• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• 대한족부족관절학회지
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• 제28권1호
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• pp.15-20
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• 2024

Purpose: Achilles tendon rupture is a frequently encountered ankle pathology associated with a substantial burden of intense pain and functional deficits. Chronic Achilles tendon ruptures with considerable defects pose intricate repair challenges that are often marred by complications such as re-rupture and persistent pain. Various treatment methods, including allograft transplantation, have been proposed, but the literature on this technique is limited. In this study, we propose a surgical approach utilizing allotendon transplantation and a calcaneal tunneling technique and provide clinical evaluation details. Materials and Methods: Fifteen patients with chronic Achilles tendon ruptures treated with allotendon between 2020 and 2022 were included in the study. Patients were evaluated at 1, 3, and 6 months postoperatively using Visual Analog Scale (VAS) scores and Achilles Tendon Total Rupture Scores (ATRSs). Complications were assessed postoperatively. Results: The average VAS score was 7 before surgery, 7.3 immediately after surgery, and 4.3 at 1 month, 2.5 at 3 months, and 1.3 at 6 months after surgery. Because the sample was limited to 15 individuals and distributions were non-normal, the analysis was conducted using the non-parametric Wilcoxon's signed-rank test, and statistical significance was accepted for p-values<0.05. Results showed a significant improvement in ATRS and VAS scores versus preoperative and immediate postoperative values. VAS scores showed a decreasing trend after surgery, whereas average ATRS scores increased from 14 before surgery, 33.8 at 1 month, 82.7 at 3 months, and 93.9 at 6 months. Conclusion: This study suggests that allograft transplantation using the described calcaneal tunnel technique provides an effective treatment for chronic Achilles tendon ruptures. However, extensive research and long-term clinical trials are required to validate and better understand the technique's efficacy.

• 대한관절경학회지
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• 제3권2호
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• pp.109-114
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• 1999

목 적 : 내측 반월상 연골후각의 후방 경골 부착부위의 절단 파열은 흔하지 않고 기존의 수기로는 봉합이 어렵다. 이에 저자들은 내측 반월상 연골의 후방 경골 부착부위의 절단 파열의 임상 양상 및 pullout suture를 통한 새로운 봉합술을 소개하고자 한다. 대상 및 방법 : 년 9월부터 1999년 7월까지 9명의 환자에서 후방 경골 부착부위의 절단 파열을 경험 하였다. 평균 나이는 59.3세로 38세에서 70세까지의 분포였다. 전예에서 자기공명영상과 임상양상으로 진단하였고, 슬관절경을 통해서 확진과 치료를 하였다. 1예에서 2차적 관절경을 시행하여 봉합 된 반월상 연골의 치유여부를 확인하였다. 임상 양상 : 대개 중년이후의 나이에서 호발하며, 특별한 외상의 과거력이 없다. 슬관절 후면의 통증을 호소하였으나, 그 위치가 불명확한 특징이 있었다. 경도내지 중등도의 슬관절의 종창을 호소하였으며, 특징적으로 슬관절을 굴곡 시킬수록 심해지는 술관절 후면의 통증으로 완전한 굴곡의 장애가 있었다. 단순 방사선 사진에서 퇴행성 변화는 없거나, 나이에 비해서 미미한 양상이었다. 술 전 자기 공명영상이 진단에 있어서 매우 중요한 역할을 하며, 특히 관상면에서 반월상 연골의 후각이 후방 경골 부착부위에서 분리되어 있는 형태를 보인다. 수술 수기 : 4개의 표준 portal 로 도달하여 후각부의 절단파열을 확인하고, 변연절제술로 시야를 확보하고 후각의 후방 부착부위의 연골하골을 노출 시킨다. 전내측 또는 후내측 도달법으로 절단단율 PDS 로 봉합한다. PDS 봉합사를 전내측 도달법으로 밖으로 꺼내 놓는다. 경골 내측 근위부에 종절개를 가한 후에 ACL tibla guide를 이용하여 경골 내측 근위부에서 후각의 후방 경골부착부위까지 골 터널을 만든다. 강선 루프를 경골 터널을 통하여 삽입하여서 전내측 도달법으로 빼내고, PDS 봉합사를 사이에 끼워서 다시 경골 터널을 통해 아래쪽으로 당겨서 끌어낸다. PDS 봉합사를 경골 내측 근위부에 post-tie 방법으로 고정한다. 결 론 : 내측 반월상연골 후각의 후방 경골부착부위의 절단피열은 임상적으로 흔하지 않고 보고도 드물다. 임상 양상과 자기공명영상이 진단에 있어서 중요한 역할을 한다. 관절경적 pullout 봉합이 이런 형태의 파열에 대한 치료로서 유용할 수 있을 것으로 사료된다.

