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범발성 특발성 골격 과골증에서 동반된 흉추부 결절성 황색 인대 골화증에 의한 척수병증
박예수 ( Ye Soo Park ),이인홍 ( In Hong Lee ),김민건 ( Min Kun Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.2
Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier`s disease, is an idiopathic rheumatological abnormality in which exuberant ossification occures along ligaments throughout the body, most notably the anterior longitudinal ligament of spine, frequently posterior longitudinal ligament or ligamentum flavum. Ossification of ligamentum flavum (OLF) causes narrowing of spinal canal and cord compression. It has been described almost exclusively in the Japanese, extremely rare in Caucasian and Korean population. The predominant location of symptomatic OLF is at the thoracolumbar junction, particularly at T10-11 followed by T11-12, and rarely in the cervical region. We experienced a case of progressive myelopathy due to the nodular ossification of ligamentum flavum in patient with DISH, who was treated by posterior decompressive laminectomy, removal of the ossified ligamentum flavum. The neurologic status of the patient was improved dramatically after operation.
박예수(Ye-Soo Park),김재훈(Jae-Hoon Kim),김영호(Young-Ho Kim),박기철(Ki-Chul Park) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.4
대퇴 경부 골절이나 고관절 탈구 등은 대퇴골두 무혈성 괴사의 원인적 인자로 잘 알려져 있으나, 이를 동반하지 않은 골반 골절 후 발생한 대퇴골두 무혈성 괴사에 대해서는 아직 보고된 바가 없다. 이에 저자들은 다발성 외상을 동반한 골반 골절 후 발생한 대퇴골두 무혈성 괴사 1예를 경험하여 보고하며, 이의 원인적 인자에 대하여 고찰해 보고자 한다. We report on a case of osteonecrosis of the femoral head after a traumatic pelvic injury, and this was not associated with skeletal injuries to his hip joint. An adolescent male developed ostenecrosis of the femoral head following a pelvic fracture, but his hip joint was not injured by the pelvic fracture. To the best of our knowledge, such a finding has not been previously reported. The risk factors fot osteonecrosis are also reviewed.
경막 파열이 동반된 경막외 농양 환자에서 발생한 경막하 농양
박예수(Ye-Soo Park),백승욱(Seung-Wook Baek),오정한(Jeong-Han Oh),김홍식(Hong-Sik Kim) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.6
척추 경막외 및 경막하 농양은 발생률이 비교적 낮지만 신속히 진행하여 마비를 초래할 수 있고, 치사율은 최근의 향상된 치료법에도 불구하고 높은 것으로 알려져 있다. 특히 경막외 농양을 치료 후 다시 경막하 농양이 발생하는 경우는 극히 드문 것으로 보고되고 있다. 저자들은 경막 파열이 동반된 경막외 농양으로 감압 및 배농술을 시행한 후 다시 경막하 농양이 발생하여 배농술을 시행한 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.
류마티스 질환 환자와 비류마티스 환자에 있어 요추부 후측방 유합술의 결과 비교 -류마티스 질환 환자에서의 척추 유합술-
박예수 ( Ye Soo Park ),황규태 ( Kyu Tae Hwang ),박태수 ( Tae Soo Park ),최층혁 ( Cheong Hyeok Choi ),성일훈 ( Il Hoon Sung ),조재림 ( Jae Lim Cho ) 대한류마티스학회 2004 대한류마티스학회지 Vol.11 No.4
Objective: To evaluate the clinical and radiological results and to compare the results of posterolateral lumbar fusion in rheumatic and non-rheumatic disease. Methods: A retrospective review of results was carried out in 20 patients who had posterolateral lumbar fusion with rheumatic disease from Jul. 1996 to Aug. 2002. And same cases of non-rheumatic disease were compared. The diagnosis of rheumatic disease was confirmed by the ARA revised criteria. Bony union was evaluated by Lenke`s criteria and the clinical results by Katz`s satisfaction degree. Statistical analysis was performed by paired T-test and ANOVA test. Results: In rheumatic disease group, there were 7 males and 13 females. Mean age was 56.6 (20∼68) years and mean fused segments were 2.7 (1∼7). Mean follow-up period was 41 months (12∼80) after surgery. In non-rheumatic group, there was 6 males and 14 females. Mean age was 57.1 (35∼71) years and mean fusion segments were 2.9 (1∼4), Mean follow-up period was 40.2 (12∼88) months. In age and fusion segments between two group, there was no statistical difference. In rheumatic disease group, the diagnosis were rheumatoid arthritis in 18 patients, ankylosing spondylitis in 1, and systemic lupus erythematosus in 1 patient. The other operations for combined disease were 8 total knee arthroplasty and 3 total hip arthroplasty. There were no statistical differences in operation time (p=0.527), perioperative bleeding (p=0.653) and postoperative (p=0.830) bleeding between two group. In radiological bony union, all patients of two groups showed A and B grade by Lenke`s criteria. Bony union was complete at 5.5 (5∼8), 5.1 (4∼7) months after surgery. There was no significant difference in clinical satisfaction (p=0.756). Conclusion: There were no significant differences in clinical and radiological results between the rheumatic and non-rheumatic patients with disease of the lumbar spine.
