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Treatment of Chronic Lateral Ankle Instability: A Modified Broström Technique Using All-Suture Anchor
Korean J Sports Med 2024;42:119-125
Published online June 1, 2024;  https://doi.org/10.5763/kjsm.2024.42.2.119
© 2024 The Korean Society of Sports Medicine.

Sungjoon Lim1, Nam Jun Baek2, Geon Jung Kim2

1Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, 2Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
Correspondence to: Geon Jung Kim
Department of Orthopedic Surgery, National Police Hospital, 123 Songi-ro, Songpa-gu, Seoul 05715, Korea
Tel: +82-2-3400-1247, Fax: +82-2-3400-1249
E-mail: kgjmoses@gmail.com
Received December 21, 2023; Revised February 13, 2024; Accepted February 26, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: This study assessed the clinical outcomes of a modified Broström operation using all-suture anchors for patients with chronic lateral ankle instability.
Methods: A comprehensive analysis was conducted on 22 cases with a minimum follow-up of 1 year. Clinical outcomes were assessed using the Karlsson scores and Sefton’s grading system.
Results: Significant improvement was observed in patients’ symptoms postoperatively. Karlsson scores increased markedly from preoperative levels, indicating substantial clinical improvement. Most patients (20 of 22, 90.9%) were categorized as ‘excellent’ or ‘good’ according to Sefton’s grading. There was no anchor related complication.
Conclusion: The modified Broström operation employing all-suture anchors demonstrated favorable clinical outcomes for patients with chronic lateral ankle instability. This technique can be promising alternative for traditional modified Broström operation, offering improved stability and symptom relief.
Keywords : Joint instability, Ankle lateral ligaments, Suture anchor
꽌 濡

諛쒕ぉ 뿼醫뚮줈 씤븳 쇅痢 씤쓽 넀긽 떊泥 솢룞씠 留롮 씤援ш뎔뿉꽌 쓷븳 遺긽씠떎. 諛쒕ぉ 쇅痢 씤 넀긽 蹂댁〈쟻 移섎즺踰뺤쓣 넻빐 샇쟾릺뒗 寃쎌슦媛 遺遺꾩씠굹, 씪遺 솚옄뿉꽌 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦(chronic ankle instability)씠 諛쒖깮븷 닔 엳쑝硫1, 씠 以 빟 20%쓽 솚옄뒗 닔닠씠 븘슂븷 닔 엳떎2. 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦뿉 빐꽌 뿭궗쟻쑝濡 떎뼇븳 닔닠踰뺤씠 떆뻾릺뼱 솕뒗뜲, 씠 以 諛쒕ぉ 쇅痢 씤瑜 鍮꾧낏뿉 옱遺李⑺븯뿬 빐遺븰쟻 쐞移섏뿉 蹂듭썝븯뒗 蹂삎 Broström 닠떇(modified Broström operation)씠 媛옣 꼸由 궗슜릺怨 엳떎. 諛쒕ぉ 쇅痢 씤瑜 鍮꾧낏뿉 怨좎젙븯뒗 諛⑸쾿 쟾넻쟻쑝濡 怨 꽣꼸쓣 씠슜븯뒗 湲곕쾿씠 궗슜릺뼱 솕떎. 怨 꽣꼸쓣 씠슜븯뒗 湲곕쾿 媛뺥븳 怨좎젙젰쓣 媛吏굹, 鍮꾧낏뿉 뿬윭 媛쒖쓽 怨 꽣꼸쓣 솗蹂댄븯뒗 怨쇱젙씠 湲곗닠쟻쑝濡 뼱젮썙 寃쏀뿕씠 留롮 븡 닠옄쓽 寃쎌슦 뜑 留롮 닔닠 떆媛꾩씠 븘슂븯硫, 꽣꼸 솗蹂 怨쇱젙뿉꽌 怨⑥젅씠 諛쒖깮븷 쐞뿕꽦씠 엳떎3,4. 씠뿉 븳 븞쑝濡 遊됲빀 굹궗(suture anchor)瑜 궗슜븷 닔 엳떎. 遊됲빀 굹궗뒗 理쒓렐 뒪룷痢좎쓽븰 遺꾩빞뿉꽌 씤 諛 嫄 옱嫄댁뿉 留롮씠 벐씠怨 엳뒗뜲, 湲곗닠쟻쑝濡 쟻슜씠 돺怨 븞젙쟻씤 怨좎젙쓣 利됱떆 뼸쓣 닔 엳뼱 떎뼇븳 닔닠뿉꽌 솢슜릺怨 엳떎. 理쒓렐 蹂삎 Broström 닠떇뿉꽌룄 遊됲빀 굹궗瑜 씠슜븳 怨좎젙諛⑸쾿씠 蹂닿퀬릺怨 엳뒗뜲, 遊됲빀 굹궗瑜 씠슜븯硫 쇅痢 씤쓽 젙솗븳 빐遺븰쟻 湲곗떆遺뿉 씤瑜 遊됲빀븯怨 옱遺李⑺븯뿬 젙긽 踰≫꽣(vector)瑜 쑀吏븷 닔 엳떎. 삉븳 遊됲빀 굹궗瑜 씠슜븳 蹂삎 Broström 닔닠 湲곗닠쟻쑝濡 돩슦硫, 닔닠 떆媛꾩씠 떒異뺣릺怨, 뿬윭 媛쒖쓽 援щ찉쓣 슟쓣 븘슂媛 뾾뼱 怨⑥젅쓽 쐞뿕꽦씠 쟻 옣젏씠 엳떎5. 븯吏留 遊됲빀 굹궗쓽 궫엯 삤瑜(misplacement), 뙆넀(breakage), 戮묓옒(pullout), 씠臾 諛섏쓳(retention of hardware)씠 엳쓣 닔 엳떎4,5.

