• Archives of Plastic Surgery
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• 제44권1호
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• pp.53-58
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• 2017

Background Adequate fixation of replanted digits is essential not only for short-term healing but for long-term function. Various bony fixation methods using Kirschner (K-) and intraosseous wire are available in replantation. We examined clinical and radiographic outcomes of fixation methods on bone union after digital replantation. Methods A single institutional retrospective review identified 992 patients who had undergone 1,247 successful replantations between July 2009 and September 2015. Exclusion criteria included amputations of the distal phalanx, comminuted fractures, and intra-articular fractures. Patients were classified according to 5 categories of fixation methods: single K-wire, double longitudinal K-wires, cross K-wires, wire with, and wire without K-wire support. Bone union was evaluated by 5-month postoperative X-ray and fixation outcomes were compared across the 5 groups. Results The exclusion criteria were applied, and 88 patients with 103 replanted digits remained for analysis. Single K-wire fixation was used in 40 digits, double longitudinal K-wires in 30, and cross fixation in 14. Wire with and without K-wire support was required in 15 and 4 digits. Nonunion was observed in 32 digits (31.1%), of which 13 required additional operations such as bone graft or corrective osteotomy. The highest percent of nonunion was observed after cross fixation (35.7%) and the lowest after wire alone (25.0%). Conclusions In this study, contrary to general knowledge, we found that single K-wire fixation was not associated with poorer outcomes. Successful bone union outcomes may be achieved by careful selection of bone fixation methods. This study provides useful information for planning bone fixation in digital replantation.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.154-159
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• 1998

Medial dislocation of the long head of the biceps brachii is a rare condition that usually occurs in association with tears of the subscapularis, chronic impingement, capsular defects or a fracture of the lesser tuberosity. Less commonly, a biceps tendon dislocation may occur after an acute traumatic event. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humeral insertion. Magnetic resonance imaging has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the subscapularis tendon. We present a patient with a traumatic dislocation of the biceps brachii tendon in which the diagnosis remained elusive for an extended period of time. In this case, he was evaluated using MRI and reconstruction was performed by restoring the tendon to its anatomical position.

• Radiation Oncology Journal
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• 제25권4호
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• pp.278-282
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• 2007

목적: 미만형 색소 융모 결절성 활액막염은 관절에 영향을 미치는 원인이 밝혀지지 않은 활액막의 증식성 질환으로 조직학적으로는 양성 염증성 소견을 보이지만 골 파괴나 공격적인 성장, 재발 등의 특성으로 저 등급의 악성 종양으로 간주되기도 하는 질환이다. 활액막 절제술이 가장 표준적인 치료이지만 미만형의 경우 주변조직으로 침윤하며 성장하는 경향 때문에 수술 후 재발률이 상대적으로 높다. 불완전 절제가 시행된 경우, 재발한 경우 저선량의 외부방사선 치료나 방사선 동위원소를 이용한 관절강 내 방사선치료를 시행하여 국소 조절율이나 관절 기능의 향상을 얻을 수 있다고 보고되고 있다. 저자는 우측 무릎 관절에 발생한 미만형 색소 융모 결절성 활액막염으로 관절경을 이용한 활액막 절제술 후 외부 방사선치료를 시행한 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하고자 한다.

• 한국수정란이식학회지
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• 제27권3호
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• pp.175-181
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• 2012

The synovial tissues are a valuable MSCs source for cartilage tissue engineering because these cells are easily obtainable by the intra-articular biopsy during diagnosis. In this study, we isolated and characterized the canine MSCs derived from synovial fluid of female and male donors. Synovial fluid was flushed with saline solution from pre and post-puberty male (cM1-sMSC and cM2-sMSC) and female (cF1-sMSC and cF2-sMSC) dogs, and cells were isolated and cultured in advanced-DMEM (A-DMEM) supplemented with 10% FBS in a humidified 5% $CO_2$ atmosphere at $38.5^{\circ}C$. The cells were evaluated for the expression of the early transcriptional factors, such as Oct3/4, Nanog and Sox2 by RT-PCR. The cells were induced under conditions conductive for adipogenic, osteogenic, and chondrogenic lineages, then evaluated by specific staining (Oil red O, von Kossa, and Alcian Blue staining, respectively) and analyzed for lineage specific markers by RT-PCR. All cell types were positive for alkaline phosphatase (AP) activity and early transcriptional factors (Oct3/4 and Sox2) were also positively detected. However, Nanog were not positively detected in all cells. Further, these MSCs were observed to differentiate into mesenchymal lineages, such as adipocytes (Oil red O staining), osteocytes (von Kossa staining), and chondrocytes (Alcian Blue staining) by cell specific staining. Lineage-specific genes (osteocyte; osteonectin and Runx2, adipocytes; PRAR-${\gamma}2$, FABP and LEP, and chondrocytes; collagen type-2 and Sox9) were also detected in all cells. In this study, we successfully established synovial fluid derived mesenchymal stem cells from female and male dogs, and determined their basic biological properties and differentiation ability. These results suggested that synovial fluid is a valuable stem cell source for cartilage regeneration therapy, and it is easily accessible from osteoarthritic knee.

