하악골 과두하부골절 정복술에서 관혈적 정복술과 비관혈적 정복술의 비교 연구

장주윤,강동희 대한두개안면성형외과학회 2008 Archives of Craniofacial Surgery Vol.9 No.2

Purpose: The choice of open versus closed reduction for mandibular subcondylar fracture is a debatable issue. To evaluate the advantage of open approach to closed method with IMF(intermaxillary fixation), we conducted a retrospective study to compare the outcomes of each method. Methods: From 2002 to 2006, 29 patients with mandibular subcondylar fractures were treated by open or closed reduction. 17 patients were treated by open reduction and 12 patients by closed reduction and IMF. Each group was assessed for duration of mandibular immobilization, incidences of buccal palsy, malocclusion, TMJ(temporomandibular joint) pain, and deviation of the mandible on mouth opening. Results: All cases showed accurate reduction in anatomical position, no significant displacement and no deviation on mouth opening during the follow-up period. IMF period is statistically shorter in open reduction (p<0.05). Differences in incidence of other complications were not significant statistically. Conclusion: As there are significant independent morbidities associated with IMF which requires postoperative rehabilitation, prolonged temporomandibular immobilization should not be overlooked. Some patients with poor compliances will not tolerate IMF in nonsurgical treatment. In the aspect of patient’s convenience and early recovery by short IMF period, open reduction would be recommended as a better treatment method.

Open versus closed treatment for extracapsular fracture of the mandibular condyle

Junyeong Lee(Junyeong Lee),Hee-Yeoung Jung(Hee-Yeoung Jung),Jaeyoung Ryu(Jaeyoung Ryu),Seunggon Jung(Seunggon Jung),Min-Suk Kook(Min-Suk Kook),Hong-Ju Park(Hong-Ju Park),Hee-Kyun Oh(Hee-Kyun Oh) 대한구강악안면외과학회 2022 대한구강악안면외과학회지 Vol.48 No.5

Objectives: Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and Methods: Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postop-erative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography. Results: A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the non-fractured sides during treatment. Conclusion: No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.

완전 전위된 소아 상완골 과상부 골절의 선택적 치료

오창욱 ( Chang Wug Oh ),박병철 ( Byung Chul Park ),김영우 ( Young Woo Kim ) 대한골절학회 2001 대한골절학회지 Vol.14 No.3

