• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.578-581
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• 2015

A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.

• Journal of Korean Neurosurgical Society
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• v.57 no.6
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• pp.460-464
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• 2015

Objective : Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. Methods : Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. Results : Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. Conclusion : Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

• Restorative Dentistry and Endodontics
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• v.38 no.3
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• pp.167-171
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• 2013

Biomechanical preparation of root canals with accentuated curvature is challenging. New rotatory systems, such as Reciproc, require a shorter period of time to prepare curved canals, and became a viable alternative for endodontic treatment of teeth with root dilaceration. Thus, this study aimed to report a clinical case of endodontic therapy of root with accentuated dilaceration using Reciproc single-file system. Mandibular right second molar was diagnosed as asymptomatic irreversible pulpitis. Pulp chamber access was performed, and glide path was created with #10 K-file (Dentsply Maillefer) and PathFile #13, #16 and #19 (Dentsply Maillefer) up to the temporary working length. The working length measured corresponded to 20 mm in the mesio-buccal and mesio-lingual canals, and 22 mm in the distal canal. The R25 file (VDW GmbH) was used in all the canals for instrumentation and final preparation, followed by filling with Reciproc gutta-percha cones (VDW GmbH) and AH Plus sealer (Dentsply Maillefer), using thermal compaction technique. The case has been receiving follow-up for 6 mon and no painful symptomatology or periapical lesions have been found. Despite the difficulties, the treatment could be performed in a shorter period of time than the conventional methods.

• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.247-254
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• 2021

Objective : The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.245-248
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• 1997

Operative interventions for the management of osteonecrosis of the femoral head (ONFH) include core drilling, with or without vascularized fibular bone grafting. Nevertheless, their clinical results have not been consistently satisfactory. Recently, a new surgical procedure that incorporates cementation with polymethylmethacrylate (PMMA) after core drilling has been tried clinically. In this study, a biomechanical analysis using a finite element method(FEM) was undertaken to evaluate surgical methods and their underlying surgical parameter. Our finite element models included five types. They were (1) normal model (Type I), (2) necrotic model (Type II), (3) core decompressed model (Type III). (4) fibular bone grafted model (Type IV), and (5) cemented with PMMA model (Type V). The geometric dimensions of the femur were based on digitized CT-scan data of a normal person. Various physiological loading conditions and surgical penetration depths by the core were used as mechanical variables to study their biomechanical contributions in stress transfer within the femoral head region. In addition. the peak von Mises stress(PVMS) within the necrotic cancellous bone of the femoral head was obtained. The fibular bone grafted method and cementation method provided optimal stress transfer behaviors. Here. substantial increase in the low stress level was observed when the penetration depth was extended to 0mm and 5mm from the subchondral region. Moreover, significant decrease in PVMS due to surgery was observed in the fibular bone grafted method and the cementation method when the penetration depths were extended up to 0 and 5mm from the subchondral region. The drop in PVMS was greater during toe-off than during heel-strike (57% vs. 28% in Type IV and 49% vs. 22% in Type V). Both the vascularized fibular bone grafting method (Type IV) and the new PMMA technique (Type V) appear to be very effective in providing good stress transfer and reducing the peak Von-Mises stress within the necrotic region. Overall results show that fibular bone grafting and cementation methods are quite similar. In light of above results, the new cementation method appears to be a promising surgical alternative or the treatment of ONFH. The use of PMMA for the core can be less prone to surgical complication as opposed to preparation of fibular bone graft and can achieve more immediate fixation between the core and the surrounding region.

• The Journal of Korean Academy of Prosthodontics
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• v.48 no.1
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• pp.61-68
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• 2010

Purpose: This article attempted to determine the factors affecting the preload and screw loosening. Methods: Available clinical studies from 1981 to 2008 from the PUBMED that presented screw loosening data and review articles regarding screw joint stability were evaluated. Eleven studies dealing the biomechanical principles of the screw mechanics were reviewed. Moreover, the results of our data were included. Results: The frequency of screw loosening was consequently reduced due to the advancement in torque tightening with torque wrench, screw material, coating technique for reducing the frictional force, and thread design, etc. If preload in the screw falls below a critical level, joint stability may be compromised, and the screw joint may fail clinically. The types of fatigue failure of screw were divided to adhesive wear, plastic deformation, and screw fracture. Conclusion: An optimum preload is essential to the success of the implant-abutment complex. To maintain optimum preload, using a torque wrench and re-tightening at recall time were needed.

