고관절 이형성증에 대한 Bernese 골반 절골술

장재석 ( Jae Suk Chang ),박종훈 ( Jong Hoon Park ),박형구 ( Hyoung Goo Park ),이수호 ( Su Ho Lee ),김용기 ( Ki Yong Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Among several kinds of pelvic osteotomies, the Bernese periacetabular osteotomy, which was developed in 1983, has an advantage of providing sufficient acetabular coverage as the osteotomy is close to the acetabulum. We have experienced 5 cases of Bernese periacetabular osteotomies which were followed up over 1 year(1.4 year in average) and roentgenographic and clinical analysis could be done. All patients were female and the mean age was 27.6 years and four hips were operated with extended iliofemoral approach and modified ilioinguinal approach was applied to one hip. The Harris hip score improved from an average of 69 points preoperatively to an average of 95 points postoperatively. The vertical center-edge(VCE) angle of Wiberg was improved from 18.8+-0.5 to 55.8+-3.4, the acetabular angle from 47.4+-1.6 to 18.6+-3.5. The acetabular depth was improved from 21.8+-1.7mm to 22.4+-3.4mm, roof angle from 16.6+-6.1 to -34.0+-4.9. The femoral head coverage was changed from 70.1+-2.8% to 98.6+-3.7% and medial shift of femoral head was 5.6+-1.8%. Along with the improvement in X-ray, all the patient were satisfied with the relief of pain, and the improvement in gait could be confirmed by gait analysis. No patient had any complication, but there we!re breakages of posterior column which were managed with hip spica cast for a month in initial 2 cases. No one complained of the loss of motion, but some degree of the loss of flexion could be identified. We found the Bernese acetabular osteotomy, although technically demanding, was very excellent method to the dysplastic hips as it provided an sufficient acetabular coverage.

퇴행성 관절염에서 Interleukin-6와 Soluble Interleukin-6 Receptor

장재석 ( Jae Suk Chang ),정용갑 ( Yong Gab Jeong ),조우신 ( Woo Shin Cho ),빈성일 ( Seong Il Bin ),엄규황 ( Kyu Hwang Ym ),김정화 ( Jung Hwa Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.3

Objective: Unlike other soluble receptors, the soluble interleukin-6 receptor (sIL-6R) cooperates with IL-6 to activate gp130 of effector cell. As the IL-6 and sIL-6R are important in the rheumatoid disease, this study was designed to measure concentration of IL-6 and sIL-6R in synovium and synovial fluid of the degenerative arthritis. Methods: The synovium and synovial fluid were obtained during total knee replacement arthroplasty. The synovium was taken from eleven patients, and synovial fluid taken from sixteen patients. Same patients between two groups were seven. Tissue cultures of the synovial tissues were done with 10% FBS for 72 hours. After irrigation, thery were incubated for 48 hours without FBS, and the culture media and the synovial fluid were collected after centrifuged at 2500rpm for 10 minutes. The level of IL-6 and sIL-6R were measured by quantitative sandwich enzyme immunoassay technique. Results: In the synovium, the IL-6 level was 5.1±0.12ng/ml, and the sIL-6R level was 0.41±0.25ng/ml. In the synovial fluid, the IL-6 level was 0.09± 0.15ng/ml, and the sIL-6R level was 10.37±3.28ng/ml. These results show that IL-6 concentration was measured highly in two groups, especially in synovium (sixty times), and the sIL-6R concentration was measured significantly high in synovial fluid (twenty-five times). Conclusion: The IL-6 and sIL-6R were elevated in degenerative arthrits. We confirmed the source of IL-6 was synovium (very high in synovial tissue culture media), but we need further study for the source of sIL-6R as it was remarkably elevated as IL-6 and its level was lower than serum.

고관절 이형성증에서 비구 후염전의 빈도

장재석(Jae-Suk Chang),박재형(Jai-Hyung Park),손현철(Hyun-Chul Shon),백동훈(Dong-Hoon Baek),김지완(Ji-Wan Kim),정광환(Kwang-Hwan Jung),안형선(Hyung-Sun Ahn) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.6

