경추성증성 신경근증

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Degenerative cervical disc disease comprises a spectrum of disorders ranging from internal disc disruption to focal soft disc hemiations to spondylosis with its osteophyte formation. The process may be isolated to a single level in the cervical spine or involve multiple levels, most commonly in the subaxial cervical spine. Cervical spondylosis is a manifestation of cervical disc degenetation and cervical radiculopathy occurs as a result of compression or distortion of a cervical nerve root. Cervical radiculopathy includes the constellation of pain and/or nerve deficit in the distribution of a specific cervical nerve root. This condition may be related to a variety of possible compressive pathologies. This article reviews the natural history of cervical spondylotic radiculopathy and relates it to the development of clinical manifestations, including the evaluation as well as the nonoperative and operative management of such problems.

흉요추 수술의 합병증

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2004 The Medical Journal of Chosun University Vol.29 No.1

퇴행성 요추부 질환의 병태생리

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2003 The Medical Journal of Chosun University Vol.28 No.2

Age-related changes in the lumbar spine manifest as a pathologic, symptomatic disease process in some patients. As the population ages and symptomatic spine diseases are becoming- ubiquitous, much more concern has been concentrated on the cause of spine degeneration. Many asymptomatic population shows spine degeneration on MRI study. So, the degeneration itself is not the only pain generator. The spectrum of changes seen in the normal aging spine anatomically, biochemically, biomechanically, and radiographically may also occur, to an exaggerated extent in the pathologically degenerated spine. But the precise cause and sequence of spine degeneration in the spine remain unknown. The degenerative changes of spine causes many symptomatic diseases such as disc hei-niation, spinal stenosis, internal disc disruption, and degenerative scoliosis. Clinical manifestations of these diseases are low back pain, radiating pain and referred pain. The degenerative changes that occur in the various components of the spine are reviewed here along with various mechanisms that might cause these changes.

단분절 후방 척추 고정술에서 추궁판 갈고리와 추경 나사못 추가 고정의 생체역학적 연구

유재원,임태홍 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study Design: This biomechanical study was designed to perform flexibility tests in multiple loading directions to compare the stabilizing effects of supplemental hook or pedicle screw fixation on short segment pedicle instrumentation system. Objective: To compare biomechanical flexibilities of short segment pedicle instrumentation constructs added by hook or pedicle screw fixation in an unstable calf spine model. Summary of Background Data: Short segment pedicle instrumentation is using recently for the surgical treatment of the unstable burst fractures of the thoracolumbar spine, but a high incidence.. of early screw failure in short segment pedicle instrumentation has reported. Materials and Methods: Ten fresh frozen calf spines (T10-L3) were loaded with pure unconstrained moments in flexion, extension, axial rotation. and lateral bending directions. A maximum moment of 6.4 Nm was achieved in 5 steps using dead weights. After removal of L1 vertebral body, testing was performed on intact specimens first and then each specimen after laminar hook or pedicle screw insertion on the short segment pedicle instrumentation of ISOLA implant. Any kinds of graft material or transfixation device were not used to make the worst possible case of instability of an injured spine. Three different fixation methods were instrumented. These included: (1) one level above and one level below with pedicle screw, (2) 2 levels above with pedicle screw and hook and one level below with pedicle screw. and (3) 2 levels above and one level below with pedicle screws. Results: At the level of corpectomy, all fixation methods significantly reduced motions in flexion, extension, and lateral bending as compared to the intact motion (P<0.001). The differences between all constructs were not statistically significant. The addition of a hook or screw on the short segment pedicle screw construct was not significantly reduced the flexibility as compared to the short segment pedicle screw construct. Axial rotational motions in groups I, II, and III were similar with each other and with intact motion as well and there were no significant statistical difference. The addition of the hook or screw on the short segment pedicle construct showed more stability as compared to the pedicle screw construct, but statistical difference was not. The addition of hook or screw on the short segment pedicle screw construct showed similar stability i n all motions with each other. At the level above corpectomy, all tested fixation methods did not improve the axial rotational stability beyond the intact case, but reduced flexion, extension, and lateral bending motions significantly (p<0.001). The addition of hook or screw on the short segment pedicle screw construct showed significant stability in all motions (p<0.001) as compared to the short segment pedicle screw construct and their stabilities were similar with each other. Conclusions: All fixation methods showed more stabilities in all motions than normal specimen. The addition of pedicle screw on the short segment pedicle screw constructs are more stable than the addition of hook, but there was no statistical difference. Adding one level of fixation cranial to the fracture using pedicle screws or hooks may be necessary to decrease the rate of clinical failure and to enhance the stability of the construct with short segment pedicle instrumentation.

