• 대한골관절종양학회지
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• 제17권2호
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• pp.65-72
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• 2011

목적: 골종양을 절제한 후 동종골을 이용한 재건술 후 발생한 합병증을 평가하고 그 합병증에 대한 문헌고찰을 하고자 한다. 대상 및 방법: 골종양 절제 후 동종골을 이용한 재건술을 시행한 15예에 대하여 임상적 및 방사선학적 자료를 통해 후향적으로 연구를 시행하였다. 결과: 남자가 8예, 여자가 7예이었으며 평균 나이는 27.1세(1-56세), 평균 추시 기간은 89.5개월(33-146개월)였다. 21예(80.0%)에서 평균 8.35개월(4-12개월)에 방사선학적 골유합 소견을 보였다. Musculoskeletal Tumor Society 점수 평균은 73.5%(46.6-93.0%)였다. 동종골 이식과 관련된 술 후 합병증을 모두 기록하였다. 추시 기간 동안 9예(60.6%)에서 한 가지의 합병증이 발생하였고 3예(20.0%)에서 두 가지 이상의 합병증이 발생하였다. 합병증으로는 감염 3예, 골절 2예, 불유합 2예, 하지 부동 2예, 내반 변형이 2예였다. 합병증이 발생하지 않은 평균 기간은 60.8개월(6-144개월)이었다. 동종골의 평균 생존기간은 80.2개월이었고 5년 생존률은 83.0%였다. 결론: 동종골의 합병증을 줄이기 위하여 동종골을 이용한 재건술시 자가비골을 추가하는 것이 추천된다. 더나아가 조직 공학 기술과 줄기 세포 및 혈소판 풍부 혈장의 적용이 동종골의 재흡수나 불유합 등의 합병증을 줄일 수 있을 것으로 생각된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제23권4호
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• pp.324-331
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• 2001

The present study was aimed to investigate the effects of latency period on alveolar ridge distraction using the intraoral distraction device. Nine adult mongrel dogs of either sex, weighing about 15kg, were used. They were divided into 3-day, 5-day, and 7-day groups according to the latency period. The left upper and lower premolars and first molars were extracted. Twelve weeks after the extraction, an osteotomy was performed and the distraction device was applied. After the latency period, the distraction was applied at a rate of 1.2mm for 8 days. The distraction device was left in place for 2 weeks to allow consolidation and was then removed. The animals were sacrified at 8 weeks after completion of distraction and were examined macroscopically, radiographically, and histologically. After completion of the distraction, the alveolar crest protruded prominently, showing the vertical augmentation of the alveolar bone. Soft tissues were broken down after the 6th day of distraction in 3-day latency group, and premature union occurred on the 7th day of distraction in the 7-day latency group. The average distance was $9.40{\pm}0.3mm$ in 3-day latency group, $9.35{\pm}0.1mm$ in 5-day latency group, and $8.85{\pm}0.1mm$ in 7-day latency group. In the radiograph taken at 8 weeks after distraction, there was slight bone resorption around the medial and distal edges of the alveolar bone segment, and a new bone deposition was observed in the neighboring alveolar crest area in all groups. Fibrous tissues were present in a part of the buccal cortical bone area of the distraction gap, and the woven and lamellar bones were observed in the distracted gap. There were bony bridges in the distraction gap in all animals examined. These results suggest that optimal time of latency period on alveolar ridge distraction using the intraoral distraction device is about 5 days in dogs, and about 7days in human beings.

• Archives of Reconstructive Microsurgery
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• 제20권1호
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• pp.43-50
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• 2011

