광범위 외측 접근법으로 수술한 종골 골절의 술 후 조기 합병증

변영수,조영호,박준우,이진석,김지환 대한골절학회 2004 대한골절학회지 Vol.17 No.4

목적 : 광범위 외측 접근법으로 수술한 종골 골절에서 술 후 조기 합병증들을 분석하고 창상 합병증에 대한 위험 요인들을 알아보았다. 대상 및 방법 : 1990년 7월부터 2003년 2월까지 광범위 외측 접근법으로 수술한 종골 골절 104명, 116예를 대상으로 하였다. 환자들의 병록지에서 술 후 조기에 발생한 합병증들을 조사하여 분석하였으며, 창상 합병증의 위험을 증가시키는 요인들을 알아보기 위해 예견되는 변수들에 대하여 통계학적 분석을 하였다. 결과 : 감염이 14예 (12.0%)에서 발생하였으며, 10예 (8.6%)는 표재 감염이었고 4예 (3.4%)는 삼부 감염으로 수술적 치료가 필요하였다. 피부 괴사가 8예 (6.9%)에서 발생하였으며, 6예 (5.2%)는 수술창 변역부의 피부 괴사였고 2예 (1.7%)는 피판 괴사로 수술적 치료가 필요하였다. 비복신경 손상이 7예 (6.0%)에서 발생하였으나 부가적인 치료 없이 회복되었다. 통계학적 분석 결과 개방성 골절 군(p=0.003)과 수술시간이 90분 이상 연장된 군 (p=0.049)에서 창상 합병증의 발생률이 유의하게 높았다. 결론 : 광범위 외측 접근법으로 수술한 종골 골절에서 술 후 조기 합병증의 발생률이 높으므로 개방성 골절에서는 개방창을 철저하게 치료하고, 술 전 계획과 계획된 술기를 통하여 수술 시간을 90분 이내로 단축하고, 비복신경의 해부학적 위치를 고려하여 절개함으로 술 후 조기 합병증의 발생률을 감소시킬 수 있을 것으로 사료된다. Purpose : To analyze early postoperative complications of calcaneal fractures operated by a lateral extensile approach and to identify risk factors for would complications. Materials and Methods : From July 1990 to February 2003, 116 calcaneal fractures in 104 patients were treated by open reduction and internal fixation through a lateral extensile approach. The patient's records were reviewed for early postoperative complications. Statistical analysis was performed to determine significant relationships between predicted variables and the development of would complications. Results: Fourteen fractures (12.0%) developed infection. Ten of them were superficial infection and four were deep infection that required surgical treatment. Eight fractures (6.9%) developed skin necrosis. Six of them were marginal skin necrosis and two were flap necrosis that required surgical treatment. Seven fractures (6.0%) developed sural nerve injury, but their symptoms were improved without additional treatment. Open fracture (p=0.003) and prolonged operating time (p=0.049) increased significantly the rate of wound complications. Conclusion: The rate of early postoperative complications of calcaneal fractures operated by a lateral extensile approach is high. These complications can be reduced by meticulous treatment of an open wound, reduced operating time within 90minutes through preoperative planning and skillful technique, and correct incision to avoid damage of the sural nerve.

쇄골 간부 골절 불유합의 수술적 치료 : 재건 금속판 고정 및 골 이식술 Reconstruction Plate Fixation and Bone Grafting

