한국성인 상완골 근위부의 골격 실계측

전재명(Jae-Myeung Chun),정의룡(Ewy-Ryong Chung),김기용(Key-Yong Kim) 대한정형외과학회 1999 대한정형외과학회지 Vol.34 No.1

관절경적 전방십자인대 재건술의 재시술

빈성일(Seong Il Bin),정의룡(Ewy Ryong Chung) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.6

분절 척추경 나사 고정술을 이용한 단일 흉요부 및 요부 만곡의 치료

석세일(Se-Il Suk),정의룡(Ewy-Ryong Chung),이정희(Jung-Hee Lee),김진혁(Jin-Hyok Kim),이상민(Sang-Min Lee),이지호(Ji-Ho Lee),김성수(Sung-Soo Kim),조범철(Beom-Chul Cho),박세진(Se-Jin Park) 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.7

Pedicle Screw Fixation in Pediatric Spinal Deformities

Jin-Hyok Kim(김진혁),Se-Il Suk(석세일),Ewy-Ryong Chung(정의룡),Sung-Soo Kim(김성수),You-Min Oh(오유민),Jae-Min Jeon(전재민),Yun-Seok Choi(최윤석) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.5

목적: 척추 변형 수술에서 3차원 교정이 가능한 척추경 나사못의 사용은 증가하고 있으나 10세 이하의 소아에서의 임상적 결과에 대한 보고는 드물어, 10세 이하의 소아에서 변형 교정을 위해 사용한 척추경 나사못의 유용성을 판단하고, 성장하는 추체에 척추경 나사못이 미치는 임상적 문제들을 알아보고자 하였다. 대상 및 방법: 수술을 시행할 때 10세 이하인 38명 환자를 대상으로 하였으며, 원인 질환으로는 25명의 선천성 척추 측만증, 9명의 특발성 척추 측만증, 기타 원인으로 인한 척추 변형 4명이었으며 최소 2년 이상(2-7년) 추시 가능한 환자를 대상으로 하였으며, 성장중인 척추에서 척추경 나사못의 효과를 알아 보기 위해 27명(72%)에서 전산화 단층 촬영을 시행하였다. 수술 방법으로 후방 고정을 시행한 환자는 21명, 후방도달 척추 절제술을 시행한 환자는 16예, 전-후방 교정을 시행한 1예였다. 결과: 관상면에서 교정도를 살펴 보면 후방 고정을 시행한 경우는 67.2%예 교정을 보였으며, 후방 도달 척추 절재술을 시행한 경우는 71.5%, 전후방 교정술을 시행한 경우는 64.7예의 교정도를 보였다. 시상면에서는 평균 교정도는 20°였다. 전체적으로 341개의 척추경 나사못을 사용하였으며 환자 평균 8.9개의 나사못을 사용하였다. 합병증으로는 7개의 나사못이 정상 위치에 삽입되지 않았으며(2.1%), 1명의 환자에서 고정의 상실이 있었으며, 1명에서 변형이 다시 진행하였으며, 1명에서 천부 염증이 관찰되었다. 그러나 모든 환자에서 심각한 신경학적 합병증은 발생하지 않았다. 또한 척추경 나사못 삽입으로 인한 척추관 협착 소견은 방사선학적 임상적으로 관찰되지 않았다. 결론: 척추경 나사못은 10세 이하의 척추 변형이 있는 소아에서도 성인과 같은 유용한 효과를 관찰할 수 있었으며 어린 소아에서 척추경 나사못 삽입 후에 척추관 협착 소견은 관찰되지 않았다. Purpose: We wanted to determine the efficacy of performing pedicle screw fixation to treat pediatric spinal deformities and we also wanted to evaluate its long-tenn effects on the growing spine. Materials and Methods: Thirty-eight consecutive spinal deformity patients (25 congenital, 9 idiopathic and 4 other etiologies) under 10 years old at the time of the surgery who underwent pedicle screw instrumentation were reviewed after a minimum follow up of 2 years (range: 2 to 7 years). To evaluate the effect of the pedicle screws on the growing spine, a thin slice CT scan was performed in 27 patients (72%) at the last follow up. The patients were treated by posterior fusion with segmental pedicle screw fixation being performed in 21 patients, vertebral column resection combined with segmental pedicle screw fixation was done in 16 patients and combined anterior and posterior correction was done in 1 patient. Results: The frontal correction was 67.2% in the posterior fusion group, 71.5% in the posterior resection group and 64.7% in the patients who underwent combined anterior and posterior correction. A mean correction of 20° was obtained in the sagittal plane. A total of 341 pedicle screws were inserted (an average of 8.9 screws per patient). The complications were comprised of 7 screw mal positions (2.1 %), 1 loss of fixation (screw pull-out), 1 recurrence of deformity and one superficial infection. There were no significant neurological or vascular complications. Any Symptoms or radiological evidence suggestive of spinal stenosis were not detected in any of the patients. Conclusion: Pedicle screw fixation may be used with the same efficacy for pediatric spinal deformities, and even for the patients under 10 years old, without causing any hazard of iatrogenic spinal stenosis.

