경추부 초음파 유도하 중재술

선승덕(Seung Deok Sun),장병권(Byung Kwon Chang),문상호(Sang Ho Moon) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.2

경추부에서 전통적으로 사용되고 있는 방사선 투시하 중재술은 환자에게뿐만 아니라 시술하는 의사에게도 방사선의 위험에 노출이 될 수밖에 없다. 더구나 방사선 투시하에서는 혈관과 신경을 직접 볼 수 없기 때문에 환자들에게도 시술에 대한 위험성이 높았던 것이 사실이다. 그런데 최근 해상도가 높은 초음파들이 개발되어 실시간 동영상하에서 연부조직의 구조물들을 확인하며 시술할 수 있게 되었다. 경추부 신경근 차단술, 후방 분지 차단술, 그리고 여러 가지 중재술들이 초음파 유도하에서 가능해진 것이다. 이러한 술기는 외래에서도 간편하게 통증의 원인을 감별하고 치료하는 데 있어서 유용하게 사용되고 있다. 또한 초음파는 방사선이 없고 간편하며 주사하는 동안 실시간으로 계속 영상을 제공함으로써 주사제가 퍼져나가는 양상을 파악할 수 있어 시술의 정확도를 높일 수 있는 술기이다. 결국 초음파 유도하 시술은 주요 신경과 혈관의 위치를 확인하면서 그에 대한 손상 혹은 주사를 피할 수 있기 때문에 이러한 구조물들의 손상 위험이 높은 경추부에서 안전하게 시행할 수 있다는 중요한 장점이 있는 술기이다. 그리하여 저자는 실시간 초음파 유도하라는 술기가 경추부 중재술에서 얼마나 유용한가에 대해 분석하여 기술하였다. Interventional procedures around the cervical spine have been classically performed under the guidance of fluoroscopy with radiation hazards to patients and doctors. Even though under fluoroscopic guidance, vascular and nerve structures cannot be shown and there are actual risks for the patient. Nowadays, we can use high resolution image ultrasound around cervical spine procedures. Real time imaging is possible. Cervical root block, medial branch block and many other interventions can be performed under ultrasound guidance. In out-patient clinics, ultrasound is very helpful in management of cervical problems in differentiating the origin of pain and treatment for the pain. Ultrasound is radiation free, easy to use and the imaging can be performed continuously while the injectant is visualized in real-time, increasing the precision of injection. Importantly, ultrasound enables visualization of major nerves and vessels and thus leads to improved safety of cervical interventions by decreasing the incidence of injury or injection into nearby vasculature. We therefore performed a review to investigate the feasibility of performing cervical interventions under real-time ultrasound guidance.

슬관절 전치환술에서 삽입물의 생존율에 대한 분석

송영석,선승덕,배대경 대한슬관절학회 1995 대한슬관절학회지 Vol.7 No.2

Survivorship analysis is used to calculate a predicted cummulative rate of success for this series of total joint replacements long-term folow-up. Survivorship analysis has been advocated a providing annual and overall failure rates, as well as the probabilities of implant survival. The survivorship of total knee replacement between 1982 and 1992 with follow-up period of up 12 years was estimated by Dobb's method(1980), and we analyzed clinically and radiologically 397 patients(588 knees) which were followed up more than 2 years(from 2 years to 12 years 4 months, average 8 years 6 months). Also, we evaluated the knee function according to the functional knee scores of Hospital for Spedial Surgery. 1. The average age at operation was 57.1 years(from 19 years to 89 years). Male was 43 patients and female was 354 patients. 2. There were oseoarthritis in 317 knees(53.8%), rtheumatoid arthritis in 213 knees(36.2%), secondary osteorthritis in 31 knees(5.4%), tuberculous arthritis in 16 knees(2.7%), and Charcot joint in 11 knees(1.9%). 3. The Hospial for Special Surgery functional knee and pain scores was improved from average 57.5 points preoperatively to average 86.4 points postoperatively.The results were satisfactory in 536 knees(91.2%, excellent in 66.4% and good in 24.8%). 4. Revision surgery was performed in 28 knees of the 588 knees(4.7%), due to aseptic loosening or patellar component wearing in 16 knees(2.7%) and septic loosening in 12knees (2.0%). 5. Survival rate of total knee replacements with reliability ws 84.2%,9 years after operation for 397 patients, 588 knees. In surmmary, total knee replacements is a effective and satisfying procedure which canobtain relief of pain, repair of defomity, restoration of the function, improvements of life quality and long term survivorship.

