442 pissn : , eissn : Original Article J Korean Orthop Assoc 2017; 52:
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1 442 pissn : , eissn : Original Article J Korean Orthop Assoc 2017; 52: 요추극외측추간판탈출증과후외측추간판탈출증의수술에대한상대위험도 : 후향적코호트연구 하대호 심대무 * 김태균 * 오성균 김진 원광대학교의과대학산본병원정형외과, * 원광대학교의과대학정형외과학교실, 원광의과학연구소 Relative Risk of Operation between Lumbar Far Lateral Disc Herniation and Posterolateral Disc Herniation: A Retrospective Cohort Study Dae Ho Ha, M.D., Dae Moo Shim, M.D.*, Tae Kyun Kim, M.D.*, Sung Kyun Oh, M.D., and Jin Kim, M.D. Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, *Department of Orthopaedic Surgery and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea Purpose: We reported relative risk of operation between patients who were diagnosed with lumbar far lateral disc herniation and posterolateral disc herniation after transforaminal epidural block. Materials and Methods: A retrospective cohort study was performed on 295 patients (131 male and 164 female) who underwent transforaminal epidural block for unilateral radiculopathy caused by lumbar intervertebral disc herniation. Among these 295 patients, 34 patients were diagnosed with far lateral disc herniation and 261 patients with posterolateral disc herniation. The median follow-up period was 23.9 months, with an average age of 55.7 years. Results: Fifty-one patients underwent surgical treatment. Among them, 38 patients had posterolateral disc herniation and 13 patients had far lateral disc herniation. Patients with far lateral disc herniation, when compared with posterolateral disc herniation, had a relative risk of operation of 2.67 ( , 95% confidence interval) with statistical significance (p=0.0002). At the final follow-up, the average visual analogue scale (VAS) score for radicular pain in the surgical and non-surgical groups was 0.69 and 1.50, respectively; the average Korean- Oswestry Disability Questionnaire (K-ODI) score was 11.7 and 9.6, respectively. The difference of average VAS score showed a statistical significance (p=0.035), however, that of K-ODI showed no statistical significance (p=0.266). Conclusion: In the case of far lateral disc herniation, the relative risk of surgery after transforaminal epidural block was 2.67, which is higher than that of posterolateral disc herniation. Therefore, we should consider surgical treatment more aggressively. Key words: spine, discectomy, epidural injections 서론 Received November 25, 2016 Revised January 3, 2017 Accepted March 20, 2017 Correspondence to: Sung Kyun Oh, M.D. Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, 327 Sanbon-ro, Gunpo 15865, Korea TEL: FAX: niceo@hanmail.net *This research was supported by grant from Wonkwang University, 극외측추간판탈출증은추간판이추간공혹은추간공외측으로탈출하는것으로측방또는극측방추간판탈출증이라고도불린다. 1) 전체추간판탈출증의 7%-12% 를차지한다고알려져있으나과거보다발달된영상기술로진단이어렵거나놓치는경우는거의없다. 2,3) 특징적인임상증상을가지고있으나후방혹은후측방추간판탈출증과동일하게비수술적치료에도호전이없거나 The Journal of the Korean Orthopaedic Association Volume 52 Number Copyright 2017 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
