• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.58-61
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• 2012

Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.176-178
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• 2009

Traumatic brainstem hemorrhage after blunt head injury is an uncommon event. The most frequent site of hemorrhage is the midline rostral brainstem. The prognosis of these patients is poor because of its critical location. We experienced a case of traumatic brainstem hemorrhage. A 41-year-old male was presented with drowsy mentality and right hemiparesis after blunt head injury. Plain skull radiographs and brain computerized tomography scans revealed a depressed skull fracture, epidural hematoma, and hemorrhagic contusion in the right parieto-occipital region. But, these findings did not explain the right hemiparesis. T2-weighted magnetic resonance (MR) image of the cervical spine demonstrated a focal hyperintense lesion in the left pontomedullary junction. Brain diffusion-weighted and FLAIR MR images showed a focal hyperintensity in the ventral pontomedullary lesion and it was more prominent in the left side. His mentality and weakness were progressively improved with conservative treatment. We should keep in mind the possibility of brainstem hemorrhage if supratentorial lesions or spinal cord lesions that caused neurological deficits in the head injured patients are unexplainable.

• 동의생리병리학회지
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• 제22권3호
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• pp.703-707
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• 2008

To examine the efficacy of electrical acupuncture combined bee venom in controlling low back with leg pain induced Herniated Intervertebral Disc (HIVD). 13 patients (men 8, women 5; age $41.30\;{\pm}\;17.27$) diagnosed as HIVD by CT or MRI had low back and leg pain as a chief complaint and diseases such as spinal tumor, infection and fracture were excluded. They were treated by electrical acupuncture (8 Hz) combined bee venom therapy three times a week in Wonkwang University Hospital, and pain intensity with VAS and functioning with Roland-Morris Disability Qestionnaire(RDQ) were measured at the baseline(B), and 4 weeks after treatment. The data were analyzed with Wilcoxon signed ranks test(SPSS12.0) and the level set for statistical significance was P<0.05. The pain was significantly reduced by two combined treatments (=0.002;$B7.69{\pm}2.06$,4Wks$4.70{\pm}2.72$). The function was also significantly improved by both treatments(=0.001;$B12.15{\pm}6.85$,4Wks$6.85{\pm}5.15$). The results suggest that a combination of acupuncture and bee venom therapy may be beneficial for low back pain from HIVD. In future, randomized clinical trials including follow-up are needed to examine the effects of these therapies.

• 한국콘텐츠학회논문지
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• 제10권1호
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• pp.286-294
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• 2010

복합부위통증증후군은 외상, 신경 손상, 골절, 뇌졸중, 척수 손상과 수술 등에 의해 부적합하게 발생하는 만성 신경병성 통증증후군으로, 질환의 경과, 치료법 등 모든 면에서 생물심리사회적 요인의 영향을 받는다. 작업치료에서는 생물학적, 심리적, 사회적 요소를 고려한 다학제적인 치료적 접근이 유용할 것이다. 생물학적 치료는 모든 영역에서의 독립성을 향상시키기 위해 사지의 기능적 사용을 증가시키는 것이다. 심리적 치료는 이완/바이오피드백 훈련과 인지행동치료를 제공하고, 사회적 치료는 레크리에이션 치료와 직업 재활을 실시할 수 있다. 복합부위통증증후군에 대한 작업치료는 다양한 전문 분야의 협조적인 치료과정을 통해 기능 회복과 통증 관리, 심리적 요인들의 회복을 이끌어 내야 할 것이다.

