사구종양의 치료

송석환,우영균,이승구,이화성,이상훈,Song, Seok-Whan,Woo, Young-Kyun,Rhee, Seung-Koo,Lee, Hwa-Sung,Lee, Sang-Hoon 대한근골격종양학회 1997 대한골관절종양학회지 Vol.3 No.2

본 대학 부속 성모병원에서 경험한 사구종양 11례를 후향적으로 분석하였다. 전례가 여자로, 특징적인 동통 및 압통, 그리고 냉각 과민성의 3 주증상을 보였다. 손톱밑 사구종양이 8례, 발톱밑 사구종양이 1례, 그리고 원위 수지 수질(pulp)내 사구종양이 2례이었다. 10례에서 합병증없이 만족스러운 결과를 얻었으며, 손톱바닥을 종괴와 함께 절제한 1례는 손톱기형으로 경과추시중이다. 사구종양은 완전한 절제시 국소재발이나 전이를 하지 않는 양성종양이나, 손톱 바닥의 손상 시 손톱의 변형을 초래할 수 있으므로 완벽한 절제 및 손톱바닥의 세심한 재 봉합이 이루어져야하겠다. From 1988 to 1997, we experienced 11 cases of glomus tumor in fingers(10 cases) and toe(1 case). All patients were female, and showed typical pain, tenderness, and cold sensitivity of the lesions. The locations were subungal in nine cases and in pulp from distal phalangeal bone in two cases. Three patients had histories of one or two failed previous operations, and two patients had another glomus tumor in their bodies. All except one had satisfactory results subjectively and without complications. One patient was operated by the excision of the tumor including germinal matrix and surrounding tissues of nail bed, and had a nail deformity in follow-up. The glomus tumor is not malignant to recur or metastasize in the case of complete excision. However, the surgeon should be alert not to injure or repair the nail bed meticulously after the excision of the tumor to prevent a late deformity of nail.

견갑관절 주위 악성종양의 치료경험

송석환,장주해,강용구,김정만,김형민,이승구,우영균,박원종,문명상,김양수,Song, Seok-Whan,Chang, Ju-Hai,Kang, Yong-Koo,Kim, Jung-Man,Kim, Hyoung-Min,Rhee, Seung-Koo,Woo, Young-Kyun,Bahk, Won-Jong,Moon, Myung-Sang,Kim, Yang-Soo 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1

견갑관절 주위의 악성종양 치료후의 기능평가를 위하여 저자들은 1991년 1월부터 1993년 12월까지 가톨릭대학교 의과대학 정형외과학 교실에서 견갑관절 주위 악성종양에 대한 수술적 치료를 받은 9례를 분석하여 다음과 같은 결과를 얻었다. 남자 5례, 여자4례이었고, 나이는 최저 22세, 최고 64세로 평균 47세이었다. 연부조직 종양이 2례(MFI, dermatofibrosarcoma protuberance 각각 1례)이었는데, 1례는 forequarter 절단, 1례는 광범위 절제술로 치료하였다. 골종양은 7례(chondrosarcoma 2례, osteosarcoma, MFH, plasmacytoma, thyroid carcinoma metastasis 및 malignant schwannoma 각각 1례)이었는데, 1례는 상완골 근위부 부분절제, 4례는 Malawer분류 제 I-A형의 절제, 1례는 제 I-B형, 1례는 제 V-B형의 절제술을 시행하였다. low grade의 연골육종 1례와 dermatofibrosarcoma protuberance 1례, 갑상선 종양 전이의 1례의 3례를 제외한 6례에서 항암화학요법, 혹은 방사선 요법을 시행하였으며, 1례에서 국소재발이 있었으나 평균 15.3개월 추시된 현재 전례가 생존하고 있다. 골종양 7례증 2례는 관절유합술, 4례는 관절전치환술로 치료하였으며, 관절유합술을 시행한 예와 관절성형술을 시행한 예의 기능은 큰 차이를 보이지 않았다. To evaluate the clinical result of surgical treatment of malignant tumors in shoulder girdle, nine patients who were treated in Department of Orthopedics, Catholic University Medical College between January 1991 and December 1993, were evaluated. There were 5 men, 4 women. The mean age at operation was 47 years(range from 22 to 64 years). Of 9 patiens, 2 were soft tissue tumors(1 MFH, 1 dermatofibrosarcoma protuberance); one was treated with forequarter amputation, and the other with wide excision, Seven were bone tumor(2 chondrosarcoma, 1 osteosarcoma, 1 MFH, 1 plasmacytoma, 1 thyroid carcinoma metastasis, 1 malignant schwannoma); one patient was treated with segmental excision of proximal humerus, 4 with Malawer type I-A resection and arthroplasty or arthrodesis, 1 with Malawer type V-B resection and arthrodesis. Five patients received adjuvant chemotherapy, with or without local radiation therapy, and one patient received radiation therapy alone. All patients have survived now, but I had local recurrence. Functional results of arthrodesis and arthroplasty were similar.

