• Archives of Plastic Surgery
• /
• 제35권2호
• /
• pp.152-158
• /
• 2008

Purpose: Mandibulotomy approach and mandible sparing approach are most common methods for oropharyngeal cancer surgery. Good surgical view and convenience of flap inset are advantages of mandibulotomy approach but deformity of mandible contour, postoperative malocclusion and radionecrosis are its limitations. To make up for the limitations, mandible sparing method is commonly performed, but limited surgical view and difficulties of flap inset are the weak points of this approach. The purpose of the study is to compare mandibulotomy and mandible sparing approaches in postoperative complications and progression of the treatment in oropharyngeal cancer operation and reconstruction. Methods: Single reconstructive microsurgeon operated for oropharyngeal cancer patients with different surgeons of head and neck department who prefer mandibulotomy and mandible sparing approach respectively, and we compared the frequency of postoperative complication, operation time, duration of hospitalization and recurrence rate between two different surgical approaches. Results: Mandibulotomy approach was used in 18 patients and mandible sparing approach was used in 15 patients. In mandibulotomy approach, there happened one case of teeth injury and one case of necrosis of skin and gingiva, but there happened no malocclusion and radionecrosis. In mandible sparing approach, there were 3 cases of fistula and 2 cases of infection which are significantly higher than mandibulotomy approach. There were no significant differences between early regional recurrence and duration of hospitalization. Conclusion: In this study we compared two different methods for the surgical approach in oropharyngeal cancer surgery. As mandible sparing approach has difficulties of limited surgical view, it can be used for the limited indications of anterior tongue and mouth floor cancer. Mandibulotomy approach has advantages of good surgical view and convenience of flap inset. In this method preservation of gingival tissue, watertight fashion suture, delicate osteotomy and plate fixation to maintain occlusion are the key points for the successful results.

• Clinics in Shoulder and Elbow
• /
• 제14권1호
• /
• pp.80-83
• /
• 2011

목적: 소아에서 외상으로 발생하는 견관절 후방 탈구는 극히 드문 손상이며 상완골 외과적 경부 골절이 동반된 경우는 국내에서 현재까지 문헌상 아직 보고된 증례가 없다. 대상 및 방법: 태권도 운동 중 수상하여 좌측 견관절 후방 탈구 및 동측 상완골 외과적 경부 골절로 내원한 10세 소아에서 전신 마취하에 개방성 정복 및 핀 고정술을 시행하였다. 결과: 수술 후 1년 추시 상 재탈구 및 상완골 두 무혈성 괴사의 합병증 없이 운동 범위의 완전 회복과 골유합 및 재형성을 얻었다. 결론: 소아에서 견관절 후방 탈구와 상완골 외과적 경부 골절을 동반한 증례를 수술적 치료로 좋은 결과를 얻어 문헌 고찰과 함께 보고하고자 한다.

• 한국지반공학회논문집
• /
• 제33권10호
• /
• pp.59-69
• /
• 2017

지반내 근입된 앵커의 인장력은 시간이 경과하면서 점차 변화하게 되는데 이때 초기 인장력의 변화는 보통 정착헤드의 정착조건과 인장자재의 기계적 특성에 의해 1차적으로 감소하게 되며, 이후 추가적인 인장력의 변화는 대부분 정착장의 정착조건과 주변 지반특성에 기인한 시간의존적인 정착거동에 좌우된다. 따라서 본 논문에서는 이러한 인장력 변화를 비교적 쉽게 측정 및 분석할 수 있는 상대변위측정기를 이용한 측정시스템에 대해서 연구하였다. 검토결과 실규모 모형시험을 통해서 본 측정시스템의 적용성을 확인 하였으며, 또한 풍화암에 정착된 지반앵커를 대상으로 실시한 현장 시험결과와도 유사함을 확인함에 따라 본 측정시스템의 적용성을 확인하였다. 그리고 초기인장력이 비교적 크게 감소된 시험앵커를 대상으로 추가적인 인발시험을 실시하였으며 이를 통해 인장형 앵커의 인발거동을 확인하였다.

