• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.169-170
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• 1998

In this study, regional variation in vertebral bone density due to osteoporosis were investigated using a method that employs images from QCT. QCT images(1mm thick slices) of the first lumbar vertebra from a normal person (23/M, BMD=139.8mg/ml) and from an osteoporotic patient (54/F, BMD=82.0mg/ml) were obtained. Uniform settings (140kVp, 204mA) were used and images of 300 Hounsfield Unit or greater were selectied to filler out soft tissue interference. To assess the regional variation of the area fraction the vertebral body was divided into 3 layers and each layer contained 9 regions. Area faction was calculated based on image analysis data. Our results showed that the area fraction at the middle of the vertebra was quite lower than the endplate and peripheral regions, but the area fraction values from the osteoporotic patient were uniform throughout the entire height of the vertebral body, which indicates the significant drop of BMD had occurred near both end-plates due to the osteoporosis, especially at the peripheral regions. Our results suggest the susceptability of the vertebrae to compression fracture types in osteoporotic spine.

• 대한정형외과학회지
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• 제54권1호
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• pp.24-29
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• 2019

목적: 골다공증성 척추 압박 골절에 대한 경피적 척추 성형술 후 조기에 발생하였던 새로운 연속 골절의 특성과 위험인자에 대하여 알아보고자 하였다. 대상 및 방법: 2013년 1월부터 2015년 12월까지 골다공증성 척추 압박 골절로 경피적 척추 성형술을 시행받은 환자 중 인접 추체에 새로운 골절이 발생한 44예를 대상으로 하였으며 골절 발생 시기에 따라 2군으로 나누었다. 3개월 내에 골절이 발생한 경우가 22예(A군)였고 3개월 이후에 발생한 경우가 22예(B군)였다. 두 군 간의 나이, 성별, 골밀도, 체질량 지수, 기존 척추 골절의 존재, 초기 골절 위치, 추간판 내 시멘트 누출, 시멘트 주입량, 추체의 높이 회복 정도, 후만각 교정 정도의 차이에 대하여 후향적으로 비교 분석하였다. 결과: 두 군 간의 나이, 성별, 골밀도, 체질량 지수, 기존 척추 골절의 존재, 초기 골절 위치, 추간판 내 시멘트 누출, 후만각 교정 정도에는 유의한 차이는 없었다. 시멘트 주입량이 많은 경우와 추체 높이 회복 정도가 큰 경우에서 3개월 내에 골절이 발생한 빈도가 유의하게 높았다. 결론: 경피적 척추 성형술 시 시멘트 양과 추체 높이 회복 정도는 3개월 이내에 발생하는 조기 인접 척추 골절의 위험인자로 판단되며 추시 과정에서 주의가 필요할 것으로 판단된다.

• Journal of Korean Neurosurgical Society
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• 제37권2호
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• pp.116-123
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• 2005

Objective: Percutaneous kyphoplasty using a balloon-catheter is an widely accepted method which achieves the restoration of vertebral height and the correction of kyphotic deformity with little complication in osteoporotic vertebral compression fractures. The authors assess the results of 59 patients who underwent kyphoplasty, and analyze the factors that could affect the prognosis. Methods: From December 2001 to May 2003, fifty-nine patients underwent kyphoplasty. The patients included 49 women and 10 men aged 52-85 years. Average t-score on bone marrow density was -3.58. About 7cc of polymethylmethacrylate(PMMA) was injected into the fractured vertebral body using $Kyphon^{(R)}$ under local anesthesia. The vertical height of all fractured vertebrae was measured both before and after surgery. Outcome data were obtained by comparing pre- and post-operative VAS score and by assessing postoperative satisfaction, drug dependency and activity. Various clinical factors were analyzed to assess the relationship with the outcome. Results: The VAS score improved significantly, and the mean percentage of restored vertebral height was 53%. The mean improvement in kyphosis was $3.6^{\circ}$. Eighty-nine percent of the patients gained excellent or good results. Any of the clinical factors including the interval between fracture and operation, the degree of height loss, the degree of the vertebral height restoration or the correction rate of kyphosis did not affect the clinical results. Conclusion: Kyphoplasty is associated with a statistically significant improvement in pain and function with little complication. The clinical results are not affected by any clinical parameters. Further follow-up study is needed to determine whether the restoration affects the long-term clinical results.

• Journal of Preventive Medicine and Public Health
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• 제41권5호
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• pp.287-294
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• 2008

Objectives : To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective. Methods : From 2002 to 2004, we identified all National Health Insurance claims records for women ${\geq}50$ years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," such that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with ${\geq}$ one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals. Results : During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84and 2,121,492 Won for those above 84. Conclusions : Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.

