• Title/Summary/Keyword: master joint

검색결과 100건 처리시간 0.022초

배양 검사로 증명된 화농성 슬관절염의 관절경적 치료 (Arthroscopic Management for Pyogenic Arthritis with Positive Culture in the Knee Joint)

  • 백승훈;김세식
    • 대한관절경학회지
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    • 제16권2호
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    • pp.167-174
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    • 2012
  • 목적: 관절경적 세척술 및 변연 절제술을 시행하고 배양 검사로 확진된 화농성 슬관절염을 가진 환자들에서, 단기적 임상 경과와 중장기적 기능적 결과를 확인하고, 이에 영향을 미치는 인자를 분석하였다. 대상 및 방법: 관절경적 변연 절제술을 시행하고, 배양검사상 양성으로 판명된 32예의 환자를 대상으로 하였으며, 평균 추시 기간은 41.6개월이었다. 감염에 대한 임상적 평가로 사망, 재발, 적혈구 침강 속도 및 C-반응성 단백 수치의 정상화 기간, 정주용 항생제 투여 기간, 재입원 여부를 조사하였다. 방사선학적 평가로 인공 슬관절 치환술, 관절염 진행 정도를, 기능적 평가로 modified Lysholm, Tegner activity 및 Korean version of the Western Ontario and McMaster Universities(K-WOMAC) score를 조사하였다. 결과: 황색 포도상 구균이 21예에서 동정되었고, 적혈구 침강 속도 및 C-반응성 단백 수치의 정상화 기간은 평균 78.0 및 67.6일이었다. 2예에서 사망하였고, 6예에서 재발하였다. 입원 중 재발은 만성 신부전이 동반된 환자에서 빈발하였다(P=0.034). 5례의 환자에서 재입원이 관찰되었고, 최초 내원시 방사선 검사상 관절염 정도가 심하고(P=0.032), 입원 중 수술 횟수가 많을 수록 재입원의 가능성이 높았다(P=0.006). 21례에서 관절염이 진행하였고, 최종 Kellgren-Lawrence 등급은 최초 내원시의 등급과 관련이 있었다(P=0.007). 5례에서 인공 슬관절 치환술을 시행받았으며, Lysholm score는 평균 53.5점, Tegner activity score는 평균 2.7점, K-WOMAC score는 평균 44.2점이었다. 결론: 관절경적 치료 후 최종 관절염 정도는 기왕의 관절염 정도에 의해 결정되었다. 기존 퇴행성 변화가 심한 환자에서 재입원이 많았고, 만성 신부전 환자에서는 재발이 많아 이들 환자들에서는 주의를 요한다.

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고관절 전치환술 후 발생한 장요건 충돌의 관절경하 장요건 절단술 (Arthroscopic Iliopsoas Tenotomy of Iliopsoas Impingement after Total Hip Arthroplasty)

  • 허순호;최병열;한상록;정우철
    • 대한정형외과학회지
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    • 제56권2호
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    • pp.125-133
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    • 2021
  • 목적: 고관절 전치환술 후 발생한 장요건 충돌 환자에서 관절경적 장요건 절단술이 유용한 방법인지 알아보기 위하여 임상 결과에 대하여 조사하였다. 대상 및 방법: 2013년 9월부터 2019년 12월까지 고관절 전치환술 후 지속되는 서혜부 통증 및 굴곡 시 통증을 호소하는 18명(19예 고관절)의 환자를 대상으로 하였다. 평균 연령 60세(범위, 50-69세)의 환자들에서 고관절 전치환술 후 증상발현까지는 평균 4개월(범위, 1-9개월)이 소요되었으며, 18명 환자 중 13명에는 직접전방접근법, 5명에는 측방접근법을 통한 고관절 전치환술이 시행되었다. 병력청취, 신체 검사, 혈액검사, 단순 방사선촬영과 컴퓨터 단층촬영을 이용한 영상 검사, 그리고 국소주사치료를 통하여 장요건 충돌을 진단하였다. 이들 모든 환자는 관절경적 처치를 시행받았고, 역동적 신체 검사를 통하여 술장 내에서 충돌이 이루어짐을 확인하였으며, 근육부위까지 도달하도록 관찰된 건 부위 모두에 대하여 건절단술을 시행하였다. 수술 전, 후, 추시기간의 증상 및 통증 정도에 대하여 조사하여 비교하였다. 결과: Western Ontario and McMaster Universities Osteoarthritis Index 점수는 술 전 평균 58.4점(범위, 40-88점)에서 술 후 평균 35.0점(범위, 15-76점)으로 감소하였다. 시각통증등급도 마찬가지로 술 전 평균 4.0 (범위, 2-6)에서 술 후 평균 1.4 (범위, 0-4)로 감소하였다. 16명(88.9%)에서 통증 경감 및 하지거상 시 통증의 호전을 보였으며, 2명에서는 통증 잔존과 술 후 근력 약화를 보였다. 이후 추시기간에서 근력 약화는 호전되었다. 1명의 경우 소전자부에서 장요건 건절단술을 시행하였으나 증상이 지속되었으며, 관절부에서 한 차례 더 건절단술 시행 후 임상증상의 호전을 보였다. 결론: 고관절 전치환술 후 발생한 장요건 충돌에서 고관절 관절경을 이용한 장요건 건절단술은 양호한 임상 결과를 보였다.

