관절경하 반월상 연골 절제술 후 발생한 혈전색전증 - 1예 보고 -

이기병,송시영,이용범,현호승,신준,Lee, Kee-Byung,Song, Si-Young,Lee, Yong-Beom,Hyun, Ho-Seung,Shin, Jun 대한관절경학회 2008 대한관절경학회지 Vol.12 No.3

관절경하 슬관절 수술 후 발생하는 폐색전증은 발생 빈도가 매우 드물며, 대부분의 경우 별다른 임상 증상이 없는 것으로 알려져 있다. 저자들은 40세 남자 환자에서 관절경하 부분 절제술 시행 후 증상을 유발하는 폐색전증이 발생한 증례를 경험하였기에 이를 보고하고자 한다. Pulmonary embolism appears to be a very rare complication of arthroscopic knee surgery. Most cases of pulmonary embolism have been clinically silent in the literature. We describe a case of symptomatic pulmonary embolism after arthroscopic partial menisectomy in 40-year-old male patient.

근위 대퇴정을 이용한 대퇴골 전자부 골절 치료의 합병증

이기병 ( Kee Byoung Lee ),이병택 ( Byung Taek Lee ) 대한골절학회 2007 대한골절학회지 Vol.20 No.1

목 적: 최근 대퇴골 전자부 골절에서 많이 사용되고 있는 근위 대퇴정의 합병증을 분석하고그 합병증을 줄일 수 있는 방법을 알아보고자 하였다. 대상 및 방법: 2001년 6월부터2005년 8월까지 근위 대퇴정으로 치료한 대퇴골 전자부 골절 환자 중에서 추시 관찰이 가능하였던 198예를 대상으로 합병증 발생 유무를 조사하였다. 결 과: 합병증이 총 28예(14.1%)에서 발생하였다. 지연 나사만의 돌출 1예, 지연 나사와 회전 방지 나사의 돌출이 3예, 회전 방지 나사만의 돌출이 3예이며 그 중 1예에서 대퇴 골두 골절이 발생하였다. 대퇴골 경부 골절 1예, 대퇴 골두 무혈성 괴사 1예, 수술 중피질골 골절이 1예, 수술 중drill bit 파손 1예, 섬유성 유합 2예, 과도한 후방 돌출로 인한 피부 자극이 3예, 수술 후 삽입물 주위 골절 2예, 10˚ 이상의 내반 함몰 변형이 4예, 감염이 3예, 근위 대퇴정의 파손 1예, 근위 대퇴정 제거후 내반 변형이 1예, 지속적인 대퇴부 동통이 1예 있었다. 이 중 심각한 합병증으로 전신 마취 혹은 척추 마취의 재수술이 필요한 경우는 9예 (4.5%)였다. 지연 나사나 회전 방지 나사 혹은 골절의 정복과 관련된 합병증이 19예 (9.6%)이며 이 중 17예 (89.5%)에서 골절의 비해부학적 정복 혹은 증가된 TAD (tip apex distance)의 소견을 보였다. 결 론: 근위 대퇴정을 사용할 때 합병증 발생을 줄이기 위해서 수술 중 골절의 해부학적 정복과 세심한 술기기 필요하며 지연 나사와 회전 방지 나사의 관절내 돌출과 후방 돌출을 줄이기 위한 디자인의 개선 노력이 필요할 것이다. Purpose: We analyzed the complications of femoral pertrochanteric fractures treated with proximal femoral nail (PFN(R)) to reduce the its complications. Materials and Methods: We evaluated the complications among 198 patients who were treated with PFN(R) from June 2001 to August 2005 in our hospital. Results: The complications were presented in 28 cases (14.1%). Cut-out of lag screw was in 1 case, cut-out of lag screw and antirotation screw were in 3 cases, cut-out of antirotation screw in 3 cases, of these femoral head fracture was in 1 case. Femoral neck fracture in 1 case, Osteonecrosis of femoral head in 1 case, cortical fracture during the insertion of distal interlocking screw in 1 case, breakage of drill bit intraoperatively in 1 case, fibrous union in 2 case, thigh skin irritation due to screw back-out in 3 cases, periprosthetic fractures in 2 cases, varus collapse more than 10 degrees in 4 cases, superficial and deep infections in 3 cases, breakage of nail in 1 case, varus collapse after PFN removal in 1 case, persistent thigh pain in 1 case. Of all these cases, 9 cases (4.5%) were required reoperation with general or spinal anesthesia. Complications related with screws or fracture reduction were 19 cases (9.6%) and, of these, 17 cases (89.5%) showed increased TAD (tip apex distance) or nonanatomical reduction. Conclusion: To reduce the complications of PFN(R), we need to exact surgical technique and anatomical reduction and consider the modification of implant design to prevent of cut-out of screws.

