Neurologic Recovery According to the Spinal Fracture Patterns by Denis Classification

박문수,문성환,양재호,이환모 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.3

Purpose: Although Denis classification is considered as one of most clinically useful schemes for the evaluation of spinal fracture, there is little documentation on the relationship between fracture pattern and the neurologic recovery. The purpose is to evaluate the correlation between the fracture patterns according to Denis classification and neurologic recovery. Materials and Methods: The 38 patients (26 men and 12 women) in this series had an average follow-up of 47.1 months, and they were all managed surgically. Denis classification had been used prospectively to determine the fracture morphology. Frankel Scale and American Spinal Injury Association Spinal Cord Injury Assessment Form [American Spinal Injury Association (ASIA) score] were obtained before surgery, after surgery and at the final follow-up. Results: The common injuries making neurologic deterioration were burst fracture and fracture-dislocation. The degree of neurologic deficits seen first and at the final follow-up was more severe in fracture-dislocation than burst fracture. The neurologic recovery was not different between burst fracture and fracture-dislocation, assessed by Frankel grading and ASIA scoring system. The neurologic recovery evaluated by ASIA score was not different between the lumbar and thoracic spinal fracture. The neurologic recovery assessed by Frankel grade was greater in the lumbar spinal fractures in than the thoracic spinal fractures. Conclusion: The severity of initial and the final follow-up neurologic deficits were correlated with the fracture patterns according to Denis classification, but the neurologic recovery was not correlated.

노령 환자에서 대퇴골 전자부 주위 골절에 대한 수술적 치료 시행 후 일상적인 기능적 회복지수

심대무 ( Dae Moo Shim ),김태균 ( Tae Kyun Kim ),김종윤 ( Jong Yun Kim ),최덕화 ( Duk Hwa Choi ),이정숙 ( Joung Suk Lee ),이성인 ( Seong In Lee ) 대한골절학회 2012 대한골절학회지 Vol.25 No.1

목적: 노령의 대퇴골 전자부 주위 골절의 대부분이 수술적 치료를 시행하는바, 이러한 수술적 치료 후 퇴원을 하여도 일상 생활 기능에 큰 영향을 받게 된다. 이에 본 연구에서는 65세 이상의 노령 인구에서 발생한 대퇴골 전자부 주위 골절에서 골절의 형태, 골절 위험 요인과 기능 회복의 정도를 평가하고 회복에 미치는 요인을 파악하고자 하였다. 대상 및 방법: 2006년 1월부터 2007년 12월까지 본원에서 대퇴골 전자부 주위 골절로 수술적 치료를 시행한 환자 중 만 65세 이상의 환자 총 121명에서 1년 이상 추시가 되었던 61명 중 면담 및 전화 설문에 응답한 50명을 대상으로 하였다. 나이, 성별, 수상 방법 및 대퇴골 전자부 주위 골절 종류, 수술을 확인하고 수술 전후 일상 생활 기능 회복 지수 평가표에 따라 100%를 기준으로 하여 점수가 높을수록 기능이 높다고 해석하고 수술 후 일상 생활 기능 회복 정도를 평가하였다. 결과: 평균 연령은 75.8세이었으며, 성별에서 여자가 31명 (62%)으로 남자보다 여자가 많았으며 수상 방법에서 골절의 원인으로 실족이 27명 (54%)으로 가장 많았다. 골절 형태 분석에서 대퇴 전자간부 골절이 34명 (68%)으로 많았으며, 수술 전에 비교하여 기능적 회복 지수는 평균 16.24% 감소하였고, 연령에 높을수록 기능적 회복 지수의 감소도 증가하였고 성별에서는 여성의 기능 회복지수가 높았으며 골절 양상에 따른 경우 대퇴 전자하부 골절에서 17.6% 감소를 가져왔다. 결론: 65세 이상의 고령 환자에서 대퇴골 전자부 주위 골절 수술 후 일상적인 기능 회복 지수는 수술 전에 비하여 평균 16.24% 감소하였으며 가장 많은 감소는 생활 능력 중 기본 생활 능력 회복의 감소였으며 나이는 증가할수록, 성별에서는 여성이, 골절 양상에서는 대퇴 전자하부 골절의 경우 기능적 회복 지수의 감소폭이 큰 것으로 조사되어 이들 요인이 기능 회복에 중요한 영향을 미칠 것으로 생각된다. Purpose: Although most peritrochanteric fractures in old age necessitates surgical treatment, daily life functions are still impaired after discharge. We assessed the types of peritrochanteric fracture, risk factors, and functional recovery in elderly patients who were over 65 years old. We also tried to determine factors for recovery to daily life. Materials and Methods: From January 2006 to December 2007, among 61 patients who were over 65 years old with the possibility of 1 year follow-up, 50 patients were selected through interviews. After verifying age, sex, mode, types of fracture, and method, we analyzed daily living activities with a functional recovery index and estimated recovery of daily life functions after surgery, assuming a score increase if functional recovery was good. Results: The mean age was 75.8 years, and females (31 patients, 62%) exceeded males. Slipping (27 patients, 54%) was the most common cause of fracture, and the intertrochanteric femur fracture was the most common fracture type (34, 68%). The average functional recovery index decreased 16.24% compared with the pre-operation value, having a tendency to decrease more in old age and female patients. Subtrochanteric femur fracture showed a 17.6% decrease in functional recovery index among the fracture types. Conclusion: In elderly patients over 65 years, the functional recovery index after peritrochanteric fracture decreased 16.24% on average compared with the preoperation state. The largest decrease was in basic life ability. The functional recovery index decreased more in old age, females, and subtrochanteric femur fracture, which indicates these factors influence functional recovery.

