재발한 무지 외반증의 치료로 시행한 Scarf 절골술

남일현,안길영,문기혁,이영현,최성필,정택영,Nam, Il Hyun,Ahn, Gil Yeong,Moon, Gi Hyuk,Lee, Yeong Hyeon,Choi, Seong Pil,Jeong, Taeg Young 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.4

Purpose: Recurrence is one of the most common complications after primary correction for hallux valgus deformities. The purpose of this study was to evaluate the usefulness of Scarf osteotomy with axial decompression in the treatment of recurrent hallux valgus. Materials and Methods: From April 2006 to April 2011, 14 cases (12 patients) of recurrent hallux valgus were managed with shortening Scarf osteotomy. Preoperative and postoperative radiographs were reviewed for the measurement of the hallux valgus angle (HVA), intermetatarsal angle (IMA), and the amount of the $1^{st}$ metatarsal shortening. Clinical outcomes including the visual analogue scale (VAS), the AOFAS score, and the range of motion [ROM] of the 1st metatarsophalangeal (MTP) joint were evaluated. Results: The mean HVA decreased from 27.9 degrees to 5.2 and the mean IMA decreased from 12.9 to 3.4. The mean VAS improved from 5.3 to 0.3 and the mean AOFAS score improved from 41 to 90. The mean amount of the 1st metatarsal shortening was 3.4 mm (2-5). The mean ROM of the $1^{st}$ MTP joint improved from 22 degrees (15-35) to 68 (55-75). Conclusion: Scarf osteotomy associated with axial decompression can be a useful revision procedure for the treatment of recurrent hallux valgus deformity.

한국 여성에서 좌골 신경 분지 위치에 대한 초음파 영상

남일현,여의동,유지수,이준호,이영구,Nam, Il Hyun,Yeo, Eui Dong,Yu, Ji Soo,Lee, Jun Ho,Lee, Young Koo 대한정형외과초음파학회 2014 대한정형외과 초음파학회지 Vol.7 No.1

목적: 슬관절 이하 부위의 정형외과적 수술을 위해 좌골 신경 차단 술기가 흔히 시행되고 있다. 좌골 신경 분지는 해부학적 차이가 있어 통상적인 신경 차단은 불완전한 신경 차단을 유발한다. 본 연구는 마취의 성공율을 개선하기 위하여 한국 여성에서 좌골 신경 분지 위치를 초음파를 이용해 확인하였다. 대상 및 방법: 한국 여성 33명을 대상으로 하였으며 체중, 키를 측정하였다. 초음파 측정을 위해 M-Turbo ultrasound system (SonoSite,Bothell, WA,USA) 13-6 MHz, 38 mm high frequency linear array transducer를 사용하였다. 복와위 자세에서 슬와 주름부터 분지부까지의 거리, 분지부에서 피부부터 신경까지의 깊이를 cm 단위로 측정하여 체중과 키와의 상관관계를 확인하였다. 측정은 한 명의 전문의에 의해 측정되었다. 통계는 SAS version 9.3를 사용하여 multiple linear regression 방법으로 분석하였다. 결과: 33명 여성의 평균 나이는 53세(34~71세), 평균 체중 59.7(50~77.1 kg), 평균 키 157.4(145~173.9 cm), 평균 BMI 24.1(18.4-28.9)였다. 슬와 주름에서 좌골 신경 분지부까지의 평균 거리는 5.7(4.5~7.5 cm)이였으며, 분지부에서 피부부터 신경까지의 평균 깊이는 2.4(1.8~3.2 cm)였으며, 통계적 분석 결과에서 거리와 키 조사 p-value 0.55, 거리와 몸무게 조사 p-value 0.34, 깊이와 키 조사 p-value 0.5, 깊이와 몸무게 조사 p-value 0.036 이였다. 결론: 한국 여성의 좌골 신경 분지 위치는 차이가 있었으며, 특히 몸무게에 따른 깊이 변화는 의미가 있었다. 한국 여성에서 좌골 신경 차단 술기를 시행할 때 평균 거리, 깊이를 생각하고 몸무게를 고려한다면 성공율이 증가할 것으로 생각되며, 슬와 주름 7.5 cm 상방에서 시행할 것을 추천하다. Purpose: We aim to determine sciatic nerve bifurcation location and depth at the level of the popliteal fossa in Korean female. Materials and Methods: Thirty three subjects were enrolled in Korean female. M-turbo ultrasound system (SonoSite, bothell, WA, USA)with 38 mm high frequency linear array transducer, 13-6 MHz probe was used for ultrasound measurements. With subject lying prone, the location of the sciatic nerve in relation to the popliteal crease and skin to nerve distance were assessed via ultrasound. Analyses were performed with SAS version 9.3 using multiple linear regression. Results: Thirty three subjects were enrolled. Distance from the popliteal crease to the sciatic nerve was 4.5-7.5 (mean 5.7 cm), and the depth of the sciatic nerve from the skin was 1.8-3.2 (mean 2.4 cm). Multiple linear regression for the usefulness of the model has a p value of 0.036, shows between weight and depth. Conclusion: We show that variability exists for sciatic nerve bifurcation location in Korean female, The success rate is creased if consider the relations between weight and depth when performs sciatic nerve block in Korean female. In our study, a sciatic nerve block is recommend that performed 7.5 cm proximal to the crease in the popliteal fossa.