목적: 고관절 이형성증에서 비구의 전염각은 증가되어 있는 것으로 알려져 있으나 비구 후염각의 증가가 관찰되는 예들도 관찰된다. 본 연구는 고관절 이형성증에서 비구 염전각을 측정하고, 후염전의 빈도를 알아보고자 하였다. 대상 및 방법: Center-Edge (CE)각이 20° 이하의 고관절 이형성증 28예를 대상으로 하였고, CE각이 정상인 20예를 대조군으로 하였다. 남자는 7예였고 평균 36.2세이었으며, 여자는 21예였고 평균 43.7세였다. 대조군은 남자가 10예였고, 나이는 평균 46.1세이었으며, 여자는 10예였고, 나이는 평균 43.5세이었다. 고관절 이형성증에서 외측 CE각은 평균 2°였으며, false profile view에서 전방 CE각은 평균 1°였다. 전산화 단충 촬영 중 축상 단면에서 4곳(대퇴골두가 나타나기 시작하는 최상부, 근위 1/2중 중간 부위, 중간 부위, 원위 1/2 중 중간 부위)의 염전각을 측정하였다. 결과: 대조군에서는 네 부위의 전염각이 위에서부터 각각 평균 14.0°, 17.5°, 19.3°, 20.3°이었으며, 후염전을 나타내는 경우는 1예가 있었다. 고관절 이형성증에서는 4곳의 전염각이 위에서부터 각각 평균 4.1°’ 10.3°, 16.5°, 19.7°이었으며, 후염 전을 나타내는 경우는 9예가 관찰되었으며 근위부 2곳의 평균이 통계학적으로 유의한 차이를 보였다(p<0.005). 후염전을 보이는 모든 예의 골반 방사선 촬영에서 비구 전방벽과 후방벽이 고관절 중간 부위에서 교차(cross-over)되는 양상을 나타내었다. 결론: 비구의 후엽전이 정상 및 고관절 이형성증에서 관찰되었고, 빈도는 정상에서는 5%이었고, 고관절 이형성증에서는 32%로 의미있게 높았다(p<0.05). 따라서, 비구 이형성증의 절골술에 있어 수술 전 전산화 단충 촬영을 시행하여 후염전 여부를 확인하고 비구 주위 절골술 후 회전 시에 후염전이 증가되지 않도록 해야 한다. Purpose: This study analysed the incidence and the degree of an acetabular retroversion in a dysplastic hip. Materials and Methods: 28 cases of dysplastic hips, in whom the CE angle was <20 degrees, and 20 cases of control group with a normal CE angle were enrolled in this study. Four cuts among the CT images (most superior cut of the femoral head, middle cut of the proximal half, middle portion, and middle cut of the distal half of the femoral head) were used to measure the acetabular anteversion. Results: In the control group, anteversion of four cuts (form the cranial to caudal) were observed with an average of 4.1, 10.3, 16.5, 19.7°, and there was one case with a retroversion. In the dysplastic hips, the average anteversion angles were 4.4, 11.0, 17.9, 20.8°, and 9 cases with retroversion were discovered. In all cases showing retroversion, an overlapping of the acetabular anterior and posterior wall (cross-over sign) was observed on the simple pelvis AP radiography. Conclusion: There was a 32% incidence of acetabular retroversion, which was much higher than the control group (p<0.05). Therefore, in order to prevent an over-correction of the retroversion, which may cause impingement, the presence and the amount of retroversion must be recognized using CT before performing a periacetabular osteotomy.

RGD 단백이 파골세포의 골흡수에 미치는 영향

장재석(Jae Suk Chang),김기용(Key Yong Kim),김영태(Yung Tae Kim),이춘성(Choon Sung Lee),한병호(Byeong Ho Han),홍순우(Soon Woo Hong) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.2

고관절 주위 절골술

장재석 ( Jae Suk Chang ),김지완 ( Ji Wan Kim ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.3

The goal of an osteotomy around the hip joint for treating hip dysplasia is to delay or prevent osteoarthritis by reducing the stress to the hip joint. This can be archived with anterolateral displacement of the acetabulum and an osteotomy around the hip joint is indicated for the young and active patients, besides performing total hip arthroplasty. As the osteotomy site is close to the hip joint, we can obtain more correction with performing this type of surgery than is possible with other types of pelvic osteotomies and we can get excellent radiological and clinical outcomes. But periacetabular rotational osteotomy is a rather difficult procedure, there may be complications and a long learning curve is needed to learn the surgical technique. A dual approach for periacetabular rotational osteotomy is easier with direct exposure of the osteotomy site and there are fewer complications than that with performing a Berneses periacetabular rotational osteotomy, as described by Ganz. Therefore, it is recommended for beginners. The osteotomy site of the proximal femur is usually around the lesser trochanter, but femoral neck osteotomy may be performed in rare cases. The preoperative planning for obtaining a correction angle of the osteotomy site is the most important factor, and excellent results can be archived by performing an accurate procedure.