목적: 소아의 제 3형 상완골 과상부 골절을 비관혈적 정복 또는 관혈적 정복술을 시행하고 그 결과를 비교 분석하였다. 연구대상 및 방법: 1997년 1월부터 2000년 6월까지, 수술적 치료 및 K강선 고정술을 시행하고 최소 1년 이상 추시한 28례를 대상으로 하였으며 환자의 평균 나이는 6년 4개월(1년 9개월-11년 6개월)이었다. 손상의 형태는 전위 방향에 따라 후 내측형이 15례 후외측형이 13례 이었으며, 신경손상은 4례로 전골간 신경손상이 3례, 요골 신경 손상이 1례이었다. 치료의 선택은 비관혈적 정복술을 원칙으로 하였으나 마취후 정복이 얻어지지 않거나, 부종이 심하여 정복이 용이하지 않다고 생각되는 경우를 관혈적 정복의 적응증으로 하였고, 비관혈적 정복이 17례, 관혈적 정복이 11례 이었으며, K강선의 고정은 외측 평행 삽입법이 23례, 교차 삽입법이 5례 있었다. 결과의 평가는 건측과의 Baumann 각의 차이, 상완-척골각의 차이, 관절운동의 범위 등을 관찰하고, Flynn 등의 방법을 변형하여 평가하였다. 결과: 전례에서 골 유합을 얻었으며, 감염증 등의 연부조직 합병증은 없었고, 손상 받은 신경증상은 8주 이내에 회복되었다. Flynn 평가에서, 우수 11례, 양호 12례, 보통 2례, 불량 3례이었으며, 양호이상의 결과는 비관혈적 정복군이 14명(82.3%), 관혈적 정복군의 9명(81.6%)으로 비슷하였다. Baumann 각의 차이는 비관혈적 정복군이 8.7도, 관혈적 정복군이 6.6도 이었고, 상완-척골각의 차이는 비관혈적 정복군이 6.6도, 관혈적 정복군이 4.5도로 관혈적 정복군이 우수하였고, 관절운동의 제한은 양 군 모두에서 심한 제한을 보이는 예는 없었다. 관혈적 정복군에서 주관절 전방부의 반흔 구축 형성이 3례에서 발생하였으나, 관절기능에는 영향이 없었다. 결론: 완전 전위된 상완골 과상부 골절에서 관혈적 정복술의 선별적인 사용은 비관혈적 정복술과 같이 합병증이 작은 유익한 치료가 될 수 있다고 생각한다. Purpose: This retrospective study was performed to know the clinical results after closed reduction and open reduction for completely displaced supracondylar fractures of distal humerus in children. Materials and Methods: Twenty-eight cases of this injury at the mean age of 6.4 (range 21-138 months), have been followed up over the minimum of one year. The types according to the position of displacement were 15 in posteromedial, and 13 in posterolateral displacement. There were 4 cases of associated nerve palsies (3; median, 1; radial). We tried the closed reduction (17 cases), but open reduction (11 cases) was indicated in irreducible cases with or without severe swelling. Then, the fractures were stabilized by percutaneous K-wires with lateral (23 cases) or cross pinning (5 cases). The differences of Baumann`s angle, humero-ulnar angle, and elbow motion to uninjured side were calculated, and Flynn`s criteria was used for evaluation. Results: All fractures were united without any infection or soft tissue compromise. The symptoms of injured nerve recovered within 8 weeks. According to Flynn`s cirteria, results were excellent in eleven, good in 12, fair in 2, and poor in 3. The rates of satisfactory results over good were similiar between closed and open reduction, and the other factors including age and type of displacement were not meaningful. The mean Baumann`s angle was 8.7 in closed and 6.6 in open reduction group. None of the patients showed restricted elbow motion above 10 degrees, even in 3 cases of hypertrophic scars in the group of open reduction. Conclusion: The selective use of open reduction in completely displced supracondylar fractures of distal humerus in children, would show results as good as closed reduction.

제한적 관혈적 정복 및 교합성 골수내정 고정술을 이용한 대퇴골 근위 간부 골절의 치료

하상호 ( Sang Ho Ha ),이준영 ( Jun Young Lee ),이상홍 ( Sang Hong Lee ),조승환 ( Sung Hwan Jo ),유재철 ( Jae Cheul Yu ) 대한골절학회 2009 대한골절학회지 Vol.22 No.4

목적: 대퇴골 근위간부 골절의 치료 시 제한적 관혈적 정복 및 교합성 골수내정 고정술을 시행하고 그 결과에 대해 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2005년 12월까지 대퇴골 근위 간부 골절로 치료받고 최소 12개월 이상 추시가 가능하였던 환자 중 제한적 관혈적 정복 및 교합성 골수내정 고정술을 시행받은 환자 15예를 대상으로 하였다. 골절의 분류는 Winquist-Hansen 분류 및 OTA/AO 분류를 사용하였으며 임상적 및 방사선학적 결과를 분석하였다. 결과: 15예 중 13예에서 골유합을 얻었고 이 중 지연 유합이 2예에서 발생하였으며 골유합 기간은 평균 21.3주 (14~32주)였다. 술 후 감염은 발생하지 않았고 불유합은 2예에서 발생하였으며 1예에서는 골이식술 및 금속정 교체술을 시행하고, 1예에서는 골이식술 및 부가적 금속판 고정술을 시행하여 골유합을 얻었다. 결론: 제한적 관혈적 정복 및 교합성 골수내정 고정술은 동측 대퇴골 및 타 부위에 동반 골절이 있는 경우나 폐쇄적 정복으로 만족할 만한 정복이 이루어지지 않는 대퇴골 근위 간부 골절에서 제한적으로 사용할 수 있는 치료법 중의 하나로 생각된다. Purpose: To evaluate the result of treatment of proximal femoral shaft fracture with limited open reduction and intramedullary nailing. Materials and Methods: Fifteen patients who had limited open reduction and intramedullary nailing due to proximal femoral shaft fracture for follow-up for more than 12 months were selected between March 2001 and December 2005. The clinical and radiologic results were analyzed. Winquist-Hansen classification and OTA/AO classification were used. Results: Thirteen cases achieved bone union and 2 cases showed delayed union. The mean bone union period was 21.3 weeks (14~32). There was no postoperative infection. Nonunion was observed in 2 cases of which bone union was acquired with the exchange of intramedullary nail and bone graft in one case and with the additional plate fixation and bone graft in the other case. Conclusion: Treating proximal femoral shaft fracture with limited open reduction and intramedullary nailing seems to be a technique to manage proximal femoral shaft fracture that has combined fracture or ipsilateral femoral fracture or is unable to acquire acceptable reduction with closed reduction.

