수부 재건을 위한 동맥화 정맥 피판의 확장된 적응증과 임상적 유용성의 재조명

우상현,김경철,이기준,하성한,유선오,김주성,Woo, Sang-Hyun,Kim, Kyung-Chul,Lee, Gi-Jun,Ha, Seung-Han,You, Sun-O,Kim, Joo-Sung 대한미세수술학회 2005 Archives of reconstructive microsurgery Vol.14 No.1

Purpose: The purpose of this study is to present extended indications for the use of arterialized venous flaps in reconstructing soft tissue, tendon, nerve, blood vessel, and composite tissue defects of the hand of various sizes based on researches and clinical experiences of the authors. Moreover, procedures to achieve complete flap survival and postoperative results are presented. Materials & methods: This study is based on 154 cases of arterialized venous flaps performed to reconstruct the hand during the past 11 years. The most common cause of injury was industrial accidents with 125 cases. One hundred thirty patients or 84% of the cases had emergency operation within 2 weeks of the injury. The flaps were categorized depending on the size of the flap. Flaps smaller than $10\;cm^2$ were classified as small (n=48), those larger than $25\;cm^2$ classified large (n=42) and those in between medium (n=64). Classified according to composition, there were 88 cases (57.1 %) of venous skin flaps, 28 cases of innervated venous flaps, 15 cases of tendocutaneous venous flaps, which incorporated the palmaris longus tendon, for repair of extensor tendons of the fingers, and 17 cases of conduit venous flaps to repair arterial defect. There were 37 cases where multiple injuries to multiple digits were reconstructed. Moreover, there were 6 cases of composite tissue effects that involved soft tissue, blood vessels and tendons. The donor sites were ipsilateral forearm, wrist and thenar area, foot dorsum, and medial calf. The recipient sites were single digit, multiple digits, first web space, dorsum and palm of hand, and wrist. Results: There were seven cases (4.5%) of emergent re-exploration due to vascular crisis, and 3 cases of flap failure characterized by more than 50% necrosis of the flap. The survival rate was 98.1 % (151/154). In small flaps, an average of 1.01 afferent arteries and 1.05 efferent veins were microanastomosed, and in large flaps, an average of 1.88 afferent arteries and 2.19 efferent veins were anastomosed. In 8 cases where innervated flaps were used for reconstructing the palm of the hand, the average static two-point discrimination was $10\;(8{\sim}15)\;mm$. In 12 cases where tenocutaneous flaps were used, active range of motion at the proximal interphalangeal joint was 60 degrees, 20 degrees at the distal interphalangeal joint, and 75 degrees at the metacarpophalangeal joint. Conclusion: We conclude that the arterialized venous flap is a valuable and effective tool in the reconstruction of hand injuries, and could have a more comprehensive set of indications.

관절경을 이용한 관절내 원위 요골 골절의 치료

박민종(Min Jong Park),하성한(Sung Han Ha) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.3

목적: 관절내 원위 요골골절의 치료 시 관절경을 사용하였던 환자를 대상으로 임상적 결과를 평가하여 수술 시 관절경의 유용성을 분석하고자 하였다. 대상 및 방법: 원위 요골의 관절내 골절로 관절경을 이용하여 수술을 시행하고 1년 이상 추시 가능하였던 환자 22명을 대상으로 하였다. 모든 환자에게 관절경을 시행하였으며 14예의 1㎜ 이상 전위된 관절내 골절의 정복과 고정은 11예에서 관절경의 도움 하에서 정복을 시도하고 경피적 핀 고정을 시행하였고 3예는 제한적인 절개를 통한 관혈적 정복을 추가로 실시하였다. 수술 후 최종 기능의 평가는 방사선 촬영의 분석과, 관절운동 범위, 파악력 측정 등 객관적 자료와 동통, 기능 상태, 관절운동, 근력, 환자의 만족도를 통한 종합적인 평가 시스템인 Modified Mayo Wrist Scoring System을 이용하였다. 결과: 전례에서 방사선 촬영 결과 요골 단축, 요골 원위 관절면의 층형성과 간격은 모두 1㎜ 이하였으며 파악력은 정상 측에 대하여 평균 87.3%, 운동범위는 89.6%였고 Modified Wrist Score는 평균 91.8점(범위 75-100)이었다. 결론: 관절내 원위 요골 골절 환자의 치료에서 관절경을 이용한 수술은 합병증을 줄이고 기능을 보다 향상 시킬수 있는 좋은 치료 방법으로 사료된다. Purpose: The purpose of this study was to investigate the usefulness of wrist arthroscopy for treating intra-articular fractures of the distal radius. Materials and Methods: Twenty-two patients with intra-articular fracture of the distal radius received arthroscopic surgery. Fourteen patients with displaced intra-articular fractures were managed by arthro-scopically assisted reduction and fixation. Three patients were treated with limited open reduction and fixation. We analysed the radiologic results, and measured the ranges of motion and grip strengths. Fuctional results were evaluated using the Modified Mayo Wrist Scoring System. The postoperative follow-up period averaged 16.8 months. Results: All showed articular step-off of less than 1 ㎜ on wrist X-rays taken at the final follow-up (mean 0.3 ㎜; range, 0-1 ㎜). The mean arc of range of motion was 89.6% of that on the uninjured side, and the mean grip strength was 87.3% of that of the uninjured side. The average Modified Wrist Score was 91.8 (range, 75-100). Conclusion: Arthroscopic-assisted surgery is an useful method that provides excellent results with few complications in the treatment of intra-articular fractures of the distal radius.

