Analysis of Clinical Features of Hip Fracture Patients with or without Prior Osteoporotic Spinal Compression Fractures

김강득,김영진,채수욱,최덕화 대한골대사학회 2013 대한골대사학회지 Vol.20 No.1

Background: To analyze and compare the clinical characteristics including bone mineral density (BMD) in a group who had operation of hip fracture with or without prior osteo-porotic spinal compression fractures. Methods: Two hundred forty patients who had undergone operation of hip fractures were evaluated, 127 patients who had with prior osteoporotic spinal compression fractures were in group I, and 113 patients without pri-or spinal fractures were in group II. In each group, we measured age, gender, body mass index (BMI, kg/m2), BMD (mg/cm3), type of hip fractures, concomitant diseases, presence of secondary hip fracture and history of percutaneous vertebroplasty. Results: The mean age of group I was 79.4 years (male/female: 28/99) and that of group II was 77.6 years (male/female: 37/76). The mean BMI of group I was 21.3 kg/m2 and that in group II was 22.0 kg/m2. The mean BMD and T-score of group I were 41.1 mg/cm3 and -4.45 and those in group II were 51.0 mg/cm3 and -4.17 (P<0.05). The numbers of patients of neck and intertrochanter fracture of group I were 31 and 96 patients and those in group II were 61and 52 patients. Sixty in group I and 45 in group II patients had concomitant diseases. Thirteen patients had undergone percutaneous vertebroplasty and 18 patients (7.5%)had second hip fractures. Conclusions: The hip fracture patients who had with prior os-teoporotic spinal compression fractures had lower BMD compared to the hip fracture patients without previous spinal compression fractures.

다발성 소아 경추 척추분리증: 증례 보고

김강득,김혜원,장성조,오정택 대한영상의학회 2006 대한영상의학회지 Vol.55 No.6

Cervical spondylolysis is a rare condition, and less than 100 cases have been reported in the world literature. Cervical spondylolysis is defined as a well corticated defect in the posterior element of a cervical vertebra. Although the etiology of cervical spondylolysis is unknown, its association with dysplastic changes and spina bifida occulta suggest that the lesion is congenital. Here, we describe the radiographs and CT images of cervical spondylolysis involving four levels in a 9 year old boy. 경추 척추분리증은 전 세계적으로 100예 이하로 보고된 드문 질환으로 피질화가 잘된 결손이 척추 후방의 신경궁에 있는 경우를 말한다. 원인은 아직 잘 모르나 동반된 이형성증이나 척추 이분증 등이 있어 선천성으로 알려져 있다. 저자들은 9세 소아에서 네 개의 경추에 발생한 척추분리증의 일반촬영과 CT 소견을 보고 한다.

Tc-99m-MAA 를 이용한 간세포암의 경동맥 관류스캔

김강득,손광준,민경윤,권영미,김창근,노병석,원종진 ( Gang Deuk Kim,Kwang Joon Sohn,Kyung Yoon Min,Young Mi Kwon,Chang Guhn Kim,Byung Suk Noh,Jong Jin Won ) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3

Puryose : Hepatic arterial perfusion scintigraphy with Tc 99m macroggregated albumin (HAPS) study was carried out in 16 patients with hepatocellular carcinoma(HCC) and in six patients without liver tumor to evaluate HAPS findings of hepatocellular carcinoma and usefullness of HAPS, Materials and Methods : HAPS with planar and SPECT study were performed in 22 patients after conventional hepatic or celiac arteriography. For HAPS study, 4 5 mCi of MAA mixed with 2ml of saline was injected into proper hepatic artery or its distal branches at the rate of approximately 1ml/sec. We anatysed 21 HCCs over 2cm in diameter(average diameter : 6.4cm) and 17 of 21 HCCs were over 4cm in diameter(Table 1). CT, sonography and angiography were performed within two week in all 16 patients and liver scan was performed in 12 patients. Results : Three different pattern of tumor perfusion were observed in 16 pat.ients with HCC (Table 2), 1) diffuse increased perfusion in 16 of 21(76%)(Fig. 1) 2) increased peripheral perfusion in 4 of 21(19%)(Fig. 2) 3) diffuse decreased perfusion in 1 of 21(5%) Arteriovenous shunt indicated by lung uptake of MAA were observed in 9 of 16(56% ) (Fig. 4). In contrast, angiography demonstrates arteriovenous shunt in 2 of 16(13%). There was no accumulation of radioactivity on RRC blood pool scan in all six patients with HCC examined (Fig. 1). Conclusion : HAPS is useful study in evaluation of perfusion pattern or vascularity of HCC and in detection of arteriovenous shunt.

