• Title/Summary/Keyword: forward neck

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Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoid-splitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures

  • Noh, Young-Min;Kim, Dong Ryul;Kim, Chul-Hong;Lee, Seung Yup
    • Clinics in Shoulder and Elbow
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    • v.21 no.4
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    • pp.220-226
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    • 2018
  • Background: This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures. Methods: From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >$5^{\circ}$ loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated. Results: In all cases, complete union was achieved. The ASES and VAS scores were improved to $85.4{\pm}2.1$ and $3.2{\pm}1.3$, respectively. Twelve patients (75.0%) had greater than a $5^{\circ}$ change in NSA; the average NSA change was $3.8^{\circ}$. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a <$100^{\circ}$ active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit. Conclusions: Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.

Comparative Immediate Effects of Isometric Chin-tuck and Dynamic Neuromuscular Stabilization on Neck Flexor Muscle Thickness and Upright Sitting Height Posture

  • Shin, Ji-won;Yoon, Hyun-sik;Park, Ji-ho;Kim, Ha-yeon;You, Joshua (Sung) H.
    • Physical Therapy Korea
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    • v.26 no.4
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    • pp.1-9
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    • 2019
  • Background: Cervical dysfunction is a common pathomechanical marker in individuals with forward head posture (FHP). To overcome the limitations of the isometric chin-tuck (ICT) exercise, dynamic neuromuscular stabilization (DNS), which emphasizes an entire spinal chain exercise, has recently shown promising clinical results. Objects: Purpose of this study was to compare the immediate effects between ICT and DNS techniques. Methods: 43 young subjects (mean age, $24.0{\pm}5.0$ years) were recruited. Group of subjects with FHP were measured under baseline, ICT, and DNS conditions. Outcome measures included sitting height, longus colli (LC) and sternocleidomastoid (SCM) muscle thickness and LC/SCM thickness ratio. One-way repeated measures ANOVA was used to compare the continuous dependent variables among FHP, ICT, and DNS conditions at p<.016. Results: Both ICT and DNS exercise conditions yielded significantly increased LC muscle thickness, LC/SCM thickness ratio and sitting height than did FHP condition (p<.0001, respectively). Sitting height was significantly greater in DNS exercise than in the ICT exercise (p<.0001). Conclusion: The present results demonstrated that sitting height was greater in the DNS exercise than in the ICT exercise, as well as both corrective postural training exercises were effective on LC/SCM muscle balance ratio when compared with the baseline FHP condition. Therefore, it is considered that DNS exercise can be the recommended exercise for people with FHP.

Dose Planning of Forward Intensity Modulated Radiation Therapy for Nasopharyngeal Cancer using Compensating Filters (보상여과판을 이용한 비인강암의 전방위 강도변조 방사선치료계획)

  • Chu Sung Sil;Lee Sang-wook;Suh Chang Ok;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.53-65
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    • 2001
  • Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

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Spinal Cord Partial Block Technique Using Dynamic MLC (동적 다엽콜리메이터를 이용한 척수의 부분 차폐 기법)

  • 조삼주;이병용;이상욱;안승도;김종훈;권수일;최은경
    • Progress in Medical Physics
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    • v.14 no.1
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    • pp.8-14
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    • 2003
  • The spinal cord dose is the one of the limiting factor for the radiation treatment of the head & neck or the thorax region. It is not an easy task to maintain the spinal cord dose below tolerance and to keep the clinically acceptable dose to the PTV in this region. To overcome this problem, the spinal cord partial block technique (PBT) with the dynamic Multi-Leaf Collimator (dMLC) has been developed. This technique is an extension of the conventional treatment planning. In the beginning the beam directions are selected as same as the conventional treatment planning to encompass the PTV, then the partial block are designed to shield the spinal cord. The plan comparisons between the conventional therapy plan and the PTB plan were performed to evaluate the validity of this technique. The mean dose and the dose volume histogram (DVH) were used as the plan comparison indices. A series of quality assurance (QA) was performed to guarantee the reliable treatment. The QA consisted of the film dosimetry for the verification of the dose distribution and the point measurements. The PBT plan generated better results than the conventional treatment plan and it was proved to be useful for the H&N region.

