무지 외반증 재발의 한 원인으로 생각되는 종자골 정복에 영향을 주는 인자

윤영필,이철형,정현윤,김영우,정재용,Yune, Young-Phil,Lee, Chul-Hyung,Jeong, Hyun-Yoon,Kim, Young-Woo,Jung, Jae-Yong 대한족부족관절학회 2010 대한족부족관절학회지 Vol.14 No.1

Purpose: The incomplete reduction of the sesamoid has lately been issued as cause for recurrence. In this study, we analysed factors that may influence reduction of sesamoid. Materials and Methods: The study consists of 50 cases operated by single surgeon. Eighteen cases were done by proximal chevron osteotomy, and 32 cases were done by scarf osteotomy. Hallux valgus (HV) angle and intermetatarsal (IM) angle were measured before and three months after the surgery. Sesamoid position (SP) was classified according to Hardy and Clapham grade system. Results: After the proximal chevron osteotomy, the correction of the mean HV angle was $19.5^{\circ}$, and IM angle was $6.2^{\circ}$. SP was changed from 5.6 to 3.4 grade. After the Scarf osteotomy, the correction of the mean HV angle was 25 degree, and IM angle was $9^{\circ}$. SP was changed from 5.5 to 2.8 grade. There was difference of sesamoid's correction between two different method of surgery (p=0.127). However, better correction of sesamoid was witnessed with bigger correction angle regardless of method of surgery (p=0.002, 0.001). Conclusion: We believe surgical method do not effect sesamoid's correction but more correction angle can result in better correction of sesamoid position.

무지 외반증에서 Akin 절골술 내측 횡 봉합사 고정술의 결과

윤영필,김정훈,Yune, Young-Phil,Kim, Jeong-Hoon 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.1

Purpose: The purpose of this study was to analyze the clinical results of medial horizontal suture fixation of Akin osteotomy in hallux valgus and present its advantages. Materials and Methods: This study was based on 48 cases of 35 patients with Akin osteotomy, who underwent surgery of hallux valgus between December 2014 and July 2015, and with at least 12 months of follow-up. The mean age of patients was 46.9 years (range, 16~71 years). The mean follow-up duration was 15.9 months (range, 12~18 months). Clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS hallux metatarsophalangeal interphalangeal scale) score, and satisfaction score. Weightbearing anteroposterior radiographs were taken to measure the distal articular set angle (DASA) of the hallux. Radiographic bone union at 6 months follow-up was regarded as a success, while a loss of reduction and nonunion was regarded as a failure. Results: The mean pre- and postoperative pain VAS scores were 4.27 and 1.67, respectively (p<0.05). The mean AOFAS score improved from 59.7 to 80.5 (p<0.05). The DASA was improved from 8.15 to -2.57 (p<0.05). There was no case of skin irritation, cortical breakage, inflammation from the knot, and infection. All patients showed union without fixation failure. Conclusion: The clinical and radiological evaluations in this study demonstrate reliable results without complication. The medial horizontal suture fixation of the Akin osteotomy was effective, and the advantage of this procedure was unnecessity of the material removal, preservation of the joint, and no skin irritation.

무지외반증 환자에서 제1중족골두의 연골 미란: 수술 중 실측한 연골 미란과 수술 전 측정지표의 연관성

윤영필,송호섭,남호진,이창수,이봉주,Yune, Young-Phil,Song, Ho-Sup,Nam, Ho-Jin,Lee, Chang-Soo,Lee, Bong-Joo 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.2

Purpose: To analyze relation between age or parameters measured before operation and cartilage erosion of the first metatarsal head measured during operation. Materials and Methods: The study was targeted at 56 patients and 79 feet, who underwent Scarf osteotomy or Scarf and Akin osteotomy from November 2009 through November 2010, and whose cartilage lesion of the first metatarsal head referred to the cartilage grade III or IV of the International Cartilage Repair Society. The measurement parameters were age, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle. The cartilage erosion of the first metatarsal head was measured by one surgeon using cellophane. Occupancy rate and frequent involved sites of the cartilage erosion were recorded using Auto$CAD^{(R)}$ and adobe Illustrator CS4 program. SPSS correlation test and T-test were used for statistical analysis of the parameters and the cartilage erosion. Results: The cartilage erosion was incurred frequently in the sagittal groove and the site where subluxation or dislocation of the tibial sesamoild bone occurred but frequent involved sites had no statistical significance with cartilage erosion. The age showed a statistical significance with the cartilage erosion in the correlation test (p=0.003). Especially, the group of over 51 year old patients was turned out to have association with the cartilage erosion, compared to the group of below 51 (p=0.007). But, hallux valgus angle, intermetatarsal angle (1~2), tibial sesamoid position, proximal articular set angle and distal articular set angle were no statistical significance with the cartilage erosion. Conclusion: We found the more the age of patients increased (especially above 51), the more cartilage erosion increased. And it is thought that we pay attention to reduce tibial sesamoid bone.

