강직성 척추염 환자의 수술적 치료 시 컴퓨터를 이용한 가상교정의 임상적 의의

이재원,김훈철,박예수 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.2

Study Design: Retrospective study. Objectives: To evaluate the clinical value of preoperative planning via computer simulation by comparing preoperative and postoperative measurements of a patient with ankylosing spondylitis. Summary of Literature Review: Ankylosing spondylitis is a disorder that results in a spinal deformity because chronic inflammation at the ligament attachment sites triggers ossification; it causes round fixed kyphosis. This causes limitations in not only everyday life but also social interaction because it is impossible for patients to face forward. Therefore, surgical correction is necessary. Materials and Methods: We analyzed 38 patients (41 instances) who underwent correctional osteotomy between June 2007 and March 2014 to treat kyphosis caused by ankylosing spondylitis. We chose the appropriate operation site on the basis of preoperative simulations of osteotomy and the site for pre- and postoperative radiological evaluations conducted from the lateral view in a standing position. For the clinical evaluation, Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Hospital Anxiety and Depression Survey (HADS), and Health Locus of Control Form C Questionnaire (HLC-C) were used. Results: The mean sagittal vertical axis (SVA) was improved from 123.4 mm to 66.1 mm, the mean thoracic kyphosis angle (TKA) changed from 42.2° to 40.1°, and the mean lumbar lordosis angle (LLA) improved from 16.0° to 28.5°. The correlation coefficients between the preoperative predictive value and the postoperative radiographic measurement were 0.43, 0.93, and 0.87, which were all statistically significant. Conclusions: By comparing the preoperative measurement with the postoperative radiologic score, we found that the two were correlated and that the clinical assessment improved on the basis of the visualization. Therefore, preoperative simulation of patients with ankylosing spondylitis along with a kyphotic deformity is thought to be clinically effective. 연구계획: 후향적 연구. 목적: 척추 후만이 동반된 강직성 척추염 환자에서 교정 절골술을 시행하기 전 가상교정을 통한 술 전 계획과 술 후 상태를 비교하여 가상교정의임상적 가치를 평가하고자 하였다. 선행문헌의 요약: 강직성 척추염은 인대의 골 부착부에 발생하는 만성적인 염증에 의한 골화 현상에 따라 척추의 변형이 오는 질환으로, 원형의고정된 후만증을 가져오게 된다. 이로 인하여 전방주시가 불가능할 뿐만 아니라 반듯이 눕지도 못하게 되어 환자의 일상 생활뿐만 아니라 사회생활의 제약 등을 초래하여 수술적 교정이 필요하다. 대상 및 방법: 2007년 6월부터 2014년 3월까지 강직성 척추염으로 인한 후만증에 대하여 척추경 제거 절골술(PSO: pedicle subtraction osteotomy)을 단독 혹은 Smith-Peterson 절골 술식(SPO: Smith-Peterson Osteotomy)을 병행한 환자 38명, 41예를 대상으로 후향적으로 분석하였다. 모든 수술은 술 전 가상교정을 시행하여 절골 부위를 결정하였고, 수술 전 후 방사선학적 평가는 기립 자세에서 촬영한 척추전장 측면 사진(long-cassette standing lateral spinal radiographs)을 촬영하였다. 임상적 평가는 Bath Ankylosing Spondylitis Function Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Hospital Anxiety and Depression Questionnaire (HADS) 및 Health Locus of Control- Form C Questionnaire(HLC-C)를 이용하였다. 결과: 방사선학적으로는 평균 시상 수직축이 123.4 mm에서 66.1 mm으로 호전되었으며, 평균 흉추 후만각은 42.2°에서 40.1°으로 변하였고, 평균 요추 전만각은 16.0°에서 28.5°로 호전되었다. 술 전후 방사선학적 지표의 상관관계를 분석하였을 때, 시상 수직축은 예측 값과 연관계수는0.43, 흉추 후만각 및 요추 전만각은 각각 0.93, 0.87로 통계학적으로 유의한 상관관계를 보여주었다. 결론: 가상교정을 통한 방사선학적 지표와 수술 후 방사선학적 지표를 비교를 하여 두 지표가 통계학적으로 일치함을 확인하였으며, 임상적 지표가 향상되었다. 이를 통해 후만 변형이 동반된 강직성 척추염 환자에서 가상교정을 이용한 술 전 계획이 임상적으로 유의한 의미를 갖는 방법으로 판단되었다.

