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전이형 외측 상완 피판술을 이용한 주관절 연부조직 결손의 피복
송주현,이윤민,이주엽,Song, Joo-Hyoun,Lee, Yoon-Min,Lee, Joo-Yup 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.2
Purpose: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. Materials and Methods: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 $cm^2$. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. Results: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. Conclusion: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.
개방성 경골 골절의 치료에서 유리 복직근 피판술의 유용성
송주현,이한용,이은상,이주엽,Song, Joo-Hyoun,Lee, Han-Yong,Lee, Eun-Sang,Lee, Joo-Yup 대한미세수술학회 2006 Archives of reconstructive microsurgery Vol.15 No.2
Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.
송주현 ( Joo Hyoun Song ),이은봉 ( Eun Bong Lee ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.3
최근에 복강경, 내시경 그리고 관절경 수술과 같이 최소 침습법을 이용한 시술이 보편화되었으며, 40년 이상의 경험이 쌓인 인공 고관절 치환술에서도 이와 같은 맥락에서 절개부위를 최소화하는, 소위 최소 침습법에 의한 인공 고관절 치환술이 시도되고 있다. 최소 침습법에 의한 인공고관절 치환술은 절개 부위와 연부 조직 손상이 적어 수술 후 통증 감소와 빠른 회복을 얻을 수 있다는 장점을 내세우고 있으나, 이 술식의 장단점과 주의 사항을 면밀히 검토하여 환자 치료에 있어 부정적인 결과가 초래되는 것을 막아야한다. Minimally invasive surgeries, such as laparoscopic, endoscopic and,arthroscopic surgery are currently being used throughout the world. The field of total hip arthroplasty has over 40 years of experience, and minimally invasive total hip arthtoplasty was introduced to reduce the perioperative morbidities. The advocates for minimally invasive total hip arthroplasty will point out the advantages of reduced pain and early ambulation after the operation because of the minimal soft tissue injury. However, we have to review the advantages and disadvantages of minimally invasive total hip arthroplasty to prevent anyharmful effects of this procedure for the patients who under go it.
Mallory-Head System을 이용한 인공 고관절 전치환술 -최소 8년 추시 결과-
송주현 ( Joo Hyoun Song ),이주엽 ( Ju Yup Lee ),정인호 ( In Ho Jung ),유현호 ( Hyun Ho Yoo ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.1
목적: 이중 tapered 된 Mallory-Head 인공 대퇴 삽입물을 이용한 고관절 전치환술의 임상적, 방사선적 추시 결과를 확인하고자 하였다. 대상 및 방법: 인공 고관절 전 치환술을 받은 81예(75명)의 환자에 대한 평균 9.8년(8~12년)까지의 수술 후 추시 결과를 분석하였다. 수술 전 진단은 46예(57%)가 대퇴 골두 무혈성 괴사, 12예(15%)에서 골관절염, 9예(11%)에서 류마티스 관절염 등이었다. 임상적 결과는 modified Harris 점수와 modified Merle d`Aubigne-Postel 점수로 평가하였고, 방사선학적 결과를 분석하였다. 결과: 평균 modified Harris hip score는 술 전 56점에서 술 후 92점으로 향상되었다. Modified Merle d`Aubigne-Postel score는 최종 추시에서 평균 15점으로 55예(68%)가 good 또는 excellent의 임상적 등급으로 분류되었다. 1예에서 비구컵의 해리로 인한 재치환술을 요하였으며, 1예는 반복적 탈구로 인한 재치환술을 시행하였다. 결론: Mallory-Head 인공 대퇴 시스템을 이용한 전 치환술의 중장기 임상적 및 방사선적 결과는 우수한 것으로 판단된다. Purpose: The purpose of this study was to assess the clinical and radiographic results of total hip arthroplasty with using the double tapered Mallory-Head system. Materials and Methods: The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed at eight to twelve years (average: 9.8 years) postoperatively. The underlying diseases were avascular necrosis in 46 hips (57%), osteoarthritis in 12 hips (15%), RA in 9 hips (11%) and others. The clinical result was evaluated on the basis of the modified Harris hip score and the modified Merle d`Aubigne-Postel score. A radiographic analysis was also performed. Results: The average modified Harris hip score was improved from preoperative 56 points to postoperative 92 points. The average modified Merle d`Aubigne-Postel score was 15 points at the latest follow up, and 55 hips (68%) were classified as having clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised because of recurrent dislocation. Conclusion: The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results.
인공고관절 전치환술에서 CAOS (Computer Assisted Orthopedic Surgery)가 필요한가? -부정적인 관점에서-
이주엽 ( Joo Yup Lee ),송주현 ( Joo Hyoun Song ),김철진 ( Chol Jin Kim ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.2
CAOS (Computer Assisted Orthopedic Surgery) has been introduced into the field of artificial joint replacement to increase the accuracy of implant placement. The advocates of CAOS insist that total hip replacement arthroplasty using CAOS will decrease dislocation, the wear rate, impingement and limb length discrepancy by increasing the accuracy and consistency of implant placement. However, we have to maximize the good results of total hip replacement arthroplasty by developing CAOS with understanding its disadvantages and limits, so we have reviewed CAOS using a critical eye for its negative aspects.