증례 : 감염; 패혈증 비브리오균에 의한 위장관염에 이은 급성 화농성 척추염 1예

옥혜성 ( Hea Sung Ok ),김병기 ( Byeong Ki Kim ),김기훈 ( Ki Hoon Kim ),박만제 ( Man Je Park ),이현수 ( Hyoun Soo Lee ),위유미 ( Yu Mi Wi ),강철인 ( Cheol In Kang ) 대한내과학회 2014 대한내과학회지 Vol.86 No.4

본 저자들은 문헌에 보고된 바가 없는 패혈증 비브리오균에의한 위장관염에 이은 급성 화농성 척추염을 경험하였기에문헌고찰과 함께 보고하는 바이다. Vibrio vulnificus is a halophilic gram-negative bacillus capable of causing severe to life-threatening infections in high-risk populations. Osteomyelitis caused by V. vulnificus is extremely rare, and a previously reported case had been associated with an adjacent soft-tissue infection. Herein we report the first case of vertebral osteomyelitis resulting from hematogenous spread of V. vulnificus gastroenteritis. The patient was successfully treated with a combination of cefotaxime and ciprofloxacin. (Korean J Med2014;86:519-522)

족근-중족 관절 골절탈구

윤형구(Hyung-Ku Yoon),오국환(Kook-Hwan Oh),강경훈(Kyung-Hun Kang),김진일(Jin-Il Kim),박만제(Man-Je Park) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.3

상완골 근위부 골절의 치료 결과

박만제,성병년,이승기,이택건,신상렬,김형수 대한골절학회 2002 대한골절학회지 Vol.15 No.2

목 적 : 수술적 방법 및 보존적 방법 으로 치료한 상완골 근위부 골절에서 견관절의 해부학적 정복 및 기능적 회복 정도와 치료 방법에 따른 결과의 차이를 알아 보고자 하였다. 대상 및 방법 : 12개월 이상 추시 된 42예를 보존적 치료군(1군, 20예), 도수정복후 Rush pin 또는 경피적 핀 삽입군(2군, 11예), 근위 골수강내 교합정 고정군(3군, 11예)으로 나누었다. 기능적 평가 에는 설문지를 이용한 modified neer 방법을 이용하였고 방사선 사진상 경간각을 이용한 Paavolainen 방법으로 해부학적 정복 정도를 분석 하였다.각 군의 결과를 비교한 통계 처리는 Generalized Liner Model을 이용한 분산분석과 Fisher's exact test을 이용하였다. 결 과 : 방사선사진에 의한 해부학적 정복정도의 결과는 3군에서 가장 우수하였다.(p<0.05). 골 유합 시기는 평균 10.33 주였다. 기능 점수 또한 3군에서 가장 높았으며 합병증도 9례 에서 발견되었는데 3군에는 1례만 존재하였다. 전체적 결과에서 3군이 다른군과 비교하여 우수한 결과를 보였다. 결 론 : 근위 골수강내 교합정 고정술은 전위형 상완골 근위부 골절에서 여러방향 으로 고정 나사의 삽입이 가능하여 골편의 정복이 용이하므로 해부학적 정복 정도가 다른 방법에 비해 좋고(p<0.05) 합병증을 최소화하면서 조기 재활 및 골 유합에 충분한 고정력을 얻을 수 있는 좋은 방법으로 사료 된다. Purpose : To evalute the anatomical and functional outcome after treatment for proximal humerus fracture according to surgical and conservative treatment and assess the final results according to treatment methods. Materials and Methods : Forty-two cases with follow-up over 12 months were divided into three groups: conservative treatment (Group 1, 20 cases), closed reduction with Rush or percutaneous pin fixation (Group 2, 11 cases), proximal intramedullary interlocking nailing(Group 3, 11 cases). The functional outcome was obtained by modified neer method using self-assessed score paper and the anatomical outcome was obtained by paavolainen method using radiologic film score. Statistics in comparing with the result of each group was analized by variance analysis using Generalized Liner Model and Fisher?s exact test. Result : Anatomical reduction was best obtained in group 3 (p< 0.05) and mean duration of bone union was 10.33 weeks. Functional score was also best obtained in group 3 (p<0.05). Complication was noted in 9 cases. There was only 1 case in group 3. In studing of overall outcome, the group 3 has good result than other groups. Conclusion : Proximal intramedullary interlocking nailing in displaced proximal humerus fracture can be demonstrated as better method for anatomical reduction(p<0.05) than other methods because it can make insertion of locking screw ease with multiple direction for anatomical reduction and can provides a sufficient fixation for early rehabilitation and union , while minimizing complication.

