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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.
뇌종양과 유사한 혈전형성된 거대 후교통동맥류 수술적 치험 1예 : A Case Report
박춘근,김문찬,박춘근,김달수,강준기,송진언 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3
A giant intracranial aneurysm(GIA) is an aneurysm greater than 2.5㎝ in size. GIA may simulate brain tumor on computed tomography scans. We report a case of giant thrombosed posterior communicationg artery aneurysm simulating brain tumor. To minimize brain retraction and achieve excellent exposure in the shortest possible distance during the operation, we used a new surgical technique, an orbitozygomatic infratemporal approach, with good results.
박춘근,지철,황장회,권성오,성재훈,최승진,이상원,박성찬,조경석,박춘근,강준기,Park, Choon Keun,Ji, Chul,Hwang, Jang Hoe,Kwun, Sung Oh,Sung, Jae Hoon,Choi, Seung Jin,Lee, Sang Won,Park, Sung Chan,Cho, Kyeung Suok,Park, Chun Kun,Yuan, Ha The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3
Polymethylmethacrylate(PMMA)는 척추 전적출술후에 척추를 재건하기 위해 사용되지만 액체 형태의 PMMA가 응고하면서 발생되는 열은 척수 신경의 열 손상 가능성을 가지고 있다. 이 연구의 목적은 이미 응고된 PMMA sheet가 척수 신경을 보호하는 방어 벽으로서의 열 차단 역할을 할 수 있는지 또한 열손상으로부터 신경을 보호하기 위해 필요한 방어벽의 최소한의 두께를 탐구하는 데 있다. 실험실에서 제 12번째 흉추체 전 적출후의 상태와 동일한 크기와 모양의 정육면체의 용기를 제작하였다. 60ml의 액체형 PMMA를 용기 안에 주입하여 응고하는 PMMA중심부와 세 가지 다른 두께의(제 1 군 : 0mm, 제 2 군 : 5mm, 제 3 군 : 8mm) 이미 응고된 PMMA sheet의 하부(척수의 전면을 의미)에서 온도를 측정하였다. 또한 이 결과에 대한 위의 세 가지 군에 대해 열역학적 분석도 시행하였다. 응고하는 PMMA 덩이의 중심부에서의 온도는 18회의 실험 동안 매우 일정하여($106.8{\pm}3.9^{\circ}C$)이 실험 모델의 재현성을 보여주고 있었다. 방어 벽이 없는 군(제 1 군)에서 척수 신경 전면의 최고 온도가 $60.3^{\circ}C$이었으나 5mm군 (제 2 군)과 8mm군(제 3 군)에서는 각각 $47.3^{\circ}C$와 $43.3^{\circ}C$로 이미 응고된 PMMA는 통계적으로 유의한(p<0.00005) 온도 차단 효과를 보였다. 최고 온도에 도달하기까지의 계산된 시간은 실제 실험치 보다 35%이내의 오차를 보였으나 최고 온도에 대한 열역학적인 계산치는 실제 실험에서 나타난 수치의 1%이내의 오차를 보였다. 이상의 열역학적인 자료를 토대로 볼 때, PMMA를 이용한 척추의 재건술에서 PMMA 방어벽은 척수의 열손상을 방지하는 효과가 있으며, 이 실험에서 가정한 척수의 열손상 역치인 $39^{\circ}C$이하로 척수 온도를 유지하기 위해 필요한 PMMA방어벽의 두께는 10mm정도로 계산되었다. PMMA 방어벽의 임상 적용에 대해서는 추가적인 임상 실험이 필요하다고 사료된다. Objective : Polymethylmethacrylate(PMMA) is often used to reconstruct the spine after total corpectomy, but the exothermic curing of liquid PMMA poses a risk of thermal injury to the spinal cord. The purposes of this study are to analyze the heat blocking effect of pre-polymerized PMMA sheet in the corpectomy model and to establish the minimal thickness of PMMA sheet to protect the spinal cord from the thermal injury during PMMA cementation of vertebral body. Materials & Methods : An experimental fixture was fabricated with dimensions similar to those of a T12 corpectomy defect. Sixty milliliters of liquid PMMA were poured into the fixture, and temperature recordings were obtained at the center of the curing PMMA mass and on the undersurface(representing the spinal cord surface) of a prepolymerized PMMA sheet of variable thickness(group 1 : 0mm, group 2 : 5mm, or group 3 : 8mm). Six replicates were tested for each barrier thickness group. Results : Consistent temperatures($106.8{\pm}3.9^{\circ}C$) at center of the curing PMMA mass in eighteen experiments confirmed the reproducibility of the experimental fixture. Peak temperatures on the spinal cord surface were $47.3^{\circ}C$ in group 2, and $43.3^{\circ}C$ in group 3, compared with $60.0^{\circ}C$ in group 1(p<0.00005). So pre-polymerized