고관절 관절경의 수술 수기

황득수,Hwang, Deuk-Soo 대한관절경학회 2010 대한관절경학회지 Vol.14 No.2

아킬레스건 파열의 수술적치료 -단단 봉합술 및 건외막피복술-

황득수,이원석,김경천,Hwang Deuk-Soo,Lee Won-Seok,Kim Kyung-Cheon 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.2

목적: 스포츠와관련된급성아킬레스건파열의직접봉합및건외막피복술의결과및예후를평가하였다. 대상및방법: 1997년부터2001년까지수술후1년이상추시가능했던21예를대상으로하였다. 30대가$55\%$로가장많았으며축구후에생긴파열이5예로가장많았고, 양측이간격을두고파열된경우가2예로확인되었다. 수술은수상후1주이내에시행하였으며, 단단봉합술후주위건외막조직을충분히봉합하여혈액순환을최대한유지한상태로봉합부를피복하였다. 수술후슬관절을25도굴곡, 족관절은족저굴곡된상태로6주간장하지석고고정후2주간격으로단하지석고고정및족관절첨족을기능적위치로전환하여10주째90도족배굴곡상태로회복시켰다. 결과는Hooker의기준을이용하여수술후평균28개월에평가하였다. 결과: 환측이정상측에비해발뒤꿈치-지면거리가평균0.7cm 감소하였고, 20회체중부하족저굴곡후에는0.8 cm 감소하였으며, 하퇴둘레는0.3 cm 감소하였고, 능동적운동범위는족배굴곡과족저굴곡이각각3도와5도가감소하였다. 수술결과는1 6예에서우수, 5예에서양호를보였으며재파열이나상처부위괴사및감염의후유증은없었다. 결론: 아킬레스건파열의단단봉합술후주위건외막조직의충분한피복봉합은건의치유와수술후유착방지에, 그리고수술후주기적족관절족배교정은잔여첨족변형의예방에좋은치료방법이다 Purpose: To evaluate the results and prognosis of operative repair to acute rupture of achilles tend on associated sports injury. Materials and Methods: 21 cases were surgically treated and average follow-up period was 1 year and eight months. The forth decade was most common with $55\%$ and soccer was most common in sports with 5 cases. End-to-end suture of ruptured achilles tendon was performed, and paratendinous structure was wrapped sufficiently. Postoperatively. ankle was plantarflexed for 6 weeks with longleg cast. And then 2 weeks interval, short leg cast with equinous position was conversed to functional position. About 10 weeks after operation, ankle was recovered to right angle. Hooker scale was used to evaluate the results. Results: Compared to normal side, heel-floor distance of ruptures side was decreased 0.7 cm in average, and 0.8 cm was deceased after 20 times weight loaded dorsiflexion. Mid-calf circumference was deceased 0.3 cm, and active dorsiflexion and plantar flexion of ankle was decreased each 3 and 5degree. 16 cases showed ‘excellent’result and 5 cases showed ‘satisfactory’. There was no complication, such as re-rupture or infection at operation site. Conclusion: After end-to-end operative repair to achilles tendon, sufficient wrapping of paratendinous structure is efficient for healing and prevention of postoperative adhesion. And serial dorsiflex-ion cast change is considered to be a successful treatment for preventing residual equinus deformity.

실패한 시멘트형 및 무시멘트형 인공고관절 대퇴스템으로부터 추출한 마멸입자에 대한 분석

황득수,Arun S. Shanbhag,Hallum O. Bailey,Harry E. Rubash (Deuk Soo Hwang) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.2

Macrophages and giant cells activated by particulate debris play an important role in osteolysis and aseptic loosening of prosthetic hip components. Histological amd chemical analysis of interface membrane retrieved from failed hip prostheses have demonstrated that a large number of polyethylene( PE ) particles induce a major inflammatory reaction by activating macrophages. But, there were still debatable reports concerning inflammatory reaction between cemented and cementless hip prostheses. The objective of this study was to isolate particles from failed cemented and cementless hip prostheses interface membranes and characterize their morphology using Scanning Electron Microscopy (SEM). We obtained 18 interface membrane from failed femoral components(11; cementless, 7; cemened). Tissues were digested using a papain buffer and then hydrolysed using 4M KOH. After several washing and centrifugation, particles were extracted and seperated using a established protocol in which suspected PE debris is retrieved from a ethanol-hexane interface and suspended in ethanol prior to analysis. A SEM in conjunction with an Energy Dispersive x-ray(EDX) spectroscopy unit was used to conduct elemental and morphologic analysis: PE particles were variable; small rounded(mostly submicron sized, 98%) and its agglomeration with variable size up to 15 u were dispersed on whole fields. More larger irregular flake shaped particles ranged from 9-18 u were seen sparsely. Sometimes, elongated thick beaded or scale like(2-3 u) and thin fibrils were seen. We couldn't find any significant differences in morphology of PE particle(ie, shape, size and distribution) between cemented and cementless hip prostheses. It was very difficult to detect metal particles in which only 2 Titanum particles were found, suggesting further analysis is necessary. We also characterized cement(PMMA, Barium), bone and ather contaminant particles.

