Vascular loop graft 술식을 이용한 $Kienb\"{o}ck$씨 질환의 치료

한정수,정덕환,박보연,남기운,한현수,Han, Chung-Soo,Chung, Duke-Whan,Park, Bo-Yeon,Nam, Gi-Un,Han, Hyun-Soo 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Although the etiology of $Kienb\"{o}ck's$ disease is clearly related to avascular changes in the lunate, but the actual cause leading to this vascular impairment has remained elusive. Therefore, a great many different surgical procedures have been proposed for the correction of the multiple factors leading to lunate collapse or for the treatment of the lunatomalacia. The treatment modalities includes lunate excision, intercarpal arthrodesis, lunate implant resection arthroplasty, joint levelling operation(e.g ulnar lengthening & radial shortening), pronater quadratus pedicle graft and vascular loop graft. In the period from Jan. 1981 to Dec. 1992, we performed operative treatment in 19 cases of $Kienb\"{o}ck's$ disease. Among them, 6 cases were treated with vascular loop graft. We analysed all patients who were treated with vascular loop graft after followed up of 4 year 6 months, on an average(range from 1 year to 8 year 10 months). The results analysed are as follows, 1. All cases were stage III according to Lichtman's classification. 2. Ulnar variance was -1.5(range$-2{\sim}0$), on an average. 3. The average age of patients were 37.7years old(range 31-41). 4. Postoperatively, there were considerable restoration of range of motion and complete relief of pain in all cases, but continued decrease of grip power in one case. 5. Decreased sclerosis, loss of fragmentation and new bone formation were appeared in the last follow up film, in all cases. The vascular loop graft considered as a useful method for the treatment of the $Kienb\"{o}ck's$ disease.

생비골 성장판 이식술을 이용한 선천성 다발성 골연골증에서 전완부 변형의 치료

한정수,유명철,정덕환,한현수,한수홍,Han, Chung-Soo,Yoo, Myung-Chul,Chung, Duke-Whan,Han, Hyun-Soo,Han, Soo-Hong 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1

It is difficult to manage the growing deformity of forearm bone caused by hereditary osteochondromatosis in children, because deformity and discrepancy of limb length is progressive. The are many treatment methods of these problems including excisio of osteochondroma, lengthening of ulna, shortening of radius, corrective osteotomy with or without lengthening apparatus. Among many treatment methods, we tried free vascularized epiphyseal transplantation with the proximal fibular epiphysis in 3 patients of hereditary osteochondromatosis for inducement of continuous bone growth and deformity correction. The average duration of follow up was 7 years and 1 month, the shortest duration being to 4 years and 5 months and the longest 10 years and 8 months. Serial radiologic and clinical evaluation were carried out during follow up and there were satisfactory length gain, deformity correction and improvement of adjacent joint motion in 2 cases. According to our follow up evaluation, free vascularized epiphyseal transplantation is valuable procedure in forearm deformity of hereditary osteochondromatosis although it needs skillful and experienced operative technique.

상완 신경총에 발생한 다발성 사구종: 증례 보고

한정수,정덕환,박광희,김환진,Han, Chung-Soo,Chung, Duke-Whan,Park, Kwang-Hee,Kim, Hwan-Jin 대한근골격종양학회 2012 대한골관절종양학회지 Vol.18 No.1

Glomus tumor is a kind of vascular tumor that arises from the glomus body, which regulates skin temperature and is placed in the skin and the subcutaneous area. It is a benign tumor that usually presents in the subungal area. It is relatively common in areas other than the fingers, but its occurrence in peripheral nerves is known to be comparatively rare. We report our experience with a case of glomus tumor arising from the brachial plexus, a rare site of occurrence for glomus tumors. 사구종은 피부와 피하 인접부위에 위치하는 피부의 온도를 조절하는 사구체에서 발생하는 혈관종의 일종으로 대개 조갑하 부위에서 발생하는 양성 종양이다. 수지 이외의 부위에서 발생하는 경우가 상대적으로 흔하나 말초 신경에서 생기는 경우는 비교적 드문 것으로 알려져 있다. 본 교실에서는 일반적으로 호발하는 부위가 아닌 상완신경총에서 발생한 사구종 1예를 경험하였기에 이에 대해 보고하고자 한다.

