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- 저자 : 장의찬 ( Eui Chan Jang ) (검색결과 40 건)
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다분절 요추관 협착증을 가진 환자의 자기공명영상에서 자기공명 척수 조영술의 관찰자 변이
장의찬(Eui-chan Jang),송광섭(Kwang-sup Song),유현(Hyun Yu) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.6
목적: 다분절 요추관 협착증을 가진 환자의 MRI에서 MR 척수강 조영술(MRM)에 대한 유용성을 평가하고자 하였다. 대상 및 방법: 요추부 MRI 촬영시 MRM을 시행한 50세 이상, 방사선 판독상 2분절이상의 요추관 협착증을 가진 100명을 대상으로 두 관찰자가 PACS 장비를 이용하여 협착증이 가장 심한 분절의 선택과 선택된 분절의 협착의 정도를 지주막하 공간의 압박의 비율로 정하여(1: 정상에서 50%, 2: 50% 이상, 완전 폐색이 아닌 경우, 3: 완전 폐색) 평가하였다. 독립적으로 평가한 3개 항(A항: MRI, B항: MRM, C항: MRI+MRM) 및 항 간에 관찰자 간 및 관찰자 내 일치도를 평가하였다. 결과: 협착이 가장 심한 분절의 선택 및 정도의 평가에서 두 관찰자 모두 A항 보다 B항에서 C항과의 일치도가 높았으며 관찰자간의 일치도(κ)의 평균 값은 분절의 선택에선 A항: 0.649, B항:0.782, C항:0.832, 협착의 정도는 A항: 0.727, B항: 0.771, C항: 0.784이었고 관찰자내 일치도는 한 관찰자의 A항의 분절의 선택을 제외하고 모두 완전 일치(0.81≤κ≤1)범위였다. 결론: MRM은 다분절 요추관 협착증시 협착 정도의 평가에서 관찰자 신뢰도를 높일 수 있는 방법으로 생각된다. Purpose: To determine if MR myelography (MRM) improves the interpretation of the severity of stenosis in patients with a multi-level lumbar stenosis. Materials and Methods: Among the patients referred for MRI with MRM prospectively, 100 patients over 50 years old with multiple lumbar stenosis were enrolled in this study. The most severe stenotic level and the degree of stenosis at that level according to the extent of the remaining subarachnoidal space (1: normal to 50%, 2: over 50% but not a total block, 3: total block) were evaluated in a blinded manner by two observers. Conventional MRI (class A), MRM (class 8) and MRI+MRM (class C) was evaluated independently and the interobserver and intraobserver reliability were assessed. Results: In the selection of the most severe level and degree of stenosis, both observers showed a higher level of consensus with classes B and C than classes A and C. The interobserver κ average values for the selection of the most severe level in classes A, B and C were 0.649, 0.782 and 0.832, respectively. In terms of the degree of stenosis, the average in classes A, B and C were 0.727, 0.771 and 0.784, respectively. The intraobserver κ values for the above two items were the highest in class (B), followed by (C) and (A) in all observers and within the range of "almost perfect" (0.81≤ κ ≤1) except for the selection of the level of one observer in clause A. Conclusion: MRM when used in routine practice can help improve the observer reliability in assessing the severity of stenosis in multiple lumbar stenosis.
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슬관절 원판형 연골에 대한 관절경적 수술 후 추시 소견
정영복,장의찬,염재광,정호중 ( Young Bok Jung,Eui Chan Jang,Jae Kwang Yum,Ho Joong Jung ) 대한슬관절학회 1996 대한슬관절학회지 Vol.8 No.2
Thirty-one patients who had symptomatic discoid lateral meniscus were operated on between january 1991 and april 1995 and twenty three patients under went follow up evaluation for more than twelve months. The patients were categorized according to Watanabe s classification, complete (20 cases), incomplete (6 cases), and Wrisberg type (0 cases). The treatment for the symptomatic lateral discoid meniscus was based on the subtotal ineniscectomy and the partial meniscectomy with or without suture of the peripheral lear achieved by total arthroscopic tectlnique under local anesthesia except 3 cases. The eighteen cases had received arthroscopic partial rneniscectomy and the eight cases had received arthroscopic subtotal meniscecloniy, among them lhere were two cases of meniscal repair by arthroscopic technique. Using Ikeuchi' s knee scale, seven- teen cases (95 %) had either excellent or good ratings in partial meniscectomy group and eight cases (100 %) in suht<>tal ineniscectomy group. There was no poor outcome. The preferable result in the knee treated by partial or suhtotai meniscectomy enable to try to preserve meniscus as much as possible instead of total meniscectomy.
