• Archives of Reconstructive Microsurgery
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• 제19권1호
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• pp.12-20
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• 2010

Purpose: Industrial punch accidents involving fingers cause segmental injuries to tendons and neurovascular bundles. Although multiple-level segmental amputations are not replanted to regain function, most patients with an amputated finger want to undergo replantation for cosmetic as much as functional reason. The authors describe four cases of digital amputation by an industrial punch that involved the reinstatement of the amputated finger involving a joint and neurovascular bundle. Amputated segments were replanted to restore amputated surfaces and distal segments. Methods: A single institution retrospective review was performed. Inclusion criteria of punch injuries requiring replantation were applied to patients of all demographic background. Injury extent (size, tissue involvement), operative intervention, pre- and postoperative hand function were recorded. Result: Four cases of amputations were treated at our institute from 2004 to 2008 from industrial punch machine injury. Average patient age was 32.5 years (25~39 years) and there were three males and one female. Sizes of amputated segments ranged from $1.0{\times}1.0{\times}1.2\;cm^3$ to $3{\times}1.5{\times}1.6\;cm^3$. Tenorrhaphy was conducted after fixing fractured bone of the amputated segments with K-wire. Proximal and distal arteries and veins were repaired using the through & through method. The average follow-up period was thirteen months (2~26 months), and all replanted cases survived. Osteomyelitis occurred in one case, skin grafting after debridement was performed in two cases. Because joints were damaged in all four cases, active ranges of motion were much limited. However, a secondary tendon graft enhanced digit function in two cases. The two-point discrimination test showed normal values for both static and dynamic tests for three cases and 9 mm and 15 mm by dynamic and static testing, respectively, in one case. Conclusion: Though amputations from industrial punch machines are technically challenging to replant, our experience has shown it to be a valid therapy. In cases involving punch machine injury, if an amputated segment is available, the authors recommend that replantation be considered for preservation of finger length, joint mobility, and overall functional recovery of the hand.

• 대한골관절종양학회지
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• 제6권1호
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• pp.10-16
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• 2000

목적 : 상지에 발생한 악성 및 침윤성 종양에서 분절절제 및 재접합술을 시행후 그 결과를 보고하고자 한다. 대상 및 방법 : 1986년부터 1994년까지 상지에 발생한 악성 및 침윤성 종양으로 분절절제 및 재접합술을 시행한 10례를 대상으로 평균 7년 7개월(3년 4개월~10년 2개월)간 추적하였다. 수술의 적응증은 절단 외에는 적절한 절제방법이 없는 stage II B의 종양을 대상으로 하였다. 종양의 종류는 연골육종이 3례, 골육종이 2례, 병적 골절을 동반한 거대세포종이 2례 동맥류성 골낭종을 동반한 광범위한 연골아세포종, 병적 골절을 동반한 광범위 유잉육종, 연부조직 및 골을 침범한 평활근육종이 각각 1례씩이었다. 종양의 발생부위는 근위 상완골이 6례로 가장 많았고 견갑골 3례, 전완부의 연부조직 1례였다. 10례중 7례에서 광범위 절제술을 시행하였고 3례에서는 변연절제술을 시행하였다. 결과 : 다발성 전이로 수술후 40개월에 사망한 1례를 제외하고 9례에서 종양의 국소재발이나 전이는 없었다. 최종추시시 상지의 평균기능점수는 65%(43~90%)였고, 수부의 파악력은 정상측에 비하여 평균 75%(28~95%), 집는 힘은 평균 82 %(63~100%)였다. 수술후 합병증으로는 3례에서 상처의 이개가 있었으나 치유되었고, 1례에서 수술후 요골신경의 마비소견이 보였으나 수술후 3개월에 신경기능은 회복되었다. 결론 : 상지에 발생한 악성 및 침윤성 종양의 치료로서 분절절제 및 재접합술은 선택적인 환자에서 절단술 대신에 부분 상지 구제술로서 추천할 수 있는 방법으로 사료된다.

