잠김 금속판을 이용한 중족부 관절 유합술의 결과

차성무,강경운,서진수,Cha, Seong Mu,Kang, Kyung Woon,Suh, Jin Soo 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.1

Purpose: The purpose of this study was to compare and analyze the results of midfoot arthrodesis with locking plate fixation and the other instruments. Materials and Methods: Twenty one patients, a total of 22 feet who underwent midfoot arthrodesis at our institution were reviewed retrospectively from January 2006 to December 2011. Locking plates were used in 9 cases, and the other instruments such as K-wires, screws, staples were used in 13 cases. Radiologic union time was evaluated and compared between both groups. Preoperative & postoperative AOFAS midfoot scores were evaluated and compared as clinical results. Results: The average AOFAS score was rising from 69.7 to 89.4 in locking plate group and from 67.6 to 80.7 in the other instrument group. There was no statistically significant difference in two groups (p=0.179). The mean radiologic union time was 10.2 weeks in locking plate group, 12.6 weeks in the other instrument group with no significant difference (p=0.062). One case of peroneal nerve irritation was detected as a complication in locking plate group. One case of peroneal nerve irritation and 1 case of superficial wound infection with skin sloughing were detected in the other instrument group. Conclusion: There was no statistically significant difference for union time and clinical results in both groups. A locking plate can be one of the useful option for midfoot arthrodesis.

선천성 족지 기형의 치료

차성무,서진수,Cha, Seong-Mu,Suh, Jin-Soo 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.3

There are many different type of congenital toe anomalies such as syndactyly, polydactyly which are more common, and less frequently macrodactyly and curly toe. Congenital anomaly of hand can decrease the hand function and easy to be visualized, so the early treatment of anomaly is natural and recommended. On the other hand, Congenital anomaly of foot rarely decrease the foot function and was hidden in the shoe, so treatment of anomaly was delayed frequently. However, the surgery can be needed, as the foot getting grown-up, discomfort of shoe fitting or intractable plantar keratosis due to secondary deformation of foot can occur. A distinct feature and surgical consideration was compared with congenital anomaly of hand and it should be taken into account in the treatment of adult toe anomalies.

종골 부정 유합에 동반된 거주상 관절 아탈구의 치료 (1예 보고)

차성무,장보훈,서진수,Cha, Seong-Mu,Chang, Bo Hoon,Suh, Jin-Soo 대한족부족관절학회 2012 대한족부족관절학회지 Vol.16 No.4

There may be complications after comminuted or intraarticular calcaneal fracture regardless of the initial treatment. Transcalcaneal talonavicular dislocation is rarely reported severe form of calcaneal fracture. We experienced a neglected transcalcaneal talonavicular subluxation case, who had been treated for intraarticular calcaneal fracture conservatively. Subtalar distraction bone block fusion was done for calcaneal malunion with talonavicular subluxation. Inspite of successful subtalar fusion, pain was persisted because of talonavicular re-subluxation with arthritis and calcaneocuboid arthritis. So, second operation, the talonavicular and calcaneocuboid fusion, was done. After union achieved, the patient's foot pain was improved. Calcaneal malunion combined with talonavicular subluxation and unstable transverse tarsal joint, such as this case, initial triple arthrodesis could be considered.

아킬레스 건 봉합 후 단일 하지 거상시기와 근력 분석

차성무(Seong Mu Cha),장보훈(Bo Hoon Chang),서진수(Jin Soo Suh) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.2

