Review Article pissn eissn J Korean Foot Ankle Soc 2016;20(3): 원위경비인대결합의단독손상

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$associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph.$ Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis.

Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis.

1 Review Article pissn eissn J Korean Foot Ankle Soc 2016;20(3): 원위경비인대결합의단독손상 김용태, 김형년, 박용욱 한림대학교의과대학강남성심병원정형외과학교실 Isolated Syndesmotic Injury Yong Tae Kim, Hyong Nyun Kim, Yong Wook Park Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea Syndesmotic injury can either be isolated or associated with bony or ligamentous ankle injury. When it is not associated with an ankle fracture, it may not be easy to diagnose, especially when there is no franck diastasis on a plain radiograph. Without proper treatment, syndesmotic injury can lead to chronic pain due to impingement of scar tissues and instability. It may further lead to ankle arthritis. Early diagnosis with appropriate management is a prerequisite to avoid these problems. Herein, we review and discuss the mechanism of injury, classification, diagnosis, and treatment of isolated syndesmotic injury. Key Words: Ankle, Sports, Syndesmotic injury 서 경비인대결합손상은단독으로발생하기보다는족관절골절이나다른인대손상과동반하여발생하는경우가많다. 1,2) 모든족관절골절의약 80% 정도에서경비인대손상을발견할수있으며회내-외회전, 회외-외회전또는회내-외전형골절에서관찰할수있는것으로알려져있다. 3,4) 족관절골절과동반된경비인대결합손상에대하여는진단과치료에대한많은논의가있어왔으며정확히정복되지않을경우불안정성이증가하여외상성관절염으로진행할수있으므로족관절골절의치료시에주의를요한다. 5) 한편, 경비인대결합단독손상은족관절골절을동반하지않는경비인대의손상을말하며족관절주위인대손상이나경비인대견열골절이동반되는경우는포함한다. 1,2,6-8) 족관절염좌로내원하는환자의 1% 18% 에서발생하는것으로알려져있고, 족관절염좌보다스포츠복귀까지두배이상의기간이필요하며더많은재 Received July 13, 2016 Revised August 11, 2016 Accepted August 11, 2016 Corresponding Author: Hyong Nyun Kim Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: , Fax: , hyongnyun@naver.com Financial support: None. Conflict of interest: None. 론 활치료를필요로한다. 9-11) 그러나족관절골절을동반하지않은경비인대결합단독손상에대하여는많이알려져있지않다. 단순방사선검사에서경비인대의이개 (diastasis) 가나타나지않는경도의손상의경우진단하기어려운경우가많고만약조기에진단하여치료하지못하는경우연부조직충돌로인한지속적인통증과족관절불안정성을초래할수있다. 6,12) 이소성골화형성 (heterotopic ossification) 과족관절변형까지초래하는경우도있어족관절염좌를수상한환자를진료할때반드시경비인대결합손상을의심하는것이필요하다. 1,2,6) 경비인대결합단독손상의진단과분류, 치료에대해알아보고자한다. 손상기전 경비인대결합단독손상은족관절의배굴상태에서갑작스러운외회전 (external rotation) 시에발생하는경우가가장흔하다. 