• 제목/요약/키워드: Foot and Ankle

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비복근을 이용한 교차하지 근육 피판술 (The Cross-Leg Gastrocnemius Muscle Flap for Leg Reconstruction of the Difficult and Unfavorable Conditions)

  • 김지예;양은정;황은아;김석원
    • Archives of Plastic Surgery
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    • 제36권5호
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    • pp.583-590
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    • 2009
  • Purpose: In the cases of a vascular compromised condition in an injured lower extremity, soft tissue coverage with free tissue transfer presents a challenging problem to the reconstructive surgeon. For this reason, cross - leg flaps are still used in unusual circumstances. Advances in surgical technique has made the cross - leg free flap possible although it may require long operation time along with significant donor site morbidity. Therefore, a pedicled cross - leg muscle flap may be an alternative treatment modality when local flap or free flap is not possible. Methods: Twelve patients(9 males and 3 females) underwent the operation between October of 2001 and December of 2008. The patients' age ranged from 6 to 82 years. The unusual defects included the regions such as the knee, popliteal fossa, distal third of the tibia, dorsal foot, and the heel. Indications for the cross - leg gastrocnemius flap are inadequate recipient vessels for free flap(in eight cases), extensive soft tissue injuries(in three cases) and free flap failure(in one case). The muscle flap was elevated from contralateral leg and transferred to the soft tissue defect on the lower leg while both legs were immobilized with two connected external fixator systems. Delay procedure was performed 2 weeks postoperatively, and detachment was done after the establishment of the adequate circulation. The average period from the initial flap surgery to detachment was 32 days (3 to 6 weeks). Mean follow - up period was 4 years. Results: Stable coverage was achieved in all twelve patients without any flap complications. Donor site had minimal scarring without any functional and cosmetic problems. No severe complications such as deep vein thrombosis or flap necrosis were noted although mild to moderate contracture of the knee and ankle joint developed due to external fixation requiring 3 to 4 weeks of physical treatment. All patients were able to walk without crutches 3 months postoperatively. Conclusion: Although pedicled cross - leg flaps may not substitute free flap surgery, it may be an alternative method of treatment when free flap is not feasible. Using this modification of the gastrocnemius flap we managed to close successfully soft tissue defects in twelve patients without using free tissue transfers.

비무장지대 출토 군화의 형태 복원을 위한 3차원 디지털 기술의 적용 및 보존처리 (Application and conservation of 3D technology for the restoration of the original shape of military boots excavated in the DMZ)

  • 오승준;위광철
    • 헤리티지:역사와 과학
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    • 제56권2호
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    • pp.124-133
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    • 2023
  • 국방부 유해발굴단을 통해 발굴된 한국전쟁 전사자 유품의 보존 방법론을 제시하고자 3D 기술의 적용과 가역성 및 안정성이 우수한 보존 재료를 이용해 군화류 2점에 대한 보존처리를 진행하였다. 3D 스캐닝과 모델링을 통해 군화를 신었던 전사자의 발 사이즈를 추정해 볼 수 있었으며, 이를 기반으로 3D 출력 구조체를 이용해 원형을 복원하였다. 원형 복원은 출토 유품의 오염물 제거와 유연제 처리 작업을 거쳐 구조체의 형태로 복원하였으며, 열화되어 찢겨지거나 멸실된 부분은 접합 및 메움처리 후 고색처리를 통해 원형을 복원하였다. 보존처리 후 2종의 군화 모두 밑창과 발등 부분은 고무류, 발등 일부와 발목 부분은 합성가죽류로 제작된 것을 확인할 수 있었으며, 이는 방수 또는 방한의 목적으로 제작되어 1944년에 도입된 모델 Shoe Pac(M-1944, 12-inch) 방한화와 유사한 군화임을 확인하였다. 이러한 결과는 보존처리를 통해 출토된 유품의 제작기법과 재질, 용도 등을 밝혀낼 수 있음을 확인한 연구로서 과학적 보존처리와 3D 기술의 융합적 연구의 중요성을 보여준 사례이다.

