소아에서의 골반골 골절

원예연,안재인,이원익,김병석,송명렬 대한골절학회 1998 대한골절학회지 Vol.11 No.1

The pelvic bone fractures in children were uncommon, except for avulsion injuries in the literature and authors had 21 cases of children' s pelvic bone fracture, ranging from 1 to 15 years. The mode of injury, type of fracture, associated injuries, morbidity and mortality, and out- come were retrospectively analyzed. The majority of injuries were from automobile-pedestrian collisions (81.0%). The Torode and Zieg type IV injury had the greatest morbidity, mortality, and complications. Sixteen patients had non-orthopedic, associated injuries and fourteen required blood transfusions within initial 48 hours after injury. Two of them passed away due to hematologic unstableness. Twenty patients were managed by conservative method, except for one operative case by using of an external fixation device. This study included only 13 cases had average I year of follow-up. One acetabular dysplasia of 5 acetabular fractures was found at 12 months after injury. The nonoperative approach for the pelvic bone injury has had a satisfactory outcome in our hospital. So, authors think that if conservative methods will be properly applied, it may be one of the methods of treatment for the children s pelvic bone fracture. Even though there is no symptoms, long-term follow-up will be inevitable for checking more severe acetabular dysplasia and leg length discrepancy.

생체역학

원예연 대한고관절학회 2003 Hip and Pelvis Vol.15 No.4

퇴행성 척추관 협착증의 치료 방법에 대한 비교

원예연,김남현 대한척추외과학회 1995 대한척추외과학회지 Vol.2 No.2

The authors reviewed 114 patients of degenerative lumbar spinal stenosis who were admitted to the Department of Orthopaedic Surgery, Severance Hospital from January 1986 to January 1991. The male to female ratio was 1:1.9 and the mean age of patient was 54 years(range 42-78). Follow-up ranged from 2 years to 5 years 4 months with a mean of 2 years 8 months. Patients could be divided into two groups. degenerative lumbar stenosis(50 patients, 44%) and with degenerative spondylolisthesis(64 patients, 56%) Of the 90 patients who had degenerative lumbar stenosis, twenty four patients(21%) was treated conservatively, fifteen patients(13%) underwent posterolateral fusion without instrumentation after posterior decompression and fifty one patients(45%) underwent posterolateral fusion with segmental spinal instrumentation using transpedicular screw after extensive posterior decompression. Among the cases applied transpedicular screw, 29 cases were Cotrel-Dubousset system, 19 cases were Steffe system and 3 cases were others. For the remaining 24 patients who had degenerative lumbar stenosis with degenerative spondylolisthesis underwent anterior interbody fusion after discectomy. According to Kim's criteria(1991), ten patients(42%) were classified as good in conservative treatment group but there was no excellent result, and seventy eight patients(87%) were classified as excellent or good in surgical treatment groups. In conclusion, for the treatment of degenerative lumbar spinal stenosis, anterior interbody fusion orposterolateral fusion after extensive decompression of stenosed neural elements are considered more reliable and satisfactory treatment than conservative treatment

인공고관절 치환술에서 신경 : 혈관계 합병증

원예연 대한고관절학회 2004 Hip and Pelvis Vol.16 No.2

비구 골절에 대한 나사못 고정시 비구와의 안전 공간에 대한 해부학적 연구

원예연,한대용,민병우,정인혁,김만경 대한정형외과학회 2004 대한정형외과학회지 Vol.39 No.6

목 적: 비구골절에서 비구의 사각형면에 평행하면서 비구와를 관통하는 나사못을 삽입하는 경우에 알아야 할 비구와의 공간적 정보를 알아보고자 하였다. 대상 및 방법: 성인 사체의 반쪽 골반 25쪽을 8토막으로 절단하여 절단선들이 비구와의 가장자리를 따라 만나는 7개의 측 정점을 얻었다. 사각형면으로부터 이들 점들까지의 수직선상에서 연골 및 뼈의 두께를 측정하고 비교하였다. 결 과: 비구와 바닥의 두께가 가장 얇은 부위의 평균 두께는 3.9±1.9 mm이었다. 사각형면으로부터 수직으로 측정한 뼈 및 연골의 총 두께의 평균은 12.7±2.1 mm에서 17.8±3.8 mm의 범위에 있었다. 비구와의 안전 공간이 제일 작은 부위는 후하방 지역으로 평균 4.8±1.6 mm (p<0.05)이었으며 다른 부위에서는 평균 8.3-10.0 mm이었다. 결 론: 본 연구의 형태학적 계측자료에 의하면 비구와의 안전 공간이 제일 작은 부위는 후하방 구역이었으므로 이 구역을 피하여 나사못을 삽입하는 것이 안전하다고 사료된다. Purpose: To obtain spatial information on the acetabular fossa concerning ‘transacetabular screw’ insertion through the acetabular fossa parallel to the quadrilateral surface for fixing an acetabular fracture. Materials and Methods: Each hemipelvis harvested from 25 adult fresh frozen cadavers was sectioned into eight segments. This resulted in seven measuring points located along the outer margin of the acetabular fossa. At these points, we measured and compared the vertical thicknesses of cartilage and bone from the quadrilateral surface. Results: The average thickness of the thinnest portion of the acetabular fossa floor was 3.9±1.9 mm. The entire thickness of the bone and cartilage measured vertically from the quadrilateral surface at the 7 points ranged from 12.7±2.1 mm to 17.8±3.8 mm. The thinnest safe space of exposed threads of the ‘transacetabular screw’ inserted through the acetabular fossa was consistently just below the posterior conus of the lunate surface, measuring 4.8±1.6 mm (p<0.05). At the other points, it measured 8.3-10.8 mm. Conclusion: We suggest that ‘transacetabular screws’ can be inserted safely if due consideration is paid to the spatial characteristics of on the acetabular fossa. Screw insertion into the postero-inferior portion of the acetbular fossa should be done carefully.

