Hydroxyapatite 피복 무시멘트 비구컵을 이용한 인공고관절 전치환술

이동훈(Dong Hoon Lee),양익환(Ick Whan Yang),한창동(Chang Dong Han) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.5

목적: Hydroxyapatite (HA) 피복 무시멘트 비구컵을 사용한 일차성 인공 고관절 전치환술을 시행 받은 환자들의 최소 10년 이상 추적 관찰 결과를 보고하고자 한다. 대상 및 방법: 1992년 1월부터 1994년 10월까지 HA 피복 무시멘트 비구 삽입물로 일차성 인공 고관절 전치환술을 시행 받은 97명, 108예의 고관절 중 최소 10년 이상 추시가 가능했던 77명, 84예의 고관절에 대해 임상적 및 방사선학적으로 평가하였다. 결과: Harris 고관절 점수는 술 전 평균 54.7 (0-77.2)점이었고 술 후 10년 평균 88.5 (27.1-100)점이었다. 84예 중 재치환술은 28예(33.3%)에서 필요하였으며 이 중 13예(15.5%)에서 비구 삽입물의 해리가 관찰되어 비구 삽입물 재치환술을 시행하였고 8예(9.5%)에서 심한 폴리에틸렌 라이너 마모 및 골용해를 보여 7예에서 비구 삽입물 재치환술을 시행하였으며 1예는 재치환술 예정이다. 또한, 골용해가 거의 없는 심한 폴리에틸렌 라이너 마모로 인한 라이너 교환술 7예(8.3%)가 있었다. 폴리에틸렌 선형마모는 평균 2.74 mm였고 연간 선형 마모율은 평균 0.28 mm/년이었으며, 추산된 용적마모는 1,689.15 ㎣이었다. 재치환술을 받은 환자군의 평균 폴리에틸렌 선형마모 및 연간 선형 마모율은 각각 3.05 mm 0.33 mm/년이었고 용적마모는 1,882,27 ㎣이었다. 결론: HA 피복 무시멘트 비구컵(Atoll<SUP>®</SUP>)은 장기 추시에서 높은 해리율과 심한 마모 및 골용해를 보였으며, 비구컵 고정에 대한 디자인 및 hydroxyapatite 피복에 관한 연구가 필요할 것으로 생각된다. Purpose: We report on minimum 10-year follow-up results of total hip arthroplasties with hydroxyapatite (HA)-coated cementless acetabular cups. Materials and Methods: From January 1992 to October 1994, we performed one-hundred eight primary total hip replacements in ninety-seven patients using HA-coated cementless acetabular cup. Eighty-four cases in seventy-seven patients were followed-up for a minimum of 10 years. Results: The mean Harris score was 54.7 (range, 0 to 77.2) points preoperatively and 88.5 (range, 27.1 to 100) points at the most recent follow-up. Revision procedures were required on twenty-eight (33.3%) hips. Thirteen (15.5%) cups were revised because of loosening. Seven (9.5%) hips among the eight that revealed excessive polyethylene wear and osteolysis were revised and one hip is waiting for the revision procedure. In seven (8.3%) cases, only a polyethylene liner exchange was performed because of excessive liner wear without osteolysis. The mean linear polyethylene wear was 2.74 mm. The mean linear wear rate was 0.28 mm per year and the corresponding estimate of volumetric wear was 1689.15 ㎣, The mean linear polyethylene wear and linear wear rate in revised hips was 3.05 mm and 0.33 mm per year, respectively. The estimated volumetric wear in the revised group was 1882.27 ㎣. Conclusion: HA-coated cementless acetabular cup (Atoll<SUP>®</SUP>) demonstrated a high rate of loosening and poor results in wear and osteolysis. Further studies are needed to promote the design of acetabular cups and the technique of HA coating.

Wagner 재치환 스템을 이용한 인공 고관절 대퇴 재치환술

한창동(Chang Dong Han),양익환(Ick Whan Yang),박진(Jin Park) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

