상완골 간부 골절과 동반된 진단이 지연된 근피신경 손상 - 증례 보고 -

노영학,김성완,정문상,백구현,오주한,이영호,공현식,Roh, Young-Hak,Kim, Seong-Wan,Chung, Moon-Sang,Baek, Goo-Hyun,Oh, Joo-Han,Lee, Young-Ho,Gong, Hyun-Sik 대한미세수술학회 2010 Archives of reconstructive microsurgery Vol.19 No.1

Injury of the musculocutanous nerve can be associated with a proximal humeral fracture or shoulder dislocation, and injury of the brachial plexus. However, injury of this nerve associated with a humeral shaft fracture has rarely been reported. Diagnosis of the musculocutaneous nerve injury is difficult because its sensory loss is ill-defined, and examination of elbow flexion is difficult when it is associated with fractures. We report an unusual case of musculocutaneous nerve injury in a 27 years old woman who had multiple injuries including a humerus shaft fracture, an ipsilateral radius shaft fracture, and an associated radial nerve laceration. Diagnosis of the musculocutaneous nerve injury was delayed because combined fractures of the humerus and radius prevented proper examination of the elbow motion and nerve grafting of the radial nerve delayed early elbow motion exercise. Delayed exploration of the musculocutaneous nerve 6 months after trauma showed complete rupture of the nerve at its entry into the coracobrachialis muscle and the defect was successfully managed by sural nerve graft.

광범위 수부 손상에서 서혜부 유경피판과 유리 포장주위피판을 이용한 단계적 무지 재건술

노영학,정문상,백구현,이영호,공현식,이승환,이예현,Roh, Young-Hak,Chung, Moon-Sang,Baek, Goo-Hyun,Lee, Young-Ho,Gong, Hyun-Sik,Rhee, Seung-Hwan,Lee, Ye-Hyun 대한미세수술학회 2009 Archives of reconstructive microsurgery Vol.18 No.2

Purpose: Despite the free tissue transfer using microsurgical technique being the current trend of soft tissue reconstruction of the hand, the pedicled groin flap has the advantage to provide coverage for the mangled hand without necessitating the use of a damaged arterial system and also providing the benefit of saving the arterial system for later free tissue transfer. This report presents the author's experience using pedicled groin flap in four cases of mangled hands with massive bone and soft tissue defects requiring later thumb reconstruction with the free wrap around flap. Materials and methods: The patients' age ranged from 30 to 51 years; three patients were male and one was female. The causes of mangled hand included two machinery crush injuries, one laboratory explosion and one motor vehicle accident. While evaluating the post-operative results, factors like flap survival, complications, stability in opposition, pinch power and 2 point discrimination were taken into account. Results: All massive soft tissue defects of the hands were completely covered with pedicled groin flap successfully. The reconstructed thumb using free wrap around flap did not have any limitation in opposition. There was no occurrence of post-operative infection and all the flaps survived completely. The average pinch power was 70% of the contralateral intact thumb and average 2 point discrimination was 10 mm. Conclusion: The pedicled groin flap for the reconstruction of the massive soft tissue defects of the hand with subsequent reconstruction of the thumb with a wrap around flap is a very useful procedure. The combined use of pedicled groin flap and wrap around flap allows adequate coverage of sizable soft tissue defects and functional thumb opposition in cases of reconstruction of the mangled hands.