변영수,유찬훈,안혁수,문성건,신동주,박준우 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 쇄골 간부 골절 불유합에 대하여 관혈적 정복, 재건 금속판 고정 및 골 이식을 시행하고 술후 조기 관절 운동을 허용한 저자들의 경험을 보고하는 것이다. 대상 및 방법: 1997년 1월부터 2001년 12월까지 수술적 치료를 시행한 쇄골 간부 골절 불유합 16예를 대상으로 하였다. 위축성 불유합이 10예, 비후성 불유합이 6예였으며, 수상 후 불유합에 대한 수술까지의 기간은 평균 6.5개월이었다. 수술적 치료로 불유합 부위를 노출시켜 섬유조직을 제거하고 골수강을 천공하였으며, 골편을 정복하고 재건 금속판으로 고정하였으며, 자가 골 이식을 하였다. 수술 후 관절 운동은 1주일 이내에 시작하였다. 결 과: 평균 추시 기간은 22.0개월이었으며, 전 예에서 평균 10.0주에 골유합을 얻었다. 최종 추시 시의 견관절 운동범위는 전 예에서 정상으로 회복되었으며, 나이가 50게 이상인 6예 중 3예에서 동측 견관절에 간헐적인 동통을 호소하였다. 술후 감염, 재검 금속판의 파손, 고정상실, 불유합, 재골절 등의 합병증은 발생치 않았다. 결 론: 쇄골 간부 골절 불유합에 대한 관혈적 정복, 재건 금속판 고정 및 골 이식은 안정성 고정으로 조기 재활이 가능하고 견고한 골유합을 얻을 수 있어 안전하고 확실한 치료방법으로 사료된다. Purpose: The purpose of this study is to present out experience with open reduction, 3.5-㎜ reconstruction plate fixation, bone-grafting, and postoperative early mobilization for nonunions of midshaft clavicular fratures. Materials and Methods: Sixteen patients were treated operatively for nonunions of the midshaft of the clavicle from 1997 to 2001. Ten nonunions were atrophic and six were hypertrophic. Nonunion had been present for an average of 6.5 months. The operative technique included removing the fibrous tissue from the nonunion site and opening the medullary canal, reduction of the fracture and fixation with a 3.5-㎜ reconstruction plate, and bone-grafting. Postoperative mobilization started within one week. Results: The average duration of follow-up was 22.0 months. All fracture were united in an average of 10.0 weeks. All patients had full range of motion of the ipsilateral shoulder, but 3 our of 6 patients who were more than 50 years old complained occasional pain in the ipsilateral shoulder at the final follow-up examination. There were no major complications of postoperative infection, metal failure of the plate, loss of fixation, nonunion, and refracture after removal of the implant. Conclusion: The technique of open reduction, reconstruction plate fixation, and bone-grafting is a safe and reliable method to allow early rehabilitation by stable fixation and to predict a high rate of union for nonunions of midshaft clavicular fractures.

압박 고 나사로 치료한 대퇴골 전자부 골절 : 고정 실패의 인자에 대한 분석 Analysis of Factors associated with Failure of Fixation

유찬훈,김홍태,변영수,남준모,조영호,문성건 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목 적 : 압박 고 나사로 치료한 대퇴골 전자부 골절의 고정 실패에 영향을 미치는 요소에 대하여 분석하고자 하였다. 대상 및 방법 : 1995년 5월부터 2000년 7월까지 대퇴골 전자부 골절을 압박 고 나사를 이용하여 치료하고 1년 이상 추시가 가능했던 97예를 대상으로 하였다. 골절의 분류는 Jensen 분류법을, 골다공증의 정도는 Singh 지수를 이용하였다. 술후 방사선 검사에서 경체각, 정복 상태, 지연 나사의 대퇴골 두 내 위치, tip-apex distance(TAD) 및 지연 나사의 활강 거리를 측정하였고 고정 실패에 미치는 영향을 통계학적으로 분석하였다. 결 과 : 97예 중 17예(17%)에서 고정 실패가 발생하였고 그 중 지연 나사의 과도한 활강으로인한 경우가 15례(15.4%), 골두 천공 1얘, 10도 이상의 외반 변형 1예였다. 고정 실패의 발생과 80세 이상의 고령, 불안정성 골절, telescoping 정복, 원위 골편의 내측 혹은 전방 전위, 대퇴골 두 내 지연 나사의 위치와 밀접한 관계가 있었다. 결 론 : 압박 고 나사를 이용한 대퇴골 전자부 골절의 치료에서 고정 실패를 방지하기 위해서는 정확한 정복이 필요하고 대퇴골 두 내에서 지연 나사의 전방 위치를 피하는 것이 좋을 것으로 사료된다. Purpose : This study was performed to analyze the significant factors that may affect failure of fixation in trochanteric fractures of the femur treated with the compression hip screw. Materials and Methods : From May 1995 to July 2000, the authors analyzed 97 cases of trochanteric fracture of the femur treated with the compression hip screw and followed more than one year. We classified the fracture type by Jensen's method. We used Singh index for the degree of osteroporosis. In the post-operative radiograph, we checked neck-shaft angle, state of reduction, position of the lag screw within the femoral head, tip-apex distance, and sliding distance of the lag screw. The relationship between these factors and failure of fixation was statistically analyzed. Results : There were 17 cases(17.5%) of failure of fixation ; 15 cases(15.4%) of excessive sliding of the lag screw, 1 case (1%) of cutting out of the lag screw, and 1 case (1%) of valgus malunion. There were significant relationship between failure of fixation and old age over 80 , unstable fracture, telescoping reduction, anterior or medial displacement of the distal fragment, and anterior placement of the lag screw within the femoral head. Conclusion : Accurate reduction and avoidance of the placement of the lag screw in the anterior part of the femoral head were important factors to prevent failure of fixation in trochanteric fractures of the femur treated with the compression hip screw.