p53 Mutations in Ewing's Sarcoma

배대경,선승덕,Bae, Dae-Kyung,Sun, Seung-Deok The Korean Musculoskeletal Tumor Society 2000 대한골관절종양학회지 Vol.6 No.4

목적 : p53 종양억제 유전자는 사람의 암에서 변형이 가장 많이 발견되는 유전자로 유잉 육종에서 p53 유전자의 변형을 관찰하고자 하였다. 재료 및 방법 : 유잉육종 환자 35례의 파라핀 블록을 사용하였으며, 유전자의 결핍과 p53 유전자의 염기서열의 변형을 관찰하였다. 결과 : 정성적인 중합효소 연쇄반응을 이용한 p53의 4-9번까지의 유전자검사중 2례에서 동일성의 유전자 결핍이 관찰되었으며, exon 5-8의 유전자 중합효소 연쇄반응에서는 3례에서 missense 점돌연변이가 관찰되었다. 결론 : 이상의 결과로 p53은 유전적으로 적은 부분에서 유잉육종에 관여하는 것으로 관찰 되었다. Purpose : The p53 tumor suppressor gene is one of the most frequently altered genes in human malignancies. We try to explore the implication of p53 alteration in Ewing's sarcoma. Materials and Methods : We analyzed 35 paraffin blocks to explore the deletion and sequence alterations of p53. Results : Quantitative PCR analysis showed that 2 tumors showed a homozygous deletion of the gene. Mutational analysis of exons 4 to 9 of p53 by PCR-SSCP revealed that 3 tumors carry sequence alterations in exons 5 or 8, and DNA sequencing analysis identified missense point mutations. Conclusion : Taken together, our data demonstrate that p53 is genetically altered in a small fraction of Ewing's sarcoma.

후내방도달법을 이용한 반월상 연골 부분 적출술에 대한 수기

김병순,안진환,선승덕,권병기 대한슬관절학회 1994 대한슬관절학회지 Vol.6 No.2

It is impossible to repair the meniscal tear when the torn fragment has severe degenerative change, or when the displaced torn fragment is not reduced into antatomic position due to loss of substance or deformation of torn fragmeat. Therefore arthroscopic partial meniscectomy is indicated at these situations. Sometimess it is extremely difficult to resect mthroscopically the posterior attachment of tom fragment of medial meniscus through standard anterior two or three portals because of poor arthroscopic visual field and a narrow space for passing of instruments. The purpose of this paper is showing the three arthroscpic surgical techniques resecting the posterior attachment of torn fragment using posteromedial portal. The advantages of these techniques are to minimize the damage of articular cartilage, to prevent inadequate resection af posterior attachment of torn fragment, to prevent inadequate resection of posterior attachment of torn fragment, to prevent the damage to articular cartilage and remaining meniscal tisssue and to avoid the damage of posterior cruciate ligament and vascular structures.

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.

거대세포종의 치료시 관절 기능의 보존

배대경,한정수,선승덕,백창희,이재훈,Bae, Dae-Kyung,Han, Chung-Soo,Sun, Seung-Deok,Baek, Chang-Hee,Rhee, Jae-Hoon 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.2

