대퇴골 만성골수염의 치료 및 비골 유리골피판술을 이용한 재건

백의환,안희창,최승석,조동인,황건성,정웅서 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: Incidence of chronic osteomyelitis in femur is lower than that of tibia due to abundantsurrounding soft tissue like muscles and subcutaneous fat. However, if the femur is infected, surgical approach would be very difficult because of surrounding soft tissue and bony defects would be getting larger due to the late detection. Chronic osteomyelitis of femur is an intractable disease with frequent recurrence and remained bone instability in spite of multiple classical operations . Methods: From August 1998 to October 2005, we had 7 cases of fibular osteocutaneous free flap to reconstruct the femur. Those were followed-up for 23 months. All 7 cases were male. 4 cases were in midshaft and the others are distal part of femur.Results: The 7 cases that had not been healed in spite of average 9.1 times previous operations were reconstructed successfully without the recurrence of chronic osteomyelitis. Continuous rehabilitation therapy and brace were very helpful for the ambulation. It took 5.6 months for complete union of bone, and 9.8 months for the ambulation.Conclusion: After wide resection, reconstruction of the femur using fibular osteocutaneous free flap guaranteed bone stability and prevented recurrence of osteomyelitis through rich blood supplying fibula and muscle. Double barrel graft of fibula would be needed in case of the sufficient strength and thickness of femur. We report the successful results of reconstruction of femur with fibular osteocutaneous free flap for chronic osteomyelitis of femur.

압박 고 나사를 제거한 대퇴골에 삽입된 대퇴주대의 미세운동 및 대퇴골의 응력집중에 관한 유한요소해석

원예연(Ye Yeon Won),안재인(Jae In Ahn),유승현(Seung Hyun Yoo),변철진(Chul Jin Byun),최원석(Won Seok Choi),조재현(Jae Hyun Cho) 대한고관절학회 1999 Hip and Pelvis Vol.11 No.1

To study the adverse effect of the bony defects created in the DHS removed femur, the authors analysed the micromotion of the femoral stem and the stress concentration of femur after removal of the DHS' system using finite element analysis and Composite Femur. The 3-D finite element models for the Composite Femur with and without cortical defects caused by the removal of the DHS system, were made from serial CT scan images. The 3-D finite element model of the No. 9 Omnifit' femoral stem was used as femoral stem. For simulation of femoral cortical defects, we put the four 4.5mm screw holes on each side, one 12mm lag screw hole was placed just below the vastus ridge and 20mm x 90mm sized postplating osteopenia of lateral cortical surface for barrel plate. Nonlinear contact analysis was performed using the ABAQUS 5.8 package system. Micromotions were calculated as 87.5 - 94.3um for intact femur and 106.7 - 110.9pm for DHS removed femur. The differences of micromotions between the intact and DHS removed femur averaged 1Spm. It was suggested that if the femoral stem in long enough to bypass the most distal screw hole that it could be used be for primary hip replacement using the DHS' removed femur. This suggestion, however, should be confirmed by the results of clinical follow-up and finite element analysis using material properties of the osteoporotic femur and bone cement.

슬관절 전치환술에서 원위 대퇴골의 계측 및 여성형 치환물의 적합성

박형택 ( Hyung Taek Park ),최선진 ( Sun Jin Choi ),박종훈 ( Jong Hoon Park ),하정민 ( Jung Min Ha ) 대한슬관절학회 2008 대한슬관절학회지 Vol.20 No.2