목적: Wagner 재치환 스템을 이용한 인공 고관절 대퇴 재치환술 후 추시 결과를 평가하고자 한다. 대상 및 방법: 1992년부터 2001년까지 Wagner 대퇴 재치환 스템을 이용하여 재치환술을 시행 받은 55명, 56예를 대상으로 하였다. 평균 나이는 50세였고, 평균 추시 기간은 8.4년(5-12.5년)이었다. 재치환술의 원인은 무균성이완 52예, 세균성 이완 2예, 스템 주위 골절 2예였다. 재치환술 전 대퇴부 결손은 Paprosky분류법을 이용하였고, 임상평가 및 방사선적 평가를 시행하였다. 결과: Harris 고관절 점수는 수술 전 평균 47점에서 최종 추시 시 평균 87점으로 향상되었다. Paprosky 분류상 Ⅰ, Ⅱ, ⅢA, ⅢB가 각각 5, 20, 22, 9예였고, 52예(93%)에서 최근 방사선 사진상 안정된 스템 소견을 보였다. 수직 침강은 평균 6.2 ㎜ (0-21 ㎜)였으며, 이중 수직 침강이 심했던 3예와 감염 1예는 2차 재치환술을 시행하였다. 결론: 대퇴 근위부 골결손이 동반된 대퇴 재치환술 시, grit-blast처리된 원추형 대퇴 재치환 스템은 원위부 압박고정으로 만족할 만한 결과를 보여주며, 디자인 자체에 기인하는 수직 침강을 줄일 수 있다면 스템의 기계적 실패율을 더욱 낮출 수 있을 것으로 기대된다. Purpose: To evaluate the results of revision total hip arthroplasty using a Wagner SL revision stem. Materials and Methods: This study reviewed 56 revisions of the femoral component performed using a Wagner stem in 55 patients between 1992 and 2001. The mean age of the patients at the time of the revision was 50 years. The mean follow up duration was 8.4 years (range, 5 to 12.5 years). The indication for revision was aseptic loosening in fifty-two hips, septic loosening in two and peri prosthetic fractures in two. The pre-revisional femoral defects were classified according to the Paprosky classification system. A clinical evaluation and radiological assessment were performed. Results: The mean Harris hip score improved from 47 points preoperatively to 87 points at the latest follow-up. There were 5, 20, 22 and 9 hips of type Ⅰ, Ⅱ, ⅢA and ⅢB according to the Paprosky classification system. Fifty two hips (93%) showed stable stems at the latest follow-up radiographs. The mean vertical subsidence of the stem was 6.2 ㎜ (range, 0 to 21 ㎜). Severe progressive vertical subsidence in three hips and an infection in one occurred requiring repeat revision. Conclusion: For severe proximal femoral bone loss, the conical femoral revision stem with a fully grit-blasted surface produced satisfactory results with distal press-fit fixation. We can expect a decrease in the rate of mechanical failure rate of the stem by reducing the subsidence derived from the stem design itself.

전후 활주형 Low Contact Stress<SUP>Ⓡ</SUP>를 이용한 인공 슬관절 전치환술

이동훈(Dong Hoon Lee),양익환(Ick Whan Yang),한창동(Chang Dong Han) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.4

목적: 전후 활주형 LCS<SUP>ⓡ</SUP> (Anteroposterior Glide Low Contact Stress<SUP>ⓡ</SUP>) Complete™ 인공 슬관절 전치환술을 시행한 환자들의 임상적 및 방사선학적 추시 결과를 보고하고자 한다. 대상 및 방법: 1999년 6월부터 2000년 6월까지 전후 활주형 LCS<SUP>ⓡ</SUP> 기기를 이용하여 시멘트형 인공 슬관절 전치환술을 시행 받은 62예 중 5년 이상 추시가 가능했던 58예를 평가하였다. 평균 추시 기간은 63.2개월 (60-72개월)이었고, 후방십자인대를 전 예에서 보존하였다. 결과: Hospital for Special Surgery Knee Score는 술 전 평균 62.9점에서 최종 추시 88.6점으로 향상되었다. American Knee Society Score상 슬점수는 술 전 평균 56.9점에서 최종 추시 평균 90.8점, 기능 점수는 평균 39.8점에서 평균 76.8점으로 향상되었다. 굴곡 구축은 술 전 평균 11.5도에서 최종 추시 1.6도, 운동 범위는 평균 103.5도(24-130도)에서 평균 112.2도(35-140도)로 향상되었다. 전 예에서 골 용해 및 부품의 이완은 없었으며 방사선학적으로 측정 가능한 폴리에틸렌 라이너의 마모도 없었다. 합병증은 폴리에틸렌 라이너와 가이드 암의 탈구 1예가 있었으며, 심부 염증 또는 부품의 해리로 인한 재치환술은 없었다. 결론: 전후 활주형 LCS<SUP>ⓡ</SUP>를 이용한 인공 슬관절 전치환술은 골 용해, 폴리에틸렌 라이너 마모 등에서는 우수한 결과를 보였으나, 관절운동 범위는 고정형 베어링 삽입물과 차이가 없었고, 장기적인 임상적 및 방사선학적 결과를 알기 위해 지속적인 추시 관찰이 필요할 것으로 생각된다. Purpose : We report the minimum 5-year follow-up results of total knee arthroplasty with anteroposterior glide LCS<SUP>ⓡ</SUP> Complete™. Materials and Methods : From June 1999 to June 2000, we performed sixty-two primary total knee replacements with the anteroposterior glide LCS<SUP>ⓡ</SUP> Complete™. Fifty-eight cases were followed-up for a minimum of 5 years. The posterior cruciate ligaments were preserved in all the cases. Results : The mean Hospital for Special Surgery Knee Score increased from 62.9 points preoperatively to 88.6 points at the most recent follow-up. The mean knee score of the American Knee Society increased from 56.9 points preoperatively to 90.8 points and the functional score increased from 39.8 points to 76.8 points at the most recent follow-up. The mean flexion contracture decreased from 11.5 degrees preoperatively to 1.6 degrees and the range of motion with flexion increased from 103.5 degrees to 112.2 degrees. There was no loosening, osteolysis, or measurable polyethylene wear in any of the cases. We experienced dislocation of the polyethylene liner and guide arm in one case, but there was no revision surgery performed due to loosening or infection. Conclusion : Anteroposterior glide LCS<SUP>ⓡ</SUP> Complete™ demonstrated ecellent clinical and radiological results in polyethylene wear and osteolysis; but there was no increased benefit in ranges of motion compared with fixed-bearing implants. Further follow-up is needed to obtain long-term clinical and radiological results.

