족부 및 족관절의 해부학, 생역학 및 신체 검사

허창룡,김학준,Hur, Chang-Yong,Kim, Hak Jun 대한정형외과초음파학회 2010 대한정형외과 초음파학회지 Vol.3 No.1

정형외과 영역에서 초음파를 이용한 진단과 치료가 광범위하게 사용되고 있다. 특히 족부 및 족관절에서의 초음파를 이용한 진단 족부 및 족관절의 해부학적 특성상 매우 유리한 것으로 알려져 있다. 족부 및 족관절에 발생하는 다양한 질환의 원인과 치료를 시행하기 위해서는 족부 및 족관절의 해부학적, 생역학적 특징을 잘 이해하여야 한다. 족부 및 족관절은 총 28개의 뼈와 많은 수의 인대, 건으로 이루어져 있으며 이들간의 유기적인 결합을 통해 신체를 지탱하는 정적 기능과 걷는 동적 기능을 동시에 수행할 수 있는 복잡한 구조 물이다. 그리고 작은 공간에 여러 구조물이 밀집되어 있어서 질환이 있는 부위의 정확한 이학적 검사가 요구된다. 그러므로 해부학적, 생역학적 지식을 바탕으로 이학적 검사를 체계적으로 시행함으로써 초음파를 이용한 진단 및 치료에 정확성을 기할 수 있다. Ultrasonographic diagnosis and treatment in Orthopaedic fields had been widely used. Sonographic diagnosis and treatment of foot and ankle is convenient because of anatomical characteristics. The knowledge of the anatomy and biomechanics in foot and ankle area can help to diagnose and treat the disease around foot and ankle. 28 bone and many tendons, ligaments and muscles are consist of ankle and foot joint and the coordinative relation among these structures can allow the dual function, weight bearing and locomotion of ankle and foot during gait cycle. Foot and ankle have small room for many structures, so systemically physical examination is essential for diagnosis. Accurate understanding of foot and ankle anatomy and biomechanics could be helpful to using ultrasonograph.

전원 잡음을 줄이기 위한 평면계획 단계에서의 Decoupling Capacitance 할당

허창룡,임종석,Heo Chang-Ryong,Rim Chong-Suck 대한전자공학회 2005 電子工學會論文誌-SD (Semiconductor and devices) Vol.42 No.9

본 논문에서는 평면계획 단계에서 모듈의 전원 잡음을 줄이기 위해 필요한 decoupling capacitance를 효과적으로 할당하는 방법을 제시한다. 먼저, 각 모듈의 decoupling capacitance가 과대평가되고 추가 면적 삽입으로 모듈의 전원 잡음이 변하는 기존 접근 방법의 문제점을 살펴보고, 이를 해결할 수 있는 새로운 방법을 제시한다. 또한, 선형프로그래밍 방법보다 빠른 시간 내에 decoupling capacitance 면적을 위한 빈 공간을 할당하는 간단한 휴리스틱 방법을 제안한다. 실험결과에서 제시된 방법은 Zhao[4]의 방법과 비교하여 decoupling capacitance 면적이 평균 $7.9\%$ 감소하고, 이로 인해 평면계획 결과의 전체 면적과 와이어 길이가 감소하였다. 또한, 추가 면적 삽입으로 인한 모듈의 전원 잡음 문제를 잘 해결하고 있음을 확인하였다. 수행시간 비교에서는 평균 $11.6\%$의 향상을 보였다. This paper proposes a method which efficiently allocates decoupling capacitance to reduce power supply noise at the floorplan level. We observe problems of previous approach that the decoupling capacitance of each module was overestimated and the power supply noises of modules were changed by inserting additional area for decoupling capacitance, and then suggest a new approach. And, we also present a simple heuristic method which can effectively allocate white space modules for decoupling capacitance area within more faster time instead of LP technique. Experimental results show that our approach can reduce the area of decoupling capacitance to average 7.9 percent compared with Zhao's approach in [4]. Therefore both total area and wire length of nniflm result are decreased. Also, we confirm that our approach solves well the problem caused by inserting additional area. In execution time comparison, our approach shows average 11.6 percent improvement.