목적: 최근 남녀간 대퇴골의 계측학적 차이를 고려한 여성형 슬관절 치환물이 등장하여 사용되고 있다. 이에 저자들은 수술 중 원위 대퇴골의 계측과 여성형 슬관절의 적합성에 대하여 알아보고자 하였다. 대상 및 방법: 인공 슬관절 전치환술을 받은 환자 중 여자 환자 100예를 대상으로 하였다. 수술 중 대퇴골절제 이후, 절단부의 크기를 6군데로 나누어 측정하였고, 두 가지 삽입물 중 측정치에 가까운 대퇴 슬관절 치환물을 사용하였으며, 같은 크기에 속하는 치환물에서 여성형 슬관절 치환물이 적용된 환자군(1군)과 고식적 슬관절 치환물이 사용된 환자군(2군)의 계측학적 차이와 적합성을 조사하였다. 결과: 58예에서 여성형 슬관절 치환물이 적용되었고(58%), 내외측 전방 크기를 제외한 수치에서 두 군 사이에 유의한 차이를 보였다(p<0.05). 여성형 슬관절 치환물을 사용한 빈도는 size C에서 33.4%, size D는 57.4%, size E는 70.4%로 나타났고, 5%에서 치환물과 대퇴골 사이에 내외측 불일치가 관찰되었다. 치환물의 크기가 증가할수록 대퇴골의 전후방 길이에 대한 내외측 길이비가 작아지는 것으로 나타났다. 결론: 한국인에서 작은 대퇴골을 가진 여성은 고식적 치환물이 더 적합하고, 큰 대퇴골을 가진 여성에 있어 기존의 고식적 삽입물보다 여성형 치환물이 형태학적인 적합성을 가지는 것으로 볼 수 있다. 그러므로 여성형 슬관절은 술 중 대퇴골의 크기를 고려하여 선택적으로 사용해야 할 것으로 생각한다. Purpose: The new prosthesis was introduced for female recently considering anthropometric differences of distal femur between male and female. We evaluated the anthropometric measurements of distal femur and compatibility of gender knee prosthesis in total knee replacement. Materials and Methods: The candidates were 100 female patients who underwent total knee replacement. We measured the size of resection site which was divided into 6 areas after resection of femur. According to this result, we made a decision which prosthesis would be better fit. Group 1 was whom gender knee prosthesis was used in and group 2 was whom conventional knee prosthesis was used in. Results: Gender knee prosthesis was used in 58cases out of 100 cases (58%). There were significant differences in measurements between group 1 and 2 except anterior flange lengths (p<0.05). Gender knee prosthesis was chosen in 33.4% of size C, in 57.4% of size D, in 70.4% of size E. There were less than 5% discrepancies of width between components and femur. The larger the femur, the lesser the ML/AP ratio. Conclusion: Conventional knee prosthesis is adequate to who has smaller distal femur and gender knee prosthesis is adequate to who has larger distal femur in total knee replacement. It is thought that we may select gender knee prosthesis considering the size of femur intraoperatively.

Sex determination using discriminant analysis of the medial and lateral condyles of the femur in Koreans

Kim, D.I.,Kwak, D.S.,Han, S.H. Elsevier Sequoia 2013 Forensic science international Vol.233 No.1

The proximal and distal parts of the femur show the differences between the sexes. Head diameter and the breadth of the epicondyle of the femur are known to distinguish males from females. The proximal end of the femur is studied to determine sex using discriminant analysis but; its distal end is not done. This study aims to develop an equation specific to Koreans by using the medial and lateral condyles of the femur, and to demonstrate the usefulness of equations for specific population groups. We used three-dimensional images from 202 Korean femurs. Twelve variables were measured with a computer program after the femurs were in alignment. Eleven variables showed a statistically significant difference between the sexes (P<0.01). The most accurate equation used width of the medial and lateral condyles (WDC), with of the medial condyle (WMC), depth of the lateral condyle (DLC), and depth of the intercondylar notch (DIN) (94.1%), and is as follows:D=0.336xWDC+(-0.097)xWMC+(-0.153)xDLC+0.372xDIN-20.912. The second highest accuracy was 90.1% for the width dimensional group and WDC. This study shows that the medial and lateral condyles of the femur should be helpful for sex determination in situations where the skull and pelvis are missing and part of the femur is available. The study also demonstrates the need for different equations for different population groups.

