• Archives of Plastic Surgery
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• 제36권5호
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• pp.629-636
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• 2009

Purposes: Wide scars occurring on the lower face and neck are a source of both functional and esthetic problems. Consequently, we can use skin grafts, pedicled flaps, free flaps, and tissue expansion for the reconstruction of this area. Compared with other reconstruction techniques, tissue expansion is advantageous in that it enables the maintenance of a color and texture similar to that of the adjacent tissue. However, the conventional method of tissue expansion has been reported to lead to an unnatural cervicomental angle and to the deformity of adjacent structures. We have therefore made efforts to prevent these problems through the use of several operative procedures. Methods: Forty-one patients with lower facial and cervical scars underwent tissue expansion. The tissue expansion was performed using a rectangular-shaped Nagosil$^{(R)}$ tissue expansion device. On insertion of the tissue expander, the intermediate area of superficial fat layer was dissected and then the tissue expander was inserted to make a flap that was as thin as possible. In advancement of the flap, a capsule-formed by the tissue expander-was used for the interrupted fixed suture of the flap to the fascia of the platysma muscle of the neck. This procedure was performed multiple times and also performed between the flap and the periosteum of the mandible, such that the tension was removed during the suture of the flap margin. Finally, the patients were fitted with a Jobst$^{(R)}$ facial garment in order to stabilize the operation site at least twelve months. Results: The most prevalent location of the scar was the cheek (15 cases), followed by the chin in 14 cases and the neck in 12 cases. The mean size of scar was $55.7{\pm}39.4cm^2$. Conclusions: Using our procedures, we have experienced no significant deformities and have also achieved a more natural cervicomental angle in the patients.

• Journal of Chest Surgery
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• 제34권6호
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• pp.472-476
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• 2001

배경: Nuss에 의한 누두흉의 최소 침습적 수술법은 연골 절제나 흉골절개가 없이 누두흉을 교정하는 새로운 수술법이다. 보고자는 Nuss술식의 조기 경험을 보고하는 바이다. 대상 및 방법: 1999년 12월에서 2001년 1월까지 20명의 누두흉 환자에서 Nuss술식을 시행하였다. 수술 대상은 남자 14 명, 여자 6 명으로, 1 세에서 33세까지 평균 10.1$\pm$7.7 세이며 대부분의 환자는(19명) 20세 이하였고, 33세된 성인 여자도 1명이 있었다. 결과: 가슴 함몰의 정도는 CT로 조사하였는데 CT지수는 평균 4.9$\pm$5.7 이었다. 평균 수술시간은 85.8$\pm$23.7 분이었다. 사용된 금속막대의 길이는 8 인치 에서 16인치 가지 평균 11.8$\pm$14.4 인치였다. 술후 조기 합병증은 3례의 환자에서 기흉이 있었고, 1례에서는 장마비, 전례에서 술후 통증조절을 위해 정맥진통제를 사용하였다. 1례의 성인 환자에서 술후 통증 조절을 목적으로 경막외 통증조절을 위한 도관을 삽입하였다. 그러나 전례에서 중대한 합병증은 발생치 않았다. 결론: 보고자가 누두흉 치료에 적용한 Nuss술식의 조기결과는 만족할만 하였지만 널리 이용되기에는 장기적인 관찰이 필요할 것으로 사료된다.

• 한국임상수의학회지
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• 제32권6호
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• pp.481-485
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• 2015

후지 전체의 정렬 평가에 필요한 정렬각도의 정상치를 측정하기 위하여, 정형외과적 질환이 없고 육안 또는 방사선 검사에서 각기형이 없는 것으로 판단되는 소형견 사체(말티즈, 푸들, 시추, 요크셔테리어) 의 후지 60개를 사용하였다. 각각의 후지를 완전히 신장시켜 전면 방사선 사진을 촬영하였으며, 이를 통해 기계적경골대퇴골각도(mechanical tibiofemoral angle, mTFA), 기계적중족경골각도 (mechanical metatarsotibial angle (mMTTA) 기계축-대퇴각도(mechanical axis-femur angle (MAFA), 기계축-중족각도(mechanical axis-metatarsus angle (MAMTA)을 측정하였으며, 무릎관절과 뒷발목관절의 기계축변위(mechanical axis deviation, SMAD or TMAD)의 평균값과 95% 신뢰구간 값을 전체 그리고 품종별로 측정하였다. 소형견 전체의 mTFA, MTTA, MAFA, MAMTA의 95% 신뢰구간 값은 각각 $5.7-7.4^{\circ}$, $-2.2--0.8^{\circ}$, $3.5-4.5^{\circ}$, $1.0-2.0^{\circ}$였으며, SMAD와 TMAD는 2.1-2.7%, 0.5-1.0%로 측정되었다. 본 연구에서 제시한 소형견의 후지정렬 측정법과 정상치는 소형견종의 후지 각기형의 진단 및 평가, 수술 계획에 있어 유용하게 사용될 수 있을 것이라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.577-583
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• 2017

