퇴행성 요추 질환의 수술 후 척추-골반 지표의 임상적 의미

박수안,이주헌 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

Study Design: A review of the literature. Objectives: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. Summary of Literature Review: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. Materials and Methods: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. Results: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. Conclusions: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques. 연구 계획: 종설. 목적: 시상면 척추 변형이 동반되었거나 동반되지 않은 요추 퇴행성 질환 환자를 대상으로 척추-골반 정열 관점에서 어떻게 환자를 분석하고 그 결과를해석하여 임상에 적용할 지에 대하여 논의하고자 한다. 선행문헌의 요약: 다양한 척추-골반 지표들이 척추 환자의 분석에 사용되고 있지만, 여러 임상 증례에서 각각 다르게 나타나기도 하고, 몇가지 교란 요인들에 의해서 측정값이 영향을 받는 등의 이유로, 척추-골반 지표는 해석하기 어려운 문제가 있다. 대상 및 방법: 각각의 척추-골반 지표와 측정값에 영향을 미치는 요인들에 대하여 설명하였다. 요추 퇴행성 질환 환자중 척추 변형이 있는 경우와 없는 경우에 어떻게 측정된 지표를 해석하고 치료에 활용할지에 대하여 설명하였다. 각각의 주제에 대하여 문헌 고찰과 저자의 경험을 토대로 작성하였다. 결과: SRS-Schwab 분류에서 사용되는 3개의 시상면 수정지표인 골반 입사각-요추 전만각(PI-LL), 시상면 수직축(SVA), 골반 경사각(PT)이 시상면 척추변형을 동반한 요추 퇴행성 질환을 평가하는 대표적 지표로 사용되고 있다. 시상면 재정열 수술은 PI를 참고하여 LL를 교정하므로써 수술 후 SVA와 PT 가 회복되도록 하는 것이지만, SVA와 PT가 과도하게 큰 환자나 SVA는 크지만 PT가 PI에 비해 상대적으로 매우 작은 환자들은 재정열을 목표로 수술 하더라도 수술 후 부정 정열이 남을 수 있기 때문에 주의를 요한다. 척추 변형이 없는 요추 퇴행성 질환의 수술에서도 10도 이상의 PI-LL mismatch가 존재한다면 병소 분절의 전만각이 증가하도록 교정하는 것이 술 후 임상증상을 보다 효율적으로 개선시키는 방법이다. 결론: SRS-Schwab 분류에서 사용하는 3개의 시상면 수정지표는 간단하고 이해하기 쉬운 면은 장점이지만 척추 세부 지역의 변형을 평가할 수 없는 단점이 있다. 더불어 척추-골반 지표는 임상에서 사용함에 있어 유용하지만, 환자의 자세, 관찰자, 측정 방법 등에 따라 오차 범위가 커지는 점을 기억해야한다.

고희화 열화 균류의 분리ㆍ동정

박수안,이동흡,전철,조병묵 한국공업화학회 2001 한국공업화학회 연구논문 초록집 Vol.2001 No.-

예로부터 우리나라는 닥을 주요 섬유 원료로, 황촉규근을 첨가제로 사용하여 한지를 제조하였다. 이러한 종이는 천년이 지나도 보존 가능한 장점을 지니고 있다. 그러나, 이러한 종이 또한 온도나 습도에 의해, 미생물에 의해 손상을 받기 쉽기 때문에 보존 과정상 많은 문제점이 노출되게 된다. 지류 문화재의 열화 원인은 물리ㆍ화학적 요인과 생물학적 요인 및 기타 인위적인 요인 등으로 구분할 수 있는데, 특히 박물관에서 사람들의 접촉 정도, 개인 소장 시의 보관 미숙으로 열화가 촉진될 가능성이 크다. 지류문화재의 생물열화과정은 특정 균류의 일종에 의하여 열화되는 것이 아니고 다양한 미생물류가 관여하며, 각 균류의 특이적인 분해과정이 작용하는 복합적 미생물열화 천이로 이루어지는 것으로 알려져 있다. 따라서, 미생물에 의한 지류문화재의 생물열화를 최소화시키기 위해서는 열화에 관련된 미생물 특성을 올바르게 파악할 필요가 있다. 본 연구에서는 고홍 수도암 칠성불화와 전남 승주군 회령 송광사 승보전유물(삼세불화) 보수 시 열화가 심하여 교체되고 남은 지류조각으로부터 미생물열화 균류를 분리하였다. 실험결과, 균류 94종과 세균류 35여종이 분리되었으며, 그중 흑색 및 청색곰팡이류가 대부분 이었다. 또한 자낭균류 6종 및 접합균류 3종도 분리되었다.

