• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.277-281
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• 2018

Objective : Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. Methods : A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation.The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. Results : In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound.When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system.Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. Conclusion : We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

• International Journal of Quality Innovation
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• 제9권1호
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• pp.22-40
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• 2008

Unnatural working postures usually cause musculoskeletal problems for workers in work field, especially in traditional industry. Many analysis and survey methodologies have been developed to identify unnatural postures and disorder risks in workplaces. The Ovako Working Posture Analyzing System (OWAS) and Nordic Musculoskeletal Questionnaire (NMQ) are the representative methods and applied widely. This study applied the both tools to investigate the work field of a manufacturing factory of the water heater's case. We divided the manufacturing process into nine workshops, took the pictures of working motions by DV camera and analyzed the postures on OWAS. From the OW AS results, we could identify the risks level of musculoskeletal symptoms as four Action Categories (AC). And from the comparison of OWAS and NMQ results, we could provide the suggestions to improve the working methods and environment. From the results of OWAS, we found that the operators' head/neck and back were above AC3 in some workshops. If the situation continued in long period, the operators might have the risk to get musculoskeletal symptoms. From the investigation of NMQ, we also found that the percentage of aches on neck, shoulders and lower back were higher than other parts of body. The correlation between aches and jobs was more than 75%. So we provided some suggestions to improve: work rotation and adjustment of work surface/height to fit in with Ergonomics. Then the risks of musculoskeletal symptoms would be reduced.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권1호
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• pp.83-91
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• 2008

The goal of reconstruction following ablative therapy for intraoral cancer is the restoration of form and function to permit a return to activities of daily life. Traditional reconstruction includes split thickness skin grafts, myocutaneous flaps and, more recently, various free flaps. Free flaps provide higher level of functional recovery relative to that seen with other techniques but require the complexity of the technique and microvascular anastomosis and thus, extended surgical time and occasionally a second team for harvesting. The platysma myocutaneous cervical flap is a possible alternative for intraoral reconstruction. It is thin and pliable like the tissue provided by the radial forearm free flap. It can be harvested with enough tissue to close most head and neck ablative defects. There is virtually no donor site morbidity involved. This study evaluated 7 patients affected by intraoral squamous cell carcinoma (SCC). All patients underwent the resection of intraoral SCC with neck dissection and subsequent intraoral reconstruction with the superiorly based platysma myocutaneous cervical flap. Flap-related complications occurred in 3 patients. Adjuvant radiation therapy was performed in 3 patients. Average follow-up was 24.1 months after surgery, with a range of 8 to 42 months. All patients presented self assessment of discomfort associated with intraoral recipient sites and cervical donor sites. However, the neck function measured by two-inclinometer technique was within the normal range during relatively long term follow-up period. Our study concluded that superiorly based platysma myocutaneous cervical flap is good alternative to free flaps, especially for relatively smaller defects and for the defects appropriate for the rotation arc of the flap.

• 대한두개안면성형외과학회지
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• 제14권2호
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• pp.107-110
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• 2013

Background: Basal cell carcinoma (BCC) is the most common skin cancer. About 74% cases of basal cell cancer occur on the head and neck. Basal cell carcinoma on the face may have a higher degree of subclinical spread than tumors arising elsewhere. And incompletely excised BCCs become more aggressive when they recur. So the surgical removal and reconstruction of BCC located on the face are important to make perfect curing and cosmetic results. Methods: A retrospective study was done with 128 patients (137 cancers) who were treated with BCC on the face since 1987 to 2011. General data of these cases such as the primary site of cancer, age and sex of the patients, operative methods, and recurrence rate were reviewed. Results: The ratio of men to women was 1:1.4. And 86.9% of the patients with BCC were older than the age of 50 years with the mean age of 65.8 years. The distribution of facial basal cell carcinoma was on the nose, eyelids, cheek, and nasolabial fold. Surgical methods for treatment were local flap, full thickness skin graft, primary closure, and split thickness skin graft. Specifically, local flap consists of V-Y advancement flap, cheek advancement flap, limberg flap, forehead flap, nasolabial flap, rotation flap, transposition flap, bilobed flap, and island flap. Six cases recurred and all of them were treated with reoperation. Conclusion: The authors reviewed facial basal cell carcinoma cases in our hospital. This study might be helpful to choose appropriate operation method to manage BCC on face in Korea.