Akin 절골술의 내측 횡 봉합사 고정: 술기 보고

윤영필,김상환,Yune, Young-Phil,Kim, Sanghwan 대한족부족관절학회 2015 대한족부족관절학회지 Vol.19 No.4

The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.

무지외반증에서 생체흡수성 나사못으로 고정한 변형 마우 절골술의 결과

김상환,윤영필,Kim, Sanghwan,Yune, Young-Phil 대한족부족관절학회 2015 대한족부족관절학회지 Vol.1 No.2

Purpose: The purpose of this study was to analyze the clinical results of application of bioabsorbable screws in hallux valgus surgery using modified Mau osteotomy. Materials and Methods: We retrospectively reviewed medical records of 25 patients. Operations were performed between May 2013 and January 2014. We performed 33 modified Mau osteotomies and fixed using bioabsorbable screws. Mean age of patients was 52 years (range 19 to 71). Mean follow up duration was 13.2 months (range 12.3 to 18.9). The clinical evaluations included pain visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and satisfaction score. Weight bearing anteroposterior radiographs were taken for measurement of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA). All radiographs were evaluated in order to detect complications related to bioabsorbable screws such as osteolysis, cyst formation, and fixation failure. Results: The mean pre- and postoperative pain VAS scores were 4.0 and 1.7 (p<0.05). The mean AOFAS score improved from 52.6 to 82.8 (p<0.05). Preoperative HVA and IMA were 31.2 and 13.9, respectively. Postoperative HVA and IMA were 5.2 and 6.2 (p<0.05). The DMAA increased from 7.8 to 9.9 (p<0.05). There was one case of superficial wound infection and one loss of correction, and no case of osteolysis, cystic formation around the screw, or deep infection. All patients showed union without fixation failure. Conclusion: The clinical and radiological evaluation of this study demonstrates reliable results without fixation failure or allergic reaction. The use of bioabsorbable screw appears not to be inferior to metal screw fixation in hallux valgus surgery.

무지 외반증 수술 후 통증조절을 위한 초음파 유도하 좌골신경 차단술의 유용성

이진철,윤영필,Lee, Jin Chul,Yune, Young-Phil 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.3

Purpose: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. Materials and Methods: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. Results: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. Conclusion: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

고관절 전치환술시 후방 도달법

선두훈 ( Doo Hoon Sun ),윤영필 ( Young Phil Yune ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.4

본 논문은 인공 고관절 전 치환술시 고식적인 후방 도달법에 대한 설명과 함께 고관절의 후방 안정성을 현격히 높일 수 있다고 보고된 단 외회전 근 보존 후방 도달법에 대한 설명을 소개하고자 함이다. 고관절 전치환 술 후 가장 흔하게 발생하는 조기 합병증은 고관절의 탈구로 보고되고 있다. 특히 고관절의 후방 도달법의 사용 시에 측방 도달법이나 전방 도달법에 비해 고관절 탈구의 빈도가 더욱 높아진다. 저자는 고관절 단 외회전 근을 보존하거나 충분히 확고하게 재건하여 단 외 회전 근을 절단 한 경우와 비교하여 고관절의 술 후 탈구 빈도를 알아보았다. 이에 고관절의 후방 도달법을 간략히 설명하고 고관절 단 외회전 근 보존 후방 도달법(수정 후방 도달법)을 소개한다. This paper was written to review the posterior approach for total hip arthroplasty and to introduce the modified short external rotator muscle saving posterior approach for enhancing the hip stability after total hip replacement arthroplasty. After total hip replacement arthroplasty, dislocation is the most commom early complication. Especially with using the posterior approach, dislocation is more common than that for the anterior or lateral approach to the hip. We report here that saving or meticulously repairing the short rotator could reduce the incidence of posterior hip dislocation after total hip replacement arthroplasty. Along with a brief review of the posterior approach to the hip, we introduce the short external rotator muscle saving modified posterior approach to total hip arthroplasty.

