저에너지 손상의 대퇴 원위 간부 골절에서 최소 침습적 금속판 고정술과 재건형의 전향적 골수강내 금속정 고정술의 결과 비교

손홍문,이광철,김바롬,오정수 대한골절학회 2024 대한골절학회지 Vol.37 No.2

목적: 저에너지 손상의 대퇴 원위 간부 골절에서 최소 침습적 금속판 고정술과 재건형의 전향적 골수강내 금속정 고정술의 결과를 비교하고자 하였다. 대상 및 방법: 2016년 1월부터 2022년 4월까지 본원에서 저에너지 손상의 대퇴 원위 간부 골절에 대해 수술적 치료를 시행한 금속판 고정술군 15예와 금속정 고정술군 15예를 대상으로 하였다. 술 중 실혈량과 수술시간, 실시간 방사선 영상장치 노출시간, 골밀도를 조사하였다. 방사선학적 평가를 통해 골유합 시기와 정복도를 평가하였다. 임상적 평가와 합병증을 조사하였고, 각 조사 항목은 통계 분석을 통해 비교하였다. 결과: 두 군 간 수술 중 실혈량 및 수술시간, 실시간 방사선 영상장치 노출시간은 통계적인 차이를 보이지 않았다. 방사선 평가 및 임상적 평가상 두 군 간 통계적 차이는 없었다. 합병증으로 N군에서 불유합 1예, 지연유합 1예가 확인되었고, P군의 경우 불유합 1예, 금속판 주위 골절 1예가 확인되었다. 결론: 대퇴 원위 간부 골절의 치료로 재건형의 전향적 골수강내 금속정 고정술은 최소 침습적 금속판 고정술과 비교하여 비등한 결과를 보였다. 대퇴 전장을 고정하고 원위부에 추가적인 고정을 통해 안정성을 높이는 재건형의 전향적 골수강내 금속정 고정술은 대퇴 원위 간부 골절의 치료로 적절할 것으로 판단된다. Purpose: This study compared the outcomes of minimally invasive plate osteosynthesis and antegrade intramedullary nailing for low-energy fracture of the distal femoral shaft. Materials and Methods: A study was conducted on 30 patients who underwent surgery for low-energy fractures of the distal femoral shaft between January 2016 and April 2022. The study compared 15 patients who underwent minimally invasive plate osteosynthesis (Group P) with 15 patients who underwent recon-type antegrade intramedullary nailing (Group N). We evaluated intraoperative blood loss, operative time, C-arm exposure time, bone density, final union status, anatomical reduction, and clinical evaluation. The complications were also examined, and statistical analysis was conducted to compare the two groups. Results: The blood loss, surgery time, and C-arm time were similar in the two groups. The radiographic assessments and clinical evaluations were also similar in the two groups. The clinical results showed no difference between the groups. Group N had one case of nonunion and one case of delayed union, while Group P had one case of nonunion and one case of peri-prosthetic fracture. Conclusion: Antegrade intramedullary nailing of the recon-type demonstrated comparable results to minimally invasive plate osteosynthesis. Hence, antegrade intramedullary nailing of the recon-type, which enhances stability by fixing the entire femur and providing additional fixation in the distal portion, is deemed appropriate for treating distal femoral shaft fractures.

Cloning and Expression of Recombinant Macrophage-colony Stimulating Factor - A Progressive Strategy for Economical Production

손홍문,고영종,Mineon Park,김보라,김옥준,김동휘,문영래,임원봉 한국생물공학회 2016 Biotechnology and Bioprocess Engineering Vol.21 No.3

Macrophage-colony stimulating factor (M-CSF) has been reported to be required for the proliferation and differentiation of macrophages from hematopoietic progenitor cells. Recently, recombinant M-CSF (rM-CSF) became widely used as a biological research reagent in bone marrow stimulations, vaccine development, gene therapy approaches, and stem cell mobilization. rM-CSF is a glycoprotein that activates and enhances the differentiation and survival of macrophages, which play a key role in the osteoclastogenetic response. Here, we describe the construction of the gene encoding rM-CSF, its cloning, and expression in Escherichia coli, as well as the purification of rM-CSF protein, and its activity in a biological assay in mouse bone marrow cells. Our results show that the combination of experimental strategies employed to obtain recombinant rM-CSF can yield a biologically active protein, and may be useful when scaling-up production of other biologically similar proteins.

