• Maxillofacial Plastic and Reconstructive Surgery
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• 제11권2호
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• pp.47-52
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• 1989

현대문명의 발달과 더불어 안면골 골절의 형태는 다양해지고 그 손상 정도와 치료개념도 새로운 변천을 하게 되었다. 안면골 골절의 치료개념은 점차 소강판 또는 압박골판과 나사 고정등의 안정된 고정들의 수술방법으로 발전되고 있는 추세에 있다. 본 증례보고는 최소한 8개소 이상의 골절선을 가진 다발성 안면골 골절을 Miniplate osteosynthesis을 주로 이용한 치험례로, 필요시 Craniofacial suspension wire등의 겸용으로 아주 양호한 결과를 얻었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제55권2호
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• pp.183-187
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• 2022

Flail chest is a critical medical condition in which multiple segmentally fractured adjacent ribs cause paradoxical movement of the thoracic cage in patients with severe blunt trauma injury. Surgical stabilization is considered essential in patients who require mechanical ventilation. However, there is no consensus on which surgical procedure to choose among the various available techniques or when to perform surgery. We report the case of a patient with traumatic anterior flail chest due to bilateral multiple fractures of the ribs requiring surgical stabilization in whom weaning from mechanical ventilation had failed. The Nuss procedure using double bars with the bridge technique was performed for chest wall stabilization. The patient was weaned from mechanical ventilation on postoperative day 44 and she underwent bar removal on postoperative day 71. After extensive rehabilitation for multiple trauma, she was discharged successfully. The patient currently shows no recurrence of chest wall depression in outpatient follow-up.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.281-289
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• 1994

This is a clinical study on 235 inpatients who sustained a total of 350 mandibular fractures and who were treated in our department during the period of Oug., 1989 through Dec., 1993. The results obtained are as follows : 1. The mumber of patients has not been increased year after year. In respect of incidence, there were the highest frequency as 67 patients(28.5%) in 1991 and the least frequency as 16 patients(6.8%) in 1989 and the highest frequency as 28 patients(11.9%) in October and the least frequncy as 12 patients(5.2%) in February. 2. The age frequency was the highest in the second decade(30.6%). The youngest patient was 8 months and the eldest patient was 80 years and mean age was 27.8 years. The ratio of men to Wemen was 4 : 1. 3. The most frequent cause was fall down as 86 patients(36.6%) and the next was fist blow 4 as 75 patients(31.9%), traffic accident as 56 patients(23.9%) in order. 4. The most common location was symphysis as 141 numbers(40.3%) and the next was condyle as 96 numbers(27.4%), angle as 94 numbers(26.8%), body as 14 numbers(4.0%) in order. The sum of fracture sites were 350 and there were 1.49 fracture sites per one patient and multiple fractures occured in 100 patients(40.5%) of the 235 patients. The ratio of Left to Right except for symphysis was 1.71 : 1. 5. Among the 333 associated injuries, facial laceration was 136(57.9%) and tooth injury was 58(24.7%) and extremity was 31(13.2%). 6. Among the 350 mandibular fractures, complications after treatment occured in 51(14.6%) and infection as 20(5.7%) was the most frequent complication. 7. In respect of treatment of mandibular fracture, close reduction was 64 patients(27.2%) and open reduction was 164 patients(69.8%) and other were 7 patients(3.0%) of all and so open reduction was the most common in type of treatment.

• Journal of Trauma and Injury
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• 제25권1호
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• pp.1-6
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• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• 대한골관절종양학회지
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• 제15권1호
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• pp.44-51
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• 2009

목적: 전이성 병적 골절 또는 병적 임박 골절로 진단받고 수술을 시행한 환자의 결과를 분석하고자 하였다. 대상 및 방법: 2004년 1월부터 2007년 12월까지 전이성 병적 골절 또는 병적 임박 골절로 진단받고 수술적 치료를 시행한 18환자, 19예를 대상으로 하였다. 남자가 6예 여자가 12예였으며 평균 나이는 65.1세였다. 평균 추시 기간은 15.2개월이였다. 초기 진단으로 병적 골절이 14예, 병적 임박 골절이 5예였다. 기능적 평가는 추시 중에 MSTS 점수를 측정하였으며 주기적인 방사선 촬영을 통해 방사선학적 결과를 분석하였으며 수술 후 합병증 유 무를 분석하였다. 결과: 원발암은 다발성 골수종 6예, 신 세포암 4예, 담관암 2예, 대장암 2예, 유방암 2예 및 평활근 육종이 2예였다. 전이 병소는 대퇴골이 10예, 쇄골 4예, 상완골 2예, 경골 2예, 요골 1예였다. 수술 방법으로 소파술, 시멘트 충전술, 내고정술 및 관절 성형술을 시행하였다. 평균 MSTS 점수는 15.9였다. 수술 후 합병증으로는 감염이 1예, 국소 재발이 1예, 고정물의 이완이 1예 있었다. 최종 추시 시 유병 상태 10명, 사망 8명이었다. 결론: 전이성 병적 골절 및 병적 임박 골절의 수술적 치료는 하지의 경우 조기 보행을 가능하게 하고 상지의 기능 숙달도에 만족할 만할 결과를 보이며, 이환 부의의 통증 조절과 환자의 정서적 만족도에 매우 우수한 결과를 보였다. 환자의 남은 여생 삶의 질 향상에 필요한 술식이라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.287-296
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• 2022