불유합의 위험 인자를 가진 족관절 병변에 시행한 족관절 유합술로서 Ilizarov 외고정 기구 장착술 및 자가골 이식술의 유용성

남일현,이용식,이태훈,안길영,이영현,이희형,황성현 대한족부족관절학회 2019 대한족부족관절학회지 Vol.23 No.4

Purpose: The aim of this study is to evaluate if the Ilizarov external fixation procedure with axial compression can help to obtain fusion across the ankle joint in patients with a high risk of nonunion. Materials and Methods: From January 2006 to December 2015, the study reviewed 17 patients who underwent ankle arthropathy with a high risk of nonunion and who underwent ankle fusion using the Ilizarov external fixator with axial compression and auto bone grafting. After the lateral surface of the ankle joint was exposed through a lateral trans-fibular approach, massive removal of the articular cartilage and excision of any loose or avascular bone were done. With the cortical bone harvested from the pelvis as corticocancellous bone blocks, we inserted the two cortical blocks longitudinally into the anterior and posterior part of the free ankle space from lateral to medial to make the rectangular chamber to fill the cancellous bones. After the Ilizarov external fixator was equipped, we tightened the frame by 5 mm to compress the bone graft space. We accessed the American Orthopaedic Foot and Ankle Society (AOFAS) AnkleHindfoot score both preoperatively and postoperatively. Results: The average age at the time of operation was 63.4 years (range, 47∼78 years). The mean frame time was 17.4 weeks (range, 15∼ 23 weeks). The average follow-up period was 3.7 years (range, 2∼6 years). Osseous fusion was obtained in 15 patients (88.2%). There were two stable pseudarthroses among the rheumatoid arthritis patients, and we continued their follow-up. The mean AOFAS AnkleHindfoot score improved from 48.5 to 73.7 points. Conclusion: Ankle arthrodesis using the Ilizarov external fixation with axial compression and auto bone grafting on the ankle arthropathy that had difficult conditions to achieve union is considered one of the useful methods with a correspondingly low incidence of complications.

무지 외반증에서 시행한 Scarf 절골술의 합병증

남일현,안길영,문기혁,이영현,최성필,이태훈,이영훈,Nam, Il-Hyun,Ahn, Gil-Yeong,Moon, Gi-Hyuk,Lee, Yeong-Hyeon,Choi, Seong-Pil,Lee, Tae-Hun,Lee, Young-Hoon 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.4

Purpose: The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications. Materials and Methods: We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared. Results: There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed. Conclusion: To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.

류마티스 관절염에 의한 고도의 무지 외반증과 소족지 갈퀴족 변형에 대한 중족골 종축 감압 절골술을 이용한 관절 보존술의 결과

남일현,안길영,문기혁,이영현,최성필,김호규,오동호,Nam, Il-Hyun,Ahn, Gil-Yeong,Moon, Gi-Hyuk,Lee, Yeong-Hyeon,Choi, Seong-Pil,Kim, Ho-Gyu,Oh, Dong-Ho 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.1

Purpose: The purpose of this study is to evaluate the effect of axial shortening metatarsal osteotomy on the treatment of advanced rheumatoid arthritis patients with severe hallux valgus and claw toe deformity of lesser toes which is used for preserving the metatarsophalangeal joint. Materials and Methods: From January 2005 to June 2009, 18 cases of axial shortening metatarsal osteotomy in advanced rheumatoid arthritis were reviewed ; all of them followed up for more than 2 years after surgical procedures and the mean follow up period was 3.4 years. We performed axial shortening Scarf osteotomy and Akin osteotomy for hallux valgus and Weil osteotomy with soft tissue release for claw toe of lesser toes, respectively. We measured preoperative and postoperative hallux valgus angle, each metatarsal shortening length and the range of motion of the metatarsophalangeal joints through radiographic and clinical examination and compared them each other. Clinical results were evaluated by American Orthopedic Foot and Ankle Society (AOFAS) score and subjective satisfaction of the patients. Results: The hallux valgus angle was reduced from the preoperative mean value of 44.8 degree to 9.0 degree postoperatively and the range of motion of the metatarsophalangeal joint of great toe and lesser toes was increased from the mean of 21.7 degree and 11.0 degree preoperatively to 38.0 degree and 32.5 degree, respectively at postoperation. Also, the mean AOFAS score was improved from 26.5 points to 67.4 points. Conclusion: Axial shortening osteotomy is a useful method to correct the deformity and preserve the metatarsophalangeal joint for severe hallux valgus and claw toe deformity in advanced rheumatoid arthritis.

