폴리메틸메타크리레이트를 사용한 경피적 척추성형술의 골다공증 척추체 압박골절에 대한 치료효과 : 예비보고

박춘근,이관성,최영근,류경식,박춘근,조경석,강준기,Park, Chun Kun,Lee, Kwan Sung,Choi, Yung Gun,Ryu, Kyung Sig,Park, Choon Keun,Cho, Kyung Suck,Kang, Joon Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Objectives : To describe a technique for percutaneous vertebroplasty of osteoporotic vertebral body compression fractures and to report preliminary results of its use. Methods : The technique was used over a 8-month period in 9 patients with 10 painful vertebral fractures. The technique involves percutaneous puncture of the involved vertebrae with a Jamshidi needle via a transpedicular approach followed by injection of polymethylmethacrylate(PMMA) into the vertebral body. Results : The procedure was technically successful in all patients, with an average injection amount of 5.9 cc per vertebral body. One patient complained of flank pain postoperatively in spite of improvement in back pain caused by the fractured vertebra. Remaining eight patients reported significant pain relief early after treatment. The patients were followed up for 3 to 15 months(average 7.2 months) and demonstrated no recurrence of pain or aggravation of deformity. Conclusion : Vertebroplasty appears to be a valuable tool in the treatment of painful osteoporotic vertebral fractures, providing acute pain relief and early mobilization in appropriate patients. However, it needs to have more extensive prospective clinical study to confirm its definitive role in the management of this condition.

Barrier Techniques for Spinal Cord Protection from Thermal Injury in Polymethylmethacrylate Reconstruction of Vertebral Body : Experimental and Theoretical Analyses

박춘근,지철,황장회,권성오,성재훈,최승진,이상원,박성찬,조경석,박춘근,강준기,Park, Choon Keun,Ji, Chul,Hwang, Jang Hoe,Kwun, Sung Oh,Sung, Jae Hoon,Choi, Seung Jin,Lee, Sang Won,Park, Sung Chan,Cho, Kyeung Suok,Park, Chun Kun,Yuan, Ha The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3

