슬관절주위 외상에 의한 슬와동맥 손상의 재혈관화

한수홍,신동은,단진명,김철,Han, Soo-Hong,Shin, Dong-Eun,Dan, Jin-Myung,Kim, Chul 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.1

Popliteal artery injury in blunt trauma of knee joint is not common but poses high rate of amputation due to anatomical characteristics or delayed diagnosis and treatment. The aim of the present study is to review the authors' experiences with this condition and identify factors contributing to disability. We reviewed 7 cases of popliteal artery injury in trauma around knee. Injury mechanism, type of vessel damage, associated injuries, mangled extremity severity scores (MESS), ischemic time and additional treatments were analyzed. Tibial fracture, distal femoral fracture and serious soft tissue defect were combined. Mean MESS was 9.9 point and mean time of revascularization was 7.1 hours. Transfemoral amputation was performed in 2 cases due to vascular insufficiency and devastating infection, and 4 patients were able to walk without any support at the last follow up. Age, the severity of soft tissue injury, ischemic time and MESS are thought to be related to prognosis, and young patients with short ischemic time show best results, but authors experienced one exceptional case. We have to consider multiple factors related to the prognosis in popliteal artery injury with fractures around knee, and careful decision is needed regarding to early amputation.

정상 한국인 수부의 악력 및 파지력에 대한 통계적 분석

한수홍(Soo-Hong Han),남기식(Ki-Shik Nam),안태근(Tae-Keun Ahn),단진명(Jin-Myong Dan) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.2

목적: 10세 이상 정상 한국인의 우수와 열수를 조사하고 수부력을 측정하여 환자의 평가에 기준을 제시하고자 하였다. 대상 및 방법: 남자 234명, 여자 281명 총 515명의 10세 이상 건강한 정상인에서 악력과 세 가지 파지력을 5분 간격으로 2회 측정하였다. 결과: 남자에서는 대부분의 수부력이 30대에 최고 평균치를 보였다. 평균 파지력은 30대 남자에서 48.8 ㎏, 30대 여자에서 28.23 ㎏로 두 그룹 모두에서 12년 전에 비해 11% 높은 수치를 보였다. 파지력에서는 지첨 집기는 40대, 나머지는 30대에서 평균이 가장 높았다. 여성의 수부력은 30대에서 최고 평균치를 보였고, 남녀 모두 파지력 중 열쇠 집기가 가장 강했다. 오른손잡이에서 왼손은 오른손에 비해 5% 정도 약했으며(p<0.005), 왼손잡이에서는 세다리 집기에서만 왼손이 유의하게 강했다(p=0.015). 결론: 수부력의 최고치는 대부분 30대에 보였고, 파지력 중 열쇠 집기가 가장 강했다. 오른손잡이에서는 오른손이 강한 악력 및 파지력을 보였으나. 왼손잡이에서는 세다리 집기만 차이를 보였고, 다른 수부력은 차이가 없었다. Purpose: We wanted to investigate the grip and pinch strength of hands and establish the clinical normative data for Korean people. Materials and Methods: A sample of 234 Korean males and 281 Korean females (age: 10 to 84) were tested. Grip strength and pinch strength were tested twice with 5 minute interval between tests. Results: Generally, hand strength peaked at 30 to 39 of age for both males and females. The average grip strength was 48.8 ㎏ for males and 28.23 ㎏ for females and they were 11 % stronger than 12 years before in both groups. Tip pinch strength peaked in the forties, but key pinch and tripod pinch peaked in the thirties. All the peak hand strength was obtained in the 30 to 39 age group of females. Among the pinch strengths, key pinch was the strongest. For the right-handed people, the grip and pinch strengths of the right hand were stronger than those of the left hand. However, for the left-handed people, the left hand was stronger than the right hand only for the tripod pinch (p<0.005). Conclusion: The hand strength of Koreans peaked in the 30 to 39 age group. Key pinch was the strongest among the three pinch strengths. Right-handed people have a stronger right hand than the left hand, but the left-handed people have almost the same hand strength in both hands, except for the tripod pinch.

