경추 퇴행성 질환 환자에서 Cage만을 이용한 2구간 경추 감압술 및 골유합술

이호범,박찬우,유찬종,김우경,이상구,김석민 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: Anterior cervical discectomy and fusion (ACDF) is a highly successful surgical treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or polyetheretherketone (PEEK) cages without cervical plate in cervical degenerative disc disease. Methods: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February 2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were assessed in all cases. Outcome assessment was done using Odom’s criteria and visual analogue scale (VAS) score. Radiological assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage subsidence. Results: Radiculopathy was improved in all cases (100%) after surgery, whereas myelopathy was resolved in three of five patients (60%). Radiographic evidence of fusion was found in all patients (100%) at last follow-up. Preoperative mean VAS score was 8.1 compared with a postoperative score 2.5 (p<0.05). The clinical outcome was excellent or good in 16 cases (89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72 ± 1.12 mm to 7.84 ± 1.09 mm. Cervical lordotic angle at last follow-up was increased from 8.9 ± 2.76° to 15.1 ± 2.38°. The mean loss of disc height was 1.40 mm during the follow-up period. However development of subsidence did not influence on clinical outcomes. Conclusion: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in twolevel cervical diseases. Objective: Anterior cervical discectomy and fusion (ACDF) is a highly successful surgical treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or polyetheretherketone (PEEK) cages without cervical plate in cervical degenerative disc disease. Methods: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February 2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were assessed in all cases. Outcome assessment was done using Odom’s criteria and visual analogue scale (VAS) score. Radiological assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage subsidence. Results: Radiculopathy was improved in all cases (100%) after surgery, whereas myelopathy was resolved in three of five patients (60%). Radiographic evidence of fusion was found in all patients (100%) at last follow-up. Preoperative mean VAS score was 8.1 compared with a postoperative score 2.5 (p<0.05). The clinical outcome was excellent or good in 16 cases (89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72 ± 1.12 mm to 7.84 ± 1.09 mm. Cervical lordotic angle at last follow-up was increased from 8.9 ± 2.76° to 15.1 ± 2.38°. The mean loss of disc height was 1.40 mm during the follow-up period. However development of subsidence did not influence on clinical outcomes. Conclusion: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in twolevel cervical diseases.

반도체 정밀 생산기기 방$\cdot$제진을 위한 미진동 Design Guide Line 해석

이호범 한국공기청정협회 1999 空氣淸淨技術 Vol.12 No.1

흉요추부 골다공성 압박 골절과 동반된 천골 기능부전 골절 - 동반 빈도와 고위험 인자에 대해-

이호범,유찬종,이상구,김우경,박찬우,홍지명 대한척추신경외과학회 2009 Neurospine Vol.6 No.2

Objective: The sacral insufficiency fractures (SIFs) are not uncommon and usually occur in osteoporotic bone with minimal or unremembered trauma. Especially, if they are accompanied by osteoporotic compression fracture of the thoracolumbar spine, SIFs can be usually overlooked due to subtle clinical symptoms and signs coupled with radiographic findings. The review aims to be raising awareness of the incidence & risk factors of the SIFs. Methods: We retrospectively reviewed the 252 patients who were admitted at our hospital due to osteoporotic compression fracture of the thoracolumbar spine with minimal or unremembered trauma for 5 years. We assessed the incidence of the SIF being accompanied by osteoporotic compression fracture of the thoracolumbar spine and the effects according to sex, age, probable risk factors (diabetes mellitus & arterial hypertension), the location of fracture and the severity of osteoporosis. Results: 252 patients, including 36 men (14.3%) and 216 women (85.7%) were involved in this study and the osteoporotic compression fractures were located at thoracic (36 cases), thoracolumbar junction (180 cases), lumbar spine (36 cases). There are 18 cases (the incidence: 7.1%), including 2 men (5.5%) and 16 women (7.4%) in which the SIF was accompanied by osteoporotic compression fracture of the thoracolumbar spine. The effects according to sex, age, probable risk factors, the location of fracture and the severity of osteoporosis were not statistically different in both groups (group with SIF and group without SIF). Conclusion: The clinicians need to consider the possibility of SIF in patients of osteoporotic compression fracture of the thoracolumbar spine. Objective: The sacral insufficiency fractures (SIFs) are not uncommon and usually occur in osteoporotic bone with minimal or unremembered trauma. Especially, if they are accompanied by osteoporotic compression fracture of the thoracolumbar spine, SIFs can be usually overlooked due to subtle clinical symptoms and signs coupled with radiographic findings. The review aims to be raising awareness of the incidence & risk factors of the SIFs. Methods: We retrospectively reviewed the 252 patients who were admitted at our hospital due to osteoporotic compression fracture of the thoracolumbar spine with minimal or unremembered trauma for 5 years. We assessed the incidence of the SIF being accompanied by osteoporotic compression fracture of the thoracolumbar spine and the effects according to sex, age, probable risk factors (diabetes mellitus & arterial hypertension), the location of fracture and the severity of osteoporosis. Results: 252 patients, including 36 men (14.3%) and 216 women (85.7%) were involved in this study and the osteoporotic compression fractures were located at thoracic (36 cases), thoracolumbar junction (180 cases), lumbar spine (36 cases). There are 18 cases (the incidence: 7.1%), including 2 men (5.5%) and 16 women (7.4%) in which the SIF was accompanied by osteoporotic compression fracture of the thoracolumbar spine. The effects according to sex, age, probable risk factors, the location of fracture and the severity of osteoporosis were not statistically different in both groups (group with SIF and group without SIF). Conclusion: The clinicians need to consider the possibility of SIF in patients of osteoporotic compression fracture of the thoracolumbar spine.