고회화 열화 균류의 분리,동정

박수안,이동흡,전철,조병묵 한국공업화학회 2001 응용화학 Vol.5 No.1

저피섬유로 제조한 수록한지의 특성에 관한 연구

박수안(Soo Ahn Park),김성주(Seong Ju Kim),전철(Cheol Cheon) 원광대학교 생명자원과학연구소 1998 생명자원과학연구 Vol.20 No.-

고령 척추 질환자의 치료: 중재적 비수술 치료

박수안(Soo-An Park) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.1

인구 구조의 고령화로 인하여 일반적인 척추 질환과는 구분되는 고령 환자에서 특징적인 척추 질환이 호발하는 추세이다. 하지만 고령의 척추 환자는 대부분 내과적 질환을 동반하기 때문에 전신 상태가 불량한 경우가 많고 골다공증을 동반하며 보다 넓은 범위에 걸친 심한 퇴행성 변화를 보이기도 하고 치료에 대한 효율성이 떨어지는 측면이 있어서 고령 척추 환자에 특화된 비수술 치료의 정립이 필요하다. 이에 저자는 노인성 척추 질환 중 문제가 될 만한 주제를 선별하고 각각의 경우에 적용 가능한 중재적 비수술 치료 방법에 대하여 살펴보고자 하였다. Owing to the upward shift in age structure, there is an increasing number of spinal diseases specific to elderly patients. Elderly spinal patients typically have a poor general condition with several medical comorbidities, low bone mineral density, more extensive and severe degeneration, and less effective treatment outcomes than young patients. This is why spinal physicians need to establish interventional nonsurgical treatment modalities for elderly patients with spinal disease. The objective of this study was to define the spinal disorders problematic to elderly patients and discuss the nonsurgical treatments for each subject.

Polyethylene Glycol 에 의한 수록한지의 광 변색 억제

전철,박수안 한국임학회 2000 한국산림과학회지 Vol.89 No.2

Classified handmade Korean paper which has been commonly used as the material for the paper cultural assets divide into four classes. We irradiated xenon arc lamp, which has almost the same spectrum distribution as natural sunlight, to test photo-induced of discoloration according to PEG molecular weight and concentration. So, we reach the followings. 1) Unbleached handmade Korean paper with PEG showed rapid decrease of brightness for 10 hours after photo-irradiation, regardless of molecular weight of PEG, but, after 10 hours, it showed gradual increase of brightness. From this, it proved that there was an effect of preventing discoloration of photo-irradiation. 2) Chemical bleached handmade Korean paper showed increase of brightness after 20 hours. Though time was delayed in increase of brightness, there was also an effect of preventing discoloration of photo-irradiation in chemical bleached paper. 3) Handmade Korean paper made with abet-mosk showed the lowest of brightness when it was tested on 400-20% PEG. Before photo-irradiation, the brightness of paper, applied it, was the lowest, but it showed the least difference of brightness after photo-irradiation. From this, it proved that there was the greatest effect of preventing discoloration in this paper. 4) Preventing yellowish, the first phenomena by photo-irradiation ageing with applying PEG was proved that there was the decrease of value of b^* +, and increase value of L^*, which could fairly prevent decrease of brightness.

경추 외상성 경막외 혈종 : 증례 보고 A Case Report

장한,박원종,박수안 대한척추외과학회 1996 대한척추외과학회지 Vol.3 No.2

Traumatic epidural hematoma is a very rare pathologic entity. A 58-year-old female is presented with acute traumatic epidural hematoma in the cervical spine. She developed incomplete quadriplegia after motor vehicle accident and recovered spontaneously six weeks after the trauma without surgical treatment. The diagnosis was made on magnetic resonance imaging, which also demonstrated subsequent complete resolution of the hematoma.

