• 대한정형외과학회지
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• 제52권1호
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• pp.25-32
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• 2017

목적: 고령 환자에서 발생한 불안정성 대퇴골 전자간부 골절의 치료 시 골수강내 금속정의 길이에 따른 방사선적, 임상적 치료 결과를 비교 분석하고자 한다. 대상 및 방법: 2009년 8월부터 2014년 12월까지 방사선 영상상 AO/OTA 분류 31-A2 대퇴골 전자간부 골절로 진단되어 골수강 내 금속정을 이용한 내고정을 시행한 뒤 최소 1년 이상 추시가 가능하였던 65세 이상의 환자 139예를 대상으로 후향적 대조군 연구를 시행하였다. 대상군을 짧은 골수정(I군)과 긴 골수정(II군)을 사용한 군으로 분류하였으며 각각 106예, 33예로 조사되었다. 방사선적인 평가로 골절의 정복 정도, 골유합까지의 기간, 합병증 발생을 조사하였으며 수술 전 혈색소, 수술 시간, 수술 중 출혈량, 수혈 유무, 입원 기간 및 최종 추시 시 Charnley 고관절 점수를 통한 임상적 평가를 시행하였다. 결과: 수술 후 단순 방사선 검사상 전 예에서 good 또는 acceptable한 정복 상태를 얻었다. 골유합까지 평균 4.8개월이 걸렸으며 두 군 간의 차이는 없었다. II군(57.87분)이 I군(45.65분)보다 수술 시간이 길었던 것으로 확인되었다(p=0.003). 수술 중 출혈량의 경우 II군(288.78 ml)이 I군(209.90 ml)보다 많은 것으로 확인되었다(p=0.046). 최종 추시 시 임상적 결과는 두 군 모두 만족스러웠다. 결론: 고령의 환자에서 발생한 후내측 골편을 동반한 불안정성 대퇴골 전자간부 골절의 치료 시 골절 부위의 정복을 잘 시행한 경우 긴 골수정과 짧은 골수정 모두 만족스러운 방사선적, 임상적 결과를 보였다.

• 대한소아치과학회지
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• 제27권1호
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• pp.1-6
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• 2000

상아질 형성 부전증은 상아질 형성에 이상을 초래하는 유전성 질환으로, 주로 상염색체 우성의 양상으로 유전된다. 제1형의 상아질 형성 부전증은 골 형성 부전증 환자에서 나타난다. 제2형 상아질 형성 부전증은 골 형성 부전증과 연관되지 않고 단독으로 나타난다. 제3형 상아질 형성 부전증은 brandywine type이라고도 하는데, 이 유형은 매우 드물며 상염색체 우성에 의해 유전되고, Maryland 주에 사는 한정된 민족에서 관찰된다. 세가지 모든 유형에서 유치열과 영구치열 모두 다양한 임상 양상을 나타낸다. 치아는 유백색을 띠고, 청회색에서 황갈색까지 다양하게 변색되어 있다. 상아질은 비정상적으로 연하고, 상부의 법랑질을 기능적으로 지지하지 못한다. 비록 법랑질이 정상이고 해도, 쉽게 파절되어 떨어져나가, 교합면이나 절단면쪽 상아질이 노출된다. 노출된 유약 상아질은 쉽고, 빠르게 심한 교모를 일으킨다. 치아는 구형의 치관과 협소화된 백악-법랑 경계 그리고 가는 치근을 나타낸다. 치수강과 치근관은 다양한 정도의 폐쇄상을 나타낸다. 백악질, 치주인대, 그리고 치조골은 정상 소견을 나타낸다. 상아질 형성 부전증에서 법랑질은 정상이다. 법랑질은 직하방의 mantle dentin은 거의 정상적이나, 나머지 상아질은 심각한 정도의 이형성을 나타낸다. 상아세관은 방향성을 상실하여 불규칙적이며, 정상보다 더 크고 공간도 넓다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권6호
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• pp.343-351
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• 2019

