응급실로 내원한 자의 손상 환자의 특징

곽영수 ( Young Soo Kwak ),이강현 ( Kang Hyun Lee ),신형진 ( Hyung Jin Shin ),박경혜 ( Kyung Hye Park ),최한주 ( Han Joo Choi ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: Many studies have addressed a psychiatric analysis of self-injury patients who have self-injurious behavior and who have attempted suicide. Few studies on the injury characteristics of self-injury related trauma patients have been conducted. We analyzed the injury characteristics of self-injury patients. Methods: A retrospective review of the medical records extracted from the injury surveillance system of Wonju Christian Hospital for the period from August 2006 to February 2008 was conducted. Of the 121 cases extracted, 103 were included in this study. We analyzed the sex ratio, age group, place of injury, injury mechanism, location of injury, management results, injury severity, and relation with drinking. Results: One hundred three cases were included (sex ratio: 1.06), and the mean age was 33.9±14.2 years old. Fifty-six patients (54.4%) were discharged from the emergency department (ED) on the day of injury after primary care, and 9 patients (8.7%) were discharged, because they refused treatment. Seven patients (6.8%) died. Of these, 4 patients (3.9%) died after attempted cardio-pulmonary resuscitation in the ED, 1 patient (1%) was dead on arrival, and 2 patients (1.9%) died after admission. Sixteen patients (15.5%) were admitted to the hospital, including 2 patients (1.9%) needing emergency surgery. Sixteen patients (15.5%) were transferred to other hospitals. Sixty-one cases (59.2%) involved drinking, and 31 (30.1%) did not; for 11 cases (10.7%), the involvement of drinking was unknown. The mean revised trauma score (RTS) was 11.26±2.52, and 88 cases (85.4%) hat a RTS of 12. The mean injury severity score (ISS) was 5.80±14.56, and 9 (8.7%) severely injured patients had scores of more than 15. Conclusion: Most self-injuries were mild traumas related to drinking and occurred at a young age. Most cases were not so severe, and the patients were discharged from the ED, but some patients needed hospitalization. Other patients had injuries so severe that they died. (J Korean Soc Traumatol 2009;22:65-70)

무시된 대퇴경부 골절로 오인된 방사선 유발 속발성 골육종의 병적 골절

전영수(Young Soo Chun),한정수(Chung Soo Han),곽상준(Sang Joon Kwak),허동범(Dong Bum Huh) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3

소발성 골육종은 소아에서는 드물며, 이들 중 절반 이상이 50세 이상의 환자에서 발생하는 것으로 알려져 있다. 방사선 치료 후 발생하는 이차성 골육종은 2,500 cGy 이상의 방사선 치료를 받은 환자의 약 1%에서, 노출 후 약 10-15년 후에 발생하며, 방사선 치료 후에 발생하는 가장 흔한 형태의 육종이다. 우측 대퇴경부골절로 본 병원을 방문한 51세 여자 환자는 9년 전 혈관점액종(angiomyxoma)으로 방사선 치료를 받은 병력을 가지고 있으며, 2주 전에 동일 부위의 낙상으로 인해 충격 받은 병력이 있었다. 방사선 사진상 골절부위의 경화소견이 관찰되어 지연 진단된 대퇴경부골절로 진단하였다. 비관혈적 정복 및 나사못 고정술로 치료한 후 통증의 지속 및 과다한 가골 형성의 소견을 보여 정밀 검사를 시행하였고, 방사선 조사 후 발생한 속발성 골육종에 의한 병적 골절로 진단하였다. 본 증례를 통하여 오진된 골육종에 대한 경각심을 주고자 한다. Secondary osteosarcoma has a relatively higher incidence in middle aged persons than in children. Radiation-induced osteosarcoma occurs in approximately 1% of patients who have been treated with more than 2,500 cGy. The time interval from radiation to onset of secondary osteosarcoma is approximately 10 to 15 years. A 51-year-old female who have been treated with radiation for angiomyxoma was hospitalized due to right hip pain. She had a minor trauma 2 weeks prior to hospitalization. A day before hospitalization, she experienced a second trauma by fall, and then, severe hip pain developed. A radiograph of the patient showed femoral neck fracture with sclerotic change of fractured margin. We diagnosed the patient as having a neglected femoral neck fracture and treated it with closed reduction using cannulated screw fixation. At 6 months post-surgery, the patient had residual pain of the right hip and we could find overproduced callus at the fracture site. Through further evaluation, we diagnosed this as secondary osteosarcoma with pulmonary metastasis. We report this case to make a warning about a misdiagnosed osteosarcoma as a simple femoral neck fracture.