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A Systematic Approach to Port related Problems An Analysis on the Actual Condition of physical Distribution System of Pusan port (항만관련문제의 시스템적 고찰 부산항 물류시스템의 실태분석)

  • Lee Cheol-Yeong;Moon Seong-Hyeok
    • Journal of Korean Port Research
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    • v.2 no.1
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    • pp.7-28
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    • 1988
  • From the viewpoint of physical distribution, the port transport process can be regarded as a system which consists of various subsystems such as navigational aids, quay handling, transfer, storage, information If management, and co-ordination with inland transport. The handling productivity of this system is determined by the production level of the least productive subsystem. So, a productivity analysis on the flow of cargoes through each subsystem should be made in order to achieve efficient port operation. The purpose of this paper is to analyze the productivity of each subsystem in Pusan port, and to bring forward problems and finally to draw up plans for their betterment. Analyzed results on the productivity of each subsystem are as follows, i) It is known that the number of tugs with low HP should be increased by a few, the number of tugs with medium HP is appropriate, and the number of tugs with high HP is in excess of that necessary. ii ) In the case of container cargoes, it is found that the transfer and storage systems in BCTOC have the lowest handling capability, with a rate of $115\%$, leading to bottle-necks in the port transport system, while the handling rate of the storage and quay handling systems in general piers is in excess of the inherent capability. iii) In the case of the principal seaborne cargoes passing through general piers, there is found to be a remarkable bottle-neck in the storage system. In the light of these findings, both the extension of storage capability and the extension of handling productivity are urgently required to meet the needs of port users. Therefore, iv) As a short-term plan, it is proposed that many measures such as the reduction of free time, the efficient application of ODCY, etc must be brought in and v) In the long-trun, even though the handling capability will accommodate an additional 960,000 TEU in 1991, the scheduled completion date of the third development plan of Pusan port, insufficiency of handling facilities in the container terminal is still expected and concrete countermeasures will ultimately have to be taken for the port's harmonious operation. In particular, the problem of co-ordination with inland transport and urban traffic should be seriously examined together in the establishment of the Pusan port development. As a method of solving this, vi) It is suggested that Pusan port (North port) should be converted into an exclusive container ternimal and overall distribution systems to the other ports for treating general cargoes must be established. vii) And finally, it is also proposed that the arrival time (cut-off time) of influx cargoes for exports such as general merchandise and steel product should be limited, with a view to securing cargoes suitable for the operational capability of BCTOC.

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The Effect of Pelvic Tilt on Muscle Activity of Cervical Erector Spinae & Upper Trapezius While Using a Smartphone (골반경사에 따른 스마트폰 사용이 목세움근과 위등세모근의 근활성도에 미치는 영향)

  • Song, Seong-In;Kang, Jong-Ho
    • Journal of Convergence for Information Technology
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    • v.7 no.4
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    • pp.97-103
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    • 2017
  • The purpose of this study was to investigate muscle activity of cervical erector spinae & upper trapezius while using a smartphone according to anterior pelvic tilt & posterior pelvic tilt in sitting position. & we also want to obtain basic data necessary for development of IoT devices. Fifteen healthy men & women aged 20-30 were enolled, After anterior pelvic tilt & posterior pelvic tilt in sitting position were adjusted, they used a smartphone for 5 minutes & EMG signal was measured simultaneously. We used median 3 minutes of measured EMG signal. The results of this study were as follows: In the sitting position, the use of smartphone in anterior pelvic tilt had significantly lower %RVC values in both cervical erector spinae (p <.001), left upper trapezius (p <.001) & right upper trapezius (p <.002) in comparison with posterior pelvic tilt. This means that anterior pelvic tilt make vertebrae maintain normal curvature & prevent forward head posture occurred while using a smartphone. It reduces loads around neck & shoulders, so that %RVC value is significantly lowered. In the future, new posture corrected IoT devices with an aspect of pelvic tilt should be developed.