소아의 종골 골절에 대한 임상적 고찰 : 3 예 보고

허창룡,변영수,이홍건 최신의학사 1979 最新醫學 Vol.22 No.11

외고정 장치를 이용한 원위 요골 골절의 치료

허창룡,윤정로,하학승 대한골절학회 1999 대한골절학회지 Vol.12 No.4

Purpose: Recently, intraarticular fractures or unstable fractures with severe comminution of the distal radius are increasing in younger ages, which are known to be difficult to treat. We designed this study to evaluate the clinical results and the prognosis of the external fixators for the treatment of the fractures of the distal radius. Meterial and Method: We reviewed 16 cases of the distal radius fractures, which were treated surgically with the external fixators since January 1995 to December 1997. We applied the external fixator with closed reduction and Kirschner-write fixation in 8 cases, and in the rest of the cases we did minimal open reduction before the application of the external fixator, because it was not enough to reduce the articular fragments in those cases with closed reduction. For the analysis of the clinincal results, we used the Demerit point rating system, and for the analysis of the radiologic parameter, we measured radial height, radial inclination, and volar tilting in comparison with the uninjured side from the anteroposterior and the lateral X-ray films which were taken at preoperative, postoperative, and last follow-up period. Results: In clinical results by Demerit rating point system, 2 cases were excellent, 10 cases were good, 4 cases were fair, and none of the cases was poor. In radiologic results, the average of the radial height was 8.43mm, the average of the radial inclination was 17.68o, and the average of the volar tilting was 3.87o. Conclusion: It is suggested that external fixator is one of the useful modalities in the treatment of the unstable fractures of the distal radius, and we can also improve the results of the intraarticular fractures by using the minimal open reduction technique.

체이동 매듭과 추가적인 반 매듭 증가에 따른 매듭의 장력 변화와 최적 유지력

허창룡,김승호,김병관,유재철,Hur, Chang-Yong,Kim, Seung-Ho,Kim, Byung-Kwan,Yoo, Jae-Chul 대한관절경학회 2004 대한관절경학회지 Vol.8 No.1

