개방성 분쇄 함몰 두개골절의 즉각 골편 복위술

조용준,김영옥,송준호,황장회,김성민,안명수,오세문,안무업,Cho, Yong Jun,Kim, Young Ock,Song, Joon Ho,Hwang, Jang Hoi,Kim, Sung Min,Ahn, Myung Soo,Oh, Sae Moon,Ahn, Moo Eob 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

Objective : The classic and accepted surgical method of compound comminuted depressed skull fractures (FCCD) involves total resection of all the contaminated bone and fragments at the fracture site. A second operation for cranioplasty is then performed at a later date. However, we have believed that primary repair of these bony defects can be achieved by the replacement of bone fragments at the time of the initial debridement, and this can be accomplished without danger to patient. The authors retrospectively reviewed the surgical results to assess the advantages and disadvantages, and also propose the selection criteria of replacement of fractured bone fragments as a primary procedure in FCCD. Materials and Methods : The authors analyzed the data extracted from medical records, and radiological findings in 22 of 71 patients with FCCD, who underwent immediate replacement of fractured bone fragments between April 1993 and October 1998. The mean follow-up period was 13.7 months. The selection criteria for the operation included the patients with mild to moderate severity, regardless of the degree of contamination or dural violation, which presented in hospital within 24 hours of injury. Results : The ages of the patients varied from 4 to 63 years, and there were 20 males and 2 females. Seventeen of 22 patients were fully conscious on admission and the others also had relatively good Glasgow coma scales. Sixteen fractures were located in the frontal area, 9 with involvement of the frontal sinuses, and 6 in the parietal and temporoparietal areas. Of the 22 patients, 8(36.3%) had dural lacerations with 3 of these requiring patching with pericranium, and 12(54.5%) had intracranial hematoma requiring wide craniotomy. The degree of wound contamination was also variable. Fifteen patients had relatively clean wounds, while seven(31.8%) had seriously contaminated wounds with soil, sand, hair, and wood. Only one patient(4.5%) developed infection, and the bone fragments were removed. All wounds healed primarily without pulsatile defect, the skull has remained solid, and no complications have occurred, except the infected case. Conclusion : It is proposed that bone fragments removal for FCCD, regardless of the degree of contamination or dural violation, is not necessary and that primary bone fragments replacement avoids a second operation for cranioplasty.

1999년 강원 동계 아시아 경기대회 의료지원 분석

송준호,황장회,안희철,송근정,최정태,신동훈,안무업,유기철,최영미,조용준 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. To determine the needs of medical service system for mass-gathering event. We analyzed the process of delivered medical care system and the types of medical problems of 1999 Winter Asian Games, thus we are able to provide the basic data for planning future events. Methods. We surveyed the organizing system of 1999 Winter Asian Game such as the operating system, medical goods, equipment, and overall patient status created at the medical room by retrospective chart review from 31st January to 6th February. Results. The medical rooms were operated at two athletic villages and six game grounds. The medical rooms of athletic villages were operated by doctors, nurses, pharmacists, and EMTs and the rooms at the game grounds were operated by a doctor and a nurse. The medical goods and equipments for minor patients were satisfied, but those for critical patients were not satisfied. Most of the patients visited the medical rooms had minor symptoms or musculoskeletal injuries. The symptom complex of the upper respiratory infection was the most commonly complained symptom(250 patients), followed by the gastrointestinal symptoms(200 patients) and musculoskeletal injuries(168 patients). However there was also a patient with acute myocardial infarction who required medically critical management including oxygen suppliment, EKG monitoring, and transfer to a specialized medical center. The oral medications(581 patients), bandages and dressings(35 patients), physical therapies(25 patients), eyedrops(23 patients), and injections(21 patients) were supplied to the patients. Conclusion. The organized medical care was mainly prepared by the administration. The management for minor patients was satisfied, but of the critical patients was not satisfied.