Background: Preterm labor and miscarriage may occur in stressful situations, such as a surgical operation or infection during pregnancy. Pharyngeal and buccal abscess and facial bone fractures are inevitable dental surgeries in pregnant patients. Remifentanil is an opioid analgesic that is commonly used for general anesthesia and sedation. Nonetheless, no study has investigated the effects of remifentanil on amniotic epithelial cells. This study evaluated the effects of remifentanil on the factors related to uterine contraction and its mechanism of action on amniotic epithelial cells. Methods: Amniotic epithelial cells were preconditioned at various concentrations of remifentanil for 1 h, followed by 24-h lipopolysaccharide (LPS) exposure. MTT assays were performed to assess the cell viability in each group. The effects of remifentanil on factors related to uterine contractions in amniotic epithelial cells were assessed using a nitric oxide (NO) assay, western blot examinations of the expression of nuclear factor-kappa B (NF-κB), cyclooxygenase 2 (COX2), and prostaglandin E2 (PGE₂), and RT-PCR examinations of the expression of the proinflammatory cytokines interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α). Results: Remifentanil did not affect viability and nitric oxide production of amniotic epithelial cells. Western blot analysis revealed that remifentanil preconditioning resulted in decreased expressions of NF-κB and PGE2 in the cells in LPS-induced inflammation, and a tendency of decreased COX2 expression. The results were statistically significant only at high concentration. RT-PCR revealed reduced expressions of IL-1β and TNF-α. Conclusions: Preconditioning with remifentanil does not affect the viability of amniotic epithelial cells but reduces the expression of factors related to uterine contractions in situations where cell inflammation is induced by LPS, which is an important inducer of preterm labor. These findings provide evidence that remifentanil may inhibit preterm labor in clinical settings.

• 대한정형외과스포츠의학회지
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• 제9권1호
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• pp.58-64
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• 2010

목적: 최근 교통 수단 및 레저 수단으로써 자전거 이용이 증가함에 따라 자전거 관련 수상 환자도 증가하는 추세이다. 본 저자들은 자전거 사고로 인해 입원 치료를 시행한 환자들의 사고 유형에 대해 분석하였다. 대상 및 방법: 본 연구는 2008년 01월 01일부터 2009년 05월 31일까지 자전거 주행중 사고로 인해 본원에 입원한 75명의 환자 중 추시 가능하였던 71명을 대상으로 하였다. 남자 54명 및 여자 17명이었고 평균 나이는 36.7세였다. 수상 정도, 수상 부위, 수상 기전, 수상 장소, 자전거 종류, 자전거 이용 목적, 동반 탑승 혹은 화물 적재 여부, 계절 그리고 보호구 착용 여부 등을 Injury Severity Score( ISS)를 이용하여 분석하였다. 결과: Injury Severity Score 는 1점이 11례, 4점이 41례, 5점이 2례, 9점이 13례, 13점이 1례,16점이 2례 및 29점이 1례였다. 상지 및 하지의 골절 46례중 수술적 치료를 필요로 하였던 환자는 36례였고, 이는 전체 환자의 50.7 %였으며, 척추체 골절, 안면부 손상 및 복부장기 손상으로 인해 수술적 치료를 시행한 환자는 각각 2례,8례 및 1례였다. 두부 손상은 전체 10례였는데, 이중 중환자실 치료를 필요로 할 정도로 심각한 손상은 3례로 전체 환자의 4.2%였다. 결론: 자전거 사고를 방지하기 위해서는 자전거 전용 도로 확충, 안전 교육 및 헬멧을 포함한 상지 및 하지 보호대 착용 등의 사고 예방 노력이 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제31권8호
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• pp.804-810
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• 1998