상완 신경총 손상시 건측 제 7번 경추신경 전이술 후 건측 상지의 신경 변화

한정수,차재룡,신동준,임양진,Han, Chung-Soo,Cha, Jae-Ryong,Shin, Dong-Jun,Im, Yang-Jin 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.1

Purpose : To evaluate the neurologic abnormalities in the donor limb after contralateral C7 transfer in brachial plexus injury. Materials and Methods : From August 1996 to December 1999, five patients with brachial plexus injury were treated with contralateral C7 nerve root transfer. The average follow up was 16 months(range, 5 to 36 months). The clinical findings were assessed using the British Medical Research Council Grading System, and also measured grip power, pinch power of hand and two point discrimination of the fingers. Results : We had no difference in shoulder abduction and elbow flexion after contralateral C7 transfer. The grip and pinch strength were recovered within 4weeks. Sensory loss occurred in all patients and was noted to be more severe on index and middle finger. Four patients recovered within 2 weeks, one continued till one year. Subjective numbness and pain on percussion minimally persisted until last follow-up. Conclusion : The division of the C7 nerve root resulted in minimal and temporary functional deficit in the donor upper limb.

악성 섬유성 조직구종에서 광배근피판을 이용한 견관절 재건술

한정수,정덕환,이영호,임양진,Han, Chung-Soo,Chung, Duke-Whan,Lee, Young-Ho,Im, Yang-Jin 대한미세수술학회 2001 Archives of reconstructive microsurgery Vol.10 No.2

Introduction : The Functional muscle transfer is used to reconstruct the injuried muscle and paralysis of the shoulder. Especially transfer of the trapezius has been the treatment of choice but it has disadvantages of inadequate function and deformed contour, and instability of humeral head in case of acromion resection. We report an operation for shoulder reconstruction after wide resection of malignant fibrous histiocytoma, using rotational latissimus dorsi flap and review the operation method and clinical outcome. Materials and Methods : A patient, 53 year old, with malignant fibrous histiocytoma in the acromioclavicular joint area had been underwent wide excision, including the deltoid, clavicular head of pectoralis major, part of trapezius, lateral 1/3 of clavicle and acromion including scapular spine. The rotational latissimus dorsi flap with its neurovascular pedicle was dissected and then placed over the resected area and transfer of muscle attached at coracoid process was done to achieve stability of the humeral head. The range of motion of the shoulder and test of muscle power were evaluated for functional outcome. Total follow-up period is 2 years 11 months. Results : At last follow-up, the range of motion of the shoulder is abduction $90^{\circ}$, flexion $90^{\circ}$, internal rotation $40^{\circ}$, external rotation $50^{\circ}$ and the muscle power is 4 grade in all direction and then we obtained good functional results. There are no complications such as instability or subluxation of the humeral head and deformed contour and he is a disease-free survival state. Conclusions : The transfered latissimus dorsi flap provides adequate lever arm and stabilization and covering of the humeral head by sufficient muscle volume and width. This procedure can be useful not only for the paralysed deltoid reconstruction but also for use in reconstructive surgery after wide resection of the shoulder for malignant tumor.

웹 응용 서비스 관리를 위한 성능 관리자 시스템의 설계 및 구현

한정수,안성진,정진욱,박형우,Han, Jeong-Soo,Ahn, Seong-Jin,Chung, Jin-Wook,Park, Hyoung-Woo 한국정보처리학회 1998 정보처리학회논문지 Vol.4 No.1

