저도의 척추 전방전위증에서 최소 침습적 경추간공 요추 추체간 유합술의 결과 - 최소 2년이상 추시 -

정흥태,조재림,김우철,김도근,김문찬 대한척추외과학회 2013 대한척추외과학회지 Vol.20 No.1

Study Designs: A retrospective study. Objectives: To analyze the clinical and radiological outcomes of spontaneous reduction via minimally invasive transforaminal lumbar interbody fusion (Mini-TLIF) as the treatment for low-grade symptomatic spondylolisthesis. Summary of Literature Review: Although minimally invasive transforaminal lumbar interbody fusion is technically demanding, this procedure is an effective method for spontaneous reduction of low grade spondylolisthesis. Materials and Methods: We analyzed consecutive series of 41 patients with low grade spondylolisthesis who underwent minimally invasive transforaminal lumbar interbody fusion, between April 2008 and July 2009. The minimum follow-up period was 2 years. Clinical evaluation was performed by an analysis of Visual Analogue Scale and Oswestry Disability Index. For the radiological evaluation, disc space height, slip percentage, and slip angle were analyzed. At the final follow-up, the fusion rate was analyzed according to the Bridwell’s anterior fusion grade. Results: For the evaluation of clinical outcomes, the Visual Analogue Scale for back pain decreased from 6.8±1.2 to 2.0±1.1, and that for radiating pain decreased from 7.9±1.3 to 1.7±1.1. Oswetry Disability Index decreased from 38.5±8.4 to 13.4±6.1. For the radiological evaluation, disc space height increased from 8.4±2.14mm to 11.8±1.54mm(P<0.05), slip percentage was reduced from 18.4±5.1% to 13.3±3.1%(P<0.05) and slip angle decreased from 10.6±4.5° to 6.2±3.4° (P<0.05). At the final follow-up, radiological union was obtained in 38 cases (92.7%). Conclusions: We conclude that minimally invasive transforaminal lumbar interbody fusion appears to be an effective method for spontaneous reduction of low grade spondylolisthesis if the surgeon becomes familiar with this method. 연구 계획: 후향적 연구목적: 경추간공 요추 추체간 유합술을 통한 저도의 척추 전방 전위증의 자연 정복후 임상적 및 방사선학적 결과에 대해 분석하고자 하였다. 선행 문헌의 요약: 최소 침습적 경추간공 요추 추체간 유합술은 기술적으로 어려움이 있지만 저도의 척추 전방 전위증의 자연 정복에 효과적인 방법이라 생각된다. 대상 및 방법: 2008년 4월부터 2009년 6월까지 증상있는 저도의 척추전방전위증으로 진단받은 최소 침습적 경추간공 요추 추체간 유합술을 시행한 41례를 대상으로 최소 2년이상 추시관찰을 하였다. 임상적 평가는 시각통증등급, Oswetry장애지수를 이용하여 평가하였다. 방사선학적 평가는 추간판 높이, 전위정도 및 전위각을 측정하였으며 최종 추시상 방사선학적 유합 평가는 Bridwell’s 전방 유합 등급을 이용하였다. 결과: 임상적 결과 및 평가는 시각통증등급은 요통은 술전 6.8±1.2점에서 최종추시 2.0±1.2점으로 감소하였으며 방사통은 술전 7.9±1.3점에서 최종추시 1.7±1.1점으로 감소하였다. Oswetry장애지수는 술전 38.5±8.4점에서 최종추시 13.4±6.1점으로 감소하였다. 방사선학적 평가는 추간판 높이는술전 8.4±2.14mm에서 최종추시 11.8±1.54mm로 증가하였으며(P<0.05) 전위 정도는 술전 18.4±5.1%에서 최종 추시 13.3±3.1%로 감소하였으며(P<0.05) 전위각 또한 술전 10.6±4.5°에서 최종추시 6.2±3.4°로 감소하였다(P<0.05). 최종추시상 방사선학적 유합율은 38례(92.7%)에서 보였다. 결론: 최소 침습적 경추간공 요추 추체간 유합술은 술기가 익숙하다면 저도의 척추 전방 전위증의 자연 정복에 효과적인 술식이라 생각된다. 약칭 제목: 최소 침습 경추간공 유합술의 결과

Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report

정흥태,황득수,전유선,김필성 대한고관절학회 2015 Hip and Pelvis Vol.27 No.1

A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.

