문제성 쇄골골절의 치료 : 특히 관혈적 정복에 대하여

안면환,인주철 최신의학사 1986 最新醫學 Vol.29 No.8

청년기

안면환,인주철 대한스포츠의학회 1988 대한스포츠의학회지 Vol.6 No.2

요추부에 발생한 경막외 유잉육종 - 증례 보고 -

안면환,신덕섭,정광암,하정옥,Ahn, Myun-Hwan,Shin, Duk-Seop,Jung, Kwang-Am,Hah, Jeong-Ok 대한근골격종양학회 1999 대한골관절종양학회지 Vol.5 No.3

Ewing's sarcoma is an uncommon malignant neoplasm of the long bone and it has a poor prognosis due to its early metastasis and aggressive local spread. It is mostly found before the age of 30 and it is rare in extraskeletal sites. Extraskeletal Ewing's sarcoma has been reported to occur in various sites including the larynx, scalp, nasal fossa, neck, chest wall, lung, pelvis, perineum, arm, finger, leg and toe, but it is extremely rare as a primary epidural tumor of the spine. We experienced a case of extraosseous epidural Ewing's sarcoma arising in the lumbar spinal canal at L3-L5 level in a 9-year-old boy. Following total laminectomy from L3 to L5 with a lumbar vertebrae and mass excision, he received chemotherapy with complete remission.

유한 요소 해석법을 이용한 척추경 나사못 삽입 상태가 고정력에 미치는 영향에 대한 연구

안면환,안창수,최용석,서재성,이춘열,정일섭 대한정형외과학회 2002 대한정형외과학회지 Vol.37 No.1

Purpose : The structural performance of a fixation system was investigated in the case of screw insertion into the pedicular canal with or without its threads fastened in the cortex and in the broken pedicle. Materials and Methods : The symmetric geometric model was used for the pull-out test, and the simplified 3-dimensional model at 3 level, namely, the 3rd, 4th and 5th lumbar vertebrae, was used for the axial compressive loading test. Results : According to the result of the axial-loading test, bending moments and Von-Mises stresses were increased at the junction between the head and the 2nd and 3rd pitches of the lumbar pedicle screw and at the center of 4th lumbar vertebral body, in the models of intact, posterior elements removed and unstable fractured spines. As the results of flexibility, there is no difference in intra-cortical insertion compared to intra-medullary pedicle insertion in the intact spine model. However, flexibility of the laminectomy model was 8% better that of the intra-cortical insertion, and the unstable fracture model 2% better. Conclusion : There is no difference in the flexibility of intra-cortical and intra-medullary pedicle screw insertion. The stability of the posterior structure is more important than anterior pedicle screw fixation. 목 적 : 척추경 나사못의 삽입 상태에 따른 강성도 분석을 위한 유한요소모델을 개발하여, 나사못의 척추경의 피질골내 삽입 혹은 척추경의 파손 등의 삽입 상태가 나사못의 안정성에 미치는 영향을 분석하여 합당한 흉추부 나사못의 삽입 방법을 확보하고자 하였다. 대상 및 방법 : 나사못의 뽑힘력에 대한 해석을 위해서는 기하학적 대칭 유한요소해석 모델을 개발하여 분석하였고, 압축하중에 대한 해석을 위해서는 2척추단위의 단순 3차원 유한요소모델을 개발하여 분석하였다. 결 과 : 정상 척추, 후방 구조물의 완전 제거 및 불안정성 골절 모델에서의 각 단면에 대한 굽힘 모멘트 및 von Mises 응력을 해석한 결과, 제 2 및 3 요추에서는 모멘트 및 von Mises 응력이 나사못 두부와 나사산이 접합하는 부위에, 제 4 요추에서는 나사의 추체부내의 중심부에 모멘트가 컸고, 유연도를 확인한 결과, 척추경 골수강내 삽입시와 비교시 정상 척추 모델에서는 피질골내 삽입여부가 유연도에는 큰 영향이 없었고, 후방 구조물의 완전 제거된 모델에서는 약 8% 증가하였고, 불안정성 골절 모델에서는 약 2% 증가하여, 후방 구조물의 완전 제거시에 유연도가 증가하였다.

