척추강 협착증 환자의 척추의 미란이 동반된 부골화된 요추 추간판 탈출증 : 증례 보고 Case Report

송경진,송경진 의과학연구소 1990 全北醫大論文集 Vol.14 No.3

We experienced 47 years old female patient with 4 years low back pain with sciatica and abnormal slow shuffling gait. On myelograghy we diagnosed as spinal stenosis induced by degenerative spondylosis and disc hemiation. But on C-T we could find vertebral erosion with abnormal shifting of theral sac by soft tissue mass. With fenestration, adhesiolysis and mass removal partent became pain free and normal gait.

고령의 퇴행성 요추부 질환에서 척추경 나사못을 이용한 요추부 유합술 후 수술주위기간 합병증 - 후외방 유합술과 후방 요추체간 유합술의 비교 연구

송경진,임영진,송지훈,함동훈 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

Study Design: This is a retrospective study that focused on the perioperative complications when performing posterior arthrodesis for treating degenerative lumbar disorders in elderly patients. Objectives: We wanted to analyze the perioperative risk factors and the complications associated with posterior lumbar decompression and arthrodesis in patients who were sixty-five years of age or older. Summary of the Literature Review: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at an increased risk for complications because of their age and their associated medical conditions. Materials and Methods: We studied 111 patients who were over 65 years old and they were able to be followed up for more than 3 months after performing posterior arthrodesis during the recent 5 years. Sixty-one patients who had undergone posterolateral fusion (PLF) were classified as group A, and 50 patients who had undergone posterior lumbar interbody fusion (PLIF) using a PEEK cage were classified as group B. We analyzed their rates of complications and the causative factors, according to operative methods and age, and these complications occurred within 12 weeks after the operations. Results: Complications occurred for 43 patients of group A, and for 26 patients of group B. The differences in the rates of complications were statistically significant, and group A had a more complications than did group B. The relations between medical problems and the incidence of perioperative complications were statistically significant for both groups. Conclusions: Elderly patients with medical problems should be made aware that they are at an increased risk for surgical com plications, and attention should be paid to controlling the blood loss and limiting the operative time. The PLIF using a PEEK cage was identified as a procedure that could reduce the perioperative complications.

흉추 및 요추부 유합술 후 심부 감염의 위험 인자

송경진,송광훈,박용근,이광복,김상림 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

Study Design: This is a retrospective analysis Objectives: We wanted to analyze the risk factors related to deep infection and removing an implant after thoracic and lumbar spinal arthrodesis. Summary of literature reviews: The relationship between deep infection and implant removal is controversial. Materials and Methods: We retrospectively compared the infection group with the non-infection group for the rates of deep infection, the preoperative diagnosis, the number of fused segments, the operative methods, the graft materials, the operating time and the blood loss. Moreover, we classified the deep infection patients into two groups: those who underwent implant removal and those who did not, and we compared the microorganisms that were cultured out of the patients. We also compared the relationship of deep infection with the risk factors, the mean hospital stay and the mean number of operations. Results: There were 18 cases (2.46%) of deep infection. The factors that did not show a significant difference were the preoperative diagnosis, the graft material, the increased number of fused segments, age, gender and BMI. The factors that were significant were the operating time (p=0.001), the amount of blood loss (p<0.000), DM (p=0.021), and PLF (p=0.054). The incidence of implant removal was higher for the cases with deep infection caused by MRSA. We were able to see a significant difference of between the group that had undergone implant removal and the group that had not undergone implant removal. Conclusions: The incidence of deep infection after thoracic and lumbar spinal athrodesis increased as the operating time and blood loss increased, and it was also higher when either PLF or DM were present. Implant removal causes bad clinical results, so physicians should be very cautious when operating on a case of implant removal.

