흉요추부 및 요추부 방출성골절의 치료 : 후방 돌출골편의 감압술 시행여부에 따른 결과비교

왕진만,김동준,김석우 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study design : Thirty-eight patients with thoracolumbar and lumbar burst fractures were evaluated according to the treatment methods of the retropulsed fragments. Objective : To confirm the pure effect of ligamentotaxi s according to the approaching methods to the involved area. Summary of Back ground data : Retropulsed fragments were effectively treated by indirect posterior reduction. Regardless of size of the retropulsed fragments, remodelling process of the retropulsed fragments was progressed during follow-up period. Methods : 38 patients with burst fractures of thoracolumbar and lumbar spine were divided into two groups according to the reduction method of the retropulsed fragments ; the one group consisted of 18 cases which were treated by posterior instrumentation and indirect reduction(Group I : ligamentotaxis) and the other groups consisted of 20 cases which were treated by posterior instrumentation and posterior direct reduction(Group Ⅱ). Change of neural canal compromise rate, neurologic status, remodelling process of the retropulsed fragments were measured using pre-, post-operative and follow-up radiographs and CT. Results : Comparing the two groups, neural canal compromise rates were decreased at postoperati ve period but, there were no significant differences in both groups. There were no correlation of neurologic status and neural canal compromise rate. We could confirm the remodelling process of the retropulsed fragments, but there were no significant changes according to the size of the retropulsed fragments between two groups. Conclusions : Indirect reduction by posterior instrumentation( ligamentotaxis ) could effectively treat the retropulsed fragments in burst fractures of thoracolumbar and lumbar spine without direct posterior reduction.

전방 추체 유합술의 이식골 공여부와 연관된 합병증의 경과

왕진만,김동준 대한척추외과학회 1996 대한척추외과학회지 Vol.3 No.2

Large blocks of corticocancellous bone are required for anterior interbody fusion, and are usually taken from the anterior aspect of the ilium. However many studies have shown that the iliac crest autograft harvest is not risk free. The present study was designed to determine the cause, rate, and risk factors for iliac crest donor site complications. The purpose of this study was to identify problems amenable to procedural improvement that could further decrease iliac crest donor site morbidity. The author prospectively evaluated 45 patients who had no cord injury and underwent anterior interbody fusion using autogenous iliac bone graft between June 1994 and December 1994. Thirtyeight patients were available at the final follow-up. The study group was composed with these 38 patients, 17 men and 21 women, with average age of 41.7 years (range, 25-67 years). The average duration of follow-up was eighteen months (range, fifteen to twenty montys). Bone graft was taken from the anterior two-third of the ilium, approached through a separate incision overlying to the iliac crest. A full thickness tricortical block was taken using reciprocating saw. The morbidities were periodically evaluated by physical examination and visual analogue scale(VAS). The average score of the donor site pain was 40.3 points at two weeks postoperatively, and it was markedly improved to 18.1 pints at three months. At one year follow-up evalution, the score was 9.4 points. Sensory deficit was noted in 34 patients (89.5%) and motor weakness was in 35 patients (92%) at two weeks postoperatively. The numbers of the patients with these deficits were decreased to five and six respectively by three months after the operation. Of ten patients complained limping gait, one had weakness of hip flexor and mild limping gait at final follow-up.

흉·요추 골절 및 골절탈구에 대한 임상적 연구

왕진만 梨花女子大學校 醫科大學 醫科學硏究所 1983 EMJ (Ewha medical journal) Vol.6 No.1

The rate of the spine fracture tends to be increased as the rate of traffic and ind-ustrial accidents are increased. One hundred and fifteen thoraco-lumbar spine fractures and fracture-dislocations out of 81 patients were evaluated from March, 1976 to September, 1981 treated at the Department of Orthpaedic Surgery of Ewha University Hospital. 1. The majority(64.1%) of the spine fracture was found in the age group of 20 to 50 years. 58% of the cases were coused by fall down injury. There was no difference between sex. 2. Most common site of the lesion occured getween T12 and L2 vertebrae(65.2%) and flexion fracture(56%) was most common. 3. Thirteen cases of the total were complicated by paraplegia, of which 76.9% was caused by rotational frecture-dislocation. 4. Prognosis for neurological recovery in initially complete lesion was poor, rega-rdless of treatment. About 15% initially complete lesion showed complete recovery and 47% showed incomplete recovery.