비구 강화 환을 이용한 고관절 비구컵 재치환술의 중기 추시 결과

곽상준 ( Sang Joon Kwak ),전영수 ( Young Soo Chun ),유기형 ( Kee Hyung Rhyu ),허동범 ( Dong Bum Huh ),유명철 ( Myung Chul Yoo ),조윤제 ( Yoon Je Cho ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.3

목적: 비구 강화 환(reinforcement ring)을 사용하여 인공 고관절 재치환술을 시행한 후 임상적 및 방사선학적 결과를 분석하고자 하였다. 대상 및 방법: 1997년부터 2005년까지 36명의 환자 36예를 대상으로 비구 강화환과 동종 골이식을 이용하여 비구 재 치환술이 시행되었다. AAOS III형 골 결손이 34예, IV형이 2예였다. 수술 후 평균 추시 기간은 7.2년이었다. 결과: 술전에 비하여 Harris 고관절 점수는 92.3점으로 의미 있게 향상되었다(p<0.001). 1예에서 이식 골과 골반 골 사이의 유합이 되지 않아 비구 컵의 해리가 발생하였고, 감염이 2예(5.4%), 고관절 탈구 2예(5.4%) 발생하였다. 수술 중 비구 강화 환의 부적절한 고정이 이루어진 1예를 제외한 모든 예에서 골 이식은 잘 유합 되었다. 재 치환술이 필요했던 경우와 비구 컵의 해리가 발생한 경우를 재 치환술의 실패로 정의하였을 때 성공률은 91.7%였다. 결론: 비구 강화환을 이용하여 비구 재치환술을 시행받은 환자에서 비구 주위 골재건과, 훌륭한 임상적 및 방사선학적 결과를 보여주었다. 좋은 결과를 얻기 위해서는 수술 시 정확한 삽입물의 삽입이 필요하며, 각각의 비구 강화환의 종류에 따른 특성을 잘 이해하고 시행해야겠다. Purpose: To evaluate the clinical and radiographic outcomes of the revision total hip arthroplasty using the acetabular reinforcement ring. Materials and Methods: Thirty-six acetabular revisions were performed in 36 patients with use of the reinforcement ring and structural or morselized allograft, between 1997 and 2005, in thirty-six patients. According to the AAOS classification, thirty-four cases of acetabular defects were Ttype III, and two were Ttype IV. Mean follow-up period after surgery was 7.2 years. Results: The mean Harris hip score was 92.3, which was significantly increased compared with the preoperative score. (p<0.001). There were five failures: a case of aseptic loosening of Muller ring, two cases of infection (5.4%) and two cases of hip dislocation (5.4%). Graft incorporation and bone remodeling occurred successfully in all hips, but in the case of aseptic loosening in which the ring fixation had been inadequate at the time of surgery. The success rate was 91.7% with a mean follow-up of 7.2 years, if the cases of revision or loosening of the component were classified into failure cases. Conclusion: Patients treated with acetabular revision with three kinds of reinforcement ring had reconstitution of periacetabular bone stock as well as good clinical and radiographic results. For the good results, the secure implant fixation during the surgery should be confirmed and we should completely understand the characters of the each kinds of reinforcement rings.

광범위 다공성 표면 처리된 대퇴 스템을 이용한 인공 고관절 재치환술 -최소 5년 이상의 추시 결과-

조윤제 ( Yoon Je Cho ),곽상준 ( Sang Joon Kwak ),전영수 ( Young Soo Chun ),유기형 ( Kee Hyung Rhyu ),고택수 ( Taeg Su Ko ),유명철 ( Myung Chul Yoo ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.3

