스포츠 두부 손상

윤영설,진동규,김긍년,장진우,김영수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

Head injury is the most frequent direct cause of death in sports. Furthermore, injury to the head takes an singular importance when we realise the brain is neither capable of regeneration nor, unlike many other body parts and organs, of transplantaion. Every effort must be made to protect the athlete's head as injury can lead to dementia, epilepsy, paralysis and death. There are three distinct types of stress that can be generated by an acceleration force to the head : compressive, tensile and shearing forces. The differential diagnosis with a head injury includes cerebral concussion, intracranial hemorrhage, postconcussion syndrome, second impact syndrome, malignant brain edema. 90 to 95% of all head injuries are cerebral concussions and more than 90% all cerebral concussions fall into mild categories. With a head injury the ABCs of first aid must be followed and then a neurological examination will be followed. In the case of the intracranial hematoma. definite surgical evacuation is indicated and in cases of the closed head injuries and most severe degree of concussion. observation is appropriate, with careful neurological monitoring. Over the last 20 years there has been a dramatic decrease in the most serious head injuries due to multiple factors. There are five areas that can affect a reduction in head injuries. The first two involve rules and coaching technique changes. The other three areas involve improvements in conditioning (especially of the neck), equipment, and finally medical supervision. The reduction in incidence and severity of athletic head injury gas been the results of changes and improvements instituted following constant study and research. And also, for the reduction in incidence of athletic head injury every effort or team physician, athletic trainer, physical trainer and team coaches should be necessary.

Long-term surgical outcomes of cervical myelopathy with athetoid cerebral palsy.

Kim, Keung Nyun,Ahn, Poong Gee,Ryu, Mi Jung,Shin, Dong Ah,Yi, Seong,Yoon, Do Heum,Ha, Yoon Springer-Verlag 2014 European spine journal Vol.23 No.7

<P>To understand the long-term surgical outcomes and prognostic factors for the operative treatment of cervical myelopathy (CM) in patients with athetoid cerebral palsy (ACP).</P>

Effect of primate bone marrow stromal cells on survival and neurite outgrowth

Kim, Keung Nyun,Guest, James D.,Oh, Jin Soo,Pennant, William A.,Yoon, Do Heum,Ha, Yoon Lippincott Williams Wilkins, Inc. 2010 NEUROREPORT - Vol.21 No.13

We tested whether bone marrow stromal cells (BMSCs) could enhance the survival and neurite growth of dorsal root ganglia (DRG) through substrate effects or secreted factors. Our results showed that in DRG with BMSCs and BMSC-conditioned media cultures compared with DRG-fibroblast cultures, there was a significant increase in the number and length of, area covered by, and number of cells with definite neurites. In cytokine assays with conditioned media, vascular endothelial growth factor, granulocyte macrophage colony-stimulating factor, and IL-6 secreted by BMSCs may contribute to observed neurotrophic effects. These findings indicate that BMSCs of adult Macaca fascicularis increased neuronal survival and promoted neurite outgrowth of DRG by means of secretory factors.

Robot-assisted anterior lumbar interbody fusion (ALIF) using retroperitoneal approach

Kim, Minji J.,Ha, Yoon,Yang, Moon Sool,Yoon, Do Heum,Kim, Keung Nyun,Kim, Hoon,Yang, Joong Won,Lee, John Y. K.,Yi, Seong,Jung, Woo Joo,Rha, Koon Ho Springer-Verlag 2010 Acta neurochirurgica Vol.152 No.4

척추관 협찬증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관협착증 환자들은 주로 60세 이상의 고령환자로장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술후환χ}들의 재원일수의 증가는병원의 병상가 동률을감소시키고, 전공의에게는불필요한 업무를 증가시킨다. 연구목적: 비용·효과면에서 최적화된 진료지침의 개발은 불필요한 의료비의 감소및 Hospital Induced Complication을 줄여 환자만족도를증진시킬 수 있으며, 각 환자에 대한전공의 업무를 줄일 수있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문 요양기관 연구방법: 정형외과및 신경외과의 척추관협착증환자 의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program (EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과': CP 적용전, 후비교를통해 재원일수는 3.8일 이 감소하였으며, 이에 따라 병상가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교검토중이다. 또한,CP 개발및 CP Master Program의 사용을 통한 전공의 업무감소에 대해 검토하고 있다.

척추관 협착증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,신현주,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영,Lee, Hwan Mo,Kim, Ho Jung,Kim, Keung Nyun,Ahn, Poong Gi,Chun, Jahae,Shin, Hyun-Ju,Kim, Yang Soo,Shin, Hye Sun,Kim, In Sook,Chung, Hye Kyung,Kim, You 한국의료질향상학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관 협착증 환자들은 주로 60세 이상의 고령환자로 장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술 후 환자들의 재원일수의 증가는 병원의 병상가동률을 감소시키고, 전공의에게는 불필요한 업무를 증가시킨다. 연구목적: 비용 효과면에서 최적화된 진료 지침의 개발은 불필요한 의료비의 감소 및 Hospital Induced Complication을 줄여 환자 만족도를 증진시킬 수 있으며, 각 환자에 대한 전공의 업무를 줄일 수 있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문요양기관 연구방법: 정형외과 및 신경외과의 척추관 협착증 환자의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program(EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과: CP 적용 전, 후 비교를 통해 재원일수는 3.8일이 감소하였으며, 이에 따라 병상 가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교 검토 중이다. 또한, CP 개발 및 CP Master Program의 사용을 통한 전공의 업무 감소에 대해 검토하고 있다.