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관절경적 전방십자인대 재건술시 자가 슬개건의 채취 부위에 따른 슬관절 동통의 비교
정영복,장의찬,염재광,김진수 ( Young Bok Jung,Eui Chan Jang,Jae Kwang Yum,Jin Soo Kim ) 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2
graft as a successful procedure that provides functional stabiIity. Complications reported include arthro5brosis, patellofemoral joint pain, patellar tendinitis, patellar tendon rupture, recurrent laxity, posterolateral instabi5ty, medial subluxation of the patella, chronic knee pain and painful neuroma. Among them, anterior knee pain was the rnost frequent eomplication. Authors performed arthroscopy-assisted one tunnel technique for reconsction of the ACL using autogenous Bone-Patellar tendon-Rone(BPTB) in 87 patients. Patients were divid@d into two groups based on the harvested side(knee) of the BPTB. Group 1 consisted of 45 cases of ipsilateral side and group 2 consisted of 42 cases of contralsteral side in harvesting the BPTB. The patients were foll4wed up for at least 12 months to determine whether using the BPTB harvested from the contralateral knee wguld reduce the anterior knee pain at the ACL reconstructed knee. Althaugh there were no statistically signifiqant differences between group 1 and 2 with regard to anterior knee pain, the prevalence of the anterior knee pain was less frequent in group 2 than group 1. This study showed that using the contralateral side harvested autogenous patellar tendon would be a possible protector for anterior knee pain and assists for early rehabilitation.
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슬괵건을 이용한 전방십자인대 재건술시 이식건과 골 사이의 골통합에 대한 조직학적 변화 - 1례 보고 -
정영복,장의찬,염재광,박근형,Jung, Young-Bok,Jang, Eui-Chan,Yum, Jae-Kwang,Park, Geun-Hyung 대한관절경학회 1999 대한관절경학회지 Vol.3 No.1
대퇴 터널 속에 횡고정 나사로 네가닥의 자가 슬괵건을 고정하는 전방십자인대 재건술은 이식된 건과 골이 만나는 부위에서 건-골 융합 과정(골통합, osteo-integration)이 필요하다. 본 증례는 외상성 전방십자인대 파열 환자에서 자가 슬괵건을 이용한 전방십자인대 재건술후 13주째에 수술한 전방십자인대 실질부(substance)의 외상성 재파열이 생겨 이를 관절경적 재수술을 시행하는 과정에서 대퇴 터널 내 골-이식건 결합부를 채취하여 조직학적 관찰을 시행하였다. 조직학적 소견은 이식건과 골 사이에 콜라젠 섬유의 연속성이 존재하는 이식건의 골통합 소견을 관찰할 수 있었다. 본 증례의 조직학적 소견과 전방십자인대 재건술후 초기에 이식건 파열의 낮은 발생율은 수술후 대퇴 터널에서의 자가 이식건-골의 융합이 수술후 12주에서 15주 사이에 완성된다는 주장을 뒷받침할 수 있을 것으로 사료된다. Arthroscopic anterior cruciate ligament(ACL) reconstruction using four-strand hamstring tendon with looping around transfixing screw in femoral tunnel requires osteointegration between the grafted tendon and bone for stability of the knee. Authors have experienced a histologic finding of osteointegration between the grafted autogenous hamstring tendon and bone in femoral tunnel after arthroscopic ACL reconstruction. A patient received arthroscopic ACL reconstruction with autogenous four strand hamstring tendon for the ACL injury. Traumatic re-rupture of mid-substance of ACL graft was developed at thirteenth week after operation. During the procedures of arthroscopic revision at fifteenth week after initial ACL reconstruction, biopsy was performed at the site of interface between grafted tendon and bone in femoral tunnel. Integration between the grafted tendon and bone was evident by demonstrating the continuity of collagen fiber between bond and tendon. This histologic finding and the low incidence of early graft failure suggest that free tendon autograft attached to bone by looping around a transfixing screw in femoral tunnel undergoes adequate osteointegration between 12 and 15 weeks after surgery and authors thought that insertion of bone chip into the femoral tunnel would accelerate osteointegration procedure.
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