• 동의생리병리학회지
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• 제36권4호
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• pp.138-142
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• 2022

This study aimed to evaluate the effectiveness of Korean rehabilitation treatement for patients with post-TKR. The medical records of inpatients undergoing Korean rehabilitation treatment after TKR from 2016.01.01. to 2021.12.31. during the admission, were analyzed retrospectively. The effect of treatment was evaluated by using a numeric rating scale(NRS) and range of motion(ROM) of knee. Statistical analysis was done using the IBM SPSS statistics 26 program. If the period of hospitalization was within 7 days or change of NRS and ROM was not recorded properly, the case was excluded. All inpatients received acupuncture treatment, Electro-acupuncture. Soyeom pharmaco-acupuncture were used at a high rate. Blood letting cupping therapy, dry cupping therapy, Interferential Current Therapy(ICT) continuous passive motion(CPM), cryotherapy were used at a high rate. A significant improvement was noted when comparing the NRS and knee ROM results at the time of admission and discharge. Korean medical rehabilitation can be effectively used for patients who have undergone TKR, to relieve pain and enable returning to daily activities. It is expected to be helpful in future studies of post-TKR in Korean Medicine. Also It can be used for medical treatment of post-TKR in Korean Medicine Hospital and clinic. However, further research with a high level of evidence is necessary to support this finding.

• 대한족부족관절학회지
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• 제26권3호
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• pp.123-129
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• 2022

Purpose: To evaluate the correlation between the fibrillar pattern of the Achilles tendon on ultrasonography (US) and functional outcomes in patients who underwent open tendon repair after Achilles tendon rupture. Materials and Methods: Data of 44 patients who had been subjected to US at least 6 months after repair, during the period between July 2012 and July 2019 were reviewed. Those with bilateral tendon rupture, re-rupture, open injury, and chronic or insertional rupture, were excluded from the review. We divided them into two groups, the homogenous group (HoP) and the heterogenous group (HeP) based on the fibrillar pattern on US. We also divided the HoP into linear and wavy subgroups, and the HeP into no hypoechoic lesion and hypoechoic lesion subgroups. The rupture type of the Achilles tendon, radiographic factors including US and magnetic resonance images, patient-related, surgical factors, and clinical results at the last visit after repair were assessed retrospectively. Results: The tendon thickness was 11.4±1.7 mm in the HoP, and 14.5±3.0 mm in the HeP (p<0.001). A shredded pattern was observed in 17 cases (65.4%) in the HoP, and in 17 cases (94.4%) in the HeP (p=0.031). The mean value of the number of sutures used was 8.9±3.05 in the HoP and 11.39±1.75 in the HeP (p=0.001). The mean value of the difference in calf circumference was 0.9±0.67 cm in the HoP and 1.36±0.71 cm in the HeP (p=0.037). There were no statistically significant differences in the fibrillar patterns and patient-related factors. Conclusion: The fibrillar pattern observed after repair was correlated with the functional outcome and showed a significant relationship with the rupture pattern and the number of sutures used. Therefore, we suggest a careful individualized postoperative rehabilitation protocol to maximize functional outcomes by referring to the fibrillar pattern in US, especially in shredded ruptures.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.72-81
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• 2023