대퇴골두 해면골의 미세구조 특성과 기계적 특성의 분석

원예연,백명현,최문권,전경진,김만경,Won Ye-Yeon,Baek Myong-Hyun,Cui WenQuan,Chun KeyoungJin,Kim Man Kyung 대한의용생체공학회 2004 의공학회지 Vol.25 No.6

골다공증이 있는 대퇴골두 해면골과 골다공증이 없는 대퇴골두 해면골의 특성을 평가하고자 미세단층촬영기 및 유한요소모델을 이용하여 해면골을 미세구조 특성과 기계적 특성을 비교 및 분석하였다. 골다공증이 있는 대퇴골두는 골밀도를 측정하여 T-score 값이 -2.5 이상인 시편 15개를 사용했으며, 골다공증이 없는 대퇴골두는 사망전 골다공증으로 인한 병력이 없었던 사체 4구에서 대퇴골두 5개를 획득하여 사용하였다. 대퇴골두 해면골의 미세구조 특성을 분석하기 위해서 미세단층촬영기를 이용하여 골다공증이 있는 대퇴골두와 골다공증이 없는 대퇴골두를 촬영하여 형태학적 지수(histomorphometry index)를 구했고, 미세단층촬영기에 의해서 획득된 미세영상(pixel size=21.31㎛)을 바탕으로 유한요소모델을 재건하여 기계적 특성을 구하였다. 형태학적지수는 골다공증이 없는 대퇴골두가 골다공증이 있는 대퇴골두에 비해서 골소주 두께, 골 체적, 골 체적비, 이방성 정도 그리고 골소주 개수가 증가했으며, 골소주 간격과 구조모델지수는 감소했다. 기계적특성 지수는 골다공증이 없는 대퇴골두 해면골 시편에서 반력, 표면응력 그리고 영률이 높게 분석되었다. 골다공증이 있는 대퇴골두 해면골 시편에서 미세구조 특성이 퇴화되며, 기계적 특성이 감소된다는 사실을 알수 있었다. This study investigates micro-structural and mechanical properties of trabecular bone in human femoral head with and without osteoporosis using Micro-CT and finite element-model. 15 cored trabecular bone specimens with 20min of diameter were obtained from femoral heads with osteoporosis (T-score > -2.5 ) resected for total hip arthroplasty, and 5 specimens were removed from femoral head of cadavers, which has no history of musculoskeletal diseases. A high-resolution micro-CT system was used to scan each specimen to obtain histomorphometry indices. Based on obtained micro-images(pixel size=21.31㎛), a FE-model was created to determine mechanical property indices. While non-osteoporosis group had increases trabecular thickness, bone volume, bone volume fraction, degree of anisotropy and trabecular number compared with those of non-osteoporotic group, the non-osteoporotic group showed decreases in trabecular separation and structure model index. Regarding the mechanical property indices, reaction force, apparent stress and young's modulus were 1ower in osteoporotic group than in non-osteoporotic group. Our data shows salient deteriorations in trabecular micro-structural and mechanical properties in human femoral head with osteoporosis.

