유잉 육종의 치료에서 수술의 역할

전대근,이종석,김석준,박현수,장진대,이수용,Jeon, Dae-Genn,Lee, Jong-Seok,Kim, Sug-Jun,Park, Hyun-Soo,Jang, Jin-Dae,Lee, Soo-Yong 대한근골격종양학회 1996 대한골관절종양학회지 Vol.2 No.1

The traditional methodology in Ewing's sarcoma was chemotherapy and radiotherapy. Recently surgery is reemerging as an important therapeutic tool and some paper report increased survival with it. The purpose of this nonrandomized study is to evaluate our result of Ewing's sarcoma with surgery, retrospectively. We experienced 30 cases for seven years and among them 6 were extraskeletal. In location, axial was 10 cases and peripheral was 20. By Enneking's classification, state IIB was 26 cases and IIIB was 4. Eighteen patients took operation, chemotherapy and/or radiotherapy, and remaining twelve took chemotherapy and/or radiotherapy only. Type of operation was limb salvage in 16 cases and amputation 2. Average dosage of radiation was 45.1Gy. Six kinds of chemotherapeutic regimen were used, but among them main protocols were Ifosfamide-Adriamycin(17 cases) and IESS(Cytoxan, Adriamycin, Methotrexate, Vincristine:8 cases). Complications were as follows. In operation group, there were 3 local recurrence and one case of nonunion. In nonoperated group, one local recurrence and one pancytopenia resulting in death. Average follow up was 29.7 months. Kaplan-Meier's ten year actuarial survival rate for the whole 30 cases was 26.8%. Significant difference in survival exists between central and peripheral lesions(p=0.05, by log rank test). Types of chemotherapy and surgery itself showed no significance. But surgery is important in function and local control. More intensive chemotherapeutic regimen to prevent distant metastasis and combined surgery and radiotherapy may be needed in Ewing's sarcoma.

전이성골암에 의한 통증에 대한 Salmon Calcitonin($Miacalcic^{(R)}$) 비강분무의 효능 및 안정성

이수용,전대근,이종석,김석준,홍석일,최수용,장진대,Lee, Soo-Yong,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Hong, Seok-Il,Choi, Soo-Yong,Jang, Jin-Dae 대한근골격종양학회 1996 대한골관절종양학회지 Vol.2 No.1

Metastaic bone tumors are usually accompanied with severe pain. The treatment modalities for this pain are so variable that patients are sometimes afraid of using them. Salmon calcitonin has a function to increase beta-endorphines followed by increasing the blood level of prostaglandin and thromboxan A2, which results in analgesic effect. This drug also has been known to decrease bone resorption. There were a few reports that parenteral use of salmon calcitonin decrease the pain from metastatic bone tumor. We wanted to know the effectiveness and tolerability of nasal spray of salmon calcitonin in relieving bone pain with metastatic tumor. We analyzed the effectiveness in the aspects of pain, sleep, performance status, mobility, supplementary analgesic use. The biologic effect of salmon calcitonin was analysed with CBC, Ca/P, BUN/Cr, uric acid. Simple radiography, alkaline phosphatase, osteocalcin, pyrilink-K were used as parameters for bone change. Eighteen cases of metastatic bone tumors took nasal spray of salmon calcitonin($Miacalcic^{(R)}$, 200IU/day) for 4 weeks, to relieve bone pain. With Wilcoxon Matched-Pairs Signed Ranks Test, we could find pain decreased significantly at 3 week and mobility become improved at 4 week of salmon calcitonin use. Other parameters didn't show any significant changes. We think the analgesic effect is mainly due to effect not on the local bone lesion but on the central nervous system, and that increased dose of salmon calcitonin can induce earlier and stronger analgesic effect.

