뇌 혈관계 질환과 중증 뇌손상 환자에 대한 Cinepazide 치료의 임상 효과

황장회,강준기 최신의학사 1992 最新醫學 Vol.35 No.4

흰쥐의 의원성 모형 측두엽 간질에 대한 Nimodipine의 효과

황장회,최창락 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.3

In order to investigate the antiepileptic effects of clalcium antagonist, nimodipine, we studied the changes of seizure pattern and electroencephalographic finding of the epileptic rats befroe and after nimodipine administration which were induced by stereotaxic instillation of penicillin solution into the right amygadala. 40 Sprague-Dowley rats were divided into 2 groups : the control group(n=10) which underwent craniectomy on the biparietal area and was instilled penicillin solution into the right amygdala on the basis of stereotaxic coordinates, and the experimental group(n=30) which was subdivided into 3 subgraups : nimodipine pre-treatment group(n=l0). nimodipine 0 minute post-treatment group(n=10) and nimodipine 20 minutes post-treatment group(n=10) depending on the intraperitoneal administration time of nimodipine. The results were as follows : 1) In control group typical epileptiform discharges were noted at 3.4±1.9 min after penicillin instillation and the frequency and amplitude of discharges were 9.8±2.2/sec. 25.0±3.9㎜/50㎶. The degree of behavioral siezure was between stage Ⅳ and Ⅵ. 2) In nimodipine pre-treatment group, there was inhibitory effects of seizure development. The frequency and amplitude were significantly decreased and the degree of behavioral seizaure was attenuated in comparison to that of control group. 3) There was no statistical difference in effects of penicillin induced seizure between nimodipine 0 minute. 20 minutes post-treatment and control group. This experiment provided that calcium antagonist showed inhibitory effects on the penicillin-induced epileptic rats. but did not prevent seizure propagation. And calcium currents might play a role to evoke seizue. Therefore calcium antagonist "nimodipine" might be beneficial to the treatment of patients with seizure.

소아기 Cerebral Rete Mirabile 병소에 대한 Encephalo-duro-arterio-synangiosis : 치험 2 예 Report of Two Operative Cases

황장회,이재수,강준기,백민우,김달수,하영수,송진언 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Cerebral rete mirabile is a unusual form of chronic cerebrovascular occlusive disease characterized usually by bilateral stenosis of distal internal carotid arteries and their vicinity, by a hazy network of collateral circulation at the base of brain called moyamoya vessels and clinically by recurring hemispheric ischemic attack in children. We have reported here 2 cases of cerebral rete mirabile in children and performed newly developed operative procedure which we think is an ideal surgical method for treatment of this disease in children and is compared with other surgical treatment.

뇌실내 출혈을 동반한 "모야모야"병의 수술결과에 대한 임상적 분석

조용준,황장회,안명수 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.7

Moyamoya disease is an unusual vascular disorder highlighted by progressive bilateral internal carotid artery occlusion and collateralization of intracranial blood flow. The purposes of the bypass procedures: 1) reduce or arrest of the chance of repeated ischemic attack by making the additional collateral blood flow. 2) decrease the chance of repeated bleeding by reducing the number of moyamoya vessels. During the period from June 1989 through February 1991.8 moyamoya diseases associated with intraventricular hemorrhage were operated by STA-MCA anastomosis plus EMS. Results are as follows : 1) Slightly female dominancy in incidence(5 : 3), and all of the patients were middle aged(range 32 to 55 years). 2) All of the patients had sudden onset of headache, and most patients had neck stiffness and vomiting. 3) In all of the patients, confirmatory diagnosis could be done by angiography, and all of the patients had typical angiographic findings of moyamoya disease. 4) All of the patients had IVH in brain CT scan 5) All of the patients were surgically treated : STA-MCA anastomosis plus EMS. 6) The postoperative revascularization rate was 89%(8 sides in 9 sides). 7) The postoperative results were excellent in 5, good in 1, and death in 2. The rarity of such lesions in Korea and their surgical results are reviewed briefly.

