• Journal of Korean Neurosurgical Society
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• 제43권2호
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• pp.119-122
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• 2008

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.

• Journal of Korean Neurosurgical Society
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• 제56권1호
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• pp.5-10
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• 2014

Objective : When the pedicle screw insertion technique is failed or not applicable, C7 intralaminar screw insertion method has been used as an alternative or salvage fixation method recently. However, profound understanding of anatomy is required for safe application of the bilaterally crossing laminar screw at C7 in clinic. In this cadaveric study, we evaluated the anatomic feasibility of the bilateral crossing intralaminar screw insertion and especially focused on determination of proper screw entry point. Methods : The C7 vertebrae from 18 adult specimens were studied. Morphometric measurements of the mid-laminar height, the minimum laminar thickness, the maximal screw length, and spino-laminar angle were performed and cross-sectioned vertically at the screw entry point (spino-laminar junction). The sectioned surface was equally divided into 3 parts and maximal thickness and surface area of the parts were measured. All measurements were obtained bilaterally. Results : The mean mid-laminar height was 13.7 mm, mean minimal laminar thickness was 6.6 mm, mean maximal screw length was 24.6 mm, and mean spinolaminar angle was $50.8{\pm}4.7^{\circ}$. Based on the measured laminar thickness, the feasibility of 3.5 mm diameter intralaminar screw application was 83.3% (30 sides laminae out of total 36) when assuming a tolerance of 1 mm on each side. Cross-sectional measurement results showed that the mean maximal thickness of upper, middle, and lower thirds was 5.0 mm, 7.5 mm, and 7.3 mm, respectively, and mean surface area for each part was $21.2mm^2$, $46.8mm^2$, and $34.7mm^2$, respectively. Fourteen (38.9%) sides of laminae would be feasible for 3.5 mm intralaminar screw insertion when upper thirds of C7 spino-laminar junction is the screw entry point. In case of middle and lower thirds of C7 spino-laminar junction, 32 (88.9%) and 28 (77.8%) sides of laminae were feasible for 3.5 mm screw insertion, respectively. Conclusion : The vertical cross-sectioned area of middle thirds at C7 spinolaminar junction was the largest area and 3.5 mm screw can be accommodated with 77.8 % of feasibility when lower thirds were the screw entry point. Thus, selection of middle and lower thirds for each side of screw entry point in spino-laminar junction would be the safest way to place bilateral crossing laminar screw within the entire lamina. This anatomic study result will help surgeons to place the screw safely and accurately.

• Journal of Korean Neurosurgical Society
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• 제41권2호
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• pp.141-144
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• 2007

A vertebral arte [VA] injury presents a difficult problem in atlantoaxial fixation. Recent technical reports described posterior C2 fixation using bilateral, crossing C2 laminar screws. The translaminar screw technique has the advantages of producing little risk of VA injury and the unconstrained screw placement. In addition, biomechanical studies have demonstrated the potential of the translaminar screw technique to provide a firmer construct that is equivalent to methods currently used. We report the successful treatment of C1-2 instability with a left-side high-riding VA. Because of the potential risk of VA injury, we performed a posterior C1-2 fixation with a combination of pedicle screws and a laminar screw in C2. We first placed bilateral C1 lateral mass screws and a right-side C2 pedicle screw. However, placement of the left- side C2 pedicle screw was technically difficult due to a narrow isthmus and pedicle. A laminar screw was inserted instead and authors believe that this posterior C1-C2 fixation with a combination of pedicle screws and a laminar screw in C2 can be a useful alternative technique for the treatment of C1-C2 instability in the presence of a unilateral high-riding VA.

• Clinics in Shoulder and Elbow
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• 제19권1호
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• pp.43-47
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• 2016

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months followup, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

• 대한족부족관절학회지
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• 제21권4호
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• pp.128-134
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• 2017

Purpose: To introduce reliable and newly developed radiographic measures based on a lateral ankle radiograph to assess a syndesmotic reduction after screw fixation and to compare with the radiographic measures based on the anteroposterior (AP) and mortise radiographs. Materials and Methods: The postoperative ankle radiographs of 34 ankle fracture cases after screw fixation for concurrent syndesmosis injury were reviewed. Two radiographic parameters were measured on each AP and mortise radiograph; tibiofibular clear space (TFCS) and tibiofibular overlap (TFO). Five radiographic parameters were measured on the true lateral radiographs; the anteroposterior tibiofibular (APTF) ratio, anterior tibiofibular ratio (ATFR), posterior tibiofibular ratio (PTFR), distances of intersection of the anterior fibular border and the tibial plafond to anterior cortex of the tibia (AA'), and the intersection of posterior fibular border and tibial plafond to the tip of the posterior malleolus (BB'). In addition, the distance (XP) between the fibular posterior margin (X) crossing tibial plafond or the posterior malleolus and posterior articular margin (P) of the tibial plafond was measured on the lateral view. Results: Using TFCS and TFO in the AP and mortise radiographs, malreductions of syndesmosis were estimated in 17 of 34 cases (50.0%). Using the introduced and developed radiographic measures in the lateral radiographs, syndesmotic malreductions were estimated in 16 out of 34 cases (47.1%). Seventeen cases (50.0%) showed no evidence of postoperative diastasis using the radiographic criteria on the AP and mortise view, 10 cases (58.8%) of whom showed evidence of a malreduction on the lateral radiograph. The newly developed measurements, XP, were measured 0 in 11 out of 34 cases (32.4%). Conclusion: The reduction of syndemosis after screw fixation can be accurately assessed intraoperatively with a combination of several reliable radiographic measurements of the lateral radiograph and traditional radiographic measurements of the AP and mortise radiograph.

