당뇨병성 족부 괴저의 치료에서 무릎 밑 경피적 경혈관 혈관성형술의 유용성

최재열,신헌규,김유진,김종민,이용택,김승권,김종민,Choi, Jae-Yeol,Shin, Hun-Kyu,Kim, Eu-Gene,Kim, Jong-Min,Lee, Yong-Taek,Kim, Seung-Kwon,Kim, Jong-Min 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.2

Purpose: To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) below the knee as a treatment in diabetic foot gangrene. Materials and Methods: Between May 2003 and May 2006, angiography was performed in 35 diabetic foot gangrene classified as either Wagner grade IV or V. Infrapopliteal PTA was performed in 10 patients among them. Clinical success was defined as prevention of major amputation. Results: Among 25 patients who did not receive infrapopliteal PTA, the major amputation rate is 22% (in one arterial occlusion cases), 50% (in two arterial occlusion cases), 63% (in three arterial occlusion cases), respectively. Infrapopliteal PTA was successfully performed in 8 among 10 patients. Two patients were failed and undergone below-knee amputation. Toe amputation were performed in 2 patients with one arterial occlusion. Out of 6 patients with three arterial occlusions, toe amputations were performed in 4 patients and the other 2 patients were healed through debridement. Conclusion: As a first choice revascularization procedure for limb salvage in diabetic foot gangrene, infrapopliteal PTA can be one of treatment options.

고령 환자 족관절 골절의 수술적 치료

최재열,정화재,신헌규,김유진,박세진,서동석,Choi, Jae-Yeol,Jeong, Hwa-Jae,Shin, Hun-Kyu,Kim, Eugene,Park, Se-Jin,Seo, Dong-Seok 대한족부족관절학회 2013 대한족부족관절학회지 Vol.17 No.1

Purpose: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. Materials and Methods: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. Results: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. Conclusion: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

근위 중족골 절골술과 변형 chevron 절골술을 이용한 무지 외반증의 수술적 치료의 비교

최재열,신헌규,김영훈,김홍균,이호진,Choi, Jae-Yeol,Shin, Hun-Kyu,Kim, Young-Hun,Kim, Hong-Kyun,Lee, Ho-Jin 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.1

Purpose: We compared the result of a proximal metatarsal closed wedge osteotomy and soft tissue procedure with a modified chevron osteotomy and soft tissue procedure in the treatment of hallux valgus. Materials and Methods: Between March 1999 and February 2003, we performed proximal metatarsal closed wedge osteotomy and soft tissue procedure on 17 feet (12 patients), and modified chevron osteotomy and soft tissue procedure on 12 feet (9 patients). Results: According to Mayo clinic forefoot scoring system (FFSS), group 1, with proximal metatarsal closed wedge osteotomy, shows 67.2 points postoperatively and group 2, with modified chevron osteotomy, shows 68.5 points postoperatively. In group 1, the average correction of hallux valgus angle and intermetatarsal angle was 20.8 degrees and 4.8 degrees, respectively. In group 2, the average correction of hallux valgus angle and intermetatarsal angle was 19.9 degrees and 4.7 degrees, respectively. The average shortening was 3.15 mm in group 1 and 1.38 mm in group 2. Conclusion: We obtained relatively good clinical and radiographic result in this study. The effect on shortening of the first metatarsal was greater in the proximal metatarsal closed wedge osteotomy than modified chevron osteotomy, but the metatarsal shortening did not related with metatarsalgia. So, both techniques seems optimal surgical treatment for hallux valgus deformity.