1999년 강원 동계 아시아 경기대회 의료지원 분석

송준호,황장회,안희철,송근정,최정태,신동훈,안무업,유기철,최영미,조용준 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. To determine the needs of medical service system for mass-gathering event. We analyzed the process of delivered medical care system and the types of medical problems of 1999 Winter Asian Games, thus we are able to provide the basic data for planning future events. Methods. We surveyed the organizing system of 1999 Winter Asian Game such as the operating system, medical goods, equipment, and overall patient status created at the medical room by retrospective chart review from 31st January to 6th February. Results. The medical rooms were operated at two athletic villages and six game grounds. The medical rooms of athletic villages were operated by doctors, nurses, pharmacists, and EMTs and the rooms at the game grounds were operated by a doctor and a nurse. The medical goods and equipments for minor patients were satisfied, but those for critical patients were not satisfied. Most of the patients visited the medical rooms had minor symptoms or musculoskeletal injuries. The symptom complex of the upper respiratory infection was the most commonly complained symptom(250 patients), followed by the gastrointestinal symptoms(200 patients) and musculoskeletal injuries(168 patients). However there was also a patient with acute myocardial infarction who required medically critical management including oxygen suppliment, EKG monitoring, and transfer to a specialized medical center. The oral medications(581 patients), bandages and dressings(35 patients), physical therapies(25 patients), eyedrops(23 patients), and injections(21 patients) were supplied to the patients. Conclusion. The organized medical care was mainly prepared by the administration. The management for minor patients was satisfied, but of the critical patients was not satisfied.

단일 나사형 Cage를 이용한 후방 요추체간 융합술과 두개의 나사형 Cage를 이용한 PLIF의 생체 역학적 비교

박춘근,황장회,지철,권성오,성재훈,최승진,이상원,김문규,박성찬,조경석,박춘근,강준기,Park, Choon Keun,Hwang, Jang Hoe,Ji, Chul,Kwun, Sung Oh,Sung, Jae Hoon,Choi, Seung Jin,Lee, Sang Won,Kim, Moon Kyu,Park, Sung Chan,Cho, Kyeung Suok,Park, 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objectives : An in vitro biomechanical study of posterior lumbar interbody fusion(PLIF) with threaded cage using two different approaches was performed on eighteen functional spinal units of bovine lumbar spines. The purpose of this study was to compare the segmental stiffnesses among PLIF with one long posterolateral cage, PLIF with one long posterolateral cage and simultaneous facet joint fixation, and PLIF with two posterior cages. Methods : Eighteen bovine lumbar functional spinal units were divided into three groups. All specimens were tested intact and with cage insertion. Group 1(n=12) had a long threaded cage($15{\times}36mm$) inserted posterolaterally and oriented counter anterolaterally on the left side by posterior approach with left unilateral facetectomy. Group 2(n=6) had two regular length cages($15{\times}24mm$) inserted posteriorly with bilateral facetectomy. Six specimens from group 1 were then retested after unilateral facet joint screw fixation in neutral(group 3). Likewise, the other six specimens from group 1 were retested after fixation with a facet joint screw in an extended position(group 4). Nondestructive tests were performed in pure compression, flexion, extension, lateral bending, and torsion. Results : PLIF with a single cage, group 1, had a significantly higher stiffnesses than PLIF with two cages, group 2, in left and right torsion(p<0.05). Group 1 showed higher stiffness values than group 2 in pure compression, flexion, left and right bending but were not significantly different. Group 3 showed a significant increase in stiffness in comparison to group 1 for pure compression, extension, left bending and right torsion(p<0.05). For group 4, the stiffness significantly increased in comparison to group 1 for extension, flexion and right torsion(p<0.05). Although there was no significant difference between groups 3 and 4, group 4 had increased stiffness in extension, flexion, right bending and torsion. Conclusion : Posterior lumbar interbody fusion with a single long threaded cage inserted posterolaterally with unilateral facetectomy enables sufficient decompression while maintaining a majority of the posterior elements. In combination with a facet joint screw fixation, adequate postoperative stability can be achieved. We suggest that posterolateral insertion of a long threaded cage is biomechanically an ideal alternative to PLIF.

Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength

박춘근,황장회,지철,이재언,성재훈,최승진,이상원,박성찬,조경석,박춘근,강준기,Park, Choon-Keun,Hwang, Jang-Hoe,Ji, Chul,Lee, Jae Un,Sung, Jae Hoon,Choi, Seung-Jin,Lee, Sang-Won,Seybold, Eric,Park, Sung-Chan,Cho, Kyung-Suok,Park, Chun-K The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.10

Introduction : The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. Methods : Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories : "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. Results : Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured $23.5{\pm}6.6$ degrees and $19.8{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured $66.3{\pm}7.0$ degrees and $62.3{\pm}7.9$ degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was $542.9{\pm}296.6N$. There was no statistically significant difference between the pull-out force for unicortical($519.9{\pm}286.9N$) and bicortical($565.2{\pm}306N$) screws. There was no significant difference in pull-out strengths with respect to zone placement. Conclusion : It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accur 서 론 : 후방 경유 경추 융합을 위한 후관절 금속판 고정술은 외상성 및 퇴행성 불안정성의 치료에 효과적인 방법이다. 후관절 금속판 고정의 안정성은 여러 가지 인자에 의해 결정된다. 이중 하나가 나사못의 삽입깊이이다. 이 방법이 처음 소개될 때에는 양피질골성 삽입이 이용되었다. 외과의사의 관심은 어떻게 안전하면서 생역학적으로 강력한 고정을 얻느냐에 있다. 목 적 : 이 연구의 목적은 사체에서 단피질성과 양피질성 나사못 삽입술을 시행한 후 안전성, pull-out 강도, 방사선학적 특성을 분석하고 나사못의 삽입에 대한 교육 훈련의 수준에 따른 영향을 평가하는데 있다. 방 법 : 평균 나이 78.9세인 21구의 사체에 대하여, Magerl의 기술을 변형하여 C3-C6(n=168)까지 3.5mm AO 나사못을 양쪽 후관절에 삽입하였다. 수술중 방사선 사진영상은 사용되지 않았다. 오른 쪽(단피질성 삽입)은 14mm 나사못(11mm의 유효 길이)을 이용하고, 왼쪽은 양피질성 삽입을 시도하였다. 각 사체는 3개의 군으로 나누어 척추 수술 수련의 수준이 다른 받은 3명의 척추 외과 의사들(전임 강사, 임상 강사, 수석 레지던트)이 수술을 시행했다. 수술 후 경추를 떼어내어 나사못의 위치를 육안적으로 확인하고 방사선학적으로 안정성과 삽입 위치 (1,2,3)를 평가하였다. 척수, 후관절, 신경근과 척추 동맥에 대한 나사못의 위치를"만족할 만한","위험한", 그리고"직접적인 손상"으로 구분하였다. material testing machine을 이용하여 모든 나사못에 대해서 Pull-out 강도를 측정하였다. 결 과 : 대다수의 나사못(92.9%)은 만족할 만한 상태였다. 전예에서 척수에 대한 위험성은 없다. 오른 편(단피질성 : 14mm) 나사못의 98.9%는"만족할 만한"에 속했다. 그리고 왼쪽 편(양피질성)의 68.1%는"만족할 만한"에 속했다. 양피질성 나사못 군에서 5.8%의 척추 동맥에 대한 직접적인 손상이 있었고 신경근의 직접적인 손상 발생율은 17.4%였다. 반면에 단피질성 나사못 군에서는 이들에 대한 직접적인 손상은 없었다. 양피질성 나사못에서 보인"직접 손상"의 거의 대부분은 외과 의사의 경험 부족으로 발생하였다. 나사못의 안정성과 삽입 위치 사이에는 특별한 관련이 없었다. 모든 나사못의 pull-out 강도는 $542.0{\pm}296.6N$였다. 단피질성에 있어서의 pull-out 강도($519.0{\pm}289.9N$)와 양피질성($565.2{\pm}306N$) 나사못에는 아무런 통계학적으로 의미있는 차이점을 발견할 수 없었다(p>0.05). 나사못 삽입위치와 pull-out 강도 사이에는 의미있는 차이가 없었다. 결 론 : 이번 연구는 경추 후관절 나사못 고정술시 단피질성과 양피질성 나사못의 안정성과 효능을 집중적으로 알아보았다. 명백한 것은 14mm의 나사못(효과적인 길이는 11mm)이 보다 긴 양피질성 나사못 보다 손상의 위험이 훨씬 낮고 거의 동등한 pull-out강도를 갖는다는 것이다. 또한, 수술시 방사선 영상을 사용할 수 없을 때, 훈련과 축적된 경험에 의해 나사못 삽입의 정확성과 안전성이 향상될 수 있다.