경추의 굴곡-신전 손상으로 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 봉합

손홍문,유재원,박상수,김보선 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: A case report. Objectives: To report the use of the shoelace technique for treatment of wound dehiscence caused by dural tears. Summary of Literature Review: It is difficult to treat wound dehiscence caused by dural tears, as it can lead to infection, loss of soft tissue, and need for a long hospital stay. Materials and Methods: An 18-year-old male who had been injured in a traffic accident was diagnosed with bilateral facet dislocation of C7-T1, with no neurologic deficit. Clear secretion appeared during the operation, but it disappeared after posterior fusion. The wound began to open about 3 weeks after the operation. We used the vessel loop shoelace technique to suture the wound, Results: The patient had the stitches taken out in the outpatient clinic three weeks after suture. His wounds are healing without complication. Conclusion: The vessel loop shoelace technique may be a useful treatment for wound dehiscence caused by dural tears. 연구 계획: 증례 보고적: 경막 파열 후 발생한 창상 벌어짐에 대해 Shoelace 기법을 이용한 창상 치료에 대한 경험을 보고하고자 한다. 선행 문헌의 요약: 경막 파열 후 발생하는 창상의 벌어짐은 창상 감염 및 연부 조직의 소실, 장기간의 입원 치료 등을 유발할 수 있어 치료하기 어렵다. 대상 및 방법: 교통사고로 신경학적 결손이 없는 경추 7번과 흉추 1번의 양측성 관절 돌기의 탈구가 발생한 18세 남자환자에 대해 후방 고정술을 시행하였다. 수술 중 뇌척수액으로 추정되는 맑은 분비물이 있었으며 후방 고정술을 시행 후 분비물은 없었다. 수술 3주 후 창상의 벌어짐이 발생하였고 이에 혈관 루프(vessel loop)를 이용한 Shoelace 기법으로 봉합을 시행하였다. 결과: 3주 후 외래에서 혈관 루프를 제거 하였으며 합병증 없이 창상 봉합이 되었다. 결론: 혈관 루프를 이용한 Shoelace 기법은 경막 파열 후 발생하는 창상 벌어짐에 대해 매우 유용한 치료 방법 중 하나라고 생각한다.

최소 절개 방법과 내시경적 방법에 의한 수근관 감압술의 결과 비교

손홍문,이준영,박성용,문영래 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.3

Controlled bending of proximal femoral nails used in fractures of bowed femurs: biomechanical study with clinical application

손홍문,조승환 조선대학교 의학연구원 2022 Medical Bilogical Science and Engineering Vol.5 No.2

We aim to investigate whether the controlled bending of the commercially available nail could affect the nail’s biomechanical properties. We also report the clinical application using such method. A commercially available titanium proximal femoral nails were used for the current study. Using the custom made bending Jig, the portion distal to the bending point of the original nail was bent to varus curvature so that the alignment of the nail is equivalent to medial bowing of 1,000 mm radius. The biomechanical test was performed using the static four point bending test according to American Society for Testing and Materials (ASTM) standards. The measured biomechanical properties were compared between the original nail and the pre-bended nail. There was no significance difference between the original nail and the pre-bended nail in terms of mechanical properties we measured (p<0.05). Only 0.32% difference in bending strength was noticed between the two group which is considered to be negligible. The patient utilizing controlled bending nail showed early bone healing without complication. The result of the current study indicates that the additional bending of the commercially available intramedullary nail has only minimal effect on the biomechanical property of the nail. Therefore, we think controlled bending can be done on a commercially available intramedullary nail and can be used safely in the patient with severe anterolateral bowing.