• 대한정형외과 초음파학회지
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• 제6권1호
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• pp.1-9
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• 2013

목적: 상완골 골절에 대한 비확공성 전향적 금속정 내고정술 시행 후, 초음파을 이용하여 회전근 개 상태 및 영향 인자를 객관적으로 평가하고, 초음파 검사의 유용성을 확인하였다. 대상 및 방법: 상완골 골절로 골수강 내 금속정 내고정술을 시행받고 견관절의 초음파 검사를 시행한 17례를 연구 대상으로 하였다. 평균 연령은 $55.7{\pm}18.6$세였으며, 최초 수술 후 평균 추시 기간은 $43.5{\pm}32.2$개월이었다. 전 례에서 술중 회전근개 상태를 확인하였고, 4례(24%)에서 피부절개 후 회전근 개의 파열이 관찰되어 금속 봉합나사못을 이용하여 단열 봉합술을 시행하였다. 임상적 평가는 visual analogue scale (VAS), 운동범위, Korean Shoulder Scoring System (KSS) 및 American Shoulder and Elbow Society (ASES) 점수를 측정하였다. 회전근개의 상태에 대한 초음파 검사를 시행하였고, 견관절 기능에 영향을 미칠 수 있는 방사선학적 유합 시기, 금속정 근위 첨부 돌출 및 근위 교합 나사의 이동을 평가하였다. 금속정 근위 첨부 돌출에 대해서는 방사선학적 검사와 함께 초음파적 검사도 병행하였다. 결과: 최종 추시시 VAS는 평균 $1.65{\pm}1.84$, 운동 범위는 전방 굴곡 평균 $137.0{\pm}33.5^{\circ}$, 외회전 평균 $43.5{\pm}12.7^{\circ}$, 내회전 평균 $16.4{\pm}2.0^{\circ}$이었다. KSS점수는 평균 $79.6{\pm}20.7$점이었으며, ASES점수는 평균 $83.7{\pm}17.0$점이었다. 방사선학적 평가상 전례에서 골유합을 얻었으며, 골유합 기간은 평균 $3.4{\pm}1.3$개월이었으며, 근위 교합 나사의 이동이 6례(35%) 관찰되었다. 견관절 초음파 검사상 회전근 개는 정상 8례(47%), 굴곡변화 4례(24%) 및 부분파열 5례(29%)가 관찰되었으나 완전파열은 관찰되지 않았다. 금속정 첨부 돌출은 방사선 검사상 8례(47%), 초음파 검사상 총 11례(65%)에서 관찰되었고, 고령의 환자에서 호발하였다(p=0.038). 회전근 개의 굴곡 변화 및 부분파열은 첨부 돌출과 관련이 있었으나(p=006), 술전 파열의 봉합여부와는 관련이 없었다(p>0.05). 결론: 금속정 삽입술시 회전근 개 손상을 피하기 위하여 금속정 첨부의 연골하골 내 적절한 함입을 요하며, 초음파를 이용한 경과 관찰은 단순 방사선 검사상 파악하기 곤란한 금속정 첨부의 돌출 및 회전근 개 손상을 확인할 수 있는 유용한 진단 및 평가 도구가 될 수 있을 것으로 판단된다.

• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• 대한구순구개열학회지
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• 제6권1호
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• pp.1-15
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• 2003

이차골 이식술을 시행 받은 구순 구개열을 가지는 성인 남자 20명의 두부계측방사선 사진을 McNamara씨 분석법을 중심으로 하여 계측한 결과는 다음과 같다. 구순 구개열 환자에서 Na. perpendicualr to point A칼은 글.98±5.70, SWh angle 값은 76.45±4.69, Pogonion to Na. perpendicular간은 -6.38± 6.73을 나타내었다. Effective maxillary length는 85.6±4.42, effective mandibular length 값은 123.88±7.10을 보였고 하악각은 29.9±5.09, facial axis angle은 5.53±2.03으로 관찰되었다. Point A에 대해 상악 전치의 돌출도는 3.95±2.74의 값을 보였다.

• 대한핵의학회지
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• 제27권1호
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• pp.118-122
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• 1993

전이성 분화갑상선암을 치료할 목적으로 사용된 $^{131}I$에 의한 염색체 손상여부를 검정하기 위하여 치료 전후의 자매염색분체교환(SCE)의 빈도 및 말초혈액의 백혈구수를 정상대조군과 환자군에서 조사하였다. 1) 정상인으로 설정한 대조군에 있어서의 자매염색분체교환 빈도수가 $3.8{\pm}0.4$인데 비하여 $^{131}I$ 투여전의 SCE 빈도가 $4.2{\pm}0.7$으로 차이를 보이지 않았다(p=0.17). 2) $^{131}I$ 투여후 2일째 SCE 빈도는 $7.9{\pm}0.8$으로 치료전에 비해 유의하게 증가하였으며 (p<0.001), 9일째에는 $6.4{\pm}0.6$으로 2일째에 비해서는 유의하게 감소하였으나(p=0.002), 치료전에 비해서는 아직도 유의하게 높았다 (P<0.001). 3) 같은 기간동안 백혈구의 수는 유의한 변화를 보이지 않았다. 결과적으로, $^{131}I$ 치료후 염색분체의 손상은 일어나며, 서서히 회복되나 1주일 이내에는 완전한 회복을 보이지 않음을 알 수 있었다.