근거중심의학에 근거한 퇴행성 슬관절염에 관한 침치료 임상선행연구 (A Pilot Study of Acupuncture Treatment for the Osteoarthritis of the Knee Joint on the EBM(Evidence Basement Medicine))

  • 임정아;이종덕;이상관;이성용;문형철;최선미;정영해;김성철
    • Journal of Acupuncture Research
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    • 제23권1호
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    • pp.187-215
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    • 2006
  • Objectives : To determine whether the pragmatic acupuncture treatment provides more effective pain relief than treatment using the same acupuncture point to the all patients. Methods : We randomly allocated participants to treatment group 1 and 2. The group 1 is the pragmatic treatment group and the group 2 is using the same acupuncture point to the all patients. Primary outcomes were measured by the Western Ontario and McMaster Universities Osteoarthritis index(WOMAC) pain and function scores at 4, 8, and 14 weeks. Secondary outcomes were measured by 100mm VAS(Visual Analog Scale), ROM(Range of Motion) using Goniometer, and pain threshold using pressure algometer. Results : When patients were extension of the knee, they were statistically significant in improvement of the ROM in 14 weeks. Whole body condition and pain rate through VAS measurement were improved significantly in 14 weeks. Also pain score and function score of WOMAC were improved significantly in 14 weeks. We could get difference in pain score of two acupuncture groups significantly in 14 weeks. But we could not get difference in whole score of two acupuncture groups significantly. Local temperature using T.C thermometer was changed significantly in 14 weeks. But we could not get difference in whole score of two acupuncture groups significantly. Excluding above item, DITI, pain threshold, and ROM of the knee flexion were no difference in before and after treatment.

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섬유강화형 복합레진브릿지의 파절강도 및 변연적합도에 관한 연구 (A COMPARATIVE STUDY ON THE FRACTURE STRENGTH AND MARGINAL FITNESS OF FIBER-REINFORCED COMPOSITE BRIDGE)

  • 최호근;신상완;임호남;서규원
    • 대한치과보철학회지
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    • 제39권5호
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    • pp.526-546
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    • 2001
  • Fiber-reinforced composite(FRC) was developed as a structural component for dental appliances such as prosthodontic framework. FRC provides the potential for fabrication of a metal-free, excellent esthetic prostheses. It has demonstrated success as a result of its simple fabrication, natural colour, and marginal integrity, and fracture resistance of veneering composite resin and the FRC material. Although it has lots of merits, clinical and objective data are insufficient. The purpose of this study was to evaluate the fracture strength and the marginal fitness of fiber reinforced composite bridge in the posterior region for clinical application. Sixteen bridges of each group. $Targis/Vectris^{(R)}$, $Sculpture-Fibrekor^{(R)}$, and In-Ceram, were fabricated. All specimens were cemented with Panavia 21 to the master dies. Strength evaluation was accomplished by a universal testing machine (Instron). The marginal fitness was measured by using the stereoscope (${\times}50$). The results were as follows. : 1. The fracture strength according to the materials was significantly decreased in order In-Ceram($238.81{\pm}82$), Targis Vectris($176.25{\pm}18.93$), Sculpture-Fibrekor($120.35{\pm}20.08$) bridges. 2. FRC resin bridges were not completely fractured, while In-Ceram bridges were completely fractured in the pontic joint. 3. The marginal accuracy was significantly decreased in order Targis/Vectris ($60.71{\mu}m$), Sculpture-Fibrekor($73.10{\mu}m$) In-ceram Bridge ($83.81{\mu}m$). 4. The fitness of occlusal sites had a lower value than the marginal sites(P<0.001), and the marginal gaps of inner site of the pontic were greater than that of outer sites of the pontic. Fiber reinforced composite bridges are new, esthetic prosthesis and can be clinically used in anterior regions and short span bridges. However, caution must be exercised when extrapolating laboratory data to the clinical situation because there are no long term clinical data regarding the overall success of the FRC.