목적: 잠김(Locking)이 가능한 이동 매듭의 (sliding knot) 최적 매듭 유지력 (knot-holdingcapacity KHC)을 가지기 위한 추가적인 반 매듭의 (additional half-hitches) 개수를 알아보고자 하였다. 대상 및 방법: 4가지의 관절경적 이동 매듭법 (Duncan매듭법, Field 매듭법, Giant매듭법, SMC매듭법)을 대상으로 매듭 유지력을 실험하였다. 각각의 매듭을 만들기 위해 처음의 이동 매듭과 추가적인 5개의 반 매듭으로 구성된 6개의 연속적인 매듭을 만들었다. 각각의 추가된 반 매듭은 서로 교차하며 매듭의 지대 (post)도 교차하여 매는 방식으로 (reversing half-hitches with alternate posts, RHAPS) 하였다. 각각의 연속적인 매듭을 구성하기위해 No.2 Ethibond봉합사를 이용하여 각각의 매듭 형태에 12개의 매듭을 만들었다. 매듭의 인장 및 유지력 실험은 servohydraulic material testing system(Instron 8511, MTS, Minneapolis, MN)으로 주기적 부하(cyclic loading)를 시켜, 임상적으로 실패라 규정한 3 mm의 전위가 생길 때까지의 부하 (load to clinical failure). 매듭이 완전히 실패했을 때의 부하 강도 (load to ultimate failure), 그리고 실패 형태 (mode of failure)를 측정하였다. 결과: 추가적인 반 매듭이 없는 최초의 이동 매듭 자체로는 대부분 주기적 부하에 의해 매듭의 실패를 보였다. 주기적 부하 검사에서 각각의 추가적인 반 매듭이 증가할수록 평균 전위 값은 감소하였다. SMC 매듭법과 Giant 매듭법은 하나의 추가적인 반 매듭 이후로 0.1 mm이하의 전위 값을 보였고 Field와 Duncan 매듭법은 3개의 추가 반매듭이 필요하였다. SMC 매듭법과 Duncan 매듭법은 80 N을 견디기 위해 단 하나의 추가 반 매듭이 필요하였고, Field와 Giant 매듭법은 2개의 추가 반 매듭이 필요하였다. 100 N이상의 부하를 견디기 위해서는 SMC 매듭법은 3개의 추가 반 매듭이 필요하였고, 다른 3가지의 매듭법은 4개의 추가 반 매듭이 필요하였다. 추가 반 매듭이 증가함에 따라 봉합사는 풀리는 것보다 끊어지는 양상을 보였다. Duncan매듭법은 5개의 추가 반 매듭 이후에도 풀림현상을 보였고, 다른 3개의 매듭법은 3개의 추가 반 매듭 이후엔 75%이상이 봉합사의 풀림 현상보다는 끊어지는 양상을 보였다. (SMC, Field 매듭법은 92%, Ciant 매듭법은 75%)결론: 어떤 매듭법이라도 이동 매듭법 만으로는 주기적 부하 검사를 견디지 못했다. 모든 종류의 실험에서 SMC 매듭법은 최소2개의 두개의 추가 반 매듭이 필요하였다. Duncan 매듭법은 최적 매듭 유지력을 위해 3개 이상의 추가 반 매듭이 필요하였다. 모든 매듭법에서 3개나 그 이상의 추가 반 매듭이 최적 유지력에서 정점에 가까운 양상을 보였다. Purpose: To evaluate the optimal number of additional half hitches for achieving an optimal knot-holding capacity (KHC) of Lockable sliding knots. Methods: Four configurations of arthroscopic knots (Duncan loop, Field knot, Giant knot, and SMC knot) were tested for their knot-holding capacity. For each knot configuration, 6 sequential knots were made including the initial sliding knot and additional 5 knots by incrementing one half hitches at a time. Each added half-hitch were in reversing half-hitches with alternate posts (RHAPs) fashion. For each sequential knot configuration, 12 knots were made by No. 2 braided sutures. On the servo-hydraulic material testing system (Instron 8511, MTS, Minneapolis, MN), cyclic loading, load to clinical failure (3-mm displacement), load to ultimate failure, and mode of failure were measured. Results: Most of the initial loop without additional half-hitch showed dynamic failure with cyclic loading. The mean displacement after the end of cyclic loading decreased with each additional half-hitches. SMC and Giant knot reached plateau to 0.1 mm or less displacement after one additional half-hitch, shereas Field and Duncan loop needed 3 additional half-hitches. The SMC and Duncan knots needed 1 additional half-hitch to reach greater than 80N at clinical failure, whefeas the other 2 knots needed2 additional half-hitches. For the load exceeding 100N for clinical failure, the SMC knot required 3 additional half-hitches and the other three knots needed 4 additional half-hitches. As the number of additional half-hitches incremented, the mode of failure switched from pure loop failure (slippage) to material failure (breakage). Duncan loop showed poor loop security in that even with 5 additional half-hitches, some failed by slippage (17%). On the other hand, after 3 additional half-hitches, the 3 other knots showed greater than 75% of failure by material breakage mode (SMC and Field 92%, Giant 75%). Conclusion: Even with its own locking mechanism, lockable sliding knot alone does not withstand the initial dynamic cyclic load. For all tested variables, SMC knot requires a minimum of 2 additional half-hitches. Duncan knot may need more than 3 additional half-hitches for optimal security. All knots showed a mear plateau in knot security with 3 or more additional half-hitches.

