다발성 수상 환자에서 요추부 후방 관절의 간과된 편측성 아탈구 - 1예 보고 -

조재림,박예수,김민건 대한골절학회 2000 대한골절학회지 Vol.13 No.1

Unilateral dislocation or subluxation of a facet in lumbar spine is extremely rare, so it has been often neglected. The mechanism of injury is hyperflexion and distraction forces. As for the treatment of lumbar facet dislocation and subluxation, open reduction and internal fixation by the posterior approach has been recommended because the injuries are resistant to closed reduction and they may cause chronic instability. We report a case of neglected unilateral subluxation of facet joint in lumbar spine of multiple trauma patient, which was treated by open reduction and internal fixation with posterolateral fusion. In the multiple trauma patients, it is mandatory to the meticulous diagnosis and treatment.

요추부 질환에서 시행한 단분절 유합과 장분절 유합간의 임상 결과에 대한 비교

조재림,윤원구,권오재 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1

In some of the lumbar sinal disorders, fusion is the method of choice for relieving spinal pain and usually one or two segments fusion is sufficient but somtimes as in degenerative spinal stenosis it is necessary to carry out three or more segments fusion. The purpose of this study is to compare the clinical results between these short and long segment fusion groups. From August 1987 to December 1992, 138 lumbar spinal disorders were operated on and followed for more than one year, the average follow up period was 2 years and 5 months. One or two segments fusion was carried out in 111 patients and three or more segments fusion in 27 patients. 49 patients were male and 89 patients were female. Most prevalent age was from 41 to 60 in both groups. Degenerative spinal stenosis was the most common etiology for operation in both groups. In all cases, pedicle screws were female. Most prevalent age was from 41 to 60 in both groups. Average operation time was 4.75 hours in short segment fusion group and 6.25 hours in long segment fusion group. Under the hypotensive anesthesia, the amount of blood loss during operation was 1520 ㎕ and 2000㎕ respectively, and the amount of postoperative suction drainage was 450㎕ and 730㎕ respectively. On clinical results, 96.4% of good to excellent results were obtained in short segment fusion group while in long segment fusion group is was 85.2% but overall clinical results had no statistical significance between these two groups. In complications, hematoma was the most frequent complication in both groups but it was more frequent in long segment fusion group. Dural tear occured in 5 patients and it was more frequent in long segment fusion group and this was the only statistically significant complication. In this series, we had no deep would infection, no nonunion and no permanant neurologic deficit.

척추경 나사못 기기술을 사용한 요추부 척추관 협착증의 수술적 치료

조재림,이광현,윤원구,이창우 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2

The purpose of this study is to report our results for pedicle screw fixation in 161 cases of lumbar spinal stenosis from August,1987 to July,1993. The operation was performed for degenerative spinal stenosis in 72 cases, for stenosis by isth- mic defect in 51 cases, for stenosis combined with herniated lumbar disc in 30 cases, and for iatrogenic stenosis in 8 cases. The age at the time of operation was from 17 to 76, the mean age was 47.1 years. Contrel-Dubousset instrument was applied in 99 cases, compact C-D in 26 cases, Diapason in 30 cases, TSRH in 4 cases, and Steffee and P.W.B. in 1 case respectively. Decompression for 1 segment was carried out in 45 cases, 2 segments in 56 cases, 3 seg- ments in 41 cases, over 4 segments in 19 cases. Wide decompression including facetectomies were necessary to obtain complete decompression. The clinical results were that among the 161 cases followed over 1 year, 151 cases(94%) were good to excellent, 9 cases were fair and I case was poor according to the criteria of Kirkaldy-Willis. We could anticipate the good result in patients who had preoperative symptom duration for less than two years. But, the degree of compression of dural sac in myelogram is not correlated with the good result. Complications were multiple, hematoma(45 cases), meralgia paresthetica(13 ases), treatsient neurologic deficit(16 cases), dural tear(5 cases), urinary tract infection(2 cases), superficial infection(3 cases), screw breakage(5 cases), malposition of screw(1 case), prenetration of anteri- or cortex(2 cases), and dissociation of screw and rod(1 case). But no permanent neurologic deficit, or deep infection was observed and no reoperation was done. To obtain excellent results, complete decompression, firm internal fixation preferably by pedicle screws, and sufficient autogenous bone grafr were necessary.

