골육종의 예후인자

전대근,이종석,김석준,양현석,이수용,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Yang, Hyun-Seok,Lee, Soo-Yong 대한근골격종양학회 1997 대한골관절종양학회지 Vol.3 No.1

Osteosarcoma is the most common primary bony malignancy and its survivorship has been progressed markedly through refined chemotherapy and surgery. But still there are many non-responders and analysis of prognostic factors may be helpful for them. Two hundred and sixty-six patients were enlisted between Mar, 1985 and Sep. 1994. Among them our inclusion criteria were: 1)primary, nonmetastatic classical osteosarcoma 2)extremity in location 3)no prior treatment at other institute and completed neoadjuvant chemotherapy and surgery according to our protocol. One hundred and eleven cases were eligible. Analyzed factors were:age, sex, location, tumor size, and pathologic response. Statistical methods were log-rank test for univariate and Cox's test for multivariate analysis. Male to female ratio was 69:42 with an average age of 17.2 years. Locations of tumor were distal femur 59, proximal tibia 29, and proximal humerus 8. Tumor size were measured by its maximal diameter and 48 cases were above 10cm and 47 cases were below 10cm. For pathologic response, 57 cases showed more than 90% and 54 cases were less than that. Limb salvage procedure was 101 cases and amputation was 10 cases and their local recurrence rate were 3.6%. Average follow-up period was 24(9-78.2) months and their final status was CDF 86, AWD 8, NED 5, and DOD 12 cases. In univariate study: type of operation(p=0.005), tumor size(p=0.005), and pathologic response(p=0.02) were significant variables. Pathologic response(p=0.03) and type of operation(p=0.01) were meaningful prognostic factors on multivariate analysis. But the latter result was interpreted as a bias, so pathologic response remained as a sole meaningful prognostic factor. More aggressive chemotherapy will be needed to improve the survival.

골연부 종양에서 저온 열처리한 자가골을 이용한 재건술

전대근,이종석,김석준,조완형,곽봉준,이수용,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Cho, Wan-Hyeong,Kwag, Bong-Jun,Lee, Soo-Yong 대한근골격종양학회 1998 대한골관절종양학회지 Vol.4 No.2

Although autoclaved autogenous bone reconstruction is one of the established procedures, it may have some problems in bone regeneration and mechanical property. The purpose of this study is to evaluate the efficacy of more biologic and anatomical reconstruction where allograft is not readily available. From Aug.1991 to Feb. 1996 the authors analyzed 32 cases of reconstruction with autogenous low heat treated bone. Autogenous graft sites were humerus 4, tibia 4, pelvis 9, and 15 femur. Average follow-up period was 23(range;12-51) months. There were 49 graft-host junctional sites. Diaphysis was 22, metaphysis 10, and flat bone 17. Average duration of healing for the 38 united sites was 7 months. Average union time for each anatomical area 8 months in 19 diaphysis, 12 months in 7 metaphysis, and 12.7 months in 12 flat bone(pelvis). Eleven nonunion sites consisted of 3 diaphysis(3/22), 3 metaphysis(3/10), and 5 flat bone(5/17). Complications other than nonunion were local recurrence(4), bone resorption(3), graft fracture(2), osteomyelitis(1), metal failure(2), and wound infection(1). Initial bone quality and stable fixation technique was important for union rate. Plate and screw is a good method for diaphyseal lesion. Metaphyseal and flat bone are weak area for rigid fixation and one stage augmentation with iliac bone graft can be a salvage procedure.

경비삽관 시도 중 발생한 심각한 비출혈

전대근,송재격,김석곤,지승헌,Jeon, Dae-Geun,Song, Jaegyok,Kim, Seok-Kon,Ji, Seung-Heon 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.2

A 30-year-old man with morbid obesity (height: 176 cm, body weight: 100 kg, body mass index: 32.28) was scheduled for reconstruction of the mandibular fracture. During induction of general anesthesia and nasotracheal intubation, we experienced massive epistaxis, hypoxemia and difficult airway management. Fortunately, we performed oro-tracheal intubation with direct laryngoscopy and it barely succeeded. He recovered without any residual complications and rescheduled seven days later and we successfully performed awake fiberoptic nasotracheal intubation. The patient discharged on the fourth postoperative day.

