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

• Archives of Plastic Surgery
• /
• 제36권3호
• /
• pp.351-355
• /
• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.

• 구강회복응용과학지
• /
• 제26권4호
• /
• pp.477-482
• /
• 2010

다수 구치부 상실을 가진 환자의 경우 상실 공간으로 대합치의 정출 및 잔존 전치부 저작으로 인한 교합 외상이 발생한다. 대합치의 정출로 인해 교합 평면이 붕괴되고 구치부 지지 상실로 잔존 치아의 심한 마모를 보이게 된다. 이 경우 보철 수복 공간을 확보하고 교합 평면을 바로잡기 위해서 최소한의 수직 고경을 높여 잔존 치아와 상실된 치아 부위의 수복치료가 필요하게 된다. 본 증례의 환자는 다수 구치 상실로 인한 저작 곤란 및 마모된 전치로 인한 심미적 문제로 내원한 환자이다. 보철 수복을 위한 치아 삭제 전 가역적인 거상 장치를 2개월간 사용한 뒤, 비가역적인 치아 삭제 후 임시 수복물을 3개월간 사용하여 총 5개월간 최종 수복물에 대한 적응 여부를 관찰하였다. 수직 고경 거상량은 3mm로 비교적 작은 양이었고 저작계가 증가된 수직 고경에 대해 특별한 병적 변화 없이 적응하였다. 최종 수복물은 중심 교합시 전체 치아가 균등하게 접촉하고 측방운동시 견치에 의해 즉각적으로 이개되도록 하였으며 금속 교합면를 부여하여 장기적으로 과도한 근육 활성 및 교합 외상, 도재의 파절을 방지하고자 하였다. 이상의 치료를 통해 교합 붕괴 환자를 안정적인 보철 수복물로 재건한 치험예를 보고하고자 한다.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.57-62
• /
• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including 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 intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. 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. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제40권
• /
• pp.27.1-27.8
• /
• 2018

Purpose: Various complications occur when a maxillofacial fracture is malunionized or improperly resolved. Malocclusion is the most common complication, followed by facial deformity, temporomandibular joint disorder (TMD), and neurological symptoms. The purpose of this study was to evaluate the dental treatment of postoperative complications after maxillofacial fracture. Materials and methods: In this study, nine patients with a postoperative complication after maxillofacial fracture who had been performed the initial operation from other units and were referred to the authors' department had been included. Of the nine patients, six had mandibular fractures, one had maxillary fractures, one had maxillary and mandibular complex fractures, and one had multiple facial fractures. All the patients had tooth fractures, dislocations, displacements, and alveolar bone fractures at the time of trauma, but complications occurred because none of the patients underwent preoperative and postoperative dental treatment. Malocclusion and TMD are the most common complications, followed by dental problems (pulp necrosis, tooth extrusion, osteomyelitis, etc.) due to improper treatment of teeth and alveolar bone injuries. The patients were referred to the department of dentistry to undergo treatment for the complications. One of the nine patients underwent orthognathic surgery for a severe open bite. Another patient underwent bone reconstruction using an iliac bone graft and vestibuloplasty with extensive bone loss. The other patients, who complained of moderate occlusal abnormalities and TMDs such as mouth-opening limitation, underwent occlusal treatment by prosthodontic repair and temporomandibular joint treatment instead of surgery. Results: One patient who underwent orthognathic surgery had complete loss of open bite and TMD after surgery. One patient who underwent reconstruction using an iliac bone graft had a good healing process. Other patients were treated with splint, injection, and physical therapy for mouth-opening limitation and temporomandibular joint pain. After treatment, the TMDs were resolved, but the remaining occlusal abnormalities were resolved with prosthetic restoration. Conclusions: Considering the severity of malocclusion and TMJ symptom and the feasibillity of reoperation, nonsurgical methods such as orthodontic and prosthodontic treatments and splint therapy can be used to manage the dental and TMD complication after the trauma surgery. However, reoperation needs to be strongly considered for severe malocclusion and TMD problem.