• 한국발생생물학회지:발생과생식
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• 제13권3호
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• pp.173-181
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• 2009

One of the most extensively studied populations of multipotent adult stem cells are mesenchymal stem cells (MSCs). MSCs derived from the human umbilical cord vein (HUC-MSCs) are morphologically and immunophenotypically similar to MSCs isolated from bone marrow. HUC-MSCs are multipotent stem cells, differ from hematopoietic stem cells and can be differentiated into neural cells. Since neural tissue has limited intrinsic capacity of repair after injury, the identification of alternate sources of neural stem cells has broad clinical potential. We isolated mesenchymal-like stem cells from the human umbilical cord vein, and studied transdifferentiation-promoting conditions in neural cells. Dopaminergic neuronal differentiation of HUC-MSCs was also studied. Neural differentiation was induced by adding bFGF, EGF, dimethyl sulfoxide (DMSO) and butylated hydroxyanisole (BHA) in N2 medium and N2 supplement. The immunoreactive cells for $\beta$-tubulin III, a neuron-specific marker, GFAP, an astrocyte marker, or Gal-C, an oligodendrocyte marker, were found. HUC-MSCs treated with bFGF, SHH and FGF8 were differentiated into dopaminergic neurons that were immunopositive for tyrosine hydroxylase (TH) antibody. HUC-MSCs treated with DMSO and BHA rapidly showed the morphology of multipolar neurons. Both immunocytochemistry and RT-PCR analysis indicated that the expression of a number of neural markers including NeuroD1, $\beta$-tubulin III, GFAP and nestin was markedly elevated during this acute differentiation. While the stem cell markers such as SCF, C-kit, and Stat-3 were not expressed after neural differentiation, we confirmed the differentiation of dopaminergic neurons by TH/$\beta$-tubulin III positive cells. In conclusion, HUC-MSCs can be differentiated into dopaminergic neurons and these findings suggest that HUC-MSCs are alternative cell source of therapeutic treatment for neurodegenerative diseases.

• Journal of Periodontal and Implant Science
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• 제41권4호
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• pp.176-184
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• 2011

Purpose: The final goal of regenerative periodontal therapy is to restore the structure and function of the periodontium destroyed or lost due to periodontitis. However, the role of periosteum in periodontal regeneration was relatively neglected while bone repair in the skeleton occurs as a result of a significant contribution from the periosteum. The aim of this study is to understand the histological characteristics of periosteum and compare the native periosteum with the repaired periosteum after elevating flap or after surgical intervention with flap elevation. Methods: Buccal and lingual mucoperiosteal flaps were reflected to surgically create critical-size, "box-type" (4 mm width, 5 mm depth), one-wall, intrabony defects at the distal aspect of the 2nd and the mesial aspect of the 4th mandibular premolars in the right and left jaw quadrants. Animals were sacrificed after 24 weeks. Results: The results from this study are as follows: 1) thickness of periosteum showed difference as follows (P<0.05): control group ($0.45{\pm}0.22$ mm)> flap-elevation group ($0.36{\pm}0.07$ mm)> defect formation group ($0.26{\pm}0.03$ mm), 2) thickness of gingival tissue showed difference as follows (P<0.05): defect formation group ($3.15{\pm}0.40$ mm)> flap-elevation group ($2.02{\pm}0.25$ mm) > control group ($1.88{\pm}0.27$ mm), 3) higher cellular activity was observed in defect formation group and flap-elevation groups than control group, 4) the number of blood vessles was higher in defect formation group than control group. Conclusions: In conclusion, prolonged operation with increased surgical trauma seems to decrease the thickness of repaired periosteum and increase the thickness of gingiva. More blood vessles and high cellular activity were observed in defect formation group.

• Molecules and Cells
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• 제19권3호
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• pp.402-407
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• 2005

Bone marrow mesenchymal stem cells (MSCs) have shown potential for cardiac repair following myocardial injury, but this approach is limited by their poor viability after transplantation. To reduce cell loss after transplantation, we introduced the fibroblast growth factor-2 (FGF-2) gene ex vivo before transplantation. The isolated MSCs produced colonies with a fibroblast-like morphology in 2 weeks; over 95% expressed CD71, and 28% expressed the cardiomyocyte-specific transcription factor, Nkx2.5, as well as ${\alpha}$-skeletal actin, Nkx2.5, and GATA4. In hypoxic culture, the FGF-2-transfected MSCs (FGF-2-MSCs) secreted increased levels of FGF-2 and displayed a threefold increase in viability, as well as increased expression of the anti-apoptotic gene, Bcl2, and reduced DNA laddering. They had functional adrenergic receptors, like cardiomyocytes, and exposure to norepinephrine led to phosphorylation of ERK1/2. Viable cells persisted 4 weeks after implantation of $5.0{\times}10^5$ FGF-2-MSCs into infarcted myocardia. Expression of cardiac troponin T (CTn T) and a voltage-gated $Ca^{2+}$ channel (CaV2.1) increased, and new blood vessels formed. These data suggest that genetic modification of MSCs before transplantation could be useful for treating myocardial infarction and end-stage cardiac failure.