감염성 척추염 및 경막외 농양으로 오인된 요추부 결절성 통풍

우영하,정주선,정흥태,이인승 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.1

Study Design: Case report Objectives: We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level in a 43-year-old man that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images. Summary of Literature Review: Some patients have chronic back pain with an epidural mass. Among the many causes of epidural masses, tophaceous gout of the lumbar spine is very rare. Materials and Methods: A 43-year-old man presented with fever and chronic back pain with radiating pain. In an MR image of L4- 5, an abnormal subcutaneous mass was found in the posterior epidural space. The subcutaneous mass was isointense on T1-weighted images compared with the intervertebral disc, and focally and strongly hyperintense and heterogeneous on T2-weighted images. After the intravenous administration of gadolinium contrast, the mass was fairly homogenous, with a low signal intensity and without enhancement. With the diagnosis of infective spondylitis with epidural abscess, we performed a decompressive mass resection. Results: The pathologic examination revealed multinuclear giant cells and amorphous crystalline fibrous tissue. The lesion was diagnosed as tophaceous gout. Conclusions: This case underscores the importance of considering tophaceous gout in the differential diagnosis of an epidural mass in a patient with chronic back pain. 연구계획: 증례 보고목적: 경막외 농양과 유사한 요추 제 4/5 번의 척추 통풍 환자를 보고하고자 한다. 선행문헌의 요약: 만성적 요통을 가지고 있는 경막외 종양을 가진 환자에 있어서 요추 통풍의 발생률은 매우 낮다. 대상 및 방법: 43세 남자 환자가 발열, 만성 요통 및 하지 방사통을 보였다. 자기 공명 영상 상 L4-5의 우측 후 경막 외 공간에서 발생한 비정상적인 연부조직 종괴가 보였다. 연부조직은 T1 강조 영상에서 추간판에 비해 비슷한 강도를 보이고 T2 강조 영상에서 고강도를 보이며 이질적이었다. 가돌리늄 조영제를 정맥내 투여 한 후, 종괴는 증강 없이 낮은 신호 강도의 초점으로 상당히 균질한 양상을 나타냈다. 경막 외 농양이 있는 감염성 척추염의 진단 하에 감압 절제술을 시행 하였다. 결과: 병리학적 검사로 다핵 자이언트 세포와 무정형의 결정질 물질을 가진 섬유 진성 조직이 나타났고 척추 통풍으로 진단되었다. 결론: 척추 통풍은 요통 및 경막 외 종괴가 있는 환자의 감별 진단에 포함되어야 한다. 약칭 제목: 요추에서 나타나는 척추 통풍

침 시술 이후 발생한 경추 척수 손상

우영하(Young-Ha Woo),이지민(Ji-Min Lee),심대무(Dae-Moo Shim),배혁(Hyuk Bae) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.6

침술은 치료적 목적으로 신체의 특정부위에 바늘을 삽입하는 시술로 근골격계 질환의 증상 완화 목적으로 대중적으로 행해지는 술기이다. 침술 이후 심각한 합병증은 20만 예 중 1예 가량으로 발생률이 낮고 대부분의 경우 증상이 가볍고 일시적이므로 비교적 안전하다. 하지만 신경계 손상, 감염, 혈종, 폐기종 등 심각한 합병증이 발생할 수 있다. 저자들은 침술 이후 발생한 경추 척수 손상을 유발한 1예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Acupuncture, which is a procedure of inserting needles in a specific portion of the body to control pain, is conducted widely. The procedure is considered relatively safe because of its minimal side effects and low occurrence (1 in 200,000). On the other hand, its side effects include neurological damage, infection, hematoma, emphysema, etc . The authors report a case of cervical neurological damage that occurred after an acupuncture procedure.

