감마 금속정을 이용한 대퇴골 전자간 골절 치료의 합병증

권석현,전철홍,박진영,배규환,양정환 대한골절학회 2009 대한골절학회지 Vol.22 No.2

목적: 근위 대퇴골 전자간 골절에서 감마 금속정을 이용한 치료 후 합병증을 분석하고 그 합병증을 줄일 수 있는 방법을 알아보고자 하였다. 대상 및 방법: 2000년 1월에서 2005년 5월까지 감마 금속정으로 치료한 근위 대퇴골 전자간 골절 환자 중에서 1년 이상 추시 관찰이 가능한 96예를 대상으로 합병증 발생 유무를 조사하였다. 평균 추시 기간은 17.8개월 (12∼52개월)이었으며, 환자 연령은 평균 75.2세 (44∼96세)였다. 골절양상, 골절의 정복 상태, 지연나사의 대퇴 골두내 위치 및 활강의 정도, tip-apex index (TAD), 골질 등과 합병증과의 연관성에 대해서 분석하였다. 결과: 합병증이 총 12예 (12.5%)에서 발생하였다. 지연 나사 돌출이 5예, 짧은 지연 나사 사용으로 인한 내반고 변형이 2예, 원위 나사 파열이 1예, 술 중 drill bit 파손 1예, 표재성 감염이 2예, 심부 감염이 1예였다. 이 중 심각한 합병증으로 재수술이 필요한 경우는 4예 (4.2%)였다. 지연 나사 돌출이 발생한 5예 모두 TAD (tip apex distance)가 25 mm 이상으로 증가되어 있었다. 결 론: 감마정을 사용할 때 합병증 발생을 줄이기 위해서 수술 중 세심한 술기가 필요하며, 지연 나사의 정확한 위치 선정 및 적절한 길이 선택이 관절내 돌출과 내반고 변형의 합병증을 줄일 수 있을 것으로 사료된다.

Clinical and Radiological Outcomes of Polished Cemented Bipolar Hemiarthroplasty for Intertrochanteric Fractures in Elderly Patients

권석현,신창현,이영창,김민우,김태호 대한골절학회 2020 대한골절학회지 Vol.33 No.3

Purpose: To evaluate the clinical and radiological outcomes of bipolar hemiarthroplasty using a polished cemented femoral stem for intertrochanteric fractures in elderly patients. Materials and Methods: From July 2005 to May 2015, 48 patients diagnosed with intertrochanteric fractures underwent bipolar hemiarthroplasty. The mean age and follow-up period were 80.5 years and 30.5 months, respectively. The postoperative results were evaluated clinically and radiologically. Results: The mean operation time was 100 minutes (range, 90-120 minutes), and the mean amount of blood loss was 334 ml (range, 170-500 ml). At the last follow-up, the mean Harris hip score (HHS), visual analogue scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were 82.2 (range, 76-90), 0.8 (range, 1-3), and 36 (range, 30-40), respectively. Walking was initiated using a walker for partial weight-bearing, and the mean walking time was 5.8 days (range, 3-14 days). Ambulatory ability was restored to a walking state before the injury in 36 cases (75.0%), and wheelchair ambulation was possible in 12 cases (25.0%). The instrumental activities of daily living (IADLs) were 17 patients (35.4%), and the basic activities of daily living (BADLs) were 31 patients (64.6%). Conclusion: Polished cemented bipolar hemiarthroplasty can achieve secure fixation with no postoperative thigh pain. Restoring the preoperative walking ability will be more helpful for intertrochanteric fractures in elderly patients.

