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통증을 유발하는 골다공증성 척추골절의 최소 침습적 치료
이재협,이지호 대한의사협회 2009 대한의사협회지 Vol.52 No.4
The consequences of osteoporotic vertebral compression fractures are pain, progressive vertebral collapse with resultant kyphosis, and systemic manifestations. Minimally invasive stabilization procedures such as vertebroplasty and balloon kyphoplasty have been introduced to treat for refractory pain due to these fractures. Vertebroplasty and kyphoplasty are new alternatives for the treatment of osteoporotic vertebral compression fractures. Both methods stabilize the fractured vertebra with polymethylmethacrylate cement to relieve pain and allow immediate mobilization. Kyphoplasty is an extension of vertebroplasty that uses an inflatable bone tamp to restore the vertebral body height while creating a cavity to be filled with bone cement. A large proportion of subjects had some pain relief both in vertebroplasty and kyphoplasty. Vertebral height restoration was possible using kyphoplasty and for a subset of patients using vertebroplasty. Cement leaks occurred in both groups but, the incidence of cement leakage in kyphoplasty is lower than that of the vertebroplasty. Vertebroplasty and kyphoplasty are safe and effective procedures. Good short-term results have been reported following both vertebroplasty and kyphoplasty for the painful osteoporotic vertebral fractures. Severe complications result from bone cement leakage into the spinal canal or the vascular system have been reported but the incidence was very rare. Both vertebroplasty and kyphoplasty offer therapeutic benefit significantly reducing pain and improving mobility in patients with vertebral fracture without significant differences between groups in term of quality. While early results are promising, more research is needed to better understand the log-term effects of both procedures on the human spine.
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이재협,이지호,Hyeong-Seok Lee,Do-Yoon Lee,이동오 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.2
Background: In cervical anterior approach, transverse skin incision is preferred due to cosmetic reasons. Precise skin incision is required to reach the surgery segment while minimizing soft tissue injury. Skin incision site is frequently identified using C-arm fluoroscopy or the carotid tubercle. Accordingly, this study was conducted to investigate the efficacy of skin incision using the carotid tubercle as a marker. Methods: This study was retrospectively conducted on 114 patients who underwent anterior cervical surgery by the same surgeon from April 2004 to June 2012. The rate of the appropriate insertion of K-wire, which was inserted into the disc after anterior approach, into the surgery segment was compared between 62 patients where skin incision site was identified using C-arm fluoroscopy before skin incision and 52 patients where skin incision site was identified using carotid tubercle palpitation before surgery. Results: The needle was shown to have been inserted into the planned site in 106 patients out of the total 114 patients. The appropriate insertion of the needle was shown in 59 patients of group I (95.2%) and in 47 patients of group II (90.4%). Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of one-segment surgery was shown to be 89.7% in group I and 82.6% in group II. Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of two-segment surgery was shown to be 100% in group I, and 96.4% in group II due to one case of the failure at C3-4 and C5-6. The success rate of three- and four-segment surgeries was shown to be 100% in both groups. Conclusions: The identification of skin incision site via carotid tubercle palpation was useful for surgeries involving two or more segments. Furthermore, it could be useful for one-segment surgery if surgical site is identified using vertebral body or soft tissues such as longus collis rather than insertion into the disc.
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이재협,이혜연,문성환,이일섭,Korean Post Menopausal Women Study Group 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.1
Background: Preventive measures need to be implemented to lower the incidence of osteoporotic fractures. Osteoporotic fractures increase morbidity and mortality as well as impose a socioeconomic burden; however, current research is limited to the administration rates of osteoporosis drugs for Korean postmenopausal females. Methods: This study represents a nationwide, observational, and cross-sectional survey that investigates the administration rates of osteoporosis drugs based upon a bone mineral density (BMD) test performed on Korean postmenopausal patients who visited outpatient orthopedic clinics. BMD test results were examined in postmenopausal female patients (50 to 80 years of age); subsequently, the patients were classified into an osteoporosis group, osteopenia group, and normal group. The administration rates of osteoporosis drugs and bisphosphonates were then analyzed. The osteoporosis group was subdivided into a T-score less than −3.0 group and a T-score between −3.0 and −2.5 group that were separately analyzed. Results: Based on the lumbar spine BMD, the rate of administration of osteoporosis drugs in the osteoporosis group was 42.1%, which was significantly higher compared to the osteopenia group or normal group. A significantly low bone mineral density was observed in patients who were administered bisphosphonates. Based on the lumbar spine BMD, the administration rate of osteoporosis drugs in the group with a T-score between −3.0 and −2.5 (34.2%) was significantly lower than the group with a T-score less that −3.0 (46.2%). The bisphosphonate administration rate was also significantly low; however, the administration rate for osteoporosis drugs was significantly lower than that of the osteopenia group. Conclusions: Only about 40% of Korean postmenopausal female patients with osteoporosis were administered osteoporosis drugs. The administration rate in patients with a T-score between −3.0 and −2.5 was particularly low and active treatment to prevent osteoporotic fractures is required in this group.
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