족부 진단용 3차원 움직임 측정을 위한 무선 이동형 시스템 개발 (Development of Wireless Ambulatory System Measuring 3-D Motion as Podiatric Diagnosis)

  • 김진호;김화인;김동욱;원용관;김정자
    • 한국통신학회논문지
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    • 제36권5B호
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    • pp.502-510
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    • 2011
  • 본 연구에서는 보행 시 발의 3차원 움직임에 대한 보다 정확한 동작 각도를 측정하고, 기존의 마커 방식에 의한 유선 동작 분석 시스템의 불편함을 해결하기 위해서 양상에 실제 사용 가능한 족부 진단용 우선 이동형 시스템을 개발하였다. 시스템의 주요 모듈은 3축 가속도계와 3축 자이로계로 이루어진 관성 측정 장치와 블루투스 전송 모듈로 구성되었다. 피험자는 전주 소아과 족부 임상 전문의에게 평발과 아킬레스건염을 진단 받은 소아과 환자 5명의 10족 에 대한 측정을 하였으며, 족부 전문의의 이학적 소견과 대비하여 개발 시스템에서 측정한 값과 근전도 데이터를 바탕으로 그 타당성을 평가하였다. 발목의 ROM은 외측 복사뼈에서 측정된 최대 피크와 최소 피크의 차이로 측정하였고, 이 값에 근거하여 평발이 심할수록 외번의 비율이 상대적으로 높아짐을 보였다. 근전도 측정 결과 내번근으로 작용하는 전경골근의 보상 작용으로 인해 전경골근의 근 활성도가 높게 측정되었고, 아킬레스건염에 의해 족배굴곡이 제한됨으로 인해 족저굴곡근으로 작용하는 비복근의 근 활성도가 높아짐을 보임으로서 족부 질환에 따르는 발의 비정상적인 움직임과 특정 근육의 활성 사이에 상관성이 있음을 확인 하였다.

오르막보행 시 타이거스텝 하지 움직임에 미치는 영향 (Effect of Tiger Step on Lower Extremities during Uphill Walking)

  • Kang, Jihyuk;Yoon, Sukhoon
    • 한국운동역학회지
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    • 제32권1호
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    • pp.17-23
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    • 2022
  • Objective: The aim of this study was to investigate the effect Tiger-step walking on the movement of the lower extremities during walking. Method: Twenty healthy male adults who had no experience of musculoskeletal injuries on lower extremities in the last six months (age: 26.85 ± 3.28 yrs, height: 174.6 ± 3.72 cm, weight: 73.65 ± 7.48 kg) participated in this study. In this study, 7-segments whole-body model (pelvis, both side of thigh, shank and foot) was used and 29 reflective markers and cluster were attached to the body to identify the segments during the gait. A 3-dimensional motion analysis with 8 infrared cameras and 7 channeled EMG was performed to find the effect of tigerstep on uphill walking. To verify the tigerstep effect, a one-way ANOVA with a repeated measure was used and the statistical significance level was set at α=.05. Results: Firstly, Both Tiger-steps showed a significant increase in stance time and stride length compared with normal walking (p<.05), while both Tiger-steps shown significantly reduced cadence compared to normal walking (p<.05). Secondly, both Tiger-steps revealed significantly increased in hip and ankle joint range of motion compared with normal walking at all planes (p<.05). On the other hand, both Tiger-steps showed significantly increased knee joint range of motion compared with normal walking at the frontal and transverse planes (p<.05). Lastly, Gluteus maximus, biceps femoris, medial gastrocnemius, tibialis anterior of both tiger-step revealed significantly increased muscle activation compared with normal walking in gait cycle and stance phase (p<.05). On the other hand, in swing phase, the muscle activity of the vastus medialis, biceps femoris, tibialis anterior of both tiger-step significantly increased compared with those of normal walking (p <.05). Conclusion: As a result of this study, Tiger step revealed increased in 3d range of motion of lower extremity joints as well as the muscle activities associated with range of motion. These findings were evaluated as an increase in stride length, which is essential for efficient walking. Therefore, the finding of this study prove the effectiveness of the tiger step when walking uphill, and it is thought that it will help develop a more efficient tiger step in the future, which has not been scientifically proven.

농업인의 근골격계 자각증상에 영향을 미치는 요인: 인구사회학적 요인 중심으로 (Factors Affecting Musculoskeletal Symptoms among Korean Farmers: Focusing on the Sociodemographic Characteristics)