청소년에서 성장판 손상을 최소화하는 전방십자인대 복원술 -수술 술기 보고-

전재균 ( Je Gyun Chon ),윤영필 ( Young Phil Yune ),이철형 ( Chul Hyung Lee ),강현석 ( Hyoun Suk Kang ),정현석 ( Hyeon Seok Jeong ),정현윤 ( Hyun Yoon Jeong ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

Substantial ACL ruptures are not common in adolescence or childhood. During this period, ACL tibia avulsion fractures are more common than substantial ACL ruptures are. However, recent advancements in MRI and increases in adolescent sports activity have led to increased diagnosis of substantial ACL ruptures. Many physeal-sparing ACL reconstruction methods have been reported. However, some physeal-sparing ACL reconstructions are associated with poor outcomes because of laxity in the reconstructed ligament and discordance in the isometric point. We report a 14-year-old male patient with a chronic substantial ACL rupture and a longitudinal medial meniscus tear who was treated with ACL reconstruction and all-inside meniscal repair, which spares the femoral physis and reduces tibia physeal injury with an Achilles allograft.

혈액질환 환자에서 대퇴골두 무혈성 괴사의 위험인자

김용식 ( Yong Sik Kim ),윤영필 ( Young Phil Yune ),임영욱 ( Young Wook Lim ),김동엽 ( Dong Yeob Kim ),권순용 ( Soon Yong Kwon ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.1

목적: 혈액질환 환자를 대상으로 대퇴골두 무혈성괴사가 발생한 군과 발생하지 않은 군을 비교 분석하여 대퇴골두 무혈성괴사와 연관된 위험인자를 밝혀 보고자 한다. 대상 및 방법: 1994년 1월 1일부터 2007년 5월 31일까지 혈액종양 내과에서 입원 치료한 혈액질환 환자를 대상으로 대퇴골두 무혈성 괴사가 발생한 군(54명)과 발생하지 않은 군(54명)을 대상으로 골수이식의 종류, 이식편 대 숙주질환, 전신 방사선 조사, 스테로이드 사용량 등을 위험 요소로 분석하였다. 결과: 복합회귀분석에서 위험 요소 중 총 스테로이드 사용량 1.5 g/BMI 이상인 경우 유의한 위험인자로 분석되었다. 골수 이식의 시행여부와 전신방사선 조사 여부는 두 군에서 통계적으로 유의하지 않은 결과를 보였다. 골수 이식을 시행한 경우에 복합회귀분석에서 이식편 대 숙주질환의 발생 유무와 동종이식의 시행여부를 조사해 보았을 때 통계적으로 유의하지 않은 결과를 보였다. 결론: 혈액 질환 환자에서 1.5g/BMI 이상의 스테로이드를 사용한 경우는 대퇴골두 무혈성 괴사의 가능성이 높으므로 주의 깊은 추시가 필요하다. Purpose: We aimed to clarify the risk factors associated with the development of ONFH by comparing patients with hematologic diseases and osteonecrosis of the femur head (ONFH) to those patients without ONFH and who have hematologic diseases Materials and Methods: The study population was limited to the patients admitted to our Hematology-Oncology department from 1 January 1994 to 31 May 2007. The patients were divided into 2 groups (those with ONFH, 54 patients and those without ONFH, 54 patients) and the risk factors for ONFH were evaluated by a comparative analysis. We analyzed the effect of a history of bone marrow transplantation (BMT), graft-versus-host disease (GVHD), total body radiation (TBI) and the amount of steroid used as the risk factors for ONFH. Results: On the multiple logistic regression analysis, a total steroid use of >1.5 g/BMI was statistically identified as a significant risk factor for ONFH. The history of BMT and TBI were not statistically correlated with the development of ONFH. Among the patients with BMT, allogenic BMT and a history of GVHD were not statistically correlated with the development of ONFH on the multiple logistic regression analysis. Conclusion: Patients with hematologic diseases and who have used steroid >1.5g/BMI should carefully observed because they are more likely to develop ONFH.

