완전 분리형 슬개상추벽(Suprapatellar Plica)의 임상적 의의

김용환,남기운,선승덕,배대경 대한슬관절학회 1993 대한슬관절학회지 Vol.5 No.2

The plicae are remaining synovial septa in adult life which existed in early fetal life. The suprapatellar plica separates the suprapatellar pouch from the knee joint, The plica syndrome has clinical significance, which has been occasionally overlooked, but the pathophysiology of symptomatic plicae may be hard to explain. To evaluate the clinical significance of the suprapatellar plicae, the authors reviewed prospectively 21 cases in 15 patients who had complained of vague pain around the knee and found total septum of suprapatellar plica at the arthroscopic examination from September 1991 to April 1993. The follow-up period was from 6 months to 2 years and 1 month. The results were as follows; 1. The age of patients ranged from 24 to 56 years old, the average being 36 years old. There were 10 females (66.7 %) and 5 males (33.3 %). 2. The symptoms were chronic mild knee pain which was aggravated at long-squatting and long-standing position and others were recurrent swelling in 6 (28.6 %), instability or giving-way in 5 (23.8 %), and catching or clicking in 3 cases (14.3 %). There was bilateral involvement in 9 patients (60.0 %), who had similar symptoms on both knees. 3. The objective findings include palpable band on superomedial side in 9 (429 %), audible snapping in 6 (28.6 %), local tenderness in 4 cases (19.0 %) and no significant abnormal findings in the laboratory. 4. The radiographic findings were normal in 17 (81.0 %), sclerosis of articular surface of the patella in 2 (9.5 %), malalignment in 1 (4.8 %), and mild degenerative change in 1 case (4.8 %). There was increased uptake around patellofemoral joint at radioisotope scanning and relatively small suprapatellar bursa at the conventional arthrogram. 5. At the arthroscopic findings, there were suprapatellar plicae with total septum in 19 (90.1 %) of 21 cases and associated lesions were presented as meniscal tears in 3(14.3 %), loose body in 1 (4.8 %), and discoid meniscus without tear in 1 case (4.8 %). 6. The complete plicae were surgically excised under the arthroscopic control in 19 cases and the results showed complete relief of pain in 12 (63.2 %), symptomatic improvement in 4 (21.1 %), no change in 3 (15.8 %), and none of worsening after 13 months follow-up. In our opinion, the complete suprapatella plica is clinically significant in patients who had equivocal diagnosis about knee problems and further studies for the pathophysiology of complete suprapatellar plica are needed.

슬관절 전치환술후 Orth - evac 을 이용한 자가수혈의 결과 분석

김용환,남기운,배대경,이홍구 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.1

Total knee arthroplaaty is an elective procedure usually accompanied by significant blood loss requiring transfusion. Recently, medical colleagues and patients have become concerned, about the immune reaction and the potential transmission of infectious diseases such as AIDS and non-A & non-B Hepatitis via homologous banked blood. From March of 1993, we have used post-operative autotransfusion through the Orth-evac after total knee arthroplasty to minimize the need for the homologous tansfusion. The patients, who had not received the post-operative salvaged transfusion after TKR from November of 1990 to April of 1993, were allocated to Group I. The patients who had received the post operative salvaged blood via the Orth-evac from March of 1993 to September of 1993 were allocated to group Il. And each group included bilateral TKR(10 patients) and unilateral TKR(10 patients) respectively. Also, each group included cemented(10 patients) and cementless(10 patients) prosthesis. We evaluated the efficacy and benefits of the post-operative blood salvage system as compared to the homologous transfusion. The results of analysis were as follows. 1. The average shed blood amount in the first 2 days after TKR was 1373 ㎖ at bilateral TKR and 742 ㎖ at unilateral TKR in group I, as compared to 1317 and 696 in group ll. 2. In group I, the average transfused-blood volume after TKR was 2,7 pints of packed RBC at bilateral TKR and 2.2 pints at unilateral TKR. In group II, the average reinfusedblood volume was 593 ㎖ at bilateral and 343 ㎖ at unilaterl. 3, In group II, 4 patients out of bilateral TKR(10 patients) required additional transfusion of average 2.5 pints of pecked RBC and no patients at unilateral TKR. 4. The mean values for the detectable specimens of salvaged blood in 16 patients of group Il were : WBC, 658O : Hgb, 9.8 g/㎗: Hct, 32.7 % : Platelet, 70400. 5. The cement had no effects on the drainaged volume of blood after TKR. 6. No significant difference was noted in maximum pre and postoperative temperature between group I and II. 7. There were no complications like fat embolism, adult respiratory distress syndrome, disseminated intravascular coagulopathy, or sepsis except febrile reaction after transfusion.