경비인대는전하경비인대 (anterior inferior tibiofibular ligament, AITFL), 후하경비인대 (posterior inferior tibiofibular ligament, PITFL), 횡경비인대 (transverse tibiofibular ligament, TTL), 골간인대 (interosseous ligament, IOL), 골간막 (interosseous membrane) 으로구성되어있는데, 이중전하경비인대가표재삼각인대 (super- Copyright c2016 Korean Foot and Ankle Society. All rights reserved. CC This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 Yong Tae Kim, et al. Isolated Syndesmotic Injury 101 ficial deltoid ligament) 와함께가장먼저손상을입는다. 13) 이후골간인대가파열되고골간막이파열되는데, 후하경비인대까지파열되는경우는드물다. 아이스하키나스키와같이부츠에발이고정되어있는경우하퇴부가발목에대하여내회전 (internal rotation) 하면서발목이손상을입는경우가많다 (Fig. 1A). 6) 또한미식축구나유도, 레슬링등의접촉스포츠 (contact sports) 의경우운동선수가넘어진상태에서발이밟히며족관절이외회전되는경우에도발생할수있다 (Fig. 1B). 10,14-16) 재성이개 ) 를보이는불안정성손상을 2단계, 단순방사선검사에서뚜렷한이개를보이는불안정성손상을 3단계로분류하였다. 최근에 Sikka 등 16) 은자기공명영상 (magnetic resonance imaging, MRI) 검사소견을토대로한분류방법을제시하였다. 1단계는전하경비인대의단독손상, 2단계는전하경비인대및골간인대손상, 3단계는전하경비인대, 골간인대및후하경비인대손상, 4단계는전하경비인대, 골간인대, 후하경비인대및삼각인대손상으로분류하였다. 분 류 진 단 경비인대결합손상의분류는먼저손상후경과한시간에따라급성, 아급성, 만성손상으로분류할수있다. van den Bekerom 등 17) 은 6주이내의손상을급성, 6주에서 6개월이내의손상을아급성, 6개월이상이경과한경우를만성손상으로분류하였다. 한편 Espinosa 등 18) 은 3주이내의손상을급성, 3주에서 3개월이내를아급성, 3개월이상경과한경우를만성손상으로분류하였다. 임상적소견과방사선적소견으로경비인대결합손상을분류할수있는데 Gerber 등 10) 은임상소견에따라경비인대결합손상을세가지단계로분류하였다. 1단계는족관절의불안정성이없는안정성손상, 2단계는외회전검사에서경도의불안정성이있으며하퇴부압박검사 (squeeze test) 에서양성소견을보이지만단순방사선검사에서는정상인손상이다. 3단계는족관절의뚜렷한불안정성을보이는손상이다. Edwards와 DeLee 7) 는단순방사선검사에서경골-비골간격의이개가없는안정성손상을 1단계, 단순방사선검사에서는이개가보이지않으나부하방사선검사에서는이개 ( 잠 1. 신체검사경비인대결합손상의진단을위하여는주의깊은신체검사와영상의학적검사를필요로한다 ) 먼저경비인대결합손상시에는족관절전외측근위부인대주변에통증을호소하고압통이저명하다. 2, 3단계의중등도, 고도의손상시에는내측의삼각인대부위와전하경비인대전방모두에서압통이있을수있다. 부종이있는지를유심히관찰해야하며특히내측삼각인대부위에부종이있을경우삼각인대손상을의심할수있고이는경비인대결합손상이동반되었을가능성이높다. 22) 다음으로경비인대결합손상을진단하는몇가지신체검사방법이있는데항상정상측과비교하는것이필요하다. 외회전부하검사법은하퇴부를한손으로고정한상태에서발목을외회전하여경비인대결합부위에통증이발생하는지를관찰하는검사방법이다. 하퇴부압박검사법은하퇴부의중앙부에서경골과비골의간격이좁아지도록압박하여경비인대결합부에통증이발생하는지를관찰하는검사법 A B Figure 1. The mechanism of syndesmotic injury is described. (A) A direct blow down to the leg of a football player external rotates the ankle to give syndesmotic injury. (B) External rotating force is applied to the ankle of an ice hockey player when the player's foot is planted and the knee internal rotated.

102 Vol. 20 No. 3, September 2016 이다. 외회전부하검사법이하퇴부압박검사법보다신뢰도가높은검사법으로알려져있고하퇴부압박검사법은예후를예측하는데좀더유용한것으로알려져있다. 23) 그러나 Han 등 23) 은경비인대결합손상을진단할수있는 8가지의신체검사법을분석하였는데, 정확하게경비인대결합손상을진단할수있는한가지방법은없었다고발표하였다.