A Portable Electromagnetic Induction Heating Device for Point-of-Care Diagnostics

안면환,백승기,민준홍,박정환 한국바이오칩학회 2016 BioChip Journal Vol.10 No.3

This paper introduces a portable magnetic field generator for producing wireless induction heating, which has recently been introduced as one of the major thermal techniques in the point-of-care (POC) diagnostic method. To produce induction heating of thin metal structures in a microcentrifuge tube at any time and place, a portable magnetic field generating device was designed and fabricated using the fullbridge FET drive circuit based on a metal-oxide-semiconductor field-effect transistor (MOSFET) and pulse width modulation (PWM). A frequency of 312 kHz was set for effectively heating the micro-scale element, and a high-frequency magnetic field was produced by using a low-power device based on the full-bridge series resonance. Induction heating of two types of heating elements in a microcentrifuge tube was conducted using the new device, and thermal characteristics of induction heating were observed. The device induced eddy currents in both twisted and straight copper elements in the microtube; heating rates were approximately 6.5 J/sec and 3.8 J/sec, respectively. Output voltage of 160 W and magnetic intensity of 80.3 μT were generated by the working coil. This portable magnetic field generator weighs 450 g without a battery and consumes 3600 mAh of power. 70% of Salmonella cells in a concentration of 107 cells/mL was lysed for 15 sec of induction heating with a portable device. The authors conclude that a portable, low-power magnetic field generator can effectively induce heat in a micro-scale heating element, which provides simple and rapid thermal treatment at any time and place.

부갑상선 이식후 골구성세포들의 흡수기능에 관한 세포화학적 연구

안면환,김익동,손윤경,채종민 慶北大學校 醫科大學 1992 慶北醫大誌 Vol.33 No.2

부갑상선 호르몬에 의한 골흡수에 있어서 골 구성세포들이 골기질을 흡수하는 기전을 알아보고자 Sprague-Dawley계 흰쥐의 경골에 동종의 부갑상선 조직을 이식한 후 1일, 2일 및 4일에 soluble protein tracer로서 horseradish peroxidase를 정맥주사한 다음 경골을 절취하여 주사전자현미경 및 조직화학적 반응에 의한 투과전자현미경적 관찰을 하였다. 그 결과를 요약하면 정맥으로 투여된 peroxidase는 osteoid층, osteocyte lacunae 및 canaliculi내에 침투하였으나 mineralized bono내에는 들어가지 않았다. 부갑상선을 이식하지않은 대조군의 골 구성세포들은 아주 적은양의 peroxidase만 세포표면에서 흡수하고 있었다. 부갑상선 조직을 이식한 실험군의 골 구성세포들은 활성화가 일어났으며 파골세포들이 증가하였고 골흡수가 일어났다. 골아세포 및 파골세포들에서 세포내로 흡입한 많은peroxidase를 관찰할 수가 있었다. 세포내로 흡입된 peroxidase는 pinocytotic vesicle, tubular structure 또는 vacuoles내에 존재하였다. 그러나 골세포들에서는 peroxidase흡수의 증가가 인정되지 않았다. 이상의 성적으로 보아 부갑상선 호르몬의 영향하에서 골아세포 및 파골세포들은 세포외 단백물질을 흡수하여 세포내 소화할 수 있는 능력이 인정되어 골기질의 유기성분을 분해한 뒤 부분적으로 세포내로 흡입하여 세포내 소화를 시킬 것으로 추측된다. An electron microscopic cytochemical study was carried out to investigate the precise mechanisms for absorption of organic bone matrix components during bone resorption induced by parathyroid hormone. Transplantation of the parathyroid tissue was done into medullary cavity of the tibia in the rats, which were examined 1, 2, and 4 days after the operation, employing horseradish peroxidase as a soluble protein tracer. The tibial bone were extirpated and examined by scanning and transmission electron microscopy with cytochemical procedures. The results obtained were summarized as follows Intravenously-injected peroxidase was filled the osteoid layer and penetrated into the osteocyte lacunae and canaliculi, but did not enter the mineralized bone matrix. Whereas bone cells of resting state rarely took up exogenous peroxidase, activated osteoblasts and osteoclasts treated with parathyroid hormone actively endocytosed peroxidase in pinocytotic coated vesicles, tubular structures and vacuoles. They also formed endocytotic vacuoles containing peroxidase in the Golgi area. The osteocytes treated with parathyroid hormone did not changed endocytotic activity. The results strongly suggest that both osteoblasts and osteoclasts be able to degrade and resorb bone matrix organic components during bone resorption induced by parathyroid hormone.

