New Skeletal Muscle Mass Index in Diagnosis of Sarcopenia

문정재,박삼국,류승민,박찬호 대한골대사학회 2018 대한골대사학회지 Vol.25 No.1

Background: We sought to develop a novel index based on the skeletal muscle mass that reflects the change of quality of life (QOL), and is the most appropriate index for the body composition of the elderly in Korea. Whether lower extremity skeletal muscle mass index (LESMI) is an appropriate novel new index to diagnose patients with sarcopenia was also evaluated. A cut-off value for each index was reported to facilitate the diagnosis of patients with sarcopenia in a Korean population. Methods: We used the 5th Korean National Health and Nutrition Examination Survey data from 2010. We analyzed 409 elderly patients, including 231 men and 178 women, aged ≥65 years. Patients were diagnosed by calculating their skeletal muscle index based on the skeletal muscle mass measured using dual energy X-ray absorptiometry. Obesity and osteoporosis were used to screen data and EuroQOL-5 dimension as a health questionnaire Results: The prevalence of sarcopenia in each index was obtained based on its cut-off value for diagnosing sarcopenia. There was a significant difference between the obesity rate of elderly patients diagnosed with sarcopenia and those who were not based on each index. There was no significant difference in the prevalence of osteoporosis between the groups. Sarcopenia diagnosis based on the LESMI was significantly correlated with QOL. Conclusions: LESMI, a novel index based on skeletal muscle mass, reflects changes in QOL and is appropriate for the body composition of elderly people in Korea.

대퇴 원위부 관절내 골절 치료 후 중기 추시 결과

박삼국 ( Sam Guk Park ),문정재 ( Jeong Jae Moon ),손욱진 ( Oog Jin Shon ) 대한골절학회 2016 대한골절학회지 Vol.29 No.4

목 적: 고 에너지에 의한 대퇴 원위부 관절내 골절(AO/OTA 33-B & C)을 당한 50세 이하의 청장년 환자에서 골유합술시행 후 방사선적 및 임상적 중기 추시 결과 및 외상 후 골관절염의 진행을 알아보고자 하였다. 대상 및 방법: 2008년 1월부터 2013년 1월까지 상기 조건을 만족하고 3년 이상 추시가 가능했던 21예를 대상으로 하였다. 방사선적으로 하지 정렬의 회복, 골유합 기간 및 외상 후 골관절염의 진행여부를 확인하고, 임상적으로는 관절의 운동 범위 및 Knee Society score (KSS)를 평가하였다. 결 과: 평균 골유합 기간은 18.2주였고, 하지의 정렬 회복은 모두 정상 범위였다. 3년 이상 최종 추시 결과 7예에서 외상후 골관절염이 진행되었고, 이는 골절의 분류, Hoffa 골절을 포함한 관상면 골절 및 나이와 관련이 있었다. 최종 추시 관절의 운동 범위는 평균 128.7o, KSS 중 knee 점수는 평균 86.1점, functional 점수는 평균 85.1점으로 나타났으며, 1년 추시에 비하여 모두 향상되었다. 결 론: 따라서 3년 이상 중기 결과는 방사선적 및 임상적으로 만족할 만하였고, 예후에 결정적인 영향을 미치는 외상 후골관절염의 진행은 33.3%에서만 경도로 진행하는 것을 확인하였다. Purpose: This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma. Materials and Methods: Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated. Results: The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7o, 86.1, and 85.1, all showing a greater improvement when compared with the one year follow-up scores. Conclusion: The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

무지외반증에 대한 근위 갈매기형 절골술 시행 후임상적 및 방사선학적 결과는 언제 안정화되는가?

