개의 만성 마비압박에서 감각 및 운동유발전위의 변화

양익환,김남현 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1

Previous experiment studies have shoun the effects of acute compression of the sprinal cord and peripheral nerve roots. However, few animal model of chronic compression of the cauda equina has been described The purpose of this study was to develop a reproducible animal model of lumbar spinal stenosis in order to detect early indices of the long-term histological and electrophysiological changes of chronic compression of the cauda equina An animal model of lumbar spinal stenosis, in which the pathophysiology of this condition could be examined, was retrieved according to Delamarter's method. Four experimental groups, each containing six dogs, were studied. One group had a laminectomy of the sixth and seventh lumbar vertebrae only; these animals served as controls. In the three other groups, a laminectomy was performed and the cauda equina was contricted by 25,50 or 75 percent to produce chronic compression. Weekly neutological examinations were carried out, and the neurological deficits were graded using the Tarlov system. Sensory evoked potentials, motor evoked potentials were recorded preoperatively, immediately after constriction, and at two weeks,one,two, and three months postoperatively. After three months of constrictions, the cauda equina of six dogs in each group was examined histologically. Sensory and motor evoked potentials revealed neurological abnormalities before the appearance of neurological signs and symptoms. Constriction of more than 50 per cent was the critical point that resulted in complete loss or reduction of evoked potentials and in neurological deficits and histological abnormalities. In cases recovered from motor and sensory evoked potentials, neurological symptom and sign have also gradually been recovered. In conclusion, for the accurate forecasting of prognosis of chronic cauda equina compression, the combined diagnostic study of sensory and moter evoked potential is recommanded.

Neurovascular Injury in Hip Arthroplasty

양익환 대한고관절학회 2014 Hip and Pelvis Vol.26 No.2

Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.

제7회 연수강좌 : 골용해 ; 골용해의 병인론

양익환 대한고관절학회 2005 Hip and Pelvis Vol.17 No.3

슬관절 전치환술 후 굴곡장애에 대한 조기 강제 관절 굴곡

양익환,김성환,한창동 대한슬관절학회 2004 대한슬관절학회지 Vol.16 No.2

Comparison of Phenotypic Characterization between "Alginate Bead" and "Pellet Culture Systems as Chondrogenic Differentiation Models for Human Mesenchymal Stem Cells

양익환,김수향,김윤희,선현진,김성재,이진우 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.5

Chondrogenesis involves the recruitment of mesenchymal cells to differentiate into chondroblasts, and also the cells must synthesize a cartilage-specific extracellular matrix. There were two representative culture systems that promoted the chondrogenic differentiation of human mesenchymal stem cells. These systems were adaptations of the “pellet” culture system, which was originally described as a method for preventing the phenotypic modulation of chondrocytes, and the “alginate bead” culture system, which was used to maintain encapsulated cells at their differentiated phenotype over time, and also it was used to maintain the cells' proteoglycan synthesis at a rate similar to that of primary chondrocytes. We performed test on the differences of phenotypic characterization with the two methods of differentiating human mesenchymal stem cells into chondrocytes. The typical gene for articular cartilage, collagen type II, was more strongly expressed in the “alginate bead” system than in the “pellet” culture system, in addition, specific gene for hypertrophic cartilage, collagen type X, was more rapidly expressed in the “pellet” system than in “alginate bead” culture system. Therefore, the “alginate bead” culture system is a more phenotypical, practical and appropriate system to differentiate human mesenchymal stem cells into articular chondrocytes than the “pellet” culture system.

Rotating Platform Low Contact Stress<SUP>Ⓡ</SUP>를 이용한 인공 슬관절 전치환술

양익환(Ick Hwan Yang),정준영(Jun Young Chung),한창동(Chang Dong Han) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