배경: 다발성 외상환자는 교통사고, 산업재해, 우발적사고, 폭력 등의 증가로 최근 증가 추세에 있다. 다발성 외상은 심장, 폐, 대혈관 등의 흉부외상을 포함하는 경우가 많으며 이때는 환자의 생명을 위협할 수 있으므로 적절한 진단과 치료가 필요하다. 대부분의 흉부외상은 보존적 치료와 흉관 삽관술과 같은 간단한 외과적 시술 만으로 만족할 만한 치료효과를 보이지만 적절한 시기에 개흉술을 시행함으로써 환자의 생명을 구할 수 있는 경우가 있어 그 적응증 이나 시기의 판단에 있어서 경험있는 흉부외과 의사의 역할이 필요하다. 대상 및 방법: 저자는 다발성 외상 후 흉부개흉술이 필요했던 70례에 대하여 분석하였다. 환자들의 평균 나이는 35.6세 남녀비는 3.4:1이었다. 손상의 기전은 주로 교통사고, 추락사고, 자상이었다. 결과: 흉부손상의 가장 일반적인 유형은 혈흉이며, 두 번째는 횡격막 파열이었다. 환자의 60%에서 골절을 동반 하고 42.9%에서 복부손상을 37.1%에서 두부손상을 동반하고 있었다. 개흉술을 시행한 이유로는 출혈교정 혹은 지혈이 48.6%, 횡격막손상의 복구가 35.7%였으며, 폐 열상 봉합이 25.7% 였으며, 흉부 손상으로 인한 수술외에도 비장적출술(14.3%), 간엽절제술(8.6%) 간 열상 복구(5.7%)를 시행하였다. 수술후 합병증으로는 무기폐(8.6%), 창상감염(8.6%), 폐렴(4.3%)이었다. 수술후 6명의 환자가 사망하였고 수술사망율은 8.6%였다. 사망의 원인으로는 호흡부전증(2례), 급성 신기능부전증(2례), 패혈증(1례), 저혈량성 쇽(1례)이었다.

• Journal of Korean Neurosurgical Society
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• 제42권5호
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• pp.371-376
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• 2007

Objective : Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty. Methods : Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications. Results : The mean postoperative VAS score improvement was $4.93{\pm}0.17$. The mean postoperative height restoration rate was $17.8{\pm}1.57%$ and the kyphotic angle reduction was $1.94{\pm}0.38^{\circ}$. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068). Conclusion : The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.

• 문화기술의 융합
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• 제6권3호
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• pp.457-462
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• 2020

골다공증은 주로 노인에서 나타나는 질병으로써 뼈 질량 및 조직의 구조적 악화에 따라 골절의 위험을 증가시킨다. 본 연구의 목적은 영양소 성분과 골다공증과의 연관성을 파악하고, 영양소 성분을 기반으로 골다공증을 예측하는 모델을 생성 및 평가하는 것이다. 실험방법으로 binary logistic regression을 이용하여 연관성분석을 수행하였고, naive Bayes 알고리즘과 variable subset selection 메소드를 이용하여 예측 모델을 생성하였다. 단일 변수들에 대한 분석결과는 남성에서 식품섭취량과 비타민 B2가 골다공증을 예측하는데 가장 높은 the area under the receiver operating characteristic curve (AUC)값을 나타내었다. 여성에서는 단일불포화지방산이 가장 높은 AUC값을 나타내었다. 여성 골다공증 예측모델에서는 Correlation based feature subset 및 wrapper 기반 feature subset 메소드를 이용하여 생성된 모델이 0.662의 AUC 값을 얻었다. 남성에서 전체변수를 이용한 모델은 0.626의 AUC를 얻었고, 그외 남성 모델들에서는 민감도와 1-특이도에서 예측 성능이 매우 낮았다. 이러한 연구결과는 향후 골다공증 치료 및 예방을 위한 기반정보로 활용할수 있을 것으로 기대된다.

• 한방재활의학과학회지
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• 제28권1호
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• pp.1-17
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• 2018