遊됲빀 굹궗뒗 珥덇린쓽 湲덉냽 遊됲빀 굹궗뿉꽌 깮泥 씉닔꽦 遊됲빀 굹궗, 뤃由ъ뿉뀛 뿉뀛 耳넠(polyether ether ketone, PEEK) 遊됲빀 굹궗 諛 쟾遊됲빀 굹궗(all-suture anchor, all-soft suture anchor)濡 諛쒖쟾빐솕떎6,7. 湲덉냽 遊됲빀 굹궗뒗 궫엯씠 슜씠븯硫 諛⑹궗꽑 궗吏꾩쑝濡 돺寃 愿李고븷 닔 엳吏留, 궇移대줈슫 遊됲빀 굹궗쓽 븘씪젢(eyelet)쑝濡 씤빐 遊됲빀궗쓽 뙆뿴씠 諛쒖깮븷 닔 엳쑝硫 옄湲 怨듬챸 쁺긽 寃궗긽 媛꾩꽠씠 엳怨, 옱닔닠씠 뼱졄떎뒗 떒젏씠 엳떎. 깮泥 씉닔꽦 遊됲빀 굹궗뒗 씠윭븳 臾몄젣瑜 以꾩뿬二쇱留 뿼利 諛섏쓳怨 굹궗 二쇱쐞 궘醫낆씠 삎꽦맆 닔 엳떎. PEEK 遊됲빀 굹궗뒗 떒닚 諛⑹궗꽑 寃궗뿉 굹굹吏 븡쑝硫 鍮꾧툑냽꽦엫뿉룄 湲덉냽 遊됲빀 굹궗 鍮꾩듂븳 戮묓옒 媛뺣룄瑜 媛吏怨 엳쑝굹 돺寃 뙆넀씠 릺뒗 떒젏씠 엳떎6,8. 씠윴 떒젏뱾쓣 蹂댁셿븳 쟾遊됲빀 굹궗뒗 湲곗〈쓽 遊됲빀 굹궗뿉 븳 븞쑝濡 몢릺怨 엳떎6,7. 쟾遊됲빀 굹궗뒗 떒떒븳 遺遺 뾾씠 遺뱶윭슫 吏곷Ъ 遊됲빀궗 냼옱濡쒕쭔 留뚮뱾뼱졇 옄洹 利앹긽 諛 뙆넀쓽 쐞뿕씠 쟻떎7. 쟾遊됲빀 굹궗瑜 씠슜븳 닔닠 寃곌낵뒗 二쇰줈 쉶쟾洹쇨컻, 씠몢洹 諛 愿젅닚 벑쓽 寃ш젅뿉꽌 二쇰줈 蹂닿퀬릺怨 엳쑝硫7,9,10, 議깅/議깃젅 씤 遊됲빀뿉 븳 뿰援щ뒗 쟻 닔쓽 궗泥 뿰援, 利앸 蹂닿퀬 엫긽 蹂닿퀬媛 엳떎11-14. 긽셿怨⑥뿉 鍮꾪빐 긽쟻쑝濡 겕湲곌 옉怨 뵾븯 뿰遺議곗쭅씠 쟻 鍮꾧낏뿉뒗 湲덉냽 遊됲빀 굹궗굹 PEEK 遊됲빀 굹궗蹂대떎 吏곴꼍씠 옉怨 遺뱶윭슫 냼옱쓽 쟾遊됲빀 굹궗媛 닔닠뿉 뜑 쟻빀븷 닔 엳떎.

蹂 뿰援щ뒗 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦뿉 빐 쟾遊됲빀 굹궗瑜 씠슜븳 蹂삎 Broström 닠떇쓣 떆뻾븯怨 엫긽 寃곌낵瑜 遺꾩꽍븯뿬 洹 쑀슚꽦쓣 솗씤븯怨좎옄 븯떎.

뿰援 諛⑸쾿

1. 뿰援 긽

蹂 뿰援щ뒗 援由쎄꼍李곕퀝썝 뿰援ъ쑄由ъ쐞썝쉶쓽 듅씤쓣 뼸 썑 吏꾪뻾븯떎(No. 111000176-202310-HR-014). 썑뼢쟻 뿰援 듅꽦긽 긽옄 꽌硫 룞쓽뒗 쑄由ъ쐞썝쉶濡쒕꽣 硫댁젣 諛쏆븯떎. 2020뀈 1썡 1씪遺꽣 2022뀈 12썡 31씪源뚯 빐떦 쓽猷뚭린愿 젙삎쇅怨쇱뿉꽌 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦쑝濡 吏꾨떒諛쏄퀬 蹂삎 Broström 닠떇쓣 떆뻾 諛쏆 솚옄뱾 以 理쒖냼 1뀈 씠긽 異붿떆 媛뒫븯뜕 솚옄瑜 긽쑝濡 썑뼢쟻 遺꾩꽍쓣 떆뻾븯떎. 닔닠 떆 쟾遊됲빀 굹궗瑜 궗슜븯吏 븡怨 怨 꽣꼸 諛⑹떇 삉뒗 깮泥댄씉닔꽦 굹궗 벑쓣 궗슜븳 寃쎌슦뒗 젣쇅븯떎.

