척골 경상 돌기 골절을 동반한 원위 요골 골절과 원위 요척 관절 불안정성과의 관계

손홍문 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Objectives: The purpose of this study was to evaluate the patterns (size, displacement) of ulnar styloid process fractures accompanying distal radius fracture and determine their relative contribution to distal radioulnar joint (DRUJ) instability. Materials and Methods: We evaluated 62 cases of distal radius fracture with ulnar styloid fractures who were treated by operation and were followed up for more than six months. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size (0-49%, 50-99%, >100%) and displacement (undisplaced, <2㎜, ≥2㎜). Each distal radius fracture was also evaluated for radiographic and clinical evidence of DRUJ instability at last follow-up. Results: DRUJ instability was revealed in 12 cases. Both the large size of the ulnar styloid fracture (50-99%; 10 cases, ≥100%; 2 cases) and its severe displacement (<2㎜; 3cases, ≥2㎜; 9 cases) at the time of injury have more instability than minimal size and displacement. The communition of the distal radius fracture was significantly related DRUJ instability, C3 type 7 cases on 6 cases(85.7%). but, involvement of the radiocarpal articular surface did not generate significant difference in the incidence of DRUJ instability, Conclusion: The fracture at the base of ulnar styloid and significant displacement of an ulnar styloid fracture were found to increase the risk of DRUJ instability.

Controlled bending of proximal femoral nails used in fractures of bowed femurs: biomechanical study with clinical application

손홍문,조승환 조선대학교 의학연구원 2022 Medical Bilogical Science and Engineering Vol.5 No.2

We aim to investigate whether the controlled bending of the commercially available nail could affect the nail’s biomechanical properties. We also report the clinical application using such method. A commercially available titanium proximal femoral nails were used for the current study. Using the custom made bending Jig, the portion distal to the bending point of the original nail was bent to varus curvature so that the alignment of the nail is equivalent to medial bowing of 1,000 mm radius. The biomechanical test was performed using the static four point bending test according to American Society for Testing and Materials (ASTM) standards. The measured biomechanical properties were compared between the original nail and the pre-bended nail. There was no significance difference between the original nail and the pre-bended nail in terms of mechanical properties we measured (p<0.05). Only 0.32% difference in bending strength was noticed between the two group which is considered to be negligible. The patient utilizing controlled bending nail showed early bone healing without complication. The result of the current study indicates that the additional bending of the commercially available intramedullary nail has only minimal effect on the biomechanical property of the nail. Therefore, we think controlled bending can be done on a commercially available intramedullary nail and can be used safely in the patient with severe anterolateral bowing.

충돌 안전 및 캐나다 기후환경을 고려한 저상트램용 Front Hood System 개발

손홍문 한국철도학회 2024 한국철도학회 학술발표대회논문집 Vol.2024 No.5

전방십자인대 파열에 동반된 반월상 연골판 손상의 관절경 수술 소견과 수술 전 자기공명영상 검사와의 비교

손홍문,이광철,김동휘,박상수,Sohn, Hong Moon,Lee, Gwang Chul,Kim, Dong Hwi,Park, Sang Soo 대한관절경학회 2012 대한관절경학회지 Vol.16 No.2

Purpose: The purpose of this study was to compare the preoperative magnetic resonance image (MRI) findings with postoperative arthroscopic findings on meniscus injury with anterior cruciate ligament (ACL) rupture. Materials and Methods: We reviewed MRI images and arthroscopic findings of 225 patients treated by ACL reconstruction due to rupture, from February 2001 to November 2010. There were 154 cases of meniscus tear in arthroscopic findings. We examined the sensitivity for detecting meniscal tears varied with the presence of a rupture of the ACL, with the location of the tear within the meniscus, and among configurations of meniscal tears. Results: In the presence of a rupture of the ACL, the sensitivity of MRI was 0.88 for medial meniscal tears and 0.69 for lateral meniscal tears. And sensitivity of MRI was lowest in posterior horn and peripheral portion tears in lateral meniscus injury accompanying ACL rupture, sensitivity was low in anterior horn and flap shape tears in medial meniscus injury accompanying ACL rupture. Conclusion: In Meniscus injury with ACL rupture, a special attention shoulder given to the posterior horn and peripheral portion injury in lateral meniscus during arthroscopic surgery due to difficulty in detecting on MRI.