Increase of TRPV1-Immunoreactivity in Dorsal Root Ganglia Neurons Innervating the Femur in a Rat Model of Osteoporosis

Kensuke Yoshino,Seiji Ohtori,Miyako Suzuki,Yuya Kawarai,Yoshihiro Sakuma,Gen Inoue,Sumihisa Orita,Kazuyo Yamauchi,Yasuchika Aoki,Tetsuhiro Ishikawa,Masayuki Miyagi,Hiroto Kamoda,Gou Kubota,Yasuhiro Oi 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: Transient receptor potential vanilloid 1 (TRPV1) is a ligand-gated nonselectivecation channel, which can be activated by capsaicin and other noxious stimuli. Recently, an association between bone pain and TRPV1 has been reported. However, the influence of osteoporosis on TRPV1 in the sensory system innervatingthe femur has not been reported. Materials and Methods: TRPV1-immunoreactive(ir) in dorsal root ganglia (DRG) neurons labeled with neurotracer [Fluoro-Gold (FG)] innervating the femurs of Sprague Dawley rats were examined in control, sham, and ovariectomized (OVX) rats. We evaluated osteoporosis in the femursand compared the proportion of TRPV1-ir DRG neurons innervating femur between the 3 groups of rats. Results: OVX rats showed osteoporotic cancellous bone in the femur. FG labeled neurons were distributed from L1 to L6 DRG, but there was no significant difference in the proportion of labeled neurons between the 3 groups (p>0.05). The proportions of FG labeled TRPV1-ir DRG neurons were 1.7%, 1.7%, and 2.8% of DRG neurons innervating the femur, in control, sham-operated,and OVX rats, respectively. The proportion of TRPV1-ir neurons in DRG innervating the femur in OVX rats was significantly higher than that in control and sham-operated rats (p<0.05). Conclusion: Under physiological conditions, DRG neurons innervating femurs in rats contain TRPV1. Osteoporosis increases the numbers of TRPV1-ir neurons in DRG innervating osteoporotic femurs in rats. These findings suggest that TRPV1 may have a role in sensory perception of osteoporoticfemurs.

대퇴골 골절시 동반되는 동측 슬관절 인대 손상

고한석,김진구,문형태,황인환,하정구 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Purpose: To retrospective analyze the type and frequency in ipsilateral knee ligament injury patient associated with the fracture of the femur. Materials and methods: from January 1998 to April 2002, the authors analyzed the patients who admitted Inje University Seoul Paik Hospital because of the fracture of the femur. The shaft fracture and subtrochanteric fracture were included in cases, but the fracture involved trochanter and the distal femur fracture were excluded from our cases. Their ages ranged from 10 to 80(average, 39). There were 47 males and 17 females. There were eleven subtrochanteric fracture and fifty three femur shaft fracture, we evaluated the cases by the physical exam, stress roentgenographic test and MRI at the time of initial visit, during fracture stabilization or during outpatient department follow-up, selectively. Result: The cases of the ipsilateral knee ligament injury associated with the femur fracture were 10 cases of the total 64 cases. There were one PCL injury of 11 subtrochanter fractures and 3 ACL injuries, 6 PCL injuries of 53 shaft fractures. There were 2 ligament injuries of 7 fractures between 11 and 20 years old. 5 of 19(26%) between 21 and 30.2 of 11(18%) between 31 and 40. There were no ligament injury associated with femur fracture below 10 and above 41 years old, the PCL injury associated with femur fracture occurred frequently than other ligament injuries, but it is not significant in the statistics. Colcusion: A high index of suspicion is needed for early diagnosis of ipsilateral knee cruciate ligament injury in a patient who has femur fracture.