Engraftment of Human Mesenchymal Stem Cells in a Rat Photothrombotic Cerebral Infarction Model : Comparison of Intra-Arterial and Intravenous Infusion Using MRI and Histological Analysis

Byun, Jun Soo,Kwak, Byung Kook,Kim, Jae Kyun,Jung, Jisung,Ha, Bon Chul,Park, Serah The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.6

Objective : This study aimed to evaluate the hypotheses that administration routes [intra-arterial (IA) vs. intravenous (IV)] affect the early stage migration of transplanted human bone marrow-derived mesenchymal stem cells (hBM-MSCs) in acute brain infarction. Methods : Male Sprague-Dawley rats (n=40) were subjected to photothrombotic infarction. Three days after photothrombotic infarction, rats were randomly allocated to one of four experimental groups [IA group : n=12, IV group : n=12, superparamagnetic iron oxide (SPIO) group : n=8, control group : n=8]. All groups were subdivided into 1, 6, 24, and 48 hours groups according to time point of sacrifice. Magnetic resonance imaging (MRI) consisting of T2 weighted image (T2WI), $T2^*$ weighted image ($T2^*WI$), susceptibility weighted image (SWI), and diffusion weighted image of rat brain were obtained prior to and at 1, 6, 24, and 48 hours post-implantation. After final MRI, rats were sacrificed and grafted cells were analyzed in brain and lung specimen using Prussian blue and immunohistochemical staining. Results : Grafted cells appeared as dark signal intensity regions at the peri-lesional zone. In IA group, dark signals in peri-lesional zone were more prominent compared with IV group. SWI showed largest dark signal followed by $T2^*WI$ and T2WI in both IA and IV groups. On Prussian blue staining, IA administration showed substantially increased migration and a large number of transplanted hBM-MSCs in the target brain than IV administration. The Prussian blue-positive cells were not detected in SPIO and control groups. Conclusion : In a rat photothrombotic model of ischemic stroke, selective IA administration of human mesenchymal stem cells is more effective than IV administration. MRI and histological analyses revealed the time course of cell migration, and the numbers and distribution of hBM-MSCs delivered into the brain.

Dural Arteriovenous Fistula of Jugular Foramen with Subarachnoid Hemorrhage : Selective Transarterial Embolization

Byun, Jun-Soo,Hwang, Sung-Nam,Park, Seung-Won,Nam, Taek-Kyun The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.45 No.3

We report the case of a 64-year-old man with dural arteriovenous fistula (DAVF) at right jugular foramen, presented as subarachnoid and intraventricular hemorrhage. The malformation was fed by only the neuromeningeal trunk of the right ascending pharyngeal artery and drained into the right lateral medullary veins craniopetally. Complete embolization was attained by selective transarterial glue injection, but patient showed lower cranial neuropathies. A 3-month follow-up angiogram still showed persistent fistula occlusion. Transarterial glue embolization is a feasible method, only if a transvenous access is not possible in case of single channel fistula.

