고관절 제거후 재건을 위한 방법으로서의 안장형 인공 고관절 치환술은 동종골 이식술후 고관절 전치환술, 열처리한 자가골 재삽입 후 고관절 전치환술, 좌골 대퇴골간 유합술, 가동 관절로 그대로 두는 방법 등에 비해서 수술 시간의 단축에 의한 감염율 및 기타 이환율의 감소, 술후 조기 보행 가능, 좌식 생활을 하는 한국인의 생활에 편리한 이점이 있다. 이 방법은 Modular system으로 다리 정렬 상태를 잘 보존시킬 수 있으며 필요하다면 추후 골 재건술도 할 수 있는 장점이 있다. 저자들은 비구를 침범한 악성 골 종양을 제거 고관절의 재건을 위해 3예에서 안장형 인공 고관절 치환술을 시행하였다. 이중 1예에서 가역성 서혜부 탈장이 관찰되었으나 12개월, 19개월(사망), 27개월의 추시 관찰 결과 자가 보행, 계단 오르내리기가 가능하고, 쪼그려 앉기와 방바닥에 앉을 수 있으며, 통증없이 일상적인 생활을 할 수 있었다. 따라서, 비구를 침범한 골 종양 제거후의 고관절 재건술의 좋은 방법으로 판단되어 이에 문헌 고찰과 함께 보고하는 바이다.

Giant cell tumor is most frequently found in juxtaarticular region, and difficult to treat because of local recurrence. Although primary resections reduce recurrence, the joint function will be markedly impaired. Techniques involving physical adjuncts(high speed burr and electric cauterization), acrylic cement or en bloc resection with VFG(vascularized fibular graft) have been employed to reduce local recurrence. From October 1984 to April 1994, twenty-nine patients diagnosed as giant cell tumor were treated at department of Orthopaedic Surgery, School of Medicine, Kyung Hee University. There were eleven men and 18 women, ranging in age from 17 to 52 years(mean: 34 years). The average follow-up period was four years and five months. The location of the lesion was around the knee in 15, distal radius in three, femoral head in three, and others in eight patients. Fifteen patients around the knee joint were treated with several modalities; curettage with bone graft in five, curettage with cement filling in three, curettage with bone graft and physical adjuncts in five, en bloc resection with VFG in one and en bloc resection with arthroplasty in one patient. The functional results, according to the Marshall's knee score, were excellent in one, good in two, and fair in two after the curettage with bone graft, good in three after the curettage with bone cement filling, excellent in one, good in four after the curettage with bone graft and physical adjuncts, and good in two after the en bloc resection with VFG or arthroplasty. Three patients had local recurrence among 15 patients with giant cell tumor around knee. Vascularized fibular graft around wrist joint provided good functional restoration without local recurrence in all three patients who had giant cell tumor in distal radius. Although there is no statistical significance, it seems that curettage with bone graft using physical adjuncts or acrylic cement reveals better results than simple curettage with bone graft. Excellent functional result were obtained without local recurrence by using vascularized fibular graft after en bloc resection.

1986년 3월부터 1993년 12월까지 연세대학교 의과대학 정형외과학 교실에서 상지에 발생한 악성 및 침윤성 양성 골종양에 대하여 사지구제술을 시행하여 다음과 같은 결과를 얻었다. 1. 총 13명의 상지에 발생한 악성 및 침윤성 양성골종양 환자에 대해 사지 구제술을 시술 하였다. 2. 사지 구제 술의 내용은 8 례가 Tikhoff -Linberg 수술, 2 례가 분절절제 및 재접합술, 2 례가 종양삽입물 치환술 그리고 1 례가 분절절제술 및 유리혈관부착 생비골이식술이었다. 3. 13 례중 3 례가 골육종, 4 례가 연골육종, 3 례가 거대세포종, 1 례가 병적 골절을 동반한 유잉육종, 1 례가 연골아세포종, 1 례가 전완부 건 및 근육과 원위요골 및 척골을 동시에 침범한 평활근 육종이었다. 4. 추시기간은 술수 1년에서부터 7년 5개월로 평균 4년 5개월이었다. 5. 총 13명의 환자 중 1 례의 상완골에 발생한 병적 골절을 동반한 유잉 육종의 환자에서 국소재발 및 다발성 골전이가 나타나 수술 후 4년 4개월만에 사망하였고 나머지 12 례의 환자는 국소재발이나 원격전이의 소견은 없었다. 6. 상지에 발생한 악성 및 침윤성 양성 골종양의 치료로 여러방법의 사지구제술은 병의 치료 면이나 기능적인 면에서 만족스런 결과를 가져왔다.

