제5 중족골 기저부 골절의 유발인자 및 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

Danis-Weber B형 족관절 외과 골절의 고정방법 비교연구 : Antiglide 금속판 고정술 대 외측 금속판 고정술

신헌규,최재열,강동호,Shin, Hun-Kyu,Choi, Jae-Yeol,Kang, Dong-Ho 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate the advantages of the antiglide plate fixation procedure for Danis-Weber type B lateral malleolar fractures of ankle compared to other methods of lateral plate fixation. Materials and Methods: We reviewed 70 cases that antiglide plate fixation and lateral plate fixation procedures were performed from Mar. 2001 through Mar. 2006. Of the total 70 cases, they were divided into two groups ; 22 cases were treated with the antiglide plate procedure (Group I) and 48 cases were treated with the lateral plate procedure (Group II). The results of the two groups were analyzed both radiographically and clinically using Ankle-Hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS). Results: All fractures were healed at average of 8 weeks both radiographically and clinically. According to the Ankle-Hindfoot scale, all cases of Group I and 48 cases of Group II were above 80 points. 2 cases (9%) in Group I complained of peroneal tendinitis, while 19 cases (39%) in Group II showed skin irritation resulting from the screw or the plate. A total of 6 cases (27%) in Group I and 27 cases (55%) in Group II complained cosmetic problems. Conclusion: we concluded that the antiglide plate fixation for Danis-Weber type B lateral malleolar fractures is one of the good methods. But, further analysis will be need to find a solution for the peroneal tendinitis.

경골 간부를 침범한 Pilon 골절에서 2단계 MIPO 수기를 이용한 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate surgical treatment using two-staged MIPO technique in tibial pilon fractures involving tibial shaft. Materials and Methods: Twelve patients, who underwent two-staged MIPO technique for pilon fractures involving tibial shaft between January 2003 and May 2005, were followed for more than one year. Radiographs were graded by the criteria of Anglen and ankle functions were graded by the criteria of Mast and Teipner. Ankle function, union time and postoperative complications were also analysed. Results: Clinically there were eight (67%) good results, three (25%) fair results and one (8%) poor result. At the last follow-up, the radiographic results showed seven (58%) excellent results, three (25%) good results, and two (17%) fair results. During the follow up, There was one case of nonunion Conclusion: Two-staged MIPO techinque is one of the good methods for the treatment of pilon fractures invloving tibial shaft.

환추축 불안정성이 없는 치상돌기 후방부의 가성 종양을 동반한 경추 척수증

신헌규(Hun-Kyu Shin),홍석우(Seok Woo Hong),박진훈(Jin Hun Park),손동욱(Dong-Wook Son) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.1

82세 남자 환자로 경부 통증, 양측 상지 위약감 및 보행장애를 주소로 내원하였다. 환자는 류마티스 관절염이나 다른 특이 과거력은 없던 분이었고 타 병원에서 시행한 경추부 자기공명영상에서 치상돌기 후방의 가성 종양 소견을 확인할 수 있었다. 단순 방사선 검사상에서 환축추 불안정성은 보이지 않았으며 이에 후방 유합술은 시행하지 않고 환추의 후궁 절제술만 시행하였다. 수술 직후 통증은 감소하였고 신경학적 증상도 호전되는 경과를 확인할 수 있었다. 환축추 불안정성이 없는 치상돌기 후방 가성 종양의 경우 환추의 후궁절제술만으로 증상 호전을 기대해 볼 수 있을 것으로 생각한다. An 82-year-old male patient was admitted for neck pain, motor weakness in both upper extremities, and gait disorder. The patient had no history of rheumatoid arthritis or other specific histories, and the findings of cervical myelopathy with retro-odontoid pseudotumor were confirmed by cervical magnetic resonance imaging. On cervical radiography, there was no evidence of atlantoaxial instability or subluxation. Therefore, posterior fusion was not performed; only a C1 laminectomy was performed. Immediately after surgery, the pain decreased, and neurological symptoms were also improved. In the case of a retro-odontoid pseudotumor without atlantoaxial instability, it is believed that the symptoms can be improved only with C1 laminectomy.

