• 대한정형외과스포츠의학회지
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• 제12권1호
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• pp.16-23
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• 2013

슬관절의 다발성 인대 손상은 2개 또는 그 이상의 인대가 손상된 경우를 의미하고, 이 중 3개 또는 4개의 인대 파열이 일어나게 되면 대퇴골-경골 관절의 통합성이 파괴된 상태, 즉 슬관절의 탈구가 일어날 수 있다. 슬관절의 다발성 인대 손상이 있는 경우 혈관, 신경 상태를 단계적으로, 세심하게 평가하여야 하며 동맥 손상이 의심 시 지체하지 말고 응급 수술을 시행하여야한다. 슬관절의 다발성 인대 손상 치료에는 여러 이견이 있을 수 있으나 보존적 치료보다는 수술적 치료가, 지연 수술보다는 조기 수술이 권유되고, 전, 후방 십자 인대의 경우 재건술이, 후외방 인대의 경우 재건술이, 내측 측부 인대의 경우 봉합술 혹은 재건술이 권유되며, 다발성 인대 손상은 단일 인대 손상보다는 좀더 적극적인 치료가 요할 것으로 사료된다.

• 한국건설관리학회논문집
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• 제16권6호
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• pp.41-52
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• 2015

군 시설물은 80년대 이후 현대화 계획 및 군 복지의 향상 등으로 인해 그 수가 급격하게 증가하였다. 그러나 이렇게 증가한 시설물에 대해 체계적인 유지관리가 이루어지지 못하여 노후화되면서 이러한 노후시설의 성능향상이 필요하게 되었다. 노후 시설물의 성능향상 방안은 재건축과 리모델링으로 나눌 수 있다.그러나 표준 리모델링 범위 내에서는 리모델링이 더 경제적이라는 연구결과에도 불구하고 군 시설의 리모델링은 성능 향상의 수단으로써 재건축과 동등하게 고려되고 있지 않다. 따라서 본 연구에서는 건축물의 생애주기 동안의 성능 변화와 리모델링 필요 범위의 관계성에 착안하여 재건축보다 리모델링이 경제적인 특정시점(SPT)에 리모델링을 선택하는 방식의 리모델링 프로세스 모델(RPM)을 제안한다. 또한 군 시설물의 자료에 근거하여 이를 위해 필요한 현실성 있는 내용연수와 기능성 평가기준을 함께 제시한다. 이 RPM을 통해 기존프로세스에서 발생하는 안전성에는 문제가 없으나 기능성에 문제가 있는 시설물들이 적절한 리모델링 시기를 놓쳐 어쩔 수 없이 재건축을 하게 되는 사례를 방지할 수 있게 하였다. 또한 준공시기와 유형이 다른 시설물을 관리하는 입장에서의 재건축/리모델링 선택의 의사결정을 보다 간단하게 할 수 있는 가능성을 제시하였다. 이러한 리모델링에 보다 초점을 맞춘 프로세스를 통해 예산절감 효과뿐만 아니라 재건축으로 인한 사회적 낭비를 줄이는데 기여할 수 있을 것이라 판단된다.

• 한국건축시공학회:학술대회논문집
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• 한국건축시공학회 2016년도 춘계 학술논문 발표대회
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• pp.164-165
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• 2016

To express the original texture of the concrete, exposed concrete finishing technique has been applied in many buildings. However, it is likely to cause quality problems after construction is completed. In addition, because of costs and time issues, reconstruction and maintenance works are difficult and ineffective. Therefore, step-by-step proactive quality management based on sufficient consensus among participants(client, designer, contractor) is very importatnt. This study analyzed factors causing low quality exposed concrete and quality contol points applied to 'A' headquarter construction project.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.344-347
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• 2009