3 102 Vol. 20 No. 3, September 2016 이다. 외회전부하검사법이하퇴부압박검사법보다신뢰도가높은검사법으로알려져있고하퇴부압박검사법은예후를예측하는데좀더유용한것으로알려져있다. 23) 그러나 Han 등 23) 은경비인대결합손상을진단할수있는 8가지의신체검사법을분석하였는데, 정확하게경비인대결합손상을진단할수있는한가지방법은없었다고발표하였다. 또한만성손상의경우신체검사를통한진단이어려워영상의학적검사방법의도움이필요하다. 21,23) 2. 영상의학적검사경비인대결합손상의영상의학적검사는양측의체중부하 ( 가능한정도 ) 상태에서의족관절전후방및측면방사선사진, 격자상 (mortise) 사진및경비골전장전후방및측면사진이필요하다. 19,20,24) Harper와 Keller 20) 는원위경비관절의이개를평가하기위한방사선상지표를제시하였는데경골-비골간격 (tibiofibular clear space), 경골-비골중복 (tibiofibular overlap), 내측경골-거골관절간격 (medial tibiotalar clear space) 이이용된다. 경골-비골간격은전후방방사선사진에서관절면의 1 cm 상방에서측정하는데후방과의외측면과비골의내측면사이의간격을말한다. 정상적으로경비인대결합손상이없다면 6 mm 이내이며이지표가가장신뢰할만한것으로알려져있다. 경골-비골중복은전후방방사선검사에서경골의전외측부분과비골의내측면사이의겹치게되는부분을관절면의 1 cm 상방에서측정하며 6 mm 이상일때를정상으로판정한다 (Fig. 2). 내측경골-거골관절간격은격자상에서내측과의외측면과거골의내측면사이의간격을의미하며정상에서는상방관절간격과같거나약간적어야하며, 간격이 4 mm 이상일때는거골의비정상적인외측전위를의미하며삼각인 Overlap Clear space 1cm Figure 2. Tibiofibular overlap (black arrows) and tibiofibular clear space (white arrows) is measured 1 cm proximal to the tibial planfond. Normal distal tibiofibular joint relationship includes overlap of more than 6 mm and tibiofibular clear space of less than 6 mm. 대손상을의심할수있다. 19,20) 경비인대결합손상이임상적으로의심되지만단순방사선사진에서발견되지않는경우관절내국소마취제주사후외회전부하방사선검사를실시하여경골-비골간격이나내측경골-거골관절간격이증가하는지관찰할수있다. 7) 또한컴퓨터단층촬영 (computed tomography, CT) 검사를통해단순방사선검사에서보이지않는 2 3 mm의이개를발견할수있고, MRI 검사는높은민감도와특이도를보이는검사방법이다 ) 한편족관절조영술검사를이용해경골과비골사이에조영제가유출되어 1 cm 이상올라가면경비인대결합손상을진단할수있으나비교적침습적인방법이어서점차사용이줄어들고있다. 9) 한편 Lee 등 21) 은초음파를이용하여전하경비인대의손상여부를직접관찰할수있고경골과비골사이의거리를측정하여경비인대결합손상을진단할수있음을발표하였다. 치료 van Dijk 등 2) 은문헌고찰을통해경비인대결합손상중골간인대손상의여부에상관없이삼각인대손상이없다면비수술적치료가가능함을설명하였다. 반면삼각인대손상과동반된전하경비인대손상은수술적치료가필요하다고발표하였다. 일반적으로안정성 (stability) 을기준으로, 불안정한경비인대결합손상은수술적치료를하고안정적인손상은비수술적인치료를하는것이원칙이며확실하지않은경우반복적인체중부하방사선검사나부하방사선검사를통해확인하는것이필요하다. 25,26) 1. 비수술적치료삼각인대손상이없는 1단계 ( 안정성 ) 손상의치료는먼저 1 3 주간환자의증상의정도에따라단하지깁스등으로고정한다. 환자의통증경감을위해목발을이기간동안사용할것을권한다. 3 주후에는단하지깁스를풀고발목고정보조기착용하에일반신발착용을허용한다. 6) 이시기에물리치료를시작한다. 물리치료는 3 6주간처음에는수동적관절운동부터시작하여능동적관절운동과근력강화운동을하고염증을줄이고빠른회복을위해초음파, 전기자극치료등을병행한다. 6,23) 환측의족저굴곡력, 족배굴곡력, 내번력, 외번력이정상측과비교하여 80% 이상도달했다면점차적으로고유수용감각운동과플라이오메트릭운동 (plyometric exercise) 과같은각각의스포츠에맞는운동을시작한다. 운동선수의경우 1단계 ( 안정성 ) 손상의경우운동복귀는 4 8주후에가능할것이다. 6) 일반방사선검사에서이개가발견되지않으나부하방사선검사나 MRI 검사등에서이개가발견되며삼각인대손상을동반한 2 단계손상의경우치료에논란이있다. 4 6주간비체중부하단하지깁스치료를하는비수술적치료방법이있지만, 이때비골이