PMMA provided statistically significant protection from heat transfer. The difference of peak temperature between theoretical and experimental value was less than 1%, while the predicted time was within 35% of experimental values. The data from the theoretical model indicate that a 10mm barrier of PMMA should protect the spinal cord from temperatures greater than $39^{\circ}C$(the threshold for thermal injury in the spinal cord). Conclusion : These results suggest that pre-polymerized PMMA sheet of 10mm thickness may protect the spinal cord from the thermal injury during PMMA reconstruction of vertebral body.
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.
박춘근,박춘근,조경석,허필우,이일우,강준기 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10
Although anterior cervical plates are thought to be good tools. their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods. it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore the authors reviewed 80 patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion. thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion. whereas patients undergoing plate placement needed only semi-rigid philadelphia braces for 4 to 8 weeks postoperatively. Two patients(8%) showed graft settling and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations. and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.
폴리메틸메타크리레이트를 사용한 경피적 척추성형술의 골다공증 척추체 압박골절에 대한 치료효과 : 예비보고
박춘근,이관성,최영근,류경식,박춘근,조경석,강준기,Park, Chun Kun,Lee, Kwan Sung,Choi, Yung Gun,Ryu, Kyung Sig,Park, Choon Keun,Cho, Kyung Suck,Kang, Joon Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3
Objectives : To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report preliminary results of its use. Methods : The technique was used over a 8-month period in 9 patients with 10 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebrae with a Jamshidi needle via a transpedicular approach followed by injection of polymethylmethacrylate(PMMA) into the vertebral body. Results : The procedure was technically successful in all patients, with an average injection amount of 5.9 cc per vertebral body. One patient complained of flank pain postoperatively in spite of improvement in back pain caused by the fractured vertebra. Remaining eight patients reported significant pain relief early after treatment. The patients were followed up for 3 to 15 months(average 7.2 months) and demonstrated no recurrence of pain or aggravation of deformity. Conclusion : Vertebroplasty appears to be a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients. However, it needs to have more extensive prospective clinical study to confirm its definitive role in the management of this condition.
朴春根,全哲昊,徐海成 동아대학교 공과대학 부설 한국자원개발연구소 1983 硏究報告 Vol.7 No.2
A numeical and experimental study has been performed on heat transfer in square duct. The effects of distant P between dry solides and Reynolds number were studied numerically by Finite Element Method(F.E.M.) The experiment were studied according to F.E.M. analysis by Universal Digital Measuring system. The results of F.E.M. analysis and experimental are as follows. 1) Comparison between mumerical and experimental results showed good agreement. 2) Heat transfer increases according to decrease of the P/D ratio and increase of H/L ratio too.