원위 요골에 발생한 거대 세포종의 일괄 절제 후 초고분자량 폴리에틸렌 삽입물을 이용한 재건술 - 증례보고 -

전대근,송원석,오정문,Jeon, Dae-Geun,Song, Won-Seok,Oh, Jung-Moon 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.1

원위 요골의 거대 세포종은 빈도가 많지는 않다. 통상적으로 골 소파술 및 골 시멘트 충전술로 치료하지만, 재발한 경우나 처음부터 골피질 파괴가 심하고 관절 침범이 있을 경우에는 일괄 절제(en bloc resection) 후 근위 비골을 이용하여 재건하는 술 식이 많이 이용되어 왔다. 본 연구는 고식적 술 식으로 치료한 후 국소 재발한 원위 요골의 거대 세포종 환자에서, 근위 비골을 이용한 재건술을 시행하여도 일차 술 식 시 오염의 범위가 심하여 다시 재발할 가능성이 높아 초고분자량 폴리에틸렌(ultrahigh molecular weight polyethylene, UHMWPE)과 골수강내 고정물 및 골 시멘트를 조합하여 원위 요골을 재건한 1례를 보고 하고자 한다. A giant cell tumor (GCT) of the distal radius is not common. Curettage with bone cementation is considered as a treatment of choice but, in the case of recurrence, marked cortical disruption, or articular invasion, en bloc excision and reconstruction with proximal fibular bone graft is usual procedure. In reconstruction of en bloc resected distal radius which had recurred GCT after conservative operation, we used the ultrahigh molecular weight polyethylene (UHMWPE) liner with intramedullary rod and bone cement, because the contamination was extent in previous operation and recurrence after fibular bone graft was fearful. This article introduce our new surgical procedure.

Hemiarthroplasty for Osteosarcoma of Proximal Tibia

전대근,조완형,김진욱,고한상,Jeon, Dae-Geun,Cho, Wan-Hyeong,Kim, Jin-Wook-,Koh, Han-Sang The Korean Musculoskeletal Tumor Society 2006 대한골관절종양학회지 Vol.12 No.1

목적: 근위 경골 육종의 절제 후 재건은, 특히 골성장이 완료되지 않은 환자의 경우 많은 문제점이 있다. 본 연구에서는 근위 경골 육종의 절제 후 재건에 따르는 문제점을 보완하기 위한 새로운 술식을 시도해 보고자 하였다. 대상 및 방법: 근위 경골에 발생한 골육종의 절제 후 반관절성형술을 시행한 4례를 대상으로 하였다. 평균 연령은 13세였으며 술후 평균 추시 기간은 64개월이었다. 전례에서 초고분자량 폴리에틸렌 삽입물(ultra-high molecular weight polyethylene liner)을 이용하여 관절면을 재건한 후 엔더정(Ender-nail)과 골시멘트를 이용하여 남아있는 경골에 고정하였다. 결과: 최종 추시상 MSTS 기준에 의한 기능적 점수는 23.5점(78.3%)이었다. 전례에서 술후 슬관절 동통, 불안정성은 관찰되지 않았다. 결론: 골성장이 완료되지 않은 소아 환자의 근위 경골 육종 절제 후 재건 방법으로서 반관절 성형술은 효과적인 술기로 판단된다. Purpose: The proximal tibial sarcoma patients, especially in their growing ages have problems of reconstruction. This study is to devise a methodology which can circumvent this limitations. Materials and Methods: Four cases of proximal tibial osteosarcoma underwent hemiarthroplasty. The mean age was 13 years (11~15) with a mean follow-up of 64 months (47~89). The procedure consists of ultrahigh molecular weight polyethylene (UHMWPE) liner as an substitute for the joint surface and this piece was fixed to the remaining tibial bone stock with Ender nail and bone cement. Results: Final functional score was 23.5 (78.3% of control) by MSTS criteria. All the cases showed stable joint without pain. Hemiarthroplasty related complications were absent. By saving the femoral physis, expected leg length discrepancy could be minimized by this procedure. Conclusions: Hemiarthroplasty of proximal tibia can be an option in pediatric sarcoma patients.

