• 제목/요약/키워드: joint opening

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Freeman-Sheldon Syndrome의 치료에 대한 고찰 (MULTIDISCIPLINARY CARE OF FREEMAN SHELDON SYNDROME)

  • 김지훈;이정섭;장채리
    • 대한소아치과학회지
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    • 제37권4호
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    • pp.545-550
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    • 2010
  • Freeman-Sheldon Syndrome(FSS)은 드물게 발생하는 선천성 유전 질환으로 휘파람을 부는 듯한 특징적인 안모로 인해 'Whistling face syndrome'으로 불리워진다. 또한 편평한 안모, 긴 인중(philtrum), 낮은 비연골이 나타나 두드러진 안면이상을 보이고, 내반족(club foot, 內反足), 손가락의 관절구축(joint contracture)으로 인한 풍차 모양의 손을 가지며, 지능은 보통 정상이다. 본원에 내원한 환아는 이 질환의 특징적 양상인 구강 주위 근육의 수축으로 소구증 및 개구제한, 높은 구개 및 부정교합, 치열의 심한 총생을 보여 구강위생이 매우 불량하였고 치과치료에 비협조적이었다. 소아치과적 행동조절 및 구강위생관리, 섭식장애의 상담으로 치과적 문제는 다소 개선되었으나, 안과 및 정형외과, 신경정신과, 교정과, 마취과적 문제로 인해 다양한 협진이 필요하며 계속적인 관찰 및 치료가 요구되기에 이를 보고하는 바이다.

중국(中國) 의료시장(醫療市場)에 대한 외국인투자현황(外國人投資現況)과 법적(法的) 과제(課題) (The Actuality and Legal Subject of foreign investment to Chinese Medical Market)

  • 김성화
    • 의료법학
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    • 제7권2호
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    • pp.311-330
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    • 2006
  • As issues of education, employment and so on, the medical issue is one of the hot spots of society in China today. The health system reform which was pushed ahead after China's Revolution and open to the outside world hasn't received great progress. Many actual problems haven't been solved, for example it is difficult and expensive to see a doctor. With the development of the economy and society, the citizen's legal consciousness has gradually risen. They make a claim for better medical service. At the same time, the number of the disputes of medical care arises annually. China has sped up the opening of service trade for fulfilling promises of entry the WTO since 2001. China has already opened many service trade fields, including medical field. From the domestic perspective, there are many problems in domestic medical department. From the international perspective, China's present medical level falls behind the world advanced medical level. Under this background, it is a bold act for China to open the medical service field to foreign investors. Today, a huge medical service market is developed in China. However, the government's investment to medical devices and the financing channels is limited. Therefore, it is inevitable that individuals, social organizations and foreign investors invest to the medical market. In view of the situation, Chinese government issued a series of relevant laws and rules. In recent years, many multinational companies, consortiums, charitable institutions, enterprises and individuals establish various medical institutions in China. But there are rare research in the actuality and legal subject of foreign investment to Chinese medical market. Hence, it is necessary to realize the actuality of foreign investment to Chinese medical market, to familiar with the elements and procedure of establishing foreign joint and cooperative medical institution. Meanwhile, analyzing the existing problems and posing the legal subject have important theoretic and practical value.

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측두하악관절의 비정복성 관절원판변위 환자에 대한 관절강 세정술의 임상효과 : 증례보고 (Clinical Effect of Arthrocentesis for Patients with Disc Displacement without Reduction of Temporomandibular Joint : Report of Cases)

  • 김철;김영준
    • Journal of Oral Medicine and Pain
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    • 제31권2호
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    • pp.177-183
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    • 2006
  • 관절강세정술은 통상의 보존적 치료법에 실패한 측두하악관절장애 환자에서 합병증의 위험성이 높은 침습적인 외과적 수술법에 대신하여 첫 번째로 고려될 수 있는 치료법이다. 본 증례의 환자들은 측두하악관절의 비정복성 관절원판변위로 진단되어 지속적인 교합안정장치치료, 행동요법치료, 물리치료, 약물치료 등의 보존적 치료에도 불구하고 심한 관절동통과 하악운동범위의 제한을 호소하였다. 따라서 보존적 치료법에 잘 반응하지 않는다고 판단하여 반복적인 관절강세정술을 시행하였고, 시술직후 유의한 동통감소, 하악운동범위의 개선과 함께 양호한 치료경과를 나타냈다. 관절강세정술은 최소의 침습성을 지니는 가장 보존적인 외과적 술식으로서 통법의 보존적 치료에 반응하지 않는 비정복성 관절원판변위 환자를 상기 증례와 같이 적절히 선택한다면 측두하악관절장애의 동통과 기능제한에 효과적인 보조적 치료법이라고 생각된다.