목적: 급성 아킬레스 건 파열에 대한 수술적 치료 후 단일 하지 거상 시기 및 족저 굴곡 근력 측정을 하여 근 재활의 경과를 분석하고자 하였다. 대상 및 방법: 2006년 3월부터 2011년 6월까지 본원에서 급성 아킬레스 건 파열로 수술적 치료를 시행한 81예 중 조건에 합당한 39예의 환자를 대상으로 하였다. 수술과 재활은 일정하게 진행하였으며, 수술 3개월째 근력 검사 및 단일 하지 거상 시기를 측정하여, 최종 추시의 임상결과와 함께 분석하였다. 결과: 단일 하지 거상 시기는 평균 14주+3일이었고 수술 후 3개월째 시행한 등속성 족저 굴곡력 검사에서 30o/s 각속도의 최대 우력은 평균 69 Nm, 120o/s 각속도의 최대 우력은 평균 41 Nm로 건측의 69%로 측정되었다. 수술 후 3개월 이내에 단일 하지 거상이 가능하였던 군에서 최종 추시의 Achilles tendon total rupture score, Foot and ankle outcome score가 통계적으로 유의하게 높았다. 결론: 아킬레스건 파열 후 재활 과정에서 단일 하지 거상이 일찍 가능하면 근력 회복이 좋음을 기대할 수 있고, 최종 추시의 임상 결과가 좋음을 예측할 수 있으리라 생각한다. Purpose: The purpose of this study is to analyze the progress of muscle rehabilitation for patients with acute Achilles tendon rupture, who underwent Achilles tendon repair, checking capable time of single heel raise and isokinetic plantar flexion power. Materials and Methods: From March 2006 to June 2011, 42 of 81 patients were excluded and the other 39 patients, who underwent surgery due to acute Achilles tendon rupture in our institute, were enrolled in this study. The operation and rehabilitation were constantly performed according to the author’s method. Isokinetic plantar flexion power was measured at three months postoperation, capable time of single heel raise was assessed, and clinical results of the last follow up were measured and analyzed. Results: Single heel raise was possible at an average of 14 weeks and three days, and repetitive single heel raise more than 10 times was possible at an average of 20 weeks. The peak torque of 30°/s plantar flexion was mean 69 Nm. The peak torque of 120°/s was 41 Nm. Assessment at three months post-operation showed 69% power, compared to the contralateral leg. The group of patients who were able to perform single heel raise within three months, showed better Achilles tendon total rupture score and foot and ankle outcome score at last follow up, and showed better plantar flexion power at three months post-operation. Conclusion: At the last follow up, we can expect better clinical results and muscle power in patients who are able to perform single heel raise early treatment of acute Achilles tendon rupture.

요내반족 교정에 있어 드와이어씨 절골술 및 제 1중족골 절골술이 방사선학적 지표에 미치는 영향

최준영,차성무,염지웅,서진수,Choi, Jun Young,Cha, Seong Mu,Yeom, Ji Woong,Suh, Jin Soo 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.1

Purpose: Several techniques have been introduced for correction of pes cavo-varus deformity. We retrospectively reviewed and compared the data of patients who underwent 1st metatarsal osteotomy alone, Dwyer's osteotomy alone, and 1st metatarsal osteotomy combined with Dwyer's osteotomy to determine the effect on radiographic parameters. Materials and Methods: Data on 28 cases in 27 consecutive patients recruited from 2006 to 2014 who underwent 1st metatarsal osteotomy alone (group F), Dwyer's osteotomy alone (group H), or 1st metatarsal osteotomy followed by Dwyer's osteotomy (group HF) with a minimum 1-year follow-up were reviewed retrospectively. Results: Calcaneal pitch angle on the standing foot lateral radiographs was significantly decreased after the operation in groups H and HF whereas Meary angle was decreased in groups F and HF. Hindfoot alignment angle and ratio on the hindfoot alignment view were improved in groups H and HF. Maximal medial cuneiform height reduction was observed in group HF. 1st ray was significantly shortened in groups F and HF. Conclusion: Combined forefoot and hindfoot operation took the largest correction power of all radiologic parameters.

대퇴 전자간 골절의 근위 대퇴 골수정 삽입술 후 발생한 전자부 통증의 초음파 소견 - 2예 보고 -

남우동,한계영,차성무,Nam, Woo Dong,Han, Kye Young,Cha, Seong Moo 대한정형외과초음파학회 2011 대한정형외과 초음파학회지 Vol.4 No.1

대퇴골 전자간 골절에서 근위 대퇴 골수정을 이용한 수술 후 고관절 외측부의 통증을 호소하는 환자들이 있다. 전자부 통증의 원인이 건병증임을 초음파 검사를 통해 확인할 수 있어 그 치험 예를 보고하고자 한다. After closed reduction and internal fixation with proximal femoral nail for intertrochanteric fracture, some patients complained lateral hip pain. We report two cases of lateral hip pain due to tendinopathy confirmed by ultrasonography.

