활차상 주근의 유무에 따른 주관증후군의 비교

윤민근,유명재,김종민,팽정욱,김영우,우상현 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.1

Purpose: To assess the clinical difference between cubital tunnel syndrome with anconeus epitrochlearis (AE) and idiopathic cubital tunnel syndrome without known other causes. Methods: This cross-sectional study included the 326 patients who were subjected to surgery because of cubital tunnel syndrome from 2008 to 2014. After exclusion of patients with other known causes of cubital tunnel syndrome, a total of 107 patients were divided into two groups; patients with and without AE. The clinical differences between two groups were analyzed retrospectively; age, sex, presence of intrinsic muscle atrophy, interval from symptom development to surgery, pinch power, the disabilities of the arm, shoulder and hand score and the nerve conduction velocity (NCV). Results: Thirty four (10.4%) patients, being subjected to surgery had the AE. Among 107 patients who had no other known causes, 26 patients had AE. 19 out of 26 patients with AE was male. Average age of patients with AE was significantly younger. The interval from symptom development to surgery in AE patients was significantly shorter. Motor NCV of ulnar nerve at above elbow joint in comparison with that at below elbow joint in AE patient was more significantly decreased (14.3 m/sec vs. 8.3 m/sec). Conclusion: The AE in cubital tunnel syndrome is no more rare structure. In younger male patients with rapidly progressive worsening cubital tunnel symptoms, and if there is significant decrease of ulnar motor nerve velocity at above elbow in comparison with at below elbow, the AE should be considered as cause of ulnar neuropathy. 목적: 활차상 주근에 의한 주관터널증후군 환자와 특발성 주관터널증후군 환자에서 임상적 차이를 알아보고자 하였다. 방법: 2008년부터 2014년까지 주관터널증후군으로 수술 받은 326명 중 주관터널증후군의 다른 원인을 가진 환자들을 제외한 총107명의 환자를 활차상 주근이 있는 군과 활차상 주근이 없는 군으로 분류하여 분석하였다. 나이, 성별, 내재근 위축여부, 증상 발현부터 수술을 받기까지 기간, the disabilities of the arm, shoulder and hand score와 the nerve conduction velocity에 대해 두 군 간의 임상적 차이를 후향적으로 분석하였다. 결과: 34명(10.4%)에서 활차상 주근이 관찰되었고, 다른 원인이 있었던 환자를 제외한 107명 중 활차상 주근을 가진 환자는 26명이었다. 활차상 주근을 가진 환자 군에서 19명(73%)이 남자로 의미 있게 남자에서 많이 발병되었으며, 평균나이는 44세로 의미 있게 젊었다. 증상 발현 후 수술까지 걸린 시간도 의미 있게 짧았으며, 근전도 검사상 활차상 주근을 가진 환자군에서 주관절 근위부에서 척골신경의 운동신경 전도 속도가 원위부 전도 속도 보다 의미 있게 감소하였다(14.3 m/sec vs. 8.3 m/sec). 결론: 주관터널증후군의 원인이 될 수 있는 활차상 주근은 드문 구조물이 아니며, 진행이 빠른 증상을 가진 젊은 남성에서 근전도 검사상 주관절 근위부와 원위부에서 수술 전 운동신경 전도 속도의 차이가 큰 점이 활차상 주근에 의한 주관터널증후군과 특발성 주관증후군의 중요한 구별점이 될 것으로 생각된다

선천성 안면기형을 동반한 증후군 환자의 악교정 수술

윤민근(Min-Geun Yoon),김창수(Chang-Soo Kim),안재명(Jaemyung Ahn),팽준영(Jun-Young Paeng) 대한구순구개열학회 2021 대한구순구개열학회지 Vol.24 No.1

There are various factors that have to be considered in orthognathic surgery for the syndromic patients with congenital facial deformities. The factors such as the shape of the jaws, pattern of mouth opening, masticatory muscle tension, degree of facial asymmetry, reconstruction of deformities and patient’s cooperation are required to be taken into consideration more than a routine treatment plan. For this reason, much more complex process, additional surgeries, and more precise and careful surgical planning are needed than general orthognathic surgery. Nearly all preparation procedures have been digitalized in recent orthognathic surgery cases. Computer-aided and 3D orthognathic surgery simulations allow for more precise model surgeries for syndromic patients with congenital facial deformities. The aim of this study is to examine the effective treatment method for syndromic patients with congenital facial deformities and discuss improvement of orthognathic surgery.