Objective : Ischemia and hemorrhage of pituitary adenomas (PA) caused important clinical syndrome. However, the differences on clinical characteristics and surgical outcomes between these two kinds apoplexy were less reported. Methods : A retrospective analysis was made of patients with pituitary apoplexy between January 2013 and June 2018. Baseline and clinical characteristics before surgery were reviewed. All patients underwent transsphenoidal surgery and were followed up at least 1 year. Results : Total 67 cases (5.8%) among 1147 pituitary tumor patients were enrolled, which consisted of 28 (~2.4%) ischemic PA and 39 (~3.4%) hemorrhagic PA. There were more male patients in the ischemic group compared with hemorrhagic group (78.6% vs 53.8%, p=0.043). However, the mean age, tumor size and functional tumor ratio were significant higher in the hemorrhagic group. Headache was more common in ischemic PA (82.1%) than that of hemorrhagic PA (51.3%, p=0.011). Magnetic resonance imaging findings found that mucosal thickening and enhancement of the sphenoid sinus was observed in 15 ischemic PA patients (n=27, 55.6%), but none in patients with hemorrhagic PA (n=38, p<0.0001). It was worth noting that the rate of pre-surgical hypopituitarism in ischemic PA patients were seemed higher than that in hemorrhagic PA patients, but not significant. The two groups got a total tumor resection rate at 94.1% and 92.9%, independently. No significant difference on the operative time, blood loss in operation and complications in perioperative period was observed in two groups. After operation, cranial nerve symptoms recovered to normal at 81.8% of ischemic PA patients and 82.6% of hemorrhagic PA patients. Importantly, the incidence of postoperative hypopituitarism partially decreased in both groups, among which the rate of hypothyroidism in ischemic PA patients significantly decreased from 46.4% to 18.5% (p=0.044). Conclusion : Patients with ischemic PA presented different clinical characteristics to the hemorrhagic ones. Transsphenoidal surgery should be considered for the patients with neuro-ophthalmic deficits and might benefit for pituitary function recovery of the apoplectic adenoma patients, especially pituitary thyroid axis in ischemic PA patients.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.64-73
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• 2022

Objective : To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK). Methods : From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups. Results : Twenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups. Conclusion : In cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.84-95
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• 2022

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.97-105
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• 2022

Background: The pentadecapeptide BPC-157 has been shown to have anti-inflammatory and wound healing effects on multiple target tissues and organs. Peptides have potent anti-inflammatory effects on periodontal tissues in rats with periodontitis. Few studies have investigated the effect of BPC-157 on pain after dental procedures or oral surgeries. The purpose of the present study was to investigate the antinociceptive effects of BPC-157 on postoperative incisional pain in rats. Methods: Sprague-Dawley rats were randomly divided into five groups: control (saline with the same volume), BPC10 (10 ㎍/kg of BPC-157), BPC20 (20 ㎍/kg of BPC-157), BPC40 (40 ㎍/kg of BPC-157), and morphine (5 mg/kg of morphine). A 1-cm longitudinal incision was made through the skin, fascia, and muscle of the plantar aspect of the hind paw in isoflurane-anesthetised rats. Withdrawal responses were measured using von Frey filaments at 0, 2, 6 h and 4, 7 d after incision. The formalin test was also performed to differentiate its anti-nociceptive effect from an inflammatory reaction or central sensitization. Pain behavior was quantified periodically in phases 1 and 2 by counting the number of flinches in the ipsilateral paw after injection with 30 µL of 5% formalin. Results: The threshold of mechanical allodynia was significantly increased in the BPC10, BPC20, BPC40 and morphine groups compared with that in the control group at 2 h. These increasing thresholds then returned to the levels of the control group. The BPC-157 group showed a much higher threshold at 4 days after incision than the control group. The thresholds of the BPC groups, except the morphine group, were normalized 7 days after incision. The flinching numbers of the BPC10, BPC20, BPC40 and morphine groups were significantly decreased in phase 1, but there was no decrease in the BPC-157 groups except the morphine group in phase 2. Conclusions: BPC-157 was effective only for a short period after incision. It was also effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 might have a short antinociceptive effect, even though it has anti-inflammatory and wound healing effects.

• 대한정형외과학회지
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• 제54권4호
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• pp.353-360
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• 2019

