• 한국산학기술학회논문지
• /
• 제16권7호
• /
• pp.4651-4655
• /
• 2015

둔상에 의한 쇄골하 동맥 가성동맥류의 발생은 드물며, 관통상 이후에 이차적으로 발생하는 경우가 있다. 대게 쇄골하 동맥은 주변의 인대, 근막뿐만 아니라 쇄골, 첫 번째 갈비뼈, 심부 경부 조직들에 의해 보호받고 있어 둔상으로 의한 합병증으로 쇄골하 동맥의 손상이 발생하는 경우는 드물다. 쇄골하 동맥의 손상은 외상 초기에 나타나며, 동맥 파열은 생명을 위협할 수 있는 출혈, 가성동맥류 형성, 상완신경총 압박 등을 유발할 수 있다. 쇄골하 동맥 손상은 쇄골골절, 총상, 관통상이나 중심정맥삽관 같은 술기의 합병증으로 발생하는 것이 대부분이다. 쇄골 주변의 큰 혈종이나 맥박이 느껴지는 종괴가 있다면 심각한 혈관 손상 가능성이 높아지므로 이러한 소견이 있는지 이학적 검사를 통해 확인해야만 한다. 1993년에 외상성 혈관손상의 치료에 있어 혈관 내 스텐트 삽입 시술이 처음 발표된 이후 혈관내 스텐트 삽입 시술을 통해 외상성 혈관 손상을 치료하는 사례가 점차적으로 많아지고 있다. 이 연구는 교통사고 10일 후에 발생한 쇄골하 동맥 가성동맥류 환자에서 혈관내 스텐트 삽입을 통한 성공적 치료와 관련된 임상양상과 추정되는 병태생리에 대해 보고한 사례연구이다.

• Journal of Chest Surgery
• /
• 제30권10호
• /
• pp.1005-1009
• /
• 1997

흉부와 복부장기 두 곳에 손상을 심하게 받으면 쇼크와 급성 호흡곤란이 동시에 발생하여 치명적일 수 있 다. 둔상이나 관통상으로 인해 발생되는 외상성 횡격막 손상은 대부분 홉부와 복부에 퐁반 손상이 유발 됨 으로 이에 대한 요인 및 평가는 중요하다 본 연구는 1993턴 3월 부터 1997년 2월 까지 5년간 서을 위생병원 흉부외과에서 치료받은 17명의 횡격막 손상 환자를 대상으로 이루어졌다. 환자의 평균 나이는 36.2세였고 남 녀 성별 비율은 3.2 1이었다. 들상에 의한 손상(N=5, 우측=4, 좌측긱)은 29.5%, 관통상에 의한 손상(N=12, 우측f5, 좌측:7)은 70.5%이었다. 호흡곤란이 가장 흔한 증상(76%)이었고, 손상의 크기(mean$\pm$ SD)는 둔상(9.8 $\pm$3.7 Cm)이 관통상의 경우(3.2$\pm$1.3 Cm) 보다 컸으며(P<0.05) 모든 환자에서 동반 손상이 있었고 치료는 수 술적 방법으로 개흉술 11례(64%), 개복술 3례(18%)그리고 개흉복술 3례(18%)였다. 다른 장기의 손상으로 수 술 중 발견된 횡격막 손상은 관통상의 경우 5례(41%)였다 흉부나 복부에 둔상이나 관통상을 입은 환자에 일 단 횡격막 손상을 의심해 보고 평가하여 뒤늦게 나타날 수 있는 합병증을 예방하는 것이 필요하다고 사료된다.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.89-95
• /
• 2010

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was $44.6{\pm}18.9$ years. One hundred four (104, 71.2%) were men, and the injury severity score was $14.0{\pm}10.38$. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

• Journal of Chest Surgery
• /
• 제54권1호
• /
• pp.59-64
• /
• 2021

Background: Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods: A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results: Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%). A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion: Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

• Journal of Trauma and Injury
• /
• 제18권1호
• /
• pp.17-25
• /
• 2005

Background: Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.

