• Journal of Trauma and Injury
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• 제32권4호
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• pp.226-237
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• 2019

Purpose: This study investigated the characteristics of adult patients who had fallen from a height and presented to an emergency room (ER) according to gender and intentionality, with the goal of reducing the harm caused by these injuries. Methods: A retrospective analysis was conducted of fall-from-height patients aged ≥19 years from the in-depth surveillance study of injured patients visiting ERs conducted under the supervision of the Korea Centers for Disease Control and Prevention from 2011 to 2016. Patterns were analyzed according to gender and intentionality. Results: There were 29,838 men (68.5%) and 13,734 women (31.5%), with mean ages of 50.3±15.7 years and 57.2±19.9 years, respectively. The most common height of the fall was ≥1 m to 4 m in men (n=15,863; 53.2%) and <1 m in women (n=7,293; 53.1%). The most common location where the fall occurred was the workplace for men (n=10,500 male; 35.2%) and residential facilities for women (n=7,755; 56.5%). Most falls from height were unintentional (n=41,765; 97.1% vs. n=1,264; 2.9% for intentional falls). Suicide was the most frequent reason for intentional falls, and the age group of 19-30 years predominated in this category (n=377; 29.9%). For intentional falls, the most common interval before presentation to the ER was 0-6 hours (n=370; 29.3%) and the most common height was ≥4 m (n=872; 69.0%). Conclusions: Among men, falls from height most often occurred from ≥1 m to 4 m, at the workplace, and during the course of paid work, whereas among women, they were most common from <1 m, in residential facilities, and during daily activities. Intentional falls most often occurred with the purpose of suicide, in the age group of 19-30 years, with an interval of 0-6 hours until treatment, from ≥4 m, and in residential facilities. Alcohol consumption was more common in intentional falls.

• 대한정형외과스포츠의학회지
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• 제9권2호
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• pp.85-90
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• 2010

목적: 재발성 슬개골 탈구에서 경피적 외측부 유리술 및 관절경적 내측부 중첩술의 결과에 대해 알아보고자 한다. 대상 및 방법: 2001년 3월부터 2008년 3월까지 외상 후 발생한 재발성 슬개골 탈구로 수술적 치료를 받은 환자 중 2년 이상 추시 관찰한 31례를 대상으로 하였으며 평균 연령은 24.2세, 평균 추시 기간은 47.4개월이었다. 결과: 술 전 일치각은 평균 24.8도, 외측 슬개-대퇴골각은 평균 -6.2도, Lysholm score는 평균 75점이었다. 술 후 일치각은 평균 -2.8도, 외측 슬개-대퇴골각은 10.2도로 정상범위를 회복하였으며 Lysholm score도 95점으로 향상 되었다. 재발성 탈구는 총 5례에서 발생하였으며 이 중 3례에서 대퇴골 이형성증이 관찰되었다. 결론: 경피적 외측부 유리술 및 내측부 중첩술은 합병증이 드물고 임상적으로 만족할 만한 결과를 보여 재발성 슬개골 탈구에 대한 치료에 유용한 방법으로 사료된다. 그러나 대퇴골 활차의 선천성 변형이 있다면 다른 수술적 치료를 고려해야 할 것이다.

• Journal of Yeungnam Medical Science
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• 제11권2호
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• pp.284-292
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• 1994