Objective : Laminoplasty is an effective surgical method for treating cervical degenerative disease. However, postoperative complications such as kyphosis, restriction of neck motion, and instability are often reported. Despite sufficient preoperative lordosis, this procedure often aggravates the lordotic curve of the cervical spine and straightens cervical alignment. Hence, it is important to examine preoperative risk factors associated with postoperative kyphotic alignment changes. Our study aimed to investigate preoperative radiologic parameters associated with kyphotic deformity post laminoplasty. Methods : We retrospectively reviewed the medical records of 49 patients who underwent open door laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) at Pusan National University Yangsan Hospital between January 2011 and December 2015. Inclusion criteria were as follows : 1) preoperative diagnosis of OPLL or CSM, 2) no previous history of cervical spinal surgery, cervical trauma, tumor, or infection, 3) minimum of one-year follow-up post laminoplasty with proper radiologic examinations performed in outpatient clinics, and 4) cases showing C7 and T1 vertebral body in the preoperative cervical sagittal plane. The radiologic parameters examined included C2-C7 Cobb angles, T1 slope, C2-C7 sagittal vertical axis (SVA), range of motion (ROM) from C2-C7, segmental instability, and T2 signal change observed on magnetic resonance imaging (MRI). Clinical factors examined included preoperative modified Japanese Orthopedic Association scores, disease classification, duration of symptoms, and the range of operation levels. Results : Mean preoperative sagittal alignment was $13.01^{\circ}$ lordotic; $6.94^{\circ}$ lordotic postoperatively. Percentage of postoperative kyphosis was 80%. Patients were subdivided into two groups according to postoperative Cobb angle change; a control group (n=22) and kyphotic group (n=27). The kyphotic group consisted of patients with more than $5^{\circ}$ kyphotic angle change postoperatively. There were no differences in age, sex, C2-C7 Cobb angle, T1 slope, C2-C7 SVA, ROM from C2-C7, segmental instability, or T2 signal change. Multiple regression analysis revealed T1 slope had a strong relationship with postoperative cervical kyphosis. Likewise, correlation analysis revealed there was a statistical significance between T1 slope and postoperative Cobb angle change (p=0.035), and that there was a statistically significant relationship between T1 slope and C2-C7 SVA (p=0.001). Patients with higher preoperative T1 slope demonstrated loss of lordotic curvature postoperatively. Conclusion : Laminoplasty has a high probability of aggravating sagittal balance of the cervical spine. T1 slope is a good predictor of postoperative kyphotic changes of the cervical spine. Similarly, T1 slope is strongly correlated with C2-C7 SVA.

• 대한두개안면성형외과학회지
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• 제12권2호
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• pp.93-96
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• 2011

Purpose: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving $Merocel^{(R)}$ that is fixed for the anatomical structure. Method: Closed reduction and internal fixation with carved $Merocel^{(R)}$ was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients' symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients' satisfaction in 4-stages was also performed. Results: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. Conclusion: Intranasal packing after carving the $Merocel^{(R)}$ considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients' symptoms by addition of a simple procedure.

