• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.247-254
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• 2021

Objective : The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

• 한국산학기술학회논문지
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• 제22권1호
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• pp.24-30
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• 2021

본 연구에서는 자동차 밸브 바디 (valve body) 나사의 조립 상태를 검지하고 조립 작업을 보조하기 위한 증강현실 (AR) 앱을 개발하고 테스트를 통해 유효성을 보인다. 조립할 나사의 조립 위치와 순서 및 조립 상황들을 표시하는 컨텐츠들을 생성한 후 스마트 폰 화면의 밸브 바디 영상 위에 정합하여, 조립 도중에 작업자에게 보여준다. 이를 위해, 밸브 바디의 2차원 이미지로부터 특징 데이터를 추출하고 밸브 바디의 포즈를 알아낸다. 밸브 바디 위의 각 나사들이 조립될 영역의 영상을 추출하고 주기적으로 해당 영역의 휘도를 판별하며, 밸브 바디 위의 정해진 위치에 순서에 따라 각 나사들이 조립되고 있는 지를 확인한다. 미조립 또는 조립 순서 오류 등 조립 에러가 검지되면 경고 음이 발생되어, 작업자가 스마트 폰 화면에서 즉시 조립 상태를 확인하고 에러를 처리할 수 있다. 테스트를 통해 5개 나사의 조립 상태를 검지하는데 약 65ms가 걸리고 1시간 동안 오류 없이 조립 상태가 검지되는 것을 확인했다.

• 대한두개안면성형외과학회지
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• 제23권1호
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• pp.23-28
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• 2022

Background: Intermaxillary fixation (IMF) is a technique that allows for the reduction and stabilization of mandibular fractures. Several methods of IMF, such as self-tapping screws or arch bars, have been developed. This study aimed to validate the usefulness of IMF with a self-tapping screw compared to IMF with arch bars with focus on the patients' perspective. Methods: We retrospectively reviewed the medical records of all patients who were treated for mandibular fractures at our hospital between August 2014 and February 2021. A total of 57 patients were enrolled in this study. Thirteen patients were excluded from the analysis: three patients were lost to follow-up, and 10 patients did not undergo IMF. Finally, 44 patients were analyzed, of which 31 belonged to the arch bar group, and 13 belonged to the screw group. Patient discomfort and pain during IMF application and removal were analyzed using a patient self-assessment questionnaire. The surgeon also assessed oral hygiene, IMF stability, and occlusion. Results: We applied IMF to 34 men (77%) and 10 women (23%). The mean age of the patients was 37.3 years. The most common fracture site was the angle (30%), followed by the parasymphysis (25%), the body (23%), the condyle (11%), and the ramus (11%). Patient discomfort and oral hygiene were statistically favorable in the screw group. The IMF application time was statistically shorter in the screw group (p< 0.001). IMF stability was not statistically different between the two groups. The pain score during IMF removal was lower in the screw group (p< 0.001). Conclusion: Compared to arch bars, IMF screws provide more comfort during the IMF period, help maintain favorable oral hygiene, and have a shorter application time. From the patient's perspective, IMF screws are an excellent alternative to conventional arch bars when applicable.

• Archives of Plastic Surgery
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• 제49권3호
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• pp.413-417
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• 2022

The authors present a unique case of osteonecrosis of a cortical half of a fibula free flap that has not been reported in the literature yet. This complication was associated with the impairment of the vascularization of periosteum in the cortical half of fibula that was fixated with a nonlocking reconstructive 2.0-mm plate and screws but other factors could have been involved. The patient was submitted to excision of a cemento-ossifying fibroma that resulted in a left hemimaxilectomy mesoinfrastructure defect classified as the Cordeiro type 2B. The 42-year-old female patient was submitted to reconstruction with an osteomusculocutaneous fibula free flap plus a segment of fibula graft. The two bone segments of the free flap used to reconstruct the anterior and left alveolar crest were fixated with a reconstructive 2.0-mm plate of matrixMANDIBLE system. The only reported complication was an oronasal fistula that healed with conservative treatment and the referred osteonecrosis of the external cortical half of the fibula free flap with plate exposure at 2.5 years postoperatively. Surgical excision of the osteonecrosed cortical half of the fibula with the plate and screws was performed, while the other cortical underwent bone union as corroborated by computed tomography scans.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.34-42
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• 2022