Lunate revascularization with the vascularized bone grafts is a current concept in the treatment of Kienbo${\ddot{o}}$ck disease. The aim of this study is to present our experience and preliminary results of the treatment using the fourth extensor compartment artery (4 ECA) vascularized bone graft for Kienbo${\ddot{o}}$ck disease. Between May 2009 and June 2010, five patients (3 men and 2 women) with Kienbo${\ddot{o}}$ck disease were treated with 4 ECA vascularized bone grafts. The mean age was 32.8 years and mean follow-up time was 13 months. The patients were composed of two patients in stage II and three patients in stage IIIa according to Lichtman's classification. Modified Mayo wrist score including pain, grip strength, range of motion and functional status and radiographic parameters such as carpal height ratio and radioscaphoid angle were evaluated at a final follow-up. Pain was markedly diminished and modified Mayo wrist score was 82 at last follow up period. There were no or little changes in carpal height ratio and radioscaphoid angle. All patients showed satisfactory bony union and no further lunate collapse on follow-up radiographs. The 4 ECA vascularized bone graft is a reliable alternative procedures among revascularization procedures for treatment of Kienbo${\ddot{o}}$ck's disease. It is less invasive and has low risk of kinking of pedicle compared to the 4+5 ECA vascularized bone graft. However, long term follow-up and MRI evaluation at follow up period should be needed for the future.

• 대한족부족관절학회지
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• 제15권4호
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• pp.201-206
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• 2011

Purpose: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. Materials and Methods: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. Results: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). Conclusion: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

• Clinics in Shoulder and Elbow
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• 제16권2호
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• pp.135-140
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• 2013

제 1형 신경 섬유종증 환자에서 발생한 재발성 견관절 탈구 및 동반된 근위 상완골 골절 1예를 보고하고자 한다. 제 1형 신경 섬유종증으로 진단된 20세 남자로 가벼운 외상 후 발생한 우측 견관절의 탈구와 근위 상완골 골절로 내원하였다. 수상측 주관절부에는 큰 망상형 신경 섬유종들이 있었으며 견관절 탈구는 재발성 병변이었다. 단순 방사선과 컴퓨터 단층 촬영 소견 상 상완골과 견갑골의 골성 변형을 보였고 자기 공명 영상 검사 상 삼각근과 회전근 개에 다발성 신경 섬유종성 변화가 관찰되었다. 관혈적 정복술 및 관절막 재건술을 시행하였으며 근위 상완골 골절은 재건 금속판을 이용하여 고정하였다. 골유합과 만족스런 기능 회복을 보였으며 수술 후 7개월 추시 상 견관절 탈구의 재발은 관찰되지 않았다. 제 1형 신경 섬유종증 환자에서 발생한 견관절 재발성 탈구와 근위 상완골 골절은 드문 합병증이나 질환의 정형외과적 접근 시 고려해야 할 것으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.97-104
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• 2005

Purpose: To report the results of surgical treatment of comminuted fractures of distal humerus and to identify factors that affect the results. Materials and Methods: Thirty-two patients who were treated with open reduction and internal fixation for comminuted fracture of distal humerus were enrolled. According to the AO classification, A2.3 was 1 case, A3.2, 2 cases, A3.3, 8 cases, B1.3, 1 case, B2.3, 1 case, C2.2, 5 cases, C2.3, 4 cases, C3.2, 3 cases and C3.3, 7 cases. As fixation technique, 17 cases were fixed by double plates, 4 cases by only K-wires, 4 cases by only screws, 3 cases by K-wires and screws and 4 cases by one plate and screws. The mean age at the time of the operation was 49 years(range, $19{\sim}77$ years). The mean follow-up period was 16 months(range, $8{\sim}51$ months). Results: At the last follow-up, the mean maximum flexion was $116.4^{\circ}\;(range,\;85{\sim}140^{\circ})$ and the mean loss of terminal extension was $11.8^{\circ}\;(range,\;0{\sim}40^{\circ})$. The average Mayo elbow performance score was $91.4^{\circ}\;(range,\;55{\sim}100^{\circ})$. Overall 29 cases(91%) showed good to excellent results. The mean range of motion of extraarticular and intraarticular fracture group was $105.5^{\circ}\;(range,\;65{\sim}140^{\circ})$ and $104^{\circ}\;(range,\;55{\sim}140^{\circ})$, respectively. The average elbow score of both groups was$93^{\circ}\;(range,\;70{\sim}100^{\circ})$ and $90.7^{\circ}\;(range,\;55{\sim}100^{\circ})$. Over 90% showed more than good results. 30 cases(94%) showed complete bony union but two cases, nonunion. One case of the nonunion cases underwent replating with bone graft as revision surgery and total elbow arthroplasty was performed in the other case. At the last follow-up, 27 patients(84.4%) showed subjective satisfaction. Conclusion: Open reduction and internal fixation with appropriate surgical technique for comminuted fractures of distal humerus showed good results, which were not affected by age at the time of operation, fixation methods and anterior transposition of the ulnar nerve. Transolecranon approach may be considered as good choice for intraarticular comminuted fractures of distal humerus.