• 대한골관절종양학회지
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• 제6권1호
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• pp.1-9
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• 2000

목적 : 전이성 척추 종양은 가장 흔한 전이성 종양 중의 하나로 치료에 있어 보통 보존적 요법이 선호되어 왔으나 신경학적 증상과 삶의 질의 개선이 극히 불량하였다. 수술적 치료 후에 신경학적 증상의 변화와 임상증상의 개선정도, 생존 기간의 증가 등에 대해 평가하였다. 대상 및 방법 : 1991년 8월부터 1999년 6월까지 본원에서 경험하였던 전이성 척추 종양 중 수술적 치료 후 추시관찰이 가능하였던 14례를 대상으로 하여 의무기록과 방사선학적 검사 등을 후향적으로 검토하여 연령별, 성별, 해부학적 발생 부위별 분포와 각각의 원발 종양에 따른 골 전이의 양상에 대해 조사하였고, 방사선 치료로 도움이 안될 때, 신경학적 증상이 악화될 때, 척추 불안정성이 있을 때, 원발 종양을 알지 못할 때, 병적 골절이 있을 때, 기대여명이 6주 이상일 때, 만성적인 통증이 있을 때 시행하였던 수술적 치료 전후의 증상의 개선 정도를 평가하여 문헌 고찰과 함께 분석하였다. 결과 : 전이성 척추 종양은 여자에서 더 많이 발생하였고 30대에서 70대까지 연령이 다양하였으며 원발 종양으로 여자는 유방암, 남자는 폐암이 가장 많았고 가장 흔한 전이 부위는 흉추부였다. 수술 전 마비의 정도가 수술 후 임상 증상의 호전에 영향을 미친 것으로 나타났으며 수술 후 전이성 척추 종양의 평균 여명은 사망한 11례에서 8.9개월, 살아있는 3례에서 14.7개월이었다. 결론 : 전이성 종양에 대한 수술적 치료는 전이성 척수 종양이 의심될 때, 치료와 동시에 조기 진단이 가능하며 그 방법과 관계없이 동통과 신경학적 증상의 회복에 큰 도움을 줄 수 있고, 초기의 적극적 치료로 삶의 질과 생존 기간을 향상시킬 수 있다. 추후 원발 종양의 종류에 따른 전이성 척수 종양의 분류와 이에 따른 수술적 치료의 역할에 대한 평가가 더 필요하리라 사료된다.

• 대한한방체열의학회지
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• 제1권1호
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• pp.28-37
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• 2002

Stable Compression Fractures(SCF hereafter) are most often caused by trauma such as traffic accidents. These SCFs usually occur in the thoracic and lumbar regions of the spinal cord. Human life spans have increased as a result of medical advances, which in turn has led to an increase in the elderly population. SCFs are divided into the categories of stable and unstable. The categories are determined through X-rays and P/Ex tests. The D.I.T.I. is then used to diagnose the severity and prognosis of the fracture injuries, and it allows an objective evaluation of the symptoms. This author researched 40 patients who were treated at Wonkwang University Oriental Medical Center from October 1995 to December 1996. The patients were diagnosed by X-ray as having SCFs and treated primarily with acupuncture. Both the changes in D.I.T.I. and patients' self-diagnoses of their conditions before and after treatment yielded the meaningful results which have been presented here. 1. 75% of those who suffer from Stable Compression Fractures are 60 years of older. Of those, the ratio of male to female is 1 to 4. This is due in part to the fact that many elderly women seek Oriental medicine treatment for conditions associated with advanced age. 2. 53.3% of these injuries occurred between T11 and L2. 3. 65% of patients were hospitalized for 10 to 29 days, and then able to be treated on an outpatiens basis. 4. The D.I.T.I. results showed 50% below $0.2^{\circ}C$, 30% between 0.3 and $0.5^{\circ}C$, 10% between 0.5 and $0.7^{\circ}C$, 10% between 0.7 and $0.9^{\circ}C$, and 0% over $0.9^{\circ}C$. 5. The results of treatment using Modified Evaluation System in Thoracolumbar Vertebral Fractures Method showed that 55% of patients achieved excellent recovery and 40% achived good recovery. After comparing the D.I.T.I. results before and after treatment, we found 50% of patients showed excellent recovery $({\Delta}T{\leq}0.2)$ and 40% showed good recovery$(0.2<{\Delta}T{\leq}0.5)$.