2 443 Relative Risk of Operation for Lumbar Far Lateral Disc Herniation 실패했을때수술적치료를시행하는것이근간이나통증이극심하고신경학적이상소견이저명하여일반적인후측방추간판탈출증같은척추관내추간판탈출증의자연경과와는다를것으로생각된다. 그러나일반적인척추관내추간판탈출증과는달리극외측추간판탈출증의자연경과에대해서는거의알려져있지않으며대증치료로성공할확률역시 10% 에서 71% 까지다양하게알려져있다. 2,4,5) 본연구는극외측추간판탈출증환자에대해서후향적코호트연구를시행하고일반적인후방혹은후외측추간판탈출증환자와비교하여수술에대한상대위험도 (relative risk) 및이들의임상결과에대해서보고하고자한다. 대상및방법 2008년 3월 1일부터 2015년 12월 31일까지요추추간판탈출증으로진단되어원광대학교산본병원정형외과에서일측방사통에대해경추간공하경막외차단술을시행받은 461명의환자를대상으로하였다. 경막외차단술은자기공명영상검사를통해진단된추간판탈출증에의한방사통으로하지직거상검사혹은대퇴신경견인검사에서양성인환자들을대상으로하였고모두수술장에서 C-arm 투시하에시행하였다. 응급실로내원하거나방사통과신경증상으로보행이어려운경우입원후경막외차단술시행을원칙으로하였으며이외의경우외래에서 1주간격으로 3 회시행하였다. 최초시행후 6주, 그리고 3개월, 6개월, 12개월후외래정기방문을원칙으로하였으며외래방문시마다요통과하지방사통에대한시각통증등급 (visual analogue scale, VAS) 평가및 Korean-Oswestry Disability Questionnaire (K-ODI) 평가를시행하였다. 정기적인외래추시를통해 6개월이상외래추시가되는환자를연구대상으로하였으며최종적으로외래경과기록및전화면담을통해수술시행여부를확인하였다. 461명의환자중 166명의환자가중도탈락하였고 295명의환자가연구대상에 해당되었다. 이들은남성 131명, 여성 164명이었고중앙연령값은 55.7세였고중앙추시값은 23.9개월이었다. 요추 45번추간판탈출증이 182예로 61.7% 였고요추 5번 ~ 천추 1번간추간판탈출증은 74예로 25.1% 였으며요추 45번및요추 5번 ~ 천추 1번간두분절이 86.8% 로대부분을차지하였다 (Table 1). 본원혹은타병원에서신경차단술을시행하고 6주이상대증치료에실패한환자나지속적인족하수를포함한보행장애를일으킬정도의하지마비가지속되는경우, 마미증후군이의심되는경우수술적응증으로하였으며추시도중 51명의환자가수술적치료를받았다. 통계분석은 SPSS ver. 12 (SPSS Inc., Chicago, IL, USA) 프로그램을이용하였으며유의수준 p<0.05로하였다. VAS 및 K-ODI 의평균값의비교는정규성을보이지않아 Mann-Whitney U-test 를사용하였다. 상대위험도분석은 Altman 6) 에의한방법으로계산하였다. 결과 295명의환자중추간공혹은극외탈출증으로진단된환자가 34 명이었으며후방혹은후외측탈출증으로진단된경우는 261명이었다. 추시도중수술적치료를시행한 51명중 13예는극외탈출증이었고 38예는후방혹은후외측탈출증이었다 (Fig. 1). 34명의극외측탈출증환자중남성 15명, 여성 19명이었고이들의중앙연령은 61.9세로 55.1세인후방혹은후외측탈출증환자보다약 7세정도더많았고요추 3, 4번추간판탈출증의비율이 18% 로 4-5배높았으나여전히요추 4, 5번에서극외측탈출증의빈도가가장높았다 (Table 2). 후방혹은후외측탈출증으로진단된경우 14.5% 에서, 극외탈출증으로진단된경우는 38.2% 에서수술로이어졌으며이들 13예의경우 2예는경추간공내시경을이용한추간판절제술이 2예, 현미경을이용한추간판절제술이 5예, 경추간공감압및유합술 Table 1. Demographic Data of Patients Variable Value Patient (male/female) 131/164 Mean age (yr) 55.7 Level L1 2 1 L2 3 8 L L L5 S1 74 Mean follow-up (mo) 23.9 Values are presented as number only or mean only. Far lateral disc herniation (n=34) Op + (n=13) Patients (n=295) Op (n=21) Posterior disc herniation (n=261) Op + (n=38) Op (n=223) MRI, P/ex assignment by investigator Follow-up period outcome of interest Figure 1. Results of retrospective cohort. MRI, magnetic resonance imaging; P/ex, physical exam; Op +, operation (+); Op, operation ( ).
