증후성 설상골 주위 부골: 증례 보고

우승훈,신원철,Woo, Seung Hun,Shin, Won Chul 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.2

An extremely rare accessory bone of the foot located in the distal portion of the navicular that articulates with the medial cuneiform was observed. Os paracuneiforme is usually located medial to the medial cuneiform or the naviculocuneiform joint. Although os paracuneiforme is often referred to as an accessory bone around the foot, few cases of this type of accessory bone have been reported. This paper reports a patient with a painful Os paracuneiform who underwent surgical excision of the accessory bone.

외측 발목 불안정성을 치료하지 않으면 어떻게 되는가

우승훈,정형진,Woo, Seung Hun,Chung, Hyung-Jin 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.1

The term chronic lateral ankle instability (CLAI) embraces a spectrum of conditions that involve functional and mechanical instability, both in athletes and lower-demand patients. The hallmarks of CLAI are recurrent sprains, persistent pain, and repeated episodes of the ankle giving way. CLAI is the main complication of acute ankle sprains, which can cause discomfort in daily and sports activity. Approximately 10% to 30% of patients with acute ligament ruptures will develop chronic instability over the course of a year from the index injury. An accurate diagnostic approach and successful treatment plan should be established based on a comprehensive understanding of the concept of functional and mechanical instability. Unfortunately, the optimal modality for the management of CLAI is unclear. Even after conservative treatment or surgical intervention, it could result in degenerative changes to the ankle joint in the long term. Thus far, the incidence of ligamentous posttraumatic ankle osteoarthritis was reported to be 13% to 78%. The mean latency time between injury and osteoarthritis was at least 10 to 34.3 years. CLAI is an important pathological condition that can cause discomfort or dysfunction in daily activity in the short term, resulting in joint destruction in the long term. Therefore, it is important to understand the various complications that can occur when CLAI is not treated properly.

불안정성 대퇴골 전자간 골절에 대한 제2형 항회전 근위 대퇴 골수정 내고정술의 치료 결과

우승훈(Seung Hun Woo),이상민(Sang Min Lee),신원철(Won Chul Shin),서근택(Kuen Tak Suh) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.4

목적: 불안정성 대퇴골 전자간 골절로 제2형 항회전 근위 대퇴 골수정으로 수술을 시행했던 환자들을 대상으로 그 결과를 보고하고자 한다. 대상 및 방법: 2009년 8월부터 2013년 12월까지 불안정성 골절로 진단되어 제2형 항회전 근위 대퇴 골수정 내고정술을 시행한 뒤 1년 이상 추시가 가능하였던 환자 108예를 대상으로 하였다. 평균 추시 기간은 15.2개월이었다. 방사선 사진에서 골절 정복 상태, 나선 칼날의 활강 정도, 골유합 및 합병증 등을 조사하였다. 임상적으로 최종 추시 시 통증 및 보행 정도, 일상 생활 능력의 회복 등에 대한 평가를 시행하였다. 결과: 전 예에서 good 또는 acceptable한 정복 상태를 얻었다. 평균 나선 칼날의 활강은 4.1 mm였으며 골유합까지 평균 4.8개월이 소요되었다. 골수정 파손 1예, 불유합 1예로 총 2예의 합병증이 관찰되었다. Charnley 동통 점수는 평균 5.1점이었으며, 술 후 74.1% 에서 술 전 보행 능력을 회복하였다. 수상 전 일상 생활 능력을 회복한 경우는 60.2%였다. 결론: 제2형 항회전 근위 대퇴 골수정은 불안정성 대퇴골 전자간 골절의 치료에 있어서 만족할 만한 결과를 보였으나 술 후 보행 능력의 감소 및 일상 생활로의 늦은 복귀를 초래할 수 있어 이에 대한 추가적인 연구가 필요할 것으로 생각된다. Purpose: The purpose of this study was to evaluate radiologic and functional outcomes of patients with unstable femoral intertrochanteric fractures treated with proximal femoral nail antirotation II (PFNA II). Materials and Methods: Between August 2009 and December 2013, 108 hips (108 patients) with unstable femoral intertrochanteric fractures were treated with PFNA II and followed for at least 1 year. The mean follow-up period was 15.2 months. The radiographic outcomes, reduction state, sliding distance of the helical blade, bone union, and complications were assessed. The functional outcomes were assessed according to the Charnley hip pain scoring system, walking ability, and the Activities of Daily Living index. Results: The postoperative radiograph showed a good or acceptable reduction in all cases. The mean sliding length of the blade was 4.1 mm. The mean duration of radiologic bone union was 4.8 months. There were 2 postoperative complications including nail breakage and nonunion. The mean Charnley hip pain score was 5.1 points. Preoperative walking ability was restored for 74.1% of patients. Preoperative activities of daily life were restored for 60.2% of patients. Conclusion: PFNA II used for treatment of unstable intertrochanteric fracture showed favorable outcomes. However, due to decreasing walking ability and delayed return to the activities of daily living, further studies are needed, focusing on functional recovery and rehabilitation to improve postoperative clinical outcomes.

