골다공증이 있는 요추에 대한 척추경 나사못 기기술식에서 골시멘트 보강의 효과

조계남,윤형구,전호승,전승주,조한준,홍정우,이준용 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.3

골다공증이 있는 요추 척추관 협착증에서 후방 추체간 유합술의 유용성

조계남,윤형구,전호승,전승주,김우성 대한척추외과학회 1999 대한척추외과학회지 Vol.6 No.3

연구 계획 : 골다공증이 있는 요추 척추관 협착증을 후방 감압술 및 후방 추체간 유합술로 치료한 2 2례를 대상으 로 방사선학적 및 임상적 결과를 분석하였다. 연구 목적 : 골다공증이 있는 요추 척추관 협착증에서 불안정성이나 변형이 동반되었거나 전주 결손이 있어 후방 기기술을 요하는 경우에, 감압술 시에 얻은 자가골을 충전한 cage를 이용하여 후방 추체간 유합술을 추가하는 것이 유용한 지를 알아보고자 하였다. 대상 및 방법 : 1996년 6월부터 1998년 7월까지 Jikei씨 골다공증 분류상 제 I, II/III 등급에 속하는 요추 척추관 협 착증 환자에서 후방 감압술 및 후방 추체간 유합술을 시행한 22례를 대상으로 하였으며, 평균 추시기간은 1.4년이었다. 척추관 협착증에 분절 불안정 척추, 변형, 추간판 탈출증이 있고 추간판 간격이 현저히 감소된 경우나 척추 전방 전위증을 동반한 경우를 추체간 유합술의 적응증으로 삼았다. 방사선학적 평가는 술 전, 술 후 및 최종 추시시의 요추 측면 방사선 사진을 이용하여 Cobb 방법을 이용한 유합 분절의 시상각과, 추간판 높이의 술 후 교정도 및 추시 중 복원의 소실 정도를 측정하였고, 최종 추시 시의 임상적 결과의 판정은 Kirkaldy-Willis 기준을 사용하였다. 결과 : 유합 분절의 술 전, 술 후 및 최종 추시 시의 평균 시상각은 7.8°, 17.8°, 16.7°로 술 후 평균 10°의 교정 ( p < 0.05 )을 얻었고, 최종 추시 시의 교정의 소실은 평균 2.8°( p > 0.05 )였으며, 각 시기별 추간판 높이의 변화는 평균 24.7%, 46%, 42.1%로 술 후 평균 21.3 %의 교정( p < 0.05 )을 얻었고, 최종 교정의 소실은 평균 3.9 % ( p > 0.05 )였다. 임상 적 결과는 우수 2례, 양호 16례, 보통 4례를 보였고, 18례( 81.8 % )에서 양호 이상의 만족스러운 결과를 보였다. 수술 중의 합병증으로는 경막 파열이 1례, 불완전 신경근 손상이 1례였으며, 술 후 합병증으로는 지속적인 하지 동통이 1례, 불유합이 1례에서 발생되었다. 결론 : 골다공증이 있는 요추 척추관 협착증에서 분절 불안정성 척추, 척추 전방 전위증, 추간판 절제술 후나 시상 각의 복원 후 전주 결손이 뚜렷하거나 변형이 동반되어 후방 기기술을 해야하는 경우에, cage를 이용한 후방 추체 간 유합술을 추가하는 술식은, 조기에 나사못의 이완을 방지하고 복원된 시상각 및 추간판 높이와 변형의 교정을 효과적으로 유지할 수 있고, 임상적으로 만족스러운 결과를 예상할 수 있는 하나의 대안이 될 수 있을 것으로 사료 되는 바이다. Study Design : The preoperative and postoperative lateral radiograms and clinical results were analyzed in 22 cases of lumbar spinal stenosis with osteoporosis treated by posterior decompression and posterior lumbar interbody fusion. Objectives : To assess the efficiency of the cage-instrumented posterior lumbar interbody fusion in lumbar spinal stenosis with osteoporosis. Summary of Literature Review : Problems in surgical treatment of osteoporotic spinal stenosis were early screw loosening and early reversal to the original deformity because of insufficient mechanical stability in the bone-screw interface, and special strategy is essential for transpedicle screwing to sustain axial and screw cut-up load applied by flexion-extension motion in vivo. Materials and Methods : We reviewed 22 cases of lumbar spinal stenosis with osteoporosis(Jikei grade I, II/III) from June 1996 to July 1998 with an average follow up period of 1.4 years. Inclusion criteria was combined segmental instability, deformity, spondylolisthesis and herniated nucleus pulposus with significant disc space narrowing. We asssessed the radiographic results of sagittal angle correction(SAC) of the instrumented segment and disc height restoration(DHR) on the preoperative, postoperative and last follow up lumbar lateral views, and clinical results according to the Kirkaldy-Willis criteria. Results : Postoperative mean SAC gain was 10°(p<0.05) and mean SAC loss at last follow up was 1.1°(p>0.05). Postoperative mean DHR gain was 21.3%(p<0.05) and mean SAC loss at last follow up was 3.9%(p>0.05). The clinical result was analyzed as 2 excellent(9.1%), 16 good(72.7%), 4 fair(18.2%) and no poor. There were 2 intraoperative complications of a dural tear and a nerve root injury and 2 postoperative complications of a transient radiculopathy and a pseudoarthrosis. Conclusions : Cage-instrumented posterior lumbar interbody fusion can be an option for the lumbar spinal stenosis with osteoporosis requiring instrumentation because of instability, deformity or postdiscectomy anterior column deficiency.

