• Archives of Plastic Surgery
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• 제35권3호
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• pp.289-294
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• 2008

Purpose: The nasal bone fracture is known as the most common facial fracture. Several authors reported the classification of nasal bone fracture. Stranc classified the type of nasal fractures based on a pattern of impaction and level of injuries. Stranc classification proposed here is based on careful clinical observation and relates to both treatment and prognosis. The aim of this study is to determine any predictive value to the preoperative classification of nasal fracture, using the description by Stranc and Robertson. Methods: We reviewed 310 patients with nasal bone fracture treated at our hospital for last two years. Results: Lateral impact type of nasal bone fracture predominated more than frontal impact in the ratio of 2.3:1. The most common type of Stranc classification was lateral impact plane I(48.4%). Male predominated more than female in the ratio of 3:1. The most frequent age group was first decade(27.1%), second decade in frontal impact(30.5%), first decade in lateral impact (30.7%). The most common etiology was violence (31.3%) followed by slip down(21.3%), and traffic accident(18.1 %).The most common associated fracture was orbital(22.9%) followed by zygoma(10%), and maxilla (6.1%). The most common complication was septal deviation(20.0%) in frontal impact, and nasal deformity (26.0%) in lateral impact. The incidence of nasal deformity in lateral impact(26.0%) was more higher than frontal impact(15.8%) Conclusion: By assessing the pathomechanics and resultant degree of injury to the nasal skeleton, a better understanding of the treatment plan and prognosis was obtained. Using this information, satisfactory informed patient consent can be obtained.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.111-117
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• 2011

Purposes: Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma. Methods: We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality. Results: Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70 % of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury ($38.0{\pm}18.56$ vs. $34.5{\pm}33.68$ days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess. Conclusion: Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.

• Journal of Chest Surgery
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• 제31권6호
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• pp.610-614
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• 1998

12세된 여자 환자에서 한국에서는 처음으로 심장-폐 동시이식이 성공적으로 이루어 졌다. 환아는 심실 중격결손증이 없는 폐동맥 폐쇄증으로 좌폐부전과 함께 우심실의존성 관상동맥혈류를 가지고 있었으며 개심술에 의한 일반적인 심장 수술은 불가능하였다. 장기 제공자는 9세된 남아로 교통사고에 의한 뇌출혈이 사망의 원인이었다. 심장폐이식은 1997년 4월 20일 이루어 졌다. 이식시 수술 방법은 소위 아리조나 방법으로 양측 폐문부를 환아의 횡격막 신경위로 놓는 방법을 사용하였는데 수술시 지혈에 큰도움이 되었다. 수술후 환자는 두가지 큰 합병증이 발생하였는데 하나는 발열이고 둘째는 기관 문합부위 협착을 들수가 있다. 수술후에 계속되었던 발열은 결핵약 투여후 극적으로 소실되었으며 기관 협착에 의한 호흡 곤란은 수술후 제 71일째 실시한 금속성 그물망에 의한 확장으로 치유 되었다. 환자는 수술후 7개월째 호흡 곤란은 보이지 않고 있으며 운동 및 일상 생활에 지장이 없이 양호한 상태로 지내고 있다.

• Journal of Chest Surgery
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• 제10권2호
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• pp.337-342
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• 1977

A clinical analysis was performed on 383 cases of chest injurjes experienced at Department of Thoracic Surgery, Seoul National University Hospital during 21 year period from 1957 to 1977. Of 383 patients of chest injuries, 209 cases were result from nonpenetrating injuries whereas 175 were from penetrating injuries, and there were 258 cases of hemothorax or/and pneumothorax, 162 of rib fracture, 33 of foreign body, 26 of clavicle fracture, 26 of lung contusion, 17 of diaphragmatic laceration, 14 of hemopericardium, 14 of flail chest and others. Stab wound was the most common in penetrating injuries and followed by gunshot and shell fragments. The majority of nonpenetrating chest injury patients were traffic accident victims. and fails accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 16 and 50 years, and 321 patients were male comparing to 62 of female. In blunt chest injuries the patients with five or more rib fractures had a 85 per cent incidence-of intrathoracic injury and 19 per cent had an intraabdominal organ damage, whereas those with four or less rib fractures had a 69 per cent and a 6 per cent incidence respectively. The principal associated injuries were cerebral contusion on 19 cases, renal contusion on 10, liver laceration on 7, peripheral vessel laceration on 5, spleen laceration on 3 and extremity fracture on 18 patients. The principles of therapy for early complications of chest trauma were rapid reexpansion of the lungs by thoracentesis [46 cases] and closed thoracotomy [125 cases] but open thoracotomy .had to be done on 90 cases [23-5%] because of massive bleeding or intrapleural hematoma, foreign body, cardiac injury, diaphragmatic laceration and bronchial rupture. The over all mortality was 2.87 per cent [11 among 383 cases], 8 cases were from penetrating injuries and 3 from nonpenetrating injuries.

