• 대한족부족관절학회지
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• 제26권4호
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• pp.157-162
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• 2022

Total ankle arthroplasty has become a viable motion-preserving alternative to ankle arthrodesis, especially in the last two decades. Recent improvements have been achieved in the strength of implant design and surgical technique. Nevertheless, addressing preoperative deformities is essential for successful outcomes of total ankle arthroplasty. Residual malalignment can produce instability and edge loading, causing acceleration of polyethylene wear, followed by osteolysis and an increased risk of revision surgery. Therefore, the accompanying deformities and their correction techniques need to be comprehensively elucidated and understood. In this article, we provide a review of the application of total ankle arthroplasty in arthritis with coronal plane varus and valgus deformities.

• 대한족부족관절학회지
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• 제23권4호
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• pp.143-148
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• 2019

Although many patients who undergo bunion repair do well and have satisfactory results, a critical evaluation of these results shows the potential for improvement. Metatarsal deformity of the hallux valgus is a 3-dimensional deformity, including rotation in the coronal plane. Theoretically, it is important to understand the 3-dimensional displacement of the first metatarsal for correcting the deformities of valgus rotation in the frontal plane. Yet the current methods of metatarsal osteotomy principally attempt to correct the deformity in the transverse plane. The modified technique for the Lapidus procedure can be used in a variety of hallux valgus conditions and severities, and the early results suggest that a powerful correction can be maintained. In addition, efforts have been made to correct the 3-dimensional deformity by performing metatarsal shaft osteotomy. In the case of degenerative arthritis, first metatarsophalangeal joint arthrodesis is a good option to correct the 3-dimensional deformation. Correction of the 3-dimensional deformity, including a rotational deformity in the frontal plane of the metatarsals, should be considered when selecting surgical treatment and is essential for achieving a good prognosis for patients with hallux valgus. This article reviews the classification and treatment of hallux valgus for correction of the 3-dimensional deformity.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.578-581
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• 2015

A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.

• 대한방사선기술학회지:방사선기술과학
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• 제29권4호
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• pp.225-228
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• 2006

목 적: 후족부의 병리학적 상태의 치료와 평가를 위해서는 관상면에서 종골과 경골이 연관된 배열상태의 정확한 평가가 필수적이다. 이전의 방사선학적 검사인 발과 발목의 전후방향, 측방향, 사방향 촬영과 종골 축방향 촬영 등의 X-선 촬영상은 관상면에서 종골과 경골이 연관된 배열상태를 증명하지 못했다. 이에 본 연구에서는 후족부 관상면 배열영상(hindfoot coronal alignment view)을 새롭게 소개하고자 한다. 검사방법 : 1) 양쪽 발을 지탱할 수 있는 방사선투과성의 스탠드형 보조기구를 제작한다. 2) 양측 발은 weight-bearing position이 되게 한다. 3) 각각의 발의 위치는 발의 종축이 보조기구 판과 수직이 되도록 자세를 유지한다. 4) silhouette tracing: 발뒷꿈치 outline과 둘째 발가락이 일직선상으로 지나도록 위치시킨다. 5) 중심 X-선: 발바닥 쪽을 향해 약 $15{\sim}20^{\circ}의 각도로 종골의 뒷쪽을 향해 입사한다. 결 과 : 1) 경골 축과 종골의 내측, 외측 결절의 영상이 함께 표출된다. 2) 종골이 회전되지 않아야 한다. 3) 거퇴관절강(talotibial joint space)이 함께 나타나야 한다. 결 론: CT나 MRI 영상에서도 관상면에서 후족부의 배열상태를 증명할 수 있지만, 환자의 체중이 주어지지 않기 때문에 발의 임상적인 증상을 보여주기에는 충분하지 못했다. 하지만 후족부 관상면 배열영상은 후족부의 inversion, eversion의 자세변화를 보여주고, 경골 원위부와 종골의 varus, valgus deformity의 치료를 위한 평가 자료로 좋은 검사방법이며, 비교적 자연스럽고 편안한 자세로 환자에게 큰 도움을 줄 것으로 사료된다.

• 대한족부족관절학회지
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• 제10권1호
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• pp.56-59
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• 2006

Purpose: The purpose of this study is to find out the normal distal tibial articular surface angle in coronal plane in Koreans. This would be helpful as the basic data for ankle reconstruction after trauma or deformity correction. Materials and Methods: Weight bearing anteroposterior radiographs of 123 normal ankles were reviewed. A line parallel to the shaft of the tibia was made. Another line was drawn parallel to the articular surface of the distal tibia. The superolateral angle that subtended by these two lines was measured. Results: There were 72 males and 51 females. The mean age overall was 35.7 years old. The mean age for males was 31.9 ($28{\sim}36$) years old. The mean age for females was 41.1 ($37{\sim}45$) years old. The mean distal tibial articular surface angle was $90.8^{\circ}$. The mean distal tibial articular surface angle for males was $91.5^{\circ}$ and for females $89.9^{\circ}$. Conclusion: The mean distal tibial articular surface angle in coronal plane for Koreans is $90.8^{\circ}$. We can avoid the error of the varization at the ankle alignment when the correction was performed vertical or minimal valgus to tibia tuberosity axis in Korean people.

• Journal of Korean Neurosurgical Society
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• 제61권6호
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• pp.716-722
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• 2018

Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.