  • 이민지;김경수;최동필
    • 농촌의학ㆍ지역보건
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    • 제47권4호
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    • pp.255-267
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    • 2022
  • Objectives: The purpose of this study was to analyze the factors affecting work-related musculoskeletal symptoms in farmers. Methods: In order to examine the factors affecting the musculoskeletal symptoms among farmers, data of 'Occupational Disease Survey for Farmers' was performed by the RDA(Rural Development Administration). Results: The odds ratio of work-related musculoskeletal symptoms among female farmers were 1.42(1.30-1.56) times higher than male farmers. The older aging and longer the agricultural work period, the higher odds ratio of musculoskeletal symptoms was shown. By major crops, all crop farmers showed higher odds ratio of musculoskeletal symptoms compared to rice crop farmers. As a result of examining the effective factors on the odds ratio of musculoskeletal symptoms by body parts, female farmers had higher odds ratio of musculoskeletal symptoms than male farmers by 1.38(1.26-1.51) times in waist, 1.58(1.44-1.74) times in knee, 1.32(1.05-0.67) times in hand/wrist, and 1.30(1.06-1.59) times in foot/ankle. By crops, animal husbandry farmers had higher odds ratio of musculoskeletal symptoms than rice crop farmers by 1.44(0.89-2.35) times in waist, and field crop farmers were 1.37(1.07-1.77) times higher in knee. Compared with rice crop farmers, odds ratio of the shoulder part the shoulder parts were 1.19(0.81-1.76) times higher in greenhouse crop farmers and 1.16(0.97-1.38) times higher in dry field crop farmers. Odds ratio of the hands/wrist parts were higher odds ratio of musculoskeletal symptoms than rice crop farmers by 1.69(1.00-2.87) times in greenhouse crop farmers. Conclusions: The results of this study would help to select the group that needs to be managed first, and could be used as basic data for the development of customized musculoskeletal disorders prevention programs.

우리나라 대표적(代表的) 표본인구(標本人口)의 연간(年間) 손상(損傷) 및 중독발생율(中毒發生率)과 역학적(疫學的) 특성(特性) (National Survey of Injury and Poisoning on a Representative Sample Population of Koreans)

  • 김정순;김성수;장성칠
    • Journal of Preventive Medicine and Public Health
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    • 제27권3호
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    • pp.447-463
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    • 1994
  • Despite the public health importance of injury and poisoning in terms of its high mortality and incidence, epidemiologic information to be utilized are scarce in Korea. This study was carried out in 1990 on a representative sample population (about 55,000 persons) along with the 6th National Tuberculosis Prevalence Survey in order to estimate the magnitude of injury and poisoning occurrence and to identify its epidemiologic characteristics which can be aided for establishing preventive strategy. Pre-tested and structured Questionnaire was used by trained interviewer to collect data including general information of the person, various information on the injury and poisoning during the past one year such as time and place of its occurrence, its nature and external causes, type of medical institute attended, duration of treatment and outcome of the accident occured. In analysis of the data collected incidence rates per 1000 persons by sex, age group and its nature as well as external causes, and relative frequencies were calculated. The result obtained are as followings; 1. The incidence rate per 1000 was 30 for both sexes, 39 for male and 22 for female, male being 1.8 times more frequent than female. Age adjusted incidences were not much different from the crude rates. Age group specific rate curve showed bimodal shape in both sexes, small peaks in preschool children and higher peaks in older ages. The incidence rate per 1000 people by area was highest in Jeon-bug province (57/1000) and the lowest in Daegu city(11/1000). 2. The place where the injuries occured were road in 46%, within the boundary of house in 25%, and working place in 12% The injuries and poisoning had occured more frequently during the months from March to August of the year than other months. 3. The relatively frequent injuries by its nature were contusion with intact skin surface (19%), fracture of upper limb (13%), open wound of head, neck and trunk (12%) and fracture of lower limb (11%) among males; contusion with intact skin surface (28%), sprains and strains of joints and adjacent muscle (14%), fracture of upper limb (10%) and fracture of lower limb (9%) among females. Higher incidence rate among males than females were fracture of skull (4.5 times), open wound and fractures of limbs ($2{\sim}3$ times). Age specific rate of injuries and poisoning by its nature showed increasing pattern by age in fractures of upper and lower limbs and sprains & strains of joints whereas the age group of 30's showed highest incidence in open wounds of upper limb. Fractures of radius and ulna in upper limb, fractures of tibia & fibula and ankle in lower limb were most frequent among fractures of upper and lower limbs. The frequent injuries among sprains and strains of joints and adjacent muscles were that of ankle, foot and back, and among open wound were that of head and fingers. 4. Relative frequency of injuries and poisoning by external causes showed following order : other accidents (25%), accidental falls (23%), motor vehicle accident (22%) and other road vehicle accident (14%) among males and accidental falls (37%), motor vehicle accident (24%) and other accident (18%) among females. The external causes revealing higher incidences among males than females, were other road vehicle accident (4.8 times), vehicle accident not elsewhere classifiable (4.4 times), accidental poisoning (4.4 times), accidents due to natural and environmental factors (2.8 times), and sucide & self-inflicted injuries (2.8 times). Age specific incidence by external causes for frequent injuries showed that incidence of other accident steadily increased from 10's till age 50's; motor vehicle traffic accident increased from age 20's and dropped after age 60's; on the other hand accidental fall increased strikingly by age. The most frequent external causes among motor vehicle traffic accidents was motor vehicle traffic accident involving collision with pedstrain (69%), pedal cycle accident (30%) and other road vehicle accident (71%) among other road vehicle accidents; falls on same level from slipping, tripping or standing (44%) and other falls from one level to another among accidental falls; accidents caused by machinary (32%) for male and striking against or struck accidentally by objects or person for female among other accidents. 5. Seventy nine percent of the injuries and poisonings were treated in general hospital or hospital/clinic. The duration of treatment ranged from a few days to 123 weeks; the majority(52%) took under 2 weeks, 36% for $3{\sim}8$ weeks and 4% over 21 weeks. 6. The accident resulted in full recovery of normal healthy state in 62%, residual functional defects in 21% and on process of treatment in 16%.

