• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.509-515
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• 2018

Objective : In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. Methods : 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured. Results : The 93 normal subjects were included in this study. The CPN passed through the "popliteal tunnel" formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the "popliteal tunnel", a length of 21 mm to <40 mm was measured. Conclusion : In Korean population, the course of the CPN through the "popliteal tunnel" was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권5호
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• pp.288-294
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• 2016

Chondrosarcoma is a malignant tumor that originates from cartilaginous cells and is characterized by cartilage formation. Only 5% to 10% of chondrosarcoma occurs in the head and neck area, and it is uncommon in the temporomandibular joint area. This report describes an unusual case with a rare, large chondrosarcoma in a 47-year-old woman who presented with painless swelling and trismus. Computed tomography showed a large mass approximately $8.5{\times}6.0$ cm in size arising adjacent to the lateral pterygoid plate and condyle. There were features suggestive of bone resorption. The tumor was resected in a single block with perilesional tissues, and a great auricular nerve graft was performed because of facial nerve sacrifice. Microscopic examination of sections stained with H&E revealed chondrocytes with irregular nuclei and heterogeneous hyper chromatic tumor cells embedded in the chondrocyte lacuna. The diagnosis was a grade I chondrosarcoma. There was no evidence of recurrence at the 8-month follow-up, and a reconstruction surgery with fibular osteocutaneous free flap was performed. We report this unusual entity and a review of the literature.

• Annals of Clinical Neurophysiology
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• 제25권2호
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• pp.84-92
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• 2023

Background: Clinical spectrum of immunoglobulin M (IgM) monoclonal gammopathy varies from IgM monoclonal gammopathy of unknown significance (IgM-MGUS) to hematological malignancies. We evaluated the clinical features, electrophysiological characteristics, and prognosis of patients with peripheral neuropathy associated with IgM monoclonal gammopathy (PN-IgM MG). Methods: We retrospectively evaluated 25 patients with PN-IgM MG. Peripheral neuropathy was classified as axonal, demyelinating, or undetermined, based on electrophysiological studies. We classified the enrolled patients into the IgM-MGUS and malignancy groups, and compared the clinical and electrophysiological features between the groups. Results: Fifteen patients had IgM-MGUS and 10 had hematologic malignancies (Waldenström's macroglobulinemia: two and B-cell non-Hodgkin's lymphoma: eight). In the electrophysiological evaluation, the nerve conduction study (NCS) criteria for demyelination were met in 86.7% of the IgM-MGUS group and 10.0% of the malignancy group. In particular, the distal latencies of the motor NCS in the IgM-MGUS group were significantly prolonged compared to those in the malignancy group (median, 9.1 ± 5.1 [IgM-MGUS], 4.2 ± 1.3 [malignancy], p = 0.003; ulnar, 5.4 ± 1.9 [IgM-MGUS], 2.9 ± 0.9 [malignancy], p = 0.001; fibular, 9.3 ± 5.1 [IgM-MGUS], 3.8 ± 0.3 [malignancy], p = 0.01; P-posterior tibial, 8.3 ± 5.4 [IgM-MGUS], 4.4 ± 1.0 [malignancy], p = 0.04). Overall treatment responses were significantly worse in the malignancy group than in the IgM-MGUS group (p = 0.004), and the modified Rankin Scale score at the last visit was higher in the malignancy group than in the IgM-MGUS group (2.0 ± 1.1 [IgM-MGUS], 4.2 ± 1.7 [malignancy], p = 0.001), although there was no significant difference at the initial assessment. Conclusions: The risk of hematological malignancy should be carefully assessed in patients with PN-IgM MG without electrophysiological demyelination features.

• Archives of Reconstructive Microsurgery
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• 제4권1호
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• pp.16-22
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• 1995

We analyzed 11 children who underwent epiphyseal transplantation to the forearm for manage growing deformity ranged from 2 years 6 months to years(average 5 years 10 months) follow-up period. Etiologies of the functional impairment of the eleven were five traumatic, three congenital and three tumorous conditions. Lesions of epiphysis were distal radius in eight patients and distal ulna in three patients. Operation was performed with removal of non-functioning or deformed epiphysis followed by transplantation of free vascularized proximal fibular epiphysis with microvascular anastomesis. Evaluation was performed radiologically and functionally. The 9(81.8%) patients showed growth of transplanted epiphysis by radiological examination during follow up. At the last follow up, average growth rate was 0.86cm per year excepts 2 cases of no growth. Active wrist motion near normal to contralateral joint was achieved in 7 patients. In other 2 patients, active joint motion was improved but weaker than contralateral joint. Complications on donor site were two transient peroneal nerve palsy which have been resolved after 2 and 5 months post operation and one valgus ankle deformity. The ankle deformity was corrected with $Langenski\"{o}ld$ operation of the dital tibiofibular fusion. At recipient site, there was one superficial infection and it was easily controlled by systemic antibiotics. Many subsequent reports have described successful nonvascularized epiphyseal transplante, but overall results have been inconsistent and unsatisfactory. Other experimental and clinical studies in the transfer of vascularized epiphyses has encourage its clinical application. We also could gel successful growth in several cases with free vascularized epiphyseal transplantation.

