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Snakebite in Korea: A Guideline to Primary Surgical Management
나중호,권성민,오진록,한병근,이강현,김재현 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5
Purpose: Snakebite is an emergency which causes local symptoms such as pain and edema around the bite. Systemic symptoms may also develop, such as dizziness or renal failure, and may even cause death. The purpose of this research was to assess the validityand safety of snakebite protocol for surgery when treating snakebite patients. Materials and Methods: Retrospective research was performed on patients who were admitted after being treated at the emergencycenter from January 2008 to December 2012. When necessary, debridement was also performed, and 46 of 111 patients (41.4%) underwent debridement. Those who had received debridement without antivenom administration due to a positive skin reaction test were classified as group A, and group B received antivenom and delayed debridement. We reviewed the emergency and admission charts of the patients in each group and recorded and compared their age, sex, bite site, severity of local and generalsymptoms, time to receive antivenin, and complications. Results: Of the ten patients (21.7%) in group A, two (66.6%) developed cellulites, and one of them experienced skin necrosis, resultingin a skin graft. In group B, there were 36 patients (78.2%), 19 (52.7%) of whom developed cellulitis. Skin necrosis occurred in two patients, and one of these patients received a skin graft. Compartment syndrome was found in one patient, and fasciotomy and a skin graft were performed. Conclusion: The treatment protocol implemented to treat snakebite patients admitted to the emergency center during this researchwas safely and properly followed during surgical treatment.
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양측성 상완이두장건 결손과 견관절 불안정성 - 증례 보고 -
나중호,정회정,김두섭,Rah, Jung-Ho,Chung, Hoi-Jeong,Kim, Doo-Sup 대한관절경학회 2010 대한관절경학회지 Vol.14 No.3
상완이두장건의 결손은 매우 드문 이상이다. 본원에 내원한 19세 남환은 우측 견관절 아탈구 증상을 주소로 내원하였다. MRI 상 상완골의 얕은 결절사이고랑이 관찰되었으며 상완이두장건의 결손이 관찰되었다. 견관절 내시경술을 시행하였으며 관절와순 파열과 함께 상완이두장건의 결손이 관찰되었다. 5개월 뒤 좌측 견관절에도 우측 견관절과 같은 증상이 발생하였고 MRI 및 견관절 내시경 소견 상 상완이두장건의 결손 소견 및 관절와순 파열 소견이 관찰되었다. 양측 견관절 모두 내시경적 관절와순 봉합술을 시행하였으며 수술 후 위팔 외전 보조기를 이용하여 고정하였다. 상완이두장건의 결손이 견관절의 불안정성을 유발할 수 있을 것이라고 생각한다. Absence of long head of biceps tendon is a very rare anomaly. We encountered a 19 year-old male patient who had right shoulder subluxation. On magnetic resonance imaging, shallow intertubercular groove on right humerus was observed, and absence of long head of biceps tendon was discovered. Arthroscopically, labral rupture and absence of long head of biceps tendon were also evident. Left shoulder had a similar symptom as right 5 months after the initial development of the symptom on the right shoulder. Both MRI and arthroscopy revealed absence of long head of biceps tendon and labral ruptre. Arthroscopic labral repair was performed for both shoulders, and, postoperatively, they were fixated with abduction brace. In this case, it is considered that the absence of long head of biceps tendon triggered the instability of shoulder found in our patient.
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나중호,박희전 대한척추외과학회 1994 대한척추외과학회지 Vol.1 No.2
The nomal development of the vertebral column and the timing of the vareous events has been elucidated. In the orthopaedic and radiological literature, a sagittally cleft vertebra is gen- erally known as a butterfly vertebra(Schmetterlingswirbel), a rare condition probably first described by Rokitansky. Sometimes, this rare condition is confused with compression frateur after trauma. We report a case of butterfly vertebra and review the literature for differentiation of this rare condition.
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외상 환자에서 초음파를 이용한 상완 신경총 차단술의 유용성
나중호,권성민,차재학,이준표,김재현 대한수부외과학회 2014 대한수부외과학회지 Vol.19 No.1
Purpose: We evaluated the efficacy of brachial plexus block under the guide ofultrasonography for immediate management of open wound in patients withmultiple trauma. Methods: From July 2012 to April 2013, 34 patients with multiple trauma hadbrachial plexus block for immediate management of open wound in the upperextremity. We evaluated the patient satisfaction of the anesthesia and any complicationsrelated to the block. Results: During the brachial plexus block, intravascular injection of lidocaineoccurred in one patient. Except this, all patients who received brachial plexusreplied they would choose brachial plexus block if they had to undergo thesame surgery. Conclusion: Brachial plexus block is an effective anesthesia technique in theimmediate management of open wound in upper extremities. 목적: 외상 환자에서 상지 개방 손상을 바로 수술하기 위해 시행한 초음파를 이용한 상완 신경총 차단술의 효용성에 대하여 알아보고자 하였다. 방법: 2012년 7월부터 2013년 4월까지의 34명의 외상 환자에게서 상완 신경총 차단술을 시행하여 상지 개방 손상에대한 수술을 시행하였으며 마취 효과와 합병증, 환자의 만족도를 조사하였다. 결과: 34명의 환자 모두 수술부위의 마취가 잘 이루어 졌으며, 1명에게서 lidocane의 혈관 내 주입에 의한 입안 저린증상이 나타났다. 34명의 환자 중 33명이 동일한 수술이 필요할 경우 동일한 방법으로 마취를 받기를 원한다고 하여높은 만족도를 보였다. 결론: 외상 환자에게서 초음파를 이용한 상완 신경총 차단술은 상지 부위 손상을 바로 수술하고자 할 때 유용한 마취 방법이다.
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나중호,박희전,윤여승,황성관 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.1
The goals of internal fixation of the spine aro to (1) correct deformity,(2)improve the fusion rate, (3)protect neural elements, and (4)reduce the rehabilitation time. These rationales are also applied to the cervical spine. Various operative techniques of internal fixations for cervical spine are introduced. But now we have some question about the appropriate diameter and length of the screws and the critical range of the safe zone for screwing. For the exact preopertive planning, such as selection of the appropriate size of implant and direction of the screwing, we measured in 100 cases of nermal adults and 10 case of human cadaveric dry bones and obtained following resule; 1.The mid sagittal and coronal diameter of the isthums of odontoid in male and female is 10.14± 1.69mm by 9.99±0.41mm and 9.20±0.52mm by 9.27±0.49mm respectively. 2.Mean length of screwing for odontoid in male and female is 46.38±1.99mm and 43.2± 2.34mm. 3.Anteroposterior diameter of the vertebral body of all cases are over 14mm. 4.Radiologic length for posterior screwing into the C2 in male and female is 38.67±1.91mm and 35.20±1.15mm. And the depth of the route for screwing is 9.27±0.70mm, 8.68±0.65mm in male and female respectively. But direct measurement of the isthmic portion of the C2 in cadaveric dry bone is 5.59±1.09mm. 5.By the method of Magerl, the appropriate and safe maximal length of the screw from C3 to C7 are 12.6mm to 16.3mm(see in text).
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