요추 추간판 질환

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2003 The Medical Journal of Chosun University Vol.28 No.2

Low back pain is a common medical problem and reported overall prevalence is 60-80% of general populations. Most of the low back pain comes from disc degeneration. Degenerative disc disease is broadly defined as "a clinical syndrome characterized by manifestations of disc degeneration and symptoms thought to be related to those changes." Disc degeneration does not necessarily produce symptoms but it is believed to be the aging process of the spine. Despite the extensive research to understand the pathophysiology of disc degeneration, the precise cause and pathophysiology of disc degeneration have not been revealed to date. This article reviews the pathophysiology of lumbar disc disease, especially the intervertebral disc herniation, and relates it to the development of clinical manifestations, including the evaluation as well as the nonoperative and operative management of such problems. 요추간판 질환은 추간판의 퇴행성 변화와 더불어 원인적인 여러인자가 복합되어 발생함에 의해 면밀한 검사가 필요하다. 요추간판 질환은 자연경과에 따라 증상이 호전될 수 있으나 보존적인 치료가 우선되어야하며 증상이 지속될 때에는 수술적인 치료가 필요하다. 수술적 치료의 성공여부는 정확한 적응증과 금기증의 적용 그리고 정확한 시술 등에 의하여 결정된다. 최근 진단기기 그리고 수술환경의 개선과 수술수기 및 척추기기의 개발로 인해 괄목할만한 임상결과를 보이고 있으나 이들의 부작용 또한 무시할 수 없는 실정임을 감안할 때 수술적 치료의 환자선택은 가장 중요하다고 할 수 있으며 수술방법 등은 최근 최소 침습 수술기법 등이 다양하게 이용되고 있으나 술자의 기술 등 여러요인을 고려하여 선택하는 것이 바람직하다고 하겠다.

청소년기 특발성 척추 측만증의 원인 및 자연사

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Adolescent idiopathic scoliosis(AIS) is a structural lateral curvature of the spine in the adolescent period in otherwise normal children. The diagnosis is obtained through evidence of a lO-degree lateral curvature with vertebral rotation on a standing upright radiograph of the spine, Prevalence studies indicate that 2% to 3% of children have idiopathic scoliosis. The exact etiology of idiopathic scoliosis, however, remains unknown at this time. The general consensus is that there is a hereditary predisposition and its actual cause is multifactohal. Approphate decisions for AIS require thorough knowledge of natural history, Understanding the natural history enables physicians to make thoughtful and appropriate management decisions that will alter the course of the disease in a positive way. The main concerns in the natural history are curve progression, back pain, Pulmonary function, mortality, Psychosocial effects and pregnancy, Previous natural history studies claimed an exaggerated results. Many recent results, however, are comparable to general population other than back pain and cosmetic concerns. 척추 측만증에 대한 원인과 자연사에 대하여 많은 보고가 있지만 아직까지 확실한 단일 원인은 밝혀지지 않았고 원인으로 생각되는 요소가 측만증의 원인인지 아니면 측만증에 의한 이차적인 변화인지 확실하지 않은 경우가 많다. 자연사는 과거의 보고는 요통, 폐기능, 사망률, 임신 등에서 정상인에 비해 좋지 않은 결과를 보인다는 보고가 많았으나 최근 보고는 정상인과 비슷하거나 약간 나쁜 정도의 결과를 보고하고 있다. 앞에서 언급한 내용틀은 일반적인 내용이며 측만증 환자에 대한 치료에 임할때는 측만증의 자연사에 대한 지식과 만곡의 크기, 골격 성숙도, 성 성숙도, 나이 등에 기초한 만곡의 진행 가능성을 충분히 고려하여 각각의 환자에 맞는 치료를 시행하여야 할 것이다.