도시형생활주택 선택에 미치는 영향요인 연구

노영학 한국부동산경영학회 2014 부동산경영 Vol.9 No.-

본 연구는 도시형생활주택의 수요자 들이 주택을 선택하는데 영향을 미치는 요인을 분석하여 이들의 요구에 맞는 주택을 제도적으로 안정적인 공급방안을 모색해 보고자 하는 목적으로 하였다. 실증분석 결과는 다음과 같다. 첫째, 물리적 요인 모형은 방의 크기 요인이 가장 큰 영향을 미치고 있는 것으로 나타나 도시형생활주택은 규모면에서 방의 크기에 대한 세심한 검토가 필요할 것이다. 둘째, 환경적 요인 모형에서는 일반적으로 예측할 수 있는 바와 같이 접근성과 대중교통의 편리성 요인이 가장 큰 영향을 미치고 있는 것으로 분석되었다. 이에 따라 소형주택은 특히 입지적 측면에서 접근성과 지하철을 비롯한 대중교통 이용의 편리성에 대한 고려가 입지선택에 반영되어야 할 필요가 있다. 셋째, 도시형생활주택 선택결정에 영향을 미치는 경제적 요인은 월임대료가 가장 큰 영향을 미치는 것으로 분석되어 일반적으로 주요 수요층이 소가구의 서민층이라는 점을 감안하고, 이들의 주거안정을 위한 정책적 측면에서 주택바우처 제도 등을 비롯한 실질적인 정책수립이 절실히 필요한 시점이 되었다. This study Urban Residential consumers of used to select houses to analyze the factors influencing their institutional needs housing for the study was to seek a stable supply . The empirical results are as follows. First, the internal factors of the number of models is one of the biggest factors affecting the size shown in the Urban Residential is the largest in terms of the size of the room will need to review. Second, the model has typically predictable external factors, as can be the convenience of public transport is one of the biggest factors that affect the analysis. As a result, a small mouth, pointed out, especially in terms of access to housing and public transportation, including the subway, considerations of convenience of location will need to be reflected in the selection . Third, Urban Residential -economic factors affecting the decision to select the most influential monthly rent is generally the main Consumers be analyzed taking into account the fact that this commonalty to stabilize their housing, including housing voucher system practical policy this is the time required for establishment .

Factors Associated with Postoperative Nausea and Vomiting in Patients Undergoing an Ambulatory Hand Surgery

노영학,공현식,김정환,남경표,이영호,백구현 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3

Background: Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels. Methods: We prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients’ satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V. Results: Postoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4–7) and high (VAS 8–10) levels of postoperative N/V and with a high level (VAS 8–10) of postoperative pain. Conclusions: Although most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.

신경성 통증: 부적응성 통증 반응의 평가와 치료

노영학 대한수부외과학회 2020 대한수부외과학회지 Vol.25 No.3

Neuropathic pain is associated with primary lesion or dysfunction of the peripheral and central nerve systems, affecting up to 10% of the general population. Although both nociceptive pain and neuropathic pain utilize the same nervous system pathways, physiologic differences exist in the pathologic mechanism, clinical presentation, and treatments. Ectopic activity in primary afferent fibers, excitatory and inhibitory somatosensory signaling, nociceptive neuron alterations, and central pain modulation have been implicated in neuropathic pain. These neuropathic mechanisms are associated with the complexity of symptoms, difficult treatment decisions, and challenging poor outcomes. Treatment options include pharmacologic (e.g., anticonvulsants, antidepressants, lidocaine, N-methyl-D-aspartate antagonist, opioids), physical, psychological (e.g., cognitive behavioral therapy), or interventional management (e.g., peripheral or neuro-axial nerve blockade, spinal cord stimulators, intrathecal medications). Medication selection should be individualized, considering patients’ symptoms and potential beneficial or deleterious effects (side effects) on comorbidities. The interventional management of chronic neuropathic pain should be considered for patients who have not responded to pharmacologic and non-interventional treatments, as an integral component of a more comprehensive approach. This article presents an overview of physiological mechanisms, clinical presentation, and assessment of neuropathic pain, and discusses treatment options for neuropathic pain. 신경성 통증은 말초 및 중추 신경계의 병변이나 기능 이상과 관련되어 발생하며, 일반 인구의 10% 정도까지 흔하게 경험한다. 통각 수용성 통증과 신경성 통증이 동일한 신경 통로를 이용하지만, 발생 기전, 임상 양상, 치료법에 뚜렷한 생리적 차이를 보인다. 구심성 신경섬유의 이소성 흥분, 체성감각신호 전달 과정에서 흥분 및 억제, 통각 수용 신경의 변화, 중추성 통증 유도 조절 등이 신경성 통증의 발생과 유지에 관여한다. 신경성 통증의 복잡한 발생 기전과 관련하여 다양한 증상이 발생하며, 치료 방법 결정에 어려움을 초래해 만족스럽지 못한 결과를 얻게 되는 경우가 흔하다. 신경성 통증의 치료로 약물치료(항경련제, 항우울제, 국소마취제, N-methyl-D-aspartate 길항제, 마약성 진통제), 물리치료, 정신치료(인지행동치료), 중재적 처치(말초 혹은 신경 축 차단, 척수 신경 자극, 척수강 내 약물 주입) 등의 다양한 접근이 시도되고 있다. 약물치료는 환자의 증상 및 동반 질환과 관련된 부작용을 고려해야 한다. 약물치료나 비중재적 처치에 만족스럽게 반응하지 않는 만성 신경성 통증 환자에서 중재적 처치를 기존 치료를 보완하는 포괄적 접근으로 고려할 수 있다. 이 논문에서 신경성 통증의 병리 기전, 임상 양상, 감별 진단 및 평가 방법들을 살펴보고, 다양한 신경성 통증의 치료법에 대해 논한다.

