A Case of Enteritis Cystica Profunda with Lipoma in the Second Portion of Duodenum

심범진,박태영 대한내과학회 2019 대한내과학회 추계학술대회 Vol.2019 No.1

척추감염을 동반한 양측 슬관절 전치환술 후 감염의 치료

심범진(Bum-Jin Shim),손욱진(Oog-Jin Sohn),조창우(Chang-Woo Cho) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

슬관절 전치환술 후 감염은 큰 관심을 가지는 문제로 국소 부위 및 전신적 감염의 형태로 나타날 수 있으며, 때로는 패혈증으로 진행되는 사례가 보고되고 있다. 이러한 패혈증은 신체의 다양한 부위로 전파될 수 있으며 사망에까지 이르게 하는 중대한 합병증이다. 하지만 감염 후 척추로 전이된 경우는 임상 증상이 뚜렷하지 않아 진단이 어려우며, 이러한 증례에 대한 보고는 어떠한 문헌에도 없었다. 이에 양측 슬관절 전치환술 후 감염으로 인하여 패혈증으로 진행되어 척추로 전이된 증례를 보고하고자 한다. Postoperative infection from total knee arthroplasty (TKA) is an issue drawing great attention, which can manifest as a local or general infection. Its development into sepsis has also occasionally been reported. Such sepsis is a critical complication that can spread to various parts of the body, which can ultimately lead to mortality. However, the cases where infection has spread to the spine do not have clear clinical signs, making diagnosis difficult. These cases are not found in the literature. Therefore, this is a case study on both postoperative infection from TKA that has developed into sepsis and spread to the spine.

상완골에 발생한 악성 골종양의 치료 및 임상적, 종양학적 결과

심범진(Bum-Jin Shim),신덕섭(Duk-Seop Shin),류승민(Seung-Min Ryu),박재우(Jae-Woo Park) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 상완골에 발생한 악성 골종양의 특징 및 질환의 분포도, 각각의 치료와 임상적, 종양학적 결과를 비교해 보고자 한다. 대상 및 방법: 2005년 5월부터 2014년 5월까지 상완골 악성 골종양으로 수술한 42예를 원발군(1군), 전이군(2군)으로 나누어 후향적으로 추적 분석하였다. 종양의 종류, 분포 등의 특징 및 치료 결과에 따른 임상적, 종양학적 결과에 대해 비교분석 하였다. 결과: 상완골에 발생한 1군으로 골육종 9예, 연골육종 5예 등이 있었고 주로 근위부에 분포하였다. 2군은 폐암에서의 전이가 12예 등 주로 간부에 분포하였다. 광범위 절제술 및 종양 인공관절 재건술 등의 방법으로 치료를 하였고 Kaplan-Meier method 분석 결과 1군 5년 생존율 87.5%, 2군 1년 생존율 70.1%였다. Musculoskeletal Tumor Society score상 두 군 모두 통증 완화, 손위치 및 수작업 능력이 높았고, 기능 지수에 있어서는 상대적으로 1군이 2군보다 높았다. 결론: 상완골의 원발성 악성 골종양은 주로 근위부에 생기며 광범위 절제술 후 종양대치물로 치료를 한다. 전이성 악성 골종양은 주로 간부에 생기며 골수강내 금속정 고정술이 주된 치료이다. 원발성 악성 종양은 생존율 향상이 치료의 주된 목적이고 전이성 악성종양 치료는 기능적 측면에서 효용성이 높다. Purpose: The purpose of this study was to compare the clinical and oncological outcomes between the primary and metastatic malignant tumor of humerus. Materials and Methods: Between May 2005 and May 2014, 42 cases of malignant tumor in humerus that were followed-up for at least 1 year were entered into the study and analyzed retrospectively. Cases were divided into two groups, the primary (group 1, 15 cases) and metastatic (group 2, 27 cases), according to the origin of the tumor. The clinical and oncological outcomes between the primary and metastatic malignant tumor of humerus were analyzed and compared. Results: In the group 1, nine cases were osteosarcoma and six cases were chondrosarcoma. The tumor lesions were distributed in the proximal area of the humerus. In the group 2, 12 cases originated from lung cancer, six cases from liver cancer, and two cases from bladder cancer. The lesions were usually distributed in the midshaft area. The patients underwent various surgical treatments, including wide excision with tumor prosthesis, curettage with bone grafting, intramedullary nailing, open reduction, and internal fixation with plate. Kaplan-Meier 5-year survival estimates were 87.5% for group 1, and 1-year survival estimates were 70.1% and 2-year survival estimates were 40.1% for group 2. The mean Musculoskeletal Tumor Society score was high in both groups. However group 1 showed a higher score on the functional index compared to group 2. Conclusion: Primary malignant bone tumors of the humerus usually involve the proximal site and tumor prosthesis is the main treatment. The metastatic malignant bone tumor usually involves the midshaft area and intramedullary nailing and radiation therapy is the main therapy. Although treatment of the primary malignant tumor increases the survival rate, treatment of metastatic malignant tumor does not affect the survival rate, though it helps in relieving pain.