Objective : Although radiotherapy (RT) is recommended for multiple myeloma (MM) involving spine, the treatment of choice between reconstructive surgery with RT and RT alone for pathologic vertebral fractures (PVFs) associated with structural instability or neurologic compromises remains controversial. The purpose of this study was to evaluate the clinical efficacies of reconstructive surgery with adjuvant RT for treatment of MM with PVFs by comparing with matched cohorts treated with RT alone. Methods : Twenty-eight patients underwent reconstructive surgery followed by RT between 2008 and 2015 in a single institution, for management of PVFs associated with structural instability of the spine and/or neurologic compromises (group I). Twenty-eight patients were treated with RT alone (group II) after propensity score matching in a 1-to-1 format based on instability of the spine, as well as age and performance. Clinical outcomes including the overall survival rates, duration of independent ambulation, neurological status, and numeric rating scale (NRS) for back pain were compared. Results : Clinical and radiological features before treatment were similar in both groups. The median survival period was similar between the two groups. However, the mean duration of independent ambulation was significantly longer in group I (88.8 months; 95% confidence interval [CI], 66.0-111.5) than in group II (39.4 months; 95% CI, 25.2-53.6) (log rank test; p=0.022). Deterioration of Frankel grade (21.4% vs. 60.7%, p=0.024) and NRS for back pain (2.7±2.2 vs. 5.0±2.7, p=0.000) at the last follow-up were higher in the group II. Treatment-related complications were similar in both groups. Conclusion : In patients with unstable PVFs due to MM, reconstructive surgery may yield superior clinical outcomes compared with RT alone in maintaining independent ambulation and neurological status, as well as pain control despite similar median survival and complications.

• Journal of Trauma and Injury
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• 제28권3호
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• pp.202-205
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• 2015

Purpose: Pulmonary cement embolization after vertebroplasty is a well-known complication. The reported incidence of pulmonary cement emboli after vertebroplasty ranges frome 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Onset and severity of symptoms are variable. Case description: We present the case of a 83-year-old women who underwent fourth lumbar vertebroplasty and subsequently had dyspnea several days later. Posteroanterior chest radiography showed multiple linear densities. Computed tomography of thorax revealed also multiple bilateral, linear hyperdensities within the lobar pulmonary artery branches are detected in axial and coronal views. Literature Reviews: Operative management of vertebral compression fractures has included percutaneous vetebroplasty for the past 25 years. Symptoms of pulmonary cement embolism can occur during procedure, but more commonly begin days to weeks, even months, after vertebroplsty. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces. Conclusion: Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.460-463
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• 2011

There are few reported cases of post-operative spondylitis caused by $Mycobacterium$ $Intracellulare$. A 75-year-old female presented to our hospital with low back pain and paraparesis after a fall. The radiologic examination revealed compression fractures of L1, L3 and L4 and an epidural hematoma compressing the spinal cord. The dark-red epidural hematoma was urgently evacuated. Four weeks post-operatively, neurologic deficits recurred with fever. On magnetic resonance image, an epidural abscess and osteomyelitis were detected in the previous operative site. Five weeks post-operatively, revision was performed with multiple biopsies. The specimen were positive for acid-fast bacilli and traditional anti-tuberculous medications were started. Because the Polymerase Chain Reaction for non-tuberculous mycobacterium (NTM) was positive, the anti-tuberculous medications were changed to anti-NTM drugs. However, the neurologic deficits did not improve and persistent elevation of erythrocyte sedimentation rate and C-reactive protein were noted. Eight weeks after the revision, $Mycobacterium$ $Intracellulare$ was detected in the specimen cultures. Despite supportive care with medication, the patient died due to multiple organ failure.

• Journal of Chest Surgery
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• 제9권2호
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• pp.117-124
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• 1976

Hemorrhage into the biliary system as a consequence of injury to the liver has been called "traumatic hemobilia," a term introduced by Sandblom in 1948. The source of gastrointestinal hemorrhage has been frequently misinterpreted, resulting in inadequate or inappropriate treatment, often with catastrophic results and needless fatalities. It is now being diagnosed with increasing frequency, due to more widespread knowledge of the syndrome and improved diagnostic means. we experienced 2 cases of hemobilia following blunt chest trauma, One patient had! multiple rib fractures on right chest by car traffic accident and 13 days later, suddenly massive melena was developed with nausea, vomiting, jaundice and severe pain on right upper quadrant. And so, he had operated on the ligation of Rt. hepatic artery and partial right hepatectomy for a traumatic hemobilia. The other one also revealed similar symptoms 20 days later following blunt chest injury by falling down accident. However, uneventful recovery was seen without any of surgical intervention in this case.

• Journal of Yeungnam Medical Science
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• 제4권1호
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• pp.157-163
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• 1987

저자들은 7세 여아에서 골형성 부전증으로 우측경골에 심한 전방만곡을 절골술 및 수내고정법으로 교정하였다.