닔닠쓽 쟻쓳利앹 6媛쒖썡 씠긽 留뚯꽦쟻씤 諛쒕ぉ 遺덉븞젙꽦怨 넻利앹쓣 샇냼븯뒗 솚옄濡쒖꽌 (1) 씠븰쟻 寃궗뿉꽌 議깃렐愿젅 쇅痢 씤遺쓽 븬넻씠 엳怨 쟾諛⑹쟾쐞寃궗뿉꽌 슌졆븳 遺덉븞젙꽦씠 솗씤릺뒗 寃쎌슦, (2) 뒪듃젅뒪 諛⑹궗꽑 寃궗뿉꽌 嫄곌낏 寃쎌궗媛곸씠 10° 씠긽씠嫄곕굹 嫄댁륫뿉 鍮꾪빐 5° 씠긽쓽 李⑥씠瑜 蹂댁씠뒗 寃쎌슦, 嫄곌낏 쟾諛⑹쟾쐞 젙룄媛 10 mm 씠긽씠嫄곕굹 嫄댁륫뿉 鍮꾪빐 3 mm 씠긽쓽 李⑥씠瑜 蹂댁씠뒗 寃쎌슦, (3) 옄湲곌났紐낆쁺긽(magnetic resonance imaging, MRI)뿉꽌 쟾嫄곕퉬 씤 醫낅퉬 씤쓽 뙆뿴, 뻼븘吏, 삉뒗 鍮꾪썑 냼寃ъ씠 蹂댁씠뒗 寃쎌슦濡 젙븯쑝硫, 쐞쓽 냼寃щ뱾쓣 醫낇빀븯뿬 닔닠 뿬遺瑜 寃곗젙븯떎.

2. 닔닠 諛⑸쾿 諛 닠 썑 移섎즺 諛⑸쾿

紐⑤뱺 닔닠 떒씪 닠옄(젙삎쇅怨 쟾臾몄쓽)뿉 쓽빐 씠猷⑥뼱議뚮떎. 泥숈텛留덉랬瑜 떆뻾븳 썑 뿀踰낆뿉 넗땲耳볦쓣 쟻슜븯떎. 븰쐞 옄꽭뿉꽌 醫낆븘由 履쎌뿉 닔닠룷 뙣뵫쓣 諛쏆퀜꽌 닔닠븯뒗 諛쒕ぉ쓣 옄쑀濡寃 議곗옉븷 닔 엳룄濡 븯떎. 닔닠 쟾 쁺긽寃궗(X-ray, MRI)뿉꽌 愿젅 궡 蹂묐뿉 븳 泥섏튂媛 븘슂븳 寃쎌슦 諛쒕ぉ 愿젅寃 닔닠쓣 癒쇱 떆뻾븯떎. 뵾遺 젅媛쒕뒗 鍮꾧낏 썝쐞遺쓽 以묒븰뿉꽌 쟾嫄곕퉬 씤 醫낅퉬 씤쓽 궗씠 遺遺꾩쑝濡 怨≪꽑 젅媛쒕 궗슜븯떎. 泥쒕퉬怨⑥떊寃 諛 삁愿씠 넀긽릺吏 븡룄濡 二쇱쓽븯뿬 뿰遺議곗쭅쓣 諛뺣━븯怨, 鍮꾧낏 썝쐞遺뿉꽌 5 mm 寃쎄퀎瑜 몢怨 愿젅궘 씤 援ъ“(capsuloligamentous complex)瑜 諛뺣━븯떎. 鍮꾧낏븯 遺怨⑥씠 엳뒗 寃쎌슦 씠瑜 젅젣븯떎. 醫낅퉬 씤쓽 긽깭瑜 솗씤븯뿬 遊됲빀 븘슂 뿬遺瑜 寃곗젙븯怨, 鍮꾧낏嫄댁쓽 긽깭瑜 솗씤븯떎. Rongeur濡 怨 湲곕컲(bone bed)瑜 젙由ы븳 썑 썝쐞 鍮꾧낏 留먮떒 쟾嫄곕퉬 씤쓽 遺李 吏젏怨 븘슂븳 寃쎌슦 醫낅퉬 씤 遺李 吏젏뿉 1.3-mm Trushot Y-knot 遊됲빀 굹궗(CONMED Corp.)瑜 궫엯븯떎. 씠썑 愿젅궘 씤 援ъ“瑜 蹂삎 硫붿씠뒯 븣젋 遊됲빀踰(modified Mason-Allen suture)쓣 씠슜븯뿬 議깃젅쓣 以묐┰쐞, 쇅踰덊븳 긽깭뿉꽌 寃ш퀬븯寃 遊됲빀븯떎. 留덉留됱쑝濡 븯떊쟾 吏(inferior extensor retinaculum)瑜 씉닔꽦 遊됲빀궗(Vicryl 1-0, Ethicon)쓣 씠슜븯뿬 쇅怨쇱쓽 怨⑤쭑(periosteum)怨 愿젅궘뿉 遊됲빀븯뿬 蹂닿컯븯쑝硫, 씠썑 뿰遺議곗쭅쓣 痢듭링씠 遊됲빀븯떎(Fig. 1).

Fig. 1. (A) A curvilinear incision was made over the distal anterior border of the lateral malleolus. (B) After preparing the bone bed with a Rongeur, two all-suture anchors were inserted at the footprint of the anterior talofibular ligament on the distal tip of the fibula. (C) Subsequently, the joint capsule ligament complex was sutured. Finally, the inferior extensor retinaculum was reinforced by suturing it to lateral malleolar periosteum and the joint capsule.