수근중수골 관절의 골절 및 탈구에 대한 수술적 치료

최재열 ( Jae Yeol Choi ),신헌규 ( Hun Kyu Shin ),손경모 ( Kyung Mo Son ),고천석 ( Chun Suk Ko ) 대한골절학회 2005 대한골절학회지 Vol.18 No.4

견봉 쇄골 관절 탈구의 수술적 치료에서 두 가지 갈고리 금속판의 임상적 비교

최재열(Jea-Yeol Choi),김유진(Eugene Kim),정화재(Haw-Jae Jeong),안진환(Jin Whan Ahn),신헌규(Hun-Kyu Shin),박세진(Se-Jin Park),이승희(Seung-Hee Lee),이재욱(Jae-Wook Lee),최규보(Kyu-Bo Choi) 대한견주관절의학회 2012 대한견주관절의학회지 Vol.15 No.2

목적: 견봉 쇄골 탈구의 수술적 치료에서 갈고리 금속판의 견봉측 고정장치 (acromial locking system)가 유용한지에 대한 조사를 위하여 견봉측 고정장치가 있는 Wolter 금속판과 그것이 없는 AO hook 금속판 두 가지 방법의 임상적 결과와 합병증을 비교하고자 하였다. 방법: Rockwood 분류 III-V형의 견봉 쇄골 관절 탈구로 수술한 환자 중 1년 이상 추시가 가능했던 71명을 대상으로 하였다. 이 중 Wolter 금속판을 이용하여 수술을 한 환자 39명, AO hook 금속판을 이용한 환자가 32명이었다. 술 후 평가는 Constant-Murley 평가 지표를 이용하여 수술 후 약 1개월, 3개월, 6개월, 12개월에 관절 기능을 점수화하고 운동범위를 측정하였으며 금속판과 골의 방사선적 합병증을 조사 하였다. 결과: 수술 후 1년 추시 Constant-Murley score는 Wolter 금속판 85.2±5.3점, AO Hook 금속판 83.2±6.8점으로 유의한 차이 없이 우수하였다. 운동범위는 수술 후 1개월 및 3개월에서 Wolter 금속판의 운동 범위가 유의하게 높게 호전 되었으나 6개월 이후에는 AO hook 금속판과 차이가 없었다. 수술 후 합병증으로 Wolter 금속판은 4예에서 방사선상 나사못의 이완 및 파열이 나타났으며, AO hook 금속판은 7예에서 견봉하 골용해 소견과 금속판 주위 골절이 나타났다. 결론: 견봉측 고정장치 유무에 상관없이 두 가지 수술 방법 모두 장기적인 임상 결과는 우수하며, 유용한 방법이라고 생각되나 견봉측 고정장치가 없는 AO hook 금속판이 수술 후 초기에 관절운동 제한이 더 많이 관찰 되었으며, 견봉의 골용해도 많았다. 그러나 Wolter 금속판은 큰 절개가 필요하다는 등의 단점이 있고 나사못의 이완 및 파열, 견봉 골절 등이 나타날 수 있어 두 방법 각각의 장단점이 있다고 판단되었다. Objective: To evaluate if acromial locking in hook plate is necessary for surgical treatment of acromioclavicular dislocation by compare Wolter plate and AO hook plate. Methods: Seventy one patients who have Rockwood type III to V acromioclavicular joint dislocation treated with AO hook plate and Wolter plate were involved. Among them, 39 patients were treated with Wolter hook plate and 32 patients with AO hook plate. The Constant-Murley score and the range of motion of shoulder joint were measured on postoperative 1<SUP>st</SUP> , 3<SUP>rd</SUP> , 6<SUP>th</SUP> and 12<SUP>th</SUP> months, and the radiological complications involving plate and bone were investigated. Results: Constant-Murley score of postoperative one year were 83.2 6.8 in AO hook plate group and 85.2 5.3 in Wolter plate group without statistical difference (p<0.05). Faster recover of forward elevation and external rotation were examined in Wolter plate group at first and third months after surgery than those of AO hook plate group, but there were no significant difference between after six months or later after surgery. Four cases of loosen or broken screws and one case of pull-out of plate were found in Wolter plate group. Seven cases of subacromial bony erosion and one periprosthetic fracture were found in AO hook plate group. Conclusion: Although clinical outcomes of both two methods were same, no matter if acromial locking system was or not. More radiological complication of plate and bone were found in AO hook plate than that of Wolter plate. However also had disadvantage like larger incision during surgery.