경골 근위부 원발성 악성 골 whddidd에서 종양 대치물을 이용한 재건술 후종양 대치물의 생존율과 기능 평가

노영학,김한수,김준혁,오주한,이상훈,강현귀,조환성 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.6

Purpose: This study retrospectively analyzed the prosthetic survival and functional results after a prosthetic reconstruction for malignant bone tumors of the proximal tibia. Materials and Methods: Thirty-five patients (32 osteosarcomas and 3 chondrosarcomas) were followedup for an average 72 months (24-167 months). A gastrocnemius flap was transferred in 12 patients and cement fixation of the stem was performed in 10. More than 40% of the bone length was resected in 12 patients. Results: Three patients had died of the disease at the time of the final follow-up. There were one local recurrence and five distant metastases. The major complications were infection (5), aseptic loosening (5) and periprosthetic fractures (1). Gastrocnemius flap affected the incidence of a deep infection in the proximal tibia (17.4% vs. 8.3%) but there were no statistical correlation. A resection of >40% of the involved tibia increased the incidence of aseptic loosening (p=0.002). The rate of prosthetic survival was 72% at 5years and 58% at 10 years. The functional score at the final follow-up was 81% (43-93%). Conclusion: A prosthetic reconstruction in the proximal tibia showed acceptable oncologic and func-tional outcomes in patients at an intermediate term follow-up. Infection and loosening were the main factors threatening the survival of the prosthesis. 목 적: 광범위 절제술 후 종양 대치물로 재건술을 시행한 경골 근위부의 원발성 악성 골 종양 환자에서 종양 대치물의 생존율, 기능적 결과 및 합병증에 대해 후향적으로 분석하였다. 대상 및 방법: 경골 근위부 악성 골 종양으로 종양 대치물 재건술을 시행받은 35명(골육종 32예, 연골육종 3예)을 평균 72개월간(24-167개월) 추시하였다. 12예에서 비복근 이전술을 시행하였으며 10예에서 골 시멘트로 고정하였고, 12예에서 40% 이상의 경골 절제가 필요하였다. 결 과: 최종 추시에서 3명의 환자가 사망하였고, 1예의 국소 재발과 5예의 원격 전이가 있었다. 주요한 합병증으로는 5예의 감염과 5예의 무균성 해리, 1예의 종양 대치물 주위 골절이 있었으며, 비복근 이전술의 시행 여부에 따른 감염률은 유의한 차이를 보이지 않았다. 골 시멘트의 사용 여부에 따른 무균성 해리의 빈도 차이는 없었으나, 40% 이상 골 절제가 필요로 했던 경우 해리의 빈도가 높았다(p=0.002). 종양 대치물의 생존율은 5년에 72%, 10년에 58%이었고, 수술 후 기능점수는 81%이었다. 결 론: 종양 대치물을 이용한 경골 근위부 재건술은 중기 추시상 종양학적 결과와 기능적인 면에서 우수한 결과를 보였으나, 감염, 무균성 해리 등의 합병증을 줄이기 위한 노력이 필요하다.