후방 도달 척주 절제술을 이용한 고도 척추 변형의 치료

석세일(Se Il Suk),김진혁(Jin Hyok Kim),이상민(Sang Min Lee),정의룡(Ewy Ryong Chung),조성태(Seong Tae Cho),이정희(Jung Hee Lee),김성수(Sung Soo Kim),남창현(Chang Hyun Nam),김현호(Hyun Ho Kim),이창수(Chang Soo Lee) 대한정형외과학회 2003 대한정형외과학회지 Vol.38 No.1

고도 성인 흉부 측만증에서 시행한 후방 척주절제술

정의룡,김진혁,이상민 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : To report the result of one stage posterior vertebral column resection(PVCR) in treating severe adult thoracic scoliosis Materials and Methods : Thirteen patients(average age 30.2 years) with thoracic scoliosis were treated with PVCR. Their results were retrospectively reviewed after a minimum follow-up of 2 years for deformity correction and complications. Etiological diagnoses were neglected idiopathic in 6, congenital in 4 and others in 3. The average preoperative scoliosis was 96°(range: 70∼143) with less than 25% flexibility. The average preoperative trunk shift was 2.Ocm(range: O∼6.0) and the shoulder height difference was 2.1 cm(range: O∼8.0). The procedure consisted of a posterior midline approach, segmental pedicle screw fixation of the index curve, resection of the posterior elements, bilateral rib heads and vertebral bodies with adjacent discs, anterior column reconstruction with a structural graft or chip bones, and correction of the deformity by derotation and cantilever method. Results : Total 17 thoracic vertebrae were resected. The most common resection was T8 in 5 patients. The mean operative time was 387 minutes with an average blood loss of 4864 ml. At latest follow up, the index curve was corrected to 36(range: 15∼78) showing a correction of 63%. The loss of correction was 4%. The trunk shift and the shoulder height difference were improved to 0.4cm(range: O∼1.4) and 0.4cm (range: O∼1.0), respectively. One paraplegia occurred in scoliosis with Beal's syndrome, who had a preoperative neurologic deficit. Conclusion: One stage posterior vertebral column resection could be performed safely and effectively for severe adult thoracic scoliosis, even though technically demanding and involves possible risk for major complications.

후방 도달 척추 절제술을 이용한 강직성 요천추 변형의 치료

석세일,정의룡,이정희,김진혁,김성수,이지호,최원기,박용원 대한척추외과학회 2004 대한척추외과학회지 Vol.11 No.2

척추경 나사 고정 및 후방 유합술만으로 치료한 Andersson 병변 : Andersson 병변 Andersson lesion

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

A60-year-old female patient with Andersson lesion is presented. Andersson lesion or spondylodiscitis in ankylosing spondylitis is a rare but well-known condition defined as an erosive and sclerotic process involving the intervertebral disc and adjacent vertebral bodies. The causes of this condition are not well understood. The Andersson lesion is often painful, and needs surgical treatment. The patient underwent segmental pedicle screw fixation and posterior fusion without any anterior procedure. The clinical features are presented with leterature review.

후방 도달 반척추 절제술을 이용한 선천성 측만증의 치료

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: To evaluate the surgical outcomes of congenital scoliosis with hemivertebra corrected by posterior vertebral column resection after a minimum follow up of 2years. Materials & Methods: Thirty five congenital scoliosis cases(20 males and 15 females) subjected to posterior vertebral column resection and without any previous operative intervention were analyzed. They were analyzed for deformity correction and complications. The mean age at operation was 14.6 year-old(range 2.6~35) and mean follow-up was 3.1 years(range 2.0~4.5). The preoperative index curve was 44.5±15.8° in coronal plane, and 22.7±35.9° in sagittal plane. Results: The total number of resected vertebrae were 36 : 17 in thoracic and 19 in lumbar. The deformity correction was 57.0% with 19.0±10.6° in the coronal plane and 69.0% with 7.0±14.9° in the sagittal plane. Mean operation time was 222.7±54.9 minutes with a total perioerative transfusion of 1992.0 ㎖. Complications were encountered in 3 patients(8.6%) : 1 hematoma and cauda equina syndrome, 1 fixation failures and 1 transient posterior cord syndrome. Conclusion: Posterior vertebral column resection in congenital scoliosis with hemivertebra is an effective method compared to anterior-posterior two stage hemivertebra resection. It could offer satisfactory correction of deformity and restoration of spinal balance.

퇴행성 요추 병변에서 척추경 나사를 이용한 요천추유합의 결과

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective: To evaluate the efficacy of lumbosacral fusion with bilateral bicortical S1 pedicle screw fixation without anterior support on the basis of the fusion levels in degenerative lumbosacral disease. Materials and Methods: Seventy three patients were treated with posterior decompression and posterolateral fusion with bilateral bicortical S1 pedicle screw fixation. Their results were analyzed retrospectively with minimum 2-year follow-up. Postoperative anteroposterior and lateral radiographs were analyzed for S1 screw loosening, fixation failure and lumbosacral fusion. Medical records were analyzed for postoperative low back pain and complications. Results: S1 screw loosening was 1(6.3%) in 2 level fixations, 3(14.3%) in 3 levels, 7(5O.0%) in 4 levels and 13(86.7%) in more than 5 levels. Fixation failure was 1(4.8%) in 3 levels fixation, 1(7.1%) in 4 levels, 5(33.3%) in more than 5 levels. Non-union was suspected in 30 patients(41.1%), 1(14.3%) in mono-level fixation, 2(12.5%) in 2 levels, 8(38%) in 3 levels, 9(64%) in 4 levels and 10(67%) in more than 5 levels. Postoperative sustained low back pain was 1 in 3 levels fixation, 2 in 4 levels and 7 in more than 5 levels. Postoperative complications were detected in more than 3 level fixations ; hematoma in 2, wound infection in 6, progressive kyphosis in 2. Conclusion: Lumbosacral fixation with bilateral bicortical S1 pedicle screw could not provide satisfactory outcome in long level fusion especially in more than 4 levels fusion of degenerative lumbar disease.