비타민 D 결핍과 저에너지 척추골절의 연관성

이재원,서완식,강병직,김준국,박예수 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.1

Study Design: Retrospective study. Objectives: To compare serum vitamin D levels in elderly patients with or without osteoporotic spinal compression fractures (OSCFs) and to identify relationships between the serum vitamin D level and other variables, such as age, bone mineral density (BMD), and bone turnover markers (osteocalcin and C-telopeptide). Summary of Literature Review: Vitamin D plays a key role in calcium metabolism in the bone tissue. Vitamin D deficiency can lead to decreased BMD and an increased risk of falls and of osteoporotic fractures. Materials and Methods: We retrospectively reviewed the medical records of 95 elderly patients (≥60 years) with OSCFs (fracture group) and 118 subjects who had been diagnosed with osteoporosis without OSCFs (control group). Serum vitamin D levels were contrasted between the two groups taking into account other factors such as patient age, sex, and seasonal variations. For all the patients, we also evaluated the correlation between the vitamin D level and the patient age, BMD, and bone turnover markers. Results: The mean of the serum 25(OH) vitamin D3 levels was significantly lower in the fracture group than in the control group. There were significant differences in the 25(OH) vitamin D3 levels in autumn. In all patients, the mean serum 25(OH) vitamin D3 levels were the highest in autumn and the lowest in spring. Furthermore, the mean serum 25(OH) vitamin D3 levels were significantly correlated with patient age and BMD. Conclusions: A low serum vitamin D level might be a risk factor of OSCFs in elderly patients. 연구계획: 후향적 연구. 목적: 노인에서의 혈중 비타민 D의 농도와 골다공증성 척추 골절의 관계를 규명하고, 혈중 비타민 D의 농도와 다른 요인들과의 관계를 밝히고자 한다. 선행 연구문헌의 요약: 비타민 D는 골 조직에서의 칼슘 대사에 있어서 아주 중요한 역할을 담당하고 있으며 비타민 D가 부족할 경우 BMD의 감소 및 낙상, 골다공증성 골절의 위험이 증가한다. 대상 및 방법: 저자들은 60세 이상의 환자 중 의료 기록을 통하여 골다공증성 골절이 있는 95명의 환자 및 골절이 없는 골다공증 환자 118명을 분석하였다. 비타민 D와 골다공증성 골절의 관계뿐만 아니라 다양한 요인들과의 상관관계 및 회귀분석을 시행하였다. 결과: 혈중 비타민 D의 농도의 평균은 골다공증성 골절이 있는 그룹에서 골절이 없는 그룹에 비하여 낮았으며 상관 관계가 있는 것으로 나타났으며, 혈중 비타민 D의 농도의 평균은 가을에 가장 높고, 봄에 가장 낮은 것으로 나타났다. 또한 환자의 나이와 BMD와도 상관관계가 있음을 보여주었다. 결론: 노인에서 혈중 비타민 D가 낮은 경우는 골다공증성 골절의 위험인자가 될 수 있다.

골다공증 환자에 있어 연 1회 정주용 졸렌드론산 투여의 순응도 평가

이정환,이재원,서완식,박예수 대한골다공증학회 2014 Osteoporosis and Sarcopenia Vol.12 No.1

Objectives: To analyze the adherence of once-yearly intravenous zolendronic acid for osteoporosis. Materials and Methods: The subjects were 322 osteoporotic patients who received more than single infusion of zolendronic acid. On clinical assessment, we assessed adherence. The changes of bone mineral density (BMD) and bone turnover marker were measured before and after infusion. Results: Reinfusion rate was 48.4% (109/225) at second infusion, and 51.3% (41/80) at third infusion. Adverse event at each time was 161 (42.1%) cases, 30 (27.5%) cases, and 8 (19.5%) cases, respectively. The measured mean BMD change was significantly increased (P-value<0.001). Conclusions: In this study, once-yearly intravenous zolendronic acid for 2 years was safe and efficacious in terms of BMD and bone turnover marker. The adherence was higher than most published studies of adherence to oral bisphosphonates, but lower than optimal. Physicians should fully explain to patients about medications and educate to improve their adherence.

