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.

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.

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.

Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine : Safety vs Strength

박춘근,황장회,지철,이재언,성재훈,최승진,이상원,박성찬,조경석,박춘근,강준기,Park, Choon-Keun,Hwang, Jang-Hoe,Ji, Chul,Lee, Jae Un,Sung, Jae Hoon,Choi, Seung-Jin,Lee, Sang-Won,Seybold, Eric,Park, Sung-Chan,Cho, Kyung-Suok,Park, Chun-K The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.10

서 론 : 후방 경유 경추 융합을 위한 후관절 금속판 고정술은 외상성 및 퇴행성 불안정성의 치료에 효과적인 방법이다. 후관절 금속판 고정의 안정성은 여러 가지 인자에 의해 결정된다. 이중 하나가 나사못의 삽입깊이이다. 이 방법이 처음 소개될 때에는 양피질골성 삽입이 이용되었다. 외과의사의 관심은 어떻게 안전하면서 생역학적으로 강력한 고정을 얻느냐에 있다. 목 적 : 이 연구의 목적은 사체에서 단피질성과 양피질성 나사못 삽입술을 시행한 후 안전성, pull-out 강도, 방사선학적 특성을 분석하고 나사못의 삽입에 대한 교육 훈련의 수준에 따른 영향을 평가하는데 있다. 방 법 : 평균 나이 78.9세인 21구의 사체에 대하여, Magerl의 기술을 변형하여 C3-C6(n=168)까지 3.5mm AO 나사못을 양쪽 후관절에 삽입하였다. 수술중 방사선 사진영상은 사용되지 않았다. 오른 쪽(단피질성 삽입)은 14mm 나사못(11mm의 유효 길이)을 이용하고, 왼쪽은 양피질성 삽입을 시도하였다. 각 사체는 3개의 군으로 나누어 척추 수술 수련의 수준이 다른 받은 3명의 척추 외과 의사들(전임 강사, 임상 강사, 수석 레지던트)이 수술을 시행했다. 수술 후 경추를 떼어내어 나사못의 위치를 육안적으로 확인하고 방사선학적으로 안정성과 삽입 위치 (1,2,3)를 평가하였다. 척수, 후관절, 신경근과 척추 동맥에 대한 나사못의 위치를"만족할 만한","위험한", 그리고"직접적인 손상"으로 구분하였다. material testing machine을 이용하여 모든 나사못에 대해서 Pull-out 강도를 측정하였다. 결 과 : 대다수의 나사못(92.9%)은 만족할 만한 상태였다. 전예에서 척수에 대한 위험성은 없다. 오른 편(단피질성 : 14mm) 나사못의 98.9%는"만족할 만한"에 속했다. 그리고 왼쪽 편(양피질성)의 68.1%는"만족할 만한"에 속했다. 양피질성 나사못 군에서 5.8%의 척추 동맥에 대한 직접적인 손상이 있었고 신경근의 직접적인 손상 발생율은 17.4%였다. 반면에 단피질성 나사못 군에서는 이들에 대한 직접적인 손상은 없었다. 양피질성 나사못에서 보인"직접 손상"의 거의 대부분은 외과 의사의 경험 부족으로 발생하였다. 나사못의 안정성과 삽입 위치 사이에는 특별한 관련이 없었다. 모든 나사못의 pull-out 강도는 $542.0{\pm}296.6N$였다. 단피질성에 있어서의 pull-out 강도($519.0{\pm}289.9N$)와 양피질성($565.2{\pm}306N$) 나사못에는 아무런 통계학적으로 의미있는 차이점을 발견할 수 없었다(p>0.05). 나사못 삽입위치와 pull-out 강도 사이에는 의미있는 차이가 없었다. 결 론 : 이번 연구는 경추 후관절 나사못 고정술시 단피질성과 양피질성 나사못의 안정성과 효능을 집중적으로 알아보았다. 명백한 것은 14mm의 나사못(효과적인 길이는 11mm)이 보다 긴 양피질성 나사못 보다 손상의 위험이 훨씬 낮고 거의 동등한 pull-out강도를 갖는다는 것이다. 또한, 수술시 방사선 영상을 사용할 수 없을 때, 훈련과 축적된 경험에 의해 나사못 삽입의 정확성과 안전성이 향상될 수 있다.