편평 상피 암의 치료에서 수술의 역할

전대근,이종석,김석준,이수용,임경진,박현수,김창원,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Lee, Soo-Yong,Lim, Gyung-Jin,Park, Hyun-Soo,Kim, Chang-Won 대한근골격종양학회 1998 대한골관절종양학회지 Vol.4 No.1

Squamous cell carcinoma is a neglected disease entity in orthopedic oncology. The purpose of this study was to analyze overall survival and the role of surgery on survival and to evaluate the significance of possible prognostic factors. From Oct, 1986 to Aug, 1996, 57 patients were enlisted and 42 patients ere eligible. Inclusion criteria included more than one year follow-up and no distant metastasis at the first visit. Staging and survival followed AJC classification and Kaplan-Meier plot. Stage II included 17 cases and stage III, 25 cases. Thirty-eight patients underwent operations, chemotherapy, and/or radiotherapy, and the remaining four had operations only. The chemotherapeutic regimen was adriamycin-cisplatin. The average follow-up period was 45 months. The ten-year actuarial survival rate of whole patients was 65.4%. Location of primary lesion, stage, pathologic grading, and intensity of chemotherapy in the same stage showed a significant difference in survival. Nine out of 42 patients had local recurrence. Seven patients had inadequate wide margins and two had intralesional margins. Average period of recurrence from operation was 13(4-35)months. The operation itself had no impact on survival but a surgical margin of no less than 3cm from the lesion was important for local control. Pathological grade and staging were significant variables for long term survival. Acral lesion had a significantly higher chance of regional and distant metastasis but actual survival showed no difference. In stage II, aggressive chemotherapy could delay or reduce the chance of regional or distant metastasis.

다발성 연골육종 1례 보고

전대근,이종석,김석준,이수용,Jeon, Dae-Geun,Lee, Jong-Seok,Kim, Sug-Jun,Lee, Soo-Yong 대한근골격종양학회 1997 대한골관절종양학회지 Vol.3 No.2

Multicentric chondrosarcoma other than the mesenchymal subtype is rare separate entity. We experienced a case with nonmonomelic synchronous multicentric chondrosarcoma without any preexisting lesions of Oilier's disease or Maffucci's syndrome. To our knowledge, there was no report of synchronous nonmonomelic multicentric chondrosarcoma. A thirty-three year old man had right distal thigh pain of one and half year. Bone scan showed hot lesions on medial condyle of right femur and shaft of left femur. Plain X-ray showed osteolytic lesion on right femur and slight cortical thickening and calcific lesion was observed on left femoral shaft. Curettage and bone cement filling was done on both lesions. The pathology reports were grade I chondrosarcoma on both side of femur. At one month from operation, pathologic fracture of left femur occurred on bone cement-host bone junction. Conservative treatment and radiotherapy of 60Gy was done. At 8 months from operation, nonunion was evident. Segmental resection of left femur with contralateral fibula graft and second look operation on right condyle lesion were done. At 6 months from revision, fracture occurred at host-graft bone junction. We removed previous hardware and applied long DCP and massive autogenous bone graft. Afterwards, the patient looks good and union was progressing. But at 4 years from last operation, hypertrophic nonunion occurred. Another revision was done with condylar plate and bone graft and now he is well without any sign of local recurrence or metastasis.

Stage IIB 골육종환자에서 항암 화학요법의 종류에 따른 생존율 비교

전대근,이수용,이종석,김태완,정동환,Jeon, Dae-Geun,Lee, Soo-Yong,Lee, Jong-Seok,Kim, Tae-Wan,Chung, Dong-Hwan 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1

From Sept. 1986 to Dec. 1992, seventy three cases of Enneking's stage IIB osteosarcoma of extremities, which were proved histologically, took neoadjuvant chemotherapy and completed our protocol. Their average age was 16.7 years(7 to 57). For neoadjuvant chemotherapy, 37 cases took high dose methotrexate(HDMTX)-adriamycin(ADR)-cisplatin(CDDP) regimen(HDMTX group) and 36 cases took ADR-CDDP(ADR-CDDP group). The average follow up was 17 months(2-63). According to Kaplan-Meier's plot, 5-year continuously disease free survival for whole 73 cases of neoadjuvant group was 45.2%, for HDMTX group 68.4%, for ADR-CDDP group 26.6%. There was significant stastical difference between these two groups(p<0.001), with log-rank test. There can be a different survival according to the chemotherapeutic protocols. Better results can be achieved through refined protocol and effective chemotherapeutic agents.