송아지 요추와 인간 요추 모델의 생역학적 비교

유재원,손홍문 朝鮮大學校 附設 醫學硏究所 2002 The Medical Journal of Chosun University Vol.27 No.2

Background and Objectives : We performed biomechanical flexibility tests using identical methods and instrumentation on calf and cadaveric lumbar spines to determine the differences between the two models. Materials and Methods : Five fresh calf spines and five cadaver lumbar spines(L2-L5) were used for flexibility tests. Three reflective markers were attached to L3 and L4 Maximum moments of 6.4 Nm were achieved in five increments of 1.6 Nm. The rotations of L3 with respect to L4 were measured to determine the stability of the specimens in five cases'. 1) intact; 2) partial discectomy, including partial lammectomy and facetomy: 3) partial discectomy with ISOLA pedicle screw instrumentation: 4) total discectomy with instrumentation: and 5) instrumentation with intel-body graft. Results : In both models, an increase in motion was observed after the partial discectomy, instrumentation reduced motion beyond the intact, and the total discectomy increased motion in all cases, Placement of the interbody graft decreased motion in axial rotation, flexion and extension, but increased motion in lateral bending. A two-way ANOVA showed no significant differences between the two models during flexion and extension(P>0.05); however, differences were noted during axial rotation and lateral bending(p<0.05). Conclusions : Calf lumbar spines can serve as a substitute for human cadaveric spines in biomechanical tests. The extrapolation of calf spine data to the in vivo case, especially during axial rotation and lateral bending, should carefully consider the variations between the two models.

고식적 검사로 간외 전이를 진단하지 못한 원발성 간암 환자에서 간이식 전에 시행한 전신 FDG-PET의 역할

이원우,류진숙,양유정,김재승,여정석,문대혁,이승규 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.6