• 콘크리트학회논문집
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• 제17권2호
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• pp.229-236
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• 2005

본 연구에서는 건설비용, 노무비 절감, 공기단축 등의 요구에 대응하기 위해, 일체형 및 분절형 PSC 거더의 구조적인 거동을 평가하는데 연구목적을 두었다. 본 논문에서는 동일한 단면을 갖는 총 3개의 거더 시험체를 제작하였으며, 접합부와 긴장재의 양을 주요변수로 하여 하중-처짐거동을 비교 분석하였다. 첫 번째 거더는 거더를 일체로 제작하여 세 개의 강연선을 배치하였고 두 번째 거더는 5개의 분절된 세그먼트로 제작하여 세 개의 강연선을 이용하여 접합하였다. 그리고 세 번째 거더는 두 번째 거더와 같이 분절된 거더로써 추가 강연선을 배치하였다. 수행된 실험의 결과를 분석함으로써 일체형 거더와 분절형거더의 거동 차이를 알 수 있었다.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.364-369
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• 2005

Objective: Spinal instrumentation without fusion often fails due to biological failure of intervertebral joints (spontaneous fusion, degeneration, etc). The purpose of this study is to investigate the influence of fixation rigidity on viability of intervertebral joints. Methods: Twenty pigs in growing period were subjected to posterior segmental fixation. Twelve were fixed with a rigid fixation system(RF) while eight were fixed with a flexible unconstrained implant(FF). At the time of the surgery, a scoliosis was created to monitor fixation adequacy. The pigs were subjected to periodic radiological examinations and 12pigs (six in RF, six in FF) were euthanized at 12-18months postoperatively for analysis. Results: The initial scoliotic curve was reduced from $31{\pm}5^{\circ}$ to $27{\pm}8^{\circ}$ in RF group (p=0.37) and from $19{\pm}4^{\circ}$ to $17{\pm}5^{\circ}$ in FF group (p=0.21). Although severe disc degeneration and spontaneous fusion of facet joints were observed in RF group, disc heights of FF group were well maintained without major signs of degeneration. Conclusion: The viability of the intervertebral joints depends on motion spinal fixation. Systems allowing intervertebral micromotion may preserve the viability of intervertebral discs and the facet joint articular cartilages while maintaining a reasonably stable fixation.

• 한국구조물진단유지관리공학회 논문집
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• 제11권5호
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• pp.99-106
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• 2007

본 연구에서는 건설비용, 노무비 절감, 공기단축 등의 요구에 대응하기 위해, 일체형 및 분절형 PSC 거더의 구조적인 거동을 평가하는데 연구목적을 두었다. 본 논문에서는 동일한 단면을 갖는 총 3개의 실험체를 제작하였으며, 접합부와 긴장재의 양을 주요변수로 하여 모멘트-처짐 거동을 비교 분석하였다. 첫 번째 거더는 거더를 일체로 제작하여 세 개의 강연선을 배치하였고 두 번째 거더는 5개의 분절된 세그먼트로 제작하여 세 개의 강연선을 이용하여 각각의 세그먼트를 접합하였다. 그리고 세 번째 거더는 두 번째 거더와 같이 분절된 거더로써 추가 강연선을 배치하였다. 수행된 실험의 결과를 분석함으로써 일체형 거더와 분절형 거더의 거동 차이를 알 수 있었으며, 수행된 2차원 비선형유한요소해석은 실험결과와 비교하여 모멘트-처짐 곡선을 비교적 잘 예측하였다.

• 대한족부족관절학회지
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• 제25권4호
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• pp.185-189
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• 2021

An aneurysmal bone cyst (ABC) can occur in many parts of the human body, but a primary ABC of the talus is extremely rare. ABCs are benign, but aggressively growing tumors that usually occur in the first two decades of life. Patients mainly complain of pain, limited movement of the involved joint or a palpable mass. Pain may worsen suddenly because of pathological fractures. If not treated properly, ABC has a risk of local recurrence, followed by the destruction of the joint and a significant functional deficit. While the complete removal of the bone tumor is essential, it is also important to treat the resultant bone defect after removal. The talus has an important part to play in weight-bearing. Therefore, an appropriate bone graft is required for large bone defects that occur after an ABC removal from the talus. We report a primary ABC of the talus in a 28-year-old male that was treated by curettage and a bone pillar pattern graft of autologous tricortical iliac crest bone. The patient had an excellent functional outcome with early weight-bearing, and there was no recurrence at 16 months of follow-up.

