환에서 골이식 방법에 따른 치료 결과 : 후외방 유합술 및 후방 요추체간 유합술의 비교 Comparison between Posterolateral Fusion and Posterior Lumbar Interbody Fusion

양준영,이준규,김영모,남대철,강찬 대한정형외과학회 골.연부조직이식학회 2003 대한골.연부 조직이식학회지 Vol.3 No.1