• The Korean Journal of Pain
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• 제28권1호
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• pp.45-51
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• 2015

Background: Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS. Methods: Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects. Results: Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were $1.6{\pm}2.3$, $3.0{\pm}4.9$ and $7.1{\pm}7.9$ mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups. Conclusions: This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

• Clinics in Shoulder and Elbow
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• 제8권1호
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• pp.49-56
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• 2005

Purpose: To review the surgical results of stiff elbow using the posterior extensile approach which provides a wide surgical view with a single posterior skin incision. Materials and Methods: From February 1999 to May 2002, we performed 6 surgical correction of stiff elbow using posterior extensile approach and followed the patients more than 1 year. In order to get better result, we performed cadaver study (four elbows of two fresh cadavers). Average duration of follow up was 15.7 months $(14{\sim}21)$. Functional results was analyzed using Brobery and Morrey analysis scale. Results: The approach through the plane between the extensor carpi radialis longus and the extensor carpi radialis brevis was ideal, because it preserves normal anatomy and provides a wide surgical view of the anterior joint. The posterior joint could be approached directly between the medial head of the triceps brachii and brachialis medially, the lateral head of triceps brachii and brachioradialis laterally. In all patients, an improved ROM was obtained with intra and extra-articular adhesiolysis: an average $61.7^{\circ}$ improvement $(50{\sim}75)$. Functional results were as follows: five excellent, one good. In addition, the patients' satisfaction was high since the scar from the operation was only a single line at the posterior surface of the elbow. Conclusion: In the treatment of stiff elbow, posterior extensile approach is thought to be useful because this method provides wide anterior and posterior surgical view.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.10-17
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• 2014

Background: The aim of this study was to assess the clinical outcomes after treatment of proximal humeral fractures with locking plates, and to determine which factors influence the clinical and radiological outcomes. Methods: Fifty six patients who were treated with locking plates for proximal humeral fractures and had been followed for more than 1 year were enrolled in this study. We performed functional evaluation using the Constant score and analyzed radiographic results. The following factors that may potentially influence the clinical outcomes were assessed: age, gender, type of fracture, presence of medial metaphyseal comminution, bone mineral density, anatomical reduction, restoration of medial mechanical support, and postoperative complications. Results: The mean Constant score was 70.1 points at the final follow-up. Female gender, 4-part fractures, AO type-C fractures, and fractures with medial metaphyseal comminution were associated with a poor clinical outcome. On the other hand, restoration of medial mechanical support and accurate anatomical reduction had a positive influence on clinical outcomes. Postoperative complications resulted in 3 patients (intra-articular screw perforation: 1 patient, varus deformity with screw loosening: 1 patient, nonunion: 1 patient). Conclusions: When treating proximal humeral fractures with locking plate fixation, following factors: a female gender, Neer type 4-part fracture, AO type C fracture, and medial metaphyseal comminution are important risk factors that surgeons should take into consideration. Factors that contribute to better clinical outcomes of operative treatment for humeral fractures are accurate anatomical reduction and restoration of medial mechanical support.

• 한국약용작물학회지
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• 제21권6호
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• pp.466-473
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• 2013

This study investigates the effect of supercritical fluid extract (CMPB803-C) of Lithospermum erythrorhizon, shikonin and acetylshikonin isolated from Lithospermum erythrorhizon on IL-$1{\beta}$-induced chondrocytes and monosodium iodoacetate (MIA)-induced osteoarthritis in rat. Shikonin ($50{\mu}m$) and acetylshikonin ($3{\mu}M$) treatment reduced significantly the mRNA expression and enzyme activity of matrix metalloproteinase (MMP)-1, -3 and -13 in IL-$1{\beta}$-induced SW1353 chondrosarcoma cells. The chondro-protective effects of CMPB803-C and acetylshikonin were than analyzed in a rat OA model using a single intra-articular injection of MIA (1mg) in the right knee joint. CMPB803-C (200mg/kg) or acetylshikonin (5mg/kg) was orally administered daily for two weeks starting after 1 week of MIA injection. In the histological observation, CMPB803-C and acetylshikonin clearly improved OA lesions being comparable to or better that control group. Our results demonstrated that CMPB803-C and acetylshikonin as active compound of Lithospermum erythrorhizon have a strong chondro-protective effect in OA rats, which likely attributes to its anti-inflammatory activity and inhibition of MMPs production.

• 대한정형외과 초음파학회지
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• 제2권1호
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• pp.24-26
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• 2009

9개월 전에 우측 제1 족지를 다친 이후에 발생한 통증을 주소로 내원하였다. 방사선 소견상 특별한 진단없이 타 병원에서 보존적 치료를 하였으나 증상이 호전되지 않고 제1 족지의 지절을 족저굴곡 하거나 족배굴곡 할 때 관절내 통증이 지속되어 전원 되었다. 단순 방사선 소견상 제 1 족지 지절 부위에 미세한 골편이 관찰 되어 초음파 검사를 시행하였다. 초음파 검사상 제1 족지 지절 관절내에 2개의 유리체가 관찰되었다. 수술적 제거술을 시행하여 증상이 치유 되었기에 이에 저자들은 무지 지절 유리체의 초음파 소견을 보고 하고자 한다.

• 대한골관절종양학회지
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• 제16권2호
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• pp.95-98
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• 2010

활액막성 연골종증은 관절 활액막으로부터 기원하는 증식성의 결절성 연골성 양성 종양이다. 영상의학적 소견은 다양하게 나타나는데 드물게 연골육종, 골육종 그리고 활액 육종과 같은 악성 종양과의 감별을 요하는 수가 있다. 저자들은 컴퓨터 단층 촬영에서는 관절 내 다 발성의 연골성 무기질침착이 뚜렷한 종괴로 인해 활액막성 연골종증을 예상할 수 있으나, 단순 방사선 소견 상 피질골에 근접하고 균질한 방사선비투과의 모습을 보여 방골성 골육종과 유사해 보이는 근위 경골의 후면에 발생한 원발성 활액막성 연골종증 1예를 보고한다.