• 한국간담췌외과학회지
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• 제27권3호
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• pp.251-257
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• 2023

Backgrounds/Aims: This is a retrospective analysis of whether the 8th edition American Joint Committee on Cancer (AJCC) was a significant improvement over the 7th AJCC distal extrahepatic cholangiocarcinoma classification. Methods: In total, 111 patients who underwent curative resection of mid-distal bile duct cancer from 2002 to 2019 were included. Cases were re-classified into 7th and 8th AJCC as well as clinicopathological univariate and multivariate, and Kaplan-Meier survival curve and log rank were calculated using R software. Results: In patient characteristics, pancreaticoduodenectomy/pylorus preserving pancreaticoduodenectomy had better survival than segmental resection. Only lymphovascular invasion was found to be significant (hazard ratio 2.01, p = 0.039) among all clinicopathological variables. The 8th edition AJCC Kaplan Meier survival curve showed an inability to properly segregate stage I and IIA, while there was a large difference in survival probability between IIA and IIB. Conclusions: The 8th distal AJCC classification did resolve the anatomical issue with the T stage, as T1 and T3 showed improvement over the 7th AJCC, and the N stage division of the N1 and N2 category was found to be justified, with poorer survival in N2 than N1. Meanwhile, in TMN staging, the 8th AJCC was able differentiate between early stage (I and IIA) and late stage (IIB and III) to better explain the patient prognosis.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.82-85
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• 2013

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to Our Hospital. He had large dorsal soft-tissue defects ($5{\times}3cm$) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.

• 대한물리치료과학회지
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• 제7권2호
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• pp.415-425
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• 2000

It is well known that the lifetime incidence of low back pain is extraordinarily high, but those who incur the majority of the cost, both personally and financially, are the chronic pain. Stabilization programmers attracted our interest, with their aims of using the muscle system to protect spinal joint structures from further repetitive microtrauma, recurrent pain and degerative change. In overviewing the stabilizing role of the trunk and back mucles our attention became focused on muscles which controlled the lumbar and lumbosacral joints rather than on muscles which span the spine from the thorax to pelvis. It was considered that muscles such as the lumbar multifidus, transversus abdominis, and possibly also parts of the obliquus internus abdominis, would most likely function to stabilize the segments of the lumbar spine. In order to check if these muscles were functioning in low back pain patients, it was necessary to devise specific muscle tests. The new concept involves exercises using only relatively low activity levels in the muscles. More emphasis is placed on a motor skill which has to be relearned, practised and then gradully incorporated back into functional movement.

• International Journal of Concrete Structures and Materials
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• 제7권4호
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• pp.319-332
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• 2013

The purpose of this study was to investigate the design comparison of totally prefabricated bridge substructure system. Prefabricated bridge substructure systems are a relatively new and versatile alternative in substructure design that can offer numerous benefits. The system can reduce the work load at a construction site and can result in shorter construction periods. The prefabricated bridge substructures are designed by the methods of Korea Highway Bridge Code (KHBD) and load and resistance factor design (AASHTO-LRFD). For the design, the KHBD with DB-24 and DL-24 live loads is used. This study evaluates the design method of KHBD (2005) and AASHTO-LRFD (2007) for totally prefabricated bridge substructure systems. The computer program, reinforced concrete analysis in higher evaluation system technology was used for the analysis of reinforced concrete structures. A bonded tendon element is used based on the finite element method, and can represent the interaction between the tendon and concrete of a prestressed concrete member. A joint element is used in order to predict the inelastic behaviors of segmental joints. This study documents the design comparison of totally prefabricated bridge substructure and presents conclusions and design recommendations based on the analytical findings.