후방 염전 비구에 시행한 비구 주위 절골술 -증례 보고-

장재석 ( Jae Suk Chang ),손현철 ( Hyun Chul Son ),박재형 ( Jai Hyung Pak ),김기형 ( Ki Hyung Kim ) 대한고관절학회 2003 Hip and Pelvis Vol.15 No.2

고관절 전치환술 환자의 보행 검사를 이용한 Scoring System

장재석 ( Jae Suk Chang ),이종복 ( Chong Pok Lee ),백승기 ( Seung Ki Baek ),이수호 ( Soo Ho Lee ),김기용 ( Key Yong Kim ),유종윤 ( Jong Yoon Yoo ),하상배 ( Sang Bae Ha ) 대한고관절학회 1997 Hip and Pelvis Vol.9 No.2

Total hip replacement arthroplasty(THA) is widely used to the patients with avascular necrosis(AVN) or degenerative arthritis(DA) to relieve pain and to obtain the recovery of function. Beside pain relief, patients want improvement in gait pattern, which is related with leg length discrepancy, range of motion, and muscle power. Accurate analysis of the recovery of gait after THA is almost impossible by the clinical observation. Therefore gait analysis is the answer for the identification of the factors related to the recovery of patients after the operation. This study was undertaken in an attempt to evaluate the gait recovery of 16 patients after unilateral THA with the scoring system using several gait parameters(single support time, walking speed, pelvic obliquity, hip motion), which was called as the gait score and to compare with Harris hip score system. We measured the gait score and the Harris hip score before and at one year after THA, and also measured the gait score in fourteen healthy persons. We compared the gait score preoperative, postoperative(POD) one year and fourteen healthy persons gait score, and also compared the gait score system with the Harris hip score system. The results were as followed: In normal control group, single support time was 38.6+-1.5, walking speed 9.4+-0.7, pelvic obliquity 4.9+-0.0, hip motion 42.3+-3.6, and total score 95.2+-4.8. Postoperative gait scores were significantly improved to 33.8+-2.7 of single support time from preoperative 23.3+-3.5, 6.8+-1.5 of walking speed from preoperative 3.6+-0.9, 4.4+-1.1 of pelvic obliquity from preoperative 2.2+-0.1, 32.9+-4.5 of hip motion(flexion-extension) from preoperative 23.8+-3.6, and 78.9+-5.3 of total score from preoperative 52.9+-4.8(P<0.05).

인공 고관절 전치환술에서 예방적 항생제의 단기적 사용

장재석(Jae-Suk Chang),김양수(Yang Soo Kim),손현철(Hyun-Chul Shon),김지완(Ji-Wan Kim),정수영(Su-Young Chung),박재형(Jai-Hyung Park) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.4

목적: 인공고관절 전치환술에서 급성 감염의 예방을 위해 사용하는 항생제의 적절한 투여기간을 알아보고자 하였다. 대상 및 방법: 1995년 12월 7일부터 2002년 6월 26일까지 인공고관절 전치환술을 시행한 467예를 대상으로 항생제 사용 기간에 따라 수술후 48시간 이후에도 항생제를 투여한 군(Ⅰ군), 배액관을 제거하기까지인 수술 후 48시간 동안 투여한 군 (Ⅱ군), 수술한 날에만 투여한 군(Ⅲ군)으로 나누어 후향적 연구를 통해 임상적 결과를 비교하였다. 모든 환자에 있어서 모두 1세대 세파제를 사용하였다. 결과: Ⅰ군의 감염 발생은 229예 중 2예였으며, 이 중 1예는 급성 표재성 감염으로 연부조직의 수술만으로 치유되었고, 나머지 한 예는 지연 심부 감염이었다. Ⅱ군에서의 감염 발생은 197예 중 1예였으며, 이는 급성 표재성 감염이었다. Ⅲ군에 있어서는 41예 모두감염이 발생하지 않았다. 결론: 인공고관절 전치환술에서 예방적 항생제 투여는 급성 감염을 예방하는 것이 목적이며, 예방 효과는 수술 당일에만 투여한 경우와 장기간 투여하는 경우에서 같은 결과를 나타내었다. 항생제 치료 기간을 단축함으로써 내성균의 출현과 약물에 의한 부작용의 억제 및 항생제 사용 감소로 인한 경제적 효과를 얻을 수 있었다. Purpose: The aim of this study was to determine an adequate period of prophylactic antibiotics administration in order to prevent postoperative acute infection in total hip arthroplasty patients. Materials and Methods: A retrospective analysis of the periods of antibiotics administration was performed in 467 cases. They were divided into three groups: those who received antibiotics more than 48 hours postoperatively (group Ⅰ), up to 48 hours postoperatively (group Ⅱ), and those received antibiotics only on the day of the surgery (group Ⅲ). The antibiotics used was first generation cephalosporin empirically. Results: An Infection occurred in 2 out of 229 cases in group Ⅰ. One case had an acute superficial infection, which was treated with soft tissue surgery. Another case had delayed deep infection, which occurred 15 months after surgery. There was 1 case of an acute superficial infection out of 197 cases in Group Ⅱ had. There was no infections in the 41 cases in Group Ⅲ. Conclusion: The prophylactic antibiotic effect in group Ⅲ was similar to those in group Ⅰ and Ⅱ. The level of resistance, the number of drug side effects and the economic benefits can be improved by shortening the period of antibiotics use.

