The Endovascular Management of Saccular Posterior Inferior Cerebellar Artery Aneurysms

송하헌,원유동,김영주,김범수 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.5

Objective: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Materials and Methods: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Results: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedurerelated morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). Conclusion: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective. Objective: The purpose of this retrospective study was to report the outcome of the endovascular treatment of eight patients with eight saccular posterior inferior cerebellar artery (PICA) aneurysms. Materials and Methods: Over the last seven years (1999-2006), eight consecutive patients with saccular PICA aneurysms were treated by endovascular methods. Five of the aneurysms were presented with subarachnoid hemorrhaging, whereas three were discovered incidentally. Four of the aneurysms (3 ruptured and 1 incidental) were treated by intrasaccular coiling, whereas the remaining four (1 ruptured and 3 incidental) were treated by vertebral artery (VA) occlusion. Results: Of the four aneurysms treated by intrasaccular coiling, three were completely packed with coils and one was partially packed. In three of four patients who underwent vertebral artery occlusions, follow-up digital subtraction angiographies demonstrated thrombosed aneurysms and PICA. No procedurerelated morbidity occurred and no re-bleed was encountered during a follow-up examination (mean; 31 months). Conclusion: As a result of this study, we found that the endovascular management of saccular PICA aneurysms should be considered as safe and effective.

만성 족관절 외측 불안정성에 대한 $Brostr{\ddot{o}}m$ 변형 술식

송하헌,심대무,이병창,김동철,조용우,양정환,Song, Ha-Heon,Shim, Dae-Moo,Lee, Byoung-Chang,Kim, Dong-Churl,Cho, Yong-Woo,Yang, Jung-Hwan 대한족부족관절학회 2004 대한족부족관절학회지 Vol.8 No.1

Purpose: The purpose of this study is to evaluate the surgical results of modified $Brostr{\ddot{o}}m$ procedure for chronic lateral ankle instability and to assess whether or not associated injuries may affect postoperative satisfaction. Materials and Methods: Twenty- four patients with chronic lateral ankle instability were evaluated retrospectively from August 1998 to March 2002. Average age was 29.3 years. All patients were performed pre & postoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device, MRI and intraoperative arthroscopic evaluations before ligament reconstruction. Results: Of the 24 cases, 23 cases was improved more than average 12 points on AOFAS scales. On modified scales of Hamilton, 3 excellent, 20 good, 1 fair results. On stress view, average 2.2 mm difference was improved on anterior drawer test and average 1.7 degree on varus test. Associated injuries were 8 osteochondral defects, 4 anterior impingements, 2 loose bodies, 2 os subfibulare, 2 os submalleolare and 2 partial ruptures of peroneus brevis. 8 cases with no associated injuries rated excellent or good. Conclusion: The modified $Brostr{\ddot{o}}m$ procedure is believed to be an effective and successful method for chronic lateral ankle instability that didn't respond to conservative treatment. Because associated injuries in chronic lateral ankle instability may affect postoperative satisfaction, appropriate detection and treatment may need for postoperative satisfaction.

