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안효세,손휘성,신지훈,안면환,이건우 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.4
Study Design: Retrospective exploratory imaging study. Purpose: To investigate the significance of the coronal magnetic resonance imaging (MRI) using Proset technique to detect the hidden zone in patients with mid-zone stenosis by comparing with conventional axial and sagittal MRI and to explore the morphologic characteristic patterns of the mid-zone stenosis. Overview of Literature: Despite advancements in diagnostic modalities such as computed tomography and MRI, stenotic lesions under the pedicle and pars interarticularis, also called the mid-zone, are still difficult to definitely detect with the conventional axial and sagittal MRI due to its inherited anatomical peculiarity. Methods: Of 180 patients scheduled to undergo selective nerve root block, 20 patients with mid-zone stenosis were analyzed using MRI. Characteristic group patterns were also explored morphologically by comparing MRI views of each group after verifying statistical differences between them. Hierarchical cluster analysis was performed to classify morphological characteristic groups based on three-dimensional radiologic grade for stenosis at all three zones. Results: At the mid-zone, the stenosis of grade 2 or more was found in 14 cases in the coronal image,13 cases in the sagittal image, and 9 cases in the axial image (p <0.05). Especially, mid-zone stenosis was not detected in six of 20 cases at the axial images. At the entrance and exit-zone, coronal image was also associated with more accurate detection of hidden zone compared to other views such as axial and sagittal images. After repeated statistical verification, the morphological patterns of hidden zone were classified into 5 groups: 6 cases in group I; 1 case in group II; 4 cases in group III; 7 cases in group IV; and 2 cases in group V. Conclusions: Coronal MRI using the Proset technique more accurately detected hidden zone of the mid-zone stenosis compared to conventional axial and sagittal images.
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Tarsal Tunnel Syndrome Associated with Gout Tophi: A Case Report
박삼국,박철현,안효세 대한족부족관절학회 2016 대한족부족관절학회지 Vol.20 No.2
Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its branches in the fibro-osseous tunnel beneath the flexor retinaculum. This pathology is associated with multiple etiologies, including trauma, space-occupying lesions, and impaired biomechanics. We report a case of tarsal tunnel syndrome associated with gout tophi in a patient with untreated gout along with a review of the relevant literature on tarsal tunnel syndrome.
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손욱진,이동철,박강현,안효세 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.4
purpose: To compare clinical and radiographic results of anterior cruciate ligament (ACL) reconstruction using modified transtibial technique (mTT), anteromedial (AM) portal technique and outside-in (OI) technique.materials and methods: From March 2007 to December 2012, ACL reconstruction was performed using the mTT, AM portal technique and OI technique in 20 patients each. Anteroposterior and rotational stability were assessed using the GNRB arthrometer and pivot-shift test. Femoral tunnel obliquity was measured on the anteroposterior and lateral radiographs.results: Tegner score, Lysholm score, International Knee Documentation Committee score, pivot-shift test were improved at final follow-up in all three groups. However, statistical difference was not shown. Side-to-side difference in GNRB arthrometer was average of 1.4 mm, 1.0 mm and 0.9 mm in mTT, AM and OI group, showing the signicant difference between mTT and AM/OI groups (p<0.001). The mean femoral tunnel obliquity was 56.4° in the mTT group, 39.4° in the AM group and 33.6° in the OI group, showing significant intergroup difference (p<0.001). It showed the significant difference among three groups (p<0.001). conclusions: Clinical results were improved in all three groups. Femoral tunnel obliquity in AM and OI were more horizontal on the coronal plane. They are thought to have more benefits in oblique positioning of the grafted ACL in rotational stability; however, there was no significant difference among three techniques in pivot-shift test to assess the rotational stability in this study.
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만성간염에 저용량 아데포비어 치료 후 발생한다발성 스트레스 골절 1예-증례 보고-
박철현 ( Chul Hyun Park ),안효세 ( Hyo Sae Ahn ),이동철 ( Dong Chul Lee ) 대한골절학회 2014 대한골절학회지 Vol.27 No.4
스트레스 골절은 일반적으로 뼈에 반복적인 부하가 가해져서 발생하며, 특히 다발성 스트레스 골절은 류마티스 관절염, 골다공증 혹은 골관절염의 전신 질환이 있는 환자에서 발생하는 것으로 알려져 있다. 아데노신 단인산염(adenosine monophosphate) 유사체인 adefovir dipivoxil (ADV)은 만성 B형 간염의 치료를 위해 하루 10 mg의 저용량을 사용하는 경우에 심한 저인산염혈증의 발생이 극히 드문 것으로 알려져 있으며, 저자들이 아는 한 저용량의 ADV를 사용한 경우에서 저인산염혈증으로 인해 다발성 스트레스 골절이 발생한 경우는 아직까지 보고된 바가 없다. 저자들은 만성 B형 간염의 치료를 위해 저용량의 ADV를 투여받던 환자에서 다발성 스트레스 골절이 발생하는 것을 경험하였기에 문헌 고찰과 함께 보고하고, 이를 통해 저용량의 ADV 투여가 스트레스 골절의 위험 인자들 중 하나로 고려되어야 함을 알리고자 한다. Stress fractures typically result from repeated abnormal mechanical loading to the bones. In particular, multiple stress frac-tures may occur in patients with systemic disease, such as rheumatoid arthritis, osteoporosis, or osteoarthritis. Adefovir dipivoxil (ADV), a nucleotide analogue of adenosine monophosphate, very rarely causes severe hypophosphatemia when using a low dosage of 10 mg daily for treatment of chronic hepatitis B. To the best of our knowledge, in English literature, this is the first report of multiple stress fractures in a chronic hepatitis B patient who has been treated with a low dosage of ADV. We think it is important to consider that use of ADV in a patient with chronic hepatitis B could be a risk factor for stress fractures.
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