• 대한정형외과학회지
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• 제55권4호
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• pp.324-330
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• 2020

목적: 족근골 유합의 유병률에 대한 국내의 연구가 드물고 특히 성인에서의 다발성 족근골 유합은 국내뿐만 아니라 외국에서도 유병률에 대한 연구가 부족하기 때문에 본원에 내원한 환자를 대상으로 시행한 영상 검사를 이용하여 한국인의 족근골 유합의 양상 및 유병률에 대해 알아보고자 한다. 대상 및 방법: 2009년 3월부터 2019년 2월까지 본원에서 시행한 족부 및 족관절의 컴퓨터 단층촬영 검사 및 자기공명영상 검사를 시행한 족관절 염좌 및 골절 환자 총 4,711명(남성 4,454명, 여성 257명)을 대상으로 족근골 유합의 유병률 및 양상에 대하여 후향적으로 조사하였다. 결과: 10년동안 총 78명(1.7%)의 환자에서 족근골 유합이 관찰되었고 전체 족근골 유합 환자 중 25명(32.1%)에서 다발성 족근골 유합이 확인되었다. 해부학적 위치에 따라 거골-종골 유합이 단발성(31명 37예, 62.7%) 및 다발성(22명 23예, 45.1%) 족근골 유합 모두에서 가장 흔하게 관찰되었고 단발성 유합에서는 종골-주상골 유합(10명, 16.9%), 주상골-설상골 유합(9명, 15.3%), 입방골-주상골 유합(3명, 5.1%)의 순서로, 다발성 유합에서는 종골-주상골 유합(14명 14예, 27.5%), 거골-주상골 유합(6명 6예, 11.8%)의 빈도 순으로 관찰되었다. 또한 총 60예의 거골-종골 유합 중 후방 관절소면에서 24예(40.0%)의 유합이 확인되었고 중간 관절소면에서 18예(30.0%), 전방 관절소면에서 4예(6.7%)가 관찰되었다. 그리고 조직학적인 분류에 따라 연골성 유합이 단발성(32명 35예, 59.3%) 및 다발성(20명 37예, 72.5%) 4예(6.7%)모두에서 가장 많이 관찰되었다. 결론: 기존의 문헌들을 통해서 알려진 바와 같이 본 연구에서는 거골-종골 유합이 가장 흔하게 나타나는 것으로 확인하였다. 하지만 거골-종골 유합은 대부분 중간 관절소면에서 주로 나타난다고 알려져 있는 것과는 달리 본 연구에서는 후방 관절소면에서 더욱 많이 관찰되었다. 그리고 극히 드물게 관찰되는 것으로 알려진 다발성 족근골 유합은 이제까지 알려진 바와 달리 다양한 양상으로 드물지 않게 발견되는 것을 확인하였다.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.412-418
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• 2015

Objective : To investigate the effects of posterior implant rigidity on spinal kinematics at adjacent levels by utilizing a cadaveric spine model with simulated physiological loading. Methods : Five human lumbar spinal specimens (L3 to S1) were obtained and checked for abnormalities. The fresh specimens were stripped of muscle tissue, with care taken to preserve the spinal ligaments and facet joints. Pedicle screws were implanted in the L4 and L5 vertebrae of each specimen. Specimens were tested under 0 N and 400 N axial loading. Five different posterior rods of various elastic moduli (intact, rubber, low-density polyethylene, aluminum, and titanium) were tested. Segmental range of motion (ROM), center of rotation (COR) and intervertebral disc pressure were investigated. Results : As the rigidity of the posterior rods increased, both the segmental ROM and disc pressure at L4-5 decreased, while those values increased at adjacent levels. Implant stiffness saturation was evident, as the ROM and disc pressure were only marginally increased beyond an implant stiffness of aluminum. Since the disc pressures of adjacent levels were increased by the axial loading, it was shown that the rigidity of the implants influenced the load sharing between the implant and the spinal column. The segmental CORs at the adjacent disc levels translated anteriorly and inferiorly as rigidity of the device increased. Conclusion : These biomechanical findings indicate that the rigidity of the dynamic stabilization implant and physiological loading play significant roles on spinal kinematics at adjacent disc levels, and will aid in further device development.

• Journal of Korean Neurosurgical Society
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• 제55권5호
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Journal of Korean Neurosurgical Society
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• 제60권4호
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• pp.433-440
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• 2017