Sanders 4형 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 치료 결과 비교

우승훈 (Seung Hun Woo),정형진(Hyung-Jin Chung),배서영(Su-Young Bae),김순규(Sun-Kyu Kim) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: Sanders 4형 관절내 종골 골절에 대한 관혈적 정복술 및 내고정술과 일차성 거골하 관절 유합술의 임상적 결과를 분석하고자 하였다. 대상 및 방법: 2003년 3월부터 2013년 11월까지 Sanders 4형 종골 골절로 진단되어 관혈적 정복술 및 내고정술을 시행한 11예와 일차성 거골하 관절 유합술을 시행한 11예를 비교 분석하였다. 평균 추시 기간은 34.6개월(18-72개월)이었다. 술 후 6, 12개월 및 최종 추시 시 American Orthopedic Foot and Ankle Society’s ankle-hindfoot scale (AOFAS) 점수 및 visual analogue scale pain (VAS) 통증 점수를 측정하였고 환자 만족도, 직장 복귀 여부 및 술 후 합병증을 조사하였다. 결과: 최종 추시 시 AOFAS 점수 및 VAS 점수는 양 군 간 의미 있는 차이는 보이지 않았으나(p>0.05) 일차성 거골하 관절 유합술을 시행한 군에서 환자의 만족도가 높았다(p=0.008). 관혈적 정복술군에서 증상을 동반한 거골하 관절염으로 이차성 거골하 관절 유합술을 5예(45.5%)에서 시행하였다. 결론: 양 군 간 임상적으로 의미 있는 결과의 차이는 보이지 않았으나 일차성 거골하 관절 유합술이 술 후 만족도가 높아 빠른 일상 복귀를 필요로 하는 환자 혹은 2차 수술이 불가피할 것으로 예상되는 경우 일차성 거골하 관절 유합술을 고려해 볼 수 있을 것으로 생각된다. Purpose: To compare clinical outcome of Sanders type IV intra-articular calcaneal fracture treated with open reduction and internal fixation (ORIF) versus ORIF and primary subtalar arthrodesis (PSTA). Materials and Methods: Between March 2003 and November 2013, 22 patients with 22 Sanders type 4 intra-articular calcaneal fractures were included in this study. Of these, 11 were treated with ORIF (ORIF group), and 11 were treated with ORIF and PSTA (PSTA group). The mean follow-up period was 34.6 months (range, 18–72 months). Clinical outcomes were assessed along with the American Orthopedic Foot and Ankle Society’s ankle-hindfoot scale (AOFAS score), and the visual analogue scale pain score (VAS score) at 6-month, 12-month, and last follow-up. Patient satisfaction, return to previous occupation and postoperative complications were also investigated. Results: The results for ORIF did not differ from those for PSTA based on the last follow-up AOFAS scores or the VAS scores (p>0.05). However, patient satisfaction was significantly higher in the PSTA group (p=0.008). Secondary subtalar arthrodesis was conducted in five patients (45.5%) of the ORIF group within 2 years postoperatively. Conclusion: We were unable to demonstrate a significant difference in clinical outcomes between ORIF and PSTA; however, the patient satisfaction was higher in the PSTA group. PSTA may be a suitable choice for patients who need fast recovery to daily activity and to prevent the need for secondary subtalar arthrodesis.