요추 및 흉요추 골절에 대하여 추체성형술을 병행한 단분절 척추경 나사못 기기술 및 유합술

조계남,윤형구,전호승,전승주,최재호,노경선 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.2

방선균 감염에 의한 척추 골수염

조계남(Kye-Nam Cho),윤형구(Hyung-Ku Yoon),전호승(Ho-Seung Jeon),전승주(Seung-Ju Jeon),김형삼(Hyung-Sam Kim) 대한정형외과학회 2001 대한정형외과학회지 Vol.36 No.2

증상을 동반한 쇄골 불유합의 수술적 치료

전호승,조계남,한홍권,윤형구 대한골절학회 2000 대한골절학회지 Vol.13 No.1

Purpose : The nonunion after mid-shaft clavicular fracture is predisposed by refracture, interposition of the soft tissue, complete displacement of the fracture fragment and bony defect with comminuted fracture by the high-energy trauma. Symptomatic nonunion may need surgical treatment. The purpose of this study is to assess the functional and radiological results of the surgical treatment of the symptomatic nonunion of the clavicle. Materials and Methods: We reviewed 10 cases of symptomatic clavicular nonunion managed with surgical treatment from January, 1994 to May, 1997. The age at operation ranged from 26 to 60 years old (average 46.5 years). The average length of follow-up was 1.7 years (range, 1 to 3 years). According to the scoring system of Rowe, the function of the shoulder was evaluated. Results: All cases were united and radiologic union was obtained at 10.2 weeks on average after surgery. On functional results, average score on pain was 9.9(3-12), average score on stability was 24.5(20-25), average score on function was 21.0(10-25). In motion, average score on abduction and forward flexion was 11.0(7-15), average score on internal and external rotation were 3.8(3-5), 3.3(0-5). According to the scoring system of Rowe, excellent in 6 cases, good in 3 cases, fair in 1 cases and the average of the total score were 83.8 Conclusion: We concluded that open reduction and internal fixation by plate or intramedullary device with autogenous bone graft could provide the relief of symptom and effective results of shoulder function in the symptomatic nonunion of the clavicle.

무지를 제외한 일측 수부에 발생한 수근중수골 관절의 골절 및 탈구 - 증례 보고 -

전호승,조계남,윤형구,한홍권 대한골절학회 1999 대한골절학회지 Vol.12 No.1

Fracture-Dislocations of the ulnar carpometacarpal joints is an uncommon injury. The priorities of management of other more extensive injuries often delay definitive treatment. If such a dislocation is diagnosed early, it can be reduced easily by closed means. We reviewed one case of fracture-dislocation of carpometacarpal joints excluding thumb with stable and pain free carpometacarpal joints in one year after closed reduction and internal fixation.