목적: 광범위 다공성 표면 처리 스템을 이용한 재치환술의 중기 추시 결과를 분석하였다. 대상 및 방법: 광범위 다공성 표면 처리 스템을 이용한 재치환술 후 평균 5년 5개월 추적 관찰한 20예를 분석하였다. 재치환술 원인은 무균성 해리, 스템 주위 골절, 감염성 인공 관절이 있었다. 4종류의 광범위 다공성 표면 처리 스템을 사용하였고, 17예에서 골 이식을 함께 시행하였다. Harris 고관절 점수, 대퇴 동통 및 파행과 운동 범위를 평가하였으며, 수직 침강, 응력 차단, 골 용해 등 방사선 변화를 관찰하였다. 결과: Harris 고관절 점수는 56.5점에서 91.9점으로 향상되었고, 만족스런 관절 운동 범위를 보였다. 지주골 이식을 시행한 1예에서 대퇴 동통이 지속되었다. 의미 있는 스템 수직 침강 및 이완소견은 없었고, 재재치환술의 예도 없었다. 결론: 광범위 다공성 처리된 대퇴 스템의 안정성은 중기 추시에서도 잘 유지되었다. 본 술식은 간부에서 견고한 골 고정을 얻어, 골 결손이 심한 때에도 스템 안정성을 얻을 수 있고, 근위부 골 재건을 도모할 수 있으며, 다른 술식에 비하여 간편한 장점이 있다. 간부까지 골 결손이 심한 경우 적합하지 않으며, 대퇴골 균열, 응력 차단, 대퇴 통증이 발생할 수 있으므로 세심한 주의가 필요하다. Purpose: We wanted to evaluate the mid-term results of revision total hip arthroplasty using a fully porous-coated long stem. Materials and Methods: A retrospective series of 20 hips in 19 patients who underwent stem revision with a fully porous-coated long stem were evaluated at a mean follow-up of 64.6 months. The causes of revision were aseptic loosening, periprosthetic fracture and infected arthroplasty. Four kinds of implants had previously been used and an additional bone graft procedure had been done in 17 cases. The Harris hip scores, thigh pain, limping and ROM were reported. Radiological changes of the radiolucent signs, subsidence, loosening and the stress shielding signs were evaluated. Results: The Harris hip score improved from an average of 56.5 to 91.9 and the ROMs were satisfactory. The only case with persistent thigh pain showed stable bony ingrowth. No signs of subsidence or loosening of the stem was found in all the cases. There were 2 cases of periprosthetic fracture. None of the patients experienced re-revision surgery. Conclusion: The mid-term results of revision hip arthroplasty using a fully porous coated long stem have demonstrated that it provides a reliable initial fixation with a propensity for stable longevity. It is relatively easy for the techniques, and there is the opportunity to restore the bone stock by bone-grafting procedures with diaphyseal fixation and bypassing a bone defect. Yet alternative techniques may be required for the femur with extensive diaphyseal bone loss. There are some concerns about the technique and the possibility of making a crack in the femur during the operation, which will cause thigh pain at the follow-up. So, only by employing great caution when performing this technique can successful results be guaranteed.

폴리에틸렌 삽입물을 교체한 인공 고관절 재치환술

조윤제 ( Yoon Je Cho ),곽상준 ( Sang Joon Kwak ),전영수 ( Young Soo Chun ),유기형 ( Kee Hyung Rhyu ),강동근 ( Dong Geun Kang ),유명철 ( Myung Chul Yoo ) 대한고관절학회 2011 Hip and Pelvis Vol.23 No.4

목적: 골성 고정된 Harris-Galante (HG) 비구컵을 제거하지 않고 폴리에틸렌 삽입물 만을 교체한 재치환술의 중기 추시 결과를 분석하고자 하였다. 대상 및 방법: 재치환술 시 골성 고정된 무시멘트 비구컵을 제거하지 않고, 폴리에틸렌 삽입물을 교체한 후, 5년 이상(평균 92개월) 추시 가능했던 33예를 대상하였다. Harris 고관절 점수, 골용해 크기 변화 및 폴리에틸렌 삽입물의 선형 마모율을 비교하였고, 이식골의 결합 정도와 새로운 골용해 병변 발생 여부를 관찰하였다. 결과: Harris 고관절 점수는 평균 89.3점으로 호전되었다. 골 이식을 시행한 군에서 골용해 크기가 감소하였고, 골 이식을 시행하지 않은 군에서 새로운 골용해의 발생은 없었다. 합병증으로 폴리에틸렌 삽입물의 해리와 치환물 주변 골절이 각 1예 있었다. 동일 관찰 시점의 비구 관절면 선형 마모율은 재치환술 전에 비하여 유의하게 감소하였다. 결론: 폴리에틸렌 삽입물 만을 교체하는 재치환술은 안전하고 효과적인 재치환술 방법으로 사료된다. 다만 잠김 기전이 약한 HG 비구컵의 특성상 조기에 잠금 장치의 손상이 발생할 위험이 높은 경우에는 비구컵 재치환술 또는 폴리에틸렌 삽입물 시멘트 고정 방법을 고려하는 것이 바람직 할 것으로 사료된다. Purpose: To analyze the results of isolated exchange of polyethylene (PE) liners for treatment of wear and osteolysis around a well-fixed Harris-Galante (HG) cementless acetabular cup. Materials and Methods: Thirty-three PE liner changes were performed without the removal of stably ingrown implants (33 hips of 32 patients). They were able to be followed for a mean period of 92 months. Clinically, the Harris hip score (HHS), pain evaluation, and complications were evaluated. Radiologically, the annual wear rate and the size of the osteolytic lesions were measured before the operation and the latest follow-up. The bone graft incorporation scale and the development of new osleolytic lesions were checked during the final follow-up. Results: HHS improved to 89.3 at last follow-up. The size of the osteolysis was significantly reduced postoperatively. Bone graft incorporation scales were Grade I in 9 and Grade II in 14 cases. New osteolytic lesions have not developed at latest follow-up. As a complication, one case of dissociation of a liner and a periprosthetic fracture were noted. Annual wear rates during the same period were significantly reduced. There was no sign of alteration in stability of the PE liner. Conclusion: Exchange of a PE liner without removal of stable implants can be a good option for the treatment of wear and osteolysis around a stable cementless THA implant, even if the system has a weak locking mechanism, such as the HG cup. In these cases, under certain states with a higher risk of early failure in the locking mechanism, it would be better to select other revision procedures such as cup revision or cemented polyethylene liner fixation.