골 및 연부 조직 종양에서의 미세 침 흡입 세포 검사

이수용,전대근,이종석,김석준,조경자,오형호,박민효,박현수,장진대,Lee, Soo-Yong,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Cho, Kyung-Ja,Oh, Hyung-Ho,Park, Min-Hyo,Park, Hyun-Soo,Jang, Jin-Dae 대한근골격종양학회 1996 대한골관절종양학회지 Vol.2 No.1

From January 1994 to August 1995 we performed 270 cases of fine needle aspiration cytology for bone and soft tissue lesions. Among them 137 cases were diagnosed histologically. Sixty-seven cases were benign and 70 cases were malignant. We analysed these on the aspect of sensitivity, specifity, positive predictive value, negative predictive value of the cytologic examination. Malignant cases consisted of bone tumor 29 cases; soft tissue tumor 25 cases; and metastatic tumor 16 cases. The sensitivity and specifity of the aspiration cytology for malignant tumor were 67.8% and 97%, respectively. The positive and negative predictive value of aspiration cytology were 97.4% and 72.7%, respectively. Among them 40 cases were primary bony lesions; 14 benign lesions, 26 malignamt bone tumors. Sensitivity of aspiration cytology for these primary bony lesion was 90%(18/20) and its specifity was 100%(13/13). Three cases showed atypical cells in cytology but with biopsy we could find them as one benign and two malignancies. Two cases of manignancy showed negative result in cytology; one was parosteal sarcoma of proximal femur and the other was osteosarcoma of proximal tibia which was biopsied already at other hospital. Although the overall sensitivity and specifity for malignant bone and soft tissue tumors were relatively low and not so predictable, the fine needle aspiration cytology for primary bony lesion was useful in the differential diagnosis of benign or malignancy.

슬관절 재전치환술시 골 결손의 처치

이명철(Myung Chul Lee),성상철(Sang Cheol Seong),조현철(Hyunchul Jo),이상훈(Sang Hoon Lee),장진대(Jin Dae Jang),박상은(Sang Eun Park),임수택(Soo Taek Lim),황창주(Chang Joo Hwang) 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.2

퇴행성 슬관절염의 관절경적 치료

이명철,성상철,장진대,조현철,유재호 대한슬관절학회 2001 대한슬관절학회지 Vol.13 No.1

Purpose: To evaluate the efficacy and the prognostic factors in arthroscopic treatment of degenerative arthritis of the knees Materials and Methods: The results of 115 knees in 110 patients had been treated arthroscopically from Jan. 1990 to June 1999 were analysed. Mean age was 56 years old and mean follow-up period was 1 years 9 months(range: 1 year-7 year). Pain, Range of motion, Lysholm score, and changes of subjective symptoms were assessed for clinical evaluation, Preoperative and postoperative X-rays of the knees and arthroscopic findings were also reviewed and statistical analysis was performed. We tried to find out the clinical results and prognostic factars in arthroscopic treatment of the degenerative arthritis. Results: The best clinical improvement was observed in postoperative 1∼2 year period and the clinical improvement was continued by 3 years after surgery. Sixty two percents of patients had significant improvement of subjective symptoms for 1∼2 year postoperatively, and 52% for at least 3 years after surgery. The patients of younger age, normal weight, normal alignment of lower leg(1°∼7° degree of tibio-femoral angle) and shorter duration of preoperative symptoms showed better clinical results. Eighty percents of improvement of subjective symptoms has been obseved in the group of patient who had the mechanical symptoms preoperatively. In the knee with mild cartilage degeneration(according to Jackson's classification, stage I or II) and with torn meniscus showed better clinical improvement after surgery compared with those of severe cartilage degeneration or intact menisci. Conclusion: Arthroscopic treatment can be considered as a succesful treatment method for temperary relief of symptoms in the degenerative arthritis of knees. However, careful selection of patients looks mandatory for favorable results. The favorable prognostic factors in the study were younger age, no obesity, shorter duration of symptoms, nearly normal alignment of knees, less cartilage degeneration, mechanical symptoms, a torn meniscus.

