당뇨병성 족부 궤양의 치료

서동교,이호승,Seo, Dong-Kyo,Lee, Ho Seong 대한족부족관절학회 2014 대한족부족관절학회지 Vol.18 No.1

In patients with diabetic foot, ulceration and amputation are the most serious consequences and can lead to morbidity and disability. Peripheral arterial sclerosis, peripheral neuropathy, and foot deformities are major causes of foot problems. Foot deformities, following autonomic and motor neuropathy, lead to development of over-pressured focal lesions causing the diabetic foot to be easily injured within the shoe while walking. Wound healing in these patients can be difficult due to impaired phagocytic activity, malnutrition, and ischemia. Correction of deformity or shoe modification to relieve the pressure of over-pressured points is necessary for ulcer management. Application of selective dressings that allow a moist environment following complete debridement of the necrotic tissue is mandatory. In the case of a large soft tissue defect, performance of a wound coverage procedure by either a distant flap operation or a skin graft is necessary. Patients with a Charcot joint should be stabilized and consolidated into a plantigrade foot. The bony prominence of a Charcot foot can be corrected by a bumpectomy in order to prevent ulceration. The most effective management of the diabetic foot is ulcer prevention: controlling blood sugar levels and neuropathic pain, smoking cessation, stretching exercises, frequent examination of the foot, and appropriate education regarding footwear.

Irreducible Spacer Subluxation after Total Ankle Replacement Arthroplasty in a Patient with Rheumatoid Arthritis: A Case Report

서동교,김상영,Seo, Dong-Kyo,Kim, Sang Young Korean FootAnkle Society 2021 대한족부족관절학회지 Vol.25 No.4

End-stage ankle arthritis is a debilitating condition that causes functional limitations and consequently a poor quality of life. Total ankle replacement arthroplasty is a good alternative to arthrodesis for preserving the ankle's range of motion. However, many complications can occur in patients with rheumatoid arthritis and with poor soft tissue and bone conditions. A 61-year-old female experienced spacer subluxation after surgery, which was not reduced by medial soft tissue release and spacer change. Buttress plating was found to be a good treatment option to prevent spacer subluxation and can be considered in patients with rheumatoid arthritis with bone erosion and soft tissue damage.

Effect of Leg Elevation Height on Reduced Swelling of Patients of Postoperative Acute Ankle Fractures

서동교,강현욱,안득숙,송재석,Seo, Dong-Kyo,Kang, Hyun Wook,Ahn, Deug Suk,Song, Jae-Seok Korean FootAnkle Society 2020 대한족부족관절학회지 Vol.24 No.1

Purpose: Leg elevation is known as an effective method for reducing leg swelling, and it has been routinely used in medical practice. However, the effect of swelling reduction in relation to the degree of elevation height is not known. This study evaluated the swelling of the leg after acute ankle fracture operations at two different elevation heights and the elevated leg heights were compared. Materials and Methods: A total of 66 patients with postoperative acute ankle fractures were classified into two groups depending on the presence of different leg elevation heights: high-elevated (HE, case) and low-elevated groups (LE, control). We checked leg swelling, pain, subjective satisfaction for the elevation device, and the American Orthopedic Foot and Ankle Society (AOFAS) score, and we retrospectively compared them between both the groups. Results: Leg swelling and pain were reduced in both groups. However, they did not show any significant differences between both the groups (p>0.05). Nineteen patients in the HE group replied with uncomfortable, while no patients in LE group did so. The AOFAS score at 1 year postoperatively did not show any significant differences between both the groups (p=0.46). Conclusion: High elevation of the leg after ankle fractures did not show a significant difference from low elevation in regard to leg swelling, pain, and function. Furthermore, high leg elevation resulted in discomfort during the postoperative period. Thus, low elevation with a pillow is enough for acute ankle fracture patients with little discomfort and satisfactory swelling reduction.

50세 이상 환자에서의 반월상 연골 절제술 - 최소 3년 이상 추시 결과 -

조성도,염윤석,고상훈,정광환,차재룡,이채칠,정지영,서동교,Cho, Sung-Do,Youm, Yoon-Seok,Go, Sang-Hun,Jung, Kwang-Hwan,Cha, Jae-Ryong,Lee, Chae-Chil,Jeong, Ji-Young,Seo, Dong-Kyo 대한관절경학회 2008 대한관절경학회지 Vol.12 No.2

