하악각 축소술 시 내측으로 편위된 절골 골편 제거에 대한 고안

김진우,선욱,신한경,정재학,김영환 대한미용성형외과학회 2007 Archives of Aesthetic Plastic Surgery Vol.13 No.1

Oriental women, in general, have prominent mandibular angles and short chins that are thought to be unattractive, square and muscular appearance. Therefore, mandibular ostectomy is one of the most common aesthetic facial bone contouring surgery in oriental and intraoral approach has been used commonly. After the angle ostectomy via intraoral approach, it is not easy for unexperienced surgeons to remove the involuted bony fragment due to the limited view and operation access. This report describes a new method for removal of involuted bony fragment in reduction mandibular angleplasty Thirty eights Case of reduction mandibular angleplasty has been operated from February 2003 to June 2005. We have experienced the involuted bony segment in 12 cases after angle ostectomy. We have adopted periosteal cottle elevator and 18 gauze spinal needle as new methods of extracting the involuted bony fragment. The institutes were used to push the involuted bone segment.We could easily extract the bony fragment with new methods involuted 12 patients mandibular angle within 5 minutes. No major complications were occurred.

고정된 골편 절제술로 치료한 요추 추간판 탈출증과 동반된 후방 연골단판 골절 - 증례 보고 -

남우동,조재환,이제민,이재우 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: A case report. Objectives: We report a case of posterior ring apophysis fracture (PRAF) with lumbar disc herniation treated by immobile bony fragment excision. Summary of Literature Review: PRAF causes severe radiculopathy, so treating with surgery is common. Materials and Methods: A 30-year-old male diagnosed with PRAF with lumbar disc herniation was treated with discectomy, but his clinical symptoms were not relieved. Consequently, bony fragment excision, extended laminectomy and interbody fusion were also done. Results: Radicular pain was relieved and showed good clinical outcome. Conclusions: When treating PRAF, bony fragment excision and extended laminectomy should be considered even if an immobile bony fragment exists. 연구 계획: 증례 보고적: 고정된 골편 절제술로 치료한 요추 추간판 탈출증과 동반된 연골단판 골절 1예를 보고하고자 한다. 선행 문헌의 요약: 후방 연골단판 골절은 심한 신경근 자극 증상을 일으켜 수술적 치료를 요하는 경우가 흔하다. 대상 및 방법: 요추 추간판 탈출증과 동반된 연골단판 골절을 진단받은 30세 남자에서 추간판 절제술을 하였으나 호전이 없어 골편 절제술, 광범위 후궁 절제술 및 추체간 유합술을 시행하였다. 결과: 술후 방사통이 호전되었으며 양호한 임상 결과를 얻었다. 결론: 연골단판 골절을 치료할 때 골편이 고정된 경우에도 골편 절제술 및 광범위 후궁 절제술을 고려해야 한다.

전두부 개방성 함몰골절에 있어서 일차적 골편 복위술에 대한 임상적 고찰

박원호,장병조 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.5

전두부 개방성 함몰골절에 있어서 일반적인 개념은 염증성 합병증을 치료 예방하기 위해서 손상 두개골편을 제거하는 것이었다. 저자는 최근 5년 동안 1년 이상 추적 관찰이 가능했던 83예의 전두부 개방성 함몰골절 환자를 대상으로 손상 두개골편의 일차 복위술을 시행한 군과 절제술을 시행한 군을 비교 관찰하여 아래와 같은 성적을 얻었다. 1) 연령 분포에서는 20대가 20%, 30대가 22%로 다른 연령군에 비해 빈도가 높았으며, 성별분포에서는 83예중 남자가 72예(87%)로 현저히 빈도가 높았다. 2) 두부 손상의 기전에서는 교통사고가 43예(51.8%)로 가장 빈도가 높았다. 3) 내원 당시 의식수준은 GCS 13~15점군이 44예(53%), 9~12점군이 10예(12%), 6~8점군이 22예(26.6%), 3~5점군이 7예(8.4%)로 의식수준의 변화가 경한 경우가 많았다. 4) 전두부의 개방성 함몰골절과 함께 인접부위의 골절 확산의 빈도는 안와상벽 골절 35예(42%), 전두동 골절 29예(35%), 사판골절 21예(25%), 비골골절 13예(16%)의 빈도순을 나타냈다. 5) 골절에 의한 두개강내 손상은 뇌경막 열상이 54예(65%), 뇌실질 열상이 42예(51%)였으며, 뇌경막 열상 54예중 뇌실질 열상을 동반한 경우는 78%였다. 6) 두부 손상으로부터 수술까지의 경과시간은 12시간 이내가 70예(84%)로 대부분이었다. 7) 전체적인 합병증의 빈도는 30예(36.1%)였으며, group Ⅰ에서는 27.7%, group Ⅱ에서는 47.2%였다. 염증성 합병증의 빈도는 group Ⅰ에서는 14.9%, group Ⅱ에서는 16.7%의 빈도로 의미있는 차이는 없었다. 이상의 결과를 종합하면 전두부의 개방성 두개골 함몰골절의 치료에 있어서 손상 두개골 골편의 오염이 의심되는 손상 두개골 골편을 일차 수술시야에서 복위술을 시행하더라도 두 대조군 사이에 의미있는 차이가 없었으므로 두개골 절제술로 인한 안면부의 추상, 이차적인 두개골 성형술을 위한 경제적 부담 등을 들어 줄 수 있으므로 개방성 두개골 함몰골절의 치료는 가능한 한 손상 두개골 골편으로 일차적 복위술을 시행하는 것이 좋은 것으로 사료된다. The injured skull bone may be contaminated in compound frontal skull fracture, so definitely left out for the prevention of infectious complications in the classic concept. The efficacy of primary replacement and resection of the injured bony fragments in the treatment of compound depressed frontal skull fractures was studied in 33 patients who could be followed up over one year during a recent 5∼year period. The patients was divided into a group Ⅰ which took a primary replacement of injured bony fragments and group II which left out the injuried bony fragments in immediate operation. The results are summarized as follows: 1) The age incidence was more frequent in the 3th and 4th decades. The sex distribution was more frequent in male(87%). 2) The motor vehicle accident was most frequent in the injury mechanism. 3) The conscious level on admission was 53% in 13∼15 GCS group, 12% in 9∼12 group, 26.6% in 6∼8 group and 8.4% in 3∼5 group. 4) The incidence of an extending fracture was 42% to orbital roof, 35% into frontal sinus, 25% into cribriform plate and 16% into nasal bone. 5) The incidence of intracranial injury was 65% in dural laceration and 51% in cerebral laceration. Of cases of dural laceration the cerebral laceration was associated in 78%. 6) The time duration from injury to operation was under 12 hours in most cases(84%). 7) The incidence of a complication was 36.1% in total group, 27.7% in group I and 472% in group Ⅱ. The infectious complication was not a significant difference between group Ⅰ (14.9%) and group Ⅱ(16.7%). In conclusion the infectious morbidity of which were most dangerous complications due to compound depressed frontal skull fractures was not a significant difference in two compared group. The author believe that immediate bone replacement for compound depressed frontal fractures with or without extension to frontal sinus, orbit, or cribriform plate is both practical and safe procedures.