1992년 12월부터 1994년 6월까지 영남대학교 의과대학 부속병원 정형외과에 내원한 대퇴골두무혈성 괴사 환자 28명, 31 고관절에 대해 시행한 경전자간 회전 절골술의 결과는 다음과 같다. 1. 대상 환자는 한명을 제외하고는 모두 남자였으며, 평균 연령은 44.3세로 삼, 사십대가 대부분이었다. 2. 무혈성 괴사의 원인은 과다한 음주에 의한 것이 18례로 가장 많았고, 괴사의 정도는 Ficat와 Arlet의 분류에 의하면 II a가 16례로 가장 많았다. 3. 절골술 후 고정 방법으로는 screw가 15례, DHS가 16례였고, 고정 방법에 따른 대퇴경간각의 변화로는, screw를 사용한 경우는 술전에 비해 내반고 되는 경향을 보였고, DHS를 사용한 경우는 외반고 되는 경향을 보였다. 4. 술전 대퇴골두 측면 방사선 사진에서 측정한 대퇴골두 전체 관절면에 대한 건전한 관절면의 비는 1/3이하가 8례, 1/3 이상이 23례(74%)이었다. 5. 술후 고관절의 전후면 방사선 사진에서 측정한 비구의 체중 부하면에 대한 전위된 건전한 대퇴골두의 관절면 비는 36% 이상이 24례(78%), 21-35%가 6례, 20% 이하가 1례였다.

• 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.

• Journal of Korean Neurosurgical Society
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• 제63권5호
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• pp.590-597
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• 2020

Objective : Covered stenting is an optional strategy for traumatic carotid pseudoaneurysm, especially in malignant conditions of potential rupture, but the long-term outcomes are not clear. Our aim was to determine if covered stenting is an effective option for traumatic carotid pseudoaneurysm with promising long-term outcomes. Methods : Self-expanding Viabahn and balloon-expandable Willis covered stents were separately implanted for extra- and intracranial traumatic carotid pseudoaneurysm. The covered stent was placed across the distal and proximal pseudoaneurysm leakage under roadmap guidance. Procedural success was defined as technical success (complete exclusion of the pseudoaneurysm and patency of the parent artery) without a primary end point (any stroke or death within 30 days after the procedure). Long-term outcomes were evaluated as ischemic stroke in the territory of the qualifying artery by clinical follow-up through outpatient or telephone consultation and as the exclusion of the pseudoaneurysm and patency of the parent artery by imaging follow-up through angiography. Results : Five patients with traumatic carotid pseudoaneurysm who underwent covered stenting were enrolled. The procedural success rate was 100%. No ischemic stroke in the territory of the qualifying artery was recorded in any of the five patients during a mean clinical follow-up of 44±16 months. Complete exclusion of the pseudoaneurysm and patency of the parent artery were maintained in all five patients during a mean imaging follow-up of 39±16 months. Conclusion : Satisfactory procedural and long-term outcomes were obtained, suggesting that covered stenting is an effective option for traumatic carotid pseudoaneurysm.

• Journal of Chest Surgery
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• 제32권6호
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• pp.532-535
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• 1999

배경: 하행 흉부 대동맥류에 대한 외과적 치료에 대하여 수술 방법과 술 후 합병증 등에 대하여 알아보고자 하였다. 대상 및 방법: 인제대학교 의과대학 서울백병원 흉부외과학 교실에서는 1987 년 3 월부터 1997년 8월까지 하행 흉부 대동맥류로 수술을 시행한 22예를 대상으로 후향적 조사를 하였다. 결과: 환자는 남자가 18예 여자 4예로 남자가 많았으며 연령은 33세에서 82 세 이었고 평균은 49 세였다. 대동맥류의 원인은 대동맥 박리증 13, 죽상경화증 3, 진균성 3, 외상성 2, 원인불명 1예였다. 수술은 절제 및 이식편 치환술 16, 액와동맥-양측 대퇴동맥 우회로 이식술 2, 대퇴동맥-대퇴정맥 우회로 이식술 1, 동맥류 공치술(exclusion) 1, 동맥류 봉합술 1, 경대퇴동맥 스텐트 삽입술 1예였다. 수술 시 대동맥을 차단하고 수술한 예는 16예였고, 이 중 14예는 대퇴동맥-대퇴정맥 바이패스를 실시하였고, 2예는 우회로 이식술을 먼저 하였다. 평균 대동맥 차단시간은 91분이었고 체외순환 시간은 116 분이었다. 사망 예는 1예로 공치술 한 환자가 술 후 52일에 갑작스런 출혈로 사망하였고, 대마비 1, 급성 신부전증 2, 급성 호흡부전증 1예가 발생하였다. 결론: 하행 흉부 대동맥류 수술은 많은 술 후 합병증이 예상되나 적절한 환자의 선택과 섬세하고 다양한 수술 기법을 사용하면 비교적 적은 합병율로 수술할 수 있다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제30권4호
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• pp.292-300
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• 2004