Purpose: Malignant soft tissue tumors, known as sarcomas, are well known to be locally aggressive, frequently metastatic, and highly recurrent. In other hands, intermediate soft tissue tumors often recur locally with adjacent tissue infiltration so the clinical management is difficult as sarcoma. In the present study, we evaluate the clinical course of the intermediate soft tissue tumors and consider the management plan for those. Methods: From March, 1998 to April 2008, total 3 patients of intermediate soft tissue tumors underwent operations. A patient with fibrohistiocytic neoplasm, a free flap reconstruction was performed, and he underwent several more operations because of recurrences. Other patients with desmoids - type fibromatosis showed local invasion and adhesion, and one of them underwent reoperation due to local recurrence. Results: 2 of 3 patients underwent recurrences of tumors and reoperations were performed. In another patient with no recurrence, follow-up period was just 5 months, so there may be recurrence of tumor in long term follow-up. Conclusion: The clinical course of intermediate soft tissue tumors shows high recurrence rate. So clinically, intermediate soft tissue tumors should be considered as sarcomas. The successful management requires wide resection, carefully planned reconstruction, and close follow up with radiologic evaluation.

• Archives of Plastic Surgery
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• 제48권4호
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• pp.404-409
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• 2021

Background To date, there are no consensus guidelines for management of lymphatic leak in groin vascular reconstruction patients. The goal of this study is to review the relevant literature to determine alternatives for treatment and to design an evidence-based algorithm to minimize cost and morbidity and maximize efficacy. Methods A systematic review of the literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two independent reviewers applied agreed-upon inclusion and exclusion criteria to eligible records. Studies that included patients who underwent groin dissection for oncologic diagnoses and level 5 data were excluded. Interventions were then categorized by efficacy using predetermined criteria. Results Our search yielded 333 records, of which eight studies were included. In four studies, the success of lymphatic ligation ranged from 75% to 100%, with average days to resolution ranging from 0 to 9. Conservative management in the form of elevation, compression, and bedrest may prolong time to resolution of lymphatic leak (14-24 days) and therefore cost. Conclusions The majority of patients should be offered early operative intervention in the form of lymphatic ligation with or without a primary muscle flap. If the patient is not an operative candidate, a trial of conservative management should be attempted before other nonsurgical interventions.

• The Journal of Korean Physical Therapy
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• 제31권4호
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• pp.161-168
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• 2019

Most athletes with anterior cruciate ligament (ACL) ruptures undergo a surgical ACL reconstruction (ACLR) and rehabilitation. On the other hand, controversy still exists because neither a reconstruction nor rehabilitation have been proven to be superior in the management of ACL injury. This study reviewed the success rates of interventions to provide recommendations for the optimal management after an ACL injury. One of the most important considerations after an ACL injury is the timing and type of intervention. At the early stages, which involve the loss of volume and strength of quadriceps femoral muscle, weight bearing (closed kinetic chain) exercises with pain management followed by high velocity resistance exercises in an open kinetic chain environment are recommended to improve the quadriceps function. After that, it is important to apply intensive isokinetic exercise with a lower extension rate. In this case, it is important to apply overload to the muscles and to simultaneously lead the co-contraction of the hamstrings. Standards are essential because the timing and type of interventions are crucial to prevent re-injury and complications, such as osteoarthritis, as well as to confirm the successful outcome of the treatment. Different interventions recommended for ACL damage have yet to reach consensus. Further studies will be needed to observe the effects of the intervention through multidisciplinary approaches.

• 한국산학기술학회논문지
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• 제19권12호
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• pp.717-724
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• 2018

사회기반시설물의 노후화에 따른 교량 유지관리비용의 급격한 증가에 대비하기 위해서는 미래 발생 가능한 유지관리비용의 예측이 선행되어야 한다. 이를 위해 본 논문에서는 교량 관리주체의 유지관리 현황 분석을 통해 교량의 관리수준을 파악하고, 이를 생애주기에 따른 목표관리수준과 성능향상 한계 값으로 모델링하였다. 이와 함께 교량 안전점수에 따른 보수보강비용 예측모델, 성능열화모델, 평균개축비용단가, 평균 개축시기로 구성된 기존의 비용 및 성능 예측모델과 연계하여, 교량 유지관리비용 추계분석을 위한 방법론 및 절차를 제안하였다. 제안된 방법의 활용성 검증을 위해 특정 관리주체가 관리하는 교량의 규모, 노후화 정도, 현재 관리현황을 고려하여 미래 유지관리비용 추계 분석을 수행하였다. 연차별로 개별 교량 수준의 안전등급과 유지관리 조치에 따른 비용 추정 결과와 이들을 관리주체 수준으로 합산하여 연차별 평균 안전점수, 안전등급 구성비, 점검진단비용, 보수보강비용, 개축비용을 합리적으로 추정할 수 있다. 향후 목표성능관리수준의 변경에 따른 생애주기 예산의 변화를 추정하여 최적의 관리수준을 제안할 수 있을 것으로 판단된다.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.622-627
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• 2007