척수 손상 백서에서 경피신경전기자극을 통한 미세전류 치료 효과

손홍문,임원봉,김영욱,고영종,박민언,김보라 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.1

Study Design: Animal study. Objectives: To investigate the effects of microelectric treatment by transcutaneous electrical nerve stimulation (TENS) on functional recovery and histological changes in a rat model of spinal cord injury (SCI). Summary of Literature Review: The effects of TENS on spasticity and its underlying mechanisms remain unclear. Materials and Methods: SCI was induced by a 1.5-mm impactor with 200,000–260,000 dyne after laminectomy. Rats were divided into the following groups: group I (normal control), group II (microelectric treatment of 0 A), group III (microelectric treatment of 100 μA for 1 hr/day), group IV (microelectric treatment of 400 μA for 1 hr/day), and group V (microelectric treatment of 400 μA for 24 hr/day). After inducing SCI, rats were assessed by a sensory test with von Frey filaments and the locomotor recovery test (BBB rating scale) at 1, 4, 7, 14, 21, and 28 days. To evaluate spinal cord damage, histopathological studies were performed with hematoxylin and eosin. Brainderived neurotrophic factor (BDNF) and TrkB immunohistochemistry studies were performed at 28 days. Results: In groups IV and V, the BBB score had significantly improved on days 21 and 28 after SCI, and the TENS-treated groups showed significant neuronal recovery. After SCI, groups IV and V showed a significant recovery of locomotor function and the motor sensory response of the withdrawal threshold to 3.5 g. In addition, necrotic tissue and cystic spaces in the spinal cord were significantly reduced and BDNF/TrkB-positive cells were highly expressed in groups III, IV, and V. Conclusions: Microelectric treatment can play a role in facilitating the recovery of locomotion following SCI. 연구 계획: 동물 실험목적: 척수 손상 백서 동물 모델에서 경피신경자극을 통한 미세전류 치료가 기능적 회복과 조직학적 변화에 미치는 영향을 알아보고자 하였다. 선행 연구문헌의 요약: 경피신경자극의 척수 기능 향상에 대한 보고는 드물다. 대상 및 방법: 실험 쥐의 후궁 절제 후 1.5 mm impactor를 이용하여 200,000-260,000 dyne의 외력으로 척수 손상을 시켰다. 실험군은 그룹 I; 비수술군, 그룹 II; 미세전류치료(0 A) 군, 그룹 III; 미세전류치료(100 μA, 하루 한시간) 군, 그룹 IV; 미세전류치료(400 μA, 하루 한시간) 군, 그룹 V; 미세전류치료 (400 μA, 하루 24시간) 군으로 나누어 실험을 진행하였다. 척수 손상 후 1, 4, 7, 14, 21일과 28일에 BBB척도를 이용한 운동 기능 검사와 von-Frey monofilament를 이용한 감각 검사를 시행하였다. 또한 손상 부위의 조직학적 변화 관찰을 위한 H&E 염색 및 신경성장인자의 발현 분석을 위한 BDNF, Trk-b의 면역조직화학염색을 수상 후 28일에 시행하였다. 결과: 그룹 IV, V군에서 척수 손상 후, 21일과 28일에서 BBB 점수가 상당히 향상하였으며, 유의한 신경원 회복을 보였다. 또한 척수 손상 후 그룹 IV, V군에서 유의한 운동기능 향상과 감각기능 회복을 보였으며, 척수의 괴사조직이 상당히 감소됨을 확인할 수 있었다. 또한 그룹 III, IV, V군에서는 BDNF 및Trk-β의 발현이 증가하였다. 결론: 척수 손상 후 경피신경전기자극 치료는 운동 기능 회복의 향상에 도움이 되리라 사료된다. 약칭 제목: 급성 척수 손상의 미세전류 치료

