하지 재건에 사용된 국소 피판술의 유용성

백종륜,박종웅,이범구,문도현,김영규,박홍기,전득수,심재앙,신원주,권부경,Baek, Jong-Ryoon,Park, Jong-Woong,Lee, Beom-Koo,Moon, Do-Hyun,Kim, Young-Kyu,Park, Hong-Ki,Jun, Deuk-Soo,Sim, Jae-Ang,Shin, Won-Ju,Kwon, Boo-Kyung 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.2

Purpose: The aim of this study was to evaluate the outcome and the effectiveness of local flaps in lower extremity reconstruction. Materials and Methods: We have performed lower extremity reconstruction with local flap in 14 cases (10 males and 4 females) from May 2006 to February 2008. The mean age was 40.1 years (range, 16~67). The defect site was the tibia in 5 cases, the ankle in 1 case and the foot in 8 cases. The local flaps were reverse flow sural artery flap in 7 cases, gastrocnemius flap in 3 cases, lateral supramalleolar flap in 2 cases, dorsalis pedis flap in 1 case and medial hemisoleus flap in 1 case. Results: All flaps were survived. Venous congestion was developed in 1 case of the rerverse flow sural artery flap but healed with secondary rotational flap. Other flaps were good without any complications. Conclusion: If we choose precisely indicated local flap in lower extremity reconstruction, the resultant coverage of defect would be excellent.

변형된 경피적 술식을 이용한 아킬레스 건 봉합술의 임상적 결과

백종륜,곽지훈,원준성,박홍기,Baek, Jong-Ryoon,Kwak, Ji-Hoon,Won, Jun-Sung,Park, Hong-Gi 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.3

Purpose: To investigate the results of percutaneous repair technique of Achilles tendon ruptures, and to describe the surgical technique. Materials and Methods: We retrospectively analyzed the outcomes of 73 patients with ruptured Achilles tendon from October 1995 to September 2009. 28 patients were excluded due to short follow up period. 34 patients were male and 11 patients were female. The mean patient age was 37.19 (10~62) years. The location of rupture site was 6.58 cm proximal to the tendon insertion into the calcaneus on average. Mean follow up period was 55 months and All patients were surgically repaired using percutaneous technique with sural nerve isolation. Results: Arner-lindholm score were excellent in 32 (71%), good in 12 (27%), poor in 1 (2%) case. 44 cases (98%) had the score more than good. Mean American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot function score was 92.93 (67~100). We had 1 case of superficial infection, 1 case of soft tissue irritation by suture knot. Conclusion: Percutaneous repair with sural nerve isolation in treating ruptured Achilles tendon showed low complication rate and reliable clinical outcome.

전방 경골 동맥에 발생한 가성 동맥류 (1예 보고)

백종륜,박홍기,양상훈,Baek, Jong-Ryoon,Park, Hong-Ki,Yang, Sang-Hoon 대한족부족관절학회 2007 대한족부족관절학회지 Vol.11 No.1

Pseudoaneurysm of the anterior tibial artery is a rare cause of pain and swelling of the lower leg and the foot following minor sports injuries. When there is no definite musculoskeletal cause of pain, it is important to consider pseudoaneurysm. Early diagnosis and management are essential for the successful outcome. MRI and angiogram are useful for early diagnosis. We report a case of pseudoaneurysm of the anterior tibial artery following minor sports injury. The patient experienced complete relief of the symptoms after resection of the pseudoaneurysm.

비외상성 대퇴골두 골괴사증에 Multilock 대퇴스템을 이용한 일차적 인공고관절 치환술 -50세 미만과 50세 이상의 비교-

백종륜 ( Jong Ryoon Baek ),박상원 ( Sang Won Park ),오광준 ( Kwang Jun Oh ),정종원 ( Jong Won Chung ),조형준 ( Hyung Joon Cho ) 대한고관절학회 2005 Hip and Pelvis Vol.17 No.2

신경 이식과 정맥 포장을 이용한 연속성 신경종의 치료 - 1예 보고 -

권부경,백종륜,김동환,Kwon, Boo-Kyung,Baek, Jong-Ryoon,Kim, Dong-Hwan 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.2

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.