척추통이 환자의 생활에 미치는 영향에 대한 군집분석 : 특히 척추골절 치유후의 상태에 대하여 Especially After Treatment of the Spine Fracture

안면환,이상재 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2

A questionnaire study of 24 patients with back pain, neutologic deficit and other problems due to spine fractures, as well as 27 patients with radicular pain and 15 patients with low back pain and referred pain owing to various pathologies such as spinal stenosis. herniated disc and others was taken. In order to assess the impact of spinal pain on the patients lives after union of the spine fracture, the Dallas Pain Questionnaire(DPQ) and the pain rating scale of Rolando and Morris were used. Using a cluster analysis and factor analysis of the SPSS package, Patients were classified into 5 groups and the characteristics were analyzed. 5 of 24 fracture patients stated that their back were as good as before the trauma without any pain 11 patients had a mild degree of pain and 8 patients a moderate degree of pain. 5 fracture patients were retired, 2 patients changed their work and 17 patients could return to their work. The intensity of the spinal pain was not related to work status statistically Group I was cahracterized by a moderate degree of impact on their common life and social life including vocational activities as well as on the emotion, such as depression, interpersonal ralationship and others, as in the patients with a moderate degree of radicular pain deu to herni- ated disc. 8 patients with spine fractures belonged to this group. One was retired and 2 patients changed their work. This group displayed poor result of treatment. Group 2 was characterized by the most severe impact on their emotions with severe physical impairment on their common lives and social activities. There were 4 fracture patients. 2 patients were retired due to neurologic deficit and 1 patient was associated with osteoporosis This group displyed failure of treatment. Group 3 was characterized by the least impact on their emotions and a severe impact on their emotions and a severe impact on physical activities. There was one osteoporosis related fracture. Group 4 was characterized by the least impact on emotions as well as on their physical activi- ties Patients in this group could return to pre-trauma activity level. 11 patients with spine frac- ture were included in this group One was retired due to neurologic deficit. This group under- went successful treatment. In group 5, characterized by a relatively severe impact on their emotion and physical activi- ties, there was no fracture case. Retirement was more prevalent in group 2 and the return-to-work rate was more prevalent in group 4. In conclusion, assessment of impact of the spinal pain on patients' lives using the DPQ was more revealing. Classification of patients into several charateristic groups, taking the various patients' situa- tion was thought to be fundamental for evaluation of the patient's impairments.