Age-Related Incidence of Cervical Spondylosis in Residents of Jeju Island

문명상,윤민근,박봉근,박민석 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.5

Study Design: Cervical spine radiograms of 460 Jeju islanders. Purpose: To investigate the age-matched incidences and severity of the cervical disc degeneration and associated pathologic findings. Overview of Literature: Several related studies on the incidences of disc and Luschka’s and facet joint degeneration have provided some basic data for clinicians. Methods: Cervical radiographs of 460 (220 males and 240 females) patients in their fourth to ninth decade were analyzed. Ninety patients in their third decade were excluded because of absence of spondylotic findings. Results: Overall incidence of cervical spondylosis was 47.8% (220 of 460 patients). The percentile incidences of spondylosis in the fourth, fifth, sixth, seventh, eighth and ninth decade was 13.2% (10 of 76 patients), 34.6% (37 of 107 patients), 58.9% (66 of 112 patients), 58.8% (50 of 85 patients), 70.3% (45 of 64 patients) and 75.0% (12 of 16 patients), respectively. The percentile incidences of one, two, three, four and five level spondylosis among 220 spondylosis patients was 45.5% (n=100), 34.1% (n=75), 15.0% (n=33), 4.5% (n=10), and 0.9% (n=2). Severity of disc degeneration ranged from ± to ++++, and was ± in 6.0% (24 segments), + in 49.6% (198 segments), ++ in 35.3% (141 segments), +++ in 9.0% (36 segments) and ++++ in 0.25% (one segment). Spurs and anterior ligament ossicle formed at the spondylotic segments, mostly at C4~6. The rate of posterior corporal spurs formation was very low. Olisthesis and ossification of the posterior longitudinal ligament were rarely combined with spondylosis. Cervical lordotic curve decreased gradually according to the progress of severity of spondylosis. Conclusions: The incidence of cervical spondylosis and number of spondylotic segments increase, and degeneration gradually becomes more severe with age.

Radiological Assessment of the Effect of Congenital C3–4 Synostosis on Adjacent Segments

문명상,윤민근,권기태,김성수,Jin-Fu Lin,이봉진 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6

Study Design: Retrospective case series. Purpose: To assess the effect of non-kyphotic aligned congenital C3–4 synostosis on the adjacent segment in 10 patients. Overview of Literature: In the cervical spine, fusion disease at the adjacent motion segments may be a risk factor for potential neurological compromise and death. Methods: Radiograms of 10 patients 13 to 69 years of age presenting with neck/shoulder discomfort or pain with or without trauma history were examined. C3–4 synostosis was found incidentally in all patients on routine examination radiographs of cervical spine. Results: Adjacent segment disease (ASD) was not found in the three patients younger than 39 years of age. Five of the 10 (50%) patients, including a 67-year-old man, did not develop spondylosis in any of the cervical mobile segments. Spondylosis was observed only in the caudal 1–2 mobile segments in the remaining five patients. The youngest was a 40-year-old male who had spondylosis in the two caudal mobile segments (C4–5 and C5–6). Spondylosis was limited to the two close caudal mobile segments and was not in the cranial segments. Flaring of the lower part of synostotic vertebra associated with advanced narrowed degenerate disc was evident in five patients. Conclusions: Mobile segment spondylosis in the individuals with congenital monosegment C3–4 synostosis over age of 40 years may be a natural manifestation of aging and is not solely an adjacent segment disease directly and fully related with congenital C3–4 synostosis.