척추측만증(脊椎側彎症)의 개요

조재림 中央醫學社 1999 中央醫學 Vol.64 No.2

퇴행성 요추 질환과 동반된 인접 분절 척추 골절의 치료

조재림,성일훈,백승욱,박예수 대한척추외과학회 2008 대한척추외과학회지 Vol.15 No.4

Study Design: Retrospective study Objective: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. Summary and Literature Review: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. Materials and Methods: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. Results: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. Conclusion: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.

정형외과영역에서의 Cefpiramide sodium (Sepatren^(�))의 임상 연구

조재림,박영봉,최태열 최신의학사 1987 最新醫學 Vol.30 No.4

임파선을 따라 원격 골화성 전이를 일으킨 골육종 : 증례보고

조재림,김태승,이창우 최신의학사 1995 最新醫學 Vol.38 No.6

Mechanisms linking particulate matter exposures and cognitive impairment: epidemiological evidence

조재림,장희선,박현지,노영,손정우,고상백,이승구,김선영,김창수 환경독성보건학회 2022 한국독성학회 심포지움 및 학술발표회 Vol.2022 No.10

Kaneda 기기를 이용한 흉요추부 및 요추부 방출성 골절의 수술적 치료

조재림,박예수,김도형 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1

Study Design : Burst fracture consists of 15% of all spine fracture and half of them show neurologic deficit because of neural compression by the posteriorly displaced bony fragment of the mid column. Operative treatment is usually indicated for decompression in moderate to severe canal compromise with or without neurologic deficit. To maintain reduction and for early rehabilitation, various instrumentations are recommended and Kaneda instrument is one of the popular device for anterior decompression. Objectives : To confirm the relationship of anterior decompression and recovery of neurological function in burst fracture and the efficacy of the Kaneda instrumentation. Summary of Literature Review : Anterior approach has the advantages that it can directly remove displaced bony fragment to the spinal canal and also effecitvely correct deformity of the kyphotic angle. In this treatment, we generally use Kaneda instrument as an internal device which is biomechanically more rigid, and can fix even the least segment than any other one. Materials and Methods : From Aug. 1989 to Nov. 1994, the authors applied Kaneda instrument after anteriordecompression in 26 cases of burst fracture, which was followed for more than 1 year. We analysed burst fracture with Denis' classification, Cobbs' method, Mumford technique, Bradford and McBride classification, Denis' pain and work scale. Results : The average rate of preoperative canal encroachment was 55.9% and complete decompression was carried out in all cases. And there was no difference of these results in both groups of with or without neurologic deficit. At the time of injury, neurlogic deficit occurred in 12 cases. 3 of which showed complete paraplegia. In cord level injury, neurologic deficit was observed in horse-shoe and crescent type but no correlation was observed in cauda equina level injury. Neurologic status was improved average 1.3 grade in 9 cases except 3 cases of complete paraplegia. According to Denis' pain and work scale, it was 77% above P₂W₂. There was 4 cases of complications including 2 cases of superficial infection, 1 case of deep infection and 1 case of metal failure. Conclusion : We recommend the anterior spinal decompression and Kaneda instrumentation for restoration of spinal canal and optimal recovery of neurological function and for early rehabilitation.

경골 과간 융기 골절의 치료방법에 따른 결과 비교

조재림,정현기,최충혁,노창호 대한골절학회 1996 대한골절학회지 Vol.9 No.3

The management of fractures of the tibial intercondylar eminence is uncomplicated when the fracture has minimal displacement(Type I ) or when only one-third or a half of the eminence is elevated(Type I ). However, the treatment of complete separation(Type III ) has been controversial. Authors reviewed 35 cases in 35 patients of the tibial intercondylar eminence fracture at the Department of Orthopedic Surgery of Hanyang University Hospital from Jan. 1988 to Dec. 1994. The results were as follows; 1) There was a predisposition for male and prevalent age distribution was 2nd to 4th decade. 2) The most common cause of injury was traffic accident in 22 cases(62.9%). 3) The most common associated injury was rupture of MCL on the ipsilateral knee in 11cases (37%). 4) According to the Meyers and McKeever's classification, type g was most common in 24 cases(69%), type ( was 7 cases(20%) and type [ was 4 cases(l 1%). 5) The excellent or good result was 82% in conservative treatment group, 83% in screw fixation group and 92% in pull out suture group. 6) In case of small size and comminution of the fragment, it was difficult to fix the fragment with screw fixation. So, we recommend the method of fixation with pull out suture technique for small or comminuted type I fracture.