후방 도달 반척추 절제술로 치료한 선천성 척추 측만증

안종국,김진혁,김성수,조범철,정락용,석세일 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.1

Study Design: Retrospective study Objectives: To evaluate the surgical outcome of congenital scoliosis with a hemivertebra treated by posterior hemivertebra excision and pedicle screw instrumentation. Summary of Literature Review: Posterior hemivertebra excision can be accomplished through a single posterior approach, and excellent correction and outcome may be achieved. Materials and Methods: Forty patients with one fully segmented hemivertebra treated by posterior hemivertebra excision with pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years (range 2~7.7 years). The mean age at surgery was 15.9 years (range 2.6~37.9 years). Preoperative and postoperative standing radiographs were used to assess radiographic parameters. Results: The average number of vertebrae in the major curve was 4.2 (range 3~8), and the average flexibility was 29% (range 8~59%). The average length of fusion was 3.5 segments (range 1~6). The number of fused vertebrae had a positive correlation with age at the index surgery (r=0.345, p 0.05). Mean preoperative scoliosis of 48±12。was corrected to a mean of 17±10。 (65% correction), and mean preoperative kyphosis of 46±18。was corrected to a mean of 12±12。at the most recent follow-up. The compensatory curve had a mean of 25±10。preoperatively and spontaneously corrected to a mean of 8±8。(70% correction) at the most recent follow-up. The mean operating time was 233±81 min, with an average blood loss of 2904 ml. There was neither crankshaft phenomenon nor iatrogenic spinal stenosis in 6 patients under the age of 5 years after an average follow- up of 6 years. Conclusions: Posterior hemivertebra excision using pedicle screw instrumentation in congenital scoliosis due to a hemivertebra is a safe and effective procedure. Posterior hemivertebra excision at an early age may reduce the fusion length while avoiding the induction of iatrogenic spinal stenosis during follow-up.

심한 척추변형(측만증 및 후만증)에 대한 척추 후방 절제술

석세일,김진혁,이상민,정의룡,이정희,김성수,정락용 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Purpose To report a technique of vertebral column resection through a single posterior approach and its first results in the treatment of severe spinal deformities. ■ Methods and materials Seventy spinal deformity patients treated by posterior vertebral column resection(PVCR) were reviewed. Minimum follow up was 2 years (2 - 3.3 years). There were 34 males and 36 females with a mean age of 27.4 years at the time of the operation. Etiologic diagnoses were adult scoliosis in 7, congenital kyphoscoliosis in 38, and post-infectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and global fusion. ■ Results The total number of resected vertebrae were 143; 76 in thoracic and 67 in lumbar. Mean operation time was 4 hours 31 minutes with average blood loss of 2333 ml. The deformity correction was 40o in the coronal plane and 5Oo in the sagiotal plane. Complications were encountered in 24 patients: 2 complete cord injuries in severe adult scoliosis and thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections and 5 hemopneumothoraxes. ■ Conclusions PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in the patients with preoperative cord compromise who are the high risk of neurological complications.

척추경 나사못 고정술을 이용한 이중 흉추 청소년기 특발성 척추 측만증의 치료

김진혁(Jin-Hyok Kim),김성수(Sung-Soo Kim),정락용(Nak-Yong Jung),김정훈(Jung-Hun Kim),한정일(Jung-Il Han),라호종(Ho-Jong Ra),이상진(Sang-Jin Lee),석세일(Se-Il Suk) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.5

목적: 척추경 나사못을 이용한 이중 흉추 청소년기 특발성 척추 측만증의 수술적 치료로 사용되는 척추 전이법과 강봉 감염술의 결과를 평가, 비교하고자 하였다. 대상 및 방법: 수술 후 최소 2년 이상(2-8.8년)의 추시 관찰이 가능했던 환자 47명을 후향적으로 조사하였다. 척추 전이술을 사용한 경우(n=14)를 TR군으로, 강봉 감염술을 사용한 경우(n=33)를 RD군으로 분류하였다. 술 전 만곡의 측정값에서 두 군 사이에 유의한 차이는 없었다. 결과: TR군에서 술 전 37±4°의 상부 흉추 만곡과 52±9°의 하부 흉추 만곡은 최종 추시시 각각 24±4° (35%교정)와 18±5o (65%교정)로 호전되었다. RD군에서 술 전 40±7°의 상부 흉추 만곡과 56±12o의 하부 흉추 만곡은 최종 추시시 각각 19±7° (51%교정)와 16±6° (72%교정)로 호전되었다. 상부 흉추 및 하부 흉추 만곡의 교정은 두 군 사이에 유의한 차이가 있어 RD군에서 더 우수하였다(p<0.05). 흉추 후만, 요추 전만, 척추 균형, 어깨 높이 차이, 제1흉추 경사 각도, 유합 범위는 두 군간에 유의한 차이는 없었다. TR군의 수술 시간과 출혈량은 각각 평균 231분과 2,050 ㎖이었으며, RD군은 263분과 3,217 ㎖로 유의한 차이가 있었다(p<0.05). 결론: 강봉 감염술은 더 우수한 상부 및 하부 흉추 만곡의 교정을 보여 주었으며, 척추 전이술은 쉬운 기기 조작으로 짧은 수술 시간 및 적은 출혈량을 나타내었다. Purpose: To compare the results of two different surgical methods (translation vs rod derotation) in a correction of double thoracic adolescent idiopathic scoliosis (AIS) using pedicle screw instrumentation. Materials and Methods: Forty-seven patients with double thoracic AIS treated by pedicle screw instrumentation were reviewed retrospectively after a minimum follow-up of 2 years. The patients were divided into two groups; TR group (translation method, n=14) and RD group (rod derotation, n=33). There were no significant differences in the preoperative curve characteristics between the two groups. Results: In the TR group, the preoperative upper thoracic curve of 37±4° improved to 24±4° (35% correction), and the lower thoracic curve of 52±9° improved to 18±5° (65% correction). In the RD group, the preoperative upper thoracic curve of 40±7° improved to 19±7° (51% correction), and the lower thoracic curve of 56±12° was improved to 16±6° (72% correction). The correction of the upper and lower thoracic curves was significantly better in the RD group (p<0.05). Thoracic sagittal kyphosis was corrected from 21° to 24° in the TR group and from 18° to 26o in the RD group. There was no significant difference in the spinal balance, shoulder height difference, T1 tilt and fusion extent. The operating time and the amount of blood loss was 231 minutes and 2050㎖ in the TR group and 263 minutes and 3217㎖ in the RD group, respectively (p<0.05). Conclusion: In correcting double thoracic AIS using pedicle screw instrumentation, the rod derotation method showed better correction for the upper and lower thoracic curves. The translation method showed the advantages of easier application, a shorter operation time and less blood loss.

