• 대한족부족관절학회지
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• 제5권1호
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• pp.35-42
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• 2001

Purpose: To analyze the results of conservative or surgical treatment after computed tomograhy(CT) classification in intraarticular calcaneal fractures. Materials and methods: From January 1996 to May 1999, we prospectively analyze 23 cases of intraarticular calcaneal fractures who were treated conservatively or operated by open reduction and internal fixation by extensive L-shaped lateral approach after CT classification. Results: A functional scoring system of 0-100 points which was based upon the responses to AOFAS Ankle-Hindfoot Scale for the operative group was at 82.8, compared with 73.2 for the non-operative group, and these were meaningful statistically(P<0.05). Of type I fracture, in the operative group there were 2 excellent results and in the non-operative group there were 2 excellent results, 1 good result. or type II fractures, in the operative group there were 2 excellent results, 3 good results, 1 fair result and in the non-operative group there were 1 good result, 1 fair result, 2 poor results. Of type III fractures, in the operative group there were 2 fair results, 2 poor results and in the non-operative group there were 1 fair result, 3 poor results. Bohler angles of subtalar joint were changed from initial average $13.3^{\circ}$ to postoperative average $20.9^{\circ}$ for the operative group compared with from initial average $15.5^{\circ}$ to follow-up average $14.8^{\circ}$ of the non-operative group(P<0.01). Conclusions: Computed tomography in the evaluation of intraarticular calcaneal fractures is effective tool. We believed that open reduction and internal fixation in all Crosby & Fitzgibbons type II and according to degrees of comminution reducible type III for the intraarticular calcaneal fractures is more effective method than conservative treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.110-115
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• 2008

목 적: 장중첩증의 일차적인 치료로 사용되는 비수술적 관장 정복은 장천공, 쇼크 그리고 복막염 등과 같은 심각한 합병증과 불필요한 스트레스 및 과도한 방사선 노출의 위험이 있다. 본 연구에서는 무리한 비수술적 정복의 시도를 피하기 위하여 장중첩증 환자의 임상 양상 및 검사 소견 중 비수술적 정복 실패를 예측할 수 있는 인자를 파악하고자 하였다. 방 법: 고려대학교 의료원 안산병원에서 1998년 3월에서 2006년 7월까지 장중첩증으로 진단되어 치료받았던 환자 314명 중 비수술적 정복이 시도되었던 300명을 대상으로 하였다. 비수술적 정복의 성공 군과 실패군으로 나누어 성별, 연령, 임상증상 및 이학적 소견 그리고 증상의 시작에서 비수술적 정복술을 시도하기까지의 시간과 비수술적 정복 실패와의 연관성을 분석하였다. 결 과: 비수술적 정복 실패 군의 경우 성공 군에 비해 연령이 어렸고(12.3${\pm}$17.2개월 vs 18.0${\pm}$15.8개월, p=0.03), 정복 시도까지의 시간 경과가 길었으며(33.6${\pm}$29.0시간 vs 21.5${\pm}$20.3시간, p<0.01), 구토, 기면은 많았음(p<0.01)에 비해 복통이나 보챔은 적었다(p<0.01). 이러한 인자들의 다중회귀분석에서 비수술적 정복 실패와 연관된 인자는 6개월 미만 연령(odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), 24시간 경과(odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), 혈변(odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), 기면(odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), 복통 또는 보챔(odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01)이었다. 결 론: 장중첩증에서 6개월 미만 어린 연령, 혈변이나 기면의 소견, 증상 시작 24시간이 경과된 경우 비수술적 정복 실패의 가능성이 많으므로 이러한 사항을 충분히 고려하여 시행 여부를 결정하는 것이 좋겠다.

• Advances in pediatric surgery
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• 제19권2호
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• pp.66-72
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• 2013

Intussusception is common cause of intestinal obstruction in children. Most of intussusceptions can be treated with non-operative reduction using air or barium. However, about 10% patients need operative treatment due to failure of reduction, peritonitis, and recurrence after reduction. We introduce our experience of laparoscopic surgery for intussusception. From April 2010 to March 2013, we reviewed 57 children who diagnosed intussusception. Twelve patients underwent an operation. The cause of operation was 7 of failure of air reduction and 5 of recurrence after air reduction. Median age was 21.5 months (range: 5.0~57.7 months) and 11 children (91.7%) underwent successful laparoscopic reduction. Median operating time was 50 minutes (range: 30~20 minutes) and median hospital days was 4.5 days (range: 3~8 days). One patient had a leading point as a heterotopic pancreas and underwent bowel resection through conversion. There was neither intra-operative nor postoperative complication. Laparoscopic reduction for intussusception can bring an excellent cosmetic effect with high success rate.

