• 대한관절경학회지
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• 제4권2호
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• pp.148-153
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• 2000

목적 : 관절경하 족근관절 고정술의 결과를 분석하여 그 유용성을 보고하고자 한다. 대상 및 방법 : 1992년 10월부터 1996년 8월까지 족근관절 동통으로 관절경하 족근관절 고정술을 시행받은 5명, 6례를 대상으로 하였으며, 3례는 류마토이드 관절염, 2례는 퇴행성 관절염 그리고 1례는 결핵성 관절염이었다. 연령은 최저 38세에서 최고 65세로 평균 48세였으며, 남자 1명, 여자 4명이었다. 추시기간은 최단 12개월에서 최장 80개월로 평균 45개월이었다. 수술 방법은 경골과 종골의 외측부에 외고정장치를 부착하여 신연시킴으로써 족근관절강을 넓게 하여 관절경 및 수술기구를 사용할 수 있는 공간을 확보하였으며 전외측, 전내측 및 전면중앙의 입구를 사용하였다. shaver와 burr를 사용하여 경골, 거골 및 비골의 관절연골 및 연골하 뼈의 일부를 제거하고 출혈을 확인하였으며 경골 내과 및 비골 외과 상방에서 $2\~3$개의 유관나사(cannulated screws)를 사용하여 압박 고정하였다. 술 후 $6\~12$주간 단하지 석고 고정을 시행하였다. 결과 : 전례에서 족근관절의 유합소견을 보였으며 방사선 사진상 골유합의 시기는 최단 6주에서 최장 15주로 평균 10주였고 합병증은 발생하지 않았다. 결론 : 관절경하 족근관절 고정술은 류마토이드 관절염, 퇴행성 관절염 및 비교적 관절에 국한된 감염이 있는 환자에서 족근관절 고정술이 적응이 될 시 사용할 수 있는 좋은 방법으로 사료된다.

• 대한족부족관절학회지
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• 제9권2호
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• pp.220-223
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• 2005

Pigmented villonodular synovitis (PVNS) in ankle is relatively uncommon. This disorder results in increased proliferation of synovium causing villous or nodular changes containing histiocytes, fibroblasts, multinucleated giant cell, and hemosiderin. PVNS is classified into two different type : localized and diffuse. Diffuse type of PVNS in ankle is more common than localized type. Also, recurrence of diffuse type is more frequent. We report a case of diffuse type of PVNS which was recurred soon after the excision.

• 대한족부족관절학회지
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• 제13권2호
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• pp.211-213
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• 2009

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder that affects synovium, tendon sheath and bursa. Although the condition can present in any joint, knee joint is the most commonly affected site and only 2.5% of cases occur in foot and ankle joint. PVNS occurs in two types: localized and diffuse. Localized type is characterized by focal involvement of the synovium with either nodular or pedunculated masses, Diffuse type affects virtually the entire synovium. Diffuse type has reported more recurrence rate. We have experienced a patient who has diffuse type PVNS of ankle joint and report an optimal method of surgical treatment.

• 대한족부족관절학회지
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• 제13권2호
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• pp.203-206
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• 2009

We experienced a case of congenital insensitivity to pain with anhidrosis mimicking a chronic osteomyelitis of the talus, with recurrent ankle swelling and intermittent fever. He was misdiagnosed as low virulence osteomyelitis at other hospital in annual recurrence for 3 years. A Charcot joint in children is a very rare condition and diagnosis should be made in a careful approach.