Prognostic Factors for Functional Recovery at 1-Year Following Fragility Hip Fractures

Nitchanant Kitcharanant,Pichitchai Atthakomol,Jiraporn Khorana,Phichayut Phinyo,Aasis Unnanuntana 대한정형외과학회 2024 Clinics in Orthopedic Surgery Vol.16 No.1

Background: The main objective of treating fragility hip fractures is to maximize the patients’ ability to return to their basic activities of daily living (ADL) levels. This study explored prognostic factors associated with the ability to recover pre-fracture ADL levels at 1 year after fragility hip fractures. Methods: We retrospectively recruited patients admitted with fragility hip fractures between July 2016 and September 2018. Details of the following were extracted from electronic medical records: age, sex, body mass index; pre-fracture Charlson Comorbidity Index (CCI), Barthel index, and EuroQol-Visual Analog Scale (EQ-VAS) scores; pre-fracture ambulatory status; and fracture type and treatment. The primary endpoint was the ability to return to the pre-fracture ADL status at 1 year. Multivariable logistic regression analysis assessed the prognostic ability of predictors. Results: Of 405 patients, 284 (70.1%) managed to return to their pre-fracture ADL status. Multivariable logistic regression analysis demonstrated that the predictor with the most apparent effect size was pre-fracture EQ-VAS scores ≥ 65 (multivariable odds ratio [mOR], 12.90; p = 0.03). Other influential predictors were CCI scores < 5 (mOR, 1.96; p = 0.01) and surgical treatment for the hip fracture. Conclusions: Three prognostic factors can predict a hip fracture patient’s ability to return to the pre-fracture ambulatory status at 1 year. They are the patient’s CCI score, operative treatment for the hip fracture, and the pre-fracture EQ-VAS score. This information could be used to develop a clinical prediction model based on the prognostic factors.

Prognostic Factors Predicting Early Recovery of Pre-fracture Functional Mobility in Elderly Patients With Hip Fracture

Dae Gu Lee,Jae Yong Jo,Ji Sun Jung,김상준 대한재활의학회 2014 Annals of Rehabilitation Medicine Vol.38 No.6

Objective To investigate the prognostic factors predicting the recovery of pre-fracture functional mobility, we evaluated this by the use of ambulatory assistive devices in short-term follow-up.Methods Five hundred and fifty-three elderly patients who had undergone hip fracture operations from January 2006 to June 2013 were enrolled in this retrospective study. Clinical characteristics and predicted factors affecting functional recovery, such as the delay of rehabilitation after the operation, were reviewed. The functional status of the gait was classified as either a bedridden state, wheelchair-bound state, walker gait, single cane gait, and self-gait without any ambulatory assistance device. When this functional grade in patients who recovered after the surgery was compared to before the surgery, this state was considered ‘functional recovery’.Results One hundred and ninety-two patients (34.7%) showed recovery of preoperative mobility in the first month after their operation. Multiple logistic regression analysis identified that the following four factors were significantly associated with a deterioration of functional recovery: old age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92–0.97), delays in rehabilitation after operation (OR, 0.94; 95% CI, 0.89–0.98), the presence of cognitive dysfunction (OR, 0.36; 95% CI, 0.18–0.71), and trochanteric fracturing (OR, 0.58; 95% CI, 0.36–0.94).Conclusion We found that old age, cognitive dysfunction, trochanteric fracture type, and delay of rehabilitation were associated with the deterioration of functional recovery after a hip fracture operation in the short-term. Therefore, early rehabilitation was required to acquire functional recovery after a hip fracture operation in the short-term.

