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송석환,장주해,강용구,김정만,김형민,이승구,우영균,박원종,문명상,김양수,Song, Seok-Whan,Chang, Ju-Hai,Kang, Yong-Koo,Kim, Jung-Man,Kim, Hyoung-Min,Rhee, Seung-Koo,Woo, Young-Kyun,Bahk, Won-Jong,Moon, Myung-Sang,Kim, Yang-Soo 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1
견갑관절 주위의 악성종양 치료후의 기능평가를 위하여 저자들은 1991년 1월부터 1993년 12월까지 가톨릭대학교 의과대학 정형외과학 교실에서 견갑관절 주위 악성종양에 대한 수술적 치료를 받은 9례를 분석하여 다음과 같은 결과를 얻었다. 남자 5례, 여자4례이었고, 나이는 최저 22세, 최고 64세로 평균 47세이었다. 연부조직 종양이 2례(MFI, dermatofibrosarcoma protuberance 각각 1례)이었는데, 1례는 forequarter 절단, 1례는 광범위 절제술로 치료하였다. 골종양은 7례(chondrosarcoma 2례, osteosarcoma, MFH, plasmacytoma, thyroid carcinoma metastasis 및 malignant schwannoma 각각 1례)이었는데, 1례는 상완골 근위부 부분절제, 4례는 Malawer분류 제 I-A형의 절제, 1례는 제 I-B형, 1례는 제 V-B형의 절제술을 시행하였다. low grade의 연골육종 1례와 dermatofibrosarcoma protuberance 1례, 갑상선 종양 전이의 1례의 3례를 제외한 6례에서 항암화학요법, 혹은 방사선 요법을 시행하였으며, 1례에서 국소재발이 있었으나 평균 15.3개월 추시된 현재 전례가 생존하고 있다. 골종양 7례증 2례는 관절유합술, 4례는 관절전치환술로 치료하였으며, 관절유합술을 시행한 예와 관절성형술을 시행한 예의 기능은 큰 차이를 보이지 않았다. To evaluate the clinical result of surgical treatment of malignant tumors in shoulder girdle, nine patients who were treated in Department of Orthopedics, Catholic University Medical College between January 1991 and December 1993, were evaluated. There were 5 men, 4 women. The mean age at operation was 47 years(range from 22 to 64 years). Of 9 patiens, 2 were soft tissue tumors(1 MFH, 1 dermatofibrosarcoma protuberance); one was treated with forequarter amputation, and the other with wide excision, Seven were bone tumor(2 chondrosarcoma, 1 osteosarcoma, 1 MFH, 1 plasmacytoma, 1 thyroid carcinoma metastasis, 1 malignant schwannoma); one patient was treated with segmental excision of proximal humerus, 4 with Malawer type I-A resection and arthroplasty or arthrodesis, 1 with Malawer type V-B resection and arthrodesis. Five patients received adjuvant chemotherapy, with or without local radiation therapy, and one patient received radiation therapy alone. All patients have survived now, but I had local recurrence. Functional results of arthrodesis and arthroplasty were similar.
박원종,장주해,강용구,송석환,문명상,김정만,우영균,이승구,김형민,김연실,장지영,윤세철,Bahk, Won-Jong,Chang, Ju-Hai,Kang, Yong-Koo,Song, Seok-Whan,Moon, Myung-Sang,Kim, Jung-Man,Woo, Young-Kyun,Lee, Seung-Koo,Kim, Hyoung-Min,Kim, Yun-Sil,C 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1
To evaluate the role of radiation and chemotherapy after limb-saving operation in the management of soft tissue sarcoma, the authors analysed retrospectively 33 patients treated in department of Orthoaepdic Surgery and Radiation Therapy, Catholic University Medical College, in terms of survival rate, local recurrence rate and prognostic factors. There were 16 males and 17 females. The age distribution ranged from 16 to 81 years with mean age of 48. The follow-up period ranged from 2 to 10 years with average of 5.5 years. The histologic diagnoses were 9 liposarcoma(27.2%), 8 malignant fibrohistiocytoma(24.2%), 7 unclassifiable(21.2%), 3 rhabdomyosarcoma(9.1%), 2 malignant schwannoma, 2 synovral sarcoma, and 2 fibrosarcoma(6.1%) in orders. While marginal and intralesional margins were gained in 24 patients(72.7%), wide and radical margins were obtained only in 9 patients(27.3%). On postoperative 3 weeks, local irradiation of 5000-7000 cGy was delivered to all patients by shrinking field technique for 5-8 weeks. Of 33 patients, 16(45.5%) patients were received adjuvant chemotherapy in combination of adriamycin, cyclophosphamide & vicristine, or VP16 & ifosfamide based on histologic type and obtained surgical margin. The survival rates by direct method at 2 years and 5 years were 58% and 37% respectively. Local recurrences occured in 15 patients(45.5%) at average 16 months after operation. Survival rates at 2 years and 5 years were 37% and 22% in case of intralesional and manginal excision, 75% and 47% in case of wide and radical excision respectively with statistical significance(p<0.05). They were 25% and 17% in the presence of local recurrence, 67% and 42% in the absence of local recurrence respectively with statistical significance(p<0.05). Even though there was no statistical correlation between survival rate and tumor size(p>0.05), the authors considered tumor size as a significant prognostic factors as well as surgical margin and the presence of local recurrence.
