• 한국정보전자통신기술학회논문지
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• 제13권3호
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• pp.219-225
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• 2020

인구고령화에 따라 노인의 근골격계질환의 유병률이 계속해서 증가하고 있다. 또한 근골격계질환은 2015년 기준으로 산재보험 보상급여에서 업무상질병 중 상위 세 번째로 사회 및 경제적 손실을 초래한 질환으로서 근로자들에게도 많이 발생하는 질병이다. 본 연구에서는 허리의 근골격계질환의 예방과 치료에 보조할 수 있는 조끼를 제작하여 실험을 통해 그 효과의 유무를 확인하고자 한다. 허리부분의 질환은 코어근육과 밀접한 연관이 있다. 따라서 제작한 조끼는 코어근육을 지지해 주는 형태로 제작하였다. 효과 검증을 위해 조끼의 착용 전과 후에 허리 신전 운동인 멕켄지 운동을 10회 실시하면서 코어근육에 해당되는 배속빗근(내복사근, Internal oblique), 배곧은근(복직근, Rectus abdominis), 척추세움근(척추기립근, Erector spinae)의 근전도 데이터를 수집하고 수집한 데이터를 근전도 분석 프로그램인RM-3를 통해 분석하여 각 근육의 10회 측정 시 RMS값을 구하고 그 평균값을 비교하는 실험을 진행했다. 데이터비교 이후 유의성 검증을 위해 PASW ver18.0을 통해 측정결과의 기술통계치 산출과 평균차를 검증하고, 실험 결과치에 대응표본 T검정을 시행하여 통계 처리를 했다. 통계분석의 유의 수준은 α=.05로 설정하고 통계처리를 진행하였다.

• Journal of Chest Surgery
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• 제34권11호
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• pp.848-853
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• 2001

배경 및 목적: 정중 흉골 절개 후 발생한 흉골 감염과 열개(dehiscence)는 드물지만 적절한 치료를 하지 않을 경우 그 사망률은 높다. 본 교실은 개심술 후 발생한 12예의 흉골 감염 및 열개 환자에서 광범위한 괴사조직 제거와 근육편 이식술로 치료하고 그 수술 결과를 보호하고 효과적인 치료 방법을 찾고자 하였다. 대상 및 방법: 개심술 후 흉골 감염과 열개가 발생한 13예 중 흉골감염의 치료 전에 뇌경색으로 사망했던 1예를 제외하고 12예를 치료대상으로 하였다. 6예가 판막치환술 환자였고, 다른 6예가 관상동맥우회로술 환자였다. 1991년 이후에 수술한 7예에서는 짧은 기간의 배액(배농)과 세척으로 발열이 없어지면 바로 수술하였다. 감염 및 괴사된 연부조직 및 뼈를 절제하고 흉골의 사장을 우측 대흉근편 (회전편), 좌측 대흉근편 (회전편 또는 전진편), 우복직근을 단독 또는 복합으로 보강하였다. 결과: 12예의 흉골 감염 및 별개의 수술 치료 후 사망은 없었다 흉골 감염 및 열개가 발견된 후 평균 6.6$\pm$3.9일에 근육편의 이식수술을 하였다. 4예에서 우측 대흉근편을, 8예에서 양측 대흉근편을 사용하였으며, 각각 1예와 2예에서는 우복직근도 사용하였다. 1예에서 좌측 대흉근의 전진편이 괴사되고 흉벽농양이 발생하여 우복직근을 이용하여 재수술하였다. 근래에 수술한 3예에서는 우측 대흉근의 전진편만을 넓게 펴서 흉골사강을 보강하여 한 근육 편으로 흉골열개를 치료하였으며 3주 이상 개방성 배액관의 거치가 필요했다. 결론: 개심술 후 합병된 흉골절개부위의 열개 및 감염에서 짧은 기간의 세척 후 조기 수술에 의한 괴사조직의 제거와 주위 근육편 이식으로 쉽게 치료할 수 있으며, 우측의 대흉근만으로도 흉골 열개의 수술치료가 가능하다고 생각된다.

• 대한임상전기생리학회지
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• 제7권1호
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• pp.43-48
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• 2009

Purpose : The purpose of this study was to study the effect of rectus abdominal muscle contraction by proprioceptive neuromuscular facilitation trunk stabilization training using extremity simultaneous pattern (PNF trunk stabilization training) and traditional trunk stabilization training methods. Methods : A group of 24 adults male and female, healthy, with no previous medical history nor disability in neuromuscular system and musculoskeletal system was chosen as subjects, and was divided into a control group, a PNF trunk stabilization training group and a traditional trunk stabilization training group. Experiments were performed on the last two groups, 3 times a week for 6 weeks, totaling 18 times. Using a dynamometer, muscle strength and endurance time on trunk flexion were measured before and after each experiment, and surface electromyography in left and right rectus abdominis were measured. Results : following results were obtained; 1. As for the change in the maximal voluntary isometric contraction (MVIC), all subjects in the trunk stabilization training group showed significant difference from those in the control group. 2. As for surface electromyography measurement and the changes in root mean square at the time of trunk flexion, in the left rectus abdominis, PNF trunk stabilization training group showed significant difference from the control group, while in the right rectus abdominis, traditional trunk stabilization training group showed significant difference. Conclusion : To sum up the results, both trunk stabilization training groups showed improvement in the MVIC of abdominal muscle, motor unit action potential activity, but the difference between two trunk stabilization training groups was not significant. Therefore, while trunk stabilization training significantly improved abdominal muscle contraction, but the difference attributable to training methods was found to be insignificant.