관절경하 후격막 통과 도달법을 이용한 후방십자인대 결절종의 치료

남일현,유연식,윤기표,안길영,Nam, Il-Hyun,Yoo, Yon-Sik,Yun, Ki-Pyo,Ahn, Gil-Yeong 대한관절경학회 2004 대한관절경학회지 Vol.8 No.1

목적: 관절경하 후격막 통과 도달법을 이용한 후방십자인대 결절종의 제거술시 전방 도달법 보다 우수한 접근성 및 제거의 용이성과 그 치료 결과에 대하여 분석하였다. 대상 및 방법: 후방십자인대 결절종의 관절경하 후격막 통과 도달법을 이용하여 제거술을 시행한 7예에 대하여 조사하였다. 증상을 동반한 후방십자인대 결절종에서 동반손상 유무, 전방 접근법과 후격막 통과 도달법의 수술시야의 차이 등에 대하여 비교 분석하고, 결과의 평가는 Lysholm 슬관절 지수를 이용하였다. 결과: 증상이 동반된 7예의 후방십자인대 결절종 중 4예에서 동반 손상이 있었으며, 또한 외상과 연관된 경우도 3예이었다 임상평가 결과, Lvsholm 슬관절 지수는 술 전 평균 93.3점에서 술 후 평균 97.8점으로 향상을 보였다. 결론: 후방십자인대 결절종의 관절경적 제거술시 수술시야의 확보 및 후방구조물의 이상 유무를 확인하기 위해서는 후격막 통과 도달법이 효과적인 술식이라 생각된다. Purpose: We reviewed the effectiveness and the result of arthroscopic resection for ganglion cyst of posterior cruciate ligament(PCL) through the posterior trans-septal approach. Material and Method: Seven patients with symptomatic ganglion cyst of the PCL were treated with arthroscopic resection using posterior trans-septal approach. We analyzed advantages of the posterior trans-septal approach and presence of intra articular problem. Knee function was assessed using the lysholm knee scale. Results: The overall result for the 7 knees were very satisfied in all. We found that four of seven patients had intra articular problems, and past history of trauma could be found in 3 cases. The Lysholm knee scale was increased from average 93.3 points preoperatively to average 97.8 points postoperatively. Conclusion: Arthroscopic posterior trans-septal approach shows an effective technique for complete resection of cyst and evaluation of the combined posterior compartment injury.

대퇴골 과상부 및 과간부 과간부 골절의 치료

남일현,박주태,안길영,지정규 대한골절학회 1995 대한골절학회지 Vol.8 No.1

Although not as common as femoral shaft fracture, supracondylar-intercondylar fracture of the femur present considerable challanges in management. Because supracondylar-intercondylsr fracture is frequently accompanied by severe soft tissue damage, comminution and intraarticular extension of fracture, it can produce some disability of the knee joint, So recently, early anatomical reduction, rigid internal fixation and early rehabilitation was recommended. The authors analyzed twenty cases of supracondylar-intercondylar fracture that treated at the Department of Orthopaedic Surgery of Pohang Saint Marys hospital from March, 1990 to December, 1993. The object of this study is to evaluate the corelation between the rigid internal fixation and early rehabilitation, The average follow up period was 18.3 months(form 14 to 27 months J The results were as follows; l. Among the twenty cases, male was more common than female and the prevalent age was 4th decade(50%). 2. The most common cause of injury was traffic accident in 15 cases(75%). 3. During 1st 3weeks after operation, we started active R.O.M, exercise by using Thomas splint with Pearson attatchment and long leg brace with ischial weight bearing was applied from 3months to 6months (averge 4.2 months). We permit partiai bearing 6weeks after operation, 4. According to Schatzker and Lambert criteria, excellent were 16 cases, good 3 cases, fair 1 case. 5. We obtained satisfactory by rigid internal fixation and early rehabilitation.