슬관절 전치환술시 슬개골 비치환술

조세현,정운화,천충우,윤영필 대한슬관절학회 2002 대한슬관절학회지 Vol.14 No.2

슬개골-대퇴골 관절의 합병증은 슬관절 전치환술 후 가장 흔한 합병증 중의 하나로, 이런 합병증을 예방하기 위해 슬관절 전치환술 시 슬개골을 치환할 것인가, 아니면 보존할 것인가에 대하여 아직도 많은 논란이 되고 있다. 1993년 8월부터 200년 8월까지 퇴행성 관절염 및 류마티스 관절염으로 슬개골 치환을 하지 않고 인공슬관절 전치환술을 시행한 환자 중 2년이상 추시가 가능했던 36명, 43례를 연구대상으로 하였다. 전례에서 슬개골의 퇴행성 변화에 관계없이 슬개골 보존술(즉 슬개골을 치환하지 않고 슬개골 성형술만 실시함)을 시행하였으며, 추시 기간은 최단 2년에서 최장 10년으로 평균 54개월이었다. 수술전 슬개골의 방사선 사진으로 정상 슬개골을 A군 (10례), 중등도의 퇴행성 변화를 B군 (20례), 심한 퇴행성 변화를 C군 (13례)으로 분리하여 세군의 슬관절 전방부 동통, 운동범위, 계단 오르기 능력 등의 임상적 소견과 슬개골 경사(patellatilt) 및 외측 슬개골 전위(lateral patella shift)의 두 가지 방사선사학적 소견을 비교 분석하였다. 35명중 퇴행성 관절염이 29명, 류마티스 관절염이 6명였으며, 임상적 분석은 American Knee Society Score(KSS)를 사용하였다. 최종추시시 평균 Knee Society Score (KSS)는 A군 93.1점, B군 92.7점, C군 94.2점이었다. 총 43례중 슬관절 전방부 동통을 호소한 예는 A군 2례, C군 2례로 4례 (9.3%)뿐이었으며, 이들은 보행 시는 동통이 없으나, 쪼그린 자세나 계단을 오르내릴 때 동통을 호소하였다. 세군간의 슬관절 운동범위, 계단 오르기 능력 등의 비교에서는 유의한 차이가 없었으며, 방사선학적 비교에서 외측 슬개골 전위는 유의한 차이가 없었고, 슬개골 경사는 A군과 B군에서는 유의한 차이가 없었으나, C군에서는 유의하게 차이가 있었으므로 술전 슬개골의 퇴행성 변화가 심할수록 슬개골 경사가 증가됨을 알 수 있었다(p=0.01). Patello-femoral problem is one of the common complications in total knee arthroplasty and whether to replace the patella or retain it has long been controversial in order to prevent the complications. 43 cases (35 patients) of total knee arthroplasty with patellar retention performed by single surgeon between August 1993 and August 2000 were reviewed retrospectively. The follow-up period averaged 54 months (range, 24-120months). The whole cases were divided into three groups according to the preoperative radiographs. Group A was normal patella (10 knees), Group B was borderline arthritic patella (20 knees), and Group C was severely deformed patella (13 knees). All of 43 knees, regardless of preoperative radiological degree of arthritis received patelloplasty including removal of osteophytes, subchondral shaving and lateral retinacular release was performed in 20 knees (47%). Each groups was evaluated in terms of the objective criteria of anterior knee pain, range of motion, stair climbing ability, and roentgenographic findings. All 35 patents were diagnosed as osteoarthritis in 29 and rheumatoid arthritis in 6. American Knee Society Score (KSS) was assessed for the clinical analysis and lateral patella shift and patella tilt were assessed for roentgenographic analysis. The mean Knee Society Score at final follow-up was 94 in group A, 93 in group B, and 94 in group C. Mild anterior knee pain was reported in 9.3% (Group A: 2 cases, Group C: 2 cases). patellar tilt was significantly higher in C group (oneway ANOVA test, p=0.01), representing that advanced patello-femoral arthritis caused increased patellar tilt. There was nither significant difference in terms of range of motion, and stair climbing ability nor of patellar shift among all three groups. TKA with patelloplasty, not resurfacing the patella, provided satisfactory results without significant problems regardless of the preoperative degree of patello-femoral arthritis.