• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.72-80
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• 1994

저자들은 수무지 절단 및 연부조직 결손을 주소로 고려대학병원 정형외과로 내원한 환자들을 대상으로 30례의 족무지 유리피부편을 이용한 수무지 재건술을 시행하고 비교적 장기간의 추시 관찰을 시행한 바 다음과 같은 결과를 얻었다. 1. 총 30례중 1례를 제외한 29례에서 이식이 성공하였으며 미용적 측면과 기능적인 면에서 모두 우수한 결과를 얻을 수 있었다. 2. 합병증으로 1례에서 이식실패, 6례에서 부분피부괴사, 1례에서 부정유합, 15례에서 이식골의 흡수가 있었으며 그중 1례에서 피로 골절이 관찰되었다. 3. 제1수장골 경부 절단시에도 수무지의 재건이 가능하였으나 무지 운동성의 제한과 많은 이식골의 골흡수가 문제점으로 제시되었다. 이상에서 족무지 유리 피부편을 이용한 수무지 재건술은 수무지 절단환자에 있어 미용상 및 기능적인 면에 있어 우수하며 공여부에도 비교적 결손이 적은 추천할 만한 수술법으로 사료되며 또한 술자는 합병증의 방지를 위하여 세심한 주의를 기울여야 할 것이며 미세수술수기에도 숙달되어야 할 것이다.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.75-80
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• 2001

Purpose : We have evaluated the morbidity of donor site after transfer of free fibular osseous and osteocutaneous flap to defect site of bone and soft tissue due to chronic osteomyelitis of long tubular bone, open fracture with bony defect, bone or soft tissue tumor and congenital anomaly. Materials and methods : The 54 cases of 79 cases to be carried out from May, 1982 to May, 2001 which could be followed up were reviewed. There were forty nine in male and five in female. The mean age was 35(4 to 66)years old and mean follow up period is 21.3 month(12 to 72). We have retrospectively analyzed the various postoperative complications such as compartment syndrome, donor site infection, skin defect, hypesthesia, hammer toes, ankle instability and activity of daily living by help of questionnaire, telephone, physical examination, follow up x-ray study and chart. Results : In the total 54 cases the medication period for pain control after operation were classified into three groups under 2 weeks(49 cases), from 2 weeks to 6 weeks(3 cases) and over 6 weeks(2 cases). The postoperative morbidity were occurred in total 12 cases(compartment syndrome: 0, infection : 2, skin defect: 1, hypesthesia: 5, hammer toe: 2 ankle pain: 2 discomfort in activity of daily living: 0), and also the morbidity rates of donor site were 23.5% in osseous flap and 21.6% in osteocutaneous flap were occurred. There was no statistical significonce in morbidity between osseous and osteocutaneous free fibular flap transfer(P>0.05). Discussion : In general the morbidity of free fibular flap transfer was relatively high but it did not have any effect on daily activity of living. We think that the meticulous operation technique, detailed wound care and early range of motion exercise will reduce the morbidity of donor site of flap.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Geomechanics and Engineering
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• 제30권2호
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• pp.169-185
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• 2022

The urbanization and increasing rate of population demands effective means of transportation system (basement and tunnels) as well as high-rise building (resting on piled foundation) for accommodation. Therefore, it unavoidable to construct basements (i.e., excavation) nearby piled foundation. Since the basement excavation inevitably induces soil movement and stress changes in the ground, it may cause differential settlements to nearby piled raft foundation. To understand settlement and load transfer mechanism in the piled raft due to excavation-induced stress release, numerical parametric studies are carried out in this study. The effects of excavation depths (i.e., formation level) relative to piled raft were investigated by simulating the excavation near the pile shaft (i.e., H_e/L_p=0.67), next to (H_e/L_p=1.00) and below the pile toe (H_e/L_p=1.33). In addition, effects of sand density and raft fixity condition were investigated. The computed results have revealed that the induced settlement, tilting, pile lateral movement and load transfer mechanism in the piled raft depends upon the embedded depth of the diaphragm wall. Additional settlement of the piled raft due to excavation can be account for apparent loss of load carrying capacity of the piled raft (ALPC). The highest apparent loss of piled raft capacity ALPC (on the account of induced piled raft settlement) of 50% was calculated in in case of H_e/L_p = 1.33. Furthermore, the induced settlement decreased with increasing the relative density from 30% to 90%. On the contrary, the tilting of the raft increases in denser ground. The larger bending moment and lateral force was induced at the piled heads in fixed and pinned raft condition.

