• 대한정형외과학회지
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• 제55권2호
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• pp.135-142
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• 2020

목적: 본 연구에서는 봉합 불가능한 광범위 회전근 개 파열에 있어서 상완 이두근 건 장두를 이용한 관절경하 부분 봉합술의 임상적 유용성 및 장기 추시 결과를 발표하고자 한다. 대상 및 방법: 봉합 불가능한 광범위 회전근 개 파열 환자 중 상완 이두근 건 장두에 50% 미만의 파열이 있는 41명의 환자를 대상으로 상완 이두근 건 장두를 이용하여 관절경하 부분 봉합술을 시행받은 1군과 파열되지 않은 상완 이두근 건 장두가 있으나 자가 이식건을 이용하지 않고 관절경하 부분 봉합술만을 시행한 2군으로 나누었다. 임상 점수는 시각통증점수(visual analogue pain scale, VAS), 운동범위(range of motion, ROM), The University of California, Los Angeles shoulder score (UCLA), American Shoulder and Elbow Surgeons Shoulder Score (ASES) 및 Korean Shoulder Scoring System (KSS) 점수로 측정하였으며 최종 추시에 측정된 점수가 사용되었다. 수술 전과 최종 추시에 촬영한 단순 방사선 사진을 이용하여 견봉상완거리(acromiohumeral interval, AHI)를 측정하였고 최종 추시에 시행한 초음파 또는 자기공명영상 검사를 이용하여 재파열 여부를 평가하였다. 결과: 환자의 평균 연령은 62.1±12.7세였으며, 평균 추시 기간은 90.3±16.8개월이었다. 1군과 2군 간에 VAS와 ROM (전방 거상, 외회전, 내회전)의 유의한 차이는 없었다(p=0.179, p=0.129, p=0.098, p=0.155). UCLA, ASES 및 KSS 점수는 2군과 비교해 1군에서 기능적 개선을 보였다(p=0.041, p=0.023, p=0.019). 최종 추시 시 AHI는 1군 9.46±0.41 mm, 2군 6.86±0.64 mm로 측정되었다(p=0.032). 재파열은 1군 21예 중 6예(28.6%), 2군 20예 중 9예(45.0%)에서 발견되었다. 1군의 경우 2군에 비하여 유의하게 낮은 재파열률을 보였다(p=0.011). 결론: 본 연구에서는 봉합이 불가능한 광범위 회전근 개 파열이 있는 환자들에게 상완 이두근 건 장두를 이용한 관절경하 부분 봉합술을 시행하여 장기 추시한 결과, 상완 이두근 건 장두를 사용하지 않은 군에 비하여 기능적 향상 및 낮은 재파열률을 보인다. 따라서 이는 봉합 불가능한 광범위 회전근 개 파열이 있는 환자에서 좋은 수술적 방법으로 생각된다.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.27-33
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• 2006

Purpose: To investigate early complications after repair of massive rotator cuff tears and to find out factors that compromise the results. Materials and Methods: Fourteen patients who had two or more cuff tendons involved were included. All patients were operated by open acromioplasty and rotator cuff repair. At 3 months after operation, we investigated whether there were any early complications or not. We used ASES scoring system for preoperative and follow up evaluation. In addition, various preoperative factors, such as duration of symptom, degree of tendon retraction, degree of fatty degeneration, and acromio-humeral distance, were compared between the complicated patients and non-complicated patients. Results: At 3 months after operation, the ASES score and pain were improved in any degree in all patients. But 5 patients complained persisting pain, and three of them showed major complications such as re-rupture of rotator cuff or deltoid rupture. But no preoperative factors in complicated patients were significantly different from those in non-complicated patients. Conclusion: None of the preoperative factors were related to the complications. There was a tendency of overestimation of fatty degeneration in MRI. Some factors in surgical technique and rehabilitation were highly suspected to be related to the complications.

• Clinics in Shoulder and Elbow
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• 제18권1호
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• pp.2-7
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• 2015

Background: The purpose of this study was to evaluate the usefulness and safety of the anterosuperior deltoid splitting approach for fixation of displaced proximal humeral fractures by analyzing the surgical outcomes. Methods: Twenty-three patients who could be followed-up for at least 8 months after the treatment of displaced proximal humeral fractures through the anterosuperior deltoid splitting approach were enrolled. We evaluated the reduction of the fractures and surgery-related complications at the last follow-up using X-ray results and clinical outcomes comprising the University of California at Los Angeles (UCLA) scoring system and the Korean Shoulder Society (KSS) score. Results: At the last follow-up of patients treated using the anterosuperior deltoid splitting approach for internal fixation of proximal humeral fractures, we found 22 cases (95.6%) of bone union, a mean UCLA score of 28.3 (range, 15 to 34) and a mean KSS score of 82.1 (range, 67 to 95). Various surgery-related complications were noted; a case of varus malunion after fracture displacement, a case of nonunion, a case of delayed union, two cases of impingement, and a case of partial axillary nerve injury, which recovered completely through the follow-up. Conclusions: Plate fixation using the anterosuperior deltoid splitting approach could be another reliable option for treating displaced proximal humeral fractures.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.87-92
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• 2019

