다분절 척추관 협착증의 장분절 후측방 유합술 -5년 이상 장기 추시 결과-

박예수,조재림 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.3

=목 적: 다분절 척추관 협착증에서 장분절 후측방 유합술을 시행하여 장기 추시 결과를 임상적, 방사선학적으로 분석하여, 후측방 유합술의 장기 추시 결과에 대해 보고하고자 한다. 대상 및 방법: 1990년 6월부터 1998년 5월까지 퇴행성 척추관 협착증으로 3분절 이상의 장분절 기기 고정 및 후측방 유합술을 시행 받았던 환자 중 최소 5년 이상 추시 관찰이 가능하였던 62예를 대상으로 하였다. 임상적으로는 Katz 등의 술 후 만족도 분류와 Oswestry 장해 평가법을 이용하였고, 인접 분절의 변화에 대해 단순 방사선 사진을 이용하여 분석하였으며, Lenke 등의 판정 기준을 이용하여 골 유합의 정도를 판정하였다.결 과: 평균 추시 기간은 94개월(61-156)이었고, 남자는 14명, 여자는 48명이었으며, 평균 연령은 58.7세(37-78) 였다. 평균 유합 분절은 3.97분절(3-8)이었고, 제1 천추까지 유합하는 고정 유합술(fixed fusion)이 60예(96.8%), 부동 유합술(floating fusion)이 2예(3.2%)였다. 임상적 평가에서 환자의 주관적 만족도에 있어서 Katz 분류에 의한 평가는 48예(77.4%)에서 만족 이상의 결과를 보여주었고, Oswestry 점수(ODI)는 평균 30.0% (6-88)을 보여주었다. 유합 분절수에 따른 ODI는 3분절 유합 25.8%, 4분절 유합 33.6%, 5분절 유합 25.9%로 모두 양호 이상의 결과를 보여주었으나 유합 분절수에 따른 ODI의 통계학적 차이는 없었다(p=0.383). 방사선 소견상 추간판 간격의 감소는 25예(40.3%), 견인골극은 26예(41.9%), 추체 골단판의 골 경화상은 22예(35.5%), 추간판 내 진공현상은 7예(11.3%)에서 보였다. 인접 분절의 변화 항목 중 1개 이상의 변화를 보인 경우는 34예(55.0%)였으며, 이 중 25예(73.5%)에서 ODI (38%)는 '만족'이상의 만족도를 보였으며, 인접 분절의 변화가 없는 경우는 28예로 이 중 24예(85.7%)에서 ODI (21%)의 만족도를 보여 두 군 간의 통계학적 차이는 없이 높은 만족도를 보였다(p=0.350). 골 유합은 1예를 제외한 전예에서 Lenke A, B등급을 보여주었고 추시 소견상 1예(1.6%)에서 최종적으로 가관절증으로 진단되었다.

다발성 골다공증성 압박 골절에서 시행한 경피적 척추 성형술

박예수,백승욱,이정환 대한골다공증학회 2011 Osteoporosis and Sarcopenia Vol.9 No.3

Recently, vertebroplasy has been widely used to treat osteoporotic vertebral compression fractures in the elderly. Outstanding results such as immediate pain relief and functional improvement have been achieved using vertebroplasty. However, some elderly patients suffer from multiple osteoporotic compression fractures due to severe osteoporosis. Although treating single- or 2-level osteoporotic spinal compression fractures using vertebroplasty has shown some significant curative effects and results, few reports are available in the management of multiple-level compression fractures. The purpose of this study is to report the cases that brought good clinical results using vertebroplasty to multiple osteoporotic compression fractures, including a review of the relevant literatures.

골다공증의 진단과 치료

박예수 대한의사협회 2012 대한의사협회지 Vol.55 No.11

Osteoporosis is a common bone disease in postmenopausal women that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, and bone micro- and macroarchitecture deteriorates. Osteoporosis is defined by the World Health Organization as a BMD of 2.5 standard deviations or more below the mean peak bone mass (average of young and healthy adults) as measured by dual energy X-ray absorptiometry (DEXA). Diagnosis of osteoporosis can be made using BMD measurement. The most popular method of measuring BMD is DEXA. In treatment, we can use various exercises and nutritional supplementation,medications, and lifestyle modification for the prevention of fractures.

토끼의 추간판에서 실험적 섬유륜 절개술에 의해 유발된 퇴행성 변화 - 불완전 섬유륜 절개술과 완전 섬유륜 절개술에 대한 비교 분석 -

박예수,조재림,JohnP.Kostuik 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.6

거골과 경골 원위부에 동시에 발생한 브로디 농양 - 1례 보고 -

박예수,박기철,Park, Ye-Soo,Park, Kee-Cheol 대한족부족관절학회 2001 대한족부족관절학회지 Vol.5 No.2

Brodie abscess is a localized form of chronic or subacute osteomyelitis that occurs most often in the long bones of the lower extremities of young adults. Involvement of the flat or small bones is less common. And there is no report of Brodie abscess which has two different lesion. We report a case of Brodie abscess of talus and distal tibia.

The Effect of Zoledronic Acid on the Volume of the Fusion-Mass in Lumbar Spinal Fusion

박예수,김홍식,Seung-Wook Baek,Dong-Yi Kong,류정아 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4

Background: Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. Methods: A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. Results: The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). Conclusions: A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Lumbosacral Fixation Using the Diagonal S2 Screw for Long Fusion in Degenerative Lumbar Deformity: Technical Note Involving 13 Cases

박예수,김홍식,백승욱,Sang-Hyun Lee 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.3

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.

척추 유합술후 인접 분절에서 탈출된 추간판의 경막외 후방이동으로 발생한 하반신 마비 - 드문 인접 분절 문제 -

박예수,이준환,강창남,조재림,박용욱 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.3

Posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. We present here an especially uncommon case involving a patient with paraparesis that was due to posterior migration of a ruptured disc in the adjacent segment after spinal fusion. The patient had a herniated lumbar disc in a diseased spinal junction with sequestered fragments that were located posterior to the thecal sac.

경골 원위 골간단부 골절에서 최소 침습적 금속판 고정술을 이용한 치료

박예수,박기철 대한골절학회 2005 대한골절학회지 Vol.18 No.3

Prevention and Treatment of Multiple Osteoporotic Compression Fracture

박예수,김희수 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.3

Korea’s demographic profile is undergoing tremendous change as the country rapidly ages at one of the fastest rates in the world. Indeed, the country is expected to become an “aged society” in 2018 when the proportion of elderly is estimated to reach 14.3% of the total population. With the notable increase in the number of elderly individuals, the incidence of osteoporotic fractures will also likely increase. Osteoporosis is a systemic musculoskeletal disease that is characterized by the decreased bone quantity and the abnormalities of the microstructures. There are both conservative and surgical treatment modalities for the fracture: conservative treatments include pharmacological treatments and orthosis; surgical treatments include vertebroplasty, kyphoplasty, and reconstructive surgery. Clinicians should consider the severity of osteoporosis, the concurrent osteoporotic fracture, the age and sex of the patient, and the underlying diseases in making a patient-tailored prescription.