원위 요골 악성 종양의 광범위 절제술 후 혈행성 유리 비골 두 이식을 이용한 수근관절 재건술

송석환,이윤민,Song, Seok-Whan,Lee, Yoon-Min 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1

Vascularized free fibula head transfer is an established method for reconstruction of long bone defects of the upper limb involving the distal radius or the proximal humerus. For the wrist following tumor resection, in cases of resection of the radial articular surface, three reconstructive options are possible: 1. fibular head transfer to replace the radial joint surface, 2. fixation of the fibula to the scaphoid and lunate, 3. complete wrist fusion. The decision on the type of the operation depends on the amount of the resection and the remained normal anatomical structures, and also the necessity of function of the wrist in the future. The authors believe that the vascularized free fibula head graft is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius, and report the operative methods, donor vascular consideration, complications, and functional result after this operation.

Mechanical Properties of Palmar Radiocarpal Ligaments of Wrist and Their Clinical Significances

Seok-Whan Song(송석환),Richard A Berger,Kai-Nan An,Seung-koo Rhee(이승구),Hwa-Sung Lee(이화성),Hyo-Seung Ahn(안효승),Young-Kyun Woo(우영균) 대한정형외과학회 1997 대한정형외과학회지 Vol.32 No.6

골절학회 심포지엄 종설 : 골다공증이 있는 원위 요골 골절의 보존적 치료

송석환 ( Seok Whan Song ) 대한골절학회 2008 대한골절학회지 Vol.21 No.1

원위 요골 골절의 후방 금속판 내고정술

송석환 ( Seok Whan Song ) 대한골절학회 2008 대한골절학회지 Vol.21 No.4

골육종의 도약전이 (3례보고)

이승구,송석환,권순용,류승준,Rhee, Seung-Koo,Song, Seok-Whan,Kwon, Soon-Yong,Ryoo, Seung-Joon 대한근골격종양학회 1997 대한골관절종양학회지 Vol.3 No.2

1980년부터 1997년까지 본 대학부속 성모병원에서 치료한 동측 대퇴골에 발생한 골육종 3예의 도약전이를 경험하였다. 도약전이는 골육종 환자 총 19례중 3례(15%)에서 발견되었고, 방사선 골주사나 자기공명영상이 진단에 필수적이었고, 고관절 이단술로 치료하였다. 도약전이의 기전은 확실하지 않았으나, 이시발생(metachronous) 기전의 초기단계로 보는것이 타당한 것으로 사료되었다. 증례 수가 적어 통계적 의미는 부여할 수 없으나, 도약전이가 있는 장관골의 골육종의 치료는 그 예후가 특히 불량하므로, 확실한 항암요법이 보장되지 않는 한 원발 종양이 발생한 장관골의 전체를 절제하거나 병소 상부관절에서 이단술을 시행하는 것이 바람직하다고 판단되었다. From 1980 to 1997, we experienced 3 skip metastasis in femur out of 19 osteosarcoma patients. After diagnostic incisional biopsy and chemotherapy, hip disarticulations for all patients were performed. Still the mechanism of skip metastasis is unclear, but there have been two suggestions including medullary extension through an intraosseous embolism of tumor cells, or trans articular extension along the planes of fascia, capsule, ligaments, and venous channels around joints. The mechanisms of skip metastasis in our cases were not clear, but it was considered as an initial preliminary stage of metachronous osteosarcoma. If there are evidences of skip metastasis, it is strongly recommended to disarticulate proximal to the skip lesion rather than to amputate transmedullary.