하악 과두 골절 환자에서 Lag Screw를 이용한 치료시 예후에 관한 임상적 연구

민승기,이동근,배진오,양희창 大韓顎顔面成形再建外科學會 1997 Maxillofacial Plastic Reconstructive Surgery Vol.19 No.2

Treatment of condylar fracture is still controversial, but the indication of surgical mangement is increased due to improved fixation methods and surgical techniques. In this article, we report our clinical and radiological results with the use of lag screw osteosyn-thesis for fixation of fractured mandibular condyle. 12 case of condyle fracture treated by open reduction and fixation with lag screw were monitored for an average of 10 months (range from 6 months to 19 months) postoperatively. The obtained results are as follows : 1. Postoperative maximum mouth opening is achieved over 40mm except one patient. 2. Although slight crepitus and deviation of mandible during mouth opening were found, Tempo-romandibular joint problem is satisfactory in all but one patient. 3. Distal migration of screw and resorption of fractured fragment were found in each 2 patients, but good functional recovery was achieved in all. According to the above results, we think that lag screw osteosynthesis is relatively indicated in level III or IV condylar fracture.

Long-core experimental study of different displacement modes on fractured-vuggy carbonate reservoirs

Wenfang Li,Jiang Chen,Xiqun Tan,Ping Liu,Yun Li,Limin Wang 한국자원공학회 2018 Geosystem engineering Vol.21 No.2

It is difficult to utilize real fractured–vuggy carbonate cores to conduct long-core displacement experiments due to the special structures of fractured and vuggy. Aiming to not affect the porosity and permeability of the original core structure, a special filling method on the sunken space of the core surface was created to meet the requirements of long-core experiments. Long-core experiments of depletion drive, water flooding, gas drive, and water alternating gas (WAG) drive were performed to simulate the actual conditions of one-dimension oil reservoir and systematically study the influence of different development approaches on the recovery of vuggy carbonate reservoirs. Results show that the optimal conversion pressure of water flooding is between 80% bubble point and bubble point pressure. In the high-pressure and high water-cut stage, the development effect of gas–water alternative drive becomes significant, it can effectively reduce water cut and improve oil recovery. The most suitable and effective displacement mode is adopted depletion drive first and converts water flooding when the pressure decreases between 80% bubble point and bubble point pressure. When the water cut approximately reaches 80%, then WAG flooding is performed. The experiments provide data and technical support for the rational development of vuggy carbonate reservoirs.

Preoperative Vitamin D Deficiency is Associated with Postoperative Functional Recovery and Complications after Hip Fracture Surgery

임채문,노영호,Saeil Kim,남광우 대한골대사학회 2021 대한골대사학회지 Vol.28 No.4

Background: Low concentrations of vitamin D are considered one of the risk factors for hip fracture and are associated with worse outcomes. The purpose of this retrospective study was to compare vitamin D deficient group and vitamin D sufficient group and assess the association preoperative vitamin D deficiency and postoperative walking ability after hip fracture surgery. Methods: Between January 2014 and January 2020, 1,029 elderly patients with hip fracture (243 in men and 785 in women) were measured preoperative serum 25-hydroxy-vitamin D3 levels. Among 1,029 elderly patients, 702 patients were classified as Vitamin D deficient group (<20 ng/mL). Outcome parameters for functional recovery were the length of the hospital stay and KOVAL score, and those for complications were delirium, pneumonia, and thromboembolism. Results: The mean length of the hospital stay in the vitamin D deficient group was significantly longer than in the vitamin D sufficient group (27.7±17.8 vs. 2.9±11.8 days; odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05; P=0.001). The mean postoperative KOVAL score in the deficient group was significantly higher than in the sufficient group (4.0±2.1 vs. 3.1±1.9 days; OR, 1.21; 95% CI, 1.11-1.32; P=0.001). Vitamin D deficiency was significantly associated with a higher risk of delirium and pneumonia in deficiency group. Conclusions: Preoperative vitamin D deficiency in hip fractures patients was associated with prolonged duration of hospital stay and decrease of postoperative ambulatory status, and may increase the risk of delirium and pneumonia. Therefore, it is necessary to evaluate the preoperative vitamin D level and recommend vitamin D supplementation in elderly patients with a high probability of hip fracture.

Rehabilitation after ankle fracture fixation

Jeong Gyu Choi,Moon Su Park,정비오 대한정형외과 스포츠의학회 2021 Arthroscopy and Orthopedic Sports Medicine Vol.8 No.2

Ankle fractures are one of the most common lower limb injuries, and the prevalence of ankle fractures has been increasing. In most cases, open reduction and internal fixation is the preferred treatment, and the postoperative prognosis is good. The range of motion and weight bearing of the joint are restricted for a certain period. If the ankle joint continues to be fixed for a long time, joint stiffness, pain, and/or loss of muscle may occur. Early weight bearing, joint movement, and muscle strengthening exercises can help prevent complications following fixation and return to daily life. However, there is controversy regarding the timing and duration of weight bearing because there is a risk of loss of reduction, nonunion, and infection of the surgical site wounds due to early rehabilitation. Patients agree with the importance of postoperative rehabilitation exercises based on their return to daily and leisure activities. In this article, we review the latest findings on the proper timing of joint motion, joint motion angle, weight bearing, and exercise protocols after surgery for treating ankle fractures.

