• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 추계학술대회
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• pp.489-492
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• 1997

The general pattern of adaptation in the appendicular skeleton with aging is that the subperiosteal apposition of bone occur along with endosteal absorption. This remodeling of diaphysis to a cylinder of larger diameter is hypothesized to serve a mechanical compensatory unction by increasing the moment of inertia as the cortex thins with aging. These findings is only true of the diaphysis of long bone. Measuring the area and inertia at each section of femur, the age-related change of proximal emur and diaphysis is observed. After screening by physical and radiological examination, 200 normal Korean adults divided 5 groups in both male and female based on age. Twenty persons were in each group. One femur in each person was analyzed using CT images. femur scanned with 60 to 80 slices and this images were digitized. Then 2-D images were reconstructed into 3-D images. Using the nonlinear method, normalization and interpolation technique, 7 locations of interest (trochanteric area: 1, 2 subtrochanteric area: 3, 4, isthmic area: 5, 6, 7) were determined. On the each cross section at each location, the area (total, cortical and medullary) and 5 inertia of moment were measured. The results were analyzed statistically. With aging, significant area change occurred mainly in diaphysis and female. In trochanteric area, no significant change was noted. With aging, total and medullary area were increased, but cortical area was not changed. In diaphysis, lateral bendingresistanceincreasedsignificantly. No inertia change was noted in trochanteric area. Anteroposterior bending resistance was constant with aging. In more than age 60, total area and medullary area were larger than that of others. Lateral bending resistance was higher especially in diaphysis. In diaphysis, with aging, the decreased properties is compensated with the increased lateral bending resistance by geometric remodeling. In trochanteric area, no compensation occur. With aging, especially in more than age 60, the higher rate of trochanteric fracture is expected.

• 대한골관절종양학회지
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• 제17권1호
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• pp.44-50
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• 2011

목적: 근위 대퇴골에 발생한 전이성 골종양의 병적 골절 혹은 임박 골절의 수술적 치료방법 중 광범위 절제술 후 종양대치 인공관절 치환술과 골절의 정복 후 골수강정을 이용한 고정술의 치료 성적을 비교하는데 있다. 대상 및 방법: 1994년 5월에서 2009년 5월까지 근위 대퇴골 전이성 골종양으로 인한 임박골절 및 병적골절로 본원에서 수술한 37명(38예))을 종양대치 인공관절 치환술을 시행한 군(1군; 22명)과 골유합 고정술을 시행한 군(2군; 15명, 16예)으로 나누었다. 평균 연령은 1군은 59세, 2군은 60세였으며, 평균 추시 기간은 수술 후 1군은 23개월, 2군은 11개월이었다. 두 수술군의 치료성적은 종양학적 성적과 Musculoskeletal Tumor Society (MSTS) scoring system, 1993의 기능적 평가방법, Kaplan-Meier 생존분석을 시행하였으며, 통계학적 분석은 Log rank test, T-test를 이용하여 평가하였다. 결과: 수술 후 평균 생존기간은 1군은 24개월(3-110개월), 2군은 11개월(1-33개월)이었으며, 1년 생존율은 1군은 86% (19/22명), 2군은 50% (8/16명), 2년 생존율은 1군은 30% (5/22명), 2군은 9% (1/16명)였다. MSTS scoring system, 1993의 기능적 평가방법을 이용한 종합적인 성적에서 1군은 평균 26점(19-30점), 88%, 2군은 평균 15점(10-23점), 51%로 평가되었다. 결론: 근위 대퇴골에 발생한 전이성 골종양의 치료 방법 중 선택된 환자에서 실시한 광범위 절제술 후 종양대치 인공관절 치환술은 골절 고정술 보다 종양학적 성적 및 기능적 성적이 우수한 것으로 나타났다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 추계학술대회
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• pp.263-266
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• 1997

