요골 원위부 골절 환자에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술

선두훈,이철형,김철우,정덕희,안충한 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.2

Purpose: The purpose of this study was to evaluate the usefulness of ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon as an anesthetic method for distal radius fracture surgery.Methods: From October 2017 to October 2018, an ultrasound-guided axillary brachial plexus block was performed on 161 cases of distal radius fracture requiring surgery. The procedure was performed by orthopedic surgeons using solution (20 mL of lidocaine HCl in 2%, 20 mL of ropivacaine in 0.75%, and 10 mL of normal saline in 0.9%). The success rate of the anesthetic procedure, the duration of analgesic effect, and the complications were investigated. If the anesthesia induc-tion failed, additional local anesthetic methods were performed stepwise and reassessment about whether the operation could proceed was made.Results: Anesthesia was successful in 155 patients and the success rate was 96.3%. The duration of analgesic effect was 6 hours (3-10 hours). In 6 failed cases of anesthesia, local anesthesia was applied to the pain site in the operating room. In 5 cases, the operation was completed without discomfort. In 1 case complaining of pain around fracture site after the local anesthesia, ultrasound-guided radial nerve block was effective in controlling the pain.Conclusion: In open surgery of distal radius fractures, an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon allows anesthesia with high success rates. Even if the surgical anesthesia is incomplete, it is expected that the surgery cab be completed safely if the nerve is identified and the stepwise additional local anesthesia method is performed. 목적: 요골 원위부 골절 수술 시 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술의 유용성에 대하여 알아보고자 한다.방법: 2017년 10월부터 2018년 10월까지 요골 원위부 골절 수술 전 마취 방법으로 초음파 유도 액와 상완 신경총 차단술을 시행한 161명을 대상으로 하였다. 2% lidocaine HCl 20 mL, 0.75% ropivacaine 20 mL, 0.9% nor-mal saline 10 mL의 혼합액을 이용하였으며 술기의 성공률, 무통 지속 시간 및 합병증을 조사하였다. 술기가 실패한 경우 단계적으로 추가 국소 마취를 시행한 뒤 재평가하였다. 결과: 161명 중 155명에서 마취가 성공하여 96.3%의 성공률을 보였다. 무통 지속 시간은 평균 6시간(3-10시간)이었다. 6명이 마취 실패로 수술실에서 통증 부위에 국소 마취제를 추가 투여하였으며 5명은 이후 환자의 불편감 없이 수술을 마칠 수 있었고, 1명은 초음파 유도 요골 신경 차단술을 통해 수술을 완료할 수 있었다.결론: 요골 원위부 골절 수술 시 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술은 높은 마취 성공률을 보였고, 마취가 불완전 하더라도 해당 신경을 파악하여 단계적 추가 국소 마취 방법을 시행한다면 안전하게 수술을 완료할 수 있을 것으로 기대한다.

골프로 발생한 유구골구 골절과 굴곡건 파열

김종민,팽정욱,유명재,우상현 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.1

Purpose: We report surgical results and the relationship between hamate hook fracture and flexor tendon rupture occurred during excessive golf practice or rounding. Methods: The 16 cases of patients with fracture of hamate hook or flexor tendon injury caused by golf swing were examined retrospectively. Hamate hook excision were underwent in fracture alone, flexor tendon reconstruction with tendon transfer of 3rd or 4th flexor digitorum sublimus (FDS) were done in the flexor tendon rupture. Postoperative results were evaluated by means of American Society for Surgery of the Hand (ASSH) to compare total range of motion and the grip strength. Results: The fracture gap was not far apart completely in computed tomography (CT) of hamate fracture alone cases. If the flexor tendon rupture with the fracture, the gap in CT was far apart completely. After flexor tendon transfer surgery, two cases were excellent, five cases were good, two cases were fair in ASSH assessment. One case was re-rupture. Grip strength as compared with the normal side was observed for the mean grip strength of 82% recovery. Conclusion: The instability of the hamate hook fracture affected to flexor tendon rupture rather than location of the fracture. Hamate hook excision and tendon transfer with FDS can be a good treatment option. 목적: 과도한 골프 연습이나 라운딩 도중에 발생한 유구골구 골절과 굴곡건 파열에 대한 관계 및 수술적 결과를 보고하고자 한다. 방법: 골프에 의해 발생한 유구골구 골절 또는 굴곡건 손상이 있는 환자 16예를 후향적으로 조사하였으며, 유구골구 골절은 골절제술, 굴곡건 파열 시 제3혹은, 제4천수지 굴곡건 이전술을 시행하였으며, 악력 및 . 미국수부외과학회(American Society for Surgery of the Hand, ASSH)의 방법으로 총 관절 운동범위를 평가하였다. 결과: 유구골구 단독 골절 시 computed tomography (CT)에서 골절틈이 완전히 벌어져 있지 않았지만 유구골구 골절 및굴곡건 파열시에는 CT상 골절틈이 완전히 벌어진 것이 관찰되었으며, 건파열이 있는 경우 굴곡건 이전술 후 ASSH 평가상 2예에서 매우 우수, 5예에서 우수, 2예에서 양호, 1예에서 재파열이 있었으며 건측과 비교하여 평균 82%의 악력회복을 관찰하였다. 결론: 골프로 인한 굴곡건 파열은 유구골구 골절의 위치보다는 골절부 전위에 의한 불안정성이 더 영향이 크며 건파열시 유구골 절제 및 천수지 굴곡건 전이술이 좋은 치료 방법이다.