• Archives of Reconstructive Microsurgery
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• 제18권2호
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• pp.55-61
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• 2009

Purpose: To analyze the clinical and radiologic results of the shoulder arthrodesis in brachial plexus injury patients with flail upper extremity. Material and Method: From Aug 1978 to April 2008, 29 shoulders in 29 patients with brachial plexus injury with shoulder fusion, we evaluated 20 shoulders in 20 patients, more than 1 year follow up. The average follow-up period was 6.45years (range: 1year~24years). There were 13 men and 7 women, and the mean age at the time of trauma was 32.0years(2~65 years). The type of injury was a motorcycle accident in 11 patients, in car accident in 5, pedestrian accident in 3, and fall from a height in 1. The lesion of injury was root and trunk in 1 patient, trunk and cord in 1, trunk in 18. Surgery was performed on the whole arm type paralysis in 12 patients, lower arm type paralysis in 8 patients. The preoperative visual analog scale score was 8.7(7~10). When the trapezius and serratus anterior muscle were in function, operation was performed. 18 patients were processed to the additional operation. Gracilis free flap in 6 patients, neurotization in 3, Steindler flexor plasty in 6, and tendon transfer in 3 were performed. Fixation was conducted with cancellous screws in 13 patients, Knoles pins in 5, and cancellous screws and Knoles pins in 2. The position of the arthrodesis at operation was $28.5^{\circ}$($20~45^{\circ}$) in abduction, $30.3^{\circ}$($20~45^{\circ}$) in flexion, and $30.8^{\circ}$($20~40^{\circ}$) in internal rotation. Result: The follow up visual analog scale score was 3.4(0~7). Postoperatively, shoulder spica cast was applied for 15.3weeks(8-20weeks). The median time to bony union was 17.7weeks(9~28weeks). Average range of motion was $32.0^{\circ}$($15~40^{\circ}$) of abduction, $24.0^{\circ}$($10~40^{\circ}$) of flexion, and $18.5^{\circ}$($10~30^{\circ}$)of internal rotation. Conclusion: The shoulder fusion in brachial plexus injury patients is one of the good methods to relieve pain, improve the function and stabilize the flail shoulder joint.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권5호
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• pp.428-434
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• 2001

After miniplate fixation of mandibular angle fractures, fracture line stability during functional loading was evaluated. Using panoramic radiographs, 15 mandibular angle fracture patients who were treated by open reduction and one miniplate fixation along the external oblique ridge, were evaluated at postoperative 1, 4 and 8 weeks. At each time, 2 radiographs were taken: one taken during maximum biting of hardened silicone sheet on the affected side molar area and the other on the non-affected side. The distraction gap of inferior border of mandible at each time and each side was measured and these data were analysed statistically with clinical findings. The differences of inferior border distraction gap during hardened silicone sheet biting on the affected side molar area and on the non-affected side molar area at 4 week radiographs were smaller than those of 1 week's except one case. At 8 week's radiographs, the fracture lines were so stabilized that it was almost impossible to find the gap differences except one case and there were increased radiopacity along the entire fracture lines. Clinically, bony union was confirmed in all cases during plate removal performed at postoperative 6 month. By statistical analysis(paired t-test), the inferior border distraction gap during biting of hardened silicone sheet on the affected side was significantly reduced during 1 and 4 week interval(p<0.01). The differences of inferior border distraction gap during biting on the affected side molar area and on the non-affected side molar area were also significantly reduced at 1 and 4 week interval(p<0.01). But the inferior border distraction(compression) gap during non-affected side biting was not significantly changed. From these findings, it could be concluded that fracture line stability during functional loading after one miniplate fixation of mandibular angle fractures stems mainly from reduction of inferior border distraction gap during affected side biting on time interval. According to these radiographic and clinical findings, the clinical superiority of one miniplate fixation technique in mandibular angle fracture treatment could be confirmed.

