사망 진단서(시체 검안서) 작성의 문제점

김규석,임용수,이중의,서길준,윤여규,어은경,염석란,정연권,이윤성 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates Methods: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. Results: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital,101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). Conclusion: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.

Orlginal Article : Total Knee Arthroplasty Using a Posterior Cruciate Ligament Sacrificing Medial Pivot Knee: Minimum 5-year Follow-up Results

( Yoon Seok Youm ),( Sung Do Cho ),( Seon Ho Lee ),( Hye Yong Cho ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.3

Purpose: To evaluate minimum 5-year follow-up clinical and radiological results of total knee arthroplasty (TKA) using a posterior cruciate ligament sacrificing (PS), non-substituting Advance Medial Pivot Knee.Materials and Methods: One hundred and twenty knees in 80 patients who could be followed up for more than 5 years after TKA using the PS Advance Medial Pivot Knee were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. The Kaplan-Meier method was used for survival analysis.Results: The ROM increased from a preoperative mean flexion contracture of 7.6o and further flexion of 115.1o to a postoperative mean flexion contracture of 1.5o and further flexion of 120.5o. The tibiofemoral angle was changed from 4.6o varus preoperatively to 5.8o valgus postoperatively. The KS knee and function scores as well as WOMAC score significantly improved after surgery (p<0.05). Complications developed in 4 cases (3.3%): 2 cases of periprosthetic patellar fracture (1.7%) and 2 cases of aseptic loosening (1.7%). The seven-year survival rate was 98.1% in the Kaplan-Meier survival analysis.Conclusions: The minimum 5-year follow-up results of TKA using the PS Medial Pivot Knee were satisfactory.

Apoptosis in the Osteonecrosis of the Femoral Head

Yoon-Seok Youm,Soo-Youn Lee,Soo-Ho Lee 대한정형외과학회 2010 Clinics in Orthopedic Surgery Vol.2 No.4

Background: Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. Methods: Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. Results: Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05). Conclusions: Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.

Bilateral Hypoplasia of the Medial and Lateral Menisci

( Yoon-seok Youm ),( Sung-do Cho ),( Hye-yong Cho ),( Tae-wook Kang ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.2

Hypoplasia of the meniscus is a very rare congenital abnormality, with only a few cases reported to date. A 9-year-old girl visited our hospital due to lateral knee pain following a hyperextension injury to the left knee. Magnetic resonance imaging showed hypoplasia of the medial and lateral menisci, as well as a posterior horn tear of the lateral meniscus, in both knee joints. To our knowledge, this is the first report of a patient with hypoplasia of the medial and lateral menisci in both knee joints.

Can We Use the Posterior Condylar Offset as a Predictive Factor for Overhang of the Implant in Total Knee Arthroplasty?

( Yoon Seok Youm ),( Sung Do Cho ),( Jin Eo ),( Ki Bong Park ),( Sun Ho Lee ) 대한슬관절학회 2011 대한슬관절학회지 Vol.23 No.3

Purpose: We tried to demonstrate whether the posterior condylar offset (PCO, the distance from the femoral diaphysis posterior cortex to the posterior condylar margin) and ratio (PCOR, dividing PCO by the maximum antero-posterior diameter of the distal femur) could be used as predictive factors for overhang of the implants or using gender implants in total knee arthroplasty (TKA). Materials and Methods: One hundred and one women who underwent TKA using NexGen(R) (LPS) implants, were analyzed prospectively. After distal femoral resection, the mediolateral (ML) width was measured at four points (anterior, distal anterior, distal posterior and posterior) and compared with the ML width of the implant. The aspect ratio (AR, ML/AP ratio) and anterior/distal posterior ML width (Ant/DP) were calculated. Preoperative radiographic PCO and PCOR were measured. Differences of PCO, PCOR, AR and Ant/DP according to the size were analyzed and correlations between PCO, PCOR and AR were also analyzed. The patients were classified into two groups according to the presence of overhang, and differences of each parameter were compared between the two groups. Results: The size of the implant was positively correlated PCO, not significantly correlated with PCOR, and negatively correlated with AR and Ant/DP. PCO and PCOR and AR showed no correlation with each other. PCO and PCOR were not significantly different between the two groups. However, AR and Ant/DP were statistically low in the group with overhang. Conclusions: Preoperative radiographic PCO or PCOR could not be used as a predictive factor for overhang of the implants or using gender implants in TKA.