• 지역사회간호학회지
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• 제17권1호
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• pp.46-55
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• 2006

Objective: This study is to examine the physical function, psychological well-being, and subjective symptom of postmenopausal osteoporotic women. Methods: Data used for this study was collected from 397 women who had experienced one years or longer menopause and visited a hospital in Seoul, Korea during the period from May to December 2005. Results: The level of physical function of the fracture osteoporosis group was significantly lower than the other three groups. The psychological well-being of the fracture osteoporosis group was significantly lower than the other three groups. Subjective symptom of the fracture osteoporosis group was significantly higher than the other three groups. The level of physical function was positively correlated with psychological well-being and negatively with subjective symptom. Psychological well-being was also negatively correlated with the level of subjective symptom. Based on the results, it is recommended that the prevention of vertebral fracture in osteoporotic woman is important, and nursing intervention is necessary for the physical function, psychological well-being, and subjective symptom care.

• Journal of Acupuncture Research
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• 제35권2호
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• pp.75-80
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• 2018

Background: The aim of this study was to assess the feasibility of conducting a clinical study of using acupuncture for chronic pain in patients with osteoporotic thoracolumbar vertebral compression fractures (VCFs) in the outpatient setting. Methods: A prospective case-series attempting to recruit 20 participants was performed from February 11, 2016, to December 31, 2016. We provided Manual and electrical acupuncture was provided one 1 to three 3 times a week, for 6 weeks, up to 18 sessions. The primary clinical outcome was the average pain intensity as measured by the visual analog scale (VAS) at 6 weeks. Secondary outcomes included back-specific dysfunction (Oswestry disability index), quality of life (quality of life questionnaire-26), patient-reported improvement, use of other healthcare resources, and adverse events at 6 weeks. Use of healthcare resources and adverse events were additionally followed-up at 12 weeks by telephone. Results: Of 33 patients screened, a total of 7 were enrolled in the study. Manual and electrical acupuncture was provided 1 to 3 times a week, for 6 weeks, up to 18 sessions. We observed reduced pain intensity at 6 weeks in all participants. The change in the quality of life and back-specific dysfunction was inconsistent among participants. Mild, temporary adverse events were observed in three patients. Conclusion: In our clinical setting, it was not feasible to recruit sufficient participants and to assess the efficacy of acupuncture for chronic pain after osteoporotic thoracolumbar VCFs under a year. Strategies to improve recruitment and to identify barriers to participation are required for future clinical trials.

• 대한정형외과학회지
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• 제54권4호
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• pp.336-342
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• 2019

목적: 자기공명영상(magnetic resonance imaging, MRI)을 이용하여 보존적 치료를 시행한 흉요추부 골다공증성 압박 골절 환자에서 후만 변형의 예측 인자를 조사하고자 하였다. 대상 및 방법: 2007년 1월부터 2016년 3월까지 흉요추 압박 골절 의심하에 진료를 본 환자들 중 보존적 치료를 시행한 환자를 따로 분류하였고 그들 중 골밀도 -2.0 미만의 골감소증 및 골다공증, 단일 분절 골절을 가진 환자 89명을 대상으로 후향적 연구를 시행하였다. 골절된 척추체에서 전·후종 인대 손상, 상부 또는 하부 종판 파열, 상부 또는 하부 추간판 손상, T2 강조 영상에서 저 신호 강도의 존재, 척추체의 골 부종 정도를 MRI를 통해 확인하였다. 결과: 상부 종판이 파열된 사례나 척추체 골 부종 수준이 높은 사례의 경우 후만각, 설상각, 전방 척추 압박이 현저하게 진행되었다. 전종 인대 손상이나 상부 추간판 손상이 있는 경우에는 후만각만 현저하게 진행되었다. T2 강조 영상에서 저 신호 강도의 병변을 보인 경우 설상각과 전방 척추 압박이 높게 나타났다. 그러나 후종 인대 손상과 하부 종판 파열 및 하부 추간판 손상의 경우는 후만 변형 및 척추 압박의 진행과 유의미한 상관관계는 없었다. 후만각이 5° 이상 증가될 위험 요인으로는 전종 인대의 손상 유무, 상부 종판 파열, 상부 추간판 손상이 있는데 손상 받지 않은 사례에 비해 각각 21.3, 5.1, 8.5배 위험했고 골 부종 수준에 따라 각각 위험도가 달랐다. 결론: 골감소증 및 흉요추부 골다공증성 압박 골절일지라도 전종 인대 손상, 상부 종판 및 추간판 손상 또는 MRI상 높은 수준의 부종이 있을 경우 후만 변형의 위험도가 증가한다.