쾌속조형공정 지원 정형외과 골절 수술 - 증례 보고 -

손홍문,이준영,하상호,유재원,이상홍,안동규 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.7

New surgical techniques utilizing computer-aided engineering have been recently developed to improve the quality of surgery and reduce the risk to patients. This paper reports the surgical cases using rapid prototyping assisted orthopeadic fracture surgery (RPAOFS). RPAOFS utilizes the symmetric characteristics of the human body, and the potential for RE and RP in which the physical shape is manufactured repidly from the CT data. The physical shape before the injury was manufactured from the RP using the mirror transformed CAD data of the uninjured extents. Subsequently, pre-operative planning, such as the selection of the proper implant, preforming of the implant, selection of the fixation positions, and surgery are performed utilizing the physical shape. RPAOFS was applied to two cases such as a distal tibia communited fracture and a proximal tibia plateau fracture. The surgical results showed that RPAOFS is an effective surgical tools. 최근 수술 결과의 개선과 환자에 대한 위험 감소를 위하여 컴퓨터 응용기술을 이용한 새로운 수술 기법들이 개발되고 있다. 본 연구에서는 쾌속조형공정 지원 정형외과 골절수술기법(RPAOFS)의 적용 증례에 대한 결과보고이다. RPAOFS 은 인체의 대칭 특성과 역공학 및 쾌속조형공정의 기술적조합의 장점인 골의 손상없이 CT 데이터로부터 3차원 실물형상 의 쾌속제작 특성을 이용한다. 환측의 골절전 원형골 실물형상은 건측의 CT 데이터를 역공학으로 3차원 복원하고, 이 데 이터를 거울 대칭 변환하여 환측의 골절전 원형골 CAD 데이터를 생성하여 Objet 쾌속조형공정을 이용하여 제작하였다. 제작된 환측 골절전 원형골 실물형상을 이용하여 인체 형상에 적합한 내고정물 선정 및 내고정물 사전 성형, 내고정물 위 치 및 고정위치 선정, 수술 경로 결정 등 사전 수술 계획 수립과 시술을 수행하였다. RPAOFS을 경골 원위부 분쇄골절과 경골 근위부 함몰 골절에 대하여 적용하였다. 수술 결과, 수술 시간, 방사선 투사횟수, 절개 크기 등을 최소화할 수 있었으 며 환자의 재활 속도가 현저히 빨라짐을 알 수 있었다. 이 결과로부터 RPAOFS가 효과적인 정형외과 골절 수술 방법임을 알 수 있었다.

전방십자인대 파열에 동반된 반월상 연골판 손상의 관절경 수술 소견과 수술 전 자기공명영상 검사와의 비교

손홍문,이광철,김동휘,박상수,Sohn, Hong Moon,Lee, Gwang Chul,Kim, Dong Hwi,Park, Sang Soo 대한관절경학회 2012 대한관절경학회지 Vol.16 No.2

목적: 전방십자인대 파열과 동반되는 반월상 연골판 손상에 대해 수술 전 자기공명영상(magnetic resonance imaging, MRI) 검사 소견과 수술 후 관절경 소견을 비교하고자 하였다. 대상 및 방법: 2001년 2월부터 2010년 11월까지 전방십자인대 파열로 본원에서 관절경적 전방십자인대 재건술을 시행받은 225명의 환자를 대상으로 하였으며 관절경 소견상 반월상 연골판 파열은 154예였다. 반월상 연골판 파열은 수술 전 자기공명영상 검사 판독 결과와 관절경 소견을 비교하여 위치 및 모양에 따라 분류하였으며 이에 따른 자기공명영상 검사의 민감도를 조사하였다. 결과: 수술 전 자기공명영상 검사상 전방십자인대와 동반된 내측 반월상 연골판 손상 진단의 민감도는 0.88이었고, 전방십자인대와 동반된 외측 반월상 연골판 손상 진단의 민감도는 0.69였다. 또한 전방십자인대 파열과 동반된 외측 반월상 연골판 손상에서는 후각 및 변연부 파열 시 자기공명영상 검사의 민감도가 가장 낮았으며 내측 반월상 연골판 손상에서는 전각 및 판상 파열 시 민감도가 낮았다. 결론: 전방십자인대 파열 시 동반된 반월상 연골판 손상에서 수술 전 자기공명영상 검사상 진단하기 어려운 외측 반월상 연골판 후각 및 변연부 파열에 대해서는 관절경 수술 시 세심한 관찰이 필요하겠다. Purpose: The purpose of this study was to compare the preoperative magnetic resonance image (MRI) findings with postoperative arthroscopic findings on meniscus injury with anterior cruciate ligament (ACL) rupture. Materials and Methods: We reviewed MRI images and arthroscopic findings of 225 patients treated by ACL reconstruction due to rupture, from February 2001 to November 2010. There were 154 cases of meniscus tear in arthroscopic findings. We examined the sensitivity for detecting meniscal tears varied with the presence of a rupture of the ACL, with the location of the tear within the meniscus, and among configurations of meniscal tears. Results: In the presence of a rupture of the ACL, the sensitivity of MRI was 0.88 for medial meniscal tears and 0.69 for lateral meniscal tears. And sensitivity of MRI was lowest in posterior horn and peripheral portion tears in lateral meniscus injury accompanying ACL rupture, sensitivity was low in anterior horn and flap shape tears in medial meniscus injury accompanying ACL rupture. Conclusion: In Meniscus injury with ACL rupture, a special attention shoulder given to the posterior horn and peripheral portion injury in lateral meniscus during arthroscopic surgery due to difficulty in detecting on MRI.

