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복부 둔상에 의한 장간막 손상 환자의 평가에서 복부단층촬영의 가치
노기철 ( Ki Cheul Noh ),김진주 ( Jin Joo Kim ),정진호 ( Jin Ho Jung ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Keun Lee ),진욱 ( Uk Jin ),박철희 ( Cheul Hee Park ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Contrast-enhanced Abdominopelvic Computed Tomography(CT) is widely used for diagnosing abdominal injuries after blunt trauma. The purpose of this retrospective study is to classify the contrast-enhanced Abdominopelvic CT finding of mesenteric injuries after blunt abdominal trauma and assess of CT finding on clinical management. Methods: Between January 2000 and December 2003, 607 consecutive spiral abdomonopelvic CT examinations were performed in the ER of Gil medical center after blunt abdominal trauma. CT represented mesenteric injuries : bowel wall thickening or hematoma, mesenteric haziness or fatty infiltration, confined fluid or hematoma within mesenteric folds. We classified patients into 5 Grade by the hematoma size on CT scans : Grade I(None, 0 mm), II(Minimal, ≤10 mm), III(Small, 11~30mm), IV(Moderate, 31~60 mm), V(Large, ≥61 mm). Results: On the basis of the CT findings, 42 of the 607 patients were selected. 18 (42.9%) of 42 patients were classified as having grade I, II, III (≤30 mm) and 24 (57.1%) of 42 patients as having grade IV, V(≥31 mm). Of the 18 patients with grade I, II, III, 16(88.9%) were managed conservatively, while 2(11.1%) underwent surgery. of the 24 patients with grade IV, V injuries, 20(83.3%) were treated surgically and 4(16.7%) patients were managed conservatively. Conclusions: It is sufficient to treat of grade I, II, III mesenteric injuries by conservative management. It should be considered emergency operation to treatment of grade IV, V mesenteric injuries. (p<0.001) There were no relations between grading and initial systolic blood pressure, initial blood pressure and operation.
김용인 ( Yong In Kim ),노기철 ( Ki Cheul Noh ),강영준 ( Young Joon Kang ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Jun Yang ),이근 ( Gun Lee ),진욱 ( Wook Jin ),황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.