Background: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. Methods: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft $f{\ddot{u}}r$ Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20-87 years), and mean follow-up period was 2.3 years (range, 1.0-6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. Results: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). Conclusions: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

• Clinics in Shoulder and Elbow
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• 제9권2호
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• pp.176-180
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• 2006

Purpose: Although surgical arthroscopic repair of rotator cuff has become much more common as surgeons have developed proficient techniques, it is still technically difficult. The purpose of this study was to evaluate the clinical results and the usefulness of mini-open repair in large and massive size tears. Materials & Methods: From January 2000 to December 2004, sixteen patients were treated with mini-open repair. There were 10 male and 6 female patients with the average age of 62.5 years. The size of tear was massive in 4 cases and large in 12 cases. All tears were repaired with metal anchor sutures. The mean duration of follow-up period was 23 months. Postoperative results were evaluated based on American Shoulder and Elbow Society scoring system. Results: Five patients showed excellent results, five good, and two fair in large tears while one patient showed excellent result, one good, and two fair in massive tears. Poor outcome was not seen during the follow-up period. There was no significant relationship between the patient's age and the size of tear, and postoperative results. However, the relationship between the duration of symptomatic period in preoperation and postoperative results showed significant correlation. Conclusion: Mini-open repair combined with the preservation of deltoid and early rehabilitation is clinically useful in large and massive size rotator cuff tear patients treatment.

• 대한관절경학회지
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• 제15권1호
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• pp.13-18
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• 2011

목 적: $TightRope^{(R)}$ (Arthrex, Inc, Naples, FL)를 이용한 급성 견봉쇄골 관절 탈구의 관절경적 오구쇄골 관절 고정술의 방사선학적 및 임상적 결과를 평가하고자 한다. 대상 및 방법: 2009년 2월부터 2010년 2월까지 Rockwood 3형 또는 5형의 급성 견봉쇄골 관절 탈구 환자 20명에 대해 $TightRope^{(R)}$를 이용하여 관절경적 오구쇄골 관절 고정술을 시행하였다. 추시 기간은 평균 13.4(10~22)개월이었다. 방사선학적 평가는 쇄골 관절 부하 사진을 통해 쇄골과 오구돌기 사이 거리를 건측과 비교하였고, 임상적 평가는 KSS(Korean Shoulder Scoring System)를 이용하였으며, 환자들의 미용적 만족도도 평가하였다. 결 과: 방사선학적 평가에서 18예는 매우 우수, 1예는 우수, 1예는 양호의 결과를 보였다. KSS는 평균 98.5(92~100)점이었으며, 전 예에서 만족할 만한 미용적 결과를 보였다. 1예에서 매듭에 의한 피부 압통 및 촉진되는 불편감을 호소하여 시행한 매듭 봉합술 후 국소 감염이 발생하여 국소 마취 하 배농술 및 2주간 항생제 사용으로 치유하였다. 결 론: Rockwood 3형 또는 5형의 급성 견봉쇄골관절 탈구의 치료에 있어 $TightRope^{(R)}$를 이용한 관절경적 오구쇄골 관절 고정술은 만족스러운 방사선학적 및 임상적 결과를 보이며, 술후 합병증이 거의 없고, 조기 재활이 가능하며, 뛰어난 미용적 결과를 보이고, 금속 고정물 제거를 위한 이차적 수술이 필요없는 훌륭한 치료 방법이 될 것으로 생각된다.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.126-132
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• 1999

Purpose : To evaluate the functional and radiographic outcome of the modified Bosworth method in the surgical treatment of acute type V acromioclavicular joint dislocation. Materials and Methods: From June 1995 to May 1998, 20 patients were operated on for acute and complete acromioclavicular dislocation(Rockwood type V). The operative technique includes fixation of the coracoclavicular joint with Bosworth screw or 6.5mm cancellous screw and imbrication of trapezius and deltoid muscles. The average age was 34 years(range, 19 to 51 years). These 20 patients with an average follow-up of 18months, were evaluated clinically using the UCLA scoring system. Additional radiographical assessment was performed with stress radiographs. Results: Excellent or good clinical results were obtained in 95%(19 cases). And the average coracoclavicular interval ratio was decreased from 3.31(2.2-6.0) to 1.13(1-1.4) in stress radiographs. There were 4 cases of hetero­topic calcification postoperatively but there was no correlation with clinical result. Posttraumatic A-C joint arthritis was developed in one case. In that case, the distal clavicular resection was done under the arthroscopic technique. Conclusion: The severe displacement observed with type V injuries is incompatible with normal shoulder function if the shoulder is left in its displaced position. In type V injuries, significant damage to the deltoid and trapezius musculature and overlying fascia occurs, therefore open reduction and good fixation must be obtained with imbrication of trapezius and deltoid muscles. In our type V acute complete acromioclavicular dislocation, the modified Bosworth technique provides excellent results with a low complication rate.

