Percutaneous aspiration of lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance -A case report-

신근만,김선명,고광민,장지수,강상수,홍성준 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.4

A 51-year-old man with a 1-month history of lower back pain and radiating pain visited to our pain clinic. A magnetic resonance imaging (MRI) scan demonstrated a cyst like mass at the level of the L4-5 interspace and compression of the thecal sac and the nerve root on the right side. We performed percutaneous needle aspiration of the lumbar zygapophyseal joint synovial cyst under fluoroscopic guidance. The patient felt an immediate relief of symptoms after the aspiration, and had no signs or symptoms of recurrence at the follow-up 6 months later. No demonstrable lesion was found in the 6 months follow-up MRI.

흉추 압박골절환자를 위한 경피적 척추성형술의 새로운 접근법

신근만 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2

Vertebral compression fractures commonly afflict the elderly. Some patients suffer from severe mechanical pain in spite of treatments with strong analgesics and bracing. Vertebroplasty, which was originally used for vertebral hemangioma, is effective for patients who do not respond to these more conservative treatments. However, the procedure has some risk. Leaks of bone cement into perineural tissues can be a serious complication. In contrast to the lumbar vertebrae, the outer margin of the pedicle of the thoracic vertebrae is almost in line with the outer margin of the body. This, combined with the thinner pedicle of the thoracic vertebrae, makes proper needle placement difficult. The posterolateral approach is preferred to the transpedicular approach in order to avoid the danger of destroying the inner cortex of the pedicle. But there can be a problems with the standard posterolateral approach. The rib can be broken, the pleura can be punctured. A new and safer approach is possible. Before penetrating the bone, the needle is positioned at the upper margin of the transverse process, 5 mm away from the pedicle. To achieve this positioning, the needle must puncture the skin 1 ~ 1.5 cm laterally and 3~5 mm cranially to the target point on the bone. This approach was used for 10 patients and we achieved good results with no serious complication.

삼차신경통에서 경피적 미세압박술의 효과

신근만,안철수,최영룡,정인석 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5

There are many surgical alternatives to medical therapy for trigeminal neuralgia. Among open procedures, Jannetta's procedure for microvascular decompression have widest favor. But there is no justification for exposing patients to such dangers when there are effective and safe alternatives such as percutaneous procedures. Of the percutaneous procedures, the most widely used are thermocoagulation, glycerolization, and microcompression of the gasserian ganglion. Percutaneous microcompression of the gasserian ganglion was introduced by Mullan in 1978 and its description was published in 1983. In the 1950's and 1960's deliberate compression of the gasserian ganglion was performed through an open operation. Mullan carried out this precedure using an inflatable balloon under brief anesthesia. 15 procedures were performed under brief general anesthesia in order to ensure maximum comfort for the patient in the operating room. The instruments consisted of a 14 gauge blunt tip needle, a 4F Fogarty catheter and a tuberculin syringe. The compression was maintained usually for 1 to 1.5 minutes. 14 out of 15 patients were relieved from their pain without serious complications. (Korean J Anesthesiol 1997; 32: 845∼849)

Partial-Thickness Rotator Cuff Tears

신근만 대한통증학회 2011 The Korean Journal of Pain Vol.24 No.2

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.

삼차신경통

신근만 약업신문사 1998 의약정보 Vol.1998 No.1

한국인에서 삼차신경절의 경피적 미세압박술시 압박하는 풍선의 부피에 관한 연구

신근만 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2

Background : Balloon volume is a very important factor in microcompression of the gasserian ganglion. Up until now, the range of figures for balloon inflation volumes came from foreign data. Experience has shown that the optimal range of balloon inflation volumes is somewhat different in Korean patients. Our aim was to determine mean, minimal, and maximal volumes among Korean patients. Methods : In each case balloon volume was measured when protrusion through the porus trigemini occurred. From a total of thirty-three cases seen over a one year period, thirty will be considered here. The remaining three were excluded because of unsuccessful outcomes due to improper positioning of the balloon. This resulted in extreme balloon volumes in these three cases. Results: The values determined from this group of patients were as follows: the mean was 0.55 ml, the maximum was 1.0 ml, and the minimum was 0.35 ml. The mean was 0.75 ml for males and 0.50 ml for females. However due to differences in age and height, this variation in the mean was not statistically significant. Conclusions : Although a comparison of the mean values is not possible because it has never been reported before now in foreign articles, the balloon volumes measured in Korean patients are generally smaller than those reported from Europe and North America. (Korean J Anesthesiol 2000; 38: 301 ~306)

도뇨관을 이용한 기관내 T-튜우브 삽입환자의 마취

신근만,이승환,김동수 한국의학사 1988 診斷과治療 Vol.8 No.8

Management of cancer pain : Characteristics and Assessment of Cancer Pain

신근만 대한임상종양학회 2005 대한임상종양연구 심포지엄 Vol.4 No.-

상지에서의 증식치료

신근만,Shin, Keun Man 대한정형외과초음파학회 2008 대한정형외과 초음파학회지 Vol.1 No.2

증식치료는 정상세포나 조직을 성장시키기 위해 성장인자 또는 성장인자 생성 자극제를 주사하는 것이다. 비록 수십 년 동안 논쟁이 되어 오고 있지만 갈수록 더 많은 의사들이 증식치료를 시술하고 있다. 증식치료라는 단어는 1950년 대에 Hacket에 의해 기술되었는데 인대나 근건에 있는 정상조직의 증식을 의미 하였다. 인대 염좌 등의 불완전한 치료는 만성 통증뿐만 아니라 관절불안 등을 초래하고 골관절염의 진행을 촉진할 수 있다. 증식치료는 통상적인 치료에 불응하는 이러한 근골격계 질환에 사용된다. 사용되는 증식제나 수기는 의사마다 수련과정 또는 선호도에 따라 차이가 있을 수 있지만 최근 가장 많이 사용되는 증식제는 10~25%의 포도당이다. 고해상도 초음파기기의 발전에 따라 인대나 근건 등을 실시간으로 볼 수 있게 됨에 따라 이를 증식치료에 접목하여 수기의 정밀도를 높이고 주입되는 약의 확산을 확인 할 수 있게 되었고 그 치료 결과를 기록할 수 있게 되었다. Prolotherapy can be defined as the injection of growth factors or growth factor production stimulants to grow normal cells or tissue. Even though it has been a controversal procedure for decades, it is currently gaining in popularity among many physicians. The term prolotherapy was coined by Hacket in the 1950s to imply proliferation of normal tissue at ligamentous and tendinous entheses. The procedure has been described by other terms, such as sclerotherapy, regenerative injection therapy, and stimulated ligament repair. Incomplete healing from sprains or strains is common and can lead to chronic pain, joint instability and laxity, and is a risk factor for the development of osteoarthritis. Prolotherapy is commonly used for these musculoskeletal conditions which are refractory to usual care therapies. The proliferant solution and technique varies according to physicial training and preferance. Commonly reported proliferants include 10% to 25% dextrose, P2G and sodium morrhuate. High resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability, low cost, ability to visualize tissue in real time motion and superior resolution of highly organized tissue such as a tendon. This procedure can be introduced by ultrasound imaging and tissue growth and repair after this procedure in a tendon or a ligament can be documented with ultrasound.

만성 어깨통증을 위한 신경차단과 방아쇠점 주사

신근만 대한견.주관절학회 2003 大韓肩.주關節學會誌 Vol.6 No.2