• 한국지반공학회논문집
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• 제24권11호
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• pp.61-70
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• 2008

본 연구에서는 국내 4개 지역에서 시공된 총 10본의 대구경 암반 근입 현장타설말뚝의 양방향 말뚝 선단재하시험과 일반적인 말뚝두부 재하시험을 토대로 하중 재하방식에 따른 말뚝의 침하거동 및 하중전이 거동 특성을 분석하였다. 이로부터 양방향 재하하중을 받는 현장타설말뚝의 등가 말뚝 두부하중침하 거동을 고찰하곤 기존 등가 두부하중침하 곡선 산정방법과의 비교분석을 통하여 주면하중에 의해 추가적인 선단침하량의 영향정도를 분석하였다. 본 연구결과, 주면하중에 의해 발생되는 선단침하량을 고려한 하중전이해석(coupled load transfer analysis)을 통한 하중-침하량 예측값은 정재하 시험결과를 적절히 예측하는 것으로 나타났으나, 근사적 해석법을 통한 등가 하중-침하 곡선 및 일반적인 하중전이해식(uncoupled load transfer analysis)의 예측값은 정재하 시험결과에 비해 침하량을 과소 평가할 수 있음을 알 수 있었다. 하지만, 시험말뚝 근입부분의 암반층이 매우 단단할 경우 주면하중에 의한 선단침하량이 매우 작은 것으로 나타났다.

• 한국운동역학회지
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• 제30권3호
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• pp.197-204
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• 2020

Objective: The purpose of this study was to investigate the effect of increased running speed on the magnitude of impact shock attenuation in high frequency (9~20 Hz) at support phase on the treadmill running. Method: Twenty-four healthy male heel-toe runners participated in this study. Average age, height, mass, and preference running speed were 23.43±3.78 years, 176.44±3.38 cm, 71.05±9.04 kg, and 3.0±0.5 m/s, respectively. Three triaxial accelerometer (Noraxon, USA) were mounted to the tuberosity of tibia, PSIS (postero-superior iliac spine), and forehead to collect acceleration signals, respectively. Accelerations were collected for 20 strides at 1,000 Hz during treadmill (Bertec, USA) running at speed of 2.5, 3.0, 3.5, and 4.0 m/s. Power Spectrum Density (PSD) of three acceleration signals was calculated to use in transfer function describing the gain and attenuation of impact shock between the tibia and PSIS, and forehead. One-way ANOVA were performed to compare magnitude of shock attenuation between and within running speeds. The alpha level for all statistical tests was .05. Results: No significant differences resulted for magnitude of the vertical and resultant impact shock attenuation between the tibia and PSIS, and forehead between running speeds. However, significant differences within running speed were found in magnitude of the vertical shock attenuation between tibia and PSIS, tibia and forehead at speed of 2.5, 3.0 m/s, respectively. Conclusion: In conclusion, it might be conjectured that muscles covering the knee and ankle joints and shoe's heel pad need to strengthen to keep the lower extremities from injuries by impact shock at relatively fast running speed that faster than preferred running speed.

• 한국산학기술학회논문지
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• 제15권3호
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• pp.1749-1755
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• 2014

진동해머에 의해 시공되는 말뚝의 해석기법을 개발하고 매개변수연구를 수행하여 개발된 해석기법의 신뢰성을 평가해보았다. 편심모멘트와 진동수에 따른 매개변수해석을 통해 구한 가속도를 비교분석해 본 결과 최대가속도의 크기는 대략적으로 편심모멘트에 비례하였으며 진동수의 제곱에 비례하였다. 또한 변위진폭은 편심모멘트에 비례하는 결과를 나타내었고 진동수에는 거의 영향을 받지 않았는데 이러한 경향은 공운전시의 거동특성과 유사하다. 매개변수해석을 통해 구한 동적 하중전이곡선을 비교해 볼 때 편심모멘트와 진동수의 크기에 관계없이 최대 동적단위선단저항력의 크기는 동일하였으며 최대 동적단위주면마찰력의 크기는 편심모멘트에 영향을 받으나 진동수와는 무관하였다. 매개변수해석결과를 종합적으로 비교분석해 볼 때 개발된 해석기법은 합리적인 해석결과를 보인다고 볼 수 있다.