원위 경골 골절에서 최소 침습적 금속판과 교합성 골수강 내고정의 비교

이기병 ( Kee Byung Lee ),송시영 ( Si Young Song ),권덕주 ( Duek Joo Kwon ),이용범 ( Yong Beom Lee ),이남규 ( Nam Kyou Rhee ),최준하 ( Jun Ha Choi ) 대한골절학회 2008 대한골절학회지 Vol.21 No.4

재발성 슬개골 불안정성에서 자가 슬괵건을 사용한 내측 슬개대퇴 인대 재건술 -예비 보고-

이기병 ( Kee Byung Lee ),송시영 ( Si Young Song ),이성진 ( Seong Jin Lee ),손원수 ( Won Su Son ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.2

Purpose: We present the short-term results of medial patellofemoral ligament (MPFL) reconstruction using the autogenous hamstring tendon for recurrent patellar instability. Materials and Methods: Seven patients with recurrent patellar instability were treated with MPFL reconstruction using a semitendinosus or gracilis autograft from February 2008 to November 2008. All the patients were evaluated preoperatively and postoperatively according to the physical findings, scores and radiographs, with a mean follow-up of 13.6 months (range: 12~15 months). Results: The apprehension test was positive in all the knees preoperatively and no knee was found to be positive at the follow-up. The grind test was positive in all the knees preoperatively and one knee was found to be positive at the follow-up. The Q-angle was 16.9˚ preoperatively and 18.3˚ at the follow-up. The Kujala score improved from 33.7 points to 94.1 points (p=0.018), the Lysholm score improved from 42.4 points to 92.6 points (p=0.018) and the Tegner activity level improved 2.1 to 5.1 (p=0.026). The congruence angle was 10.2˚ preoperatively and -3.4˚ at follow-up (p=0.018). The patellar height was 1.95 preoperatively and 1.6 at follow-up (p=0.028). There were no patients with recurrent dislocation. Conclusion: MPFL reconstruction using the autogenous hamstring tendon for recurrent patellar instability is an effective operation, according to the short term follow-up.

Rapid Loc 기기를 이용한 관절경적 반월상 연골판 봉합술

권덕주,이기병,정웅교,이병택,박상욱,Kwon, Duck-Joo,Lee, Kee-Byung,Joeng, Woong-Kyo,Lee, Byung-Taek,Park, Sang-Wook 대한관절경학회 2005 대한관절경학회지 Vol.9 No.2