Polymethylmethacrylate(PMMA)는 척추 전적출술후에 척추를 재건하기 위해 사용되지만 액체 형태의 PMMA가 응고하면서 발생되는 열은 척수 신경의 열 손상 가능성을 가지고 있다. 이 연구의 목적은 이미 응고된 PMMA sheet가 척수 신경을 보호하는 방어 벽으로서의 열 차단 역할을 할 수 있는지 또한 열손상으로부터 신경을 보호하기 위해 필요한 방어벽의 최소한의 두께를 탐구하는 데 있다. 실험실에서 제 12번째 흉추체 전 적출후의 상태와 동일한 크기와 모양의 정육면체의 용기를 제작하였다. 60ml의 액체형 PMMA를 용기 안에 주입하여 응고하는 PMMA중심부와 세 가지 다른 두께의(제 1 군 : 0mm, 제 2 군 : 5mm, 제 3 군 : 8mm) 이미 응고된 PMMA sheet의 하부(척수의 전면을 의미)에서 온도를 측정하였다. 또한 이 결과에 대한 위의 세 가지 군에 대해 열역학적 분석도 시행하였다. 응고하는 PMMA 덩이의 중심부에서의 온도는 18회의 실험 동안 매우 일정하여($106.8{\pm}3.9^{\circ}C$)이 실험 모델의 재현성을 보여주고 있었다. 방어 벽이 없는 군(제 1 군)에서 척수 신경 전면의 최고 온도가 $60.3^{\circ}C$이었으나 5mm군 (제 2 군)과 8mm군(제 3 군)에서는 각각 $47.3^{\circ}C$와 $43.3^{\circ}C$로 이미 응고된 PMMA는 통계적으로 유의한(p<0.00005) 온도 차단 효과를 보였다. 최고 온도에 도달하기까지의 계산된 시간은 실제 실험치 보다 35%이내의 오차를 보였으나 최고 온도에 대한 열역학적인 계산치는 실제 실험에서 나타난 수치의 1%이내의 오차를 보였다. 이상의 열역학적인 자료를 토대로 볼 때, PMMA를 이용한 척추의 재건술에서 PMMA 방어벽은 척수의 열손상을 방지하는 효과가 있으며, 이 실험에서 가정한 척수의 열손상 역치인 $39^{\circ}C$이하로 척수 온도를 유지하기 위해 필요한 PMMA방어벽의 두께는 10mm정도로 계산되었다. PMMA 방어벽의 임상 적용에 대해서는 추가적인 임상 실험이 필요하다고 사료된다. Objective : Polymethylmethacrylate(PMMA) is often used to reconstruct the spine after total corpectomy, but the exothermic curing of liquid PMMA poses a risk of thermal injury to the spinal cord. The purposes of this study are to analyze the heat blocking effect of pre-polymerized PMMA sheet in the corpectomy model and to establish the minimal thickness of PMMA sheet to protect the spinal cord from the thermal injury during PMMA cementation of vertebral body. Materials & Methods : An experimental fixture was fabricated with dimensions similar to those of a T12 corpectomy defect. Sixty milliliters of liquid PMMA were poured into the fixture, and temperature recordings were obtained at the center of the curing PMMA mass and on the undersurface(representing the spinal cord surface) of a prepolymerized PMMA sheet of variable thickness(group 1 : 0mm, group 2 : 5mm, or group 3 : 8mm). Six replicates were tested for each barrier thickness group. Results : Consistent temperatures($106.8{\pm}3.9^{\circ}C$) at center of the curing PMMA mass in eighteen experiments confirmed the reproducibility of the experimental fixture. Peak temperatures on the spinal cord surface were $47.3^{\circ}C$ in group 2, and $43.3^{\circ}C$ in group 3, compared with $60.0^{\circ}C$ in group 1(p<0.00005). So pre-polymerized PMMA provided statistically significant protection from heat transfer. The difference of peak temperature between theoretical and experimental value was less than 1%, while the predicted time was within 35% of experimental values. The data from the theoretical model indicate that a 10mm barrier of PMMA should protect the spinal cord from temperatures greater than $39^{\circ}C$(the threshold for thermal injury in the spinal cord). Conclusion : These results suggest that pre-polymerized PMMA sheet of 10mm thickness may protect the spinal cord from the thermal injury during PMMA reconstruction of vertebral body.

물-에탄올 혼합물을 작동유체로 한 회전형 히트파이프의 전열 특성에 관한 연구

박춘근(Choon-Kun Park),전철호(Chul-Ho Jun),서해성(Hae-Sung Seo) 한국태양에너지학회 1991 한국태양에너지학회 논문집 Vol.11 No.1

내부에 삼각형 핀을 갖는 회전형 히트파이프의 작동유치를 물-에탄올 2성분 유체를 사용하였을 때 Nusselt의 막응축이론을 기초로 하여 핀 및 그루브의 전열특성을 유한요소법에 의한 수치해석을 하였으며 또한 실험을 행하여 비교하였다.<br/> 히트파이프의 회전수가 증가할수록, 내부 증기압이 높을수록 전열량은 완만하게 증가하지만 에탄올 농도가 커질수록 전열량은 감소하였다. 그리고 순수 에탄올만을 작동 유체로 하는 경우는 증류수만을 작동유체로 하는 경우의 전열량의 0.75~0.85정도로 나타났다. 또한 에탄올 농도가 0.2전후에서 전열효과 및 작동온도 범위 등이 가장 유리하게 나타났다. Heat transfer characteristics of a rotating heat pipe have been studied numerically and experimentally with using water-ethanol mixture as working fluid. And triangular fins are attached inside the rotating heat pipe.<br/> Experimental results generally agreed with numerical results.<br/> According to increasing rpm and vapour pressure of the rotating heat pipe, the heat transfer rate increased. And also according to decreasing the concentration of ethanol, the heat transfer rate increased.<br/> In the case of using the pure ethanol as working fluid, the heat transfer rate was about 80% of using distilled water.<br/> The heat transfer rate and operating temperature difference of the rotating heat pipe was much influenced by ethanol concentration, and the optimum ethanol concentration was 0.2.