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치과위생사의 스켈링 작업 시 발현되는 두경부 및 견부 주위 근육들의 표면 근전도를 이용한 특성 분석 (Analysis Characteristic the Using Surface Electromyography of Head Neck and Around of Shoulder Muscles Express Scaling Working of the Dental Hygienist)

  • 전은숙;남건우;하미숙
    • 치위생과학회지
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    • 제12권4호
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    • pp.437-442
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    • 2012
  • 이 연구는 20명의 치위생과 학생들을 대상으로 스켈링 실습 시 발현되는 근육들의 활성도와 통증부위를 파악하여 치과위생사의 작업자세에 따른 기초자료를 제시하고자 연구를 실시하였다. 스켈링 시 근활성도의 측정은 free EMG를 이용하였고, 근골격계 통증부위를 알아보기 위해 Nordicstyle 설문지를 이용하여 측정된 연구결과는 다음과 같다. 1. 자세에 따른 스켈링 시 통증의 발현은 팔꿈치, 등, 다리, 무릎, 발목/발은 그룹간에 차이가 없는 것으로 나타났으나 목, 어깨, 손목/손, 허리에서는 자세에 따라 통증의 정도 차이가 높게 나타났다. 2. 자세에 따른 근활성도를 측정한 결과 올바른 자세를 가진 그룹에서는 시간의 경과에 따라 상승모근과 상완요골근에서 변화를 보였고, 나쁜 자세를 가진 그룹에서는 후두부근, 상승모근, 상완요골근에서 근활성도가 높게 나타났다. 3. 근활성도에서 두 군간의 변화양상은 좋은 자세로 스켈링을 실시한 그룹에서는 낮은 근활성도를 보였으나, 나쁜자세로 스켈링을 실시한 그룹에서는 근활성도가 과하게 증가되었다. 따라서 올바른 자세를 유지하며 스켈링을 실시하는 것이 근육의 활성을 효과적으로 사용하는데 도움이 되었음을 알수 있었고, 앞으로 임상에서 근무하는 치과위생사를 대상으로 연구를 실시하여 직무 효율성을 높이는 것이 필요하리라 생각된다.

태권도 찍어차기의 무릎편 유형과 구부린 유형의 운동학적 비교분석 (Kinematic analysis of skill between flexed and extended type of knee during Jigeo-Cha-Gi in Taekwon-Do)

  • 김동규;류재청
    • 한국운동역학회지
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    • 제15권4호
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    • pp.25-42
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    • 2005
  • The study was to investigate kinematic difference between flexed and extended type of knee during Jigeo-Cha-Gi in Taekwon-Do. For this subjects participated were consisted of weights of fin (1), bantam (1) and welter class(1) of male 3 national representative level skilled in two type(flexed and extended type) of Jigeo-Cha-Gi. 3D cinematography analysis was performed for motion analysis and Kwon 3D ver. 3.1) was used for 3D coordinates & analysis variables calculation. In Temporal variable there was no significant difference statistically in all phases & total elapsed time between flexed and extended type, but flexed type was delayed more 0.016 sec than extended type. In displacement of COG there was significant difference in level of p<.05 showing longer mean 6.13 cm in case of flexed type than extended type in displacement of COG during all phase and too significant difference in level of p<.01 showing longer mean 4.4 cm in case of flexed type than extended type in displacement of COG in follow through phase. In velocity of COG there was significant difference in level of p<.001 showing higher mean 15.53cm/s in case of flexed type than extended type in velocity of COG(Y direction) during targeting phase and peak velocity(Y) was more fast 8.74 cm/s in extended type than flexed type. In velocity of leading leg in forward direction(Y) there was significant difference in level of p<.05 showing higher thigh mean value in case of flexed type than extended type but showing higher foot mean value in extended type at level of p<.001 than flexed type in velocity of COG(Y direction). In velocity of leading leg in vertical direction(Z) there was no significant difference in the second & third phase in case of vertical velocity level, but momentum transferred efficiently form proximal to distal endpoint. In front-back & right-left orientation angle of trunk there was possibility of more stable Jigeo-Cha-Gi in extended than flexed type by decreasing in right-left orientation angle of trunk. In relative angle of lower leg(hip, knee, ankle) there was significant difference in level of p<.001 showing longer mean 32.74 deg. in case of flexed type than extended type in hip joint during the second phase but maintained insufficient extended knee of mean 168 deg. in targeting phase.