In this paper, we shows the implementation of Web based performance manager which analyze the traffic of a Web server to support the diagnostics of it. The manager monitors the HTIP traffic by polling and measures and presents is performance on demand. To enhance the adaptability of management interface Web based interfaces with JAVA is used. Recently, the need of traffic management on s Web has grown, because of increasing Web traffic. Therefore, the traffic management of Web service and the effective management of a Web server's performance are needed. We have designed interfaces with which is comprised of Collection-Request, Analysis-Request, Realtime-Monitoring, Comparison-Analysis on a client with Web Browser on a network, and implemented the server system that can analyze these requests. Also we have introduced some perfonnance indicator by referring a Web related MIB. Also, we have designed and developed a message format for communication between the Web client and the server system. 본 논문은 웹 서버의 트래픽 관리를 위하여 성능 파라미터를 정의하고 이를 분석하기 위한 관리자 시스템을 웹 기술과 JAVA 기술을 이용하여 구현함으로써 웹 서비스를 모니터링하고 웹 서버의 성능을 관리하고자 하였다. 현재 웹 상에서의 트래픽 관리가 웹 성장에 의한 웹 트리팩의 증대로 그 필요성이 대두됨에 따라, 웹 서비스 트래픽 관리와 웹 서버 성능에 대한 효율적인 관리가 필요하게 되었다. 이를 위해 네트워크 상의 임의의 호스트에 성능 관리자 시스템을 위한 클라이언트를 구현하여 사용자로 하여금 수집 요구와 분석 요구, 실시간 모니터링, 그리고 비교 분석 요구 등을 t할 수 있는 인터페이스를 설계하고, 이러한 요구를 분석하는 서버 시스템을 구현하였다. 또한 기존의 MIB을 사용하여 각 분석 항목에 맞게 HTTP 메시지량과 바이트량 분석, 연결 수 분석, 입출력 트래픽 비교 분석 등과 같은 새로운 성능 파라미터를 정의하였다. 아울러, 웹 클라이언트-서버 시스템간의 통신을 위해 새로운 메시지 형식을 정의하고 구현하였다. 따라서 웹 서버 시스템의 운영과 관리 시 성능에 따른 문제점을 발견하고 해결을 지원하는데기여할 수 있다.

제 2족지 근위 지골에 발생한 저악성도 골육종 - 증례 보고 -

한정수,정덕환,신동준,임양선,정찬종,Han, Chung-Soo,Chung, Duck-Hwan,Shin, Dong-Jun,Lim, Yang-Sun,Jung, Chan-Jong 대한근골격종양학회 2001 대한골관절종양학회지 Vol.7 No.4

족부에 발생하는 골육종은 전체 골육종의 0.2~2%로 매우 드물며 장관골의 골간단부에 발생하는 저악성도 골육종은 전체 골육종의 약 1.9% 정도를 차지하는 드문 종양이다. 본 교실에서는 제 2족지 근위 지골의 종물과 심한 동통으로 내원한 38세 여자 환자에서 발생한 저악성도 골육종 1례를 경험하였다. 환자는 단순 방사선 검사상 좌측 제 2족지 근위 지골 전체를 침범한 골용해성 병변이 관찰되었으며 피질골은 얇고 팽대된 소견을 보였다. 골주사 검사상 단순 방사선 사진에서 보인 것과 동일한 위치에 흡수 증가의 소견을 보여 양성 골종양으로 판단하고 종양 절제 후 늑골을 이용한 관절 재건술을 시행하였다. 수술 후 조직학적 소견상 저악성도 골육종으로 판정되었고 이차적으로 좌측 제 2족지의 근치적 광범위 절제술을 시행하였다. 제 2족지 근위 지골에 발생한 저악성도의 골육종은 매우 드문 종양으로 광범위 절제술 후 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. The reported incidence of osteosarcoma of the foot varies between 0.2-2% of all osteosarcoma. Low grade osteosarcoma of the long bone represents only 1.9% of all osteosarcoma. A 38-year-old female had suffered painful mass in the proximal phalanx of the second toe for 1 year. Radiographic finding showed enlarged osteloytic mass which had penetrated thin cortex of the second toe and apparent increased uptake in bone scan was seen. Mass resection with autogenous bone graft using rib was performed. Histologically, the tumor was compatible with "low grade osteosarcoma". Second stage wide resection was performed. Because low grade osteosarcoma located in the proximal phalanx of the second toe is very rare, we report this unusual case with review of literature.