관절 내 종골 골절에서 Ollier 접근법을 이용한 나사못 고정술 시 삼면 피질골 이식

방태정,배서영,우승훈,정형진,Bang, Taejung,Bae, Su-Young,Woo, Seung Hun,Chung, Hyung-Jin 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.1

Purpose: Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach. Materials and Methods: We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricortical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the $B{\ddot{o}}hler$ angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications. Results: According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the $B{\ddot{o}}hler$ angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546). Conclusion: We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.

급성 족근과 골절 환자에서 시행한 컴퓨터 단층촬영 영상의 유용성

전숙하,배서영,안수형,정형진,우승훈,Jeon, Suk-Ha,Bae, Su-Young,Ahn, Soo-Hyung,Chung, Hyung-Jin,Woo, Seung-Hun 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

Purpose: We compared plain radiographs with computed tomography (CT) images to evaluate the usefulness of preoperative CT in acute ankle malleolar fracture in terms of accuracy of diagnosis and planning of operative strategy. Materials and Methods: A retrospective analysis was conducted on 210 cases of malleolar fracture treated at our institute for which plain radiograph and CT were obtained preoperatively. Observers had reviewed plain radiographs and recorded fracture classification, anatomical diagnosis, extent and configuration of fractures and then subsequently reviewed CT images. Records from each image were compared and information regarding the differences in fractures was assessed. Results: Fractures were notably changed in appearance in 88 cases (41.9%) and diagnosis changed in 30 cases (14.3%). According to the change of diagnosis and fracture appearances, the operative strategy was changed in 15 cases (7.1%) including incision, order of reduction, and target of fixation. Conclusion: CT could be a useful adjunctive imaging tool in addition to the plain radiograph in planning of operative treatment for acute malleolar fracture in terms of estimating exact configuration, extent of fractures and even newly revealed hidden fractures.

두경부에 발생한 모기질종(Pilomatricoma) 4예

정필상(Phil Sang Chung),우승훈(Seung Houn Woo),이상훈(Sang Hun Lee),명나혜(Na Hye Myong),이상준(Sang Joon Lee) 대한두경부종양학회 2004 대한두경부 종양학회지 Vol.20 No.1

Pilomatricoma is a benign neoplasm of the hair follicle origin which most common occur in the head and neck, particularly in the cheek and preauricular region. This neoplasm is superficially located and stony, hard consistency on palpation and sometimes shows reddish or bluish discoloration on the overlying skin. The diagnosis is confirmed by histopathologic examination. Radiologic evaluation is little diagnostic and fine needle aspiration biopsy often misdiagnose because both tissues from basaloid cell component and shadow cell component should be obtained for correct diagnosis. And Otolaryngologist should consider the possibility of philomatricoma when childhood or early adulthood persion visits with hard, supferficial mass on the parotid or cheek area. The treatment of choice is surgical excision with clear resection margin. In many instances, overlying skin excision is needed. We report 4 cases of philomatricoma arising from preauricular, cheek and posterior neck.