Lateral override 과두하골절에서 내시경을 이용한 관혈적 정복술 및 내고정의 결과

최은주(Eun-Joo Choi),차인호(In-Ho Cha),남 웅(Woong Nam) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.1

Introduction: Endoscope-assisted open reduction and internal fixation (EAORIF) reduces the amount of facial scaring, but limitations, such as the possibility to convert to the open technique and the large learning curve, remain. Materials and Methods: The medical records of 19 patients diagnosed as lateral overridden subcondyle fractures and treated with endoscopeassisted open reduction and internal fixation at Yonsei University Health System from December 2006 to August 2010 were reviewed. Results: 11 patients underwent temporary discomfort or pain such as limitation of mouth opening, temporomandibular joint discomfort, lip paresthesia or facial weakness, but the symptoms disappeared within 3 months. There was no severe long-term complication except 2 patients with re-fractures of operated subcondyles. Conclusion: Subcondyle fracture with lateral overridden proximal segment is a better indication of endoscope-assisted open reduction and internal fixation than a condylar head/neck fracture, or medial overridden subcondyle fracture: allowing an anatomic reduction.

하악 과두 골절에 대한 4년간의 후향적 임상연구

류재영(Jae-Young Ryu),김현섭(Hyun-Syeob Kim),박충열(Chung-Youl Park),국민석(Min-Suk Kook),박홍주(Hong-Ju Park),오희균(Hee-Kyun Oh) 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.3

The present study was performed to evaluate the function of the mandible according to the pattern of fracture and treatment methods of condylar fractures of the mandible and help operators in making a treatment plan. Sixty patients (average follow-up period was 7.8±9.4 months) who were treated for condylar fracture from June, 2002 to May, 2006 at the Department of Oral and Maxillofacial surgery, Chonnam National University Hospital were reviewed. The common causes of the condylar fracture were traffic accident and fall-down (35.0%). In concomitant injuries, laceration was 46.7% and the fracture of the mandibular symphysis was highest incidence (60.0%). The common site of the fracture was the condylar head (47.8%), followed by subcondyle (36.2%) and condylar neck (15.9%). Under 15 years old patients, the closed reduction was performed in 87.5% out of the patients. All of the condylar fragments were fixed to the mandible with titanium miniplates in cases of open reduction. The mean period of intermaxillary fixation (IMF) was 14.2±6.5 days in closed reduction and 10.0±4.2 days in open reduction. The old patient with bilateral condylar head fractures, who were treated by closed reduction with IMF for 3 weeks, showed the limitation of mandibular movements. But, there was no significant different results between open reduction and closed reduction with the respect of the Helkimo s mandibular mobility index and clinical dysfunction index (DI). Complications, such as fibrous ankylosis and resorption of the mandibular condyle, were not observed in all patients. These results suggest that the good results can be obtained by closed reduction with proper IMF periods and functional exercise in most condylar fractures of the mandible except severely displaced extracapsular fractures.