Repofix 외고정 기구를 이용한 제 3형 개방성 경골 골절의 치료

원예연,전창훈 대한골절학회 1995 대한골절학회지 Vol.8 No.4

We reviewed 18 patients with type III open tibial fracture from February 1992 to June 1995(mean follow-up period 56.7 weeks) treated with Repofix external fixator. There were 16 men and 2 wemen. According to the Gustilo's classification, there were type IIIa in ll cases and type IIIb in 7 cases. Mean period of removal of external fixator was 19.3 weeks and after removal of external fixator, cast immobillization was performed in 4 cases. Among them, bony unions were noted in 15 cases and there were nonunion in 2 cases and malunion in 1 case. The causes of nonunion were failure of accurate reduction in I cases and severe initial comminuted fracture in 1 case. Complications were nerve injury, pin site infection and ring-type osteomyelitis. After removal of external fixator, nerve injuries were recovered and pin site infections except l case were healed. Ring-type osteomylitis was occurred in 1 case after removal of external fixator and osteomyelitis was dured after curettage. When type E open tibial fractures were treated with Repofix external fixator, there were advantages of 1) early weight bearing, 2) sagittal and coronal reduction of fracture and 3) correction of rotation. With advantages, this external fixator was appropriate for the treatment of type g open tibial fractures.

다발성 골절 치료시 발생한 지연성 용혈성 수혈 부작용

원예연,이원익,민병현,송명렬 대한골절학회 1998 대한골절학회지 Vol.11 No.3

This is a case report of delayed hemolytic transfusion reaction due to Anti-Le*b and Anti- Jk*b in treatment of multiple fracture. The patient was a 14 year-old boy and had no history of transfusion or blood products. The patient underwent open reduction and internal fixation for fracture of supracondyle of femur with massive blood transfusion. Abnormal finding of ABO incompatibility was not found as usual method. The patient developed a marked fall in hemoglobin and hematocrit value and a marked hyperviliruvinemia at 8 day after surgery, which suggested hemolytic anemia and jaundice. After the evaluation of this hemolytic anemia and jaundice, we found the Anti-Le*b antibody and Anti-Jk*b antibody. A delayed hemolytic transfusion reaction represents an infrequent, but potentially hazardous complication of blood transfusion. The phenomenon usually originates from exposure to a blood group antigen by prior transfusion or pregnancy. Delayed appearance of isoantibodies, first detected 4 to 14 days after the transfusion of apparently compatible blood, has bee detected by the authors.

미세단층촬영기(Micro-CT) 및 유한요소모델을 이용한 대퇴골두의 기계적 특성비교 : 골다공증이 있는 경우와 없는 경우의 비교

원예연,백명현,최문권,김한성,우대곤 한국정밀공학회 2003 한국정밀공학회 학술발표대회 논문집 Vol.2003 No.10월

성인 엉덩관절을 이루는 구조에 대한 형태학적 연구

원예연,장준섭,정인혁,한대용,한창동,서진석 아주대학교 의과학연구소 1999 아주의학 Vol.4 No.1

With 77 hip joints of Korean adults available, anatomical study was carried out to clarify morphological variations of the acetabular labrum, the acetabular articular cartilage, the penetrating sites, the purchasing lengths of transacetabular screws including dangerous neurovascular structures, and the theoretical safe space of the acetabular fossa. The results were as follows; 1. The posterior superior region of the acetabulum through which the screw could be inserted more than 50 ㎜ in length was the safest region. However, depending on the insertion angle, the screw could penetrate the psoas muscle with an average 30 ㎜ of intervening space. 2. The average purchasing length of the screws penetrating the mid point (B) of the articular surface which was located on the inferior portion of the line (AB) connecting the anterior superior iliac spine and the center of the acetabulum: the mid points (C and D) of the articular surface which was located on the anterior and posterior portion of the line (CD) perpendicular to the line AB; and the mid point (G) of the articular surface which was located on the posterior inferior portion of the acetabular articular surface, was more than 20 ㎜. The screws penetrating the point "C" had a risk to damage the bladder and the screws penetrating the points "D" and "G" had a risk to endanger gluteal neurovascular bundles. 3. The screw placed in the anterior superior region of the acetabulum could be directed toward the external iliac vessels. The perpendicular bony thickness of this region averaged 13 ㎜. The topographical relationship of the external iliac artery and vein was variable and classified into 6 types. 4. At the center of the acetabulum, the most vulnerable structure was the obturator neurovascular bundle and the average thickness of bone at this point was measured as 6.5 ㎜. 5. The thickness of the compact bone became wider from the inner side to the outer side of the lunate surface. 6. The posterior inferior portion of the acetabular fossa would be a danger area when we used the screws for infernal fixation of the acetabular fracture through the acetabular fossa. 7. The morphological variations of the acetabular labrum which were measured differently at different locations should be considered during reading magnetic resonance images. 8. The anterior, anterosuperior and posterosuperior portion of the acetabular labrum might be easily torn because the labrum was attached to the bone-like "seating on a flat bony surface." 9. The shape of the articular cartilage was classified into 5 types according to the position of both ends. The above data in this study revealed new findings which should be considered at the times of diagnosis and operation of the hip joint together with morphological characteristics of Korean adult hips.