건 유착 형성에 미치는 Polylactic Acid 흡수성 Film의 효용성

박상원(Sang Won Park),백종륜(Jong Ryoon Baek),이순혁(Soon Hyuck Lee),정종원(Jong Won Chung),조형준(Hyung Joon Cho) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.1

목적: 건 봉합술 후 생기는 건의 유착 방지에 polylaetic acid 성분의 bioresorbable film이 유용한지 알아보고자 하였다. 대상 및 방법: 가토 24마리(48예)의 저113족지에서 심 족지 굴근을 절단하고 건을 봉합한 후 조작없이 건막을 봉합한 군을 제1군, 건과 건막 봉합 후에 건과 건막 사이에 hyaluronic acid를 주입한 군을 제2군, 건 봉합 후 film을 봉합건 주위에 피복 시킨 후 건막 봉합 술을 시행한 군을 제3군으로 나누어 수술 후 1주, 2주, 3주 및 6주에 조직학적 소견 및 생역학적 평가를 하였다. 결과: 광학 현미경 소견에서 섬유화의 정도는 제1군에서 가장 뚜렷하였고 제2군과 제3군에서는 큰 차이를 보이지 않았다. 만능 시험기를 통한 생역학적 검사상 모든 군에서 시간이 경과할수록 유착력(adhesion strength)은 증가하였다. 술 후 6주에는 제1군이 2군 및 3군에 비해 약 2.5-3배의 유착력을 나타냈고 통계적으로 유의성이 있었으며 제2군이 제3군에 비해 다소 높은 유착력을 나타냈으나 통계적으로 의미있는 차이는 보이지 않았다. 결론: 건 봉합 후 건이 치유됨에 따라 육아조직의 증식과 섬유화가 일어남을 확인하였고 polylactide resorbable film이건 봉합 후 건 유착 방지에 효과가 있었다. Purpose: To evaluate the effectiveness of a polylactic acid bioresorbable film in the prevention of tendon adhesion after tendon repair. Materials and Methods: Twenty-four adult rabbits (48 cases) were used in this study. In the first (control) group, the flexor tendons of the third toe were cut and a tenorrhaphy was performed. The 2nd group was injected with hyaluronic acid between the tendon and tendon sheath after suturing. The 3rd group underwent an enveloping of the tendon with polylactic acid film, followed by tenorrhaphy. The test animals were euthanized at 1, 2, 3, and 6 weeks after surgery, and the histology and biomechanics were evaluated. Results: Microscopic evaluations revealed fibrosis to be most apparent in group 1, while groups 2 and 3 showed no significant differences. The biomechanical tests, which were carried out using a Universal Testing Machine, revealed that an increase in adhesion strength with time. At 6 weeks after surgery, group 1 exhibited an adhesion strength that was 2.5-3 times greater than that exhibited by groups 2 and 3. Group 2 had a higher adhesion strength than group 3, but this difference was not statistically significant. Conclusion: Increases in granulation tissue and fibrosis during the healing of sutured tendons were observed, and the tested polylactide resorbable film was found to be effective in reducing the level of adhesion formation after tendon repair.

전위성 관절내 종골 골절의 관혈적 정복 시종골 후방 조면 골편 정복의 중요성

박홍기 ( Hong Ki Park ),백종륜 ( Jong Ryoon Baek ),최장석 ( Jang Seok Choi ),이상진 ( Sang Jin Lee ),백제원 ( Je Won Paik ) 대한골절학회 2016 대한골절학회지 Vol.29 No.4

목 적: 전위성 관절내 종골 골절의 치료 시 성공적인 관혈적 정복을 위한 요소로, 일차 골절 선에 의한 종골 후방 조면 골편 정복의 중요성을 확인하고자 하였다. 대상 및 방법: 2010년 1월부터 2015년 12월까지 전위성 관절내 골절로 관혈적 정복을 시행한 90예의 환자를 대상으로, 술후 3개월 후방 조면 골편의 외측 전위 정도와 건측과의 종골 길이 및 높이 차이를 측정하여 종골 후방 조면 골편의 정복 상태를 평가하였다. 골절부 간격 및 층 형성 정도, Bohler 각과 Gissane 각의 건측과의 차이를 측정하여 각각 후방 관절 소면 정복 상태와 종골 각도 회복을 평가하였다. 결 과: 후방 조면 골편의 정복 상태를 평가한 3가지 항목과 골절부 간격 및 층 형성의 상관계수는 각각 r=0.538, 0.467, r=0.505, 0.456, r=0.518, 0.493이었으며, 건측과의 두 가지 종골 각 차이와의 상관계수는 각각 r=0.647, 0.579, r=0.684, 0.630, r=0.670, 0.628이었다. 모든 항목 간의 p-value는 <0.01로 통계적으로 유의미한 상관관계를 보였다. 결 론: 종골 후방 조면 골편의 정확한 정복은 후방 관절 소면 정복 및 종골 각도 회복을 포함한 종골 체부의 해부학적 정복을 위한 중요한 요소로 생각된다. Purpose: We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures. Materials and Methods: A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in Bohler’s and Gissane angle with the uninjured side on the lateral view of both sides. Results: The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of Bohler’s and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01. Conclusion: The precise reduction of calcaneal posterior tuberosity fragment developed by the primary fracture line was considered as an important process of anatomical reduction of calcaneal body, including the posterior facet and calcaneal angle restoration.