대한민국 정형외과 전공의 평가시험 분석: 수부 및완관절 분야

김동희,김준엽,심승보,김주학 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.1

Purpose: To evaluate the questions of hand and wrist section of Korean orthopedic in-training examination (KOITE). Methods: We analyzed questions of hand and wrist section of KOITE between 2010 and 2014. The weight of hand and wrist section was calculated and topics were thoroughly analyzed. The construct of questions were evaluated and taxonomic classifications were also performed. The frequency of presentations of physical examinations and radiologic evaluations in diagnosis and treatment related questions were analyzed. The coverage of available references which were recommended by Korean Orthopedic Association (KOA) were analyzed. Results: Sixty one out of 500 questions (weight: 12.2%) were related with hand and wrist section. Disease (30/61, 48.2%) was more commonly asked than trauma, however most frequently asked topic with a broad classification was fractures and dislocations (19/61, 31.1%). The description only questions (46/61, 75.4%) were most commonly asked construct of question. According to taxonomic classification, taxonomy B (diagnosis; 27/61, 44.3%) was most frequently asked. The Campbell’s operative orthopedics (54/61, 88.5%) and textbook of KOA (53/61, 86.9%) were representative references covering questions most widely. Conclusion: This analysis of hand and wrist section of KOITE could be used as the check-up tools for resident training programs of each training hospitals. 목적: 본 연구에서는 정형외과 전공의 평가시험 중 수부 및 완관절 분야를 분석하여 평가시험의 출제 경향과 문제점을논의 하고자 한다. 방법: 2010년에서 2014년까지 5년간 치러진 정형외과 전공의 평가시험 문항 중 수부 및 완관절 관련 문항들을 분석하였다. 수부와 완관절 영역이 차지하는 비중과, 문제 주제, 출제 형태 및 유형에 따른 분류 등의 분석을 시행하였다. 또한정형외과 참고서적 및 문헌들의 가용 정도를 조사하였다. 결과: 수부 및 완관절 관련문항은 총 500문항 중, 61문항(12.2%)이었으며 대분류에서 질환 문제(30/61, 48.2%)가, 주제분류(광범위)로 골절 및 탈구 문항이(19/61, 31.1%) 출제 빈도가 높았다. 출제 형태는 단순 서술형 문제(46/61, 75.4%), 출제 유형에선 진단관련 문항(27/61, 44.3%)이 가장 빈번하였다. 참고서적으로 캠벨의 수술적 정형외과학(54/61, 88.5%)과 대한 정형외과학 교과서(53/61, 86.9%)가 광범위하게 이용되었다. 결론: 이번 수부 및 완관절 영역 전공의 평가시험 분석은 현재 수부 및 완관절 분야의 교육 프로그램의 적절성을 검토할만한 근거 자료가 될 수 있겠다.

주관절 건병증의 생물학적 제재 치료

정형석,이재성 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.4

Although elbow tendinopathy is the one of common diseases causing elbow pain, ideal nonoperative treatment to provide long-term satisfaction has not been introduced. Recently, there is significant interest in biological treatment to facilitate the healing environment and tissue proliferation in elbow tendinopathy. Biological agents such as platelet-rich plasma (PRP) or stem cells are likely to be established as one of the nonoperative treatment methods that can have long-term therapeutic effects in the future, given their theoretical basis. Despite many previous studies using biological agents such as PRP and stem cells in the elbow, its beneficial effect on elbow tendinopathy is controversial. Thus, the purpose of this review is to provide an evidence-based summary of the biologic agent for treating elbow tendinopathy and to identify areas where further research is warranted. 주관절 건병증은 팔꿈치의 통증을 유발하는 가장 대표적인 질환 중 하나로 그동안 여러 가지 치료 방법들이 소개되었지만 일시적인 효과를 보일 뿐 장기적으로 만족을 줄 수 있는 이상적인 비수술적 치료 방법은 아직 밝혀지지 않았다. 최근 주관절 건병증에서 치유 환경을 향상시키고 조직의 증식을 촉진하는 생물학적 제재를 이용한 치료 방법이 각광을 받고 있다. 혈소판 풍부 혈장이나 줄기세포 같은 생물학적 제재는 그 이론적 근거를 볼 때 향후 장기적인 치료 효과를 볼 수 있는 비수술적 치료 방법으로 자리를 잡을 가능성이 높다. 하지만 혈소판 풍부 혈장이나 줄기세포 같은 생물학적 제재를 이용한 여러 연구에도 불구하고 아직 그 효과에 대해서는 논란이 있다. 따라서 여러 문헌 고찰을 통해 주관절 건병증에서 생물학적 제재 치료의 근거를 알아보고 향후 연구 방향에 대해 알아보고자 한다.