목적: 듀피트렌 구축의 이상적인 치료 방법은 재발률을 줄이고 합병증이 적게 발생하게 하는 것이다. 본 연구의 목적은 낮은 재발 및 합병증 발생을 위해 아전 근막절제술을 시행하여 치료한 듀피트렌 구축 환자의 결과를 보고하고자 함이다. 대상 및 방법: 2007년부터 2017년 3월까지 아전 근막절제술을 시행한 45명의 환자를 후향적으로 연구하였다. 아전 근막절제술은 구축된 결절과 끈과 함께 주변에 정상 근막을 포함하여 절제하는 수술 방법이다. 평균 추시 기간은 45.9개월이었으며, 92개의 수지가 이환되었다. 선행 인자 및 이환된 관절을 조사하였으며, 수술 전 후 관절 구축의 정도를 측정하였다. 임상 결과를 확인하기 위해 quick disabilities of the arm, shoulder, and hand (quick DASH) score를 사용하였다. 수술 후 피부 결손 및 상처 관련 문제, 신경손상, 혈종, 복합 부위 통증 증후군과 같은 합병증을 조사하였다. 결과: 수술 전 관절 구축은 근위지관절 평균 43.2°, 중수지관절 평균 32.9°였고, 수술 후 9예에서 평균 9.7° (범위, 5°-20°)의 잔여 구축이 남았으며, 전체 수지에 비교했을 때 평균 2.3°의 구축이 발생하였다. 수술 후 12개월 quick DASH score는 평균 12.4점이었고, 전체 합병증 발생률은 26.6%였다. 결론: 듀피트렌 구축에서 아전 근막절제술은 비관혈적 치료에 비해 현저히 낮은 재발률을 보이고, 타 수술치료에 비해 합병증 발생이 적은 효과적인 치료 방법이다.

• Journal of Korean Neurosurgical Society
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• 제66권4호
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• pp.446-455
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• 2023

Objective : Chronic subdural hematoma (CSDH) is a common neurosurgical disease and generally treated with burr-hole surgery alone. Tranexamic acid (TXA) is an antifibrinolytic agent that potentially reduces recurrence rates and the residual hematoma volume. However, the role of postoperative TXA medication remains unclear to date. This study aimed to verify the effectiveness of adjunctive TXA in the view of early hematoma resolution. Methods : Between January 2018 and September 2021, patients with CSDH who underwent burr-hole trephination in a single tertiary institute were reviewed. The study population was divided into three groups, TXA, non-TXA, and antithrombotics (AT) groups, according to the medical history of cardio-cerebrovascular disease and TXA administration. The primary endpoint was CSDH recurrence, defined as re-appearance or re-accumulation of CSDH requiring neurosurgical interventions. The secondary outcome was CSDH resolution, defined as complete or near-complete resorption of the CSDH. The CSDH resolution time and serial changes of hematoma thickness were also investigated. Results : A total of 240 patients was included in the analysis consisting of 185 male and 55 female, with a median age of 74 years. During the median imaging follow-up period of 75 days, 222 patients were reached to the primary or secondary endpoint. TXA was administered as an adjunctive therapy in 41 patients (TXA group, 16.9%) while 114 patients were included in the non-TXA group (47.9%) and 85 were in the AT group. The recurrence rate was the lowest in the TXA group (2.4%), followed by non-TXA (7.0%) and AT (8.2%) groups. However, there was no statistical significance due to the small number of patients with recurrence. CSDH resolution was achieved in 206 patients, and the median estimated time to resolution was significantly faster in the TXA group (p<0.001). Adjunctive TXA administration was a significant positive factor for achieving CSDH resolution (p<0.001). The hematoma thickness was comparable among the three groups at the initial time and after surgery. However, CSDH thickness in the TXA group decreased abruptly in a month and showed a significant difference from that in the other groups (p<0.001). There was no TXA-related adverse event. Conclusion : The adjunctive use of TXA after CSDH surgery significantly facilitated the resorption of residual CSDH and resulted in the early CSDH resolution. Adjunctive TXA may be an effective treatment option to reduce recurrence by enhancing CSDH resolution in the selective patients.

• Journal of Chest Surgery
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• 제36권9호
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• pp.674-677
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• 2003