Orbital blowout fractures are common consequence to blunt periorbital trauma. Pure orbital blowout fractures first occur at the weakest point of the orbital wall. Computed tomography(CT) is recognized to be the best imaging technique to evaluate orbital fractures. The extent and location of a blowout fractures in the CT scan were noted to have an effect on the clinical outcome. In the early posttraumatic period, the presence of significant enophthalmos is difficult to detect because of orbital edema. Early surgical intervention may improve the ultimate outcome because open reconstruction becomes more difficult if surgery is delayed. In this study, we evaluated isolated blowout fractures of the orbital floor by region-of-interest measurements from CT scans and their relationship to ophthalmologic findings. Six patients of the medial orbital wall fractures, eleven patients of the inferior orbital wall fractures, nineteen of the medial and the inferior orbital wall fractures confirmed by CT scan, were evaluated. The area of fracture and the volume of the displaced orbital tissue were determined from CT scan using linear measurements. Each of the calculated values for the area and the volume were compared with the degree of the enophthalmos, the diplopia, and the eyeball movement limitation to determine whether there was any significant relationship between them. The fracture area and the volume of the herniated orbital tissue were significantly positively correlated with the enophthalmos and the ocular motility limitation and not correlated with the diplopia. For the enophthalmos of 2mm or greater, the mean fracture area was 3.55{\pm}1.25cm^2$ and the volume of the herniated orbital tissue was $1.74{\pm}0.97cm^3$; for less than 2mm enophthalmos, $1.43{\pm}0.99cm^3$ and $0.52{\pm}0.49cm^3$, respectively. The enophthalmos of 2mm can be expected with $2.92cm^2$ of the fracture area and $1.40cm^3$ of the herniated orbital tissue. In conclusion, the enophthalmos of 2mm or more, which is a frequent indication for surgery. It can be expected when area of fracture is $2.92cm^2$ or more, or the volume of herniated orbital tissue is $1.40cm^3$ or more. And the CT scan using linear measurements has an application in the assessment of patients with blowout fractures and provides useful information in the posttraumatic evaluation of orbital fractures.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.59-66
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• 2006

Purpose: Acute liver failure after massive partial hepatectomy is critical condition with high mortality. To prevent postoperative liver failure from being induced by a massive partial hepatectomy, many doctors do a minimal resection on the single lobe of the liver that might cause postoperative bleeding from the remaining ruptured parenchyma. The objective of this study was to assess clinical experience with postoperative hepatic arterial embolization to control bleeding from the remaining ruptured liver during the postoperative period. Methods: This retrospective 4-year study was conducted from May 2002 to April 2006 and included consecutive patients who had sustained massive hepatic injuries and who had undergone a laparotomy, followed by postoperative hepatic arterial angiographic embolization to control bleeding. Data on the injury characteristics, the operative treatment and embolization, and the amount of transfused packed red cells (PRBC) were gathered and analyzed. In addition, data on the overall complications and survival rate were collected and analyzed. Results: Every case showed severe liver injury, higher liver injury scaling grade IV. Only ten cases involved a ruptured bilateral liver lobe. A lobectomy was done in 6 cases, a left lobectomy was done in 3 cases, and a primary suture closure of the liver was done in 2 cases. Suture closure was also done on the remaining ruptured liver parenchyma in cases of lobectomies. The postoperative hepatic arterial embolizations were done by using the super-selection technique. There were some cases of arterio-venous malformations and anomalous vessel branches. The average amount of transfused PRBC during 24 hours after embolization was $2.36{\pm}1.75$, which statistically significantly lower than that before embolization. Among the 11 cases, 9 patients survived, and 2 died. There was no specific complications induced by the embolization. Conclusion: In cases of postoperative bleeding in severe hepatic injury, if there is still a large amount of bleeding, postoperative hepatic arterial embolization might be a good therapeutic option.