Simultaneous Volar Pulp and Nail Bed Reconstruction with the Second Toe Onychocutaneous Free Flap

이경진,박일우,노시영,고성훈,김진수,홍민기 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.2

Fingertip injury is one of the most common hand injuries. Although several types of advancement and cross-finger flaps exist, they would not be essential for nail bed defects. The authors present a simultaneous volar pulp and nail bed reconstructive technique that uses a second toe onychocutaneous free flap. Four patients without amputees underwent fingertip amputation reconstruction between 2011 and 2019. After thorough debridement, the defect size was estimated, and the digital arteries, nerves, and veins of the recipient were evaluated. The flap, composed of pulp tissue and nail bed, was harvested with continuity from the second toe. Additional split-thickness skin grafts were performed in two cases. All flaps survived without considerable complications. We evaluated the scar and contour, and nail growth was reported over Zook’s criteria grade B. The second toe onychocutaneous free flap provides a reliable option for fingertip defects that involve pulp tissue and nail bed without further amputation.

난치성 수근관 증후군

이재후,박민종 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.2

수근관 유리술의 실패와 합병증은 3%에서 25%까지 보고되며, 이에 따른 재수술은 일차 수술에 비해 결과가 좋지 않고 예후를 예측하기 어렵다. 수근관 증후군 환자에서 수술 후에도 증상의 호전이 없거나 재발되는 경우의 원인은 다양하나, 수술 이후 증상의 발생 양상에 따라 수술 후에도 지속되는 증상, 호전 후 재발되는 증상, 호전 후 새로운 증상의 발생의 세 가지로 크게 분류할 수 있다. 이에 대한 적절한 치료도 원인에 따라 결정되어야 한다. 저자들은 난치성 수근관 증후군의 임상 증상, 원인, 진단, 그리고 치료에 대하여 기술하고자 한다. Complications and failures after carpal tunnel release have been reported from 3% to 25%. And the revision surgeries usually show poorer outcomes than the primary surgeries. There are diverse etiologies causing neuropathic symptoms after the carpal tunnel release, which became a clinical challenge. Potential causes of the symptoms are categorized into three by those natures; persistent symptom, recurrent symptom, and new symptom. The decision of proper management should be based on the etiologies of reproduced symptoms. This article described an overview of the clinical presentation, etiologies, diagnosis, and treatments of the recalcitrant carpal tunnel syndrome.

중수근 불안정성의 이해

강홍제 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.2

The midcarpal instability is the state with instability between the proximal and distal carpal rows, without dissociation between carpal bones. It can be divided into the intrinsic one that is caused by ligament hyperlaxity, and extrinsic one that is caused secondarily by the malunion of distal radius. The pathophysiology of the intrinsic one is still unknown, and the treatment is also controversial. On the other hand, the extrinsic one can be treated by corrective osteotomy of the radial malunion. This review investigated the comprehension, definition, classification, symptoms, diagnosis, and treatment of the midcarpal instability. 중수근 불안정은 수근골 사이의 해리 없이 근위 수근열과 원위 수근열 사이에 발생하는 불안정성을 말한다. 중수근 불안정은 과도한 인대 이완에 의해 발생하는 내재성 불안정과, 요골의 부정 유합에 의해 이차적으로 발생하는 외재성 불안정으로 크게 나눌 수 있다. 아직도 내재성 중수근 불안정을 유발하는 병태 생리가 정확하게 알려지지 않고 있으며 치료 역시 논란이 많다. 반면 외재성 중수근 불안정은 원인이 되는 요골의 부정 유합에 대해 교정 절골술을 시행하여 치료할 수 있다. 이에 수근 불안정의 기본 개념과 중수근 불안정의 정의, 분류, 증상, 진단, 치료에 대해 알아보고자 한다.