상둔 동맥 혈관경 후방 장골릉 골 이식을 이용한 대퇴골 두 무혈성 괴사의 치료

이상욱,송석환,서유준,박승범,Lee, Sang-Uk,Song, Seok-Whan,Suh, Yoo-Jun,Park, Seung-Bum 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.1

Introduction: To evaluate the efficacy of superior gluteal artery-pedicled iliac crest for the treatment of avascular necrosis of femoral head. Material & Method: From January 2001 to October 2001, we used the superior deep branches of superior gluteal artery for the pedicled posterior iliac crest bone graft to revascularize the avascular femoral head in 4 patients. They were 1 man and 3 women, and the mean age of the patients was 34 years (range, 27 to 60). The average follow-up after surgery was over 57 months (range, 15 to 82). We analyzed the clinical results by the Harris hip score, and evaluated the vascularity of the femoral head by radiographic methods. Results: All cases showed no evidence of collapse on femoral heads and good revascularizations on the radiographic images. The average Harris hip score was 88.5 points. There was no complication. Conclusion: The revascularization procedure using the superior gluteal artery-pedicled posterior iliac crest was thought to be one of the effective and promising techniques for the treatment of the avascular necrosis of femoral head.

흉곽 출구 증후군의 치료

이윤민,송석환,최기범,이승구,Lee, Yoon-Min,Song, Seok-Whan,Choi, Ki-Bum,Rhee, Seung-Koo 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.2

Purpose: As clinical manifestations of thoracic outlet syndrome are vague pain or symptoms in upper extremity, the diagnosis of the disease is delayed or misdiagnosed as cervical HNP, shoulder pathologies, or peripheral neuropathies. In that reason, many patients spend time for unnecessary or ineffective treatments. We report the results of our thoracic outlet syndrome cases, which were treated by conservative care or surgical treatment. Materials & Methods: Twenty five cases, diagnosed as thoracic outlet syndrome since 1999, were reviewed retrospectively. Physical examinations including Adson's and reverse Adson's test, hyperabduction test, costoclavicular maneuver, and Roo's test, plain radiography of shoulder and cervical spine, MRI of neck or brachial plexus, and EMG were checked. If subjective symptoms were not improved after conservative treatments over three months, surgical treatment were performed. Nine patients were performed operative treatment and the others had conservative treatment in outpatient clinic. Postoperative improvement of symptoms and the follow up period, and the results of conservative care were reviewed. Results: Among five physical examinations, mean 1.75 tests were positive, and EMG has little diagnostic value. MRI were performed in twenty cases and compression of brachial plexus were found in 6 cases (30%). Ten patients out of 16 conservative treatment group had excellent improvement of symptoms, and 5 had good results. Eight patients out of 9 operative treatment group had excellent improvement with mean 5.1 months of follow-up period. Conclusion: Diagnosis of thoracic outlet syndrome is difficult due to bizarre and vague symptoms. However if the diagnosis is suspected by careful physical examinations, radiologic studies, or nerve conduction studies, conservative care should be done as initial treatment and at least after three months, reassess the patient's condition. If the results of conservative treatment is not satisfactory and still the thoracic outlet syndrome is suspected, surgical treatment should be considered. Conservative treatment and operative technique are the valuable for the treatment of this disease.

주관 증후군의 수술적 치료: 척골 신경의 전방 근하 전위술과 전방 근막하 전위술의 비교

강수환,송석환,박일중,이상욱,이승구,박승범,Kang, Soo-Hwan,Song, Seok-Whan,Park, Il-Jung,Lee, Sang-Uk,Rhee, Seung-Koo,Park, Seung-Bum 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.1

Surgical treatment of compressive ulnar neuropathy at the elbow has been performed with a wide variety of techniques. Among these techniques, anterior submuscular transposition of the ulnar nerve has been regarded as the method of choice by many authors. It has many advantages including a low recurrence rate, scar-free vascular bed, and protection from repeated trauma to the nerve. However, anterior submuscular transposition is technically demanding and requires more extensive soft tissue dissection. On the other hand, anterior subfascial transposition is less invasive, requires a relatively shorter operation time than the submuscular technique, and also can be done safely even in patiensts with elbow arthritis. We evaluated the clinical results of anterior submuscular transposition compared with anterior subfascial transposition. Fifteen patients underwent anterior submuscular transposition and ten patients underwent anterior subfascial transposition of the ulnar nerve. The mean follow-up time was 15 months (range 10 to 38 months) in the anterior submuscular transposition group and 7 months (range 6 to 15 months) in the anterior subfascial transposition group. According to the outcome status determination algorithm devised by Mowlavi, 3 patients (20%) showed total relief, 10 patiensts (66.7%) improvement and 2 patients (13.3%) no changes in the anterior submuscular transposition group. In the anterior subfascial transposition group, 2 patients (20%) showed total relief, 7 patients (70%) improvement and 1 patient (10%) displayed no changes. Statistically there was no significant difference of the clinical results between the two surgical techniques. Therefore we would suggest anterior subfascial transposition of the ulnar nerve as a preferred method for treatment of cubital tunnel syndrome.