강직성 척추염에 동반된 IgA 신증 1 예

유대현(Dae Hyun Yoo),변정원(Jeong Won Byeon),이오영(Oh Young Lee),김태화(Tae Hwa Kim),김성윤(Seong Yoon Kim),강종명(Chong Myung Kang),김목현(Mok Hyun Kim),박문향(Moon Hyang Park) 대한내과학회 1989 대한내과학회지 Vol.37 No.4

N/A The renal lesions in ankylosing spondylitis are known as renal injury due to nonsteroidal anti-inflamatory drugs, renal amyloidosis and golomrelonephritis, but the accurate incidence of renal lesions in ankylosing spondylitis has not been determined. After the first report of IgA nephropathy associated with ankylosing spondylitis by Sisson et al., several investigators have reported a few cases of IgA nephropathy associated with ankylosing spondylitis and related spondyloarthritides. Elevated serum IgA and IgA circulating immune complexes are noted in ankylosing spondylitis and play a major role in the pathcogenesis of ankylosing spondylitis. lgA nephropathy is characterized by predominant deposition of IgA at the mesangium and renal injury is caused by circulating immune complexes in IgA nephropathy. Because of the similarity of the suggested pathogenesis between ankylosing spondylitis and IgA nephropathy, a few investigators have proposed that ankylosing spondylitis and IgA nephropathy are related. We experienced a case of IgA nephropathy associated with ankylosing spondylitis in a 34-year-old male patient and report this with a review of the literature.

강직성 척추염과 비분류성 척추관절증 환자의 심장이상에 대한 연구

이영호 ( Young Ho Lee ),지종대 ( Jong Dai Ji ),진동규 ( Dong Kyu Jin ),박창규 ( Chang Gyu Park ),서홍석 ( Hong Seong Seo ),오동주 ( Dong Joo Oh ),송관규 ( Gwan Gyu Song ) 대한류마티스학회 1997 대한류마티스학회지 Vol.4 No.1

Objective: To investigate the frequency, type and severity of cardiac abnormalities in the patients with ankylosing spondylitis and undifferentiated spondyloarthopathy. Methods: A history, clinical examination, standard 12 lead electrocardiography, two dimensional, M mode, and Doppler echocardiographies were performed on 19 patients with ankylosing spondylitis, 15 patients with undifferentiated spondyloarthropathy and 21 normal controls. Results: 1) Cardiac abnormalities were detected in 8 patients(42.1%) with ankylosing spondylitis. 2) Cardiac abnormalities were detected in 8 patients (53.3%) with undifferentiated spondyloarthropathy including 2 patients with aortic valve abnormalities (mild aortic insufficiency, aortic valve thickening). 3) Cardiac abnormalities were detected in one (4.8%) among normal controls (mild tricuspid regurgitation). 4) There were sinus bradycardias on electrocardiography in 2 patients among patients witn ankylosing spond litis and in 1 patient among undifferentiated spondyloarthropathy. But there was no conduction disturbance in both groups. 5) The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. 6) The mean age, mean disease duration, presence of uveitis, peripheral arthritis, HLA-B27, enthesopathy, Schober test and chest expansion in the patients with ankylosing spondylitis and undifferentiated spondyloarthropathy with cardiac abnormalities were not different from those in the patients without cardiac abnormalities. Conclusion: The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. The frequency, type and severity of cardiac involvement in patients with ankylosing spondylitis were not different from those in patients with undifferentiated spondyloarthropathy.