주두 박편을 동반한 삼두근 건의 견열 손상 - 3예 보고 -

이대희,허윤무,김상범,이진웅,남효종 대한수부외과학회 2012 대한수부외과학회지 Vol.17 No.4

삼두근 건 부착부의 견열 손상은 드물게 발생하며 적절한 진단을 하지 못하면 근력 저하와 운동 범위 감소를 유발할 수있다. 일반적으로 손을 짚고 넘어지거나 상완부에 가해지는 직접적인 충격에 의하여 갑작스럽게 삼두근이 수축하여 주두의 부착부에서 삼두근 건이 파열이 일어난다. 치료 방법을 선택하기 위해 완전 파열과 불완전 파열을 구분해야 한다. 주관절의 측면 방사선 검사에서 삼두근 건이 주두 부착부에서 견열되며 작은 골편이 관찰되기도 한다. 저자들은 단순방사선 검사에서 주두 박편(flake sign)이 확인되어 삼두근 건 부착부의 견열 손상으로 진단한 3예를 경험하였고 수술적 치료로 우수한 결과를 얻었기에 보고하는 바이다. Triceps tendon avulsion from the olecranon is a rare injury. Missed or delayed diagnosis may result in a weakness of strength or a decreased range of motion of the elbow. This injury is usually caused by a fall on the outstretched hand or a direct blow to the posterior arm. In addition, the rupture of the triceps tendon is implicated by a sudden eccentric contraction of the triceps muscle. To determine whether the rupture is complete or incomplete is critical to guide the treatment method. A small avulsed fragment from the olecranon may be detected on lateral radiographs of the elbow. We report three cases of the triceps tendon avulsion with a bony flake from the olecranon, which were surgically treated, along with a brief review of the literature.

Usefulness of Color Doppler Ultrasonography for the Preoperative Evaluation of Thin Anterolateral Thigh Flap Perforators

Kyung Jin Lee,박일우,Si Young Roh,Sung Hoon Koh,Jin Soo Kim,Dong Chul Lee,구진회 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.4

Purpose: The anterolateral thigh flap is commonly applied to various body sites for reconstruction. However, surgeons often struggle against unexpected locations and the nature of perforator vessels during surgery. Thus, this study aimed to assess the accuracy and usefulness of color Doppler ultrasonography as a preoperative tool for the perforator position and course of anterolateral thigh flaps. Methods: A prospective study involving 77 anterolateral thigh flaps was conducted between March 2016 and February 2021. Among them, 37 perforators (group A) were detected using the preoperative color Doppler ultrasound, and the other 40 perforators (group B) were tested using a hand-held Doppler only. All patients in group A underwent color Doppler ultrasonography performed by a radiologist at our institution. The nature and course of the perforator vessels were recorded, and their precise locations were plotted in an orthonormal coordinate system. Results: A total of 37 anterolateral thigh perforator flaps (group A) were successfully dissected. The median distance between the preoperative color Doppler ultrasonography and the real location during surgery of the perforators was 7.50 mm, which was statistically smaller than 10 mm (p<0.001). This preoperative ultrasound test also had a success rate of 94.6% to determine the nature of the perforators (musculocutaneous type vs. septocutaneous type). Conclusion: Preoperative color Doppler ultrasonography provides a harmless, reliable, and accurate technique for visualizing the vascular anatomy of anterolateral thigh flaps. It has a high correlation with surgical findings, allowing surgeons to cope with variable vascular anatomy.

Osteoarthritis after Extension Block Technique for the Bony Mallet Finger

Sung Hoon Koh,Jung Hyun Park,Jin Soo Kim,Si Young, Roh,Kyung Jin Lee,Dong Chul Lee 대한수부외과학회 2021 대한수부외과학회지 Vol.26 No.4

Purpose: The purpose of this study is to investigate osteoarthritis after treatment of bony mallet finger using the extension block method. Methods: A single institutional retrospective review identified 163 patients with bony mallet between January 2012 and July 2020 and received surgical treatment using extension block method. The radiographic examination showed that the fracture line disappeared and a bridging callus was formed and bone union was confirmed. Fractures were classified according to the Tubiana classification method. Demographic data, fracture pattern, postoperative X-ray, and late complications were analyzed. Clinical outcomes were analyzed using Crawford’s criteria. Results: Surgical treatment was performed within an average of 8.8 days after injury, and the average follow-up period was 11.6 weeks. Osteoarthritis findings were confirmed by joint space narrowing and osteophytes on radiographic examination of 32 out of 163 patients. Age, sex, occupation, location of trauma, operation time, and type of fracture did not affect the osteoarthritis after extension block. Invasion of Kirschner wire (K-wire) to the fracture surface, family history of osteoarthritis, and operation time turned out to have a statistically significant effect on osteoarthritis (p<0.05). Conclusion: Fracture surface invasion of K-wire and family history of osteoarthritis affect osteoarthritis after treatment of bony mallet.