외측 도달법을 이용한 종골 관절내 골절의 관혈적 정복

송경진,양근호,이주홍 대한골절학회 2002 대한골절학회지 Vol.15 No.4

목적 : 관절내 종골 골절에 대해 외측 도달법을 이용한 내고정을 시행 후 치료결과를 분석하여 그 유용성을 확인해보고자 하였다. 대상 및 방법 : 관절내 골절을 가지고 종골 골절의 경우 중 외측 도달법으로 내고정술을 시행하고 1년이상 추시 관찰이 가능했던 20명(21예)를 대상으로 하였다. 성별은 남자 17명, 여자 3명이었고 평균 33세(16~62세)이었으며, 원인별로는 추락사고가 14예이었고 나머지는 교통사고로 인한 골절이었다. 골절의 분류는 단순 방사선 사진상 Essex-Lopresti 분류를 이용하였고, 모든 예는 관절내 골절을 가지는 경우만 포함하였으며 이 중 관절 함몰형이 17예로 대부분이었고, 4례의 설상형은 심한 분쇄골절 양삼이었다. 술 전과 술 후 Bo¨hler 각의 변화를 비교하였고, 임상적 평가는 Paley와 Hall에 의한 평가 기준을 따랐다. 결과 : 수술 전 Bo¨hler 각은 평균 2.8에서 술 후 평균 25.1로 회복 되었고, 임상적 평가 상 우수 3예, 양호 13예, 보통 4예, 불량 1예이었다. 술 후 합병증으로 3예의 창상 열개, 1예의 감염, 1예의 비복신경 손상이 있었으먀, 추 후 합병증으로 일상 생활에 지장을 초래하는 정도의 족관절 운동범위 제한이 3예, 지속되는 동통이 3예, 외상성 관절염이 2예에서 확인되었다. 이 중 1 예에서 운동범위 제한과 동통이, 1예에서 운동제한과 외상성 관절염이 동시에 존재하였다. 1예는 창상 조직의 감염과 이에 따른 괴사로 자유 피판술을 시행하였다. 결론 : 분쇄가 심한 종골의 관절내 골절에서 외측 도달법은 거골하 관절을 직접 노출시켜 정확한 해부학적 복원과 견고한 내고정을 시행할 수 있고 신경 혈관 손상이 적어 유용한 방법으로 사료된다. Purpose : This study was designed to investigate the usefulness of lateral approach for accurate reduction and rigid internal fixation comminuted intra-articular fracture of calcaneus. Meterial and Method : Twenty patients(21 cases) who had inter-articular fracture of calcaneus and underwent an open reduction and internal fixation using lateral approach were enrolled. Using Essex-Lopresti classification, all cases were intra articular fracture, which joint depression type was 17 case and 4 of severe comminuted tongue type. We compared the preoperative and postoperative change of Bo¨hler’s angle and clinical results were analyzed using Paley and Halls evaluation protocol and scoring system. Results : The average Bo¨hler’s angle was restored from 2.8 to 25.1 after operations and clinical results classified 4 well, 12 good, 4 fair, 1 poor cases. Postoperative complications were 2 cases of wound dehiscence, 1 of infection and one had sural nerve injury. Late complocations included 3 cases of limitation of motion of ankle that disturb usual activity, 3 of sustained pain and 2 of traumatic arthritis and 2 cases had 2 complications at the same patients. Conclusion : The lateral approach is valuable for the comminuted intra-articular fractures of calcaneus that enables accurate anatomical reduction and rigid internal fixation by providing direct exposure of subtalar joint, and also with little morbidity of neurovascular injury.

Efficacy of PEEK Cages and Plate Augmentation in Three-Level Anterior Cervical Fusion of Elderly Patients

송경진,Gyu Hyung Kim,Byeong Yeol Choi 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.1

Background: To evaluate the clinical effi cacy of three-level anterior cervical arthrodesis with polyethyletherketone (PEEK) cagesand plate fi xation for aged and osteoporotic patients with degenerative cervical spinal disorders. Methods: Twenty one patients, who had undergone three-level anterior cervical arthrodesis with a cage and plate construct fordegenerative cervical spinal disorder from November 2001 to April 2007 and were followed up for at least two years, were enrolledin this study. The mean age was 71.7 years and the mean T-score using the bone mineral density was -2.8 SD. The fusionrate, change in cervical lordosis, adjacent segment degeneration were analyzed by plain radiographs and computed tomography,and the complications were assessed by the medical records. The clinical outcomes were analyzed using the SF-36 physical compositescore (PCS) and neck disability index (NDI). Results: Radiological fusion was observed at a mean of 12.3 weeks (range, 10 to 15 weeks) after surgery. The average angle ofcervical lordosis was 5° preoperatively, 17.6° postoperatively and 16.5° at the last follow-up. Degenerative changes in the adjacentsegments occurred in 3 patients (14.3%), but revision surgery was unnecessary. In terms of instrument-related complications,there was cage subsidence in 5 patients (23.8%) with an average of 2.8 mm, and loosening of the plate and screw occurred in 3patients (14.3%) but there were no clinical problems. The SF-36 PCS before surgery, second postoperative week and at the lastfollow-up was 29.5, 43.1, and 66.2, respectively. The respective NDI was 55.3, 24.6, and 15.9. Conclusions: For aged and osteoporotic patients with degenerative cervical spinal disorders, three-level anterior cervical arthrodesiswith PEEK cages and plate fi xation reduced the pseudarthrosis and adjacent segment degeneration and improved the clinicaloutcomes. This method is considered to be a relatively safe and effective treatment modality.