단일 나사형 Cage를 이용한 후방 요추체간 융합술과 두개의 나사형 Cage를 이용한 PLIF의 생체 역학적 비교

박춘근,황장회,지철,권성오,성재훈,최승진,이상원,김문규,박성찬,조경석,박춘근,강준기,Park, Choon Keun,Hwang, Jang Hoe,Ji, Chul,Kwun, Sung Oh,Sung, Jae Hoon,Choi, Seung Jin,Lee, Sang Won,Kim, Moon Kyu,Park, Sung Chan,Cho, Kyeung Suok,Park, 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objectives : An in vitro biomechanical study of posterior lumbar interbody fusion(PLIF) with threaded cage using two different approaches was performed on eighteen functional spinal units of bovine lumbar spines. The purpose of this study was to compare the segmental stiffnesses among PLIF with one long posterolateral cage, PLIF with one long posterolateral cage and simultaneous facet joint fixation, and PLIF with two posterior cages. Methods : Eighteen bovine lumbar functional spinal units were divided into three groups. All specimens were tested intact and with cage insertion. Group 1(n=12) had a long threaded cage($15{\times}36mm$) inserted posterolaterally and oriented counter anterolaterally on the left side by posterior approach with left unilateral facetectomy. Group 2(n=6) had two regular length cages($15{\times}24mm$) inserted posteriorly with bilateral facetectomy. Six specimens from group 1 were then retested after unilateral facet joint screw fixation in neutral(group 3). Likewise, the other six specimens from group 1 were retested after fixation with a facet joint screw in an extended position(group 4). Nondestructive tests were performed in pure compression, flexion, extension, lateral bending, and torsion. Results : PLIF with a single cage, group 1, had a significantly higher stiffnesses than PLIF with two cages, group 2, in left and right torsion(p<0.05). Group 1 showed higher stiffness values than group 2 in pure compression, flexion, left and right bending but were not significantly different. Group 3 showed a significant increase in stiffness in comparison to group 1 for pure compression, extension, left bending and right torsion(p<0.05). For group 4, the stiffness significantly increased in comparison to group 1 for extension, flexion and right torsion(p<0.05). Although there was no significant difference between groups 3 and 4, group 4 had increased stiffness in extension, flexion, right bending and torsion. Conclusion : Posterior lumbar interbody fusion with a single long threaded cage inserted posterolaterally with unilateral facetectomy enables sufficient decompression while maintaining a majority of the posterior elements. In combination with a facet joint screw fixation, adequate postoperative stability can be achieved. We suggest that posterolateral insertion of a long threaded cage is biomechanically an ideal alternative to PLIF.

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

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.

돼지의 체외수정시 난관상피세포가 정자의 침입에 미치는 영향

박춘근,정희태,양부근,김정익 韓國受精卵移植學會 1995 한국동물생명공학회지 Vol.10 No.3

Porcine follicular oocytes matured in culture were inseminated with frozen-thawed spermatozoa. When the oocytes were inseminated in the medium with oviductal epithelial cell monolayer, the penetration rates higher in those with (4.1, 31.7, 45.1, 54.5 and 69.4%) than without cells (0, 17.1, 34.8, 45.2 and 58.9%) at 4, 8, 12, 16 and 20 h after insemination. The proportions of polyspermy in penetrated oocytes in medium with or without cells increased with time of examine. In another experiment, the penetration rate was higher without (57.6%) than with (19.6~24.1%) preincubation of spermatozoa for 1~4 h in medium. However, when the oocytes were inseminated with spermatozoa preincubated for 1~2 h, the penetration rates significantly higher (P<0.05) in those with (65.6 and 55.9% for 1 and 2 h) than without (24.1 and 20.6% for 1 and 2 h) oviductal epithelial cell monolayer. On the other hand, the proportions of polyspermy decreased with time of spermatozoa preincubation. These results indicate the significant advantages of the spermatozoa preincubation with oviductal epithelial cell monolayer for 1 and 2 h to maintain penetration potential during in vitro fertilization in the porcine.

