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.

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.

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

제7회 연수강좌 : 외상학 ; 고령 환자에서의 수술 전후 처치

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

의료기관 간 협의진료 활성화

문도현,박연호,이주강,조유순,김미경,이진우,이후석 한국의료QA학회 2009 가을학술대회 Vol.2009 No.3

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.

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).

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.

신생아기 급성 화농성 관절염 및 골수염에 대한 임상적 고찰

이광훈,김길현,이원영,이학수,문도현 대한감염학회 1996 감염 Vol.28 No.4

목 적 : 신생아기의 급성화농성 관절염 및 골수염은 비교적 드문 질환으로, 임상증상이 비특이적이서 조기 진단이 어려워서 여러 가지의 합병증과 후유증을 야기할 수 있다. 이에 저자들은 급성 화농성 관절염 및 골수염으로 진단된 신생아들의 임상적 고찰을 통하여 조기 진단방법과 적절한 치료 방법을 제시하고자 하였고, 예후에 대하여 관찰하고자 하였다. 방 법 : 저자들은 1991년부터 1995년까지 만 5년간 중앙 길 병원 신생아 중환아실에 입원하여 급성 화농성 관절염 및 골수염으로 진단, 치료받은 신생아 35명에 대한 분석을 하였다. 결 과 : 남녀비는 1.6 : 1 로 남자에서 많이 발생하였고, 평균 발생 연령은 생후 19.5 일이었으며, 미숙아와 저 출생체중아에서 발생 빈도가 높았다(38.2%). 선행요인으로는 미숙아, 대퇴정맥천자, 패혈증, 폐렴, 뇌막염등이 있었고, 가장 흔한 임상 증상은 관절 운동 장애와 동통(100%) 및 종창(67.6%)이었다. 고관절에 호발(44.1%)하였고, 다음은 슬관절, 견관절 순이었으며 6예(17.6%)에서 2개 이상의 관절이 이환되었고 총 15개(35.7%) 관절에서 급성 골수염을 동반하였다. 방사선 검사상 단순 방사선 촬영의 양성율은 67.6%, 초음파는 90.0%로 나타났으며 두 검사에서 음성이었던 경우 골주사 검사에서 43.8%의 양성율을 보였고, 골주사에서도 음성이었던 3예가 자기공명촬영에서 모두 양성을 보였다. 적혈구 침강 속도는 94.2%에서 30mm/hr 이상으로 증가되었으며 C-반응단백이 97.0%에서 2+(2.60-4.59 mg/dl)이상이었다. 원인균은 포도상 구균이 29.4%, Klebsiella pneumoniae가 23.6%이었다. 포동상 구균에 대한 감수성은 vancomycin이 100%이었고, ceftazidime과 cefotaxime도 비교적 감수성이 높았으며(70%), 그람 음성균에는 amikacin(83%)이 감수성이 높게 나타났다. 이환 기간은 평균 5.14일로 기간이 길수록 예후가 나빴으며, 3예를 제외한 모든 예에서 진단 즉시 조기 관절 절개 및 배농술을 시행하였고 진단후 48시간 이내에 시행한 경우가 예후가 가장 좋았다. 후유증은 추적관찰이 가능했던 환아 20예(24개 관절) 가운데, 고관절이 이환된 15개 관절 중 12개의 관절에서 나타나서 가장 많았고(80.0%), 견관절(50.0%), 슬관절(40.0%)의 순으로 많이 나타났다. 결 론 ; 신생아기의 급성 화농성 관절염 및 골수염은 조기 진단 및 조기 치료만이 영구적인 신체 장애를 예방할 수 있는 최선의 방법으로 사료되며, 예후는 이환 기간, 진단 및 치료의 시기, 침범된 관절의 종류 및 골수염의 동반 여부에 의해 크게 좌우된다. Background : Acute septic arthritis and osteomyelitis in neonatal period are difficult to diagnose and it may leave permanant sequelae. This study was performed to evaluate the clinical course, diagnosis, treatment and sequelae. Methods : Thirty four neonates diagnosed as acute septic arthritis and osteomyelitis who were admitted to neonatal intensive care unit, in the department of pediatrics, Chung Ang Gil Hospital, were investigated for retrospective study. Results : Acute septic arthritis involved the hip joint most frequently (16 cases, 19 joints), followed by knee joint (10 cases, 11 joints), and shoulder joint(8 cases, 8 joints). Acute osteomyelitis occurred concomittently in 6 cases (17.6%). Sex ratio was 1.6 : 1 with male predomenance. Twenty cases (58.8%) of the neonates had some antecedant illness or certain procedures prior to the diagnosis. Limitation of movement of limb and arthralgia were found in all cases, and swelling of the joints in 23 cases. MRI (magnetic resonance imaging) was the most sensitive diagnostic method, and radiographic changes of lateral subluxation and metaphyseal rarefaction were noted in 28 of 42 joints. Staphylococcus aureus was cultured in 10 cases (29.4%) and 7 cases (70.0%) of those cases were sensitive to third-generation cephalosporins and 10 cases (100%) were sensitive to vancomycin. Klebsiella pneumoniae was cultured in 8 cases (23.5%) and Enterobacter cloacae in 5 cases (14.7%), Proteus mirabilis in 2 cases (5.9%). Thirteen cases (86.7%) of gram-negative bacili were sensitive to amikacin. No organisms were cultured in 8 cases (23.5%). Average interval between the onset of the clinical symptoms and the initial time of operation was 5.14 days. The hip joint had yielded most frequent complications (14 cases) followed by shoulder and knee joint. Conclusion : The prognosis of acute septic arthritis and osteomyelitis is well correlated to the interval between the onset of the clinical symptoms and the initial time of operation, the type of joints, and the status of osteomyelitis. Early diagnosis and treatments is essential for the prevention of permanant physical handicaps.