외상성 척추 압박골절 : 자기공명영상 신호강도와 골절시기 Usefulness of MRI to Predict the Time of Fracture Onset

김강득 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

배경 : 인구의 노령화로 인한 골다공증 환자의 증가와 빈발하는 자동차 사고로 척추 압박골절은 흔한 병이 되었으며 임상적으로 급성 및 만성 골절의 감별은 많은 논란을 야기하고 있다. 자기공명영상으로 외상성 척추 압박 골절의 신호강도 변화를 통해 골절 시기를 예측할 수 있는지 알아보고자 하였다. 방법 : 척추 자기공명영상을 시행한 환자 중 양성압박골절을 보이는 환자 33명(남:여=13:20, 나이; 20-79)의 67개 척추체(흉추 17개, 요추 50개)를 대상으로 하였고 이중 12명의 환자는 1회 내지 3회 추적조사를 하였으며, 척추체의 형태 및 신호강도를 정상 척추체와 비교하여 5가지 형태로 분류하여 후향적 및 전향적으로 관찰하였다. 결과 : 자기공명영상에서 모든 골절부위는 골수 신호강도의 이상이 관찰되었으며 12주이내에 시행한 자기공명영상 37예중 35예의 골절부위에서 T1강조영상에서 저신호강도, T2강조영상에서는 불균질한 고신호강도를 보였고(type Ⅰ) 이러한 소견은 13주 이후에는 보이지 않았다. 13주 이후에 시행한 30예 모두 병변의 범위 및 추체높이 감소가 있었으며 T1 및 T2강조영상에서 저신호강도를 보이는 경우(type Ⅲ and Ⅳ)는 25예, 고신호강도를 보이는 경우(type Ⅱ)는 3예, 동등신호강도를 보이는 경우(type Ⅴ)는 2예에서 보였다. 결론 : 외상성 척추 압박골절에서 신호강도의 변화와 골절기간과는 밀접한 상관관계가 있었으며 자기공명영상의 신호강도 변화를 통해 척추압박골절의 시기를 예측할 수 있을 것으로 사료된다. Background : The vertebral compression fracture is common, and distinction between the acute and chronic vertebral compression fractures pose a common clinical problem. So we evaluated the usefulness of MRI to predict the time of fracture onset in patients with traumatic vertebral compression fractures. Materials and Methods : We retrospectively and prospectively studied MR images of 67 cases (17 thoracic, 50 lumbar spines) of vertebral compression fracture in 33 patients (13 men, 20 women; range, 20-79 years), and 12 patients underwent follow up MR imaging for 1 to 3 times following initial examination. MR images were evaluated for the signal intensity pattern and shape of the vertebral compression fracture comparing with those of normal vertebrae. Results : The signal intensity in 35 of 37 fractures less than 12 weeks was low SI pattern on Tl-weighted images and inhomogeneous high on T2WI (type Ⅰ), and type Ⅰ was not seen after 13 weeks on MR images. All 30 fractures more than 13 weeks had been decreased in the area of low signal intensity and also in height of the compressed vertebral bodies. Twenty-five cases had low signal intensities (type Ⅲ and Ⅳ), 3 cases had high signal intensities (type Ⅱ) and 2 cases had iso signal intensities (type Ⅴ) on all pulse sequences. Conclusion : There are good correlation between the signal intensity change and fracture age of traumatic vertebral compression fracture. So sequential change of signal intensity can predict the time of fracture onset of vertebral compression fracture on MRI.

피부의 평활근육종 : 1예 보고

김강득,김혜원,오정택 圓光大學校 醫科學硏究所 2003 圓光醫科學 Vol.18 No.1

16채널 다중검출 CT를 이용한 말초 폐동맥의 평가

김강득,오정택 圓光大學校 醫科學硏究所 2004 圓光醫科學 Vol.19 No.2

Medial Malleolar Insufficiency Fracture of the Ankle in an Elderly Patient with Osteoporosis

김강득,채수욱,차명수 대한골대사학회 2013 대한골대사학회지 Vol.20 No.2

Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficien-cy fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we re-port a case with a medial malleolar insufficiency fracture of the ankle in an elderly pa-tient with osteoporosis. This case shows that we should be aware of the possibility of en-countering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.

