골수강내 금속정 고정 및 나사못 맞물림법을 이용한 장골골절의 지연 및 불유합의 치료

한홍준,이병창 圓光大學校 醫科學硏究所 1990 圓光醫科學 Vol.6 No.1-2

Interlocking nailing method has many advantages for treatment of delayed or non-union of long bone fractures. During the reaming of medullary cavity, bone marrow tissues are pushed out under the subperiosteal space and act as an “autotransplant”. The reaming itself also removes some of the intramedullary fibrous tissue and debris at the non-union site, which is delaying factor of bone healing. Destroyed medullary circulation caused by reaming is overcome by enhanced periostral vascularity. In addition to the above mentioned advantages, the interlocking nail allows stable, dynamic intramedullary osteosynthesis, and early weight bearing enhances bone healing process. The authors analyzed the 19 cases of delayed or non-union which were treated with the interlocking nail, and the result were as follows. 1. There were 10 cases of delayed union and 9 cases of nonunion. 2. As a primary treatment method, there were 9 cases of external fixation among 19 cases. 3. All of the cases were united. 4. Bridging callus appeared at 4 months and complete union was obtained at 7.6 months. 5. 9 cases of open nailing and 7 cases bone graft were performed, but no infections were developed among them. 6. Post-operative deep infection was developed in 1 case (5%). 7. Interlocking nailing was thought to be useful to treat delayed or nonunion of long bone fractures if there was no active infection or large soft tissue defect.

심한 골 결손에 대하여 전 근위 대퇴골 동종골을 이용한 인공 고관절 재치환술 : 증례 보고 2례 2 Cases Report

한홍준,김재명,이원구 대한정형외과학회 골.연부조직이식학회 2003 대한골.연부 조직이식학회지 Vol.3 No.1

감마금속정을 이용한 불안정성 대퇴 전자부골절의 치료

한홍준,유희준 대한골절학회 1996 대한골절학회지 Vol.9 No.1

The Gamma nail was designed to treat unstable intertrochanteric and subtrochanteric fractures with the theoretical advantages of a load-sharing component which could be implanted by a semi-closed procedure. We report a retrospective study of 27 unstable peritrochanteric fractures treated by the Gamma nail. Gamma nail were implanted with an average duration of anesthesia of 84 minutes and little intra- operative bleeding by a semi-closed technique. Complications were few, and clinically not implant except one case of femoral shaft fracture at the distal end of the nail which healed weli after treatment with Gamma nail and circlage wiring.