Life Cycle Cost 기법에 의한 RC Slab 교량의 절감비용 예측에 관한 연구

권석현,김상범,박용진 한국구조물진단유지관리공학회 2007 한국구조물진단유지관리공학회 논문집 Vol.11 No.5

연구는 교량의 경제성 평가를 통해 교량 가설시 유용한 정보를 제공하기 위해, RC Slab교를 대상으로 유지관리수준에 따른 교량의 LCC를 예측하여 절감비용을 예측하고자 하였다. 본 연구의 수행 결과를 정리하면 다음과 같다. (1) 사례교량 LCC 분석 모델을 제안하였다. (2) 교량의 유지관리수준을 현행과 필요로 구분하고, 분석기간은 80년, 실질할인율은 4.5%로 가정하여 사례대상 교량에 대한 유지관리수준별 LCC를 예측하였다. (3) 사례교량의 LCC 예측결과를 통하여 절감비용을 예측하고 경제적인 절감효과를 파악하였다. This study predicts Life Cycle Cost of RC Slab bridge case in maintenance and operation level and calculated economic efficiency by the avoidable costs of a bridge. This result of the study can be summarized as follow: (1) LCC analysis model on the bridge case is suggested. (2) Maintenance and operation level of a bridge have been divided, and LCC of the bridge case has been predicted at current maintenance and operation level and required maintenance and operation level. (3) Reduction costs is predicted by LCC of the bridge case, and its economic efficiency is calculated.

Sewable soft shields for the γ-ray radiation

권석현,선정윤 한국고분자학회 2017 한국고분자학회 학술대회 연구논문 초록집 Vol.42 No.2

Outcomes of Cephalomedullary Nailing in Basicervical Fracture

권석현,이성현,국승환,최영채 대한고관절학회 2017 Hip and Pelvis Vol.29 No.4

Purpose: A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. Materials and Methods: Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients’ fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. Results: In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0-21.1 mm), which showed insertion point of <25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1-16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3-10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P<0.05). Conclusion: In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.

Gelation Dynamics of Ionically Crosslinked Alginate Gel with Various Cations

권석현,선정윤,윤주일,석현광,오규환 한국고분자학회 2015 Macromolecular Research Vol.23 No.12

Alginates can be crosslinked with multivalent cations, leading eventually to hydrogel formation. The properties of alginate gel depend on its lock structure, monomeric composition, concentration of polymer and cross linker. Among these, the properties of ionically crosslinked alginate gel can be greatly affected by multivalent cations as cross-linker. Knowledge of gelation dynamics by multivalent cations allows control over gelation characteristics, such as modulus of gel and the time required for equilibrium state, and healing properties. We have studied gelation dynamics of ionically crosslinked alginate gel. According to different types of anions bound with cations, gelation time and equilibrium viscosity was changed due to the solubility kinetics of the cation. The equilibrium viscosity is increased as the size of the cations increased even though the cations have same valency. A theoretical model is introduced to interpret dynamic change of viscosity during gelation.