뇌실질내 스파르가눔증

조용준,황장회,안명수 한림대학교의료원 1994 人間科學 Vol.18 No.8

내고정술을 시행한 흉요추이행부 골절 환자의 수술결과

최재준,조용준,황장회,안명수 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

The thoracolumbar spine is frequently involved in spinal injuries. with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management. including surgery of that lesion. is very important and can determine the long-term outcome of the treatment. The authors analysed the surgical results of twenty-nine thoracolumbal spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December. 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression. the initial radiological findings. and the extent of reducibility of the fractures. Of twenty-nine patients. 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12cases). B was 11. and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(p<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbal fractures can improve neurological recovery and normalize anatomical deformities.

척추내 낭미충증

이종필,조용준,황장회,안명수 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.6

Cysticercosis in the humar, is caused by infestation by larvae of pork tapeworm, taenia solium. Although they may grow anywhere in the body such as the liver, lung, eyes, heart, muscle, ect, they are most commonly found in the brain and its coverings. The cysticercus vesicles have occasionally been found in spinal structures other than the brain. We present a case of spinal cysticercosis in a 63-year-old male. The patient presented with a marked paraparesis and paresthesia below a T10 dermatome level, and moderately decreased deep tendon reflexes. After performing total laminectomies at T11-12 & L3-5, 30 cysticercus vesicles were removed.

본태성 고혈압의 미세혈관 감압술

한정훈,조용준,황장회,안명수 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.3

Idiopathic arterial hypertension, termed "essential" or "neurogenic", is a common generalized cardiovascular syndrome comprised of a sequence of pathologic changes and accommodations. Although an extensive literature exists concerning that, the primary etiology has been unclear yet. However, Jannetta and coworkers have reported a possible etiological connection between essential hypertension and intraoperatively observed neurovascular compression of the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial verves on the left, recently. They have also introduced one of new therapeutical concept for essential hypertension by microvacular decompression(MVD) of offending vessels. Based on Jannetta and coworker's hypothesis the authors have made some operations for the control of hypertension. Seven essential hypertensive patients have been underwent retromastoid craniectomy and MVD in the left ventrolateral medulla between July 1992 and June 1993. Five of them showed multiple episodes of intracerebral hemorrhages, one was an intractable hypertension case and the other one had a left hemifacial spasm with essential hypertension. The most common offending vessel was the posterior inferior cerebellar artery and ti had been confirmed during operation. Postoperatively, in three cases, blood pressure was lowered to normal without medications. Of remaining four cases, blood pressure was significantly improved in one and slightly improved in three. There were no major complications in patients with surgery and no poor outcomes. These results indicate that the MVD for essential hypertension is relatively safe procedure and alternative choice as one of the management of intractable essential hypertension, repeated hypertensive intracerebral hemorrhages and left cranial nerve hyperfunction disorders combined with essential hypertension.

응급실로 내원한 소아학대 환자

최정태,안무업,송준호,안희철,황장회,조용준,유기철,신동훈,최영미,송근정 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. To develop the guidelines and the education models for primary agents caring for victims of child abuse, and investigate victims of child abuse visited the department of emergency medicine, College of Medicine, Hallym University, Choon-chun Sacred Heart Hospital. Methods. Survey assessed the age, sex, visiting time, offender, tools of maltreatment, types of maltreatment, and types of injury of 47 victims under 18 years old visited the emergency center, between the Jul. 1996 and the Aug. 1998. The injury severiy of victims of child abuse was compared with control group of 197 general violence victims visited the same emergency center at the same duration. Results. The age distribution was 12.8%(n=6) of the 0-1 year old, 17%(n=8) of the 1-3 years old, 8.5%(n=4) of the 4-6 years old, 12.8%(n=6) of the 7-12 years old, and 48.9%(n=23) of over the 13 years old, The sex distribution was 49%(n=23) of male and 51%(n=24) of female, The most common visiting time was 59.6%(n=28) of the 22-02 o'clock. The types of abuse were 46.6%(n=22) of the physical abuse, 27.7%(n=13) of the neglect, 17%(n=8) of the psychic abuse, and 8.5%(n=4) of the sexual abuse. The offender was 38%(n=18) of the parents, 26%(n=12) of the relatives, 4.3%(n=3) of the grandmothers, and 6.4%(n=3) of the nurses. The severity of injury was applied to the ISS(injury severity score). The severity of injury according to ISS was mean ISS=3.82±2.2 in the case of child abuse and mean ISS=1.86±1.6 in the case of general violence(P=0.000). Conclusion. Most victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals. Therefore the establishment of CAN(Child abuse and neglect) protocol and the organization of CAN team in the hospital consisted by department of emergency medicine, pediatrics, and psychiatrics is essential. Furthermore, the co-operation system with child welfare facilites and polices in community is needed.