대퇴골두 및 대퇴전자간 골절이 동반된 고관절 후방탈구 -증례보고-
김용식(Yong Sik Kim),장주해(Ju Hai Chang),선두훈(Doo Hoon Sun),한석구(Suk Ku Han),이기행(Kee Haeng Lee) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1
Twenty-one hips in fourteen patients with rheumatoid arthritis who underwent total hip arthroplasty with fully rough blasted(RB) CLS stem were studied retrospectively to identify the clinical results and the efficacy of Hydroxyapatite(HA) coat. The follow-up period averaged 34(24-60)months. The average age of the patients were 48(28 to 61) years. The incidence of morbidity on other joints near affected hip averaged 57 percent. The incidence of thigh pain at 3 month was 19% and thigh pain improved as much as 9% at 1 year and maintained the favorable results until final follow-up. According to chronologic change of mean Harris hip score(HSS), scores for pain, deformity, ROM improved early and rapidly to near maximal score until 1 year and scores for function(gait and activity) improved late and slowly until 1 year. Since 1 year, total mean HHS shows excellent with more than 92 points. Mean time of weight bearing without support was 11.6 weeks(8 to 16 weeks). In radiologic finding, endosteal bone formations appeared first in 3 to 6 months mostly and appeared 80% on Gruen zone 1,2,6,7 and 20 to 70% on zone 3,4,5 at final follow-up. Radiolucencies appeared only 5 to 14% on zone 2,3,4,5,6. One measurable subsidence(4mm) was observed and osteolysis was not found. 4 complications were noted as 3 incomplete calcar fractures during operation and one superficial wound infection. This report present that fully rough blasted stem with proximal HA coating could be used as one of the good options in patient with rheumatoid arthritis requiring hip arthroplasty.
우영균 ( Young Kyun Woo ),장주해 ( Ju Hai Chang ),김용식 ( Yong Sik Kim ),권순용 ( Soon Yong Kwon ),김기원 ( Ki Won Kim ),김양수 ( Yang Soo Kim ) 대한고관절학회 1995 Hip and Pelvis Vol.7 No.1
We took a retrospective assessment about the relationships to steroid therapy with 12 patients of AVN in SLE, comparing with the control cases which were composed of 25 patients of SLE followed up more than 5 years but free from evidence of AVN, who had been treated at Catholic University Medical College from 1986 to 1992. Based on results of above assessment, we carried out comparative analysis of above 2 groups to delineate the statistical significance between AVN and steroid therapy in SLE using Student's t-test, and its each items of statistical analysis were as follows; initial cumulative dosage on 1, 3, 6 months, average monthly dosage, average monthly dosage of pulse therapy and average monthly dosage of maintenance therapy throughout follow up period. In addition, we also reported the author's clinical experience in the orthopaedic management of 12 AVN patients in SLE with a respect of age & sex distribution, interval between diagnosis of SLE and AVN, involvement sites, radiologic stage especially in femoral head, treatment method and complication of treatment. This retrospective study was relatively fragmentary but shows that both initial higher steroid therapy and average dosage per months seem to be related with eventual development of AVN in SLE. In addition, the average monthly dosage of pulse therapy seems to have an influence on development of AVN in SLE also. But, the more distinct cause of AVN and the role of steroid in SLE may be elucidated through the further prospective attempt with an elaborate plan in concert with medical doctors.