4 Yong Tae Kim, et al. Isolated Syndesmotic Injury 103 경골의비골구에정확하게정복되지않은상태에서깁스를적용하면후에관절강직이나불안정성의원인이될수있다. 깁스적용시족관절을중립위에서약간내회전하여적용하는데이는거골체부의전방부위가비골을외측으로밀어내어경비관절의이개를증가시키는것을방지하기위함이다. 2,3,6,18) 2. 수술적치료경골-비골간격의이개를보이고내측관절간격의증가를보이는 3단계손상의경우수술적치료가필요하다. 한편잠재성이개를보이는 2단계경비인대결합손상의경우논란이있으나보다적극적으로수술하여추후불안정성이나만성통증을방지해야한다는주장이있다. 9) 수술적방법으로는금속나사를이용하여경골과비골을고정하는방법과 TightRope (Arthrex Inc., Naples, FL, USA) 를이용한고정방법이있다 ) 또한 K-강선 (Kirschner wire), staple, 환강선 (cerclage wire) 을이용한방법들도소개되었다. 6) 1) 나사고정술나사고정술은가장많이사용되고있는방법으로나사고정을통해일시적으로경골-비골사이의해부학적위치를유지하여손상된인대들이치유될수있도록한다. 하지만경골-비골사이의골결합 (synostosis) 이나골형성 (ossification) 등의합병증이발생할수있고족관절배굴운동을제한할수있으며경골-거골사이의운동제한으로체중의정상적인전달 (load distribution) 을저해할수있다. 27,30) 나사고정술에관하여몇가지논란이되는것은나사의크기와종류, 고정하는피질골의수, 고정하는위치, 체중부하시기및제거시기등이다. 4,9) 문헌에는 3.5 mm와 4.5 mm 나사못고정방법들이소개되었고사체실험 (cadaveric study) 을통해서두나사못을비교하였는데, 큰직경의나사가전단력 (shear stress) 에대해더잘견디는것으로나타났으나임상적으로더유리한지는밝혀지지않았다. 31) 4개의피질골을고정하는경우더강하고안정적이지만나사못파손의가능성이높고나사못머리가돌출되는경우가많다. 3개의피질골을고정하는경우좀더생리적인운동이허용되고나사못파손은적지만나사못주변의골용해가일어날수있다. Heim 등 27) 은 3개의피질골을고정한경우 91% 에서나사못주변골용해가일어났음을보고하였다. 한편나사못이파손된경우 4개피질골을고정한경우반대측피질골부위에서파손된나사못을제거하기가용이하다. 사체연구및임상연구에서 3 개혹은 4개의피질골을고정하는것사이에큰차이는없는것으로발표되었다. 32) 경비결합인대가회복된경우에는나사못을제거해야정상운동을회복할수있는데, 따라서제거가필요없는생체흡수성나사가소개되어사용되고있다. 33,34) 그러나금속나사에비해강도가떨어지고염증반응, 나사못파손이나타날수있는단점이있다. 생체흡수성나사를사용해우수한결과들이보고 되었으나금속나사와비교하여서는차이가없었다는발표도있다. 28,34) 나사를고정할때의족관절위치에관하여는거골의전방이후방보다넓으므로족저굴곡한상태에서고정하는경우운동제한의원인이되므로최대한족배굴곡한상태에서고정해야한다는주장이있었다. 그러나족배굴곡한상태에서는오히려경비인대결합의정복을방해할수있다는보고도있고, 족저굴곡한상태에서는너무많이조여질가능성이있으므로족관절의중립위에서고정하는방법이추천되고있다. 34) 나사를고정하는방법에대하여는비골이경골의후외방에위치하게때문에경골의관절면과평행하게 30도전방을향하여고정한다. 4,9,35) 삽입위치는관절면에서 cm 근위부에서삽입하는것이추천되며너무근위부에서고정하는경우비골이변형되면서관절내격자상 (mortise) 이더벌어질수있다. 나사의제거에관하여는 van den Bekerom 등 17) 은 4개의피질골을고정한경우 6 8주에제거할것을추천하였지만 3개의피질골을고정한경우에는나사로인한불편함이나증상이생긴경우에만선택적으로제거할것을추천하였다. 4개의피질골을고정한경우나사못을제거하기전에미리체중부하를허용할경우나사못파손의가능성이높고너무일찍제거하는경우경비인대결합이개가다시발생할수있다. 22) 따라서고정후 12주에제거하고체중부하를허용해야한다는주장이있다. 반면 3개의피질골을고정한경우나사제거전에체중부하를허용하면나사의파손보다는나사주변골용해가발생하고나사가뒤로나와피부를자극할수있다. 3개의피질골을고정하고좀더일찍체중부하를허용하며혹시나사의피부자극이나나사로인한불편함이있는경우에만제거하면된다는주장이있다. 2) Suture button 고정술 TightRope 등을이용한 suture button 고정술은 2차적인제거술이필요없다는장점과조기보행이가능하고경골-비골관절사이에미세운동이가능하여보다생역학적이라는장점이있다. 그러나고정력이나사고정술보다약할수있다. 최근까지의발표된논문을고찰해보면경비인대결합단독손상에서 suture button 고정술이나사고정술보다열등하다는논문은없다. Naqvi 등 29) 은 46 명의경비인대결합손상환자에서 23명은나사고정술을, 23명은 suture button 고정술을시행한후 CT 검사를시행하였을때, 나사고정술의경우 5명의환자에비골이거골의비골구에정확히정복되어있지않았지만 suture button 고정술의경우모든예에서정복되어있었음을보고하였다. Suture button 고정술이경비인대결합손상의가장좋은치료방법인지에대하여는좀더장기적인연구결과들이있어야할것으로생각된다. 3. 만성경비인대결합손상의치료 6개월이상경과된만성경비인대결합손상의경우증상이지속된다면관절경을이용한충돌조직제거술, 나사고정술, 해부학