• Journal of Yeungnam Medical Science
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• 제18권1호
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• pp.112-122
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• 2001

구순 구개열을 가지는 성인 남자 17명의 두 부계측방사선 사진을 McNamara씨 분석법을 중심으로 하여 정상 대조군과 비교하여 다음과 같은 결론을 얻었다. 구순 구개열 환자에서 Na. perpendicular to point A. SNA angle이 통계적으로 유의하게 작게 나와 두개저에 대해 상악이 후방에 위치하였다(p<0.01). Effective maxillary length, Maxillomandibular differential, Wit's appraisal 등이 구순 구개열 환자와 대조군에서 통계적으로 유의하였으나 Effective mandibular length, Mandibular plane angle, Facial axis angle, Lower anterior facial height 등은 유의하지 않았다. 이는 하악의 경사도, 성장방향 등은 정상이나 상악의 절대적인 길이가 작으며 이로 인하여 상하악간의 부조화가 생긴 것으로 사료된다. 구순 구개열 환자에서 pogonion to Na. perpendicular가 95% 신뢰구간에서 통계적으로 유의하게 작게 나와 하악이 두개저에 대해 상대적으로 후방에 위치하였다. 교정치료에도 불구하고 point A에 대해 상악 전치가 상대적으로 후방에 위치하였다.

• 한국자원식물학회지
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• 제14권3호
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• pp.251-258
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• 2001

한국 자생 매발톱꽃속 종자 식물유전자원의 장기저장을 위해 건조 전처리에 의해 종자 수분함수율을 저하시킨 후 액체질소(-196$^{\circ}C$) 중에서 생존 가능성 및 보존에 관해 시험하였다. 종자 수분함수율은 10분~2시간에 걸친 다양한 건조조건에 의해 9.7~3.2%로 비례적으로 감소하였다. 건조 전처리한 매발톱꽃속 종자를 액체질소 내에 6개월간 저장하여 38$\pm$5$^{\circ}C$ 온수에 해동시켜 발아율 및 발아세, 평균발아기간을 조사하였다. 건조 무처리 한 수분 함수율10.9% 조건의 매발톱꽃 종자는 초저온 보존 후, 발아율이 52.5%로 나타났으나 60분간 건조 전처리 하여 수분 함수율이 6.0%로 조정된 종자의 경우는 84.7%가 발아하였다. 또한 발아세에 있어서도 수분 함수율이 5% 내외로 적절히 건조 전처리 한 매발톱 꽃속 종자는 초저온 보존 이후에 60%이상의 높은 발아세와 11~13일의 고른 평균 발아기간이 나타났다. 본 시험의 결과, 적절한 처리시간에 의해 건조 전처리한 자생 매발톱꽃속 종자를 초저온 조건의 액체질소에 장기 저장하여도 대조구에 비해 발아율은 약 0.5%가 저하하였으나 발아세, 평균발아율에는 큰차이가 나타나지 않았다. 또한 발아묘의 기형적인 형태적 변화도 관찰되지 않았다. 그러므로 단명성인자생 매발톱꽃속 종자의 초저온 보존은 식물 유전자원을 유전적으로 안전하고 경제적으로 저장할 수 있는 방법으로 사료된다.

• 대한족부족관절학회지
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• 제24권4호
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• pp.129-134
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• 2020

Purpose: This study compared the results of proximal and distal chevron osteotomy in patients with severe hallux valgus. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include severe hallux valgus. Materials and Methods: This study analyzed 127 severe hallux valgus surgeries. Of these, 76 patients (76 feet) were excluded for lack of adequate follow-up and additional procedures (Akin procedure), leaving 51 patients (51 feet) in the study. The mean age of the patients was 58 years (21~83 years), and the mean follow-up duration was 18 months (12~32 months). The patients were divided into two groups. Group 1 underwent distal chevron osteotomy, and group 2 underwent proximal chevron osteotomy performed sequentially by a single surgeon. The patients were interviewed for the American Orthopaedic Foot and Ankle Society (AOFAS) score before and one year after surgery. The anteroposterior weight-bearing radiography of the foot was taken before and one year after surgery. Results: There were no significant differences in pain and function after one year in either group. Both groups experienced significant pain reduction and an increase in the AOFAS score. Significant improvement of the hallux valgus and intermetatarsal angle corrections was observed in both groups, and the sesamoid position was similar in each group. More improvement in radiographic correction of intermetatarsal angle was noted in group 2. Both procedures gave similar good clinical and radiological outcomes. Conclusion: This study suggests that a distal chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting severe hallux valgus as a proximal chevron osteotomy with a distal soft-tissue procedure.

