• Archives of Reconstructive Microsurgery
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• 제9권2호
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• pp.114-119
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• 2000

The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct. Recently, several free composite flaps including the tendon have been used to reconstruct large defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an open injury to the Achilles tendon. He was referred to our department with gross infection of the wound and complete rupture of the tendon associated with loss of skin following reduction of distal tibial bone fracture. After extensive debridement, $6{\times}8cm$ of skin loss and 8cm of tendon defect was noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory unit including the extensor digitorum longus to provide tendon repair and sensate skin for an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint discrimination and moving two-point discrimination were more than 1mm at the transferred flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis flap. The advantages such as to control infection, adequate restoration of ankle contour for normal foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first choice for reconstruction of soft tissue defect including the Achilles tendon.

• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.75-78
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• 2000

Purpose: The purpose of this study was to review primary traumatic anterior shoulder dislocation in the 40 years and older to determine the incidence of recurrence, rotator cuff injury and associated fractures. Materials and Methods: From May, 1991 to October, 1998, seventeen patients were available to participate in the study. The average age was 55 years(range, 40 to 75 years). Follow-up averaged 27 months(range, 12 to 48 months). There were 12 men and 5 women. 10 right and 7 left shoulders were involved. Any participant with a history of shoulder pain and limitation of motion was excluded from the study. Each shoulder was evaluated with UCLA shoulder functional assessment. Results: The overall results were excellent in 9 patients(52.9%), good in 3 patients(17 .6%), fair in 3 patients(17.6%), and poor in 2 patients(11.7%). Surgical treatment of the associated rotator cuff and greater tuberosity fracture injuries resulted in 5 patients with excellent(55.6%), 3 patients with good(33.3%) and I patient with poor(11.1 %) and Nonsurgical treatment of the associated injuries resulted in 2 patients with excellent(33.3%), 3 patients with fair(50%), 1 patient with poor(16.7%)(P=0.025). Conclusion : Our findings on small number of patients suggest that the diagnosis of a rotator cuff and other pathologies should be approached aggressively by an MRI, CT arthrogram if significant pain and weakness are still present and early surgical repair of rotator cuff and greater tuberosity can lead to restoration of shoulder function and better outcomes in selected patients.

• 대한관절경학회지
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• 제6권2호
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• pp.131-135
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• 2002

목적 : 40대 이상의 중장년층에서 견관절 전방 탈구와 동반된 회전근 개 파열환자에서 예후 인자를 파악하고자 하였다. 대상 및 방법 : 1995년 5월부터 1998년 10월까지 내원한 견관절 탈구 후 발견된 회전근 개 파열 12 예의 환자를 대상으로 하였으며, 환자의 연령은 42세에서 67세까지 였고, 이중 2예에서 액와 신경 마비를 보였으며 대결절 골절을 동반하였다. 모든 예에서 회전근 개 파열을 보였으며 파열 범위는 8예가 광범위 파열 3예가 광범위 파열, 1예가 소범위 파열이었다. 결과 : 견관절 탈구와 동반된 회전근 개 파열 환자에서 회전근 개 봉합술을 시행한 결과 불행 삼주징을 동반한 2예를 제외 한 10예에서 UCLA shoulder rating scale 을 이용하여 결과를 판정한 바 양호 이상의 결과를 보였다. 결론 : 중장년층에서 발생한 견관절 탈구의 경우 동반 병변의 확인과 액와신경 손상이 동반된 회전근 개 파열 환자에서 적절한 회전근 개 봉합술 및 액와 신경 손상에 대한 적절한 재활 프로그램이 필요하리라 사료된다.

• Journal of Trauma and Injury
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• 제29권3호
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• pp.93-97
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• 2016

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of ${\bigcirc}{\bigcirc}$ trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.

• 콘크리트학회논문집
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• 제17권3호
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• pp.329-334
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• 2005

폴리머콘크리트는 시멘트 콘크리트에 비해 강도와 내구적 성능 등 여러면에 있어 우수하여 건설현장에서의 벽체용 패널, 통신용 맨흘, 기계설비의 기초, 지하연결박스 등 다양한 용도로 개발되고 사용되어지고 있다. 그러나 폴리머콘크리트는 그 결합재로 쓰이고 있는 수지의 비용이 높아 경제적인 면에서 불리하여 기존 수지를 대체할 수 있는 결합재에 관한 연구가 필요하다. 여기서, PET를 재활용한 폴리머콘크리트는 산업폐기물을 재활용한 것이므로 경제적인 건설 소재가 될 수 있으며, 친환경적인 효과를 가져올 수 있기 때문에 현재 연구가 활발하게 이루어지고, 사용 영역이 확대 될 것으로 전망된다. 하지만 아직까지 PET재활용 폴리머콘크리트의 응력-변형률 거동에 관해서는 기초적인 연구상태에 있다. 따라서, 본 연구에서는 폐 PET를 합성한 불포화 폴리에스터 수지를 폴리머콘크리트의 결합재로 이용하여 콘크리트를 제조하였으며, 수지량, 골재의 최대치수, 양생방법에 변화를 주었다. 그리고 변위제어가 가능한 M.T.S 장비를 사용하여 응력-변형률 곡선을 관찰하였다. 그 결과 PET 재활용 폴리머콘크리트의 압축강도는 수지의 함량, 굵은골재의 크기변화, 양생방법에 모두 영향을 받는 것으로 나타났다. 탄성계수의 변화는 수지의 함량이 크게 좌우하였으며, 굵은골재의 최대치수와 양생방법에서 크게 영향을 받지 않았다. 최대응력에서의 변형률은 수지의 함량과 굵은골재의 최대치수에 영향을 많이 받는 것으로 나타났다.

