제7회 연수강좌 : 외상학 ; 고령 환자에서의 수술 전후 처치

문도현 대한고관절학회 2005 Hip and Pelvis Vol.17 No.3

비구 골절의 인공관절 치환술

문도현 대한고관절학회 2004 Hip and Pelvis Vol.16 No.2

염증성 고관절염의 치료

문도현 대한고관절학회 2003 Hip and Pelvis Vol.15 No.4

근위 대퇴 골수정을 이용한 불안정성 대퇴 전자간 골절의 치료

문도현,최장석,김건범,김진원,김기태 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 최근 개발된 근위 대퇴 골수정 (proximal femoral nail)을 이용한 불안정성 대퇴 전자간 골절의 치료 후 단기 추시 결과를 분석하여 보고하고자 한다. 대상 및 방법: 불안정성 대퇴 전자간 골절에서 근위 대퇴 골수정을 이용하여 수술적 내고정을 시행한 47예를 대상으로 임상적 및 방사선적 결과와 합병증을 평가 하였고, 수술 당시 평균 연령은 76.8세 (62~96세)였고, 평균 추시 기간은 약 15개월(12~24개월)이었다. 결 과: 술 후 보행능력은 타인의 도움 없이 보행대를 사용하여 혼자 걸을 수 있는 정도를 만족하다고 판단하였으며, 전체 47명 중 43예 (91.5%)에서 만족할 만한 결과를 얻었고, 최종 추시상 모든 예에서 골 유합을 얻었으며, 대퇴 경부 나사의 활강은 평균 3.0㎜활강을 보였고, 대퇴골의 대퇴 경간각의 변화는 평균 2.6도를 보였다. 술 후 합병증으로 1예(2.1%)에서 대퇴 경부 나사의 대퇴 골두 천공 (cut-out)을 보였고, 슬부 표재성 국소 감염이 1예(2.1%), 대퇴 전자부의 통증을 호소한 경우가 1예(2.1%) 있었다. 결 론: 근위 대퇴 골수정은 불안정성 대퇴 전자간 골절의 치료시 내고정 장치와 관련된 합병증이 다른 내고정 장치에 비해 적고 술기 또한 간단하여 대퇴 전자간 골절의 치료시 좋은 내고정 장치로 사료된다. Purpose: To review the clinical and radiographic results of the treatment of unstable intertrochanteric femoral fractures with a proximal femoral nail(PFN). Material and Methods: We reviewed 47 unstable intertrochanteric femoral fracture cases that had been treated with a PFN operatively. The clinical and radiographic results and complications were analyzed. The mean age was 76.8 years old(62~96 years old) and the mean duration of follow-up was 15 months(12~24 months). Results: The postoperative walking ability was regarded as satisfactory when the patient could walk alone using an walking frame without other aids and satisfactory results was achieved in 43 cases(91.5%). In all cases the radiologic bone change of neck-shaft angle was 2.6 degree. There were three cases of postoperative complication which were including 1 case of cut-out of femoral neck screw, local superficial in 1 case and pain complaints over trochanteric area in 1 case. Conclusion: The PFN is an useful implant for the treatment of unstable intertrochanteric femoral fracture because of the simplicity of the surgical technique and the low level of the complications encountered.

Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury

문도현,김남기,원준성,최장석,김동현 대한고관절학회 2014 Hip and Pelvis Vol.26 No.4

Purpose: To evaluate the radiologic and clinical outcomes of AO type C pelvic ring injury and identify the prognostic factors. Materials and Methods: We studied 53 patients who were treated for AO type C pelvic ring injury from January 2002 to February 2010. Mean age and mean follow-up duration were 42.4 years and 14 months, respectively. We had 8 cases of AO type C1-1, 19 cases of C1-2, 11 cases of C1-3, 6 cases of C2 and 9 cases of C3 injury. We analyzed type of fracture, displacement, method of fixation and associated injuries. Radiologicoutcome was evaluated with Matta and Saucedo criteria and clinical outcome was evaluated using Majeed score. Results: The average Majeed score was 86.2 distributing as 36 excellent cases, 15 good cases and 2 fair cases. Using radiologic Matta and Saucedo criteria, patients were divided as 31 excellent cases, 17 good cases and 5 fair cases. There was no significant difference between the outcomes of anterior, posterior and antero-posteriorfixation. Neurologic injury was the reason for an unsatisfactory functional outcome. We identified two cases with complication, one with postoperative infection and the other with nonunion following anterior-posterior fixation. Conclusion: Satisfactory radiologic and clinical outcomes were obtained with open reduction and internal fixation in the management of AO type C pelvic ring injuries. Neurologic injuries affected the clinical outcome.

고관절 전치환술시 Wood Pecker의 효용성

문도현 대한고관절학회 2004 Hip and Pelvis Vol.16 No.1

Purpose: The purpose of this study was to evaluate the benefits of WoodpeckerⓇ in total hip arthroplasty. Materials and Methods: Operation time, amount of transfusion, femur fracture during the operation, and the incidence of infection were analyzed in two groups. Group A consisted of 81 cases in 71 patients who underwent primary THA rasping with WoodpeckerⓇ from January 2001 to June 2002. Group B comprised 75 cases of 67 patients who underwent primary THA rasping by the usual method from March 1997 to February 1998. All the operations were performed by the same operator. All the procedures were identical except for rasping using WoodpeckerⓇ in group A and using the manual method in group B. Results: The mean operation time of group A was reduced by 19 minutes compared with group B (122 vs. 141 minutes), and the amount of transfusion was also reduced (2.1 vs. 2.9 units). No cases of femur fracture were reported in group A while there were 3 cases in group B. There was no deep wound infection in either group, but there were three superficial wound infections, one in group A and two in group B. C o n c l u s i o n: Total hip arthroplasty using WoodpeckerⓇ may be effective in reducing operation time, transfusion and femur fracture during operation. 고관절 전치환술시 W o o d p e c k e rⓇ를 이용해 r a s p i n g을 시행하였을 때의 장점을 알아보고자 한다. 대상 및 방법: 본원 정형외과학 교실에서 2001년 1월부터 2002년 6월까지 WoodpeckerⓇ를 이용하여 rasping을 시행한 71명 81례를 A군, 1997년 3월부터 1999년 2월까지 수동으로 rasping을 시행한 67명 75례를 B군으로 하여 수술시간, 수술 중 수혈량, 수술 중 대퇴부 골절, 감염의 발생 등을 비교하 였다. 두 군 모두 한 명의 고관절 전문의가 수술을 시행하였으며, A군은 WoodpeckerⓇ로, B군은 수동 으로 rasping을 시행한 것 외의 수술 방법의 차이는 없었다. 결과: 수술 시간은 A군은 평균 122분, B군은 평균 141분으로 WoodpeckerⓇ를 사용하여rasping을 시행한 A군에서 19분 적게 소요되었다. 수술 중 수혈량은 A군은 2.1 units, B군은 2.9 units로 A군 에서 0.8 units 적었다. 수술 중 대퇴골의 골절은 A군은 없었고, B군에서는 3례 있었으며, 심부 감염은 A군과 B군 모두에서 없었고, 천부 감염은 A군에서 1례, B군에서는 2례가 있었다. 결론: 고관절 전치환술에서 WoodpeckerⓇ를 사용할 때 수술 시간 단축 및 수술 중 수혈량의 감소, 대 퇴골 골절의 감소 등 좋은 결과를 보였다.