고관절 비구순의 해부학 및 기능

권석현,Kwon, Seok Hyun 대한관절경학회 2011 대한관절경학회지 Vol.15 No.2

비전형적 대퇴골 골절의 골유합에 영향을 미치는영상의학적 및 혈청학적 요인에 대한 분석

권석현,유병민 대한골절학회 2019 대한골절학회지 Vol.32 No.1

Purpose: The purpose of this study was to investigate the radiologic and serologic factors related to postoperative union using intramedullary (IM) internal fixation in atypical femoral fractures (AFF), which are closely related to bisphosphonates (BPs) for osteoporosis. Materials and Methods: From February 2008 to December 2016, 65 patients (71 cases) who had undergone IM nail fixation after diagnosis of AFF were enrolled in this study. Patients were divided into group A, who experienced union within 6 months and group B, who did not experience union within 6 months. They were evaluated for duration of BPs use, radiologic factors and serological factors. Results: The mean duration of BPs use was 6.17 years in group A and 8.24 years in group B (p=0.039). In the subtrochanteric area, there were 14 cases (27.5%) in group A and 14 cases (70.0%) in group B. In the femoral shaft, there were 37 cases (72.5%) in group A and 6 cases (30.0%) in group B (p=0.001). On the preoperative, the flexion in the coronal plane was 5.9o (2.1o-9.2o) in group A and 8.0o (3.1o- 12.1o) in group B (p=0.041). On the postoperative, conversion to valgus was 15 cases (29.4%), 8 cases (40.0%); conversion to neutral was 34 cases (66.7%) and 8 cases (40.0%); conversion to varus was 2 cases (3.9%) and 4 cases (20.0%), each (p=0.037). The fracture site gap was 1.5 mm (0-2.9 mm) on the front side and 1.2 mm (0-2.2 mm) on lateral side and 2.2 mm (0.9-4.7 mm) and 1.9 mm (0.5- 3.5 mm), each (p=0.042, p=0.049). Among serological factors, there was no significant difference between the two groups. Conclusion: Factors adversely affecting the union should be recognized before surgery, such as longterm BPs use or a severe degree of bending of the femur in the coronal plane. During surgery, proper reduction and spacing of the fracture site on the coronal plane should allow adequate reduction of the anterior and posterior surfaces. Obtaining anatomic reduction would be most beneficial for union, but if that is not possible, obtaining congenital valgus rather than varus on the coronal plane may be helpful for union. 목적: 골다공증에 대한 치료 제제인 비스포스포네이트와 밀접한 관련을 가진 대퇴골 비전형 골절에서 골수 내정을 이용한 수술 후 유합에 관련된 영상 의학적 요인과 혈청학적 요인을 알아보고자 한다. 대상 및 방법: 2008년 2월부터 2016년 12월까지 대퇴골의 비전형 골절로 진단 후 골수강내 금속을 통한 고정수술을 받은65명(71예)을 대상으로 후향적 연구를 시행하였다. 수술 후 6 개월 이내에 골유합을 얻은 군(A군)과 6개월까지 골유합을 얻지 못한 군(B군)으로 나누었다. 각 군에서 체질량 지수, 골밀도, 비스포스포네이트 복용 기간 및 영상의학적인 인자, 혈청학적 인자 등으로 나누어서 평가하였다. 결과: 비스포스포네이트 평균 복용 기간이 A군에서 6.17년, B군에서 8.24년(p=0.039), 골절 부위는 A군에서 전자 하부가 14예(27.5%), 간부가 37예(72.5%), B군에서 전자 하부가14예(70.0%), 간부가 6예(30.0%) (p=0.001), 수술 전 영상의학적 검사상 관상면에서 휨이 A군에서 5.9o (2.1o-9.2o), B군에서 8.0o (3.1o-12.1o) (p=0.041), 수술 후 영상의학적 검사상 A군과 B군에서 관상면에서 외반으로 정복된 것이 15예(29.4%), 8예(40.0%), 중립으로 정복된 것이 34예(66.7%), 8 예(40.0%), 내반으로 정복된 것이 2예(3.9%), 4예(20.0%) (p=0.037)였다. 골절 부위 간격은 A군과 B군에서 앞면이 1.5 mm (0-2.9 mm), 2.2 mm (0.9-4.7 mm) (p=0.042), 외측면 간격에서는 1.2 mm (0-2.2 mm), 1.9 mm (0.5-3.5 mm) (p=0.049)였다. 혈청학적 인자 두 군 간의 유의한 차이를 확인할 수 없었다. 결론: 비스포스포네이트의 복용력이 길거나 관상면에서 대퇴골의 휨 정도가 심할 경우에 유합에 악영향을 미치는 인자임을 수술 전에 미리 인지하여야 하며, 수술 중에는 관상면에서적절한 정복 및 골절 부위 간격이 앞면과 뒷면에서 적절한 정복을 얻을 수 있게 해야 한다. 해부학적인 정복을 얻는 것이가장 골유합에 유리하겠지만 그렇지 못할 경우에는 관상면에서 내반보다는 외반이 되도록 정복을 얻는 것이 골유합에도움이 될 것으로 생각된다.

Elbow의 Superficial Radial Nerve에 발생한 결절종 1례 보고

권석현,김동철,김정우 圓光大學校 醫科學硏究所 2005 圓光醫科學 Vol.20 No.2

Assessment Model on Environmental Economics for Construction Projects in Korea

권석현,김경주,김경민,조남호 대한토목학회 2012 KSCE Journal of Civil Engineering Vol.16 No.4

This study aims to propose an assessment model for environmental economics that will provide useful information for decisionmaking on the implementation of pro-environmental and economical construction projects. To meet this objective, this study suggests a procedure for estimating the environmental cost of construction projects. The model combines environmental load assessment and environmental value assessment. The environmental cost of pollutants generated from a construction project was estimated utilizing Contingent Valuation Method (CVM), a value assessment method borrowed from economic science. A case analysis was subsequently conducted to verify the applicability of the proposed model to actual construction projects. The devised model is expected to provide a useful methodology that will scientifically support the planning and management of sustainable construction not only in terms of the environmental aspect but also of the economical aspect.