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대구 팔공산의 가치와 활용방안 (The Value and Application of The Mt. Palgong in Daegu)

  • 전영권
    • 한국지형학회지
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    • 제19권2호
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    • pp.51-68
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    • 2012
  • 대구 팔공산의 문화 역사 생태적 가치를 파악하기 위해 문헌, 인터뷰, 현장답사를 진행하였고, 이를 토대로 팔공산 활용방안을 모색하여 다음과 같은 연구결과를 얻었다. 1) 팔공산의 자연지리적 범위는 협의의 범위(화강암산지로 구성된 팔공산괴), 광의의 범위( 팔공산괴에 접하는 접촉변성암지대까지 포함)로 구분된다. 문화적 범위는 대구(달성군 제외)와 경북의 경산시 영천시 군위군 칠곡군(동명면과 기성면)으로 생각해 볼 수 있다. 2) 남서사면이 북동사면에 비해 지질적 경계가 다소 분명하다. 팔공산에는 토르, 판상절리지형, 거터 등이 보편적으로 발달하며, 남서사면은 산지지형(암괴류, 다각형 균열바위 현상)이, 북동사면은 하천지형(하식애, 폭포, 포트홀, 소)이 상대적으로 우세하다. 3) 팔공산의 명품 관광단지 조성을 위해서는 팔공산에 산재하는 다양한 명품 이야기 거리를 발굴하는(스토리텔링) 것이 필요하다. 4) 팔공산의 체계적 관리를 위해 팔공산의 국립공원 지정이 요구되며, 나아가 팔공산 제천단의 복원과 갓바위의 세계문화유산 등재를 통한 팔공산 정체성 확보와 대구의 브랜드 가치제고를 위한 마스터플랜이 마련되어야 한다. 5) 팔공산의 개발방식은'느림'에 토대를 둔'슬로우 라이프 타운'형태가 바람직하며, '팔공산 박물관'조성을 통해 탐방객들에게 팔공산에 관한 모든 정보를 한 자리에서 통합적으로 제공해 줄 수 있는 즉, one stop service가 이루어질 수 있어야 한다.

슬관절 전치환술 후 지속 통증 및 기능 장애가 있는 환자에 대한 추나병행치료 임상연구 (Clinical Study of Chuna Combination Therapy for Patients with Persistent Pain and Dysfunction after Total Knee Arthroplasty)

  • 이웅진;이진현;박태용;박정식;송윤경
    • 한방재활의학과학회지
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    • 제32권2호
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    • pp.123-138
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    • 2022
  • Objectives This study was conducted to evaluate the clinical efficacy and safety of the chuna combination treatment for patients who complain of functional impairment and pain even 3 months after total knee arthroplasty. Methods 24 patients who had 3 months of surgery and who had knee joint pain with a score of 4 or higher on the numerical rating scale (NRS) for more than a week were selected as subjects. The test group received usual care and Chuna treatment and the control group received the administration of drugs as usual care. And then the clinical efficacy and safety were compared and evaluated. Follow-up was performed 1 month after the end of treatment. Results As a result of the analysis, it was confirmed that the primary parameter Korean Western Ontario and McMaster Universities (K-WOMAC) showed statistical significance in the amount of change in visit 2-visit 10 (V2-V10) in the pain domain and in the amount of change in visit 2-follow 1 (V2-FU1) in the functional domain and total score domain. The secondary parameter (NRS, risk of fall, and range of motion) showed a tendency to decrease in the degree of discomfort, but statistical significance could not be confirmed. Conclusions Because this study did not have enough study subjects, it is difficult to use the results as confirmatory evidence. However, it was confirmed that the 4-week Chuna treatment had a significant effect and safety in patients who underwent total knee arthroplasty. Therefore, this study is meaningful as a prior research data to prepare confirmatory evidence in the future.