요추 후방 감압과 추체간 유합술시 합병한 경막 손상후 소뇌 출혈 - 증례 보고 -

최병완,이상민,윤민근,문명상 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.4

Study Design: A case report. Objectives: To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression andlumbar interbody fusion (PILF). Summary of Literature Review: Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause isknown to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosisand treatment of RCH is very important in the patient with suspicious symptoms. Materials and Methods: A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosisat L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developednausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservativelymanaged with clamping of the wound drainage. Results: The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapyat postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2weeks. Conclusions: Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treatingsurgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small. 연구 계획: 증례 보고목적: 척추 수술 후 드물게 발생하는 원격부 소뇌 출혈에 대한 한 증례 보고와 문헌고찰선행문헌의 요약: 척추 수술 중 또는 수술 후 뇌척수액의 누출에 의한 소뇌 출혈은 드물게 보고되었으며, 의심증상 발생시 빠른 진단과 치료가 필요함이강조되었다. 대상 및 방법: 57세 여자 환자로 제 4-5요추의 심한 척추관 협착증으로 후방 광범위 감압과 추체간 유합술을 시행받았으며, 수술중 경막 천공 및 뇌척수액 누출이 있어 경막 봉합을 시행한 바 있다. 술후 2시간째부터 혈압 저하 및 오심, 두통 증상을 호소하여 촬영한 뇌 컴퓨터 단층촬영상 소뇌에 출혈 소견이 보여 수술부의 배액관을 닫고 보존적 치료를 시행하였다. 결과: 수술 부 배액관을 닫고 보존적 치료를 시행 후 1일째(술후 2일째)부터 혈압 상승제 없이 정상 혈압 유지 및 오심, 두통이 감소되었으며 수술 후 2주째 신경학적 변화 및 의식 변화 없이 퇴원하였다. 결론: 척추 수술 중 또는 후 뇌척수액 누출이 있는 경우, 누출된 양이 적더라도 수술 후 혈압 저하, 오심, 두통이 발생시 원격부 소뇌 출혈을 의심해야 하고 빠른 진단과 치료가 필요 하다. 색인 단어: 소뇌 출혈, 뇌척수액, 경막, 파열, 요추약칭 제목: 후방 추체간 유합술후 소뇌 출혈

Radiographic Assessment of Effect of Congenital Monosegment Synostosis of Lower Cervical Spine between C2–C6 on Adjacent Mobile Segments

문명상,김성수,윤민근,서영훈,이봉진,문한림,김성심 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.5

Study Design: A prospective radiographic study of cervical spine with congenital monosegment fusion. Purpose: To evaluate the effect of cervical synostosis on adjacent segments and the vertebral morphology. Overview of Literature: There are numerous clinical studies of adjacent segment disease (ASD) after monosegment surgical fusion. However, there was no report on ASD in the cervical spine with congenital monosegment synostosis. Methods: Radiograms of 52 patients, aged 5 to 90 years, with congenital monosegment synostosis (CMS) between C2 and C6, who complained of neck/shoulder discomfort or pain were studied. 51 were normally aligned and one was kyphotically aligned. Results: Spondylosis was not found in the patients below 35 years of age. Only 12 out of 24 patients with normally aligned C2–3 synostosis had spondylosis in 19 more caudal segments, and only one at C3–4. A patient with kyphotic C2–3 had spondylolysis at C3–4. In 8 patients with C3–4 synostosis, spondylosis was found in only 9 caudal segments (4 at C4–5, 4 at C5–6, and 1 at C6–7). The caudate C4–5 disc was the most liable to degenerate in comparison with other caudate segments. Caudal corporal flaring and inwaisting of the synostotic vertebra were the features that were the most evident. In 2 of 9 C4–5 and 7 out of 10 C5–6 synostosis patients, spondylosis was found at the two adjacent cephalad and caudate segments, respectively. Only corporal inwaisting without flaring was found. In all cases, spondylosis was confined to the adjacent segments. More advanced spondylosis was found in the immediate caudal segment than the cephalad one. Conclusions: It is concluded that spondylosis at the mobile segments in a synostotic spine is thought to be a fusion-related pathology rather than solely age-related disc degeneration. Those data suggested that CMS definitely precipitated the disc degeneration in the adjacent segments.

Prevalence of Diffuse Idiopathic Skeletal Hyperostosis Diagnosed by Whole Spine Computed Tomography: A Preliminary Study

김범수,문명상,윤민근,김성태,김상재,김민수,김동석 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.1

