고령의 환자에서 발생한 대퇴 경부 부전골절의 임상결과 및 방사선학적 특징

예희욱 ( Hee-uk Ye ),이경재 ( Kyung-jae Lee ),민병우 ( Byung-woo Min ),임경환 ( Kyung-hwan Lim ),김범수 ( Beom-soo Kim ),김영훈 ( Young-hoon Kim ) 대한골절학회 2021 대한골절학회지 Vol.34 No.1

목적: 고령 환자에서 외상력 없이 발생하는 대퇴 경부 부전골절은 진단과 치료에 어려움이 있어 골절을 조기에 의심하는 것이 강조되고 있다. 저자들은 대퇴 경부 부전골절의 임상결과와 대퇴골 근위부의 구조 및 형태를 외상성 대퇴 경부 골절과 비교하여 특징을 찾고자 하였다. 대상 및 방법: 2010년 12월부터 2019년 12월까지 70세 이상 환자에서 발생한 12예의 대퇴 경부 부전골절 환자(제1군)와 외상성 대퇴 경부 골절 환자 50예(제2군)를 대상으로 하였다. 인구학적 정보와 단순 방사선 검사에서 계측한 피질 두께, 대퇴 골두 지름, 대퇴 경부 폭, 대퇴골 전자부 폭, 근위 대퇴골간부의 폭, 대퇴골 경간각 및 고관절 축 길이를 비교하였다. 결과: 12예 중 7예가 비전위 골절이었으며, 증상 발생 후 골절의 진단까지 평균 19.2일이 소요되었다. 방사선 사진에서는 대퇴 경부 내측 피질골의 두께가 1군에서 3.16 mm, 2군에서 4.11 mm로 두 군 간 유의한 차이를 보였다(p=0.004). 결론: 대퇴 경부 부전골절은 골절의 특성상 진단이 지연되는 경우가 많았다. 단순 방사선 사진에서 측정한 대퇴 경부 내측피질골의 두께는 자세한 병력청취와 함께 고려한다면 대퇴경부 부전골절을 조기에 의심하는 데 도움이 될 것으로 생각된다. Purpose: In elderly patients, femoral neck insufficiency fractures that occur without a history of trauma are difficult to diagnose and treat, so it is emphasized that early suspicion of fractures and additional diagnostic tests are conducted. Materials and Methods: Between December 2010 to December 2019, 12 femoral neck insufficiency fractures (group 1) were evaluated by comparing them with 50 traumatic femoral neck fractures of a similar age. Along with demographic data, neck cortical thickness, shaft cortical thickness, head diameter, neck width, trochanter width, shaft width, neck-shaft angle, hip axis length, femoral neck index on the simple radiographic image were compared. Results: Seven of the 12 cases were non-displaced fractures, and it took an average of 19.2 days to diagnose the fracture after the symptoms occurred. The height was smaller than the control group at 149.1 cm in group 1 and 157.2 cm in group 2 (p<0.001). The cortical thickness of the medial femoral neck showed significant differences between the two groups: 3.16 mm in group 1 and 4.11 mm in group 2 (p=0.004). There was no statistical difference in the other measurements. Conclusion: Femoral neck insufficiency fracture often has a delayed diagnosis because of the characteristics of the fracture. The cortical thickness of the medial femoral neck in simple radiographic images can help suspect femoral insufficiency fractures in elderly patients when considered with detailed medical history taking and a physical examination.

Gender Affects Early Postoperative Outcomes of Rotator Cuff Repair

조철현,예희욱,정재원,이영국 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2

The literature does not provide consistent information on the impact of patients’ gender on recovery after rotator cuff repair. The purpose of this study was to determine whether gender affects pain and functional recovery in the early postoperative period after rotator cuff repair. Methods: Eighty patients (40 men and 40 women) were prospectively enrolled. Pain intensity and functional recovery were evaluated, using visual analog scale (VAS) pain score and range of motion on each of the first 5 postoperative days, at 2 and 6 weeks and at 3, 6, and 12 months after surgery. Perioperative medication-related adverse effects and postoperative complications were also assessed. Results: The mean VAS pain score was significantly higher for women than men at 2 weeks after surgery (p = 0.035). For all other periods, there was no significant difference between men and women in VAS pain scores, although women had higher scores than men. Mean forward flexion in women was significantly lower than men at 6 weeks after surgery (p = 0.033) and the mean degree of external rotation in women was significantly lower than men at 6 weeks (p = 0.007) and at 3 months (p = 0.017) after surgery. There was no significant difference in medication-related adverse effects or postoperative complications. Conclusions: Women had more pain and slower recovery of shoulder motion than men during the first 3 months after rotator cuff repair. These findings can serve as guidelines for pain management and rehabilitation after surgery and can help explain postoperative recovery patterns to patients with scheduled rotator cuff repair.

Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases

이경재,민병우,장형규,예희욱,임경환 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.

Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

장형규,이경재,민병우,예희욱,임경환 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

Purpose: The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods: Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results: The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion: Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.