Purpose: Percutaneous iliosacral (IS) screw fixation for pelvic ring injuries is a minimally invasive technique that reduces the amount of blood loss and shortens the procedure time. Moreover, two unilateral IS S1 screws exhibit superior stability to a single IS screw and are also safer for neurological injuries than an S2 screw. Therefore, this study aimed to evaluate fixation using percutaneous two unilateral IS S1 screws for pelvic ring injuries and its subsequent clinical outcomes. Methods: We retrospectively reviewed 38 patients who underwent percutaneous two unilateral IS S1 screw fixation for pelvic ring injuries. The procedure time, blood loss, achievement of bone union, radiological outcomes (Matta and Tornetta grade), and postoperative complications were evaluated. Results: The mean procedure time, hemoglobin loss, bone union rate, and time to union were 40.1 minutes (range, 18-102 minutes), 0.6 g/dL (range, 0.3-1.0 g/dL), 100%, and 153.2 days (range, 61-327 days), respectively. The Matta and Tornetta grades were excellent, good, and fair in 24 (63.1%), 11 (28.9%), and three patients (7.9%), respectively, and the postoperative complications were S1 screw loosening, widening of the symphysis pubis (2.3 and 2.5 mm), lumbosacral plexopathy, and S1 radiculopathy in one (2.6%), two (5.3%), one (2.6%), and one patient (2.6%), respectively. However, all neurological complications recovered spontaneously. Conclusions: Percutaneous two unilateral IS S1 screw fixation was useful for treating pelvic ring injuries. In particular, it involved a short procedure time with little blood loss and also led to 100% bone union and good radiological outcomes.

• 대한치과보철학회지
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• 제41권4호
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• pp.503-518
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• 2003

Statement of problem : There have been previous studies about considerable variations in machining accuracy and consistency in the implant-abutment-screw interfaces. Purpose : The purpose of this study was to evaluate the machining accuracy and consistency of implant/abutment/screw combinations on two randomly selected implants from each of four manufactures. Material and methods : In this study, screws were respectively used to secure a cemented abutment, to a hexlock implant fixture ; teflon coated titanium alloy screw(Torq-Tite) and titanium alloy screw in Steri--Oss system, gold-plated gold-palladium alloy screw(Gold-Tite) and titanium alloy screw in 3i system gild screw ana titanium screw in AVANA Dental Implant system, and titanium screws in Paragon System. The implants were perpendicularly mounted in polymethyl methacrylate autopolymerizing acrylic resin block(Orthodontic resin, Densply International Inc. USA) by use of dental surveyer. Each abutment screw was secured to the implant with recommended torque value using a digital torque controller. Each screw was again tightened after 10 minutes. All samples were cross sectioned with grinder-polisher unit(Omnilap 2000 SBT Inc) after embeded in liquid unsaturated polyester (Epovia, Cray Valley Inc) Results : There were the largest gaps in the neck areas of screws in hexagonal extension implants which were examined in this study. The leading edge of the abutment screw thread (superior surface) was in contact with the implant body thread, and the majority of the contacting surfaces were localized to the middle portion of the mating threads. Considerable variation in the contacting surfaces was noted in the samples evaluated. Amounts of contact in the abutment screw thread were larger for assemblies with Gold-Tite screw, gold alloy screw. Torq-Tite screw than those with titanium screws. The findings of intimate contact between the screw and screw seat were seen in all samples, regardless of manufacturers. However, microgap between the head and lateral neck surface of the screw and the abutment could be dectected in all samples. The findings of intimate contact between the platform of the implant and the bottom of the abutment were consistent in all samples, regardless of manufacturers. However, microgaps between the lateral surface of external hex of the fixture and the abutment could be dectected in all samples. Conclusion : Considerable variations in machining accuracy and consistency were noted in the samples and the implant-abutment-screw interfaces were incomplete. From the results of this study, further development of the system will be required, including improvements in pattern design.

