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김재형,인주철,김풍택,오창욱,박일형,김신윤 대한골절학회 1997 대한골절학회지 Vol.10 No.1
The significant risk to life associated with the hip fracture has long been recognized, and the reports of poor prognosis are well known with wide range of mortality rates. We retrospectively studied 164 patients(older than 60 years) who had a hip fracture to determine the effects of the age, treatment methods, pre-existing medical condition, operative delay after injury, type of fracture, and others on patient mortality. The summarized results were as follows; l. One hundred twenty three patients survived and forty one patients died (overall mortality rate; 25.0 %). 2. Twenty one patients died within one year (one-year mortality rate; 12.8 %). 3. Mortality was related to age of patient at injury, ASA classification, absense or presence of operative treatment. operation-related complication, which were statistically significant (P $lt; 0.05). 4. The operative delay after injury did not influence mortality, but we think that it is not statistically because this study was done retrospectively.
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저온열 자가골 처리시 골내부로의 열전달에 관한 실험적 연구
인주철,박일형,김신윤,김신근 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.1
목적 : 사지골에 악성종양이 발생하였를 때 절단하지 않고 사지구제술이 많이 적용되고 있는바, 이중한 방법으로 이완된 골을 광범위 절제후 열처리하여 재삽입하는 방법이 이용되고 있다. 이는 종양세포를 기사 시키면서 골의 강도를 유지해야 하며 가능한한 낮은 온도에서 열처리하는 것이 골의 강도를 유지할수 있는 좋은 방법이다. 이에 저자들은 저온 열처리시에 주로 이용되는 60℃, 80℃ 및 100℃ 조건에서 어느 정도 시간이 경과하면 골 내부까지 충분히 열이 전달 되는지를 측정하기 위해 본 연구를 시행하였다. 대상 및 방법 : 인체골과 유사한 돼지경골 및 대퇴골에서 중심부위(가장 온도가 천천히 올라가는 부위)를 찾아내고 이것을 기준으로 인체의 근위경골 3개와 원위 대퇴골 2개에 중심부위까지 열감지기를 삽입후 60℃, 80℃ 및 100℃의 항온조에 침잠시켜 상온인 25℃에서 종양의 불활성 온도인 43℃까지 상승하는데 걸리는 시간을 측정하였다. 결과 : 1. 60℃에서 골의 중심온도가 25℃에서 종양괴사 온도로 알려진 43℃에 이르는 시간은 원위 대퇴골에서 470초, 근위경골에서 610초가 소요되었고, 80℃에서는 원위 대퇴골에서 280초가 근위경골에서 380초가 소요되었다. 2. 근위경골이 원위대퇴골 보다 열전달이 지연되었다. 3. 골중심온도(core temperature)가 외부 식염수온도와 같아지는 데는 식염수의 온도와 큰 상관없이 30분이상 소요되었다. 4. 골형성골육종이 있는 골에서는 열전달 속도가 정상골 보다 지연되었다. 결론 : 대부분 80℃ 정도에서 10∼15분 정도 자가소독해서 사지구제술에 이용하고 있지만 본 실험에서는 경골 근위부에서 60℃에서 610±180초, 80℃에서는 380±180초 동안 뼈를 가열하면 골괴사를 시킬 수 있는 시간임을 알아내었고 임상에서 인체골 조직을 자가소독해서 적용할 때 이에 대한 지표로 사용할 수 있다고 사료되었다. In countries where Confucianism is popular, it is extremely hard to get fresh cadaver bone for allograft. Therefore in Korea, the reimplantation of resected autoclaved autogenous bone segments has been increasingly performed for limb reconstruction of extremities with malignancies. To preserve the bone morphogenetic protein and mechanical strength of heated bone, many studies have reported that pasteurization of bone is far better than autoclaving over 100℃- Based on this assumption, replacement with a pasteruized autogenous bone graft after resection of a malignant bone tumor was deemed feasible for reconstruction. However, little is known about how high a temperature and how much time for pasteurization is needed to make tumors completely necrotic and to maintatin the mechanical strength of bone. Consequently, experimental studies were carried out to test heat conductivity of human bone and torsional strength of porcine tibia after pasteurization. Two pairs of human proximal tibia and distal femur were used. We used T-type thermocouples to check core temperature of the bone and a computerized data acquisition system to record results. Without reaming of the medullary cavity, in a 60℃-thermostatic saline tub, it took 32 minutes and 50 seconds to raise the core temperature of human proximal tibia from 20℃ to 58℃, and 30 minutes for distal femur. In a 80℃ saline tub, it took 12 minutes and 50 seconds for proximal tibia, and 11 minutes and 10 seconds for distal femur. In contrast, using procine tibia whose cortical thickness is similar to that of human tibia, after reaming of the medullary canal, it took less than 3 minutes and 30 seconds in a 60℃ saline tub, less than 1 minute and 45 seconds in a 70℃ tub, and less than 1 minute in a 80℃ tub to elevate core temperature from 20℃ to 58℃.
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안형수,박병철,인주철,김신윤 대한골절학회 1994 대한골절학회지 Vol.7 No.2
Surgical fixation, early weight bearing and bony union remain a challange in the treatment of intertrochanteric femur fractures, especially if the fractures are comminuted or unstable. We have experienced 18 cases of intertrochanteric femur fracture that were treated using Asian Gamma nails(Gamma AP ) in Kyungpook National University Hospital in period from Feb. 1993 to Oct. 1993. Early full weight bearing was encouraged and this seemed to be beneficial for old patients. All fractures were healed securely and many patients(15/18) could be painless ambulatory regardless of fracture configuration(9 fractures classified as unstablej. Major complications included screw cut-out(2 cases), lateral cortical fracture(1 cases) and delayed union(1 case). In this early experience, the Gamma nail appears to be useful internal fixator for intertrochanteric femur fractures and it allows early ambulation regardless of the fracture configuration with excellent clinical results.
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인주철,김풍택,양동렬,김신윤 대한골절학회 1994 대한골절학회지 Vol.7 No.2
We analyzed Twenty eight cases of femoral head fracture associated with posterior hip dislocation managed in Kyungpook National University Hospital between 1984 march and 1993 June. Classification was made by Pipkin and we added impaction fracture as another classification by post reduction CT finding. The results were as follows 1. Most common type of fracture was impaction of femoral head by CT, Which is not included by pipkin classification. 2. Excellent, or Good result according to Epstein criteria, 7 of 8 cases in Pipkin type [, 1 of 3 cases in type II, 0 of 4 cases in type 0, 1 of 4 cases in type N, 6 of 9 cases in impaction fracture. 3. There were no significant difference between the results of operative treatment and conservative treatment. 4. Post reduction CT was useful to determine the method of the further treatment. 5. Complications were avascular necrosis in 5 cases, posttrumatic arthritis in 3 cases, sciatic nerve paresis in 2 cases, heterotropic ossification in 1 case.
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