원위 쇄골 골절의 보존적 치료 후 발생한 불유합의 관련 인자

강철형(Chul-Hyung Kang),정재훈(Jae Hoon Jung),예희욱(Hee-Uk Ye),조철현(Chul-Hyun Cho) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.2

목적: 보존적 요법을 시행한 원위 쇄골 골절 환자의 치료 결과 및 불유합과 관련된 인자를 분석하고자 하였다. 대상 및 방법: 29명의 환자를 대상으로 하였으며, 단순 방사선 사진을 통해 Neer 분류, 오구 쇄골 간 거리, 초기 전위 및 분쇄 여부, 골유합 여부를 알아보았다. 임상적 결과 판정을 위해 최종 추시 시 University of California at Los Angeles (UCLA) 점수, American Shoulder and Elbow Surgeons (ASES) 점수 및 subjective shoulder value (SSV)를 측정하였다. 결과: 6예(20.7%)에서 불유합이 발생하였으며, 증상이 없는 불유합이 3예였다. 유합 군에서 최종 추시 시 평균 UCLA, ASES, SSV 점수는 30.9점, 88.3점, 87.0점이었고, 불유합 군에서는 26.7점, 76.2점, 70.8점이었으나 두 군 간의 통계적 유의성은 없었다. 고령 및 수상 당시 오구 쇄골 간 거리가 길수록 불유합의 빈도가 높았다(p=0.047, p=0.007). 결론: 원위 쇄골 골절의 보존적 치료 후 만족할 만한 중기 추시 임상적 결과를 보였으며, 고령 및 수상 당시 오구 쇄 간골 거리가 길었던 경우에 불유합이 잘 발생하는 것으로 나타났다. Purpose: The purpose of this study was to evaluate radiological and clinical outcomes and to analyze factors associated with nonunion after conservative management in patients with distal clavicle fracture. Materials and Methods: We analyzed 29 cases. Neer type, coracoclavicular distance (CCD), initial displacement, comminution, union, and presence of bony union were evaluated by plain radiographs. Clinical outcomes according to University of California at Los Angeles (UCLA), American Shoulder and Elbow Surgeons (ASES), and subjective shoulder value (SSV) scores were assessed. Results: Six cases (20.7%) had developed nonunion. Three cases had asymptomatic nonunion. Mean UCLA, ASES, and SSV scores were 30.9, 88.3, and 87.0 in the union group and 26.7, 76.2, and 70.8 in the nonunion group. Although the nonunion group had inferior clinical outcome compared to the union group, there was no significant difference between the two groups. Older age and more CCD showed correlation with nonunion (p=0.047, p=0.007). Conclusion: Conservative management of distal clavicle fractures provided satisfactory clinical outcomes. The rate of symptomatic nonunion was 10.4%. Occurrence of nonunion showed correlation with older age and more CCD.

골다공증성 고관절 골절 수술 후 반대측의 2차 고관절 골절의 위험인자

이경재 ( Kyung-jae Lee ),최정훈 ( Jung-hoon Choi ),예희욱 ( Hee-uk Ye ),김영훈 ( Young-hun Kim ),임경환 ( Kyung-hwan Lim ) 대한골절학회 2021 대한골절학회지 Vol.34 No.2

목적: 골다공증성 고관절 골절 수술 후 발생한 새로운 고관절 골절(2차 골절)의 특성과 위험인자에 대하여 알아보고자 하였다. 대상 및 방법: 본원에 2008년 3월부터 2016년 2월까지 골다공증성 고관절 골절로 수술한 이후 추시상 반대측 고관절의 2차 골절이 발생한 68명(실험군)을 대상으로 조사하였다. 이들을 일측에만 골다공증성 고관절 골절이 발생하여 수술한 475명(대조군)과 나이, 성별, 체질량지수, 골밀도, 골다공증약 복용력, 골절 과거력, 동반 질환, 수술 방법, 수술 전후 보행 능력, 수술 후 섬망 여부에 대하여 후향적으로 비교 분석하였다. 결과: 두 군 간의 나이, 성별, 체질량지수, 골밀도, 골다공증약 복용력, 동반 질환, 골절 형태, 수술 방법, 수술 후 섬망에서 유의한 차이는 없었다. 첫 수술 후 3개월째 평가한 보행 능력이 실험군에서 대조군보다 유의하게 더 낮았다(p<0.001). 결론: 첫 수술 후 3개월째의 보행 능력 감소는 골다공증성 고관절 골절 수술 후 발생하는 2차 고관절 골절의 위험인자로 판단되며 그 원인에 대한 분석이 필요하고 기능회복 치료 프로그램의 개발 및 보행 능력 회복에 대한 세심한 관리가 필요하겠다. Purpose: This study examined the risk factors contributing to subsequent hip fractures in patients with osteoporotic hip fractures. Materials and Methods: Between March 2008 and February 2016, 68 patients sustained a subsequent contralateral hip fracture after surgery for a primary osteoporotic hip fracture (Study group). The patients were compared with 475 patients who had been followed up for a minimum of one year with a unilateral osteoporotic hip fracture (Control group). The demographic data, bone mineral density (BMD), osteoporosis medication, osteoporotic fracture history, comorbid disease, type of surgery, preoperative, postoperative ambulatory capacity, and postoperative delirium in the two groups were compared. Results: The demographic data, BMD, osteoporosis medication history, comorbid disease, type of surgery, and postoperative delirium were similar in the two groups. At three months after the primary surgery, the poor ambulatory capacity was significantly higher in the study group than the control group (p<0.001). Conclusion: The ambulatory capacity after primary surgery is an important risk factor in the occurrence of subsequent hip fractures after osteoporotic hip fracture. Cause analysis regarding the poor ambulatory capacity after surgery will be necessary, and the development of a functional recovery program and careful management of the walking ability recovery will be needed.