슬관절 전치환술 후 발생한 인공삽입물 주위 골절

이명철,박상은,조현철,성상철,서성욱,장진대,최지욱 대한슬관절학회 2000 대한슬관절학회지 Vol.12 No.1

Purpose : To analyse of the result of the treatment of periprosthetic fractures after total knee arthroplasty Materials and Methods: We reviewed 11 knees of 11 patients with supracondylar periprosthetic fractures who underwent total knee arthroplasty between July 1989 and October 1998. There are 1 man and 10 women. The average follow-up period was 24 months(Range, 6 - 61). The patients were grouped according to the treatment methods; Group I is the patients who were treated by cast or cast brace. Group II is the patients who were treated by skeletal traction followed by cast or cast brace. Group III is the patients who were treated by retrograde intramedullary nails, We analysed time required for union, tibiofemoral angle after union, Range of motion and HSS score of each group. Results: Time required for union is shorter in Group I and III than Group II. Tibiofemoral angle after union is not significant change in all Groups postoperatively. ROM was not decreased in Group III but there was significant changes. HSS score was decreased in Group II, 85 preoperatively and 64 postoperatively. Conclusion: Cast or Cast brace only can be recommended for knees in which the initial alignment and stability of fracture were in acceptab1e range, In knees with malaligned and unstable periprosthetic fracture, retrograde IM nails can be recommended for better clinical and radiological results.

비대칭적 경골 치환물을 사용한 슬관절 전치환술의 임상적, 방사선학적 결과

조현철,이명철,김재광,박상은,김상림,성상철,임창균,장진대 대한슬관절학회 2000 대한슬관절학회지 Vol.12 No.2

Purpose : Purpose of this study was to evaluate the clinical and radiological results and complications of total knee arthroplasty(TKA) using the systems including an asymmetric tibial tray and a deep trochlear-grooved femoral component. Materials and Methods: Ninety-five total knee replacement arthroplasties(68 patients) with the implant system, which has the asymmetric tibial tray and a deep trochlear grooved femoral component were analyzed clinically and radiologically. Retrograde analysis with the Knee Society clinical rating system, roentgenographic evaluation and scoring system and the Hospital for Special Surgery(HSS) score were done. The patients were average 66 years old and the follow-up period was 23month(range, 12 month to 49 month) Results : Knee score was improved from 43 points to 90 points. Function score was improved from 47 points to 85 points. HSS score was improved 57 points to 89 points. Tibio-femoral angle was improved from varus 4o to valgus 5o. In last clinic visit, there was no case which had progressive radiolucent line or above 4 points in radiolucent score except one septic loosening case. There was no case of patellofemoral complications, including patellofemoral instability, patellar fracture, patellar component failure, patellar component loosening, and patellar clunk syndrome. Conclusion: The TKA in this series showed excellent clinical and radiological results and low incidence of patellar complication.

경피적 장력대 강선 고정법과 개방성 장력대 강선 고정법을 이용한 슬개골 골절의 치료

김재윤,이명철,박상은,조현철,김상림,성상철,장진대 대한슬관절학회 2000 대한슬관절학회지 Vol.12 No.1

Purpose: By comparing the results of the percutaneous tension band wiring with those of the open tension band wiring for the treatment of patellar fracture, we tried to show the practical use of the percutaneous tension band wiring. Materials and Methods: We analyzed radiological and clinical results of 10 cases of isolated patellar fractures treated with the percutaneous tension band wiring and 10 cases of isolated patellar fractures treated with the open tensian band wiring. Results: There were no significant differences between the percutaneous tension band wiring and open tension band wiring on operation time, knee score and function score, but the percutaneous tension band wiring showed more rapid on bony union. Two cases treated with the open tension band wiring showed limitation of motion of the knee joint, and one case treated with the open tension band wiring showed patellar elongation. Conclusion: Comparing with the open tension band wiring, the percutaneous tension band wiring can be done without wide skin incision and can give patients more satisfaction. We concluded that the percutaneus tension band wiring is a good method and can replace the conventional open tension band wiring.