뇌동맥류와 고혈압의 관계에 대한 임상적 연구

김긍년,주진양,이규창 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.9

To investigate relationship between intracranial aneurysm and systemic hypertension, 199 consecutive cases of intracranial aneurysm which were treated surgically were analized in regard to the incidence of hypertension and to the effect of hypertension on their outcome. The incidence of hypertension in cases with aneurysm was higher than in general population. Multiple aneurysm patients had significantly higher incidence of hypertension than single aneurysm paients did. The amount of subarachnoid clot on postictal CT scan and neurological status on admission were not statistically different between hypertensive and normotensive group. Frequency of rebleeding was significantly higher in hypertensive group than in normotensive group. The incidence of cerebral vasospasm or hydrocephalus was statistically not significant between hypertensive group and normotensive group. The clinical outcome was similar between two groups.

Surgical Management of Gorham-Stout Disease in Cervical Compression Fracture with Cervicothoracic Fusion: Case Report and Review of Literature

Kim, Jung Hwa,Yoon, Do Heum,Kim, Keung Nyun,Shin, Dong Ah,Yi, Seong,Kang, Jiin,Ha, Yoon Elsevier 2019 World neurosurgery Vol.129 No.-

<P><B>Background</B></P> <P>Gorham-Stout disease (GSD) or “vanishing bone” disease is characterized by progressive osteolysis with intraosseous lymphangiomatosis (hemangiomatosis). Given its rarity, with about 300 reported cases, its pathophysiology, etiology, and treatment guidelines are not established yet.</P> <P><B>Case Description</B></P> <P>A 22-year-old man was admitted to Severance Hospital with the chief complaint of neck pain from an injury due to falling. Initial cervical radiography showed a C4 burst fracture, and cervical magnetic resonance imaging revealed diffuse osteolytic lesions with coarse trabeculation with T2 hyperintensity and T1 enhancement in the entire cervical and upper thoracic area. He had a previous history of chylothorax that was still noticeable on a chest radiograph at the time of admission. A 2-stage operation was conducted. First, anterior corpectomy of C4 and anterior plate fixation of C3-5 were performed. Second, a week later, posterior fixation of C3-5 was performed. Thereafter, the patient was discharged without any neurologic complications. However, during the 1-month follow-up, asymptomatic progressive kyphosis was detected via radiography, and posterior cervical fusion of C2-T4 was performed. A minimal postoperative symptom of an intermittent left arm pain of 4–5 on the visual analog scale was experienced. No further deformity progression was noted until the last outpatient follow-up.</P> <P><B>Conclusions</B></P> <P>Spinal GSD can cause severe deformity and neurologic deficits such as paralysis. Although treatment for GSD is not established, surgical treatment is recommended in severe deformity or aggravated neurologic deficit. The appropriate timing of surgery is after the arrest of osteolysis. Magnetic resonance imaging could be helpful in determining stable GSD.</P>

Effective Dose of Peri-operative Oral Pregabalin as an Adjunct to Multimodal Analgesic Regimen in Lumbar Spinal Fusion Surgery

Kim, Jong Chan,Choi, Yong Seon,Kim, Keung Nyun,Shim, Jae Kwang,Lee, Ji Yeon,Kwak, Young Lan Lippincott Williams Wilkins, Inc. 2011 1528-1159) Vol.36 No.6

STUDY DESIGN.: A prospective, randomized, controlled, and double-blind trial. OBJECTIVE.: To evaluate the effects of 2 different doses of perioperative pregabalin administration, twice on the day of surgery, on acute postoperative pain after spinal surgery. SUMMARY OF BACKGROUND DATA.: Besides its well-established role on neuropathic pain, pregabalin seems to be a promising adjunct to multimodal analgesic regimen following surgery. No comprehensive data exist regarding the optimal dosage of pregabalin on reducing postoperative pain and opioid consumption in spinal surgery. METHODS.: Patients were randomly assigned to 1 of 3 groups. The placebo group (n = 28) received placebo capsules 1 hour before the anesthetic induction and 12 hours after surgery. The pregabalin groups received pregabalin 75 mg (P75 group, n = 28) or 150 mg (P150 group, n = 28), respectively at the same points. Assessed variables were total amount of administered fentanyl-based intravenous patient-controlled analgesia, pain intensity, and the frequency of rescue analgesic administered during the first 48 hours after surgery, subdivided into the following 4 periods: on arrival of patient to the postanesthesia care unit, 1 to 6 hours, 6 to 24 hours, and 24 to 48 hours. RESULTS.: The amount of patient-controlled analgesia volume infused until 24 hours (P 5 0.025) and 48 hours (P 5 0.028) after surgery was significantly less in the P150 group compared with the control group. The frequency of additional anodynes administered until 6 hours (P 5 0.049) and 24 hours (P 5 0.045) after surgery was significantly less in the P150 group compared with the control group. CONCLUSION.: Perioperative administration of pregabalin 150 mg before and 12 hours after surgery, but not 75 mg, significantly reduced opioid consumption and the use of additional pain rescue for 48 hours after surgery without significant side effects in patients undergoing spinal fusion surgery.

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

Kim, Hyung Cheol,Jeon, Hyeongseok,Jeong, Yeong Ha,Park, Sangman,An, Seong Bae,Heo, Jeong Hyun,Shin, Dong Ah,Yi, Seong,Kim, Keung Nyun,Ha, Yoon,Cho, Sung-Rae The Korean Neurosurgical Society 2021 Journal of Korean neurosurgical society Vol.64 No.5

Objective : Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP. Methods : Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained pre- and postoperatively and compared between those with and without postoperative complications. Results : Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications. Conclusion : The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.