대한정형외과학회지에 발표된 논문들의 피인용 횟수와 연관된 특성(2001년부터 2015년까지의 논문 분석)

배정연(Jung Yun Bae),곽상호(Sang Ho Kwak),강상우(Sang Woo Kang),우승훈(Seung Hun Woo),안태영(Tae Young Ahn),이상현(Sang Hyun Lee) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.6

목적: 대한정형외과학회지에 게재된 논문 중 어떠한 특성의 논문이 보다 많이 인용되는지에 대한 보고는 아직 발표되어 있지 않다. 이 연구에서는 대한정형외과학회지에 게재된 논문을 기준에 따라 분류하고 각 기준이 피인용 횟수와의 연관되었는지 분석하여 어떤 특성이 피인용 횟수와 연관되는지 알아보고자 한다. 대상 및 방법: 2001년부터 2015년까지 대한정형외과학회지에 게재된 논문 전체를 대상으로 3명의 저자가 논문의 양식, 대상, 연구 시점, 연구 설계, 임상적 위치, 저자 수, 그리고 증례 수에 따라 분류하고 2020년 1월까지 국내 및 국제 학술지에 인용된 횟수와의 연관관계를 분석하였다. 결과: 1,640편의 논문 중 724편이 1회 이상 인용되었으며, 평균 1.0회(표준편차 1.9)의 피인용 횟수를 기록하였다. 연도별로는 2009년에 게재된 논문들의 피인용 횟수가 가장 높아서, 평균 1.6회 인용되었다. 논문의 양식에 따라서는 원저, 수술기법 및 종설, 연수 강좌, 증례 보고의 순서대로 평균 피인용 횟수가 높았고(p<0.001), 증례 보고 중에서는 외상 일반에 대한 논문이 가장 피인용 횟수가 높았다(mean=1.5, p=0.006). 원저 중에서는 정형외과 일반에 대한 논문, 임상 논문, 실험 논문 순으로 피인용 횟수가 높았으며, 임상 논문 중에서 위치에 따라서는 척추에 대한 논문(mean=1.7, p<0.001)이, 연구 설계에 따라서는 역학 논문(mean=5.0, p<0.001)이 유의하게 높은 피인용 횟수를 기록하였다. 결론: 2001년부터 2015년까지 대한정형외과학회지에 게재된 증례 보고 중에서는 외상 일반을 다룬 논문이, 원저 중에서는 역학 연구이거나 척추 관절을 대상으로 작성된 논문이 게재 후 피인용 횟수가 유의하게 높았다. Purpose: No attempt has been made to identify the relationship between the study characteristics and citation rates of articles published in the Journal of the Korean Orthopaedic Association (JKOA). This study classified the study characteristics of articles in the JKOA and analyzed the relationship between the study characteristics and citation rates. Materials and Methods: A cohort study was conducted on all articles published from February 2001 to December 2015. Three independent reviewers classified the articles according to the article type, material, time of the study, design, clinical categories, number of authors, and number of cases. The citation numbers of each article by other journals were taken in January 2020. Univariate analyses were conducted to assess the effect of each characteristic, and multivariate linear regression analysis was performed to analyze the overall relationship between the characteristics and the citation rates. Results: A total of 1,640 articles were published from 2001 to 2015, and 724 articles were cited more than once. The articles published in 2009 had the highest average number of citations. Original articles had the highest citation rates, followed in descending order by surgical techniques and reviews, instructional course lectures, and case reports (p<0.001). Among the case reports, articles dealing with general trauma scored significantly higher average citations (mean=1.5, p=0.006). Among the original articles, articles on general orthopedics had the highest citation rates, followed in order by clinical articles and experimental articles. Among the clinical articles, epidemiologic studies (mean=5.0, p<0.001) and studies on the spine (mean=1.7, p<0.001) recorded significantly higher citation rates than the others. Conclusion: Of all the articles published in the JKOA from 2001 to 2015, articles dealing with general trauma had the highest citation rates among case reports. Among the original articles, epidemiologic studies and studies concerning the spine were cited significantly more than others.

