대퇴 골두 무혈성괴사에서 양극성 고관절 반치환술

서유성(You Sung Suh),권중호(Joong Ho Kwon),임수재(Soo Jae Yim),김연일(Yon Il Kim),최창욱(Chang Uk Choi) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.3

Purpose : To report the analysis of the clinical and radiological results of Bipolar endoprosthesis treatment in patients with avascular necrosis(AVN). Materials and Methods : During 5 years and 7 months from January 1, 1990 to July 31, 1995, Bipolar endoprosthesis treatments, utilizing cementless stem have been performed in patients with AVN. For this study, 25 patients were followed up for 2 years minimum and 9 years and 7 months maximum with the average of 5 years and 1 month. We retrospectively analyzed the clinical results of Harris hip scores, thigh pain, and inguinal pain. In order to provide the statistical foundation for the comparison of acetabular erosion, we used x-rays of the acetabular cartilage from the anteroposterior view that were taken postoperatively each year for 4 years. These pictures were compared with the x-ray picture of the anteroposterior view that was taken immediately after the operation. The thickness of the acetabular cartilages has been measured with a caliper ; we found more than 50% acetabular ero-sion in the area between the acetabulum and the artificial cup. In the cases with more than 50% ero-sion, We investigated the effects of age, disease, process of AVN, type of stem, size and duration of the metal cup after insertion, and the occupation of the patient to determine risk factors for the erosion. Results : After the operation, Harris hip score improved in overall from 46 to 80 points. We found 10 cases of inguinal pain(40%) and 4 cases of thigh pain(16%). Among 17 cases(67%) of more than 50% erosion, 7 cases(40%) had occurred within 1 year after the operation, 4 cases(24%) within 2 years, 4 cases(24%) within 3 years, and 2 cases(12%) within 4 years. Younger age group with relative-ly more active life style showed a faster progress of erosion(p=0.01). We also found that more acetabu-lar erosion occurred with more serious AVN(Ficat stage) ; 1 case(25%) out of 4 at the Ficat stage 2 and 16 cases(76%) out of 21 at Ficat stage 3. Conclusion : We found that the degree of acetabular erosion increases in patients with young age,serious AVN, and longer period after the metal cup insertion.

무시멘트형 Metal-Backed Cup에서 발생한 Polyethylene Liner의 분리

서유성(You-Sung Suh),유재응(Jae-Eung Yoo),진소영(So-Young Jin),신병준(Byung-Joon Shin),김연일(Yeon-Il Kim),최창욱(Chang-Uk Choi) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.4

정맥혈전 색전증 고위험군에서 시행한 혈전색전 예방요법(American College of Chest Physicians 지침 및 American College of Orthopedic Surgeons 지침)의 준수율 비교 연구

서유성(You-Sung Suh),노재휘(Jae-Hwi Nho),장병웅(Byung-Woong Jang),강덕원(Deokwon Kang),원성훈(Sung-Hun Won) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.4

목적: 인공관절 치환술 및 고관절 골절 환자에서 시행한 2가지 정맥혈전 색전증 예방요법의 준수율을 비교 분석하고자 하였다. 수술후 발생하는 정맥혈전 색전증은 인공 슬관절 치환술이나 인공 고관절 치환술 및 고관절 골절 수술 후 발생하는 가장 심각한 합병증이다. 이에 대한 적절한 예방이 무엇보다 중요하기 때문에 항응고제 사용의 필요성 또한 증가하고 있다. 대상 및 방법: 2009년 3월부터 2011년 2월, 2012년 3월부터 2014년 2월까지 순천향대학교 부속 서울병원에서 인공 슬관절 치환술, 고관절 전치환술 및 고관절 골절로 고관절 반치환술 및 내고정술을 시행받은 환자들을 의무 기록과 영상 검사를 검토하여 각각 American College of Chest Physicians (ACCP) 가이드라인과 American College of Orthopedic Surgeons (AAOS) 가이드라인에 따라 시행한 정맥혈전 색전증 예방요법의 준수율을 후향적으로 비교 분석하였다. 결과: 인공관절 치환술 및 고관절 골절 환자에서 정맥혈전 색전증 예방을 위한 가이드라인이 적용되고 있으며 실제로 ACCP 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 수술 전에 56.0%, 수술 후에는 67.0%, 물리적 요법에서는 80.5%의 준수율을 보였다. 또한 AAOS 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 74.1%, 물리적 요법에서는 88.3%의 준수율을 보이며 ACCP 가이드라인에 비해 높은 준수율을 보였다. ACCP 가이드라인의 수술 전 후 화학적 예방요법과 물리적 예방요법의 준수율과 AAOS 가이드라인의 화학적 예방요법과 물리적 예방요법의 준수율을 비교 분석하였으며, 인공 슬관절 치환술의 수술 전과 후, 고관절 골절 수술의 수술 전과 후, 전체 고위험군 수술에서 수술 전과 후 유의한 차이를 보였다(p<0.05). 결론: 정맥혈전 색전증 고위험군 수술에서 정맥혈전 색전증 예방요법의 가이드라인에 따른 준수율을 전반적으로 높여서 적절한 예방이 이루어지도록 해야 하며, 일선 정형외과의를 위한 통일된 방향의 가이드라인이 필요할 것이다. Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

골용해의 진단 및 치료

서유성 ( You Sung Suh ),원성훈 ( Sung Hun Won ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms cement disease. However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms particle disease. In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weightpolyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.