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

송경진,Byung-Wan Choi,Hye-Young Kim,Taek-Su Jeon,Han Chang 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.1

Background: After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can beassessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery,and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was toevaluate the clinical signifi cance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fi xation for thetreatment of degenerative cervical spinal disorders. Methods: One hundred and thirty-fi ve patients that underwent anterior cervical fusion with plate augmentation for degenerativecervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments andlocation of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphoniawere evaluated. Results: PSTS increments were signifi cantly greater in patients that had undergone multi-level or high-level fusion. Complicationsof dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group. Conclusions: Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences ofcomplications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutivecervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.

개방성 경골골절의 수술적 치료

송경진,장선웅 대한골절학회 2002 대한골절학회지 Vol.15 No.1

목적: 본 연구는 개방성 경골 골절시 골절의 고정 방법, 내고정물의 종류 및 심부 감염 등이 치료 결과에 미치는 영향에 대해 분석하고자 하였다. 재료 및 방법: 다양한 고정방법을 이용한 수술적 치료를 받은 87례의 개방성 경골 골절 환자를 대상으로 하였다. 환자는 즉시 내고정을 한 군과(IIF) 지연 내고정을 한 군(DIF!, DIF2) 그리고 외고정을 한군(EF)으로 나누었고, 개방성 경골 골절은 Gustilo의 분류에 의거하였다. 손상원인, Gustilo의 분류, 치료방법, 그리고 골고정 기구들에 따른 심부 감염율과 평균 골유합 시기 등을 서로 비교 분석하였다. 결과: 개방성 골절 제Ⅰ, Ⅱ, Ⅲa, Ⅱb형과 그리고 Ⅲc형의 평균 골 유합율은 각각 5.7개월, 8.6개월, 7.1개월, 9.7개월 그리고 18.0개월이었다. IIF, DIF1, DIF2, 그리고 EF 군의 평균 골유합은 각각 7.2개월, 5.5개월, 10.7개월 그리고, 13.1개월이었다. 교합성 골수정을 사용한 경우, 금속판과 나사못을 이용한 경우 및 외고정을 사용한 경우 골유함 기간은 각각 6.3개월, 6.9개월 그리고 10.6개월이었다. 골절부위에 따른 골유합 기간은 근위부, 중간부, 원위부에서 각각 8.6개월, 8.8개월, 8.6개월로 차이가 없었다. 결론: 제Ⅰ, Ⅱ, Ⅲa형과 일부의 Ⅲb형에서 IIF, DIF1, DIF2군의 심부 감염율과 평균 골유합 기간이 EF군보다 양호하며, 지연 내고정을 한군 보다 즉시 내고정을 한군에서 심부 감염율이 낮았다. 제Ⅰ, Ⅱ, Ⅲa형과 일부 Ⅲb형의 골절에서 즉시 내고정이 추천될 수 있겠다.

양측 경골 골절의 치료

송경진,송상헌,박종혁 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 사고로 발생된 양측 경골 골절에서 동반 손상, 치료의 문제점 및 치료 후 합병증을 분석하여 골절 형태와 손상 정도에 따른 치료 지침을 제시하고자 하였다. 대상 및 방법: 양측 경골 골절로 본 병원에서 치료 받은 환자 12례를 대상으로 하였다. 손상 원인은 10례가 자동차 사로고 그 중 5례는 보행자 사고였으며 오토바이 사고가 1례, 경운기 사고가 1례였다. 양측 개방성 골절이 6례, 일측만 개방성 골절인 경우는 2례였고 양측 모두 폐쇄성 골절인 경우가 4례였다. 수술까지의 기간, 평균 재원기간, 방사선 소견상 양측 모두 골유합 될 때까지의 기간 및 합병증의 병발을 분석하였다. 결 과: 양측의 개방성 골절이 있는 경우에서 수상 후 수술까지의 기간은 12.5일 이었고 평균 재원 기간은 3.2개월, 골 유합 기간은 14.5개월이었고 4례에서 불유합으로 수술 받았으며 그 중 2례는 감염에 의한 것이었다. 일측만 개방성 골절이 있는 경우에 수술까지의 기간은 25일, 평균 재원 기간은 3.75개월, 골유합 기간은 8.7개월이었다. 양측 모두 폐쇄성인 경우에서 수술까지의 기간은 15일, 평균 재원 기간은 1.92개월, 골유합의 기간은 4.8개월이었고 1례에서 술후 변형으로 재수술을 시행하였다. 결 론: 양측 경골 골절은 대부분 고 에너지에 의한 다발성 손상으로 타 부위와 하지 연부조직 손상이 동반되므로 수술시 연부조직의 상태 파악과 골절의 안정성을 충분히 고려하여야 한다. 또한 수술 후 합병증을 최소화하기 위하여 정확한 해부학적 정복과 견고한 고정이 필요하다. Purpose: The purpose of this study was to analyze the associated injury, difficulties in management and complications with surgery, and to suggest the guideline according to the severity and type of injury in the management of both tibia fractures. Material and Method: We analyzed 12 patients, 8 men and 4 women and their age was 43.4 years old in average. The cause of injury was traffic accident in 10, autobike in 1 and farm machine injury in 1 case. There were both open tibia fracture in 6, one side open fracture in 2 and both closed fracture in 4 cases. We analyzed the average interval from injury to operation, duration of hospitalization, duration of both side bone union and complications. Results: In both open tibia fracture, the average interval from injury to operation was 12.5 days, average duration of hospitalization was 3.2 months, and average duration of bone union was 14.5 months. In one side open fracture, the average interval to operation was 25 days, average duration of hospitalization was 3.75 months, and average duration of bone union was 8.7 months. In both closed fracture, the average interval to operation was 15 days, average duration of hospitalization was 1.92 months, and average duration of bone union was 4.8 months Conclusion: Both tibia fractures were caused by high energy and also associated with multiple injury, and fracture stability and soft tissue damage should be evaluated thoroughly before surgery. Anatomical reduction and rigid fixation should necessary to reduce the post-surgical complications.