• Clinics in Shoulder and Elbow
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• 제19권2호
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• pp.110-116
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• 2016

Background: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. Methods: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. Results: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. Conclusions: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권1호
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• pp.49-57
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• 2006

Mandibular fractures have higher incidence rate compared to facial bone fractures because of relatively prominent form. Specially, mandibular angle fractures were known as common fracture site because of morphological anatomic structure. The mandibular third molar appears to be the most frequent impacted tooth. The mandibular third molar have influence on mandibular angle fractures according to it's eruption state. Also, the mandibular angle fracture including the third molar may influence on post operative infection whether the third molar is in impacted or extracted state when reduction of fracture site is operated. The presence or absence and degree of impaction of the mandibular third molar were assessed for each patient and were related to the occurrence of the mandibular angle fracture. The extraction or non extraction of the mandibular third molar were related to the occurrence of the post operative infection in the reduction of mandibular angle fractures. In the presence of mandibular third molar, the possibility of mandibular angle fractures were relatively common. When viewing the mandibular third molar at occlusal plane, the possibility of mandibular angle fractures were high in the class C group. The possibility of mandibular angle fractures were high in the mesial angulation and partial impaction. There was a statistically significant difference(P<0.05). In complete erupted mandibular third molar, the possibility of post operative infection occurs quite often, but there was no statistical significant difference(P>0.05). In the extracted or non extracted of mandibular third molar, the post operative infection showed no statistical significant difference(P>0.05). With the results mentioned above, mandibular third molar was significantly more susceptible to mandibular angle fracture. In the reduction of mandibular angle fracture, it was recommended that mandibular third molar should be extracted especially in case of pericoronitis, periodontitis and other infections.

• 대한두개안면성형외과학회지
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• 제10권2호
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• pp.76-80
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• 2009

Purpose: Zygoma is a major portion of the midfacial skeleton, forms the malar prominence and the three adjacent bony articulations. Zygoma fracture is a very common in facial trauma. Open reduction and rigid fixation of displaced zygoma fractures are necessary to avoid immediate and delayed facial asymmetry and depression. However, it is possible to happen the complications related to the plates and screws. So, we planned to treat the 24 patients of Group II, III, IV zygoma fractures with precise reduction and non-fixation method via intraoral approach. Methods: From August, 2006, to August, 2009, we treated 24 cases of zygoma fracture with reduction and non-fixation methods. Before the surgery, we choose the patients who could be treated with this method among the Group II, III, IV patients. Results: No patients in this study had postoperative complications such as displacement of bony fragments, facial depression and asymmetry, malocclusion, hypoesthesia. Satisfactory aesthetic and functional results can be obtained. Conclusion: In the treatment of the zygoma fracture, it is possible to treat with precise reduction and non-fixation method. The greatest advantage is to decrease the operative time, no need to wide dissection, no complications related to the plates and screws. For the using of this method, it is necessary to choose the adequate patients through the preoperative planning.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.287-294
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• 2011

Purpose: Reduction malarplasty is one of the common aesthetic procedures performed in the Orient. We have analyzed effective operative methods according to the pivot point for the osteotomy and reposition of the zygoma for reduction malarplasty after confirming the shapes of the individual zygomas. Methods: Thirty-six patients had been received malarplasty over the last 10 years. The average follow-up period was 16 months. We categorized the patients into three groups according to their prominent appearance features. Group I had a prominently protruded zygomatic body, group II had a prominently protruded zygomatic arch, and group III had a prominently protruded body and zygomatic arch. In the group I, two parallel oblique osteotomies on the body, the middle portion was removed, and with the zygomatic arch as the pivot point, the body was repositioned inwards. In the group II, the zygomatic body and arch osteotomy is performed, with the body as the pivot point, and the arch is depressed medially. In the group III, using the two aforementioned methods, the zygoma was repositioned medially. In each case, postoperative complications and patients satisfaction over the surgery were surveyed. Results: Each group had 25, 5 and 12 patients respectively. No significant complications were found except for one patient who experienced a non-union of zygomatic bone. In the case of group I, four patients underwent a secondary operation. Conclusion: Reduction malarplasty is popular as an effective facial contouring surgery. In order to obtain more effective results,however, the zygomatic shape should be identified, and appropriately repositioned by different operative technique according to pivot points.