• 대한정형외과학회지
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• 제56권3호
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• pp.208-214
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• 2021

목적: 급성 골다공증성 요추 골절 환자에서 척추 변형의 진행을 예측할 수 있는 여러 인자들 중 척추의 자기공명영상 촬영에서 척추 주변 근육의 정량적 분석을 통해 척추 기립근 및 다열근의 감소와 후만각의 변형의 상관관계를 알아보고자 한다. 대상 및 방법: 이 연구는 2007년 1월부터 2018년 3월까지 단일 분절의 급성 요추 골절로 진단되어 보존적 치료 중인 환자를 대상으로 하였다. 다열근 및 척추 기립근의 감소는 지방으로 변성된 비율을 통해 확인하였고 이는 진단 당시 촬영한 요추 자기공명영상 촬영을 사용하여 측정되었으며, 지방으로 변성된 비율은 총 지방 침윤율로 정의하였다. 1년 추적 관찰에서 요추의 측면 방사선 사진에 기초하여 추체 압박률, 콥스각 및 쐐기각을 측정하였다. 피어슨 상관 계수를 분석하여 통계적 유의성을 확인하였다. 결과: 연구 대상은 129명으로 30명은 남자, 99명은 여자를 대상으로 하였다. 평균 연령은 71.28±9.55세, 평균 BMD 점수는 -3.53±0.79 g/cm², 평균 지방 침윤율은 15.20%±11.99%였다. 지방침투율은 수상 당시 나이(R=0.373, p<0.001)와 양의 상관 관계가 있었지만, BMD 점수(R=-0.252, p=0.004)와는 음의 상관 관계를 보였다. 1년 후 추적관찰하여 확인한 결과에서 지방 침윤율은 추체 압박률(R=0.369, p<0.001) 및 콥스각(R=0.386, p<0.001)과 양의 상관 관계를 보였다. 요추 골절이 아래 분절로 내려 갈수록 추체 압박률(R=-0.191, p=0.030) 및 후만각(R=-0.428, p<0.001)은 감소하는 경향이 있었다. 결론: 급성 골다공증 요추 골절 환자에서 지방 침윤율은 보존적 치료를 위한 중요한 예측 인자가 될 수 있다. 지방 침윤율이 높은 환자의 예후는 환자 교육 과정에서 설명을 해야 하며 단기 외래 환자 후속 조치를 통해 환자를 면밀한 모니터링이 필요하다.

• 대한정형외과학회지
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• 제55권6호
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• pp.520-526
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• 2020

목적: 척추 유합술을 받은 환자 중에서 척추 유합 재수술을 받는 경우가 증가하고 있다. 척추 유합 재수술을 위해 기존 장치와 연결기를 통해 연결하여 고정술을 연장하는 revision rod를 새롭게 개발하였다. 본 연구에서는 revision rod를 이용하여 척추 유합 재수술을 시행한 후 임상적·방사선적 결과를 분석하였다. 대상 및 방법: 2개의 대학병원에서 척추 유합술 후 유합 연장술을 시행하고 최소 1년 추적관찰이 가능했던 21명의 환자가 포함되었다. 진단명은 인접 분절 병증 16명, 흉요추 골절 4명, 황색인대골화 1명이었다. 임상 결과는 Oswestry Disability Index (ODI)와 수치평가척도(numerical rating scale, NRS)로 평가하였고, 방사선 결과는 요추 전만각, 흉추 후만각, 재수술 부위의 시상면 각도, 그리고 근위부 인접부의 후만각 및 골유합률을 평가하였다. 결과: 수술 전 평균 ODI는 54.6±12.5에서 최종 추시 시 29.8±16.5로 향상되었다. 허리 통증과 다리 통증 NRS는 5.0±1.7, 6.4±2.0에서 2.9±1.6, 2.9±2.2로 향상되었다. 요추 전만각은 수술 전 18.1±11.9도가 최종 추시 시 21.1±10.3도였고, 근위부 인접부 후만각은 수술 전 10.8±10.1도가 최종 추시 시 9.2±10.5도로 유의미한 차이를 보이지는 않았다. 골유합률은 후외측 골유합을 시행한 1명을 제외하고는 모든 예에서 성공적인 유합이 이루어졌다. 결론: Revision rod를 사용한 흉요추의 재유합술에서 우수한 임상 결과를 보였다. 새롭게 개발된 revision rod와 관련된 문제는 발생하지 않았고 방사선상 골유합은 성공적이었다.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.311-316
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• 2007