• 대한물리치료과학회지
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• 제3권3호
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• pp.65-70
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• 1996

Torticollis is a deformity of the neck that shows tilting of the head toward the affected side and rotation of the chin toward the opposite side. In many cases with this condition, unilateral tightness of the sternocleidomastoid muscle is found frequently with fibrous tumor. The analysis of 43 cases of congenital muscular torticollis and result of their physical therapy are reported. The research was from Jan. 1, 1990 to Dec. 31, 1995 at Ulsan Dong Kang Hospital. The results obtained were as follows. 1. There were 30 males(69.8%) and 13 females(30.2%). Age distribution of patients showed below 2 month 20 cases(46.5%), above 1 year 7 cases(16.3%), $5{\sim}6/11{\sim}12$ months 4 cases(9.3%), and $7{\sim}8$ month 2 cases(4.6%). 2. 25 cases(58.1 %) were on the right and 18 cases(41.9%) on the left side. Torticollis was mild to moderately severe in mild 22 cases(51.1 %), moderate 18 cases (41.9 %) and severe 3 cases(7%). 3. There were normal spontaneous delivery in 36 cases(83.7%), Cesaean section in 4 cases (9.3%) and breech presentation in 3 cases(7%). Sequence of birth, the 1st born babys were 30 cases(69.8%) and the 2nd born babys were 13 cases(30.2%). 4. Above fair result of physiotherapy were 36 cases(83.7%). 5. Of the 43 cases with fellow up, above fair 32 cases(74.4%) and poor 11 cases(25.6%) showed. As conclusion, passive stretch exercise of sternocleidomastoid muscle with early torticollis diagnosis seems more successful in recovery than no exercise.

• International Journal of Control, Automation, and Systems
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• 제4권3호
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• pp.325-332
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• 2006

The dynamic responses of human standing postural control were investigated when subjects were exposed to long-term horizontal vibration. It was hypothesized that the motion of standing posture complexity mainly occurs in the mid-sagittal plane. The motor-driven support platform was designed as a source of vibration. The AC Servo-controlled motors produced anterior/posterior (AP) motion. The platform acceleration and the trunk angular velocity were used as the input and the output of the system, respectively. A method was proposed to identify the complexity of the standing posture dynamics. That is, during AP platform motion, the subject's knee, hip and neck were tightly constrained by fixing assembly, so the lower extremity, trunk and head of the subject's body were individually immovable. Through this method, it was assumed that the ankle joint rotation mainly contributed to maintaining their body balance. Four subjects took part in this study. During the experiment, the random vibration was generated at a magnitude of $0.44m/s^2$, and the duration of each trial was 40 seconds. Measured data were estimated by the coherence function and the frequency response function for analyzing the dynamic behavior of standing control over a frequency range from 0.2 to 3 Hz. Significant coherence values were found above 0.5 Hz. The estimation of frequency response function revealed the dominant resonance frequencies between 0.60 Hz and 0.68 Hz. On the basis of our results illustrated here, the linear model of standing postural control was further concluded.

• 대한정형도수물리치료학회지
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• 제2권1호
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• pp.51-56
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• 1996