최대하운동시 스키지도자의 혈중젖산농도 및 체표면 온도 변화 분석

우영하(Woo Young-Ha),이원재(Lee Won-Jae),강명훈(Kang Myung-Hun) 한국체육과학회 2008 한국체육과학회지 Vol.17 No.2

This study is to know how the exposure to the skiing ground environment on the normal temperature will have influence on bloodstream and distribution. So we chose A group is composed of 7men in their twenties(who has experience in teaching skiing) and B group is composed of 7 men in their twenties(who have take any experience) and have analyzed their lactic acid concentration in blood and body temperature on submaximal exercise. At the result of this study, we obtained following results. In the case of heart rate change and lactic acid concentration change when we compare two groups, we could find a difference(p<.001). In the case of an arrival time of expected heart rate and faceㆍchest surface temperature change there was no special difference but in the specific figure. AS we generalize outcome, Although regular long-term working under the low temperature does not have difference with working under the normal temperature, in the specific figure, there is difference in some field. As a result of these study, we could know that A group's physiological reaction when they work during a slack season. So I consider this study would be basic data for other studies such as how human can adopt new environment and what kind of physiological reaction will be happening from working out under the various environment.

태권도 품새 수련이 여성고령자의 건강체력과 체표면 온도 변화에 미치는 영향

우영하(Woo Young-Ha),한승완(Han Seung-Wan),이원재(Lee Won-Jae) 한국체육과학회 2009 한국체육과학회지 Vol.18 No.3

This study was performed by applying Taekwondo Pumsae training program to the female senior citizens who are deficient of social characteristics because of the reduced physical activities and weakened sports functions to make comparative analysis of the effects of the program on the physical strength. The results are as follows; Although it was not significantly different in Pumsae training group, blood pressure decreased in number. Comparison group showed a little increase in diastolic blood pressure. Although both groups did not show significant difference in resting heart rate, Taekwondo Pumsae training group showed decrease after the training, while the control group did not show any changes. In the comparison of face temperature, both groups did not show statistically significant difference between before and after dumbbell exercises. However, in the comparison after 12 weeks between before and after dumbbell exercises, Taekwondo group showed statistically significant increase (p<.001), while control group did not show significant difference. In the comparison between before and after 12 weeks before dumbbell exercise, both groups showed statistically significant decrease (p<.001). Also in the comparison between before and after 12 weeks after dumbbell exercise, both groups showed statistically significant decrease (p<.001). Regarding the comparison of chest temperature, both of training (p<.001) and comparison group (p<.05) showed significant decrease in the comparison between before and after dumbbell exercise. In the comparison between pre and post dumbbell exercise after 12 weeks, both groups showed significant decrease (p<.001). In the comparison between before and after 12 weeks before dumbbell exercise, both groups showed statistically significant decrease (p<.001). In the comparison between before and after 12 weeks after dumbbell exercise, both groups showed statistically significant decrease (p<.001). In the changes in physical strength, there was no statistically significant difference in the grip of the left hand. In the grip of the right hand and back muscle strength, Taekwondo group showed significant increase (p<.001). In bending forward in the seated posture and bending backward, Taekwondo group showed significant increase (p<.05). In bending backward, control group, also, showed significant increase (p<.05). In push-up, Taekwondo group showed significantly higher value than comparison group (p<.05).

A Combined Protocol for Enhancing the Performance of TCP over Wireless Links

Ying Xia Niu(우영하),Choong Seon Hong(홍충선) 한국통신학회 2001 한국통신학회 학술대회논문집 Vol.2001 No.7

경피적 척추 성형술에서 혈액 혼합 시멘트의 특성

서진혁,우영하,정주선,김도훈,김옥걸,이상욱,박찬호 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.5

