생비골 이식술을 통한 대퇴골의 난치성 감염성 불유합의 치료 - 3예 보고 -

정덕환,정비오,소동혁,한정수,Chung, Duke-Whan,Jeong, Bi-O,So, Dong-Hyuk,Han, Chung-Soo 대한미세수술학회 2007 Archives of reconstructive microsurgery Vol.16 No.1

Purpose: To report the clinical results of the vascularized fibular graft in the treatment of intractable infected nonunion of femur. Materials and Methods: We reviewed 3 patients who were performed vascularized fibular graft in treated for intractable infected nonunion of femur. They had received an average of 5.6 times($4{\sim}8\;times$) surgical treatment at different hospitals. 1 case was of a infected nonunion in a fracture treated with internal fixation, the fracture having occurred after resection of a malignant tumor and transplantation of pasteurized autologous bone. 2 cases occurred after internal fixation in closed fractures. Surgical treatment was performed an average of 4 times($3{\sim}5\;times$) at our hospital and in all of the cases debridement of necrotic tissue and sequestrectomy. And vascularized fibular graft was performed. In all cases unilateral external fixation devices were used, of these, 1 case was changed into internal fixation. The final conclusion was made by assessment of functional outcomes and complications according to the standards of Paley. Results: As a result, in all of the cases bone union was achieved, and in the last follow up the functional results were excellent in 2 cases and good in 1 case. There were not presented leg length discrepancy of more than 2 cm, and further loss of knee joint motion. After previous treatment, average 23.3 months($16{\sim}30\;months$) was taken to eliminate infection and achieve complete bone union via vascularized fibular graft in our hospital. Conclusion: In treatment of intractable infected nonunion of femur, fairly good results can be expected after firm fixation, through debridement and vascularized fibular graft.

동종 전경골건과 자가 슬괵건을 이용한 관절경적 전방 십자 인대 재건술의 결과 비교

윤경호,배대경,소동혁,이정환,김정원,박수연,Yoon, Kyoung-Ho,Bae, Dae-Kyung,So, Dong-Hyuk,Lee, Jeong-Hwan,Kim, Jeong-Weon,Park, Soo-Yeon 대한관절경학회 2007 대한관절경학회지 Vol.11 No.2

목적: 동종 전경골건과 자가 슬괵건을 이용한 전방 십자 인대 재건술 후 임상적 평가와 추시 관절경을 통한 이식물의 재형성 정도를 비교, 분석하였다. 대상 및 방법: 2002년 3월부터 2005년 8월까지 동종 전경골건과 자가 슬괵건을 이용한 관절경적 전방 십자 인대 재건술 후 1년 이상 추시가 가능하였던 250예를 대상으로 하였다. 동종 전경골건 군 150예, 자가 슬괵건 군 100예였고 평균 추시기간은 각각 15개월, 14개월이었다. 수술 전, 후의 Lachman, Pivot shift, KT-1000 관절계 검사, 2000 IKDC 슬관절 검사를 비교하였고, 29예의 추시 관절경 상 이식건의 강도, 활액막 형성 정도 등을 관찰하였다. 결과: 최종 추시 시 Lachman, Pivot shift, KT-1000 관절계 검사, 2000 IKDC 슬관절 검사 등에서 양 군 간의 차이는 없었다. 추시 관절경상 75%이상의 활액막 형성 정도는 동종 전경골건 군에서 2예, 자가 슬괵건 군은 8예로 자가 슬괵건 군에서 우수하였으나(p=0.005) 강도는 양 군의 차이가 없었다(p>0.05). 결론: 동종 전경골건과 자가 슬괵건을 이용한 전방 십자 인대 재건술 후 양 군의 임상적 차이는 없었고 추시 관절경상자가 슬괵건 군에서 우수한 활액막 형성 소견을 보였다. Purpose: To analyze the clinical results and second look arthroscopic findings of anterior cruciate ligament(ACL) reconstruction with a tibialis anterior tendon allograft and a hamstring tendon autograft. Materials and Methods: We reviewed the cases of athroscopic ACL reconstructions using allogenous tibialis anterior(TA) tendon and autogenous hamstring tendon done from March, 2002 to August, 2005 and followed-up more than 1 year. The 250 cases were included in this study and allogenous TA tendon was used in 150 cases and autogenous hamstring tendon in 100 cases. The mean follow-up period was 15 months and 14 months, respectively. The clinical evaluation was done by Lachman test, Pivot shift test, KT-1000 arthrometer and International Knee Documentation Committee(IKDC) knee score. Graft tension, synovial coverage were observed in cases of second look arthroscopy. Results: At final follow-up, there was no significance between the two groups in clinical examination. On second look arthroscopy, synovial coverage was better in autogenous hamstring tendon group than allogenous TA tendon group(p=0.005). But no difference was found in graft tension(p>0.05). Conclusion: There were no significant differences between the two groups in the clinical results. But autogenous hamstring tendon group had better synovial coverage than allogenous TA tendon group in second look arthroscopy.

슬관절에 발생한 관절내 골연골종 - 2례 보고-

한정수,정비오,소동혁,Han, Chung-Soo,Jeong, Bi-O,So, Dong-Hyuk 대한근골격종양학회 2004 대한골관절종양학회지 Vol.10 No.2

골연골종은 원발성 골종양 중 가장 흔한 양성 종양 중 하나이지만 관절내 발생은 매우 드물다. 저자들은 2세 남아가 좌측 슬관절에 내반 변형을 주소로 내원 후 시행한 단순방사선 검사와 수술 소견 및 생검상 좌측 슬관절내 골연골종으로 진단, 치료한 1예와 10세 남아가 우측 슬관절 동통 및 굴곡 구축을 주소로 내원, 우측 슬관절내 골연골종으로 진단하고 치료한 1예를 문헌고찰과 함께 보고하고자 한다. Conventional osteochondroma is common bone lesion usually originated near the end of a long bone. But intra-articular osteochondromas are very rare and have been reported less than a dozen cases. The authors experienced two cases of intra-articular osteochondroma of the knee joint. Histology as well as gross finding were consistent with osteochondroma. The tumor was excised surgically, and symptoms were relieved.

