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척추 압박골절에 대한 경피적 척추 성형술시 Polymethylmethacrylate의 척추체의 유출에 영향을 주는 인자에 대한 분석
도현우,권영준,양재영,최천식,주문배 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.5
Objective : To assess causative factors that may induce the leakage of the PMMA after the vertebroplasty performed on osteoporotic compression fracture patients. Methods : Percutaneous vertebroplasty was done on 80 vertebral compression fractures in 54 patients from June.2001 to Nov.2002. Leakage of PMMA was divided into paravertebral, venous, epidural, and intradiscal leakage. The relationship between leakage of PMMA and various factors were analyzed such as clinical features, bone mineral density, existence of bone sclerosis, interval from injury to operation, amount of PMMA, tip location, operation method, compression pattern, compression ratio etc. Results : Leakage was found in 39 vertebral bodies out of a total of 80 operated vertebral bodies. A large amount of PMMA, which was injected into compressed vertebra, induced a high incidence of leakage(P=0.042). Preoperative high bone mineral density in Compressed Vertebra induced a high incidence of leakage(P=0.014). The existence of sclerosis caused a high incidence of leakage.(P=0.014). Other factors, which were examined, did not induce the leakage of PMMA. Conclusion : Percutaneous vertebroplasty must be done carefully after a detailed examination of factors that might cause leakage of PMMA.
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족관절 내과골절에서 피질골 나사못을 이용한 변형된 긴장대 고정술
최호림,도현우,김병흠,김규현,박종석,송준민 대한골절학회 2004 대한골절학회지 Vol.17 No.4
목적 : 전위된 족관절 내과골절에 대해 피질골 나사못을 이용한 변형된 긴장대 고정술을 이용한 치료결과를 분석해 보고자 하였다. 대상 및 방법 : 2001년 1월부터 2003년 1월까지 전위된 내과골절에 대해 변형된 긴장대 고정술을 시행 받고 최소 1년 이상 추시관찰 가능 하였던 24례를 대상으로 하였다. 남자 13례, 여자 11례로 평균 연령은 46세였다. 골절은 Lauge-Hansen 분류법을 사용하였으며, 결과는 Meyer와 Kumler의 평가 방법을 이용하였다. 결과 : 13례 (54%)에서 우수의 결과를 얻었고, 9례 (38%)에서 양호의 결과를 얻었으며, 운동범위의 제한이 발생한 1례에서 보통, 후외상성 관절염이 발생한 1례에서 불량의 결과를 얻었다. 결론 : 전위된 족관절 내과골절에서 피질골 나사못을 이용한 변형된 긴장대 고정술은 견고한 내고정과 조기 관절 운동이 가능한 효과적인 수술 방법이 될 수 있을 것으로 사료된다. Purpose : To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle. Materials and Methods : From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria. Results : There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle. Conclusion : Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.
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전신마취와 척추마취 하에 하지 수술시 구혈기에 의한 혈역학적 변화
최윤정,도현우,전재규,김진모 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.2
A tourniquet is commonly used to achieve a bloodless field in surgery of the extremities. However, tourniquet use occasionally has been associated with intranperative hypertension and with circulatory collapse after deflation. The purpose of this study is to define the hemodynamic changes in this setting using thoracic electrical bioimpedance (TEB) device. Twenty patients of ASA class I, scheduled for lower extremities surgery using a thigh tourniquet, were randomly divided into two groups. Group I underwent general anesthesia (including enflurane) and group Ⅱ underwent spinal anesthesia (0.5% bupivacaine 12.5 mg). The changes of blood pressure (BP), heart rate (HR), stroke index (SI), cardiac index (CI), systemic vascular resistance index (SVRI), and end-diastolic index(EDI) were measured (1) before induction, (2) just before inflation of tourniquet, (3) at the time of the maximal change of CI within 10 minutes after inflation of it, (4) just before deflation of tourniquet, and (5) at the time of the maximal change of CI within 10 minutes after deflation of it. During a tourniquet inflation, SI, CI and SVRI were markedly changed in group I , but not effectively changed in group H. During a tourniquet deflation, CI and SVRI were changed significantly in group I and only SVRI was decreased effectively in group Ⅱ (p<0.05). However, there were no significant changes in BP, HR, and EDI in both groups during a tourniquet inflation and deflation. In cases of the use of a thigh tourniquet for lower extremities surgery, the hemodynamic fluctuations of CI and SVRI are obviously less changed in the spinal than in the general anesthesia during the inflation and deflation of a tourniquet and prominent during 5-10 minutes just after inflation and deflation of a tourniquet. Accordingly, it is suggested that spinal anesthesia is preferred to general anesthesia for the use of a thigh tourniquet in patients scheduled for lower extremities surgery and close observation is required during 5-10 minutes just after inflation and deflation of a tourniquet.