• 한국지반공학회논문집
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• 제22권11호
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• pp.113-122
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• 2006

국내에서 말뚝 정재하 실험이 수많이 수행되고 있지만, 그 결과의 활용도가 낮아서 재하실험 방법과 분석방법 등에 대하여 재고할 필요성이 제기되고 있다. 본 연구에서는 두터운 연약지반 하부의 모래층에 PHC 말뚝 선단을 지지시킨 후 하중전이 정재하 실험을 수행하였다. 말뚝의 설치 이후에 장기간에 걸쳐 주면 마찰력을 측정하였으며, 국내에서 보편적으로 적용되고 있는 재하법과는 다른 급속재하법에 의하여 정재하실험을 실시하였다 그 실험결과를 이용하여 말뚝의 탄성계수, 잔류응력 및 참 지지력을 산정하였다. 결과적으로, 재하실험 전에 말뚝에 존재하는 잔류하중이 주면 마찰력과 선단지지력에 크게 영향을 미친다는 사실을 확인할 수 있었다. 또한, 점성토 지반에서의 장대말뚝에 대해서는 지반의 강도회복(setup) 효과가 매우 크다는 사실을 알 수 있었다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 추계학술대회
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• pp.245-248
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• 1997

Operative interventions for the management of osteonecrosis of the femoral head (ONFH) include core drilling, with or without vascularized fibular bone grafting. Nevertheless, their clinical results have not been consistently satisfactory. Recently, a new surgical procedure that incorporates cementation with polymethylmethacrylate (PMMA) after core drilling has been tried clinically. In this study, a biomechanical analysis using a finite element method(FEM) was undertaken to evaluate surgical methods and their underlying surgical parameter. Our finite element models included five types. They were (1) normal model (Type I), (2) necrotic model (Type II), (3) core decompressed model (Type III). (4) fibular bone grafted model (Type IV), and (5) cemented with PMMA model (Type V). The geometric dimensions of the femur were based on digitized CT-scan data of a normal person. Various physiological loading conditions and surgical penetration depths by the core were used as mechanical variables to study their biomechanical contributions in stress transfer within the femoral head region. In addition. the peak von Mises stress(PVMS) within the necrotic cancellous bone of the femoral head was obtained. The fibular bone grafted method and cementation method provided optimal stress transfer behaviors. Here. substantial increase in the low stress level was observed when the penetration depth was extended to 0mm and 5mm from the subchondral region. Moreover, significant decrease in PVMS due to surgery was observed in the fibular bone grafted method and the cementation method when the penetration depths were extended up to 0 and 5mm from the subchondral region. The drop in PVMS was greater during toe-off than during heel-strike (57% vs. 28% in Type IV and 49% vs. 22% in Type V). Both the vascularized fibular bone grafting method (Type IV) and the new PMMA technique (Type V) appear to be very effective in providing good stress transfer and reducing the peak Von-Mises stress within the necrotic region. Overall results show that fibular bone grafting and cementation methods are quite similar. In light of above results, the new cementation method appears to be a promising surgical alternative or the treatment of ONFH. The use of PMMA for the core can be less prone to surgical complication as opposed to preparation of fibular bone graft and can achieve more immediate fixation between the core and the surrounding region.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.593-598
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• 2007

Purpose: Talipes equinus deformity is defined as impossibility of heel weight-bearing and lacking of improvement of toe-tip gait despite sufficient duration of conservative treatment. The incidence of equinus deformity induces post-traumatic extensive soft tissue defect and subsequently increases it. Severe equinus deformities of the foot associated with extensive scarring of the leg and ankle were corrected using achilles Z-lengthening and free-tissue transfer. Methods: Free radial forearm flap was done in nine cases of eight patients from January 2000 to November 2006. Causes of deformity were post-traumatic contracture (one patient) and post-burn scar contracture (seven patients). Seven patients were male, one patient was female. Mean age was 32.1 (range, 10-57). Flap donors were covered with artificial dermis ($Terudermis^{(R)}$) and split thickness skin graft (five cases), and medium thickness skin graft only (four cases). Results: The size of flaps varied from $6{\times}12$ to $15{\times}12cm$ (average, $12{\times}7.8cm$). Achilles tendon was lengthened 4.2cm on average. Free radial forearm flap was satisfactory in all cases. All patients could ambulate normally after the surgery. Cases having donor coverage with $Terudermis^{(R)}$ were aesthetically better than those having skin grafts only. Conclusion: This study suggested that severe equinus deformities associated with extensive scarring of the leg and ankle can be corrected effectively free radial forearm flap and Achilles tendon lengthening.