Purpose: This study evaluated the efficacy of blood mixed cement for osteoporotic vertebral compression fractures in reducing the complications of percutaneous vertebroplasty using conventional cement. Materials and Methods: This study was performed retrospectively in 80 patients, from January 2016 to January 2017. Porous cement was formed by mixing 2, 4, and 6 ml of blood with 20 g of cement used previously. A tube with a diameter and length of 2.8 mm and 215 mm, respectively, was used and the polymerization temperature, setting time, and optimal passing-time were measured and compared with those using only conventional cement. Radiologically, the results were evaluated and compared. Results: The polymerization temperature was 70.3°C, 55.3°C, 52.7°C, and 45.5°C in the conventional cement (R), 2 ml (B2), 4 ml (B4), and 6 ml (B6), respectively, and the corresponding setting time decreased from 960 seconds (R) to 558 seconds (B2), 533 seconds (B4), and 500 seconds (B6). The optimal passing-time was 45 seconds (B2), 60 seconds (B4), and 78 seconds (B6) at 73 seconds (R), respectively and as the amount of blood increased, it was similar to the cement passing-time. The radiological results showed that the height restoration rates and the vertebral subsidence rates similar among the groups. Two cases of adjacent vertebral compression fractures in the R group and one in the B2 and B4 groups were encountered, and the leakage rate of the cement was approximately two times higher than that in the conventional cement group. Conclusion: In conventional percutaneous vertebroplasty, the procedure of using autologous blood with cement decreased the polymerization temperature, reduced the setting time, and the incidence of cement leakage was low. These properties may contribute to more favorable mechanical properties that can reduce the complications compared to conventional cements alone. 목적: 골다공증성 척추 압박골절을 가진 환자에서 혈액을 혼합한 시멘트를 사용함으로써 기존 시멘트를 이용하여 경피적 척추 성형술을 시행했을 경우 나타나는 합병증을 줄이는 데 적합한지 알아보고자 한다. 대상 및 방법: 2016년 1월부터 2017년 1월까지 80명을 대상으로 후향적으로 진행되었다. 각 군에서 기존에 사용하던 시멘트 20 g에 혈액을 각각 2, 4, 6 ml를 섞어서 다공성 시멘트를 생성하였다. 지름 2.8 mm, 길이 215 mm의 튜브를 이용하였고 중합온도, 응결시간, 적절한 통과시간을 측정하여 기존의 시멘트만 사용하던 것과 비교하였다. 방사선적으로 컴퓨터 단층촬영 및 X-ray를 통하여 결과를 평가하여 비교하였다. 결과: 중합온도는 기존의 시멘트(R), 2 ml (B2), 4 ml (B4), 6 ml (B6) 군에서 각각 70.3°C, 55.3°C, 52.7°C, 45.5°C였으며, 응결시간은 960초(R)에서 558초(B2), 533초(B4), 500초(B6)로 감소하는 양상을 보였다. 통과시간은 각각 73초(R)에서 45초(B2), 60초(B4), 78초(B6)를 보였으며, 혈액의 양이 증가할수록 기존의 시멘트 통과시간과 유사하였다. 방사선적 결과 분석에서 추체 재건율과 추체 재함몰률은 4군 간에 유의한 차이가 없었다. 인접 추체 골절은 R군에서 2건, B2, B4 군에서 1건씩 나타났으며, 시멘트 누출률은 기존 시멘트 군에서 약 2배 높게 측정되었다. 결론: 기존의 경피적 척추 성형술 시 본인 자가 혈액을 시멘트와 혼합하여 사용하는 술식은 중합온도의 감소, 응결시간의 단축을 보이며 시멘트 누출 발생률이 적었다. 이러한 물성은 기존의 시멘트만 사용하는 경우보다 합병증을 줄일 수 있는 더 적합한 기계적 특성에 도움일 될 것으로 판단된다.