• Journal of Korean Biological Nursing Science
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• 제16권4호
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• pp.318-325
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• 2014

Purpose: The purpose of this study was to investigate the effects of preoperative patient controlled analgesia (PCA) education on total knee replacement arthroplasty (TKRA) patients' PCA usage, level of pain, the frequency of pro re nata (prn) administrations, number of ambulations/day and continuous passive motion (CPM) angle after TKRA. Methods: This research used the non-equivalent control group pre-test and post-test design. Forty-five TKRA patients at a hospital in Seoul, Korea were included for in the study. For the experimental group, a 20-minute education session was provided a day before surgery. Data were analyzed using Windows SPSS Statistics 21.0 program. Results: Knowledge was higher in the experimental group than in the control group (p<.001). Incidence of nausea was lower in the experimental group (p=.01). No significant differences were found in post-operative pain scores, the frequency of prn analgesics administrations, dizziness, number of ambulations/day and CPM angle. Conclusion: This study showed that pre-operative PCA education could be an effective nursing intervention for increasing patient knowledge on PCA and nausea reduction after TKRA.

• 대한치과의사협회지
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• 제58권2호
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• pp.103-113
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• 2020

Background: Reduction malarplasty is one of the most popular facial contouring surgeries in east Asia for making patients' faces smaller. Currently in Korea, reduction malarplasty surgeries are performed mostly at plastic surgery clinics, but few cases are done at oral and maxillofacial surgery clinics. The reason might be because of post-operative complications after reduction malarplasty, such as undercorrection, overcorrection, asymmetry, cheek drooping, malunion, pain and noise. Those complications should be uneasy to be handled by oral and maxillofacial surgeons, however, they can be prevented by knowing the effective and safe reduction malarplasty techniques. Therefore, in this article the author as an oral and maxillofacial surgeon, would like to suggest safe and effective surgical methods for reduction malarplasty customized for Korean patients. Method: L- shape osteotomy of zygomatic body was performed with intraoral approach via vestibular incision, and the zygomatic arch was osteotomized with extraoral approach via sideburn incision. Then zygomatic complex was separated and rotated mesio-superiorly without removal of a bony strip and fixed with miniplates and microplates without making a bony gap. Conclusion: Surgical results were favorable and satisfied by the patients without cheek drooping, malunion, undercorrection and asymmetry.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.66-71
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• 1998

The fractures of lateral end of clavicle can be treated by conservative or operative treatment, but many authors report the higher rate of non-union with conservative treatment and that the operative treatment is more effective for the type II fractures. The authors reviewed and analysed 15 cases of lateral end fracture of clavicle which had been treated at Department of Orthopedic Surgery, Kyungpook National University Hospital from 1991 to 1996. The results were as follows; 1. Among the 15 patients, male was 6,female 9 and the average age was 46.2 years ranged from 21 to 72 years. 2. According to the classification by Rockwood, type II a was 8 cases and II b was 7 cases. 3. We treated operatively 12 cases, 9 cases with tension band wiring and 3 cases with intramedul-Iary K-wire fixation. And we treated conservatively 3 cases with Velpeau cast, but I case of nonunion was treated with tension band wiring. 4. The average follow-up was 3.2 years ranged from 2.1 to 4.7 years. 5. The functional results were evaluated with Weitzman's classification. 6. In the operatively treated cases, there were 4 cases(30.7%) in excellent, 7 cases(53.8%) in good and 2 cases(15.3%) in fair result. But, in the conservatively treated cases, there were 2 cases in good and I case in poor result, and the poor case did not united and had open reduction and internal fixation. 7. In conclusion, the operative treatment revealed good functional results in most cases (10/12) and early open reduction and internal fixation was better method than conservative treatment.