3 444 Dae Ho Ha, et al. Table 2. Results of Each Group Variable Posterolateral (n=261) Far lateral (n=34) Patient (male/female) 116/145 15/19 Mean age (yr) Level L1 2 1 (0.4) 0 (0) L2 3 8 (3.1) 0 (0) L (9.2) 6 (17.6) L (61.7) 21 (61.8) L5 S1 67 (25.7) 7 (20.6) Total 261 (100) 34 (100) Values are presented as number only, mean only, or number (%). Table 3. Relative Risk of Operation for far Lateral Disc Herniation Patients Variable Result Relative risk % CI Z statistic Significance level p= NNT (benefit) % CI CI, confidence interval; NNT, number needed to treat. Table 4. Clinical Outcomes of Patients with Lumbar Far Lateral Disc Herniation Patients Operation group Conservative p-value VAS (leg pain) 0.69± ± VAS (back pain) 1.46± ± K-ODI 11.7± ± Values are presented as mean±standard deviation. VAS, visual analogue scale; K-ODI, Korean-Oswestry Disability Questionnaire. 이 6예에서시행되었다. 요추극외측추간판탈출증의수술에대한상대위험도는 2.67 (95% confidence interval, ) 였고 p값은 로통계적으로유의한값이었다 (Table 3). 요추극외측탈출증으로진단된환자의최종추시방사통에대한 VAS 값의경우수술군에서 0.69±0.95점, 대증치료군에서 1.50±1.04점으로수술군에서낮았으며 (p=0.035), 요통에대한 VAS의경우는수술군에서 1.46± 1.10, 대증치료군에서 1.80±0.95로유의한차이를보이지않았다 (p=0.356). 또한극외탈출증환자의최종추시 K-ODI의경우수술군에서 11.7±1.4, 대증치료군에서 9.6±1.2로오히려수술군에서높았으나통계적으로유의한차이는아니었다 (p=0.266) (Table 4). 고찰 전형적인척추관내추간판탈출증의경우보존적치료에도양호한결과를보여수술적치료로이어지는경우는 10%-26% 로보고되고있다. 7-9) 최근국내에서보고된척추강내 1/3 이상침범한추간판탈출증 39예를대상으로한평균 28개월추시전향적연구에서보존적치료의성공률이 85% 였고 39예중 4예, 즉 10% 에서만수술로의전환이필요하였다고보고한바있다. 7) 그러나극외측탈출증과척추관내추간판탈출증의해부학적특성이다르고더고령에서발생하는차이점이있으므로자연경과나보존적치 료의결과에차이가있을것으로생각된다. 1995년까지도 Epstein 등 2) 은극외탈출증에대한비수술적치료의성공률은 10% 미만으로대부분수술적치료가필요하다고주장하였다. 하지만이후신경차단술을포함한보존적치료의발달로 Weiner와 Fraser 10) 는 30명의환자중 27명이추간공신경차단술후즉각적인통증경감을보여 3명만이수술적치료가필요하다고하였고 Rust와 Olivero 5) 도 17명의극외측추간판탈출증의비수술적치료시 12명은 3년추시에서방사통이소실되어그성공률을 71% 로보고하기도하였다. 국내에서도 Kim 등 11) 은극외측탈출증으로진단된 24명의환자중신경차단술등의보존적치료에실패한 9예 (37.5%) 는수술적으로치료하였다고보고하였다. 12) 이렇듯극외측탈출증역시보존적치료가초기에시도될수있으나심한방사통과동반된신경학적인장애로인해수술적치료로전환되는경우가기존척추관내추간판탈출증보다높을것으로예상할수있다. 극외탈출증에의한신경근압박시에는후방신경절 (dorsal root ganglion) 을직접자극하고추간공내에고정된신경근이압박되어극심한통증과보행장애혹은똑바로눕게하지못하게되는등급성기극심한통증이선행하고이후보행에영향을주는신경학적인결손이나타나게된다. 13,14) 이는본연구에서보듯이요추 3, 4번과 4, 5번분절이환이 80% 이므로출구신경근인요추 3번신경근과 4번신경근이압박되어대퇴및하지의통증과