최소 침습적 신경공 경유 요추 추체간 유합술

정흥태,나채오,하상훈,신동렬 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.1

Study design: A retrospective study Objectives: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results. Summary of Literature Review: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner. Materials and Methods: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated. Results: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms. Conclusions: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques. 연구계획: 후향적 연구 연구목적: 요추 질환에서 최소 침습적 신경공 경유 요추 추체간 유합술의 소개 및 그 결과를 알아보고자 하였다. 대상 및 방법: 최소 침습적 신경공 경유 요추 추체간 유합술을 시행한 환자 중 일년 이상 추시가 가능하였던 38명을 대상으로 하였다. 연령은 평균 57세, 평균 추시 기간은 19개월, 추간판 재탈출증이 2예, 척추관 협착증이 22예, 협부 결손형 척추 전방 전위증이 8예, 퇴행성 척추 전방 전위증이 6예이었다. 임상적 평가로는 Oswestry 장해평가 설문지 를 이용하였고, 방사선학적 평가로는 Bridwell 등의 전방 유합 기준에 의한 유합율, 전방 추체간 간격, 합병증 등을 분 석하였다. 결과: Oswestry disability index에 의한 기능평가는 수술 전 평균 30점(50~16점), 최종 추시상 평균 10점(2~24점)으로 향상되었으며, 34예(90%)에서 양호 이상의 결과를 보였다. 36예(95%)에서 골유합을 얻었으며, 2예의 불유합이 있었 으나 임상 증상은 양호하였다. 추체간 간격은 술 전 8.7 mm에서 최종 추시상 10.8 mm로 유지되었다. 합병증으로는 항생제 치료가 필요하였던 술 후 추간판염, 케이지가 이탈되어 재수술이 필요하였던 경우, 척추경 나사못의 이탈이 있었으나 임상 증상이 없던 경우가 각각 1예씩 있었다. 결론: 최소 침습적 신경공 경유 요추 추체간 유합술은 술기 습득에 시간이 걸리지만 연부조직 손상의 최소화, 출혈 량의 감소 및 회복 기간의 단축으로 보다 좋은 수술 술기로 사료된다.

전문병원제도의 성공적 안착을 위한 과제

정흥태 건강보험심사평가원 심사평가연구소 2012 HIRA 정책동향 Vol.6 No.2

Prednisolone이 골격근에 미치는 효과 연구

鄭興泰,吳貞姬 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.1

The association of muscle weakness with glucocorticoids treatment has been reported clinically and experimentally. Light microscopic study of biopsy specimens from patients and animals given such steroids has revealed pathologic changes with a variety of myofilament alteration or histochemical features. However, the lesions have not been described in detail. The purpose of this paper is to correlate the morphologic changes in cross sectioned muscles of rats receiving prednisolone acetate parentally with the size of diameter and glycogen content from those muscles known as white muscle in the medial head of gastrocnemius and red muscle in the soleus. The experimental rats were divided into 5 groups with those of control, 5, 10, 15 days of prednisolone acetate treated and 30 days after completion of 15 days prednisolone treated groups. Prednisolone acetate were given intra muscular injection with 8 mg/kg daily according to the each experimental group. The cross section of the medial head of the gastrocnemius and soleus muscles were observed by light microscope numberring them on the H & E preparation and glycogen content by PAS technique. The results obtained were as follows: 1. Significant alterations were observed in the size of the diameter and glycogen content with the cross sectioned muscle fibers in both muscles. 2. The average size of the muscle fibers of the medial head of gastrocnemius gradually reduced from 28.85㎛ to 16.18㎛, the smallest in it's average size at 15 days prednisolone treatment and the average size of the soleus gradually reduced from 28.71㎛ to 19.68㎛, the smallest size in it's diameter at 10 days treatment. 3. The regeneration action was observed in soleus muscle with 15 days prednisolone treatment with replacement of hypertrophic fibers and the average diameter was increased by 115% (33.3 ㎛). 4, Cross sections stained with PAS for glycogen showed a marked generalized increment in color from 1.9% to 85.8% dark reaction at 10 days prenisolone treatment in medial head of the gastrocnemius, and 20.8% to 92.0% dark reaction at 5 days treatment which were remained until 10 days treatment in soleus muscle but the variations were recovered relatively at 15 days treatment. 5. The alteration of muscle fibers induced by prednisolone treatment were greatly fast but the replacement action with hypertrophic fibers were dominant in soleus (red) muscle than medial head of the gastrocnemius (white) muscle. 6. At 30 days after completion of prednisolone treatment, the muscle fibers were recovered relatively to normal in both muscles.