고령의 고관절 골절 환자의 수술 후 사망률 및 관련 인자

서유성(You-Sung Suh),김용범(Yong-Beom Kim),최형석(Hyung-Suk Choi),윤홍기(Hong-Kee Yoon),서기원(Gi-Won Seo),이병일(Byung-Ill Lee) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.6

목적: 고령의 고관절 골절 환자의 사망률과 수술 후 사망률에 영향을 미치는 인자에 대해 알아보고자 하였다. 대상 및 방법: 2006년 3월부터 2009년 12월까지 65세 이상의 고관절 골절로 수술을 시행 받은 304명의 환자들 중 수술 후 1년 내 사망 여부 추적이 불가능했던 43명을 제외한 261명을 대상으로 하였다. 연령, 성별, 수술 방법, 골절의 유형, 마취 방법, 수술 전 기저 질환, 그리고 수상 후 수술까지의 경과시간을 조사하여 수술 후 1년 내 사망과 관련이 있는 인자들을 통계적으로 분석하였다. 결과: 고령의 고관절 골절 환자의 수술 후 1년 내 사망률은 10.7%였다. 수술 방법, 골절의 유형, 마취 방법은 수술 후 사망률과 관계가 없었으나 연령, 성별, 수술 전 기저 질환의 수, 수상 후 수술까지의 경과시간, 기저 질환 중의 치매는 고령의 고관절 골절 환자의 수술 후 사망률에 영향을 미치는 것으로 조사되었다. 결론: 고령의 고관절 골절 환자의 수술 후 사망률은 10.7%였으며, 고령의 고관절 골절 환자의 수술 후 사망률에 영향을 미치는 인자는 연령, 성별, 동반 기저 질환의 수, 수상 후 수술까지의 경과시간, 기저 질환 중의 치매였다. Purpose: The aim of this study was to determine the mortality and factors that are related to the mortality in elderly patients with hip fracture. Materials and Methods: Between March 2006 and December 2009, 304 patients who were 65 years or older underwent surgery for hip fracture. Among them, 261 patients were available and 43 patients excluded from this study, as they were unable to be evaluated for one year mortality. We analyzed the relationship between the postoperative mortality and the associated factors (age, gender, the type of operation, the type of fracture, method of anesthesia, comorbidity, operation delay). Results: The one year mortality rate for elderly patients with hip fracture was 10.7%. There was no relationships between the postoperative mortality and the type of operation, the type of fracture, and method of anesthesia. However, age, gender, the number of comorbidity, operation delay, and dementia of comorbidity were factors associated with the mortality rate for elderly patients with hip fracture. Conclusion: The one year mortality rate for elderly patients with hip fracture was 10.7%. Age, gender, the number of comorbidity, operation delay, and dementia of comorbidity were factors associated with the mortality rate in elderly patients with hip fracture.

불안정성 대퇴 전자간 골절에서 양극성 고관절 반치환술 시 대전자부 골편 고정 방법의 비교

서유성 ( You Sung Suh ),최상욱 ( Sang Wook Choi ),박종석 ( Jong Seok Park ),임수재 ( Soo Jae Yim ),신병준 ( Byung Joon Shin ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.2