• Journal of Korean Neurosurgical Society
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• 제47권4호
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• pp.278-281
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• 2010

Objective : For the treatment of osteoporotic vertebral compression fracture, percutaneous vertebroplasty (PVP) is currently widely used as an effective and relatively safe procedure. However, some patients do not experience pain relief after PVP. We performed several additional PVP procedures in those patients who did not have any improvement of pain after their initial PVP and we obtained good results. Our purpose is to demonstrate the effective results of an additional PVP procedure at the same previously treated level. Methods : We reviewed the medical records and the radiologic data of the PVP procedures that were performed at our hospital from November 2005 to May 2008 to determine the patients who had undergone additional PVP. We identified ten patients and we measured the clinical outcomes according to the visual analogue scale (VAS) score and the radiologic parameters, including the anterior body height and the kyphotic angulation. Results : The mean volume of polymethylmethacrylate injected into each vertebrae was 4.3 mL (range: 2-8 mL). The mean VAS score was reduced from 8 to 2.32. The anterior body height was increased from 1.7 cm to 2.32 cm. The kyphotic angulation was restored from 10.14 degrees to 2.32 degrees. There were no complications noted. Conclusion : The clinical and radiologic outcomes suggest that additional PVP is effective for relieving pain and restoring the vertebral body in patients who have unrelieved pain after their initial PVP. Our study demonstrates that additional PVP performed at the previously-treated vertebral levels could provide therapeutic benefit.

• 대한의용생체공학회:의공학회지
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• 제25권1호
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• pp.27-32
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• 2004

본 논문에서는 골다공증성 척추압박골절에 대한 척추성형술시 골강화제인 PMMA 주입방법을 제안하였다. 척추성형술의 정량적 분석을 위해서는 유한요소해석을 사용하였으며 1m간격의 척추체 CT를 바탕으로 보다 정교한 척추체 모델을 제시함으로써, 단순화된 척추의 기하학적 형상과 간단한 재료 물성치를 사용하는 기존의 연구의 한계를 극복하고자 하였다. 본 연구 결과를 토대로 추체내 망상골에 주입되는 PMMA의 주입형태, 주입위치를 정량적으로 평가하여 이상적인 수술방법을 제시하였다. PMMA의 구입위치는 망상골의 앞쪽-위쪽에 많은 양이 집중하여 주입되었을 때, 가장 효율적으로 추체를 보완해 주는 것으로 나타났다.

• 대한정형외과학회지
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• 제55권4호
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• pp.318-323
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• 2020

목적: 근감소증에 중요한 요소인 척추 주변 근육 감소를 수치화한 총 지방 침윤율(total fat infiltration rate, TFI rate)과 골다공증성 척추 압박 골절(osteoporotic vertebral compression fracture) 및 관련 수치와의 상관 관계를 찾는 것을 목표로 하였다. 대상 및 방법: 2012년 1월부터 2016년 12월까지 요추의 압박 골절 진료를 본 환자들 중 1) 골밀도(bone mineral density, BMD) T score -2.5 g/cm² 미만으로 골다공증을 진단받고, 2) 요추 골절로 경피적 척추성형술(vertebroplasty) 또는 경피적 풍선척추성형술(kyphoplasty)을 받았으며, 3) 요추의 한 분절만 골절된 4) 1년 이상 추시한 환자 98명을 대상으로 후향적 연구를 시행하였다. TFI는 Image J 프로그램으로 자기공명영상을 분석하여 확인하였다. 이를 바탕으로 다열근(multifidus) 및 척추기립근(erector spinae)의 TFI와 골다공증 요소들과의 연관성을 분석하였다. 결과: 다열근및 척추기립근의 평균 TFI는 14.66±10.16이었다. 척추 BMD는 고관절 BMD와 통계적으로 유의한 양의 상관 관계를 보였으나 TFI와 음의 상관 관계를 보였다. 고관절 BMD는 체질량지수(body mass index)와 유의한 양의 상관 관계를 보였다. 또한 비타민 D 수치는 척추 BMD와 고관절 BMD에서 모두 양의 상관 관계를 보였으나, TFI와는 음의 상관 관계를 보였다. 결론: 근육량은 근감소증 환자뿐만 아니라 골다공증 환자의 치료에 있어서도 도움이 되므로 주의깊게 보아야 할 것이다. 또한 비타민 D를 증가시키는 것은 근육 위축의 진행을 늦출 수 있으므로 이로써 골절을 예방하는 효과를 가져올 수 있다.