전외측과 외측 병용 도달법에 의한 관절 외 원위 상완골 골절의 치료

권대규 ( Dae Gyu Kwon ),문경호 ( Kyoung Ho Moon ),나석인 ( Suk In Na ),신병기 ( Byung Ki Shin ),이동주 ( Tong Joo Lee ) 대한골절학회 2012 대한골절학회지 Vol.25 No.3

목 적: 상완골 원위 간부 골절의 치료에서 요골 신경 손상 방지를 위한 새롭게 고안된 전외측과 외측 병용 도달법을 이용한 관혈적 정복술의 임상적 유용성에 대하여 분석하였다. 대상 및 방법: 상완골 원위 간부 골절 환자 중 수술적 정복 및 금속판 내고정술을 시행 받고 1년 이상 추시가 가능하였던 24예를 대상으로 하였다. 연령, 성별, 골절 유형, 골유합 시기, 주관절의 운동 범위, 합병증 등을 분석하였고, 주관절 기능은 Mayo elbow performance index (MEPI)로 평가하였다. 결과: 임상적 골유합은 평균 10.8주 (6∼20주)였다. 술 전부터 요골 신경 마비가 있었던 3예는 불완전 마비로 모두 회복되었다. 주관절의 기능은 MEPI상 매우 우수가 13예, 우수가 10예로 우수 이상이 95.83%였다. 술 후주관절 관절 운동 범위는 신전 5.5도 (0∼15도), 굴곡 131.5도 (120∼145도)로 대부분 기능적 장해가 없었다. 수상 전 작업으로 복귀는 평균 11.2주 (5∼32주)였다. 특이 합병증은 없었다. 결론: 새롭게 고안된 전외측과 외측 병용 도달법은 요골 신경의 보호가 용이하며 충분한 고정 공간을 확보할 수 있는 유용한 수술법이다. Purpose: The purpose of this study was to analyze the clinical effectiveness of open reduction in the treatment of distal humeral fracture using a newly designed combined approach of anterolateral and lateral approaches to protect the radial nerve. Materials and Methods: We investigated 24 consecutive cases of distal humeral fracture who received open reduction and internal fixation with a plate and screws with a minimum follow-up period of 1 year. We analyzed the patients` age, sex, fracture pattern, timing of the union, range of motion of the elbow joint, and complications. The Mayo elbow performance index (MEPI) was employed for the assessment of elbow joint function. Results: Clinical union was observed at 10.8 weeks (6∼20 weeks) on average. Pre-operatively, there were 3 cases of incomplete radial nerve palsy. All of the cases recovered, and there was no additional radial nerve palsy due to surgery. According to the MEPI, 13 cases were excellent and 10 cases were good or better, comprising 95.83% of the cases. The range of motion at the elbow was 5.5 degrees (0∼15 degrees) of extension, and 131.5 degrees (120∼145 degrees) of flexion, suggesting no functional disability. The duration of return to work was 11.2 weeks (5∼32 weeks) on average. There were no nonunion, malunion, or infection complications. Conclusion: The combined anterolateral and lateral approach we designed is a clinically effective approach due to facilitation of protection of the radial nerve and attainment of adequate fixation space.

외상 후 발생한 횡문근육종

권대규(Dae Gyu Kwon),박성준(Sung Jun Park),윤영훈(Young Hoon Yoon),이동주(Tong Joo Lee) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.3