• Journal of Chest Surgery
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• 제40권12호
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• pp.871-873
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• 2007

무명동맥은 길이가 짧고 가슴 골격에 의해 보호되기 때문에 외상에 의한 무명동맥의 파열은 드문 질환으로 알려져 있다. 본 증례는 자동차 사고로 내원한 25세 남자로 흉부 전산화 단층촬영 및 혈관 조영술로 무명동맥 파열이 진단되어 우측 쇄골하 절개를 동반한 정중 흉골 절개술을 이용하여 응급 수술을 시행하였다. 다른 동반 손상이 많아 인공 심폐기를 사용하지 않고 수술을 하였으며, 손상은 무명동맥의 중위부부터 우측 쇄골하 동맥 및 총경동맥의 기시부까지 약 3 cm 정도로 동맥 내막까지 완전히 찢어져 있었다. 복제정맥을 이용하여 첩포 혈관 성형술을 시행하였으며, 수술 후 환자는 별 다른 이상 없이 외래 추적 관찰 중이다.

• Journal of Chest Surgery
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• 제30권2호
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• pp.213-218
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• 1997

저자들은 4례의 가성 흉부대동맥류를 외과적으로 치료하였는데 개심술후와 대동맥치환술후에 발생 한 예가 각 1례씩 이었고 2례는 교통사고에 의한 흉부둔상후 발생하였다. 심실중격결손증으로 개심술을 받았던 1례에서는 대동맥도관과 심정지액도관을 삽입하였던 부위로 생각되는 상행대동맥에서 발생하 였고, 하행대동맥에 발생한 죽상대동류로 대동백치환술을 받았던 1례에서는 인조혈관의 봉함부위에서, 그리고 교통사고에 의한 흉부둔상의 예에서는 좌쇄골동맥 기시부 직하방에서 발생하였다. 개심술 및 대 동백치환술을 받았던 환자들에서는 감염이 발병원인으로 생각되었고 외상환자에서는 하행대동맥의 파 열이 원인이었다. 외상에 의한 1례가 술후 3일째쉐 사망하였는데 수상시 동반된 담즙성 복막염에 의한 패혈증으로 사망하였다. 생존한 3례는 술후 10개월에서 18개월이 경과하였는데 특별한 합병증은 발견 되 지 않고 있다. 이상의 소견으로 미루어 외상에 의한가성대동류가의심되는 경우에서는타장기 손상의 합병을 충분히 검토하여야 하고 개심술이나 대동백치환술후 추적관찰 중에도 드물게 발생하는 가성 흉부대동맥류가 발견되면 곧바로 외과적 \ulcorner치술을 시행하면 양호한 성적을 기대할 수 있을 것으로 생각된다.

• Journal of Chest Surgery
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• 제30권5호
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• pp.517-523
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• 1997

동국대학병원에서는 1992년 2월부터 1995년 12월까지 3년 10개월동안 외상에 의한 횡격막 파열환자 14fl를 수술치험하여 이를 분석하였다. 대상환자는 남자가 10례, 여자가 4례였고, 연령은 17세부터 73세까지로 평균연령은 41.7세였다. 손상의 원인은 둔상 12r11(85.7%), 관통상 2fBl(14.3%)였으며, 둔상에서는 교통사고 lIfTl, 압좌상 1례였고 관통상은 2례 모두 칼에 의한 자상이었다. 들상에 의한 횡격막 파열 12례 중에서는 좌측 손상이 7례(58.3%), 우측 손상이 5례(41.7%)로 우측 파열이 비교적 많은 비율을 차지굻였으며, 관통상에 의한 2례는 모두 우측 파열이었다. 단순흉부촬영, 전산화단층촬영, 초음파검사, 그리고 방사선투시검사 등을 이용하여 횡격막 파열을 진단하였으며, 14례 중 8례는 술전 진단하였고(57.1%), 술전 진단이 안된 경우는 6511(42.9%)였으며 모두 우측 파열이었다. 이들 중 5례는 횡격막 파열을 의심하여 시행한 시험적 개흉술로 진단하였으며, 1례는 동반손상에 대한 개흉술 중에 발견되었다. 우측 파열 7례는 개흉술로 수술하였으며, 좌측 파열의 경우 6례는 개복술로, 1례는 개복술 및 개흉술로 수술하였다. 술후 2례에서 사망하 \ulcorner수술사망율은 14.3%였다.