추간반 및 후관절의 퇴행 정도를 이용한 요추 불안정 판단의 임상적 유용성

이호범,박찬우,이상구,김우경,유찬종 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: Treatment for symptomatic lumbar stenosis is usually surgical decompression and additional global fusion is recommended for patients with segmental instability. The aim of this article is to evaluate that degeneration degree of the disc and facet joint could be the indicator of judgment for segmental instability. Methods: We retrospectively reviewed 84 patients who underwent surgical treatment for lumbar spinal stenosis. Patients in Group 1 (30 patients) with radiological instability underwent decompression with global fusion, patients in Group 2 (54 patients) without radiological instability underwent decompression with global fusion or decompression only according to the existence and nonexistence of clinical instability. Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the facet joints degeneration from Grade 0 (normal) to Grade 3 (advanced). All patients were checked with the simple X-ray stress view and evaluated. Results: Severity of the disc degeneration had no significant association with the segmental instability, and no correlation with the facet joint degeneration. Severity of facet joint degeneration had significant correlation with the radiological instability. The segmental instability was increased with increasing severity of facet joint degeneration, especially translation. There was a significant association between facet joint degeneration and clinical instability. The facet joint degeneration was increased in patients with clinical instability. Conclusion: Our results suggest that the facet joint degeneration may be the useful indicator of judgment for segmental instability Objective: Treatment for symptomatic lumbar stenosis is usually surgical decompression and additional global fusion is recommended for patients with segmental instability. The aim of this article is to evaluate that degeneration degree of the disc and facet joint could be the indicator of judgment for segmental instability. Methods: We retrospectively reviewed 84 patients who underwent surgical treatment for lumbar spinal stenosis. Patients in Group 1 (30 patients) with radiological instability underwent decompression with global fusion, patients in Group 2 (54 patients) without radiological instability underwent decompression with global fusion or decompression only according to the existence and nonexistence of clinical instability. Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the facet joints degeneration from Grade 0 (normal) to Grade 3 (advanced). All patients were checked with the simple X-ray stress view and evaluated. Results: Severity of the disc degeneration had no significant association with the segmental instability, and no correlation with the facet joint degeneration. Severity of facet joint degeneration had significant correlation with the radiological instability. The segmental instability was increased with increasing severity of facet joint degeneration, especially translation. There was a significant association between facet joint degeneration and clinical instability. The facet joint degeneration was increased in patients with clinical instability. Conclusion: Our results suggest that the facet joint degeneration may be the useful indicator of judgment for segmental instability

구조물에 대한 진동 및 진동제어 방법에 관한 해석

이호범 한국공기청정협회 1996 空氣淸淨技術 Vol.9 No.2

반도체공장 클린룸 구조에서의 미진동 연구

이호범 한국공기청정협회 1992 空氣淸淨技術 Vol.5 No.2

식생이 다른 계류수의 수질영향인자에 관한 연구

이호범,이중기,하훈,김양기,박찬오,박혜영,박송인,허남칠,신대윤,북도순이 대한환경공학회 2006 대한환경공학회 학술발표논문집 Vol.2006 No.12