• Journal of Chest Surgery
• /
• 제46권3호
• /
• pp.197-201
• /
• 2013

Background: Most traumatic tracheobronchial injuries are fatal and result in death. Some milder cases are not life threatening and are often missed at the initial presentation. Tracheobronchial rupture is difficult to diagnose in the evaluation of severe multiple trauma patients. We reviewed the traumatic tracheobronchial injuries at Konyang University and Eulji University Hospital and analyzed the clinical results. Materials and Methods: From January 2001 to December 2011, 23 consecutive cases of traumatic tracheobronchial injury after blunt trauma were reviewed retrospectively. We divided them into two groups by the time to diagnosis: group I was defined as the patients who were diagnosed within 48 hours from trauma and group II was the patients who diagnosed 48 hours after trauma. We compared the clinical parameters of the two groups. Results: There was no difference in the age and gender between the two groups. The most common cause was traffic accidents (56.5%). The Injury Severity Score (ISS) was 19.6 in group I and 27.5 in group II (p=0.06), respectively. Although the difference in the ISS was not statistically significant, group II tended toward more severe injuries than group I. Computed tomography was performed in 22 cases and tracheobronchial injury was diagnosed in 5 in group I and 6 in group II, respectively (p=0.09). Eighteen patients underwent surgical treatment and all four cases of lung resection were exclusively performed in group II (p=0.03). There were two mortality cases, and the cause of death was shock and sepsis. Conclusion: We believe that close clinical observation with suspicion and rigorous bronchoscopic evaluation are necessary to perform diagnosis earlier and preserve lung parenchyma in tracheobronchial injuries from blunt trauma.

• Journal of Chest Surgery
• /
• 제50권4호
• /
• pp.229-234
• /
• 2017

Rib fractures are a common injury resulting from blunt chest trauma. The most important complications associated with rib fractures include death, pneumonia, and the need for mechanical ventilation. The development of new osteosynthesis materials has stimulated increased interest in the surgical treatment of rib fractures. Surgical stabilisation, however, is not needed for every patient with rib fractures or for every patient with flail chest. This paper presents an easy-to-use evidence-based algorithm, developed by the authors, for the treatment of patients with flail chest and isolated rib fractures.

• Journal of Chest Surgery
• /
• 제31권2호
• /
• pp.182-185
• /
• 1998

최근 교통사고와 산업재해로 인한 기관지파열상이 증가하고 있는 추세이다. 일단 기관지 파열상이 발생한 경우는 매우 심각한 증상을 유발하여 생명의 위협을 초래하고, 많은 합병증을 야기하기 때문에 조기 진단과 조기 치료가 원칙이다. 본 저자들은 승용차 전복사고로 흉부둔상을 받아 좌주기관지가 완전 절단된 21세 여자 환자에서 수상후 14일이 경과된 후, 기관지내시경과 흉부 단층 촬영으로 확진하고 , 기관지 성형술과 단단문합술을 시행하였으며 술후 2일간의 호기말양압을 이용한 인공호흡기 적용, 기관지내시경을 이용한 분비액 흡인, 지속적인 물리치료와 체위 배액요법을 시행하여 좌폐기능이 완전 정상화되었음을 추적 검사하에 확인하였다.

• Journal of Chest Surgery
• /
• 제33권12호
• /
• pp.968-970
• /
• 2000

26세 남자가 길가다 버스에 치어, 다발성 늑골골절, 흉골골절, 우견갑골골절, 좌쇄골하동맥 폐색, 외상성 기관식도루로 입원 치료 중 이완기 심잡읍이 생겼다. 심초음파 검사에서 심한 대동맥판 폐쇄 부전과 증식물로 진단하였다. 심폐기 운영 하에 좌 우 관상 동맥 첨판에 10mm, 7mm 파열을 발견 5-0 Prolene 연속 봉합하여 좋은 수술 결과를 얻고 환자는 수술 14일에 퇴원하였다.

• Journal of Chest Surgery
• /
• 제24권2호
• /
• pp.222-226
• /
• 1991

Authors recently experienced a case of traumatic pulmonary pseudocyst in 4 year-old girl. Traumatic pulmonary cyst is a rare complication of blunt thoracic trauma, simulating surgical conditions such as lung abscess, localized empyema, or congenital bronchogenic cyst. Unless infection is supervened, surgery is not indicated because of its spontaneous regression. In this article, authors present the case and review the traumatic pulmonary pseudocyst with related articles.