Objective : Although minimally invasive posterior cervical foraminotomy (MI-PCF) is an established approach for motion preservation, the outcomes are variable among patients. The objective of this study was to identify significant factors that influence motion preservation after MI-PCF. Methods : Forty-eight patients who had undergone MI-PCF between 2004 and 2012 on a total of 70 levels were studied. Cervical parameters measured using plain radiography included C2-7 plumb line, C2-7 Cobb angle, T1 slope, thoracic outlet angle, neck tilt, and disc height before and 24 months after surgery. The ratios of the remaining facet joints after MI-PCF were calculated postoperatively using computed tomography. Changes in the distance between interspinous processes (DISP) and the segmental angle (SA) before and after surgery were also measured. We determined successful motion preservation with changes in DISP of ${\leq}3mm$ and in SA of ${\leq}2^{\circ}$. Results : The differences in preoperative and postoperative DISP and SA after MI-PCF were $0.03{\pm}3.95mm$ and $0.34{\pm}4.46^{\circ}$, respectively, fulfilling the criteria for successful motion preservation. However, the appropriate level of motion preservation is achieved in cases in which changes in preoperative and postoperative DISP and SA motions are 55.7 and 57.1%, respectively. Based on preoperative and postoperative DISP, patients were divided into three groups, and the characteristics of each group were compared. Among these, the only statistically significant factor in motion preservation was preoperative disc height (Pearson's correlation coefficient=0.658, p<0.001). The optimal disc height for motion preservation in regard to DISP ranges from 4.18 to 7.08 mm. Conclusion : MI-PCF is a widely accepted approach for motion preservation, although desirable radiographic outcomes were only achieved in approximately half of the patients who had undergone the procedure. Since disc height appears to be a significant factor in motion preservation, surgeons should consider disc height before performing MI-PCF.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.552-561
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• 2021

Objective : To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS). Methods : Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2-7 Cobb's angle, segmental angle, and fusion rates. Results : There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2-7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group. Conclusion : In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

• 대한족부족관절학회지
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• 제5권2호
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• pp.160-164
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• 2001

Intraosseus ganglion cysts are uncommon, benign, juxta-articular and usually found within long bones. A 35-year-old male presented with acute right ankle pain. He denied any traumatic event. Tenderness was localized on the subtalar joint. Radiologic studies demonstrated a cystic lesion in the juxta-articular portion of the posterior facet of the calcaneus. The patient underwent excision and curettage. Postoperative recovery was uneventful. A histological examination confirmed a typical intraosseus ganglion cyst. A case of an intraosseus ganglion cyst of the calcaneus causing acute subtalar joint pain is described.

• 대한치과교정학회지
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• 제19권2호
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• pp.109-120
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• 1989

We tend to consider only static occlusion such as molar relationship, canine key, and interdigitation at finishing stage. Of course, this static occlusion is important for post-orthodontic stability. But we should remember that mandible is always on the move during its various functions. If no pressure or too much pressure is put on during its functions, untoward tooth movement could occur. And tooth mobility, periodontitis, wear facet, bruxism, and far worse temporomandibular disorder could occur. After many studies have been done on what is a desirable occlusal scheme to strengthen post-orthodontic stability, today, "mutually protective occlusion" is recommended. If an orthodontist does not have understanding about this occlusal scheme during orthodontic treatment, the following conditions will be resulted after orthodontic treatment. I. Centric discrepancy 1. centric prematurity 2. sunday bite 3. molar fulcrum II. Eccentric discrepancy 1. posterior interference 2. anterior interference If we have deep understanding about these discrepancies that can happen after orthodontic treatment and their causes, corrections, and especially preventions against them, post-orthodontic stability could be strengthened and further temporomandibular disorder could be prevented.

• 대한족부족관절학회지
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• 제10권2호
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• pp.271-273
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• 2006

In closed calcaneus fractures, the occurrence of FHL interposition in subtalar joint is relatively rare and difficult to diagnosis preoperatively. But careful physical examination and significant radiologic findings could be useful tools to diagnosis preoperatively. This findings is shearing off a superior medial fragment made up of the sustentaculum talus connected to a significant portion of the medial wall and medial aticular surface of the posterior facet.

• 대한족부족관절학회지
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• 제27권1호
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• pp.1-6
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• 2023

Displaced intra-articular calcaneal fractures are difficult to treat because of complex anatomy and high soft tissue complications. Various surgical approaches have been introduced to solve these problems, but the treatment remains complex. Recently, clinically and radiographically superior results were reported using a subtalar arthroscopy in reducing the posterior facet in both percutaneous and open approaches. In the percutaneous approach, the arthroscopically assistant percutaneous approach must be selected carefully for mild-to-moderately displaced fractures because of the limited view. In the open approach, there is little evidence of the utility of subtalar arthroscopy. Therefore, intraoperative arthroscopy should always be used in conjunction with fluoroscopy to achieve reduction and assess the internal fixation placement.

• 한국전산구조공학회논문집
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• 제33권3호
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• pp.145-152
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• 2020

본 논문에서는 유한요소해석을 이용하여 흉요추 후방 고정술의 고정분절 변화에 따른 척추 안정성을 평가하였다. 이를 위해 추간판, 인대, 추간관절(Facet joint) 등을 포함한 정상 흉요추(T10-L4)의 유한요소모델을 구축하였으며, 문헌으로 보고된 재료물성치를 부여하였다. 한편, L1을 병변 부위로 가정하였으며, L1-L2, T12-L2, T12-L1-L2 총 3가지 종류의 후방 고정술을 흉요추 유한요소모델에 구현하고 전방 굽힘, 후방 굽힘, 측면 굽힘, 축 회전의 하중 조건을 부여하였다. 시리즈 유한요소해석을 통해 고정분절에 따른 척추경 나사못, 척추골, 추간판의 변형량, 등가 응력, 운동 범위, 모멘트를 계산하였으며, 그 결과를 바탕으로 척추 안정성을 평가하였다.