외상은 횡문근육종을 포함한 일부 육종의 발생에 영향을 미친다고 알려져 있고 수술 후 반흔이나 화상 흉터, 골절 부위, 금속 내고정물 주위에서 수년 간의 잠복기를 거쳐 육종을 일으킨 사례들이 드물게 보고되고 있다. 저자들은 컨베이어 벨트에 의해 압궤상을 입은 전완부에 11년 뒤 발생한 횡문근육종의 사례를 경험하였다. 조직 손상으로 인한 염증 반응, 많은 방사선 촬영에 대한 노출, 금속 내고정물, 감각 및 운동 마비로 인한 무의식적이고 반복적인 손상이 육종의 발생에 영향을 미쳤으리라고 생각된다. 이러한 광범위한 조직 손상 후에는 육종 발생 가능성을 염두에 두고 육종 유발 요인에 대한 노출에 주의를 기울여야 하겠다. Trauma is frequently implicated in the development of sarcomas, including rhabdomyosarcoma. Rare soft tissue sarcomas have been reported to arise in scar tissue following surgical procedures or thermal or acid burns, at fracture sites, and in the vicinity of plastic or metal implants, usually after a latent period of several years. The authors encountered a case of a rhabdomyosarcoma arising from the forearm crushed by a conveyor belt 11 years ago. Several possible etiological factors for sarcoma development were identified in this patient, including tissue damage and inflammation, as well as the presence of metal implants and the limb’s exposure to radiation during multiple imaging tests. After severe soft tissue damage, the occurrence of a sarcoma should be considered and more attention should be paid to the causative factors for sarcoma.

미세입자 분사가공시 직교배열표의 통계적 분석에 의한 표면형상의 최적 분사 조건

권대규(Dae-Gyu Kwon),왕덕현(Duck Hyun Wang) 한국기계가공학회 2016 한국기계가공학회지 Vol.15 No.4

A study on the micro particle blasting was conducted to find the optimum conditions of the blasted surface of aluminum 6061. The particle type such as Al₂O₃ and SiC, nozzle diameter, pressure, standoff distance and injection time were used as blasting conditions. Statistical method of orthogonal arrays(ANOVA) was used to find optimum conditions of maximum depth and maximum diameter of blasted surface. Particle type, nozzle diameter, and pressure were found to be the main factors of maximum blasted depth and diameter. Maximum blasted diameter was affected by increasing pressure and nozzle diameter but saturated maximum diameter. Maximum blasted depth was affected by pressure and nozzle diameter when aluminum 6061 was blasted with Al₂O₃ particle. The value of surface roughness was increased as pressure and nozzle diameter increased when aluminum 6061 was blasted with SiC

버블을 이용한 미세칩 제거장치의 개발

최성윤(Sung-Yun Choi),권대규(Dae-Gyu Kwon),이세한(Sea-Han Lee),박태현(Tae-hyun Park),왕덕현(Duck Hyun Wang) 한국기계가공학회 2021 한국기계가공학회지 Vol.20 No.10

Machining operations require the removal of chips to keep the water-soluble cutting oil clean and fresh throughout the operation time. Water-soluble cutting oil for metal processing is diluted using a 3-8% solution in water which is generally replaced every three to six months. This study aims to develop multiple purification devices to efficiently remove fine contaminating particles from water-soluble cutting oil. The 2D concept designs were created using AutoCAD. The designs were drawn using the 3D modelling feature of CATIA. Flow analysis was performed in a bubble purifier using Ansys computational fluid dynamics (CFD). This analysis has aided in improving the design and structure of the device to create the final prototype. Experiments were conducted to check the prototype"s performance. Comparisons of the effects of each process variable on the experiment was carried out using ANOVA.

코너부 모깍기 엔드밀가공시 가공정밀도의 최적조건에 관한 연구

최성윤(Sung-Yun Choi),권대규(Dae-Gyu Kwon),박인수(In-Su Park),왕덕현(Duck-Hyun Wang) 한국기계가공학회 2016 한국기계가공학회지 Vol.15 No.4

Endmill fillet cutting at the corner was conducted with the online measurement of cutting forces and tool deflection by a tool dynamometer and an eddy current sensor system. The profile of the machined surface was also compared with the CAD profile with a Coordinate Measuring Machine (CMM) and CALYPSO software. It was found that the end mill cutter with four blades has a better surface profile than that with two blades, and the cutting forces and tool deformation were increased as the cutting speed was increased. When the tool located at the degree 45° corner was found to conduct the maximum cutting force than started to the point of the workpiece. As it was compared with the CMM and ANOVA analysis result in the case that the cutting force and tool deformation was the maximum, it was found that the result was affected by the spindle speed and the number of blades.

