대한기계학회논문집B (Transactions of the Korean Society of Mechanical Engineers B)

  • 제36권3호
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  • Pages.351-361
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  • 2012
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  • 1226-4881(pISSN)
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  • 2288-5324(eISSN)
대한기계학회 (The Korean Society of Mechanical Engineers)
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Computer Assisted Surgery(CAS)를 이용한 개방형 근위경골절골술 시 전내측피질골경사각이 경골후방경사각에 미치는 영향

Effect of Anteromedial Cortex Oblique Angle on Change of Tibial Posterior Slope Angle in High Tibial Osteotomy Using Computer Assisted Surgery (CAS)

  • 이호상 (한양대학교 기계공학과) ;
  • 김재정 (한양대학교 기계공학과) ;
  • 왕준호 (성균관대학교 의과대학 삼성서울병원 정형외과) ;
  • 김철웅 (고려대학교/(주)트리플씨메디칼)
  • Lee, Ho-Sang (Dept. of Mechanical Engineering, Hanyang Univ.) ;
  • Kim, Jay-Jung (Dept. of Mechanical Engineering, Hanyang Univ.) ;
  • Wang, Joon-Ho (Dept. of Orthopedics, Samsung Medical Center Sungkyunkwan Univ. School of Medicine) ;
  • Kim, Cheol-Woong (RITE, Korea University / Triple-C Medical Corp.)
  • 투고 : 2011.11.09
  • 심사 : 2012.01.07
  • 발행 : 2012.03.01
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초록

슬관절 내반슬과 외반슬의 부정정렬을 교정하는 방법 중 대표적인 수술법이 근위경골절골술이다. 개방형 쐐기 근위경골절골술(OWHTO)의 경우 근위비골 인접부의 경골외측 비골신경을 손상시킬 우려가 없고, 수술도중 교정각의 개방 정도를 임의대로 조절 변경 가능한 장점으로 최근 선호되고 있다. 그러나 술후 관상면에서의 외반 및 내반 교정은 바르게 이루어지는 반면, 시상면에서는 수술자가 의도하지 않은 경골내측고평부의 후방경사각(PSA) 변화가 발생한다는 문제점이 있다. 저자들은 이와 같은 문제의 극복을 위해 Computer Assisted Surgery를 이용한 근위경골절골술 기법을 자체적으로 개발하였고, 근위경골부의 CT 이미지 3차원 재건과 컴퓨터를 이용한 가상절골술을 수행하였다. 또한 술후에도 후방경사각(PSA)이 변화하지 않는 수술기법에 대해 제시하였다. 본 연구결과는 환자고유의 전내측피질골 경사각(ACOA)과 후방경사각(PSA)의 명확한 관계성에 대해 제시해줄 것이며 환자마다 다른 최적의 후방경사각 결정법에 대해 제시해 줄 것으로 판단된다.

The leading surgical method for correcting the misalignment of the varus and valgus in the knee joint is the high tibial osteotomy (HTO). In the opening wedge HTO (OWHTO), there is no concern about damaging the peroneal nerve on the lateral tibia of the proximal fibula. OWHTO has been the preferred choice, as the opening of the correction angle can be modulated during the operation. The correction of the varus and valgus on the coronal plane are performed adroitly. Nevertheless, there have been numerous reports of unintended changes in the medial tibial plateau and posterior slope angle (PSA). The authors have developed an HTO method using computer-assisted surgery with the aim of addressing the abovementioned problems from an engineer's perspective. CT images of the high tibia were reconstructed three-dimensionally, and a virtual osteotomy was performed on a computer. In addition, this study recommends a surgical method that does not cause changes in the PSA after OWHTO. The results of the study are expected to suggest a clear relationship between the anteromedial cortex oblique angle of each patient and the PSA, and an optimal PSA selection method for individuals.

키워드

참고문헌

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