유리피판을 이용한 사지 연부조직 악성종양 절제 결손의 재건례

권영호,사공은성,Kwon, Young-Ho,SaGong, Eun-Seong 대한미세수술학회 2008 Archives of reconstructive microsurgery Vol.17 No.1

Purpose: Evaluation of results of free flap as a method of reconstruction in soft tissue defect after wide excision of soft tissue tumor of extremity. Materials and Methods: From 2000 through 2007, 11 patients received free flap surgery for soft tissue defect after wide excision operation for soft tissue tumor of limbs. Four cases were upper extremities and seven were lower extremities. Four subjects were diagnosed as squamous cell carcinoma, three as malignant melanoma, two as synovial sarcoma and one as malignant fibrous histiocytoma and alveolar soft part sarcoma. Donor sites of free flap varied with anterolateral thigh flaps in six cases, latissimus dorsi flaps in four, reverse forearm flap in one. By the method of doppler ultrasound, venous circulation was evaluated for the survival of each flap on the third, fifth and seventh day respectively after the operation. Results: 10 of 11 free flaps were successfully survived. Necrosis of free flaps in 1 cases occurred in case of anterolateral thigh flap. Conclusion: Free flap can be a useful method for reconstruction of soft tissue defect after wide excision of soft tissue sarcoma of extremity.

고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화

장원모,은상준,사공필용,이채은,오무경,오주환,김윤,Jang, Won-Mo,Eun, Sang-Jun,SaGong, Pil-Young,Lee, Chae-Eun,Oh, Moo-Kyung,Oh, Ju-Hwan,Kim, Yoon 대한예방의학회 2010 Journal of Preventive Medicine and Public Health Vol.43 No.6

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

선택적 외측 슬개 지지대 이완술의 장점

손정환,사공은성,권영호,장재호,김재도,Son, Jung-Hwan,SaGong, Eun-Seong,Kwon, Young-Ho,Jang, Jae-Ho,Kim, Jae-Do 대한관절경학회 2006 대한관절경학회지 Vol.10 No.1

목적: 슬개-대퇴간 부정 정렬 환자에서 외측 지지대를 이완시키는 수술에는 지금까지 관혈적 이완술(Open release), 고식적 관절경적 이완술(arthroscopic complete release)등의 방법을 이용하여 왔으나 저자는 관절경적 선택적인 이완술(arthroscopic selective release)로 이환된 지지대만을 최소 절제하여 수술함으로써 수술 후 환자의 합병증 및 만족도 등의 결과를 비교 분석하여 환자에게 가장 유용한 방식을 알아보고자 한다. 대상 및 방법: 1993년 1월부터 1998년 6월까지 외측 지지대 이완술을 시행하고 추시 가능하였던 94명, 129예 중 관절경적 이완술의 경우 68명, 90예, 관혈적 이완술의 경우 26명, 39예였으며 관절경적 이완술의 경우 고식적인 방식에 의한 경우가 42명, 57예였으며 이환된 외측지지대만을 선택적으로 이완시킨 경우가 26명, 33예였다. 위 예를 대상으로 수술 전 계측과 수술 후 1년, 수술 후 5년 이상의 최종 추시를 시행하여 슬개골 경사, 전위, 수렴 각, O-angle을 방사선학적 및 임상적으로 측정하여 분석하였으며, 임상적 평가는 슬관절 평가 지수 및 변형 슬개골 지수를 이용하였다. 결과: 방사선학적 평가에서 슬개골 경사와 전이는 고식적인 방법에 의한 관절경적 이완시$13.4^{\circ}$, 12.1 mm에서 $3.6^{\circ}$, 3.8 mm로, 관절경하 선택적 이완시 $12.3^{\circ}$, 11.2 mm에서 $4.8^{\circ}$, 5.2 mm로, 관혈적 이완시 $13.6^{\circ}$, 12.3mm에서 $3.3^{\circ}$, 3.4 mm로 향상된 결과를 보였으나, 통계적으로는 유의한 상관관계를 보이지 않았다. 슬관절 평가 지수는 각각 84.2%(48/57), 81.8%(27/33), 82.1%(32/39)에서, 변형 슬개골 지수는 82.5%(47/57), 81.8%(27/33), 82.1%(32/39)에서 만족스러운 결과를 보였고 서로 간에 유의한 차이는 보이지 않았다. 결론: 슬개-대퇴 부정 정렬을 가진 환자의 수술방법 중 하나인 관절경적 선택적 이완술은 적은 수술범위에서 이환된 지지대를 이완시킴으로써 유착등의 합병증 없이 환자의 재활 및 만족도를 높이는 하나의 치료 방법으로서 관혈적 방법과 고식적 관절경적 수술보다 좋은 치료라고 판단된다. Purpose: Open lateral release and complete lateral release have been conducted as a surgical method in patients with patellofemoral malalignment. But authors sought to find out the best method by conducting selective release, with minimal excision of the involved lesion, and comparative analyzing the result, as postoperative satisfaction and complication. Materials and Methods: Over the 68 patients of 90 cases who underwent arthroscopic release, among 94 patients of 129 cases who underwent lateral retinacular release, from January 1993 to June 1998 were followed up prospectively. A radiological evaluation of patellar inclination, patellar tilt, congruence angle, and Q-angle and a clinical evaluation of HSS-Knee score and modified patellar score were used for analysis data before operation and data at 1 year and 5 year after operation. Results: According to the radiologic evaluation, the patellar tilt and translation revealed improvement of the results, from $13.4^{\circ}$ and 12.1mm to $3.6^{\circ}$ and 3.8mm with arthroscopic lateral complete release, and from $12.3^{\circ}$ and 11.2mm to $4.8^{\circ}$ and 5.2mm with selective release, and from $13.6^{\circ}$ and 12.3mm to $3.3^{\circ}$ and 3mm with open release. But they were not significantly related to the clinical results. HSS-Knee score was 84.2%(48/57), 81.8%(27/33), 82.1%(32/39) and modified patellar score was 82.5%(47/57), 81.8%(27/33), 82.1%(32/39) respectively, which revealed satisfactory results. And no significant difference among the operative methods were shown. Conclusion: Arthroscopic lateral retinacular release which is one of the surgical method for patellofemoral malalignment enhances rehabilitation and satisfaction of the patient, by releasing the involved retinaculum within lesser surgical extent, compared to open and complete lateral release without complications such as adhesion.