혈관부착 생비골 이식술을 이용한 골종양의 치료

한정수,유명철,정덕환,이건희,이종원,Han, Chung-Soo,Yoo, Myung-Chul,Chung, Duke-Whan,Lee, Geon-Hee,Lee, Chong-Won 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.2

Recently vascularized fibular transfer has been used in the treatment of bone tumor that are more than six centimeter in length. With refinements in microsurgical techniques and understanding of the biological and biomechanical characteristics of vascularized bone graft, the success rate of this procedure was increased. Fifteen bone tumor patients, sixteen cases seen from Apr. 1979 to Jun. 1995 were managed by means of vascularized bone graft at Kyung Hee University Hospital. Ten cases were done intercalary graft and the others were done osteoarticular graft. the ratio of male and female was 6 : 9, and mean age was 20.4 years old at operation. Mean follow up period was 5 years 4 months(range 17 months to 16 years 2 months) and mean graft length was 13.8cm. Duration for union was 5.3 months(range 3 months to 1 year) and over-all rate of union at the last follow up examination was 93.8%. Sufficient hypertrophy of grafted bone was obtained in all cases at the time of last follow up as compared to initial size of grafted bone. Several complications were found such as stress fractures, recurrence. Vascularized fibular transfer for the treatment of bone tumor is a valuable procedure in appropriately selected patients.

하지 연부조직 종양의 절제 후 발생한 결손의 재건을 위한 도서형 유경 피판술로서의 족배동맥 피판술

한정수,신동준,문지수,박현철,Han, Chung-Soo,Shin, Dong-Jun,Moon, Jee-Soo,Park, Hyun-Chul 대한미세수술학회 2003 Archives of reconstructive microsurgery Vol.12 No.1

Purpose : Various free flaps and pedicled island flaps are effective for reconstruction of soft tissue defect developed after tumor excision. We want to know the advantage of dorsalis pedis island flap for reconstruction of soft tissue defect caused by soft tissue tumor excision. Materials and Methods : Between 1992 and 2002, we performed 4 dorsalis pedis island flap procedure for reconstruction of soft tissue defect of lower limb developed after soft tissue tumor excision. Average age was 54.7 years old $(40{\sim}68)$, and male 2 cases, female 2 cases. The kinds and number of soft tissue tumors were 2 squamous cell carcinoma and 2 malignant melanoma. The procedures that we performed were all dorsalis pedis island flap. The analysis for the result of treatment was retrospectively accessed by physical examination and questionnaire for whether the change of symptom after operation, range of adjacent joint motion. Also we reviewed associated complication after operative treatment. Results : All dorsalis pedis island flaps were alive. There is no problem for activity of daily living, no skin necrosis and no limitation of motion of adjacent joint. In 1 case of them, the patients died of distant metastasis. Conclusion: Dorsalis pedis island flap procedure as a pedicled island flap procedure is very effective and easy operative procedure for reconstruction of soft tissue defect of lower limb developed after tumor excision compared to free flap procedure because there is no need for microvascular surgery, we can obtain relatively large flap and the lesion and flap donor site locate in the same limb.

거대 세포종에서 발생한 골육종 - 2례 보고 -

한정수,이영호,하정한,Han, Chung-Soo,Lee, Young-Ho,Ha, Jeong-Han 대한근골격종양학회 2001 대한골관절종양학회지 Vol.7 No.4

양성 거대세포종의 방사선 치료후 발생한 골육종은 드물지 않으나, 거대세포종의 수술적 처치후 자연적으로 악성 전환한 골육종은 매우 드문 질환으로 높은 사망률을 가지는 악성종양이다. 대퇴골 원위부에 발생한 양성 거대세포종을 소파술과 골이식술 또는 시멘트 충진술과 같은 수술적 치료후 추시기간 2년 1개월, 9년 8개월에 동일 부위에서 악성전환으로 인해 발생한 골육종 2례에 대하여 화학요법 및 광범위 절제술과 재건술로 치료하여 추시결과를 보고하는 바이다. It is not uncommon for sarcomatous transformation of giant cell tumor of bone to occur after radiation, but osteosarcoma arising from giant cell tumor after surgical treatment is very rare and remains an aggressive form of sarcoma of bone with high mortality rate. We experienced 2 cases in whom a osteosarcoma developed long after benign giant cell tumor of bone was removed surgically from the same site. Malignant transformation was presented at 2 years 1 month and 9 years 8 months each after initial surgery. We describe our experience concerning clinical features, methods of treatment and outcomes of osteosarcoma arising from giant cell tumor.