Relationship between Mucoid Degeneration of the Anterior Cruciate Ligament and Posterior Tibial Slope in Patients with Total Knee Arthroplasty

( Yoon Seok Youm ),( Sung Do Cho ),( Hye Yong Cho ),( Seung Hyun Jung ) 대한슬관절학회 2016 대한슬관절학회지 Vol.28 No.1

Purpose: The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. Materials and Methods: Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. Results: There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9o (range, 0.6o to 20.1o) in group I (161 knees), 10.8o (range, 0.2o to 21.8o) in group II (342 knees) and 12.3o (range, 2o to 22.2o) in group III (133 knees), which showed significant differences (p<0.001). Conclusions: The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.

슬관절 전치환술 시 수술 중 슬개골 주행의 검사에서 "Single Stitch Method"의 임상적 유용성

염윤석(Yoon-Seok Youm),조성도(Sung-Do Cho),정창윤(Chang-Yoon Jung),박한창(Han-Chang Park) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.2

목적: 슬관절 전치환술 시 외측 지대 이완술의 빈도 및 수술 중 슬개골 주행의 검사법에 따른 및 임상적 결과에 대해 알아보고자 하였다. 대상 및 방법: 슬관절 전치환술을 시행한 환자 278명 365예를 대상으로, 수술 중 지혈대를 감압하지 슬개골 주행이 양호하였던 경우를 1군, 감압한 뒤 슬개골 주행이 개선되었던 경우를 2군, single stitch method로 슬개골 주행이 개선되었던 경우를 3군, 슬개골 주행이 계속 좋지 않아 외측 지대 이완술을 시행하였던 경우를 4군으로 나누었다. 각 군에 대해 술 후 방사선상 슬개골 경사각을 측정하고, 임상적 결과를 비교, 분석하였다. 결과: 1군이 176예, 2군이 127예, 3군이 57예, 4군이 5예이었다. 지혈대 감압 후 single stitch method를 시행한 뒤 5예(1.4%)에서 주행이 좋지 않아 외측 지대 이완술을 시행하였다. 술 후 평균 슬개골 경사각은 1군 4.1˚, 2군 3.4˚, 3군 5.1˚, 4군 4.3˚로 각 군 간 유의한 차이는 보이지 않았다(p>0.05) 추시 시 전방 슬관절 동통을 9예에서 호소하였으니. 각 군 간 차이는 없었다. 결론: 슬관절 전치환술에서 지혈대 감압 후 single stitch method로 슬개골 주행이 개선되면 외측 지대 이완술이 필요 없을 것으로 생각된다. Purpose: We evaluated the lateral release rate and the clinical results according to the intraoperative assessment of patellar tracking in total knee arthroplasty (TKA). Materials and Methods: We analyzed 365 primary total knee arthroplasties in 278 patients. The knees showing good patellar tracking without tourniquet deflation were classified into group 1, those showing improved patellar tracking after tourniquet deflation were classified into group 2, those showing improved patellar tracking after the single stitch method were classified into group 3 and those showing persistent patellar maltracking, that resulted in lateral retinacular release, were classified into group 4. The postoperative patellar tilting angle was measured and the clinical results were evaluated for all the groups. Results: We classified 176, 127, 57 and 5 knees into groups 1, 2, 3 and 4 respectively. Only 5 knees (14%) showed poor patellar tracking with the single stitch method after tourniquet deflation and this resulted in lateral retinacular release. The postoperative mean patellar tilting angle was 4.1˚, 34˚, 5.1˚ and 4.3˚ in each group, respectively, and no statistical differences were shown between the groups (p>0.05). Nine knees complained of anterior knee pain and there was no difference between groups. Conclusion: Lateral retinacular release in TKA may not be necessary if the patellar tracking is improved with the single stitch method after tourniquet deflation.

후방 십자인대 대치형 Medial Pivot Knee와 Nexgen(R) LPS 슬관절 전치환술의 단기 추시 결과 비교

엄윤석 ( Yoon Seok Youm ),조성도 ( Sung Do Cho ),정지영 ( Ji Young Jeong ),전형민 ( Hyung Min Jeon ),신승명 ( Seung Myeong Shin ) 대한슬관절학회 2010 대한슬관절학회지 Vol.22 No.3