목적: 원발성 간암의 치료를 위해 간이식이 시행되고 있으나, 8-54%의 환자에서는 이식 후 원격 전이로 인한 재발이 보고 되고 있다. 이 연구는 간이식 예정인 원발성 간암 환자들에서 고식적인 검사로 진단하지 못한 간의 전이 진단에 있어서 FDG-PET의 유용성을 평가하고자 시행되었다. 대상 및 방법: 2001년 8월 이후 본원에서 간이식을 계획하고 전신 FDG-PET을 시행한 환자 중, FDG-PET 검사 이전에 복부 초음파와 CT, 흉부 x선 검사와 CT, 골스캔 등의 고식적인 검사를 시행하여 전이의 증거가 없거나(n=22), 애매한 이상 소견이 있었던(n=4) 원발성 간암 환자 26명(남:여=23:3), 평균 나이 55.7세)을 조사하였다. FDG-PET에서 양성을 보인 결과는 조직 검사나 임상적인 추적 검사로 전이 여부를 확인하였다. 결과: 고식적 검사에서 애매한 이상 소견이 있었던 환자 4명 중 3명의 6개 병변이 FDG-PET에서 국소 대사 항진을 보였고, 전이로 확인되어 간이식을 시행하지 않았다. 이 중 5 병변들은 의심되지 않았던 부위에서 새로 발견된 것이었다. 다른 1명은 PET에서 음성 소견으로 간이식을 시행하였다. 고식적인 검사에서 전이를 의심할 만한 소견이 없었던 22명 중에서는 5명의 환자에서 7개의 간의 국소 대사항진 병변들이 FDG-PET에서 발견되었는데, 이들 줄 1명은 2 개의 전이 병변이 확인되어 간이식을 시행하지 않았다. 다른 4명의 환자들에서 보인 5개의 국소 대사항진 병변들은 양성병변으로 확인되었고 이 중 3명은 간이식을 시행하였다. 요약하면, FDG-PET으로 4명의 환자에서 고식적인 검사로 찾지 못하던 전이 병변을 찾아 불필요한 간이식을 피할 수 있었다. 모두 17명에서 간이식이 시행되었다. 간의 조직 검사 소견과 비교하였을 때 생존 원발성 간암을 진단하는 FDG-PET의 민감도는 55.6% (5/9)이었고, 특이도는 87.5% (7/8)이었다. 결론: FDG-PET 전신 스캔은 간이식 예정인 원발성 간암 환자들에서 이전에 시행한 고식적인 검사들로 진단하지 못한 전이 병소들을 추가로 진단하여 불필요한 간이식 수술을 줄이는데 기여할 수 있었다. Purpose: Liver transplantation (LT), one of the therapeutic options of primary liver cancer has been suffering from recurrence caused by metastasis in 8-54% of patients. This study was performed to investigate whether FDG-PET is useful for detecting hidden metastasis in LT candidates. Materials and Methods: Twenty-six patients (male:female=23:3, mean age 55.7 year) underwent FDG-PET. Their previous conventional diagnostic studies (CDS) like a abdomen US and CT, chest x-ray and CT, and bone scan were negative (n=22) or equivocal (n=4) for metastasis. Positive FDG-PET findings were confirmed by biopsy or clinical follow-up. Results: Among 4 patients with equivocal metastatic lesions on CDS, 3 had 6 hypermetabolic lesions on FDG-PET, which were confirmed as metastasis and subsequently LTs were cancelled. Of these, 5 lesions were initially negative on CDS. Remained 1 patient underwent LT with a negative FDG-PET result. Among 22 patients without metastasis on CDS, 5 had 7 hypermetabolic lesions on FDG-PET. One of these patients proved to have 2 metastatic lesions, and LT was cancelled. The other 4patients had 5 hypermetabolic lesions on FDG-PET, which were confirmed as benign lesions, and 3 patients of them underwent LT. In summary, FDG-PET was useful in avoiding 4 unwarranted LT by detecting unsuspected metastatic lesions on CDS. A total of 17 patients underwent LT. In comparison with pathology, the sensitivity and specificity of FDG-PET for detecting viable primary liver cancer were 55.6% (5/9) and 87.5% (7/8), respectively. Conclusion: FDG-PET can detect additional hidden metastasis and contribute to reducing unwarranted LT in the patients with primary liver cancer. (Korean J Nucl Med 2002;36;368-80)

구분모우드합성법을 이용한 판의 모우드해석

정재훈,박영필,유원희 연세대학교 산업기술연구소 1991 논문집 Vol.23 No.2

Component mode synthesis which is one of substructure synthesis methods is studied for the determination of vibration characteristics of plate problem. Comparisons are made in terms of accuracy and computational efficiency. As a result, computation time of component mode synthesis is much shorter than that of whole structure analysis. In lower modes natural frequencies obtained from component mode synthesis are almost equal to those obtained from whole structure analysis, but in higher the differences of results obtained from two methods are increased.

치골결합의 외상성 분리에 대한 치료

하상호,유재원,이상홍,신동민,표영배,안병관 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.2

The separation of symphysis pubis as a result of injury is uncommon, but it is increasing in number in parallel with today's speedy development of car industry. Most cases of the separation of symphysis pubis are amenable to closed treatments, but unstble separation where the reduction is difficult to maintain may require open techniques. Authors analyzed 27 cases of traumatic separation of symphysis pubis with 16 months follow-up on an average, who had been treated at the Orthopaedic Department, Chosun University Hospital. The results obtained were as follows; 1. The most common cause was traffic accident (81.5%). 2. Among of 27 patients, instability on the posterior stabilizer of pelvic bone was noticed in 18 patients. 3. Fifteen patients were treated with closed methods(bed rest, hammock, traction)and twelves were treated by the open reduction and internal fixation. 4. Internal fixations were carried out with plate and screw(5 cases), screw and wiring(4 cases), and wiring (3 cases). 5. The separation of symphysis pubis with minimal disruption of posterior stabilizer were treated by closed treatment or internal fixation of the separation of symphysis pubis diastasis alone, and its result was good or excellent. 6. We think that the symphysis pubis diastasis with severe disruption of posterior stabilizer should be fixed anteriorly and posteriorly both.