악성 두개강내압 상승환자에 대한 Barbiturate치료 : Management of Patients and Effect on Outcome

박춘근,황장회,김달수,이상원,김문찬,강준기,송진언 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.3

In spite of high-dose steroid, hyperventilation, hyperosmolar agents, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (ICP) exceeded 25㎜Hg for 2 hours or more. occurred in 8 patients. Persistent elevated ICP occurred in 4 patient with acute subdural hematoma and brain contusion, in 2 patients with aneurysm and brain infarction, in 1 patient with hypertensive intracerebral hematoma, and in 1 patient with meningioma. All of these patients received intravenous barbiturate to control the ICP. The initial thiopental loading dose(10㎎/㎏) effectively reduced the ICP in 5 patients (62.5%). In those patients responding to the initial loading dose, four have survived, and one died due to pulmonary comlication. None of three nonresponders to barbiturate survived. Two of the survivors have returned to a productive life, and two remain moderately disabled. The favorable outcome in this series suggests that early aggressive treatment of intracranial hypertension with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, especially in postoperative state. A broader investigation of the clinical application of barbiturates is indicated.

이차적으로 발생한 경추관 협착증에 대한 수술적 처치 경험

정후재,황장회,안명수 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.5

The surgical intervention for secondary developmental cervical spinal stenosis that results in myelopathy and radiculopathy has been modified by technical improvement to obtain more reliable enlargement of the cervical spinal canal. The authours have experienced good results with the modified open door expansive laminoplasty, so we report this article. The patients were treated by surgical intervention during the period from October 1989 to February 1991. The results obtained were as follows : 1) The average age was 54.7 years, and the sex distribution ratio of female to male was 2:8. 2) In clinical symptoms and neurological findings, all patients had painful limitation of neck motion and symptoms of both myelopathy and radiculopathy. 3) In morphologial analysis of lesions, all patients except one case had lesions over 3 levels. The lesions were spondylosis, spondylosis combined with soft disc herniation, spondylosis combined with OPLL, spondylosis combined with OPLL and soft disc herniation, OPLL and OYL in the order of frequency. 4) The operation method was as follows : after the patient was positioned in modified Concorde position, open door lamina was anchored to facet joint capsule and surrounding tissue with nylon sutures. And then the raw epidural space was covered with Lyodura by the modified Hirabayashi method. By this method, reclosure of widened spinal canal was prevented. 5) The outcomes were evaluated by JOA score difference between preoperation and post operation times. The outcome of recovery rate was 100% in five cases. There were no aggravated or unimproved cases. The results were excellent 8 cases, ood 1 case, unchanged 0 case, poor 0 case and expired 1 case.

흉요추 이행부 골절치료시 전측방진입법에 의한 기구고정 및 골융합

정후재,황장회,박용기,안명수 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.7

In the treatment of fractures of the thoracolumbar junction area, surgical intervention was performed when posterior part of veretbral body, posterior structure supporting ligaments were involved and body compression more than 40%. Number of cases satisfying above criteria were seven between Aug. 1990 and Jun. 1991. Age distribution ranged from 15 to 57 years. Sex ratio was 4 : 3(F : M). Four patients presented with nerve root sign, one patient with cauda equina signs, and two patients were normal neurologically. In all cases, spinal canal decompression, internal instrument fixation, and bone fusion with iliac bone were performed via anterolateral approach. After surgical treatment, neurological deficits disappeared and kyphotic angle returned to normal range of thoracolumbar junction area in all cases. Percentage of body compression was improved from preop. 55% to postop. 21% in average. According to above results, we concluded that anterior instrumental fixation combined with bone fusion using iliac bone was supperior to posterior approach in providing biomechanical stability and decompression of protruding ventral bone fragments.