• 대한정형외과학회지
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• 제56권4호
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• pp.317-325
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• 2021

목적: 본 연구는 족관절 후과 골절을 동반한 경골 원위부 나선상 골절에서 경골에 대한 고정술로 골수강 내 금속정 고정술과 최소 침습적 금속판 고정술의 기능적, 방사선학적 결과 및 후과 골절에 대한 고정술 유무에 따른 기능적, 방사선학적 결과를 비교하였다. 대상 및 방법: 2010년 1월부터 2018년 12월까지 본원에서 족관절 후과 골절을 동반한 경골 원위부 나선상 골절(AO Foundation/Orthopaedic Trauma Association 분류 42-A1, B1, C1) 30명의 환자를 대상으로 연구하였다. 골수강 내 금속정 고정술을 시행한 16명을 intramedullary nailing (IMN)군으로, 최소 침습적 금속판 고정술을 시행한 14명을 minimally invasive plate osteosynthesis (MIPO)군으로 분류하여 양 군의 골유합 시기, 술 후 각 정렬, 족관절 후과 골편의 전위 정도 및 American Orthopaedic Foot and Ankle Society (AOFAS) 점수를 비교, 분석하였다. 또한 각 군에서 후과 골절에 대한 고정술 유무에 따른 족관절 관절 운동 범위 및 AOFAS 점수를 비교하였다. 결과: 평균 골유합 시기는 IMN군에서 21.8주, MIPO군에서 23.1주였다(p=0.500). 최종 추시 평균 각 변형은 IMN군에서 관상면 1.8°, 시상면 1.6°를 보였고, MIPO군에서 관상면 1.2°, 시상면 1.7°를 보였다(p=0.131, p=0.850). 술 후 및 최종 추시 방사선 사진상 양 군 모든 환자에서 족관절 후과 골편의 전위는 없었고, 최종 추시에서 족관절 관절염은 없었다. 임상적 평가로 최종 추시에서 AOFAS 점수는 IMN군에서 평균 88.0점, MIPO 군에서 평균 87.6점을 보였다(p=0.905). 각 군에서 후과 골절에 대한 고정술 유무에 따른 족관절 관절 운동 범위 및 AOFAS 점수를 비교하였고 유의한 차이는 없었다. 결론: 족관절 후과 골절을 동반한 경골 원위부 나선상 골절의 치료에서 골수강 내 금속정 고정술과 최소 침습적 금속판 고정술은 영상학적, 임상적 결과에서 차이가 없이 모두 우수한 결과를 보였다.

• 대한정형외과학회지
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• 제54권1호
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• pp.45-51
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• 2019

목적: 족관절 내과 절골술 및 대형신연기를 이용하여 전내측 접근법으로 수술적 처치를 시행한 제3형 거골 경부 골절 환자들의 임상적, 방사선적 결과를 후향적으로 분석하여 보고하고자 하였다. 대상 및 방법: 2009년 3월부터 2016년 8월까지 조선대학교병원에서 족관절 내과 절골술 및 대형신연기를 이용하여 전내측 접근법으로 수술적 처치를 시행한 제3형 거골 경부 골절 환자 중 12개월 이상 추시가 가능했던 12명(12예)을 대상으로 하였다. 술 후 6주에 외래 추시 시 시행한 전후면 및 측면 단순 방사선 사진으로 Hawkins sign의 유무를 확인하였고 술 후 3개월에 자기공명영상 촬영을 시행하여 무혈성 괴사 여부를 판정하였다. 이후 3개월 간격으로 단순 방사선 사진 및 임상 증세 기반으로 골유합 여부 및 시기를 판정하였고 술 후 12개월에 시행한 단순 방사선 사진으로 후외상성 관절염 발생 여부 및 Takakura stage를 판정하였으며 미국족부족관 절정형외과학회(American Orthopaedic Foot and Ankle Society, AOFAS)의 족관절-후족부 수치(ankle-hindfoot score)를 조사하여 분석하였다. 결과: 7예에서 술 후 3개월에 시행한 자기공명영상상 무혈성 괴사가 발생하였으나 모두 술 후 12개월 추시에서 수술적 처치 없이 AOFAS 점수 83.86±4.53점이라는 결과를 얻었다. 전 예에서 평균 5.3개월에 방사선적 골유합을 얻었고 총 10예에서 방사선적 후외상성 관절염이 발생하였으나 모두 Takakura stage IIIA 이하로 보존적 처치를 통하여 일상생활이 가능하였다. AOFAS 족관절-후족부 수치는 평균 85.17점으로 측정되었다. 그 외 합병증으로 2예에서 얕은 창상 감염이 발생하였다. 결론: 제3형 거골 경부 골절 환자의 수술적 치료에 있어 족관절 내과 절골술 및 대형신연기를 이용한 전내측 접근법은 외측 절개 없이 해부학적 전위 골편의 정복을 얻을 수 있어 거골의 혈류를 비교적 보존할 수 있는 수술적 접근법 중 하나가 될 수 있을 것으로 판단된다.