• 대한의용생체공학회:학술대회논문집
• /
• 대한의용생체공학회 1995년도 춘계학술대회
• /
• pp.19-22
• /
• 1995

A biomechanical study was made to demonstrate the superior mechanical performance of the newly designed Miniplate staple to the conventional Coventry staple in high tibial osteotomy(HTO). Using twenty fresh porcine tibiae, the fixational strengh of the two different types of staple in HTO was compared. To minimize the error due to the specimen-to-specimen individuality, the bone mineral density of the tibiae was measured with a bone densitometry (Dual photon absorptionometer, Luner, USA) and those with $0.8\;{\sim}\;1.2\;gm/cm^2$ at the proximal tibia was used in the biomechanical test. Testing was performed on a material testing system (Autogram ET-5, Shimatzu, Japan) with aid of a commercial data processor (IBM 80386/ ASYST). Using two differant loading modes, 'pull-out' and 'push-out', the maximum resistant force required to release the staple from the substrate bone was recorded. In the pull-out test, ten non-osteotomized specimens were used and the staple was pullout by subjecting an axial tension on the head of the staple inserted. While in the pull-out test where ten tibiae osteotomized in the usual way of HTO were used, the staple was not directly loaded. In this testing, as a mimic condition of the natural knee, the distal part of the specimen tibia was pushed horizontally in order for the staple to be pulled out while the proximal tibia was fixed. The pull-out strength of Coventry staple and miniplate staple were found to be $27.88\;{\pm}\;5.12\;kgf$ and $182.47\;{\pm}\;32.75\;kgf$, respectively. The push-out strength of Coventry staple and miniplate staple were $18.40\;{\pm}\;4.47\;kgf$ and $119.95\;{\pm}\;19.06\;kgf$, respectively. The result revealed that miniplate staple had the pull-out/ push-out strength at least fivetimes higher than Coventry staple. Based on the measured data, it was believed that the newly designed miniplate staple could provide much better postoperative fixation in HTO. The postoerative application of long leg casting may not be needed after HTO surgery.

• 대한족부족관절학회지
• /
• 제16권4호
• /
• pp.235-240
• /
• 2012

Purpose: The aim of this study was to evaluate the radiographic and clinical results of short scarf osteotomy that has minimized longitudinal cut for moderate hallux valgus. Materials and Methods: Total 12 patients (12 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 41.5 years. The mean followup time was 21.2 months. We modified original scarf osteotomy by shortening the longitudinal cut to 15~20 mm in length. Additionally, Akin osteotomy of the first proximal phalanx was done in 7 feet and Weil osteotomy of the second metatarsal was done in 4 feet. First-second intermetatarsal and hallux valgus angles were analyzed radiographically before and after the operation. And the clinical result was assessed by AOFAS (American Orthopaedic Foot and Ankle Society) hallux score. Results: First-second intermetatarsal and hallux valgus angles were reduced from the mean preoperative values of $14.6^{\circ}$ and $32.8^{\circ}$ to $6.5^{\circ}$ and $11.2^{\circ}$, respectively. The mean AOFAS hallux score was increased from 52.4 points preoperatively to 88.2 points at followup. Three complications were found: metatarsal fracture during the operation, painful scar around second metatarsal head after Weil osteotomy and postoperative neuralgia. There was no transfer metatarsalgia or recurrence of hallux valgus during followup. Conclusion: Short scarf osteotomy would be an effective surgical procedure for moderate hallux valgus with the benefits of minimized soft tissue dissection and stable fixation.