Free Vascularized Medial Femoral Condyle Bone Graft for Scaphoid Nonunion with Poor Prognosis Factors

박삼국,심범진,석현규 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.2

Purpose: Authors attempt to evaluate the clinical and radiographic results of the treatment of scaphoid nonunion with poor prognostic factors with the free vascularized medial femoral condyle bone graft. Methods: We operated on eight patients with avascular necrosis or prolonged nonunion of the scaphoid between January 2016 and July 2019. Wrist motion in terms of flexion, extension, and ulnar and radial deviation, a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the modified Mayo wrist score, scapholunate angle, and carpal height index were collected in the clinic setting preoperatively and at the latest follow-up in all patients Results: Eight patients with union achieved correction and maintenance of both scapholunate angle and carpal height index. The VAS pain scores significantly improved from 5.1 preoperatively to 3.3 postoperatively. There was a statistically significant improvement in the average DASH score at the final follow-up. Scapholunate relationships in the reconstructed wrists remained almost unchanged, with average scapholunate angles of 49.7° before surgery and 47.0° at the latest postoperative follow-up. There was no statistical significance between the number of poor prognosis factors and the time to union, but there was a positive correlation. Conclusion: It could help surgeons manage the scaphoid nonunion associated with poor prognostic factors such as avascular necrosis, carpal collapse (posttraumatic arthritis), prolonged nonunion, and failed prior scaphoid nonunion surgery.

Comparative Study of Clinical and Radiographic Outcomes of High Tibial Osteotomy in Patients with Kissing Lesions and Non-Kissing Lesions

손욱진,박상진,심범진,이동열 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

Purpose: High Outerbridge grade lesions of the articular cartilage have been associated with poor outcomes of high tibial osteotomy (HTO). However, there has been no report on the efficacy of HTO in the presence of kissing lesions. The purpose of this study was to compare clinical and radiographic outcomes of HTO between kissing lesion and non-kissing lesion groups. Materials and Methods: Of the patients with medial compartment osteoarthritis and varus deformity treated with HTO between 2007 and 2012, 21 cases with kissing lesions and 22 cases without kissing lesions were selected. Clinical outcomes were assessed using the Lysholm knee scoring scale score, visual analogue scale score, Hospital for Special Surgery score, Western Ontario and McMaster Universities score, and Tegner activity score. Radiographic outcomes were assessed using the femoral-tibial angle, mechanical axis deviation, medial proximal tibial angle, posterior tibial slope angle, and joint space width. Results: Clinical outcomes were improved in both groups from the postoperative assessment to the final follow-up, which showed no statistically significant difference between groups at the final follow-up. No statistically significant differences were observed with regard to radiographic assessment. Conclusions: Since both groups showed favorable short-term clinical and radiographic outcomes, HTO might be an alternative treatment option for degenerative osteoarthritis with kissing lesions in relatively young patients.