수종 한약재 추출물의 Staphylococcus aureus에 대한 항균활성
박춘근,방경환,이승은,차문석,성정숙,박희운,성낙술 한국약용작물학회 2001 한국약용작물학회지 Vol.9 No.4
수종의 한약계를 70% 메탄올로 추출하여 식중독 세균인 Staphylococcus aureus에 대한 항균활성으로 생균수의 측정, 생육저해환의 측정, 최소저해농도와 최소사멸농도를 조사한 결과 이들 추출물의 Staphylococcus aureus에 대한 항균활성의 크기는 Rubus coreanus 〉 Sanguisorba officinalis 〉 Eriobotrya japonica 〉 Prunus mume 〉 Crataegus pinnatifida로 나타났다. 생육저해환은 복분자가 16.5 mm, 지유 14.3 mm, 오매 14.0 mm, 산사 12.7 mm로 측정되었다. MIC는 지유가 5mg / ml로 가장 낮았으며, MBC는 복분자가 10mg / ml로 나타났다. 실험에 사용된 한약재 추출물중 복분자, 비파엽, 산사, 오매, 지유는 Staphylococcus aureus에 대해서 강한 항균활성을 나타내었다. 따라서 이들 추출물을 이용한 천연보존료를 개발하여 식품에 적용한다면 그 기대효과가 상당히 클 것으로 생각된다. Medicinal plant extracts including Rubus coreanus, Sanguisorba officinalis, Eriobotrya japonica, Prunus mume, Crataegus pinnatifida, Rosa leavaigate Prunus persica, Prunus japonica var. nakaii and Spiraea blumei were prepared for the test of antibacterial activity. Tryptic soy broth (TSB) containing 0~10mg/ml of medicinal plant extracts was inoculated with 106 cells/ml of Staphylococcus aureus and incubated at 35℃ for 24 hours. The plate counting method and clear zone test were used to test inhibitory effect of the extracts. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) was derived from the survival curves of S. aureus. The order of antibacterial activities of medicinal plant extracts on the S. aureus was Rubus coreanus 〉 Sanguisorba officinalis 〉 Eriobotrya japonica 〉 Prunus mume 〉 Crataegus pinnatfida. Minimum inhibitory concentration of Sanguisorba ofEcmalis on the Staphylococcus aureus was 2.5mg/ml and minimum bactericidal concentration of Rubus coreanus was 1.0%. Inhibition zone of Rubus coreanus, Sanguisorba officinalis, Eriobotrya japonica, Prunus mume, and Crataegus pinnatifida was 16.5mm, 14.3mm 11.0mm, 14.0mm and 12.7mm, respectively. The morphology of S. aureus cells treated with medicinal plant extracts showed damage of cell wall and cytoplasmic membrane. Severely damaged cells of S. aureus lost electron dense material and cytoplasm. This result suggests that medicinal plant extracts can be used as an effective natural antibacterial agent in food.
요추 분리증에서 축추경 나사와 Universal Hooks을 이용한 협부 결손 직접 재건술
박춘근,류경식 대한신경외과학회 2002 Journal of Korean neurosurgical society Vol.32 No.3
Objective:The authors introduce a technique of direct repair of pars defects in symptomatic lumbar spondylolysis using pedicle screws and universal hooks. Methods:From March 2001 to September 2001, six patients with symptomatic lumbar spondylolysis and positive pars injection test underwent this procedure. Patients with lumbar instability and discogenic pain were excluded. After posterior midline incision, clearing of fibrous, cartilaginous and sclerotic tissues in and around the defects of pars was done until healthy bone was exposed. Strips of cancellous bone were taken from adjacent laminae and packed into the defects of pars. After insertion of the pedicle screws, universal hooks were placed in the lower margin of the lamina of the involved vertebra. With gentle compression between the head of screw and universal hook, the nut was fixed. Same procedures were done on the contralateral side. Results:Postoperatively, all six patients experienced clinical improvement and there was no complication related with operation. Conclusion:This new technique is considered useful for direct repair of the defects in symptomatic lumbar spondylolysis without significant injury in the normal structures. Key words:Lumbar spondylolysis;Pars interarticularis;Direct repair;Pedicular screw;Universal hook.