• Structural Monitoring and Maintenance
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• 제1권1호
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• pp.131-157
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• 2014

Special track systems used to divert a train to other directions or other tracks are generally called 'railway turnout'. A traditional turnout system consists of steel rails, switches, crossings, steel plates, fasteners, screw spikes, timber bearers, ballast and formation. The wheel rail contact over the crossing transfer zone has a dip-like shape and can often cause detrimental impact loads on the railway track and its components. The large impact also emits disturbing noises (either impact or ground-borne noise) to railway neighbors. In a brown-field railway track where an existing aged infrastructure requires renewal or maintenance, some physical constraints and construction complexities may dominate the choice of track forms or certain components. With the difficulty to seek for high-quality timbers with dimensional stability, a methodology to replace aged timber bearers in harsh dynamic environments is to adopt an alternative material that could mimic responses and characteristics of timber in both static and dynamic loading conditions. A critical review has suggested an application of an alternative material called fibre-reinforced foamed urethane (FFU). The full-scale capacity design makes use of its comparable engineering characteristics to timber, high-impact attenuation, high damping property, and a longer service life. A field trial to investigate in-situ behaviours of a turnout grillage system using an alternative material, 'fibre-reinforced foamed urethane (FFU)' bearers, has been carried out at a complex turnout junction under heavy mixed traffics at Hornsby, New South Wales, Australia. The turnout junction was renewed using the FFU bearers altogether with new special track components. Influences of the FFU bearers on track geometry (recorded by track inspection vehicle 'AK Car'), track settlement (based on survey data), track dynamics, and acoustic characteristics have been measured. Operational train pass-by measurements have been analysed to evaluate the effectiveness of the replacement methodology. Comparative studies show that the use of FFU bearers generates higher rail and sleeper accelerations but the damping capacity of the FFU help suppress vibration transferring onto other track components. The survey data analysis suggests a small vertical settlement and negligible lateral movement of the turnout system. The static and dynamic behaviours of FFU bearers appear to equate that of natural timber but its service life is superior.

• Journal of the Korean Wood Science and Technology
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• 제14권1호
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• pp.3-44
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• 1986