Three dimensional numerical model based on the finite element method(FEM) were developed to predict the mechanical behavior of hip implants. The purpose of this study is to investigate the stress distribution of two types of cementless total hip replacement femoral component -a straight stem and a curved stem, and to compare their effect on the stress shielding between two types by three dimensional finite element method. The authors analyzed von Mises stress in the cortex & stem and compared the stress between the straight and the curved stem. In comparison of stresses between two different design of femoral stem, there was 25% more decrease of stress in straight stem than curved stem in the medial cortex at proximal region. The straight stem had consistently much lower stresses than the curved stem throughout the whole medial cortex with maximum 70% reduction of stress. However, there was little change in stress between nature and 2 implanted femur throughout the lateral cortex. Stress of femoral stem was much higher in the straight stem than the curved stem up to 60%. The straight stem had more chance of stress shielding and a risk of fatigue fracture of the stem compared with the curved stem in noncement hip arthroplasty. In design of femoral stem still we have to consider to develop design to distribute more even stress on the proximal medial cortex.

• Journal of Mechanical Science and Technology
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• 제20권12호
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• pp.2168-2177
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• 2006

The purpose of this investigation was to determine the specific fracture mechanics response of cracks that initiate at the stem-cement interface and propagate into the cement mantle. Two-dimensional finite element models of idealized stem-cement-bone cross-sections from the proximal femur were developed for this study. Two general stem types were considered; Rectangular shape and Charnley type stem designs. The FE results showed that the highest principal stress in the cement mantle for each case occurred in the upper left and lower right regions adjacent to the stem-cement interface. There was also a general decrease in maximum tensile stress with increasing cement mantle thickness for both Rectangular and Charnley-type stem designs. The cement thickness is found to be one of the important fatigue failure parameters which affect the longevity of cemented femoral components, in which the thinner cement was significantly associated with early mechanical failure for shot-time period.

• Hip & pelvis
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• 제34권3호
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• pp.140-149
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• 2022

The increase in the number of primary total hip arthroplasties that will be performed over the next several decades will lead to an increase in the incidence of periprosthetic fractures around the femoral stem. A search of targeted articles was conducted using on-line databases of PubMed (National Library of Medicine) and articles were obtained from January 2008 to November 2021. Reliable prediction of treatment can be achieved using the Vancouver classification; internal fixation is indicated in fractures involving a stable implant and revision arthroplasty is indicated in those with unstable prostheses. To the best of our knowledge, relatively fewer studies regarding periprosthetic proximal femur fractures of cemented stems have been reported. The focus of this review is on the risk factors and strategies for treatment of these fractures for periprosthetic femoral fractures around a cemented hip arthroplasty.

• 대한골관절종양학회지
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• 제17권1호
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• pp.36-43
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• 2011

목적: 사지의 악성 골 종양에서 $MUTARS^{(R)}$ 종양 대치물을 이용한 사지 구제술의 중기 추시에서 합병증 발생과 기능적 및 방사선학적 결과를 평가하고자 하였다. 대상 및 방법: $MUTARS^{(R)}$ 종양 대치물을 이용한 사지 구제술을 받은 환자 31명을 대상으로 하였다. 평균 연령은 49.2세였으며, 추시기간은 평균 39.8개월이었다. 후향적으로 최종 추시에서 합병증을 분석하고 Enneking 기능 점수와 ISOLS 방사선학적 대치물 평가 체계를 이용하여 기능적, 방사선학적 평가를 시행하였다. 결과: 3명이 사망하였고 4명에서 원격전이가 발생하였으며, 1명이 국소 재발하였다. 12명에서 합병증이 발생하였는데, 창상 및 심부감염 6명, 하지 부동 2명, 방사선학적 이완 2명, 대퇴골 골절이 1명, 나사못의 이완이 1명이었다. 최종 추시 시 기능적 분류 척도의 평균 점수는 근위 대퇴골에서 81.2%, 원위 대퇴골에서 77.4%, 근위 경골에서 78.1%, 근위 상완골에서 80.2%였으며 방사선학적 결과는 전반적으로 우수한 결과를 보였다. 결론: $MUTARS^{(R)}$ 종양 대치물을 이용한 사지 구제술은 기능적, 방사선학적으로 만족할 만한 방법이지만 감염 등의 합병증에 주의를 해야 할 것으로 생각된다.

