• Hip & pelvis
• /
• 제30권4호
• /
• pp.254-259
• /
• 2018

Purpose: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ${\geq}45$ years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. Materials and Methods: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. Results: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0-5; P<0.05); HHS was 85 (range, 72-90); and mean bone union time was 5.0 (range, 2.0-8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27-14.63) mm; lateral average TAD was 7.26 (range, 1.20-18.43) mm; total average TAD was 14.21 (range, 2.47-28.66) mm; average lag screw sliding was 4.63 (range, 0-44.81) mm; and average angulation was varus $0.72^{\circ}$(range, $-7.6^{\circ}-12.7^{\circ}$). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than $5^{\circ}$. Conclusion: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제46권6호
• /
• pp.393-402
• /
• 2020

Objectives: Here, we present cases of mandibular fracture that were managed with the cortical lag screw fixation technique (CLSFT) in order to critically evaluate technique indications and limitations of application at various fracture sites. Materials and Methods: This was a retrospective cohort study. The study sample was composed of patients suffering from mandibular fractures that were treated by the CLSFT. The outcome variables were fracture type, duration of surgery, number of screws, and pattern of application. Other study categories included patient demographics and causes of injury. Chi-square tests were used to assess descriptive and inferential statistical differences, and the P-value was set at 0.05. Results: Thirty-three patients were included in the study sample, with a mean age of 30.9±11.5 years and a male predominance of 81.8%. The technique was applied more frequently in the anterior mandibular region (51.5%) than in other sites. Double CLSFT screws were required at the symphysis and parasymphysis, while single screws were used for body and angle regions. No intraoperative and postoperative variables were significantly different except for surgical duration, which was significantly different between the sites studied (P=0.035). Conclusion: We found that CLSFT is a rapid, cost-effective technique for the fixation of mandibular fractures yielding good treatment results and very limited complications. However, this technique is sensitive and requires surgical expertise to be applied to mandibular fractures that have specialized characteristics.

• Journal of Korean Neurosurgical Society
• /
• 제61권4호
• /
• pp.503-508
• /
• 2018

Objective : Anterior odontoid screw fixation is a safe and effective method for the treatment of odontoid fractures. The surgical technique is recommended for perforation of the apical cortex of the dens by the lag screw. However, overpenetration of the apical cortex may lead to potentially serious complications such as damages of adjacent vascular and neural structures. The purpose of this study was to assess the role of three-dimensional computed tomography (CT) scan to evaluate the safe margin beyond dens tip to ventral dura for anterior odontoid screw fixation. Methods : We retrospectively analyzed the three-dimensional CT scans of the cervical spines in 55 consecutive patients at our trauma center. The patients included 38 males and 17 females aged between 22 and 73 years (mean age${\pm}$standard deviation, $45.8{\pm}14.2years$). Using sagittal images of 3-dimensional CT scan, the safe margins beyond dens tip to ventral dura as well as the appropriate screw length were measured. Results : The mean width of the apical dens tip was $9.6{\pm}1.1mm$. The mean lengths from the screw entry point to the apical dens tip and posterior end of dens tip were $39.2{\pm}2.6mm$ and $36.6{\pm}2.4mm$. The safe margin beyond apical dens tip to ventral dura was $7.7{\pm}1.7mm$. However, the safe margin beyond the posterior end of dens tip to ventral dura was decreased to $2.1{\pm}3.2mm$, which was statistically significant (p<0.01). There were no significant differences of safe margins beyond dens tip to ventral dura with patient gender and age. Conclusion : Extension by several millimeters beyond the dens tip is safe, if the trajectory of anterior odontoid screw is targeted at the apical dens tip. However, if the trajectory of the screw is targeted to the posterior end of dens tip, extension beyond dens tip may lead to damage immediately adjacent to the vental dura mater.