• Clinics in Shoulder and Elbow
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• 제8권1호
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• pp.14-18
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• 2005

Purpose: Limitation of motion of the elbow joint due to stiffness affect on life quality of the patients. So contracture of the elbow should be treated as soon as possible. Among the many treatment modalities, we described the result of arthroscopic treatment. Materials and Methods: From Mar. 2000 to Mar. 2003, 40 patients, who received the arthroscopic treatment by author for contracted elbow, were the subjects. We estimated the range of motion (ROM) of elbow joint before and after surgery by goniometer. The clinical result was evaluated by Severance elbow scoring system. The final ROM was evaluated at the point of no further increasement of joint motion. Male ware 30 cases, female ware 7 cases, average 42.6 years old and mean follow up period were 31 months. During arthroscopic treatment we had done release of the joint capsule or resection, synovectomy, removal of loose bodies. We used traditional portals. Results: The avarage preoperative ROM of elbow joint was 72.5 degree(range, 5 - 132 degree) and the increasement of ROM was totally 49.3 degree in flexion 26.5 degree and extension 22.8 degree. There was no other complication. Conclusion: Arthroscopic treatment for contracted elbow permit early joint ROM and it decrease the secondary injury to the elbow joint. Also there are few complications. It is thought to be a good treatment modality in contracted elbow joint.

• Clinics in Shoulder and Elbow
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• 제12권2호
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• pp.180-188
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• 2009

목적: 회전근 개 건 전층 파열 시 관절경적 교량형 봉합술 시행 후 단기 추시 관찰을 통해 이 술식의 임상적 결과에 대해 알아보고자 하였다. 대상 및 방법: 회전근 개 건 전층 파열로 관절경적 교량형 봉합술을 시행 받고 조기 재활을 시행한 29명 (남자:17명, 여자:12명)의 환자를 대상으로 시행하였다. 평균 나이는 56.4세 (34~73세)였으며 추시 관찰 기간은 평균 13개월 (12~15개월)이었다. 임상적 및 기능적 평가로 The University of California at Los Angeles (UCLA) score, The Korean Shoulder Scoring system (KSS) 및 Visual Analogue Scale (VAS) score를 이용하였다. 15예에서 최종 추시시 자기 공명 영상을 촬영하여 Sugaya 분류를 통해 회전근 개의 구조적 상태를 분석하였다. 결과: 수술 후의 UCLA score는 수술 전과 수술 후 각각 16.4에서 31.6으로 측정되어 유의할만한 호전을 보였고 (p< 0.05), KSS는 수술 후 6개월에 88이었고, 최종 추시 시 92로 측정되었다. VAS score는 수술 전 8.6에서 수술 후 3개월에 2.1로, 수술 후 6개월에는 1.4로 나타났다. 28예 (96.5%)에서 수술 후 관절 운동 범위가 증가되었다. 추시 시 자기 공명 영상을 촬영한 15예에서 Sugaya 분류에 의해 I형이 6예, II형이 7예, III형이 1예, V형이 1예이었다. 결론: 회전근 개 건 전층 파열에 대한 관절경적 교량형 봉합술을 이용한 회전근 개 봉합술은 임상적으로 96.5%에서 양호 이상의 만족할 만한 결과를 보였으므로 믿을 만한 수술적 방법 중 하나라고 생각한다.

• Clinics in Shoulder and Elbow
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• 제14권2호
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• pp.222-228
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• 2011

서론: 회전근 개 대 파열 및 광범위 파열에 대한 관절경적 봉합술 군과 개방적 봉합술 군 간의 중기 임상적 결과를 비교 분석하였다. 대상 및 방법: 회전근 개 대 파열 및 광범위 파열에 대해 봉합술을 실시한 48예 를 후향적으로 분석하였다. 관절경적 봉합술을 시행한 군은 28예, 개방적 봉합술을 시행한 군은 20예 였다. 임상적 결과는 관절운동 범위, 통증과 기능에 대한 VAS, ASES 점수 및 KSS 점수를 평가하였다. 결과: 관절운동 범위, 통증에 대한 VAS 점수, 기능에 대한 VAS 점수 및ASES 점수는 두 군 모두 술 전에 비해 최종 추시상 의미있는 향상을 보였으나 최종 추시상 두 군간에 통계학적으로 유의한 차이는 없었다 (p>0.05). KSS 점수도 최종 추시상 두 군간에 통계학적으로 유의한 차이는 없었다 (p>0.05). 결론: 관절경적 봉합술과 개방적 봉합술 모두 향상된 중기 임상 결과를 얻을 수 있었으며 두 군간에 의미있는 차이는 없었다.