Based on clinical observations, it is suspected that the bone-tendon origin is the site where piratical failure, leading to pathophysiological changes in the humeral epicondyle after repetitive loading, is initiated Mechanical properties and failure patterns of the common extensor and flexor tendons of the humeral epicondyle under static and repetitive loading have not been well documented. Our goal was to determine mechanical properties of failure strength and strain changes, to correlate strain changes and the number of cyclic repetitions, and to identify the failure pattern of bone-tendon specimens of common extensor and flexor tendons of the humeral epicondyle. Mechnaical properties of human cadaver bone-tendon specimens of the common extensor and flexor tendons of the humeral epicondyle were tested under two different loading rates. No statistically significant difference in ultimate tensile strength was found between male and female specimens or between slow (10 mm/sec) and fast elongation (100 mm/sec) rates. However, a statistically significant difference in ultimate tensile strength between the common extensor (1190.0 N/$cm^2{\pm}$388.8) and flexor 1922.0 N/$cm^2{\pm}$764.4)tendons was found (p<0.05). When loads of 25%, 33%, and 41% of the ultimate tensile strength of their contralateral sides were applied, the number of cycles required to reach 24% strain change for the common extersor and flexor tendons were approximately 8,893, 1,907, and 410, respectively. The relationship between cycles and loads was correlated ($R^2$=0.46) Histological observation showed that complete or partial failure after tensile or cyclic loadings occurred at the transitional zone, which is the uncalcified fibrocartilage zone between tendon and bone of the humeral epicondyle. Sequential histological sections revealed that failure initiated at the upper, medial aspect of the extensor carpi radialis brevis tendon origin. Biomechanical and hstological data obtained in this study indicated that the uncalcified fibrocartilage zone at the bone-tendon origin of the common extensor and flexor tendons is the weak anatomical structure of the humeral epicondyle.
Hong, Jin Ho;Park, Yong Bok;Ryu, Ho Young;Jeon, Sang Jun;Park, Won Ha;Yoo, Jae Chul
The Journal of Korean Orthopaedic Ultrasound Society
/
v.7
no.1
/
pp.7-12
/
2014
Purpose:The effectiveness of transdermal buprenorphine patch on the patients with frozen state of frozen shoulder was evaluated. Materials and Methods: Between March and September in 2013, 127 patients with pain and limited range of motion in shoulder joint over 6 months were included. Every patient was confirmed the diagnosis through MRI or ultrasonogram and each patient received intra-articular injection of steroid once. After 2~4 weeks, every patient was interviewed via telephone survey and finally 105 patients were included, 54 patients received only oral NSAIDs (NP group) while 51 patients received additional transdermal buprenorphine patch (BP group). Pain and functional visual analog scale (PVAS, FVAS), American Shoulder Elbow Society (ASES) score was checked. Results: Generally, every outcome variables showed improvements in both groups (p<0.001). PVAS score after treatment showed superior result in NP group but it was not significant (p=0.088). In ASES score, NP group had superior result than BP group and it had significant difference. Similarly in FVAS, NP group showed superior result but the data before treatment was significantly different (p=0.028) Conclusion: Transdermal buprenorphine patch didn't show superior treatment result in the patient with frozen state of frozen shoulder which was applied with oral NSAIDs after single intra-articular glenohumeral steroid injection in short-term follow-up.
The aims of this study were to compare the shaping effect and safety between single length technique recommended by manufacturer and crown-down technique using Mtwo rotary file and to present a modified method in use of Mtwo file. Sixty simulated root canal resin blocks were used. The canals were divided into three groups according to instrument and the manner of using methods. Each group had 20 specimens. Group MT was instrumented with single length technique of Mtwo, group MC was instrumented with crown-down technique of Mtwo and group PT was instrumented with crown-down technique of ProTaper. All of the rotary files used in this study were operated by an electric motor. The scanned canal images of before and after preparation were superimposed. These superimposed images were evaluated at apical 1 to 8 mm levels Angle changes were calculated. The preparation time, weight loss, instrument failure and binding, canal aberrations, and centering ratio were measured. Statistical analysis of the three experimental groups was performed with ANOVA and Duncan's multiple range tests for post-hoc comparison and Fisher's exact test was done for the frequency comparison. In total preparation time, group MT and group MC were less than group PT. In the aberrations, group MT had more elbows than those of group MC and group PT. The binding of group MC was least and group MT was less than group PT (P < 0.05). Under the condition of this study, crown-down technique using Mtwo rotary file is better and safer method than single length technique recommended by the manufacturer.