증례보고 : 맥박산소계측기에 의한 화상

전대근 ( Dae Geun Jeon ),김석곤 ( Seok Kon Kim ),이관우 ( Gwan Woo Lee ),홍성호 ( Sung Ho Hong ),김성훈 ( Sung Hoon Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

A pulse oximeter is used widely on account of its convenience and very few complications. We experienced a case of accidental burning by a pulse oximeter sensor. An 83-year-old woman underwent total hip replacement surgery. A pulse oximeter (Oxisensor II N-25, Nellcor Puritan Bennett Inc., USA) was placed on the left index finger. The patient complained of pain on her index finger 5 minutes after the operation began. A localized skin burn was found underneath the sensor of the pulse oximeter. The skin burn healed without any sequelae. (Korean J Anesthesiol 2007; 52: 228~30)

근위 상완골 종양 치료 실패 후 역 견관절 전치환물을 이용한 구제술

전대근(Dae-Geun Jeon),조완형(Wan Hyeong Cho),김범석(Bum Suk Kim),박환성(Hwanseong Park) 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.6

목적: 상완골 근위부 절제 후 다양한 재건술이 시도되었으나 역 견관절 전치환술의 도입으로 기능적 결과의 향상이 있었다. 그러나 광범위한 골결손을 동반한 경우에도 이 방법을 적용할 수 있는지와 비수술적 치료 실패 후 지연 재건하면 기능회복의 정도가 어떤지에 대해서는 불확실하다. 대상 및 방법: 상완골 근위부 재건술 후 실패한 11예는 중첩 동종골과 역 견관절 전치환술의 조합술을, 비수술적 치료가 실패한 6예는 지연 역 견관절 전치환술을 시행하였다. 수술 전, 후 기능적 결과를 비교하였으며 합병증을 기술하였다. 결과: 역 견관절 전치환술과 동종골 조합술로 일차 수술이 실패한 11예 전부에서 안정된 재건술이 가능하였으며 수술 전 주 증상도 해소되었다. 골 접합부 평균 골유합 기간은 5.5개월이었다. 수술 전, 후 근골격계 기능 점수는 평균 20.3점에서 25.7점으로 증가하였다. 일차 수술 후 4년 이내에 역 견관절 전치환술로 치환한 6예 중 4예에서 90° 이상의 상지 거상이 가능하였으며, 일차 수술 후 4년 이후에 수술한 5예는 견관절의 안정성은 얻었으나 전부 90° 이상 거상이 불가능하였다. 합병증은 관절탈구와 무균성 감염이 각각 1예로 폴리에틸렌 교체와 반흔 조직 절제술로 치료하였다. 비수술적 치료 실패로 지연 역 견관절 전치환술을 한 6예에서 기능평가 점수는 향상되었으나 전 예에서 상지의 90° 이상 거상은 불가능하였다. 결론: 중첩 동종골과 역 견관절 전치환술의 조합술은 대량의 상완골 골결손이 발생한 환자에서 간단하고 합병증이 적은 골질 회복 방법으로 생각된다. 진단 시 근위 상완골 전 절제가 필요한 전이성 골종양 환자는 조기에 역 견관절 전치환술을 하는 것이 기능유지에 도움이 될 것으로 생각된다. Purpose: Many reconstruction methods have been attempted after an en-bloc resection of the proximal humerus. In particular, the introduction of reverse shoulder arthroplasty (RSA) has made a breakthrough in the functional recovery of the shoulder. Nevertheless, RSA has limitations when the humeral bone stock loss is significant. In addition, it is unclear if RSA is effective in patients showing failure with non-operative treatment of a proximal humeral tumor. Materials and Methods: A reconstruction was performed using an overlapping allograft-RSA composite for 11 patients with a failed proximal humeral construct. Delayed RSA was performed on 6 patients with failed non-operative treatment. The pre- and postoperative Musculoskeletal Tumor Society (MSTS) score and the complications were addressed. Results: Overlapping allograft-RSA composite afforded a stable construct in 11 failed proximal humeral reconstructions and the patient’s chief complaints were resolved. The mean time to the union of overlapped allograft-host junction was 5.5 months. Average preoperative MSTS score of 20.3 point increased to 25.7 point, postoperatively. Four of the six patients who had RSA within 4 years from the index operation showed arm elevation of more than 90° whereas the remaining 5 patients showed some disability. The complications include one case each of dislocation and aseptic infection, which were resolved by changing the polyethylene liner and scar revision, respectively. None of the 6 patients who underwent delayed RSA after the failure of non-operative treatment showed arm elevation more than 90°. Conclusion: An overlapping allograft-RSA composite is a simple and reliable reconstructive modality in patients with massive bone loss. In patients with metastatic cancer necessitating a surgical resection at presentation, early conversion to RSA is recommended to secure functional recovery.