A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

장종범,나경욱,Gautam M. Shetty,이종성,김영찬,권재호 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.4

Purpose: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral releasefor recurrent patellar instability with genu valgum. Materials and Methods: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performedwith reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. Results: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperativelyto 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly,from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). Conclusion: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, correctsdeformity, and improves clinical outcomes.

Bi₂WO<SUB>6</SUB> 로딩 PDMS 고분자 필름기반 나노발전소자의 제작 및 특성

장종범,Sontyana Adonijah Graham,Punnarao Manchi,유재수 한국통신학회 2022 한국통신학회 학술대회논문집 Vol.2022 No.11

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

장종범,김태균,Yeon Gwi Kang,성상철,강승백 대한의학회 2014 Journal of Korean medical science Vol.29 No.10

This study sought to demonstrate bone mineral density (BMD) conditions in elderly femalepatients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). Inaddition, we sought to determine whether their BMD conditions differ from those ofcommunity-based females without knee OA. Finally we sought to determine whetherclinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 femalepatients undergoing TKA and 273 community-based females were evaluated. Additionally,comparative analyses of BMD between age and body mass index-matched knee OA groups(n = 212) and the control groups (n = 212) were performed. In the pre-matched knee OAgroup, regression analyses were performed to determine whether preoperative clinicalstatuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%)was found in the pre-matched knee OA patients undergoing TKA. We found no significantdifferences of the BMD T-scores and the prevalence of osteoporosis between the age andbody mass index-matched knee OA and control groups. In the pre-matched knee OApatients, poorer preoperative clinical scores were related to poorer BMD T-scores in theproximal femur and/or lumbar spine. Our study suggests that more attention should bepaid to identify and treat osteoporosis in elderly female patients with advanced knee OAundergoing TKA.

Association of Weight Change and Physical Activity with Knee Pain and Health-Related Quality of Life in East Asian Women Aged 50 Years and Older with Knee Osteoarthritis: A Population- Based Study

장종범,최영,강승백,정진엽,박문석,이경민 고신대학교(의대) 고신대학교 의과대학 학술지 2021 고신대학교 의과대학 학술지 Vol.36 No.2

Objectives: This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data. Methods: A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five- dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m2). Results: In the whole group, the level of knee pain was significantly associated with K-L grade (P < 0.001), and EQ-5D was negatively associated with age (P < 0.001), the level of knee pain (P < 0.001), and weekly hours of vigorous-intensity activity (P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m2 < BMI ≤ 27.5 kg/m2 (P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m2 (P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m2. Conclusions: The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.

인공 슬관절 전치환술에서 대퇴 삽입물의 회전 정렬을 위한 원위 대퇴골의 해부학적 계측

장종범(Chong Bum Chang),성상철(Sang Cheol Seong),이상훈(Sahnghoon Lee),유재호(Jae Ho Yoo),이승환(Seung Hwan Rhee),이명철(Myung Chul Lee) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.7

목적: 본 연구의 목적은 인공 슬관절 전치환술시 대퇴골 삽입물의 회전 정렬과 관련된 여러 가지 해부학적 지표들의 관계를 계측하고, posterior condylar axis를 회전 정렬의 척도로 적용할 때 고려해야 할 점을 제시하고자 함이다. 대상 및 방법: 건강한 지원자 40명(남자 20명, 여자 20명)의 40 슬관절을 대상으로 슬관절 신전위(0°)에서의 원위 대퇴골 축상면의 자기 공명 영상에서 임상적 transepicondylar axis (TEA), 외과적 transepicondylar axis, posterior condylar axis (PCA), 대퇴 전후 축(AP axis)들의 관계를 계측하였으며, 퇴행성 관절염의 모델로 대퇴 후과의 내, 외측 연골의 마모가 다른 경우를 가정하여 PCA와 TEA사이의 각도 변화를 계측하였다. 결과: 여러 척도 중 임상적 TEA는 AP axis과 수직의 관계를 보였으며 임상적 TEA와 PCA사이의 각도는 평균 5.4°였고 남자군은 평균 4.3°, 여자군은 평균 6.5°로 여자군에서 통계적으로 유의하게 큰 값을 보였다. 임상적 TEA와 외과적 TEA사이의 차이는 남자는 평균 3.2°, 여자는 평균 3.8°였다. 대퇴 후과 중 내측의 연골은 모두 마모되고 외측의 연골은 모두 보존된 상태를 가정하여 계측한 PCA에 의한 회전 정렬은 정상에 비하여 1.9°의 외회전이 추가됨을 알 수 있었다. 결론: 임상적 TEA와 외과적 TEA는 3° 이상 차이를 보이는 회전 정렬의 척도로서 수술 시 혹은 연구 논문에서 명확히 구별하여 적용되어야 할 것으로 사료된다. TEA와 PCA사이의 각도는 성별간 유의한 차이를 보이나 이는 추가의 검증이 필요할 것으로 사료된다. PCA를 이용하여 회전 정렬을 정하는 경우 관절 연골의 마모 정도의 차이에 따라 대퇴 치환물의 회전의 각도가 변하게 되므로 수술시 이점을 고려를 해야 한다. Purpose: We evaluated the relationship among the various rotational reference axes of femoral component in TKA, and the potential change in rotational alignment when a posterior condylar axis (PCA) was used as a reference for different cartilage erosions between the medial and lateral posterior femoral condyles. Materials and Methods: The study subjects included twenty male and twenty female volunteers. Axial MR image of the distal femur were used to measure the angles among the clinical transepicondylar axis (cTEA), surgical transepicondylar axis (sTEA), the PCA, and the AP axis. We then evaluated the difference in the amount of rotation between a normal and osteoarthritic model when the PCA was used as a rotational reference. Results: The mean angle between cTEA and PCA was 5.4 degrees, and it was significantly greater in the female (6.5 degrees) than in the male group (4.3 degrees). The cTEA demonstrated a perpendicular relationship with the AP axis in both groups. The average angles between cTEA and sTEA were 3.2 degrees in the male group and 3.8 degrees in the female group. When we assumed complete erosion of the cartilage on the medial posterior condyle with preservation on the lateral side, the angles between the cTEA and PCA decreased by an average of 1.9 degrees in both groups. Conclusion: This study suggests that the two transepicondylar axes, which demonstrated greater than 3 degrees in angle-difference, should be defined clearly in scientific reports and in their application as rotational references in TKA. Some significant gender differences in the rotational profile were noted. When the PCA is used as a rotational reference, potential errors caused by the different amounts of cartilage erosion between the medial and lateral posterior condyles should be considered.