심한 개방성 경골 간부 골절의 혼합형 외고정 장치와 제한적 내고정술을 이용한 치료

한홍준,채수욱,정을오 대한골절학회 2003 대한골절학회지 Vol.16 No.1

목 적 : 경골 간부의 심한 개방성 골절에 대해 혼합형 외고정 장치를 이용한 외고정술과 제한적 내고정술을 시행 후 결과를 분석하여 임상적 유용성을 알아 보고자 한다. 대상 및 방법 : 1998년 6월부터 2001년 6월까지 경골 간부 골절중 Gustilo분류상 Ⅱ형 이상의 심한 개방성 골절시 본원에서 개발한 혼합형 외고정 장치(AnyFix??)와 함께 제한적 내고정술을 시행후 1년이상 추시 관찰이 가능한 25례의 환자를 대상으로 하였다. 남자는 20례, 여자는 5례였으며 평균 연령을 45세(11세-72세)이었고, 결과는 방사선학으로 골유합 기간과 지연 유합, 불유합, 부정 유합의 여부등을 분석하였으며, 수술후와 최종 추시상에 임상적으로 동통 유무, 관절 운동범위, 창상 감염 발생, 연부 조직 피복등을 관찰하였다. Gustilo분류상 Ⅱ형은 6례 Ⅲa형은 9례, Ⅲb형은 10례였다. 손상 원인으로는 교통사고가 18례, 추락 사고가 2례, 압궤 손상이 5례이였다. 결 과 : 25례중 15례에서 합병증 병발없이 골유합을 얻었으며 골유합기능은 평균 6.8개월이었다. 10례는 개방성 창상을 동반한 골결손과 심한 분쇄골절로 염증 조절후 조기에 2차적 골이식이 필요하였는데 이 중 9례에서 외고정 장치의 재고정없이 골유합을 얻었고 평균 골 유합 기간은 8.7개월이었고, 1례에서만 불유합으로 골수내 금속정 삽인 및 골이식술을 시행하였다. 골절 부위의 동통을 호소한 경우는 없었으나 2례에서만 경도의 관절강직 소견이 보였고, 창상 감염은 2례에서 발생하여 항생제 치료 및 창상 소독으로 치료 되었다. 심한 연부조직 손상을 동반한 5례중 외고정 장치의 재고정없이 3례에서 피판 이식술을 시행하였으며, 1례에서 근육 이전술, 1례에서 광범위한 피부 이식술을 시행하여 적절한 연부 조직 피복이 가능하였다. 결 론 : 경골 간부의 심한 개방성 골절에서 혼합형 외고정 장치와 제한적 내고정술을 이용하여 골절편의 해부학적 안정적 고정으로 조기 골유합을 얻을 수 있으며, 부수적인 연부조직 손상없이 고정이 가능하다는 점에서 유용한 방법이라 사료되며 혼합형 외고정 장치는 장치의 교체없이 골이식술이나 연부조직 재건술이 가능하다는 점에서 유용한 방법이라 사료된다. Purpose : To evaluate the radiographic and clinical results of severe open tibial shaft fracture treated by hybrid external fixation and limited internal fixation. Materials and Methods : We reviewed 25 patients open tibial shaft fracture(≥Gustillo classification type Ⅱ) which were treated with hybrid external fixation(AnyfixR) that was invented by authors and limited internal fixation between June 1998 to June 2001. 20 males and 5 females were minimum follow up period of 12 months(12-27 months). The mean age was 45 old years(11-72 old years). The results were based on the assessment radiographical analysis with duration of bony union, delayed union including of states of nonunion and malunion, clinical analysis with pain, joint range of motion, wound infection and skin & soft tissue coverage. All fractures were classified according to the Gustilo classification, there were 6 cases of type Ⅱ, 9 cases of type Ⅲa and 10 cases of type Ⅲb. The cause of injury, there were 18 cases of motor vehicle accident, 5 cases of direct trauma and 2 cases of fall from height. Results: In twenty-five cases, fifteen had union, the average time of bone union was 6.8 months and additional bone graft without change of external fixator performed in ten cases, but one case have failed and then change of intramedullary nail with bone graft. In the group of bone graft, bone union was completed at mean 8.7 months. According to the clinical analysis, no pain in the fracture site, in complications, there were 2 cases of mild joint range of motion that has acceptable result and 2 cases of wound infection were treated with effective antibiotics theraphy and wound dressing. Five cases need to coverage of the open wound, 3 cases were flap operation and each case were muscle transfer, skin graft without change of external fixator. Conclusion: The use of hybrid external fixation and limited internal fixation in severe open tibial shaft fracture to be successful for the stabilization of fracture and subsequent plastic and/or orthopaedic procedure for muscle and skin coverage, bone grafting are more easily accomplished without change of external fixator.

石斛이 卵巢摘出로 骨多孔症이 誘發된 흰쥐에 미치는 影響

한홍준,김종환,조한백,최규섭 대한한의학회 부인과학회 2000 大韓韓方婦人科學會誌 Vol.13 No.2

Osteoporosis is one of the most common metabolic bone disease. When the bone density is reduced to the level below the fracture threshold, the risk of fracture is greatly increased. A trivial trauma can easily cause one or more bones to break in a person with severe osteoporosis. So it is a major health problem. Physicians and patients are concerned with the optimum approach to the treatment and prevention of osteoporosis. Until a recent date, many oriental medicine studies were performed to find the preventive and curative efficacy on the osteoporosis. The proper use of Herb-med are issues that have generated major research efforts. The purpose of this study is to examine what are the effects of the Herba Dendrobii(HD) on the ovariectomized rat model of postmenopausal osteoporosis. The results of the experiment are as follows: 1. Body weight in control group showed significant increase in comparison with sham, but that in HD-treated showed no change in comparison with control. 2. The level of serum albumin in control group showed significant decrease in comparison with sham. That in HD-treated was slightly decreased in comparison with control. 3. The level of serum ALP activity in control group showed significant increase in comparison with sham, but that in HD-treated was significantly decreased in comparison with control. 4. The level of serum phosphorous in control group showed significant increase in comparison with sham, but that in HD-treated showed no change in comparison with control. 5. The level of serum calcium in control group showed no change in comparison with sham, but that in HD-treated was significantly decreased in comparison with control. 6. The level of serum T4 in control group showed significant increase in comparison with sham, and that in HD-treated showed significant decrease in comparison with control. 7. The level of serum T3 in control group showed no change in comparison with sham, but that in HD-treated was significantly decreased in comparison with control. 8. Mechanical strength of the femur neck in control group showed significant decrease in comparison with sham. That in HD-treated showed no change in comparison with control. According to the above these results, HD has shown to be capable of preventing and curing osteoporosis caused by and postmenopause.

