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Treatment of unusual locked posterior fracture–dislocation of the shoulder: a case series
박호연,김석중,서유준,Jae Woong Jung,공재관 대한견주관절학회 2020 대한견주관절학회지 Vol.23 No.4
Background: Locked posterior fracture-dislocation of the shoulder (LPFDS) is a very rare injury that occurs predominantly in young patients following high-energy trauma. The long-term outcome of the treatment of this injury is often poor. This study sought to present the characteristics of injury, discuss the pathological anatomy, and to report the treatment outcomes of our case series. Methods: Between January 2012 and May 2018, a total of 234 patients who underwent surgical treatment for proximal humerus fractures were reviewed. Among them, six patients (mean age, 54.7 years; range, 35–76 years) with LPFDS were included in this study. Four patients were treated with open reduction and internal fixation (ORIF) with locking plates, one with hemiarthroplasty, and one with reverse total shoulder arthroplasty. Clinical results were evaluated by Constant, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores and radiologic evaluation was conducted using follow-up radiographs. Results: The mean length of follow-up was 26.2 months (range, 12–54). The mean Constant, ASES, and VAS scores were 66.7, 65.5, and 2.2, respectively. Four patients who underwent ORIF achieved bony union, but avascular necrosis (AVN) of the humeral head was observed in two patients. No complications were observed in the patients who underwent arthroplasty surgery until final follow-up. Conclusions: In the treatment of LPFDS, replacement arthroplasty can produce predictable results. The approach of ORIF may be considered as a first choice of treatment in young patients but is sometimes correlated with postoperative complications such as AVN and the functional outcomes may be unpredictable. Therefore, patients should undergo careful diagnosis and treatment of this type of injury.
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요골동맥을 이용한 관상동맥 중재술 후 발생한 전완부 구획증후군
박호연,김윤빈,김주영,서유준 대한수부외과학회 2017 대한수부외과학회지 Vol.22 No.2
Transradial percutaneous coronary artery interventions are increasingly used because of low complication rates and patients’ convenience. However, the radial artery is more vulnerable to damage due to its small diameter and frequent anatomical variations. We experienced a case of forearm compartment syndrome after transradial percutaneous coronary artery intervention which has not been reported in Korean literature yet. We report the case with a review of the literature. 요골동맥을 이용한 관상동맥 중재술은 합병증 발생률이 적고 환자의 주관적 만족도도 높아서 시행 빈도가 점차 증가하고 있다. 하지만 요골동맥은 대퇴동맥보다 가늘고 해부학적 변이가 다양하여 요골동맥 손상이 발생할 가능성이 항상 존재한다. 저자들은 요골동맥을 이용한 관상동맥 중재술 후에 발생한 전완부 구획증후군 증례를 경험하였는데, 아직까지국내 문헌에 보고된 바가 없기에 문헌 고찰과 함께 증례를 보고하고자 한다.
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박호연,윤준오,조원준 대한수부외과학회 2011 대한수부외과학회지 Vol.16 No.4
Purpose: The purpose of this study was to evaluate the results of surgical treatment in patients with chronic flexor carpi ulnaris tendinopathy. Materials and Methods: Five patients with 7 wrists underwent surgical treatment for chronic flexor carpi ulnaris tendinopathy. The degenerative tissue inside the tendon over the pisiform was debrided and partial release of the tendon was performed. The clinical outcome was evaluated using pre and postoperative visual analogue scale (VAS)pain score and modified Mayo wrist score at the final follow-up. Results: The mean VAS score was 7.3 preoperatively, which was significantly improved to 3.6 at postoperative 2weeks, 1.9 at 6 weeks, 1.1 at 3 months, 0.7 at 6 months, and 0.7 at the final visit. Modified Mayo wrist score showed 3excellent, 3 good, and one fair result. Biopsy showed degenerative tissue findings in all cases. Conclusion: Chronic flexor carpi ulnaris tendinopathy is a degenerative disease and surgical treatment of refractory cases can decrease clinical symptoms in the early postoperative period and enable patients to return to activities of daily-living. 목적: 만성 척수근 굴곡건 건병증 환자에서의 수술적 치료 결과를 보고하고자 한다. 대상 및 방법: 만성 척수근 굴곡건 건병증으로 수술 받은 환자 5명, 7예를 대상으로하였다. 수술은 두상골에 부착하는 건 심부의 퇴행성 조직을 제거하고 건에 대한 부분 유리술을 시행하였다. 결과는 술 전후의 visual analogue scale (VAS) 통증 점수와 최종 추시에 측정한 modified Mayo wrist score로 평가하였다. 결과: VAS 통증 점수는 술 전 7.3에서 술 후 2주에 3.6, 6주에 1.9, 3개월에 1.1, 6개월에 0.7, 최종 추시에 0.7로 유의하게 호전되었다. 최종 추시에 측정한 modified Mayo wrist score는 매우 우수 3예, 우수 3예, 양호 1예이었다. 조직 검사 결과 모든예에서 퇴행성 소견을 관찰하였다. 결론: 만성 척수근 굴곡건 건병증은 퇴행성 질환이며 보존적 치료에 반응이 없는 경우 수술적 치료는 빠른 통증 완화 및 일상생활로의 복귀에 도움이 될 수 있을 것으로생각된다.