경피적 역행성 골수강내 핀 고정술을 이용한 제5중수골 간부 단독 골절의 치료

한수홍 ( Soo Hong Han ),윤형구 ( Hyung Ku Yoon ),신동은 ( Dong Eun Shin ),한승철 ( Seung Chul Han ),김영웅 ( Young Woong Kim ) 대한골절학회 2010 대한골절학회지 Vol.23 No.4

목적: 제5중수골 골절 치료로 경피적 역행성 골수강내 핀 고정술의 해부학적 및 기능적 결과를 보고하고자 하였다. 대상 및 방법: 제5중수골의 비개방성 골절에 대하여 역행성 골수강내 핀 고정술을 시행받은 31명의 환자를 대상으로 하였으며, 방사선학적으로 골유합 시기 및 각형성을 평가하였고, 임상적으로는 관절 운동 범위 및 DASH 점수 및 합병증을 평가하였다. 결과: 골유합은 모든 예에서 이루어졌으며, 가골의 형성은 수술 후 평균 41일에 관찰되었다. 최종 추시에서 골절 부위의 평균 각 형성은 전후면상에서는 3도 측면상에서는 1.2도였으며, 측정 가능한 단축은 보이지 않았다. 평균 총 능동적 운동 범위는 253도, DASH 점수는 2.6이었다. 추시 관찰 중 2명의 환자에서 금속핀의 전위가 있었다. 결론: 제5중수골 간부 골절 치료로 최소 침습적인 경피적 역행성 골수강내 핀 고정술은 비교적 합병증이 적고 좋은 기능적 결과를 얻을 수 있는 치료법 중 하나라고 생각된다. Purpose: To evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. Materials and Methods: Thirty one consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radio-logically, and clinical evaluations were performed including range of motion, DASH score and complications. Results: Fracture union was achieved in all cases and callus formation was obvious at postoperative 41 days. Average angulation of fracture site was 3˚ in the coronal plane and 1.2˚ in the sagittal plane at the last follow up and no measurable metacarpal shortening was observed. Mean TAM was 253˚ and DASH score was 2.6. There were two cases of pin migration as intermediate complications. Conclusion: Closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.

배측 접근을 이용한 월상골 주위 탈구 및 월상골 탈구의 수술적 치료

한수홍 ( Soo Hong Han ),단진명 ( Jin Myoung Dan ),이동훈 ( Dong Hoon Lee ),김영웅 ( Young Woong Kim ) 대한골절학회 2011 대한골절학회지 Vol.24 No.4

목적: 월상골 주위 탈구 및 월상골 탈구에 있어 배측 접근법만으로 관혈적 정복 및 내고정, 골간 인대 복원술 등을 시행하였으며, 이에 그 임상적, 방사선학적 결과를 보고하고자 한다. 대상 및 방법: 월상골 주위 탈구 및 월상골 탈구로 배측 접근법을 이용한 관혈적 정복 및 내고정, 인대 복원술을 시행하고, 1년 이상 추시가 가능했던 13명의 환자를 대상으로 하였다. 대상 중 탈구된 월상골이 손목관절을 넘어서 근위부까지 전위된 경우는 제외하였다. 임상적 결과 분석은 설문지를 통한 DASH 점수와 Mayo 손목점수를 이용하였다. 또한 방사선 사진에 의한 주상-월상골간각과 주상골 경유 탈구에서는 골절의 유합 여부를 파악하여 방사선학적 결과를 분석하였다. 결과: 최종 추시 시의 DASH 점수는 평균 16.3점 (범위, 10.8~26.7)이었고, Mayo 손목점수는 평균 79점 (범위, 65~90)으로 매우 우수 2예, 우수 7예, 양호 4예였고, 65점 미만의 불량한 결과를 보인 예는 없었다. 방사선 사진상 주상-월상골간각이 평균 49.0° (범위, 35~55°)로 전례에서 정상 범위 내로 유지되었으며, 7예의 주상골 골절도 모두 골유합되었다. 결론: 월상골 주위 탈구 및 월상골 탈구의 수술적 치료에 있어 탈구된 월상골이 손목관절을 넘어 근위부로 전위된 예외적인 경우를 제외하고는 월상골 주위 탈구 및 월상골 탈구의 치료 시 배측 접근법만으로도 좋은 결과를 기대할 수 있을 것으로 생각된다. Purpose: To evaluate the clinical and radiologic outcomes of the perilunate dislocation and the lunate dislocation which were managed surgically through a dorsal approach. Materials and Methods: Retrospective reviews of the 13 patients who had minimum 1-year follow-up after surgical treatment through isolated dorsal approach for their perilunate dislocations or the lunate dislocations were performed. The case that dislocated lunate migrated proximally through the wrist was excluded in this series. We evaluated the DASH score in questionnaire method and Mayo wrist score to analyze the clinical outcomes. Radiologic results were investigated by measurement of the scapho-lunate angle, and fracture union was also evaluated in the case of trans-scaphoid dislocation. Results: The mean DASH Score was 16.3 points (range, 10.8~26.7 points) and the mean Mayo wrist score was 79 points (range, 65~90 points) at the final follow-up. There were 2 cases of excellent, 7 cases of good and 4 cases of fair in the Mayo wrist score. On the radiologic analysis, the mean scapho-lunate angle was 49.0° (range, 35~55°) and all cases were within the normal range. All cases of the trans-scaphoid perilunate dislocation achieved bone union. Conclusion: Author`s cases showed satisfactory outcomes in clinically and radiologically. Isolated dorsal approach could give anatomical reduction and appropriate internal fixation in treatment of the perilunate dislocations and the lunate dislocations except the rare case of proximal migration of the lunate through the wrist.