당뇨병성 발궤양 발생 위험 예측모형과 노모그램 개발

이은주(Lee, Eun Joo),정인숙(Jeong, Ihn Sook),우승훈(Woo, Seung Hun),정혁재(Jung, Hyuk Jae),한은진(Han, Eun Jin),강창완(Kang, Chang Wan),현수경(Hyun, Sookyung) 한국간호과학회 2021 Journal of Korean Academy of Nursing Vol.51 No.3

Purpose: This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM). Methods: This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples. Results: The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years. Conclusion: The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

두부 외상을 동반한 골절 환자의 혈청에서 Receptor Activator of Nuclear Factor-κB Ligand와 Osteoprotegerin의 변화

박신영 ( Shin Young Park ),서근택 ( Kuen Tak Suh ),류창훈 ( Chang Hoon Ryu ),우승훈 ( Seung Hun Woo ),이정섭 ( Jung Sub Lee ),김성장 ( Seong Gang Kim ) 대한골절학회 2008 대한골절학회지 Vol.21 No.2

목적: RANKL과 OPG는 골의 재형성에 있어 파골기전의 중요한 조절 인자이며, 골절의 치유 과정에 관여한다. 그러나 두부 외상과 골절이 있는 환자에서 이들에 대한 연구는 부족하다. 이에 두부 외상을 동반한 골절 환자군과 골절 환자군의 혈청에서 이들의 변화를 분석하여 비교하였다. 대상 및 방법: 두부 외상과 골절이 있는 18명의 남자 환자와 골절이 있는 20명의 남자 환자, 대조군으로 건강한 20명의 남자를 선정하였다. 두부외상-골절군과 골절군에서 수상 후 수 시간 내, 수상 후 4, 8, 12주에 혈액을 채취하여 RANKL과 OPG의 변화를 분석하였다. 결과: 두부외상-골절군은 외상 후 8, 12주에 골절군에 비하여 RANKL의 발현이 낮았으며 두부외상-골절군에서 골절군에 비하여 외상 후 4, 8,12주에 OPG의 발현이 증가되었다. 두부외상-골절군에서 외상 후 수 시간 내, 4, 8, 12주에 대조군보다 RANKL/OPG의 비율이 낮았으며, 두부외상-골절군에서 골절군에 비해 외상 후 8주와 12주에 RANKL/OPG 비율이 낮았다. 결론: 두부 외상과 골절이 있는 환자에서 RANKL, OPG, RANKL/OPG의 비율의 변화를 보았고, 두부 외상과 골절이 있는 환자에서 이들의 변화가 골절 환자에서 보다 오랫동안 지속되었다. Purpose: Receptor activator of nuclear factor-κ B ligand (RANKL), osteoprotegerin (OPG) have been shown to be important regulators of osteoclastogenesis during bone remodeling, and their expressions were examined during fracture healing in a mouse model of tibial fracture. However, studies linking RANKL and OPG in patients with head injury and fracture are lacking. We evaluated the changes in serum levels of RANKL and OPG in patients with head injury and fracture (head injury group) and in patients with fracture (fracture group) and compared these with levels found in healthy control subjects. Materials and Methods: 18 male patients of head injury and fracture and 20 male patients of fracture alone were enrolled. 20 healthy men were recruited to serve as controls. Within the first few hours of admission to hospital, at 4, 8 and 12 weeks after injury 20 ml of blood were obtained from 18 patients with head injury and fracture and 20 patients with fracture only. Results: RANKL levels were significantly lower in the head injury group than in the fracture group at 8 and 12 weeks after injury. OPG levels were significantly higher in the head injury group than in the fracture group at 4, 8 and 12 weeks after injury. RANKL/OPG ratios were significantly lower in the head injury group than in the controls immediately after and 4, 8 and 12 weeks after injury, and were significantly lower in the head injury group than in the fracture group at 8 and 12 weeks after injury. Conclusion: We have shown changes in the profiles of RANKL, OPG and RANKL to OPG ratio. The altered RANKL, OPG and RANKL/OPG ratio in the head injury group lasted longer than in those of the fracture group.