당뇨발 환자에서 절단 부위 결정에 영향을 주는 요인에 관한 연구

박인헌,송경원,신성일,이진영,이승용,송시영,박재용,Park, In-Heon,Song, Kyung-Won,Shin, Sung-Il,Lee, Jin-Young,Lee, Seung-Yong,Song, Si-Young,Park, Jae-Yong 대한족부족관절학회 2003 대한족부족관절학회지 Vol.7 No.1

Purpose: To evaluate the factors which affect the level of the amputation for treatment of DM foot excluding arterial occlusion. Materials and Methods: We selected 30 patients (10 of major amputations, 20 of minor amputations) who were amputated from May, 1999 to April, 2001 because of DM foot. Major amputation is BK amputation, and minor amputation is amputation below ankle joint. Gender, age, size of the wound, extent of the necrosis, infectious organism, medical com orbidity, duration of DM and blood glucose level, duration of DM foot and treatment history were investigated. Results: In major amputations, male to female ratio was 9:1, average of the age was 63.8, the average of sizes of the wound was 16cm2, duration of DM was 15.0 years, duration of DM foot was 10.6 weeks, and 80% of patients had necrosis and the organisms were S. aureus, E. faecium, Streptococcus, P. vulgaris, average of the blood glucose levels was 301 and 40% of them had been treated for DM foot. In minor amputations, male to female ration was 9:1, average of the age was 56.6, the average of sizes of the wound was 4.8cm2, duration of DM was 11.2 years, duration of DM foot was 5.7 weeks, and 40% of patients had necrosis and the organisms were S. aureus, Streptococcus, M. morganini, E. faecium, average of the blood glucose levels was 257 and 20% of them had been treated for DM foot. Conclusion: In DM foot patients, extents of the necrosis, duration of DM, duration of DM foot, the infectious organism were significant factors to decide extent of the amputation level.

종골 골절 후 거골하 관절면의 전위 정도와 운동 범위의 상관 관계

박인헌,이기병,송경원,이진영,이응주,박래성,Park, In-Heon,Lee, Kee-Byung,Song, Kyung-Won,Lee, Jin-Young,Lee, Eung-Joo,Park, Rae-Seong 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.1

The characteristics of the patients after the calcaneal fracture that were associated with an unsatisfactory outcome were subtalar incongruity, decreased Bohler angle ratio of the fractured to the normal side, an age of more than fifty years, work involving strenuous labor, and increased time missed from work due to the injury. The purpose of this study was to examine the reliability of measurements of the range of motion of the subtalar joint. To determine reliability, evaluates of the correlatioinship between the degree of the displacement of the subtalar joint and Circle draw test after the calcaneal fracture. Fifty patients who had had fifty five calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between 4months and three years after the operation, with use of an evaluation system for the subtalar joint and with plain radiographs. At follow up evaluation, the result was assessed on the basis of restoration of anatomy and function of the subtalar joint. We evaluated the subtalar joint with plain films that consist of anteroposterior projection, lateral projection, calcaneal axial view, and Broden's view, and the measurements of the displacement of the subtalar joint surface after the calcaneal fracture. And we evaluated the range of motion of the subtalar joint with Circle draw test for physical evaluation. Circle draw test was evaluated and demonstrated the motion of flexion-supination-adduction and extension-pronation-abduction of the subtalar joint. And there are correlationship between the degree of the displacement and range of motion of the subtalar joint after the calcaneal fracture. The report critically reviews methords used to measure Circle draw test for physical examination of the follow up after the calcaneal fracture.

족근 관절 외과 부위의 압박궤양과 괴사

박인헌,송경원,신성일,이진영,서동현,Park, In-Heon,Song, Gyung-Won,Shin, Sung-Il,Lee, Jin-Young,Suh, Dong-Hyun 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.1

Pressure sores are an ulceration and necrosis of the skin and underlying tissue usually occur after prolonged or repeated pressure by interruption of blood flow from the small. vessels to the skin and deep tissue. The management of pressure sores is mostly difficult and requires prolonged hospitalization or repeated surgical interventions with a high recurrence rate. In this article we reviewed 14 cases of National Pressure Ulcer Advisory Pannel staging III, IV over the lateral malleolar area of the ankle in 2 years period from January 1999 to October 2001. The pressure over lateral malleolar area was mainly due to unique Korean sitting position with cross legs at flexed hips and knees or supine position of patient with external rotation of low extremity. Male to female ratio was 11: 3 and ages were between 36 and 83 (mean age: 67.1 years). Associated diseases were DM(7 cases), Hemiparesis caused by CVA(2 cases), Liver cirrhosis(2 cases), disarticulation of opposite hip due to squamous cell ca.(1 case), Intertrochanteric Fx.(1 case). Wound cultures reported Staphylococus, Pseudomonas and others. Abnormally elevated ESR and CRP were seen in 6 cases. Operative treatments were irrigation and debridement, direct closure with gravity drainage and skin grafting. The most important aspect of pressure sore treatment is pressure relief of the lateral malleolar area. Pressure-relieving Cast or Brace was helpful for local management and preventing recurrence.

