고령의 환자군에서 대퇴골 전자간부 불안정성 골절의 치료

안철세,황득수,이상용 대한골절학회 1996 대한골절학회지 Vol.9 No.2

Intertrochanteric fractrures in elderly are a frequent problem and are becoming more common as the population of elderly people in the population increase. The treatment of unstable intertrochanteric fracture present a challenging problem. Severe comminution in elderly osteoporotic patients renders internal fixation difficult and precipitate varus malpositioning after internal fixation. We analysed 48 unstable intertrochanteric fractures in 48 elderly patient (58 to 91 yeared, mean age: 78 years) with advanced osteoporosis (grade III or more by Singh et al., and by BMD) between May, 1990 to March, 1995; Nineteen had been treated with an anatomical reduction with dynamic hip screw(DHS). In addition to DHS fixation, additional circumferential wiring was done in 7 cases, adjunctive methylmethacrylate bone cement fixation in head and neck was done 2 cases. We classified lag screw fixation alone group as DHS I, lag screw fixation and additional circumferential wire reinforcement group as DHS II . Twenty had been treated with an anatomical reduction with gamma nail. Another nine that had severe comminuted fracture had been treated with bipolar hemiarthroplasty. In DHS II and gamma nailing group, operation time was longer and amount of transfusion after postoperative period was much than DHS [ group. In DHS fixation group, lag screw fixation and additional circumferential wire reinforcement of posteromedial fracture fragment group was more favor result than lag screw fixation alone. Nonunion developed in two cases of adjunctive methylmethacrylate fixation with DHS, and malunion(external rotation) developed in two cases of DHS fixation group. We concluded that better result are obtained when posteromedial fracture fragment reduced with circumferential wiring with DHS. In addition to anatomical reduction of fragment, encouraging early postoperative ambulation also contribute to good prognosis. A number of the patients who had fear for weight bearing after 3 month postoperatively compromise ambulation an further follow up. In severely commented fracture that was not able to get stable reduction or in patient necessary for early weight bearing, hemiarthroplasty permit to early ambulation, but it also have many disadvantage.

사지에 발생한 신경 초종의 임상 분석 : 다발성 병변 2례 포함 Include 2 Cases of Multiplicity

박찬희,안철세 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

Neurilemoma is the most common tumor arising from peripheral nerves. Neurilemomas arise from a benign proliferation of Schwann cells usually as a single lesion and rarely disturb the function of involved nerve. The tumors are well encapsulated and may be easily enucleated from the parent nerve. Resection of involved nerve is seldom necessary except when small nerves are extensively involved. We reviewed our 7 experiences and found out that multiplicity is not rare (two in seven cases) and sometimes there was a symtpoms of pain, tenderness, paresthesia.

천추 척색종 : 술후 8년간 추시된 1례 보고 A Case Report of 8 Years Follow up after Partial Sacrectomy

이준규,안재성,안철세,우영길,정현태 대한척추외과학회 1996 대한척추외과학회지 Vol.3 No.2

Study design. This is a report of sacral chordoma in whom received partial sacrectomy at S3 level. We report the postoperative complication and outcome with 7 years follow up. Objective. To describe the outcome of a 72 years-old man who visited Chung-Nam National University complaining voiding and defecation difficulty. Summary of Backround Data. Chordoma is an uncommon malignant bone tumor though to derive from remnant of the embryonal notochord. Although chordomas are considered low-grade malignant lesions and are slow to metastasize, they are malignant by position, in that their proximity to spinal cord and cauda equina makes them extremely difficult to treat effectively. Methods. We performed mpartial sacrectomy at S2 level with posterior approach in 1988. In 1995, 7 years after initial operation, local recurrence was noted. The tumor was partially extirpated repeatedly. Several complications were developed after operation. At 2 months after initial operation, rectovesical fistula was developed. At that time, colostomy and cystostomy was done. At each operation in 1988 and 1995, opstoperative wound complication was noted. Wound revision was required to solve this problem. The evidence of distant mctastasis was not noted at last follow up in 1996.

