• 한국병원경영학회지
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• 제29권3호
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• pp.1-10
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• 2024

Purposes: When rehabilitation services are provided remotely using information and communication technologies to patients living at home, there is an advantage in providing rehabilitation services to individuals in their everyday social and physical environment, which can improve functional outcomes and satisfaction. The purpose of this study was to analyze the effectiveness of the pilot project by analyzing the outpatient and inpatient medical use and expenses of patients who participated in the rehabilitation patient home-based care pilot project. Methodology: To analyze the effectiveness of the home-based care pilot project for rehabilitation patients, health insurance claims data from the Health Insurance Review and Assessment Service was used. The subjects of analysis were patients who had undergone major lower extremity joint replacement surgery, including hip, knee, and ankle joint replacement surgery, and patients who had lower extremity fracture surgery, which were the targets of the rehabilitation patient home-based care pilot project. To compare medical use and expenses between patients participating in the rehabilitation patient home-based care pilot project and those not participating, chi-square test, t-test, and multiple regression analysis were performed. Findings: As a result of analyzing the number of medical use cases and expenses of patients who participated and those who did not participate in the rehabilitation patient home-based care pilot project, the average outpatient medical use and outpatient medical expenses per person for participating patients were lower than those for patients who did not participate. The average hospitalization cost per person and the average length of stay per person were also lower than those of patients who did not participate. Practical Implications: Home-based care for rehabilitation patients continues to provide medical services at home, not at medical institutions, and can be expected to reduce readmissions and complications by resolving patients' emergency situations at home or on their own, thereby reducing medical use.

• 대한의용생체공학회:의공학회지
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• 제17권1호
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• pp.61-70
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• 1996

In cementless total hip arthroplasty(THA), an initial stability of the femoral component is mandatory to achieve bony inyowth and secondary long term fixation. Primary stability of the femoral component can be obtained by minimizing the magnitude of relative micromotions at bone stem interface. An accurate evaluation of interf'ace micromotion and stress/strain fields in the bone-implant system may be relevant for better understanding of clinical situations and improving THA design. Recently finite element method(FEM) was introduced in'orthopaedic research field due to its unique capacity to evaluate stress in structure of complex shape, loading and material behavior. The authors developed the 3-dimensional finite element model of proximal femur with $Multilock^{TM}$ stem of 1179 blick elements to analyse the micromotions and mechanical behaviors at the bone-stem inteface in early post-operative period for the load simulating single leg stance. The results indicates that the values of relative motion for this well fit stem were $150{\mu}m$ in maximum $82{\mu}m$ in minimum and the largest relative motion was developed in medial region of Proximal femur and in anterior-posterior direction. The motion in the proximal bone was much greater than in the distal bone and the stress pattern showed high stress concentration on the cortex near the tip of the stem. These findings indicate that the loading on the hip joint in the early postoperative situation before achieving bony ingrowth could produce large micromotion of $150{\mu}m$ and clinicaly non-cemented THA patient should not be allowed weight bearing strictly early in the postoperative period.

• Clinics in Shoulder and Elbow
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• 제15권2호
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• pp.138-142
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• 2012

색소 융모 결절성 활액막염(Pigmented villonodular synovitis)은 활액막, 건막 및 점액낭 등에 융모 증식과 결절을 형성하는 드문 양성 활액막 증식성 질환으로 대부분 성인의 슬관절과 고관절에 발생한다. 수부, 완관절, 견관절 및 주관절에는 드물게 발생하며, 특히 소아에서의 주관절 색소 융모 결절성 활액막염은 아주 드물다. 좌측 주관절 통증이 있는 8세 남아의 단순 주관절 방사선 검사상 좌측 주두와에 양성 골종양과 같은 병변이 관찰되었다. 수술시 좌측 주관절의 활액막 이상 증식 소견이 관찰되어 임상적으로 색소 융모 결절성 활액막염을 의심하였으며, 병변의 개방 소파술 및 좌측 주관절의 근치적 활액막 절제술을 시행하였다. 절제 조직의 조직학적 검사 결과 색소 융모 결절성 활액막염으로 확진 되었다. 술 후 좌측 주관절의 통증이 호전되었으며, 정상 운동범위를 회복하였다. 저자들은 소아의 주관절에 발생한 골종양을 닮은 색소 융모 결절성 활액막염 1예를 보고함과 동시에 문헌 고찰을 하였다.

• 한국기계가공학회지
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• 제12권4호
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• pp.3-9
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• 2013

Falling related injuries are categorized as the most serious and common medical problems experienced by the elderly. Hip joint fracture, one of the most serious consequences of falling in the elderly, occurs in only about 1% of falling. In this study, according to the loading conditions, the analysis is the behavior of the femur. The CT images using the commercial program "Mimics" the bones of three-dimensional CAD data generated, and we will analyze the results of finite element analysis. The boundary conditions on the basis of existing research has been simplified. In this paper, the whole femur was assumed to be isotropic linear elastic material. Predicted the behavior of the femur according to the loading condition, it can be help the development of high-precision artificial bones and joints can be treated with surgery and will be able to perform efficiently.