전방경유 경추체유합술에서 금속판 사용여부의 결과 비교

박춘근,박춘근,조경석,허필우,이일우,강준기 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Although anterior cervical plates are thought to be good tools. their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods. it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore the authors reviewed 80 patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion. thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion. whereas patients undergoing plate placement needed only semi-rigid philadelphia braces for 4 to 8 weeks postoperatively. Two patients(8%) showed graft settling and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations. and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.

뇌종양과 유사한 혈전형성된 거대 후교통동맥류 수술적 치험 1예 : A Case Report

박춘근,김문찬,박춘근,김달수,강준기,송진언 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3

A giant intracranial aneurysm(GIA) is an aneurysm greater than 2.5㎝ in size. GIA may simulate brain tumor on computed tomography scans. We report a case of giant thrombosed posterior communicationg artery aneurysm simulating brain tumor. To minimize brain retraction and achieve excellent exposure in the shortest possible distance during the operation, we used a new surgical technique, an orbitozygomatic infratemporal approach, with good results.

전방 또는 전측방 흉수 종양 수술에서 후측방도달법

조경석,박춘근,성재훈,허필우,박춘근,백민우,김달수,강준기 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

Giant Global Intracranial Aneurysm in an Infant : Case Report

Kang, Joon Ki,Park, Chun Kun,Kim, Moon Chan,Huh, Choon Wong,Ha, Young Soo,Song, Jin Un,Chi, Je G. 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.1

저자들은 10개월된 유아의 중뇌동맥에 선천성으로 발생한 거대한 구상 뇌동맥류 1례를 치험하였다. 환자는 진행성 우측 반신부전마비와 심부전등을 주소로 입원하였으며, 이학적 검사, 뇌전산화 단층촬영 및 우측 경동맥 조영술로 확진되어 별다른 합병증없이 수술로 완전 적출되었다. 저자들은 문헌고찰과 함께 이와같은 동맥류의 생성기전, 병리소견 및 수술요법에 관하여 논하였다.

신경근 압박증상을 동반한 천추내 경막외 낭종 : "현성 천추부 수막류"와 "Tarlov의 낭종" "Occult Sacral Meningocele" and "Tarlov's Cyst"

최영근,박춘근,최승진,박춘근,이상원,강준기,최창락 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.1

Twenty eight year-old male with 3 year history of radiating pain to both thighs and thirty six year-old female with one year history of perineal hypesthesia and constipation were presented. The clinical features, radiologic features, surgical techniques and complications are discribed. In both cases, postoperative cerebrospinal fluid leakage was developed and managed successfully with lumbar drainage and rest respectively. The preoperatively presented symptoms were completely disappeared after surgery.