송아지와 사람의 요추 모델의 생역학적 비교

손홍문,유재원,임만택 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

Background and Objectives: Calf spines are commonly used in biomechanical research as a substitute for human cadaveric spines. Despite widespread use, the validity of this model has not been thoroughly investigated. The purpose of this study was to perform biomechanical flexibility tests using identical methods and instrumentation on calf and cadaveric lumbar spines to determine whether significant differences exist between the results from the two models. Materials and Methods: Five fresh calf spines and five cadaver lumbar spines (L2-L5) were used for flexibility testing. The L2 and L5 vertebrae were used to attach the loading and base frames, respectively. Three reflective markers were attached to L3 and L4. Specimens underwent nondestructive biomechanical testing using the VICON 3-D motion analysis system. Maximum moments of 6.4 Nm were achieved in five increments of 1.6 Nm. The rotations of L3 with respect to L4 were measured to determine the stability of the specimens in five cases : 1) intact ; 2) partial discectomy, including partial laminectomy and partial facetomy ; 3) partial discectomy with ISOLA pedicle screw instrumentation ; 4) total discectorny with instrumentation and 5) instrumentation with inter body graft. Rotational angles were normalized to the intact case to determine the overall stabilizing effects. Data were analyzed using ANoVA to determine if significant differences existed. Results: In both models an increase in motion was observed after the partial discectorny, instrumentation reduced motion beyond the intact, and the total discectomy increased motion in all cases. Placement of the inter body graft decreased motion in axial rotation, flexion, and extension, but increased motion in lateral bending. A two-way ANoVA showed no significant differences between the two models during flexion and extension (p)O. 05) however, differences were noted during axial rotation and lateral bending (p<0.05). In all loading cases there were differences between the various testing cases (p<.05). Conclusion: This study demonstrated that calf lumbar spines can serve as a substitute for human cadaveric spines in biomechanical testing. Motion trends were similar for the two models in flexion and extension ; however, significant differences were found in axial rotation and lateral bending. These results suggest that the calf lumber spine can be a good model for in vitro biomechanical evalution of spinal instrumentation. The extrapolation of calf spine data to the in vivo case, especially during axial ratation and lateral bending, should carefully consider the variations between the two models.

전위된 관절내 종골 골절의 수술적 치료 후 방사선학적 계측치와 임상 결과와의 관계

손홍문,임만택,문현식 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.3

Objectives: The purpose of our study was to evaluate the relationship between radiographic parameters and clinical results after operative treatment of the displaced intra-articular calcaneal fractures. Materials and Methods: We analyzed 35 patients of unilateral displaced intraarticular calcaneal fractures who had been treated by operative treatment. At the last follow up, we measured the radiographic parameters including Bohler angle, Gissane angle, heel height, calcaneal length, talocalcaneal angle, talar declination angle, and subtalar incongruity between normal and affected site. Clinical results were measured by Creighton-Nebraska Health Foundation Assessment Score (CNH). And then the correlation between the radiographic parameters and the clinical results were analysed by Pearson correlation method. Results: The average difference between normal and affected site were Bohler angle 15˚ (0-35), Gissan angle 6.5˚(0-20), heel height 4.7mm (1-12), calcaneal length 2.0mm (0-7), talocalcaneal angle 5.5˚(1-19), talar declination angle 2.2˚(0-8), calcaneal width 4.0mm (1-9), subtalar incongruity 0.54mm (0-2.5). The correlation coefficients between radiographic parameters and CNH score were Bohler angle 0.066 (p=0.75), Gissane angle 0.038 (p=0.829), heel height 0.019 (p=0.916), calcaneal length 0.091 (p=0.386), talocalcaneal angle 0.059 (p=0.737), talar declination angle 0.118 (p=0.501) , calcaneal width 0.250 (p=0.291), and subtalar incongruity 0.784 (p=0.002) respectively. Among the all radiographic parameters, The subtalar incongruity shows strong linear correlation with clinical results. Conclusion: We suggested that the subtalar incongruity was significantly correlated with the' clinical results after operative treatment of the displaced intraarticular calcaneal fractures.

급성 척수 손상 후 신경보호 및 재생을 위한 약물 치료

손홍문,양경호 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

This is a retrospective review of current literature regarding neuroprotection and regeneration after acute spinal cord injury. Our objective was to provide an update for clinicians of the pathophysioloy of secondary injury, which is the main target for the treatment of spinal cord injury and the emerging therapeutic strategies for promoting neural regeneration. We particularly focused on currently used medications that may have neuroprotictive potential in spinal cord injury. While laboratory research in animal models reportedly resulted in some degrees of promising result, prospective randomized clinical results are anxiously awaited.

