• 한국방재학회 논문집
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• 제6권1호
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• pp.9-16
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• 2006

모멘트 저항골조는 내진성능이 매우 우수한 것으로 알려져 왔으며 많은 건축물의 설계에 이용되며 시공되어지고 있으나 노스리지 지진과 고베 지진시 충분한 내진성능을 발휘하지 못하고 접합부에서 균열 또는 취성파괴가 발생하였다. 양지진 이후 접합부의 내진성능을 향상시키고자 접합부 상세에 대한 연구가 활발히 진행되고 있으며, 우리나라에서도 지진에 대한 사회적 관심과 일본에서 발생한 지진이 한반도에 영향을 주는 상황에서, 이에 대한 사회전반의 관심과 우려가 제기되고 있다. 본 논문에서는 H형 보 웨브의 고장력볼트 전단접합과 H형 플랜지의 리브보강 유무를 변수로 한 실대형 실험체를 가지고 실험을 실시하였다. 실험을 통해 보 웨브의 2면 전단접합을 통해 고장력 볼트수 감소와 시공성 향상을 기대하며, 리브플레이트 보강을 통해 내진성능을 향상시키고자 한다. 또한 논 스켈럽을 통해 응력집중에 의한 취성파괴를 방지하고자 한다.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.173-180
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• 2022

Purpose: The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population-as the highest-risk population-may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States. Methods: The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65-79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy. Results: Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF. Conclusions: By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.

• Korean Journal of Radiology
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• 제21권7호
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• pp.891-899
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• 2020

Objective: To assess the diagnostic performance of a deep learning-based algorithm for automated detection of acute and chronic rib fractures on whole-body trauma CT. Materials and Methods: We retrospectively identified all whole-body trauma CT scans referred from the emergency department of our hospital from January to December 2018 (n = 511). Scans were categorized as positive (n = 159) or negative (n = 352) for rib fractures according to the clinically approved written CT reports, which served as the index test. The bone kernel series (1.5-mm slice thickness) served as an input for a detection prototype algorithm trained to detect both acute and chronic rib fractures based on a deep convolutional neural network. It had previously been trained on an independent sample from eight other institutions (n = 11455). Results: All CTs except one were successfully processed (510/511). The algorithm achieved a sensitivity of 87.4% and specificity of 91.5% on a per-examination level [per CT scan: rib fracture(s): yes/no]. There were 0.16 false-positives per examination (= 81/510). On a per-finding level, there were 587 true-positive findings (sensitivity: 65.7%) and 307 false-negatives. Furthermore, 97 true rib fractures were detected that were not mentioned in the written CT reports. A major factor associated with correct detection was displacement. Conclusion: We found good performance of a deep learning-based prototype algorithm detecting rib fractures on trauma CT on a per-examination level at a low rate of false-positives per case. A potential area for clinical application is its use as a screening tool to avoid false-negative radiology reports.

• Journal of Chest Surgery
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• 제23권5호
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• pp.916-921
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• 1990

Clinical observations were performed on 17 cases of the traumatic sternal fracture, those were admitted and treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the past 6 years 5months period from January 1983 to May 1989. Obtained results were as follows: 1. The frequency was about 4.8% of the nonpenetrating chest trauma. 2. The ratio of male to female was 16: 1 in male predominance and age distribution was from 24 to 62 years old. 3. The common cause were high decelerating injury [impact of the steering column] and falling down[more than 3 m in high]. 4. The most common fracture site was sternal body and next was sternomanubrial junction. 5. Associated intrathoracic organ injuries were cardiac contusion [6 cases], hemopneumothorax[1 Case], mediastinal bleeding[1 case], and thoracic cage and extrathoracic organ injuries were rib fracture, head injuries, thoracic spinal fracture, and long bone fracture. 6. Abnormal EGG findings were sinus bradycardia[1 case], bundle branch block [2 cases], and sinus tachycardia[3 cases]. 7. The operative reduction and fixation was necessary in only one case and the others were treated with conservative treatment.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.362-368
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• 2023

Purpose: Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution. Methods: A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain. Results: Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5-18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3-23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3-48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention. Conclusions: Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

• Journal of Chest Surgery
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• 제30권3호
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• pp.315-321
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• 1997