Purpose: Although the autogenous tissue transfer has been the mainstay of the breast reconstruction, concern for the donor site morbidity can lead to the superseded method using tissue expander with implant or permanent expander-implant. However, the additional procedure of tissue expansion possibly cause discomfort and raise the cost. We tried to verify the efficacy of using the saline-filled breast implant by itself for the safe and convenient immediate breast reconstruction modality if the patients have small, round and non-ptotic breasts and the sufficient breast skin can be saved with mastectomy. Methods: From July 2002 to July 2005, 29 breasts of 26 patients were restored only with the saline-filled breast implant immediately after the skin sparing or nipple-areolar skin sparing mastectomy in Asan Medical Center. A pocket with pectoralis major and serratus anterior muscle was created and the implant was covered with this muscle pocket. Simultaneous contralateral augmentation was performed in patients whose mastectomy specimen weighed less than 100g. Results: Using only the saline-filled breast implant resulted in the successful reconstruction with few complications including partial necrosis of nipple areolar skin (five cases, 17.2%), capsular contracture (three cases, 10.3%), hematoma (one case, 3.4%), depigmentation of areolar skin (one case, 3.4%), hypertrophic scar (one case, 3.4%), which were all healed by conservative management. There were no significant complications such as implant exposure and subsequent removal. Conclusion: Immediate breast reconstruction only with the saline-filled breast implant can be a satisfactory alternative option for the patients whose breast is small, round and non-ptotic, especially when the nipple-areolar skin of the breast is preserved in the mastectomy.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.522-527
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• 2012

Background A pectoralis major flap is one of the standard tools for the reconstruction of defects of the head and neck. Despite the technical advancement in free tissue transfer in head and neck reconstruction, the benefits of a pectoralis major flap should not be overlooked. The purpose of this study is to evaluate our 17 years of experience in reconstructing defects of the head and neck region using the pectoralis major flap. Methods We retrospectively reviewed the medical records of 112 patients (120 cases) who underwent pectoralis major flap operations for head and neck reconstruction during a period ranging from 1994 to 2010. Results In our series, no total necrosis of the flap occurred. Of the total cases, 30.8% presented with flap-related complications. Major complications occurred in 20% of all of the cases but were then all successfully treated. The male sex was correlated with the occurrence of overall complications (P=0.020) and major complications (P=0.007). Preoperative albumin levels of <3.8 g/dL were correlated with the formation of fistula (P=0.030). Defects of the hypopharynx were correlated with the occurrence of major complications (P=0.019) and the formation of fistula (P=0.012). Secondary reconstructions were correlated with the occurrence of overall complications (P=0.013) and the formation of fistula (P=0.030). Conclusions A pectoralis major flap is still considered to be a safe, versatile one-stage reconstruction procedure in the management of the defects of head and neck and the protection of the carotid artery.

• 대한족부족관절학회지
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• 제14권1호
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• pp.47-52
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• 2010

Purpose: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. Materials and Methods: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. Results: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average $8.2{\pm}0.9$ (range, 7~10) to $2.7{\pm}1.7$ (range, 0~6) and the AOFAS score improved from $46.4{\pm}14.6$ points (range, 23~69) to $80.1{\pm}9.3$ points (range, 65~95) at final follow-up. Anterior draw test improved $15.2{\pm}3.4$ mm (range, 12~23 mm) to $8.8{\pm}2.6$ mm (range, 6~13mm), varus stress test improved from $13.9{\pm}4.6^{\circ}$ (range, $10-18^{\circ}$) to $6.2{\pm}4.7^{\circ}$ (range, $2-18^{\circ}$) at final follow up. Conclusion: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.