Epidemiology of Hip Replacements in Korea from 2007 to 2011

윤필환,이영균,안정훈,장은진,김윤정,곽홍석,윤강섭,김희중,유정준 대한의학회 2014 Journal of Korean medical science Vol.29 No.6

We analyzed national data collected by the Health Insurance Review and AssessmentService in Korea from 2007 to 2011; 1) to document procedural numbers and proceduralrate of bipolar hemiarthroplasty (BH), primary and revision total hip arthroplasties (THAs),2) to stratify the prevalence of each procedure by age, gender, and hospital type, andquantified, 3) to estimate the revision burden and evaluate whether the burden is changedover time. Our final study population included 60,230 BHs, 40,760 primary THAs, and10,341 revision THAs. From 2007 to 2011, both the number and the rate of BHs, primaryTHAs increased steadily, whereas there was no significant change in revision THAs. Overthe 5 yr, the rate of BHs and primary THAs per 100,000 persons significantly increased by33.2% and 21.4%, respectively. The number of revision THAs was consistent over time. The overall annual revision burden for THA decreased from 22.1% in 2007 to 18.9% in2011. In contrast to western data, there were no changes in the number and rate ofrevision THAs, and the rates of primary and revision THAs were higher for men than thosefor women. Although 5 yr is a short time to determine a change in the revision burden,there have been significant decreases in some age groups.

Zn의 첨가량이 다이캐스팅용 ADC12 알루미늄 합금의 특성변화에 미치는 영향 (초)

윤필환,손현진,임관우,권용재,이광학,김용현,박주열 대한금속재료학회 ( 구 대한금속학회 ) 2008 대한금속재료학회 학술대회 개요집 Vol.2008 No.1

Aspergillus Septic Arthritis of the Hip in an Immunocompetent Middle-aged Female with Undiagnosed Recurrent Pulmonary Aspergillosis

윤필환,송주호,윤강섭,장재석,김희중,유기형 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.

사지 구제술 합병증 치료에서 연부조직 연장을 위한 한시적 외고정 기기의 유용성

윤필환,강현귀,김갑중,오주한,이상훈,이상기,김한수,Yoon, Pil-Whan,Kang, Hyun-Guy,Kim, Kap-Jung,Oh, Joo-Han,Lee, Sang-Hoon,Lee, Sang-Ki,Kim, Han-Soo 대한근골격종양학회 2005 대한골관절종양학회지 Vol.11 No.2