목적: 후방 십자인대 제거형인 rotating platform LCS<SUP>ⓡ</SUP> Complete™ 인공 슬관절 전치환술 후 추시 결과를 후향적으로 평가하였다. 대상 및 방법; 2001년 1월부터 2002년 12월까지 rotating platform LCS<SUP>ⓡ</SUP> Complete™로 슬관절 전치환술을 시행받은 환자 63명 82예 중 3년 이상 추시가 가능하였던 61명 79예를 대상으로 하였다. 평균 추시기간은 3.5년이었으며, 전 예 퇴행성 슬관절염이었고, 평균연령은 67.4세였다. 슬개골 치환술은 전 예에서 시행하지 않았다. 결과: 술전 평균 능동운동범위는 118˚ (95˚-134˚)였으며, 술후 능동운동범위는 123˚ (100˚-140˚)이었다. 술전 평균 굴곡 구축은 15˚ (0-30˚), 술후 굴곡 구축은 2˚ (0˚-10˚)이었다. 술전 평균 HSS score는 64점, 술후 90점이었다. 방사선 투과성선은 경골 전후면상 10%, 대퇴골에서 9%에서 관찰되었으며, 합병증으로는 2예의 폴리에틸렌 삽입물 탈구로 1예는 관혈적 정복, 1예는 폴리에틸렌 삽입물을 교환하였다. 결론: 후방 십자인대 제거형인 rotating platform LCS<SUP>ⓡ</SUP> Complete™를 이용한 인공슬관절 치환술의 3년 추시 결과, 운동범위와 기능에서 매우 양호한 결과를 보였으나, 폴리에틸렌 삽입물 탈구에 대한 주의가 요구되었다. Purpose: To retrospectively evaluate the clinical and radiology results of total knee arthroplasty using a rotating platform Low Contact Stress (LCS<SUP>ⓡ</SUP>) Complete™. Materials and Methods: Of 63 patients (82 knees) who had undergone a total knee arthroplasty with a rotating platform LCS<SUP>ⓡ</SUP> Complete between Jan. 2001 and Dec. 2002, 61 patients (79 knees) were followed up for more than three years and evaluated retrospectively. The average follow-up period was 3.5 years and the diagnosis in all cases was degenerative osteoarthritis. The average age at the time of surgery was 67.4 years, and no patient underwent patella resurfacing. Results: The average active range of motion increased from 118° (95°-134°) preoperatively to 123° (100°-140°) at the last follow up. The average flexion contracture improved from 15° (0°-30°) preoperatively to 2° (0°-10°) at the last follow up. The average HSS knee score also improved from preoperative 64 points to 90 points at the last follow up. The radiology evaluation revealed a radiolucency rate of 10% in the tibia anteroposterior view and 9% in the femur. The complications encountered were two cases of a polyethylene liner dislocation; one in whom an open reduction was performed, and the other in whom the liner had been exchanged. Conclusion: A follow-up of the rotating platform LCS<SUP>ⓡ</SUP> Complete™ of more than three years yielded overall satisfactory results in the range of motion and function. However, there should be some concern regarding the development of polyethylene liner dislocation.

노령층의 양극성 고관절 반치환술 후 예후적 지표로서의 혈액 내 총 임파구 수

양익환, 한창동김홍희 대한고관절학회 2003 Hip and Pelvis Vol.15 No.2

Alendronate Sodium의 거식세포에서의 산화질소 유리 억제 효과

양익환(Ick-Hwan Yang),이수현(Soo-Hyun Lee),한창동(Chang-Dong Han) 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.2