하악골 과두 골절의 관혈적 정복술과 비관혈적 정복술의 예후에 관한 후향적 연구

김병수,이재훈,김철환,Kim, Byoung-Soo,Lee, Jae-Hoon,Kim, Chul-Hwan 대한악안면성형재건외과학회 2005 Maxillofacial Plastic Reconstructive Surgery Vol.27 No.4

Condylar process of mandible, has the specialized anatomic structure compared with any other body structure, acts directly in connection with mastication and speech and so on. In general, mandibular condyle fractures have been managed by two methods as open and closed reduction. But, there are no reasonable consensus about the proper management of this injury. This study was designed for analysis of the prognosis of two methods of treatment, open and closed reduction, with positional change of fractured condyle and complications within 6 months post-intermaxillary fixation period. We conducted a retrospective analysis of 154 patients whose unilateral mandibular condyle fractures were treated by open or closed reduction in our department. The horizontal, sagittal, and coronal change of the condyle was examined using modified Towne's and panoramic radiographs before intermaxillary fixation(IMF), immediately after IMF, and at 6 months after IMF. Patients, whose mandibular condyle fractures were treated by closed reduction, had significantly shorter ramus height on the side of injury(P<0.05). But, fractured condylar fragments were displaced insignificantly with aspect to sagittal and coronal plane(P>0.05). The level of the fracture influenced the ramus length and the degree of coronal change in the closed reduction group(P<0.05). There was no significant correlation among the level of the fracture, treatment methods and complications(P>0.05). From the results obtained in this study, fractured mandibular condyles, were treated by closed reduction, had a tendency that continuous condylar displacement was occurred with aspect to horozontal and coronal plane in treatment period including intermaxillary fixation. And then there was a correlation between the level of the fracture and the position change in close reduction group statistically. These result suggested that care must be taken in basing treatment decisions on the degree of displacement of the condyle and in treating the mandibular condyle fractures for a long time.

대퇴 전자하 골절의 골수강 내 금속정을 이용한 치료

이상준(Sang Joon Lee),이상홍(Sang Hong Lee),박상수(Sang Soo Park),박형석(Hyung Seok Park) 대한정형외과학회 2015 대한정형외과학회지 Vol.50 No.1

목적: 대퇴골 전자하 골절을 긴 골수강 내 금속정으로 치료한 후 정복 방법에 따른 결과를 분석하고자 하였다. 대상 및 방법: 최근 7년간 수술받은 환자 중 최소 1년 이상 추시가 가능한 환자 44예를 대상으로 후향적 연구를 시행하였다. 폐쇄적 정복술을 시행한 경우(1군)는 27예였고, 최소 절개 정복술을 시행한 경우(2군)는 17예였다. 결과: 평균 골유합 기간은 1군에서 2군보다 조금 길었으나 두 군 간의 통계적 유의성은 없었다(p=0.37). 2군에 비해 1군에서 부정 정렬이 많이 발생하였으며(p=0.03) 의인성 골절 및 하지 부동도 1군에서 많이 발생하였으나 통계적 의의는 없었다(p=0.52). 골 유합에 미치는 요소로서 성별, 손상 기전, 골절 유형, 사용된 금속정의 형태, 피부 절개 크기 및 폐쇄적 정복과 최소 절개 정복은 통계적 의의가 없었으나 부정 정렬 시 불유합의 가능성이 높아져 1o의 부정 정렬이 증가될 때 불유합의 가능성은 1.5배 높아지는 것으로 나타났다. 결론: 골수강 내 금속정을 이용한 대퇴골 전자하 골절의 치료에 있어 부정 정렬이 발생했을 때 불유합률이 높아지므로 폐쇄적 정복으로 만족스럽지 않을 경우 최소 절개 정복술을 통한 해부학적 정복이 필요하다. Purpose: The purpose of the study was to evaluate methods for treatment of femur subtrochanteric fractures using the intramedullary long nail. Materials and Methods: This retrospective study included 44 patients (44 cases) who were available for follow-up for at least one year. The patients had undergone intramedullary fixation specifically with a long nail for traumatic femur subtrochanteric fractures during the period from June 2005 to May 2012 in Chosun University Hospital. The study compares two groups. For group 1, closed reduction was attempted, and group 2 underwent minimal open reduction. Group 1 included 27 cases, and group 2 included 17 cases. Study parameters included injury mechanism, fracture classification according to the Seinsheimer type, nail design, size of skin incision, alignment, bony union time, malunion or nonunion, and complications. Results: Bony union times were 19.4 weeks (group 1) versus 21.4 weeks (group 2), but there were no statistical differences between the two groups with respect to gender, injury mechanism, fracture classification, or nail design. However, there were significant differences between the two groups with respect to skin incision, malalignment, and complications. Gender, injury mechanism, fracture classification, nail design, size of skin incision, minimal open reduction or close reduction, did not show a significant relationship with bony union. However, in cases of malalignment, the possibility of malunion increased 1.5 times per 1° increase in malaligment. Conclusion: In treatment of femur subtrochanteric fracture using intramedullary nail, nonunion rate increases when malalignment occurs. Therefore, anatomical reduction with minimal open reduction is necessary if closed reduction is not satisfactory.