Torticollis is a deformity of the neck that shows tilting of the head toward the affected side and rotation of the chin toward the opposite side. In many cases with this condition, unilateral tightness of the sternocleidomastoid muscle is found frequently with fibrous tumor. The analysis of 43 cases of congenital muscular torticollis and result of their physical therapy are reported. The research was from Jan. 1, 1990 to Dec. 31, 1995 at Ulsan Dong Kang Hospital. The results obtained were as follows. 1. There were 30 males(69.8%) and 13 females(30.2%). Age distribution of patients showed below 2 month 20 cases(46.5%), above 1 year 7 cases(16.3%), 5~6/11~12 months 4 cases(9.3%), and 7~8 month 2 cases(4.6%). 2. 25 cases(58.1%) were on the right and 18 cases(41.9%) on the left side. Torticollis was mild to moderately severe in mild 22 cases(51.1%), moderate 18 cases (41.9%) and severe 3 cases(7%). 3. There were normal spontaneous delivery in 36 cases(83.7%), Cesaean section in 4 cases(9.3%) and breech presentation in 3 cases(7%). Sequence of birth, the 1st born babys were 30 cases(69.8%) and the 2nd born babys were 13 cases(30.2%). 4. Above fair result of physiotherapy were 36 cases(83.7%). 5. Of the 43 cases with fellow up, above fair 32 cases(74,4%) and poor 11 cases(25.6%) showed. As conclusion, passive stretch exercise of sternocleidomastoid muscle with early torticollis diagnosis seems more successful in recovery than no exercise.

• 대한방사선치료학회지
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• 제21권2호
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• pp.83-88
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• 2009

목 적: 온 보드영상(OBI)장치를 이용한 콘빔CT는 환자 치료 중 실시간으로 전산화모의치료 영상과 비교하여 환자의 자세 및 표적용적의 움직임과 셋업오차를 확인 할 수 있다. IMRT 시 콘빔CT를 이용해 환자의 자세 및 표적용적의 변화와 움직임을 확인하여 치료계획과의 오차정도를 산출하고, Automatic Match System을 이용하여 위치 보정을 한 후 전자포털영상 장치를 통하여 위치보정의 정확성을 검증하고, IMRT에서 콘빔CT의 유용성과 Automatic Match System의 정확성에 대하여 알아보고 자 한다. 대상 및 방법: 본원에서 치료받은 IMRT 환자 중 두 경부 치료환자 3명, 골반부 치료환자 1명을 대상으로 치료 자세의 변동과 그에 따른 조사용적의 위치변동을 알아보기 위해 선형가속기에 장착된 온 보드 영상 장치를 이용해 콘빔 CT를 촬영하였다. IMRT 전 매 치료 시 마다 콘빔CT를 촬영하여 전산화단층모의치료 영상과 비교하여 좌표별로 치료계획과의 오차값을 확인하고 3D/3D Match의 Automatic Match System을 통하여 치료계획과 일치하도록 이동 보정한 후 전자포털영상 장치를 이용하여 검증, 평가하였다. 결 과: 치료 전 콘빔 CT와 전산화단층모의치료 영상 비교 시 두 경부에서 좌표별 평균오차는 Vertical 0.99 mm, Longitudinal 1.14 mm, Lateral 0.84 mm, Rotation $0.49^o$이고, 골반부의 평균오차는 Vertical 2.78 mm, Longitudinal 2.04 mm, Lateral 4.91 mm, Rotation $1.07^o$로 부위별로 다소 근소한 차이를 보였다. 보정 후 검증에서는 전자포털영상 장치에 의한 영상과 DRR 영상 비교 결과 0.5 mm 이내의 오차로 정확한 보정이 이루어졌음을 알 수 있었다. 결 론: 치료 전 콘빔CT 영상은 환자의 셋업오차와 장기 및 표적의 위치변화를 2차원적 영상의 비교와 달리 하나의 체적으로 재구성된 3차원적 영상으로 비교함으로써 보다 정확하게 위치변화와 표적용적의 변동 등을 측정, 보정하여 정확한 치료를 할 수 있으며, 그 오차 값을 산출하여 비교할 수 있다. 이상의 연구로 보아 콘빔CT는 치료계획과 일치하는 정확한 치료전달과 반복적인 치료재현성에 유용하였으며, 만족스러운 결과를 얻을 수 있었다. 콘빔CT에 의해 향상된 정확도는 복잡한 모양의 표적용적과 급격한 선량분포의 변화가 나타나는 IMRT에서 더욱 필요하며 각 치료 부위별, 치료 목적별로 Match focus에 대한 기준을 연구해야 될 것으로 사료된다.