유역관리계획수립(流域管理計劃樹立)에 관(關)한 기초적(基礎的) 연구(硏究) (Drainage Analysis for the Anyang-cheon Upper-watershed Management Planning)

  • 우보명
    • 한국산림과학회지
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    • 제42권1호
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    • pp.39-54
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    • 1979
  • 우리나라에서는 치산(治山) 치수(治水) 이수사업(利水事業)의 계획(計劃)과 시행(施行)에 있어서 정부(政府) 각(各) 부처간(部處間)에 유기성이 결여되어 있으므로 합리적(合理的)인 유역관리계획면(流域管理計劃面)에서 비효율성(非効率性)을 내포하고 있는 것이다. 본(本) 연구(硏究)에서는 안양천상류유역(安養川上流流域)(약 12,600ha) 내(內)의 배수밀도(排水密度)를 15개(個) 소유역단위(小流域單位)로 조사(調査) 분석(分析)하였는데, 이 연구결과(硏究結果)는 장래 유역관리계획수립(流域管理計劃樹立)에 주요한 기초자료(基礎資料)가 될 것이다. 1. 안양천상류유역(安養川上統流域)은 13개 준용하천(準用河川)(수암천(秀岩川), 삼성천(三聖川), 삼막천(三幕川), 학의천(鶴儀川), 내손천(內蓀川), 호계천(虎溪川), 당정천(堂井川), 산본천(山本川), 오전천(五全川), 왕곡천(旺谷川), 갈현천(葛峴川), 청계사천(淸溪寺川), 학현천(鶴峴川), 소하천(小河川)(세찬(細川), 소천(小川), 중천(中川)), 그리고 계곡으로 주배수조직(主排水組織)을 이루고 있다. 2. 조사유역내(調査流域內)의 하천대장상(河川臺帳上)의 총하천(總河川) 연장(延長)은 71.2km이며 새마을하천표상(河川表上)의 소하천(小河川)의 총연장(總延長)은 43,010m인데, 소하천(小河川)에 있어서는 약 43,410m나 누락(漏落)되었음이 조사(調査)되었다. 그리고 계곡(溪谷)(계류(溪流))는 모두 91개(個)로서 총연장(總延長)은 71,900m에 달(達)한다. 3. 소유역단위(小流域單位)의 배수밀도(排水密度)의 범위는 계곡연장(溪谷延長)을 총연장(總延長)에 포함할 경우에 14.79~24.10(m/ha)이며, 조사유역전체(調査流域全體)의 평균배수밀도(平均排水密度)는 18.21이었다. 그러나 계류(溪流)를 포함하지 않을 때에는 12.50으로 저하되었다. 4. 합리적(合理的)인 치산치수사업(治山治水事業)을 수행하기 위한 유역관리계획(流域管理計劃)을 수립(樹立)하기 위해서는 "하천(河川)", "소하천(小河川)", "야계(野溪)" 및 "계류(溪流)"를 포함하는 모든 배수조직(排水組織)에 대한 일관성 있는 유로분류기준(流路分類基準)이 확립(確立)되어야 할 것이다.

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STRAIN AND TEMPERATURE CHANGES DURING THE POLYMERIZATION OF AUTOPOLYMERIZING ACRYLIC RESINS