골감소증에서 사용된 연 1회 정주용 졸레드론산의 효과

성창호,박예수,서완식 대한골다공증학회 2013 Osteoporosis and Sarcopenia Vol.11 No.3

Objectives: To assess the clinical efficacy of once-yearly treatment with Zoledronic acid in patients with osteopenia. Materials and Methods: From June 2009 to November 2011, patients diagnosed with osteopenia were applied to fracture risk assessment tool (FRAX). Among them, 40 patients who showed high possibility of osteoporotic fracture were selected and treated with intravenous zoledronic acid once-yearly. At the baseline and after one year of injection of zoledronate, we measured the changes in the bone mineral density (BMD) and bone turnover markersIn addition, we analyzed the side effects and thereby assessed the drug safety. Results: Mean 10 year probability of fracture calculated by FRAX tool was 4.2±1.8% for hip fracture, and 17.7±4.3% for other major osteoporotic fracture. Mean T-score was -1.89±0.42 at baseline and -1.71±±0.54 at 1 year after treatment. But this differences did not reachstatistical significance (P>0.05). Mean C-telopeptide levels were 0.35±±0.32 ng/mL and 0.22±±0.16 ng/mL, , mean osteocalcin levels were 13.64±5.15 ng/mL and 11.7±6.02 ng/mL before and after treatment. These differences reached a statistical significance (P<0.001). During the treatment, there were no serious adverse effects. Conclusions: Once-yearly treatment with Zoledronic acid was effective in reducing bone resorption in patients with osteopenia. In addition, the BMD levels were slightly increased. But this was not statistically significant. Further long-term follow-up studies are warranted to assess the efficacy of a once-yearly treatment with Zoledronic acid in patients with osteopenia.

척수 원추 주변에 발생한 경막내 추간판 탈출증 - 증례 보고 -

이재원,박예수,서완식,오영하 대한척추외과학회 2014 대한척추외과학회지 Vol.21 No.3

Study Design: A case report. Objectives: To report a rare case of intradural disc herniation (IDH) around conus medullaris. Summary of Literature Review: IDH is rare with an incidence of less than 1% of all lumbar disc herniations. It is important todifferentiate IDH from other condition with accurate diagnosis and subsequent surgical treatment. IDH has a higher risk of neurologicdeficit, like conus medullaris syndrome and cauda equina syndrome. Materials and Methods: A 62 year-old male was affected by lumbar back pain radiating to the anterolateral aspect of the right thighfor 5 days. MRI showed a mass that existed on the anterior portion of the conus medullaris. We performed partial laminectomy at the L1-L2level. The mass located anteriorly in the intradural space was eliminated after durotomy by a posterior approach. Results: We confirmed the IDH for histopathology. Conclusions: IDH usually needs accurate differential diagnosis. Preoperative MRI scans are necessary to differentiate IDH from otherintradural lesions. The confirmative diagnosis can be done only in the operative field. Key Words: Intradural disc herniation, Conus medullaris 연구 계획: 증례 보고목적: 척수 원추 주변에 발생한 경막내 추간판 탈출증에 대하여 보고한다. 선행 문헌의 요약: 경막내 추간판 탈출증은 매우 드문 질환으로 전체 추간판 탈출증 중 1% 미만으로 보고되고 있다. 다른 경막내 종물과 감별진단이 필요하며 본 증례에서와 같이 척수 원추 주변에 발생하는 경우는 매우 드물고, 또한 병변의 위치로 인해 척수 원추 증후군(conus medullaris syndrome)이나 마미 증후군(cauda equina syndrome)등의 신경학적 손상을 초래할 수 있어 정확한 진단과 수술적 제거가 필요하다. 대상 및 방법: 62세 남자가 내원 5일 전부터 시작된 요추부의 통증과 우측 대퇴부 전외측으로 저린 감각을 호소하였다. 자기 공명 영상 검사에서 척수원추 부위에 발생한 종물을 발견하였다. 후방 접근법으로 제1-2요추간 추궁판을 일부 제거하고 경막에 절개를 하여 경막내 공간(intradural space)으로돌출되어 있는 종물을 제거하였다. 결과: 종물은 병리 조직 생검을 통해 퇴행성 추간판으로 확진하였다. 결론: 경막내 요추부 추간판 탈출증은 정확한 감별 진단을 요한다. 수술 전 자기 공명 영상 검사는 다른 경막내 병변과 감별하기 위하여 반드시 필요하며 확진은 수술 중 가능하다. 색인 단어: 경막내 추간판 탈출증, 척수 원추약칭 제목: 경막내 추간판 탈출증

360 Mbit/s 광수신기의 제작

박문수(M.S.PARK),서완식(W.S.SEO),고정훈(J.H.KO),김용환(Y.H.KIM) 대한전자공학회 1985 대한전자공학회 학술대회 Vol.1985 No.6

자가면역질환 환자에서 장기간 당질 코르티코이드 복용에 의해 유발된 골다공증성 다발성 압박 골절

박예수 ( Ye Soo Park ),서완식 ( Wan Sik Seo ),조재림 ( Jae Lim Cho ),김태환 ( Tae Hwan Kim ) 대한류마티스학회 2009 대한류마티스학회지 Vol.16 No.3

Reduced bone mineral density precedes the development of vertebral fractures in patients under long term glucocorticoid therapy. Osteoporosis is a frequent complication in steroid-dependent patients, and the risk of developing vertebral fractures in these patients is much higher than involutional osteoporosis. We described a 54-year-old patient who presented with autoimmune hepatitis and had a 6-year history of steroid medication. The patient had multiple compression fractures (T10∼L5) without trauma, and was treated successfully with multi-level vertebroplasty and an intravenous injection of bisphosphonate without complications.