• 한국임상수의학회지
• /
• 제36권5호
• /
• pp.292-295
• /
• 2019

A 2-year-old, 440 kg, thoroughbred gelding showed a lameness grade of 3 out of 5, as well as swelling and heating on the proximal interphalangeal joint (PIPJ). Periarticular new bones due to the arthritis were observed on performing radiography and ultrasonography. PIPJ arthrodesis was performed under general anesthesia. With the PIPJ open, the articular cartilage was removed by using curette, chisel, and mallet. Arthrodesis was performed with a PIP plate and two additional transarticular cortex screws inserted in lag fashion. A cast was placed over the limb distal from the proximal metatarsal bone. At 6 months after surgery, complete union of the PIPJ was confirmed by radiography, and the incision site was well closed. Based on the outcome, a PIP plate with two additional transarticular cortex screws inserted in lag fashion is recommended as a method for treating osteoarthritis of the PIPJ in horses.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제19권2호
• /
• pp.167-180
• /
• 1997

1993년 1월부터 1995년 12월까지 원광 대학교 치과대학 구강악안면외과에 하악 과두 골절을 주소로 내원한 환자중 관혈적 정복술 적응증에 해당되는 79명의 환자에 대하여 관혈적 정복술을 시행하였다(이 중 25명은 Dr. 남씨법을 행한 환자임). 평균 환자 나이는 32.5세(8-65세)이었으며 환자 관찰기간은 약 18.4개월(3-28개월)이었다. 62명(81%)에서 편측 과두 골절 양상이었으며, 57명(72%) 환자가 하악골내 다른 부위와 연관되어 골절되었고 이중 47명(59%)에서 정중부와 관련되어 골절되었다. 환자 나이, 골절된 과두의 심한 정도, 임상 증상, 방사선 사진상 등을 통하여 수술 방법을 선택하였으며 과두부 골절이 아닌 경우 대개 골절 부위의 견고 고정 및 근심쪽 과두 골편 제거, 관절 성형술 및 관절원판 정복술, lag screw고정 등을 시행하였다. 술 후 악간 고정은 약 2주 정도 하였으며 이후 수동적 개구 운동 및 능동적 개구 운동을 2에서 4주, 4주이상에서 시행하였다. 술후 방사선학적 관찰시 과두 흡수 및 후방 부위로 근심 과두부 변위 등, 약 21.5%에서 술 후 방사선학적 변화를 가져왔으며 특히 Dr. 남씨법에서 더 많이 나타났다(Dr. 남씨법(32%), 다른 정복술(16%)). 술 후 임상 증상은 19%의 일시적 안면신경 마비, 개구시 하악 변위(16.4%), 악관절 동통(15.2%), 35mm 이하에서의 개구제한(10%), 기타 부정교합, 관절잡음, 가성 관절 강직 등의 합병증을 나타냈으며 이중 Dr. 남씨법에서 더 많은 합병증을 나타냈다. 과두 골절의 와괴적 처치는 가능한 견고 고정을 시행하는 것이 좋으며 이중 Dr. 남씨법은 그 사용에 있어 고려 해 보는 것이 좋다고 사료된다. 특히 과두 골절 처치에 있어 무엇보다도 술 후 계속적인 환자 관리 및 장기간 예후 관찰이 필수적이라 사료된다.

• Journal of the Korean Wood Science and Technology
• /
• 제36권4호
• /
• pp.26-36
• /
• 2008

건축구조 설계기준이 개정됨에 따라서 목조건축물의 제한 기준이 완화되어 경골 목조건축의 다층 시공이 가능하게 되었다. 건축물의 규모 증가는 건물에 작용하는 하중을 증가시키므로 증가된 작용하중에 맞추어 하중저항성능을 향상시켜 설계하고 시공해야 한다. 기존에는 경골 목조건축의 전단성능을 향상시키기 위하여 벽량을 보강하는 방법을 적용하였으나 본 연구에서는 홀드다운 접합철물을 사용하는 방법을 적용하였다. 홀드다운은 아직까지 국내에서 보편적이지 않은 접합철물이므로 홀드다운의 국내 적용 적합성을 평가하기 위하여 본 연구를 수행하였다. 홀드다운을 적용한 경골 목조 전단벽에 대하여 정적하중 시험을 통한 전단성능 평가 결과 홀드다운 적용 후에 전단벽의 초기강성, 항복하중 및 기준하중이 향상됨을 확인하였으며, 전단성능 향상에 따라 수평 변위와 전단변형의 증가율이 감소하는 것이 확인되었다. 홀드다운과 스터드의 접합방법에 따른 전단성능의 차이는 크지 않은 것으로 확인하였고, 홀드다운 제품 설계강도가 증가할수록 전단벽의 전단성능도 증가하는 경향이 나타났으나 그 차이가 제품 설계강도 차이에 비하여 크지 않은 것으로 판단되었다. 홀드다운을 설치하는 스터드의 규격에 따라서 89 mm 스터드를 사용한 경우와 38 mm 스터드를 두 겹으로 사용한 경우에 비슷한 성능을 나타내므로 38 mm 부재에 홀드다운을 설치할 경우는 스터드의 두께 보강을 통한 성능 향상이 필요하다고 판단하였다.