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최형석,도현우,이병일,민경대,나수균,김연일,서유성,Choi Hyung Suk,Doh Hyun Woo,Lee Byung Ill,Min Kyung Dae,Rah Soo Kyun,Kim Yeon Ill,Seo Yoo Sung 대한정형외과스포츠의학회 2004 대한정형외과스포츠의학회지 Vol.3 No.1
목적: 인라인 스케이트를 타던 중 발생한 골절상을 분석하여 골절의 분포 및 경향을 파악 하고자 한다. 대상 및 방법: 2002년 9월부터 2003년 8월까지 1년간 인라인 스케이트를 타다가 골절이 발생하여 입원 가료 하였던 35명의 환자 중 최소 1년 이상 추시가 가능하였던 20명, 20례를 대상으로 환자의 성별, 연령분포, 부위별 빈도, 동반손상, 숙련도별 손상, 손상 유형 등을 후향적으로 분석하였다. 남자가 18명(90$\%$), 여자가 2명(10$\%$)이었고, 연령대별로는 활동성이 강한 연령층인 21$\~$30세 (6명 30$\%$), 31$\~$40세 (6명 30$\%$)의 순이었다. 결과: 상지골절이 12명(60$\%$)로 하지골절 8명(40$\%$)보다 많았다. 손상 부위별 빈도는 족관절부가 7례(35$\%$)로 가장 많았고, 전완부 4례(20$\%$), 수근부 4례(20$\%$), 주관절 3례(15$\%$), 대퇴부 1례(5%$\%$)의 순이었다. 족관절 골절 손상은 Lauge-Hansen 분류 상, 회외 -외회전 형이 4례로 가장 많았으며, 회외-외전 형이 2례, 회내-외회전 형이 1례였고, 전완부 골절손상과 수근부 골절 손상의 경우에는 요골 원위부 골절 3례, 요골-척골 골절 1례, 주상골 골절 2례, 중수골 골절 2례로 넘어질 때 손으로 짚으면서 발생한 골절의 양상이 많았다. 주관절 골절은 2례에서 과상부 골절이었고 1례에서는 외과 골절 이었다. 성장판 손상이 동반된 소아 골절 3례는 모두 Salt-Harris type II 였으며, 보존적 치료를 시행 하였다. 전체 골절 중 6례는 관절 내 골절 이었다. 동반 손상으로는 타박상이 8명 (42.11$\%$)으로 가장 많았고, 숙련도 별로는 인라인 스케이트를 시작한지 3개월 이내의 초보자들이 8명(40$\%$)으로 가장 많았고, 수상 형태로는 넘어짐과 같은 비접촉성 수상이 14명(70$\%$)으로 접촉성 수상(6명 30$\%$)보다 많았다. 11례 (55$\%$)가 수술적 치료를 받았으며, 9례(45$\%$)는 보존적 치료를 받았고, 추시 중에 특별한 합병증은 발생되지 않았다. 결론: 20$\~$30대의 젊은층의 초보자들에서 족관절부의 골절 손상이 가장 많았으므로, 이에 대한 주의가 필요할 것으로 사료된다 Purpose: The purpose of this study is to investigate the incidence and patterns of fractures occurred in Inline skating accident. Materials and Method: We evaluated 20 patients, 20 cases(from september 2002 to August 2003) with fractures occurred during Inline skating. The incidence, sex, age, fracture site, associated injuries, causes of Inline skating injuries were analysed. The cases were male in 18(90$\%$), and female in 2(10$\%$). The most common distribution of age was in twenties and thirties. Result: The patients(12cases 60$\%$) with upper extremity fracture were more common than patients(8cases 40$\%$) with lower extremity fracture. Patients who had fracture in ankle were 35$\%$(7cases), forearm 20$\%$(4cases), wrist 20$\%$(4cases), elbow 15$\%$(3cases), thigh 5$\%$(1cases). According to the The Lauge-Hansen classification in ankle fractures there were four patients of supination-external rotation type, two patients of supination-abduction type, and 1 patient of pronation-external rotation type. In forearm and hand fractures, there were three distal radius fractures, one radio-ulnar shaft fracture, 2 scaphoid fractures, and two meta-carpal fractures. In elbow fractures, there were two supracondyle fractures, and one lateral condyle fracture. There were three epiphyseal plate injuries (Salt-Harris type II) in children, and all of them were treated by conservative method. Six fractures were intra-articular fractures. The most common associated injury was contusion(8cases 42.1$\%$). The number of patients who only rode Inline skating less than 3months(8cases 40$\%$) was the greatest. The number of non-contact injury(14cases, 70$\%$) in Inline skating was more than contact(6cases,30$\%$) injury. 11cases(55$\%$) had operative treatment, and 9cases(45$\%$) had conservative treatment, and there was not any complication. The more detailed study is required since the materials were only limited to fracture patients, and the follow up period was short. Conclusion: The most common age for fracture in Inline skating was in twenties, and thirties, and ankle was the most common fracture site.
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