생비골 이식술을 이용한 거대세포종의 치료

한정수,유명철,정덕환,남기운,박보연,Han, Chung-Soo,Yoo, Myung-Chul,Chung, Duke-Whan,Nam, Gi-Un,Park, Bo-Yeon 대한미세수술학회 1992 Archives of reconstructive microsurgery Vol.1 No.1

The management of giant cell tumor involving juxta-articular portion has always been a difficult problem. In certain some giant cell tumors with bony destruction, a wide segmental resection may be needed for preventing to recur. But a main problem is preserving of bony continuity in bony defect as well as preservation of joint function. The traditional bone grafts have high incidence in recurrence rate, delayed union, bony resorption, stress fracture despite long immobilization and stiffness of adjuscent joint. We have attemped to overcome these problems by using a microvascular technique to transfer the fibula with peroneal vascular pedicle as a living bone graft. From Apr. 1984 to Nov. 1990, we performed the reconstruction of wide bone defect after segmental resection of giant cell tumor in 4 cases, using Vascularized Fibular Graft, which occur at the distal radius in 3 cases and at the proximal tibia in 1 case. An average follow-up was 2 years 8 months, average bone defect after wide segmental resection of lesion was 11.4cm. These all cases revealed good bony union in average 6.5months, and we got the wide range of motion of adjacent joint without recurrence and serious complications.

미세 혈관 접합술에서 봉합적 수기와 비봉합적 수기의 실험적 비교 연구

정덕환,한정수,유명철,남기운,선승덕,Chung, Duke-Whan,Han, Chung-Soo,Yoo, Myung-Chul,Nam, Gi-Un,Sun, Seung-Deok 대한미세수술학회 1994 Archives of reconstructive microsurgery Vol.3 No.1

Suture microvascular anastomosis is time-consuming and tedious and demands long and continuous training. Techinique of anastomosis of microvessel was presented interrupted suture and continuous suture. Recently the unilink instrument system is created as a fast and simple method to achieve high patency rates without long and continuous training in the anastomosis of small vessels. The author experimentally studied the femoral artery of 20 mice(0.5-1.0mm, av. 0.7mm), the femoral vein of 20 mice(0.8-1.6mm, av. 1.2mm) after anastomosis with interrupted suture in 20 cases and continuous sutre in 20 cases. For the unilink apparatus we used the carotid arteries of 15 cases in 14 rabbits(1.0-1.6mm, av. 1.3mm) and facial veins of 12 cases in 14 rabbits(0.9mm-2.2mm, av. 1.5mm). A total of 27 arterial and venous anastomoses were performed. We examined the postoperative patency at immediate, 2 weeks, and 8 weeks. The results were as followings, 1. In the arterial anastomosis the rate of patency was 90%(18/20) in interrupted suture, 90%(18/20) in continuous suture and 93%(13/15) in unilink apparatus. In the venous anastomosis the rate of patency was 90%(18/20) in interrupted suture, 80%(16/20) in continuous suture and 100%(9/9) in unilink apparatus. 2. The mean time for completion of the arterial anastomosis were 12.2 minutes in interrupted suture group, 10.3 minutes in continouous suture group and 8.5 minutes in unillnk apparatus group. The mean time for completion of the venous anastomosis were 13.6 minutes in interrupted suture group, 11.0 minutes in continuous suture group and 6.2 minutes in unilink apparatus group. 3. At the histological examination of suture group, hyperplastic reaction of middle layer and subintimal hyperplasia were observed. In unilink apparatus group, the endothelium layer was continued and the thickness of vessel wall was decreased due to moderate atrophy of the media and mild degree of nonspecific chronic inflammation were seen around the unilink apparatus. 4. No significants was noticied in foreign body reaction among the interrupted, continuous and unilink apparatus group. 5. A case of the arterial anastomosis was released with acting out at 15 minutes after operation. 6. The important factors in the technical problems were accurate apposition of the cut vessel edges in suture group and the proper selection of the ring size and optimal fitting between two rings in unilink apparatus group. Even though the outer diamater of vessel in suture group was different from that in unilink apparatus group the unilink method provides a very safe, fast, and simple way to perform microvascular anastomoses especially in anastomosis of vein. But howerver suture was needed in vessels below 1 mm outer diamater. In that situation continuous suture was benefit than the interrupted suture in operation time.