Two Cases of Acute Glufosinate Ammonium Intoxication with Disparate Outcomes

한홍준,정주호,Han, Hong Joon,Jeong, Ju Ho Korean Society for Rural Medicine and Community He 2018 농촌의학·지역보건 Vol.43 No.2

목적 글루포시네이트암모늄은 비선택성 제초제로 1984년 일본에서 개발되었으며, 급성 중독시에는 위장관계 증상뿐만 아니라 의식변화, 경련, 호흡부전 및 기억소실 등과 같은 다양한 임상증상을 보이는 것으로 알려져 있다. 한국에는 1994년 소개된 이후로 널리 사용되고 있으며, 사용량의 증가와함께 음독환자가 점점 증가하여 사회적 문제가 되고 있다. 저자들은 최근 글로포시네이트 중독 환자에서 초기치료 후 지연성 악화를 보였던 2례를 문헌고찰과 함께 보고하고자 한다. 방법 및 결과 첫 번째 증례는 62세의 남자환자로 음주상태에서 글루포시네이트암모늄 음독 후 의식 저하 상태로 발견되어 응급실로 이송되었다. 응급 위세척을 시행 후 보존적 치료 및 집중모니터링을 유지하였고, 의식수준은 6시간 후에 거의 명료한 상태로 호전되었다. 지연성 악화의 가능성에 대해설명하고 지속적인 경과관찰 및 치료를 위해 집중치료실 입원이 필요함에 대해 설명하였으나, 환자와 보호자는 타상급병원으로의 전원을 원하였다. 환자는 이송 중에 발생한 심폐정지로 심폐소생술을 시행하였으나, 회복되지 못하고 사망하였다. 두 번째 증례는 54세의 남자 환자로 글루포시네이트암모늄 음독 후 발생한 의식 변화로 응급실로 이송되었다. 내원시 의식은 혼미한 상태였으며 앞의 증례와 같이 응급 위세척을 시행하였다. 본 환자는 초기치료 후 본원 집중치료실에서 지속적인 혈액 및 생화학적 검사를 시행하였으며, 집중모니터링 및 치료를 유지하였다. 입원 2일째 혈액검사 소견은 호전 중이었으나, 경련이 발생하였으며 의식은 혼미한 상태가 지속되었다. 신경과 협진하여 뇌파검사를 시행 후 항경련제를 증량한 후로 경련은 발생하지 않았다. 입원 7일째에는 의식 수준은 거의 명료한 상태까지 호전되었다. 입원 13일째 혈액 및 생화학검사에서 약간의 혈색소 감소 외에는 정상소견을 보였으며, 뚜렷한 신경학적 합병증 없이 퇴원하였다. 결론 급성 글루포시네이트중독 환자는 매우 다양한 임상증상을 보이며 초기치료 후에 상태가 안정적이더라도 지연성으로 임상적 또는 신경학적 악화가 발생할 가능성이 있으므로 치료에 유의하여야 한다.

Huge Aneurysmal Bone Cyst of the Sacrum - A Case Report -

한홍준,박찬우,유찬종,김우경,박진규,이상구 대한척추신경외과학회 2009 Neurospine Vol.6 No.1

We present a rare case of 22-year-old man who had a huge aneurysmal bone cyst of the sacrum. Preoperative adjuvant selective arterial embolization of the branches of internal iliac arteries was performed. The next day, the patient received a radical surgical excision and posterolateral screw fixation. The patient was discharged without neurological problems or symptoms. Currently, the patient has been treated without local recurrence and is symptom free. Overall, in similar cases, an aneurysmal bone cyst, chordoma, osteoblastoma and giant cell tumor should be included in a differential diagnosis based on the imaging studies. We present a rare case of 22-year-old man who had a huge aneurysmal bone cyst of the sacrum. Preoperative adjuvant selective arterial embolization of the branches of internal iliac arteries was performed. The next day, the patient received a radical surgical excision and posterolateral screw fixation. The patient was discharged without neurological problems or symptoms. Currently, the patient has been treated without local recurrence and is symptom free. Overall, in similar cases, an aneurysmal bone cyst, chordoma, osteoblastoma and giant cell tumor should be included in a differential diagnosis based on the imaging studies.

Postoperative Thecal Sac Compression Induced by Hydrogel Dural Sealant after Spinal Schwannoma Removal

한홍준,정주호,김진욱,성원배 대한신경손상학회 2020 Korean Journal of Neurotrauma Vol.16 No.1

Cerebrospinal fluid (CSF) leak is a common complication of spinal and cranial surgery,and patients undergoing spinal tumor surgery are probably particularly predisposed dueto the presence of an intradural tumor and many other factors. Furthermore, a meticulousdural closure technique does not always result in watertight closure. A number of adjunctivemethods have been used to assist with dural closure. Synthetic, absorbable polyethyleneglycol hydrogel dural sealants are widely used and have been approved for use as adjunctsfor cranial applications requiring sutured dural closure. We report a case of thecal saccompression by DuraSeal® Dural Sealant used to repair the CSF leak afer intentionaldurotomy during lumbar schwannoma extirpation.