목적: 양극성 고관절 반치환술로 대퇴 전자간 골절을 치료하는 경우, 대전자 골편을 고정하는 3가지 방법의 임상적 및 방사선학적 결과를 평가하고자 하였다. 대상 및 방법: 46예를 대상으로 하여, 고정 방법은 1군) 8자형 강선 결박술(18예), 2군) 원형 강선 결박술(23예), 3군) 인장 대 강선 결박술(11예)이였다. 강선의 파손과 골편의 전위 여부로 방사선학적 평가를 하였고, Merle d’Aubigne 기준에 따라 기능적 평가를 하였다. 결과: 골편 전위 발생율은 1 군 22.2%, 2 군 52.2%, 3군 9.1%로, 군 간 유의한 차이가 있었다(p=0.022). 강선 파손 발생율은 27.8%, 13.0%, 9.1%로 유의한 차이가 없었다. 1군 78.6%, 2군 82.4%, 3군 88.9%이 Merle d`Aubigne 기준의 양호 이상의 기능적 결과를 보였다. 결론: 대전자 골편을 고정하는데 인장 대 강선 결박술이 더 유용한 방법으로 사료된다. Purpose: To evaluate clinical and roentgenographic outcomes after bipolar hemiarthroplasty utilizing three different greater trochanteric fragment fixation methods for intertrochanteric fracture repair. Materials and Methods: Forty-six hips (Boyd-Griffin type II: 44, type IV: 2) that had undergone greater trochanteric fragment fixation through bipolar hemiarthroplasty were evaluated at a minimum of 1 year following surgery. The fixation groups were: 1) figure of 8 wiring (18 cases), 2) cerclage wiring (23 cases), and 3) tension band wiring (11 cases). The roentgenographic results were evaluated in terms of fragment migration and wire breakage. The functional results were evaluated according to the hip rating scale of Merle d`Aubigne. Results: The rate of fragment migration was 22.2% in group 1, 52.2% in group 2, and 9.1% in group 3, and there was a statistically significant difference among the groups (p=0.022). The rate of wire breakage was 27.8% in group 1, 13.0% in group 2, and 9.1% in group 3, but there was no statistically significant difference among the groups. According to the Merle d`Aubigne scale, 78.6% of the repairs in group 1, 82.4% of the repairs in group 2, and 88.9% of the repairs in group 3 were rated as excellent, very good, or good. Conclusion: The tension band wiring method is more useful than the figure of 8 and cerclage wiring methods for fixing the greater trochanteric fragment during bipolar hemiarthroplasty.

고관절 골절의 수술적 치료

서유성 ( You Sung Suh ),김병민 ( Byoung Min Kim ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.2

Hip fracture is much more common after the age of 65 year old, and this malady has increased because to the longer average life span with the advances of medical care. Despite the development of the treatments and rehabilitation techniques, hip fracture is well known for having high rates of complications and mortality. The risk factors, mechanisms of injury and the underline disease of hip fracture are also well known, and this has helped these patients to recover as soon as possible and to walk and move earlier after appropriate surgical operations. Most fractures must be treated by an open operation and performing rigid internal fixation or arthroplasty. We report here on the major operational treatments for femur neck fracture and intertrochanter fracture.

무수혈 환자에서 시행한 인공관절 치환술의 혈역학적 분석

서유성(You-Sung Suh),최형석(Hyung-Suk Choi),원성훈(Sung-Hun Won),김명회(Myoung-Hoe Kim),천동일(Dong-Il Chun),노재휘(Jae-Hwi Nho) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.6

목적: 무수혈 환자군을 대상으로 인공관절 치환술 시행함에 있어 수혈 대체 요법을 적용하고 혈역학적 변화를 분석하여 그 결과를 알아보고자 하였다. 대상 및 방법 : 인공슬관절 치환술 및 인공고관절 치환술을 시행 받은 48명의 환자 57예를 대상으로 하였다. 수술 당시 평균 연령은 70.9세 였다. 총 57예 중 인공 슬관절 치환술 15예, 인공 고관절 치환술은 42예에서 시행하였다. 술 전 혈색소 수치가 10g/dL 이상인 경우 재조합 에리스로포에틴 2,000 단위를 일주일, 경구철분제 일주일을 투여하였고 혈색소 수치가 10g/dL 이하인 경우 재조합 에리스로포에틴 4000단위를 일주일, 경구철분제나 베노페롬을 일주일 투여하였다. 술 중에는 술 전 혈색소치에 상관없이 자가수혈, 혈장증량제, 국소지혈제를 사용하였으며, 술 후에는 재조합 에리스로포에틴 4,000 단위, 베노페롬을 일주일 투여하였다. 결과: 내원 시 평균 혈색소 수치가 10g/dl 이상인 환자군은 수술 후 7일째 평균 혈색소 수치가 10.7g/dl로 평균 1.85g/dl의 감소율을 보였고, 내원 시 평균 혈색소 수치가 10g/dl 이하인 환자군은 수술 후 7일째 평균 혈색소 수치가 9.18g/dl이었다. 인공 슬관절 치환술을 시행한 환자군은 내원 시 혈색소 수치가 12.8g/dl에서 수술 후 7일째 혈색소 수치가 10.96g/dl, 인공 고관절 치환술을 시행한 환자군은 내원시 혈색소 수치가 13.4g/dl에서 수술 후 7일째 혈색소 수치가 11.8g/dl, 재치환술을 시행한 환자군은 내원 시 혈색소 수치가 13.8g/dl에서 수술 후 7일째 혈색소 수치가 12.75g/dl였다. 결론: 무수혈 환자에서 정형외과적 인공관절 치환술시 적절한 수혈대체 요법의 정립이 필요하며 저자들은 적극적인 수혈 대체 요법의 적용을 통해 혈역학적 관점에서 좋은 결과를 얻었다. Purpose: To analyze the hemodynamic changes in patients who underwent total joint arthroplasty and received alternative treatment to blood transfusion. Materials and Methods: Fifty-seven cases in 48 patients who received total knee and hip arthroplasty between 1998 September and 2008 February were enrolled. The mean age at the point of surgery was 709 years. The types of joint arthroplasty included 15 cases of total knee arthroplsty and 42 cases of total hip arthroplasy. Alternatives to blood transfusion entailed administration of 2,000 units of recombinant EPO and oral iron supplement for 1 week in patients with preoperative hemoglobin level higher than 10 g/dl, and 4,000 units of recombinant EPO with oral iron supplement or venoferrum for 1 week in patients with preoperative hemoglobin level lower than 10 g/dl. Intra-operatively, autotransfusion, plasma expander, topical hemostatic agents were used irrespective of the preoperative hemoglobin level. Postoperatively, 4,000 unit of recombinant EPO and venoferrum were administered for one week. Results: Patients with mean hemoglobin level higher than 10 g/dl exhibited mean hemoglobin level of 10.7 g/dl (a mean 1.85 g/dl decrease) 7 days after the operation. Patients with mean hemoglobin level lower than 10 g/dl exhibited increased mean hemoglobin level of 9.18 g/dl (a mean 0.38 g/dl decrease) 7 days after the operation Patients who underwent total knee arthroplasty exhibited reduction of hemoglobin from 12.8 g/dl to 10.96 g/dl (a mean decrease of 14 g/dl) 7 days after the operation Patients who underwent total hip arthroplasty exhibited a change of hemoglobin from 13.4 g/dl to 11.8 g/dl (a mean decrease of 1.84 g/dl) 7 days after the operation. Patients who underwent revision arhtroplasty exhibited a change of hemoglobin from 13.8 g/dl to 12.75 g/dl (a mean decrease of 1.05 g/dl) 7days after the operation. Conclusion: In patients who refuse blood transfusion, there is a need to establish an adequate alternative blood management plan for surgery, such as total joint arthroplasty. We obtained good results with the hemodynamic protocol adapted for the perioperative period.