• Journal of Periodontal and Implant Science
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• 제33권2호
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• pp.259-269
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• 2003

The ideal goal of periodontal therapy is the regeneration of periodontal tissue repair of function. Although is very difficult to attain the goal, recent advances in periodontal wound healing concepts encourage hope reaching it. Recently many efforts are concentrated on the regeneration potential of material used in traditional Korean medicine. Phlomidis Radix has been used for the treatment of blood stasis, bone fracture and osteoporosis in traditional Korean medicine. The purpose of this study is to examine effects of dichloromethane fraction Phlomidis Radix on Bone Formation in Human Fetal Osteoblasts. Human fetal osteoblastic cell line(hFOB1 1.19 ;American Type Culture Collection, Manassas, VA) were used and cells were cultured containing DMEM and dichloromethane fraction Phlomidis Radix(100 ng/ml , 1 ${\mu}$/ml, 10 ${\mu}$/ml) at 34$^{\circ}C$ with 5% $CO_2$ in 100% humidity. MTT was performed to examine the viability of the cell, and alkaline phosphatase activity was analyzed to examine the mineralization. Also bone calcification nodules were evaluated. The cellular activity of hFOB1 was increased in 100 ng/ml, 1 ${\mu}$/ml , 10 ${\mu}$/ml of dichloromethane fraction of Phlomidis Radix and especially significant increation was showed in 100 ng/ml of dichloromethane fraction of Phlomidis Radix at 6days (p <0.05). ALP level of hFOB1 was significantly increased in 100 ng/ml , 1 ${\mu}$/ml, 10 ${\mu}$/ml of dichloromethane fraction of Phlomidis Radix and especially more increation was showed in 10 ${\mu}$/ml of dichloromethane fraction of Phlomidis Radix (p <0,05). Calcification nodules of hFOB1 significantly increased in 10 ${\mu]$/ml of dichloromethane fraction of Phlomidis Radix at 21 days of incubation(p<0.05). The results indicate that dicholoromethane fraction of Phlomidis Radix has excellent effects on mineralization of hFOB1.

• 대한정형외과스포츠의학회지
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• 제2권2호
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• pp.77-81
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• 2003

목적: 슬관절 주위 골격의 기초과학을 생체역학을 중심으로 설명하고 빈도가 높은 스포츠 손상들에 대해 기술하고자 한다. 해부 밀 운동학: 슬관절은 순수한 경첩 관절이 아니며 적합하지 않으므로 여섯 방향의 운동이 가능하다. 경골대퇴간 운동역학: 슬관절의 굴곡-신전 축은 시상면에 수직이 아닐 뿐 아니라, 관상면상 관절선과 평행하지 않으므로, 경골대퇴관절은 굴곡 시 내반과 내회전이 동반되고 신전 시에는 외반과 외회전이 동반된다. 슬개대퇴 관절: 슬개대퇴 관절 압박력은 슬관절의 굴곡 각도와 사두고근력에 비례한다 슬개골은 신전기전의 moment arm을 증가시켜 신전기전의 효율을 증대시키고 지렛대 역할을 한다. 슬개골 골절: 비전위성 골절이면서 하지 직거상 운동이 보존된 경우에 비수술적 치료의 적응증이 되며 수술적 치료 시 고정 방법의 선택은 골절 양상에 따라 결정되겠으나 어느 술식을 선택하여도 신전지대의 봉합은 필수적이며 중요하다 슬개골 불안정성: 선행 해부학적 이상을 조사해야 하며 급성 탈구에서도 골연골 골절편이 있거나 재발의 위험이 높은 운동선수에서 인대 봉합을 고려할 수 있다. 비수술적 치료 및 재활에도 불수하고 계속되는 재발성 아탈구나 탈구는 수술이 필요하다 학령기 스포츠 손상: Idiopathic Adolescent Anterior Knee Pain, Osgood-Schlatter Disease, Sinding-Larsen-Johansson Disease 등이 흔하다

• 대한치과교정학회지
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• 제18권1호
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• pp.189-207
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• 1988