• Journal of Biomedical Engineering Research
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• v.24 no.5
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• pp.401-410
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• 2003

This study investigates the biomechanical efficacies of various cement augmentation techniques with or without pressurization for varying degrees of osteoporotic femur. For this study, a biomechanical analysis using a finite element method (FEM) was undertaken to evaluate surgical procedures, Simulated models include the non-cemented(i.e., hip screw only, Type I), the cement-augmented(Type II), and the cemented augmented with pressurization(Type III) models. To simulate the fracture plane and other interfacial regions, 3-D contact elements were used with appropriate friction coefficients. Material properties of the cancellous bone were varied to accommodate varying degrees of osteoporosis(Singh indices, II∼V). For each model. the following items were analyzed to investigate the effect surgical procedures in relation to osteoporosis of varying degrees : (a) von Mises stress distribution within the femoral head in terms of volumetric percentages. (b) Peak von Mises stress(PVMS) within the femoral head and the surgical constructs. (c) Maximum von Mises strain(MVMS) within the femoral head, (d) micromotions at the fracture plane and at the interfacial region between surgical construct and surrounding bone. Type III showed the lowest PVMS and MVMS at the cancellous bone near the bone-construct interface regardless of bone densities. an indication of its least likelihood of construct loosening due to failure of the host bone. Particularly, its efficacy was more prominent when the bone density level was low. Micromotions at the interfacial surgical construct was lowest in Type III. followed by Type I and Type II. They were about 15-20% of other types. which suggested that pressurization was most effective in limiting the interfacial motion. Our results demonstrated the cement augmentation with hip screw could be more effective when used with pressurization technique for the treatment of intertrochanteric fractures. For patients with low bone density. its effectiveness can be more pronounced in limiting construct loosening and promoting bone union.

• Journal of the Ergonomics Society of Korea
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• v.34 no.3
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• pp.279-291
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• 2015

Objective: The purpose of the study is to evaluate appropriate weight for aged farmers in manually handling livestock feed in bags using ergonomic methods. Background: In the livestock industry in South Korea, despite the trend of aging of labor manpower, heavy items are still manually handled in many farms. In particular, among stockbreeding works, the handling of feed in bags weighing 25~30kg is reported as a cause of frequent injuries and musculoskeletal system diseases. However, studies on the standard for recommended weight allowed considering the physical characteristics of aged farmers older than 60 years with greatly decreased physical strength and muscle strength are insufficient. Method: To evaluate appropriate weight for handling of heavy livestock feed in bags, physical techniques for measuring recognized levels of physical work loads, the NLE (NIOSH lifting equation) a method that is an observation type technique, and an ergonomic modeling technique to predict compressive force imposed on L5/S1 were used. Subjects who participated in the experiment were organized into two groups of males/females with mean age exceeding 60 years, and lifting tasks were evaluated for nine weight levels. Results: Based on the results of psychophysical measurement, females showed a tendency of more drastic increases compared to males when weight was over 19kg. The results of estimation of regression models for the weight, 18.0 kg ($r^2=0.97$) and 15.3kg ($r^2=0.97$) were evaluated as stable load for males and females, respectively. In addition, both the observation type evaluation and ergonomic model evaluation showed stable loads in a range of 15~18kg. Conclusion: Given the results of the study, the weight of the feed in bags currently distributed to farms can become a cause of not only overexertion but also farm work related disasters such as musculoskeletal disorders and safety accidents. Providing livestock feed in bags weighing not more than 19kg for aged farmers is judged desirable, and managerial improvement for this matter is considered necessary. Application: The results of the present study can be utilized as useful data for institutional improvement of the weight of livestock feed in bags.

• Korean Journal of Applied Biomechanics
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• v.25 no.1
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• pp.39-47
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• 2015

Objective : The purpose of this study was to investigate the velocity conversion coefficient and invariance for the optimal phase ratio on the performance of the women's triple jump. Methods : Three-dimensional kinematic data were obtained from the three finalists of the women's triple jumper competition at the 2011 Daegu IAAF World Championships. Computer simulations were performed using the biomechanical model of the triple jump to optimize the phase ratio for the longest actual distance for all athletes with altered velocity conversion coefficients. Results : Top elite triple jumpers showed better technical consistency at the phase ratio. Also, no consistent relationship was observed between the loss in horizontal velocity and the gain in vertical velocity across supporting the three phase. In addition, regardless of the magnitude A1, all athletes were optimized with jump-dominated technique. Finally, as the magnitude of A1 increased, the athletes showed better performance. The obtained overall distance jumped showed the longest actual distance when the optimal phase ratio was transferred from hop-dominated to jump-dominated(the step ratio was 30%~31%), and when the optimal phase ratio was transferred from balanced to jump-dominated(the step ratio was 27%~29%). Conclusion : Future studies need to be conducted in order to explore the active landing motion and the inclination angle of the body with the velocity conversion coefficient simultaneously at each supporting phase.

• Korean Journal of Applied Biomechanics
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• v.21 no.2
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• pp.161-171
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• 2011

The purpose of this study was to identify biomechanical characteristics of glide and delivery motion of In-Sung Hwang, player who is a member of the national team among the finalists in the men's shot put at the 2010 National Sports Festivals. Three-Dimensional motion analysis using a system of 3 video cameras at a sampling frequency of 60 Hz was performed for this study. During the glide and delivery phase the results showed following characteristics; 1) The glide type was suitable for the short-long technique, but the trajectory of shot at the glide and delivery phase showed a different trajectory pattern with "S-shaped" type of elite players due to many deviating from central axis of the APSS(athletic-plus shot system). 2) Left knee was more flexed during failed trials compared to successful trials but COG was higher. Therefore, the player showed less stability of COG as he may not get enough breaking force at the left foot. 3) Furthermore, it would be required to have strong muscle power at the trunk, throwing arm, and the lower extremity in order to achieve maintain a low projection angle of the release.