신경학적 증상을 동반한 흉요추 골절에서 후방 유합술: 유합술과 감압술 추가한 군과의 비교

손홍문,유재원,박상수,김보선,정성 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.1

Study Design: A retrospective study. Objectives: To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit. Summary of Literature Review: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit. Materials and Methods: 40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification. A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion. Results: The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusion: We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement. 연구 계획: 후향적 연구. 목적: 신경학적 증상이 있는 흉요추 골절환자에서 후방 유합술을 시행한 군과 추가적인 후방 감압술을 시행한 군을 비교하여 신경 증상의 호전을 위한 추가적인 후방 감압술의 필요성에 대해 알아보고자 하였다. 선행 문헌의 요약: 신경학적 증상이 있는 흉요추 골절환자에서 후방 감압술에 대한 명확한 적응증 및 일치된 의견은 확립되지 않았다. 대상 및 방법: 2004년 1월부터 2012년 6월까지 신경학적 증상을 동반한 흉요추부 골절로 수술적 치료를 시행받은 40예를 대상으로 하였다. 후방 유합술만시행 받은 23(남:여=14:9)예를 제 1군으로, 추가적인 후방 감압술을 시행 받은 17(남:여=9:8)예를 제 2군으로 하였다. 손상 부위는 두 군 모두 요추 1번이 가장많았으며 McAfee분류에 따른 골절 분류상 두 군 모두 불안정성 방출성 골절이 많았다. Frankel 등급에 따른 술 전 신경학적 증상은 등급 D 가 두 군 모두 가장많았다. 방사선학적 평가는 수상 당시와 술 후, 최종 추시때의 척추관 함입률과 후만각의 변화를 측정하였고 임상적 평가는 신경학적 호전 정도를 평가하였다. 결과: 후만각의 변화는 술전에 비해 최종 추시시 두 군 모두 호전되었으며 척추관 함입률은 제 1군에서 술전 53.4%, 제 2군에서 술전 59.8%였다. 최종 추시때 제 1군에서 신경 증상의 호전 19예, 제 2군에서 신경 증상의 호전 14예로 두 군간에 의의 있는 신경학적 호전의 차이는 없었다. 하지만 두 군에 따른 척추관 함입률 및 후만각의 변화와 최종 신경학적 증상 호전과의 상관 관계는 없었다(p>0.05). 결론: 신경학적 증상을 동반한 흉요추 골절에서 신경학적 호전을 위한 추가적인 후방 감압술은 반드시 필요한 술식은 아니라고 사료된다.

경추의 굴곡-신전 손상으로 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 봉합

손홍문,유재원,박상수,김보선 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: A case report. Objectives: To report the use of the shoelace technique for treatment of wound dehiscence caused by dural tears. Summary of Literature Review: It is difficult to treat wound dehiscence caused by dural tears, as it can lead to infection, loss of soft tissue, and need for a long hospital stay. Materials and Methods: An 18-year-old male who had been injured in a traffic accident was diagnosed with bilateral facet dislocation of C7-T1, with no neurologic deficit. Clear secretion appeared during the operation, but it disappeared after posterior fusion. The wound began to open about 3 weeks after the operation. We used the vessel loop shoelace technique to suture the wound, Results: The patient had the stitches taken out in the outpatient clinic three weeks after suture. His wounds are healing without complication. Conclusion: The vessel loop shoelace technique may be a useful treatment for wound dehiscence caused by dural tears. 연구 계획: 증례 보고적: 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 치료에 대한 경험을 보고하고자 한다. 선행 문헌의 요약: 경막 파열 후 발생하는 창상의 벌어짐은 창상 감염 및 연부 조직의 소실, 장기간의 입원 치료 등을 유발할 수 있어 치료하기 어렵다. 대상 및 방법: 교통사고로 신경학적 결손이 없는 경추 7번과 흉추 1번의 양측성 관절 돌기의 탈구가 발생한 18세 남자환자에 대해 후방 고정술을 시행하였다. 수술 중 뇌척수액으로 추정되는 맑은 분비물이 있었으며 후방 고정술을 시행 후 분비물은 없었다. 수술 3주 후 창상의 벌어짐이 발생하였고 이에 혈관 루프(vessel loop)를 이용한 Shoelace 기법으로 봉합을 시행하였다. 결과: 3주 후 외래에서 혈관 루프를 제거 하였으며 합병증 없이 창상 봉합이 되었다. 결론: 혈관 루프를 이용한 Shoelace 기법은 경막 파열 후 발생하는 창상 벌어짐에 대해 매우 유용한 치료 방법 중 하나라고 생각한다.