하부 경추 병변에 대한 전방경유 골융합술 및 금속판 고정술

임춘수,조용준,안성기,황장회,안명수 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.1

가정불화로 인한 질환과 손상으로 응급센터에 내원한 환자

송근정,조용준,최영미,안무업,신동훈,황장회,최정태,안희철,송준호,유기철 대한응급의학회 2000 대한응급의학회지 Vol.11 No.1

Background. It is important for the medical providers who work in the emergency department to have the adequate knowledge about the nature and the ways to deal with the patients who suffer from domestic violence because in our country the management of them is primarily performed at the emergency centers. The purpose of this study is to provide basic data about the domestic violence and to help in developing the education and management model for the medical providers. Methods. The authors retrospectively reviewed the medical records of 198 patients who visited the emergency center of Chunchon Sacred Heart Hospital from July 1997 to August 1998. Results. The violence against the spouses was highest(108 cases:54.5%) and most of the victims were female(92%) in those cases. The violence against children younger than age 3 was 30%. The majority of the victims were arrived around noon(54.5%) and among them, the aged and children were more concentrated. The degree of injury was severer than that of the victims of general violence. Conclusion. In this study the violence against the spouses was the highest in incidence and against the aged was the lowest. The violence rate against children younger than age 3 was lower than that of other comparable studies. The incidence of sexual violence was significantly lower than that of other countries. The degree of injury was generally severer than that of general violence patients. But these result should be carefully criticized and accepted because up to now the system for the detection and management for them is not well established.

외상성 후두개와 경막외혈종

김성민,이종인,조용준,황형식,송준호,임대현,안무업,안명수,황장회 대한외상학회 2001 大韓外傷學會誌 Vol.14 No.1

Background: Extradural post-traumatic posterior fossa hematoma is a rare condition estimated to complicate about 0.3% of all craniocerebral injuries and represents 1.2% to 15% of the entire group of extradural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fetal if not promptly treated. The recommended treatment for a posterior fossa extradural hematoma is surgical evacuation soon after the diagnosis. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. Materials and Methods: In our study, a review of 52 cases with posterior fossa extradural hematomas among a total number of 367 patients with extradural hematoma is presented. In this series, 20 patients were treated conservatively (Group Ⅰ) while 32 required surgery (Group Ⅱ). We evaluated the common clinical manifestations, the treatment methods and results, the complications, and the outcomes. Hospital data were obtained from medical records and radiological data. The x2-test and the Fisher-test were used for statistics, and p<0.05 was taken as the measure of statistical significance. Result: Hematomas commonly occurred in the younger age groups and with a clear male predominance. The most common cause of injury was falls (40.3%). A fracture of the occipital bone was seen in 43 cases (82.7%). Thirty-three patients (63.4%) had other lesions of the brain, mainly cerebral contusions and subdural hematomas. Nineteen cases among Group Ⅰand 25 among Group Ⅱ(84.6% of total cases) showed excellent recovery, 2 patients had a severe disability, I patient was in a vegetative state, and 2 patients died (mortality rate of 3.8%). The significant factors related to outcome were the initial Glasgow coma scale, pupil response, brain stem compression signs, and cerebellar compression signs. Conclusion: The signs and the symptoms are usually nonspecific for an extradural post-traumatic posterior fossa hematoma. Because an early diagnosis is mandatory for a favorable outcome, an aggressive use of computed tomography scanning and careful physical neurological examinations for all patients should be carried out during the acute phase.