Eight patients with Ewing's sarcoma were treated between September 1983 and September 1992 at medical college, Department of Orthopaedic Surgery, Guro Hospital, Korea University. There were 5 males and 3 femails, with mean age of 28.2 years(ranging from 2-66 years). Three patients with soft tissue Ewing's tumor were excluded from the study. Of the eight patients, two patients presented with multiple metastasis, two cases occurred in the rib, and in the distal femur, mandible, scapular, 3rd, 4th thoracic spine in each patients. Chemotherapy alone was applied in 3 patients, radiotherapy alone in 1 patient, 2 patients were treated with chemotherapy and radiotherapy. Four patients died from the disease itself. Remissions were achieved in the other 4 patients. However, among them two patients relapsed 5 and 36 months later, I patient was not able to be followed, I patient died due to sepsis. The poor prognosis observed for patients with axial lesions should encourage other methods of managing these tumors.

Recently vascularized fibular transfer has been used in the treatment of bone tumor that are more than six centimeter in length. With refinements in microsurgical techniques and understanding of the biological and biomechanical characteristics of vascularized bone graft, the success rate of this procedure was increased. Fifteen bone tumor patients, sixteen cases seen from Apr. 1979 to Jun. 1995 were managed by means of vascularized bone graft at Kyung Hee University Hospital. Ten cases were done intercalary graft and the others were done osteoarticular graft. the ratio of male and female was 6 : 9, and mean age was 20.4 years old at operation. Mean follow up period was 5 years 4 months(range 17 months to 16 years 2 months) and mean graft length was 13.8cm. Duration for union was 5.3 months(range 3 months to 1 year) and over-all rate of union at the last follow up examination was 93.8%. Sufficient hypertrophy of grafted bone was obtained in all cases at the time of last follow up as compared to initial size of grafted bone. Several complications were found such as stress fractures, recurrence. Vascularized fibular transfer for the treatment of bone tumor is a valuable procedure in appropriately selected patients.

Malignant tumor of the pelvic bone has nonspecific symptom and it is not easily detected by physical examination or by radiologic study in early stage, because of its anatomical characteristics. Associated with their variety of disease entity, the treatment of malignant pelvic bone tumor is a problematic point. We have analysed 36 cases of malignant pelvic bone tumors diagnosed at the Severance hospital from 1968 to 1993 to provide a reference for diagnosis and treatment of the malignant pelvic bone tumors. We found that the chondrosarcoma(27.8%) and the osteogenic sarcoma(27.8%) were the most common type of pelvic bone malignancy, and then, in the order of incidence, there were Ewing's sarcoma(16.7%), malignant fibrous histiocytoma(11.1%). There were differences of the age distribution among each diseases and the average age was Ewing's sarcoma 20.5, osteogenic sarcoma 27.2, chondrosarcoma 40.0, malignant fibrous histiocytoma 64.8, respectively. Three of the 5 patients with low grade tumors survived(60%), whereas 3 of the 17 patients with high grade tumors survived(18%). The survival rate of the low grade malignant group was 60%, the high grade was 18%.

저자들은 1980년 5월부터 1994년 5월까지 양성골 종양으로 서울대학교 병원 정형외과에서 수술적 치료를 시행한 49례를 분석하여 다음과 같은 결론을 얻었다. 1. 양성 골종양을, 소파술과 화학적 처리한 이종골 및 이종골과 자가 해면질골을 혼합 이식하여 만족한 결과를 얻었다. 2. 화학적 처리한 이종골 이식은 자가골 이식시보다 수술 시간, 수술중 출혈 및 수혈양을 줄여 수술 및 수혈 합병증을 감소시킨 것으로 사료된다. 3. 이종골 이식은 자가골 이식시 발생할 수 있는 문제를 염두에 둘 때 고려할 만한 골 이식 대치물로 사료된다.