닔닠 썑 4二쇨컙 떒븯吏 遺紐 怨좎젙 諛 鍮꾩껜以 遺븯瑜 쑀吏븯怨, 씠썑 諛쒕ぉ 蹂댄샇瑜 李⑹슜븳 긽깭뿉꽌 諛쒕ぉ 愿젅 슫룞 諛 遺遺꾩껜以 遺븯 蹂댄뻾쓣 떆뻾븯떎. 닔닠 썑 8二 씠썑 쟾泥댁쨷 遺븯 蹂댄뻾쓣 뿀슜븯怨 鍮꾧낏洹 媛뺥솕 슫룞쓣 떆뻾븯떎. 떖由ш린뒗 닔닠 썑 빟 4媛쒖썡 씠썑遺꽣 뿀슜븯떎.

3. 엫긽쟻 諛 諛⑹궗꽑븰쟻 룊媛 諛⑸쾿

닔닠뿉 뵲瑜 엫긽 寃곌낵뒗 닔닠 썑 1뀈留덈떎 愿李 떆 Sefton쓽 룊媛 泥숇룄15 Karlsson 젏닔16瑜 痢≪젙븯떎. Sefton쓽 룊媛踰뺤쓣 씠슜븯뿬 諛쒕ぉ 湲곕뒫쓣 슦닔, 뼇샇, 蹂댄넻, 遺덈웾쓽 4벑湲됱쑝濡 遺꾨쪟븯떎. ‘슦닔(excellent)’뒗 紐⑤뱺 떊泥 솢룞뿉 엳뼱 넻利, 遺醫, 遺덉븞젙媛먯씠 쟾 뾾뒗 긽깭, ‘뼇샇(good)’뒗 寃⑸젹븳 슫룞 썑뿉뒗 媛꾪뿉쟻 넻利앹씠 엳쓣 닔 엳吏留 遺덉븞젙媛먯씠굹 遺덉븞 뒓겮吏 븡뒗 긽깭, ‘蹂댄넻(fair)’ 닔닠 쟾蹂대떎 遺덉븞젙媛먯씠굹 遺덉븞씠 媛쒖꽑릺뿀吏留 뿬쟾엳 臾몄젣媛 궓븘 엳뒗 긽깭, ‘遺덈웾(poor)’ 씪긽 깮솢뿉꽌 넻利앷낵 遺醫낃낵 븿猿 吏냽쟻쑝濡 遺덉븞젙媛먯씠 엳뼱 닔닠 쟾怨 蹂솕媛 뾾嫄곕굹 닔닠 썑 삤엳젮 뜑 븙솕맂 긽깭濡 젙쓽븯떎. Karlsson 젏닔16濡 븞젙꽦, 넻利 젙룄, 遺醫, 寃쎌쭅룄(stiffness), 怨꾨떒 궗슜 뒫젰, 떖由ш린 뒫젰, 吏곸옣씠굹 뒪룷痢 솢룞, 洹몃━怨 諛쒕ぉ 蹂댁“湲 궗슜 뿬遺 媛숈 떎뼇븳 슂냼瑜 湲곕컲쑝濡 닔닠 썑쓽 利앹긽 媛쒖꽑 諛 湲곕뒫 쉶蹂듭쓣 룊媛븯떎. 삉븳 異붿떆 愿李 以 닔닠 썑 씪긽깮솢 蹂듦源뚯쓽 떆媛 諛 슫룞쓣 떎떆 떆옉븷 븣源뚯 嫄몃┛ 떆媛꾧낵 닔닠 썑 뒪룷痢 솢룞쓽 젙룄瑜 룊媛븯떎. 쓽臾닿린濡앹쓣 遺꾩꽍븯뿬 닔닠 썑 듅씠 빀蹂묒쬆(媛먯뿼, 닔닠 李쎌긽 臾몄젣 벑)씠굹 옱닔닠 뿬遺瑜 議곗궗븯떎.

諛⑹궗꽑븰쟻 룊媛濡 닔닠 쟾怨 닔닠 1뀈 씠긽 寃쎄낵 썑 쟾諛 쟾쐞 諛 궡諛 뒪듃젅뒪 寃궗瑜 떆뻾븯뿬 嫄곌낏 寃쎌궗媛곴낵 嫄곌낏 쟾諛⑹쟾쐞 젙룄瑜 痢≪젙븯뿬 鍮꾧탳븯떎(Fig. 2). 삉븳 떒닚 諛⑹궗꽑 珥ъ쁺뿉꽌 怨⑥젅씠굹 愿젅뿼쓽 諛쒖깮, 遊됲빀 굹궗쓽 戮묓옒 벑 씠긽 냼寃 쑀臾대룄 솗씤븯떎.

Fig. 2. (A, B) During the preoperative evaluation, anterior translation and talar tilt were measured. (C, D) These parameters were subsequently reassessed approximately 8 months postoperatively to evaluate changes following the surgical procedure.

넻怨꾩쟻 諛⑸쾿쑝濡 닔닠 쟾썑 Karlsson 젏닔쓽 李⑥씠, 嫄곌낏 寃쎌궗媛곴낵 쟾諛⑹쟾쐞 젙룄쓽 李⑥씠뒗 吏앹 t-寃젙쓣 떆뻾븯떎. 넻怨 遺꾩꽍 넻怨꾨텇꽍 IBM SPSS version 28.0 (IBM Corp.)쓣 씠슜븯怨, 쑀쓽 닔以 p<0.05濡 젙쓽븯떎.