Epidermoid Cyst after Groin Flap Mimicking Malignancy

강홍제,우영하 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.3

Epidermoid cyst is a benign tumor containing a layer composed by stratified squamous epithelium and filled with keratin. The epidermoid cyst after soft tissue damage such as bite, laceration could be caused by implantation of epidermal cells. There are reports of epidermoid cyst rarely occurred after surgical procedures such as bone graft or spine puncture. However, the report of epidermoid cyst associated with flap in the hand is very rare. We experienced such epidermoid cyst after the groin flap mimicking malignancy in the distal phalanx of the thumb. We found calcified mass with bony erosions in radiologic findings and heterotrophic signals and partial necrosis in magnetic resonance imaging that suggested malignancy. However, it was pathologically diagnosed as an epidermoid cyst. Therefore, we report the case and literature review.

정형외과 영역에서의 뮌하우젠 증후군

심대무,우영하,김창수,장봉준,박진성 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.1

Munchausen syndrome is a rare factitious disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. These patients distort their medical history, undergoing dangerous diagnostic and therapeutic procedures, often resulting in misdiagnosis. Management of this syndrome requires collateral history taking, sound clinical approach, exclusion of organicity, and addressing psychological issues. We report a 54-year-old female, who underwent orthopedic surgery 13 times. She was always unsatisfied with her surgical outcomes, and underwent additional surgical treatment of the shoulder, elbow, wrist, and knee joint. She repeatedly complained of joint pain, which was much more exaggerated than expected from her examination results. Therefore, we considered artificial arthrosis for a differential diagnosis of unclear arthrosis, and paid special attention when she exhibited odd behaviors. 뮌하우젠 증후군(Munchausen syndrome)은 환자가 되기 위해 빈번한 입원, 병적 허언, 그리고 의도적으로 증상을 만들어내는 행동을 수반하는 흔치 않은 인위적인 장애(factitious disorder)이다. 이들은 의식적으로 병력을 왜곡시키고 스스로 가한 상처를 통해 오진하게 하여 육체적 질환의 양상을 가장함으로써 위험한 진단적 치료적 방법을 유도한다. 이들에 대한 치료는 주변의 병력을 청취하며, 긍정적인 방향으로의 유도, 기질적인 문제에 대한 배제와 정신과적인 이슈에 대해 확인하는 것이다. 우리는 13회의 정형외과적 수술을 받은 54세 여자 환자의 증례를 보고하고자 한다. 그녀는 수술 결과에 항상 만족스럽지 못하였고 견주관절과 완관절 및 슬관절 전문의에게 매번 추가적이며 다른 수술적 치료를 요구하였다. 그녀는 검사 결과보다 더 심한 관절 통증을 반복적으로 호소하였고 이에저자들은 명확하지 않은 관절증의 감별 진단으로 인위적 관절증을 고려하게 되었으며, 기이한 입원 생활이나 비정상적인 행동을 보이는 경우에는 특별히 관심을 두게 되었다.

요추 추간공 협착증에서 일측성 양방향 내시경적 측부 추간공 감압술의 효과

이지민(Ji-Min Lee),우영하(Young-Ha Woo),유성호(Seong-Ho Yoo),김영준(Young-Jun Kim),서진혁(Jin-Hyuk Seo),배혁(Hyuk Bae) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.5

