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만성요통의 치료에서 중재적인 치료가 보존적 치료보다 우세한가?: 긍정적인 입장에서
장상범 대한임상신경생리학회 2010 Annals of Clinical Neurophysiology Vol.12 No.1
The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed,and some of our cases who showed favorable results by interventional therapy will be presented.
장상범,Jang, Sang-Beom 한국정보통신집흥협회 1997 정보화사회 Vol.113 No.-
2000년 문제란 현재 컴퓨터에서 사용하고 있는 년도표기를 1997년 대신 뒤의 두자리 97년으로 사용함으로써 2000년을 00년으로 표기하게 되어 결국 1900년으로 인식함으로써 연산처리는 물론 정보의 혼란상태를 초래하게 되는 것을 말한다.
요추 추간판 절제술 후 발생한 화농성 척추염에 대한 Chuinard & Peterson 골 이식술을 이용한 전방 유합술 및 경피적 후관절 나사못 고정술
장상범,이상호,이승철,신송우,김원중 대한척추신경외과학회 2004 Neurospine Vol.1 No.1
Objective: To describe the surgical techniques and the preliminary results of anterior fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for pyogenic spondylitis following lumbar discectomy. Methods: From April to October 2003, five consecutive patients underwent anterior lumbar interbody fusion with Chuinard & Peterson bone graft and posterior percutaneous facet screw fixation for the treatment of pyogenic spondylitis that developed after primary lumbar disc surgery. There were three males and two females. The mean age was 49.8 years(range, 28-75 years). Three patients had persistent inflammation with neurologic deterioration and two had severe back pain despite of less invasive interventions. The mean interval from the primary operation to fusion was 3.3 months(range, 1.5~7 months). All patients were allowed to ambulate immediate postoperatively with a lumbar orthosis, which was kept for three months. Intravenous and oral antibiotics were continued until hematologic profiles normalized. All patients were followed up clinically and radiologically. Results: The mean operating time, blood loss, and post-operative hospital stay were 210 mins, 890 ml, and 27 days, respectively. Four patients showed a solid fusion at 3 monthes and one patient showed fusion at 4 monthes postoperatively. M patients showed remission of infection and significant clinical improvement of back pain. Conclusions: Anterior fusion using Chuinard & Peterson bone graft and posterior facet screw fixation may be employed for postoperative pyogenic spondylitis without prolonged cast immobilization or risk of persistent infection caused by instrumentation.
白鏞舜,張祥範,이진무 中央醫學社 1963 中央醫學 Vol.5 No.3
A case of partent urachus is presented with its review of literatures. It is the second case reported in Korea, the first case reported by Yonsei University. Medical School in June, 1960. It was associated with other congenital anomalies such as agenesis of gher left kidney, ureter and trigon of the bladder, and tuberculous infection in the urachus. Embryologically, it is considered that the urachus is probably originated from the cloaca rather than allantois.
비스테로이드성 소염진통제 β -Cyclodextrin-Piroxicam의 유효성 및 안전성에 관한 비교연구 : Double Blind Study
석세일,이상훈,김상수,장상범 中央醫學社 1995 中央醫學 Vol.60 No.2
The authors have conducted a clinical study on the safety and efficacy with newly developed β-Cyclodextrin-Piroxicam(Brexine®) in 60 cases of the patients of osteoarthritis and rheumatoid arthritis during six months from June 1994 to November 1994. The study was a randomized controlled study of 19 β-Cyclodextrin-Piroxicam versus Piroxicam(Dispersible tablet) assessing the clinical efficacy and side effects in 30 patients receiving daily 20 mg of β -Cyclodextrin-Piroxicam and in 30 patients receiving daily 20 mg of Piroxicam(Dispersible tablet). Total period of administration was eight weeks. Therapeutic efficacy and tolerability after 4, 8 weeks were evaluated by themselves and doctors. The average age of patients was 55.8 years and 13 cases were men and 47 cases were women. The sites of pain were knee in 28 cases, low back in 27 cases, neck in 5 cases, hand and wrist in 5 cases and others in 4 cases. The results were as follows ; 1. Most patients showed significant improvements in pain scale, morning stiffness and tenderness in both the β-Cyclodextrin-Piroxicam and the Piroxicam group. 2. There were four cases of gastrointestinal intolerance in the Piroxicam group and two in the β-Cyclodextrin-Piroxicam group. 3. The efficacy of Piroxicam at 8 weeks was 70.0 % and tolerance was 86.7 % and the efficacy of β-Cyclodextrin-Piroxicam was 83.3 % and tolerance was 93.3 %. In conclusion, β-Cvclodextrin-Piroxicam, used in the treatment of osteoarthritis and rheumatoid arthritis, appears to be a effective and well tolerated drug compared to Piroxicam.