Upper Limb Reconstruction in Tetraplegic Patients: A Primer for Spinal Cord Injury Specialists

Siew Khei Liew,심범진,공현식 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.2

Cervical spinal cord injury (SCI) ofen causes debilitating loss of function of the upper limb. Upper extremity reconstruction surgery can restore some of the upper limb function in tetraplegic patients with SCI. The procedures are typically muscle-tendon unit transfer surgeries, which redistribute the remaining functional muscles to restore active elbow extension, key grip, and fnger grasping. In addition to the tendon transfer surgeries, nerve transfers have emerged recently and are showing promising results. However, despite more than half of the tetraplegic patients can beneft from upper limb surgery, only a few of them receive the procedures. This missed opportunity may be due to the lack of communication between SCI specialists and hand surgeons, or the lack of awareness of such options among the specialists and patients. In this review, we provide a basic overview of upper limb reconstruction in tetraplegic patients with target audience of SCI specialists for their better understanding of the basic concept of surgery and information for patient consultation before referring to hand surgeons

Non-cirrhotic portal hypertension in an ankylosing spondylitis patient

박석기,이지현,최준설,김현우,심범진,최원규,김상현 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

Idiopathic non-cirrhotic portal hypertension (INCPH) is a disease with an uncertain etiology consisting of non-cirrhotic portal hypertension and portal pressure increase in the absence of liver cirrhosis. In INCPH, patients exhibit normal liver functions and structures. The factors associated with INCPH include the following: Umbilical/portal pyremia, bacterial diseases, prothrombic states, chronic exposure to arsenic, vinyl chloride monomers, genetic disorders, and autoimmune diseases. Approximately 70% of patients present a history of major variceal bleeding, and treatment relies on the prevention of complications related to portal hypertension. Autoimmune disorders associated with INCPH are mainly systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis. To the best of our knowledge, a case of ankylosing spondylitis (AS) associated with INCPH has not been reported thus far. Therfore, we report our experience of a patient with AS accompanied by INCPH, who showed perisplenic varices with patent spleno-portal axis and hepatic veins along with no evidence of cirrhosis on liver biopsy, and provide a brief literature review.

원위 경골 골절에서 금속정 및 최소 침습적 금속판 고정술의 결과 비교

박철현(Chul-Hyun Park),최치범(Chi-Bum Choi),심범진(Bum-Jin Shim),이동철(Dong-Chul Lee),손욱진(Oog-Jin Shon) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.4

목적: 원위 경골 골절에서 금속정 고정술과 최소 침습적 금속판 고정술의 임상적 및 방사선학적 결과를 비교하였다. 대상 및 방법: 2007년 1월부터 2012년 2월까지 원위 경골 골절로 영남대학교의료원에서 수술을 받은 57예를 대상으로 하였다. 32 예에서 금속정 고정술을(금속정군), 25예에서 최소 침습적 금속판 고정술을(금속판군) 시행하였다. 임상적 결과는 족관절의 운동범위 와 American Orthopaedic Foot and Ankle Society (AOFAS) 점수와 Olerud-Molander 족관절 점수를 비교하였다. 방사선학적 결과 는 골유합 시기와 관상면 및 시상면에서의 부정 정렬 및 단축의 정도를 비교하였다. 결과: 금속정군에서 술 후 6개월까지 더 좋은 족관절 운동 범위를 보였으나 최종 추시에서는 유의한 차이가 없었다. 최종 추시의 AOFAS 점수와 Olerud-Molander 족관절 점수는 양 군 간에 유의한 차이가 없었다. 금속정군에서 관상면과 시상면상에서 5도 이상 의 부정 유합이 각각 1예 발생하였다. 금속판군에서 불유합이 1예 발생하였으나 자가골 이식술 시행 후 골유합을 얻을 수 있었다. 결론: 원위 경골 골절에서 금속정 고정술이 최소 침습적 금속판 고정술에 비해 더 빠른 재활이 가능하였다. Purpose: The purpose of this study was to compare the results of treatment of distal tibial fractures between intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO). Materials and Methods: Between January 2007 and February 2012, 57 patients (57 cases) were treated for distal tibial fractures. Thirty-two patients (32 cases) were treated with IM nailing (nail group) and the 25 patients (25 feet) were treated with MIPO (plate group). Clinical results were compared using range of motion (ROM) of the ankle joint, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Olerud-Molander score between nail group and plate group. Radiographic results were compared using mean bony union time, coronal and sagittal malunions, and shortening between the groups. Results: Mean ROM of the ankle joint was significantly larger in nail group until 6 months after surgery; however, it was not different between two groups at the last follow-up. AOFAS score and Olerud-Molander score were not different between two groups at the last follow-up. In the nail group, two malunions more than 5 degrees were observed in coronal and sagittal planes, respectively. One case showed non-union in the plate group, however, bone union was obtained after autogeneous bone graft. Conclusion: Treatment using IM nailing is more advantageous in terms of postoperative rehabilitation than MIPO in distal tibial fractures.