Background: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of the enthesis. The diagnosis has been mainly based on the chest or whole spine lateral plain film. Recently, chest or thoracolumbar computed tomography (CT) has been reported to be more reliable for the diagnosis of DISH. The purposes of this study were to investigate the prevalence and location of DISH and evaluate the prevalence of comorbidities, such as ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF), using whole spine CT. Methods: Whole spine CT scans of patients over 16 years of age who were examined at Cheju Halla General Hospital between February 2011 and December 2016 were reviewed for this study. The diagnosis of DISH was made according to the modified Resnick criteria. The prevalence of DISH in each age decade and its location were evaluated. Also, the prevalence of OPLL and OLF in DISH patients was investigated. Results: The overall incidence of DISH was 24.4% (40 of 164 cases). There was no case of DISH in patients in their 40s and younger. The percentile incidences of DISH in patients in their fifth, sixth, seventh, eighth, and ninth decades were 20.0% (4 of 20 cases), 32.3% (10 of 31 cases), 40.0% (10 of 25 cases), 34.5% (10 of 29 cases), and 27.3% (6 of 22 cases), respectively. A strong positive correlation between the age decade and the incidence of DISH was noted (r = 0.853, p = 0.007). DISH patients had higher incidences of OLF (22.5%) and OPLL (37.5%). The most common location of DISH was the middle thoracic spine (90.0%) followed by the lower thoracic spine (87.5%). There was one case of DISH involving only the cervical spine. Conclusions: The incidence of DISH diagnosed by CT was higher than we expected. Whole spine CT can be a valuable modality to evaluate the location of DISH in the cervical and lumbar spine and the comorbidity rates of OLF and OPLL.

Metabolic improvement and liver regeneration by inhibiting CXXC5 function for non-alcoholic steatohepatitis treatment

서설화,김은환,윤민근,Lee Soung-Hoon,Park Byung-Hyun,최강열 생화학분자생물학회 2022 Experimental and molecular medicine Vol.54 No.-

Non-alcoholic steatohepatitis (NASH) is a chronic liver disease that results from multiple metabolic disorders. Considering the complexity of the pathogenesis, the identification of a factor mediating the multiple pathogenic phenotypes of NASH will be important for treatment. In this study, we found that CXXC5, a negative feedback regulator of the Wnt/β-catenin pathway, was overexpressed with suppression of Wnt/β-catenin signaling and its target genes involved in hepatic metabolism in obese-NASH patients. Cxxc5−/− mice were found to be resistant to NASH pathogenesis with metabolic improvements. KY19334, a small molecule that activates the Wnt/β-catenin pathway via interference of the CXXC5-Dvl interaction, reversed the overall pathogenic features of NASH as Cxxc5−/− mice. The improvement in NASH by KY19334 is attributed to its regenerative effects through restorative activation of the suppressed Wnt/β-catenin signaling. Overall, the pronounced metabolic improvements with the stimulation of liver regeneration by interfering with the CXXC5-Dvl interaction provide a therapeutic approach for NASH.

The Meniscofemoral Ligament Mimicking a Lateral Meniscus Tear

박봉근,이호형,김성태,윤민근 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.4

A 58-year-old male patient who had developed left knee pain with a history of trauma was referred to our hospital. Physical examination and further examination by magnetic resonance imaging revealed results that closely resemble a horizontal tear of the lateral meniscus and a tear of the medial meniscus. Arthroscopically, we found a cord-like structure originating from the posterior 1/3 portion of the lateral meniscus and passing obliquely toward the medial femoral condyle in front of the posterior cruciate ligament without a tear of the lateral meniscus. In this report, we describe a rare case of anterior meniscofemoral ligament that was clearly seen on arthroscopy and mimicked a meniscal tear, which is also known as a pseudo-tear of the meniscus.

Painful Snapping Shoulder Complicating Soft Tissue Pseudotumor Secondary to Rib Osteochondroma: A Case Report

문명상,전달재,김성수,윤민근,Moon, Myung-Sang,Jeon, Dal-Jae,Kim, Sung-Soo,Yoon, Min Geun The Korean Musculoskeletal Tumor Society 2014 대한골관절종양학회지 Vol.20 No.1

Osteochondromadevelop most commonly at distal femur, proximal humerus and proximal tibia, but the rib osteochondroma was reported less commonly. In this report, scapular snapping syndrome complicated by adventitious bursa and soft tissue pseudotumor surrounding the osteochondroma of the $6^{th}$ rib body was treated successfully by surgical excision of them. We report this rare case with reviewing the relevant literature. 골연골종은원위 대퇴골, 근위 상완골, 근위 경골에 흔히 발생한다고 알려져 있으며 늑골에 발생한 골연골종은 상대적으로 드물게 보고되고 있다. 본 증례에서는 좌측 제6늑골 체부에 생긴 골연골종에 의한 우발성 점액낭과 그 주변에 생긴 연부조직 가성 종류가 발음성 견갑골 증후를 야기하여 관혈적 제거수술을 시행한 1례를 문헌 고찰과 함께 보고하고자 한다.