A Study on the Musculoskeletal Pain Experience of Dental Hygienist's Treatment Postur (치과위생사의 진료자세에 따른 근골격계 통증 경험에 대한 연구)

  • Kim, Ji-Hee;Kim, Hye-Jin
    • Journal of dental hygiene science
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    • v.9 no.4
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    • pp.413-418
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    • 2009
  • This study was to investigate the muscoulosckeletla pain from 214 dental hygienist during treatment process in Ulsan and Kyungnam. The data collection was done from March to May in 2009 with questionnaire. The study results were as follows. In the participant's age characteristic, under 23 years old(34.1%) was majority, other participant age group were 24~26 years old(33.6%), 25~29 years old(20.6%), and over 30 years old(11.7%). Other participant characteristic were unmarried participant(86.4%), none religion(43.5%), and graduation from college(88.3%). In the participant's business characteristic, working place were dental clinic(57.5%), and dental hospital(42.5%), career was 1~2 years(42.5%) and a number of change job was once(45.1%). Salary were 1,300,000~1,490,000 won (33.6%), 1,500,000~1,990,000 won(29.9%), under 1,300,000 won(26.2%), 2,000,000~2,490,000 won(7.5%). A number of dental hygienist was over 20 person(85.9%) and the average dental hygienist was 15.6 person. A number of dentist were one person(28.5%), 2 person(22.4%), 4 person(19.2%) and the average dentist was 3.2 person. Dental hygienist's working hour was 8~9(49.5%), a large part of dental hygienist was assistance of general treatment(70.1%). Other results were 5 days/week working(60.3%), and night shift(49.1%). In an effect of musculoskeletal pain during working, neck pain was significantly influenced by body posture such as "head forward 15 degree or head round", "non balanced shoulders", "bend waist", "bend wrist", and "sit astraddle on a chair". Shoulders pain was significantly influenced by body posture such as "head forward over 15 degree", "bend waist", and "stand up straightly". Knee pain was significantly influenced by body posture such as "stand up straightly", and hip pain was influenced by "sit astraddle on chair".

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A Study on the Traditional Costumes and Tattoo of the Maori (마오리族 傳統 服飾과 文身 考察)