• Clinics in Shoulder and Elbow
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• 제12권2호
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• pp.142-149
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• 2009

목적: 단순 소두 골절 및 주관절 주위 손상을 동반한 소두 골절의 수술적 치료에 대한 결과를 분석하고 예후 인자를 알아보고자 하였다. 대상 및 방법: 관혈적 정복 및 내고정술을 시행한 25명의 환자 (평균나이, 49세)를 대상으로 하였고, 소두 골절은 1형 골절이 19예, 3형 골절이 6예 있었다. 평균 추시 기간은 14.8개월이었고 최종 추시시 방사선학적 및 기능적 결과를 분석하여 소두 골절의 형태, 동반 골절 유무가 예후에 영향을 미치는가를 평가하였다. 결과: 25예 중 24예에서 평균 1년에 방사선학적 유합을 얻었으며, 기능적 결과는 Broberg와 Morrey의 점수에 의해 우수 18예, 양호 4예, 보통 2예, 불량 1예였다. 소두 골절은 1형의 빈도가 가장 높았고, 동반 주위 골절은 외과 골절이 가장 많았다. 1형 골절이 3형 골절인 경우보다, 주위골절이 있는 경우 비관절면 골절인 경우가 관절면 골절인 경우보다 임상적 결과가 좋았다. 나이, 동반골절의 종류, 소두 골절에 대한 내고정물의 종류, 수술적 접근법, 수술 후 고정 기간에 따른 임상적 결과의 차이는 없었다. 결론: 전체의 88%에서 만족할 만한 결과를 얻었다. 그리고 소두 골절의 형태와 추가적인 관절면 골절 동반 유무가 중요한 예후 인자로 조사되었다.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.130-137
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• 2012

목적: 골다공증이 있는 노인환자에서 상완골 원위부 관절부위 골절로 관혈적 정복술 및 내고정술과 주관절 전치환술 시행 후 기능적 결과에 대해서 평가 보고하였다. 대상 및 방법: 2007년1월부터 2009년 10월까지 상완골 원위부 관절내 골절을 주소로 내원한 65세 이상의 환자 24명을 대상으로 하였으며 18명은 후방 도달법을 이용하여 관혈적 정복술 및 내고정술을 시행하고 (Fig. 1), 6명은 주관절 전치환술을 시행하였다 (Fig. 2). 평균 추시 기간은 16.3 개월 이였으며 골절형태는 AO 분류로 8명이 C2, 16명이 C3 형태의 골절이였다. 추시 시 모든 환자들은 방사선촬영 및 신체검사를 시행하였고, Mayo 주관절 수행점수, 및 DASH 점수를 이용하여 임상적 결과를 측정하였다. 결과: Group I 18예 모두 골유합 되었으며 골절부터 골유합까지 평균 기간은 14주였다. 합병증으로 2예에서 주두골 절골부위에 불유합이 관찰되었으며 척골신경증상을 보였던 2예 중 1예는 전방이전술에도 불구하고 개선되지 않았다. Mayo 주관절 수행점수는 평균 87.0점이였으며, DASH 점수는 평균 32.4점이였다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 121.0도 (95~145도), 굴곡구축은 평균 12도 (0~35)이였다. Group II 6예 모두 추시 기간내 합병증은 없었으며, Mayo 주관절 수행점수는 평균 89.1점 이였으며, DASH 점수는 평균 44.3점이었다. 마지막 추시 시에 시행한 이학적 검사에서 굴곡은 평균 125.1도 (100~145도), 굴곡 구축은 평균 12.6도 (0~30)이였다. 결론: 골다공증을 동반한 고령의 상완골 원위부 관절내 골절 환자에서 적절한 환자 선택시 내고정술 뿐만 아니라 전치환술에서도 단기 추시 시 만족할만한 결과를 보임을 확인할 수 있었다.