Synthesis and Characterization of Mononuclear Octahedral Fe(III) Complex Containing a Biomimetic Tripodal Ligand, N-(Benzimidazol-2-ylmethyl)iminodiacetic Acid

문도현,김정현,나명수 대한화학회 2006 Bulletin of the Korean Chemical Society Vol.27 No.10

The mononuclear iron complex 1, FeIII(Hbida)Cl(H2O), was synthesized using a tripodal tetradentate ligand, N-(benzimidazol-2-ylmethyl)iminodiacetic acid (H3bida), which has two carboxylate groups, one benzimida- zoyl group, and one tertiary amine where it serves as a tetradentate chelating ligand for the octahedral Fe(III) ion. The four equatorial positions of the octahedral complex are occupied by two monodentate carboxylates, a benzimidazole nitrogen, and an oxygen of a water molecule. One of the axial positions is occupied by an apical nitrogen of the Hbida and the other by a chloride anion. The mononuclear octahedral complex 1 mimics the geometry of the key intermediate structure of the catalytic reaction cycle proposed for the FeSODs, which is a distorted octahedral geometry with three histidyl imidazoles, an aspartyl carboxylate, a superoxide anion, and a water molecule. The redox potential of complex 1, E1/2 is -0.11V vs. Ag/AgCl (0.12 V vs. NHE), which is slightly lower than those reported for the most FeSODs. The magnetic susceptibility of complex 1 at room temperature is 5.83 m B which is close to that of the spin only value, 5.92 m B of high-spin d5 Fe(III).

Synthesis, Characterization and Crystal Structure of trans-Aquahydroxobis(2,2-dimethyl- 1,3-propanediamine)chromium(III) Diperchlorate

문도현,이창섭,유건상,최종하 대한화학회 2014 Bulletin of the Korean Chemical Society Vol.35 No.10

Chromium is the seventh most abundant element on earth.1 It occurs in various oxidation states ranging from Cr(II) to Cr(VI) with trivalent and hexavalent states being the most stable and common in terrestrial environments. The coordination chemistry of chromium(III) complexes is relevant to third generation solar photoconversion scheme.2 The geometrical isomerism and conformation in transition metal complexes with mixed ligands are very important in the medical application, and likely to be a major factor in determining the antiviral activity and its side-effect.3,4 2,2Dimethyl-1,3-propanediamine (Me2tn, Fig. 1) is a bidentate ligand that can coordinate to the central metal ion by forming six-membered chelate ring with a chair conformation. The trans-[Cr(Me2tn)2(OH)(H2O)]2+ can adopt either the trans or cis geometric isomer. In addition, two different kinds of conformation with respect to the chelate rings of Me2tn occur in the trans isomer, as shown in the bottom of Figure 1. The carbon atoms of the two chelate rings of the two conformers may be on the same side (syn conformer) or on the opposite side (anti conformer) of the coordination plane. In the case of trans-anti/syn-[Cr(Me2tn)2Cl2]Cl, trans-anti/ syn-[Cr(Me2tn)2Br2]2Br2·HClO4·H2O and trans-anti/syn[Cr(Me2tn)2Br2]Br, independent syn and anti conformational isomers were found within the same crystals.5-7 However, structural analyses of trans-anti-[Cr(Me2tn)2(NCS)2]NCS·1/2H2O, trans-anti-[Cr(Me2tn)2Cl2]ClO4, and trans-anti-[Cr(Me2tn)2Cl2]2ZnCl4 indicated that two chelate rings of Me2tn ligands were only in the anti chair-chair conformation.6-9 The different conformations of the two sixmembered chelate rings of Me2tn ligands may be dependent on the crystallographic disorder, packing forces, hydrated molecules and counter anions in the crystals. The factors which determine the stability of these geometric conformations are subtle and complicated.5-9 X-ray crystallography is generally used to establish the presence of either conformation but the syn or anti conformer of the six-membered chelate rings cannot be readily discriminated by infrared and visible absorption spectroscopy. The elucidation of the factors that stabilize the either the syn- or anti-conformation in these complex cations continues to be of interest. Here we report the synthesis, crystal structure and spectroscopic properties of the trans-anti-[Cr(Me2tn)2(OH)(H2O)](ClO4)2 with the purpose of elucidating the influence of Odonor ligands occupying the axial positions and counter anions, on the geometry and the conformation referring to the position of the carbon atoms of the Me2tn chelate rings with respect to the equatorial coordination plane.