  • 황춘섭;정현주
    • The Research Journal of the Costume Culture
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    • v.3 no.2
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    • pp.241-260
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    • 1995
  • The Maori's traditional clothing materials, basic forms of dress, and the pattern and technique of tatoo were examined in the present study in order to deepen the appreciation of the cultural heritage of the Maori. The research method employed was the analysis of written materials. And a fild-trip was also made for the study. The study was limitted to the traditional culture of body adornment of the Maori including the clothing which is preserved and practicing by them at the present day, and the origin and the process of the historical development of those are not included in the scope of the present study. Followings are the results of the study: (1) By far the most widely used fiber for Maori clothing is abtained from what is commonly called New Zealand Flax. The fiber of kiekie(Freycinetia baueriana) and cabbage trees(Cordyline spp.) may also be used. The strong, long-lasting fiber of toi(cordyline indivisa) is used for a prestige warrior's cloak. Flat strips of ti kauka(Cordyline australi) are also used as thatch on rain cloaks. (2) Regardless of technique used, Maori weaving is always worked horizontally from left to right. Traditionally the work was suspended between two upright turuturu or weaving sticks. As the work progressed a second pair of uprights was used to keep the work off the ground. These uprights were moved forward as required. Because the weaver sat on the ground, the working edge was kept at a height that was comfortable to reach. No weaving tools are used, the wefts(aho) being manipulated by the fingers. The two main Maori weaving techniques are whatu aho patahi(single-pair twining) and whatu aho rua(double-pair twining). (3) The Maori wore two basic garments - a waist met and a cloak. The cloth of commoners were of plain manufacture, while those of people of rank were superior, sometimes being decorated with feather or dyed tags and decorated borders. Children ran more-or-less naked until puberty, being dressed only for special events. Some working dress consisted of nothing more than belts with leaves thrust under them. Chiefs and commoners usually went barefoot, using rough sandals on journeys over rough country (4) The adornment of men and women of rank was an important matter of tribal concern as it was in chiefly persons that prestige of the group was centred, The durable items of Maori persons adornment were either worn or carried. Ornaments of various kinds were draped about the neck or suspended from pierced earlobes. Combs decorated the head. Personal decorations not only enhanced the appearance of men and women, but many had protective magical function. The most evident personal ornament was the hei-tiki made of jade or other material. Maori weapons were treasured by their owners. They served on bottle and were also personal regalia. A man of rank was not fully dressed without a weapon in hand. Also weapons were essential to effective oratory. (5) No man or woman of rank went without some tattoo adornment except in extremely rare instances when a person was too sacred to have any blood shed. The untattooed were marked as beeing commoners of no social standing. This indelible mark of rank was begun, with appropriate rite and ritual, at puberty. And tattoo marked the person as being of a marriageable age. Maori tattoo was unlike most traditional tattoo in that its main line were 'engraved' on the face with deep cuts made by miniature bone chisels. The fill-in areas were not tattooed with cuts but with the multiple pricks of small bone 'combs' that only lightly penetrated the skin surface. The instrument of tattoo consisted of small pots of pumice or wood into which was placed a wetted black pigment made from burnt kauri gum, burnt vegetable caterpillars or other sooty materials. A bird bone chisel or comb set at right angles on a short wooden handle was dipped into the gigment, that a rod or stick was used to tap head of this miniature adze, causing penetration of the skin surface. Black pigment lodged under the skin took on a bluish tinge. A full made facial tattoo consisted of major spirals with smaller spirals on each side of the nose and sweeping curved lines radiating out from between the brows over the forehead and from the nose to the chin. The major patterns were cut deep, while the secondary koru patterns were lightly pricked into the skin.

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The Study on Musculoskeletal Symptoms and it's Related Factors in Radio-Technologists (방사선사의 근골격계 증상과 유해 요인에 관한 연구)

  • Lee, Hyang-Seob;Han, Man-Seok
    • Journal of radiological science and technology
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    • v.31 no.3
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    • pp.239-247
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    • 2008
  • In order to study the occurrence of symptoms of musculoskeletal disorders of radio-technologists employed at metropolitan general hospitals and the factors that influence such occurrence, standardized questionnaire by NIOSH that was modified and supplemented to be suitable for conditions in Korea was used. Answers collected from 143 radio-technologists in two weeks from June 13, 2007 were analyzed and the results are as follows. Factor that influence symptoms of musculoskeletal disorders by area were analyzed through multiple logistic regression analysis and the results found that in the neck area, risk increased as the burdening work category 2(Korea ministry of labor)(OR=3.94) and burdening work category 9(Korea ministry of labor)(OR=4.72) increased. In the shoulder region, risk increased as burdening work category 2(Korea ministry of labor)(OR=5.36), burdening work category 7(Korea ministry of labor)(OR=3.90), and burdening work category 9 (Korea ministry of labor)(OR=5.76) increased. In the arm/hand/wrist regions, risk increased as burdening work category 2 (Korea ministry of labor) (OR=6.91), and burdening work category 9 (Korea ministry of labor)(OR=3.76) increased. In the lower back region, risk increased as burdening work category 2 (Korea ministry of labor) (OR=3.06), and burdening work category 8 (Korea ministry of labor)(OR=8.14) increased. In the leg/knees/foot regions, risk increased as burdening work category 2 (Korea ministry of labor) (OR=3.63), and burdening work category 9 (Korea ministry of labor)(OR=2.96) increased. Conclusively, in factors that influence musculoskeletal disorder symptoms in radio-technologists, influence of subjective health conditions, total work experience, experience in current division, and burdening work category 2, 7, 8, and 9 (Korea ministry of labor) were most significant. Therefore, for preventive management, in addition to ergonomic and educational intervention for correcting improper posture during work, efforts for break time adjustment and stress reduction is needed, and encouragement and support for regular exercise is needed.

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