• 한국임상수의학회지
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• 제25권2호
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• pp.131-135
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• 2008

5연령의 치와와 견이 사지 부전마비를 평가하기 위해서 내원하였다. 내원 시에 보행이 불가능한 사지 부전마비와 목 부위 통증을 보였다. 방사선 상에서 환축추 아탈구와 C1 등쪽의 추궁과 C2의 가시돌기의 거리가 증가 된 소견을 보였다. 외과적 고정은 투시기 유도 하에서 복측 접근을 통하여 2개의 나사(screw)를 사용하여 실시하였으며, 외부 고정(neck brace)을 3주 동안 실시하였다. 수술 후 4주 후 임상증상이 개선되어 보행이 가능 하였으며, 방사선 상에서 고정을 유지하고 있었으며, 나사의 이주 소견은 없었다. 4개월 후에 임상증상이 완전히 회복되었다. 본 증례에서는 복측 나사 고정을 투시기 유도하에서 실시함으로, 나사의 적합한 각도로 위치 시킬 수 있었다.

• 대한의용생체공학회:의공학회지
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• 제36권6호
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• pp.276-282
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• 2015

Recently, during the multi-level fusion with pedicle screws, interspinous spacer are sometimes substituted for the most superior level of the fusion in an attempt to reduce the number of fusion level and likelihood of degeneration process at the adjacent level. In this study, a finite element (FE) study was performed to assess biomechanical efficacies of the interspinous spacer combined with posterior lumbar fusion with a previously-validated 3-dimensional FE model of the intact lumbar spine (L1-S1). The post-operative models were made by modifying the intact model to simulate the implantation of interspinous spacer and pedicle screws at the L3-4 and L4-5. Four different configurations of the post-op model were considered: (1) a normal spinal model; (2) Type 1, one-level fusion using posterior pedicle screws at the L4-5; (3) Type 2, two-level (L3-5) fusion; (4) Type 3, Type 1 plus Coflex$^{TM}$ at the L3-4. hybrid protocol (intact: 10 Nm) with a compressive follower load of 400N were used to flex, extend, axially rotate and laterally bend the FE model. As compared to the intact model, Type 2 showed the greatest increase in Range of motion (ROM) at the adjacent level (L2-3), followed Type 3, and Type 1 depending on the loading type. At L3-4, ROM of Type 2 was reduced by 34~56% regardless of loading mode, as compared to decrease of 55% in Type 3 only in extension. In case of normal bone strength model (Type 3_Normal), PVMS at the process and the pedicle remained less than 20% of their yield strengths regardless of loading, except in extension (about 35%). However, for the osteoporotic model (Type 3_Osteoporotic), it reached up to 56% in extension indicating increased susceptibility to fracture. This study suggested that substitution of the superior level fusion with the interspinous spacer in multi-level fusion may be able to offer similar biomechanical outcome and stability while reducing likelihood of adjacent level degeneration.

• 대한치과보철학회지
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• 제44권2호
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• pp.229-242
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• 2006

Statement of problem: In order to increase preload with reducing the friction coefficient, abutment screws coated with pure gold and Teflon as dry lubricant coatings have been introduced. But the reported data indicate that if screw repeated tightening and loosening cycle, an efficiency of increasing preload was decreased by screw surface wearing off. Purpose: This study was to evaluate the influence of tungsten carbide/carbon coating, which has superior hardness and frictional wear resistance, on the preload of abutment screws and the stability of coating surface after repeated closures. Material and method: The rotational values of abutment screws and the compressive forces between abutment and fixture were measured in implant systems with three different joint connections, one external butt joint and two internal cones. Moreover the stability and the alteration of coating surface were examined by comparison of the compressive force and the removable torque values during 10 consecutive trials, observation with scanning electron microscope and analyzed the elemental composition with energy dispersive x-ray spectroscopy Results and conclusion: 1. Application of coating resulted in significant increase of compressive force in all implant systems(P<.05). The increasing rate of compressive force by coating in external butt joint was gloater than those in internal cones (P<.05). 2. Coated screw showed the significant additional rotation compared to non-coated screw in all implant systems (P<.05). There were no significant differences in the increasing rate of rotation among implant systems (P>.05). 3. Removable torque values were greater with non-coated screw than that with coated screw (P<.05). 4. Coated screw showed insignificant variations in the compressive forces during 10 consecutive trials(P>.05) 5. After repeated trials, the surface layer of coated screw was maintained relatively well. However surface wearing and irregular titanium fragments were found in non-coated screw.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.60-72
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• 2024

Objective : Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. Methods : This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. Results : The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. Conclusion : In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.