목적: 50세 이상 환자에서 반월상 연골 절제술 후 최소 3년 이상 추시시 임상적 및 방사선적 결과를 알아보고자 하였다. 대상 및 방법: 1997년 12월부터 2003년 12월까지 반월상 연골 절제술을 시행 받았던 50세 이상 환자 36명, 36예의 슬관절을 대상으로 하였다. 평균 나이는 56.4세, 평균 추시 기간은 5년 3개월이었다. 술전 Kellgren and Lawrence 분류 상 Grade I 16예, II 12예, III 6예, IV 2예, Outerbridge 분류상 Grade I 16예, II 10예, III 7예, IV 3예이었다. 술후 Lysholm 점수, 환자의 주관적인 만족도, 방사선학적 변화 등을 후향적으로 비교, 분석하였다. 결과: Lysholm 점수는 24예(66.7%)에서 양호 이상의 결과를 보였으며, 26예(72.2%)의 환자들이 술후 결과에 만족하는 것으로 조사되었다. 대퇴 경골간 각이 술전 평균 외반 3.9도에서 술후 평균 외반 2.6도로 변화하였으며, 술후에 관절염이 진행한 경우가 22예(61.1%)로 나타났다. 결론: 50세 이상 환자에서 반월상 연골 절제술 후 최소 3년 이상 추시시 72.2%의 환자에서 만족할만한 임상적인 호전을 보였으나 방사선적으로 술전 관절염 변화나 관절경적 관절 연골 손상이 심한 경우 임상적 결과가 좋지 못한 것으로 나타났다. Purpose: To evaluate the clinical and radiographical results of arthroscopic meniscectomy in patients aged over 50 with minimum 3-year follow-up. Materials and Methods: Of the patients who had undergone arthroscopic meniscectomies between Dec. 1997 and Dec. 2003, 36 patients(36 knees) were available for retrospective evaluation. The average age at the time of surgery was 56.4 years and the mean follow-up period was 63 months. According to the Kellgren-Lawrence classification, grade I change were noted in 16 patients, II in 12, III in 6 and IV in 2. According to Outerbridge classification, grade I articular lesions were noted in 16 patients, II in 10, III in 7 and IV in 3. Postoperative Lysholm score, patient s subjective satisfaction and radiographic changes were evaluated retrospectively. Results: Twenty-four patients(66.7%) were good or excellent for the Lysholm score and 26 patients(72.2%) were satisfied at final follow-up. Tibiofemoral angle was changes from mean valgus 3.9 degrees to mean valgus 2.6 degrees and 22 patients(61.1%) showed the progression of osteoarthritic changes. Conclusion: The satisfactory results could be obtained in 72.2% of patients aged over 50 with a minimal follow-up of 3 years after arthroscopic meniscectomy. The results tended to be worse in patients with moderate or severe tibiofemoral osteoarthritic changes or with articular cartilage lesions.

외측 반월상 연골 손상의 분석 - 비원판형과 원판형의 비교 -

조성도,고상훈,정광환,차재룡,이채칠,염윤석,서동교,Cho, Sung-Do,Go, Sang-Hun,Jung, Kwang-Hwan,Cha, Jae-Ryong,Lee, Chae-Chil,Youm, Yoon-Seok,Seo, Dong-Kyo 대한관절경학회 2007 대한관절경학회지 Vol.11 No.2

Purpose: To know about the clinical characteristics such as causes, types, associated injuries and treatment of the lateral meniscus injuries. Materials and Methods: Retrospective analysis was performed for 129 lateral meniscus tears which were divided into 2 groups, Non-discoid and Discoid. Analysis included age and sex distribution, causes of injury, types and location of tear, associated injuries, and methods of treatment. Results: Both Non-discoid and Discoid were prevalent in man and Discoid group was equally distributed through 2nd to 5th decades and Non-discoid group was more prevalent in 4th to 5th decades. Sports injury was the most common cause in both groups and the Nondiscoid group tended to sustain minor injuries compared to Discoid group. Complex tear and body was most common type and site of tear in both groups. Associated injuries were common in Non-discoid group and isolated injuries were common in Discoid group. Partial meniscectomy was commonly done in Non-discoid group and subtotal meniscectomy in Discoid group based on the types of tear. Conclusion: Non-discoid and Discoid lateral meniscus injuries are similar in types and sites of injuries but different in causes of injury, associated injuries and methods of treatment. Therefore, proper diagnosis and treatment would be necessary according to the characteristics. 목적: 외측 반월상 연골 손상의 원인, 형태, 동반 손상의 여부 및 치료 방법 등을 분석하여 임상적 양상을 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2005년 12월까지 외측 반월상 연골 손상으로 진단되어 수술적 치료를 받은 129례를 대상으로 후향적 연구를 시행하였으며, 원판형과 비원판형으로 나누어 각각에 대한 연령 및 성별 분포, 손상 원인, 파열 형태 및 부위, 동반 손상 여부와 치료 방법에 대하여 비교 분석하였다. 결과: 외측 반월상 연골 손상은 비원판형과 원판형 모두 남자에서 많이 발생하였으며 원판형은 10-40대에 걸쳐 비교적 균등하게, 비원판형은 30-40대에 많이 발생하였다. 손상 원인은 두군 모두에서 운동 손상이 가장 많았으며 비원판형에서는 상대적으로 경미한 외상이 많았다. 파열 형태는 두 군 모두 복합 파열이 많았으며, 손상 부위는 두 군 모두 중위부가 흔하였다. 비원판형은 동반 손상이 많았으며 원판형인 경우 단독손상이 많았다. 파열 양상으로 인해 비원판형은 부분 절제술을 원판형은 아전절제술을 많이 시행하였다. 결론: 외측 반월상 연골의 손상은 비원판형과 원판형으로 나누어 볼 때 파열 형태와 손상 부위에서는 비슷하나 손상 원인과 동반 손상의 여부, 수술 방법에는 차이가 있어 그에 따른 적절한 진단과 치료가 필요할 것으로 생각된다.