미분화 척추관절증 환자의 임상상 ; 강직성 척추염 환자와의 비교

이혜순(Hye Soon Lee),김찬(Chan Kim),박효숙(Hyo Sook Park),임미경(Mi Kyoung Lim),김홍자(Hong Ja Kim),최승원(Seung Won Choi),유빈(Bin Yoo),문희범(Hee Bom Moon) 대한내과학회 1997 대한내과학회지 Vol.52 No.1

Objectives: To investigate the clinical features of undifferentiated spondyloarthropathy among the HLA-B27 positive arthralgic patients and to compare with those of ankylosing spondylitis. Methods: Two hundred and three HLA-B27 positive subjects among patients with arthralgia in various joints were classified according to the standard diagnostic criteria. The onset age, disease duration, numbers of involved joint, X-ray and bone scan findings were compared between patients with undifferentiated spondyloarthropathy(uSpA) and ankylosing spondylitis(AS). Results: 1) The patients diseases were classified as ankylosing spondylitis(46%), undifferentiated spondyloarthropathy(29%), juvenile spondyloarthropathy(4%), reactive arthritis(3%), psoriatic spondyloarthropathy(1%) and unclassified(17%). 2) In undifferentiated spondyloarthropathy, the durations of the symptoms were shorter than ankylosing spondylitis and the male predominance is less prominent(5; 1 as compared to 17:1 in ankylosing spondylitis). 3) The numbers of involved peripheral joints and the frequency of peripheral joint inflammation were more frequent in undifferentiated spondyloarthropathy while the spinal joint symptoms including sacroiliac joint and the radiological severity grade of sacroiliitis were higher in ankylosing spondylitis. 4) There were no significant differences in bone scan uptake and ESR between undifferentiated spondyloarthropathy and ankylosing spondylitis. Conclusion: The prevalence of undifferentiated spondyloarthropathy was notable high in HLA-B27- posicive arthralgic patients when a new classification criteria was applied, Attention should be paid on the diagnosis and progression of this elusive and challenging clinical entity.

강직성척추염 환자 1례에 대한 임상적 고찰

이재민,홍권의,Lee, Jae-Min,Hong, Kwon-Eui 대한약침학회 2006 Journal of pharmacopuncture Vol.9 No.2

Object : This study is designed in order to evaluate oriental medical treatment of ankylosing spondylitis. Methods : The authors observed patient by ROM & VAS for operated acupuncture treatment, herbal medicine treatment and physiotherapy Conclusion : 1. Ankylosing spondylitis patient of this case is caused by taiyang channel warm-heat evi. 2. Ankylosing spondylitis patient by taiyang channel warm-heat evi is evaluated by acupuncture treatment. ; SP3, S36, LIll, LI4, S40. 3. Ankylosing spondylitis patient by taiyang channel warm-heat evi is evaluated by Hervbal medication. ; Gamikangwhalsungsub-Tang.

Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis

Kim, Do Youn,Lee, Seok Jeong,Ryu, Yon Ju,Lee, Jin Hwa,Chang, Jung Hyun,Kim, Yookyung The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosing spondylitis in a 56-year-old man with progressive pulmonary bullous fibrocystic changes on both upper lobes that were misdiagnosed as tuberculosis in the early stages of the disease.

Progressive Pulmonary Fibrocystic Changes of Both Upper Lungs in a Patient with Ankylosing Spondylitis

김도연,이석정,류연주,이진화,장중현,김유경 대한결핵및호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4

Ankylosing spondylitis is a chronic inflammatory multisystem disease that primarily affects the axial joints. Pleuropulmonary involvement is an uncommon extra-articular manifestation of ankylosing spondylitis. There is a wide spectrum of pulmonary parenchymal changes in ankylosing spondylitis, beginning in the early stages of the disease and increasing over time. The lesions are usually asymptomatic, and not visible on chest radiographs in early stages. We reported a case of advanced ankylosing spondylitis in a 56-year-old man with progressive pulmonary bullous fibrocystic changes on both upper lobes that were misdiagnosed as tuberculosis in the early stages of the disease.