• Archives of Reconstructive Microsurgery
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• 제16권1호
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• pp.48-51
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• 2007

There could be several methods for trochanteric reconstruction including local flap, pedicled perforator flaps, free flap, etc. We performed greater trochanteric reconstruction with lumbar artery perforator free flap in some aberrant method. So we report this experience with review of literatures. A 42-year-old man visited our hospital with a large soft tissue defect in his left greater trochanteric area by traffic accident. The patient had wide skin and soft tissue defect combined with open femur fracture. During one month period of admission, he underwent femur open reduction and wound debridement four times. After that we planned thoracodorsal perforator free flap reconstruction. The flap was outlined as large as $20{\times}15\;cm$ and elevated in a suprafascial plane from the lateral border. During intramuscular perforator dissection, we found that two 1.5 mm diametered perforator vessels coursed inferomedially toward second lumbar region. Finally the flap became lumbar artery perforator flap based on second lumbar artery perforator as a main pedicle. After flap transfer, the perforator vessels were connected with inferior gluteal artery and vein microsurgically. The operation was successful without uneventful course. We found no significant postoperative complication and donor site morbidity during six months follow up periods. Lumbar artery perforator flap could be an alternative procedure for thoracodorsal perforator flap in some patients with anatomic variant features.

• 보건교육건강증진학회지
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• 제6권1호
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• pp.91-105
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• 1989

The purpose of this study is to identify the body images of patints with low back pain and their status on adjustment of daily living. The data were collected from 11 general hospitals during Feburary 2, 1987 through May 30,1987. One hundred and ninety five subjects having physical therapy treatment because of low back pain were analyzed. For measurement of body image, 11 pairs of adjectives were used on semantic differential scale, and for measurement of adjustment of daily living, 10 items were used on a likert type scale. Results of the study are summerised as follows. 1. The average patient age were 34yeats and 62% of the patients were men. High school grade completed were 43.1% and Cause of Low Back Pain were respctively;Unknown etiology 31.8%, lifting heavy objects 27.7%, Traffic accident and injury 17.9%. Types of treatment were;medication plus physical therapy 54.9%, physical therapy only 22.6%. Average treatment duration were 24.5 months. 2. There were significant difference in the body image between before low back pain and after low back pain. The body image before low back pain were 59.89(Mean) but after low back pain were 37,24(Mean) and two groups were statistically significant (t=21.3, p<0.00l). 3. there were no significant difference in the body image between the male and female.(t=1.49, p＞0.05) 4. The correlation between body image and adjustment of daily living. in both sexes showed positive correlation coefficient; male(r=0.4648, p<0.00l) female(r=0.4516, p<0.00l) respectively. It means that patients with positive body image can adjust well in daily living. 5. The relation between the body image and general variables revealed sigificant difference with occupation and age.(F=2.12 p<0.05, F=3.48 p<0.05). That is different occupation and different age groups can show different body image. In conculsion with the above results, It is my strong belief that multidisciplinary approach including the concept of body image and patient education about postural care, activities of daily living, lifting mechanics should be applied in treating and dealing with those patients.

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.41-45
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• 2004

In adhesive capsulitis of the shoulder of no response to nonoperative treatment, an arthroscopic capsular release and manipulation improves range of motion and pain relief. We performed an arthroscopic examination in the stiff shoulder, of which she had no response to nonoperative treatment, after the conservative treatment of a clavicular shaft fracture by motorcycle-driver traffic accident. We found the intra-articular 'rotator interval bridging scar adhesion' between subscapularis tendon and antero-superior glenoid fossa under the rotator interval which was no adhesion and contracture itself. We performed the scar adhesion removal and synovectomy, maintaining the rotator interval. We recommended nonsteroidal anti-inflammatory drug for postoperative pain relief and continuous active and passive range of motion (ROM) exercise to gain motions. Preoperatively, active and passive range of motion were 70° for forward elevation, 60° for abduction and especially 0° for external rotation. After postoperative 2 months, active ROM were 150° for forward elevation, 130° for abduction and 80° for external rotation. After postoperative 6 months, passive and active ROM were full. UCLA score improved from preoperative 9 points to postoperative 29 points.