• Archives of Reconstructive Microsurgery
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• 제15권2호
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Archives of Plastic Surgery
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• 제32권2호
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• pp.183-188
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• 2005

Defect on the temporal area caused by, surgical ablation of a tumor or an infection should be reconstructed immediately to prevent potentially life-threatening complications such as meningitis and cerebrospinal fluid leakage. The defect on the temporal area usually presents as a typical 'cone-shape'. Successful reconstruction requires sufficient volume of well-vascularized soft tissue to cover the exposed bone and dura. From 1994 through 2003, the authors applied rectus abdominis free flap for the reconstruction of the temporal defect from 1994 through 2003. There were 10 patients with a mean age of 52.1 years. Of these 10 patients, external auditory canal cancer was present in four patients, temporal bone cancer in two, parotid gland cancer in one and three patients were reconstructed after debridement of infection(destructive chronic otitis media). All the free flaps survived, and flap-related complications did not occur. Compared to a local flap, the rectus abdominis free flap can provide sufficient volume of well-vascularized tissue to cover the large defect and can be well-tolerated during an adjuvant radiation therapy. The long and flat muscle can be easily molded to fit in to the 'cone-shape' temporal defect without dead space. It is also preferred because of the low donor site morbidity, a large skin island and an excellent vascular pedicle. Two-team approach without position change is possible. In conclusion, the authors think that rectus abdominis free flap should be considered as one of the most useful method for the reconstruction of a cone-shaped temporal defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권5호
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• pp.367-375
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• 2012

Midfacial reconstruction following resection of extensive malignant oral cavity tumors constitutes a challenging problems for reconstructive surgeons. Rectus abdominis muscle free flap (RAMFF) can be considered as the optimal reconstructive option in this case, because this flap has some advantages including consistent deep inferior epigastric artery anatomy, easy to dissect with well defined skin boundaries, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with oral cancer ablation surgery. The rectus abdominis muscle forms an important part of the anterior abdominal wall and flexes the vertebral column, which is a long strap-like muscle divided transversely by three tendinous intersections, fibrous bands which are adherent to the anterior rectus sheath, which is thickly enclosed by the rectus sheath, except for the posterior part below the arcuate line that is usually located midway between the umbilicus and symphysis pubis. Below the arcuate line, this muscle lies in direct contact with the transversalis fascia and parietal peritoneum. For the better understanding of RAMFF as a routine reconstructive procedure in oral and maxillofacial surgery, the constant anatomical findings muse be learned and memorized by the young doctors in the course of the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article will discuss the anatomical basis of RAMFF with Korean language.

• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.29-36
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• 2010

The purpose of this study was to present the clinical significance of rectus abdominis free muscle flap for large sized diabetic ulcer and necrosis of the foot to salvage limb. From June 2000 to February 2006, eleven patients were included in our study. There were seven males and four females with a mean age of 58.3 years (48~65) at the surgery. All had a history of diabetics and subsequent huge soft tissue defect caused by necrotizing abscess formation around the foot and the ankle. After complete debridement of large sized, infected necrotic tissue, susceptible intravenous antibiotics and wound care were done. After control of infection, confirmed by clinical and laboratory findings, the rectus abdominis free muscle flap was applied to cover remained large soft tissue defect and to prevent the recurrence of infection. All flaps survived and it provided satisfactory coverage for the soft tissue defect on the foot and the ankle area for a mean of 41.1 months (24~85) follow up period. All except of one patients did not have any recurrence of infection on the operation site and could salvage their limbs. The rectus abdominis free muscle flap could be recommended for large sized soft tissue defect after necrotizing abscess in diabetic foot to salvage major limb.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.510-513
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• 2006

Purpose: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. Methods: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. Results: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. Conclusion: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.

• Archives of Reconstructive Microsurgery
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• 제3권1호
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• pp.90-96
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• 1994

1. 교통사고 등으로 인한 외상성 골노출이 8례로 가장 많았으며, 원인으로서는 교통사고가 7례이었고 1례는 기계사고 이었으며, 부위 별로는 하지 경골이 7례, 종골이 1례이었다. 2. 2례의 만성 골수염에서는 유리조직 이식술과 함께 골소파술 및 정주 항생제 요법을 병행하였다. 3. 총 10례중 9례에서 완전 생존하여 90%의 성공률을 보였다. 4. 공여부위에 대한 합병증은 소량의 혈종을 형성한 1례에서 2차 탐구술과 흡인술을 시행하였으며 합병증없이 치유되었다.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.555-558
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• 2009

Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.