목적: 후방 십자 인대 대치형 (PCL sacrificing, PS) Medial Pivot Knee (MPK)와 Nexgen(R) LPS 슬관절 전치환술의 임상적, 방사선학적 결과를 비교하였다. 대상 및 방법: PS ADVANCE(R) MPK (1군)와 Nexgen(R) LPS (2군)로 슬관절 전치환술을 시행받고 2년이상 추시가 가능했던 1군 48명 70예와 2군 45명 67예를 후향적으로 분석하였다. 수술 전후 운동범위, 슬관절 점수와 기능 점수, 대퇴경골간 내외반 변형 및 술 후 합병증에 관해 알아보았다. 결과: 슬관절 운동범위는 제 1군에서 술 전 평균 굴곡구축 6.3o, 후속굴곡 116.4o에서 술후 1.9o, 120.5o로, 제 2군에서 각각 술 전 12.6o, 117.6o에서 술 후 0.9o, 123.0o로 향상되었다. 슬관절 점수와 기능 점수는 제 1군에서 각각 46점, 37점에서 87점, 83점으로, 제 2군에서 각각 50점, 48점에서 87점, 83점으로 호전되었다. 대퇴 경골간 각은 제 1군에서 평균 내반 4.0o에서 외반 5.5o로, 제 2군에서 내반 4.1o에서 외반 5.3o로 개선되었다. 합병증으로 1군에서 슬개 치환물 주변의 슬개골 골절 2예(2.8%)와 경골 치환물의 실패 1예 (1.4%)가 있었으며, 2군에서 대퇴골 치환물의 조기 실패 1예(1.5%)와 관절섬유증 1예(1.5%)가 있었다. 결론: PS MPK 슬관절 전치환술의 최소 2년 이상의 추시 결과 Nexgen(R) LPS와 유사한 만족할 만한 결과를 얻을 수 있었으며, 대퇴부의 골을 상대적으로 많이 보존할 수 있는 장점을 갖는 치환물인 것으로 생각된다. Purpose: We wanted to compare the clinical and radiological results after performing total knee arthroplasty (TKA) with the PCL sacrificing (PS) Medial Pivot Knee (MPK) and the Nexgen(R) LPS. Materials and Methods: Seventy knees in 48 patients after TKA with the PS ADVANCE(R) MPK (group I) and 67 knees in 45 patients with the Nexgen(R) LPS (group II) were retrospectively evaluated. All the patients were followed up for more than 2 years. The evaluations included the preoperative and postoperative range of motion (ROM), the Knee Society (KS) scores, the tibiofemoral angle and the postoperative complications. Results: For group I, the ROM increased from a mean flexion contracture of 6.3o and further flexion of 116.4o to 1.9o and 120.5o, respectively, and for group II, from 12.6o and 117.6o to 0.9o and 123.0o, respectively. For group I, the KS knee and function scores increased from 46 and 37 to 87 and 83, respectively, and for group II, from 50 and 48 to 87 and 83, respectively. For group I, the tibiofemoral angle changed from varus 4.0o to valgus 5.5o, respectively, and for group II, from varus 4.1o to valgus 5.3o, respectively. The complications were 2 knees (2.8%) with periprosthetic patellar fractures and 1 knee (1.4%) with a tibial component failure in group I, and 1 knee (1.5%) with early femoral component failure and 1 knee with arthrofibrosis (1.5%) in group II. Conclusion: The minimum 2-year follow-up results of PS MPK TKA were comparable to those of Nexgen(R) LPS TKA. However, we think that the MPK system has the advantage of more bony preservation at the femoral intercondylar notch area.

한국 남성 및 여성에서 슬관절 전치환술 시 원위 대퇴 절단면의 형태 계측 차이

염윤석(Yoon-Seok Youm),조성도(Sung-Do Cho),이선호(Seon-Ho Lee),황일영(Il-Yeong Hwang),강태욱(Tae-Wook Kang) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.2

