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고영관,윤형구,박병문,조한준 대한골절학회 2002 대한골절학회지 Vol.15 No.2
목 적:고관절 골절 탈구의 형태와 신경손상과의 관련성, 골절 탈구의 치료와 신경회복과의 관련성,신경손상의 진단과 임상적 결과에 있어서 근전도, 신경전도검사에 대한 효용성에 대해 알아보고자 하였다. 대상 및 방법:1 9 9 3 년 3월부터 1 9 9 9 년 1 2월까지 본원에서 고관절 골절 탈구로 진단받고 치료 받은 환자 5 2례중 신경손상이 동반되었던 8례를 대상으로 하였으며, 평균 연령은 3 6 . 1 세였고 평균 추시기간은1 8 . 1 개월이었다. 신경손상의 진단은 응급실에서의 이학적 검사와 이후, 근전도, 신경전도 검사를 이용하였고, 임상적 신경 회복의 결과는 C l a w s o n 과 Seddon 분류를 이용하여 평가하였다. 결 과:수상원인은 전례에서 교통사고였고, 신경손상은 4례에서 완전 회복을, 3례에서 부분적 회복을보였고, 1례에서는 2년 7개월의 추시 기간중 전혀 호전되지 않았다. 임상결과는 7례에서 만족, 완전형좌골신경손상의 1례에서, 추시 근전도, 신경전도 검사에서는 호전을 보였으나 임상적 결과는 불만족이었다.
고영관,박호철,고석환,김도균,주홍재 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.1
Background: Arterial emboli remain an important cause of acute arterial ischemia. Despite simplification of operative techniques, the substantial morbidity and mortality still associated with an acute embolus remain a challenge to the vascular surgeon. We wanted to know the adequate evaluation and treatment modality for this limb threatened condition, and to evaluate the results according to etiology, location, time interval before starting treatment, clinical conditions, and limb survival rate. Material and Methods: A retrospective review was conducted on 91 patients who treated for acute lower leg thromboembolism between Jan. 1992 and Dec. 1997. Results: There were 73 men and 18 women and most prevalent age group was in the 5th and 6th decades (53.8%). Over all amputation rate was 25.3% and mortality rate was 5.5%. Cardiac problem was the most common etiologic factor. Associated diseases were cardiac problem (37.4%), hypertension (35.2%), cerebrovascular accident (17.6%), and diabetes (15.4%). Interval from attack to definite therapy, within 24 hours in 14 cases (15.4%), 1 ∼3 days in 23 (25.3%), after 4 days in 54 (59.3%) were noted. The locations were aorta and iliac in 25.3%, femoral in 38.5%, popliteal in 19.8%, tibial in 4.4%, and 15.4% in graft site in other of frequency. Clinical categories were grade I in 9.9%, IIa in 40.7%, IIb in 30.8%, and III in 18.7%. According to Eagle' s criteria, low risk group were 34 cases (37.4%), moderate risk group were 39 cases (42.9%), and high risk group were 18 cases (19.8%). Of the 91 patients, conservative treatment in 2 (2.2%), thrombolytic therapy in 33 (36.3%), thromboembolectomy in 56 (61.5%), bypass in 16 (17.6%), endarterectomy and vessel ligation were performed. The 1-month and 1-year limb salvage rates were 73.4% and 71.1%, respectively. Especially, salvage rates in the Department of Vascular Surgery were 84.9% and 83.7%, whereas that of Thoracic and Orthopedic Surgery were 44.4% and 33.0% (p=0.0001). Conclusions: Cardiac problem especially atrial fibrillation was the most common etiologic factor. Prompt balloon catheter embolectomy performed under local anesthesia is a safe, simple, and effective method of treatment and the preferred mode of management in the great majority of patients. Nonoperative management with thrombolytic agents or high-dose heparin therapy alone is occasionally indicated in highly selected patients. The prognosis of acute arterial thromboembolism of lower extremity can be improved by early detection, early adequate treatment, and the involvement of a qualified vascular surgeon.
흉부 자창 환자에게 부러진 칼날이 복강내로 전위한 1 예
고영관,박현경,김명천 대한외상학회 2001 大韓外傷學會誌 Vol.14 No.2
Stab wounds of the chest can penetrate the abdomen by crossing the diaphragm. Penetrating thoracoabdominal trauma presents a difficult diagnostic dilemma, and the management of penetrating trauma to the lower chest and upper abdomen continue to generate interest, controversy, and much discussion. The intrathoracic abdomen, as defined by the Advanced Trauma Life Support Guidelines of the American Colleague of Surgeons, is the area protected by the bony thorax extending from the nipple line to the costal margins. Injury to the diaphragm is the most difficult to assess after a penetrating trauma. We report a case of a stab wound to the chest with diaphragmatic penetration which resulted in displacement of the broken knife into the abdominal cavity.