• 대한소아치과학회지
• /
• 제33권1호
• /
• pp.122-130
• /
• 2006

선천성 치아 결손(congenital missing teeth)은 1개 이상 치아의 선천적 결손으로 hypodontia라고도 불리며 인간에서 가장 흔한 치아 발육 이상이다. 그러나 6개 이상 영구치가 결손되는 severe hypodontia, 또는 oligodontia의 경우는 $0.3{\sim}0.4%$의 매우 낮은 유병율을 보인다. 이환치는 제3 대구치, 상악 측절치, 하악 제2 소구치 순으로 빈발한다. 원인은 정확하게 알려진 바는 없고 외배엽 이형성증, 다운 증후군과 같은 전신질환이나 특정 유전자의 돌연변이와 연관되어 나타나기도 한다. 선천성 치아 결손이 존재하면 비이환치의 위치 이상이나, 악골 발육 감소, 심미적, 기능적 문제 등이 발생할 수 있다. 조기발견을통한 해당유치의 보존이 중요하며 이러한 상황의 개선을 위해 한 사분악 당 최소의 저작 단위를 확보할 수 있도록 교정적, 보철적으로 포괄적 인 치료가 필요하다. 본 증례는 전신질환이 없는 다수의 영구치 선천 결손 환아에 대한 보고로써 이들은 교정치료와 간격유지를 위해 주기적으로 내원하고 있다.

• 대한소아치과학회지
• /
• 제35권1호
• /
• pp.175-180
• /
• 2008

치아 및 치조골은 복합적인 구조이므로 치아의 함입이나 측방 탈구와 같은 치조와의 변위가 있는 다수 치아를 포함한 외상에서 치조골 골절이 동반될 수 있다. 치조골이 골절되면 치주인대 및 치수로의 혈행이 단절되어 치아의 합병증을 유발할 수 있고, 특히 유치열기 외상은 후속 영구치배에 손상을 줄 가능성이 있으므로 장기간의 관찰이 필요하다. 치아 및 치조골 골절의 치료 시에는 환자의 연령과 외상의 위치 및 범위, 유치의 변위 정도 및 방향을 고려해야하며, 골절편을 재위치 시키고 고정하기 위하여 아치바(arch bar), 레진-강선 고정, 교정용 밴드, 아크릴 또는 금속 캡 스플린트(acrylic or metal cap splint), 화이버 스플린트(fiber-splint) 등의 다양한 방법이 고안되었다. 본 증례는 외상으로 인하여 치조골이 골절되어 내원한 1세 11개월 된 환아로서 모형상에서 레진-강선 오픈 캡 스플린트(resin-wire open cap splint)를 제작하여 고정한 후 양호한 치료 결과를 얻었다. 이 방법은 부가적인 기공 과정이 필요하지만, 유치열기에서 사용할 수 있고, 시술시간이 짧아 비협조적인 환아에게 진정요법 없이 적용할 수 있으며, 일반적인 아크릴 캡 스플린트에 비해 부피가 작아 불편감이 적고, 교합을 방해하지 않으며, 접착시 시멘트가 빠져나갈 공간이 있어서 스플린트의 정확한 안착이 가능하다. 또한 비교적 통증이 적으며 침습적이지 않아 출혈이 없으므로 의과적문제가 있는 경우에도 사용할 수 있다.