스포츠 손상에서의 비구순 파열

황득수,이광진,권육상,Hwang Deuk-Soo,Rhee Kwang-Jin,Kwon Youk-Sang 대한정형외과스포츠의학회 2002 대한정형외과스포츠의학회지 Vol.1 No.1

목적: 스포츠손상에의한비구순파열환자에서진단및치료에대해고찰해보고자하였다. 대상및방법: 1995년3월부터2000년1월까지스포츠손상후발생한고관절통으로본원에내원한환자에서비구순파열로진단된15예를대상으로하였다. 원인별로달리기5예, 격투기3예, 에어로빅3예, 수영2예, 등산1예, 자전거 1예등이었다. 남자가6명, 여자가9명이었고, 나이는 평균41세였다. 모든 환자는6개월간격으로 추시하였고, 보존적 치료를 시행한 경우최소2년 이상 투약 및 증세관찰을 하였고, 관절경적 수술을 시행한6예에서 수술 전, 수술 후 6개월과 12개월에 Harris Hip Score (이하HHS)를측정하였고, JOA pain scoring system에의해결과를평가하였다. 결과: 보존적치료를 시행한9예에서 HHS는 평균 15점 향상되었고, 그중 4예는 1단계의 통증 지수 향상이 있었는데, 이들 모두Czerny 분류상type IA였다. 관절경적수술을 시행한6예에서수술후 HHS는 32점향상되었고, 6예모두에서2단계이상의통증지수향상이관찰되었다.결론: 스포츠손상환자에서급,만성고관절통을호소하는경우비구순파열은반드시감별진단되어야하며, 이학적검사상의심이될경우자기공명관절조영술을이용한진단이유용할것으로사료된다. 확진이된경우관절경을이용한파열된비구순의변연절제술이효과적인치료방법으로생각된다. Purpose: The purpose of this study is to evaluate diagnosis and treatment of acetabular labral tears in sports injuries. Materials and Methods: From March 1995 to January 2000, We treated 15 patients with acetabular labral tear by sports injuries. There were 6 men and 9 women. Mean age was 41 years old. Running injuries are 5 cases, fighting 3, aerobic exercise 3, swimming 2, climbing 1, bicycle 1. For conservative treatment, we performed medication and observation at least for 1 year. For the patients with arthroscopic surgery, we performed Harris Hip Score (pain and function) preoperatively and postoperatively at 6, 12 months, and evaluated patient’s pain by JOA pain scoring system and postoperative subjective satisfaction. Results: The mean score of HHS improved 15 points with conservative treatments and 32 points with hip arthroscopy. In 4 cases of conservative treatment, there was 1 scale improvement of JOA pain scoring system. In arthroscopic partial labrectomy, all cases were improved to more than 2 scale. Conclusion: We considered that acetabular labral tears occurred associated with sports injuries. So it is important to be interested in enthusiastic diagnosis and appropriate treatment for hip pain caused by sports injuries, especially about acetabular labral tears.

인공 고관절 치환술시 저분자량 헤파린(Nadroparin Calcium)을 이용한 심부 정맥 혈전증 및 혈전 색전증의 예방적 치료

황득수(Deuk Soo Hwang),윤승호(Seung Ho Yune),권순태(Soon Tae Kwon),양준영(Joon Young Yang),김영모(Young Mo Kim),최정희(Jeong Hee Choi) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.1

슬관절 전치환술 후 발생한 이소성 골형성

황득수(Deuk-Soo Hwang),김영모(Young-Mo Kim),이창환(Chang-Hwan Lee),주용범(Yong-Bum Joo) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.2

이소성 골형성은 성숙한 충판골이 연부조직에 생기는 반응성 질환으로 슬관절 전치환술 후에 1-42%에서 발생하는 것으로 알려져 있으나 관절 운동의 장애 및 강직을 야기하는 경우는 매우 드물게 보고되고 있다. 저자들은 슬관절 전치환술 후 발생한 과도한 이소성 골형성으로 인해 보행이 불가능한 심한 슬관절 강직이 발생했던 1예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Heterotrophic ossification (HO) is a reactive disease that is defined as the formation of mature lamellar bone in the soft tissue but it is rarely associated with loss of motion and stiffness. The reported incidence of HO after total knee arthroplasty (TKA) ranges from 1% to 42%. We experienced a case of HO adversely affecting the ambulation of the patient as a result of the severe ankylosis of the knee after TKA. We report this case with a review of the relevant literature.