슬립폼 공법으로 건설된 벽식 구조의 거동에 관한 연구 (Structural Behavior of Wall-Type Structure with the Application of Slip-Form System)

  • 문정호;이리형
    • 콘크리트학회지
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    • 제7권4호
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    • pp.157-168
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    • 1995
  • Slip-Form시스템을 사용하였을 때 공기단축 및 우수한 품질의 벽체타설이 가능하기 때문에, 그 적용성 및 구조적 거동을 평가하는 연구가 수행되었다. 그러나 슬래브를 벽체와 동시에 타설할 수 없기 때문에 벽체-슬래브 접합부의 주변에 취약점이 생기게 될 가능성이 있으므로, 본 연구는 Slip-Form시스템을 사용한 벽식 구조의 성능을 평가하고, 효과적인 접합부를 개발하는 것을 목적으로 하였다. 이를 위하여 7개의 벽체 실험체와 8개의 벽체-슬래브 접합부 실험체를 제작하여 실험을 실시하였다. 그리고 실험결과들을 설계식 및 이론적인 해석 결과와도 비교하였다. 벽체압축 실험으로부터 그 구조적 거동이 일체식 구조와 유사함을 알 수 있었으며, 벽체-슬래브 접합부 실험으로 부터는 철근연결용 철물이 있는 경우는 제외하고는 좋은 성능을 나타냄을 알 수 있었다. 그러나 외벽에 철근연결용 철물을 사용한 경우에는 벽체의 강도을 검토하여 설계에 반영하여야 함을 알 수 있었다.

Anterior open bite with temporomandibular disorders treated with intermaxillary traction using skeletal anchorage system

  • Kim, Hye-Sun;Lee, Sang-Hoon;Youn, Taegyun;Kim, Hyung-Gon;Huh, Jong-Ki
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제38권5호
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    • pp.284-294
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    • 2012
  • Objectives: The anterior open bite with temporomandibular disorders (TMD) is one of the most challenging cases both orthodontically and surgically. We introduce an intermaxillary traction treatment for patients with anterior open bite and TMD using a skeletal anchorage system (SAS). Materials and Methods: This study was comprised of 52 patients with anterior open bite and TMD. A total of four mini-screws were inserted, two screws each into the maxilla and mandible, to obtain a class II pattern of elastic application with 120-200 g force. Adjunctive muscle relaxation treatments, such as splint therapy, medication, and botulinum toxin injection were applied during or before intermaxillary traction. At least one treatment among adjunctive muscle relaxation treatment, mentioned above, was applied to 96.2% of patients. We evaluated the clinical characteristics of patients, TMD symptom changes, amount of open bite improved. The degree of open bite improvement was compared between the open bite-reduced group (21 patients) and not-reduced group (5 patients). Results: TMD symptoms (muscle/joint pain, joint sound, mouth opening) remained or improved in most patients, and worsened in about 10% of patients for each items. Anterior open bite was improved by a mean of 1.75 mm (P<0.01) during treatment. The open bite-reduced group exhibited a significant open bite improvement compared to the not-reduced group (P<0.05), with 37% of open bite improvement occurring during the first 3 months of treatment. Conclusion: The intermaxillary traction technique using SAS is a valid modality for correction of anterior open bite and improvement of TMD symptoms.

