종골 골절의 제한적 후방 접근법 수술적 치료 후 조기 운동 및 재활 치료의 결과

송경원,김갑래,이진영,이광남,서은호,Song, Kyung-Won,Kim, Gab-Lae,Lee, Jin-Young,Lee, Kwang-Nam,Seo, Eun-Ho 대한족부족관절학회 2008 대한족부족관절학회지 Vol.12 No.1

Purpose: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. Materials and Methods: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. Results: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. Conclusion: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.

수종의 트레이 레진과 고무 인상재간의 인장 접착강도에 관한 연구

송경원,임주환,조인호,Song Kyung-Won,Lim Ju-Hwan,Cho In-Ho 대한치과보철학회 2001 대한치과보철학회지 Vol.39 No.4

For accurate impression taking, accurate impression material, solid individual tray, and bond strength between impression materials and resin tray are important factors. The purpose of this study was to evaluate tensile bond strength of rubber impression materials to various tray resin materials. This study tested the time dependent tensile bond strength between commercial brands or poly ether, polysulfide, additional silicone impression materials and commercial brands of self curing tray resin. light activited tray resin when applying adhesive Resin specimens were made with 20mm in diameter, 2mm in thickness. 1 made total 360 specimens, 10 per each group and the tensile bond strength was measured by using the Instron($M100EC^{(R)}$, Mecmesin Co., England). The results were as follows ; Comparisons of various impression materials. 1. In case of Impregum $F^{(R)}$, the bond strength of tray resin was decreased in order of SR $Ivolen^{(R)}$, Ostron $100^{(R)}$ Instant tray $mix^{(R)}$, $Lightplast^{(R)}$. All groups excluding Ostron $100^{(R)}$, Instant tray $mix^{(R)}$ are significant difference (p<0.05). Drying time after applying adhesive, the tensile bond strength of tray resin was insignificantly decreased in order of 10 min drying time group. 1 min drying time group. 5 min drying time group. 2. In case of Permlastic $regular^{(R)}$ the bond strength of tray resin was insignificantly decreased in order of Ostron $100^{(R)}$. SR $Ivolen^{(R)}$, Instant tray $mix^{(R)}$ $Lightplast^{(R)}$. About drying time after applying adhesive, the tensile bond strength of tray resin was significantly decreased in order of 5 min drying time group, 10 min drying time group, 1 min drying time group(p<0.05). 3. In case of Exaflex $regular^{(R)}$. the bond strength of tray resin was decreased in order of $Lightplast^{(R)}$, SR $Ivolen^{(R)}$, Instant tray $mix^{(R)}$, Ostron $100^{(R)}$. $Lightplast^{(R)}$ was significant difference(p<0.05). About drying time after applying adhesive, the tensile bond strength of tray resin was decreased in order of 5 min drying time group, 10 min drying time group, 1 min drying time group(p<0.05). Especially 5 min ding time group was significant difference(p<0.05). According to the results of this study, we can see the greatest tensile bond strength when using Impregrm $F^{(R)}$ and Permlastic $regular^{(R)}$ with self curing tray resin, when using Exaflex $regular^{(R)}$ with light activated tray resin In my opinion, adhesive should be dried more than 5 min before impression taking to achieve the greatest tensile bond strength.

단배부 절개를 이용한 무지 외반증 수술

송경원,박인헌,김갑래,이승용,현윤석,서은호,Song, Kyung-Won,Park, In-Heon,Kim, Gab-Lae,Lee, Seung-Yong,Hyun, Youn-Seok,Seo, Eun-Ho 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: In this study, we introduced a newly developed technique of operation for hallux valgus. We used a single dorsal incision to correct major components of Bunion in stead of two or three incisions, which had been used by most of surgeons for long time. Materials and Methods: Between 2003 and 2005, 27 feet with hallux valgus deformity were operated through single dorsal incision. 10 out of 17 patients underwent operation on both feet, 5 patient underwent operation on left feet, remaining 2 underwent operation on right. There were 16 women and 1 man. Average age of patients was 45 (range, 21-59). Post operatively all feet were evaluated by physical examination, Maryland Foot score profile, radiographic measurements and complication. Results: Maryland foot score profile increased from preoperative 67/100 to postoperative 95/100. Most patients satisfied pain relieve and cosmesis. Average preoperative intermetatarsal angle was 15 degrees, which were decreased to 9 degrees after operation and average preoperative hallux valgus angle was 32 degrees, which were decreased to 12 degrees after operation. Conclusion: According to our experience, the single dorsal incision technic for correction of moderate to severe hallux valgus deformities was rather safe and easily performed without noticeable complication with almost same results as multiple incisions technics. We highly recommend this technic to be tried by foot surgeons without hesitation.