Purpose: Rotator cuff tears involving the subscapularis are less common than those involving the superior and posterior rotator cuff. The purpose of the present study was to report the clinical results of repair of isolated traumatic tears of the subscapularis tendon. Materials and Methods: Fifteen patients (13 males, 2 females; mean age 46.2 years; range 35 to 52) with unilateral ruptures of the subscapularis tendon after trauma who underwent arthroscopic repair between February 2003 and October 2008 were reviewed retrospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon and were followed for at least two years (mean 28 months). The entire subscapularis was involved in 9 cases and the tear was localized to the upper two thirds in 6 cases. The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index) and postoperative integrity was determined through magnetic resonance imaging. Results: The average clinical outcome scores and strength were all improved significantly at the time of the final follow-up. The constant shoulder score improved from 41.5 to 81.3 points (P<0.05) compared to before surgery and ASES index improved from 46.4 to 89.6 points (P<0.05) postoperatively. Thirteen patients (87%) were satisfied with the result of the treatment. The total tears were significantly more improved by surgery than the partial tears. In 12 of 15 patients (80%) were judged to reveal healed tendon on magnetic resonance imaging at a mean of 13 months postoperatively. The postoperative score was significantly lower for the patients with a failed repair than it was for those with an intact repair (P<0.05). Conclusion: Repair of traumatic isolated subscapularis tears through arthroscopic techniques effectively restores patient function with regard to pain, mobility, strength and postoperative tendon integrity. The postoperative integrity of the repair correlates with the functional results and the total tears were more improved by surgery than the partial tears, but future studies may be needed.
Journal of The Korean Society of Inherited Metabolic disease
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v.18
no.3
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pp.78-86
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2018
Purpose: We aimed to delineate clinical spectrum and short-term effects after enzyme replacement therapy (ERT) for 5 mucopolysaccharidosis type II (MPS II). Methods: Five patients were diagnosed with MPS II by clinical findings, enzyme activity, and genetic testing. Idursulfase was administered by intravenous infusion at a dose of 0.5 mg/kg every week. Observational chart analysis of patients, who underwent systematic investigations more than 12 months after initiation of ERT was done retrospectively. Results: Three patients were classified as having the attenuated type, and 2 patients were classified as having the severe type. The median age at the diagnosis was 9.6 years (range 3.4-26 years). Four different mutations in 5 Korean patients (4 families) with MPS II were identified, among which two were novel mutations (1 small insertion mutation: p.Thr409Hisfs*22, and 1 missense mutation: p.Gly134Glu). Two severe type sibling patients with the same mutation had different clinical manifestation. Urinary glycosaminoglycan excretion decreased within the twelve months of ERT (P=0.043). Liver and spleen volumes showed reductions that were maintained in all patients (P=0.043 and P=0.043, respectively). Improvements were also noted in left ventricular mass index (P=0.042), shoulder flexion (P=0.043), shoulder abduction (P=0.039), knee flexion (P=0.043), elbow flexion (P=0.042), and respiratory distress index (P=0.041). Conclusion: This study demonstrates that Korean patients with MPS II are clinically heterogeneous and indicates that idursulfase is relatively effective in several clinical parameters including heart size and respiratory distress index without infusion-related reactions in patients with MPS II.
Kim, Cheol-U;Lee, Chul-Hyung;Yoon, Ja-Yeong;Rhee, Seung-Koo
Journal of the Korean Orthopaedic Association
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v.53
no.6
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pp.513-521
/
2018
Purpose: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. Materials and Methods: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. Results: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5-13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5-40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141-540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. Conclusion: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.