무 시멘트 대퇴 stem의 canal filling에 관한 임상적 고찰

서유성(You-Sung Suh),노영복(Young-Bock Know),신병준(Byung-Joon Shin),나수균(Soo-Kyun Rah),최창욱(Chang-Uk Choi) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.3

고관절 주변에 발생한 요독성 종양성 석회증

서유성 ( You Sung Suh ),최형석 ( Hyung Suk Choi ),천동일 ( Dong Il Chun ),최성우 ( Sung Woo Choi ),김용범 ( Yong Beom Kim ),장병웅 ( Byung Woong Chang ),서기원 ( Gi Won Seo ) 대한고관절학회 2014 Hip and Pelvis Vol.26 No.1

종양성 석회증은 고관절, 견관절, 주관절과 같은 큰 관절 주변의 연부조직에 칼슘염이 침착 되는 매우 드문 질환이다. 발생원인에 대하여는 아직까지 명확하게 밝혀진 바는 없으나 신장의 근위 세뇨관에서 인의 대사 장애가 원인이라는 가설이 있고, 만성 신질환이나 부갑상선 기능항진증과 같은 질환이 원인이 될 수도 있다. 혈액 투석을 하는 만성 신부전 환자에서 발생한 속발성 종양성 석회증, 이른바 요독성 종양성 석회증에 대해 수술적 절제술 후 결과에 대하여 보고한 예는 국내에서는 없는 실정이다. 저자들은 고관절부 주위 종괴를 주소로 내원한, 혈액 투석 중인 57세 여자 환자에서 단순 방사선, 자기공명영상 및 전산화단층 촬영상 요독성 종양성 석회증을 진단하고 절제술 후 추시하여 임상적으로 만족할 만한 결과를 얻었기에 문헌고찰과 함께 보고하고자 한다. The term tumoral calcinosis in used to describe the deposition of nodular calcareous masses in the soft tissue around large joints, such as the hips, shoulders, and elbows. Although the cause has not yet been clearly determined, according to the hypothesis, failure of phosphorus metabolism in the proximal tubule in kidney, chronic renal disease and hyperparathyroidism may cause tumoral calcinosis. No cases of tumoral calcinosis treated with surgical resection in chronic renal failure patients on hemodialysis, so called uremic tumoral calcinosis, have been reported in Korea. The authors experienced the case of a 57-year-old woman with chronic kidney disease on hemodialysis who presented with a mass around the hip. We made a diagnosis using plain radiographs, magnetic resonance imaging, and computed tomography of tumoral calcinosis, and treated the patient successfully with surgical resection. We report on a case of uremic tumoral calcinosis with a review of the literature.