성장기의 편측 하악 과두 골절이 하악골 성장 및 기능에 미치는 영향에 대한 연구 (The study of the effect of mandibular growth and function in pediatric unilateral condyle fractures)

  • 상진규;이재훈
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제37권6호
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    • pp.448-456
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    • 2011
  • Introduction: Condylar fractures are common in the maxillofacial region, comprising 29-40 percent of all mandibular fractures, accounting for about 20-62 percent). Previous studies reported that pediatric condylar fractures can cause disorders in facial growth and function, and the treatment methods have been controversial. Recently, conservative treatment has shown good results in skeletal growth and functional recovery but the conservative treatment of pediatric condylar fractures has shown unpredictable and undesirable results in some cases, such as facial asymmetry and temporomandibular joint disorder. This study examined the specific age groups and specific mandibular condylar fracture type in growing children treated conservatively in the past. Materials and Methods: Eighteen patients (10 men and 8 women) who received conservative treatment for unilateral condylar fractures in Dankook University Dental Hospital between 2000 to 2007 were followed up for a mean period of 7.2 years. Results: In the survey of 18 pediatric patients who received conservative treatment for condylar fractures, the incidence of temporomandibular dysfunction and growth disturbance was 45% and 35%, respectively. Conclusion: In all complications, the symptoms observed most frequently was mouth opening displacement of the mandible exceeding 2 mm. The other complications of functional and growth disturbance included facial asymmetry concentrated along specific condylar types. Complications including facial asymmetry and functional and growth disturbances showed an increasing tendency according to the specific fracture types. Functional and growth disturbances in the undisplaced condylar fracture type showed a lower incidence(P <0.05). Functional and growth disturbances differed according to the fracture type, which has poor relationship with articular fossa and condyle(P <0.05). Functional and growth disturbance in the cases of the high-level condylar fracture type showed a higher incidence(P <0.05). The functional and growth disturbances of the fracture types were similar in the fragment-contact and non-contact groups(P >0.05).

Thermoelastic effect on inter-laminar embedded delamination characteristics in Spar Wingskin Joints made with laminated FRP composites

  • Mishra, P.K.;Pradhan, A.K.;Pandit, M.K.;Panda, S.K.
    • Steel and Composite Structures
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    • 제35권3호
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    • pp.439-447
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    • 2020
  • This paper presents two sets of full three-dimensional thermoelastic finite element analyses of superimposed thermo-mechanically loaded Spar Wingskin Joints made with laminated Graphite Fiber Reinforced Plastic composites. The study emphasizes the influence of residual thermal stresses and material anisotropy on the inter-laminar delamination behavior of the joint structure. The delamination has been pre-embedded at the most likely location, i.e., in resin layer between the top and next ply of the fiber reinforced plastic laminated wingskin and near the spar overlap end. Multi-Point Constraint finite elements have been made use of at the vicinity of the delamination fronts. This helps in simulating the growth of the embedded delamination at both ends. The inter-laminar thermoelastic peel and shear stresses responsible for causing delamination damage due to a combined thermal and a static loading have been evaluated. Strain energy release rate components corresponding to the Mode I (opening), Mode II (sliding) and Mode III (tearing) of delamination are determined using the principle of Virtual Crack Closure Technique. These are seen to be different and non-self-similar at the two fronts of the embedded delamination. Residual stresses developed due to the thermoelastic anisotropy of the laminae are found to strongly influence the delamination onset and propagation characteristics, which have been reflected by the asymmetries in the nature of energy release rate plots and their significant variation along the delamination front.

농업-기업 간 상생협력 구축 전략에 대한 연구: 유통협력형을 중심으로 (A Study on Win-Win Cooperation between Agriculture and Corporations: Focusing on Distribution Cooperation)

  • 박성진;허성윤;최종우
    • 유통과학연구
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    • 제14권10호
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    • pp.137-146
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    • 2016
  • Purpose - Korean agriculture is facing internal and external environmental changes and the need for secure stable outlets. Active participation and mutually beneficial cooperation between enterprises and agricultural is necessary for a win-win situation. This study investigates the case for distribution cooperation and a cooperative system. To respond to the diverse needs of consumers and market reclamation, there is a need to analyze and categorize distribution cooperation. Research design, data, and methodology - A literature study, relevant interviews with enterprises, and meetings with local government practices were conducted. A survey frame was derived through the participation of agricultural enterprises and distribution cooperation models were categorized identifying win-win cooperation and best practices. It was organized on the basis of six best practice examples of distribution cooperation between industry and agricultural sectors, divided into three types: opening distribution channels, exporting cooperation, and developing new products. Results - An innovation management system that can adapt to environmental changes and problems of agriculture is necessary. A company has to supply high-quality agricultural products reliably to meet the preferences of consumers by introducing products that promote domestic market differentiation. In addition, consumers are choosing a variety of products that may include not only high quality products but also local products and safe products. The main areas of cooperation are the direct provision of agrifood raw materials to consumers. Next, would be to help agricultural sectors distribute and pioneer international markets. The ideal step for distribution cooperation is the joint investment in new products by business and agriculture. Conclusions - Agriculture and win-win cooperation with enterprises is in an early stage of social contribution. To implement a distribution cooperation model between business and agricultural sectors, it is crucial to establish a structured support system including joint councils. Additional requirements include strengthening agricultural capacities, creating a legal basis for provision, and producing a win-win cooperation environment. The promotion of win-win cooperation and agricultural enterprises needs to exist in various forms in order to establish a different type of incentive system.

