광범위 수부 손상에서 서혜부 유경피판과 유리 포장주위피판을 이용한 단계적 무지 재건술

노영학,정문상,백구현,이영호,공현식,이승환,이예현,Roh, Young-Hak,Chung, Moon-Sang,Baek, Goo-Hyun,Lee, Young-Ho,Gong, Hyun-Sik,Rhee, Seung-Hwan,Lee, Ye-Hyun 대한미세수술학회 2009 Archives of reconstructive microsurgery Vol.18 No.2

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

상완골 간부 골절과 동반된 진단이 지연된 근피신경 손상 - 증례 보고 -

노영학,김성완,정문상,백구현,오주한,이영호,공현식,Roh, Young-Hak,Kim, Seong-Wan,Chung, Moon-Sang,Baek, Goo-Hyun,Oh, Joo-Han,Lee, Young-Ho,Gong, Hyun-Sik 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.1

Injury of the musculocutanous nerve can be associated with a proximal humeral fracture or shoulder dislocation, and injury of the brachial plexus. However, injury of this nerve associated with a humeral shaft fracture has rarely been reported. Diagnosis of the musculocutaneous nerve injury is difficult because its sensory loss is ill-defined, and examination of elbow flexion is difficult when it is associated with fractures. We report an unusual case of musculocutaneous nerve injury in a 27 years old woman who had multiple injuries including a humerus shaft fracture, an ipsilateral radius shaft fracture, and an associated radial nerve laceration. Diagnosis of the musculocutaneous nerve injury was delayed because combined fractures of the humerus and radius prevented proper examination of the elbow motion and nerve grafting of the radial nerve delayed early elbow motion exercise. Delayed exploration of the musculocutaneous nerve 6 months after trauma showed complete rupture of the nerve at its entry into the coracobrachialis muscle and the defect was successfully managed by sural nerve graft.

평행 이중 금속판을 이용한 상완골 원위부 골절의 치료

노영학 ( Young Hak Roh ),정문상 ( Moon Sang Chung ),백구현 ( Goo Hyun Baek ),이영호 ( Young Ho Lee ),이혁진 ( Hyuk Jin Lee ),이준오 ( Joon Oh Lee ),오규원 ( Kyu Won Oh ),공현식 ( Hyun Sik Gong ) 대한골절학회 2010 대한골절학회지 Vol.23 No.2

목적: 최근 도입된 두 개의 해부학적 금속판을 시상면에 평행하게 배치하는 고정법을 이용하여 상완골 원위부 골절을 수술한 결과를 보고하고자 한다. 대상 및 방법: 2004년 5월부터 2008년 6월까지 상완골 원위부 골절로 평행 이중 금속판을 이용해 내고정술을 시행받고 1년 이상 추시가 가능했던 17예를 대상으로 하였다. AO 골절 분류를 사용하였고, 수술 후 관절 운동 범위와 합병증 유무를 확인하고, 최종 치료 결과의 판정으로 Mayo Elbow Performance Index을 이용하였다. 결과: 18개월 평균 추시 후, 4예가 아주 우수, 8예가 우수, 5예가 양호의 결과를 보여 주었다. 수술 후 관절의 운동범위는 굴곡 구축 평균 13 (범위, 0∼30)도, 후속 굴곡 평균 116 (범위, 90∼140)도이었다. 수술 후 고정 실패 1예에서 재수술이 시행되었고, 6예에서 관절의 부분 강직으로 관절막 유리술이 시행되었으며, 척골 신경 증상 7예 중 3예에서 신경 유리술이 시행되었다. 동반 손상이 있는 경우 유의하게 낮은 기능 지수를 보였고, 관절 운동의 시작 시기는 관절 운동 범위와 유의한 음의 상관관계를 보였다. 결론: 평행 이중 금속판을 이용한 내고정술을 통해 골절의 형태와 관련없이 견고한 내고정을 얻을 수 있었다. 관절의 부분 강직과 척골 신경 증상은 환자들이 추가적인 수술을 받는 주 원인이었다. Purpose: The purpose of this study was to review the outcome of fixation of distal humerus fractures using recently-introduced double parallel plate system in sagittal plane. Materials and Methods: From May 2004 to June 2008, seventeen patients with distal humerus fractures underwent primary open reduction and internal fixation with double parallel plates. According to the AO classification, there were 2 A3, 2 C1, 7 C2, and 6 C3 type fractures. Outcome assessment was performed by using the Mayo Elbow Performance index (MEPI). Results: At a mean follow up of 18 (range, 12 to 32) months, 4 patients were rated as excellent, 8 as good, and 5 as fair in terms of MEPI. The average arc of elbow flexion after primary operation was 116 (range, 90∼140) degrees with a mean flexion contracture of 13 (range, 0 to 30) degrees. One patient required reoperation due to fixation failure and six patients underwent capsulolysis and three patients underwent ulnar nerve neurolysis. The time to begin elbow motion exercise had negative correlation with total elbow range of motion and multiple trauma patients had significantly lower MEPI functional score compared to those without combined injury. Conclusion: Double parallel plating allowed adequate fixation for distal humerus fractures regardless of patient age and fracture pattern. Partial ankylosis and unlar nerve compression symptoms were the main causes of reoperation.