목적: 슬관절 전치환술 시 원위 대퇴 절단면 형태 계측의 남녀 차이에 대해 알아보고자 하였다. 대상 및 방법: 슬관절 전치환술을 시행받은 696명 1,008예의 환자를 대상으로 하였다. Nexgen® legacy posterior-stabilized (LPS)와 PS ADVANCE® medical pivot knee (MPK) 기구를 사용하였으며, 원위 대퇴골 절제면의 전, 후 너비와 네 부위(전방, 원위전방, 원위후방, 후방)에서의 내외측 너비를 측정하여, aspect ratio (AR)와 width ratio (WR)를 계산하였다. 성별간 AR 및 WR의 차이를 분석하였고, 대퇴 절제면의 내외측 너비와 각 치환물의 제원을 비교하여 성별간 적합성의 차이를 조사하였다. 결과: AR은 LPS 및 MPK에서 모두 남성이 여성에 비해 컸으며, WR은 성별간에는 차이를 보이지 않았지만, 치환물 간에는 LPS보다 MPK에서 유의하게 컸다. LPS와 MPK 모두 남성보다 여성에서 적합성이 높았으며, 남성이 적합성이 떨어지는 원인은 과소가 많았기 때문이었다. MPK의 경우 전방과 원위 전방 절제면에서 돌출이 유의하게 많았다. 결론: 한국 남성은 여성보다 AR이 큰 경향이 있으며 과소의 문제로 적합성이 여성에 비해 떨어진다. WR은 남녀간의 차이가 없지만, 치환물의 종류 사이에는 차이가 있어 MPK가 LPS에 비해 전방부 돌출이 많았다. Purpose: The purpose of this study is to evaluate the morphometric differences of distal femoral cut surface between Korean males and females in total knee arthroplasty. Materials and Methods: A total of 696 patients (1,008 knees: male 92, female 916) who underwent TKA using NexGen® legacy posteriorstabilized (LPS) (605 knees: male 41, female 564) and PS ADVANCE® medical pivot knee (MPK) (403 knees: male 51, female 352) implants were analyzed prospectively. After distal femoral resection, the mediolateral width (ML) was measured at four points (anterior [Ant], distal anterior [DA], distal posterior [DP], and posterior [Post]) and compared with the ML width of the implant respectively. The aspect ratio (AR=ML/anteroposterior width) and width ratio (WR=Ant ML/DP ML) were calculated. Differences in AR, WR, and fitness between male and female were analyzed. Results: The AR of males was larger than that of females for both LPS and MPK; however, no differences in the WR were observed between males and females. The WR in MPK was larger than that in LPS. For both LPS and MPK, females showed greater anatomical fitness than males, and males had relatively greater incidence of undersize than females. For MPK, there were relatively more cases of overhang in Ant and DA cut surface. These results were consistent with the fact that the WR of implant in MPK was larger than that in LPS. Conclusion: Korean males tend to have larger AR and less anatomical fitness of the femoral component than females because of undersize. No difference in WR was observed between Korean males and females. However, the cut surfaces as well as femoral implant of MPK had larger WR than those of LPS. MPK has more overhang on the anterior cut surface than LPS, due to a wider Ant flange (larger WR) of the implant.

전방십자인대 재재건술

염윤석(Yoon-Seok Youm),조성도(Sung-Do Cho),조혜용(Hye-Yong Cho),정승현(Seung-Hyun Jung),강승우(Seung-Woo Kang),주용태(Yong-Tae Joo) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.5

목적: 전방십자인대 재재건술 시 일차 재건술의 실패 원인과 동반 손상을 분석하고, 재재건술 후 기능적 결과를 알아보고자 하였다. 대상 및 방법: 실패한 전방십자인대 재건술에 대하여 재재건술을 시행하고 2년 이상 추시가 가능하였던 46예를 대상으로 하였다. 일차 재건술의 실패 원인과 동반 손상을 분석하였고, 임상적 평가는 2000 International Knee Documentation Committee (IKDC) 주관적 슬관절 점수, Lachman 검사, Pivot shift 검사와 KT-1000 arthrometer 검사를 이용하였다. 결과: 실패 원인은 외상이 27예(58.7%)로 가장 많았으며, 부적절한 수술술기로 인한 실패는 19예(41.3%)였다. 동반 손상의 경우 반월상 연골 손상 29예(63.0%), Outerbridge 등급 II 이상의 관절 연골 손상이 19예(41.3%)에서 확인되었다. 임상적 결과에서 IKDC 점수, Lachman 검사, Pivot shift 검사 및 KT-1000 arthrometer 검사 모두 술 전에 비해 최종 추시 시 유의하게 호전되었다. 결론: 전방십자인대 재재건술 시 술 전 실패의 원인은 외상이 가장 많았으며, 슬관절의 안정성 면에서는 만족할 만한 결과를 보였으나 기능적 면에서는 기존에 문헌상 보고된 일차 재건술 후의 통상의 결과보다는 만족스럽지 못하였는데 이는 많은 동반 손상으로 인한 결과로 생각된다. Purpose: The aim of this study was to analyze the causes of failure after a primary anterior cruciate ligament reconstruction (ACLR), associated injuries, and the clinical results of revision ACLR. Materials and Methods: This study evaluated 46 patients (46 knees), who were followed at least two years after revision ACLR. The evaluations included the causes of failure after primary ACLR, associated injuries, 2000 International Knee Documentation Committee (IKDC) subjective knee scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurement. Results: The most common cause of failure was trauma (27 patients, 58.7%) and 19 failures (19 patients, 41.3%) were caused using an inappropriate surgical technique. The associated injuries were meniscus tears in 29 cases (63.0%) and articular cartilage injuries of Outerbridge grade II to IV in 19 cases (41.3%). The IKDC scores, Lachman test, Pivot shift test, and KT-1000 arthrometer measurements were improved significantly at the final follow-up. Conclusion: The most common cause of failure after primary ACLR was trauma. One stage revision ACLR resulted in relatively satisfactory stability but less satisfactory clinical function than the primary reconstruction, as reported previously, which is believed to be due to the more associated injuries.