• Journal of Acupuncture Research
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• 제36권4호
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• pp.282-285
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• 2019

Scoliosis is a 3-dimensional spinal deformity defined as lateral curvature of the spine in the coronal plane of more than $10^{\circ}$. This study describes a case of functional scoliosis after hip injury. In this case, the patient fell whilst inline skating (June 2015) causing severe tilting of her spine, and left hip pain. She received outpatient treatment from July 14, 2015 to December 28, 2015. For approximately 5 months, acupuncture therapy was performed to relax the tension in both hips, Chuna therapy, and foot orthosis were applied to reduce the body's imbalance. Based on X-ray images, the Cobb angle had decreased from $14.73^{\circ}$ (pretreatment) to $1.90^{\circ}$ (posttreatment). This case report suggested that Korean medicine treatment could be an effective therapeutic choice for functional scoliosis.

• 대한물리의학회지
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• 제17권3호
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• pp.23-30
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• 2022

PURPOSE: This study was designed to investigate the effects of keeping contraction of abdominal and pelvic floor muscles on 3D pelvic stability in individuals with nonspecific chronic low back pain (CLBP) during normal speed walking. METHODS: The subjects were 20 adults with CLBP deformity and had moderate pain intensity of the visual analog scale. A three-dimensional camera capture system was used to collect kinematic pelvic motion data with and without contraction of the abdominal and pelvic floor muscles during gait. The subjects were asked to walk on a walkway in the lab room and they were attached 40 reflective markers to their pelvic segment and lower extremities. A Visual3D Professional V6 program and Vicon Nexus software were used to analyze 3D pelvic kinematic data. RESULTS: There were significant differences between with and without contraction of the abdominal and pelvic floor muscles of the pelvic depression and the total pelvic motion in coronal plane during gait (p < .05). However, there were no significant differences in any of the maximal motion of the pelvic segment in sagittal and transverse motion plane according to the different muscle contraction conditions (p > .05). CONCLUSION: The results of this study suggest that maintaining co-contraction of the abdominal and pelvic floor muscles in individuals with CLBP increased pelvic stability and contributed to preventing excessive pelvic movements during gait.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.151-157
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• 2018

Background: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. Methods: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, $90^{\circ}$ flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. Results: Ulno-humeral joint moved to the varus on the coronal plane during flexion, $25.45^{\circ}$ in the non-united cubitus valgus group and $-2.03^{\circ}$ in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane $-26.75^{\circ}$ in the non-united cubitus valgus group and $-3.09^{\circ}$ in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. Conclusions: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.

• 대한정형외과학회지
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• 제56권3호
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• pp.253-260
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• 2021

목적: 일차 슬관절 전치환술 시에는 일반적으로 가능한 한 구속력이 적은 치환물을 이용한 슬관절 전치환술이 권장된다. 그럼에도 불구하고 후방 십자인대 보존형 혹은 대치형 치환물로 적절한 슬관절 안정성을 얻기가 불가능한 경우에는 수술 중 내·외반 구속형 슬관절 치환물로 전환을 고려해야 한다. 내·외반 구속형 치환물이 항시 구비되어 있지 않는 국내 현실을 감안하여 일차 슬관절 전치환술의 효율적인 술 전 계획을 위해 내·외반 구속형 슬관절 치환물을 준비하는 적응증을 제시하고자 본 연구를 시행하였다. 대상 및 방법: 2003년 5월부터 2016년 2월까지 시행되었던 일차 슬관절 전치환술 1,797예 중 내·외반 구속형 슬관절 치환물로 일차 슬관절 전치환술이 시행되었던 27명(29예)를 대상으로 내·외반 구속형 슬관절 치환물로 최종 결정한 원인 등을 후향적으로 분석하였다. 결과: 일차 슬관절 전치환술 시 내·외반 구속형 슬관절 치환물이 사용된 경우는 전체 일차 슬관절 전치환술 중 29예로 1.6%의 빈도를 보였다. 남자 6명, 여자 21명이었으며, 2명에서 양측 모두 내·외반 구속형 치환물이 필요하였다. 환자의 나이는 평균 63.4세(34-79세)였고, 술 전 최대신전각도는 평균 16.2° (-20°-90°), 최대굴곡각도는 평균 111.7° (35°-145°)였다. 일차 슬관절 전치환술 시 내·외반 구속형 치환물이 필요하였던 원인으로는 심한 외반 변형으로 내·외반 불안정성을 보강하기 위한 경우가 10예, 심한 강직으로 인해 내·외반 구속형 치환물이 사용되었던 경우가 10예였으며, 과거력상 내측측부인대 4예, 외측측부인대 1예, 원위 대퇴골과의 무혈성 괴사로 인한 경우가 4예였다. 심한 외반 변형으로 수술을 시행한 10예 경우의 술 전 슬관절 전후방기립 사진상 해부학적 대퇴경골간각은 평균 25.7° (21°-43°)의 외반각을 보였고, 심한 강직으로 수술을 시행한 10예 경우의 굴곡 구축은 평균 37.5° (20°-90°), 관절운동범위는 평균 48.5° (10°-70°)였다. 결론: 20° 이상의 해부학적 대퇴경골간각의 외반 변형, 굴곡 구축 20° 이상 및 관절운동범위 70° 이하를 가진 관절운동 제한, 과거 측부인대 손상 병력이 의심되는 경우에는 일차슬관절 전치환술 시라도 술 전 계획 시 내·외반 구속형 치환물을 준비하는 것이 수술 중 발생할 수 있는 불안정성의 해결에 도움이 될 것으로 생각된다.