Relationships between eyelid position and levator-superior rectus complex and inferior rectus muscle in patients with Graves’ orbitopathy with unilateral upper eyelid retraction

Byun, Jun Soo,Lee, Jeong Kyu Springer-Verlag 2018 Graefe's archive for clinical and experimental oph Vol.256 No.10

The Numerical Study of the Hemodynamic Characteristics in the Patient-Specific Intracranial Aneurysms before and after Surgery

Byun, Jun Soo,Choi, Sun-Young,Seo, Taewon Hindawi Publishing Corporation 2016 Computational and mathematical methods in medicine Vol.2016 No.-

<P>The patient-specific pre- and postsurgery cerebral arterial geometries in the study were reconstructed from computed tomography angiography (CTA). Three-dimensional computational fluid dynamics models were used to investigate the hemodynamic phenomena in the cerebral arteries before and after surgery of the aneurysm under realistic conditions. CFD simulations for laminar flow of incompressible Newtonian fluid were conducted by using commercial software, ANSYS v15, with the rigid vascular wall assumption. The study found that the flow patterns with the complex vortical structures inside the aneurysm were similar. We also found that the inflow jet streams were coming strongly in aneurysm sac in the presurgery models, while the flow patterns in postsurgery models were quite different from those in presurgery models. The average wall shear stress after surgery for model 1 was approximately three times greater than that before surgery, while it was about twenty times greater for model 2. The area of low WSS in the daughter saccular aneurysm region in model 2 is associated with aneurysm rupture. Thus the distribution of WSS in aneurysm region provides useful prediction for the risk of aneurysm rupture. </P>

Temporary Semi-Jailing Technique for Coil Embolization of Wide-Neck Aneurysm with Small Caliber Parent Artery Following Incomplete Clipping

Byun, Jun Soo,Kim, Jae Kyun,Lee, Hwa Yeon,Hwang, Sung Nam The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.53 No.4

The authors describe the use of a self-expandable stent in a temporary deployment for treatment of a very wide-neck A1 segment of anterior cerebral artery (ACA) aneurysm following incomplete clipping. A 39-year-old hypertensive man presenting with seizure-like movement underwent computed tomography, which showed acute subarachnoid hemorrhage and an A1 segment of ACA aneurysm with superior and inferior projection. He underwent surgical clipping of the aneurysm, but superior and posterior portion of wide-neck aneurysm remained. We decided to treat the remnant aneurysm using an endovascular modality. After selection of the aneurysm, coil packing was performed assisted by the temporary semi-jailing technique. The Enterprise stent (Cordis Neurovascular, Miami, FL, USA) was deployed and recaptured repeatedly for angiography to ensure safety of the small caliber parent artery. Successful semi-deployment and recapture of the stent allowed subtotal coil occlusion of the aneurysm with good anatomic and clinical results. No complications were encountered. The stent could be recaptured up to the point where the proximal end of the stent marker was aligned with distal marker band of the microcatheter, approximately 70% of the stent length. The temporary semi-jailing technique is feasible for wide-neck aneurysm with small caliber parent artery.

Differential effects of blood insulin and HbA1c on cerebral amyloid burden and neurodegeneration in nondiabetic cognitively normal older adults

Byun, Min Soo,Kim, Hyun Jung,Yi, Dahyun,Choi, Hyo Jung,Baek, Hyewon,Lee, Jun Ho,Choe, Young Min,Sohn, Bo Kyung,Lee, Jun-Young,Lee, Younghwa,Ko, Hyunwoong,Kim, Yu Kyeong,Lee, Yun-Sang,Sohn, Chul-Ho,Woo PERGAMON PRESS LTD 2017 NEUROBIOLOGY OF AGING Vol. No.