비정형적 대퇴골 골절에서 골수강 내 정을 이용한 내고정 후 테리파라타이드(Teriparatide)의 투여가 골절의 치료에 미치는 영향

박철현(Chul Hyun Park),손욱진(Oog Jin Shon),문정재(Jeong Jae Moon),심범진(Bum Jin Shim),허재희(Jae Hee Heo) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 비정형적 대퇴골 골절 환자에서 골수강 내 정을 이용한 수술 후 teriparatide의 투여가 골절의 치유에 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 2009년 1월부터 2013년 12월까지 비정형적 대퇴골 골절로 골수강 내 정을 이용하여 수술을 시행한 26명(26예)을 대상으로 하였다. 이 중 수술 후 teriparatide를 투여하지 않은 15예(비투여군)와 투여한 11예(투여군)로 나누어 임상적 평가 및 방사선적 평가를 진행하였다. 결과: 수상 전의 보행 정도로 회복하는 데 걸린 기간 및 수술 후 골절 부위의 통증이 visual analogue scale 2점 이하가 되는 데 걸린 기간은 투여군에서 비투여군에 비해 유의하게 빨랐다. 최초 가골 및 가골교 형성 시기와 골유합 시기는 투여군에서 비투여군에 비해 유의하게 빨랐다. 수술 후 비투여군에서는 지연유합이 5예(33.3%), 불유합이 1예(6.7%) 발생하였고, 투여군의 모든 환자는 골유합을 얻었다. 결론: 비정형적 대퇴골 골절 환자에서 골수강 내 정을 이용한 수술 후 teriparatide의 투여가 임상적 및 방사선적 결과를 호전시켰다. 그러므로 비정형적 대퇴골 골절 환자에서 수술 후 teriparatide의 투여는 골절의 유합을 촉진시킬 수 있는 유용한 방법이라고 생각한다. Purpose: The purpose of this study is to evaluate the effects of teriparatide administration on fracture healing after intramedullary nailing in atypical femoral fractures. Materials and Methods: We retrospectively reviewed 26 patients (26 cases) with atypical femoral fracture who were treated using intramedullary nailing between January 2009 and December 2013. Teriparatide was not administered to 15 patients (non-injection group) and was administered to 11 patients after surgery (injection group). Clinical results were assessed using the Nakajima score and the visual analogue scale (VAS). Radiographic results were compared for the time of callus formation, callus bridge formation, and bone union between the groups. Results: Time to recover walking ability and to decrease pain in the surgery region (VAS≤2) were significantly shorter in the injection group than in the non-injection group. The time of callus formation, callus bridge formation, and bone union was significantly shorter in the injection group than in the non-injection group. There were 5 cases of delayed bone union (33.3%) and 1 case of none union (6.7%) in the non-injection group and all cases obtained bone union in injection group. Conclusion: The injection group showed better clinical and radiographic results than the non-injection group after intramedullary nailing in atypical femoral fracture. Therefore, we think that teriparatide administration after intramedullary nailing could be a useful treatment option to promote bone union.

골다공증성 고관절 골절 환자에서 테리파라타이드 치료 후 골밀도와 골 표지자의 변화

박응규(Eung-Kyoo Park),백승훈(Seung-Hoon Baek),심범진(Bum-Jin Shim),정보길(Bo-gil Jeong),김신윤(Shin-Yoon Kim) 대한정형외과학회 2023 대한정형외과학회지 Vol.58 No.2