• Journal of Chest Surgery
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• 제37권2호
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• pp.160-165
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• 2004

다방성 흉막수 또는 농흉 환자의 성공적인 치료를 위해서는 효과적인 배액술과 원인적 질환의 확진이 필요하다. 본 연구의 목적은 폐쇄성 흉강 삽관술 등의 치료에도 배액되지 않은 농흉이나 다방성 흉막수 환자에서 비디오 흉강경을 이용한 배액술 및 데브리망, 세척술의 효과와 실효성의 평가를 목적으로 한다. 대상 및 방법: 2000년 4월부터 2002년 7월까지 본원 흉부외과에 흉막수 및 농흉으로 입원한 환자 중 폐쇄성 흉강 삽관술 등으로 적절히 배액되지 않았던 환자 중 발병한지 2주일이 안된 20명을 대상으로 수술 전 흉부 전산화 단층 촬영을 실시하여 환자의 상태를 평가한 후 전신 마취하에서 비디오 흉강경을 이용한 배액술 및 데브리망, 조직검사, 세척술을 실시하였다. 결과: 20예의 환자 중 18예에서 성공적인 비디오 흉강경 배액 및 세척술이 실시되었고 2예에서 개흉술을 시행하였다. 남녀 비는 4 : 1이었으며 평균 연령은 48.9세(17∼72세), 수술 후 평균 흉관 거치 기간은 8.2일(4∼22일), 수술 후 평균 재원 기간은 15.2일(7∼33일)이었다. 원인 질환으로 결핵, 폐렴에 의한 합병증, 외상에 의한 혈흉, 전이성 유방암 등이었다. 수술 후 중대한 합병증은 없었으며 환자들은 증상이 호전되어 외래 통원 치료 및 추적 관찰 중이다. 결론: 기질화 되지 않은 초기의 농흉이나 다방성 흉막수 환자에서 비디오 흉강경을 이용한 배액술, 데브리망은 비교적 안전하고 유용한 시술이라 하겠다.

• 구강회복응용과학지
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• 제25권4호
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• pp.329-336
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• 2009

선천적 기형이나 후천적인 외상 또는 신생물에 의해 상악골 절제술을 받은 경우, 상악에서 발생하는 구강내 결손은 흔히 비강과 상악동 및 구강이 연결된 형태로 나타난다. 이러한 상악골의 결손은 구강과 비강이 교통되어 발음, 저작, 연하 등의 기능에 이상을 초래하게 된다. 이러한 경우에도 보철치료의 기본적인 목표가 적용되며, 후천적 상악 결손부에 수복되는 폐색장치는 발음, 연하, 저작 기능을 회복할 수 있어야 하고, 적절한 심미적 만족을 제공해야 하며, 환자가 편안하게 사용할 수 있어야 한다. 상악 폐색장치의 무게를 감소시키는 것은 잔존 조직의 건강과 정상적인 기능 및 환자의 안락함을 개선시킬 수 있다. 개방형 폐색장치는 결손부의 크기에 따라 6.55~33.06% 까지 무게를 줄여줌으로써 환자에게 편안함과 편의성을 제공해 주며, 생리적 기능을 향상시켜 치아와 지지 조직에 불필요하게 가해지는 부하를 감소시켜 준다. 본 증례는 hemi-maxillectomy를 시행한 환자에서 이중온성법을 이용하여 기존의 방법보다 더 균일한 의치상 두께를 가진 폐색장치를 제작하여 환자의 기능적, 심미적인 만족을 얻었기에 이를 보고하는 바이다.