• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.9-15
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• 1994

It is difficult to obtain a satisfactory bony union of large bone defect secondary to trauma, tumor resection, congenital pseudarthrosis of tibia and bony metaplasia following infection with conventional methods. Conventional nonvascularized autologous bone graft do not provide adequate large amounts of donor bone and usually undergo necrosis or nonunion due to lack of vascular nutrition. Currently, advanced in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization without sacrificing viability. We reviewed 11 cases of vascularized fibular grafts which were performed from December 1982 to January 1993 and the following results were obtained: 1. Large bone defects with chronic osteomyelitis secondary to trauma were could be successfully treated by the vascularized fibular transfer. 2. In our experience, the vascularized fibular transfer was thought to be one of good methods of treatment for congenital pseudathrosis of tibia. 3. Complete tumor resection was followed by a free vascularized fibular transfer, resulting in good functional improvement, without local recurrence. Long bone defect secondary to bony dysplasia was could be reconstructed by the vascularized fibular transfer. 4. The transferred vascularized fibula had been hypertrophied with bony union during follow-up period and there was no resorption of the grafted fibula.

• Asian Spine Journal
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• 제12권6호
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• pp.1010-1016
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• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

• 대한정형외과학회지
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• 제54권5호
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• pp.463-468
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• 2019

선천성 무통증과 무한증(congenital insensitivity to pain with anhidrosis, CIPA)은 감각신경계와 자율신경계가 이환되는 질환으로 상염색체 열성으로 유전되는 드문 질환이다. 우리 환자는 방치된 원위 대퇴골 골절로 내원한 5세 여아로 추시 도중 시행한 방사선 사진에서 과도한 가골과 가관절 소견을 보였으며, 손가락의 절단, 반복적인 불명열의 과거력을 갖고 있었다. 근전도/신경전도 검사에서는 이상 소견이 관찰되지 않았고, 정량적 발한 축삭 반사검사에서는 한선의 분비 기능이 거의 없는 소견을 보여 이를 바탕으로 CIPA로 진단하였다. 매우 드문 질환이고 감각자율신경계 질환이기 때문에 정형외과 의사가 CIPA 환자를 만날 확률은 매우 낮지만 본 증례의 경우처럼 정형외과 의사가 CIPA를 처음으로 진단하는 의사가 될 수도 있으므로 그 가능성을 염두에 두어야 하겠다.