증상이 있는 거골 골연골병변의 비수술적 치료 결과

김진수(Jin Soo Kim),이호승(Ho Seong Lee),서상교(Sang Gyo Seo),송중원(Joong Won Song),서동교(Dong-Kyo Seo),류창현(Chang Hyun Ryu) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.2

목적: 최근 거골 골연골병변에 대한 적극적 수술이 행해지고 많은 보고가 있지만, 비수술적 치료에 대한 보고는 많지 않다. 본 연구는 거골 골연골병변에 대한 비수술적 치료의 경과를 보고하고자 한다. 대상 및 방법: 2003년부터 2013년까지 수술을 권유 받았으나 시행 받지 않고 2년 이상의 관찰을 시행한 104명을 대상으로 후향적 연구를 진행하였다. 자기공명영상 또는 컴퓨터 단층촬영을 통해 병변 위치, 크기, stage를 확인하였다. 최종 추시 시 단순 방사선 영상을 시행하여 관절염 진행 여부를 확인하였으며, 운동의 제한 여부를 조사하고, visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scale, SF-36을 측정하였다. 결과: 최종 추시 시 관절염의 진행은 없었으며, 2명(2.4%)의 환자만 원하는 운동의 제한을 호소하였다. 평균 VAS는 내원 시 4.3에서 1.1로 감소하였다(p<0.001). 평균 AOFAS scale는 83.3에서 92.5로(p<0.001), 평균 SF-36도 52.6에서 72.9로 호전되었다(p<0.001). 결론: 거골 골연골병변은 일시적 증상이 있더라도 호전되는 경우가 많고, 관절염으로의 진행이 드물기 때문에 거골 골연골병변 환자의 치료 시 충분한 비수술적 치료가 선행되어야 한다. Purpose: Although reports on operative treatment of osteochondral lesion of the talus (OLT) are increasing, to the best of our knowledge, there have been only a few reports on non-operative treatment of OLT. The purpose of this study is to report the prognosis of non-operative treatment for OLT patients. Materials and Methods: This retrospective study included 104 patients (57 male, 47 female) with OLTs having a follow-up period of more than two years, between 2003 and 2013. The location, size, and stage of the OLT were confirmed by magnetic resonance imaging or computed tomography. At the final follow-up, simple radiographs confirmed the progression of osteoarthritis. We surveyed the limitations of sports activity, visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) scale, and SF-36. Results: There were no patients with progression of osteoarthritis at the final follow-up. Only two patients (2.4%) complained the limitation of desired sports activity. The mean VAS significantly decreased from 4.3 (range, 0-8) to 1.1 (range, 0-4) (p<0.001). The mean AOFAS scale significantly improved from 83.3 (range, 41-100) to 92.5 (range, 65-100). Moreover, the mean SF-36 also improved from 52.6 (range, 30.0–91.0) to 72.9 (range, 40.6-97.0) (p<0.001). Conclusion: Sufficient non-operative treatment is initially recommended to OLT patients because pain, in general, improves in most cases despite the presence of symptoms. Moreover, it’s worth noting that the progression to osteoarthritis is rare.

Arthroscopic Repair of Type II SLAP Lesion with Bioabsorbable Knotless Suture Anchor

Chae-Chil Lee(이채칠),Sung-Jae Kim(김성재),Chang-Ho Hwang(황창호),Dong-Kyo Seo(서동교),Sang-Hun Ko(고상훈) 대한견주관절의학회 2007 대한견주관절의학회지 Vol.10 No.1

최소 절개 접근법과 고식적 접근법에 의한 슬관절 전치환술의 초기 결과

조성도 ( Sung Do Cho ),염윤석 ( Yoon Seok Youin ),고상훈 ( Sang Hun Go ),정관환 ( Kwang Hwan Jung ),차재룡 ( Jae Ryong Cha ),이채칠 ( Chae Chil Lee ),서동교 ( Dong Kyo Seo ) 대한슬관절학회 2007 대한슬관절학회지 Vol.19 No.2