목재(木材)파아티클과 성질(性質)이 전혀 다른 철선(鐵線)을 물리적(物理的)으로 결합(結合)시킴으로써 목재(木材)와 철재(鐵材)의 재료적(材料的) 특성(特性)을 서로 보완(補完)하여 목재(木材)파아티클과 철선(鐵線)의 새로운 복합체(複合體)인 목질(木質)-철선(鐵線)보오드를 제조(製造)하고 그 특성(特性)을 구명(究明)하여 기초자료(基礎資料)를 얻고자 하였다. 메란티 합판제조폐재(合板製造廢材)을 이용(利用)한 팔만칩을 12mesh를 통과하고 20mesh체에 남는 큰 파아티클과 20mesh을 통과하고 60mesh체에 남는 작은 파아티클로 구분하여 요소수지를 분무한 다음, 굵기 1mm인 철선(鐵線)을 나비방향과 길이방향으로 1, 2 및 3층(層)으로 배열하여 성형(成型)하고 시험용(試驗用) 복합(複合) 파아티클 보오드를 제조하였다. 1층(層) 철선구성(鐵線構成)보오드의 경우에는 철선간(鐵線間)의 배치간격(配置間隔)을 나비방향과 길이방향(方向)으로 각기 0.5cm, 1cm, 1.5cm, 2cm 및 2.5cm 등(等) 5가지로 하여 24가지의 철선구성방법(鐵線構成方法)으로 하였으며, 2층(層) 철선구성(鐵線構成 )보오드는 철선구성간격(鐵線構成間隔)을 1cm로 하였고 철선구성방법(鐵線構成方法)을 3가지로 하였으며, 3층(層) 철선구성(鐵線構成)보오드는 철선구성간격(鐵線構成間隔)을 1cm로 하고 철선구성방법(鐵線構成方法)을 11가지로 하여 제조(製造)한 보오드는 대조(對照)보오드를 포함(包含)하여 312개였다. 보오드를 성형(成型)한 열압온도(熱壓溫度) 160$^{\circ}C$, 악력(壓力) 35kgf/$cm^2$, 열압시간(熱壓時間) 9분(分)으로 하여 보오드를 제조(製造)하고 이 목질(木質) 철선복합(鐵線複合)보도드의 물리적(物理的) 및 기계적(機械的) 성질(性質)을 측정(測定)분석(分析)한 바 다음과 같은 결과(結果)를 얻었다. 1. 큰 파아티클과 작은 파아티클로 제조(製造)한 보오드에서 철선구성층수(鐵線構成層數) 및 구성철선(構成鐵線)의 수(數)가 많은 보오드일수록 그 비중(比重)은 컸었다. 2. 큰 파아티클로 제조(製造)한 보오드는 철선구성(鐵線構成)으로 인하여 두께팽창율(膨脹率)의 감소(減少)가 뚜렷하였으며 특히 철선구성층수(鐵線構成層數)가 많을수록 이 팽창율(膨脹率)은 더 개선되었다. 3. 큰 파아티클 및 작은 파아티클로 제조(製造)한 보오드 공(共)히 철선구성층수(鐵線構成層數)가 증가(增加)함에 따라 철선(鐵線)의 강도적(强度的) 특성(特性)이 파아티클 휨강도(强度) 성질(性質)을 보강(補强)하여 파괴계수(破壞係數), 탄성계수(彈性係數), 휨 극한하중(極限荷重) 일량(量) 등(等)이 개선(改善)되었으며, 2층(層) 및 3층(層) 철선구성(鐵線構成)보오드의 경우 보오드의 하층(下層)의 철선구성방향(鐵線構成方向)이 보오드의 길이방향(方向)과 일치(一致)하는 보오드가 특(特)히 큰 휨강도(强度) 향상(向上)을 보여 인장라미네이션을 얻었다. 4. 1층(層) 철선구성(鐵線構成)보오드는 철선구성간격(鐵線構成間隔)에 따른 개구면적(開口面積)과 파아티클의 크기에 따라 파괴계수(破壞係數), 탄성계수(彈性係數), 휨 극한하중(極限荷重) 일량(量) 등(等)이 다르게 나타났으나, 큰 파아티클로 제조(製造)한 보오드의 파괴계수(破壞係數)는 개구면적(開口面積)이 1.5~3$cm^2$이고, 나비 방향(方向)의 철선구성간격(鐵線構成間隔)이 1~2cm이면서 길이방향(方向)의 철선구성간격(鐵線構成間隔)이 1.5~2.5cm인 보오드가 높은 값을 나타냈고 작은 파아티클로 제조(製造)한 보오드의 파괴계수(破壞係數)는 개구면적(開口面積)이 0.5~1.5$cm^2$ 및 3.75~6.25$cm^2$이고 나비 방향(方向)의 철선간격(鐵線間隔)이 0.5cm이거나 2.5cm인 보오드가 높은 값을 나타냈다. 5. 큰 파아티클로 제조(製造)한 1층(層) 철선구성(鐵線構成)보오드의 탄성계수(彈性係數)는 개구면적(開口面積)이 1.5~3$cm^2$이고 나비방향(方向) 및 길이방향(方向)의 철선구성간격(鐵線構成間隔)이 1~2.5cm에서 큰 값을 나타냈으며, 한편 작은 파아티클로 제조(製造)한 보오드의 탄성계수(彈性係數)는 개구면적(開口面積)이 0.75~1.25$cm^2$ 민 3~6.25$cm^2$이고, 나비방향(方向)의 철선구성간격(鐵線構成間隔)이 0.5 또는 2.5cm에서 큰 값을 나타내었다. 6. 큰 파아티클로 제조(製造)한 1층(層) 철선구성(鐵線構成)보오드의 휨 극한하중(極限荷重) 일량(量)은 개구면적(開口面積)이 1~3$cm^2$인 보오드가 큰 값을 보였고, 작은 파아티클로 제조(製造)한 보오드의 경우의 그것은 철선(鐵線)의 개구면적(開口面積)이 좁은 것이 크게 나타났다. 7. 박리저항(剝離抵抗) 및 나사못보지력(保持力)은 큰 파아티클로 제조(製造)한 3층(層) 및 2층(層) 철선구성(鐵線構成)보오드에서 대부분(大部分) 대조(對照)보오드보다 큰 값을 보였으나 작은 파아티클로 제조(製造)한 보오드에서는 뚜렷한 경향이 없었다. 큰 파아티클로 제조(製造)한 1층(層) 철선구성(鐵線構成)보오드의 박리저항(剝離抵抗) 및 나사못보지력(保持力)은 전체적으로 비슷한 수준(水準)을 보였고 작은 파아티클로 제조한 보오드에서는 개구면적(開口面積)이 증가(增加)함에 따라 박리저항(剝離抵抗)은 증가(增加)하고 나사못보지력(保持力)은 감소(減少)하는 현상(現象)을 보였다.