Vascular loop graft 술식을 이용한 $Kienb\"{o}ck$씨 질환의 치료

한정수,정덕환,박보연,남기운,한현수,Han, Chung-Soo,Chung, Duke-Whan,Park, Bo-Yeon,Nam, Gi-Un,Han, Hyun-Soo 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Although the etiology of $Kienb\"{o}ck's$ disease is clearly related to avascular changes in the lunate, but the actual cause leading to this vascular impairment has remained elusive. Therefore, a great many different surgical procedures have been proposed for the correction of the multiple factors leading to lunate collapse or for the treatment of the lunatomalacia. The treatment modalities includes lunate excision, intercarpal arthrodesis, lunate implant resection arthroplasty, joint levelling operation(e.g ulnar lengthening & radial shortening), pronater quadratus pedicle graft and vascular loop graft. In the period from Jan. 1981 to Dec. 1992, we performed operative treatment in 19 cases of $Kienb\"{o}ck's$ disease. Among them, 6 cases were treated with vascular loop graft. We analysed all patients who were treated with vascular loop graft after followed up of 4 year 6 months, on an average(range from 1 year to 8 year 10 months). The results analysed are as follows, 1. All cases were stage III according to Lichtman's classification. 2. Ulnar variance was -1.5(range$-2{\sim}0$), on an average. 3. The average age of patients were 37.7years old(range 31-41). 4. Postoperatively, there were considerable restoration of range of motion and complete relief of pain in all cases, but continued decrease of grip power in one case. 5. Decreased sclerosis, loss of fragmentation and new bone formation were appeared in the last follow up film, in all cases. The vascular loop graft considered as a useful method for the treatment of the $Kienb\"{o}ck's$ disease.

내측 족저 동맥을 이용한 도피판술의 임상적 고찰

정덕환,한정수,김용환,남기운,김진원,Chung, Duke-Whan,Han, Chung-Soo,Kim, Yong-Hwan,Nam, Gi-Un,Kim, Jin-Won 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Soft-tissue deficits over the plantar forefoot, plantar heel, Achilles tendon, and distal parts of lower leg are often troublesome to cover with a simple graft or local flap due to limited mobility of surrounding skin and poor circulation in these area. Soft-tissue reconstruction in these regions should provide tissue components similar to the original lost tissue, supply durability and minimal protective pressure sensation and result in a donor site that is well tolerated and treated. We analysed 7 cases that were treated with the Instep flap due to soft-tissue defects over these regions from July of 1990 to July of 1993. All flaps were viable and successful at follow-up. 1. The age ranged from 9 years to 60 years, and 6 cases were male and 1 case female. 2. The sites of soft-tissue loss were the plantar forefoot(1 case), plantar heel(3 cases), Achilles tendon(2 cases), and distal parts of lower leg(1 case). 3. The causes of soft-tissue loss were simple soft-tissue crushing injury(1 case), crushing injury of the 1st toe(1 case) and posttraumatic infection and necrosis(5 cases). 4. The associated injury were open distal tibio-fibula, fracture(2 cases), medial malleolar fracture of the ankle(1 case), Achilles tendon rupture(2 case) and 1st metatarso-phalangeal disarticulation(1 case). 5. The size of flap was from $3{\times}4cm$ to $5{\times}10cm$(average $4{\times}5.6cm)$. 6. In 7 cases, we were not to find post-operative necrosis and infection, non-viability, limitation of ankle joint, and gait disturbance caused by the Instep flap surgery. 7. This study demonstrates that the Instep flap should be considered as another valuable technique in reconstruction of these regions.

회전근개 파열의 초음파 진단

이용걸(Yong Girl Rhee),배대경(Dae Kyung Bae),김종진(Chong Jin Kim),남기운(Gi Un Nam),류경남(Kyung Nam Ryu) 대한정형외과학회 1993 대한정형외과학회지 Vol.28 No.1

단환성 기구(Unilink Apparatus)에 의한 비봉합적 미세혈관 접합술에 대한 연구

유명철(Myung-Chul Yoo),정덕환(Duke-Whan Jung),한정수(Jung-Soo Han),남기운(Gi-Un Nam) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.4

하퇴에 발생한 석회화 근육괴사

배대경(Dae-Kyung Bae),유경남(Kyung-Nam Ryu),남기운(Gi-Un Nam),김용환(Yong-Hwan Kim) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.2