Etiology and Related Factors of Postoperative Delirium in Orthopedic Surgery

송경진,고종현,권태영,최병완 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.3

Background: Delirium is a serious complication for elderly patients after orthopedic surgery. The purpose of this study was to assess the etiology and related factors of delirium after orthopedic surgery in Korea. Methods: We retrospectively reviewed the medical records of 3,611 patients over 50 years who had orthopedic surgery. The age of patients (50s, 60s, 70s, and > 80s), type of anesthesia (general, spinal, and local), operation time (more than 2 hours vs. less than 2 hours), surgical site (spine, hip, knee, or others), and etiology (trauma or disease) were compared to determine possible risk factors of delirium after orthopedic surgery. Results: Of 3,611 patients, 172 (4.76%) were diagnosed with delirium after orthopedic surgery. Postoperative delirium occurred in 1.18% in their 50s, 3.86% in their 60s, 8.49% in their 70s, and 13.04% in > 80s (p < 0.001). According to anesthesia type, 6.50% of postoperative delirium occurred after general anesthesia, 0.77% after spinal anesthesia, and 0.47% after local anesthesia (p < 0.001). More than 2 hours of operation was associated with higher occurrence of delirium than less than 2 hours was (5.88% vs. 4.13%, p = 0.017). For the etiology, 8.17% were trauma cases and 3.02% were disease (p < 0.001). Postoperative delirium occurred in 22 of 493 patients (4.46%) after spine surgery, 18 of 355 patients (5.07%) after hip surgery, 17 of 394 patients (4.31%) after knee surgery, and 15 of 1,145 patients (1.31%) after surgery at other sites (p < 0.001). Conclusions: Postoperative delirium was more common in older patients who had surgery under general anesthesia, whose surgery took more than 2 hours, and who were hospitalized through the emergency room.

요배부 재수술의 치료 결과

송경진,김기남,김규형,송지훈,황병연 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

=목 적: 수술 후에도 증상의 호전이 없거나 증상이 재발한 환자에 대하여 재수술을 시행 후 재수술의 원인 및 이에 따른 치료 결과를 분석하여 적절한 치료 원칙을 제시하고자 한다.대상 및 방법: 1996년에서 2004년까지 요배부의 재수술이 필요하다고 판단되어 수술적 치료를 받은 환자 중 최소 1년 이상 추시되었던 97예를 대상으로 재수술의 원인 및 이에 따른 치료 방법과 그 결과에 대하여 Kirkaldy-Wilis 판정 기준에 따라 분석하였다.결 과: 97예 중 재발한 추간판 탈출증이 37예(이전 수술부위 35예, 다른 부위 2예)로 가장 많았으며, 척추관 협착증이 17예, 그 외 경막외 유착(9), 가관절증(9), 인접 분절 협착증(9), 감염(8), 요추 불안정성(4), 금속 고정물 실패(2) 등이 원인이었다. 치료는 91예에서 유합술을 시행하였으며, 6예는 감압술만을 시행하였다. 치료 결과는 재발한 추간판 탈출증의 경우에서 임상적 결과가 양호하였고 치료 방법으로는 유합술을 시행한 경우가 감압술만 시행한 경우보다 양호한 결과를 보였으며(p=0.002), 장 분절 유합보다는 단 분절 유합술을 시행한 경우가 더 만족스러운 결과를 보였다(p=0.043). 최종 추시 결과 97예 중 62예에서 양호 이상의 결과를 보였다.