• 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.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제32권5호
• /
• pp.459-466
• /
• 2010

Alveolar distraction osteogenesis (ADO) has been regarded as an acceptable treatment for the alveolar bone deficiency. For ADO at anterior maxillary area, the vector should be oriented to forward and down-ward direction to get an adequate occlusion with mandibular teeth and to increase bone length and width for implant placement. However, the conventional commercial distraction devices for ADO are designed to allow mainly downward movement of alveolar segment, even though a forward movement can be obtained a little by controlling of inclination of device. To make ADO with controllable bidirectional vector possible, we used customized devices using self-manufactured ABDUL (Alveolar Bone Distractor Using Lag screw principle) and commercial orthodontic palatal expansion device ($Hyrex^{(R)}$). In all cases (n = 4), ADO could be performed successfully and dental implants were able to placed with adequate occlusion. We report the procedures, advantages and disadvantages of these methods.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제23권3호
• /
• pp.270-276
• /
• 2001

The treatment of mandibular subcondylar fractures is a matter of controversy. The majority of mandibular subcondylar fracture are treated by closed reduction, but the displaced or dislocated mandibular subcondylar fractures may be treated by open reduction. The characteristics of open reduction are the anatomical reduction, the functional restoration, the rapid function, the maintenance of vertical ramus dimension, the better appearance and the less resultant TMJ problem etc. When an open reduction is considered, the wire, miniplate, lag screw and Kirschner wire are available with internal fixation. Of these, Kirschner wire is a simple method relatively and correct positioning of the wire achieves rigid fixation. But many open reduction methods for mandibular subcondylar fractures require extraoral approach. The extraoral approach has some problems, the facial scar and the risk of facial nerve injury. On the other hand, the intraoral approach eliminates the potency of the facial scar and the facial nerve injury, but is difficult to access the operation site. Since the intraoral approach was first described by Silverman (1925), the intraoral approach to the mandibular condyle has been developed with modifications. The purpose of this article is to describe the intraoral technique with the Kirschner wire on mandibular subcondylar fractures. Conclusion : The intraoral reduction with Kirschner wire on mandubular subcondylar fractures avoids the facial scar and facial nerve injury and is simple method to the extraoral approach. And it has minimal morbidity and better esthetics.

• 한국콘크리트학회:학술대회논문집
• /
• 한국콘크리트학회 2008년도 춘계 학술발표회 제20권1호
• /
• pp.233-236
• /
• 2008

구조재로서 목재는 자연에서 쉽게 얻을 수 있는 재료로서 뛰어난 미관, 가공성 등으로 인해 전통가옥이나 사찰 등에 널리 사용되어져 왔지만, 콘크리트나 강재에 비해 연소와 부식의 우려 등 내구성에 문제를 가지고 있다. 따라서, 목재를 구조부재로 활용하기 위해서는 타 재료와의 하이브리드화가 필요하다. 따라서, 본 연구에서는 구조용집성재보(100${\times}$200${\times}$3000(mm)), 콘크리트슬래브(800${\times}$100${\times}$3000(mm), fck=21MPa) 및 전단연결재(볼트, 래그스크류)로 구성된 합성보의 탄소성거동을 평가하기 위하여 구조 실험을 수행하였다. 실험결과, 전단연결재의 종류와 간격에 무관하게 항복비(항복내력/최대내력)가 크고, 항복 후에는 바로 취성파괴로 연계되었다. 따라서, 이러한 취성파괴를 방지할 수 있는 휨보강(철근, 섬유쉬트 등)이 필요할 것으로 판단된다. 또한, 전단연결재 배치간격이 좁을수록 합성효과가 우수하여 사용성이 뛰어나기 때문에 경제적 설계와 재료의 효율적 사용이 가능할 것으로 판단된다.