5 104 Vol. 20 No. 3, September 2016 적경비인대재건술, 경비관절유합술등의수술적치료가필요하다. Parlamas 등 36) 은문헌고찰에서만성경비인대결합손상에대한여러수술방법들중에어느한가지가다른것보다더우수하다는증거는없다고밝혔다. 환자의손상의정도와증상에맞게수술방법을선택해야하고, 한가지혹은여러가지의수술방법을함께사용해야하는경우도있다. 경비결합나사고정술은가장많이사용되는방법으로관절경술이나해부학적경비인대재건술과함께시행되는경우가많다. Yasui 등 37) 은자가박근건 (gracilis tendon) 을이용한전하경비인대재건술및나사고정술로우수한결과를보고하였다. 한편 Zamzami와 Zamzam 38) 은관절경을이용한충돌조직제거술과자가반건양근건 (semi-tendinosus tendon) 을이용한재건술로우수한결과를보고하였다. 한편, Han 등 23) 은만성경비인대결합손상에서족관절내측불안정성이나거골의외측전위가없다면재건술이나나사고정술없이관절경을이용하여통증을일으키는과증식및충돌조직을제거하는방법이효과적이라고발표하였다. 한편, Olson 등 39) 은족관절에관절염이시작된만성경비인대결합손상의경우비골을경골에대하여지연정복한후에경비관절을유합하는방법으로 10명의환자를치료하였고평균 41개월추시에서모든환자들이만족하였고관절염의진행은없었으며족관절유합술을시행한경우는없었음을보고하였다. 결 족관절골절을동반하지않은경비인대결합단독손상은단순방사선검사에서경비인대의이개가나타나지않는경우진단하기어려운경우가많다. 만약조기에진단하여치료하지못하는경우연부조직충돌로인한지속적인통증과족관절불안정성을초래할수있으며관절격자의유지에이상을일으켜족관절관절염으로진행할수있다. 따라서, 족관절염좌를수상한환자를진료할때반드시경비인대결합손상을의심하는것이필요하며적절한진단과치료가필요하다. 론 REFERENCES 111 van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, et al. Classification and diagnosis of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24: van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, et al. Conservative and surgical management of acute isolated syndesmotic injuries: ESSKA-AFAS consensus and guidelines. Knee Surg Sports Traumatol Arthrosc. 2016;24: Hopkinson WJ, St Pierre P, Ryan JB, Wheeler JH. Syndesmosis sprains of the ankle. Foot Ankle. 1990;10: Gwak HC, Kwon YW. Ankle syndesmotic injury. J Korean Foot Ankle Soc. 2011;15: Zalavras C, Thordarson D. Ankle syndesmotic injury. J Am Acad Orthop Surg. 2007;15: Miller TL, Skalak T. Evaluation and treatment recommendations for acute injuries to the ankle syndesmosis without associated fracture. Sports Med. 2014;44: Edwards GS Jr, DeLee JC. Ankle diastasis without fracture. Foot Ankle. 1984;4: Frick H. Diagnosis, therapy and results of acute instability of the syndesmosis of the upper ankle joint (isolated anterior rupture of the syndesmosis). Orthopade. 