인공고관절 전치환술에서 세공피복과 HA/TCP 피복 대퇴삽입물의 비교

한창동(Chang Dong Han),이우석(Woo Suk Lee),양익환(Ick Whan Yang) 대한정형외과학회 2000 대한정형외과학회지 Vol.35 No.4

슬관절의 전후 방사선 및 측면 방사선 사진상 경골축의 분석

정재봉 ( Jae Bong Chung ),한창동 ( Chang Dong Han ),양익환 ( Ick Whan Yang ),제진호 ( Jin Ho Che ) 대한슬관절학회 2005 대한슬관절학회지 Vol.17 No.1

환영 근위 피복 대퇴스템을 이용한 무시멘트 인공고관절 전치환술 -최소 10년 이상 추시 결과-

한창동 ( Chang Dong Han ),박진 ( Jin Park ),이동훈 ( Dong Hoon Lee ),양익환 ( Ick Whan Yang ) 대한고관절학회 2006 Hip and Pelvis Vol.18 No.4

목적: 환형 근위 미세공 피복 대퇴스템을 이용한 인공 고관절 전치환술후 최소 10년이상 추시결과를 보고하고자 한다. 대상 및 방법: 1991년 8월부터 1994년 7월까지 Multilock스템을 이용하여 고관절 전치환술을 시행받고 10년 이상 추시가 가능했던 76명(80예)을 대상으로 하였다. 평균연령 47.3세, 평균추시기간 12.3년이었고 임상적, 방사선적 평가를 시행하였다. 결과: Harris 고관절 점수는 술 전 평균 54.7, 술 후 10년 평균 88.5점이었다. 최종추시시 골내막 신생골 형성은 70예(90%)에서 보였으며 모든 대퇴스템이 생물학적 안정상태였다. 골용해는 67예(84%)에서 관찰되었는데 Gruen 1. 7영역에서 선형 골용해를 보였으며 대부분 대퇴스템 근위부에 국한된 양상이었다. 대퇴 윈위부 골용해는 없었고 대퇴스템의 해리, 이동소견 및 대퇴스템에 대한 재치환술도 없었다. 결론: 환형 근위 미세공 피복 Multilock스템을 이용한 고관절 전치환술은 최소 10년추시에서 안정된 골성고정을 보였고, 대퇴 원위부 골용해가 없어 임상적, 방사선적으로 우수한 결과를 보였다. 따라서 대퇴스템에서 환형 근위 미세공 피복 디자인은 비구컵 디자인의 결점과 관절면 마모를 보완한다면 무균성 해리에 대한 하나의 대안이 될 수 있을 것으로 생각된다. Purpose: The results of a more than 10-year follow-up after total hip arthroplasties with circumferential and proximal porous-coated femoral stems were evaluated. Materials and Methods: Seventy-six patients (80 hips), who were operated on between Aug. 1991 and July 1994, were followed for more than 10 years after primary total hip arthroplasties using Multilock stems. The mean age at the time of the operations was 47.3 years old and the mean duration of follow-up was 12.3 years. The clinical results and radiological findings were evaluated. Results: The mean Harris hip scores improved from 54.7 points to 88.5 points at the time of the 10-year follow up. On the last follow-up radiograph, endosteal bone formation was observed in 70 hips (90%) and all femoral stems were biologically stable. Femoral osteolysis, which was linear in Gruen zone I and VII and mostly restricted to the proximal zones, was observed in 67 hips (84%), and no hip had distal osteolysis in the femur. There was no loosening, migration, or revisions of the stems. Conclusion: Total hip arthroplasties using circumferential and proximal porous coated Multilock femoral stems demonstrated stable osseous fixation and no distal osteolysis for a minimum 10-year follow-up; therefore, all stems were reported to have satisfactory outcomes. With improvement of cup design and liner wear, circumferential and proximal porous coating designs of femoral stems can be an alternative answer to mechanical failure due to aseptic loosening.