고관절 이형성증에 대한 이중 도달법을 이용한 Bernese 비구주위 절골술

장재석(Jae-Suk Chang),권기대(Ki-Dae Kwon),손현철(Hyun-Chul Shon) 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.2

대퇴골두 변형을 동반한 고관절 이형성증에서의 비구주위 절골술

장재석(Jae Suk Chang),오형근(Hyoung Keun Oh),김지완(Ji Wan Kim),홍수헌(Soo Heon Hong) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.6

목적: 대퇴골두 변형이 동반된 고관절 이형성증에서 비구주위 절골술 및 근위부 대퇴 절골술을 시행한 결과를 고찰하고자 한다. 대상 및 방법: 대퇴골두 변형을 동반한 고관절 이형성증 환자 중 1년 이상 추시가 가능하였던 13예를 대상으로 하였고 비구주위 절골술만 시행한 군은 8예, 대퇴골 절골술을 함께 시행한 군은 5예였다. 임상적으로는 수술 전후 HSS, 통증과 파행 VAS를 비교하였으며, 방사선학적으로는 CEA, Tonnis angle, FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) 그리고 AI (acetabular index)를 비교하였다. 결과: 비구주위 절골술만 시행한 군에서 HHS와 통증 VAS는 각각 수술 전 평균 66.5점에서 90.4점으로, 그리고 6.7점에서 1.9점으로 호전이 있었으나, 파행 VAS는 거의 변화가 없었다. 비구주위 절골술과 대퇴 절골술을 함께 시행한 군에서는 HHS는 평균 78점에서 91점으로 호전되었으나 통증, 파행 VAS는 뚜렷한 변화가 없었다. CEA, Tonnis angle, FHC, AA, AI는 두 군 모두에서 의미 있는 호전을 보였으나 DBSPFH는 두 군에서 모두 통계학적으로 의미 있는 변화는 없었다. 결론: 대퇴골두의 변형을 동반한 고관절 이형성증에서 비구주위 절골술이 권장되며 대퇴골두의 변형이 심할 경우, 필요에 따라서 근위부 대퇴 절골술을 병행하는 것이 권장된다. Purpose: To evaluate the results of a periacetabular osteotomy (PAO) combined with a femoral osteotomy (FO) for a dysplastic hip with a deformed femoral head. Materials and Methods: Thirteen hips with dysplasia and a deformed femoral head were followed up for more than 12 months. Eight hips were in the PAO group and 5 hips were in the PAO and FO group. The two groups were compared clinically according to the HHS (Harris hip score), pain and limping VAS (visual analogue scale), and radiologically according to the CEA (central edge angle of Wiberg), Tonnis angle (acetabular index of weight bearing surface), FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) and Al (acetabular index of depth to width). Results: Regarding the clinical results, the PAO group showed improvement in the HHS from 66.5 preoperatively to 90.4 postoperatively (p=0.01) and the pain VAS from 6.7 to 1.9 (p=0.01). However, there was no significant improvement in limping (p=0.39). In the PAO with FO group, the HHS was improved from 78 to 91 (p=0.04). Radiologically, the CEA, Tonnis angle, FHC, AA and Al improved significantly but there were no significant improvement in the DBSPFH in the two groups. In addition, there was no significant clinical or radiological difference between the two groups. Conclusion: Periacetabular osteotomy is recommended for dysplastic hips with deformed femoral head. A concomitant femoral osteotomy should be considered in hips with a severely deformed femoral head.