수술적 치료 결과 향상을 위한 수술 전후 약물요법

신헌규(Hun Kyu Shin),이재욱(Jae Wook Lee),송승철(Seung Cheol Song) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.1

고령화의 진행 및 의학 기술의 발전으로 고령인구의 척추 수술이 증가하고 있다. 하지만 고령인구의 경우 젊은 연령에 비해 수술 범위가 넓어질 수 있고 골다공증이 동반될 수 있기 때문에 성공적인 수술 결과를 얻기 위해서는 세심한 준비가 필요하다. 이에 저자는 고령인구에서 수술적 치료 결과 향상을 위해 수술 전, 후 필요한 약물 요법 중 특별히 골다공증의 치료에 중점을 두어 살펴보고자 한다. As the population grows older and medical treatments are advancing, the number of spine surgeries in elderly patients has been increasing. To obtain a successful outcomes of spine surgery in elderly patients, surgeons should prepare meticulously because elderly patients can have osteoporosis and surgery can be more extensive than in younger patients. Therefore, this study reviewed the perioperative medical treatment, particularly for osteoporosis, to improve the surgical outcomes in elderly patients.

다발성 골괴사를 동반한 Schmorl씨 결절

신헌규(Hun-Kyu Shin),박기태(Ki Tae Park),홍석우(Seok Woo Hong) 대한정형외과학회 2022 대한정형외과학회지 Vol.57 No.2

추간판이 연골단판 및 골단판을 통해 인접 척추체로 돌출되는 질환인 Schmorl씨 결절은 척추체 주변부의 통증 및 골괴사를 일으킬 수 있는 질환이다. 저자들은 고관절 및 슬관절의 골괴사 병력이 있는 환자에서 Schmorl씨 결절 부근의 척추체 골괴사가 동반된 59세 여자의 치료를 경험하였다. Schmorl씨 결절과 동반된 골괴사가 척추 이외의 다른 부위에 동시에 나타난 경우는 아직 국내에 보고된 바 없어 저자들은 문헌 고찰과 함께 이를 보고하고자 한다. A Schmorl’s node is defined as intervertebral disc herniation from the endplate to the adjacent vertebral body. This can cause pain and osteonecrosis in the vertebral body. The authors encountered a 59-year-old female patient with a Schmorl’s node accompanying multiple osteonecroses. To the best of the author’s knowledge, a Schmorl’s node accompanying multiple osteonecroses has not been reported in Korea. The authors report this case with a literature review.

회전근 개 파열의 진단을 위한 극상근 검사에서 유용한 양성 징후는 무엇인가?

신헌규(Hun-Kyu Shin),김유진(Eugene Kim),정화재(Hwa-Jae Jeong),김종민(Jong-Min Kim),최재열(Jae-Yol Choi),이용택(Yong-Taek Lee) 대한견주관절의학회 2007 대한견주관절의학회지 Vol.10 No.1

AML (Anatomic Medullary Locking) 인공관절 삽입물을 이용한 고관절 전치환술의 임상 및 방사선학적 결과 -최소 7년 이상 추시-

신헌규 ( Hun Kyu Shin ),최재열 ( Jae Yeol Choi ),정화재 ( Haw Jae Jeong ),임종준 ( Jong Joon Lim ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.4

Purpose: To evaluate the long-term results (minimum 7 Years` follow-up) of cementless total hip arthroplasty using an Anatomic Locking Medullary (AML) hip prosthesis. Materials and Methods: Fifty-one patients (57 hips) underwent total hip arthroplasty between January 1995 and July 2002. They were followed up for a minimum of seven years (7.1 to 14.6) after the initial operation. The mean age of the patients was 56.8 years. The radiographs were reviewed and the clinical results were evaluated. Results: The mean Harris hip score improved from 52.4 points preoperatively to 88.2 points postoperatively. Of the 40 hips showing a good press-fit, 29 hips (72.5%) exhibited bone ingrowth fixation. Of the remaining 17 hips with a poorer press-fit, 7 hips (35.3%) showed bone ingrowth fixation and 6 hips (35.3%) had unstable fixation. Of the 36 hips showing bone ingrowth fixation, 28 hips (77.8%) exhibited stress mediated bone resorption. On the last follow-up radiographic examination, osteolysis occurred around the femoral stem and acetabular cup in 21 (36.8%) and 6 (10.5%) hips, respectively. Conclusion: The results of cementless AML total hip arthroplasty were acceptable up to 7 years but polyethylene wear and osteolysis should be followed carefully over the long term.