소아 상완골 과상부 골절에 대한 수술적 치료 : 경피적 K-강선 고정술과 관혈적 정복술후 내고정을 중심으로 Closed reduction and percutaneous pinning or Open reduction and Internal fixation

강재도,김광렬,박정하,고상훈 침례병원 1994 浸禮病院學術誌 Vol.11 No.

인공수로를 이용한 비점오염저감장치의 탁도 저감효과 연구

김민영 ( Minyoung Kim ),김승희 ( Seounghee Kim ),김진오 ( Jinoh Kim ),이상봉 ( Sangbong Lee ),염성현 ( Sunghyun Yum ) 한국농공학회 2012 한국농공학회 학술대회초록집 Vol.2012 No.-

급경사 농경지나 나지에서의 토양침식에 의한 토사발생은 인근 수생태계의 피해를 초래하며, 이는 기후변화에 따른 집중 및 국지성 호우로 인해 더욱 심각해지고 있다. 등고선 재배, 완충지 및 승수로 설치 등 다양한 농경지 비점오염원유출을 억제하고자 하는 많은 대책들이 개발되어 사용되어 오고 있으나, 좁은 면적에 다양한 영농활동을 하는 국내의 현실을 반영하기에는 역부족이다. 지역맞춤형, 저렴한 설치비, 유지관리가 용이한 새로운 비점오염저감대책에 대한 요구가 끊임없이 이어져 왔으며, 본 연구에서는 기존의 비점오염저감시설인 체크댐을 변형시킨 섬유체크댐과 고분자유기 응집제를 혼용한 방법을 제안하였다. 현장적용에 앞서 인공수로를 이용한 각종 수리학적(유량 등), 물리학적 인자(수로경사, 섬유체크댐 종류 등)들이 이러한 새로운 비점오염저감방법의 효능에 미치는 영향을 살펴보았다. Due to increasing awareness of severity by non-point source pollution generated from agricultural farmlands, much studies have been conducted that attempt to reduce the amount of pollutants discharged into neighboring streams and rivers. This study carried out a series of laboratory open channel experiments for turbidity control with a combined application of fiber check dam and Polyacrylamide (PAM). Open-channel facility in a 0.20m wide and 20.0m long was built and various hydraulic and physical conditions of open channel were generated to assess their impacts on turbidity control using fiber check dam and PAM. Positive relationships between the degree of turbidity reduction and a slope of open channel, flow were observed. Different materials for a fiber check dam, straw, coconut fiber, chaff) were compared. Further studies will continue to evaluate the effects of more factors, such as a number of fiber check dam, PAM dosage, etc. on reducing water turbidity.