척추 변형 수술에서 Aprotinin의 출혈량 감소

석세일(Se-Il Suk),김진혁(Jin-Hyok Kim),김성수(Sung-Soo Kim),김정훈(Jung-Hoon Kim),조범철(Beom-Cheol Cho),정락용(Nak-Young Jung) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.3

목적: 척추 변형 수술은 마취 시간 및 수술 시간이 길어 대량 출혈로 인한 합병증이 흔히 발생한다. 본 논문의 목적은 척추 변형 수술에서 Aprotinin의 효과를 평가, 비교하고자 한다. 대상 및 방법: 척추 변형 수술을 시행 받은 59명을 조사하였으며, 환자는 Aprotinin 투여 군 32명과 비 투여군 27명을 대조 군으로 설정하여 비교하였다. 수술 전후 혈액학적 지표, 술 중 출혈량, 수술 시간, 수혈량과 술 후 흡입 배액 관으로의 출혈량과 흡입 배액관 유지 기간을 측정하였다. 결과: 술 전 두 군 간의 나이, 성비, 키, 몸무게, 혈액학적 지표 및 술 후 흡입 배액 관으로의 출혈량과 흡입 배액관 유지 기간은 두 군 간에 차이가 없었다. 술 중 출혈량, 수혈량 및 수술 시간은 각각 1,345±425 cc, 1,008±721 cc, 247분과 2,070±1,276 cc, 2,552±2,791 cc, 279분으로 양 군 간에 유의한 차이가 있었다. 수술 후 혈색소와 적혈구 용적 수치 또한 각각 12.9±1 cc, 38.3±3.1%와 1l.9±1.8 cc, 35±5.5%로 양 군 간에 유의한 차이를 보였다. 결론: 척추 변형 수술에서 Aprotinin을 사용하여 의미 있는 술 중 출혈량과 수혈량 감소 및 수술 시간 단축을 얻을 수 있었다. 그러므로 많은 출혈이 예상되는 척추 변형 수술 시 Aprotinin 사용이 적극적으로 권장된다. Purpose: Complications are quite common in surgery to correct spinal deformities due to the long duration under anesthesia and massive blood loss. The aim of this study was to evaluate and compare the effectiveness of Aprotinin in spinal deformity surgery. Materials and Methods: Fifty-nine patients who underwent spinal deformity surgery were analyzed. Thirty-two patients were administered Aprotinin, and 27 control patients were not. The Pre-and Post- operative hemoglobin and hematocrit, blood loss, transfusion requirements, operative time, postoperative blood loss through suction drains and duration of suction drains were measured in both groups. Results: There were no differences in age, gender, height, weight, hemodynamic indices, post-operative blood loss through the suction drains and the duration of the suction drains between the two groups. Intraoperative blood loss, transfusion and operative time were 1,345±425 cc, 1,008±721 cc, and 247 minutes in the Aprotinin (+) group and 2,070±1,276 cc, 2,552±2,791 cc, and 279 minutes in the Aprotinin (-) group, respectively. The postoperative hemoglobin and hematocrit levels Werew also significantly different (12.9±1 cc and 38.3±3.1% in the Aprotinin (+) group, and 11.9±1.8 cc and 35±5.5% in the Aprotinin (-) group, respectively). Conclusion: There was significantly less intraoperative blood loss, transfusion and surgery time in the group administered Aprotinin. Therefore, Aprotinin can be used in spinal deformity surgery that has a high risk of massive blood loss.