寃 怨

珥 19紐낆쓽 솚옄(궓옄 17紐, 뿬옄 2紐)濡 22삁(렪痢 16삁, 뼇痢 6삁)媛 理쒖쥌 뿰援 긽뿉 룷븿릺뿀떎. 닔닠 떦떆 솚옄뱾쓽 룊洹 뿰졊 34꽭(踰붿쐞, 22–58꽭)떎. 40꽭 씠긽씠 6삁, 40꽭 誘몃쭔씠 16삁쑝硫, 씠솚 湲곌컙 以묒븰媛 41媛쒖썡(踰붿쐞, 4–365媛쒖썡)씠뿀떎. 룊洹 異붿떆 湲곌컙 16.1媛쒖썡(踰붿쐞, 12–34媛쒖썡)씠뿀떎(Table 1). 닔닠 쟾 珥ъ쁺븳 MRI 냼寃ъ긽 쟾嫄곕퉬 씤쓽 뙆뿴씠 솗씤맂 寃쎌슦媛 22삁 以 13삁怨 쟾嫄곕퉬 씤쓽 鍮꾪썑 냼寃ъ씠 5삁쑝硫, 뻼븘吏 냼寃ъ 4삁뿉꽌 솗씤릺뿀떎. 醫낅퉬 씤쓽 뙆뿴씠 솗씤맂 寃쎌슦媛 22삁 以 6삁怨 醫낅퉬 씤쓽 鍮꾪썑 냼寃ъ씠 7삁떎. 鍮꾧낏븯 遺怨⑥쬆 2삁뿉꽌 愿李곕릺뿀떎. 怨⑥뿰怨 蹂묐 4삁뿉꽌 愿李곕릺뿀쑝硫, 씠 以 2삁媛 怨④레(osteophyte)쑝濡 씤븳 쟾諛 異⑸룎 利앺썑援(anterior impingement syndrome)쓣 룞諛섑븯뿬 愿젅寃 닔닠쓣 癒쇱 吏꾪뻾븯떎. 넀긽쓽 醫낅쪟濡쒕뒗 슫룞 以 諛쒖깮븳 넀긽씠 8삁, 洹쇰Т 以 넀긽씠 1삁, 씪긽 깮솢 以 넀긽씠 13삁떎.

Table 1 . Summary of findings in 22 cases of chronic ankle instability treated with modified Broström operation using all-suture anchors

Case No.SexAge (yr)DirectionOccupationCurrent sportsSefton gradeKarlsson score
PreoperativePostoperative
1Male25RightAthleteTaekwondoExcellent67100
2LeftExcellent65100
3Male25RightTrainerWeighttrainingGood5279
4Male26LeftConscripted policemenWeight trainingExcellent70100
5Male55LeftPolice officerNonePoor5240
6Male28RightConscripted policemenSoccerExcellent72100
7Male40RightPolice officerBadmintonExcellent75100
8Female35RightOfficeWalkingGood6287
9Male23RightPhysical educationRunningGood6090
10Male24LeftConscripted policemenRunningGood5790
11RightGood5290
12Male24LeftConscripted policemenBodyweight trainingGood6590
13Male22LeftConscripted policemenBasketballExcellent85100
14Male25LeftConscripted policemenSoccerFair6270
15Male54LeftPolice officerWalkingGood5067
16RightExcellent80100
17Male58LeftPolice officerWalkingExcellent8095
18Male37LeftFire fighterFoot volleyballExcellent6089
19Male45RightPolice officerWalkingExcellent6295
20Male22LeftSoliderNoneExcellent6095
21Female30RightOffice workerHikingExcellent6595
22Male46RightPolice officerGolfGood6795


닔닠 썑 씪긽깮솢 蹂듦源뚯뒗 룊洹 2.6媛쒖썡(踰붿쐞, 1–6媛쒖썡)씠 냼슂릺뿀쑝硫, 슫룞쓣 떎떆 떆옉븯湲 源뚯뒗 룊洹 5.0媛쒖썡(踰붿쐞, 4–11媛쒖썡)씠 냼슂릺뿀떎. 쟾泥 22삁 以 20삁뒗 슫룞쓣 二쇨린쟻쑝濡 븯怨 엳떎怨 떟蹂븯쑝硫, 洹 以 嫄룰린 닔以쓽 슫룞 5삁, 떖由ш린 諛 썾씠듃 듃젅씠떇怨 媛숈 鍮꾧꼍웳쟻 뒪룷痢좊뒗 9삁, 援ш린 醫낅ぉ怨 媛숈 寃쎌웳쟻 뒪룷痢좊뒗 6삁濡 蹂닿퀬릺뿀떎(Table 1).

Karlsson 젏닔뒗 닠 쟾 룊洹 64.5±9.6젏뿉꽌 닠 썑 룊洹 89.4±14.4젏쑝濡 利앷븯쑝硫(p<0.001), Sefton쓽 벑湲됱뿉 쓽븳 寃곌낵뒗 슦닔 12삁, 뼇샇 8삁, 蹂댄넻 1삁, 遺덈웾 1삁瑜 蹂댁뿬 遺遺꾩뿉꽌 뼇샇 씠긽쓽 寃곌낵媛 굹궗떎(Table 1).