하악관절융기 절제술과 악관절원판 성형술을 이용한 악관절 탈구의 외과적 치료 (SURGICAL TREATMENT OF RECURRENT TMJ DISLOCATION BY EMINECTOMY WITH DISCOPLASTY)

  • 김형곤;최희수;허종기;박광호
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제28권2호
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    • pp.141-146
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    • 2002
  • Purpose: Various treatment methods have been utilized for recurrent dislocation of the TMJ (temporomandibular joint). The purpose of this study is to define the effect of the eminectomy with discoplasty that had been performed in patients with TMJ luxation. Materials and Methods: Twenty patients (22 joints), whose diagnosis were TMJ dislocation were selected in 772 patients (871 joints) who had been underwent TMJ surgery between 1988 and 2000. The selected patients were divided into two groups. Group I (12 joints) was the habitual-luxation group which involves the recurrent TMJ dislocation patients. Group II (10 joints) was the open lock-history group which involves the patients who had more than two episodes of TMJ luxation and TMJ disorders. The history of TMJ luxation, maximum mouth opening and other TMJ signs and symptoms before and after surgery were reviewed. Results: In group I, one patient who had been underwent both TMJ operation had a intermittent locking, but it disappeared after post-operative 32 months. In group II, intermittent pain was present in one patient who had bruxism, but it was disappeared by splint therapy. No more TMJ dislocations and other pains were checked in other patients of group I and II. Conclusion: Eminectomy with discoplasty may be used to successfully treat the TMJ habitual luxation accompanied with abnormal condition of the disc-condyle complex.

외상과 턱관절 장애 연관성에 관한 연구 (THE RELATIONSHIP BETWEEN TRAUMA AND TEMPOROMANDIBULAR JOINT DISORDER)

  • 김영균;윤필영;안민석;김재승
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제31권5호
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    • pp.375-380
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    • 2009
  • Objective : Trauma has been a controversial issue although it has been considered to be a major factor for the temporomandibular disorder(TMD). We evaluated the relationship between macrotrauma or microtrauma and TMD. Methods : This study was performed in patients with TMD undergoing treatment at SNUBH from October 2006 to January 2007. Sixty one male patients and 166 female patients(total 227) were included and the average age was 34 years(ranging from 14 to 85 years). We investigated the possible etiologic factors, diagnosis and treatment with the review of medical records and radiography. Chronic pain, depression, somatic score(including pain item), somatic score(excluding pain item) were evaluated on the basis of diagnostic index from the Research Diagnostic Criteria on TMD. Results : Eighteen patients(7.9%) out of 227 patients suffered from TMD as a result of macrotrauma. Ninety four(41.4%) patients had microtrauma and six patients(2.6%) had both macro- and microtrauma(etiologic factor). The main symptoms included pain. joint noise and mouth opening limitation while the other symptoms were headache and tinnitus. The patients had suffered from TMD for average 41 weeks (ranging from 1 to 480 weeks). 116 patients took splint as a major treatment. As a prognosis, 19 patients(8.4%) recovered completely. 26(11.0%) had improvement and 181(80%) had persistent symptoms. 1 patient(0.4%) underwent an arthroplasty. Diagnostic index from RDC chart showed that macrotrauma was the highest score(except depression score) among the other etiologic factors. Conclusion : This study showed that macro- and microtrauma can be considered to be the major etiologic factors of TMD, which also affect the chronic, depression and somatic discomfort.