경골 간부를 침범한 Pilon 골절에서 2단계 MIPO 수기를 이용한 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate surgical treatment using two-staged MIPO technique in tibial pilon fractures involving tibial shaft. Materials and Methods: Twelve patients, who underwent two-staged MIPO technique for pilon fractures involving tibial shaft between January 2003 and May 2005, were followed for more than one year. Radiographs were graded by the criteria of Anglen and ankle functions were graded by the criteria of Mast and Teipner. Ankle function, union time and postoperative complications were also analysed. Results: Clinically there were eight (67%) good results, three (25%) fair results and one (8%) poor result. At the last follow-up, the radiographic results showed seven (58%) excellent results, three (25%) good results, and two (17%) fair results. During the follow up, There was one case of nonunion Conclusion: Two-staged MIPO techinque is one of the good methods for the treatment of pilon fractures invloving tibial shaft.

Danis-Weber B형 족관절 외과 골절의 고정방법 비교연구 : Antiglide 금속판 고정술 대 외측 금속판 고정술

신헌규,최재열,강동호,Shin, Hun-Kyu,Choi, Jae-Yeol,Kang, Dong-Ho 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: To evaluate the advantages of the antiglide plate fixation procedure for Danis-Weber type B lateral malleolar fractures of ankle compared to other methods of lateral plate fixation. Materials and Methods: We reviewed 70 cases that antiglide plate fixation and lateral plate fixation procedures were performed from Mar. 2001 through Mar. 2006. Of the total 70 cases, they were divided into two groups ; 22 cases were treated with the antiglide plate procedure (Group I) and 48 cases were treated with the lateral plate procedure (Group II). The results of the two groups were analyzed both radiographically and clinically using Ankle-Hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS). Results: All fractures were healed at average of 8 weeks both radiographically and clinically. According to the Ankle-Hindfoot scale, all cases of Group I and 48 cases of Group II were above 80 points. 2 cases (9%) in Group I complained of peroneal tendinitis, while 19 cases (39%) in Group II showed skin irritation resulting from the screw or the plate. A total of 6 cases (27%) in Group I and 27 cases (55%) in Group II complained cosmetic problems. Conclusion: we concluded that the antiglide plate fixation for Danis-Weber type B lateral malleolar fractures is one of the good methods. But, further analysis will be need to find a solution for the peroneal tendinitis.

제5 중족골 기저부 골절의 유발인자 및 치료

신헌규,최재열,이지원,Shin, Hun-Kyu,Choi, Jae-Yeol,Lee, Ji-Won 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

노년층에서 고관절 골절과 골밀도의 상관관계

정화재(Hwa Jae Jeong),최재열(Jae-Yeol Choi),이진명(Jinmyung Lee),최규보(Kyubo Choi),전병삼(Byeongsam Jeon) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.3

