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정형외과 영역에서 이물질의 진단 및 치료에 대한 임상적 고찰
김용욱,신몽룡,안응선 인제대학교 1992 仁濟醫學 Vol.13 No.4
정형외과 영역에서 흔히 볼수 있는 이물질로서는 유리, 바늘, 연필심, 가시 등이 있으며 빈도가 높은 관계로, 상대적으로 소홀히 취급하므로서 그 진단과 치료에 있어 불만족 스럽거나, 예기치 못한 합병증이 생기기도 한다. 이런 불만족스러운 결과나, 예기치 못한 합병증을 방지하기 위해서 이물질 손상을 받은 환자의 진단과 치료에 있어 유의할 점에 대해 보고하고자 한다. We clinically analyzed 45 patients who were injured by foreign bodies between Auguest 1989 and January 1992, and the following results were obtained. 1.History taking must be done carefully and roentgenographic finding have to be observed carefully for identification of foreign bodies. 2.Ultrasonogram and C-T scan are useful for diagnosis of foreign bodies. 3.Foreign bodies have to be excised rapidly with complete debridement, and image-intensifier is useful for removal of foreign bodies.. 4.Associated injuries should he observed carefully in removal of foreign bodies.
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고한석,김병직,신몽룡 인제대학교 1993 仁濟醫學 Vol.14 No.1
1981년 1월부터 1991년 12월까지 6년 동안 하지 장관골 불유합 85례를 분석하여 불유합을 잘 일으키는 원인을 찾아서 올바른 치료방법의 지침을 얻고자 본 연구를 시작하였다. Recent therapeutic concept categorizes the nonunion of long bone fractures into three types according to the osteogenic potential of fractured bone ends. In the first type the bone ends no longer have osteogenic power, in the second one the bone ends have only limited power to unite, and in the third one unstable internal or external fixation does not allow bone union even though the bone ends have excellent ability to unite. Each type of nonunion can be managed by removal of the nonosteogenic sites, bone grafts, and stable fixations respectively. We applied the concept to the analysis of 85 cases of the noununion of the lower limb long bones, which were experienced at Seoul Paik Hospital from January 1986 to December 1991, to elucidate the causal relationship of the nonunion with types of injury, morphological features of fracture, types of instrument used. vascularity of fracture sites and other possible etiologic factors. The results of the analysis showed that the high energy injury, open and comminuted fracture, hypovascularity, and instrumentation with plate and screws were strongly associated with the nonunion. Metal failures were usually caused by the avascular nonunion and the plates were usually broken through the empty hole near fracture site. The results suggested that 1) intramedullary nailing is preferable to plating for the treatment of long bone shaft fracture, 2) caution should be paid to ensure adequate blood circulation when plate is used, 3) bone graft should be performed immediately when avascular bone fragments of gap exist, 4) close proximities of bone ends should be maintained when there are no comminuted bone fragments.
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Ilizarov 치료의 임상적 연구 : 1차 보고 The Preliminary Reports
서광윤,권칠수,김용욱,김형수,신몽룡 인제대학교 1992 仁濟醫學 Vol.13 No.4
The Ilizarov external fixator, though developed in the Soviet Union over 35 years ago, is now gaining popularity in the world. Its design and versatility allow the physician to treat a wilder range of limb diseases than any other external fixation system. The Ilizarov method of fixation also permits the treatment of some dwarfism that were previously considered to be untreatable, difficult and have many problems. The device can be used to correct limb length disorepancies, manage open and closed fractures, nonunion, and bony or soft tissue deformities. Since 1989, we have applied the Ilizarov external fixator for the treatment of the limb length discrepancies, fractures, nonunions, malunions and other formities. We have had the good clinical progresses and results so far. We report the early results of the Ilizarov treatments of 50 cases.
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김용욱,서광윤,김진혁,신몽룡 대한골절학회 1991 대한골절학회지 Vol.4 No.1
The authers report a clinical experience of 7 cases having fracture of the lower extremity associated with vascular injury from August 1989 to July 1990 in the Department of Orthopedic Surgery, In Je University Sang Gye Paik Hospital. We obtained the noticeable key point in the diagnosis and treatment of fracture of lower extremity associated with vascular injury. The result were as follows: 1. Orthopedic trauma rarely produces injuries requiring vascular surgical repair. This relative rarity is further complicated by the potentially subtle nature of vascular injury. 2. Displaced fractures of the distal femur and proximal tibia are associated with highest risk of concomitant vascular injury. 3. Doppler signals and even palpable pulses do not exclude vascular damage. 4. Amputation before life threatening sepsis develops is required for the extremities which were cadaveric foot at the initial examination, and had severe muscle crushing injury and bone loss.
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