• 한국의학물리학회지:의학물리
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• 제14권3호
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• pp.189-195
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• 2003

방사선 치료시 치료계획과 실제 치료가 정확히 일치하고 있는 지를 확인하기 위해 수행하는 모의치료 영상과 포탈 영상과의 비교, 분석은 방사선 치료의 정확도를 보장하기 위한 중요한 과정이다. 본 연구에서는 이와 같은 모의치료 영상과 포탈 영상의 비교 및 오차의 정량적 분석을 위해 영상정합 방법의 하나인 챔퍼 매칭 알고리즘을 적용한 분석 프로그램을 개발하여 그 정확성과 타당성을 분석하였다. 가상의 포탈 영상을 사용하여 분석 알고리즘의 정확도를 분석한 결과, 이동에서 평균 0.64 mm, 회전에서 평균 0.32 $^{\circ}$, 스케일에서 평균 1.61% 이내의 오차를 보여 그 정확성을 입증하였고, 인체 모사 팬텀을 대상으로 한 실제 포탈 영상에서도 이동에서 평균 1.55 mm, 회전에서 평균 0.80 $^{\circ}$, 스케일에서 1.72% 이내의 오차를 보여, 본 연구에서 개발한 분석 프로그램의 타당성을 검증하였다. 본 연구를 통해 모의치료 영상과 포탈 영상의 비교, 분석에 있어 챔퍼 매칭 알고리즘을 적용할 수 있음을 확인하였으며, 개발한 분석 프로그램은 필름을 기반으로 한 모의치료 영상과 포탈 영상의 비교와 오차의 정량적 분석에 효율적으로 사용 될 수 있을 것으로 사료된다.

• 대한치과교정학회지
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• 제23권4호
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• pp.455-474
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• 1993

Degenerative joint disease(DJD) has hun known as one of the diseases which affect the middleor old-aged people. But as orthodontists are getting interested in the adult orthodontics, it is not rare for them to meet the open-bite patients with the TMJ DJD in their clinics. The purpose of this article is to investigate the cephalometric characteristics of the open-bite cases with TMJ DJD. Twelve TMJ DJD patients($15.1\~39.5$ years old) were selected from the patients who visited Department of Orthodontics, Seoul National University Hospital. Cephalograms were taken and means from 60 measurements were compared by t-test with those of the fifty four healthy adults($20.0\~26.7$ years old) who have normal occlusion and TMJ. In this study male and female are compared respectively, for in the normal samples 26 measurements showed significant differences between the male and the female. The results and conclusions axe as follows: 1 In DJD group, ANB and Angle of convexity decreased, which means the retruding of the mandible. The interincisal angle was smaller than that of the normal group. The means of the overbite were -2.1mm in male and -3.0mm in female, and the means of the overjet were 5.6mm in male and 6.7mm in female. The profile was similar to that of Angle's Class II div.1 open-bite. 2. SN-GoMe and FMA increased in DJD but SN-PP and FH-PP did not show any significant difference. In TMJ DJD open-bite cases, the bony structure lower than the palatal plane seemed to play an important role in developing open-bite. 3. In DJD group, PH-ArGo, SArGo and Y-sxis angle increased significantly, but genial angle showed no significant difference. The means of hか were 50.1mm in male and 40.2mm in female, which were significantly smaller than those of the normal(56.5mm in male, 50.9mm in female). These findings seemed to indicate the posterior rotation of mandible resulted from the shortening of the ramus height. 4. Anterior faical height(AFH), upper anterior facial height(UAFH) and lower anterior facial height (LAEH) of DJD showed no significant increase as compared with those of the noraml group. There was no significant difference in the ratio of upper anterior facial height to lower anterior facial height(UAFH/LAFH). But, lower posterior facial height(LPFH) was significantly smaller than that of the normal group. 5. It was thought that the peculiar profile of the TMJ DJD open-bite was resulted from the posterior rotation of mandible as the ramus became short following the degerative destruction of of the condylar head and neck.