강직성 척추염 환자에서 발생한 일반 방사선 사진으로 확인되지 않은 흉추의 파열골절 1례

신명철,옥택근,조준휘,문중범,박찬우,양고은,김민수,이제민 대한응급의학회 2016 大韓應急醫學會誌 Vol.27 No.2

Patients with ankylosing spondylitis (AS) are at high risk for spinal fracture even after a minor injury. Most spinal fractures with ankylosing spondylitis occur in the cervical spine, whereas spinal fractures in thoracic or lumbar spine are rare. These fractures are often difficult to detect on standard radiographs, because the normal anatomical landmarks are lacking and the abnormal spinal stiffness precludes optimal exposure of the spine. We report on a case of a 12th thoracic spine fracture in ankylosing spondylitis with bamboo spine after a minor injury. In this case, anteroposterior and lateral radiographs of the thoracolumbar spine showed a bamboo spine typical for ankylosing spondylitis with no evidence of fracture. However, computed tomography showed a 12th thoracic fracture with burst. Therefore, this fracture, in a patient with AS involved all three spinal columns, was considered unstable.

강직성 척추염 환자의 대장 병변에 관한 연구

이형호 ( Young Ho Lee ),박진호 ( Jin Ho Park ),김재선 ( Jae Sun Kim ),박영태 ( Young Tae Bak ),이창홍 ( Chang Hong Lee ),김철환 ( Chul Hwan Kim ),채양석 ( Yang Suk Chae ),송관규 ( Gwan Gyu Song ) 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

Objective: To investigate the frequency of gut inflammation in the ankylosing spondylitis and the role of gut lesion in the pathogenesis of the ankylosing spondylitis. Methods: Ileocolonoscopy and biopsy were performed in 24 patients with ankylosing spondylitis. Results: 1) Endoscopic lesions were observed in 7 patients (29.2%) of 24 patients and more often in the terminal ileum (6/7) than in the colon (1/7). Among 7 patients with endoscopic lesions, S patients were presented as juvenile chronic arthritis. 2) Histologic signs of gut inflammation were detected in 14 patients (58.3%). Actue lesions were seen in 2 patients (8.3%) and chronic lesions were seen in 12 patients (50%). 3) In 12 patients without the involvement of peripheral joints, acute lesion was not seen (0%), and chronic lesions were seen in 6 patients (50%). In 12 patients with the involvement of peripheral joints, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 6 patients(50%). Gut inflammations were more frequent in patients with the involvement of peripheral joints than in those without the involvement of peripheral joints. 4) In 12 patients without the administration of sulfasalazine, acute lesion was not seen(0%), and chronic lesions were seen in 7 patients (58.7%) In 12 patients with the administration of sulfasalazine, acute lesions were seen in 2 patients (16.7%), and chronic lesions were seen in 5 patients (41.6%). The frequency of gut lesions in patients without the administration of sulfasalazine was not different from that in patients with the administration of sulfasalazine(p<0.05). Conclusion: Gut inflammation was frequently found in patients with ankylosing spondylitis. Chronic gut inflammation could play a role in the pathogenesis of the ankylosing spondylitis.

Clinical and Radiographic Features of Adult-onset Ankylosing Spondylitis in Korean Patients: Comparisons between Males and Females

정영옥,김인제,김수호,서창희,박한정,박원,권성렬,정재천,이윤종,류희정,박영배,이지수,이유현,서영일,정원태,홍승재,홍연식,백한주,최효진,강효종,이찬희,김상현,김현아 대한의학회 2010 Journal of Korean medical science Vol.25 No.4

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4±8.9 yr and average disease duration was 9.6±6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober’s test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.