• 대한족부족관절학회지
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• 제11권1호
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• pp.45-50
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• 2007

Purpose: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. Materials and Methods: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. Results: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. Conclusion: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.

• 대한족부족관절학회지
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• 제11권2호
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• pp.130-134
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• 2007

Purpose: To investigate the relationship between classification based on simple radiographic findings and arthroscopic findings of the cartilage lesions in medial degenerative arthritis of the ankle joint. Materials and Methods: We studied 41 ankles of 36 patients with asymmetrical narrowing of the medial joint space. Degenerative arthritis following fracture and those with generalized arthritic disease were excluded, but those with a history of ankle sprain were included. Standing radiographs of all patients were graded according to the Takakura classification and the Kellgren-Lawrence (K/L) classification. Arthroscopic findings were classified according to the depth, width, and anteroposterior dimension of articular cartilage damage. Results: According to the Takakura classification, 29 ankles were classified as stage II, 7 cases as stage IIIA and 2 cases as stage IIIB. According to our classification of arthroscopic findings of 29 ankles in stage II, 1 ankle was graded as Grade I, 3 ankles as grade II, 10 ankles as grade III, and 15 ankles as grade IV. Spearman correlation coefficient between Takakura classification and arthroscopic classification was 0.342 (P=0.028), and coefficient between K/L classification and arthroscopic classification was 0.480 (P=0.001). Conclusion: Degenerative changes of the articular cartilage are more advanced than radiographic findings in many patients with ankle degenerative arthritis with asymmetrical narrowing of medial joint space. Therefore, we conclude that more aggressive effort should be made for correct diagnosis and treatment of degenerative arthritis.

• 대한족부족관절학회지
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• 제18권4호
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• pp.189-194
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• 2014

Purpose: The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods: There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively. Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion: After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.

• 대한족부족관절학회지
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• 제26권2호
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• pp.71-77
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• 2022

Purpose: This study sought to investigate the appropriate indications for intra-articular injection of hyaluronic acid in ankle osteoarthritis, its efficacy at each stage of osteoarthritis and to compare the efficacy related differences at each stage. Materials and Methods: A retrospective study was conducted from January 2016 to September 2019 on 43 patients (50 cases) diagnosed with ankle arthritis and given intra-articular injection of hyaluronic acid. Patients were classified according to the modified Takakura ankle osteoarthritis stages. Stage 2 comprised 24 cases; stage 3A, 15 cases; stage 3B, 8 cases; and stage 4, 3 cases. The clinical evaluation was carried out using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot and Ankle Outcome Score (FAOS). The patients' satisfaction with the injection was evaluated at 1 year after injection. A radiographic evaluation was performed to gauge the progression of osteoarthritis before and after the injection. Results: The VAS, AOFAS score, and FAOS at 3 months and 1 year after injection showed statistically significant improvements compared to those before the injection. There was a significant difference in the VAS for each stage over time; however, this was not the case with the AOFAS score and the FAOS. A significant improvement of the VAS after injection was seen only in stage 3A when compared with the other stages. The overall satisfaction rate with the injection was 90%. There were no ankle osteoarthritic stage changes in the serial follow-up radiograph. Conclusion: Intra-articular injection of hyaluronic acid resulted in a significant clinical improvement up to 1 year after the injection. Therefore, the intra-articular injection of hyaluronic acid could be a treatment option for ankle osteoarthritis.