천미골부에 발생한 내피동종양

송경원(Kyung Won Song),조덕연(Duck Yun Cho),김기용(Key Yong Kim) 대한정형외과학회 1978 대한정형외과학회지 Vol.13 No.2

성인의 상완골 원위부 과간 골절에 대한 수술적 치료

송경원 ( Kyung Won Song ),이승용 ( Seung Yong Lee ),신성일 ( Sung Il Shin ),이진영 ( Jin Young Lee ),김갑래 ( Kab Rae Kim ),오형석 ( Hyung Seok Oh ),김진덕 ( Jin Duck Kim ),최대은 ( Dae Eun Choi ) 대한골절학회 2006 대한골절학회지 Vol.19 No.1

목적: 성인의 상완골 원위부 과간 골절의 치료에 있어 기존의 후방 도달법, 경주두 도달법 과는 달리 삼두근의 절제나 주두 절골술 없이 변형된 후방 도달법으로 내고정한 경우 골유합 시기 및 합병증을 분석하여 그 유용성을 알아보고자 한다. 대상 및 방법: 1999년 1월부터 2003년 10월까지 본원에서 상완골 원위부 과간 골절 환자 중 1년이상 원격 추시가 가능한 20예를 대상으로 하였다. 전 례에서 삼두근의 절제나 주두 절골술 없이 변형된 후방 도달법으로 내고정하고 골유합, 합병증, 술 후 기능을 분석하였다. 결과: 평균 추시기간은 12.8개월, 평균 연령은 55세였다, 거의 모든 예에서 만족스런 일차적 골유합을 얻었으며 평균 유합 기간은 14주였다. 척골신경 손상과 내고정 소실 등의 합병증은 각 2례씩 있었다. 평균운동 범위는 110도 (65∼120도), 신전 제한이 평균 8도 (5∼15도), 후속 굴곡은 120도 (75∼140도)였다. Riseborough와 Radin의 척도에 따른 기능적 평가에서는 총 13례에서 우수, 4례에서 양호, 3례에서 불량의 결과를 보였다. 결론: 성인의 상완골 원위부 과간 골절의 치료에 있어서 변형된 후방 도달법을 이용한 술식은 골이식이 필요할 정도의 심한 관절내 분쇄에서는 어렵다는 제한이 있지만 그 외는 삼두근과 주두를 보존하면서도 관절면의 정확한 정복과 견고한 내고정을 위해 충분한 시야를 확보하였고 만족스런 골유합, 합병증 및 기능평가에 있어 임상적으로 좋은 결과를 얻었다. Purpose: To evaluate and report the clinical results of the treatment of distal humerus intercondylar fractures treated with internal fixation through the modified posterior approach. Materials and Methods: From January 1999 to October 2003, 20 patient who had intercondyle fracture of the distal humerus treated with internal fixation through the modified posterior approach. We evaluated bone union, complication, postoperative elbow function. Results: The average follow up period was 12.8 months. Nearly all most cases united at 14 weeks in an average. There were two neuropraxia and two hardware failure. The range of the elbow joint motion was flexion contracture 8 degree (5∼15 degree) to further flextion 120 degree (75∼140 degree) in average. The functional result with Riseborough and Radin`s functional scale were as follows; 13 good, 4 fair, 3 poor. Conclusion: Not with severe comminuted like type C3 fracture, but in cases with intercondylar distal humerus fracture the modified posterior approach provided satisfactory exposure for open reduction and rigid internal fixation with satisfactory bone union. There was satisfactory bone union and good clinical result in postoperative elbow function.