대퇴골 원위부 연골 신연술 - 2례 보고 -

박찬희,이광진,안철세,정진선 대한골절학회 1995 대한골절학회지 Vol.8 No.1

Chondrodiatasis is a limb lengthening technique involving slow, controlled, symmetric epiphyseal distraction. The technique has significant advantages over other correction methods that involves osteotomies. We have used this methods with other surgical technique to lengthen limbs in 2 children with leg-length discrepancies or with angular deformities. Shonely after initial lengthening, the growth plate seemed maintain its function. But, several years later, the growth plate fused. In spite of many report that chondrodiatasis having many complications, there was no special complications in our cases. In the absence of definite proof, we decide to use this technique clinically almost during the last two years of the growth period.

요추 핵자기 공명 영상 소견에서 보이는 추체종판 인접 추체골의 변화

이준규,안재성,권순태,안철세,이원석 대한척추외과학회 1996 대한척추외과학회지 Vol.3 No.2

Study design. 254 magnetic resonance imaging of lumbar spine with degenerative disc disease and chronic low back pain were assessed on vertebral endplate signal change. Objective. This study was undertaken to retrospectively analyzed the relationship of vertebral endplate signal change in lumbar magnetic resonance imaging with low back pain, radiating pain and hypermobility of lumbar spine. Summary of Background Data. Vertebral endplate signal change may result from edema, inflammation or vascular change, but exact pathophysiology and relationshop with clinical finding was uncertain. Methods. We reviewed the 254 magnetic resonance imaging of lumbar spine. We excluded patients who had had previous lumbar disc surgery including LASER discectomy, chemonucleolysis and those with vertebral endplate lesions, such as ostemoyelitis or tumorous condition. Abnormalties on endplate were classified into type A with decreased signal intensities on T1 weighted spin echo image, and type B with increased signal intensities on vertebral endplates. Results. 31(12%) of 254 patients had focal alternations in the endplates and bone marrow adjacent to degenerative disc. Of 31 patients, Sixteen was type A, fifteen was type B. Fourteen(87%) patients in type A had low back pain, while ten(67%) patients in type B. Lateral motion views of lumbar spine showed hepermobility over 3mm in ten patients(63%) with type A, and in six patients(40%) with type B. Spondyloithesis was most common disease associated with endplate and bone marrow changes. 15 cases were spondylolisthesis, of these, 10 cases were type A, and 5 cases were type B. Conclusions. We concluded that type A is associated with segmental hypermobility and low back pain, while type B were more common in patients with stable degenerative disc disease.

요추 추간판 탈출증의 핵자기 공명 영상 : Diagnostic accuracy on the high Tesla MRI

이준규,권순태,고광표,안철세 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.2

Magnetic resonance imaging is the newest technological investigation for spinal pathology, especially offers several advantages over methods of evaluating causes of low back pain and sciatica. We reviewed seventy-nine patients with surgically confirmed lumbar disc herniation at 96 level which were studied retrospectively to compare the diagnostic accuracy of magnetic resonance imaging between March, 1994 to May, 1995. There were 60 men and 19 women, averaging 35 years of age with range of 18 to 64. Disc herniation classified into three group, namely, protruding(PD), extruding(ED), sequestered (SD) by MRI. The operatively confirmed location of herniated disc was compared with MRI. All studies were evaluated by one radiologist who had no knowledge of clinical findings or other diagnostic test results. For protruding disc, there was 87% sensitivity, 83% specificity, 94% accuracy for MRI in distinguishing from other forms of lumbar disc herniation. There was 92% sensitivity, 88% specificity, 94% accuracy for extruded disc and 89% sensitivity, 99% specificity, 89% accuracy for sequestered disc. The relatively high rate of MRI accuracy could be due to technique of using a smaller slice thickness with no gap between slice, a 1.5 Tesla field strength that allow better resolution and more accurate interpretation.