Objective : The objective of this study is to investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. Methods : Charts and radiographs of 32 patients who underwent posterior cervical fixation between October 2004 and February 2006 were retrospectively reviewed. Posterior cervical polyaxial screw-rod fixation was applied on the cervical spine and/or upper thoracic spine. The surgical indication was fracture or dislocation in 18, C1-2 ligamentous injury with trauma in 5, atlantoaxial instability by rheumatoid arthritis (RA) or diffuse idiopathic skeletal hyperostosis (DISH) in 4, cervical spondylosis with myelopathy in 4, and spinal metastatic tumor in 1. The patients were followed up and evaluated based on their clinical status and radiographs at 1, 3, 6 months and 1 year after surgery. Results : A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segment (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and computed tomography (CT) scans in all cases. Revision surgery was required in two cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. Conclusion : Posterior cervical stabilization with a polyaxial screw-rod system is a safe and reliable technique that appears to offer several advantages over existing methods. Further biomechanical testings and clinical experiences are needed in order to determine the true benefits of this procedure.

• 여성건강간호학회지
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• 제6권1호
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• pp.67-81
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• 2000

The purpose of this study was to analyze women's health problems using Green & Kreuter's(1991) PRECEDE model and to develop health education program for women's health. The subjects were recruited women from Wonju city 18 years or older. 1. The results showed that about 50% of the women were satisfied with their lives as women, 23% of the sample felt there was a need for a women's health care center. The mean number of health problems was 3.1 and the prevalence rate, 44.4%. 2. We developed on educational program according to group differences related to health problems, diagnosis of disease, variables influencing health promotion behavior, and programs which each group wanted. Also we stressed self-efficacy and self-help group for the management of individual health to all groups. 3. The diagnoses of diseases that were experienced premarital over the past year were gastritis, bronchitis, spinal disk, and fracture, for the childbearing/rearing group, gastritis, vaginitis and cervicitis, cervical cancer and cystitis and nephritis and arthritis and for the middle-aged/elderly group arthritis, gastritis, vaginitis and cervicitis, and spinal disk. Of the sample 30.5% did not have a health exam in the past year, and only 10% of the premarital group, 12.5% of the childbearing/child-rearing group, and 18.3% of the middle aged-elderly group were concerned about their health and did something for their health. 4. The average score on the HPLP was 2.41. the HPLP was scores according to group were found to have significant differences. self-efficacy, family functions, health attention and were considered important variables in the premarital group, in the childbearing/child-rearing group self-efficacy, family functions, internal locus of control, health attention, and health perception and power others locus of control and then for the middle aged-elderly group self-efficacy, health attention, internal locus of control, family functions and health perception. 5. There are a few educational programs in the city provided by the Wonju Health Center and by community health nurse practitioners. The premarital group requested the educational programs on diet, health exercise, family health and stress management. Also the childbearing/child-rearing group wanted programs on diet, family health, stress management, and health exercise, and the middle-aged/elderly group wanted that of family health, diet, climacteric changes stress management and health exercise. The program suggested that this program should be applied to women in the community to insure adequate management of women's health. Follow-up research with PROCEED is needed to analyze health outcomes, also, a women's health nursing specialist system is required to develop health promotion, and improve the quality of life for women.