• 대한골관절종양학회지
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• 제11권2호
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• pp.175-182
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• 2005

목적: 대퇴골에서 골 종양은 주로 근위 전자부와 원위 간단부에 발생한다. 그러나 대퇴골은 체중부하와 연관하여 종양의 크기에 따라서는 병적 골절을 유발하게 된다. 그러므로 종양제거후 대퇴골의 해부학적 특성을 고려한 angled blade plate로 보완해 준다면 생역학적 측면에서 그 예후를 훨씬 개선할 수 있을 것 여겨진다. 대상 및 방법: 1991년 10월부터 2005년 4월까지, 대퇴골에 발생한 골 종양을 제거하고 Blade Plate로 보완해준 환자 16명 17예를 대상으로 하였다. 종양제거 후 11예에서 골 이식으로, 6예에서 골 세멘트로 채워 넣었으며, 모든 예에서 angled blade plate를 사용하여 내고정을 시행하였다. 결과: 평균 추시 기간은 16명 환자(17예)에서 55.5개월 이었다. 시술 후 금속에 관련된 실패는 없었다. 종양의 재발로 인하여 재수술이 4예에서 있었으며 재수술전까지 내고정은 유지되었다. 결론: angled blade plate는 종양수술 후 이식 골의 결합이 이루어질 때까지 그 부위를 골절로부터 보호하며, 골 세멘트를 사용한 경우는 골 세멘트와 골조직과의 취약한 이음새를 골절로부터 보호하였다.

• 대한골관절종양학회지
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• 제3권1호
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• pp.32-38
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• 1997

PURPOSE : For the reconstruction of large bone defect after tumor resection, it is possible to reuse the bone involved by tumor with some treatment to it. Several bone-reusing methods have been reported such as autoclaving, low-heat treatment(pasteurization) and intraoperative radiotherapy. We have used extracorporeally radiated autogenous bone graft for reconstruction after tumor resection, and analyzed the periods for junctional union, functional results and complications to know the indications of this method. METHODS : From Dec. 1993 to Sept. 1995, nine patients had taken autogenous bone graft with extracorporeal irradiation. Eight cases were osteosarcoma and 1 giant cell tumor. The graft sites were 5 in femur, 3 proximal tibia and 1 femur and tibia. Stage 3 was 1 case(GCT), Stage IIB 3 and Stage IIIB 5. After wide resection, surrounding soft tissue and intramedullary and extramedullary portion of the tumor were removed. Radiation was done in 5000cGy to the resected bone. Ender nails and bone cement were inserted and filled into the medulla to prevent fracture. RESULTS : Average follow-up period was 12.3(4 to 21) months. Average junctional union period in simple X-ray was 6.5 months in 4 cases. Average functional score following Enneking's criteria was 19(12-27). Complications were as follows ; condylar fractures and femur neck fracture in 4 cases, subluxation of the knee joint 3 and infection 1. Although local recurrence was detected in 1 case, the site of recurrence was not in the radiated bone but surrounding soft tissue. At final follow-up, no recurrence was found in one case(GCT), CDF 2, AWD 2, DOD 3, and died of chemotherapy related sepsis 1. CONCLUSIONS : Extracorporeally radiated bone autograft is considered to be a method for reconstruction of the large bone defect made by tumor resection, especially in the reconstruction around the joint.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• 한국임상수의학회지
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• 제41권2호
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• pp.139-142
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• 2024

A wild Whooper swan (Cygnus Cygnus) with limping due to an injured left pelvic limb in an accident was rescued on the seashore and transferred to the Jeju Wildlife Rescue Center on November 23rd, 2020. On physical examination, its body condition score was 1 out of 5 due to starvation and dehydration. The left coxofemoral joint was also examined by careful palpating and estimating the damage. Moderated soft tissue swelling and crepitus surrounding the hip joint were confirmed. Radiography and computed tomography (CT) were used together for an accurate diagnosis of the joint. By radiographs readings, it was difficult to accurately confirm the condition of the proximal femur due to superimposition of the synsacrum and internal organs. However, signs such as avulsion fracture of the femoral head and a few fragments around the joint were revealed by CT imaging. Besides, through three-dimensional (3D) image analysis of CT, the dislocated area and condition of the left hip joint could be accurately and easily confirmed. The diagnostic process showing in this paper could be used as a good reference for diagnosing coxofemoral joint luxation in wild swan.