• Journal of Trauma and Injury
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• 제32권1호
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• pp.32-39
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• 2019

Purpose: The aim of this study was to determine which factors contribute to the surgical treatment outcomes of acetabular fractures. Simultaneously, we aim to report on the treatment results after our hospital was designated as the focused training center for trauma. Methods: We conducted a retrospective review of all patients who experienced acetabular fractures from January 1, 2014 to May 1, 2017 and visited our hospital. Patients who had associated pelvic ring fractures or were lost to the one-year follow-up were excluded; a total of 37 fractures were evaluated. We evaluated the clinical results using the scoring system of Merle $d^{\prime}Aubign\acute{e}$ (MDA) and grade of Brooker for heterotopic ossification. Results: Thirty-seven patients (31 men and 6 women) were identified. The mean injury severity score (ISS) was 8.7, with 32.4% of patients having a score >15. The average blood transfusion in the first 24 hours was 0.54 pints. Falling was the most common injury mechanism (32.4%). Chest injury was the most common associated injury (16.2%), followed by head injury (13.5%). The posterior wall and both column fracture were the most common (37.8%) fracture patterns. Excellent and good clinical grades of MDA included 28 patients (75.6%) and fair and poor grades included nine (24.3%), respectively. Four patients were diagnosed with a post-operative infection (10.8%); one out of four patients who had co-morbidity died (2.7%), and another patient underwent a replacement surgery (2.7%). Multivariate analysis showed that age and operation time were associated with MDA. In addition, operation time and ISS were significant co-factors of the Brooker grade. Conclusions: Korea University Guro Hospital showed similar treatment results of acetabular fractures compared to other publications. The age and operation time were co-factors of the clinical outcome of this fracture. Additionally, increased operation time and injury severity score were suggested to increase the Brooker grade.

• 대한영상의학회지
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• 제82권4호
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• pp.923-935
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• 2021

목적 흉부 외상에 의해 발생한 혈흉에 대해 동맥 색전술의 임상적 효용성을 보고하고자 한다. 대상과 방법 2015년부터 2019년까지 68명의(남자 56명; 평균 나이 58.2세) 흉부 출혈에 대한 동맥색전술을 시행 받은 환자가 포함되었다. 후향적으로 환자군의 특징, 혈관조영술 소견, 색전술에 사용한 기법, 기술적 및 임상적 성공률과 합병증을 조사하였다. 결과 출혈 부위는 늑간동맥(50%)이 가장 많았고, 그다음은 내흉동맥(29.5%)이었다. 한 명을 제외한 나머지 환자에서는 즉각적인 출혈 정지로 정의된 기술적 성공을 획득할 수 있었다. 첫 동맥 색전술 이후 네 명의 환자에서 지연 출혈 또는 혈흉의 증가 소견이 있었고, 이에 대해 반복적 동맥 색전술을 시행하여 성공적인 결과를 얻었다. 동맥 색전술 후 지혈 목적의 개흉술이 필요하지 않은 것으로 정의된 임상적 성공은 92.6%로 보고되었다. 다섯 명의 환자는 지혈을 위해 색전술 후 개흉술을 시행하였다. 뇌경색이나 사지 마비와 같은 동맥 색전술과 관련한 주요 합병증은 발생하지 않았다. 결론 외상성 흉벽 및 흉곽 내 장기 손상에 의한 동맥 출혈에 대해 시행하는 동맥 색전술은 안전하고 효과적인 최소 침습적 시술이다. 외상성 혈흉 환자에서 응급 수술을 필요로 하지 않는 혈흉만 있거나, 또는 동반된 복부나 골반 손상의 지혈을 위해 응급 동맥 색전술을 시행하는 경우, 흉부 영역의 동맥 색전술을 고려할 수 있다.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.354-359
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• 2020

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap that has been used successfully in the reconstruction of defects across the body. In specific cases, it may prove superior to more commonly used options (e.g., anterolateral thigh flap and radial forearm free flap). Historically, a disadvantage of the MSAP flap is the relatively small surface area it provides for reconstruction. We recently encountered a patient with extensive pelvic injuries from prior trauma resulting in significant scarring and contracture of the groin, tethering of the penis, and loss of the scrotum and one testicle. The patient was unable to achieve erection from tethering and his remaining testicle had been buried in the thigh. In considering the reconstructive options, he was not a suitable candidate for a thigh-based or forearm-based flap. An extended MSAP flap measuring 25 cm×10 cm was used for resurfacing of the groin and pelvis as well as for the formation of a neoscrotum. This report is the first to document an MSAP flap utilized for simultaneous groin resurfacing and scrotoplasty. Additionally, the dimensions of this flap make it the largest recorded MSAP flap to date.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.77-86
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• 2009

Purpose: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. Results: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. Conclusion: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional thoracotomy.

• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.258-266
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• 2018

Objective : The diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention. Methods : Between January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified. Results : Patients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption ("bone bruise") (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal. Conclusion : The new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

• Journal of Chest Surgery
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• 제20권4호
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• The Korean Journal of Pain
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• 제29권1호
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• pp.23-28
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• 2016

Background: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode ($Interstim^{(R)}$, Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. Methods: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. Results: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. Conclusions: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.

• 대한물리치료사협회지
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• 통권3호
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• pp.11-18
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• 1981

A Clinical Study of physical Therapy on the Low Back Conditions J. B. Rhee, S. K. fang, D. J, Han Low back pain usually is due primarily to a faulty mechanics, ,dis'c disease and other contributing factors .Conservative treatment of low back pain is considered to be useful with applicationes physical therapeutic measures including elimination of gravity, but surgical treatment is alternative to conservative .This study 1s conducted to analyse and evaluate efficiency of physical therapy on the low back pain on 452 cases who were treated at the Korea University Hospital, from January 1, 1978 to December 31. 1978.The results obtained in this study are summarized as follows :1. Sex distribution of total rationㄷs surveyed showed that 5l.3% in male and 487% in female.2 . In the age distrbution. the mest Liedominant age group was 25-54 years with7O.8 % .3 . The most proportion of the cases by occupation was housewife 27.7%, clerical and office workers 2l.7% , students 12.8% and labours 12.2 % respectively .4 . The most common causes of low back conditions classified, the Strain or Trau-rla revealed the highest frequency with 58.4% and thc Herniated Nucleus Pulpe-sus with 29.2 % of the total.5 . The modalities of physical therapy suitable to each cases were applied : 94.0%of all cases were treated with deep thermotherapy, 91.4 % hydrocollator steampack, 86.7% strengthening exercise of the weak muscles, pelvic traction 34.1%.6 . In regard to the duration required for the physical therapy. Herniated Nucleus Pulposus were approximately 4 weeks and strain or trauma were 2 weeks.7 . The improvement by physical therapy on lcw back conditions was classified in-to 41grades and showed following reaulits , excellent 42.5%, good 37.8%, fair 13.7% and poor 6.0% respectively.