대퇴골두 무혈성 괴사 환자에 대한 양극성 인공고관절 반치환술

신헌규 ( Hun Kyu Shin ),정화재 ( Hwa Jae Jung ),최재열 ( Jae Yeol Chooi ),김홍균 ( Hong Kyun Kim ),김영훈 ( Young Hun Kim ),이종근 ( Jong Keun Lee ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.4

목적: AML 무시멘트 대퇴 스템을 이용한 양극성 인공 고관절 반치환술을 시행한 대퇴 골두 무혈성 괴사 환자들의 임상적, 방사선학적 치료 결과를 보고하고자 한다. 대상 및 방법: 1994년부터 1998년 까지 대퇴 골두 무혈성 괴사 환자에서 AML 무시멘트 대퇴스템을 이용한 양극성 인공고관절 반치환술을 시행 받은 환자 중 5년 이상 추시가 가능했던 환자 20명 22예를 대상으로 수술 후 임상적, 방사선적 결과를 분석하였다.결과: 총 20명중 남자 13명, 여자 7명 이었고, 평균 추시시간은 6년 2개월로 수술 당시 평균연령은 49세였고 Harris Hip score를 사용한 임상적 결과로는 술 전 53,5점에서 87.9점으로 향상된 결과를 얻었으며, 서혜부 및 대퇴 동통은 총 3예 (17%)에서 발생되었다. 방사선적 결과롤 비구의 근위부이동이 1 예에서 보였으며 대퇴 삽입물은 안정적인 고정을 보여주었다. 결론: 대퇴 골두 무혈성 괴사 환자의 치료로 시행한 AML 무시멘트 양극성 인공 고관절 반치환술은 비교적 낮은 합병증과 임상적, 방사선학적 안정성을 고려해 볼 때 만족스러운 치료 결과을 얻을 수 있을 것으로 사료된다. Purpose: We wished to analyze the clinical and radiological results of bipolar hip arthroplasty using AML cementless stems in patients with osteonecrosis of the femoral head. Materials and Methods: Between 1994 and 1998, 20 patients who underwent bipolar prosthetic replacement using AML cementless stems for osteonecrosis of the femoral head. We retrospectively reviewed and analyzed the clinical and radiological results of 22 hips of 20 patients, and the minimum follow-up period was 5 years. Results: The twenty patients included 13 men and 7 women. The mean duration of follow-up was 6 years and 2 months. The mean patient age was 49 years. The mean Harris hip score was improved from preoperative 53.5 points to 87.9 points at the latest follow up. Three patients (17%) had complaints about groin or thigh pain. One hip (5%) developed acetabulum migration. All the femoral stems remained stable. Conclusion: AML cementless bipolar hip arthroplasty for osteonecrosis of the femoral head produced satisfactory clinical and radiologic results on this follow-up study, and there was a relatively low rate of complications.

무지외반증 치료에서 근위 중족골 절골술과 원위 연부조직 교정술 후 종자골의 교정정도

정화재,신헌규,장일성,이종근,Jung, Hwa-Jae,Shin, Hun-Kyu,Chang, Il-Sung,Lee, Jong-Keun 대한족부족관절학회 2005 대한족부족관절학회지 Vol.9 No.1

Purpose: A retrospective review of the radiographs of the proximal metatarsal osteotomy and distal soft tissue procedure for hallux valgus, evaluating the correction of the tibial sesamoid, was undertaken. We evaluated the correlation between the reduction of the tibial sesamoid and the clinical outcomes. Materials and Methods: 17 patients (23 cases) with moderate to severe hallux valgus deformity underwent the proximal metatarsal osteotomy and distal soft tissue procedure. The preoperative and last follow-up radiographs were reviewed according to the tibial sesamoid grade classification recommended by the Research Committee of the American Orthopedic Foot and Ankle Society (AOFAS). We divided them into two groups according to the reduction of the tibial sesamoid. We anaylyzed the clinical outcomes in each group according to Mayo Clinic Forefoot Scoring System (FFSS). Results: In all of the patients, the preoperative tibial sesamoid position were grade 2 or greater. At the last follow-up, 52% (n=12) were grade 1 or less (Group I) and 48% (n=11) were grade 2 or greater (Group II). In group I, the forefoot score was improved from preoperative mean value of 32.0 points to final follow-up value of 66.3 points. In group II, the forefoot score was improved from preoperative mean value of 31.7 points to final follow-up value of 65.9 points. There was no statistical significance between postoperative, average scores in group I and II (p>0.05). Conclusion: The position of the tibial sesamoid was corrected insufficiently in almost half of all cases. In view of clinical outcomes, there was no significant difference between the corrected group and the other group.