• Anatomy and Cell Biology
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• 제57권2호
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• pp.229-237
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• 2024

The infiltration of the interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block, is a novel ultrasound-guided technique used for postoperative pain management of the knee. The success of the block is attributed to the spread of injectate between the capsule of the knee and the popliteal artery. This novel technique is believed to target the articular branches of the tibial, common fibular (peroneal) and obturator nerves. However, the extent of the spread in a paediatric population is unknown. Therefore, this study aims to evaluate the spread of the IPACK block. Using ultrasound guidance, the IPACK block was replicated bilaterally in neonatal cadavers. Methylene blue dye (0.3 ml/kg) was injected proximally and distally. Subsequently, cadavers were dissected to determine the injectate spread. Proximal injections resulted in staining of some of the articular branches, while the distal injections resulted in staining of all four articular branches. Additional staining of the superior lateral and medial genicular nerves was noted irrespective of the technique. Overall, both injections resulted in posterior, anterolateral spread with limited medial spread. Results from this study reveal preservation of the main nerve trunks following the proximal technique, while the distal technique displayed greater staining of the articular branches. We believe that the block can be seen as a more holistic and viable alternative to lower limb blocks for the paediatric population, as it allows for a wider spread in the posterior and medial-lateral compartments of the knee.

• 대한골관절종양학회지
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• 제1권2호
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• pp.154-163
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• 1995

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.

• 대한골관절종양학회지
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• 제8권3호
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• pp.96-105
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• 2002

목적: 견관절 주위 원발성 골 종양 환자에서 시행한 사지 구제술의 종양학적, 기능적 결과를 평가하고자 하였다. 대상 및 방법: 1982년에서 2001년 사이에 견관절 주위 원발성 골 종양으로 본원에서 사지 구제술을 시행 받은 환자 중 추시 관찰이 가능한 2 9명을 대상으로 하였다. 평균 연령은 35세, 평균 추시 기간은 7년 1개월(1년 2개월~19년 9개월)이었고, 골육종 7예, 연골육종 14예, 방골성 골육종 1예, 혈관외피종 1예, 거대세포종 6예였다. 사지 구제술의 방법으로는 시멘트 충전술을 7예에서, 시멘트 주형 관절성형술 및 골수강내 정 삽입술을 10예에서, 종양 대치물 삽입술을 7예에서 이용하였으며, 5예에서는 절제만 시행하거나, 골이식, 관절 유합술 등을 실시하였다. 술 후 기능 평가는 근골격계 종양 학회(Musculoskeletal Tumor Society)의 상지 근골격계 종양 환자 기능 평가 방법을 이용하였다. 결과: 추시 도중 6예에서 국소 재발 하였고, 2예에서 폐 전이로 재발 하였고, 2예에서는 국소 재발과 폐전이가 모두 있었으며 3명이 사망하였다. 구제된 상지의 생존율은 최종 추시상 88.6%였으며, 재발이나 전이가 있을 경우 열등한 사지의 생존율을 보였다(p=0.012). 근골격계 종양 학회 기능 평가상 구제된 상지의 기능 점수는 평균 80%(24점, 18~30점)였다. 치료방법에 따른 기능 점수는 시멘트 충전술 86%, 시멘트 주형 관절성형술 및 골수강내 정 삽입술 71%, 종양 대치물 삽입술 83%점으로 시멘트 주형 관절성형술 및 골수강내 정 삽입술이 통계적으로 유의하게 좋지 않은 결과를 보여주었다(p=0.034). 합병증으로 요골 신경 마비와 액와 신경 마비가 각각 1예 있었으며, 생 비골 이식편의 이탈로 재수술을 받은 경우가 1예, 창상 감염이 1예 있었다. 결론: 견관절 주위 악성 골 종양과 거대 세포종의 치료에 있어서, 사지 구제술은 종양학적, 기능적으로 만족할 만한 결과를 얻을 수 있는 방법으로 사료된다.