Modified Extended Iliofemoral 도달법에 의한 복합비구 골절의 치료

박만제 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Purpose: To assess the results of reduction and complication of modified extended iliofemoral approach recommended by Reinert in complex acetabular fracture. Materials and Methods: Ten cases with follow-up over 12 months had open reduction and internal fixation of a complex aetabular fracture using this surgical approach and evaluated the anatomic reconstruction as well approach-related mobidity and complications. Treatment result was analyzed by Harris's hip scoring system and Matta's reontgenographic grading system. Result: Eight cases produced a satisfactory reduction of fracture(3㎜ or less displacement ). Clinical result were satisfactory in 9 cases according to Harris's hip scoring system. The complications were superficial wound infection in 1 case, marginal skin necrosis 1 case, heterotopic ossification 1 case. There were no deep infection and funtionally significant heterotopic ossification. Conclusion: Anatomical reduction and firm fixation is essential for good result and modified extended iliofemoral approach is one of the good methods for surgical exposure of complex acetabular fracture.

요추 질환에 대한 경추간공 후방 추체간 유합술의 치료 결과

박만제 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Purpose : To evalute the clinical and radiological result treated by transforaminal lumbar interbody fusion(TLIF) and transpedicular instrumentarion for lumbar disease. Materials and Methods : Twenty-seven cases with follow-up over 12 months were analyzed retrospectively. Etiologic conditions were lumbar stenosis in 15 cases, failed back surgery syndrom in 7 cases, spondylolithesis in 3 cases, lumbar disc with instability in 2 cases. Data regarding blood loss, operative time were recorded. Clinical result was analyzed by Kim's criteria. Radiologic evaluation containing the bone union and intervertebral space height was assessed by simple X-ray. Result : The satisfactory clinical result rate was 86%. Postoperative fusion states were bone union in situ 28 level, delayed union in 3 level, Disc height was changed from 10.6mm preoperatively to 13.1mm postoperatively and remained 12.2mm at the latest follow-up. The average blood loss was 480ml. The average operation time was 185 min. Postoperative complications were dural laceration and wound infection. There were no nonunion, instrument breakage and nerve palsy. Conclusion : Transforaminal lumbar interbody fusion(TLIF) and transpedicular instrumentarion for lumbar disease showed excellent clinical and radiological result. TLIF also provide elimination of the need for prolonged retraction of the dura and conus medullaris and maintenance of the normal muscular attachments, but long-term clinical outcomes studies are necessary to address issues concerning the clinical effectiveness of these procedures.

비 확공성 골수강내 교합정을 이용한 경골 간부 골절의 치료

전호승,윤형구,전광표,정대은,박만제 대한골절학회 1996 대한골절학회지 Vol.9 No.2

Recently intramedullary nailing has become the most common method treating tibial fractures. Reamed intramedullary nailing technique leaves the problem of destroying thc endosteal blood supply, which associated with delayed union and postoperative infection. Recent reports have shown excellent rate of union and low rate of infection with unreamed interlocking intramedullary nail. Author reviewed 58 cases of tibia shall fractures that were treated with unreamed interlocking nail from Feb. 1992 to Feb. 1994. I. Forty nine fractures were closed and 9 were open (Gustilo-Andersonl;3,II;5, IIIa;1). Thirty one fractures involved the distal portion, 19 fractures the middle portion, 6 fractures the proximal portion and 2 fractures were segmental. 2. Thirty six cases were male and 22 were female. The most common age was 3rd decade (25.8%). 3. The most common cause was traffic accident. 4. Average interval from injury to operation were 5.7 days in closed fracture and 11.3 days in open fracture. 5. The mean duration of hone union were 15.7 weeks in closed fracture and 19.5 weeks in open fracture. 6. Complications include I case of delayed union, I case of joint stifmess and 1 case of screw failure. 7. According to the functional results by Klemm and Borner, 42 cases were excellent, 15 cases were good and 1 was fair.