1986;15: Lee KB. Ankle syndesmotic injury. J Korean Fract Soc. 2007;20: Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int. 1998;19: Ogilvie-Harris DJ, Gilbart MK, Chorney K. Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery. Arthroscopy. 1997;13: Van Heest TJ, Lafferty PM. Injuries to the ankle syndesmosis. J Bone Joint Surg Am. 2014;96: Ostrum RF, De Meo P, Subramanian R. A critical analysis of the anterior-posterior radiographic anatomy of the ankle syndesmosis. Foot Ankle Int. 1995;16: Rammelt S, Zwipp H, Grass R. Injuries to the distal tibiofibular syndesmosis: an evidence-based approach to acute and chronic lesions. Foot Ankle Clin. 2008;13: Degroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. 2011;32: Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, et al. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot Ankle Int. 2012;33: van den Bekerom MP, de Leeuw PA, van Dijk CN. Delayed operative treatment of syndesmotic instability. Current concepts review. Injury. 2009;40: Espinosa N, Smerek JP, Myerson MS. Acute and chronic syndesmosis injuries: pathomechanisms, diagnosis and management. Foot Ankle Clin. 2006;11: Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. 1997;18: Harper MC, Keller TS. A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle. 1989;10: Lee HS, Park SS, Kim JW, Shin MJ, Kim SM, Lee SH, et al. Diagnostic value of ultrasonography for acute tear of tibiofibular syndesmosis in ankle. J Korean Foot Ankle Soc. 2004;8: Reckling FW, McNamara GR, DeSmet AA. Problems in the diagnosis and treatment of ankle injuries. J Trauma. 1981;21: Han SH, Lee JW, Kim S, Suh JS, Choi YR. Chronic tibiofibular syndesmosis injury: the diagnostic efficiency of magnetic resonance imaging and comparative analysis of operative treatment. Foot Ankle Int. 2007;28: Vogl TJ, Hochmuth K, Diebold T, Lubrich J, Hofmann R,

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Review Article pissn eissn J Korean Foot Ankle Soc 2018;22(4): 원위경비인대염좌의치료 최귀연

Review Article pissn eissn J Korean Foot Ankle Soc 2018;22(4): 원위경비인대염좌의치료 최귀연 Review Article pissn 1738-3757 eissn 2288-8551 J Korean Foot Ankle Soc 2018;22(4):145-150 https://doi.org/10.14193/jkfas.2018.22.4.145 원위경비인대염좌의치료 최귀연, 이준영 조선대학교의과대학정형외과학교실 Management of High Ankle Sprain