70세 이상의 대퇴 경부 골절에서 골시멘트를 이용한 양극성 고관절 성형술의 임상적 결과

전호승,조계남,윤형구,이종화 대한골절학회 1998 대한골절학회지 Vol.11 No.2

There have been much controversy about prosthetic replacement or internal fixation for patients over 70 years old. Authors reviewed and analyzed 45 cases of cemented bipolar hemiarthroplasty in patient over 70 years treated at the Department of Orthopedic Surgery, Sung-Ae General hospital from January l988 to July 1995. The purpose of this study was to analyse the clinical and radiological results and to detect the motion study of bipolar cup. Follow up period was average 26.1 months, ranged from 24 months to 37 months. The following results were obtained. l. In clinical evaluation, excellent & goad result were in 31 cases(68.87o). 2. In radiologic evaluation, acetabular erosion were in 2 cases and loosening of the femoral component was in 1 case. 3. With time elapsed, the amount of the inner bearing motion was decreasing with preservation of the total joint motion. 4. Complications were idiopathic pain 7 cases, nerve paresis 2 cases, superficial infection 2 cases, intraoperative fracture I case, dislocation I case, loosening 1 case.

삽관 나사못을 이용한 경골 고평부 골절의 치료

전승주,전호승,조계남,윤형구,정강우 대한골절학회 2001 대한골절학회지 Vol.14 No.1

Purpose: The results of treatment of tibial plateau fractures by extensive soft tissue exposure were less satisfactory even if anatomical reduction was achieved. The purpose of this study is to assess the functional and radiological results of the treatment of tibial plateau fractures by cannulated screw fixation to decrease soft tissue injury and operation time. Materials and Methods: From January 1996 to February 2000, 19 patients were treated by limited open reduction and internal fixation by cannulated screw. According to scoring of Rasmussen, the functional results were rated. Results: In all cases, Bony union was obtained and according to scoring of Rasmussen, excellent in 1 case, good in 14, fair in 4 cases. There were 2 cases of limitation of joint motion and 2 cases of persistant pain as sequale. Conclusion: We considered that if accurate preoperative evaluation was done, Cannulated screw fixaction was easier and faster method than other methods for treatment of tibial plateau fractures.

소아에서 상완골 과상부 골절과 동반된 신경손상의 회복

전승주,전호승,조계남,윤형구,강철원 대한골절학회 2000 대한골절학회지 Vol.13 No.1

Purpose: The purpose of our study is to determine the incidence of spontaneous recovery from neural injuries associated with supracondylar fractures of the humerus and to assess the results of electromyographic study and nerve conduction velocity. Materials & Methods: The 160 displaced supracondylar fractures of the humerus which had operation at the Sung Ae general hospital between April 1994 and June 1998 were reviewed. Twelve(7.5%) were associated with complete neural injuries involving 16 nerves; 9 radial, 5 ulnar and 2 median nerves. The mean age was 7.8 years old and boys outnumbered girls by 9 to 3. The follow-up period ranged from 1 year to 5 years 2 months. 11 fractures were managed with closed reduction and one with open means. All of the neural injuries were initially managed only by closed observation. At recent follow-up examination, we assessed the motor and sensory neurological status with Seddon’ s modification, grip strength and two-point discrimination in the autonomous zone. Electromyography(EMG) and nerve conduction velocity(NCV) were performed in 13 nerves of 10 patients who were assessed as completely recovered clinically. Result: Spontaneous neurological recovery occurred in 11 patients(15 nerves) at a mean of 2.4 months(range, 2 to 3.5 months). Clinically, these nerves were assessed as normal. In the EMG and NCVs, 4 of 13 nerves resulted in adnormal findings. 2 radial and 1 ulnar nerve showed mild sensory neuropathy and 1 ulnar nerve showed mild denervation potentials in EMG and slow motor and sensory NCVs. Conclusion: We think that neural injuries associated with the displaced supracondylar fractures of the humerus tend towards spontaneous recovery within 4 months. And even though the neurologic recoveries are clinically complete, these are not always completely recovered in electromyographic study and nerve conduction velocity.

흉요추 방출성 골절의 보존적 치료 또는 후방기기술 후 치료 결과에 미치는 인자들

윤형구,전호승,조계남,강승일 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.2

Study Design : This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures. Objectives : To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure. Summary of Literature Review : In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic. Materials and Methods : We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group I consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analyzed with the Denis' pain and work scores, and were compared between groups on anterior body height and local kyphosis. Results : A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group I and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, Ⅱ /Ⅲ), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01). Conclusions : Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.