목적: 양방향 내시경적 감압술(unilateral biportal endoscopic decompression, UBE)의 유용성을 증명하기 위해 수술의 임상적, 영상학적 결과를 보고하고자 한다. 대상 및 방법: 요추 추간공 협착증으로 일측성 양방향 내시경적 측부 추간공 감압술(unilateral biportal endoscopic far-lateral decompression, UBEFLD)을 시행받은 20명의 환자들을 분석하였다. 임상적으로 시각통증척도(visual analogue scale, VAS), modified Macnab criteria, Oswestry Disability Index (ODI), 영상학적으로 수술 전후 단순영상을 비교하여 intervertebral angle (IVA), percentage slip, disc height index (DHI), foraminal height index (FHI)를 분석하였다. 결과: VAS는 평균적으로 술 전 6.20에서 술 후 1개월 2.05, 3개월 1.75, 1년 1.45로 호전을 보였다(p<0.001). Modified Macnab criteria는 술 후 1개월 70.0%, 3개월 80.0%, 1년 85.0%의 환자들에서 good 혹은 excellent 판정을 받았다(p=0.034). ODI는 술 전 59.8%, 1개월 35.8%, 3개월 33.2%, 1년 17.1%로 호전을 보였다(p<0.001). IVA는 술 후 평균 0.40도 증가(p=0.057), percentage slip은 술 후 0.19% 증가하였다(p=0.134). DHI는 술 전 0.49에서 술 후 0.62로 증가(p=0.359), FHI 또한 술 전 0.71에서 술 후 0.79로 증가하였다(p<0.001). 결론: UBEFLD는 임상학적 및 영상학적으로 모두 만족스러운 결과를 보였으며 종래의 척추 유합술이나 현미경 추간공 성형술의 훌륭한 대체가 될 수 있음을 의미한다. Purpose: This paper reports the short-term clinical and radiological results of unilateral biportal endoscopic decompression (UBE) to prove its efficacy. Materials and Methods: Twenty patients who received unilateral biportal endoscopic far-lateral decompression (UBEFLD) were analyzed statistically using the visual analogue scale (VAS), modified Macnab criteria and Oswestry Disability Index (ODI) clinically. Radiologically, their intervertebral angle (IVA), percentage slip, disc height index (DHI) and foraminal height index (FHI) were analyzed pre- and postoperatively. Results: The VAS scores were 6.20 preoperatively, which improved to 2.05, 1.75 and 1.45 at postoperative one month, three months and one year, respectively (p<0.001). The modified macnab criteria in both the good or excellent category was 70.0%, 80.0% and 85.0% at postoperative one month, three months and one year, respectively (p=0.034). The ODI improved from 59.8% preoperatively to 35.8%, 33.2%, and 17.1% at postoperative one month, three months, and one year, respectively (p<0.001). The IVA was increased 0.40±0.88 after a surgery (p=0.057). Percentage slip was increased 0.19% after surgery (p=0.134). The DHI changed from 0.49 preoperatively to 0.62 postoperatively (p=0.359), and the FHI changed from 0.71 preoperatively to 0.79 postoperatively (p<0.001). Conclusion: UBEFLD displayed satisfactory results. Such a result highlights the potential of UBEFLD as an excellent alternative to spinal fusion or microscopic surgery.

태권도 품새 수련이 고령여성의 심혈관질환 유발요인과 당내인성 변인에 미치는 효과

한승완(Han Seung-Wan),우영하(Woo Young-Ha),김경한(Kim Kyoung-Han) 한국체육과학회 2010 한국체육과학회지 Vol.19 No.4

This study wasperformed by applying Taekwondopumsae trainingprogram to the female senior citizens who are deficient of social characteristics because of the reduced weakened sports functions to make comparative analysis of the effects of theprogram on thephysical strength, cardiovascular disease and sugar tolerance variables. The results are as follows; HDL-C increased significantly in Taekwondo group (p<.001). Both groups did not show statistically significant difference in LDL-C. They didn’t show any difference in either TG (triglyceride) or T-C. Fibrinogen decreased significantly in Taekwondo group (p<.001) while it did not show any significant difference in control group. Blood glucose was not significantly different in Taekwondo group, but it decreased in number. In control group, it decreased significantly (p<.05). While HbAlc increased in Taekwondo training group significantly (p<.05), there was no change in control group. Concluding from the above results, Taekwondo Pumsae training brought it will help the senior citizens to improve the status of fat in the blood, reduce fibrinogen, sugar tolerance factors and keep 4 kinds of CBC in normal range, which willprevent cardiovascular disease and coronary artery disease in elderly women. It will have important meaning in theprevention of age related disease of female senior citizens. Therefore it is very important to maintain and improve thephysical functions throughproper physical activities before the aging isprogressed too much in order to do healthyphysical activities in elderly women.