火傷患者 443例에 對한 臨床的 考察

宋坰元(Kyung Won Song),洪起雄(Ki Ung Hong),李庸彰(Yong Chang Lee),朴容喆(Yong Cho Park) 대한외과학회 1980 Annals of Surgical Treatment and Research Vol.22 No.8

역행적 골수강 내 금속정 고정술을 이용한 대퇴골 골절의 치료

송경원 ( Kyung Won Song ),이승용 ( Seung Yong Lee ),신성일 ( Sung Il Shin ),이진영 ( Jin Young Lee ),김갑래 ( Gab Lae Kim ),최대은 ( Dae Eun Choi ),고영석 ( Young Suk Ko ),오형석 ( Hyung Suk Oh ) 대한골절학회 2006 대한골절학회지 Vol.19 No.3

목적: 역행적 골수강 내 금속정 고정술로 치료가 편리하였던 대퇴골 골절의 예들을 후향적으로 연구하여 치료의 효용성에 대해 알아보고자 한다. 대상 및 방법: 2001년 3월부터 2003년 3월까지 역행적 골수강 내 금속정 고정술 후 최소 18개월 이상 추시가 가능하였던 대퇴골 골절 환자 32명(34예)을 대상으로 연구하였다. 골절의 분류는 골절의 해부학적 위치에 의하면 대퇴골 간부 골절 6예, 원위부 골절 28예였으며 AO 골절 분류에 의하면 대퇴부 간부 골절의 경우 A1골절 1예, A2골절 1예, A3골절 2예, C1골절 2예였고 대퇴부 원위부 골절의 경우는 A1골절 11예, A2골절 7예, A3골절 7예, B1골절 1예, C1골절 2예였다. 그 중 개방성 골절은 5예로 Gustilo 등의 분류에 의하면 type I 3명, type II 2명이었다. 방사선 검사를 통해 골유합 시기 및 불유합, 부정유합 등을 평가하였고 임상적 검사를 통해 동통 및 보행 장해를 평가하였다. 특히 슬관절 기능은 술 후 18개월 후에 Knee score를 통해 평가하였다. 결과: 평균 골유합 기간은 16주(범위 12∼20주)였고 총 34예 중 골유합 30예, 불유합 4예였으며 나사못 부전이 3예 있었으나 이외의 합병증은 없었다. 슬관절의 기능은 29예에서는 정상적으로 슬관절 운동 범위가 회복되었으나 5예에서 슬관절 운동이 제한되었으며 Knee score8)에 의한 슬관절 기능 평가는 우수 28예, 양호 1예, 불량 5예였다. 결론: 대퇴골 골절에 있어서 역행적 골수강 내 금속정 고정술은 수술 시 슬관절에 손상을 줄 수 있다는 단점이 있으나 동측 하지의 동반된 골절이나 다발성 골절이 있는 환자, 전신 상태가 불량한 환자, 그리고 대퇴골 원위부 골절 환자 등에 있어서 수술이 편리할 뿐만 아니라 마취 및 수술시간을 줄일 수 있는 유용한 수술법으로 생각된다. Purpose: To evaluate the effectiveness. analyze the result after retrograde intramedullary (IM) nailing in femoral shaft fracture Materials and Methods: Thirty-four femoral shaft fracture (32 patients) were operated with retrograde IM nail and followed the result for more than 18 month from march 2001 to march 2003. There were 6 of femoral mid shaft fractures and 28 of distal femur fractures. According to AO classification, there were 1 of A1, 1 of A2, 2 of A3, 2 of C1 in femoral mid shaft fracture and 11 of A1, 7 of A2, 7 of A3, 1 of B1, 2 of C1 in distal femur fracture. They included 5 open fracrures. By Gustilo classification there were 3 of type I, 2 of type II. Through radiologic study we evaluated the time of union, nonunion, malunion. And in clinical evaluation we checked knee function in 18 month after operation. Results: It took 16 weeks (range 12∼20 weeks) for average bone uion period. 30 cases out of 34 cases had the bone union but 4 cases showed nonunion. There were not any complication except 3 cases of screw migration. Full rage of motion was gained in 29 cases. However knee stiffness occurred in 5 cases. The knee function through knee score was assessed by showing 28 of excellent, 1 of good, 5 of poor. Conclusion: Even though the retrograde intramedullary nailing may have some defect to be able to damage to knee joint in operating, It can be useful surgical technique for femoral shaft fracture in such as ipsilateral fracture or multiple fracture, poor general condition, and so on.