비구 골절의 수술적 치료 후 5년 이상 추시

문도현,최장석,박기주,윤종민 대한골절학회 2002 대한골절학회지 Vol.15 No.3

목 적 : 비구 골절의 수술적 치료 후 5년 이상 추시시 임상적, 방사선적 결과를 분석하여 보고하고자 한다. 재료 및 방법 : 1993년 3월부터 1996년 7월까지 비구 골절로 수술적 치료를 시행한 환자 중 5년 이상 추시를 시행한 22례를 대상으로 하였다. 치료 결과의 판정은 수술 후 정복 상태와 방사선적 평가는 Matta 방법을, 임상적 평가는 d'Aubigne과 Postel 방법을 사용 하였다. 결 과 : 술 후 총 22례 중 18례(81.8%)에서 양호한 정복을 얻었고, 이 중 최종 추시상 14례(63.6%)와 13례(59.1%)에서 각각 방사선적 및 임상적 평가에서 양호 이상의 결과를 얻었다. 술 후 1년 방사선적 추시상 17례(77.3%)에서 양호 이상의 결과를 보였으나, 5년 추시상 14례(63/6%)에서 양호 이상의 결과를 보였고, 최종 추시상 1년 추시에 비해 6례에서 방사선적으로 퇴행성 변화가 진행되었다. 임상적 평가는 1년 추시상 16례(72.7%)에서 양호 이상의 결과를 보였으며 5년 추시상 13례(59.1%)에서 양호 이상의 결과를 보였다. 결 론 : 술 후 3mm 이하의 양호한 정복을 이룬 군에서 임상적 및 방사선적 평가에서 만족할 만한 결과를 얻어 비구 골절 치료시 정복 정도가 예후에 중요한 인자임을 보였고, 최종 추시상 1년 추시에 비해 퇴행성변화의 증가로 불량한 예후를 보여 술 후 시간이 경과 할 수록 퇴행성관절염이 더 증가 할 것으로 사료되며 보다 장기적인 추시가 필요할 것으로 사료된다. Purpose : To review the clinical and radiographic results of operative treatment of acetabular fractures for which there were minimum five-year follow-up. Material and Methods : We reviewed 22 acetabular fracture cases that had been treated operatively from March 1993 to July 1996. Each of the patients had been followed for a minimum five-year. The radiographic results were classified by Matta' s criteria and the clinical results were analyzed according to d' Aubigne and Postel's criteria. Results : Satisfactory reduction were obtained in 18 hips (81.8%), 14 and 13 hips of which were included in good or excellent categories of roentgenographic and clinical results respectively. Overall radiographic results for 17 hips (77.3%) at the one-year follow-up and 14 hips (63.6%) at the minimum five-year follow-up were excellent or good. According to clinical criteria, 16 hips (72.7%) at the one-year follow-up and 13 hips (59.1%) at the minimum five-year follow-up were classified as excellent or good. Conclusion : Folow-up roentgenographic and clinical results were good or excellent in satisfactory reduction group. Threrefore the accuracy of reduction is an important prognostic factor in acetabular fracture. The results were worse at the minimum five-year follow-up than at the one-year follow-up. Late-postoperative complication is expected to increase as time passes.

대퇴 전자간 골절과 동반된 고관절 후방 탈구- 증례보고 -

문도현,최장석,김기태 대한골절학회 2002 대한골절학회지 Vol.15 No.1

대퇴 골두의 골절과 동반된 고관절의 후방 탈구는 매우 드문 손상으로 알려져 왔으나 교통사고 및 고층에서의 추락사고 등 고에너지 손상의 증가로 증가하고 있는 추세이다. 그러나 지금까지 대퇴 전자간 골절과 동반된 고관절 후방 탈구는 보고된 예가 없었다.