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이광석,하경환,임당재,김태하,Lee, Kwang-Suk,Ha, Kyung-Hwan,Lim, Dang-Jae,Kim, Tae-Ha 대한미세수술학회 1999 Archives of reconstructive microsurgery Vol.8 No.2
In general, amputation has been performed in the treatment of diabetic foot which doesn't respond to the conservative treatment. We have evaluated the existence of post-operative infection, the morbidity of donor site, the degree of recovery of sensation, weight bearing ambulation and recurrence in the 6 cases(5 patients) of diabetic foot patients among the 230 cases of free flap transfer done in our department. In all cases of free flap transfer to diabetic foot, 100% of survival rate was shown. The sensory recovery was more than average of 40% of the area of the transferred flap, and two points discrimination was shown average of 5cm as a result. In all cases, no evidence of post-operative infection was discovered and the weight bearing gradually became easier, and at the average of 5 months after operation, the full weight bearing ambulation became possible. If the infection of diabetic foot and the level of blood sugar could be controlled successfully, the free flap transfer could be considered one of the treatment option to avoid amputation.
이광석,변영수,하경환,이순혁 대한골절학회 1997 대한골절학회지 Vol.10 No.1
The injury of popliteal artery is commonly produced by fracture or dislocation around the knee. Well established protocol for urgent diagnosis and treatment is essential to avoid amputation. The 14 cases of popliteal artery injury, treated between April 1987 and June l995 at the Department of Orthopedic Surgery Korea University Hospital, were reviewed. The results were as follows. l. In all 14 cases, 4 extremities(28%) were amputated. The amputation rate was closely correlated with the ischemic time since the accident. 2. The use of Doppler flowmeter after physical examination and emergency arteriography before exploration was recognized to be an exellent method in determination of arterial injury. 3. Among the patients who could avoid amputation(l0 cases), the vein graft was performed in 8 cases(80%) and primary repair by end to end anastomosis in 2 cases(20%). 4. External fixation is recommended for its simplicity and low infection rate to provide the fixation and collateral circulation of fracture site. 5. The patients who were injured with the wide soft tissue defect by crushing could be treated by latissimus dorsi free flap transfer to avoid amputation.
박상원,변영수,하경환 대한골절학회 1996 대한골절학회지 Vol.9 No.4
Since the original description by G. Monteggia of a fracture of the ulna associated with dislocation of the radial head, attention has been focused on the immediate recognition and treatment of this fracture, but the dislocation of the radial head is not infrequently missed. The purpose of this study is to analyse the clinical results according to types of the fracture and methods of treatment. 'he authors reviewed twenty-four patients treated for Monteggia fracture at the Department of Orthopaedic Surgery, Korea University Hospital from January 1986 to April l995. The mean follow up period was 21 months (12 month - 37 months ). The results were as follows: l. According to Bado classification, there were l5 cases(63%) of Type I, 3 cases(12%) of Type 2, 2 cases(8%) of Type 3, and 4 cases(l 7%) of Type 4. 2. The location of the ulna fracture site was proximal metaphysis in 7 cases(29%), proximal 1/3 in 15 cases(63%), and middle I/3 in 2 cases(8%). 3. Treatment for ulna fracture were open reduction and internal fixation in 21 cases(88%). and closed reduction in.3 cases(12%). 4. Treatment for dislocated radial head were closed reduction in 20 cases(84%), open reduction in 2 cases(8%), and radial head resection in 2 cases(8%). 5. Transient palsy of posterior interosseous nerve was observed in 3 patients(I3%). 6. The results by Bruce et al critera were excellent in 7 cases(29%), good in 9 cases(38%), fair in 6 cases(25%), and poor in 2 eases(8%).
이광석,박종웅,하경환,한상석,Lee, Kwang-Suk,Park, Jong-Woong,Ha, Kyoung-Hwan,Han, Sang-Seok 대한미세수술학회 1997 Archives of reconstructive microsurgery Vol.6 No.1
We have evaluated the clinical results following the 46 cases of free vascularized osteocutaneous fibular flap transfer to the tibial defect combined with skin and soft tissue defect, which were performed from May 1982 to January 1997. Regarding to the operation, flap size, length of the grafted fibula, anastomosed vessels, ischemic time of the flap and total operation time were measured. After the operation, time to union of grafted fibula and the amount of hypertrophy of grafted fibula were periodically measured through the serial X-ray follow-up and also the complications and results of treatment were evaluated. In the 46 consecutive procedures of free vascularized osteocutaneous fibular flap transfer, initial bony union were obtained in the 43 grafted fibulas at average 3.75 months after the operation. There were 2 cases in delayed unions and 1 in nonunion. 44 cutaneous flaps among the 46 cases were survived but 2 cases were necrotized due to deep infection and venous insufficiency. One necrotized flap was treated with latissimus dorsi free flap transfer and the other was treated with soleus muscle rotational flap. Grafted fibulas have been hypertrophied during the follow-up periods. The fracture of grafted fibula(15 cases) was the most common complication and occurred at average 9.7 months after the operation. The fractured fibulas were treated with the cast immobilization or internal fixation with conventional cancellous bone graft. In the cases of tibia and fibula fracture at recipient site, the initial rigid fixation for the fibula fracture at recipient site could prevent the fracture of grafted fibula to the tibia.