상완골 원위 골절에서 주두 절골 시사전 천공 후 유관나사못 및 강선 고정

한수홍 ( Soo Hong Han ),이호재 ( Ho Jae Lee ),김우현 ( Woo Hyun Kim ),조용길 ( Yong Gil Jo ),송원태 ( Won Tae Song ) 대한골절학회 2015 대한골절학회지 Vol.28 No.2

Purpose: The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus. Materials and Methods: This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated. Results: All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem. Conclusion: Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra- articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.

족부 및 족관절부 연부조직 재건을 위한 전외측 대퇴 천공지 피판술의 임상결과

한수홍(Soo-Hong Han),홍인태(In Tae Hong),이요한(Yohan Lee),조용길(Yong-Gil Jo),권영우(Young Woo Kwon) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.1

목적: 족부 및 족관절부의 연부조직 결손은 해부학적 한계와 기능적 특성상 선택할 수 있는 재건술의 폭이 비교적 적은 편으로 미용 및 기능적 필요로 인하여 동일 하퇴부의 추가 반흔을 피하고자 하는 경우 그 선택의 폭은 더 줄어들게 된다. 저자들은 이런 경우 전외측 대퇴 천공지 피판술을 시행하였고 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 총 16예가 대상에 포함되었고 남자 12명, 여자 4명, 평균 나이는 34세였다. 연부조직 결손의 가장 흔한 원인은 외상으로 9예였다. 추시기간은 평균 33개월이었고 피판의 평균 크기는 146 cm²로 피판의 생존 및 합병증, 보행 여부 등을 평가하였다. 결과: 총 16예의 피판 중 15예는 성공적으로 생존하였으며 1예에서는 환자의 조기 보행으로 인한 천층 일부 괴사로 피부이식술을 추가하여 호전되었다. 모든 환자들에게서 보조 기구 없이 독립 보행이 가능하여 피판이 보행에 지장을 준 경우는 없었고 최종 추시까지 잔존하는 특별한 합병증은 없었다. 결론: 족부 및 족관절 연부조직 결손의 재건에 있어 이차 치유나 단순 봉합, 또는 유경 피판술 등의 방법으로 피복이 어려운 경우 전외측 대퇴 천공지 피판술은 안전하면서도 얇게 결손 부위를 피복할 수 있어 유용한 유리 피판술로 생각된다. Purpose: Soft tissue reconstruction of a defect around the foot and ankle is a particularly challenging procedure due to the anatomical and functional characteristics of this area. Hence, only a limited number of treatment options are available. Moreover, if patients wish to avoid additional scars on the ipsilateral lower leg for cosmetic reasons, even fewer options are available for treatment. The authors used an anterolateral thigh perforator flap for soft tissue defects in this area, when other surgical options were inadequate. The aim of this study was to report the clinical results and the efficacy of this procedure. Materials and Methods: Sixteen cases of soft tissue defects around the foot and ankle were included. Participants included 12 male and 4 female subjects, and the mean age was 34 years. The most common cause of defect was acute trauma, and the average follow-up period was 33 months. Flap survival time, surgical complications, and ambulation status at the final follow-up stage were evaluated. Results: All 16 flaps successfully survived, except for one case with partial flap necrosis that was thought to be due to weight bearing earlier than scheduled. All patients were able to walk independently without any aid at the final follow-up stage. No patients showed other significant surgical complications. Conclusion: The anterolateral thigh perforator flap is a good alternative for soft tissue defects of the foot and ankle, when other options are not applicable. This study also demonstrated that surgery using an anterolateral thigh perforator flap is safe and highly reliable.