족근-중족 관절 골절 탈구의 치료경험

정영기,유정한,박용욱,노동근,하성한,Chung, Yung-Khee,Yoo, Jung-Han,Park, Yong-Wook,Noh, Dong-Geun,Ha, Sung-Han 대한족부족관절학회 1997 대한족부족관절학회지 Vol.1 No.2

Tarsometatarsal fracture-dislocation is uncommon but severe lesion. Since this lesion is sometimes difficult to recognize by roentgenography, it is easily overlooked. Three patients were treated with open reduction and internal fixation with 3.5 mm cannulated screw and K-wire, two had treatment with open reduction and internal fixation with 3.5 mm cannulated screw only and two had treatment with dosed reduction and short leg cast only between January 1994 and May 1996. The duration of follow-up ranged from twelve to twenty-nine months after the diagnosis. Results were assessed by a subjective questiormaire, physical examination, and radiographic analysis. Multiple fixation techniques for maintaining the reduction of tarsometatarsl joint have been introduced. We recent]y used the 3.5 mm cannulated screw for internal fixation of the tarso-first and second metatarsal fracture-dislocation. We think cannulated screw fixation has several advantages; 1. The cannulated screw fixation is more rigid than the K-wire fixation. 2. There is an decreased risk of screw breakage with early weight bearing. 3. It is possible to compress the involved joints, if necessary. There were no disability in all patients. One patient who was treated with delayed open reduction and internal fixation with 3.5 mm cannulated screw and K-wire had a radiographic mild degenerative arthritis. And one patient who was treated with dosed reduction and short leg cast had a mild metatarsus adductus. But. these two patients were symptom free. There was no correlation between the severity of the diastasis and the patient s functional result.

견관절 전방 불안정성 평가에서의 자기공명 관절조영술

김진섭(Jin Sub Kim),박용욱(Yong Wook Park),유정한(Jung Han Yoo),정영기(Yung Khee Chung),하성한(Sung Han Ha) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.5

Symptomatic Neural Loop of the Distal Ulnar Nerve

Hyun Il Lee(이현일),Min Jong Park(박민종),Gi Jun Lee(이기준),Sung Han Ha(하성한) 대한정형외과학회 2014 대한정형외과학회지 Vol.49 No.3

척골관 증후군의 감압 수술 중 발견된 원위 척골 신경의 해부학적 변이를 보고하고자 한다. 척골 신경은 신경 고리 형태의 해부학적 변이를 보이고 있었으며 이 고리의 중앙으로 척측 수근 굴곡근이 통과하는 양상이었다. 능동적 손목 움직임 시 척측 수근 굴곡근에 의한 동적인 압박이 환자의 척골 신경 증상을 유발한 것으로 판단되었으며 신경박리술과 주위 조직의 이완술 후 증상의 회복을 관찰하였다. 척골 신경의 압박성 신경병증이 의심되는 완관절 척측 통증 환자의 경우 이와 같은 해부학적 변이가 압박성 신경병증의 원인이 될 수 있음을 주지하여야 할 것이다. We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon’s canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

급성 외상성 견관절 전방 탈구의 관절경적 관찰

김진섭(Jin Sub Kim),오창수(Chang Soo Oh),박용욱(Yong Wook Park),유정한(Jung Han Yoo),정영기(Yung Khee Chung),하성한(Sung Han Ha) 대한정형외과학회 1998 대한정형외과학회지 Vol.33 No.1