평엔드밀 포켓가공시 절삭력과 공구변형에 관한 연구

최성윤(Sung-Yun Choi),권대규(Dae-Gyu Kwon),박인수(In-Su Park),왕덕현(Duck-Hyun Wang) 한국기계가공학회 2017 한국기계가공학회지 Vol.16 No.2

Recently, the operation of precision pocket machining has been studied for the high speed and accuracy in industry to increase production and quality. Moreover, the demand for products with complex 3D free-curved surface shapes has increasing rapidly in the development of computer systems, CNC machining, and CAM software in various manufacturing fields, especially in automotive engineering. The type of aluminum (Al6061) that is widely used in aerospace fields was used in this study, and end-mill down cutting was conducted in fillet cutting at a corner with end-mill tools for various process conditions. The experimental results may demonstrate that the end mill cutter with four blades is more advantageous than that of the two blades on shape forming in the same condition precise machining conditions. It was also found that cutting forces and tool deformation increased as the cutting speed increased. When the tool was located at 45° (four locations), the corner was found to conduct the maximum cutting force rather than the start point of the workpiece. The experimental research is expected to increase efficiency when the economical precision machining methods are required for various cutting conditions in industry.

알루미늄 환봉의 나선형 표면 미세입자 분사가공의 조건에 대한 연구

최성윤(Sung-Yun Choi),이은주(Eun-Ju Lee),이세한(Sea-Han Lee),권대규(Dae-Gyu Kwon) 한국기계가공학회 2020 한국기계가공학회지 Vol.19 No.8

The goal of this study is to determine the influence of major factors on the spiral surface microparticle injection machining of cylindrical specimens by the statistical method ANOVA. Before the experiment, rod-shaped test specimens and jigs for helical surface spraying were prepared, and the surface roughness was measured with a surface roughness meter. The injection particle, nozzle diameter, and injection pressure were the primary parameters of the experiment. Other factors that were considered were injection height, injection time, revolutions, and feed distance. The surface roughness after machining was measured, and the effects of the surface roughness data on the primary factors were determined with ANOVA.

미세입자 분사가공 시 표면 조건 변화에 따른 가공 표면 형상 분석

최성윤(Sung-Yun Choi),황철웅(Cheol-Ung Hwang),권대규(Dae-Gyu Kwon) 한국기계가공학회 2018 한국기계가공학회지 Vol.17 No.5

This study analyzes the change of Al 6061-T6 specimen surface shape when undergoing microparticle spraying and analyzes the influence of factors on the experiment. Fine particle spraying is applied to the specimen and the surface shape of the processed surface is measured through a surface shape measuring device. The measured data was analyzed by the ANOVA method to investigate the effect of factors such as particle, nozzle diameter, pressure, injection height, and injection time on the injection depth and injection diameter.

전위된 상완골 원위부 과간 골절에서 재건 금속판 및해부학적 잠김 금속판을 이용한 내고정술의 비교

이동주 ( Tong Joo Lee ),김영태 ( Young Tae Kim ),권대규 ( Dae Gyu Kwon ),박주용 ( Ju Yong Park ) 대한골절학회 2014 대한골절학회지 Vol.27 No.4

