흉요추 방출성 압박골절의 Z-plate를 이용한 고정술후 추적검사 결과

심병수,김근수,이정청,Shim, Byeoung-Su,Kim, Keun-Su,Lee, Jung-Chung 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.

경추 전방 유합술 이후 발생한 경추 뼈 나사의 탈출을 현수 후두경을 이용하여 제거한 1예

심병수,하민수,한경열,송용진 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.3

Anterior cervical approaches to the cervical spine have been widely and safely used in spine surgery in recent years; however, they also have posed some otorhinolaryngological complications. We present a case of suspension laryngoscope assisting in the removal of a cervical screw. The patient was a 63-years-old man who was operated on traumatic cervical herniated disc. Surgical interference included C5 corpectomy, iliac bone autograft, anterior cervical fusion at C4-C6 level using an anterior cervical plate and screws. Five years later, he presented a foreign body sensation in the neck and odynophagia. The laryngoscopic exam showed the medial wall of the right pyriform sinus protrusion and the migration of an upper screw was observed in plain films and computed tomography of the cervical spine. The suspenson laryngoscope and C-arm fluoroscope were used for the transpharyngeal screw removal. The removal of the screw in question was successful with no complications. We report this case with a review of the literature.

양측 부비동에 발생한 진균구의 임상양상

심병수,송용진,한경열,김진호,하민수,김종양 대한비과학회 2010 Journal of rhinology Vol.17 No.1

Background and Objectives:Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. Materials and Methods:We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms,nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. Result:The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. Conclusion:Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

두정엽 및 후두엽 간질에 대한 수술전략

심병수,최하영,Sim, Byung-Su,Choi, Ha-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Purpose : Resection of the epileptogenic zone in the parietal and occipital lobes may be relevant although only few studies have been reported. Methods : Eight patients with parietal epilepsy and nine patients with occipital epilepsy were included for this study. Preoperatively, all had video-EEG monitoring with extracranial electrodes, MRI, 3D-surface rendering of MRI using Allegro(ISG Technologies Inc., Toronto, Canada), and PET scans. Sixteen patients underwent invasive recording with subdural grid. Eight had parietal resection including the sensory cortex in two. Seven had partial occipital resection. Two underwent total unilateral occipital lobectomy. The extent of the resection was made based mainly on the data of invasive EEG recordings, MRI, and 3D-surface rendering of MRI, not on the intraoperative electrocorticographic findings as usually done. During resection, electrocortical stimulation was performed on the motor cortex and speech area. Results : Out of eight patients with parietal epilepsy, three had sensory aura, two had gustatory aura, and two had visual aura. Six of nine patients with occipital epilepsy had visual auras. All had complex partial seizures with lateralizing signs in 15 patients. Four had quadrantopsia. One had mild right hemiparesis. Abnormality in MRI was noticed in six out of eight parietal epilepsy and in eight out of nine occipital epilepsy. 3D-surface rendering of MRI visualized volumetric abnormality with geometric spatial relationships adjacent to the normal brain, in all of parietal and occipital epilepsy. Surface EEG recording was not reliable in localizing the epileptogenic zone in any patient. The subdural grid electrodes can be implanted on the core of the structural abnormality in 3D-reconstructed brain. Ictal onset zone was localized accurately by subdural grid EEGs in 16 patients. Motor cortex in nine and sensory speech area in two were identified by electrocortical stimulation. Histopathologic findings revealed cortical dysplasia in 10 patients ; tuberous sclerosis was combined in two, hamartoma and ganglioglioma in one each, and subpial gliosis in six. Eleven patients were seizure free at follow-up of 6 months to 37 months(mean 19.7 months) after surgery. Seizures recurred in two and were unchanged in one. Six produced transient sensory loss and one developed hemiparesis and tactile agnosia. One revealed transient apraxia. Two patients with preoperative quadrantopsia developed homonymous hemianopsia. Conclusion : This study suggests that surgical treatment was relevant in parietal and occipital epilepsies with good surgical outcome, without significant neurologic sequelae. Neuroimaging studies including conventional MRI, 3Dsurface rendering of MRI were necessary in identifying the epileptogenic zone. In particular, 3D-surface rendering of MRI was very helpful in presuming the epileptogenic zone in patients with unidentifiable lesion in the conventional MRI, in planning surgical approach to lesions, and also in making a decision of the extent of the epileptogenic zone in patients with identifiable lesion in conventional MRI. Invasive EEG recording with the subdural grid electrodes helped to confirm a core of the epileptogenic zone which was revealed in 3D-surface rendered brain.

경부 심부 농양의 초음파 유도하 흡인 및 배농

한경열,이종혁,김진호,김종양,심병수,송용진 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.4

Background and Objectives:For abscesses in the head and neck, traditional open surgical incision-and-drainage procedure may incur added morbidity and result in disfiguring scars. Therefore, a noninvasive alternative to open surgical drainage may be quite beneficial. The purpose of this study was to evaluate the efficacy of percutaneous ultrasonography-guided aspiration and drainage in the management of the selected head and neck abscesses. Subjects and Method:Retrospective review was done for 12 patients with unilocular or multilocular abscess sized 2 cm or more in the greatest in different locations and origins. All patients did not present imminent airway compromise and subsequently underwent ultrasonography guided aspiration and drainage. Results:All of the abscesses were resolved in 11 patients within 10 days. Even multilocular abscesses were resolved without open surgical drainage. One abscess in which Mycobacterium tuberculosis was isolated persisted more than 3 weeks in spite of ultrasonography guided aspiration and drainage, and resolved by antituberculosis medication of more than 10 months. Conclusion:Percutaneous ultrasonography-guided aspiration and drainage is a safe and effective procedure, for the abscesses in the head and neck without life threatening conditions.

아세트산 음독 후 발생한 후두염

한경열,송용진,고한성,김종양,김진호,심병수 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.12

Acetic acid is not uncommon suicidal material and it can cause serious laryngitis. The purpose of this study was to investigate the clinical characteristics, proper management, and clinical course of laryngitis induced by acetic acid. Subjects and Method:We analyzed the medical records of 39 patients with acetic acid ingestion from 1996 to 2006, retrospectively. Results:Flexible fiberoptic laryngoscopy showed supraglottic laryngeal edema or mucosal ulcer with narrowed airway in 15 cases (38.5%). More common reason of ingestion was suicidal attempt than accidental exposure. There was no significant correlation between severity and the amount of ingestion, or the reason of ingestion. Eight patients needed orotracheal intubation for airway management, but no emergency tracheotomy was imperative. Most laryngeal lesions were relieved by supportive care within 2 weeks. Conclusion:Acetic acid laryngitis could narrow airway, and could be resolved by supportive management. Flexible fiberoptic laryngoscopy was useful in evaluating laryngeal involvement and severity. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:1129-33)