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흉강경을 이용한 측만증 교정술 후 척추 체 축상회전의 변화
오성균(Sung Kyun Oh),정성수(Sung Soo Chung),강창석(Chang Suk Kang),김연상(Yeon Sang Kim),곽봉준(Bong Jun Kwag),이종서(Chong Suh Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5
목적: 흉강경을 이용한 측만증의 전방 교정술시 효과적인 측만증의 반회전이 일어나는 지와 기기 술이 이루어진 분절 내와 그 원위 및 근위 부에서의 회전의 양상을 알아보고자 하였다. 대상 및 방법: 특발성 측만증환자 20명에서 술 전과 술 후에 척추 전장에 걸친 자기공명 검사를 시행하였고 이들에서 각각의 척추 체에서의 횡단면상을 얻어 Aaro씨 방법을 이용하여 수술 전 후의 척추 체의 축상 회전각을 측정하였다. 첨추체 부위, 기기 술 근위부위 및 윈위부위, 그리고 기기 술이 이루어지지 않은 척추 체로의 분절 이행부위에서의 척추 체 반회전각을 비교하였다. 또한 각각의 부위에서의 분절간 회전과 분절간 반회전 정도를 계산하였다. 통계적 분석은 2원 배치 분산분석 (2-way ANOVA) 및 Wilcoxon 부호순위 검정을 이용하여 분석하였다. 결과: 첨추체 부위에서의 평균 축상 회전각은 술 전 10.1도였으며 술 후 5.3도로 평균 48%의 축상 회전 교정율을 얻을 수 있었다. 첨추체 부위에서의 반회전은 기기 술 근위부 및 원위부에 비해 큰 값을 보였으며 원위부에서는 유의한 반회전은 일어나지 않았으나(p=0.023) 근위부의 경우는 의의 있는 반회전을 보였다(p<0.001). 술후 기기 숨이 이루어지지 않은 근위 및 원위부의 첫 척추체는 기기 술 끝 척추의 방향과 동일한 방향으로 의의 있게 회전하였다. 분절간 회전은 기기 술 근위부 및 원위부에서 술 전과 술 후에 모두 첨추체부위 보다 더 큰 값을 보였지만 분절간 반회전은 기기 술이 행해진 근위부 및 원위부 그리고 첨추체 부위 모두에서 균일하게 일어났다. 기기 술이 이루어 지지 않은 분절 이행 부위에서는 술 전 분절간 회전은 기기 술이 행해진 근위부나 원위부와 동등한 값을 보였지만 수술 후 분절간 반회전은 경미하였다. 결론: 흉강경을 이용한 측만증의 전방 교정술은 각 척추 체의 반회전과 분절간 반회전을 통해 효과적인 회전변형에 대한 교정이 이루어지는 것으로 생각된다. Purpose: In this study, we investigated whether thoracoscopic anterior correction can effectively derotates the scoliotic spine and we also evaluated the patterns of derotational changes inside the instrumented area and at the junction between the instrumented and un instrumented area. Materials and Methods: Preoperative and postoperative MR images with single axial cuts through each vertebral level were obtained in 20 patients who underwent thoracoscopic anterior instrumentation. Each vertebral rotation was measured by the use of Aaro's method. Vertebral axial derotation of the apical zone (AZ), upper instrumented zone (UIZ), lower instrumented zone (LIZ) and junctional segment were compared. The amount of segmental rotation and segmental derotation in each zone was calculated. Statistical analysis was performed by the use of by 2-way ANOVA and the Wilcoxon signed ranks test. Results: The average axial rotations at AZ were 10.1° preoperatively and 5.3° postoperatively with an average correction rate of 48%. Derotation of the AZ was greater than the UIZ and LIZ. For the LIZ derotation was not significant (p=0.023) while for the UIZ there was a significant derotation (p < 0.001). Postoperatively, the first uninstrumented vertebra rotated significantly in the direction of rotation of the instrumented end vertebra. Preoperative and postoperative segmental rotation was higher in the UIZ and LIZ than in the AZ. However, segmental derotation occurred uniformly in the instrumented area. At the junctional segment, preoperative segmental rotation was same as that of the UIZ and LIZ and segmental derotation was not significant. Conclusion: Thoracoscopic scoliosis correction can achieve effective axial correction by causing derotation of each of the vertebral bodies and segmental derotation.
임신길,오민석,임준섭,강명기,곽연상,박승규,송경배,김한웅,Yim, Sin Gil,Oh, Min Suk,Lim, Jun Seob,Kang, Myung Gi,Kwak, Yeon Sang,Park, Seung Gyu,Song, Gyung Bae,Kim, Han Yung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2
Arteriovenous malformations of the face and scalp are uncommon. We report a patient with facial AVM feeding from external carotid artery. This 26-year old man presented with an arteriovenous malformation involving left forehead. The patient first noted a coin-sized lesion on the site 20 years previously after blunt trauma which progressively enlarged. Surgical resection of AVM was performed after ligation of feeding artery.
임신길,오민석,임준섭,강명기,곽연상,박승규,송경배,김한웅,Yim, Sin Gil,Oh, Min Suk,Lim, Jun Seob,Kang, Myung Gi,Kwak, Yeon Sang,Park, Seung Gyu,Song, Gyung Bae,Kim, Han Yung 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2
Objectives : CT-guided stereotactic evacuation for spontaneous intracerebral hemorrhage can minimize the brain damage and can be performed safely and simply under local anesthesia. But that procedure is time consuming and has a risk of rebleeding because of the stress during head pin fixation. So authors describe easy and precise guidelines for FHA of putaminal hemorrhage without stereotactic instrument. Methods and Materials : We analyzed the data of 298 patients who underwent CT-guided stereotactic aspiration of putaminal hematoma in our hospital between January 1990 and December 2000. We divided the patients into three groups according to the location of hematoma : anterior portion, middle portion and posterior portion of putamen. Total number of catheters inserted into the hematoma were 345 and there were with regard to the direction and depth of catheters. Results : Proposed guidelines of catheter insertion to putaminal hemorrhage in our institution. 1) hematoma at the anterior portion of putamen ; Direction of catheter was the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between external auditory meatus(EOM) and 1cm posterior to EOM. Depth of catheter was 6-6.5cm. 2) hematoma at the middle portion of putamen ; Direction of catheter was the midpupillary line of the the eye and the point intersecting a line drawn from the burr hole to a point between 1cm and 2cm posterior to EOM. Depth of catheter was 6.5-7cm. 3) hematoma at the posterior portion of putamen ; Direction of catheter was 15 degree laterally from the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between 2cm and 3cm posterior to EOM. Depth of catheter was 7-7.5cm. We have performed FHA of putaminal hemorrhage in 48 cases according to this guideline. All catheter were inserted exactly at the center of hematoma and average operation time was about 30 minutes. Conclusion : Our proposed guidelines for putaminal hemorrhage are considered to be safe and simple method with similar accuracy and rapid decompression compared with traditional stereotactic method. Main advantages of this technique were unnecessity of stereotactic frame application and less time requirement for hematoma removal.