4 445 Relative Risk of Operation for Lumbar Far Lateral Disc Herniation 함께대퇴사두군과전방경골근마비를주로초래하기때문이다. 대퇴사두근과전방경골근은무릎과발목관절의대표적인근육으로안정성에중요하므로이들근육의영구적인마비는이차적인관절의문제를일으킬수있다. 또한보행에영향을주는저명한마비역시극심한방사통과함께기존척추관내추간판탈출증보다높은수술비율로이어졌다고생각된다. 또한본연구에서도극외탈출증의평균발생연령이척추관내추간판탈출증보다약 7세가량높았는데이는기존에알려진것과유사하게평균 61.9세였으며, 이는퇴행성변화에의한영향으로섬유륜외측의퇴행성변화와상요추부의시상면배열후관절이추간판에더많은전단력을전달하기때문이라고알려져있다. 2,12,14) 본연구에서도고령의경우동반된협착증과퇴행성불안정성등의이환이더높아수술로이어진경우도있고또한단순감압술보다는유합술을선택하게되는이유가될것으로생각된다. 특히수술한 13예의평균연령은 64세로비수술적치료군보다훨씬고령이었으며, 단순추간판절제술만시행한 7예의경우평균연령은 60세였고유합술을시행한 6예는평균 69세였다. 극외측탈출증치료의결과는중앙값 23.9개월추시에서수술군에서방사통에대한 VAS 값이 0.69, 비수술군에서 1.50으로수술군에서의미있게낮았으나요통에대한 VAS의경우수술군이 1.46으로대증치료군의 1.80보다낮았으나통계적으로의미있는차이를보이지않았고수술후기능결과지표인 K-ODI 값은오히려수술군에서더높았는데이는수술군에서더욱더고령인점과요추부유합술에대한이차적보상성등의편견이작용했을것으로유추해볼수있었다. 또한요통의경우통계적으로의미있는차이를보이지않았으므로대증치료결과와대등하다고해석하기보다는수술군에서요통에대한 VAS값이낮았으나 13예로통계적유의성을검증하기는어렵다고해석하는것이옳다고생각된다. 극외탈출증의해부학적특성으로인한심한통증과신경학적이상, 그리고고령에서의발생이척추관내탈출증보다높은수술비율로이어진것으로보이며수술에대한상대위험도가 2.67배높아진원인중하나인것으로저자는분석하였다. 본연구는극외탈출증에대한보존적치료의결과및척추관내추간판탈출증보다수술위험도가 2.67배이상높다는것을밝힌최초의연구이다. 다만극외측탈출증의발생빈도가높지않아후향적코호트연구방법을선택하여수술에대한상대위험도를구하였으나 461예중 166예가중도탈락하는등중도탈락자비율이 36.0% 로높아중도탈락자의경향에따라편견개입이가능할수도있다. 또한탈락자중증상이심한증례보다는경한증례일가능성이높아척추관내탈출증환자의수술비율을더높일수있는여지도있었다고생각된다. 그러나극외탈출증의경우타병원으로의전원등의사유로 3예 (8.1%) 에서만중도탈락하였으므로극외탈출증의환자의수술비율은편견개입여지가다 소적을것으로추정되었다. 극심한통증으로인해신경차단술에의한호전이있었음에도잔존혹은재발하는통증이심해타병원으로전원을원한증례였다. 따라서척추관내추간판탈출증과는다르게극외탈출증의경우대증치료의기간을 2-3주정도로짧게하고통증조절이안되거나신경학적인이상이지속되는경우적극적인수술적치료를고려할수있도록국내추간판절제술에대한급여기준또한척추관내탈출증과는차이를두어야한다고생각된다. 결론 극외측탈출증의경우후방혹은후외측탈출증보다신경차단술후수술에대한상대위험도가 2.67로높고극외탈출증환자들의수술후방사통감소가대증치료군보다좀더뚜렷했으므로마비가동반되었거나통증이심한경우적극적으로수술을고려해야한다. CONFLICTS OF INTEREST The authors have nothing to disclose. REFERENCES 1. Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord. 2002;40: Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995;83: Ahn MW, Kim US, Kim GB. Usefulness of the ProSet MRI for diagnosis of the extraforaminal disc herniation. J Korean Soc Spine Surg. 2013;20: Epstein NE. Different surgical approaches to far lateral lumbar disc herniations. J Spinal Disord. 1995;8: Rust MS, Olivero WC. Far-lateral disc herniations: the results of conservative management. J Spinal Disord. 1999;12: Altman DG. Practical statistics for medical research. London: Chapman and Hall; Shin BJ, Lee JC, Lee HH, Jang HD. Conservative treatment of lumbar disc herniation: a prospective study of disc herniation encroaching more than one-third of spinal canal. J Korean Soc Spine Surg. 2011;18: Weber H. Lumbar disc herniation. A controlled, prospective