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

외전 감입에 의한 상완골 근위부 사분 골절의 보존적 치료 - 증례 보고 -

김문찬,조재림,정흥태,김동준,김인보 대한골절학회 2011 대한골절학회지 Vol.24 No.1

상완골 근위부 골절 중 특히, 외전 감입에 의한 사분 골절은 수술적 치료 후 조기 재활로 견관절의 운동범위를 회복시켜야 좋은 임상 결과를 얻을 수 있다. 하지만 저자들은 보존적인 치료를 시행하여 우수한 임상결과를 얻은 환자의 증례를 경험하였다. 이에 문헌 고찰과 함께 증례를 보고하는 바이다.

고관절 비구순 파열 진단의 초음파에 대한 유용성

김필성 ( Pil Sung Kim ),정흥태 ( Heung Tae Jung ),전유선 ( Yoo Sun Jeon ),이문종 ( Mun Jong Lee ),박유진재진 ( Yoojin Jaejin Park ),황득수 ( Deuk Soo Hwang ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.3

목적: 대퇴비구 충돌 환자에서 비구순 파열의 진단에 있어 초음파의 유용성에 대해 알아보고자 한다. 대상 및 방법: 2010년 3월부터 2011년 10월까지 대퇴비구 충돌로 관절경적 수술을 시행 받은 환자 중 비구순 파열이 확인된 58명(58예: 남자 26예, 여자 32예)을 대상으로 하였다. 대상 환자들은 수술 전 시행된 고관절 초음파 검사와 자기 공명 관절 조영술의 비구순 파열의 유무와 형태를 확인하고 관절경의 비구순 파열과 비교하여 그 상관 관계에 대해 조사하여 초음파의 민감도와 양성 예측률을 측정 하였다. 결과: 대퇴비구 충돌을 동반한 비구순 파열의 초음파를 이용한 진단의 민감도와 양성 예측률은 각각 89.6%, 100%였다. 또한 초음파의 비구순 파열의 일치율은 84.6%(44/52)였다. 결론: 고관절 초음파 검사는 대퇴비구 충돌 환자에서 비구순 파열의 병변의 진단에 유용한 방법으로 판단된다. Purpose: This study evaluated the usefulness of ultrasonography for a diagnosis of acetabular labral tear in femoroacetabular impingement (FAI). Materials and Methods: From March 2010 to October 2011, an ultrasonographic examination was performed in 58 patients(58 hips: 26 men and 32 women) with acetabular labral tear. The sensitivity and positive predictive value of ultrasonography were evaluated for 58 cases with acetabular labral tear confirmed by hip arthroscopy. Results: The sensitivity and positive predictive value for an acetabular labral tear using ultrasonography was 89.6% and 100%, respectively. The concordance rate of an acetabular labral tear between arthroscopy and ultrasonography was 84.6%. Conclusion: Hip ultrasonography can make a significant contribution to a pathologic diagnosis and isa useful diagnostic tool for acetabular labral tears.

불안정 흉요추 골절 및 골절

이철승(Chul-Sung Lee),정흥태(Hung-Tae Jung),신문식(Moon-Seek Shin) 대한정형외과학회 1982 대한정형외과학회지 Vol.17 No.4

관절내 종골 골절에 있어 전산화 단층 촬영을 이용한 비골 건초여의 발생예측

정주영,서정탁,유총일,김휘택,정흥태,황성호 대한골절학회 2000 대한골절학회지 Vol.13 No.3

Purpose: The purpose of the current study is that CT can predict peroneal tenosynovitis in the intraarticular calcaneal fracture. Materials and Method: Sixty five calcaneal fractures in 55 patients were evaluated with CT scan. The follow-up period after operation was averaged 19 months (ranging from 4 to 79 months). A classification for peroneal tendon injury was developed, based on CT scan. Results: Of the 65 intraarticular calcaneal fractures, the incidence of peroneal tenosynovitis were 14 cases(26%)[open reduction and internal fixation group 7/43(16%), Essex-Lopresti group 7/22(32%)]. According to the author's classification, the incidence of peroneal tenosynovitis among open reduction and internal fixation subgroup was followed; type I was none(0/4), type II 11%(2/19), type III 20%(3/15) and type IV 40%(2/5) respectively(p=0.074). The incidence of peroneal tenosynovitis among Essex-Lopresti subgroup was followed; type I was none(0/4), type II 16%(1/6), type III 33%(3/9) and type IV 100%(3/3) respectively(p=0.009). Conclusion: CT can be used to evaluate the status of the peroneal tendon as well as to predict the development of peroneal tenosynovitis. The open reduction and internal fixation in type III and IV is preferable to achieve a alignment of peroneal tendon and a accurate reduction of subtalar joint.