닔닠 쟾 떆뻾븳 뒪듃젅뒪 諛⑹궗꽑 珥ъ쁺긽 쟾諛⑹쟾쐞뒗 10.7±1.4 mm (踰붿쐞, 9.0–14.0 mm)쑝硫, 솚痢≪쓽 젙긽痢≪뿉 븳 쟾諛⑹쟾쐞 李⑤뒗 룊洹 5.1±0.4 mm (踰붿쐞, 5.0–7.0 mm)怨, 嫄곌낏 寃쎌궗媛곸 룊洹 10.9°±4.8° (踰붿쐞, 3.6°–22.4°)濡 遺덉븞젙꽦씠 愿李곕릺뿀떎(Table 1). 닔닠 썑 룊洹 16.1媛쒖썡(踰붿쐞, 12–34媛쒖썡) 以 珥ъ쁺븳 뒪듃젅뒪 諛⑹궗꽑긽 쟾諛⑹쟾쐞뒗 5.3±0.7 mm (踰붿쐞, 4.1–6.5 mm)쑝硫, 嫄곌낏 寃쎌궗媛곸 룊洹 5.0°±0.9° (踰붿쐞, 3.3°–6.6°)瑜 蹂댁뿬 紐⑤몢 닔닠 쟾뿉 鍮꾪빐 쑀쓽誘명븳 媛먯냼瑜 蹂댁떎(p<0.001) (Fig. 2).

遊됲빀 굹궗 愿젴 빀蹂묒쬆쓣 蹂댁씤 利앸뒗 뾾뿀쑝굹, 3삁뿉꽌 닔닠 썑 李쎌긽 遺쐞 臾몄젣瑜 蹂댁떎. 씠 以 2삁뒗 닔닠 뾾씠 李쎌긽씠 옒 移섏쑀릺뿀쑝굹, 1삁(55꽭/궓)뿉꽌 李쎌긽 遺쐞 蹂뿰젅젣닠 諛 옱遊됲빀 닔닠씠 븘슂븯떎. 닔닠 썑 긽泥섍 理쒖쥌 移섏쑀릺뿀怨 遺덉븞젙꽦 빐냼릺뿀쑝굹, 씠썑 吏냽릺뒗 넻利앹쑝濡 썝뿉꽌 蹂듯빀遺쐞 넻利앹쬆썑援(complex regional pain syndrome, CRPS)쓣 吏꾨떒諛쏆븯쑝硫 Karlsson 젏닔 40젏, Sefton grade뿉꽌 遺덈웾쑝濡 룊媛릺뿀떎.

怨 李

留뚯꽦 諛쒕ぉ 遺덉븞젙꽦쓽 닔닠쟻 移섎즺뒗 겕寃 빐遺븰쟻 諛⑸쾿怨 鍮꾪빐遺븰쟻 諛⑸쾿쑝濡 굹늻뒗뜲, 씠 以 빐遺븰쟻 諛⑸쾿쑝濡 넀긽맂 씤瑜 遊됲빀븳 썑 븯떊쟾 吏瑜 怨⑤쭑뿉 遺李⑺븯뿬 蹂닿컯븯뒗 蹂삎 Broström 닠떇씠 媛옣 꼸由 궗슜릺怨 엳떎. 蹂삎 Broström 닠떇 꽦怨듬쪧씠 넂怨 빀蹂묒쬆 諛쒖깮瑜좎씠 궙쑝硫 愿젅 슫룞 踰붿쐞瑜 蹂댁〈븯怨 궡쉶쟾 諛 쟾諛⑹쟾쐞瑜 媛먯냼떆耳 슫룞뿭븰(kinematics)쓣 뼢긽떆궓떎17. Bell 벑18 蹂삎 Broström 닠떇쓣 떆뻾븳 22紐낆쓽 솚옄瑜 룊洹 26.3뀈媛 옣湲 異붿떆 愿李고븳 寃곌낵, 룊洹 92젏쓽 functional outcome score19 91%쓽 솚옄뿉꽌 留ㅼ슦 슦닔 삉뒗 슦닔븳 諛쒕ぉ 湲곕뒫쉶蹂듭쓣 뼸뿀떎. Tourné 벑20룄 蹂삎 Broström 닠떇쓣 씠슜븳 닔닠쓣 諛쏆 150삁瑜 11뀈媛 옣湲 異붿떆븯뿬 洹 寃곌낵瑜 諛쒗몴븯뒗뜲, 93%뿉꽌 留뚯”뒪윭슫 寃곌낵瑜 뼸뿀쓬쓣 蹂닿퀬븯쑝硫 愿젅뿼쑝濡 吏꾪뻾맂 利앸뒗 뾾뿀떎.

쇅痢 씤瑜 鍮꾧낏뿉 怨좎젙븯湲 쐞빐 怨 꽣꼸쓣 씠슜븯뒗 湲곕쾿쓣 二쇰줈 궗슜빐 솕쑝굹, 湲곗닠쟻씤 뼱젮 諛 怨⑥젅쓽 쐞뿕꽦쑝濡 理쒓렐뿉뒗 遊됲빀 굹궗瑜 씠슜븳 닠떇씠 二쇰ぉ諛쏄퀬 엳떎3-5,21-23. 留뚯꽦 議깃렐愿젅 쇅痢 遺덉븞젙꽦 솚옄뿉 븳 蹂삎 Broström 닠떇 썑쓽 Karlsson 젏닔 룊媛뿉꽌 떚뒆 옱吏덉쓽 湲덉냽 遊됲빀 굹궗씤 2.8-mm FASTak II 遊됲빀 굹궗(Arthrex Inc.)瑜 궗슜븳 Kim 벑4쓽 뿰援ъ뿉꽌뒗 Karlsson 젏닔媛 닠 쟾 룊洹 45.2젏(踰붿쐞, 29–59젏)뿉꽌 닠 썑 룊洹 90.1젏(踰붿쐞, 71–97젏)쑝濡 샇쟾릺뿀쑝硫, Sefton쓽 湲곗뿉 뵲瑜대㈃ 슦닔 7삁, 뼇샇 6삁, 蹂댄넻 2삁瑜 蹂댁떎怨 蹂닿퀬븯떎. 깮泥댄씉닔꽦 굹궗씤 Bio-Corkscrew FT 4.5 mm×15 mm (Arthrex Inc.) PushLock Anchor (Arthrex Inc.)瑜 씠슜븳 Shin 벑24쓽 뿰援ъ뿉꽌뒗 American Orthopaedic Foot and Ankle Society (AOFAS) 젏닔긽 Bio-Corkscrew 떒룆 궗슜 援곗뿉꽌뒗 닠 쟾 68.2젏뿉꽌 닠 썑 90.1젏쑝濡 利앷븯怨, Bio-Corkscrew Pushlock 굹궗瑜 蹂묒슜븳 援곗뿉꽌뒗 닠 쟾 69.7젏뿉꽌 닠 썑 93.1젏쑝濡 利앷븯떎. PEEK 遊됲빀 굹궗씤 PopLok (CONMED Corp.)쓣 씠슜븳 Bajuri 벑25쓽 뿰援ъ뿉꽌뒗 AOFAS 젏닔媛 닠 쟾 63.5젏뿉꽌 닠 썑 93.5젏쑝濡 利앷븯떎.