목적: 노년층에서 통증, 장애 등을 초래하는 근위 대퇴부 골절은 점점 증가하고 있다. 골밀도의 감소, 골다공증은 이러한 근위 대퇴부 골절과 연관된 인자 중 하나로 여겨지고 있다. 저자들은 근위 대퇴부 골절이 발생한 노년층에서 골밀도를 측정하여 골절과의 상관관계를 알아보았다. 대상 및 방법: 대퇴 경부골절이 있는 60명, 전자간 골절이 있는 82명을 대상으로 DEXA를 이용한 골밀도를 측정하였다. 대퇴부의 경부와 전자 부에서 측정하였으며, 본원 건강 검진 센터에서 골밀도 검사를 시행한 근위 대퇴골의 골절이 없었던 158명을 대조군으로 설정하였다. 이들을 각각 성별 및 골절 유행에 따라 나눈 후 비교분석을 하였다. 결과: 근위 대퇴부 골절군에서 대조군 보다 골밀도기 유의하게 낮게 나타났다. 대퇴 전자간 골절의 골밀도는 대퇴 경부 골절의 골밀도 보디 낮았지만, 통계적으로 차이는 없었다. 대퇴 경부 골절과 전지간 골절군에서 각각 형태에 따른 골밀도 비교에서 유의한 차이는 없었다. 결론: 노년층 근위 대퇴부 골절 환자들은 정상인에 비하여 골밀도 감소를 나타내었으니, 남성에서 발생하는 대퇴 경부 골절은 감소된 골밀도와 연관이 적은 것으로 생각된다. 근위 대퇴부 부위별 골밀도는 골절의 위치 및 유형과 연관성이 낮은 것으로 사료된다. Purpose: The incidence of hip fracture associated with disability, pain and death increases in old age. The decreased bone mineral density, particularly due to osteoporosis, has been described as one of factors associated with the proximal femur fracture. Therefore, this study, measured the bone mineral density (BMD) of elderly patients with hip fractures to better understand the relationship between osteoporosis and proximal femur fractures. Materials and Methods: The bone densities of the femoral neck and trochanteric region were measured by dual energy x-ray absorptiometry (DEXA) in 60 patients with femur neck fractures and 82 patients with intertrochanteric fractures. Individuals (158 subjects) who had their BMD checked in a Health promotion center without a proximal femoral fracture were selected as a control group The patients were divided into subgroups according to gender and type of fracture. Results: The BMD of the hip in the patients with proximal femur fractures was significantly lower than that of the control subjects. The intertrochanteric fracture group had a lower T-score than the femur neck fracture group. However the differences were not significant. No significant differences were found between the displaced and undisplaced femur neck fracture groups and between the stable and unstable intertrochanteric fracture groups Conclusion: The BMD in elderly patients with proximal femur fracture was significantly lower than that of the control group. There was a poorer association between a decreased BMD and femur neck fractures in elderly males. There were no association between the BMD and location of the fracture or fracture type.

골다공증을 동반한 고령 환자에서 불안정성 대퇴 전자간 골절의 금속 내 고정술과 양극성 반치환술의 결과 비교

정화재 ( Haw Jae Jung ),최재열 ( Jae Yeol Choi ),신헌규 ( Hun Kyu Shin ),김유진 ( Eu Gene Kim ),박세진 ( Se Jin Park ),이용택 ( Yong Taek Lee ),김광신 ( Gwang Sin Kim ),김종민 ( Jong Min Kim ) 대한골절학회 2007 대한골절학회지 Vol.20 No.4

목적: 골다공증을 동반한 고령 환자에서 발생한 불안정성 대퇴 전자간부 골절의 치료에 있어서 금속 내 고정술을 시행한 집단과 양극성 반치환술을 시행한 집단의 술 후 임상 결과 및 방사선학 결과를 후향적으로 비교 분석하였다. 대상 및 방법: 2003년 2월부터 2006년 2월까지 대퇴골 전자간부 골절로 수술을 시행 받은 환자 중 1년 이상 추시 가능하였던 환자로, 골절 유형이 Evans분류로 불안정성 골절, 70세 이상, 골밀도 (BMD)상 T-score가 -3.0이하인 골다공증 환자 36예를 대상으로 하였다. 압박 고 나사 고정술 또는 골수강 내 금속정 삽입술을 시행한 23예를 A군, 양극성 반치환술을 시행한 13예를 B군으로 정하였다. 두 집단을 수술 전후와 최종 추시 시의 단순 방사선 사진의 비교 분석과 Clawson분류로 수술 후 고관절 기능에 대해 평가하였다. 결과: A군에서는 6예에서 고정 실패를 보였다. 이중 1예에서 지연 나사의 이완을 보였고, 5예에서 불유합을 보였다. B군에서는 13예에서 삽입물의 안정적인 유지를 보였다. 수술 전후 보행 능력 회복 정도는 B군에서의 결과가 더 양호하였다. 결론: 금속 내 고정술의 경우가 양극성 반치환술에 비하여 골절의 불유합 및 고정물의 고정 실패가 더 많은 빈도로 발생하였고, 고관절 기능 회복에서도 좋지 않은 결과를 보였다. 따라서, 골다공증을 갖는 불안정성 대퇴골 전자간부 골절에서는 금속 내 고정술보다는 양극성 반치환술이 수술적 치료로 더 유용할 것으로 생각한다. Purpose: To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone. Materials and Methods: From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient`s age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than-3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarlhroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically. Results: Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered. Conclusion: Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarlhroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.