In almost all biologic systems, mechanically induced electric charge separation is a fundamental phenomenon. Since the hypothesis was established that the generation of electric potentials in bone by mechanical stress including muscular force might control the activity in bone by mechanical stress including muscular force might control the activity of osseous cells and their biopolymeric byproduct, the concept of electrically mediate growth mechanism, which involves biological growth and bone remodeling by any means, in living systems has been applied clinically and experimentally to orthopedic fracture repair, the regulation of orthodontic tooth movement, epiphyseal cartilage regeneration, etc. On the other hand, recent numerous research data available show apparently that the mandibular condyle has the characteristics of growth center as well as growth site. In addition, there exists a considerable difference of opinion as to the role of external pterygoid muscle in condylar growth. In view of these evidences, this. experiment was performed to investigate the effect of the galavic current on the growth of the mandible and condyle for elucidating the nature of condylar growth. The bimetallic device was composed of silver and platinum electrode connected with resistor (3.9 Mohm), which was expected to produce galvanic current of 23.6 nA according to the galvanic principle. The 25 Sprague-Dawley rats were divided into two group, 2 week group comprising 8 animals exposed to satanic current for 2 weeks and 3 control animals not exposed for 2 weeks, 4 week group comprising 10 animals in experimental group and 4 animals in control group applied for 4 weeks respectively. The experimental rats were subjected to application of the galvanic current invasively to codylar head surface and the control groups with sham electrode. On the basis of anatomic and histologic data from the mandibular condyle of experimental and control group, the following results were obtained. 1. After 2 weeks, there was no increase of mandibular size in experimental group over that of the control group. 2. After 4 weeks, the size of the condylar head was larger in experimental group than that of the control. 3. In 2 week group, the thickness of the mitotic compartment and hypertrophic chondroblastic layer was increased in experimental group. 4. In 4 week group, the number and the size of the hypertrophic chondroblasts were increased significantly on experimental group over that of the control group. 5. The application of the satanic current caused an increase in chondrocytic hypertrophy and intercellular matrix in both groups.

• 대한치과보철학회지
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• 제49권4호
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• pp.283-290
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• 2011

연구 목적: 현대의학의 발달로 평균 수명이 증가하고 고령의 환자가 늘어남에 따라 무치악 환자의 비율도 증가하고 있다. 특히 심하게 흡수된 하악골에선 기존의 총의치로는 환자가 사용하기에 유지, 지지의 부족으로 사용상에 어려움이 있다. 하악에 2개의 임플란트 식립하여 피개의치를 제작하면 환자에게 좀 더 사용하기가 편한 의치를 제작해 줄 수 있다. 간단한 보철과정과 추후 수리가 쉽다는 이유로 현재 Locator가 보편적인 유지장치로 사용되고 있다. Locator를 이용한 하악 임플란트 유지 피개의치에서 임플란트와 보철물의 장기적인 성공률을 알아보았다. 연구 재료 및 방법: 대구가톨릭대학병원 치과 구강외과에서 2004년부터 2010년까지 총 10명의 환자(남 4명, 여 6명)의 하악에 2개의 임플란트(총 20개)를식립후Locator를 이용한 조직-유지 피개의치를 하였다. 본 연구는 최근 7년간 시술된 10명의 환자들을 대상으로 진료 기록부를 조사하고 방사선 사진을 계측하여 후향적 임상연구를 하였으며, 임플란트의 생존률 및 보철적인 합병증에 대해 알아보았다. 결과:임플란트는 100%의 누적 성공률을 보였고, 1년후(평균 58주) 방사선 사진에서 임플란트는 평균 1.03 mm ${\pm}$ 0.20 mm의 골소실을 보였으며, 임플란트의 기능에는 이상을 보이지 않았다. 피개의치는 의치파절, 의치상 이장 또는 개상, 메일의 탈락 또는 유지력 감소로 인한 메일 교체 등 다양한 합병증을 보였다. 그러나 의치상 이장 및 개상, 메일 인써트의 간단한 교체로 인해 장기적으로 임플란트 및 임플란트 유지 피개의치가 환자에게 유지되고 있었다. 결론: 하악 전방부위에 임플란트 2개를 식립 후 Locator를 이용한 임플란트 유지 하악 피개의치는 최소침습적인 수술, 간단한 보철 과정 및 수리 과정의 장점으로 인해 장기적으로 안정적인 치료법으로 사료된다.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.50-56
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• 2014

Purpose: Rollover motor vehicle crashes have a higher injury severity and fatality than other motor vehicle crash types. From a left-quarter turn rollover accident of 25-passenger bus, we intend to assess the injury of the occupant and the injury severities according to the occupants' position. Methods: We carried out the 3 steps investigation of occupants' interview, visiting the repair shop and using the police report. We analyzed injuries sustained by occupants, and compared injury severities considering column, row in occupant's position and passenger interaction Results: The rollover involved 14 passengers in the bus who were all old women except a man driver. The most common injury was in the upper extremity, with six occurrences being a left clavicle fracture. Major injuries including hemothorax and pneumothorax were diagnosed at left side of the occupant. In the comparison of injury severity among driver's column (left side), mid column and passengercolumn, ISS of passenger column was the highest ($9.9{\pm}7.4$, $8.8{\pm}5.5$, and $10.3{\pm}4.0$, respectively, p>0.05). The injury severity of multiple occupants by row was higher than that of single occupant (10.8 vs. 3, p<0.05). Conclusion: An occupant must fasten their seat belt to prevent an injury by passenger interaction in the left-quarter turn rollover accident of a bus.