留뚯꽦 議깃젅 遺덉븞젙꽦 솚옄뿉꽌 湲덉냽 遊됲빀 굹궗 깮泥 씉닔꽦 굹궗 諛 PEEK 遊됲빀 굹궗瑜 씠슜븳 蹂삎 Broström 닠떇뿉 븳 엫긽뿰援щ뒗 蹂닿퀬맂 諛 엳쑝굹4,24-26, 쟾遊됲빀 굹궗瑜 씠슜븳 蹂삎 Broström 닠떇뿉 븳 뿰援щ뒗 쟻 닔쓽 궗泥 뿰援, 利앸 蹂닿퀬 엫긽 蹂닿퀬留뚯씠 엳떎11-14. 쟾遊됲빀 굹궗뒗 겕湲곌 옉븘 젣븳맂 遺쐞뿉 湲곗〈쓽 遊됲빀 굹궗蹂대떎 뜑 留롮 굹궗瑜 궫엯븷 닔 엳쑝硫, 궫엯 룄以 怨 넀떎씠 쟻뼱 怨⑤웾씠 쟻 遺쐞瑜 닔닠븯뒗 寃쎌슦굹 옱닔닠 븣뿉룄 옣젏씠 엳떎9. 蹂 뿰援ъ뿉꽌뒗 쟾遊됲빀 굹궗(1.3-mm Trushot Y-knot)瑜 씠슜븳 蹂삎 Broström 닠떇쓣 떆뻾븳 22삁 以 21삁뿉꽌 留뚯”뒪윭슫 엫긽 寃곌낵瑜 뼸뿀쑝硫, Sefton 湲곗뿉 뵲瑜대㈃ 슦닔 12삁, 뼇샇 8삁, 蹂댄넻 1삁, 遺덈웾 1삁瑜 蹂댁떎. 삉븳 Karlsson 젏닔뒗 룊洹 89.7젏(踰붿쐞, 40–100젏)쓣 蹂댁떎. 씠뒗 湲곗〈쓽 怨좎젙 諛⑹떇씤 怨 꽣꼸 諛⑸쾿씠굹 湲덉냽 遊됲빀 굹궗瑜 씠슜븳 諛⑸쾿怨 鍮꾩듂븳 寃곌낵떎. 紐⑤뱺 利앸뿉꽌 쟾遊됲빀 굹궗 愿젴맂 빀蹂묒쬆 諛쒖깮븯吏 븡븯뒗뜲, 씠뒗 遺뱶윭슫 吏곷Ъ 냼옱濡 留뚮뱾뼱졇 湲곗〈쓽 遊됲빀 굹궗蹂대떎 옄洹 利앹긽씠 쟻怨, 뿬윭 깮뿭븰쟻 뿰援ъ뿉꽌 諛앺吏 諛붿 媛숈씠 쟻젅븳 뵾吏덇낏쓽 몢猿섍 엳쓣 寃쎌슦 寃ш퀬븳 怨좎젙쓣 뼸쓣 닔 엳湲 븣臾몄쑝濡 깮媛곷맂떎10,11. 떎留, 蹂 뿰援ъ쓽 몴蹂 닔媛 쟻뼱 쟾遊됲빀 굹궗 愿젴맂 빀蹂묒쬆쓣 遺꾩꽍쓣 븯뒗 뜲 븳怨꾧 엳떎.