족부 주위 연부조직 종물

박인헌,송경원,신성일,이진영,이승용,송시영,Park, In-Heon,Song, Kyung-Won,Shin, Sung-Il,Lee, Jin-Young,Lee, Seung-Yong,Song, Si-Young 대한족부족관절학회 2002 대한족부족관절학회지 Vol.6 No.2

Purpose: To evaluate clinical characteristics of soft-tissue masses around the foot Materials and Methods: Sixty seven cases of soft tissue masses around the foot, excised at Kang Dong Sacred Heart hospital from Jan. 1987 to Oct. 2000, were included in the study. The age and sex of the patient, location and size of the lesion, history of trauma, presence or absence of pain and neurological symptoms as wellas final pathological diagnosis were obtained from retrospective analysis. Results: For type of lesion, all lesions were benign. Ganglion was 23 cases, epidermal inclusion cyst was 10 cases, lipoma was 8 cases, hemangioma was 5 cases and fibroma was 4 cases. For age, 63 percent of the patients were either between the ages of twenty and thirty nine or between the ages of fifty and fifty nine. For sex, the male-to-female ratio was 1 to 1.4. For zones of the foot, 18 cases were in Zone 1, 17 in Zone 4, 12 in Zone 2, 12 in Zone 3 and 8 in Zone 5. For clinical finding, 18 cases had pain. Conclusion: Ganglion was the most common lesions, followed in order of frequency by epidermal inclusion cyst, lipoma, hemangioma and fibroma. Lesions occurred frequently at Edward and Michael Zone 1, 4 and pain was the most common symptom.

폐쇄성 족관절 골절에 동반된 후경골건 및 장족지 굴건 파열

박인헌,이기병,송경원,이진영,최민,Park, In-Heon,Lee, Kee-Byoung,Song, Kyung-Won,Lee, Jin-Young,Choi, Min 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.2

폐쇄성 족관절 양과 골절에 동반된 후경골근 건파열 1례를 치험 하여 우수한 결과를 얻고 그 임상적 중요성을 고찰하였기에 보고하는 바이다. A tibialis posterior and flexor digitorum longus tendon rupture associated with a closed bimalleolar ankle fracture occured in a 30 years old man due to traffic accident. The tendon injury was not recognized before surgery but was diagnosed at the time of operation. The treatment was open reduction and internal fixation of the ankle fracture with primary repair of the ruptured tendons. one year postoperatively, he had a nearly full range of ankle and toes motion without pain and a radiologic normal longitudinal arch. This associated tendon injury, although rare, maybe first time in reviewed similar reports, should be considered in the management of ankle fracture because the tendon rupture could easily have been overlooked.

무지 외반증의 수술적 방법에 대한 임상적 고찰

박인헌,이기병,송경원,이진영,김익지,Park, I.H.,Lee, K.B.,Song, K.W.,Lee, J.Y.,Kim, I.J. 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.1

Hallux valgus deformity has been slowly getting popular in Korea. Many surgical procedures are available for treating the hallux valgus, but it is still controversial for the best treatment. We operated 25 feet(15 patients) of hallux valgus between May. 88 and December. 94. The clinical results were as follow ; 1. Age distribution was 25 to 82, and all female. 10 patients have bilateral hallux valgus. 2. 19 feet were treated by soft tissue procedures only and 6 feet by combined soft tissue and bony procedures. 3. Bunion deformity was recurred in 2 feet (1 Patient) which were treated with modified McBride Method. 4. Lateral sesamoidectomies were performed in 7 feet without development of hallux varus. 5. The cosmetic and functional results were good in 6 cases treated by proximal metatarsal osteotomy. 6. 9 feet had other digits deformities, which need surgical correction. 7. Tightening repair of medial capsule seems to be important for prevention of recurrence of bunion.