대퇴골 두 골절의 수술적 치료 결과

강준순 ( Joon Soon Kang ),문경호 ( Kyoung Ho Moon ),이동주 ( Tong Joo Lee ),양종혁 ( Jong Hyuck Yang ) 대한골절학회 2014 대한골절학회지 Vol.27 No.3

Purpose: This study analyzed the clinical and radiological long-term follow-up results of patients with femoral head fracture who received surgical treatments. Materials and Methods: Retrospective evaluation was performed for 20 patients with femoral head fracture who received surgical treatments between December 1997 and May 2010. According to Pipkin`s classification, there were five type I, six type II, one type III, and eight type IV fractures. Results: The average Merle d’Aubigne’-Postel score was 12.8 (12.80±3.53). According to surgical method, the score for the bony fragment excision group was 9.8 (9.83±2.79), and that for the open reduction and internal fixation group was 13.9 (13.92±3.07). Depending on Thompson-Epstein criteria, two patients were good, two were fair, and two were poor in the bony fragment excision group. Four patients were excellent, six were good, and three were poor in the open reduction and internal fixation group. Conclusion: Bony fragment excision should be performed with caution in patients with femoral head fracture. Considering fragment size, location, and presence of acetabular fracture, better outcome can be expected using the open reduction and internal fixation method in comparison with excision.

신전 제한법을 이용한 골성 추지 골절 치료의 예후 인자

한수봉(Soo-Bong Hahn),박광환(Kwang-Hwan Park),최윤락(Yun-Rak Choi),강호정(Ho-Jung Kang),이정길(Jung-Kil Lee) 대한정형외과학회 2010 대한정형외과학회지 Vol.45 No.2

목적: K-강선을 이용한 신전 제한법으로 수지 골성 추지 골절을 치료하였을 때의 임상적 결과와 예후 인지에 대해 알아보고자 하였다. 대상 및 방법: 2002년 7월부더 2009년 1월까지 수지 골성 추지로 내원한 환자들 중 K-강선을 이용한 신전제한법을 시행한 환자 중 6개월 이상 추시 관찰이 가능했던 49명의 환자를 대상으로 하였으며, Wehbe and Schneider 분류를 이용하여 골절양상을 분류하였고, Crawford 분류를 이용하여 임상적 결과에 대한 평가를 하며, 나이, 성별, 수상부터 수술까지의 기간, 수술 전 골절면과 관절면이 이루는 각도, 수술 후 전위 정도를 조사하여 예후 인자를 분석하였다. 결과: Crawford 분류에 의한 임상적 결과 평가로 우수 22예, 양호 20예, 보통 6예, 불량 1예이었다. 고령일수록, 이탈구가 있을수록, 수술 전 추지 골절편각이 30도 이하일수록, 수술 후 전위가 클수록 결과가 좋지 않은 것으로 조사되었다.(p<0.05). 결론: 수지 골성 추지 골절 치료에서 K-강선을 이용한 신전 제한법은 나아가 젊고, 아탈구가 없고. 정복이 정확한 경우, 특히, 추지 골절편각이 30도 이상인 경우에 예후가 좋은 것으로 나타났다. Purpose: The purpose of this study was to evaluate the clinical results and prognostic factors of the extension block technique for treating a bony mallet finger. Materials and Methods: Between July 2002 and January 2009, forty-nine patients who underwent the extension block technique for a bony mallet finger were evaluated. The minimum period of follow up was 6 months. The type of fracture was classified by the Wehbe and Schneider method. The results were evaluated by the Crawford classification. The prognostic factors were analyzed according to age, gender, the timing of the surgery, the mallet fragment angle and the residual displacement. Results: According the Crawford classification, there were 22 excellent, 20 good, 6 fair and 1 poor results. The poor prognostic factors were an older patient age, subluxation, a smaller mallet fragment angle and smaller postoperative displacement (p<0.05). Conclusion: The prognostic factors of the extension block technique for bony mallet finger were the patient age, subluxation, the mallet fragment angle (more than 30 degrees) and the postoperative displacement.