이미지 분석기법을 이용한 콘크리트 구조물의 균열 검출 시스템 개발

이호범,김종우,장일영 한국구조물진단유지관리공학회 2012 한국구조물진단유지관리공학회 논문집 Vol.16 No.1

본 연구에서는 디지털 이미지 분석기술을 이용하여 콘크리트 구조물의 대표적인 열화인자인 콘크리트의 균열을 검지할 수 있는 기술을 개발하기 위해 형태수리학에 근거한 모폴로지 기법이 도입된 이미지 분석기법을 적용한 균열검출 시스템을 개발하였다. 개발된 시스템에는 분석결과의 효율적인 관리를 고려하여 촬영된 다수의 이미지를 하나의 전체 이미지로 재구성하는 이미지 조합기술이 추가로 적용되었다. 그리고 개발된 시스템의 적용성 및 신뢰도 검증은 균열이 발생된 콘크리트 암거를 이용한 현장검증 실험을 통해 이루어졌으며, 실험에 사용된 촬영장비로는 40m까지 0.2mm의 균열을 검지할 수 있는 성능을 확인하였다. 이미지 분석을 통해 산정된 균열폭의 경우 실측 균열폭과의 차이가 최대 0.08mm로 나타나 일정 수준 이상의 정확도를 구명하였고, 이미지 조합의 경우 추상 패턴 이미지 면에 대한 분할 촬영 이미지를 조합한 결과 실제 전체촬영 원본 이미지와 육안으로 차이를 확인할 수 없을 정도로 우수한 조합결과를 도출하였다. In this study, the crack detecting system with digital image processing techniques based on the mathematical morphology method was developed to detect cracks in concrete structures. In the developed system, the image combining technique of reconstructing multiple images as an entire single image considering efficient management of analysis results was applied as an additional module. The developed system was verified through a field test with the cracked concrete culvert and the crack width of 0.2 mm was able to be detected in the 40m span. In the image analysis, the difference between calculated crack width and actual crack width were less than 0.08mm. For image combination in the stitching test of pattern images, the stitched image was identical with the original picture of entire subject in the visual perception level.