Objectives The purpose of this study was to evaluate the effect of Jeopgolsan (JGS) extract on anti-oxidant, anti-inflammatory activities in RAW 264.7 cells and on factors related with fracture healing in skull fractured rat. Methods Experimental animals were divided into four groups: normal group without any treatment (Normal), contral group were treated orally with distilled water (Control), Experimental group were treated orally with JGS at a concentration of 200 mg/kg/day (JGS 200) and Experimental group were treated orally with JGS at a concentration of 200 mg/kg/day (JGS 400). Rats in each group except the normal group were induced fractures in the skull. The 1,1-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid (ABTS) radical scavenging activity were measured to evaluate antioxidant activity. The production of nitric oxide (NO), $interleukin-1{\beta}$ ($IL-1{\beta}$), interleukin-6 (IL-6) and tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$) in the RAW 264.7 cells were measured to evaluate anti-inflammatory activity. The production of osteocalcin calcitonin, carboxy-terminal telepeptides of type II collagen (CTX II), transforming growth $factor-{\beta}$ ($TGF-{\beta}$), bone morphogenetic protein-2 (BMP-2), Insulin and alkaline phosphatase (ALP) in serum of rats were measured to evaluate the effects of fracture healing at 0, 2, 4, and 6th week. X-rays were taken every 3 week from 0 to 6th week to evaluate fracture healing effect. Results 1. No cytotoxicity was observed. 2. DPPH and ABTS radical scavenging activity were increased in a concentration dependent manner, indicating anti-oxidant effect. 3. NO, $IL-1{\beta}$, IL-6, and $TNF-{\alpha}$ were not significantly changed, indicating no anti-inflammatory effect. 4. Osteocalcin, Calcitonin, $TGF-{\beta}$ and ALP were significantly increased in the experimental groups. 5. CTX II, insulin were significantly decreased in the expermental groups. 6. Radiologic examination showed that union of fracture was promoted. Conclusions From above results, JGS showed significant results in factors related with fracture healing and radiologic examination. Threfore, JGS is expected to be effective in the treatment of fracture.

• Restorative Dentistry and Endodontics
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• 제19권2호
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• pp.345-371
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• 1994

Restorative procedures can lead to weakening tooth due to reduction and alteraton of tooth structure. It is essential to prevent fractures to conserve tooth. Among the several parameters in cavity designs, cavity isthmus and depth are very important. In this study, MO amalgam cavity was prepared on maxillary first premolar. Three dimensional. finite element models were made by serial photographic method and cavity depth(1.7mm, 2.4mm) and isthmus (11 4, 1/3, 1/2 of intercuspal distance) were varied. linear, eight and six-nodal, isoparametric brick elements were used for the three dimensional finite element model. The periodontal ligament and alveolar bone surrounding the tooth were excluded in these models. Three types model(B, G and R model) were developed. B model was assumed perfect bonding between the restoration and cavity wall. Both compressive and tensile forces were distributed directly to the adjacent regions. G model(Gap Distance: 0.000001mm) was assumed the possibility of play at the interface simulated the lack of real bonding between the amalgam and cavity wall (enamel and dentin). When compression occurred along the interface, the forces were transferred to the adjacent regions. However, tensile forces perpendicular to the interface were excluded. R model was assumed non-connection between the restoration and cavity wall. No force was transferred to the adjacent regions. A load of 500N was applied vertically at the first node from the lingual slope of the buccal cusp tip. This study analysed the displacement, von Mises stress, 1 and 2 direction normal stress and strain with FEM software ABAQUS Version 5.2 and hardware IRIS 4D/310 VGX Work-station. The results were as follows: 1. G model showed stress and strain patterns between Band R model. 2. B model and G model showed the bending phenomenon in the displacement. 3. R model showed the greatest amount of the displacement of the buccal cusp followed by G and B model in descending order. G model showed the greatest amount of the displacement of the lingual cusp followed by B and R model in descending order. 4. B model showed no change of the displacement as increasing depth and width of the cavity. G and R model showed greater displacement of the buccal cusp as increasing depth and width of the cavity, but no change in the displacement of the lingual cusp. 5. As increasing of the width of the cavity, stress and strain were not changed in B model. Stress and strain were increased on the distal marginal ridge and buccopulpal line angle in G and R model. The possibility of the tooth fracture was increased. 6. As increasing of the depth of the cavity, stress and strain were not changed in B and G model. Stress and strain were increased on the distal marginal ridge and buccopulpal line angle in R model. The possibility of the tooth fracture was increased.

• Archives of Plastic Surgery
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• 제37권1호
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• pp.99-103
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• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.