간외 악성 종양 환자에서의 작은 낭성 간병변 : CT상 발생 빈도와 그 의의

송하헌 대한영상의학회 1994 대한영상의학회지 Vol.30 No.1

목적: 간의 낭성 병변은 복부 전산화단층촬영을 시행한 환자에서 비교적 흔히 발견된다. 이런 낭성 병변들은 간외악성종양을 가지고 있을 경우 조기 전이성 간염과 감별하기 어렵다. 이에 저자들은 간외악성종양을 가진 환자에서 작은 낭성 간 병변이 CT상 발견되는 빈도와 그 의의를 알아 보고자 이 연구를 시도하였다. 대상 및 방법: 최근 3년간 시행한 1112명의 복부 CT를 후향적으로 조사하여 간내 작은(<2cm) 낭성 병변의 발생빈도를 알아보았고 특히 간외악성 종양을 가진 환자에서는 이들의 크기(<1cm,1-2cm),수(1,2-4>4),경계(명확,불명확), 그리고 위치(중심부,변연부)등과 신장 낭종 동반 여부를 조사하였으며 추적 CT, 초음하 소견, 그리고 생검 결과와 비교 분석 하였다. 결과: 총 1112명의 복부 CT중 99명(8.9%)에서 2cm 이하의 작은 낭성병변이 발견되었고 471명이 간외악성종양을 가지고 있었으며 이들 중 62명 (13.2%)에서 작은 간내 낭성 병변이 발견되었다. 62명에서 발견된 작은 낭성 병변은 13예(21.1%)사 악성(전이성 간암)으로, 27예(43.6%)는 양성(단순 간 낭종과 혈관증)으로 확인되었으나 나머지 22예(33.3%)는 분류할 수 없었다. 양성 혹은 악성으로 판명된 40명에서 발견된 작은 낭성 병변의 개수는 총 106개(악성:28, 양성:78)이었고, 악성 낭성 병변의 크기는 1cm 이하가 7개(25%),1-2cm이 21개(75%)이었으며, 양성 낭성 병변은 1cm 이하가 58개(74.4%), 1-2cm이 20개(25.6%)이었다. 이들의 위치는 낭성 병변 중 18개(64.3%)가 간의 변변부에, 10개(37.7%)는 중심 부위에 위치하였고, 양성 낭성 병변은 변연부와 중심부에 각각 41개(62.6%), 37개(47.4%)가 분포하고 있었다. 병변의 경계는 28개의 악성 낭성 병변중 18개(64.3%)가, 78개의 양성 낭성 병변 중 51개(67.9%)사 불분명하게 나타났다. 또 낭성 병변이 단독으로 나타난 경우가 19명(47.5%),2-4개인 경우가 14명(35.5%), 5개 이상인 경우가 7명(17.5%)이었는 데, 이들 각 군에서의 악성 빈도는 각각 26.3%(5/19명),42.9%(7/14명),28.6%(2/7명)이었다. 신장 낭종은 총 6명에서 동반되었는데 악성과 양성 각각 3명에서 발견되었다. 결론 : 간외악성종양환자에 있어서의 작은 낭성 간 병변은 비교적 흔히 볼 수 있는 소견(13.2%)으로 CT상 병소의 크기가1cm 이상 일 때에는 악성일 가능성이 높으므로 밀접한 추적 검사와 다른 진단기기를 이용한 검사를 더 해야 할 것으로 사료된다. Purpose : We evaluated the frequency of detection of small hepatic cystic lesion(SHC) on abdominal CT films and its significance in patients with extrahepatic malignancies.Materials and Methods: We retrospectively reviewed the abdominal CT films of a total 1112 patients to determine the frequency of detection of SHC, and 62 patients who had both extrahepatic malignancies and SHC were selected. A total 106 SHC determined as benign or malignant in 40 patients was analyzed according to thesize(( 1 cm, 1-2cm), the number(1, 2-4, )4), the margin(well-defined, ill-defined),and the location(central, peripheral) of individual cystic lesions. The findings of follow-up CT and ultrasonography and the results of biopsy were also reviewed. The frequency of combined renal cyst was also considered. Result :SHC of those 62 patients were classified as benign(27 patients, 43.6%), malignant(13 patients, 20.9%), or undetermined(22 patients, 35.5%) by the follow-up CT, ultrasonography, and biopsy. Most benign SHC(74.4%) measured under 1 cm, but 75% of the malignant SHC were in 1-2cm in size. The percentage of the malignancy in one and two to four SHC was 37.5% and 40%, respectively. The margin of SHC was ill-defined in67.9% of the benign and 64.3% of the malignant lesions. SHCs were mainly located at the periphery of the liver(benign 62.7%, malignant 64.3%). Coexisting renal cyst was rare.Conclusion: SHC Is not uncommon finding(13.2%) In patients with extrahepatlc malignancy and has a hlghprobablity of metastasis when it is larger than 1 cm, which should be closely followed and intensively studied further.

족부족관절 질환에서 주사 치료는 얼마나 효과가 있는가?

송하헌,Song, Ha Heon 대한족부족관절학회 2021 대한족부족관절학회지 Vol.25 No.1

Evidence-based papers on the treatment of some chronic tendinopathy or ligament lesions using an injection in foot and ankle disorders have been reported, but there are few reports on the treatment of acute ankle ligament injury. On the other hand, some papers have reported a faster return to play for injection therapy that combines RICE (Rest, Icing, Compression, and Elevation) treatment and rehabilitation. Injection therapy can be used as an additional treatment for ankle ligament injury. Rather than having narrow-minded thinking about these treatments, it is important to make efforts to verify the safety and precautions of treatment and recognize them as a category of normal treatment. Continuous analysis and monitoring of these treatments can satisfy patients whose needs are changing rapidly.