C-D 또는 MOSS기구를 이용한 퇴행성 척추관 협착증의 수술적 치료

송경원(Kyung Won Song),김영훈(Young Hoon Kim) 대한정형외과학회 1991 대한정형외과학회지 Vol.26 No.1

척수 허혈 후 토끼 척수 전각에서 Glutamate와 GABA 면역반응구조의 변화

송경원(Kyung Won Song),박인헌(In Heon Park),원무호(Moo Ho Won),송영선(Young Sun Song),이승용(Seung Yong Lee),오원석(Won Seok Oh),박재용(Jae Yong Park),최대은(Dae Eun Choi) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.6

목적: 척수 허혈(spinal ischemia)이 시간 경과에 따라 신경전달물질인 glutamate와 γ-aminobutyric acid (GABA) 면역 반응양상의 변화에 미치는 영향을 면역조직학적으로 규명하고자 본 연구를 수행하였다. 대상 및 방법: 토끼를 실험동물로 하여 정상군과 15분간 척수 허혈 후 재관류한 실험군(허혈-재관류 후 0.5, 1, 3, 6, 12, 24 및 48시간)의 척수 제7요수분절 전각에서 glutamate 및 GABA 면역조직화학반응의 변화를 관찰하였다. 결과: Glutamate 면역반응양상은 30분 군의 제 Ⅸ층의 신경세포들에서 면역반응을 보였고, 주변의 신경섬유들에서 염색성이 증가한 후 감소하였으며, 6시간 군 이후부터 혈관 주변에서 면역염색성이 나타나기 시작하여 12시간 군까지 증가하였다. 그러나 24시간 군 이후부터 다시 감소하여 48시간 군에서는 면역염색이 거의 관찰되지 않았다. GABA 면역반응양상은 6시간 군부터 12시간 군에 걸쳐 신경세포가 소실된 부위를 중심으로 증가하였고, 이러한 증가 양상은 제 Ⅶ 및 제 Ⅷ층에서도 관찰되었다. 그러나 24시간 군 이후부터 GABA 면역염색성이 다시 감소하여 48시간 군에서는 면역염색성이 관찰되지 않았다. 결론: 척수 허혈-재관류 후 척수 전각에서 glutamate 면역반응양상의 변화는 허혈-재 관류 후 짧은 시간대부터 일어나며, GABA 면역반응양상은 glutamate에 비해 늦은 시간대에서 변화가 일어나는 것으로 사료된다. Purpose: This study was carried out to investigate chronological changes of glutamate and γ-aminobutyric acid (GABA) immunoreactivities in the anterior horn of the spinal cord after ischemia-reperfusion. Materials and Methods: Spinal cord ischemia was induced by clamping the abdominal aorta for 15 minutes in New Zealand white rabbit, and then the spinal cord was reperfused. These animals were sacrificed at 0.5, 1, 3, 6, 12, 24 and 48 hours after ischemia-reperfusion. Spinal cord sections at the level of L7 were immunostained against glutamate and GABA. Results: Glutamate immunoreactive neurons and fibers were first detected in the lamina Ⅸ at 30 minutes, but at 1 hour, the immunoreactivity returned to the control level. At 6 hour, glutamate immunoreactivity was observed around the blood vessels and its immunoreactivity increased between 6 and 12 hour. Thereafter the immunoreactivity decreased and eventually disappeared at 48 hours. GABA immunoreactivity increased in the anterior horn from 6 to 12 hours. Thereafter, GABA immunoreactivity decreased and eventually disappeared at 48 hours. Conclusion: These results suggest that the alteration of the glutamate immunoreactivity may occur much rapidly than that of GABA immunoreactivity in spinal anterior horn after ischemia-reperfusion.

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.