븳렪 蹂 뿰援ъ뿉꽌 遺덉븞젙꽦 빐냼릺뿀쑝굹, 닔닠 李쎌긽 遺쐞 移섏쑀 臾몄젣濡 옱닔닠쓣 떆뻾븳 썑 吏냽쟻씤 넻利앹쑝濡 CRPS쑝濡 吏꾨떒諛쏆 1삁媛 엳뿀떎. 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦 닔닠 씠썑 CRPS쓽 遺옉슜쓽 썝씤뿉 븳 뿰援щ뒗 蹂닿퀬맂 諛 뾾쑝굹, Rewhorn 벑27쓽 뿰援ъ뿉꽌뒗 븳 쓽猷뚭린愿뿉꽌 떆뻾맂 390삁쓽 議깅 諛 議깃젅 닔닠뿉꽌 17紐(4.35%)씠 CRPS쓽 빀蹂묒쬆쓣 蹂댁씤 諛 엳떎. 遺遺꾩씠 뿬꽦(14/17, 82.4%)씠뿀쑝硫, 룊洹 굹씠뒗 47.2꽭(踰붿쐞, 27–61꽭)떎. 삉븳 8紐(8/17, 47.1%)뿉꽌 遺덉븞 諛 슦슱濡 씤븳 젙떊怨쇱쟻 蹂묐젰쓣 蹂댁떎. 蹂 뿰援ъ쓽 CRPS 솚옄쓽 寃쎌슦 젙떊怨쇱쟻 蹂묐젰 솗씤릺吏 븡븯쑝굹, 뾽臾댁긽 옱빐 蹂댁긽怨 愿젴 엳뜕 솚옄濡 吏냽쟻쑝濡 넻利앹쓣 샇냼븯뿬 CRPS濡 吏꾨떒諛쏆븯떎. 닔닠 愿젴 씤옄濡쒕뒗 뿰遺議곗쭅쓣 怨쇰룄븯寃 寃ш퀬븯寃 遊됲빀븯嫄곕굹, 遊됲빀 굹궗濡 씤븳 泥쒕퉬怨⑥떊寃쎌쓽 옄洹 벑씠 CRPS쓽 썝씤쑝濡 옉슜븯쓣 媛뒫꽦룄 怨좊젮븷 닔 엳떎. Ahn 벑28쓽 뿰援ъ뿉 뵲瑜대㈃ 궛뾽옱빐濡 씤븳 넀긽쓽 寃쎌슦 洹몃젃吏 븡 寃쎌슦뿉 鍮꾪빐 寃곌낵뿉 븳 遺덈쭔議깆쓽 鍮덈룄媛 넂 寃곌낵瑜 蹂댁떎. 빐떦 利앸쓽 寃쎌슦 뾽臾댁긽 옱빐 蹂댁긽怨 愿젴 엳뜕 젏, 긽쟻쑝濡 怨좊졊(55꽭/궓)씤 젏 벑씠 遺덈웾븳 寃곌낵 愿젴맂 씤옄濡 깮媛곷릺硫, 씠윭븳 遺덈웾 삁썑씤옄媛 엳뒗 寃쎌슦 닔닠쟻 移섎즺 뿬遺瑜 寃곗젙븯뒗 뜲 떊以묒쓣 湲고븷 븘슂媛 엳떎.

Lee 벑29쓽 뿰援ъ뿉꽌 留뚯꽦 諛쒕ぉ 遺덉븞젙꽦뿉꽌 愿젅궡 뿰怨 寃곗넀, 솢븸留됱뿼, 嫄곌낏泥댁쓽 異⑸룎 뿭떆 쓷엳 룞諛섎릺뼱 愿젅寃쎌쓣 씠슜븳 愿젅궡 蹂묐쓽 솗씤 諛 移섎즺瑜 븿猿 떆뻾븯쓣 븣 醫뗭 寃곌낵瑜 蹂닿퀬븯떎. 蹂 뿰援ъ뿉꽌뒗 2삁뿉꽌 愿젅 궡 뿰怨 寃곗넀 諛 愿젅 궡 怨④레씠 愿李곕릺뼱 愿젅寃쎌쓣 씠슜븯뿬 怨④레쓣 젣嫄고븯쑝硫, 愿젅 궡 뿰怨 寃곗넀 寃쎈명븯뿬 蹂꾨룄쓽 泥섏튂瑜 떆뻾븯吏 븡븯떎.

닔닠 썑 슫룞쓣 떎떆 떆옉븯湲 源뚯뒗 룊洹 5.0媛쒖썡(踰붿쐞, 4–11媛쒖썡)씠 냼슂릺뿀떎. 닔닠 썑 슫룞 蹂듦源뚯 嫄몃━뒗 떆媛꾩쓣 뿰援ы븳 Kim 벑30쓽 뿰援ъ뿉꽌뒗 6媛쒖쓽 臾댁옉쐞 議 떆뿕뿉꽌 룊洹좎쟻쑝濡 슫룞 蹂듦源뚯 16.5二쇨 냼슂릺뿀떎怨 蹂닿퀬븯뿬, 쟾遊됲빀 굹궗瑜 씠슜븳 蹂 뿰援ъ 쑀궗븳 寃곌낵瑜 蹂댁떎.

蹂 뿰援ъ쓽 젣븳젏쑝濡쒕뒗 怨 꽣꼸 諛⑸쾿쓣 씠슜븳 솚옄援곗씠굹 떎瑜 醫낅쪟쓽 遊됲빀 굹궗瑜 궗슜븳 솚옄援곌낵 쟾遊됲빀 굹궗瑜 씠슜븳 寃곌낵瑜 吏곸젒 鍮꾧탳븯吏 븡븯떎뒗 젏씠떎. 삉븳 몴蹂 닔媛 쟻怨 怨④레 젅젣닠씠 븘슂븳 씪遺 눜뻾꽦 蹂솕媛 엳뒗 솚옄媛 룷븿맂 젏, 쓽猷뚭린愿 듅꽦긽 꽦鍮꾧 怨좊Ⅴ吏 紐삵븯뿬 렪뼢맆 媛뒫꽦, 異붿떆 愿李 湲곌컙씠 湲몄 븡 젣븳젏씠 엳떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Acknowledgments

This research was supported by a grant from the National Police Hospital.

Author Contributions

Conceptualization, Investigation, Project administration, Super-vision: SL, GJK. Data curation, Methodology, Visualization: SL, NJB. Formal analysis: all authors. Funding acquisition: GJK. Resources: SL. Writing–original draft: SL, NJB. Writing–review & editing: all authors.

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