FLUENT를 이용한 날개끝 보오텍스 해석

노영학,이동연,현범수 한국해양대학교 해양과학기술연구소 2000 硏究論文集 Vol.9 No.1

FLUENT를 이용하여 사각 수중익 (Rectangular Hydrofoil)의 날개 끝에서 발생하여 전개되는 날개끝 보오텍스 (Tip Vortex)가 날개의 받음각과 위치에 따라 어떻게 전개되는지를 조사하였다. 해석된 결과를 검증하기 위하여 회류수조에서 입자영상유속계 (PIV)를 이용하여 구한 유속계측결과와 비교하고 그 물리적 타당성을 분석하였다. 또한 Vortex Core를 정의하는 방법을 제안하고 그 형상의 대칭성 여부, 받음각에 따른 크기의 변화여부를 면밀히 분석하고자 하였다.

유통단지 입주자 만족도 연구

노영학,윤성만 한국부동산경영학회 2012 부동산경영 Vol.6 No.-

This study, the future just live in the industrial supplies distribution company that operates business in the operational aspects of satisfaction and tenant satisfaction, and investment assets as part of environment and facilities for tenant satisfaction by analyzing large target national or industrial dimension distribution in the complex, and when you want to develop and supply was attempted for the purpose of the policy alternatives presented. Goods between the tenants in common exchanges and cooperation factor analysis in this study is the satisfaction factor was identified as the most important factor in terms of investment and operational aspects of business in the empirical analysis. Facilities, and environmental aspects of satisfaction, satisfaction with the 'parking' space and facilities that can be the most important part in modern logistics distribution shows the highest good parking space and facilities to tell the tenants are generally satisfied with the fact that give.

오피스 임대료와 관리방식 결정 요인 분석

노영학(Noh, Young- Hak) 한국지역개발학회 2009 韓國地域開發學會誌 Vol.21 No.3

This study anyzes the determining faα.ors of rent ntle - the primιy ne sçurce of lhe office bui1dings. focused in Seoul city area and proves the import of managemcnl process (professional managemcnt) among I those factors. This also intend 10 analyze what factors are used 10 dctcnnine the provcd important managemenl αocess iL draws severa1 faclOrs affecting lhe decision of renta1 rate, lhrough the analyzed results from the three Multiple Regression AnaJysis mcel s. It proves lhal lhe mosl important faCLOr is lhe managemenl process and that pfofessional m‘magement ralher than self nlanagement is more effectivc in jll(;reasing office rental I<lle B.:"lsed on lhis. il anaIyzes how the proven anagement process(profcssÎonal management) is delermined by what factors. by COIucting Logistic Regression Anal}'sis. It identifies that gross area. ages of bui띠ing. ownership enÙty‘ number of elevators, the lease exchangc rate and parlting 5αx:c are important factors of determining management process. Thal is to sa ι lherc are high 쩌d s of selecùng over self management with bigger gross area. conx>rate ownership. morc numbers of e1evators and parking spaκe. Conversely. there are high ωds of sclecling s히f management over professional managemcnt with more ages of building and high the lease exchange rale. which are negative factors.

오피스 임대료와 관리방식 결정요인 분석

노영학(Noh, Young-Hak) 한국지역개발학회 2009 韓國地域開發學會誌 Vol.21 No.2

This study analyzes the determining factors of rental rate - the primary income source of the office buildings, focused in Seoul city area and proves the importance of management process (professional management) among all those factors. This also intends to analyze what factors are used to determine the proved important management process. It draws several factors affecting the decision of rental rate, through the analyzed results from the three Multiple Regression Analysis models. It proves that the most important factor is the management process and that professional management rather than self management is more effective in increasing office rental rate. Based on this, it analyzes how the proven management process(professional management) is determined by what factors, by conducting Logistic Regression Analysis. It identifies that gross area, ages of building, ownership entity, number of elevators, the lease exchange rate and parking space are important factors of determining management process. That is to say, there are high odds of selecting over self management process. That is to say, there are high odds of selecting over self management with bigger gross area, corporate of selecting self management over professional management with more ages of building and high the lease exchange rate, which are negative factors.