경첩 운동이 가능한 외고정장치를 이용한 Pilon골절의 치료

박인헌,이기병,송경원,이진영,이승용,Park, In-Heon,Lee, Kee-Byung,Song, Kyung-Won,Lee, Jin-Young,Lee, Seung-Yong 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.1

Pilon fracture is an intraarticular fracture of distal tibia. It is high energy injury with significantly associated soft tissue damage, bone comminution, and articular surface disruption. Until recently, this treatment has followed the AO principles, Because the risk of complications outweighs potential benefits, the principle of a Pilon fracture treatment are changing. Newer techniques using articulated external fixation minimize disturbance of the soft tissue envelope and have decreased these complications. Series of 5 patients with Pilon fracture were treated by articulated external fixator and followed up more than 12 monthes at the Department of orthopaedic surgery, Kang Dong Sacred Heart Hospital, College of medicine, Hallym University. The results were as follows: 1. The type of fracture were type C2(3 cases),type C3(2 cases) according to AO-$M{\ddot{u}}ller$ classification. 2. The clinical results according to functional criteria by Mast and Teipner were good in 4 cases and poor in 1 case, which is an old fracture. 3. Techniques utilizing articulated external fixator were associated with satisfactory results and appeared to significantly decrease the incidence of soft tissue complication, post-traumatic arthritis, osteoporosis, and fibrosis of ankle joint.

경골 극원위부 골절에서 교합성 골수강내 금속정을 이용한 치료

박인헌,송경원,신성일,이진영,이승용,김태형,차정훈 대한골절학회 2003 대한골절학회지 Vol.16 No.3

목적: 일반적으로 경골 간부 골절에 사용하는 교합성 골수강내 금속정은 그 원위부 교합나사의 위치로 인하여 극원위부 골절에는 사용하기가 어려운 점이 있다. 그러나 저자들은 원위부 교합나사의 위치를 변경하여 설계된 교합성 골수강내 금속정을 이용하여 8예의 경골 극원위부 골절을 치료하였고 그 결과를 분석하였다. 대상 및 방법: 1999년 1월부터 2002년 4월까지 본원에서 치료하고 12개월 이상 추시가 가능했던 총 8예를 대상으로 후향적 연구를 시행하였다. 이들의 평균 연령은 41.5세 (23~74세)였으며, 남자가 5예, 여자가 3예였다. 수술 후 추시 기간 중 골 유합의 시기, 마지막 추시 때 슬관절 및 족근 관절의 운동 장애, 보행 장애 등을 조사하였다. 결과: 가장 원위부에 위치한 골절선과 족근 관절 사이의 거리는 평균 1.1㎝이었으며, 골 유합은 평균 18.6중에 이루어졌으며, 마지막 추시 때 슬관절의 운동 장애는 모든 예에서 없었으며, 족근 관절의 운동 장애는 1예에서 5도 신전, 35도 굴곡의 운동 범위를 보였다. 보행 장애는 모든 예에서 보이지 않았다. 결론: 경골 간부 골절에서와 같이 극원위부 골절에서도 교합성 골수강내 금속정의 사용은 적은 연부 조직의 손상과 조기 관절 운동, 조기 거동 등의 장점으로 인해 슬관절 및 족근 관절의 기능 회복 및 보행에 좋은 결과를 보이는 권장할 만한 치료 방법이라 할 수 있다. Purpose: We analyzed the result of treatment for most distal extraarticular tibial fracture using interlocking intramedullay nail. Material and Method: From January 1999 to April 2002 , 8 patients who had most distal tibial fracture were treated by interlocking intramedually nailing. The duration of follow-up was more than 12 months. The mean age was 41.5 years old. There were 5 males and 3 females. During follow-up period, we evaluated the bone union, range of motion of knee and ankle joint and gait pattern. Results: The average distance from fracture line to ankle joint line was 1.1㎝. The bone union was achieved at average 18.6 weeks. At the last follow-up, there was no limited motion on knee. But at one case, ankle range of motion was limited from 5 degree extension to 35 degree flexion. There was no gait disturbance. Conclusion: Interlocking intrameduallary nailing can be recommendable and useful in the most distal tibial fractures.

족근관절 전치환술의 중장기 추시

박인헌,송경원,신성일,이진영,이건형,Park, In-Heon,Song, Kyung-Won,Shin, Sung-Il,Lee, Jin-Young,Lee, Keon-Hyung 대한족부족관절학회 2000 대한족부족관절학회지 Vol.4 No.1

Purpose: To show the results in term of pain and functional recovery in the mid-term follow up of total ankle replacement. Materials and Methods: We followed up 7 patients who had undergone total ankle arthroplasty during the periods between April 1990 and May 1997. They were evaluated after mean follow up of 3.6 years. Results: We reviewed these cases with regand to (in terms of) pain, function and alignment according to the Ankle-Hindfoot Scale designed by American Orthopaedic Foot and Ankle Society. The average point was 78. Conclusion: Total ankle replacement especially unconstrained type seems good alternative to arthrodesis in selected cases of ankle arthrosis.

90°-90°골견인술을 이용한 소아대퇴골 간부 골절의 임상적 결과

박인헌,송경원,양현철 한림대학교의료원 1990 人間科學 Vol.14 No.12