급성 허혈성 뇌병소에 대한 혈압강하의 영향에 관한 실험적 연구

허춘웅,박춘근,김문찬,김달수,하영수,강준기,송진언 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Controlled hypotension and temporary clip of feeding artery are used to reduce bleeding and to facilitate the neurosurgical operations, especially in intracranial aneurysm surgery, but the microvasculature of acute ischemic brain from impaired blood flow is quite susceptible to decrease in blood pressure and blood volume. The reversibility of brain damage following an ischemic brain lesion depends on the amount of regional cerebral blood flow as well as the severity of ischemia. The present study was designed to elucidate the effect of controlled hypotension on cerebral blood flow, cerebrovascular resistance, and pathological changes in acute ischemic brain lesion. Cerebral ischemia was induced in cats by middle cerebral artery occlusion for 6 hours through the transorbital appraoch. Forty-nine cats were divided into 3 groups, namely control group with mean blood pressure maintained at normal after right middle cerebral artery occlusion, hemorrhagic hypotension group with mean blood pressure decreased to 80, 60, and 40 ㎜Hg by with drawing of blood after right middle cerebral artery occlusion and drug-induced hypotension group with mean blood pressure decreased to 80, 60, and 40 ㎜Hg with arfonad infusion after right middle cerebral artery occlusion Regional cerebral blood flow was measured by the hydrogen clearance method following middle cerebral artery clipping and gradual decreasing mean blood pressure. Cerebrovascular resistance was calculated after regional cerebral blood flow was measured and size of infarct were examined in each groups after the experiment was completed. Results were as follows: 1) In control group, regional cerebral blood flow and cerebrovascular resistance of the right parietal area with mean blood pressure maintained at normal after right middle cerebral artery occlusion were 19.4±2.1㎖/2.1㎖/100g/min and 5.5±0.4㎜Hg/㎖/100g/min. The size of cerebral infarct was minimal in 71% of the control group. 2) In hemorrhagic hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure decreased to 80, 60, and 40 ㎜Hg was 17.6 ±1.5, 15.4±3.8, and 7.8±2.9㎖/100g/min respectively, thus 6, 25, and 57% lower than the control group. Cerebrovascular resistance of the right parietal area with mean blood pressure at 80 and 60㎜Hg was 4.7±0.1 and 4.5±0.3㎜Hg/㎖/100g/min respectively, thus showing a gradual decrease in relation to the decreasing mean blood pressure. With mean blood pressure reduced to 40 ㎜Hg, the cerebrovascular resistance drastically increased to 5.1±0.5㎜Hg/㎖/100g/min. When mean blood pressure was reduced to 60 and 40 ㎜Hg, the size of infarct was marked in 57 and 85% of the hemorrhagic hypotension group. 3) In drug-induced hypotension group, regional cerebral blood flow of the right parietal area with mean blood pressure reduced to 80, 60, and 40 ㎜Hg was 19.1±2.3, 17.8±3.1, and 7.4±2.7㎖/100g/min respectively, thus 2, 10, and 38% lower than the control group. The regional cerebral blood flow of the right parietal area in the drug-induced hypotension group was slightly higher than the hemorrhagic hypotension group when mean blood pressure was reduced to 80 or 60㎜Hg, while there was no significant difference of regional cerebral blood flow in the both groups when mean blood pressure was reduced to 40㎜Hg. Cerebrovascular resistance of the right parietal area with mean blood pressure at 80 and 60 ㎜Hg was 4.1±0.3 and 3.1±0.2㎜Hg/㎖/100g/min respectively, thus showing a gradual decrease in relation to decreasing mean blood pressure. With mean blood pressure reduced to 40㎜Hg, the cerebrovascular resistance was 5.6±0.9㎜Hg/㎖/100g/min, thus higher than the hemorrhagic hypotension group. When mean blood pressure was decreased to 60 and 40 ㎜Hg, the size of infarct was marked in 42 and 85% of the drug-induced hypotension group. The extent of cerebral infarct was more extensive in the hemorrhagic hypotension group than in the drug-induced hypotension. 4) In the contralateral hemisphere of the infarct, there was no change in regional cerebral blood flow when the mean blood pressure was decreased to 80 and 60㎜Hg but when the mean blood pressure decreased to 40㎜Hg, the regional cerebral blood flow was markedly reduced in all groups. When the mean blood pressure decreased to 60 ㎜Hg there was no change in cerebrovascular resistance, however when the mean blood pressure was at 40 ㎜Hg, there was a drastic increase in cerebrovascular resistance in all groups. Due to loss of autoregulation in the ischemic brain lesion, the regional cerebral blood flow depends on the brain perfusion pressure and accordingly when there is ischemic brain lesion., the hemorrhagic hypotension produces serious brain infarction and edema than drug-induced hypotension.

흉추 및 흉요추 이행부의 전방 또는 전측방 병변시 후측방도달법

조경석,박춘근,허필우,유도성,김달수,강준기 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.8