To evaluate the role of post-operative irradiation in reducing local recurrence after surgical treatment of liposarcoma, 19 patients who were treated between July 1988 and June 1994 at Department of Orthopedic Surgery, Catholic University were studied retrospectively. The average follow up was 31 months. 1. There were 14 males and 5 females and an average age was 51 years old. 2. Thirteen cases were in extremities and buttock, 3 in neck, 2 in retroperitoneum and 1 in back. 3. Histologic types were 16 cases of myxoid type and 3 cases of well differentiated type. 4. Ten cases were achieved with wide margin and 9 with inadequate(intralesional or marginal) margin. 5. There were no local recurrence in 10 cases with wide margin, whereas 6(67%) local recurrences in 9 cases with inadequate margin. 6. Among 6 cases of local recurrence, 5 cases had been treated with post-operative irradiation. In conclusion, post-operative irradiation for inadequate margin(intralesional or marginal margin) was not sufficient to reducing local recurrence.

Twenty three rhabdomyosarcoma patients who were registered in Korea Cancer Center Hospital from Mar. 1985 to Apr. 1994 were analysed in the aspect of treatment and survival. Thirteen cases were male and 10 female. Average age was 29.5 years(range 1 to 66). Locations of the tumor were as follows: 13 in lower extremity, 6 in upper extremity and 4 in trunk. According to the UICC classification, stage II b was 1 case, stage III a 4, stage III b 10, stage IV a 3 and stage IV b 5. In histological categories, embryonal rhabdomyosarcoma was 7 cases, alveolar 7, pleomorphic 7 and undetermined 2. Average follow up period was 35.3 months(1 tk 7.5 years). Ten cases were continuous disease free, 3 no evidence of disease, 3 alive with disease and 7 died of disease at final follow up. Kaplan-Meier's actuarial 5-year survival rate was 60.3% and 5-year continuous disease free survival rate was 31.4%, Surgical margin was an important factor in local tumor control. Although there was no definite statistical significance, our results suggest chemotherapy and radiation therapy have meaningful roles in reducing local recurrence and improving survival.

A desmoid tumor is a locally aggressive growth of connective tissue origin which infiltrates the surrounding tissue and has a marked tendency for recurrence. And so it was also called as an aggressive fibromatosis, musculofascial fibromatosis or fibrosarcoma etc. Thirteen cases of desmoid tumor was treated since 1980, and their retrospective study was done with 79 months of follow-up after initial surgical excision. The female was involved in 12 cases(one male) with the age ranged from 7-50 years, average 28 years, and seven patients in third decade. A slowly growing mass was excised on average 4 months after first notice of the mass, but their margins are not demarcated clearly in most cases. Wide excision in 12 cases was done, but wide excision and saphenous vein graft was performed in one case because of invasion of posterior tibial artery by tumor mass. The tumor was found on extraabdominal region in 8 cases(61.5%) but 5 cases in abdominal wall(38.5%). The recurrence rate was high(6/13, 46.2%), and 11 times in 6 patients were recurred(average 1.8 times), within 27 months of initial excision. Six cases of recurrence were treated with wide excision again in 3 cases, wide excision combined with radiotherapy(4,000-6,000cGy) in 4 cases and wide excision with chemotherapy in one case. During the follow-up for average 21 months after treatment, no recurrences are found. Tumor remission periods without recurrence are average 67 months in all, and 11 years in longest case. Histologically it was very mimic with fibrosarcoma but could be differentiated with Trichrome stain, and their findings are not changed after recurrence.

Many different factors which may affect the prognosis of the soft tissue sarcomas have been reported by many authors ; Generally, tumor size, histologic type, surgical margin, and multi modality therapy therapy as the prognostic factors were reported. The objectives of this retrospective study of soft tissue sarcomas are : 1) to define more clearly prognostic variables that have significant predictive value for disease-free and overall survival ; and 2) to evaluate tumor histologic grade based upon extent of tumor necrosis as a means of stratifying more aggressive soft tissue sarcomas(grade II & III) of the extremities. We treated 94 patients who had soft tissue sarcoma of the extremities and trunk from May 1984 to September 1994(average duration of follow-up was 5 years ranging from 2 months to 10 years) and evaluated the prognostic factors of the soft tissue sarcomas; age, sex, depth, size, location, histologic type and grade, stage, therapy modality, surgical margin, local recurrence and distant metastasis. The results were as follows. 1. The patients with poorer prognosis were over the age of fifty, whose mass was deeply located, size of the mass was over 10cm in diameter, grade III in histology, who had local recurrence, metastasis, and received only surgery. 2. Among these prognostic factors, the most significant prognostic factor was histologic grade base upon extent of tumor necrosis.