목적: Alendronate sodium을 이용한 거식세포의 기능억제를 통해서 인공관절 치환술 후 야기되는 골 용해를 감소 혹은 지연시킬 수 있는 가능성과 약물의 적절한 투여기간을 알아보고자 하였다. 대상 및 방법: Titanium-6% aluminum-4% vanadium (TiAlV) 금속봉과 TiAlV 금속판을 회전 연마(milling)한 후 단계적 세척, 원심분리 및 재 부유하여 TiAlV 미세입자를 제작하고, 주사 전자 현미경으로 그 크기를 확인하였다. 실험견 12마리에 1mg/kg의 Alendronate sodium을 3개월간 경구 투여하면서 3주, 6주, 3개월에 각각 채혈하여 Lipopolysaccharide (LPS, 양성대조군), N-monomethyl-L-arginine (L-NMA, 음성대조군), 1배수와 5배수의 surface area ratio (SAR) Ti-particles를 첨가하여 24시간의 배양하였다. 이 후 각 군을 Mendelow 방법을 이용하여 산화질소(Nitric-oxide) 방출량을 측정하였고, 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium (MTT)에 의한 purple insoluble formazan 형성을 이용한 세포 생존율 검사를 통해 산화질소 방출량을 적정화하였다. 결과: 실험에 사용된 TiAlV 업자들의 직경은 최소 0.17 ㎛, 최대 4.0 ㎛로 평균 1.1±0.8 ㎛였다. 1.0 ㎛보다 작은 경우는 55%였고 3.0 ㎛보다 작은 경우는 96%였다. 적정화 한 후 일정세포 수에서의 산화질소 방출량을 비교하였다. 대조군에 비하여 3주 투여군은 산화질소 생성이 다소 감소하였으나 통계적 의미는 없었고 6주와 3개월 투여군에서는 유의하게 산화질소 생성이 감소하였으며 두 군간의 차이는 없었다. 결론: Alendronate의 6주 이상 투여군에서 염증성 매개 유리체 중의 하나인 산화질소가 감소한 것으로 미루어, 6주 이상의 Alendronate의 투여가 인공관절 치환술 후 혹은 추시 관찰 중 골용해를 초래하는 거식세포의 작용을 억제할 것으로 사료된다. Purpose: This study was designed to present the effect of alendronate sodium on prevention of osteolysis after arthroplasty by suppression of macrophage. Materials and Methods: Submicron-sized titanium particles were made from TiAIV cylinder and plate after milling, and by repeated washing, centrifugation and floating method. 12 dogs were given alendronate by oral administration for 3 months and blood was sampled at 3 weeks, 6 weeks and 3 months. Monocytes were separated from canine blood by isopycnic centrifugation with Percoll solution and cultured in media with LPS, L-NMA, TiAIV particle (×1 SAR and ×5 SAR) for 24 hours. Nitric Oxide (NO) assay by Mendelow s method and MTT assay as a cell viability test were performed. Results: Average diameter of TiAIV particles was 1.1±0.8 ㎛ (from 0.17 to 4.0 ㎛). Particles less than 1.0 ㎛ were 55% and 3.0 ㎛, 96%. Compared with control group, there was slight decrease of NO production in 3 weeks group with no statistic difference, but there was significant decrease in 6 weeks and 3 months group statistically. Conclusion: Administration of alendronate for more than 6 weeks may be effective in suppression of macrophage, prevention of osteolysis after arthroplasty.

베체트 관절염의 임상적 관찰

양익환(Ick Hwan Yang),한창동(Chang Dong Han),오현철(Heun Cheul Oh),김진영(Jin Young Kim) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.2

목적: 류마토이드 관절염과 감별해야 하는 베체트 관절염의 병력, 진단과 치료, 임상양상을 관찰하고자 하였다. 대상 및 방법: 1990년 1월부터 2000년 12월까지 베체트 증후군으로 진단받은 1,602명의 환자 중 관절증상으로 의뢰되었던 87명의 환자를 대상으로 임상적 양상을 분석하고, 조조강직 여부, 그리고 적혈구 침강속도, C-반응단백, 항스트렙톨라이신O, 류마토이드 인자를 포함한 혈액검사를 시행하였다. 진단 기준으로는 Shimizu 분류를 사용하였다. 결과: 87명 중 남자 49명, 여자는 38명이었으며, 20-30대가 가장 많았다. 슬관절이 60예로 가장 많았고, 한 관절 이환이 47예(54.0%), 두 관절은 29예(33.3%), 세 관절 이상은 11예(12.7%)이었다. Shimizu 분류상 완전형이 4예(4.6%), 불완전형이 59예(67.8%), 가능형 8예(9.2%), 추측형 16예(18.4%)이었다. 보존적인 요법만으로 대부분의 환자에서 호전을 보였으며, 12예(13.8%)에서 호전 후 1년 내에 재발을 보였다. 2예에서 관절경적 활액막 제거술을 시행하였다. 결론: 베체트 관절염은 류마토이드 관절염과 감별해야 하고 일반적인 보존치료로서 만족스러운 결과를 얻을 수 있었다. Purpose: The clinical manifestations of Behcet's arthritis are similar to those of rheumatoid arthritis, and they need to be differentiated. The objective of this study was to evaluate the past history, diagnosis, treatments and clinical findings of Behcet's arthritis. Materials and Methods: Among 1,602 cases with Behcet's disease, 87 cases with Behcet's arthritis were enrolled in this study between January 1990 and December 2000. A thorough review of each case was done by examining the patients' medical charts and personal interview. The clinical manifestation, the existence of morning stiffness and laboratory studies including ESR, CRP, AS, and RF were investigated. The Shimizu classification was used as diagnostic criteria. Results: There was no preponderance of gender and the most prevalent age group was in their 3<SUP>rd</SUP> and 4<SUP>th</SUP> decades. The most common involved site was the knee joint (60 of 87 cases), and multiple site involvement was common (56.0%). Clinically, symptoms such as pain, tenderness and joint swelling were common. According to the Shimizu classification, the incomplete type was the most common (67.8%). The symptoms improved after conservative treatment, but 12 cases (21.0%) recurred within one year. Arthroscopic synovectomy was performed in 2 cases, but these cases showed no improvement. Conclusion: Behcet's arthritis should be differentiated from rheumatoid arthritis, and conservative treatment showed good clinical results.