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

흉요추 골절의 임상적 고찰

이상언,송영석,김기택,선승덕,배대경 대한외상학회 1995 大韓外傷學會誌 Vol.8 No.1

In recent years, the rate of the spine fracture tends to be increased year by year along with increasing rate of traffic and industrial accidents and it also related with also long life expectancy and increasing population of older people. The authors analysed the classifications of spine fractures and results, according to age, methods of treatment. The authors evaluated 98 patients of thoracolumbar spine fracture, who were admitted and managed at Dept. of orhtopeadic Surgery, Kyung Hee University, from January, 1992 to June, 1994. 1. Most frequ.ent injured level was $quot;$quot;T12 and Ll (69.4%), the most common causes of injury were fall down in younger patients(39.1%) & slip down in older patients(27.8%). 2. $quot;$quot;Compression fracture$quot;$quot; was the most common type of injuries which were classified by 3-column concept according to Denis & McAfee (41.8%). 3. In the treatment, conservative management was bed rest under hyperextension state for 3 weeks and cast or thorocolumbosacral orthosis brace was applied for 3-6 months. Elderly patients, especially female, were managed by calcium, calcitonin or hormone therapy for treatment of osteoporosis. Decompresive operation was performed with instrumentation through anterior, or posterior, or combined approach in unstable spine f racture. 4. The amount of encroachment on neural canal was 48.6% in Frankel Scale A,B, C, 26% in Frankel scale D, and 18% in Frankel scale E. 5. Improvement in frankel grade was 1.4 grade in average after operation. 6. Residual pain was remained 35 patients(64%) after the conservative management and 21 patients(49%) after operative management. In elderly patients, the osteoporotic spines were vulnerable to minor trauma, resulting in fracture with more than two level, while in younger patients, it occurred mainly by major trauma, in the single level with neurologic deficit. So it is important to prevent further damage, and an adequate management is needed immediately according to the patient's age, stability of fracture, and associated neurologic damage.

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.

고령의 대퇴경부 및 대퇴전자간 골절시 일차 고관절 부분 치환술

조윤제,김기택,유명철,선승덕,박경찬 대한골절학회 1994 대한골절학회지 Vol.7 No.2

From January 1982 through December 1992, 102 hips in 100 patients had a primary hemiarthroplasty for the treatment of femur neck and intertrochanteric fractures in the elderly who had severe comminuted fractures or poor bone quality and poor genenral condition, Of these, we reviewed 62 hips in 62 patients with a minimum follow-up over one year. 1. The average age at operation was 71.7 years(50-96 years). 2. The most common cause of injury was slip down in 56 cases(90.4%). 3. Bone quality was evaluated with Singh index radiologically and 42 cases(67.8%) were classified to below grade III. 4. Most patients were possible to sit and start wheel chair ambulation within a week and the average period of time from operation to partial weight bearing was 12.9 days. 5. In clinical evaluation, the average Harris hip score was 75.9 in the femoral neck fractures and 71.9 in intertrochanteric fractures and 73.2 in the unipolar endoprosthesis group and 69.5 in the bipolar endoprosthesis at the final follow up. 6. Postoperatively, 13 hips(21%) had only mild discomfort, 6 hips(10%) had moderate pain, one hip(1.6%) had severe pain on the ipsilateral hip or thigh, or knee. 7. The most common early postoperative complications were superficial wound infection(3 cases, 6.4%). 8. In the radiological evaluation, the most common late postoperative complications were leg length discrepancy(L.L.D) in 6cases(9.7%) and acetabular erosion in 5 cases(8.1%). 9. In the analysis of the relationship between prosthetic head size compared to acetabular size and acetabular erosion, more proper size of prosthetic head raised less acetabular erosion, 1 case(2.5%), and large size of prosthetic head raised more acetabular erosion, 2 cases(28%). There was no significant difference in the incidence of the acetabular erosion between the unipolar and bipolar endoprosthesis group. In this study, most of the patients had relatively good results and lower incidence of local or general complictions. Therefore, hemiarthroplasty can be suggested for one of primary treatment method of intertrochanteric fractures and femur neck fractures in elderly patients who had severe comminuted fractures or poor bone quality and poor general condition.

슬관절 전치환술후 발생한 심부감염의 치료

배대경(Dae Kyung Bae),이상권(Sang Gweon Lee),선승덕(Seung Deok Seon) 대한정형외과학회 1994 대한정형외과학회지 Vol.29 No.3