영유아 탑승자의 차량사고에서 보호장구에 따른 손상 분석

성강민 ( Kang Min Sung ),김상철 ( Sang Chul Kim ),전혁진 ( Hyuk Jin Jeon ),곽영수 ( Yeong Soo Kwak ),윤영한 ( Young Han Youn ),이강현 ( Kang Hyun Lee ),박종찬 ( Jong Chan Park ),최지훈 ( Ji Hun Choi ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: To compare injury sustained and severity of child occupant according to the types of safety restraint systems in motor vehicle crashes. Methods: This was a retrospective observational study. The study subjects were child occupants under the age of 8 years who visited a local emergency center following a motor vehicle crash from 2010 to 2014. According to safety restraint: child restraint systems (CRS), belted, and unbelted, we compared injuries sustained and injury severity using the maximal Abbreviated Injury Scale (MAIS) and Injury Severity Score (ISS), and analyzed the characteristics of severe injuries (AIS2+). Results: Among 241 subjects, 9.1% were restrained in CRS, 14.5% were only belted, and 76.3% was unbelted at the time of the crashes. Fourteen had severe injuries (AIS2+), all of whom didn’t be restrained by CRS. Injuries in face and neck were the highest in unbelted group, and MAIS and ISS were the lowest in CRS group. Conclusion: Among safety restraint systems for child occupant in motor vehicle crashes, the CRS have the preventive effect of face and neck injuries, and are the most effective safety restraint systems. [ J Trauma Inj 2015; 28: 98-103 ]

조영제 혈관 외 유출이 관찰된 복부 둔상 환자의 유출부위에 따른 예후

신형진 ( Hyung Jin Shin ),이강현 ( Kang Hyun Lee ),곽영수 ( Young Soo Kwak ),김선휴 ( Sun Hyu Kim ),김현 ( Hyun Kim ),황성오 ( Sung Oh Hwang ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. Methods: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients` clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. Results: Of the 50 patients (mean age: 45±18years, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention-either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). Conclusion: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization. (Korean Soc Traumatol 2009;22:57-64)

25인승 버스 전복사고의 탑승자 손상 분석

박상민 ( Sang Min Park ),김상철 ( Sang Chul Kim ),이강현 ( Kang Hyun Lee ),이재완 ( Jae Wan Lee ),전혁진 ( Hyuk Jin Jeon ),김호중 ( Ho Jung Kim ),김진용 ( Jin Yong Kim ),곽영수 ( Young Soo Kwak ),이우성 ( Woo Sung Lee ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.3

Purpose: Rollover motor vehicle crashes have a higher injury severity and fatality than other motor vehicle crash types. From a left-quarter turn rollover accident of 25-passenger bus, we intend to assess the injury of the occupant and the injury severities according to the occupants` position. Methods: We carried out the 3 steps investigation of occupants` interview, visiting the repair shop and using the police report. We analyzed injuries sustained by occupants, and compared injury severities considering column, row in occupant`s position and passenger interaction Results: The rollover involved 14 passengers in the bus who were all old women except a man driver. The most common injury was in the upper extremity, with six occurrences being a left clavicle fracture. Major injuries including hemothorax and pneumothorax were diagnosed at left side of the occupant. In the comparison of injury severity among driver`s column (left side), mid column and passengercolumn, ISS of passenger column was the highest (9. ±7.4, 8.8 ±5.5, and 10.3±4.0, respectively, p>0.05). The injury severity of multiple occupants by row was higher than that of single occupant (10.8 vs. 3, p<0.05). Conclusion: An occupant must fasten their seat belt to prevent an injury by passenger interaction in the left-quarter turn rollover accident of a bus. [ J Trauma Inj 2014;27:50-56 ]

韓國人血液中 Vitamin C 含有量에 對하여

朱軫淳,金仁子,韓輔相,金根欽,郭榮水 醫藥係社 1955 綜合 醫學 Vol.12 No.9