대학병원 직원들의 부검에 대한 인식도

이호범,곽정식,Lee, Ho-Beom,Kwak, Jyung-Sik 대한수사과학회 2007 대한수사과학회지 Vol.2 No.2

부검은 검안만으로 사인 또는 사망의 종류를 확인할 수 없는 경우 시체를 해부하여 이를 확인하는 검시(檢屍)방법이다. 본 연구자는 대학병원 직원들의 부검에 대한 인식도를 알아보기 위해 설문지를 이용하여 2007년 4월 2일부터 5월 4일까지 1개월간 대구광역시 영남대학교의료원의 직원들을 대상으로 설문조사를 실시하였다. 전체 286 명 중 남자가 121 명(42.3%), 여자가 165 명(57.7%)이었으며, 의사 57 명(19.9%), 간호사 71 명(24.8%), 의료기술직 83 명(29.0%), 행정사무직 58 명(20.3%), 기타 직종 17 명(5.9%)이었다.대상자들의 설문조사를 살펴보면 부검에 대한 교육정도에서 의사는 2회 이상이 61.4%인데, 간호사는 1.4%, 의료기술직은 15.7%, 행정사무직은 1.7%, 기타 직종은 5.9%로 의사들에 비해 교육정도가 많이 부족하였다. 본인이나 가족이 갑자기 쓰러져 사망했을 때 부검을 의뢰하겠는가라는 질문에 의사는 의뢰한다가 59.6%로 높았으나, 간호사는 22.5%, 의료기술직은 39.8%, 행정사무직은 41.4%, 기타 직종은 35.3%로 낮게 나타났다. 직장 동료가 근무 중 갑자기 쓰러져 사망한 경우 부검을 해야 한다고 생각하는가라는 질문에서도 의사는 그렇다가 66.7%로 높았으나, 간호사는 33.8%, 의료기술직은 39.8%, 행정사무직은 43.1%, 기타 직종은 17.6%로 낮게 나타났다. 병원내 환자가 병사했을 때 부검을 해야 한다고 생각하는가라는 질문에서도 의사는 그렇다가 50.9%, 간호사는 8.5%, 의료기술직은 19.3%, 행정사무직은 24.1%, 기타 직종은 17.6%로 낮게 나타났다. 부검은 어떤 곳에서 해야 하는가라는 질문에 의사는 의과대학 법의학교실이 73.7%로 가장 높았고, 다른 직종에서는 국립과학수사연구소가 가장 높게 나타났는데, 간호사는 62.0% 의료기술직은 59.0%, 행정사무직은 46.6%, 기타 직종은 58.8%이었다. 부검의 주체는 모든 직종에서 대부분의 대상자들이 전문 법의병리의사가 되어야 한다고 생각하는 것으로 나타났는데, 의사는 98.2%, 간호사는 94.4%, 의료 기술직은 96.4%, 행정사무직은 89.7%, 기타 직종은 88.2%이었다. 평소 부검의 필요성은 의사는 73.7%, 간호사는 23.9%, 의료기술직은 47.0%, 행정사무직은 34.5%, 기타 직종은 23.5%로 의사들이 평소 부검의 필요성을 많이 느끼는 것으로 나타났다. 사후 본인의 사체를 의과대학이나 연구기관 등에 기증할 용의가 있는가라는 질문에 의사는 22.8%, 간호사는 11.3%, 의료기술직은 24.1%, 행정사무직은 22.4%, 기타 직종은 23.5%만이 있다라고 답했다. 대상자들의 설문조사를 분석한 결과, 의사들에 비해 다른 직종의 대상자들이 부검에 대한 교육정도나 거부감이 더 큰 것으로 나타났다. 부검에 대한 부정적 의식의 개선을 위해 전문 인력의 양성과 관련 법률을 정비하여 우리나라 실정에 맞는 올바른 검시제도의 정착과 국민들에 대한 체계적인 법의학교육에 힘써야 할 것이다. An autopsy is a postmortem assessment or examination of a body to determine cause of death or manner of death. The author had surveyed Personnel's perception toward conducting an autopsy in general hospital with autopsy at YeungNam University Medical Center, Daegu, Korea from April, to May, 2007. The total number of 286 personnel consisted of 121 men(42.3%), 165 women(57.7%). There were 57 doctors(19.9%), 71 nurses(24.8%), 83 medical technicians (29.0%), 58 office workers(20.3%), and 17 others(5.9%). 61.4% of doctors had an experience of education for autopsy more than 2 times, but nurses(1.4%), medical technicians(15.7%), office workers(1.7%), and others(5.9%) had little experience. Response of conducting an autopsy for sudden death of respondent or respondent's family member was 59.6% of doctors, 22.5% of nurses, 39.8% of medical technicians, 41.4% of office workers, and 35.3% of others. Response of conducting an autopsy for sudden death of respondent's companion was 66.7% of doctors, 33.8% of nurses, 39.8% of medical technicians, 43.1% of office workers, and 17.6% of others. Response of conducting an autopsy for sudden death of patients in general hospital was 50.9% of doctors, 8.5% of nurses, 19.3% of medical technicians, 24.1% of office workers, and 17.6% of others. Survey about a proper institution for autopsy showed 73.7% of doctors for department of forensic medicine in medical school, and 62.0% of nurses, 59.0% of medical technicians, 46.6% of office workers, and 58.8% of others for National Institute of Scientific Investigation. Most of the respondents agreed with the forensic pathologist as the director of autopsy:98.2% of doctors, 94.4% of nurses, 96.4% of medical technicians, 89.7% of office workers, and 88.2% of others. Survey for necessity for autopsy showed responsiveness of doctors, 23.9% of nurses, 47.0% of medical technicians, 34.5% of office workers, and 23.5% of others. Survey for donation of him- or herself after death to the medical school or institution for the death investigation revealed responsiveness of 22.8% of doctors, 11.3% of nurses, 24.1% of medical technicians, 22.4% of office workers, and 23.5% of others. The result of the survey questionnaire showed more negative awareness for autopsy in nurses, medical technicians, office workers, others and than doctors. To improve the negative awareness for autopsy and settle proper postmortem inspection system, education of professional manpower for forensic medicine and inaction of law which is adequate for the actual circumstance of Korea should be considered.

자기공명영상에서 표준화된 ACR 팬텀 영상을 통한 상용화된 딥러닝 기법 평가

이호범,장지성 대한자기공명기술학회 2022 대한자기공명기술학회지 Vol.32 No.3

Compared to existing imaging equipment, MR images exhibit a relatively large difference in reproducibility according to hydrogen density in the human body. It is therefore extremely important for the DL algorithm to demonstrate this in clinical practice and supplement it when a problem is found. Therefore, this study evaluated the changes before and after application of the DL algorithm by implementing the method now clinically applied to image quality standards using the MR phantom of the American College of Radiology (ACR) recommended by special medical equipment. The results revealed that aspects of the resolution-related image quality, such as high illuminance spatial resolution, improved resolution, and location accuracy were statistically different from the previous DL algorithm before application. There was no difference between images in the intensity of the DL algorithm. These results meet the evaluation criteria of ACR Phantom applied to the special medical equipment image quality management regulations, but the existence of statistical differences before and after application of the DL algorithm suggest other related research tools will be needed in the future.