• 대한영상의학회지
• /
• 제81권3호
• /
• pp.676-687
• /
• 2020

목적 외상 후 스트레스 장애(posttraumatic stress disorder; 이하 PTSD)가 없는 외상에 노출된 소방관들에서 뇌 구조의 변화와 휴식기 뇌기능 변화를 연구하고자 한다. 대상과 방법 모든 피험자는 휴식기 기능 뇌자기공명영상(resting-state functional MRI; 이하 rsfMRI) 검사를 시행하였다. PTSD가 없는 40세 이상의 31명의 소방관(31명, 평균 연령, 49.8 ± 4.7세)이 포함되었다. 26명의 외상을 받지 않은 건강한 대조군(26명, 평균 연령, 65.3 ±7.84세)도 포함되었다. Voxel-based morphometry 분석을 시행하여 뇌 해부학상의 국소적 차이를 조사하였으며, 휴식기 뇌기능의 차이를 조사하기 위해 seed-based functional connectivity analysis 분석을 시행하였다. 결과 서울언어학습결과(Seoul Verbal Learning Test)의 평균 z 값을 비교했을때 소방관은 건강한 대조군에 비해 즉각회상(immediate recall), 지연 회상(delayed recall), 통제단어연상검사(Controlled Oral Word Association Test; 이하 COWAT)의 동물(animal)과 음소(phonemic) 항목에서 점수가 유의하게 낮았으며, 신경인지 기능이 감소한 것으로 나타났다. 소방관은 좌위마루이랑(left superior parietal gyrus)과 좌하관자이랑(left inferior temporal gyrus)의 회색질 부피가 건강한 대조군에 비해 감소되어 있었다. 소방관은 방추향이랑(fusiform gyrus)과 소뇌(cerebellum) 등을 포함한 여러 부위에서 rsfMRI 값의 변화를 보였다. 결론 구조적 뇌 및 휴식 상태 기능 이상은 외상에 노출된 소방관의 변화를 확인하는 데 유용한 이미징 바이오 마커일 수 있다.

• Journal of Trauma and Injury
• /
• 제18권2호
• /
• pp.155-160
• /
• 2005

Background: Falls are a major cause of emergency room visits. Injury secondary to falls is a largely preventable public health problem. This study helps to better understand the epidemiology of falls from height, then develops prevention strategies. Methods: We reviewed the medical records of 192 patients admitted to the emergency department of Konyang university hospital with a history of falls from January 2004 to December 2004. Collected data included the patient's age, gender, height of fall and method, outcome of management, Injury Severity Score(ISS). Results: According to the characteristics of height of fall, the ISS was higher when the patient fell from height of 2 meters or more($13.79{\pm}12.17$) than not($8.13{\pm}9.25$)(p<0.05). There were positive correlation between mean age and ISS(p<0.001, r=0.7). To gender, ISS was higher in the male group($12.73{\pm}11.78$) than the female group($8.48{\pm}10.00$)(p<0.05). Conclusion: Falls often results from multiple concurrent problems including environmental and behavioral factors. This study suggests that we need to improve the occupational environment, especially above 2meters, for decreasing injuries of fall from heights. Also we consider the prevention of children from injuries of fall from heights.

• Archives of Plastic Surgery
• /
• 제42권4호
• /
• pp.424-430
• /
• 2015

Background Reconstruction of combined orbital floor and medial wall fractures with a comminuted inferomedial strut (IMS) is challenging and requires careful practice. We present our surgical strategy and postoperative outcomes. Methods We divided 74 patients who underwent the reconstruction of the orbital floor and medial wall concomitantly into a comminuted IMS group (41 patients) and non-comminuted IMS group (33 patients). In the comminuted IMS group, we first reconstructed the floor stably and then the medial wall by using separate implant pieces. In the non-comminuted IMS group, we reconstructed the floor and the medial wall with a single large implant. Results In the follow-up of 6 to 65 months, most patients with diplopia improved in the first-week except one, who eventually improved at 1 year. All patients with an EOM limitation improved during the first month of follow-up. Enophthalmos (displacement, 2 mm) was observed in two patients. The orbit volume measured on the CT scans was statistically significantly restored in both groups. No complications related to the surgery were observed. Conclusions We recommend the reconstruction of orbit walls in the comminuted IMS group by using the following surgical strategy: usage of multiple pieces of rigid implants instead of one large implant, sequential repair first of the floor and then of the medial wall, and a focus on the reconstruction of key areas. Our strategy of step-by-step reconstruction has the benefits of easy repair, less surgical trauma, and minimal stress to the surgeon.