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이제형(Je Hyung Lee),전상훈(Sang Hoon Jeon),임홍재(Hong Jae Yim),이상범(Sang Beom Lee) 한국자동차공학회 2003 한국자동차공학회 춘 추계 학술대회 논문집 Vol.- No.-
In this paper, the reliability-based design optimization (RBDO) system using internet web is developed for a vehicle pillar section design. Interface modules are developed to communicate data between the internet web and the analysis and design codes such as section analysis program, finite element analysis program, reliability analysis program, and software integration program. Response surface method (RSM) is utilized to approximate the limit state functions describing the vehicle system characteristics in the design process. To demonstrate the developed optimization system, reliability-based optimal design for the pillar sections of a passenger car body structure is performed.<br/>
정운섭,박용욱,이제형,Jeong, Un-Seob,Park, Yong-Wook,Lee, Jae-Hyung 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2
Purpose: The purpose of this study is to assess the clinical and radiological results of the early primary repair for acute ankle sprains. Materials and Methods: From October 2002 to September 2005, nine patients with acute ankle sprain were analyzed. Among them, eight patients took the inversion stress X-ray at local clinics, and the mean talar tilting angle was 28 degrees. We observed avulsion fragment near lateral malleolus in the other. The average age at the time of operation was 24 years and average follow-up period was 29 months. We evaluated postoperative symptoms by Hasegawa's clinical rating system, postoperative complications, and compared the talar tilting angle and anterior draw distance between both ankles at the final follow-up X-rays. Results: Anterior talofibular ligament was ruptured at fibula in 4, at midsubstance in 3, at talus in 1 and at fibula and midsubstance simultaneously in 1. Calcaneofibular ligament was ruptured at fibula in 3 including a case of avulsion fracture, at midsubstance in 2, and at calcaneus in 4. And posterior talofibular ligament was ruptured at midsubstance in 2. Clinical results were rated as excellent in all. We did not find major postoperative complications except for one sural nerve irritation. Both (injured ankle/uninjured ankle) talar tilting angle averaged 6.8/8.2 degrees and anterior draw distance averaged 2.9/3.7 mm at final follow-up X-rays. Conclusion: Early primary repair is recommended for treating acute severe ankle sprains and in case found avulsion fracture in X-ray taken after ankle sprain.
내측 거골 체에 발생한 비교적 큰 골연골 병변에 대한 수술적 치료 결과
정운섭,박용욱,이제형,Jeong, Un-Seob,Park, Yong-Wook,Lee, Jae-Hyung 대한족부족관절학회 2006 대한족부족관절학회지 Vol.10 No.2
Purpose: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. Materials and Methods: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. Results: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. Conclusion: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.
Superior Labrum Anterior to Posterior (SLAP) 병변 봉합 후 실패 시 치료
박진영(Jin-Young Park),이제형(Jae-Hyung Lee),이준규(Joon-Gyu Lee) 대한정형외과학회 2017 대한정형외과학회지 Vol.52 No.5
상부 관절와 전후방(superior labral anterior to posterior, SLAP) 병변의 수술적 치료 후의 실패는 관절 강직(stiffness)과 통증(pain)이 있으면서 회전근 개 질환(rotator cuff disease), 견쇄관절 병변(acromio-clavicular lesion), 관절염(arthritis), 충돌증후군(impingement syndrome) 및 다른 견관절 병변의 동반 병변이 없으며 보존적 치료에 반응하지 않는 경우를 지칭한다. 일반적으로 SLAP 병변의 복원술 후 실패의 치료로 물리치료, 강화 운동, 경구 소염제 및 주사 치료를 포함한 보존적 치료를 시행할 수 있다. 보존적 치료에 실패할 경우 수술적 치료를 시행할 수 있으며, 반드시 환자의 나이, 손상 기전, 병변의 안정성, 환자의 활동성과 여가 생활의 다양성을 고려하여 신중히 결정해야 한다. 수술적 치료는 변연절제술(debridement), 재복원술(revisional repair), 상완 이두박건 고정술(tenodesis) 및 건절술(tenotomy)이 있으며, 각각의 방법은 적응증과 예후에 있어서 논란이 많은 실정이다. SLAP 병변에 대한 수술적 치료는 점점 증가하고 있고 복원술 후 실패한 경우도 함께 증가하는 추세로 이에 대한 적절한 치료에 대한 연구가 많이 진행되었다. 이에 대한 치료로 먼저 보존적 치료를 생각해 볼 수 있고, 수술적 치료도 좋은 결과를 보여 환자의 상태와 병변의 양상, 동반된 병변의 유무에 따라 다양한 치료를 선택할 수 있다. 하지만 술자들은 SLAP 병변에 대한 첫 치료 시 동반된 병변을 정확히 찾고 그에 대한 적절한 치료를 선행하여 치료 효과를 높여야 한다. SLAP 복원술 후 실패의 경우를 줄이는 노력도 기울여야 하며 충분한 보존적 치료를 통한 신중한 접근이 필요할 것으로 생각된다. 또한 SLAP 병변 봉합 후 실패의 원인 및 환자의 상태에 따라서 개별화된 치료 방법 설정이 필요한 상태이다. Stiffness and pain are major causes of failed superior labral anterior to posterior (SLAP) repair. The term, ‘failed SLAP repair’, can be defined as stiffness or pain without rotator cuff tears, acromio-clavicular pathology, arthritis, impingement syndrome, and other shoulder diseases. Moreover, it does not respond to conservative management. Generally, for failed SLAP repair, the initial conservative management includes physical therapy, strengthening exercise, oral medications, and injections. In addition, with failed conservative treatment, surgical intervention can be carried out. Surgical indications must be in consideration with patients’ age, mechanism of injury, stability of the lesion, activity, former history of sports activity, and types of sports. Surgical treatments include debridement, SLAP repair, biceps tenodesis and tenotomy. However, each type of surgical method is controversial on both indications and prognosis. Surgical treatment on SLAP lesion is increasing, and studies on failed SLAP repair are expanding. The recommended first line therapy for failed SLAP lesion is conservative management, and with limited and thorough indications, surgical treatment yields good results, depending on concurrent lesions. However, authors recommend that it is important to seek for adjacent lesions prior to the initial SLAP repair to decrease failed SLAP repair.