5 446 Dae Ho Ha, et al. study with ten years of observation. Spine (Phila Pa 1976). 1983;8: Saal JA. Natural history and nonoperative treatment of lumbar disc herniation. Spine. 1996;21:2S-9S. 10. Weiner BK, Fraser RD. Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 1997;79: Kim MH, Suh KJ, Lee JY, Min SH, Yoo HY. Usefulness of coronal MR image in diagnosis of foraminal and extraforaminal disc herniation. J Korean Soc Spine Surg. 2008;15: Cho YW. Effect of intensive conservative treatment on extraforaminal lumbar disc herniations: 1 year prospective followup study. J Korean Acad Rehabil Med. 2009;33: Phan K, Dunn AE, Rao PJ, Mobbs RJ. Far lateral microdiscectomy: a minimally-invasive surgical technique for the treatment of far lateral lumbar disc herniation. J Spine Surg. 2016;2: Faust SE, Ducker TB, VanHassent JA. Lateral lumbar disc herniations. J Spinal Disord. 1992;5:
6 447 pissn : , eissn : Original Article J Korean Orthop Assoc 2017; 52: 요추극외측추간판탈출증과후외측추간판탈출증의수술에대한상대위험도 : 후향적코호트연구 하대호 심대무 * 김태균 * 오성균 김진 원광대학교의과대학산본병원정형외과, * 원광대학교의과대학정형외과학교실, 원광의과학연구소 목적 : 코호트연구를통해요추후외측탈출증과극외측탈출증환자의수술에대한상대위험도를알아보고자하였다. 대상및방법 : 요추추간판탈출증으로진단된환자중일측방사통에대해경추간공하경막외차단술을시행받은총 295명의환자에대해후향적코호트연구를시행하였다. 극외측탈출증으로진단된 34명과후방혹은후외측탈출증으로진단된환자는 261명이었다. 이들의중앙추시기간은 23.9개월이었고, 평균연령은 55.7세, 남성은 131명, 여성은 164명이었다. 결과 : 추시중총 51명이수술을시행받았으며, 38명은후방혹은후외측추간판탈출증이었고 13명은극외측추간판탈출증이었다. 척추관내추간판탈출증에비해극외측탈출증이었던경우수술에대한상대위험도 (relative risk) 와 95% 신뢰구간 (95% confidence interval) 은 2.67 ( ) 이었으며이러한관련성은통계적으로도유의하였다 (p=0.0002). 극외측추간판탈출증환자들의수술군과비수술군의최종추시방사통에대한평균시각통증등급 (visual analogue scale) 은 0.69, 1.50으로비수술군이유의하게높았고 (p=0.035), Korean-Oswestry Disability Questionnaire 는각각 11.7점, 9.6점유의한차이를보이지는않았다 (p=0.266). 결론 : 극외탈출증의경우척추관내탈출증에비해신경차단술후수술에대한상대적위험도가 2.67로높아보다적극적으로수술을고려해야한다. 색인단어 : 요추, 추간판절제술, 경막외신경차단술 접수일 2016 년 11 월 25 일수정일 2017 년 1 월 3 일게재확정일 2017 년 3 월 20 일책임저자오성균 15865, 군포시산본로 327, 원광대학교의과대학산본병원정형외과 TEL , FAX , niceo@hanmail.net * 본연구는 2017 년원광대학교연구비지원에의하여수행됨. 대한정형외과학회지 : 제 52 권제 5 호 2017 Copyright 2017 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar
Lumbar spine
Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical
Journal of Korean Society of Spine Surgery Loss of Disc Height after Spontaneous Regression of a Herniated Lumbar Disc - A Case Report - Hyoung Bok Ki
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Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic
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Received : 2011. 11. 16 Reviewed : 2011. 11. 25 Accpeted : 2011. 12. 5 A Case Report of Prescribing Yanghyeolgeopung-tang(yangxuequfeng-tang) to Two Patients with Cervical Disc Herniation and Headache
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대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실