상완 신경총에 발생한 신경초종의 수술적 치료 결과

이혁진,이영호,공현식,이승환,이준오,노영학,김강욱,백구현,Lee, Hyuk-Jin,Lee, Young-Ho,Gong, Hyun-Sik,Rhee, Seung-Hwan,Lee, Joon-Oh,Roh, Young-Hak,Kim, Kang-Wook,Baek, Goo-Hyun 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.1

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

방형 회내근 보존법을 이용한 심한 원위 요골 분쇄 골절의 치료 결과

조승현 ( Seung Hyun Cho ),박홍기 ( Hong Gi Park ),전득수 ( Deuk Soo Jun ),심재앙 ( Jae Ang Sim ),노영학 ( Young Hak Roh ),윤용철 ( Yong Cheol Yoon ),백종륜 ( Jong Ryoon Baek ) 대한골절학회 2015 대한골절학회지 Vol.28 No.3

목 적: 심한 분쇄성이 동반된 원위 요골 골절에서 방형 회내근 보존 접근법(pronator preserving approach)에 의한 수장부금속판 고정술의 임상적 결과를 보고하고자 한다. 대상 및 방법: 심한 분쇄성이 동반된 14예의 원위 요골 골절을 대상으로 하였으며, 남자 8명, 여자 6명이었다. 평균 나이는64.9세였고 AO/OTA 분류에 의해 23-C2가 7예로 가장 많았고 23-C3가 5예, 23-A3가 2예 순이었다. 방사선적 평가로요측 경사, 수장측 경사, 요골 길이를 측정하였고 임상적 평가로 modified Mayo wrist score (MMWS)를 이용하였다. 결 과: 14예 전부에서 골 유합을 얻었으며 유합을 얻을 때까지 기간은 평균 4.3개월(3-6개월)이었다. 방사선적 평가에서는 최종 추시 시에 평균 요측 경사는 20.5o, 평균 수장측 경사는 7.57o, 평균 요골 길이는 11.8 mm였다. MMWS 결과에서 보통,1예, 양호 4예, 우수 9예였고 특별한 합병증은 없었다. 결 론: 심한 분쇄성이 동반된 원위 요골 골절에서 방형 회내근 보존 접근법을 이용한 수장부 금속판 고정술은 유용한 치료법으로 이용될 수 있을 것으로 제안한다. Purpose: We investigate the outcomes of treatment of patients with severe comminuted distal radius fractures with volar plate fixation using a pronator-preserving approach. Materials and Methods: Fourteen patients with severe comminution of the distal radius fractures for whom anatomical reduction of the fractures was deemed difficult to achieve with traditional approaches were enrolled. The gender ratio was 8 males to 6 females, and the average age of the patients was 64.9 years. According to the AO/OTA classification of fractures, 2 patients had 23-A3 fractures, 7 patients had 23-C2, and 5 patients had 23-C3. Radial length, radial inclination, and volar tilt were measured for radiologic evaluation. Modified Mayo wrist score (MMWS) was used for clinical outcome. Results: Bony union was achieved in all 14 patients without signs of complications. The average time-to-union was 4.3 months (3-6 months). The radiological findings at the final follow-up were as follows: the average radial inclination was 20.5o; the average volar tilt, 7.57o; and the average radial length, 11.8 mm. At the final follow-up, the results of the MMWS were ‘Fair’ in 1 patient, ‘Good’ in 4, and ‘Excellent’ in 9. Conclusion: We propose that a pronator-preserving approach is an effective treatment for severe comminuted distal radius fracture.

몬테지아 골절에 동반된 불완전 전방 골간 신경 마비

양보규(Bo-Kyu Yang),김성완(Seong-Wan Kim),이승림(Seung-Rim Yi),안영준(Young-Jun Ahn),노정호(Jung-Ho Noh),노영학(Young-Hak Roh),이승원(Seung-Won Lee),제민수(Min-Soo Je),김석진(Seok-Jin Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.1

전방 골간 신경은 장 무지 굴근, 제 2수지의 심 수지 굴근과 방형회내근에 분포하며 감각 신경 섬유 없이 운동 신경 섬유로만 분포되어 있다. 몬테지아 골절에서 전방 골간 신경의 마비는 드물게 보고 되고 있으나, 이 중 불완전 마비는 거의 보고된 바가 없다. 저자는 몬테지아 골절의 합병증으로 장 무지 굴근 마비의 불완전 전방 골간 신경 마비가 발생한 환자 1예를 경험하였다. 요골 두에 대한 도수 정복을 시행한 후 수술적 치료로 척골 근위부 골절에 대해서 관혈적 정복 및 내고정을 시행하였으며 술 후 4개월에 장 무지 굴근 마비의 회복을 보였다. The anterior interosseous nerve innervates the flexor pollicis longus, the flexor digitorum profundus and the pronator quadratus. There are no sensory fibers from the anterior interosseous nerve leading to the skin. Paralysis of the anterior interosseous nerve that accompanies a Monteggia fracture has rarely been reported, and incomplete paralysis of the anterior interosseous nerve has almost not been reported. We experienced a patient with incomplete anterior interosseous nerve palsy involving the flexor pollicis longus as a complication of a Monteggia fracture. The paralysis of the flexor pollicis longus recovered 4 months after the surgery for the Monteggia fracture.