수부 골절 및 탈구치료의 최신지견

윤용철 ( Yong Cheol Yoon ),백종륜 ( Jong Ryoon Baek ) 대한골절학회 2016 대한골절학회지 Vol.29 No.2

Fractures and dislocation of the hand is a body injury involving complex structures and multiple functions, which frequently occur as they represent 10%-30% of all fractures. Such fractures and dislocation of the hand should be treated in the context of stability and flexibility; and tailored treatment is required in order to achieve the most optimal functional performance in each patient since deformation may occur if not treated, stiffness may occur with unnecessarily excessive treatment, and both deformation and stiffness may occur coincidently with inappropriate treatment. Stable injuries can be fixed with splintage whereas surgery is actively considered for unstable injuries. In addition, surgeons should keep in mind that as the surgical intervention is done aggressively, aggressive rehabilitation must be followed in correspondence with the surgical intervention. Successful outcome requires effort to prevent any potential complication including nerve hypersensitivity and infection. Finally, it is also important that the patient to know that swelling, stiffness, and pain may last for a long period of time until the recovery of fractures and dislocation of the hand.

백서 좌골신경 봉합 부위의 반흔 형성에 대한 비교 연구

이광석(Kwang Suk Lee),백종륜(Jong Ryoon Baek),이규혁(Gyou Hyuk Lee),최기원(Gi Won Choi) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

목적: 덱사메타손(dexamethasone), 히알루론산(hyaluronic acid) 그리고 양수 등을 말초 신경 봉합 부위에 국소적으로 투약하여 그 효용성과 신경 재생의 정도를 비교 연구하고자 하였다. 대상 및 방법: 40마리의 백서를 대상으로 좌측 좌골신경을 절단한 후 단단 봉합을 하고 생리 식염수 0.3 ㎖를 점적 투여한 군을 제1군, 단단 봉합 후 dexamethasone 0.3 ㎖를 투여한 군을 제2군, hyaluronic acid를 투여한 군을 제3군, 양수 0.3 ㎖를 국소적으로 점적 투여한 군을 제4군으로 나누었다. 술 후 4주, 12주 후에 비복근의 근전도 검사, 그리고 좌골 신경봉합 부위와 원위부에서 광학현미경과 전자 현미경을 이용하여 유수 신경의 개수와 반혼 조직의 두께를 측정하였다. 결과: 근전도 검사상 복합 운동 활성 전위의 진폭은 4주 경과 후에는 제2군에서, 12주 경과 후에는 제3군에서 가장 높았으며 유수 신경의 개수는 4, 12주 경과 후에 제3군에서 가장 많이 관찰되었다. 신경 주위 반혼의 두께는 4주 경과 후에는 제2군에서, 12주 경과 후에는 제3군에서 가장 얇은 것으로 측정되었다 결론: Dexamethasone, HA, 양수를 국소적으로 투여한 군에서 생리 식염수를 투여한 군보다는 신경 재생과 반혼 형성의 정도에서 좋은 결과를 보였다. Purpose: To investigate the effectiveness and to compare the degree of axonal regeneration with the control after the topical application of dexamethasone, hyaluronic acid and amniotic fluid at the repair site of the peripheral nerve. Materials and Methods: The left sciatic nerves of 40 adult Sprague-Dawley rats were transected and neurorrhaphy was performed. The nerves were divided into four groups according to the solution applied around the repair site: control group (group 1), 0.3 ㎖ normal saline: experimental groups, 0.3 ㎖ dexamethasone (group 2), 0.3 ㎖ hyaluronic acid (group 3), and 0.3 ㎖ amniotic fluid (group 4). The thickness of the perineural scar tissue, the count of the myelinated nerve fiber and axonal regeneration on the repair site were evaluated electromyographically and histologically 4 and 12 weeks after surgery. Results: The peak amplitude of the compound motor action potential was observed in group 2, at postoperative 4 weeks and group 3 at postoperative 12 weeks. The increase in the number of myelinated nerve fibers was most prominently in group 3 at 4 and 12 weeks after surgery. The degree of perineural scarring was lowest in group 2 at postoperative 4 weeks and in group 3 at postoperative 12 weeks. Conclusion: A single dose topical application of Dexamethasone, HA and Amniotic fluid is more effective in preventing perineural scar formation as well as in facilitating the nerve regeneration process in a rat hind-limb model than using saline.