시각장애 아동의 보행 시 하지의 운동역학적 분석 (Kinetic analysis of the lower limb in visual handicap children)

  • 이재훈
    • 한국산학기술학회논문지
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    • 제12권9호
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    • pp.3952-3958
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    • 2011
  • 이 연구는 시각장애 아동과 비 장애 아동의 보행형태를 비교 분석하여 하지분절의 생체역학적 변화와 패턴 및 이에 대한 시각장애 아동과 비 장애 아동의 차이를 구명하는데 그 목적이 있다. 이를 위해 하지에 최근 6개월간 병적 결함이 없는 시각장애 아동 4명과 비 장애 아동 2명을 선정하였다. 두 그룹의 보행 특성에 관한 자료 수집을 위해 적외선 카메라 6대와 지면반력기 1대를 사용하였다. 또한 기초자료 수집은 QTM프로그램을 이용하였고, Visual3D 프로그램을 이용하여 운동역학적 변인을 계산하였으며 다음과 같은 결론을 얻었다. 지지국면의 전 후 최대 지면반력은 제어기와 추진기 모두 시각장애 아동이 비 장애 아동에 비하여 지면반력이 작게 나타났으며, 제어기의 비율이 추진기에 비하여 긴것으로 나타났다. 하지관절 모멘트의 경우 발목에서는 일반적인 보행에 비하여 신전모멘트가 매우 작게 나타났으며, 무릎관절의 경우 지지국면동안 변화가 거의 없는 것으로 나타나 일반적인 보행 패턴과 상이한 결과로 나타났다. 그러나 엉덩관절 모멘트는 다른 관절에 비하여 상대적으로 크게 나타났다. 하지분절의 에너지 변화는 발과 정강이의 경우 비 장애 아동과 유사한 형태를 보였으나 에너지 발현이 매우 작은 것으로 나타났으며, 대퇴의 발현 형태는 다소 다르지만 다른 분절에 비하여 가장 에너지가 많이 발생하는 것으로 나타났다.

골프화의 구조적 특성 및 내부형태에 따른 스윙의 운동학적 변인에 미치는 영향 (Effect of Golf Shoe Design on Kinematic Variables During Driver Swing)

  • 박종진
    • 한국운동역학회지
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    • 제19권1호
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    • pp.167-177
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    • 2009
  • 본 연구의 목적은 골프화 개발에 있어 골프화 종류에 따른 기능성 검증을 위해 골프 스윙 시 골프화 종류별 3차원 동작분석을 통하여 골프화가 골프 스윙에 미치는 영향을 알아보고자 한다. 연구대상은 골프 프로 자격증을 소지한 경력 10년 이상인 프로골퍼 5명으로 착용 골프화 사이즈가 270mm이었다. 스윙 동작 분석을 위해 Motion Analysis사(Santa Rosa CL USA)의 3차원 동작분석 시스템 및 EVaRT 4.2 소프트웨어를 사용하여 변인 값들을 분석하였다. 드라이버 스윙동작 중 어드레스(El), 탑(E2), 임팩트(E3), 피니쉬(E4)시의 각 이벤트 간의 구간(P1, P2, P3) 변인 값을 분석하여 스윙 구간별 시간, 최대속도, 신체이동 속도, 양발 분절의 속도, 발목의 뒤틀림 각도에 대한 조사를 실시하여 골프화의 종류와 수행능력의 연관성에 대하여 알아보았다. 실험결과 골프화 Type C의 경우 어드레스에서 탑까지의 시간이 가장 짧게 나타나 어드레스 시 안정성을 향상시켜 줄 것으로 사료된다. 또한 좌우 골프화의 최대 속도 신체중심 이동 최대 속도 좌우 발의 최대 속도의 경우도 골프화 Type C의 속도가 가장 빠르게 나타났으며 신체의 중심을 빠르게 하고 발의 회전력을 증가시켜 임팩트 시 다른 골프화보다 큰 힘을 전달할 수 있을 것으로 사료된다.