목적: 종양 대치물을 이용한 사지 구제 술 후 발생한 심부감염, 해리, 또는 하지 단축 등의 합병증으로 종양 대치물을 제거한 후 단계별 치료를 하는 과정에서 연부 조직 구축으로 인해 초래되었거나 또는 합병증 치료 시작 당시부터 있었던 하지 단축에 대하여 연부조직 연장 만을 위하여 외고정 기기를 한시적으로 사용한 결과를 평가하고 그 유용성을 알아 보고자 하였다. 대상 및 방법: 악성 골 종양으로 종양대치물을 이용하여 사지구제술을 받은 후 발생한 합병증으로 연부 조직 구축 및 하지 단축이 발생되어, 연부 조직 연장을 위해 외고정 기기(Dyna-extor$^{(R)}$)를 사용하였던 5명의 환자 6예를 대상으로 하였다. 외고정 기기는 골격 결손부위의 근위와 원위 정상 뼈 부분에 금속핀을 삽입 후 설치 하였다. 외부 고정기 연장은 술 후 약 3일부터 하였으며, 신경학적 증상이 나타나지 않는 범위에서 하루에 2~3 mm 이상씩 시행하였다. 결과: 치료 부위는 원위 대퇴골이 3예, 근위 경골이 2예였다. 최초 사지 구제술시의 평균연령은 13.4세(9~19세)였으며, 외부 고정기를 설치할 때의 평균연령은 22.2세(15~29세)로 최초 사지구제술 후 합병증으로 하지 단축이 발생되어 외부 고정기를 설치할 때까지의 기간은 평균 8.8년(3~14년)이었다. 4명의 환자 5예에서 평균 착용 기간은 37일(25~50일)에 평균 5.8 cm을 연장 하였으며, 1명의 환자는 150일 동안 착용하여 7.2 cm을 연장하였다. 외부 고정기 제거 3명의 환자에서 종양 대치물을 재삽입 하였고, 2예의 환자는 슬관절 유합술을 시행하였다. 이후 평균 추시 기간은 22개월이었으며 감염은 재발하지 않았다. 결론: 종양 대치물을 이용한 사지 구제술 후의 합병증으로 또는 합병증의 치료 과정에서 초래되는 연부 조직 구축과 하지 단축에 대하여 외고정 기기를 한시적으로 사용하여 효과적으로 하지 길이를 연장할 수 있었으며, 추후 종양 대치물 재 삽입이나 관절 고정술의 수술을 용이하게 해줄 수 있는 유용한 방법이라고 사료된다. Purpose: We evaluated the effectiveness of temporary using the extendible external fixator (EF) for lengthening of soft tissue that contracture caused by tumor prosthesis removal in the treatment of complications after limb salvage surgery like deep infection and loosening. Materials and Methods: Five patients six cases were included who underwent extendible EF (Dyna-extor(r)). EF was applied after insertion of half pin to the proximal and distal bone of defect area. EF lengthening started at third day of post-operation, above 2-3 mm per day in the range of no neurological sign. Results: The treatment area was three in femur and two in tibia. Mean age when the time of EF apply was 22.2 years old (range 15-29), but its primary limb salvage operation had done in 13.4 years old (range 9-19), therefore mean times of interval between initial tumor prosthesis reconstruction and temporary EF apply was 8.8 years (range 3-14). One patient had EF for 150 days with 7.2 cm lengthening. Others 5 cases of 4 patients had EF for mean 37 days (range 25-50) and mean soft tissue lengthening was 5.8 cm. Three patients underwent re-insertion of tumor prosthesis and two patients underwent knee fusion as final operation and showed no evidence of infection through mean 22 months follow up period. Conclusion: Temporary using of extendible EF is an effective method for correction of leg shortening which occurred by soft tissue contracture in the complications of limb salvage operation or their treatment process, and it could be provide easily application of tumor prosthesis and knee fusion as final operation.

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

윤필환,곽홍석,유정준,윤강섭,김희중 대한의학회 2014 Journal of Korean medical science Vol.29 No.4

We evaluated the clinical course of subchondral insufficiency fracture of the femoral head(SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearingconservative treatment. During the follow-up period, the patients with intractable painunderwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edgeangle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC wasclassified as mild (< 2 mm), moderate (2-4 mm), and severe (> 4 mm). The progression ornew development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation betweenclinical outcomes and the extent of initial FHC. However, a significantly larger proportionof patients that underwent THA showed JSN and FHC progression compared to thesymptom improvement group. The risk factor significantly associated with failedconservative treatment was JSN (P = 0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinicalresults of conservative treatment for SIFFH in elderly patients are relatively poor. Thepatients with JSN are at higher risk of failed conservative treatment.

Femoral Head Fracture without Dislocation by Low-Energy Trauma in a Young Adult

윤필환,Hyun Seok Jeong,유정준,구경회,윤강섭,김희중 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidenceof hip dislocation. While plain radiographs showed no defi nite fracture or dislocation, computed tomography (CT) and magneticresonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspectof the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probablyrepresented subluxation with spontaneous relocation. The characteristic fi ndings and possible mechanisms of this fracture werepostulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were betterthan those of previously reported indentation fractures.