박철현,이우천,박재우,문정재 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.3

Purpose: The purpose of this study is to evaluate the sequential changes of clinical and radiographic results after proximal chevron osteotomy in patients with moderate to severe hallux valgus. Materials and Methods: Between January 2008 and December 2009, 93 patients (117 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. The mean age of patients was 51 years (range, 19 to 71) and the mean duration of follow-up was 27.5 months (range, 24 to 35). Clinical results were evaluated using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively, at 3, 6, and 12 months after surgery, and at the last follow-up. Radiographic parameters including hallux valgus angle, intermetatarsal angle, and sesamoid position were evaluated preoperatively, immediately postoperatively, at 6 weeks, at 3, 6, and 12 months after surgery, and at the last follow-up. Results: VAS and AOFAS score showed significant improvement until 12 months after surgery. Hallux valgus angle and sesamoid position stabilized at 12 months after surgery and intermetatarsal angle stabilized at 6 months after surgery. Conclusion: Clinical and radiographic results were stabilized beyond 12 months after proximal chevron osteotomy in patients with moderate to severe hallux valgus.

무지외반증에 대한 근위 갈매기형 절골술 시행 후 임상적 및 방사선학적 결과는 언제 안정화되는가?

박철현,이우천,박재우,문정재,Park, Chul Hyun,Lee, Woo Chun,Park, Jae Woo,Moon, Jeong Jae 대한족부족관절학회 2015 대한족부족관절학회지 Vol.1 No.2

Purpose: The purpose of this study is to evaluate the sequential changes of clinical and radiographic results after proximal chevron osteotomy in patients with moderate to severe hallux valgus. Materials and Methods: Between January 2008 and December 2009, 93 patients (117 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. The mean age of patients was 51 years (range, 19 to 71) and the mean duration of follow-up was 27.5 months (range, 24 to 35). Clinical results were evaluated using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively, at 3, 6, and 12 months after surgery, and at the last follow-up. Radiographic parameters including hallux valgus angle, intermetatarsal angle, and sesamoid position were evaluated preoperatively, immediately postoperatively, at 6 weeks, at 3, 6, and 12 months after surgery, and at the last follow-up. Results: VAS and AOFAS score showed significant improvement until 12 months after surgery. Hallux valgus angle and sesamoid position stabilized at 12 months after surgery and intermetatarsal angle stabilized at 6 months after surgery. Conclusion: Clinical and radiographic results were stabilized beyond 12 months after proximal chevron osteotomy in patients with moderate to severe hallux valgus.

비정형적 대퇴골 골절에서 골수강 내 정을 이용한 내고정 후 테리파라타이드(Teriparatide)의 투여가 골절의 치료에 미치는 영향

박철현(Chul Hyun Park),손욱진(Oog Jin Shon),문정재(Jeong Jae Moon),심범진(Bum Jin Shim),허재희(Jae Hee Heo) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 비정형적 대퇴골 골절 환자에서 골수강 내 정을 이용한 수술 후 teriparatide의 투여가 골절의 치유에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 2009년 1월부터 2013년 12월까지 비정형적 대퇴골 골절로 골수강 내 정을 이용하여 수술을 시행한 26명(26예)을 대상으로 하였다. 이 중 수술 후 teriparatide를 투여하지 않은 15예(비투여군)와 투여한 11예(투여군)로 나누어 임상적 평가 및 방사선적 평가를 진행하였다. 결과: 수상 전의 보행 정도로 회복하는 데 걸린 기간 및 수술 후 골절 부위의 통증이 visual analogue scale 2점 이하가 되는 데 걸린 기간은 투여군에서 비투여군에 비해 유의하게 빨랐다. 최초 가골 및 가골교 형성 시기와 골유합 시기는 투여군에서 비투여군에 비해 유의하게 빨랐다. 수술 후 비투여군에서는 지연유합이 5예(33.3%), 불유합이 1예(6.7%) 발생하였고, 투여군의 모든 환자는 골유합을 얻었다. 결론: 비정형적 대퇴골 골절 환자에서 골수강 내 정을 이용한 수술 후 teriparatide의 투여가 임상적 및 방사선적 결과를 호전시켰다. 그러므로 비정형적 대퇴골 골절 환자에서 수술 후 teriparatide의 투여는 골절의 유합을 촉진시킬 수 있는 유용한 방법이라고 생각한다. Purpose: The purpose of this study is to evaluate the effects of teriparatide administration on fracture healing after intramedullary nailing in atypical femoral fractures. Materials and Methods: We retrospectively reviewed 26 patients (26 cases) with atypical femoral fracture who were treated using intramedullary nailing between January 2009 and December 2013. Teriparatide was not administered to 15 patients (non-injection group) and was administered to 11 patients after surgery (injection group). Clinical results were assessed using the Nakajima score and the visual analogue scale (VAS). Radiographic results were compared for the time of callus formation, callus bridge formation, and bone union between the groups. Results: Time to recover walking ability and to decrease pain in the surgery region (VAS≤2) were significantly shorter in the injection group than in the non-injection group. The time of callus formation, callus bridge formation, and bone union was significantly shorter in the injection group than in the non-injection group. There were 5 cases of delayed bone union (33.3%) and 1 case of none union (6.7%) in the non-injection group and all cases obtained bone union in injection group. Conclusion: The injection group showed better clinical and radiographic results than the non-injection group after intramedullary nailing in atypical femoral fracture. Therefore, we think that teriparatide administration after intramedullary nailing could be a useful treatment option to promote bone union.