경골에 발생한 골막하 결절종 : 1례 보고 A Case Report

허창룡 최신의학사 1990 最新醫學 Vol.33 No.10

S-자형 금속판을 이용한 요추 전방전위증의 수술적 치료 : Preliminary report

허창룡,한승범 최신의학사 1994 最新醫學 Vol.37 No.5

장기운동이 손상건재생에 미치는 영향에 관한 실험적 연구

허창룡,채인정 고려대학교 의과대학 1986 고려대 의대 잡지 Vol.23 No.1

The purpose of this study is to investigate the effects of long-standing exercise on the repair of injured tendon and prevention of adhesion with tendon sheath and epitenon. The experiment was carried out with 64 rabbits which were operated by the following procedure. The 2nd deep flexor tendon of hindpaw of each rabbit was exposed through longitudinal incision of skin, subcutaneous and tendon sheath. The exposed tendon was served by 1/3 of the width of tendon including its epitenon. In group Ⅰ, only the incised tendon sheath was sutured with 7-0 silk under the nicroscopic procedure. In Group Ⅱ, the incised tendon sheath was sutured with 7-0 silk and the edges of severed tendon ends including epitenon with 4-0 silk. All the operated limbs were left free to mobilize. Furthermore, early active exercise was allowed for a long period and the severed tendons were examined at postoperative 1, 2, 3, 4, 16, 24, 32, and 40 weeks respectively. The results obtained were as follows: 1. Grossly, hemorrhage, inflammatory reaction, and adhesion between tendon and tendon sheath were mainly observed during the first two weeks and were severer in group Ⅱ. 2. Microscopically, inflammatory reaction of tendon sheath and tendon adhesion were observed during the first three weeks only and were also severer in group Ⅱ. 3. The proliferation of tenocytes and capillary blood vessels and the disarrangement of tenocytes at the severed ends of tendon were lasted longer in group Ⅱ and group Ⅰ. 4. The inflammatory reaction and tendon adhesion were almost not observed after postoperative 16 weeks and no differences were noted between group Ⅰ and group Ⅱ grossly and microscopically. The above findings leads to the following conclusion that long-standing active exercise after tendon injury helps regeneration of the injured tendon and prevents from adhesion between the tendon sheath and the epitenon.

탈출된 요추부 추간판의 형태학적 양상과 직하지 거상시의 임상적 증상과의 관계에 대한 연구

허창룡,변영수,최용경,한상원 고려대학교 의과대학 1998 고려대 의대 잡지 Vol.35 No.2

Low back pain is one of the leading cause of discomfort people complaining worldwide. It is well known that about 80% of people experience low back pain and its leading cause is the herniated intervertebral disc (HIVD) . Diagnostic approaches towards HIVD are mainly myelography, computerized tomogram(CT) and magnetic resonance imaging(MRI) and in physical examination straight leg raising test(SLRT) serves its main role. In this study, We analysed 72 patients of HIVD and tried to evaluate the relationship between clinical manifestations during SLRT and morphological figures of the herniated disc including its size, shape and location classified by the CT image. The results obtained were as follows : 1. The locations of the herniated disc were intermediate in 30 cases(42%), central in 26 cases(36%) and lateral in 16 cases(22%). 2. In twenty six cases of central herniation, 19 patients(73%) complained low back pain and radiating leg pain and 7 patients(27%) complained only low back pain. In thirty intermediate type herniations, 21 patients(70%) complained low back pain and radiating leg pain and 9 patients(30%) complained only low back pain. In sixteen lateral type herniations, 13 patients(81%) complained low back pain and radiating leg pain and 3 patients(l9%) complained only low back pain. 3. The pattern of pain produced by passive straight leg raising : Only the symptoms of low back occurred in 10 cases(43%) of central type, 1 case(4%) of intermediate type. Low back pain and radiating leg pain occurred in 13 cases(57%) of central type, 19 cases(73%) of intermediate type and 7 cases(44%) of lateral type. Symptoms of only leg pain occurred in 6 cases(23%) of intermediate type and 8 cases(56%) of lateral type. 4. The size index of herniated disc was on average 0.27. Those who complained of continuous pain showed 0.32±15.47 on average and intermittent pain, 0.21±17.24. There were statisticall significance between the size index and pain. 5. In the morphologic figures of the herniated disc, 43 cases(63%) showed blunt apex, and 29 cases(37%) showed sharp apex. 6. The relationship between SLRT (+) patients and the size, shape and morphology of the herniated disc showed no statistical significance.

