목적: 65세 이상의 대퇴 전자간부 골절 환자에서 환자 위험 인자와 임상적 치료 결과와의 관계에 대하여 결과를 분석하였다. 대상 및 방법: 2000년 1월부터 2012년 3월까지 대퇴 전자간부 골절로 내원하여 본원에서 수술을 시행하였던 65세 이상 환자, 321명을 대상으로 하였다. 연령, 성별, 음주 및 흡연 유무, 심혈관계 질환, 뇌혈관계 질환, 술전 혈액 검사 수치 등의 환자 위험 요인을 분석하였으며, 입원 후 수술까지 지연된 기간, 주말 입원 여부, 마취 방법, 수술 시간 등의 수술 전 후 처치에 따른 수술 후 합병증 발생률 및 사망률과의 관계에 대하여 비교 분석하였다. 결과: 환자 위험 요인의 분석에서는 여성의 경우 사망률이 13.0%로 더 높은 것으로 나타났다(P=0.043). 수술 시간이 3시간 이상이었을 경우 사망률 및 합병증 발생률이 각각 29.1%, 20.8%로 더 높은 것으로 나타났으며(P<0.001, P=0.027), 수상 후 수술까지 지연된 시간이 4일 이상 지연된 경우 사망률 및 수술 후 합병증 발생률이 각각 20.1%, 18.8%로 더 높은 것으로 나타났다(P<0.001, P<0.001). 음주 및 흡연 유무, 수술 전 기저질환, 마취 방법, 수술 시간 등의 사망률 및 합병증 발생률은 통계적으로 유의한 차이를 보이지 않았다. 결론: 대퇴 전자간부 골절 환자의 치료에서 환자 위험요인의 중요성에 대해 인지하고, 수술 전후 처치 시에 수술까지의 기간과 마취 방법 등의 조절 가능한 인자들을 조절한다면 수술 후 사망률 및 합병증 발생률을 줄일 수 있을 것이다.
In Brief Study Design. Retrospective study. Objective. To report on the technique and results of posterior vertebral column resection (PVCR) for severe rigid scoliosis. Summary of Background Data. The treatment of severe rigid scoliosis is a demanding surgical challenge. Conventional procedures such as combined anteroposterior instrumentation enable limited correction. In rigid scoliosis, vertebral column resection is a better option for accomplishing translation of spinal column. PVCR is performed through a single posterior approach. Methods. A total of 16 patients with scoliosis (average age 29 years) subjected to PVCR were retrospectively reviewed after a minimum follow-up of 2 years (range 2−6.8). The indication for PVCR was scoliosis more than 80°, with flexibility less than 25%. The radiographic parameters were evaluated, and clinical records were reviewed. Results. The number of vertebrae removed averaged 1.3, and 21 total (15 thoracic and 6 lumbar). Average fusion extent was 10.6 vertebrae. The mean preoperative scoliosis of 109.0° was corrected to 45.6° (59% correction) at the most recent follow-up, and the minor curve of 59.3° was corrected to 29.2° (51% correction). The mean preoperative coronal imbalance of 4.0 cm was improved to 1.0 cm at the most recent follow-up, and sagittal imbalance of 4.2 cm was improved to 1.6 cm. Complications were encountered in 4 patients, including 1 complete paralysis, 1 hematoma, 1 hemopneumothorax, and 1 proximal junctional kyphosis. Conclusions. PVCR is an effective alternative for severe rigid scoliosis. It is a highly technical procedure and should only be performed by an experienced surgical team. A total of 16 patients with severe rigid scoliosis subjected to posterior vertebral column resection were retrospectively reviewed after a minimum follow-up of 2 years. The preoperative scoliosis of 109°± 20° was corrected to 46°± 15° (51% correction), and the minor curve of 59°± 15° was corrected to 29°± 11° (51% correction). Complications were encountered in 4 patients. Posterior vertebral column resection is an effective alternative for severe rigid scoliosis.
This report documents three elements of a two-year project conducted under the direction of the Midwest Transportation Center. The first element, a comprehensive two-dimensional truck simulation, has a modular program construction to allow variation of vehicle characteristics, and is able to predict vehicle motion and the tire-road surface interaction forces. The second element is a rigid pavement model that is used to determine slab deflection, cracking, and stress at predetermined nodes. The pavement model allows for user control of traditional thickness design factors. The third and final element describes the implementation of both modeling systems using a work station with menu driven modules and Hypercard interfaces, allowing both existing and proposed pavements to be evaluated given specific characteristics of the heavy vehicles that will be using the facility. This modeling package will assist the Departments of Transportation in their evaluation of maintenance procedures and determination of appropriate performance standards for urban and rural highway segments and commercial highway networks. This report presents the results of and documents the work that has been performed during this two-year study. It is organized in the following chapters: (1) Introduction; (2) Truck Modeling; (3) Pavement Modeling; and (4) Integrated Software Environment.
Purpose: The purpose of this study is to compare and analyze the radiological and clinical results after treatment of intertrochanteric fractures of the femur by three devices including DLT, PFNA and Gamma 3 nail. Materials and Methods: From January 2007 to January 2012, we reviewed 131 patients who suffered intertrochanteric fractures(33 cases of DLT, 59 cases of PFNA, 39 cases of Gamma 3 nail). The following were measured for all three groups; The tip apex distance (TAD), neck shaft angle and lag screw position at the head of femur, as well as the amount of blood loss and transfusion, operation time, duration of hospitalization and postoperative ICU admission, complications were also assessed. Results: In comparison of the radiological results, there were no statistical differences among the three groups in TAD, neck shaft angle and the lag screw position. There was no statistical difference in clinical results. In the last follow-up, there was one case of nonunion in the PFNA group. There also was, in the last follow up, a development of varus angulation & cut-out of lag screw that occurred in 2 cases (DLT), 4 cases (PFNA), 1 cases (Gamma 3). There was no statistical difference among the three groups in the sliding length of the lag screw. Conclusion: Any certain group was not better than the others with regard to the radiological and clinical results among DLT, PFNA and Gamma nail groups in treating intertrochanteric fracture. To achieve favorable results, precise reduction of fracture site and surgical techniques are important.
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