다발성 요추 척추관 협착증에서 실시한 선택한 선택적 감압술 : 5년 이상 추시 결과 More than 5 Yesrs Follow Up

송하헌,심대무,김동철,김태균,신호식 대한척추외과학회 2000 대한척추외과학회지 Vol.7 No.4

연구계획 : 다발성 요추 척추관 협착증을 가진 환자에서 고정기기를 이용한 척추유합술을 시행하지 않고 선택적 감압술을 시행한 경우에 대하여 임상 결과를 평가 분석하고자 한다. 연구목적 : 수술 현미경을 이용한 선택적 감압술을 시행한 경우를 5년 이상 추시 관찰하여 임상 결과를 알아보고자 한다. 대상 및 방법 : 1993년 1월부터 1994년 12월까지 고령의 환자에서 두 분절이상 침범한 요추 척추관 협착증을 대상으로 술 전 신경 차단술을 실시하여, 주증상 유발분절을 확인하고 수술현미경을 이용하여 선택적인 감압술만을 시행하였던 환자 중 최소 5년 이상 추시 관찰하였던 21례를 대상으로 하였다. 요통의 치료결과에 있어서 주관적인 측면이 강한 동시에 객관적인 판단이 필요하나 그 정확한 지표가 없고 많은 양식 중에서 단순화된 설문 방식의 Low-Back Outcome Scale을 사용하여 평가하였다. 결과 : 이환 분절에 따라서 2분절 이환에서 14례중 10례(47.6%), 3분절 이환에서 6례중 4례(19.0%), 4분절 이환에서 1례(4.8%), 총 15례(71.4%)에서 양호 이상이었고, 증상 이환 기간에 있어 1년 미민 5례중 4례, 1년 이상 5년 미만 12례중 8례, 5년 이상 4례중 3례에서 양호 이상의 결과를 보였다. 임상적 결과는 4례(19.0%)에서 우수, 11례(52.4%)에서 양호, 3례(14.3%)에서 보통, 3례(14.3%)에서 불량의 결과를 보여, 71.4%에서 양호이상 이었으며, 평균 산출 점수는 54.8로 양호의 결과를 나타냈다. 선택적 감압술을 시행하였던 환자에서 술 전 신경 차단술을 시행한 전체21례중 2회 실시가 가장 많았고 18례에서 50%이상의 증상호전을 보였다. 결론 : 다발성 요추 척추관 협착증을 가진 고령의 환자에서 술 전 신경근 차단술을 이용하여 최소분절을 선택적으로 수술 현미경을 통한 감압술을 실시함으로써 조기에 보행이 가능함과 동시에 합병증을 예방할 수 있어 권장할만한 방법중의 하나로 사료된다. Study Design : A rectrospective study of microscopic lumbar decompressions was performed elderly patients suffering from multiple level of lumbar stenosis. Objectives : The Purpose of this study were to assess the outcome of this procedure performed only microscopic decompression on multiple lesions in 5 years follow up and to identify the clinical features of the elderly patients with multiple stenosis. summary of Background Data : There was a common to perform fusion and instrumentation in spinal stenosis surgery, because of ixtensive decompression and instability. However the introduction of microscope in spine operation can minimize lesions and the incidence of spinal fusion. Material and Methods : Twenth-one patients were identified as having had a microscopic decompression without arthrodesis, for degenerative lumbar spinal stenosis over 60 years. The follow up period was more than 5 years. The clinical results was evaluated by Low-Back Outcome scale. Results : Ten cases were above good results in two levels involved 14 cases, 4 cases above good results in three levels involved 6 cases, one case above good results in four levels. In the cases of affected duration, 4 of 5 cases in less than 1 year, 8 of 12 cases in 1 to 5 years, 3 of 4 cases in more than 5 years were above good results by the criteria. We had calculated the average score (54.8) and concluded that the long-term outcome of decompressive surgery in the elderly is good. Conclusion : Selective microscopic decompression is one of the effective method for the elderly patients or parients with osteoporosis in addition to multiple stenotic lesions. And preoprative root block is also useful for selective microscopic decompression.

인라인스케이트와 관련된 손상

송하헌,김정우,조용우,양정환,Song Ha Heon,Kim Joung Woo,Cho Yong Woo,Yang Jung Hwan 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.1