급성 척수 손상 후 신경보호 및 재생을 위한 약물 치료

손홍문,양경호 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

This is a retrospective review of current literature regarding neuroprotection and regeneration after acute spinal cord injury. Our objective was to provide an update for clinicians of the pathophysioloy of secondary injury, which is the main target for the treatment of spinal cord injury and the emerging therapeutic strategies for promoting neural regeneration. We particularly focused on currently used medications that may have neuroprotictive potential in spinal cord injury. While laboratory research in animal models reportedly resulted in some degrees of promising result, prospective randomized clinical results are anxiously awaited.

전위된 관절내 종골 골절의 수술적 치료 후 방사선학적 계측치와 임상 결과와의 관계

손홍문,임만택,문현식 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.3

Objectives: The purpose of our study was to evaluate the relationship between radiographic parameters and clinical results after operative treatment of the displaced intra-articular calcaneal fractures. Materials and Methods: We analyzed 35 patients of unilateral displaced intraarticular calcaneal fractures who had been treated by operative treatment. At the last follow up, we measured the radiographic parameters including Bohler angle, Gissane angle, heel height, calcaneal length, talocalcaneal angle, talar declination angle, and subtalar incongruity between normal and affected site. Clinical results were measured by Creighton-Nebraska Health Foundation Assessment Score (CNH). And then the correlation between the radiographic parameters and the clinical results were analysed by Pearson correlation method. Results: The average difference between normal and affected site were Bohler angle 15˚ (0-35), Gissan angle 6.5˚(0-20), heel height 4.7mm (1-12), calcaneal length 2.0mm (0-7), talocalcaneal angle 5.5˚(1-19), talar declination angle 2.2˚(0-8), calcaneal width 4.0mm (1-9), subtalar incongruity 0.54mm (0-2.5). The correlation coefficients between radiographic parameters and CNH score were Bohler angle 0.066 (p=0.75), Gissane angle 0.038 (p=0.829), heel height 0.019 (p=0.916), calcaneal length 0.091 (p=0.386), talocalcaneal angle 0.059 (p=0.737), talar declination angle 0.118 (p=0.501) , calcaneal width 0.250 (p=0.291), and subtalar incongruity 0.784 (p=0.002) respectively. Among the all radiographic parameters, The subtalar incongruity shows strong linear correlation with clinical results. Conclusion: We suggested that the subtalar incongruity was significantly correlated with the' clinical results after operative treatment of the displaced intraarticular calcaneal fractures.

척골 경상 돌기 골절을 동반한 원위 요골 골절과 원위 요척 관절 불안정성과의 관계

손홍문 朝鮮大學校 附設 醫學硏究所 2006 The Medical Journal of Chosun University Vol.31 No.2

Objectives: The purpose of this study was to evaluate the patterns (size, displacement) of ulnar styloid process fractures accompanying distal radius fracture and determine their relative contribution to distal radioulnar joint (DRUJ) instability. Materials and Methods: We evaluated 62 cases of distal radius fracture with ulnar styloid fractures who were treated by operation and were followed up for more than six months. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size (0-49%, 50-99%, >100%) and displacement (undisplaced, <2㎜, ≥2㎜). Each distal radius fracture was also evaluated for radiographic and clinical evidence of DRUJ instability at last follow-up. Results: DRUJ instability was revealed in 12 cases. Both the large size of the ulnar styloid fracture (50-99%; 10 cases, ≥100%; 2 cases) and its severe displacement (<2㎜; 3cases, ≥2㎜; 9 cases) at the time of injury have more instability than minimal size and displacement. The communition of the distal radius fracture was significantly related DRUJ instability, C3 type 7 cases on 6 cases(85.7%). but, involvement of the radiocarpal articular surface did not generate significant difference in the incidence of DRUJ instability, Conclusion: The fracture at the base of ulnar styloid and significant displacement of an ulnar styloid fracture were found to increase the risk of DRUJ instability.