인공 슬관절 전치환술 시 적절한 대퇴 치환물의 회전 정렬을 위한 원위 대퇴골과 경골의 해부학적 고찰

장종범 ( Chong Bum Chang ),성상철 ( Sang Cheol Seong ),이상훈 ( Sahng Hoon Lee ),이명철 ( Myung Chul Lee ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.1

Purpose: This study aimed 1) to identify the rotational axis of the femur that provides a balanced 90˚ flexion space in TKA, 2) to assess the changes in the flexion space in deep flexion, and 3) to assess the changes in rotational alignment, with using the posterior condylar axis (PCA) as a guide, and as the changes are related to asymmetric cartilage erosion of the posterior condyle. Materials and Methods: The axial MR images of the distal femur in knee extension and the coronal images of the distal femur and the entire tibia at 90 and 130˚ were examined in 40 healthy adults. Results: The clinical transepicondylar axis (TEA) provides a balanced 90˚ flexion space on average. The balanced flexion space in 90˚ became an asymmetrical space with relative narrowing of the medial side in 130˚. Every 1 mm of asymmetrical cartilage erosion between the posterior condyles changed the femoral rotation by approximately 1˚ when using the PCA as a guide. Conclusion: This study suggests that the clinical TEA is the rotational reference that provides a balanced flexion space. When using the PCA as a rotational reference, a surgeon should consider the potential change in the rotational angle that is caused by asymmetrical cartilage erosion.

요산 나트륨이 침착된 황색인대의 비후에 의한 척추관 협착증

박종범(Jong-Beom Park),김승기(Seung-Gey Kim),최우성(Woo-Sung Choi),맹이소(Lee-So Maeng),채종우(Jong-Woo Chae),장한(Han Chang) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.3

대퇴와 관상명 골절의 치료

박종범,장건,장한,인용,김승기,박원종 대한골절학회 2000 대한골절학회지 Vol.13 No.4

Purpose: To evaluate the results of treatment in 6 cases of coronal split fractures of the femoral condyle Materials and Methods: Six cases of coronal split fractures of the femoral condyle were treated and followed up 16 to 36 months. Five cases were treated operatively. We used anteromedial approach for 3 cases, posteromedial approach for 1 case and posterolateral approach for other 1 case. Non-displaced case was treated conservatively with cast. We compared the results of each case using Letenneur assessment system. Results: All 3 cases approached anteromedially and the case approached posterolaterally showed good results. But the case approached posteromedially showed fair result with mild limitation of motion and pain. Non-displaced case treated with cast resulted in poor result with nonunion. Conclusion: We propose operative treatment for coronal split fracture of the femoral condyle even though there is no displacement. Anteromedial approach and headless screw fixation could be the best method for reduction and fixation of fracture.

요추의 추간공외 추간판 탈출증의 진단 및 치료

장한,박종범,이인주,김승기,박성진,최우성,임승재 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study Design : We retrospectively reviewed nine patients of lumbar extraforaminal disc herniation which underwent conservative or surgical treatment. Objectives : We evaluated the clinical characteristics, accuracy of diagnostic methods, and result of conservative or surgical treatment for the lumbar extraforaminal disc herniation. Summary of Background Data : Lumbar extraforami nal disc herni ation represents an important component of lumbar disc herniation because of the difficulty in diagnosis and the difference in clinical characteristics and surgical approaches in contrast to usual intracanalicular disc herniation. Materials and Methods : Nine patients which we have experienced from March 1994 to February 1997 were evaluated by physical examination, magnetic resonance imaging, EMG, and discoenhanced computed tomogram. There were 4 males and 5 females, and average age was 42.4 years(30-72). Results : The level of herniation was 4 cases at L4-5 and 5 at L5-S1. Radiating pain was chief complaint but low back pain was absent or mild. Accuracy of disco-enhanced computed tomogram was superior to that of magnetic resonance imaging. The results of conservative treatment were good in 2 cases(40%), fair in 2 cases(40%), and poor in l case(20%). And those of surgical treatment including partial laminectomy, medial facetectomy, and discectomy or extraforaminal approach were excellent in 3 cases(75%), good in 1 case(25%) according to the grading of MacNab. Conclusions : Lumbar extraforaminal disc herniation represents compressive symptoms of upper lumbar root of the involved level characteristically. Location and degree of disc herni ation is an important factor for determining the surgical approach, and disco-enhanced computed tomogram is a definite diagnostic method.

Relationship between LDL/HDL ratio and mortality in patients with acute ST-elevation myocardial infarction (초)

김종범,김원,황선호,김완,정명호,안영근,김영조,최동훈,조명찬,김수중,장양수,나승운 대한내과학회 2008 대한내과학회지 Vol.75 No.1S