목적: 인라인 스케이트 사용자가 증가함에 따라 부상도 증가하여 인라인 스케이트 손상에 대한 인식이 높아지고 있는 상태이나, 부상 요인 정도에 대한 연구가 미흡하여 인라인 스케이트와 관련된 급성 손상과 과사용 손상에 대해 알아보고, 이런 손상을 예방할 수 있는 방법에 대해 기술하고자 한다. 결과: 급성 손상은 주로 10대에서 많이 발생하고, 도로나 인도변에서 동작의 미숙이나 충돌에 의해 발생하며, 손상은 요골 원위부 골절, 손목 관절 염좌, 주관절 부위 골절 순으로 많이 발생 하였으며, 보호 장비를 제대로 착용하지 않은 경우가 많았다. 과사용 손상은 주로 인라인 상급자에서 발생하는데, 이 손상은 대개 부츠 자체 때문에 발생하거나, 부츠에 관련하여 발생하거나, 적절하지 않은 스케이팅 기술에 의해 발생하는 것으로 생각된다. 결론: 인라인 스케이트와 관련된 손상중 급성 손상을 예방하기 위해서는 보호 장비를 잘 착용하고, 정지 동작들을 정확하게 습득한 후, 안전한 장소에서 탈 수 있도록 교육을 시켜야 할 것으로 생각된다. 또한 과사용 손상을 예방하기 위해서는 발에 잘 맞는 스케이트를 선택하는 것이 중요하고, 정확한 스케이팅 기술의 습득과 충분한 휴식을 하는 것이 중요하겠다. Objective: Recently, inline skates are populary increasing and have become major recreational activities. This study was performed to determine the effective prevention means on various extremity injury by investigating injury severity occording to acute injury and overuse injury. Results: Acute inline skating injury was experienced mostly among the age between 6$\~$14 years old children after school around nearby their home without using no appropriate safety device gear. The wrist injury was mostly happened. We think that overuse injury is related to boot itself, boot fitting and improper skating techniques. Conclusion: So afterall, appropriate safety equipment wearing in inline skating at the safe place after learning about the skating skills can reduce the acute inline skating extremity injuries. Choosing a pair of good fitting boots, performing the exact pushing techniques and take good rests in the middle of skating frequently can reduce the overuse injury.

족부합병증을 알아보는 검사는 무엇이 있을까?

송하헌,Song, Ha-Heon 사단법인 한국당뇨협회 2005 당뇨 Vol.188 No.-

무지 외반증의 수술비 및 보험

송하헌,심대무,김동철,권석현,김종윤,Song, Ha-Heon,Shim, Dae-Moo,Kim, Dong-Churl,Kweon, Seok-Hyun,Kim, Jong-Yun 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2

Purpose: The purpose of this study was to figure out the appropriate and systemic insurance charge for the hallux valgus operations. Materials and Methods: 5 Hospitals for hallux valgus operations were analyzed how they have been charging the national health insurance corporation for their operation fees and how to use the estimated guide and authoritive interpretation through the guide book of health insurance medical treatment grant expense and the guide book of Health insurance medical treatment. Results: There are nothing for guiding principle of hallux valgus operations in both books but a guide of Mcbride operation which is approved 'JA-93-KA and JA-31' for operation fee. So majority of hospitals have charged operation fee depending on their own interpretations they like. According to the guide books, there was a authoritive interpretation that simultaneous operation of osteotomy and tendon transfer for cerebral palsy and flat foot can be eatimated as 'osteotomy+JA-93-NA'. Conclusion: Distal soft tissue procedure should be approved as 'JA-93-NAx100%+JA-31x50%' according to the the estimated guide and authoritive interpretation if transected adductor hllucis is transfered to first metatarsal head. So distal chevron osteotomy could be 'JA-30-1-RAx100%+JA-31x50%', proximal metatarsal osteotomy could be 'JA- 93-NAx100%+JA-31-50%+JA-30-1-RAx50%', first metatarsocuneiform joint arthrodesis could be 'JA-93-NAx100%+ JA-31x50%+JA-73-RAx50%'.

AO Synthes 금속판을 이용한 전방 경추 유합술후 발생한 지연성 식도 천공

송하헌,김태균,심대무 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.1

Esophageal perforation after anterior cervical discectomy operation has a rare incidence. Also Delayed Esophageal perforation after anterior cervical discectomy has a very rare incidence. Esophageal perforaton is usually characterized as being due to the surgical exposure, metallic implant, bone graft, fractured vertebrae and polymethylmethacrylate. Esophageal perforaton result in fatal mediastinitis, which may lead to die from sepsis. The mortality rate continues to be more than 20%. Factors that adversely affect the outcome include the location and severity of the esophageal injury] associated injuries and delayed diagnosis and treatment. The purpose of this report is to present the our case of a patient who had delayed esophageal perforation by irritation of metallic screw and 3 weeks post operatively, and to know how can we get a early diagnosis and treatment in delayed esophageal perforation.

발목 관절의 스포츠 손상과 수술

송하헌 대한운동사협회 2013 대한운동사협회 운동사대회자료집 Vol.2013 No.-