저자들은 1994년 1월부터 1995년 12월까지 비관통성 늑골골절로 인하여 도시지역에 위치한 조선대학 교 부속병원 흉부외과에 입원한 326명의 환자와,농촌지역에 위치한 전남 화순중앙병원 흉부외과에서 입원 치료 받았던 환자 102명에 대하여 임상적 차이를 서로 비교하였다. 가장 흔한 연령층은 도시지역 30∼50대, 농촌지 역 40∼60대 였고 남녀비는 전체지 역에서 남자에서 3배이상의 많은 빈도를 보였다. 비 관통성 늑골골절의 가장 흔한 원인은 양 그룹에서 교통사고가 가장 많았으며 두번째로 많은 원인은 도 시지 역은 추락사고로 355례중 66례(20.2%), 농촌지 역은 농기구 사고로 102례중 18례(17.6%)였다. 손상 부위별로는 도 · 농간. 유의한 차이없이 좌측에서 많았고 가장 흔한 늑골골절은 3번에서 6번까지의 늑골 이었다. 수상후 첫 1시간내에 내원한 경우는 도시지역이 16.0%, 농촌지역이 23.5%로 차이를 보였다. 치 료는 보존적 치료, 흉강천자술, 폐쇄성 흉관 삽관술, 개흉술 등으로 하였는데, 도시지역이 326례중 134 례(41.1%), 농촌지역of 102례중 81례(79.4%)에서 보존적 요법을 시 행하였고, 개흉술은 도시지 역이 37례 (11.3%),농촌지역이 3례 2.9%)에서 시행하여 도시지역이 농촌지역에 비하여 더 적극적인 치료방법을 선택하는것으로 나타났다. 전체 사망률은 도시지역이 4.29%(14례), 농촌지역이 1.96%(2례)였고 사망원 인은 출혈성 쇽, 뇌부종 등이었다.

• Journal of Chest Surgery
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• 제21권3호
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• pp.563-566
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• 1988

Thoracic outlet syndrome refers to compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax. it was previously designated according to presumable etiologies such as scalenus anticus, costoclavicular, hyperabduction, cervical rib and first thoracic rib syndromes. We experienced a case of thoracic outlet syndrome[costoclavicular syndrome] which was caused by posttraumatic left clavicular fracture. Patient had suffered from swelling and cyanosis of left forearm and hand. preoperative vascular doppler test, angiography and venography were performed. First rib resection was done with transaxillary approach. After operation preoperative cyanosis and swelling of left forearm and hand were disappeared. Postoperative course was uneventful.

• Journal of Trauma and Injury
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• 제31권3호
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• pp.174-176
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• 2018

Most of aortic injuries after blunt chest trauma usually occur at the aortic isthmus and are identified in the emergency department soon after arrival. Delayed aortic injures by fractured posterior ribs, however, are relatively rare and have been reported only a few times. We recently experienced an iatrogenic descending aortic injury sustained as a result of a direct puncture by a sharp rib end after surgical stabilization of rib fractures.

• Journal of Trauma and Injury
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• 제31권1호
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• pp.12-15
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• 2018

Rib fixations for flail chest or displaced rib fractures are not a new technique. However, reports on rib fixations involving costal cartilage fractures are very few and surprisingly there are no reports of internal fixations involving only the costal cartilage in the English literature. The diagnosis is difficult and the necessity of the procedure may be quite controversial. Placing plates in screws into the costal cartilage alone may seem unstable and easily dislodged or stripped through the cartilage. We report a 31-year-old male scuba diver instructor who underwent rib fixations over his 7th and 8th costal cartilage ribs for severe pain. The procedure was done with conventional plates and screws. He had the plates and screws removed 2 months later due to lingering pain, but with them removed he is now quite happy with the results without pain. The procedure for fixation of painful overlapped costal cartilage is quite simple and can be done with the usual conventional methods, fixating plate and screws directly over the cartilage alone without fixation over the bony rib.

• Journal of Chest Surgery
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• 제30권10호
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• pp.1010-1014
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• 1997

다발성 늑골골절 환자의 치료시 Judet씨의 struts를 사용한 늑골고정 술 유효성을 알아보기 위해 1995년 12 월부터 1996년 12월까지 1년 1개월 동안 천안 충무병원에서 치험한 Judet씨 struts를 사용하여 늑골고정술을 시행한 30명의 환자를 대상으로 임상분석을 시행하였다. 외과적 늑골고정 술의 대상은 다발성 늑골골절에 동 요흉이 동반된 경우가 14r11,분쇄골절을 포함하여 늑골의 전위가 심했던 경우가 8례, 그리고 흉강내 장기의 손상으로 심한 혈흉이나 혈기흉이 동반되어 수술중 부수적으로 시행됐던 경우가 7례였다. 수술후 환자의 상 태는 비교적 양호하여 단지 1례만이 술후 5일간 인공호흡이 요했으며,술후 합병증으로 혈기흉이 2례, 알코 올 금단현상에 의한 진전섬망이 2례, 그리고 간염이 1례 있었고, 입원기간 역시 짧아 흉곽외 타장기의 손상이 없는 경우에 평균 10.5일로 조기퇴원이 가능하였다. 이상의 결과로 Judet씨 struts를 사용한 늑골고정술은 흉곽의 안정성을 조기에 확보하여 치료기간을 단축시킬 뿐만 아니라 흉곽의 변형에 의한 폐활량의 감소 및 흉통의 예방에 기여할 것으로 예상되나, 향후 더 많은 치료방법에 대한 비교연구가 요\ulcorner 것으로 생각된다.