본원에서 시행한 최근 5년간 전폐절제술 중 기관지 절단부의 처리 방법에 있어 수기봉합 35예, 자동봉합 65예를 선정하여 술 후 합병증의 발생을 중점으로 비교 분석하였다. 대상 및 방법: 자동봉합기를 사용한 65예 중 남성은 55명, 여성은 10명이었으며 평균 연령은 56.7$\pm$10.3세였다. 수기봉합을 시행한 35예 중 남성은 26명, 여성은 9명으로 평균연령은 61.4$\pm$9.2세)였다. 자동봉합기를 사용한 수술예 중 38예가 좌주기관지에, 27예가 우주기관지 봉합 예였으며, 수기 봉합의 경우 좌주기관지 22예, 우주기관지 13예였다. 자동봉합기를 사용한 65예 중 편평세포암이 39예, 선암종이 9예, 기타 악성 폐암 5예, 양성 페질환이 12예였으며, 수기봉합을 시행한 35예 중 편평세포암이 21예, 선암종이 5예, 기타 악성폐암 2예, 양성 폐질환이 7예였다. 결과: 술 후 합병증으로 자동봉합기를 사용한 65예 중 4예의 기관지-흉막루가 발생하였고 2예에서 폐부종이 발생하여 호흡부전으로 사망하였다. 또한 2예는 술 후 급성 호흡부전으로 사망하였다 수기 봉합의 35예 중 기관지-흉막루가 2예 발생하여 그중 1예에서 농흉이 동반되어 폐혈증으로 사망하였으며, 2예는 술 후 급성 호흡부전으로, 1예는 폐렴 후 폐혈증으로 사망하였다. 결론: 수기 봉합과 자동 봉합기의 사용 예를 비교하여 술 후 합병증의 빈도는 통계학적 유의성을 보이지 않았으며, 술자의 선택에 따라 두 방법 모두 가능한 방법이라 하겠다

• Journal of Chest Surgery
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• 제30권2호
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• pp.172-178
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• 1997

인제대학교 서울 백병원에서 실시한 말초동맥 색전제거술을 후향적으로 분석하였다. 1987년 3월부터 1996년 2월까지 26명의 환자가 색전제거술을 시술받았고 남자는 18명 여자는 8명이였으며 평균연령은 56.8세 였다. 24명의 환자에서 휴식시 동통이 주소였고 2명의 환자에서 급성 증상의 회복후 장기간의 간헐적 파행을 호소하였으며 10명의 환자에서만 신경/근육 증상을 보였다. 대부분의 색전은 심인성으로 빈도가 높은 원인질환으로8명의 환자는 허혈성 심질환, 11명의 환자는 심장판막질환이 있었다. 동맥색전 부위는 상지동맥이 6명, 안장색전증이 2명, 하지동맥 18명이였고 대퇴동맥이 11명으로 가장 많았다. 술전 동맥조영술은13명의 환자에서 진단과 수술계획을 위해 실시하였으나 나머지 환자에서는 실시하지 않았다. 2명만이 6시간이내 색전제거술을 실시하였으나 나머지 환자는 모두 6시간 이후에 수술하였 다. 모든 환자에서 우회로 조성술 엄이 포가티 색전제거 카테터를 사용하여 색전제거술을 하였는데, 상지동맥 색전증은 상완동맥 절개로 수술하였고, 안장색전증의 경우 양측 서혜부 절개로 접근하였으며, 하지동맥 색전증은 경대퇴동맥 접근을 하 느립\ulcorner3명의 원위부 슬와-경골동맥 색전증 환자에서 재수술시 경술와 동맥 색전제거술을 시행하였다. 수술 전후로 18명의 환자가 헤파린이나 푸락시파린으로 항응 고제 요법을 받았고 17명의 환자에서 퇴원시 와파린을 투여하였으며 항응고제 투여의 적응증은 심판막 질환, 심방세동, 말초동맥 죽상경화증, 재발색전 등이었다. 색전제거술후 14명의 환자에서 좋은 결과가 있었고, 5명에서 재수술후 증상 호전되었으며, 심한 하지동맥 죽상경화증을 보인 환자 1명에서 슬관절 이하 하지절단을 시행하였다. 색전재발은 1명, 사망 환자는 2명이 였는데, 사인은 각각 급성 신부전과 뇌동맥 혈전증이였다. 색전제거술 합병증으로 재관류 손상, 가성동맥류, 내막박리 등이 각각 1례 발생하였다. 결론적으로 사지동맥 색전증치 진단이 지연되고 있고, 허혈성 심질환을가진 고령환자가 증가되고 있는 경향이었다. 술전 동맥조영술은 항상 진단과 수술을 위해 필요하지 않으며 항응고제는 적응증에 따라 선택적으로 투여하여 색전재발을 방지할 수 있다. 원위부 슬와-경골동맥 색전증의 경우, 경대퇴동 맥 접근으로 선택적인 경골동맥 색전제거에 어려움이 있었다.