The purpose of this study was to compare Gwonbeop motions among "Gihyosinseo", "Mubiji", "Muyejaebobunyuksokjib" and to analysis catalogue of books on Gwonbeop for comprehensive interpretation in "Muyedobotongji". the conclusion through literature review was as follows. First, There were total 16 references which were composed of 14 references of China and 2 references of Korea. In particular there was no reference of Japan for Gwonbeop. In detail, unrepresentative references of China were "Hanseo", "Gihyosinseo", "Mubiji" and unrepresentative reference of Korea was Muyejaebobunyuksokjib". Second, We compared motions of Gwonbeop between China and Korea. There were located 5 motions such as Gyungakguheese(False Prey Posture), Gigose(Flag Beating Posture), Ahnshichukshinse(Goose Wing Posture), Jumjoose(Picking Elbow Posture), Pogase(Throwing Shelf Postere). In other three references unmentioned "Mubiji" there were located 8 motions such as Jungranse(Spring Railing Posture), Gichukgakse(Ghost Kicking and Leg Striking Postere), Jidangse(Open Finger Attacking Posture), Soodoose(Beast Head Shield Posture) Shingwon(Heavenly Fist Posture), Il-jopyunse(Whipping Lunging Posture), Jakjiryongse(Dragon Prey Snatching Posture), Joyangsoose(Slanting Hero Hand Posture), In two references of Korea there were located 2 unique motions such as Nachaluichoolmun Gakabyunhase(Low Encountering Posture), Gumgyedongnipse(Single Leg Throwing Postere). Third, Most of all we found two kinds of unique motions such as Chukcheonse and Eungswaeik on "Muyejaebobunyuksokjib" and such as Nachaluichoolmun Gakabyunhase(Low Encountering Posture), Gumgyedongnipse (Single Leg Throwing Postere) on "Muyedobotongji". Based on chronological table although "Gihyosinseo" is the longest literature, there was begun changing techniques in details on literatures of Korea. Transformed into techniques of Gwonbeop on Korea could be supposed that those skills were reflected in society and culture of the Joseon Dynasty. To sum it up, Gwonbeop of "Muyedobotongji" was written by "Gihyosinseo", "Mubiji", "Muyejaebobunyuksokjib" but most motions of Gwonbeop were begun to change gradually except 5 motions of "Gihyosinseo". Especially, there were 8 unique motions which could not be found in references of China. Those unique motions of Korea literatures were living proof of attempting transfiguration from motions of China. The significance of this study was to be able to put stepping-stone to interpretate history of Taekwondo which takes center stage on bare hands martial arts and analyzed the meaning of historical martial arts on Gwonbeop in Joseon Dynasty.
Purpose: To investigate the incidence and associated factors of delirium after orthopedic surgery. Materials and Methods: A total of 2,122 cases, who were older than 20 years and underwent orthopedic surgery at a single medical center during a one year period were included. Among them, 132 patients who were diagnosed with delirium after surgery under the Diagnostic and Statistical Manual of Mental Disorders-V criteria and medicated under the consultation of a psychiatrist were included in the study The differences in the incidence of delirium and several affecting factors were analyzed. Results: The overall incidence of delirium after surgery was 6.2% (132 in 2,122 cases). The mean age of the delirium group was 77.4 years (range, 54-92 years), which was higher than that of the non-delirium group (58.1 years). The percentage of women in the delirium group was 63.6% (84 in 132 cases), which was higher than that of the women in the non-delirium group (49.0%). The incidence of delirium after surgery was 9.3% (85 in 916 cases) due to trauma and 3.9% (47 in 1206 cases) due to disease. The incidence of postoperative delirium according to the surgical region was 29.2% (7 in 24 cases) in two or more regions, 13.7% (72 in 526 cases) in the hip, and 9.6% (14 in 146 cases) in the spine, 3.5% (20 in 577 cases) in the knee-lower leg, 2.5% (5 in 199 cases) in the foot-ankle, 2.4% (11 in 457 cases) in the shoulder-elbow, and 1.6% (3 in 189 cases) in the forearm-wrist-hand. Delirium occurred more rapidly in women and surgery due to disease, and the duration of delirium was longer in patients with dementia and major depressive disorders. Conclusion: The incidence of postoperative delirium was high in cases of surgery due to trauma and in cases of surgery in two or more sites. The incidence of postoperative delirium according to a single surgical region was higher in the order of the hip, spine, and knee. Active intervention is needed regarding the correctable risk factor.
In this study, machine learning-based clustering and classification of residential noise in apartment buildings was conducted using frequency and temporal characteristics. First, a residential noise source dataset was constructed . The residential noise source dataset was consisted of floor impact, airborne, plumbing and equipment noise, environmental, and construction noise. The clustering of residential noise was performed by K-Means clustering method. For frequency characteristics, Leq and Lmax values were derived for 1/1 and 1/3 octave band for each sound source. For temporal characteristics, Leq values were derived at every 6 ms through sound pressure level analysis for 5 s. The number of k in K-Means clustering method was determined through the silhouette coefficient and elbow method. The clustering of residential noise source by frequency characteristic resulted in three clusters for both Leq and Lmax analysis. Temporal characteristic clustered residential noise source into 9 clusters for Leq and 11 clusters for Lmax. Clustering by frequency characteristic clustered according to the proportion of low frequency band. Then, to utilize the clustering results, the residential noise source was classified using three kinds of machine learning. The results of the residential noise classification showed the highest accuracy and f1-score for data labeled with Leq values in 1/3 octave bands, and the highest accuracy and f1-score for classifying residential noise sources with an Artificial Neural Network (ANN) model using both frequency and temporal features, with 93 % accuracy and 92 % f1-score.
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