The Epidemiology and National Trends of Bearing Surface Usage in Primary Total Hip Arthroplasty in Korea

윤필환,유정준,김윤정,유승미,이상훈,김희중 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.1

Background: We analyzed the data for primary total hip arthroplasty (THA) in the Korean nationwide database to assess (1) the epidemiology and national trends of bearing surface usage in THAs and (2) the prevalence of each type of bearing surface according to age, gender, hospital type, primary payer, and hospital procedure volume. Methods: A total of 30,881 THAs were analyzed using the Korean Health Insurance Review and Assessment Service database for 2007 through 2011. Bearing surfaces were sub-grouped according to device code for national health insurance claims and consisted of ceramic-on-ceramic (CoC), metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM). The prevalence of each type of bearing surface was calculated and stratified by age, gender, hospital type, primary payer, and procedure volume of each hospital. Results: CoC was the most frequently used bearing surface (76.7%), followed by MoP (11.9%), CoP (7.3%), and MoM (4.1%). The proportion of THAs using a CoC bearing surface increased steadily from 71.6% in 2007 to 81.4% in 2011, whereas the proportions using CoP, MoP, and MoM bearing surfaces decreased. The order of prevalence was identical to that in the general population regardless of age, gender, hospital type, primary payer, and hospital procedure volume. Conclusions: The trends and epidemiology of bearing surface usage in THAs in Korea are different from those in other countries, and the CoC bearing surface is the most prevalent articulation. In future, the results of a large-scale study using nationwide data of THAs involving a CoC bearing surface will be reported in Korea.

전주시 유통산업발전법으로 인한 갈등사례

윤필환 한국갈등학회 2017 한국갈등학회보 Vol.3 No.1

결합 링 반사기 레이저 다이오드의 광대역 파장 가변 및 변조 특성 해석

윤필환,김수현,정영철,Yoon, Pil-Hwan,Kim, Su-Hyun,Chung, Young-Chul 한국광학회 2006 한국광학회지 Vol.17 No.6

본 논문에서는 기존의 DBR 격자 기반의 파장선택성 반사기를 대체시킬 수 있는 결합 링 반사기가 집적된 레이저 다이오드를 연산자 분리 시 영역 모델을 통해서 분석한다. 결합 링 반사기는 브래그 격자(Bragg grating) 필요로 하지 않는 평판 도파로 형태의 반사기이다. 결합 링 반사기는 하나의 직선 도파로와 두 개의 결합된 형태의 링 공진기가 하나의 직선 도파로에 결합되어 있다. 위상 조절 전류의 조절에 따른 파장 가변 범위는 수십 nm 정도가 되고, 파장 가변 과정에서 부모드 억압비도 35 dB 이상이 됨을 수치 해석을 통해 확인했다. 또한 결합 링 반사기 레이저 다이오드는 종래의 레이저 다이오드에 비해서 유효 공진기 길이(Effective Cavity Length)가 매우 길기 때문에 진폭 변조 시 20-30 GHz 주파수 영역에서 추가적인 공진 특성을 보이고, 이 특성으로 인해 진폭 변조 대역폭이 상당히 향상될 수 있으리라 기대된다. A time-domain modeling approach is used to study characteristics of a widely tunable coupled-ring reflector (CRR) laser diode(LD). The CRR consists of a bus waveguide and two coupled ring resonators coupled to the bus without resorting to distributed Bragg grating structure. The tuning range can be a few tens of nanometers with a side mode suppression ratio exceeding 35dB through the adjustment of currents into the phase control sections in the rings. The CRR laser diode has long effective cavity length compared to conventional laser diodes. Accordingly, a broad additional resonance peak in the amplitude modulation characteristics is observed between 20 to 30 GHz, implying the extension of amplitude modulation bandwidth.

Cementless Total Hip Arthroplasty for Patients with Crowe Type III or IV Developmental Dysplasia of the Hip: Two-Stage Total Hip Arthroplasty Following Skeletal Traction after Soft Tissue Release for Irreducible Hips

윤필환,김중일,Dong Ok Kim,Cheol Hwan Yu,유정준,김희중,윤강섭 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.3

Background: Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. Methods: Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. Results: The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. Conclusions: The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.