잠김 금속판(LCP-DF)을 이용한 대퇴골 원위부의 관절외 복합골절 치료시 나사못 배열에 따른 생체역학적 안정성 분석

권경제,조명래,오종건,이성재,Kwon, Gyeong-Je,Jo, Myoung-Lae,Oh, Jong-Keon,Lee, Sung-Jae 대한의용생체공학회 2010 의공학회지 Vol.31 No.3

The locking compression plates-distal femur(LCP-DF) are being widely used for surgical management of the extra-articular complex fractures of the distal femur. They feature locking mechanism between the screws and the screw holes of the plate to provide stronger fixation force with less number of screws than conventional compression bone plate. However, their biomechanical efficacies are not fully understood, especially regarding the number of the screws inserted and their optimal configurations. In this study, we investigated effects of various screw configurations in the shaft and the condylar regions of the femur in relation to structural stability of LCP-DF system. For this purpose, a baseline 3-D finite element (FE) model of the femur was constructed from CT-scan images of a normal healthy male and was validated. The extra-articular complex fracture of the distal femur was made with a 4-cm defect. Surgical reduction with LCP-DF and bone screws were added laterally. To simulate various cases of post-op screw configurations, screws were inserted in the shaft (3~5 screws) and the condylar (4~6 screws) regions. Particular attention was paid at the shaft region where screws were inserted either in clustered or evenly-spaced fashion. Tied-contact conditions were assigned at the bone screws-plate whereas general contact condition was assumed at the interfaces between LCP-DF and bone screws. Axial compressive load of 1,610N(2.3 BW) was applied on the femoral head to reflect joint reaction force. An average of 5% increase in stiffness was found with increase in screw numbers (from 4 to 6) in the condylar region, as compared to negligible increase (less than 1%) at the shaft regardless of the number of screws inserted or its distribution, whether clustered or evenly-spaced. At the condylar region, screw insertion at the holes near the fracture interface and posterior locations contributed greater increase in stiffness (9~13%) than any other locations. Our results suggested that the screw insertion at the condylar region can be more effective than at the shaft during surgical treatment of fracture of the distal femur with LCP-DF. In addition, screw insertion at the holes close to the fracture interface should be accompanied to ensure better fracture healing.

교합성 골수강내 금속정으로 치료한 대퇴골 골절의 치료

권칠수,안종국,김용욱,김진혁,정병현,성열보,강재철 인제대학교 1995 仁濟醫學 Vol.16 No.4

대퇴골 간부 골절시 교합성 골수강내 금속정을 이용한 견고한 고정은 조기 관절 운동과 조기 체중부하가 가능한 보편적인 수술적 치료방법으로 그 사용이 증가하고 있다. 그리고 최근에는 골수강내 금속정이 대퇴골 간부 골절 뿐만 아니라 대퇴골의 근위부나 원위부에 치우친 골절이나 청소년기의 대퇴골 간부 골절의 치료에도 확대되고 있다. 본 논문은 대퇴골 골절 환자 54례를 대상으로 금속정 삽입술의 적응증의 확대와 그에 수반되는 문제점에 관하여 증례 분석 및 결과를 문헌 고찰과 함께 보고하고자 한다. The rigid internal fixation of femur shaft fracture with intramedullary nailing enables early joint motion and weight bearing. This procedure has been used with wide popularity because it is possible simultaneously to preserve the range of motion and to obtain the bone union. But in the proximal and distal femur fracture, the interlocking screws are too close to the fracture site, the rigid fixation cannot be achieved and when early weight bearing is permitted, failure of the metal is possible. Also, when femur fractures in the adolescence be treated with traction followed by casting, sometimes angular deformity and shortening may develope. These problems have solved to the use by intramedullary nailing. The authors reviewed and analyzed 54 cases of the fractures of femur treated by interlocking nails at Sang-Gye Paik Hospital from August 1989 to July 1992. The results were as follows ; 1.Among the 54 patients, male were 42 and female were 12. 2.The mean time of bone union was 19.3 weeks. 3.The authors usually used the closed locked nailing technique to fix the mid-shaft fracture of femur. In cases such as mid-shaft fracture combined wish proximal or distal femoral fracture, for the stability of fracture and the early mobilization, a reconstruction nail or modified nailing technique was used and an excellent bone union was obtained without any complication. 4.In a mid-shaft fractures of the femur in adolescents or young adult, the authors used interlocking nails of proper length or diameter by cutting-off the distal portion of the nail or by over-reaming of the too narrow medullary canal, and the outcome was favorable.