Alveolar soft part sarcoma, named by Christopherson in 1952, is a very rare soft tissue sarcoma. It reportedly accounts for 0.5 to 1.0% of all soft tissue sarcoma and no established treatment principle assists it. The relative lack of symptoms makes it easily overlooked and consequently early diagnosis is frequently impossible. Often, the metastasis to the lung or the brain is the first manifestation of the disease. In some cases wide excision is not performed because it is misdiagnosed as a benign tumor. Authors experienced 7 cases of alveolar soft part sarcoma in 20 years and found the ultimate prognosis grave and the treatment not promising. Therefore, the authors recommend the following; 1. Early diagnosis and early treatment are important for successful management of alveolar soft part sarcoma. 2. Preoperative incisional biopsy is necessary for pathologic diagnosis. 3. The recommended treatment modality is a combination of wide excision, chemotherapy and radiotherapy.

Survival rate of osteosarcoma has been improved recently due to the neoadjuvant and adjuvant chemotherapy. Limb-salvaging operation(LSO) has replaced the amputation technique without' lowering the survival rate. And there occurred a lot of patients who are suffering from the high cost of artificial implants and forced to choose amputation due to economic problem. In LSO, usually relatively high cost artifical implant is needed. When a patient and not afford such an expensive implant he had to choose an inexpensive way, amputation. Authors tried bone lengthening by adopting Ilizarov technique after wide resection of tumor in two patients. Bone transportation was successful in one patient and less successful in the other. One case in CDF(continuosly disease free since the surgical procedure) state at follow-up 3 year 4 months after knee joint fusion. And the other was given lobectomy for lung metastasis at postop. 1 year and 9 months, and given osteosynthesis for infected nonunion at the docking site. Bone transportation was thought to be a good method for the bony coverage of dead space caused by wide resection. Bone transportation technique was economical as well as biological We present two osteosarcoma patient who treated with Ilizarov bone transportation.

Hemangiopericytoma is a rare tumor of blood vessels, first described and named by Stout and Murray in 1942, arising from the contractile, elongated cells which surround capillaries originated from the pericytes of Zimmermann. It can develop anywhere there are capillaries and mostly in the connective tissue of the human body. It can also develop at any age from 12 to 90 years old, and the rate of metastasis and prognosis vary with its histologic finding, We report three cases of hemangiopericytoma - one recurred in the right forearm where a tumor was excised 15 years ago, another occurred in the left pubis which metastasized to lung and head, the other metastasized from the lung to the right scapular area - treated at the department of orthopaedic surgery, Hanyang University Hospital from 1989 to 1995.

본 저자들은 희귀 증례로 사료되는 주상골에 발생한 유골 골종 1 례를 치험하였기에 보고하며, 유골 골종의 특징적인 임상적, 방사선학적 소견으로 인하여 진단은 어렵지 않았으며, 치료는 구역 절제술(en bloc excision)이 원칙이나, 주상골에 발생한 유골 골종의 경우는 광범위 소파술과 자가골 이식술을 통하여 재발없이 종양의 완전 치유가 가능하였던 것으로 사료된다.

사구종 환자 8례중 단순 절제만으로 전례에서 동통 소실과 함께 종괴 제거 후 세심한 조상 봉합을 함으로써 손톱의 변형을 최소화 할 수 있었고, 수술시 손톱을 완전히 제거하지 않고 다시 제 위치에 고정함으로써 수술후 창상치료가 간편하였으며, 환자가 조기에 손가락을 사용하는데 불편함을 최소화 할 수 있었다.

The fibrous dysplasia is a progressive and disabling condition that lead to deformity, especially weight bearing bones. The morbidity that is associated with the polyostotic fibrous dysplasia is the recurrent fracture and deformity. Various methods of treatment had been failed to control this problem. We used osteotomy and reconstruction nailing for polyostotic fibrous dysplasia occured in the proximal part of right femur with varus deformity and reconstruction nailing in left femur without osteotomy, and interlocking intramedullary nailing in right tibia to prevent pathologic fracture. These methods brought a good result of bone union and full weight bearing ambulation after 1 year and 6 month follow up. We think these methods are useful methods to control refracture and deformity, so we reported this case with bibliographic reviews.