반복적 관절내 출혈이 관절 활막과 연골 세포의 변화에 미치는 영향

유명철(Myung Chul Yoo),조윤제(Yoon Jae Cho),김강일(Kang Il Kim),전성욱(Sung Wook Chun),소동혁(Dong Hyuk So),조형준(Hyung Jun Cho),양형인(Hyung-In Yang),이상훈(Sang-Hoon Lee),이연아(Yeon-Ahn Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.3

목적: 혈액의 관절강내 반복주사 동물 모델을 이용하여, 혈우병성 관절염에서 활막의 변화와 연골 파괴에 대한 병리 기전과 경과 과정을 연구하였다. 대상 및 방법: 뉴질랜드 백색 토끼 수컷 20마리에 18주간 1주 3회씩 귀에서 자가 혈액을 채취하여 우측 슬관절에 1 ㎖를 주사하고, 좌측 슬관절에 생리식염수 1㎖를(대조군) 주사하였다. 11주 후와 18주 후에 양측 슬관절의 X선 촬영을 시행하였고, 활액막과 연골을 채취하여 조직검사를 시행하였다. 활막 세포 배양에서 RT PCR를 이용한 cytokine의 변화를 관찰 하였고, 연골 세포를 추출 배양하여 GAG 및 PGE₂, MMP-1,3 생성을 측정하였다. 결과: 11주째 육안적 변화는 없었으나, 우측 슬관절의 활액막은 조직학적으로 경한 증식반응과 형질세포 및 단핵세포의 활액막내 침착을 보이며 약간의 염증 소견을 나타냈다. 단순 방사선 소견상 특이 소견은 발견되지 않았다. 18주 후에는 육안적으로 우측 슬관절이 좌측에 비하여 부어 있었고, 단순 방사선학적 소견에서는 관절의 퇴행성 변화가 관찰 되었다. 병리학적 소견은 활막의 심한 증식과 염증세포의 침윤이 관찰되었다. 활막의 real-time RT PCR 시행결과 TNF-alpha, IL-1, MMP-1 mRNA 발현이 증가되었다. 연골세포 배양에서 대조군과 비교시 GAG 생성은 감소하고 PGE₂는 증가하였으며 MMP-1과 MMP-3는 변화가 없었다. 결론: 반복적인 관절 내 출혈은 활막세포를 자극하여 활막의 심한 증식과, proinflammatory cytokines의 생성을 증가시키며, 이는 연골 세포의 재생을 억제하고 연골세포의 염증을 증가시켜 연골의 대사기능이 억제되면서 퇴행성 변화를 촉진하여 점차적으로 관절염으로 이행되는 것으로 사료된다. Purpose: We designed this study to demonstrate the pathophysiology of hemophilic arthropathy (HA) by creating an animal model for determining the effect of repeated intraarticular bleeding in the synovium and articular cartilage. Materials and Methods: 20 normal male New Zealand white rabbits were used for this study. We injected 1 ㎖ of autologous blood from the ear vein of the rabbits into the right knee joint three timeds a week for 18 weeks, and we injected 1 ㎖ of normal saline into the left knee joint three times a week for 18 weeks as a control group. We examined the pathologic changes by microscopy and plain X-ray, and we determined the mRNA expression of proinflammatory cytokines in the synovium of the HA by performing real time RT-PCR at the 11<SUP>th</SUP> week and 18<SUP>th</SUP> week after starting blood-injection. We also examined the GAG and the PGE2 production in cultured chondrocytes that were extracted from the HA knees. Results: At the 11<SUP>th</SUP> week, after blood injection there were no remarkable gross changes in the HA knees and the control knee joints. At the 18<SUP>th</SUP> weeks, the experimental knee joints (HA knees) showed grossly swelling and degenerative changes by X-ray. The infiltration of inflammatory cells and the synovial proliferation in the HA knee joints were compared with that in the control knee joints by microscopic examination. The expressions of the mRNA of TNF-alpha, IL-1, MMP-1 and MMP-3 in the HA synovium were increased, as determined by real time RT-PCR, as compared with that in the control knee. In the cultured chondrocytes, the GAG production was decreased and the PGE2 was increased, but the MMP-1 and MMP-3 were not changed, as determined by ELISA. Conclusion: Our results showed that the GAG production of chondrocytes of the HA knees was decreased and there was increased PGE2, so that the cartilage degeneration by intra-articular bleeding was caused by the decreased metabolism of chondrocytes rather than by increased catabolism of the chondrocytes. We suggest that HA was associated with synovitis and cartilage degeneration, but decreased cartilage metabolism was the major mechanism of HA.

관절경적 후방십자인대 이중 다발 보강술

윤경호 ( Kyoung Ho Yoon ),이정환 ( Jung Hwan Lee ),김정원 ( Jeong Weon Kim ),박수연 ( Soo Yeon Park ),송상준 ( Sang Jun Song ),소동혁 ( Dong Hyuk So ) 대한스포츠의학회 2007 대한스포츠의학회지 Vol.25 No.2