실험적 중대뇌동맥에 의한 지연성 허혈성 뇌경색 : 제2부 : Glutamate 길항제(MK-801)의 뇌경색 진화에 대한 효과 Part 2 : Effect of the NMDA Antagonist, MK-801, Upon Ischemic Evolution

박춘근,강준기,송진언 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.4

Excessive activation of the N-methyl-D-aspartate(NMDA) subtype of glutamate receptor, has been implicated in the sequence of neurochemical events which results in irreversible neuronal damage in cerebral ischemia. The effect of the NMDA antagonist upon the amount of ischemic brain damage has been already assessed by some investigators. But most of them were performed only in acute ischemic models. In the light of clinical experiences, it's neuroprotective effect is much more important in the prolonged ischemic model. So, authors produced the permanent occlusion of the left middle cerebral artery(MCAO) and sacrificed the animals 48 hours after the occlusion to observe the nouroprotective effect of the NMDA antagonist, MK-801, in the maturated condition of ischemia according to the previous Part Ⅰ experiments. MK-801 was administered 2 times, intravenously 1 hours prior to MCA occlusion (0.5㎎/㎏) and intraperitoneally 1 hour after the induction of ischemia(5㎎/㎏) to maintain proper concentration of the drug. CBF was measured by hydrogen clearance method. Areas of brain infarction were delineated by tetrazolium salt at the preselected 8 coronal levels of forebrain and measured on scale diagrams by a plannimeter. MK-801 had no effect on the cardiopulmonary function. In the control, the basal value of CBF was around 118㎖/100g/min. Immediately after MCAO, CBF of the ipsilateral cortex was reduced to 13.3±2.6㎖/100g/min and not recovered until the end of the experiment. But CBF of the contralateral cortex was maintained in the basal value throughout the experiment. In the treated, immediately after the intravenous administration of the drug. CBF of both frontal cortices was reduced to 15 to 20% of the basal value(P<0.001), and the reduced CBF was noted even after MCAO, comparing to the control, but 24 hours later the reduced CBF of the contralateral cortex recovered to the basal value. Treatment with MK-801 reduced the total amount of ischemic damage in the cerebral hemisphere(15.82±2.41 versus 10.66±1.33㎝, P<0.001) and the cerebral cortex(11.0±3.73 versus 6.30±1.6㎝, P<0.001). But the effect on the caudate necleus was minimal. This experiment provides evidence for the potency of the glutamate antagonist, MK-801, in reducing ischemic brain damage, despite the result was obtained 48 hours after MCAO. And the anti-ischemic effect of MK-801 in the experiment could not be attributed to by improvement of blood flow to the hypoperfused cerebral tissue.

가로변 건축물과 도시 가로공간의 건축계획적 특성에 관한 연구 : 가로변 건축물과 수평 수직적 공간조절을 중심으로

박춘근,송대호,윤장우 대한건축학회 1996 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.16 No.1

The aim of this study is to purpose $quot;improvement of auagty$quot; for the space of urban street. It is focused on the building on street that influences on architectural design. Through a case study, one could propose a rational design method on street architectress. The result of this study is as follows. 1. It`s type of eastest cross piece on a frame that cause trouble about entry relation to building, the front and lighting inferiority. 2. The road system shows extreme difference in a contrariety aspect and causes of the choas on road of a walker and drive way, it bring about difficulty in walking and danger for a safety accident. 3. Dimension of urban street vitality, it's need of consideration of place arid scale on resident type of business and open space such as center square that a city dweller could easily use.

번식 육종 1 ; 우체외수정란의 발생능에 미치는 난관상피세포의 영향

박춘근,여인서,김정익 한국동물자원과학회 ( 구 한국축산학회 ) 1992 한국동물자원과학회 심포지움자료집 Vol.- No.-