자가면역질환 환자에서 장기간 당질 코르티코이드 복용에 의해 유발된 골다공증성 다발성 압박 골절
박예수 ( Ye Soo Park ),서완식 ( Wan Sik Seo ),조재림 ( Jae Lim Cho ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.3
Reduced bone mineral density precedes the development of vertebral fractures in patients under long term glucocorticoid therapy. Osteoporosis is a frequent complication in steroid-dependent patients, and the risk of developing vertebral fractures in these patients is much higher than involutional osteoporosis. We described a 54-year-old patient who presented with autoimmune hepatitis and had a 6-year history of steroid medication. The patient had multiple compression fractures (T10∼L5) without trauma, and was treated successfully with multi-level vertebroplasty and an intravenous injection of bisphosphonate without complications.
외상성 척추 후만증에서 전후방 병합수술과 후방 단독 수술의 비교
박예수(Ye-Soo Park),이영석(Young-Seok Lee),백승욱(Seung-Wook Back),김재훈(Jae-Hoon Kim),이두연(Doo-Yeon Lee) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3
목적: 외상 후 척추 후만 변형에 대한 교정술을 받은 환자를 대상으로 후향적 연구를 실시하여, 전후방 및 후방 도달법에 의한 교정술에 따른 결과의 차이를 비교 분석하고, 수술 후 국소 후만각의 교정 소실과 연관된 위험 인자를 분석하고자 하였다. 대상 및 방법: 2004년 9월부터 2009년 8월까지 흉요추부 골절에서 외상 후 후만 변형으로 교정 수술을 시행하고 1년이상 추시가 가능하였던 환자 19예로, 전후방 교정 유합술을 시행한 10예를 A군, 후방 교정 유합술을 시행한 9예를 B군으로 분류하여 비교 분석하였다. 술 전, 술 후, 최종 추시시 방사선 분석 및 한국어판 Oswestry disability index (ODI) 및 visual analog scale(VAS)를 이용한 임상적 평가를 시행하였으며 교정 소실에 있어서 위험 인자들의 상관 관계를 분석하였따. 결과: A군에서 술 전 국소 후만 변형은 35.2도였고 수술 직후 11.1도, 최종 추시시 15.7도 교정되어 24.1도의 후만 교정(68.4%)과 4.6도(19%)의 교정 소실이 관찰되었다. B군에서 술 전 국소 후만 변형은 34.2도였고 수술 직후 9.3도, 최종 추시시 13.8도 교정되어 24.9도의 후만 교정(72.8%)과 4.5도(18.3%)의 교정 소실이 관찰되었다. 교정 소실의 위험도 분석에서는 A군과 B군 모두에서 골다공증이 유의한 상관관계를 보였다. 임상적 결과 ODI와 VAS 값은 두 군에서 모두 호전을 보여주었으며 통계학적 차이는 없었다. 결론: 외상 후 척추 후만 변형은 후방 교정만으로도 전후방 교정 유합술과 동일한 정도의 교정이 가능하였으며 교정 소실률에서도 차이가 없었다. 최종 추시시 교정 소실의 방지를 위해 골다공증에 대한 예방이 필요할 것으로 사료된다. Purpose: We wanted to analyse the differences of the radiological and clinical results between the combined approach and the posterior approach for treating posttraumatic kyphosis in elderly patients and to determine the risk factors for the loss of correction after the operation. Materials and Methods: Between September 2004 and August 2009, 19 patients who underwent an operation for posttraumatic kyphosis and were follow-up for at least one year were included in this study. The combined approach (A group) was done for 10 patients, while the posterior approach (B group) was done for 9 patients. Radiological study and clinical evaluation, including the Korean version of the Oswestry disability index and the visual analog scale (VAS), were performed before surgery, after surgery and at the final follow-up. The risk factors related to the loss of correction of kyphosis at the fracture site were analyzed. Results: In group A, the mean kyphotic angles were 35.2 before surgery, 11.1 degrees after surgery and 15.7 degrees at the final follow-up. There was 24.1 degrees (correction; 68.5%) of correction of the kyphotic angle with 4.6 degrees (19%) loss of correction. In group B, the mean kyphotic angles were 34.2 before surgery, 9.3 degrees after surgery and 13.8 degrees at the final follow-up. There was 24.9 degrees (72.8%) correction of the kyphotic angle with 4.5 degrees (18.3%) loss of correction. The clinical data was improved to the same degrees. The loss of correction was statistically correlated with osteoporosis. Conclusion: In conclusion, the posterior approach can correct the posttraumatic kyphosis in a fashion similar to that of the combined approach. The patient’s osteoporosis should be thoroughly treated for preventing correction loss.
교정 절골술 후 나사못 이완으로 발생한 교정 소실에서 Teriparatide 사용에 따른 이식골과 방사선 투과대의 변화
박예수 ( Ye Soo Park ),김재훈 ( Jae Hoon Kim ),이창훈 ( Chang Hun Lee ) 대한류마티스학회 2011 대한류마티스학회지 Vol.18 No.2
Among osteoporosis medications, Teriparatide is an agent that promotes bone formation and it seems to have an effect, due to an anabolic mechanism, in the early postoperative period after osteosynthesis or joint replacement. But to the best of our knowledge, the effect of teriparatide on pedicle screw loosening has not been previously reported. We report there on a case of pedicle screw loosening after corrective osteotomy in a patient with ankylosing spondylitis with osteoporosis, which was not improved by teriparatide, and we review the related literature.