무시멘트형 비구컵 주위에 발생한 골용해

박상원 ( Sang Won Park ),백종륜 ( Jong Ryoon Baek ),이상원 ( Sang Won Lee ),이대희 ( Dae Hee Lee ) 대한고관절학회 2004 Hip and Pelvis Vol.16 No.4

목적: Harris-Galante 2형 무시멘트 비구컵 주위에 발생한 골용해에 영향을 미치는 인자들을 분석하고자 하였다. 대상 및 방법: 1991년부터 1994년 사이에 Harris-Galante 2형 무시멘트 비구컵과 Multilock 대퇴스템을 이용하여 인공고관절 전치환술을 시행하고 10년이상 추시가 가능하였던 44례를 대상으로 비구컵 주위에 발생한 골용해 발생빈도와 연령, 성별, 체중, 원인, 비구컵의 경사각, 폴리에틸렌 라이너의 두게, 폴리에틸렌 라이너의 선상 마모율과 골용해 발생과의 관계를 분석하였다. 결과: 총 44례중 18례(40.9%)에서 비구컵 주위에 골용해가 발생하였으며, Charnley와 DeLee의 2구역에서 16례로 가장 많이 발생하였다. 연령, 성별, 체중, 원인, 비구컵의 경사각과 골용해는 통계학적으로 의미있는 차이는 없었으나 폴리에틸렌 라이너의 두게, 폴리에틸렌 라이너의 선상 마모율과는 통계적으로 유의성이 있었다. 결론: Harris-Galante 2형 무시멘트형 비구컵을 이용한 인공고관절 전치환술을 시행하고 10년이상 추시시 비구컵 주위의 골용해 발생 빈도는 시간이 지남에 따라 증가하였고 폴리에틸렌 라이너의 두께, 폴리에틸렌 라이너의 선상 마모율이 골용해 발생에 영향을 미치는 것으로 나타났으며 잠금 장치가 개선된 비구컵과 폴리에틸렌 라이너의 개선 및 세라믹이나 금속과 같은 관졀면의 사용이 필요할 것으로 사료된다. Purpose: The purpose of this study was to evaluate the factors that have an influence on the osteolysis of cementless acetabular components (Harris-Galante type 2). Material and Method: From 1991 to 1994, 36 patients (44 cases) of total hip arthroplasty using a Multilock femoral stem and a Harris-Galante type 2 acetabular cup were reviewed with minimal follow-up period of 10 years. The relationship between the osteolysis and several factors such as the age, gender, weight, etiology, inclination, polyethylene liner thickness and wear rate were analyzed. Results: Osteolysis around the acetabular cup was found in 18 cases (40.9%). The most common area where this developed was zone 2 (16 cases, 36.4%). There was no statistically significant relationship between the age, gender, weight, etiology, inclination angle and the osteolysis. However, there was statistically significant correlation between the polyethylene liner thickness, wear rate and osteolysis. The average polyethylene liner thickness was 7.1 mm in cases with osteolysis and 8.1 mm in cases without osteolysis. The average wear rate was 0.26 mm/year in the osteolysis group, and 0.14 mm/year in the non-osteolysis group. Conclusion: The incidence of osteolysis in the cementless acetabular component (Harris-Galante type 2) may increase as the follow-up period increases, and it was significantly related to the thickness and wear rate of the polyethylene liner. We suggest that the acetabular component needs an improved locking mechanism, improvement for the polyethylene liner longevity, and a ceramic or metal bearing surface is needed.