  • Ahn Hyung-Jun;Kim Chang-Whe;Kim Yung-Soo
    • 대한치과보철학회지
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    • 제39권6호
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    • pp.709-734
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    • 2001
  • The aims of this experiment were to investigate the strain and temperature changes simultaneously within autopolymerzing acrylic resin specimens. A computerized data acquisition system with an electrical resistance strain gauge and a thermocouple was used over time periods up to 180 minutes. The overall strain kinetics, the effects of stress relaxation and additional heat supply during the polymerization were evaluated. Stone mold replicas with an inner butt-joint rectangular cavity ($40.0{\times}25.0mm$, 5.0mm in depth) were duplicated from a brass master mold. A strain gauge (AE-11-S50N-120-EC, CAS Inc., Korea) and a thermocouple were installed within the cavity, which had been connected to a personal computer and a precision signal conditioning amplifier (DA1600 Dynamic Strain Amplifier, CAS Inc., Korea) so that real-time recordings of both polymerization-induced strain and temperature changes were performed. After each of fresh resin mixture was poured into the mold replica, data recording was done up to 180 minutes with three-second interval. Each of two poly(methyl methacrylate) products (Duralay, Vertex) and a vinyl ethyl methacrylate product (Snap) was examined repeatedly ten times. Additionally, removal procedures were done after 15, 30 and 60 minutes from the start of mixing to evaluate the effect of stress relaxation after deflasking. Six specimens for each of nine conditions were examined. After removal from the mold, the specimen continued bench-curing up to 180 minutes. Using a waterbath (Hanau Junior Curing Unit, Model No.76-0, Teledyne Hanau, New York, U.S.A.) with its temperature control maintained at $50^{\circ}C$, heat-soaking procedures with two different durations (15 and 45 minutes) were done to evaluate the effect of additional heat supply on the strain and temperature changes within the specimen during the polymerization. Five specimens for each of six conditions were examined. Within the parameters of this study the following results were drawn: 1. The mean shrinkage strains reached $-3095{\mu}{\epsilon},\;-1796{\mu}{\epsilon}$ and $-2959{\mu}{\epsilon}$ for Duralay, Snap and Vertex, respectively. The mean maximum temperature rise reached $56.7^{\circ}C,\;41.3^{\circ}C$ and $56.1^{\circ}C$ for Duralay, Snap, and Vertex, respectively. A vinyl ethyl methacrylate product (Snap) showed significantly less polymerization shrinkage strain (p<0.01) and significantly lower maximum temperature rise (p<0.01) than the other two poly(methyl methacrylate) products (Duralay, Vertex). 2. Mean maximum shrinkage rate for each resin was calculated to $-31.8{\mu}{\epsilon}/sec,\;-15.9{\mu}{\epsilon}/sec$ and $-31.8{\mu}{\epsilon}/sec$ for Duralay, Snap and Vertex, respectively. Snap showed significantly lower maximum shrinkage rate than Duralay and Vertex (p<0.01). 3. From the second experiment, some expansion was observed immediately after removal of specimen from the mold, and the amount of expansion increased as the removal time was delayed. For each removal time, Snap showed significantly less strain changes than the other two poly(methyl methacrylate) products (p<0.05). 4. During the external heat supply for the resins, higher maximum temperature rises were found. Meanwhile, the maximum shrinkage rates were not different from those of room temperature polymerizations. 5. From the third experiment, the external heat supply for the resins during polymerization could temporarily decrease or even reverse shrinkage strains of each material. But, shrinkage re-occurred in the linear nature after completion of heat supply. 6. Linear thermal expansion coefficients obtained from the end of heat supply continuing for an additional 5 minutes, showed that Snap exhibited significantly lower values than the other two poly(methyl methacrylate) products (p<0.01). Moreover, little difference was found between the mean linear thermal expansion coefficients obtained from two different heating durations (p>0.05).

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한방병동과 일반병동 간호사의 직무만족도의 비교연구 (Comparative Study on the Nurses' Job Satisfaction between the Oriental Medicine Ward and the General Ward)