Minimally Invasive Percutaneous Hydrodiscectomy: Preliminary Report

한홍준,김우경,CK Park,SH Oh,DG Lee,ES Doh 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: The standard of care for surgical treatment of degenerative disc disease (DDD) is open microdiscectomy, but various minimally invasive procedures have been introduced to treat DDD. For example, there are many techniques such as endoscopic discectomy (with or without laser), intradiscal electrothermal therapy (IDET), nucleoplasty, automated percutaneous discectomy (APLD), etc. Among them, some surgical techniques are still used and others have disappeared as a result of their respective advantages and disadvantages. This paper will report the feasibility of percutaneous hydrodiscectomy Methods: A total of 13 patients who underwent hydrodiscectomy from November 2007 to March 2008 at 3 university hospitals and 2 general hospitals, respectively, were evaluated. Preoperative symptoms were low back pain with radiculopathy in 12 cases and back pain only in one case. All of the patients had soft disc herniation. Patients who had a sequestered disc fragment and instability in preoperative dynamic roentgenogram were excluded. Results: There were 13 patients: 10 male and 3 female patients. Mean age was 38.1 years old. The mean duration of the symptoms and conservative treatment period were 18.7±18.3 months and 4.7±1.98 months, respectively. Mean follow-up period was 5.5±1.3 months. Preoperative back and leg visual analogue scale (VAS) scores were 6.2±1.9 and 8.5±1.1, respectively. Postoperative back and leg VAS scores were decreased to 3±1.4 (p<0.05) and 2.7±1.0 (p<0.05), respectively. Preoperative ODI score was 48±19.1% and postoperative ODI score was decreased to 23± 22.1% (p<0.05). Using Odom’s criteria there were 5 patients (38.5%) with excellent results; 7 cases with good results (53.8%); and one patient with a poor result (7.7%). Conclusion: Percutaneous hydrodiscectomy could be a good alternative procedure in surgical treatment of lumber disc degenerative disease. The present series demonstrates promising early clinical results, but more long term follow-up and additional cases are needed to confirm these initial results. Objective: The standard of care for surgical treatment of degenerative disc disease (DDD) is open microdiscectomy, but various minimally invasive procedures have been introduced to treat DDD. For example, there are many techniques such as endoscopic discectomy (with or without laser), intradiscal electrothermal therapy (IDET), nucleoplasty, automated percutaneous discectomy (APLD), etc. Among them, some surgical techniques are still used and others have disappeared as a result of their respective advantages and disadvantages. This paper will report the feasibility of percutaneous hydrodiscectomy Methods: A total of 13 patients who underwent hydrodiscectomy from November 2007 to March 2008 at 3 university hospitals and 2 general hospitals, respectively, were evaluated. Preoperative symptoms were low back pain with radiculopathy in 12 cases and back pain only in one case. All of the patients had soft disc herniation. Patients who had a sequestered disc fragment and instability in preoperative dynamic roentgenogram were excluded. Results: There were 13 patients: 10 male and 3 female patients. Mean age was 38.1 years old. The mean duration of the symptoms and conservative treatment period were 18.7±18.3 months and 4.7±1.98 months, respectively. Mean follow-up period was 5.5±1.3 months. Preoperative back and leg visual analogue scale (VAS) scores were 6.2±1.9 and 8.5±1.1, respectively. Postoperative back and leg VAS scores were decreased to 3±1.4 (p<0.05) and 2.7±1.0 (p<0.05), respectively. Preoperative ODI score was 48±19.1% and postoperative ODI score was decreased to 23± 22.1% (p<0.05). Using Odom’s criteria there were 5 patients (38.5%) with excellent results; 7 cases with good results (53.8%); and one patient with a poor result (7.7%). Conclusion: Percutaneous hydrodiscectomy could be a good alternative procedure in surgical treatment of lumber disc degenerative disease. The present series demonstrates promising early clinical results, but more long term follow-up and additional cases are needed to confirm these initial results.

골반골 골절의 진단

한홍준 대한골절학회 1994 대한골절학회지 Vol.7 No.1

비구를 포함한 골반골 골절의 올바른 치료를 위해서는 정확한 진단이 이루어져야겠고, 정확한 진단을 할려면 먼저 해부학적 구조와 병리기전의 이해가 선행되어야 겠다. 골반골 골절에 전산화 단층 촬영이나 3차원적 전산화 단층 촬영등 첨단 장비를 이용함으로써 정확한 진단을 내릴 수 있게 되었으나, 무엇보다도 사고 당시의 정확한 과거력과 이학적 검사, 단순 방사선 사진의 세밀한 판독, 그리고 3차원적 해부학적 구조와 병리기전의 이해가 선행되어야 하며, 단층 촬영이나 기타의 진단 방법들은 이러한 단순 방사선 촬영을 대신한 기본 검사로서가 아닌 보조적인 방법으로 이용되어야 할 것으로 사료된다.