핀 지렛대 방법 [Pin Leverage]을 이용한 소아 요척골 간부 골절의 정복

한수홍 ( Soo Hong Han ),조덕연 ( Duck Yun Cho ),윤형구 ( Hyung Ku Yoon ),김병순 ( Byung Soon Kim ),강성훈 ( Sung Hoon Kang ),김태형 ( Tae Hyung Kim ) 대한골절학회 2004 대한골절학회지 Vol.17 No.1

하지 골절과 동반된 연부조직 결손 재건을 위한 역행성 비복동맥 피판술

한수홍(Soo-Hong Han),홍인태(In-Tae Hong),최성주(SeongJu Choi),김민욱(Minwook Kim) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.3

목적: 하지, 특히 정강이 앞 부분이나 발, 발목에서의 연부조직 결손은 피복에 어려움이 있다. 저자들은 하지의 개방성 골절 또는 폐쇄적 골절 후 수상부위에 발생한 다양한 연부조직 결손에 대하여 역행성 표재 비복동맥 피판술을 사용하여 피복을 시행한 예들을 수집, 분석하여 그 임상적 결과를 보고하고자 한다. 대상 및 방법: 2003년 8월부터 2018년 4월까지 하지의 골절 후 수상 부위에 발생한 연부조직 결손에 대하여 역행성 비복동맥 피판술을 시행받은 환자를 대상으로 하였다. 수술 후 최소 6개월 추시가 가능했던 16명의 환자를 대상으로 하였으며, 평균 추시기간은 18개월이었다. 8예는 개방성, 다른 8예는 폐쇄적 골절 후 발생한 합병증으로 연부조직 결손이 발생했다. 피판의 평균크기는 51.9 cm²였으며, 가장 큰 피판의 크기는 10×15 cm²였다. 결과 분석을 위해 수술 후 피판의 생존 여부와 추가 술식, 합병증 등을 조사하였다. 결과: 최종 추시 시 이식 피판은 모두 생존하였으며, 공여부에 별다른 합병증도 발생하지 않았다. 수술 후 단기 추시 당시 1예에서 경계부의 부분 괴사 소견이 발견되었으나 변연절제술과 1차 봉합을 통해 회복되었다. 다른 1예에서는 혈종이 발생하여 추가로 혈종제거술을 시행하였으며, 추시기간 내 피판은 성공적으로 생존하였다. 이식부의 미용적 목적으로 피판 축소수술이 3예에서 시행되었고, 피판부를 절개하고 접근하여 내고정물을 제거하거나 추가적 내고정술을 시행한 건이 3예였었다. 결론: 역행성 표재 비복동맥 피판술은 하지 골절과 동반된 연부조직 결손의 치료에 있어 적극적 적용을 고려할 만한 유용한 술기의 하나가 될 수 있을 것으로 생각된다. Purpose: Soft tissue defects of the distal lower extremity are commonly accompanied by a fracture of the lower extremities. Theses defects are caused by the injury itself or by complications associated with surgical treatment of the fracture, which poses challenging problem. The reverse superficial sural artery flap (RSSAF) is a popular option for these difficult wounds. This paper reviews these cases and reports the clinical results. Materials and Methods: Between August 2003 and April 2018, patients who were treated with RSSAF for soft tissue defects of the lower third of the leg and ankle related to a fracture were reviewed. A total of 16 patients were involved and the mean follow-up period was 18 months. Eight cases (50.0%) of the defects were due to an open fracture, whereas the other eight cases (50.0%) were postoperative complication after closed fracture. The largest flap measured 10×15 cm² and the mean size of the donor sites was 51.9 cm². The flap survival and postoperative complications were evaluated. Results: All flaps survived without complete necrosis or failure. One case with partial necrosis of the flap was encountered, but the wound healed after debridement and repair. One case had a hematoma with a pseudoaneurysmal rupture of the distal tibial artery. On the other hand, the flap was intact and the wound healed after arterial ligation and flap advancement. A debulking operation was performed on three cases for cosmetic reasons and implant removal through the flap was performed in three cases. No flap necrosis was encountered after these additional operations. Conclusion: RSSAF is a relatively simple and safe procedure for reconstructing soft tissue defects following a fracture of the lower extremity that does not require microsurgical anastomosis. This can be a useful treatment option for soft tissue defects on the distal leg, ankle, and foot.