목적: 본 논문의 목적은 Rapid Loc 기기를 이용한 관절경적 연골판 봉합술의 임상적, 방사선학적 결과를 평가하고자 하였다. 대상 및 방법: 44례를 대상으로 후향적으로 결과를 분석하였다. 퇴행성 병변이 동반되지 않은 단순 종파열로 진단되어 관절내시경하에서 Rapid Loc 기기를 이용하여 연골판을 봉합한후 평균 6개월이상의 추시가 가능하였던 환자 군을 대상으로 하였다. Orthopaedische Arbeitsgemeinschaft Knie (OAK) 평가 지표와 자기 공명 영상 촬영을 이용하여 임상적 방사선학적 결과를 평가하였다. 관절연 압통, 관절내 부종, McMurray 검사에서 양성인 경우는 임상적 실패로 간주하였다. 결과: 평균 연령은 33.4세 평균 추시기간은 15개월이었다. 임상결과는 우수 15례(34.1%), 좋음 20례 (45.5%), 양호 7례(15.9%), 불량 2례(4.5%) 였다. MRI상 Reicher 분류를 이용한 방사선학적 평가에서 grade 1 15례(33.3%), grade II 21례(50%), grade III 7례(16.7%)였으며, 임상적 실패는 8례(18%)였다. 술후 합병증은 1례에서 발생되었다. 결론: Rapid Loc 기기는 연골판 봉합술에 있어서 매우 우수한 결과를 보였으며, 삽입물이 유연하여 연골 손상이 적고, 사용이 간편하고 파열 부위의 압박 정도를 조절 할 수 있는 등 많은 장점이 있는 기법이라 사료된다. Purpose: To purpose of this study is to evaluate the clinical and radiological results of arthroscopic meniscus repair using Rapid Loc device. Materials and Methods: A retrospective study was performed on 44 cases which had been turned out longitudinal tear without degeneration. We repaired all cases with Rapid Loc device. Patients were evaluated using clinical examination, Orthopaedische Arbeitsgemeinschaft Knie (OAK) scheme, and MRI. We regarded patients with joint line tenderness, swelling or McMurray positive test as clinical failure. Results: A mean age was 33.3 years and follow-up period was average 15 months. Clinical results were excellent 15 cases(34.1%), good 20 cases(45.5%), fair 7 cases(15.9%), poor 2 cases(4.5%). MRI showed grade 115 cases(33.3%), grade II 22 cases(50%), grade III 7 cases(16.7%). Clinical failures were 8 cases and only one complication was developed. Conclusion: Rapid Loc device showed the excellent results in meniscus repair. We regard it has a lot of advantages in safety, softness, ease, ability to control tension at repair site.

경첩 운동이 가능한 외고정장치를 이용한 Pilon골절의 치료

박인헌,이기병,송경원,이진영,이승용,Park, In-Heon,Lee, Kee-Byung,Song, Kyung-Won,Lee, Jin-Young,Lee, Seung-Yong 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.1

Pilon fracture is an intraarticular fracture of distal tibia. It is high energy injury with significantly associated soft tissue damage, bone comminution, and articular surface disruption. Until recently, this treatment has followed the AO principles, Because the risk of complications outweighs potential benefits, the principle of a Pilon fracture treatment are changing. Newer techniques using articulated external fixation minimize disturbance of the soft tissue envelope and have decreased these complications. Series of 5 patients with Pilon fracture were treated by articulated external fixator and followed up more than 12 monthes at the Department of orthopaedic surgery, Kang Dong Sacred Heart Hospital, College of medicine, Hallym University. The results were as follows: 1. The type of fracture were type C2(3 cases),type C3(2 cases) according to AO-$M{\ddot{u}}ller$ classification. 2. The clinical results according to functional criteria by Mast and Teipner were good in 4 cases and poor in 1 case, which is an old fracture. 3. Techniques utilizing articulated external fixator were associated with satisfactory results and appeared to significantly decrease the incidence of soft tissue complication, post-traumatic arthritis, osteoporosis, and fibrosis of ankle joint.

종골 골절 후 거골하 관절면의 전위 정도와 운동 범위의 상관 관계

박인헌,이기병,송경원,이진영,이응주,박래성,Park, In-Heon,Lee, Kee-Byung,Song, Kyung-Won,Lee, Jin-Young,Lee, Eung-Joo,Park, Rae-Seong 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.1

The characteristics of the patients after the calcaneal fracture that were associated with an unsatisfactory outcome were subtalar incongruity, decreased Bohler angle ratio of the fractured to the normal side, an age of more than fifty years, work involving strenuous labor, and increased time missed from work due to the injury. The purpose of this study was to examine the reliability of measurements of the range of motion of the subtalar joint. To determine reliability, evaluates of the correlatioinship between the degree of the displacement of the subtalar joint and Circle draw test after the calcaneal fracture. Fifty patients who had had fifty five calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between 4months and three years after the operation, with use of an evaluation system for the subtalar joint and with plain radiographs. At follow up evaluation, the result was assessed on the basis of restoration of anatomy and function of the subtalar joint. We evaluated the subtalar joint with plain films that consist of anteroposterior projection, lateral projection, calcaneal axial view, and Broden's view, and the measurements of the displacement of the subtalar joint surface after the calcaneal fracture. And we evaluated the range of motion of the subtalar joint with Circle draw test for physical evaluation. Circle draw test was evaluated and demonstrated the motion of flexion-supination-adduction and extension-pronation-abduction of the subtalar joint. And there are correlationship between the degree of the displacement and range of motion of the subtalar joint after the calcaneal fracture. The report critically reviews methords used to measure Circle draw test for physical examination of the follow up after the calcaneal fracture.