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386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon
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Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :
KISEP Clinical Research J Korean Neurosurg Soc , 1998 다발성요추간반탈출증에서의컴퓨터적외선전신체열촬영의진단적가치 * 조용은 김영수 장호열 = Abstract = Clinical Efficacy of Digita
KISEP Clinical Research J Korean Neurosurg Soc 27237-245, 1998 다발성요추간반탈출증에서의컴퓨터적외선전신체열촬영의진단적가치 * = Abstract = Clinical Efficacy of Digital Infrared Thermographic Imaging in Multiple Lumbar Disc Herniations
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Journal of the Korea Institute of Information and Communication Engineering 한국정보통신학회논문지(J. Korea Inst. Inf. Commun. Eng.) Vol. 19, No. 2 : 258~264 Feb. 2015 ID3 알고리즘 기반의 귀납적 추론을 활용한 모바일 OS의 성공과 실패에 대한
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Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation
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Abstract Musculoskeletal Symptoms and Related Factors for Nurses and Radiological Technologists Wearing a Lead Apron for Radiation Pro t e c t i o n Jung-Im Yoo, Jung-Wan Koo 1 ) Angio Unit, Team of Radiology,
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Chromosomal Alterations in Hepatocellular Carcinoma Cell Lines Detected by Comparative Genomic Hybridization Sang Jin Park 1, Mahn Joon Ha, Ph.D. 1, Hugh Chul Kim, M.D. 2 and Hyon Ju Kim, M.D. 1 1 Laboratory
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Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis
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The e-business Studies Volume 17, Number 4, August, 30, 2016:319~332 Received: 2016/07/28, Accepted: 2016/08/28 Revised: 2016/08/27, Published: 2016/08/30 [ABSTRACT] This paper examined what determina
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Does Real-time Compound Imaging Improve Evaluation of reast Cancer Compared to Conventional Sonography? o Kyoung Seo, M.D., Yu Whan Oh, M.D., Kyu Ran Cho, M.D., Young Hen Lee, M.D., Hyung Joon Noh, M.D.,
Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie
Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung
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Case Report J Korean Orthop Assoc 2011; 46: 438-442 http://dx.doi.org/10.4055/jkoa.2011.46.5.438 www.jkoa.org Far-out Stenosis by the Lumbosacral Transitional Vertebrae 김영훈 윤기식가톨릭대학교서울성모병원정형외과 요천추이행성척추의만성요통과인접분절추간판의퇴행성변화에대한임상적의미에대하여는이견이많다.