척추결핵의 임상적 연구

왕진만 梨花女子大學校 醫科大學 醫科學硏究所 1982 EMJ (Ewha medical journal) Vol.5 No.4

The spinal tuberculosis has been decreased because of development of anti-tu-berculosis drugs and the new surgical procedures but still have challenging pro-blems in Korea. Fourty-eight cases of spinal tuberculosis were treated with conservative and sur-gical treatments during 6 years from 1976 to 1981 at Ewha Univ. Hospital with fol-lowing results ; 1. The age distribution showed the peak incidence in the first decade. 2. The predilection site was the thoracic area(49.2%) 3. In 35.4% of the cases, anti-TB drug was taken befure surgery. 4. Paraplegia showed in 29.2% of cases. 5. In paraplegia, most involved bodies were in the thoracic and lumbar vertebra and the percentage was 85.7%. 6. The recovery rate of the paraplegia was 92.9%. 7. Anterior fusion was performed in 35.4%, and the posterior fusion was perfor-med in 31.3%. 8. The kypotic angle was increased according to the numbers of involved vertebra.

척추불안정성이 동반된 척추분리증에 대한 후방기기 및 전방추체유합술

왕진만,김동준 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2

Most of patients with spondylolysis do not need surgical treatment. However, for patients who have persistent pain that is unresponsive to conservative measures, operative intervention seemed to be indicated. A recently developed technique for the surgical treatment of spondylol- ysis involves the direct repair of the spondylolytic defect with bone graft. Although many advantages these procedure, some authors point out that the procedures should be limited to younger patients, because in the older patient there is concomitant degenerative disc disease that is frequently present. This disc lesion is a possible source of persistent symptom after fusion of the spondylolytic defect. It seems that adults require a more reliable fixation. This study examines the long-term follow up and satisfaction level of patients who underwent staged posterior instrumentation and anterior interbody fusion in attempt to analyze the effec- tiveness of this procedure. Thi study includes twenty-one patients who had spondylolysis with segmental instability underwent staged posterior instrumentation and anterior interbody fusion at Ewha University Hospital from 1989 to 1922. Average age was 39 years from the range of 31 to 60 years. The mean follow-up was 18 months from the range of 12 months to 5 years. The fusion rate was 86% and the clinical results were satisfactory in 81%. The most common complication was the donor site pain. The data suggest that this strategy is safe and effective when performed in adult spondyloly- sis. It produces high fusion rates and satisfactory clinical results.

Visual Analogue Scale(VAS)을 이용한 동통평가의 유용성

왕진만,김동준 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.2

In spine injury pain is the overwhelming indicator for treatment. Despite of its widespread prevalence, objective data assessing the pain and the results of various forms of treatment are largely lacking in Korea. In order to compare the value of different types of treatment, it is necessary to develop standardized and meaningful forms of assessment. Thirty-nine patients with a diagnosis of spinal stenosis, spodylolisthesis or herniated disc entered the study. Mean age was 48 ranged from 24 to 71. An initial questionnaire was developed by adoption of the Million's Pain Score. Each question was answered by patients. Marking on a Visual Analogue Scale and repeated one bour later. Statistical analysis using SPSS(V3.2) was performed for reproducibility of the questionnaire. The questions shown unsatisfactory degree of agreement (a correlation less than 0.7) were replaced with new questions seeking similar information but designed to produce less confusion than its predecessor. The revised questionnaires were asked and analyzed in same manner as the previous procedure. With initial questionnaire, the mean scores did not show significant difference between the answers of the first visit and the second. The overall degree of agreement was 0.7720. Questions 4. 5. 6 and 12, however, showed unsatisfactory degree of agreement. With revised questionnaire, the mean scores had no significant difference between the answers of the first visit and the second. The overall degree of agreement was improved to 0.8878. All questions showed satisfactory dcgree of agrccment. This questionnaire is thought to be helpful to assess patient's subjective symptoms, and analyze and compare the results of various forms of treatments. Although satisfactory, there is still room for some further improvement.

골·관절 염증에서 골사주의 진단적 의의

왕진만 梨花女子大學校 醫科大學 醫科學硏究所 1986 EMJ (Ewha medical journal) Vol.9 No.4

Early detection of bone and joint infection is very important in establishing early therapeutic intervention and prevention of complications. Bone scan with Tc 99m-MDP was done in 35 cases for the confirmation of infections on bone and joints at Ewha Womans University Hospital from January 1985 to July 1986 and analysed both clinically and roentgenographically, and following results were obtained. 1) In 15 cases of bone scan for early diagnosis of acute osteomyelitis, positive was 13 cases, and the sensitivity in acute osteomyelitis with bone scan was 86.7%. 2) In 6 cases of bone scan for chronic osteomyelitis, all were positive in bone scan and in X-ray. 3) In 13 cases of suspected infection of joints, 9 were positive in bone scan. In 7 cases of tuberculous arthritis, positive bone scan was 4 cases(55.6%), and in 5 cases of pyogenic arthritis, positive bone scan was 4 cases(80%). From above data, bone scan is very important in establishing early diagnosis and appropriate treatment in the cases of bone and joint infections especially in acute and chronic osteomyelitis and pyogenic arthritis.