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알코올 의존 환자군의 PPAT(사과 따는 사람 그리기 검사) 반응 특성
박호연,박경 서울여자대학교 2010 심리치료: 다학제적 접근 Vol.10 No.2
This study is intended to examine responsive characteristics that both patient group with alcohol dependence and normal group show in the PPAT (Person Picking an Apple from a Tree) and examine what difference in response the patient group with simple alcohol dependence, the patient group with comorbid alcohol dependence and normal group show in the PPAT. For this study, the PPAT was individually performed for patients who were in the J-alcohol special hospital and the W-alcohol special hospital that were located at the In-cheon. Patients who had different mental disorder such as schizophrenia, bipolar disorder, depression and personality disorder were also included in the patient group with alcohol dependence. AUDIT (Alcohol Use Disorder Inventory Test) questionnaire and PPAT were individually performed to the normal. Only data that the AUDIT score does not exceed the alcohol dependence level of 20 point was used in this study. Participants in this study were male and female adults whose age was between 19 years and 69 years, and were 200 total persons consisted of 100 patients with alcohol dependence and the normal of 100 persons. FEATS (Formal Elements Art Therapy Scale) was used as a scoring system to analyze formal factors of the picture, and contents of the picture were treated through Contents Scale. The test was scored by 4 art therapists. Independent samples T-test was scored for 14 FEATS, and chi-square test was scored for 13 questions on the Contents Scale. A Scheffe test was performed to particularly examine relative difference between the patient group with simple alcohol dependence, the patient group with comorbid alcohol dependence and the normal group. The results of this study are as follows:First, as the results of analyzing FEATS of the patient group with alcohol dependence and the normal group, there was significant difference in all 14 FEATS items such as prominence of color, color fit, implied energy, space, integration, logic, realism, problem solving, developmental level, details of objects & environment, line quality, person, rotation and perseveration. Of them, most highest difference of level appeared from the 13 remaining items except for rotation. Second, as the result of analyzing FEATS on the patient group with simple alcohol dependence, the patient group with comorbid alcohol dependence and the normal group, there was no significant difference between the patient group with simple alcohol dependence and the patient group with comorbid alcohol dependence but significant difference appeared in all 14 items between the normal group and the other two groups. Third, as the result of analyzing difference between the patient group with alcohol dependence and the normal group by using the Contents Scale, significant difference appeared in numbers of the colors used in the whole picture, colors used in the whole picture, person, numbers of the colors used for person, colors used for person, sex, actual energy of person, direction of the face, age, clothes of person, existence or not of the apple tree, trunk of the apple tree, crown of the apple tree, the color of apple tree and detailed description. In conclusion, the PPAT showed the value as a drawing test that can complement limitations of the existing evaluation tools in evaluation of the patient group with alcohol dependence using the excessive defense mechanism. 본 연구는 알코올 의존 환자군과 정상군이 PPAT(Person Picking an Apple from a Tree:사과 따는 사람 그리기 검사)에서 보이는 반응 특성을 살펴보고, 단순 알코올 의존 환자군과 공병 알코올 의존 환자군, 그리고 정상군이 PPAT에서 어떠한 반응의 차이가 있는지 알아보고자 했다. 이를 위해 인천 지역에 소재한 알코올 전문 병원에 입원중인 환자들을 대상으로 하여 PPAT를 개별적으로 실시하였다. 본 연구에 참여한 참여자는 만 19세에서부터 69세사이의 성인 남·여로 알코올 의존 환자 100명,정상인 100명으로 총 200명이다. 그림의 형식적인 요소를 분석하기 위하여 FEATS(Formal Elements Art Therapy Scale:형식 척도)를 채점의 체계로 사용하였으며 Contents Scale(내용 척도)을 통하여 그림의 내용적인 면을 다루었다. 평정은 총 4명의 미술치료사가 실시하였으며, FEATS 14개는 독립 표본 t-검증을 하였고, Contents Scale 13개의 문항은 각각 x2 검증을 실시하였다. 단순 알코올 의존 환자군, 공병 알코올 의존 환자군, 정상군 각각의 상대적 차이를 좀 더 구체적으로 알아보기 위하여 Scheffe test를 실시하였다. 본 연구의 결과는 다음과 같다. 첫째, 알코올 의존 환자군과 정상군의 FEATS를 분석한 결과, 색칠정도, 색적절성, 내적 에너지, 공간, 통합, 논리성, 사실성, 문제해결력, 발달단계, 세부묘사, 선의질, 사람, 변환성, 보속성의 총 14가지 FEATS 항목 중 14가지의 모든 항목에서 유의한 차이가 있었다. 그 중 변환성을 제외한 나머지 13개의 항목에서 매우 높은 수준의 차이가 나타났다. 둘째, 알코올 의존 환자군, 공병 알코올 의존 환자군과 정상군에 따라 FEATS를 분석한 결과, 단순 알코올 의존 환자군과 공병 알코올 의존 환자군 간에는 유의한 차이가 없었으나 정상군과 나머지 두 집단 간에서는 14문항 모두 유의한 차이를 보였다. 셋째, Contents Scale를 통한 알코올 의존 환자군과 정상군 간의 차이를 분석한 결과, 그림 전체에 사용된 색의 수, 그림 전체에 사용된 색, 사람, 사람을 그리는데 사용된 색의 수, 사람을 그리는데 사용된 색, 성별, 사람의 실제적 에너지, 얼굴 방향, 사람의 나이, 옷, 사과나무의 유무, 사과나무의 기둥, 사과나무의 수관, 사과의 색, 세부묘사에서 유의한 차이가 있는 것으로 나타났다. 결론적으로 PPAT는 과도한 방어기제를 사용하는 알코올 의존 환자군의 평가에 있어서 기존의 평가 도구들이 가지는 한계점을 보완해 줄 수 있는 그리기 검사로서의 가치를 확인하였다.
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