만성요통의 감별과 치료

안면환 대한가정의학회 1994 Korean Journal of Family Medicine Vol.15 No.1

ProSet 자기공명영상의 추간공외 추간판 탈출증 진단에서 유용성

안면환,김의식,김기범 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.1

©Copyright 2013 Korean Society of Spine Surgery www.krspine.org 28Usefulness of the ProSet MRI for Diagnosis of the Extraforaminal Disc Herniation Myun-Whan Ahn, M.D., Ui-Sik Kim, M.D., Gi-Beom Kim, M.D. Department of Orthopaedic Surgery, Yeungnam University Hospital, Daegu, South Korea Study Design: This is a retrospective study. Objectives: The purpose of this study is to confirm the clinical usefulness of utilizing ProSet imaging for checking the nerve root compression and swelling in extraforaminal disc herniation. Summury of Literature Review: Diagnosing extraforaminal disc herniations can be neglected with using a conventional MRI. Materials and Methods: A retrospective analysis was performed on 25 patients, who underwent both conventional & Principles of the selective excitation technique (ProSet) MR imaging for the evaluation of extraforaminal disc herniation, from April 2008 to October 2010. Radiographic analysis was based on the notion that the degree of nerve root compression and swelling was decided by Pfirrmann’s classification. Results: Severe compression in the ProSet 3D rendering image was observed in 21 subjects, as compared with 8 subjects in the conventional axial image. Especially, nothing was ever detected in the conventional sagittal image. Severe compression in the ProSet 3D rendering image was observed in 4 subjects, while their nerve root compression was not clear in the conventional axial image. Severe compression and severe swelling in the ProSet 3D & coronal image was observed in 15 subjects, while their nerve root compression was none or not clear in the conventional sagittal image. The swelling degree of the ProSet coronal image turned out bigger than the swelling degree of conventional axial image, and the signal intensity change was also obvious. Conclusions: ProSet imaging is regarded useful to investigate the symptom triggering nerves, because ProSet image not only observes better nerve root compression, but also identifies the swelling degree more easily than that of the conventional magnetic resonance imaging (MRI). 연구 계획: 후향적 연구목적: 추간공외 추간판 탈출증에서 신경근의 압박 및 부종의 정도를 확인하여 ProSet 자기공명영상의 임상적 유용성을 확인하고자 하였다. 선행문헌의 요약: 추간판 탈출증의 진단에 있어서 자기공명영상검사가 가장 유용하다는 사실에는 이견이 없으나, 고식적 축 방향 혹은 시상면의 자기공명영상을 이용한 추간공 및 추간공외 추간판 탈출증의 진단은 어려운 것으로 알려져 있다. 최근 이를 극복하기 위하여 관상면 혹은 사위의 고식적 자기공명영상의 이용하여 그 정확성을 증가시키고자 하고 있다. 최근 근골격계의 연부조직 영상을 개선하기 위한 ProSet(Principles of the selective excitation technique: water selective excitation) 프로토콜이 개발되어 초기 임상 도입 단계에 있다. 대상 및 방법: 2008년 4월부터 2010년 10월까지 요부 추간공외 탈출증 환자로 고식적 자기공명영상검사 및 ProSet 영상 자료 획득이 가능하였던 25예를 연구대상으로 하였으며, 방사선학적 분석은 고식적 자기공명영상과 ProSet 영상을 비교 분석하였다. 신경의 압박의 정도는 Pfirrmann씨 분류에 의거하여 판정하였고, 신경근의 종창의 정도는 4등급으로 분류하였다. 결과: 고식적 축방향 자기공명 영상 분석에서는 8예에서 신경근의 심한 압박을 확인할 수 있었으나, ProSet 3차원 영상에서는 21예에서 심한 압박이 관찰되었다. 특히, 시상면 영상분석에서는 12예에서 신경근의 접촉조차 확인할 수 없었다. 고식적 축방향의 자기공명영상에서 신경근 압박이 확실하지않았던 4예에서 ProSet 3차원 영상 재구성에서 심한 압박이 관찰되었다. 고식적 시상면상의 자기공명영상에서 신경근의 압박이 없거나 확실하지 않았던 15예에서 ProSet 3차원 영상 및 관상면 영상에서 심한 신경근의 압박과 신경근의 종창이 확인되었다. ProSet 관상면 영상에서 신경근 부종의 정도가 고식적 축방향 영상의 부종보다 큰 경향으로 확인되었으며, 부종에 의한 신호 강도의 변화도 저명하였다. 결론: ProSet 자기공명영상은 고식적인 자기공명영상에 비해 추간공외 추간판 탈출증에 의한 신경근의 압박을 관찰하는데 우수할 뿐만 아니라 이에 의한 부종의 정도를 보다 쉽게 확인할 수 있기 때문에 증상 유발의 신경을 탐색하는데 매우 도움이 될 것으로 기대된다. 약칭 제목: 추간판 탈출증에서 Proset 자기공명영상

요추의 압축 거동 해석 -단순 수직 하중과 Follower Load에 대하여-

안면환,신규식,이장우,정일섭,이춘열 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.2