고관절 전치환술 시 각도기와 지시봉을 사용한 술전 측와위 방사선 검사의 유효성

한계영 ( Kye Young Han ),차성무 ( Seong Mu Cha ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4

Purpose: For inserting an acetabular cup with the correct inclination angle, we checked the pelvic tilts using the lateral decubitus position X-ray and a goniometer and pointer. The accuracy of the cup inclination at the targeted angles was evaluated after insertion of the cup at an adjusted angle with using a goniometer and pointer. Material and Methods: Between January 2008 and December 2009, 56 hips in 50 patients who underwent total hip replacement arthroplasty (THRA) were enrolled. The mean age at the time of surgery was 63.8 years. There were 31 male patients (36 hips) and 19 female patients (20 hips). The preoperative diagnoses included osteonecrosis of the femoral head in 27 hips, secondary osteoarthritis in 10 hips and femoral neck fracture in 14 hips. The preoperative pelvic tilts were evaluated according to the lateral decubitus position X-ray with using a goniometer and pointer. The target inclination angle was 40˚ for 27 hips that underwent ceramic-on-ceramic THRA. The target inclination angle was 45˚ for the 29 hips that underwent ceramic-on-polyethylene THRA. The inclination of the cup was evaluated after inserting the acetabular cup at the adjusted angle using a goniometer and pointer. Results: The mean inclination angle of the acetabular cup was 39.3˚ for the ceramic-on-ceramic THRA and 44.4˚ for the ceramic-on-polyethylene THRA. There were no significant differences between the 40˚ and 45˚ (P=0.059, P=0.071). Conclusion: The pelvic tilt can be evaluated by checking the lateral decubitus X-ray with a goniometer and pointer. Insertion of an acetabular cup at the adjusted angle could be a credible method for reducing the variability of cup inclination.

족관절 후과 단독 골절의 치료

김지훈(Ji Hoon Kim),차성무(Seong Mu Cha),조대연(Dae Yeon Jo),서진수(Jin Soo Suh) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.1

목적: 족관절 후과 단독 골절은 매우 드문 골절로 8예의 후과 단독 골절을 치험하여 보고하고자 한다. 대상 및 방법: 2008년 3월부터 2012년 2월까지 일산백병원에서 족관절 후과의 단독 골절로 치료를 받은 8예를 대상으로 하였다. 평균 연령은 30세(11-49세), 남자가 6예, 우측이 5예였다. 수상 기전은 실족 사고가 4예로 가장 많았다. 4예에서 수술적 치료를 시행하였으며, 3예에서 석고 고정을, 1예에서 족관절 보조기를 이용하여 치료하였다. 최초 내원 시 골절을 인지하지 못한 경우가 3예였으며, 진단하는 데 걸린 기간은 각각 9일, 56일, 110일이었다. 2예에서는 컴퓨터 단층 촬영을, 1예에서는 자기공명영상 촬영을 통해 인지하였다. 결과: 주된 증상은 발목 통증 및 부종이었다. 후과 골편의 원위 경골 관절면의 침범 정도는 평균 21.4%였으며, 전위는 평균 1.25 mm 였다. 수술적 치료를 시행한 3예 중 2예에서 후외측 접근법을, 1예에서 후내측 접근법을 이용하였으며, 골유합까지 평균 12.1주가 소요되었다. 최종 추시 평균 미국정형외과족부족관절학회 점수는 92.5점이었다. 결론: 족관절 후과 단독 골절은 매우 드문 골절이지만, 간과하면 발목의 지속적인 통증을 유발할 수 있으므로 발목 외상의 감별 진단에 포함하여 주의 깊게 살펴보아야 할 것이다. Purpose: An isolated posterior malleolar fracture in the ankle is very rare. We treated eight cases of isolated posterior malleolar fracture, and describe the clinical features and outcomes of treatment. Materials and Methods: Between from March 2008 to February 2012, eight cases of isolated posterior malleolar fracture were treated in Ilsan Paik Hospital. The mean age of patients was 30 years (11-49 years); six patients were male and five were right. Slip down (4 cases) was the most common injury mechanism. We treated four cases surgically, three cases by cast and one case by ankle brace. We could not recognize three cases of isolated posterior malleolar fracture at first. The time delay to diagnose unrecognized isolated posterior malleolar fracture was nine days, 56 days and 110 days respectively. We were able to diagnose the unrecognized isolated posterior malleolar fracture using computed tomography (two cases) and magnetic resonance imaging (one case). Results: The main symptom was painful swelling. The average for articular involvement of the posterior malleolar fragment was average 21.4%, and average displacement was 1.25 mm. We treated three cases surgically using a posterior lateral approach and one case using a posterior medial approach. The average American Orthopaedic Foot and Ankle Society score was 92.5 at the last follow-up. Conclusion: The isolated posterior malleolar fracture is very rare and if it is neglected, persistent ankle pain can remain. Isolated posterior malleolus fracture should be included as one of the differential diagnoses after ankle trauma.