슬개하 지방체에 발생한 관절 주위 연골종 - 증례 보고 -

남일현,안길영,문기혁,이영현,최성필,김정현,백애란,Nam, Il-Hyun,Ahn, Gil-Yeong,Moon, Gi-Hyuk,Lee, Yeong-Hyeon,Choi, Seong-Pil,Kim, Jung-Hyun,Paik, Ae-Lan 대한정형외과스포츠의학회 2011 대한정형외과스포츠의학회지 Vol.10 No.2

주변골과 연결성을 가지지 않는 것을 특징으로 하는 골격계 외의 연골종에는 활액막성 연골종증, 관절 내 및 관절 주위 연골종, 연부 조직성 연골종 등이 있으며, 후자의 두 경우는 매우 드물다. 본 증례는 20세 군인이 심한 훈련을 한 후 발생한 슬관절의 압통, 굴곡시의 통증과 충만감, 운동 제한을 주소로 내원하여 시행한 x-ray와 MRI 검사에서 발견한 종괴에 대한 것으로, 이 종괴에 대해 절제술이 시행되었으며, $5.5{\times}4{\times}3$ cm 크기의 단단한 고립성 종괴였다. 현미경 소견 상 종괴는 소엽상을 이루는 초자 연골이 바깥쪽의 섬유성 피막에 의해 싸여져 있었으며, 이에 관절 주위 연골종으로 진단하였다. 저자들은 슬관절 슬개하 지방체에서 발생한 관절 주위 연골종 1 예를 경험하여 임상적, 방사선학적, 조직학적 소견에 대해 문헌 고찰과 함께 보고하고자 한다. Extra-skeletal chondroma, characterized by its lack of connection with the adjacent bone, includes synovial chondromatosis, intra-articular and para-articular chondroma, and soft tissue chondroma. Among them, the last two lesions are extremely rare. This is the case about 20-year-old soldier, who had complained of tenderness of the knee, pain and fullness during knee flexion and limitation of motion after a hard military training. We found a mass in the x-ray and MRI and resect the mass surgically, which was a $5.5{\times}4{\times}3$ cm size hard solitary mass. On microscopic finding, it was consisted of lobulated hyaline cartilage and outer fibrous capsule, and we ascertained it as para-articular chondroma. We experienced a case of para-articular chondroma in the infrapatellar fat pad of the knee joint and present its clinical, radiologic and pathologic findings with literature review.

수부 주상골 골절 및 수근골 탈구에 K-강선을 이용한 치료에 관한 임상적 고찰

남일현,박주태,안길영,지정규 대한골절학회 1993 대한골절학회지 Vol.6 No.1

The wrist consists of a complex structure, including 8 tiny carpal bones and their adjoining soft tissue. Because of biomechanics of wrist joint, scaphoid fracture and carpal dislocation is often combined with ligamentous injury of wrist joint and disturbance of blood supply of carpal bone, especially scaphoid. Even though early diagnosis and treatment was performed on the scaphoid fracture and carpal dislocation, the pain and limitation of motion of wrist joint due to non-union or AVN is cammonly complicated. So, we analyzed 22 cases to which long-term follow-up was available, among 26 cases which were treated with open reduction and internal fixation with K-rwire at the department of orthopaedic surgery, Pohang St. Mary's Hospital. The results were as follow; 1. Of all cases were males and males in 30, 40 decades numbered 16 cases, forming 72.796 of all. 2. Of 22 cases, 98 cases were scaphoid fracture with carpal dislocation and 8 cases of remaining 13 cases were waist fracture. 3. The complications were assessed by 3 cases of non-union, and 4 cases pf AVN. 4. We assessed the results based on the Maudsleys assessment chart as 9 cases of excellent, 7 cases of good, 2 cases of fair, and 4 cases of poor. On the treatment of scaphoid fracture with or without carpal dislocaion, the open reduction and internal fixation with K-wire is provided relatively sttisfactory results.

족관절 골절 - 탈구에 대한 임상적 고찰

남일현,박주태,안길영,금종명 대한골절학회 1993 대한골절학회지 Vol.6 No.2

The injuries of ankle fracture-dislocation cause severe destruction of soft tissue component. So the goal the treatment of ankle fracture-dislocation is restoring ankle mortise and reducing soft tissue injury and complication. A clinicai observation was performed on the 11 patients of fracture-dislocation of the ankle joint, who were treated with open reduction and internal fixation at department of orthopedic surgery, St. Marys Hospital, Pohang city from Nov. 1987 to Mar. 1992. The obtained results were as follows; l. In two cases accommpanying talus fracture, the avascular necrosis of talus had been developed, the results were poor. 2. In six cases accompanying the severe destruction of soft issue, the serious complication such as infection, joint stiffness and traumatic arthritis had been developed. 3. The methods of internal fixation did not correlate to the result. 4. The results of treatment correlated to the presence of talus fracture and the degree of soft tissue injury