<P><B>Abstract</B></P> <P>We tested the hypothesis that lower insulin or higher glycated hemoglobin (HbA1c) levels in blood are associated with increased cerebral beta amyloid (Aβ) deposition and neurodegeneration in nondiabetic cognitively normal (CN) older adults. A total of 205 nondiabetic CN older adults underwent comprehensive clinical assessment, [<SUP>11</SUP>C]Pittsburgh compound B (PiB)-positron emission tomography (PET), [<SUP>18</SUP>F]fluorodeoxyglucose-PET, magnetic resonance imaging, and blood sampling for fasting insulin and HbA1c measurement. Lower blood insulin was significantly associated with increased Aβ positivity rates and decreased cerebral glucose metabolism in the AD-signature region. In contrast, higher HbA1c levels were not associated with Aβ positivity rates but were significantly associated with higher rates of having neurodegeneration in the AD-signature regions. Our results suggest different roles of insulin and HbA1c in AD pathogenesis, in that decreased blood insulin below optimal levels may contribute to increasing cerebral Aβ deposition and neurodegeneration whereas impaired glycemic control may aggravate neurodegeneration through a nonamyloid mechanism in nondiabetic CN older adults.</P>

MR Imaging of the Internal Auditory Canal and Inner Ear at 3T: Comparison between 3D Driven Equilibrium and 3D Balanced Fast Field Echo Sequences

Jun Soo Byun,Hyung-Jin Kim,Yoo Jeong Yim,Sung Tae Kim,Pyoung Jeon,Keon Ha Kim,Sam Soo Kim,Yong Hwan Jeon,Jiwon Lee 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.3

Objective: To compare the use of 3D driven equilibrium (DRIVE) imaging with 3D balanced fast field echo (bFFE) imaging in the assessment of the anatomic structures of the internal auditory canal (IAC) and inner ear at 3 Tesla (T). Materials and Methods: Thirty ears of 15 subjects (7 men and 8 women; age range, 22 71 years; average age, 50 years) without evidence of ear problems were examined on a whole-body 3T MR scanner with both 3D DRIVE and 3D bFFE sequences by using an 8-channel sensitivity encoding (SENSE) head coil. Two neuroradiologists reviewed both MR images with particular attention to the visibility of the anatomic structures, including four branches of the cranial nerves within the IAC, anatomic structures of the cochlea, vestibule, and three semicircular canals. Results: Although both techniques provided images of relatively good quality, the 3D DRIVE sequence was somewhat superior to the 3D bFFE sequence. The discrepancies were more prominent for the basal turn of the cochlea, vestibule, and all semicircular canals, and were thought to be attributed to the presence of greater magnetic susceptibility artifacts inherent to gradient-echo techniques such as bFFE. Conclusion: Because of higher image quality and less susceptibility artifacts, we highly recommend the employment of 3D DRIVE imaging as the MR imaging choice for the IAC and inner ear. Objective: To compare the use of 3D driven equilibrium (DRIVE) imaging with 3D balanced fast field echo (bFFE) imaging in the assessment of the anatomic structures of the internal auditory canal (IAC) and inner ear at 3 Tesla (T). Materials and Methods: Thirty ears of 15 subjects (7 men and 8 women; age range, 22 71 years; average age, 50 years) without evidence of ear problems were examined on a whole-body 3T MR scanner with both 3D DRIVE and 3D bFFE sequences by using an 8-channel sensitivity encoding (SENSE) head coil. Two neuroradiologists reviewed both MR images with particular attention to the visibility of the anatomic structures, including four branches of the cranial nerves within the IAC, anatomic structures of the cochlea, vestibule, and three semicircular canals. Results: Although both techniques provided images of relatively good quality, the 3D DRIVE sequence was somewhat superior to the 3D bFFE sequence. The discrepancies were more prominent for the basal turn of the cochlea, vestibule, and all semicircular canals, and were thought to be attributed to the presence of greater magnetic susceptibility artifacts inherent to gradient-echo techniques such as bFFE. Conclusion: Because of higher image quality and less susceptibility artifacts, we highly recommend the employment of 3D DRIVE imaging as the MR imaging choice for the IAC and inner ear.