관혈적 정복 및 내고정으로 치료한 근위 경골외과 골절

손종민,장주해,박수안,안동헌 대한골절학회 1996 대한골절학회지 Vol.9 No.1

Tibial condyle fracture involving articular surface can produce some disabilities of the knee because they are usually accompanied with the injuries of the ligaments and menisci. Though recent studies suggest that anatomical reduction and rigid fixation of the fracture followed by early knee mobilization have improved clinical end results, the results were not always successful. The lateral condyle fracture is more often in the incidence than the medial one. This is due to the physiologic valgus of the knee, the weaker trabeculation under the lateral tibial plateau, and the increased frequency of valgus injuties as the knee is protected medially by the contralateral side. Eighteen lateral condyle fractures of the tibia treated by open reduction and internal fixation at the Our Lady of Mercy Hospital from June 1991 through February 1995 were analized. The results are as follows. 1. The patients were 13 males and 5 females, mean age was 39.2 years and mean follow up-period was 19.2 months. 2. The most common cause was motor vehicle accident(8 cases, 44.4%). 3. The most frequent type of fracture was split(8 cases, 44.4%) by Rasmussen's lateral condyle fracture classification and the next was split-compression(6 cases, 33.3%). 4. According to Blokker's criteria, 15 cases(83.3%) had satisfactory results. Among 3 cases of unsatisfactory results, I developed secondary degenerative change, I had valgus instability and 1 secondary degenerative change and mild valgus instability. It is thought that the most important factor influencing results was the anatomical reduction of the articular surface, rigid fixation and early joint mobilization.

불안정 비구골절의 수술적 치료 : 수술시 문제점 및 합병증을 중심으로 Clinical analysis of 28 cases with consideration of surgical problems and complications

김인,우영균,김용식,송석환,권순용,박수안 대한골절학회 1994 대한골절학회지 Vol.7 No.2

Authors reviewed total 28 cases of acetabular fracture with operative management followed up over 1 year. The clinical results were retrospectively analyzed with consideration of surgical prohlems and complications. The overall results were as follows: l. According to the classification by Judet and Letournel(l974), 20 cases were elementary fractures and 8 cases were associated fractures. The posterior wall fractures were most common in 9 cases. 2. Kocher-Langenbeck approach in 18 cases, ilioinguinal in 4 cases, iliofemoral in 4 cases and triradiate transtrochanteric approach in 2 cases were used. 3. The devices for internal fixation were as follows: screw only in 8 cases. plate and screw in 14 cases, plate and screw with circumferential wiring in 4 cases, wire and staple only in 1 each case. 4. The early and late complications occurred postoperatively as follows: incomplete sciatic nerve palsy 2 cases, wound infection 2 cases as early complications and posttraumatic arthritis 6 cases, avascular necrocis of femoral head 2 cases, heterotropic oscification 1 case as late complications. Two cases of sciatic nerve palsy were spontaneously recovered and 2 cases of wound infection were controlled by adequate drainage and antibiotic therapy. And then, the total hip arthroplasty were carried out for 2 cases of avascular necrosis of femoral head, and 6 cases of posttaumatic arthritis and 1 case of heterotopic ossification were under observation. 5. Postoperatively, the causes of inadequate reduction and insufficient fixation were radiographically analyzed with immediately and lastly checked plain films, of which causes in 9 cases were as follows: inappropriate approach for exposure in 4 cases, delayed operation due to major associated injury over 3 weeks in 3 cases and severe comminution in 2 cases. As a result, we reached to put an emphasis on an importatnce of preoperative planning, including the evaluation of individual fracture personality, the choice of surgical approach and the method of intemal fixation.

비심멘트 반구형 비구부품의 고정방법에 따른 부품의 안착성에 대한 연구 -반구형 부품의 선상고정, 압박고정 및 이중반경 부품의 고정에 대한 비교-

김용식 ( Yong Sik Kim ),우영균 ( Young Kyun Woo ),권순용 ( Soon Yong Kwon ),김기원 ( Ki Won Kim ),이화성 ( Hwa Sung Lee ),이성재 ( Sung Jae Lee ),박수안 ( Soo An Park ) 대한고관절학회 1996 Hip and Pelvis Vol.8 No.2

Thirty-eight paired, size-matched, fresh-frozen cadaver acetabular were used to study reamed surface topography and the seating of on-line versus oversized noncemented components. Four commonly used constructs were considered: on-line reamed and 2-mm oversized hemispherical cups, and on-line reamed and 1-mm oversized dual-radius cups. Reamed surface topography was indexed by three-dimensional surfaces mathematically fitted to digitized castings. Component seating was indexed by the distribution of bone-cup contact and the thickness of the gap between the component backing and the bone. The reamed surfaces were better approximately by slightly blunt ellipsoids than by spheres, especially for the smaller acetabulae. Seating of the on-line hemispherical cups was best near the pole and poorest near the equator, whereas the converse was true for the 1-mm oversized dual-radius cups. The on-line dual-radius cups offered better overall compromise between polar and equatorial contact than did the 2-mm oversized hemispherical components.