목적: 성인의 전위된 상완골 원위부 과간 골절의 수술적 치료에서 재건 금속판 및 해부학적 잠김 금속판을 이용한 내고정술의 임상적, 방사선학적 결과 및 합병증 등에 대해 후향적으로 비교 분석하고자 하였다.대상 및 방법: 2002년 8월부터 2012년 5월까지 상완골 원위부 과간 골절로 수술적 치료를 받은 환자 중 재건 금속판을 이용하여 고정한 20예의 환자들을 A군으로, 해부학적 잠김 금속판을 이용하여 고정한 20예의 환자들을 B군으로 하였다. 임상적 결과는 Cassebaum 평가 척도와 Mayo 주관절 기능 평가 척도, disabilities of the arm, shoulder and hand 점수를 이용하여 비교하였다.결과: Mayo 주관절 기능평가 점수는 A군에서 우수 8예, 양호 10예, 보통 2예였으며, B군에서는 우수 12예, 양호 7예, 보통 1예였다. 그 외 수술 후 운동범위가 90도 굴곡부터 120도 굴곡까지 획득된 시기는 A군의 경우 평균 8.3일(6-15일), B군의 경우 평균 5.5일(5-9일)로 두 군 간 유의적인 차이가 있었다(p=0.04). 이 중 골밀도가 낮은 환자 2예에서 나사 이완의 고정소실이 발생하였는데 모두 재건판을 이용한 경우였다.결론: 전위된 상완골 원위부 과간 골절에서 해부학적 잠김 금속판을 이용한 치료는 나사 이완의 합병증을 줄이면서 조기 관절 운동이 가능하여 좋은 임상적 결과를 얻을 수 있는 방법으로 생각된다. Purpose: To analyze the clinical result of a conventional reconstruction plate (CRP) fixation and locking compressive plate (LCP) fixation on the surgical treatment of an adult’s displaced intercondylar fracture of humerus. Materials and Methods: A total of 40 patients enrolled in the study were treated between August 2002 and May 2012. Fixation with a CRP was performed in 20 patients (group A) and anatomical locking compression plate fixation was performed in 20 patients (group B). The clinical and functional evaluation was performed according to the Mayo elbow performance score and Cassebaum classification of elbow range of motion (ROM), disabilities of the arm, shoulder and hand score. Results: The Mayo elbow functional evaluation scores, eight cases were excellent, 10 cases were good, and two cases were fair in group A, and 12 cases were excellent, seven cases good, and one case fair in group B; both groups showed satisfactory results. The durations of attaining 90 to 120 degrees of the ROM of joints postoperatively were 8.3 days on average (6 to 15 days) in group A and 5.5 days on average (5 to 9 days) in group B, demonstrating a significant difference between the two groups (p=0.04). Although the correlations of clinical results according to the difference of bone mineral densities (BMDs) were not statistically significant between the two groups (p=0.35), loss of fixation occurred due to loosening of screws in two patients with low BMDs in whose operations reconstruction plates were used. Conclusion: The use of locking compressive plate on the surgical treatment of an diaplaced intercondylar fracture of humerus have a good clinical results because that permits early rehabilitation through good fixation and reduces the complications such as loosening of screws.

원위부 쇄골 골절에서 부리돌기-쇄골 간 나사와 긴장대를 이용한 고정의 유용성

문경호 ( Kyung Ho Moon ),이동주 ( Tong Joo Lee ),권대규 ( Dae Gyu Kwon ),신병기 ( Byoung Ki Shin ),우민수 ( Min Su Woo ) 대한골절학회 2013 대한골절학회지 Vol.26 No.1

목적: 전위된 원위부 쇄골 골절의 치료에 있어 부리돌기-쇄골 간 나사 고정과 긴장대를 이용한 고정의 유용성을 분석하였다. 대상 및 방법: 2006년 10월부터 2010년 12월까지 Neer type 제2형의 원위부 쇄골 골절에 대하여 수술적 치료를 받은 18명의 환자를 대상으로 하였다. 부리돌기-쇄골 간 나사 고정술 및 나사 머리를 이용한 장력 대 강선 고정술을 모든 환자에게 시행하였다. 임상적, 방사선학적 분석을 시행하였으며 University of California at Los Angeles (UCLA) shoulder score를 측정하여 수술 후 견관절의 기능을 평가하였다. 결과: 모든 환자는 수술 후 평균 9.5주(8-11주)에 골유합을 이루었고 국소마취하 금속제거술을 시행하였다. 모든 환자는 수술 1년 후 정상적 견관절 운동범위를 보였다. 2명의 환자는 나사의 이완이 발생했고 1명의 환자는 나사의 파손이 발생했으나 골유합의 지연이나 감염, 재골절 등의 합병증은 관찰되지 않았다. 술 후 1년 시의 UCLA shoulder score는 1명의 환자를 제외하고는 우수(excellent)의 결과를 보였다. 결론: 전위된 원위 쇄골 골절에 있어 부리돌기-쇄골 간 나사 고정과 긴장대를 이용한 고정술은 합병증이 적고 임상적으로 우수한 결과를 얻을 수 있는 유용한 방법으로 판단된다. Purpose: The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures. Materials and Methods: From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function. Results: Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation. Conclusion: Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.