Osteoporotic Lumbar Compression Fracture in Patient with Ankylosing Spondylitis Treated with Kyphoplasty

김강득,채수욱,김영진,최덕화 대한골대사학회 2013 대한골대사학회지 Vol.20 No.1

Ankylosing spondylitis (AS) is an inflammatory disease primarily affecting the spine. Os-teoporosis can be a complication of AS and associated with low bone mineral density. As well, spinal fractures in the AS are usually unstable and may cause neurologic deficit at the mainly cervical region with low energy trauma. However, reports of lumbar com-pression fracture in AS are very rare. Thus, we report a 73-year-old male patient with os-teoporotic L3 compression fracture with AS treated with kyphoplasty which has no symptom improvement with conservative treatment. Kyphoplasty is a useful procedure option in the treatment of the lumbar compression fracture in AS.

상완골 대결절의 낭성 병변: 회전근개 파열과 나이와의 연관성

김강득,오정택 대한영상의학회 2008 대한영상의학회지 Vol.59 No.6

목적: 상완골 대결절에 생기는 낭성 병변의 위치를 알아보고 회전근개 파열과 나이와의 연관성을 알아보고자 한다. 대상과 방법: 어깨 통증으로 자기공명관절조영술을 시행하고 관절경이나 개방적 수술을 시행한 19-82세(평균 51세)의 환자 78명을 대상으로 하였다. 낭성 병변의 위치는 극상근만 부착되는 부위를 A, 극하근만 부착되는 부위를 C, 극상근과 극하근이 중첩되어 부착되는 부위를 B, 이두근구 후방에 있는 부위를 BG, 상완골 경부의 노출부에 있는 경우를 P로 나누었다. 자기공명관절조영술에서 낭성 병변의 위치와 극상근과 극하근 파열 여부를 조사하였고 카이제곱 검정과 로지스틱 회귀분석으로 분석하였다. 결과: BG 부위와 A 부위의 낭성 병변은 극상근 파열과, C 부위의 낭성 병변은 극하근 파열과, B 부위의 낭성 병변은 극상근과 극하근 파열 모두와 관계가 있었다(p < 0.05). P 부위의 낭성 병변은 회전근개 파열과 연관성이 없었다. 나이에 따라 모든 낭성 병변의 발생은 증가하였으나 통계적으로 연관성은 없었다. 결론: 극상근과 극하근 부착부위의 낭성 병변은 위치에 따라 각각의 회전근개 파열을 예측할 수 있는 유용한 소견이다. 그러나 모든 상완골 대결절의 낭성 병변은 나이와 연관성이 없었다.

견관절의 16-절편 다중검출기 CT 관절조영술: 관절순 및 회전근개 파열에 대한 정확도

김강득,이성아,김형준,김혜원,오정택,정선관 대한영상의학회 2007 대한영상의학회지 Vol.56 No.4

Purpose: We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. Materials and Methods: We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. Results: At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. Conclusion: 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US. 목적: 견관절의 관절순 및 회전근개 파열에 대한 16-절편 MDCT 관절조영술(Multidetector CT arthrography, CTA)의 진단 정확도를 알아보고자 하였다. 대상과 방법: 견관절 동통이나 불안정성으로 CTA 촬영 후 관절경을 시행한 45명의 환자를 대상으로 하였다. CTA 영상은 관절순 파열의 유무, 손상부위 및 형태와 회전근개 파열의 여부 및 정도에 관하여 분석하였다. 관절경 검사의 결과를 바탕으로 관절순 및 회전근개 파열에 대한 CTA의 민감도, 특이도, 정확도를 구하였다. 결과: 관절경 검사상 관절순 파열은 SLAP 병변(n=33)과 Bankart 병변(n=6)이 있었고 SLAP 병변은 type I 9예, type II 23예, type III 1예였다. 회전근개 파열은 31예였고 극상근 21예, 극하근 9예, 견갑하근 1예였다. type I을 제외한 24예의 SLAP 병변에 대한 CTA의 민감도는 83%, 특이도 100%, 정확도 91%였다. 모든 회전근개 파열에 대한 CTA의 민감도는 90%, 특이도 100%, 정확도 98%였고, 극상근 완전파열에 대한 민감도는 100%, 특이도 94%, 정확도 96%였으며, 극상근 부분파열에 대한 민감도는 29%, 특이도 100%, 정확도 89%였다. 결론: 16-절편 MDCT 관절조영술은 관절순 이상이나 회전근개 파열 진단에 높은 정확도를 보이며 MRI나 초음파를 대신할 수 있는 유용한 방법이라 생각한다.