고구마의 貯藏 및 利用에 關한 硏究 : 第二報 冷害와 軟腐病菌 感染중의 酵素活性度

李瑞來,梁益桓,金浩植 서울대학교 1968 서울대학교 論文集 Vol.19 No.-

In order to investigate the formation of pectolytic and cellulolytic enzymes upon the infection of the soft rot fungus Rhizopus nigricans to chilled or unchilled sweerpotato tubers, the fungus was inoculated to the tubers and the enzymatic activities were assayed in the course of infection at proper intervals. The results are summarized as follows: (1) The enzymatic activities were generally stronger and more durable in the unchilled sweetpotatoes than in chilled tubers. The difference was more remarkable with respect to polymethylgalaturonase, pectin methyl esterase and pectin transeliminase. (2) The activity of pectic acid transeliminase in the chilled sweetpotatoes was higher than that in the unchilled. (3) The cellulase activity has a tendency to increase from the period of declining in the pectolytic enzyme activities.

우리나라 김치의 포장과 저장방법에 관한 연구

이양희,양익환 한국농화학회 1970 Applied Biological Chemistry (Appl Biol Chem) Vol.13 No.3

Studies were carried out to develope the most economical and practical methods of packaging and preservation of kimchi, so commercialization of kimchi manufacture could proceed rapidly. The results obtained may be summarized as following. (1) It is generally established that the acceptable range of lactic acid content of kimchi is between 0.4% and 0.75%. Based on sensory evaluation, kimchi having lactic acid content below 0.4% and above 0.75% was not edible, and the time of optimum taste corresponded to the vicinity of 0.5% of lactic acid content. For the refrigeration storage with or without preservatives, the packaging kimchi in plastic film must be done at the lactic acid content of 0.45%, for lactic acid fermentation will continue slowly after the packaging. However, for the heat sterilized kimchi the packaging should be done at the 0.5% of lactic acid content for the best because lactic acid fermentation is completely stopped after the packaging. (2) Polyethylene, polypropylene, and polycello were chosen as suitable packaging materials. Polyethylene is cheapest among them but kimchi packaged in this film was damaged frequently in handling process and gave off kimchi flavor. On the other hand polypropylene also gave off kimchi flavor, but its higher mechanical strength gave better protection to kimchi and it had superior display effect due to the transparancy. Therefore polypropylene made much better packaging material. Polycello proved to be the best packaging material from the standpoint of physical characteristics but its price is higher than that of other plastic films. To be effective, the thickness of plastic films for packaging kimchi must exceed 0.08㎜. (3) Keeping property of kimchi appeared to be excellent by means of freezing. However, by the time the frozen kimchi was thawed out at room temperature, moisture loss due to drip was extensive, rendering the kimchi too stringy. (4) Preservation of kimchi at refrigerated temperatures proved to be the best method and under the refrigerated condition the kimchi remained fresh as long as 3 months. The best results were obtained when kimchi was held at 0℃. (5) In general, preservatives alone were not too elective in preserving kimchi. Among them potassium sorbate appeared to be most effective with the four fold extension of self-life at 20℃ and two fold extension at 30℃. (6) In heat sterilization the thickness of packaged kimchi product had a geat effect upon the rate of heat penetration. When the thickness ranged from 1.5 to 1.8㎝, the kimchi in such package could be sterilized at 65℃ for 20 minutes. Kimchi so heat treated could be kept at room temperature as long as one month without apparent changes in quality. (7) Among combination methods, preservation at refrigerated and heat sterilization could be favorably combined. When kimchi was stored at 4℃ after being sterilized at 65℃ for 20 minutes, it was possible to preserve the kimchi for more than 4 months.