Femoral Bowing Increases Early Postoperative Stress around the Femoral Stem in Humans: A Finite Element Analysis

Nobuhiro Kaku,Tsuguaki Hosoyama,Yutaro Shibuta,Hiroshi Tsumura 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.5

Background: This study aimed to clarify the characteristics of stress distribution caused by the placement of tapered wedge stems in bowed femurs compared with that in normal femurs and the effect of varus stem placement. Methods: Models with normal and enhanced bowing were created from the right-side computed tomography data of a 17-yearold woman with the least bowing among 40 participants who underwent anterior cruciate ligament reconstruction or operative treatment for trauma in our hospital between January 2017 and May 2018. Finite element analysis was performed, assuming the tapered wedge stem was placed in the neutral and varus positions. Results: Varus stem placement on a femur with normal bowing showed a deviation and increase of von Mises stresses in the medial femur. Stem placement on a bowed femur, even when placed in the neutral position, increased stress across the periprosthetic bone. When the stem was placed in the varus position, von Mises stress across the periprosthetic bone increased. Zone 7, with strong bowing, demonstrated 3.6-fold increased stress compared with normal femurs. The maximum tensile principal stress was greatest in zone 6 and increased in zones 3 and 4. Conclusions: Surgeons should assess femoral bowing preoperatively and pay particular attention to intraoperative stem alignment for femurs with high bowing.

광학현미경과 투과전자현미경을 이용한 토끼와 닭 대퇴골의 미세구조 분석

김창연,김은경,전태훈,남승원,김윤중,Kim, Chang-Yeon,Kim, Eun-Kyung,Jeon, Tae-Hoon,Nam, Seung-Won,Kim, Youn-Joong 한국현미경학회 2010 Applied microscopy Vol.40 No.3

뼈는 단계별 (hierarchical) 구조를 가진 복합 재료이며 독특한 구조와 기계적 특성 때문에 재료공학 분야에서 많이 연구되어져 왔다. 뼈는 주로 hydroxyapatite, 콜라겐과 물로 구성된 층판형 유 무기 재료 복합체이다. 주요 무기물로써 hydroxyapatite로 잘 알려진 calcium phosphate를 통하여 뼈는 특유의 강도를 유지하게 된다. 본 실험에서는 광학 현미경(LM)과 투과전자현미경(TEM)을 이용하여 토끼와 닭 대퇴골의 구조를 연구하였다. 구성물질 분석은 대퇴골의 calcium, potassium, oxygen 분포 변화를 알아보는데 이용하였다. 실험은 두 구조 범위에 중점을 두었다: micro scale에서 치밀골의 배열을, nano scale에서 콜라겐 섬유와 apatite 결정을 관찰하였다. Micro scale에서 닭과 토끼 대퇴골 구조의 뚜렷한 차이점이 발견되었다. Nano scale에서는 apatite 결정의 모양과 크기 그리고 콜라겐의 배열을 비교 분석하였다. 그 결과 토끼와 닭은 종이 다름에도 불구하고 nano scale에서는 화학성분과 구조가 매우 유사한 것으로 나타났다. Bone is a hierarchically structured composite material which has been well studied by the materials engineering community because of its unique structure and mechanical properties. Bone is a laminated organic-inorganic composite composed of primarily hydroxyapatite, collagen and water. The main mineral that gives bone's hardness is calcium phosphate, which is also known as hydroxyapatite. Light microscopy (LM) and transmission electron microscopy (TEM) were used to study the structure of femurs from chicken and rabbit. The elemental analysis was used to search variation in the distribution of calcium, potassium and oxygen in the femur. Current investigation focused on two structural scales: micro scale (arrangement of compact bone) and nano scale (collagen fibril and apatite crystals). At micro scale, distinct difference was found in microstructures of chicken femur and rabbit femur. At nano scale, we analyzed the shape and size of apatite crystals and the arrangement of collagen fibril. Consequently, femurs of chicken and rabbit had very similar chemical property and structures at nano scale despite of their different species.