  • 변창자;최상순;백승남;이미애
    • 간호행정학회지
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    • 제1권1호
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    • pp.97-111
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    • 1995
  • In our society today, a variety of medical caring system, along with a scientific development in the area of oriental medical science plus national demand, has increased the augmentation and the opening of oriental wards and hospitals (Han Bang), which has come to create an additional requirement of nursing activity at oriental medicine wards should be different from that of the general wards or the same as the other. In view of this, various studies need to be made in this connection. The purpose of this study is to comprehend the number of nurses who want to work at oriental medicine wards and measure job satisfaction in nursing as compared with those working at general wards so as to provide basic materials for future assignment and supplementary training for the nurses. An attempt was made to contribute toward nursing administration on the one hand improving nursing training course on the other hand. A total of 72 nurses currently working at two oriental medicine hospitals available in Seoul and 82 general nurses were selected for this study using the questionaire from December 1993 to January 1994. An instrument for the study was based on the measurement of work satisfaction developed by Paula L. Stamps including 37 questions complemented by Kim for revision (1993) and 14 questions regarding general characteristics and oriental medicine wards. The instrument to test dependability showed Cronbach's=0.7711. The collected data have been processed by computer package SPSS. General characteristics of the two groups and the matters involved in oriental medicine wards were calculated into real figure and percentage an similarities between the two groups were analyzed by t-test and F-test according to the characteristics of variables. The comparative test on work satisfaction among the two groups including general characteristics and work factors were conducted by t-test and F-test. The major findings as a result of the study are as follows : 1. As general characteristics, age group of $26{\sim}30$ years are more than any segment of age. As to marital status, the number of those in single status is slightly higher than the married. Approximately 80% of them are graduates of nursing schools and nursing colleges. They are mostly in service for one to three years. There is no significant difference between the two groups. 2. The number of those who want to work at oriental medicine wards represents 40.3% against 58.4%, being in favor of general wards. 3. The reason for service at oriental medicine wards is that "there is room for potential research" which happened to rank first, followed by "easy job," "good working atmosphere" and "growing interest in oriental medicine." 4. Work satisfactions among nurses who work at oriental medicine wards prove greater than that of nurses who work at general wards. 5. Work satisfaction between the two groups by work factors is reflected with significant difference statistically on task requirement, interaction and doctor-nurse relationships. 6. The general charcateristics and the work satisfaction by work factors prove that there are significant difference in age, marital status, education and the period of work. They tend to be more satisfied with the work as they grow in age. Significant differneces are found in the work factors such as autonomy, adiministration and professional job in the relationship with doctor-nurse. As to marital status, the married are more satisfied than the unmarried. There are significant differneces in the factors respecting administration and doctor-nurse college graduates are highly satisfied with task requirement. However, satisfaction with the professional level has proven the highest degree for those having master degree. The period of work and satisfaction : There are significant differneces in task requirement, administration, interactions, professional level and doctor-nurse relationships. As a general rule, the degree of satisfactions is in proportion to the lengrh of service. The following conclusions are drawn based on the fndings mentioned above. Even though the work satisfaction of the nurse who work at oriental medicine ward is relatively high, it is desired that personal consultation be given as to disposition of nurses when they are assigned to oriental medicine wards. It is also recommended that lectures on oriental medicine be conducted through supplementary training and/or basic nursing course in order that they may be motivated for ingenious activities with an increasing sense of self-esteem which will eventually enhance positive changes for the patients who are in need of oriental medicine nursing and for the medical teams. In addition, joint reseaches involvingclinical care and education should be in constant process for unique and scientific development for those who are subject to oriental medicine nursing care.

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국제프랜차이징 연구요소 및 연구방향 (Research Framework for International Franchising)

  • 김주영;임영균;심재덕
    • 마케팅과학연구
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    • 제18권4호
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    • pp.61-118
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    • 2008
  • 본 연구는 국내외 프랜차이즈의 해외진출에 대한 연구들을 바탕으로 국제프랜차이징연구의 전체적인 연구체계를 세워보고, 연구체계를 형성하고 있는 연구요인들을 확인하여 각 연구요소별로 이루어지는 연구주제와 내용을 살펴보고, 앞으로의 연구주제들을 제안하고자 한다. 주요한 연구요소들은 국제프랜차이징의 동기 및 환경 요소과 진출의사결정, 국제프랜차이징의 진입양식 및 발전전략, 국제프랜차이징의 운영전략 및 국제프랜차이징의 성과이다. 이외에도 국제프랜차이징 연구에 적용할 수 있는 대리인이론, 자원기반이론, 거래비용이론, 조직학습이론 및 해외진출이론들을 설명하였다. 또한 국제프랜차이징연구에서 보다 중점적으로 개발해야 할 질적, 양적 방법론을 소개하였으며, 마지막으로 국내연구의 동향을 정리하여 추후의 연구방향을 종합적으로 정리하였다.

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