재발성 화농성 관절염에 대한 치료로서의 2단계 인공관절 치환술

손욱진(Oog Jin Sohn),이동철(Dong Chul Lee),이성준(Sung Jun Lee),문정재(Jeong Jae Moon),손휘승(Whee Sung Son) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.2

목적: 퇴행성 관절염이 동반된 재발하는 화농성 슬관절염 환자에서 인공관절 치환술의 유용성을 평가하고자 하였다. 대상 및 방법: 2005년 1월부터 2012년 4월까지 최소 1년 이상의 추시된 관절염을 동반한 재발한 화농성 슬관절염 환자 중 2단계 인공관절 치환술을 시행한 22예를 대상으로 하였다. 임상적 평가는 슬관절 점수, 기능적 점수, International Knee Documentation Committee (IKDC) 평가를 이용하였으며, 방사선 소견, 배양 균주, 당뇨병 유무, 인공관절 치환술까지 소요된 기간 등에 따른 결과를 분석하였다. 결과: 최종 추시 시 슬관절 운동 범위는 평균 115o였으며, 수술 후 슬관절 점수는 평균 81.0점, 슬관절 기능 점수는 평균 73.2점이었 으며, IKDC 주관적 만족도 평가에서는 normal 15예, nearly normal 7예로 조사되었다. 당뇨병을 가진 환자군이나 배양 균주가 검출 된 환자군에서 유의한 차이는 없었다. 최종 추시 시 슬관절의 감염이 재발한 예는 없었다. 결론: 퇴행성 관절염이 동반된 재발성 화농성 슬관절염 환자에서 2단계 인공관절 치환술은 만족할 만한 결과를 보여, 치료방법의 하 나로서 선택적으로 사용할 수 있을 것으로 생각한다. Purpose: The purpose of this study is to evaluate the usefulness of a two-stage approach to primary knee arthroplasty with recurrent septic arthritis. Materials and Methods: We studied 22 patients with recurrent septic arthritis, and we observed them for more than one year of follow-up survey from January 2005 to April 2012 at Yeungnam University Medical Center. The clinical assessment was performed following Knee Society knee score, Knee Society function score, and International Knee Documentation Committee Score (IKDC) subjective assessment. In addition, we analyzed the causative organisms, significant medical comorbidities (diabetes mellitus), period up to primary knee arthroplasty, and radiologic assessment with reference to disease prognosis. Results: The average range of postoperative knee motion showed a good result, with an average of 115o. Knee Society knee score improved from 23.5 to 81.0, and Knee Society function score also increased from 22.5 to 73.2. Subjective assessment by IKDC was divided into 15 normal patients and 7 nearly normal patients. No significant difference was observed between patients with causative organisms and those with diabetes mellitus. In the final follow-up survey, recurrence of infection was not reported. Conclusion: A two-stage approach to primary knee arthroplasty with recurrent septic arthritis is a useful method, because it showed good clinical and radiologic results and favorable subjective assessment.