척추경 나사못과 후궁 갈고리를 이용한 흉요추부 골절의 수술적 치료

왕진만,노권재,윤여헌,고영도,오종건,정훈,김동준 대한척추외과학회 1998 대한척추외과학회지 Vol.5 No.1

Study Design : Clinical and radiographic results of spine fracutre treated with pedicle screws and hooks were reviewed. Objectives : Evaluate the efficacy of the pedicle screw and hook for thoracolumar bursting fracture Summary of Literature Review : Despite of the mechanical advantage of the pedicle screw, the metal failure in short segment fusion has been reported. A biomechanical study showed additional laminar hook increased rotational strength. Materials and Methods : Between 1994 and 1996, seventeen patients who had a Denis type B bursting fracture of the thoracolumbar spine were treated by posterior instrumentation with pedicle screws and laminar hooks and anterior interbody fusion after partial corpectomy. They have been followed for an average of 13.4 months. Results : At last follow-up, radiographs showed successful fusion of the injured spinal segment in all patient. The subsidence of grafts which were used in anterior interbody fusion was an average of 0.76㎜. There was a loss of 2.6 degrees on average in the correction of the kyphosis. No patients had screw breakage or loosening. Conclusions : We concluded that posterior fixation with screws and hooks, anterior decompression by partial corpectomy, and strut-grafting in patient who had a Denis type B bursting fracture of the thoracolumbar spine yielded good radiographic and functional results.

추간판 내장증의 진단에서 자기 공명 영상 소견의 진단적 가치 및 의의

왕진만,김동준 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1

Study Design : Image findings of MRI were analyzed comparing to pattern of provocative pain during discography. Objective : To evaluate the diagnostic value of the image findings of MRI in the internal disc disruption Summary of Literature Review : Some authors have reported MRI was more accurate than discography, but other reports have indicated MRI was less specific and could not reliably predict discogenic pain. Materials and Methods : The concordant pain at discography was considered as a gold standard for evaluation of the diagnostic value of these modalities. The image findings of MRI in 28 patients were graded and compared with the pain response at discography. The validity and predictive value(PV) of this modality were calculated and the incidence of concordant pain in each image grade was evaluated. Results : The sensitivity and specificity of MRI was 93.9% and 48.9% respectively. The positive PV of MRI was 56.4%, and the negative PV was 92%. The incidence of concordant pain was different in each grade. Grade Ⅲ showed the highest (78.6%) and grade V showed the lowest (0%) incidence of concordant pain. This difference was statistically significant(p<0.05). Conclusion : The current study suggests that MRI can be considered as a screening test for internal disc disruption since it is non-invasive and sensitive diagnostic tool. For decision of fusion level MRI is unreliable test due to it's low specificity.

Chymopapain이 중추 및 말초신경에 미치는 영향에 관한 실험적 연구

왕진만 梨花女子大學校 醫科大學 醫科學硏究所 1989 EMJ (Ewha medical journal) Vol.12 No.4

The treatment of herniated lumbar disc has been a challenging problem in spite of various methods of treatments such as conservative, chymopapain injection, percutaneous automated nucleotome method and surgical removeal of discs. Among the above listed treatment, Smith and Brown reported the clinical experience by way of intradiscal injection of chymopapain with beneficial result and clinical reports followed thereafter. On the other hand, the serious neural adverse effects were reported by Smith laboratories since the clinical application of chymopapain such as transverse myelitis, paralysis, seizures and hemiplegia which is not fully clarified but may be due to chymopapain itself and improper technique. This study was carried out to clarify the effect of chymopapain on the spinal cord and peripheral nerves by way of application topically in rabbits. The results were as follows : 1) There were no abnormal gross or histological findings when the chymopapain was spread around the sciatic nerve and spinal cord extradurally. 2) In the group of the chymopapain injected into the sciatic nerve sheath, there was immediate nerve paralysis and severe necrosis of the axon. But the schwann's sheath was intact and no hemorrhage was observed. 3) In the group of intradural chymopapain injection, there was massive hemorrhage, perivascular neutrophil infiltration and necrosis of the gray mater of spinal cord. In conclusion with this experimental study, the chymopapain induced peripheral neuropathy followed by axonal necrosis when injected into peripheral nerve. The central neuropathy was developed with hemorrhage and necrosis of the gray mater of the cord when the chymopapain injected intradurally.