• Clinics in Shoulder and Elbow
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• 제4권2호
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• pp.196-198
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• 2001

Synovial chondromatosis is the chondroid metaplasia of the synovial membrane, Large joints such as the knee and hip are commonly involved. Synovial chondromatosis very rarely develops within the shoulder joints. We have experienced the synovial chondromatosis developed in the right subscapular recess communicating the shoulder joint of a 30 year-old-female who was diagnosed by plain radiograph, MRI and microscopic findings, and then treated by arthroscopic synovectomy and removal of loose bodies.

• Archives of Reconstructive Microsurgery
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• 제24권2호
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.75-78
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• 2002

슬근의좌골결절부착부 견열손상은스포츠인구의증가와군대훈련을받고있는 젊은 남자에게 간혹볼수있는손상이며 대부분은젊은성인 특히 운동선수에게주로발생한다. 이는 슬관절이신전된상태에서고관절이 과도히굴곡되면슬근에강력한 긴장을 일으켜야기된다. 조기에진단하여 견열된 근육을 좌골에 부착시키는 수술적 치료로 기능을 회복시키고 기형을 교정할수있으나진단과치료가지연되면기능적으로나임상적으로양호한결과를얻기어렵다. 좌골결절에서슬근견열골절의수술적치료후생길수있는합병증은이소성골형성과고정실패외에크게알려진것이없으며, 특히좌골신경손상은보고된적이없다. 저자들은수상후3개월된슬근의좌골결절부착부파열을수술적치료한후좌골신경손상을경험하여보고하는바이다.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.528-535
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• 2000

Objective : To investigate objectively the postoperative improvement of gait disturbance in patients with cervical myelopathy through a gait analysis. Patients and Methods : Ten patients who underwent cervical decompression and fusion for cervical myelopathy caused by spondylosis, OPLL, or concomitant hypertrophy of ligamentum flavum were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated by gait analysis using three dimensional motion analyzer to collect data of linear and kinematic parameters before surgery, 1 week and 3 months after surgery. Statistical analysis of the related pre-and post-operative data were performed. Results : In the linear parameters, average value of cadence, walking speed, stride length, step time, width and double support were increased postoperatively compare to preoperative value. In the kinematic parameters, average value of knee flexion during initial swing phase, plantar flexion of ankle and range of motion of hip joint were increased as well. These differences were statistically significant(p<0.05). Conclusion : This study suggests that gait analysis can be used as a method of quantitative analysis of postoperative gait improvement in patients with cervical myelopathy.

• The Korean Journal of Physiology
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• 제24권1호
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• pp.103-113
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• 1990

The role of cervical proprioceptors in the control of body posture was studied in bilaterally labyrinth-ectomized, decerebrate cats. The animals were suspended on hip pins with the neck extended horizontally. With this placement the EMG activities of extensor and flexor muscles of the upper extremities were observed by means of sinusoidal head rotator. The rotator can induce two kinds of neck movement: The one is 'pitch' which describes a rotatory neck motion to transverse axis of the body and mainly occurs at skull-C1 (atlantooccipital) joint and the other is 'roll', side-to-side relation of the neck to longitudinal axis, whose center is C1-C2 (atlanto-axial) joint. The following results were obtained. 1) Responses of EMG activity were closely dependent on the rotatory range of the neck. And the EMG activity was not changed during sustained neck torsion, eliciting a typical tonic neck reflex. 2) On pitching movement, the head-up rotation produced the excitation of bilateral triceps muscles, whereas the head-down rotation produced the inhibition. And the response of bilateral biceps muscles was the opposite to that of triceps. 3) On rolling movement, the side-up rotation of the head produced the excitation of ipsilateral triceps muscles and the inhibition of contralateral ones. And the response of biceps muscles was the opposite to that of triceps. 4) The minimum requirement of motion to evoke EMG activities in the upper extremities was $3.2^{\circ}{\sim}12.5^{\circ}$. These results have shown that the cervical proprioceptors produce tonic discharge on the upper brachial muscles, regulate the EMG activities of those muscles, and are very sensitive to neck rotation. And it can be stated that the cervical proprioceptors may play an important role in the control of body posture and movement.

• 대한골관절종양학회지
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• 제3권2호
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• pp.119-126
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• 1997

1980년부터 1997년까지 본 대학부속 성모병원에서 치료한 동측 대퇴골에 발생한 골육종 3예의 도약전이를 경험하였다. 도약전이는 골육종 환자 총 19례중 3례(15%)에서 발견되었고, 방사선 골주사나 자기공명영상이 진단에 필수적이었고, 고관절 이단술로 치료하였다. 도약전이의 기전은 확실하지 않았으나, 이시발생(metachronous) 기전의 초기단계로 보는것이 타당한 것으로 사료되었다. 증례 수가 적어 통계적 의미는 부여할 수 없으나, 도약전이가 있는 장관골의 골육종의 치료는 그 예후가 특히 불량하므로, 확실한 항암요법이 보장되지 않는 한 원발 종양이 발생한 장관골의 전체를 절제하거나 병소 상부관절에서 이단술을 시행하는 것이 바람직하다고 판단되었다.