• 대한골관절종양학회지
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• 제4권1호
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• pp.22-29
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• 1998

A limb-sparing operation has a definitive role in the treatment of osteosarcoma in the lower extremity of skeletally-immature patients. After a limb-sparing operation, leg length discrepancy remains as a major disability that should be corrected. This study was designed to suggest methods of tumor resection and proper timing of leg length equalization in skeletally immature osteosarcoma patients. From September 1990 to January 1998, we reviewed eight osteosarcoma patients in an immature skeletal age. There were 4 males and 4 females, and their mean duration of follow-up was 50.37 months (range : 25 to 88 months). Mean skeletal age was 8 years (range : 8 months to 11 years). The patients were classified according to the methods of tumor resection ; intercalary resection in 1 case, transepiphyseal resection in 1, intra-articular resection in 5, and extra-articular resection in 1. The results were as follows ; 1. The leg lengthening was begun when a patient's leg length discrepancy reached 4-5cm. 2. The age of final lengthening with permanent reconstruction was 14 years in males and 12 years in females (about 2 years before skeletal maturity). 3. When reconstruction was performed with a temporary spacer, the site of lengthening Was in the soft tissue, not in bone, and then a permanant reconstruction was done. 4. Reconstruction with a biologic spacer to preserve the joint function was a reasonable method for equalization of leg length. In conclusion, the appropriate choice of reconstructive method and the age at which to correct the leg length discrepancy in a skeletally-immature osteosarcoma patients are important factors for maintaining leg length at full maturity.

• 대한골관절종양학회지
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• 제11권1호
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• pp.100-104
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• 2005

원발성 악성 골종양중에서 가장 흔한 골육종은 10세에서 14세사이에 호발하며, 6세이하에서는 발병이 드문 것으로 알려져 있다. 문헌고찰에 의하면 지금까지 보고된 최소 연령의 골육종환자는 13개월된 여아로써 제2 중수골에 발생한 골육종이었다. 저자들은 생후 8개월된 남아의 우측 근위 경골에 발생한 골육종에 대한 치험례를 보고하고자 한다. 환아는 광범위 절제술 및 동종골 이식술을 시행하였으며 술 후 20개월에 동종골 이식편 근위 접합부에 내반 변형이 나타나서 변형교정 및 근위 비골 전이술을 시행하였다. 술 후 51개월의 추시관찰에서 잔류 병변은 보이지 않았으며 슬관절 운동범위는 15도에서 75도로 측정되었다. 영유아의 골육종은 매우 드물지만 감별진단으로 고려해야 할 것이며 수술적 치료에서 절단술 대신 사지 보존술도 가능하며 향후 발생할 수 있는 하지 부동에 대한 해결방안을 고려하여야 할 것으로 사료되었다.

• 대한골관절종양학회지
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• 제14권2호
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• pp.157-162
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• 2008

악성 골종양의 사지 구제술이 보편화 되었으나 슬관절 주위의 골육종환자 중 예상되는 하지부동이 5 cm 이상 되는 경우의 재건 술식의 선택은 아직 논란이 많다. 양측 골단판 중 하나를 희생하는 것이 불가피한 미성숙 소아의 슬관절 주위 악성골종양에서 가장 이상적인 재건술은; 1)인접 골 단판을 손상하지 않고, 2)가동관절을 유지할 수 있으며, 3) 일차술식이 추후 하지 연장술에 방해가 되지 않아야 할 것으로 생각된다. 저자들은 4세 원위 대퇴골 간부 골육종을 분절절제술 후 저온 열처리 자가골 재삽입술로 재건하였다. 술 후 6개월에 대퇴골 과 열처리 자가골 근위부의 불유합, 열처리 자가골의 흡수 및 파괴 와 내고정물의 해리가 발생하여 환자의 근위 대퇴골을 동종골 간단부에 안착시키는 술식을 이용하여 3개월 만에 근위부 골유합을 얻었으며 기능적 결과도 양호하여 보고하고자 한다.

• 대한골관절종양학회지
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• 제5권1호
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• pp.1-8
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• 1999

A single fraction of 50 Gy extracorporeal irradiation, as a modality of limb-sparing operation, has been used to achieve tumor necrosis in osteosarcoma. Although this modality of radiation therapy preserving the mobility of a joint is commonly practiced, the precise knowledge on the radiobiological response of osteosarcoma cell has remained to be elucidated. We therefore observed whether a single high dose irradiation caused apoptosis in osteosarcoma cells and whether the commitment to apoptosis was associated with cell kinetics. We also investigated radiation dose response along the time course for development of apoptosis following single high dose irradiation. The morphologic change in apoptosis was observed by fluorescence with Hoechst 33258 and the degree and the fraction of cells by flow cytometry. Irradiation of osteosarcoma cells with 10, 30 and 50 Gy resulted in chromatin condensation and apoptotic body formation. The degree of apoptosis in osteosarcoma cells was $29.5{\pm}3.56%$, $39.9{\pm}4.83%$ at 24 and 48 hours after 10 Gy irradiation ; $41.1{\pm}3.93%$, $66.9{\pm}5.21%$ at 24 and 48 hours after 30 Gy irradiation ; and $48.0{\pm}3.69%$, $75.6{\pm}4.65%$ at 24 and 48 hours after 50 Gy irradiation. The fraction of cells in cell-cycle kinetic was $39.2{\pm}4.3%$ in G2/M, $22.1{\pm}4.65%$ in G1 at 24 hours after 10 Gy irradiation ; $51.0{\pm}4.3%$ in G2/M, $20.4{\pm}4.7%$ in G1 at 48 hours after 10 Gy irradiation ; $40.3{\pm}3.9%$ in G2/M, $26.1{\pm}4.7%$ in G1 at 24 hours after 30 Gy irradiation ; $59.2{\pm}3.9%$ in G2/M, $5.9{\pm}5.1%$ in G1 at 48 hours after 30 Gy irradiation ; and $44.3{\pm}4.2%$ in G2/M, $21.1{\pm}3.5%$ in G1 at 24 hours after 50 Gy irradiation. The fraction of cells at 48 hours after 50 Gy irradiation could not be observed because of irradiation induced cell death of most of cells. All values for irradiated cells showed accumulation in G2/M phase and reduction in G1 phase, irrespective of irradiation dose. The results suggest that a single fraction of high dose irradiation with 50 Gy results in accumulation of cells at G2/M phase, leading to apoptosis.