후방십자인대 대치형 인공 슬관절 전치환술의 결과

양익환(Ick Hwan Yang),이대영(Dae Young Lee),최철준(Chul Jun Choi),한창동(Chang Dong Han) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.4

목적: 후방 십자인대 대치형의 Scorpio<SUP>®</SUP> 인공슬관절 전치환술 후 추시 결과를 후향적으로 평가하였다. 대상 및 방법: 1999년 1월부터 2001년 6월까지 Scorpio<SUP>®</SUP>로 슬관절 전치환술을 시행받은 환자 58명 80예 중 3년 이상 추시가 가능하였던 51명 71예를 대상으로 하였다. 평균 추시기간은 3.6년이었으며, 전례 퇴행성 슬관절염이었고, 평균연령은 70.1세였다. 슬개골 치환술은 37예에서 시행하였다. 결과: 수술 전 평균 능동운동범위는 108°(75-144°)였으며, 수술 후 능동운동범위는 120°(90-144°)이었다. 수술 전 평균 굴곡 구축은 12°(0-30°), 수술 후 굴곡 구축은 2° (0-13°)이었다. 수술 전 평균 HSS score는 54점, 수술 후 88점이었다. 슬개골 치환술을 시행한 군과 슬개골 치환술을 시행하지 않은 군에서의 운동범위, 굴곡구축 및 임상적 결과는 차이가 없었다. 방사선 투과성선은 경골 전후면상 11%, 대퇴골에서 10%에서 관찰 되었으며, 합병증으로는 대퇴골 치환물 주위골절 1예, 수술 후 심부 감염으로 변연절제술과 배농술 시행한 1예, 비골신경 마비가 1예가 있었다. 1예에서 무감염성 해리로 인한 대퇴치환물과 경골 치환물의 이동이 관찰되어 재치환술을 시행하였다. 결론: 후방 십자인대 대치형의 Scorpio<SUP>®</SUP>를 이용한 인공슬관절 치환술은 3년 추시 결과, 운동범위와 기능에서 매우 양호한 결과를 보였다. 슬개골 전치환술을 시행한 군과 시행하지 않은 군간에 임상적 결과에 있어서 차이는 없었다. Purpose: To evaluate the clinical and radiologic result of total knee arthroplasty using Scorpio<SUP>®</SUP> total knee system retrospectively. Materials and Methods: Between January 1999 and December 2001, 71 knees in 51 patients who had been followed up mean 3.6 years (minimum 3.0 years) after total knee arthroplasty with Scorpio<SUP>®</SUP> system (posterior substitution type) were evaluated retrospectively for clinical result, active range of motion, flexion contracture and radiologic result. Results: The average active range of motion increased from 108° (75-144°) preoperatively to 120° (90-144°) at last follow up. The average flexion contracture improved from 12° (0-30°) preoperatively to 2° (0-13°) at last follow up. The average HSS knee score was measured 54 preoperatively and was measured 88 postoperatively. There was no difference in clinical result, active range of motion and flexion contracture between resurfaced patella group and non resurfaced patella group. Radiologic evaluation revealed radiolucency rate of 11% in Tibia anteroposterior view and 10% in femur. Complications were periprostheitc fracture in one case, deep infection in one case and peroneal nerve palsy in one case. In one case, femoral and tibial component migration due to aseptic loosening was noted. Revision of tibial and femoral component was done. Conclusion: The 3.6 years follow up results of Scorpio<SUP>®</SUP> system (posterior substitution type) were excel-lent in range of motion and function. There was no difference between resurfaced patella group and non-resurfaced patella group in clinical result.