분말야금법으로 제작한 NiAl합금의 기계적성질 및 형상기억특성

한창석,진성윤,권혁구,Han, Chang-Suk,Jin, Sung-Yooun,Kwon, Hyuk-Ku 한국재료학회 2020 한국재료학회지 Vol.30 No.5

The composition of martensite transformation in NiAl alloy is determined using pure nickel and aluminum powder by vacuum hot press powder metallurgy, which is a composition of martensitic transformation, and the characteristics of martensitic transformation and microstructure of sintered NiAl alloys are investigated. The produced sintered alloys are presintered and hot pressed in vacuum; after homogenizing heat treatment at 1,273 K for 86.4 ks, they are water-cooled to produce NiAl sintered alloys having relative density of 99 % or more. As a result of observations of the microstructure of the sintered NiAl alloy specimens quenched in ice water after homogenization treatment at 1,273 K, it is found that specimens of all compositions consisted of two phases and voids. In addition, it is found that martensite transformation did not occur because surface fluctuation shapes did not appear inside the crystal grains with quenching at 1,273 K. As a result of examining the relationship between the density and composition after martensitic transformation of the sintered alloys, the density after transformation is found to have increased by about 1 % compared to before the transformation. As a result of examining the relationship between the hardness (Hv) at room temperature and the composition of the matrix phase and the martensite phase, the hardness of the martensite phase is found to be smaller than that of the matrix phase. As a result of examining the relationship between the temperature at which the shape recovery is completed by heating and the composition, the shape recovery temperature is found to decrease almost linearly as the Al concentration increases, and the gradient is about -160 K/at% Al. After quenching the sintered NiAl alloys of the 37 at%Al into martensite, specimens fractured by three-point bending at room temperature are observed by SEM and, as a result, some grain boundary fractures are observed on the fracture surface, and mainly intergranular cleavage fractures.

인공수압파쇄 적용을 위한 울릉도 화산암류 저류특성 평가

김만일 ( Man Il Kim ),장광수 ( Kwang Soo Chang ),석희준 ( Hee Jun Suk ),김형수 ( Hyoung Soo Kim ) 대한지질공학회 2006 지질공학 Vol.16 No.2

대수층 저류 특성을 이용하는 대수층 저장 및 회수(ASR) 기술의 현장 적용성 평가를 위해 화산암 지대인 울릉도 내에 다공성 매질인 부석층으로 이루어진 대수층을 대상으로 양수시험 및 인공수압파쇄시험을 실시하였다. 공내TV검층에서 확인된 GL-13 m와 GL-21 m의 주파쇄대 구간에서 수압파쇄실험을 각각 실시하였고, 또한 수압파쇄 전과 후로 나누어 양수시험을 수행하였다. 사전/사후 양수시험 결과, 충적층이 위치한 GL-13 m 하부에서는 수리적 연결성을 확인할 수 있었으나, 암반층 구간인 GL-21 m 하부에서는 파쇄대의 연결 상태가 다소 불량한 것으로 판단된다. 현장시험 결과를 종합해 보면, 조사지역내 인공함양 적용은 불리한 조건을 가지는 것으로 판단되나, 현장 실험이 특정한 지역에서 이루어져 있기 때문에 울릉도 전반적인 지역 내에 ASR 적용성 평가를 대표할 수 없다. 따라서 울릉도내 전반적인 ASR 적용성 평가를 위해서는 보다 광역적인 실험이 수행되어야 할 것으로 판단된다. In order to establish the in-situ application of the artificial storage and recovery (ASR) technology which is used the property of the aquifer storage of groundwater. We carried out to the in-situ experiments such as borehole TV logging, pumping test and artificial hydraulic fracturing in volcanic island, Ulleungdo. In-situ experiments were conducted to divide the before- and after-hydraulic fracturing. Pumping test was achieved to confirm the two fracture zones, GL-13m and GL-21m, which are determined by the borehole TV logging. From the results of the before- and after-pumping tests, the hydraulic connectivity was confirmed to locate at GL-13m in the residual deposit zone of pumice media as alluvium. However, in the bedrock zone at GL-21m the hydraulic connectivity could be considered to faulty. Consequently, in this study area the artificial recharge has a little unsatisfied to geostructural condition and desired to more detail investigation works.