Journal of Korean Society of Spine Surgery Unilateral Biportal Endoscopy as a Treatment for Acute Radiculopathy after Osteoporotic Lumbar Compression
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Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.251-273 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.251 : 1997 2005 Research Trend Analysis on the Korean Alternative Education
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한지닥섬유제품의인체생리반응및쾌적성평가 임순 Evaluation of Thermal Physiological Responses and Comfort in Dox Fabric Soon Im Professor, Dept. of Fashion Industry, Incheon National University This study performed the evaluation
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T H E K O R E A N D O C T O R S W E E K L Y www.docdocdoc.co.kr I N S I D E 38 3 5 6 7 10 13 28 29 30 31 38 41 42 2 Advertisement Government & Medicine 3 Government & Medicine 4 Government & Medicine Government
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Journal of Educational Innovation Research 2018, Vol. 28, No. 4, pp.577-601 DOI: http://dx.doi.org/10.21024/pnuedi.28.4.201812.577 3 * The Effect of Home-based Activities Using Traditional Fairy Tales
KISEP Clinical Research J Korean Neurosurg Soc , 1997 극돌기절제및부분적후궁절제술을이용한추간공내요추간판탈출증의수술적치험 * 김주영 이승명 신호 = Abstract = Surgical Experience of L
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비인강암의방사선치료결과및생존율에관한예후인자분석 2005 2 1 2005 3 28. :, Tel: 053)250-7665, Fax: 053)250-7984 E-mail: jhkim@dsmc.or.kr 정영연외 2 인 : 비인강암의예후인자분석 정영연외 2 인 : 비인강암의예후인자분석 Carcinoma of the nasopharynx treated by radiotherapy
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Focused Issue of This Month Gyu Cheol an, MD Department of Otolaryngology ead & Neck Surgery, Gachon University of College Medicine E - mail : han@gilhospital.com Won-o Jung, MD Department of Otolaryngology
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주요개념 : 컴퓨터음란물 접촉자, 성지식, 성태도 남자중학생의 컴퓨터음란물 접촉자와 비접촉자간의 성지식과 태도의 차이 김 영 혜* 이 화 자** 정 향 미*** 1. 연구의 필요성 한국은 I. 서 론 1960 년대 이후부터 시작된 돌진적 산업화 ( 한 상진, 1996) 로 인하여 경제적 부흥을 이루어 집집마다 TV 수상기를 가질 수 있게 되었고 최근에는 PC보급율
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Review Article Randomization, What is the Proper Method? Jin Ho Hong, M.D., Jae Chul Yoo, M.D. Shoulder & Sports medicine, Department of Orthopedic Surgery, Samsung Medical Center Purpose: Among the numerous
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농업생명과학연구 49(4) pp.31-37 Journal of Agriculture & Life Science 49(4) pp.31-37 Print ISSN 1598-5504 Online ISSN 2383-8272 http://dx.doi.org/10.14397/jals.2015.49.4.31 국가산림자원조사 자료를 적용한 충남지역 사유림경영율 추정 서연옥
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The e-business Studies Volume 17, Number 6, December, 30, 2016:237~251 Received: 2016/11/20, Accepted: 2016/12/24 Revised: 2016/12/21, Published: 2016/12/30 [ABSTRACT] Recently, there is an increasing
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The e-business Studies Volume 17, Number 6, December, 30, 2016:275~289 Received: 2016/12/02, Accepted: 2016/12/22 Revised: 2016/12/20, Published: 2016/12/30 [ABSTRACT] SNS is used in various fields. Although
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스포츠와 물리학: 구기운동 안티-싸커 와 간접-축구 DOI: 10.3938/PhiT.23.005 이 인 호 Anti-soccer and Indirect Soccer 편성은 없다고 장담한다. 벨기에(FIFA 랭킹 11위), 러시아 (FIFA 랭킹 22위), 알제리(FIFA 랭킹 26위), 그리고 한국(FIFA 랭킹 61위)으로 이어지는 H조 편성 결과이다. 이
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Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding
Study on the Improvement of Management System through Analysis of golf semi- market: Focus on Physical Education Facility Act Ji-Myung Jung 1, Ju-Ho Park 2 *, & Youngdae Lee 3 1 Korea Institute of Sport
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대한정형외과학회지 : 제 43 권제 5 호 2008 J Korean Orthop Assoc 2008; 43: 588-594 자기공명영상을이용한요추부척추관면적계측방법및분석 심대무ㆍ최윤홍ㆍ양정환ㆍ오성균ㆍ김채근ㆍ박정현 원광대학교의과대학정형외과학교실 Analysis and Measurement of the Lumbar Spinal Canal Dimension using
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Vol. 11, No. 4, December, 2004 Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic
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