하부 요추 방출 골절의 수술방법 결정시 고려 요인들

장태안,김종문,Jahng, Tae-Ahn,Kim, Jong-Moon 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

경추 손상 후 뇌척수액 유출에 대한 관리

이수언 ( Soo Eon Lee ),정천기 ( Chun Kee Chung ),장태안 ( Tae Ahn Jahng ),김치헌 ( Chi Heon Kim ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period. Methods: A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma. Results: Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission. Conclusion: The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.

손상 척주와 수술 척주에 따르는 하부 경추 손상의 외과적 치료방법의 선택

장태안,김종문 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.5

성인요추 척추전방전위증의 외과적 치료 : 치료방법간의 비교 Comparision of Various Method

장태안,김종문 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.4

In retrospective study of 35 cases(male=17. female=18) of lumbar spondylolisthesis(isthmic 24 degenerative 6 iatrogenic 5) treated with different surgical management. we elucidate the result of follow-up radiologic changes and surgical outcome Percent-slip was reduced and percent-disc height was increased in all three groups at 1 month after the operation But S months follow-up after the operation revealed that percent-slip was increased to around the value of preoperation in PPLF group(Pedicle screw flxation with posterolateral fusion. 13cases) and PLIF group(Posterior lumbar interbody fusion only. 11cases) and that percent-disc height was decreased compared to postoperative 1 month in PPLF group. Although PPlF group(Pedicle screw fixation with posterior lumbar interbody fusion, 11cases) showed better correction and maintenance But there was no significant differences in overall outcome among the three surgical groups(PPLF 76.9% PLIF : 81.8% PPIF 81 8%, % of satisfaction) and the outcome of surgery was not related with bone union rate(PPLF=76.9% PLIF=72.7%, PPIF=81.8%) or accompanied NIC and HNP. There were S patients with complications(17.1%), such as two wound infection. two screw fractures and two others. Further longterm follow-up and evaluation is needed for clarifying the efficiency and superiority in surgical options associated with type. degree of slip, complications. bone fusion and patient satisfaction.

뇌동맥류 조기수술후 발생한 뇌혈관연축에 영향을 미치는 임상적 인자

최양문,장태안,강성돈,김종문 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.12

Much controversies still exist with respect to the risk factors influencing symptomatic cerebral vasospasm. In our study, the patient group had some unique characteristics, ie. : 42.5%(65) of the 153 patients were aged 60 years or older(mean : 55.6 years) and consequently the proportion of Hunt-Hess grade 3-5 was higher than grade 1-2(57.5% vs. 42.5%). The authors analyzed the relationship between vasospasm and Hunt & Hess grade, Fisher grade, hydrocehalus, age & hypertension among these 153 early operative cases after a 3 year follow up study. The incidence of vasospasm was significantly higher in the Hunt-Hess grade, Ⅲ, Ⅳ, Ⅴ and the Fisher grade Ⅲ, Ⅳ, compared to grade Ⅰ& Ⅱ, and also in preoperative hydrocehalus but it was insignificant in old and hypertensive patients. These results suggest initial severe direct insults and complicating preoperative hydrocephalus increase the chance of postoperative symptomatic vasospasm in this older aged, poorer grade study group.

자발성 종양내 출혈로 뇌졸중을 초래한 수막종 1례

정진환,장태안,김종문 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.11

Spontaneous intracranial hemorrhage occurs in approximately 4% of cases of intracranial or metastatic carcinoma and occasionally in pituitary adenomas. By contrast hemorrhage into meningiomas in exceedingly rare. Because of their unusual clinical presentation, these cases were not diagnosed correctly prior to radiological studies. The histological features of the hemorrhagic meningiomas are described and the importance of adequate radiological investigations and early radical surgery is stressed. In this report the authors present a case of spontaneous intracranial hematoma associated with meningioma and a review of other reports.

외상성 제2경추 골절 환자에 대한 임상적 고찰

한영희,장태안,강성돈,김종문 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.2

A series of 26 patients of acute axis fractures were treated at th5 Wonkwang Medical Center. Wonkwang University between Janualy, 1988 and December, 1992. The medical records and roentgenograms of these 26 patients were reviewed in detail. Follow-up data were available for all of the cases, for a median duration of 25.6 monthdrange 3 months to Syears). There were 8 hangman's fractures(31%>, 10 odontoid type Ⅱ fractures(38%)). 6 odontoid type Ⅲ fractures(23%). 2 miscellanous fractures(8% >. The odontoid type Ⅱ fracture was the most common axis fracture and the most common cause of injuly was motor-vehicle accident followed by fall, Hangman's fracture. odontoid type Ⅱ, miscellanous fracture were effectively treated with external stabilization. In the 10 odontoid type I1 fractures, 7 patients were treated by external stabilization .and 3 were by early surgical stabilization. Among the external stabilization group, the fusion failure occured 2 of the dens displacement of 4mrn or greater in the initial treatment. We offered the treatment algorithm for the subtype of axis fractures based on our experience.

Vulnificolysin의 溶血 作用에 미치는 Ca^2+ 의 影響

朴鎭宇,姜信和,張泰安,金鐘碩,盧惠援,金炯魯 의과학연구소 1990 全北醫大論文集 Vol.14 No.1

Effect of Ca^2+ on the hemolysis of mouse erythrocytes induced by the vulnificolysin from Vibrio vulnificus was investigated. 1. Divalent cations such as Ca^2+, Mg^2+ and Mn^2+ protected mouse erythrocytes from hemolysis caused by vulnificolysin, whereas the monovalent cations showed no protective effects. 2. The protective effect of Ca^2+ on the vulnificolysin-induced hemolysis was exerted in millimolar concentrations with maximum at 30mM. In the presence of 30mM CaCl_2 the mouse erythrocytes were about 18 folds more resistant to hemolysis than the control. Pretreatment of mouse erythrocytes with Ca^2+ followed by the removal of Ca^2+ showed no protection on vulnificolysin-induced hemolysis. 3. Ca^2+ did not block the binding of vulnificolysin to mouse erythrocytes and the pore formation measured by the release of potassium. Since the three steps of the vulnificolysin-induced hemolytic sequence are known as: i) binding to cell memebrane, ii) formation of transmembrane pore, and iii) cell lysis, the protective effect of calcium seemed to act on the final step of cell lysis.