생비골 성장판 이식술을 이용한 선천성 다발성 골연골증에서 전완부 변형의 치료

한정수,유명철,정덕환,한현수,한수홍,Han, Chung-Soo,Yoo, Myung-Chul,Chung, Duke-Whan,Han, Hyun-Soo,Han, Soo-Hong 대한근골격종양학회 1995 대한골관절종양학회지 Vol.1 No.1

It is difficult to manage the growing deformity of forearm bone caused by hereditary osteochondromatosis in children, because deformity and discrepancy of limb length is progressive. The are many treatment methods of these problems including excisio of osteochondroma, lengthening of ulna, shortening of radius, corrective osteotomy with or without lengthening apparatus. Among many treatment methods, we tried free vascularized epiphyseal transplantation with the proximal fibular epiphysis in 3 patients of hereditary osteochondromatosis for inducement of continuous bone growth and deformity correction. The average duration of follow up was 7 years and 1 month, the shortest duration being to 4 years and 5 months and the longest 10 years and 8 months. Serial radiologic and clinical evaluation were carried out during follow up and there were satisfactory length gain, deformity correction and improvement of adjacent joint motion in 2 cases. According to our follow up evaluation, free vascularized epiphyseal transplantation is valuable procedure in forearm deformity of hereditary osteochondromatosis although it needs skillful and experienced operative technique.

전완골 분절의 전위 이식술

정덕환,한수홍,이재훈,권부경,Chung, Duke-Whan,Han, Soo-Hong,Lee, Jae-Hoon,Kwon, Boo-Kyung 대한미세수술학회 2007 Archives of reconstructive microsurgery Vol.16 No.2

Introduction: Ulna is nearly equal to radius in function and bony architecture and strength in forearm. But in lower extremity, fibula is 1/5 of tibia in anatomic and functional point so we can find fibula transposition is commonly used in defect of tibia. We cannot find other article about segmental forearm bone transposition in man. The purpose of this study was to report our clinical and functional result of undergoing segmented transposition of ipsilateral ulna with its own vascular supply in defect of radius in 6 cases. Material and method: From June 1994 to October 2007, 7 segmented bone transpositional grafts in forearm were performed in Kyung Hee Medical Center. The distribution of age was from 20 years old to 73 years old. There was male in 6 cases and female in 1 case. The causes of operation were giant cell tumor in 1 case and traumatic origin in 6 cases; it was nonunion in 2 cases and fracture with severe comminution in 4 cases. Ipsilaterally segmented ulna keeping its own vascular supply was transported to defect of radius in severe traumatic patients and one patient whose tumor in radius had been excised. Transported ulna was fixed to proximal and distal radius remnants by plate and screw. In one case with giant cell tumor, transported ulna was connected to radius across wrist joint as wrist joint fusion. Joint preserving procedures were performed in 6 cases with crushing injury of radius. Results: We could obtain solid bony union in all cases and good functional results. The disadvantage was relative shortening of forearm, but we could overcome this problem. Conclusion: We think that ipsilateral segmented ulna transposition keeping its own vascular supply to radius can be perfomed with one of procedures in cases with wide defect in radius.