• 한국항공우주학회지
• /
• 제45권5호
• /
• pp.417-428
• /
• 2017

본 논문에서는 항공기 조종사 지능형 헬멧시현시스템(IHDS, Intelligent Helmet Display System)의 아키텍쳐 설계, 단위 구성품 설계, 핵심 소프트웨어 설계내용(헬멧 자세추적, 고도오차 보정 소프트웨어)을 기술하며, 단위시험 및 통합시험에 대한 결과를 기술한다. 세계적인 최신 헬멧시현시스템 개발 추세를 반영하여 3차원 전자지도 시현, FLIR(Forward Looking Infra-Red) 영상시현, 하이브리드형 헬멧자세추적, 바이저 반사형광학계, 야시카메라 영상시현 및 경량 복합소재 헬멧쉘 등의 사양을 설계에 적용하였다. 특히 3차원 전자지도 데이터의 고도오차 자동보정 기법, 고정밀 영상정합 기법, 다색(Multi-color) 조명광학계, 회절소자를 이용한 투과형 영상발광면, 헬멧자세 추정시간을 최소화하는 추적용 카메라, 장/탈착형 야시카메라, 머리 밀착용 에어포켓 등의 신개념의 설계를 제안하였다. 모든 시스템 구성품의 시제작을 완료한 후 단위시험과 시스템 통합시험을 수행하여 기능과 성능을 검증하였다.

• Journal of Gastric Cancer
• /
• 제19권3호
• /
• pp.290-300
• /
• 2019

Purpose: The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. Materials and Methods: This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. Results: The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien-Dindo classification grade ${\geq}II$) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. Conclusions: Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.

• 대한정형외과학회지
• /
• 제55권3호
• /
• pp.193-199
• /
• 2020

골수강 내 금속정(골수정)은 1988년부터 대퇴골 전자간 골절을 치료하는 데 사용되어 왔다. 골수정은 활강고나사와 같은 골수강 외 고정 장치에 비하여 기계적 이점이 있으나 대퇴 전자간 골절 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A1 및 31-A2 골절 치료에 활강고나사보다 유리한 고정 기구인지에 대해서는 논란이 계속되고 있다. 지난 30년 동안 여러 시행 착오가 극복되었고 새로운 유형의 대퇴 골수정이 개발되어 임상에서 사용되고 있다. 새로 개발된 골수정은 삽입 과정이 쉬워지고 지연나사를 사용한 대퇴 골두의 고정 능력이 향상되어 왔다. 그러나 고정 실패율은 여전히 정형외과 의사의 수술 술기에 달려 있다고 할 수 있다. 이 종설에서 우리는 골수정을 이용하여 대퇴 전자간 골절을 치료하는 동안 내측 지지대 복원의 중요성에 대해 초점을 맞추고 그 기본 원칙에 대하여 논의해 보고자 한다.

• 대한두개안면성형외과학회지
• /
• 제24권4호
• /
• pp.167-173
• /
• 2023

Background: Mandibular split fractures, in which the fracture occurs exclusively in the posterior wall, are uncommon. This study aimed to enhance clinicians' understanding of mandibular split fractures and offer insights for future research. Methods: This study included six patients who visited our hospital between January 2020 and June 2023 and were diagnosed with mandibular split fractures. We retrospectively collected data from patients' medical records on their age, sex, symptoms, mechanism, impact site, associated injuries, and treatment method, as well as the location, pattern, and number of fractures observed on computed tomography (CT) and panoramic images. The frequency of split fractures among all mandibular fractures was calculated. Results: The six patients included three men (50%) and three women (50%), ranging in age from 20 to 71 years (mean age, 49.8 years). The split fractures were located in the symphysis in one patient (16.7%), symphysis to parasymphysis in two patients (33.3%), parasymphysis in one patient (16.7%), and parasymphysis to the body in two patients (33.3%). Four patients (66.7%) had condylar head fractures, while two patients (33.3%) had single split fractures. The mechanism of trauma was a slip-down incident in four cases (66.7%), while two cases (33.3%) were caused by motorcycle traffic accidents. Four patients (67%) underwent intermaxillary fixation, while two patients (33%) improved with conservative treatment. Split fractures were diagnosed in all six patients on CT, whereas the fracture line was not clearly visible on panoramic images. Mandibular split fractures accounted for 5.6% of all mandibular fractures. Conclusion: This study provides insights into the clinical characteristics of rare mandibular split fractures and the diagnostic imaging findings. Furthermore, CT scans and three-dimensional image synthesis-instead of panoramic images-may be essential for accurately diagnosing mandibular fractures, including mandibular split fractures, in the future.

• Journal of Korean Neurosurgical Society
• /
• 제67권1호
• /
• pp.6-13
• /
• 2024

The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.