인공 고관절 치환술 후 적혈구 침강속도 및 C-반응성 단백질의 변화

허창룡,박찬응홍재영,손원용 대한고관절학회 2005 Hip and Pelvis Vol.17 No.4

Purpose: Fever and leukocytosis are commonly used indicators of infection but are nonspecific and can be influenced by several factors other than infection. Although changes of erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) are currently being used as the standard laboratory tests for the assessment of infection, very few studies have evaluated their application in total hip arthroplasty (THA). The authors evaluated the levels of ESR and CRP after THA to define the value of these two tests as indicators of infection after THA. Materials and methods: We analyzed 94 primary THA and 47 revision THA. None of the cases had any clinical evidence of infection. The serum levels of ESR and CRP were determined preoperatively and postoperatively at 1, 3, 7, 14, 30, 60, 90 and 180 days in all the cases. Results: The mean ESR increased to a maximum (51.5 mm/hr in primary THA, 55.7 mmg/hr in revision THA) on the 3rd day postoperatively after which it decreased gradually and returned to normal level in the first postoperative month. The level of CRP was remarkably high (90.4 mg/l in primary THA and 102.4 mg/l in revision THA) on the 3rd day postoperatively after which it also began to fall more rapidly and returned to normal level in the 2nd week postoperatively. CRP was not influenced by age or sex. Conclusion: Measurement of both ESR and CRP is helpful in the detection of infection after THA, but the level of CRP is more sensitive and informative than ESR. 목적: 인공 고관절 치환술 후 발열이나 혈중 백혈구 수의 증가가 감염의 발생을 나타내는데 흔히 사용되는 진단 방법이지만 비특이성과 여러 가지 요인으로 인해 많은 영향을 받으므로, 최근에는 적혈구 침강속도(ESR)와 C-반응성 단백질(CRP)이 감염을 진단하는 지표로 많이 사용되고 있다. 그러나 인공 고관절 치환술 후 정상적인 적혈구 침강속도와 C-반응성 단백질의 변화에 대한 발표는 많지 않아 그 변화를 조사하고 이를 통계적으로 분석하였다. 대상 및 방법: 인공 고관절 치환술을 시행 받은 환자 중 적혈구 침강속도 및 C-반응성 단백질에 대하여 6개월 이상 추시가 가능하였던 환자를 대상으로 하였다. 이 중 전치환술 94예, 재치환술 47예였다. 전치환술의 경우는 남자 62예, 여자 32예였으며, 재치환술의 경우는 남자 33예, 여자 14예였다. 적혈구 침강속도 및 C-반응성 단백질의 측정은 술 전, 술후 3일, 1주, 2주, 1개월, 2개월, 3개월 및 6개월 이후에 시행하였다. 결과: 적혈구 침강속도는 전치환술 및 재치환술 후 3일에 각각 51.5 mm/hr 및 55.7 mm/hr로 가장 높았으며 1주부터 감소하기 시작하여 1개월에 모두 정상범위로 회복되었다. C-반응성 단백질은 전치환술 및 재치환술 후 3일에 각각 90.4mg/l 및 102.4 mg/l로 가장 높았고, 그 후 급격히 감소하기 시작하여 2주에 정상범위로 회복되었다. 술 후 시간의 경과에 따라 수치가 감소하는 공통된 양상을 보였으나, C-반응성 단백질의 경우에서 적혈구 침강속도의 경우보다 술 후 초기의 수치 증가 폭 및 감소 폭이 더 뚜렷한 변화를 보이고 성별, 연령 등에 따른 영향이 없었다. 결론: 인공 고관절 치환술 후 감염의 진단에 적혈구 침강속도 및 C-반응성 단백질 검사가 이용될 수 있으며, C-반응성 단백질 검사가 적혈구 침강속도보다 더 유용할 것으로 사료된다.