중증도 이상의 무지 외반증에서 Ludloff 절골술의 결과

권덕주,송시영,이기병,이남규,최준하,Kwon, Duck-Joo,Song, Si-Young,Lee, Kee-Byung,Rhee, Nam-Kyou,Choi, Jun-Ha 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: To evaluate the clinical and radiologic results of the Ludloff osteotomy for moderate to severe hallux valgus deformity retrospectively. Materials and Methods: Between January 2003 and October 2006, 33 patients (42 feet) who had undergone with Ludloff osteotomy combined with distal soft tissue procedure were followed up for more than one year. The average follow-up period was 14.6 months and the average age at the time of surgery was 47.7 years (26-70 years). The American Othopeaedic Foot and Ankle Society (AOFAS) score was used for clinical outcome assessments. We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA) and the degrees of the tibial sesamoid subluxation in preoperative and the last follow-up radiographs. Results: The AOFAS score improved from a preoperative average of 45.6 points to an average 84.3 points at the last follow-up. HVA and IMA were 34.8 and 14.5 degrees preoperatively, 17.2 and 5.9 degrees at the last follow-up. The tibial sesamoid position improved from a preoperative average of grade 2.5 to the last follow-up average of grade 1.2. Conclusion: Ludloff osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

체외충격파를 이용한 테니스 엘보우의 치료

이석범(Seok-Beom Lee),권덕주(Duck-Joo Kwon),송영준(Young-Joon Song),이기병(Kee-Byung Lee) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.2

목적: 본 연구는 주관절 외 상과염에 대한 체외충격파 치료의 효과를 알아보고자 시행되었다. 대상 및 방법: 불응성 외 상과염을 가진 24병의 환자에게 체외충격파 치료를 하였다. 치료효과 판정을 위해 visual analog scale (VAS)을 이용한 통증 평가와 simple elbow test (SET)를 이용하였다. 전체적인 평가를 위해 추시 1년에는 Roles와 Maudsley의 평가방법을 이용하였다. 결과: 추시 1년뒤 Roles와 Maudsley 평가결과 20명(83%) 환자들에게서 만족한 결과를 볼 수 있었고 SET와 VAS의 평균 점수는 체외충격파 치료후 통계학적으로 의미있게 호전되었다(p<0.05). 결론: 본 연구는 주관절의 불응성 외 상과염에 대한 체외충격파의 치료가 비침습적이면서도 효과적인 치료 수단이 될 수 있음을 시사하고 있다. Purpose: The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) an lateral epicondylitis of the elbow. Materials and Methods: Twenty-four patients with refractory lateral epicondylitis were treated with shock waves. The patients were evaluated by assessing of pain using visual analog scale (VAS) and a simple elbow test (SET). Overall clinical outcomes were evaluated using Roles and Maudsley scores at 12 months after ESWT. Results: Significant symptom improvement were observed in 20 (83%) patients at the 12 months follow up according to the Roles and Maudesley scores. Average SET and VAS scores were also significantly improved after ESWT (p<0.05). Conclusion: This study suggests that shock waves therapy could be considered as an effective and noninvasive treatment modality for refractory lateral epicondylitis of the elbow.

나사못을 이용한 척추분리증의 치료

박인헌(In Heon Park),이기병(Kee Byung Lee),송경원(Kyung Won Song),이진영(Jin Young Lee),한준규(Jun Gyu Han) 대한정형외과학회 1992 대한정형외과학회지 Vol.27 No.7