카이로프랙틱 도수요법에 의한 경추성 두통의 치료

장재호,사공은성 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4

Purpose : Cervicogenic headache is a neck induced headache syndrome. Chiropractic Spinal Manipulation Therapy (CSMT) is non-invasive treatment method for painful lesion. CSMT is considered to relief the pain and increase the range of motion of cervical spine without complications. Materials and Methods : A follow-up observation has been made by retrospective study after applying chiropractic spinal manipulation therapy on 28 cases of cervicogenic headache patients who visited our hospital from April 2005 to April 2007. Every patiens had performed Short-Form McGill Pain Questionnaire, Neck Disability Index, and SF-36 Questionnaire. Results : 28 patients average age was 37(14∼73). Female patient was 23 out of 28 and 5 was male patients. The average duration of treatment was 13.6 weeks. The Short-Form McGill Pain Questionnaire, in which questions about the level of pain in general and the Pain Relating Index (PRI), was 11.7 in average before chiropractic spinal manipulation and 3.7 in average after manipulation (P=0.196). The Visual Analog Scale (VAS 0-10) showed pain decrement from 6.1 to 3.1 after manipulation (P=0.126). PPI showed improvement from 2.75 to 0.5 after manipulation(P=0.1). In the Neck Disability Index, which questions the physical disability due to pain, the decrement in average was 14.6 to 4 after manipulation. The results of SF-36 Questionnaire, which deals with the patient's general health showed decrement from 57.8. to 69.4(P=0.317) after manipulation. Conclusion : CPMT has pain relieving effects in cervicogenic headache and also shows increased neck range of motion after treatment. Therefore, CSMT can be a one of useful treatment method for cervicogenic headache.

전반슬의 보존적 치료 -증례 보고

손정환 ( Jung Hwan Son ),사공은성 ( Eun Seong Sagong ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.4

전반슬의 경우 대부분에서 일리자로브 외고정 장치를 이용한 수술적 치료가 이루어지고 있으며 보조기를 이용한 치료는 드물게 보고되고 있다. 좌측 슬관절의 과신전으로 내원하였던 4세 6개월 여아로 방사선 사진상 25˚의 과신전이 관찰되었다. 사두고건과 슬건간의 불균형으로 인한 전반슬로 Knee-ankle-foot orthosis를 이용한 보존적 치료를 시행하기로 하였으며, 보조기는 목욕시간과 취침시간을 제외한 대부분의 시간을 착용하도록 하였다. 이후 1개월마다 외래 방문하여 단순 방사선 촬영을 하여 과신전의 호전여부를 관찰하였으며, 6개월째 단순 방사선 측면 사진상 2˚의 과신전 소견이 관찰되었다. 사두고건과 슬건간의 균형이 이루어져 정상적인 보행을 확인할 수 있었다. 사두고건과 슬건간의 부조화같은 연부조직의 원인으로 인해 발생한 전반슬의 경우 보조기를 이용한 보존적 요법으로 치료한 증례를 보고하고자 한다. Genu recurvatum has commonly treated by Ilizarov devices, and treatment with an orthosis has rarely been reported. A 54 month old girl visited our hospital because of left knee hyperextension. The overall imbalance of the quadriceps with the hamstring muscles created 25 degrees of hyperextension. So we applied a knee-ankle-foot orthosis (KAFO) for treatment. After six months, the plain radiograph show 2 degrees hyperextension and stabilization of the knee. Genu recurvatum can be treated with an orthosis in a patient with imbalanced quadriceps and a hamstring muscle problem.