실패한 무시멘트형 양극성 고관절 반 치환술 및 고관절 전 치환술 주위조직으로부터 추출한 폴리에틸렌 마모세편의 비교 분석

황득수 ( Deuk Soo Hwang ),정제택 ( Je Taek Jeong ),이광진 ( Kwang Jin Rhee ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Many researchers have been reported wear mechanism of bipolar hip endoprostheses. i.e. Persistent cyclic impingement of the stem neck on the rim of the polyethylene liner has been widely accepted main mechanism. Also some authors have been described larger amounts and sizes of polyethylene wear debris in the bipolar hemiarthroplasty than total hip arthroplasty. But the relative roles of particle shape, size and number and wear mechanisms remain unclear. The purpose of present study is to isolate and characterize polyethylene wear debris around periprosthetic tissues in both cementless bipolar and total hip arthroplasty and compare polyethylene particles(size, number and shape). From 1994 to 1997, revision of eleven hips performed and isolated polyethylene particles retrieved from periprosthetic tissues. Five hips of revised hips had underwent cementless bipolar hemiarthroplasty and six hips cementless total hip arthroplasty before revision surgery. Polyethylene particles were isolated by digestive enzymes(Papain buffer) and KOH and subsequentiy examined by scanning electron microscopy(SEM). The results were followings: 1) Total hip arthroplasty group showed larger amounts and sizes of the polyethylene particles than bipolar group, but not different in shapes. 2) All the revised hips showed more substantial wear of the bearing surface of the polyethylene liner than circumferential wear of the polyethylene insert rims. Indeed, bearing surface wear could be play an another important role in aseptic loosening as well as impingement in bipolar hemiarthroplasty. Therefore we should be consider implants design and other factors producing polyethylene wear debris.

고관절의 퇴행성 골관절염시 관절경의 임상적 적용

황득수(Deuk-Soo Hwang),김영모(Young-Mo Kim) 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.7

성인의 화농성 고관절염에서 관절경적 치료

황득수(Deuk-Soo Hwang),이창환(Chang-Hwan Lee),남대철(Dae-Cheol Nam),김경태(Kyung-Tae Kim) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.4

초록성인의 고관절의 화농성 관절염의 치료는 현재까지 조기 관절 절개술에 의한 세척술이 일반적인 방법으로 알려져 있으며 국내에서 관절경적 치료는 아직 많이 시도되지 않고 있는 실정이다. 최근 수술 기법의 향상과 시술기구의 개발로 관절경의 유용성이 확장되고 고관절경의 진단적 가치 및 치료적 유효성이 발전되고 있다. 본 저자들은 성인 고관절의 화농성 관절염 4예에 대해 관절경적 세척술 및 변연절제술을 통해 만족할만한 임상 결과를 경험하였기에 이를 보고하고자 한다. Treatment of pyogenic arthritis in hip joints in adults usually required debridement through early arthrotomy. However, domestically arthroscopic management is not widely performed. Recent development of operation techniques and equipments helped to improve the value of arthroscopic approach and its diagnostic value and therapeutic usefulness. We report the clinical results from the 4 cases of pyogenic arthitis of hip joint in adults treating with arthroscopic irrigation and debridement.

소아에서 발생한 고관절 질환 후유증 환자에서 Conical 대퇴 스템을 이용한 무시멘트형 고관절 치환술 -최소 2년 이상의 단기 추시보고-

황득수 ( Deuk Soo Hwang ),윤승오 ( Seung Ho Yune ),이광진 ( Kwang Jin Rhee ),김상범 ( Sang Bum Kim ) 대한고관절학회 1998 Hip and Pelvis Vol.10 No.2

Total hip arthroplasty in patients with pediatric hip sequelae is technically demanding and associated with special difficulties due to severe alternations in the proximal femur. For example, femurs in patients with dysplastic hip have straighter and moderate anteversion of the femoral neck. Also the canal of femur is greater in the anterior to posterior dimension than the medial to lateral dimension which turns the rectangular prosthesis stem to an undesired anteversion. So this proximal femoral shapes require a special prosthesis, overreaming, undersizing and cementing, or an osteotomy. The use of conical prothesis(Protek AG, Berne, Switzerland) in cemetless femoral fixation for proximal femoral deformity has been a benefit to matches as closely as possible the anatomical shape of femur. The conical fixation ensures excellent primary stability and the stump longitudinal ribs along the prosthesis stem that cut into the bone provided strong rotational stability. The coarse-blasted surface of the titanium implant encourages osteointegration, gradually leading to permanent fixation. Twenty-three primary total hip arthroplasties had been performed patients between June 1993 and June 1996 at Chungnam National University Hospital, and had been followed for the period from 24 months to 60 months(mean 39 months). The average age at surgery was 40 years(range, 24 to 53 years). The mean Harris hip score increased from 45.7 to 85 points and revealed mild thigh pain in ten cases(43.5%). The mean leg length discrepancy decreased from 3.1cm to 1.1 cm. The radiographic evaluation demonstrated endosteal bone formation in 19 cases(82.6%), calcar atrophy in two cases(8.7%), and average 2.86 mm vertical subsidence. During operation, there were four cases of linear fractures that were treated by circumferential wiring. After operation, there was one incomplete sciatic nerve injury. There was one heterotropic ossification but no osteolysis. Revision was performed for septic loosening in one case. Conical prosthesis is one of the alternatives for total hip arthroplasties in pediatric hip sequelae patients who have secondary arthritis with pain.