• Journal of Korean Neurosurgical Society
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• 제64권3호
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• pp.437-446
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• 2021

Objective : To investigate the radiographic characteristics of the uppermost instrumented vertebrae (UIV) and UIV+1 compression fractures that are predictive of revision surgery following long-segment spinal fixation. Methods : A total 27 patients who presented newly developed compression fracture at UIV, UIV+1 after long segment spinal fixation (minimum 5 vertebral bodies, lowest instrumented vertebra of L5 or distal) were reviewed retrospectively. Patients were divided into two groups according to following management : revisional surgery (group A, n=13) and conservative care (group B, n=14). Pre- and postoperative images, and images taken shortly before and after the occurrence of fracture were evaluated for radiologic characteristics Results : Despite similar degrees of surgical correction of deformity, the fate of the two groups with proximal junctional compression fractures differed. Immediately after the fracture, the decrement of adjacent disc height in group A (32.3±7.6 mm to 23.7±8.4 mm, Δ=8.5±6.9 mm) was greater than group B (31.0±13.9 mm to 30.1±15.5 mm, Δ=0.9±2.9 mm, p=0.003). Pre-operative magnetic resonance imaging indicated that group A patients have a higher grade of disc degeneration adjacent to fractured vertebrae compared to group B (modified Pfirrmann grade, group A : 6.10±0.99, group B : 4.08±0.90, p=0.004). Binary logistic regression analysis indicated that decrement of disc height was the only associated risk factor for future revision surgery (odds ratio, 1.891; 95% confidence interval, 1.121-3.190; p=0.017). Conclusion : Proximal junctional vertebral compression fractures with greater early-stage decrement of adjacent disc height were associated with increased risk of future neurological deterioration and necessity of revision. The condition of adjacent disc degeneration should be considered regarding severity and revision rate of proximal junctional kyphosis/proximal junction failures.

• 헤리티지:역사와 과학
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• 제50권4호
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• pp.38-63
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• 2017

본 논문은 조선시대 음각운문청자의 제작 추이에 주목하여 관요 운영이 지방 가마에 미친 영향과 그 결과에 대해 구체적인 규명을 시도한 글이다. 이를 위해 음각운문청자가 제작된 가마와 제작시기를 밝히고, 15세기 관요에서 제작된 청자의 문양을 확인하는 동시에 관요가 설치 운영된 이후 지방에서 자기가 제작된 양상을 살펴보았다. 음각운문청자는 관요가 운영되기 이전 전라도 일대에서 공물자기와 함께 제작되던 청자였다. 동일 가마에서 제작된 여타의 자기에 비해 태토의 발색이 밝고 정제수준이 높았으며 시유상태와 유조가 고른 양질 자기였다. 더욱이 음각운문청자에 일정한 규격과 위치로 시문된 문양은 고려청자의 운문과 조선시대 공예품의 운문이 독창적으로 반영된 특징을 보였다. 특히 음각운문청자는 관요가 설치되기 이전에 각 지역별로 다양한 공예적 특징을 보일 수 있었던 시대적 배경을 바탕으로 지역색이 뚜렷하게 반영된 자기였다. 지방 가마는 관요의 설치와 운영으로 인해 많은 영향을 받았다. 양질 백토를 사용하는데 제약을 받았고, 자기 공급처의 변경에 따라 왕실과 중앙 관청이 아닌 지방 관아나 민가에서 사용할 자기를 제작해야했다. 뿐만 아니라 기술력이 뛰어난 사기장의 대다수는 관요로 차출되어 지방의 자기 제작에 큰 타격을 끼쳤다. 그 결과 관요가 운영된 이후 지방 가마의 대다수는 인력과 자원확보에 어려움을 겪었고, 음각운문청자 역시 전라도 일대 가마에서 더 이상 제작되지 않았다. 반면에 관요에서는 지방 사기장 기술력의 이전에 따라 음각 운문청자가 일시적으로 제작되는 양상을 보였다. 즉, 음각운문청자는 관요로 차출된 전라도 사기장의 기술력이 관요에 투영된 증거인 동시에 관요 자기의 제작이 이내 안정되었음을 보여주는 단서로 그 의미를 찾을 수 있다.