편마비 환자에서의 견관절 아탈구 진단에 유용한 촬영법

조광호(Kwang-ho Cho),강영한(Yeong-han Kang) 대한방사선과학회(구 대한방사선기술학회) 2009 방사선기술과학 Vol.32 No.3

연구목적 : 편마비 환자에 있어 견구 아탈구 진당에 유용한 촬영법을 알아보고, 편마비 상태를 고려한 촬영방법을 알아보고자 하였다. 연구방법 : 뇌졸중으로 인한 편마비 환자 중 마비측 견관절 부위의 견봉 끝과 상완골두 사이가 1 수지폭 이상인 33명의 환자를 대상으로 견관절 전후방향촬영은 누운 자세와 앉은 자세의 영상을 비교하였고, 흉곽을 통한 상완골 측방향 촬영은 앉은 자세에서 건측과 환측의 영상을 비교하였다. 축방향 촬영은 누운 자세에서 건측과 환측을 비교하였고, 상완골두의 중심, 관절와의 중심, 견봉의 최하외측단의 3가지 기준점으로 거리를 측정하여 평균비교 분선(t-test)을 시향하였다. 연구결과 : 대상자를 누운 자세에서 앉히고 견관절 자연지위를 취한 후 견관절 아탈구가 되기까지의 시간은 평균 123초였다. 견관절 전후 방향 촬영에서 상완골두의 중앙점과 견봉의 최하외점과의 거리가 누운 자세에서는 평균 49.90±13.6mm이었고, 앉은 자세에서는 60.72±16.3mm로 유의한 차이가 있었다. 흉곽을 통한 측방향 촬영에서는 환측 36.92±6.2mm, 건측 28.76±5.4mm으로 유의한 차이가 있었다. 누운 자세의 견관절 축방향 촬용에서는 건측과 환측 각각 23.01±9.1mm, 22.45±8.2mm로 유의한 차이가 없었다. 결론 : 견관절 아탈구 진단을 위한 견관절 촬영은 촬영 전 수지폭 검사를 통해 아탈구가 진행됨을 확인한 후 촬영을 하여한 진단적 가치가 있다. 이를 위해 앉은 자세에서 견관절 자연지위로 120초 지난 후 촬영을 하여야 한다. 또한 견관절 전후방향 영상과 흉곽을 통해 측방향 촬영은 아탈구를 평가하는데 유효하였고, 견관절 축방향에서는 아탈구의 차이가 없으므로 진단적 가치가 떨어진다고 볼 수 있다. Purpose : The purpose of this study was to find out useful radiological projection of shoulder subluxation in patients with post-stroke hemiplegia. Methods : A total of 33 patients with post-stroke hemiplegia were included(20 men and 13 women, mean age 62.3 years) and having the subluxed shoulder over one finger breath. The shoulder subluxation was determined as the ratio of the radiographic vertical and horizontal distance. The vertical distance was determined by measuring the distance between the most inferolateral point of the acromion and the central point of the humeral head. The horizontal distance was determined by measuring the distance between the central point of the glenoid fossa and the central point of the humeral head. To measure of the shoulder subluxation, the shoulder AP, axial and transthoracic lateral projections were taken on both affected and unaffected shoulders. We analyzed the difference of subluxation distance by t-test. Results : When patients was in sitting position, the average time of being shoulder subluxation was 123 second. There was significant difference between supine(49.90±13.6mm) and sitting position(60.72±16.3mm) in the vertical distance of shoulder anterior-posterior projection. Also, there was significant difference on transthoracic lateral projections, Affected 35.92±6.2mm, Unaffected 28.76±5.4mm. But in case of shoulder axial projection(supine position), there was no significant difference (Unaffected and affected was 23.01±9.0mm, 22.45±8.2mm each). Conclusion : Radiological projection of shoulder subluxation has diagnostic value when in goes after check out the process of subluxation through finger breadth test. For this, patients must be in sitting and shoulder neutral position about 2 minutes. In addition, Shoulder anterior-posterior and transthoracic projection were significant to diagnose subluxation, But in axial projection, there wasn't meaningful differences.

보조기구를 이용한 shoulder supero-inferior axial 검사에 대한 유용성 평가

최진혁(Jin-Hyuk Choi),김동진(Dong-Jin Kim),구본승(Bon-Seung Goo),박신호(Sinho Park),대창민(Chang-Min Dae),민관홍(Kwan-Hong Min) 대한영상의학기술학회 2017 대한영상의학기술학회 논문지 Vol.2017 No.1

목 적:회전근개 질환과 오십견, 외상환자의 경우 어깨 관절 외전이 통증으로 인해 어려워 shoulder axial 검사에 한계가 있다. 따라서 본 연구에서는 새로 개발한 보조기구를 이용한 shoulder supero-inferior axial 검사 시 유용성에 대해서 알아보고자 한다. 대상 및 방법:2016년 11월부터 2017년 1월까지 본원에 내원하여 외상, 오십견, 회전근개 파열을 진단 받은 환자 중 어깨 관절의 외전(abduction)이 90도 이하인 32명을 대상으로 보조기구를 이용하여 shoulder supero-inferior axial 검사를 시행하였다. 보조기구를 사용하기 전 영상과 보조기구를 사용하여 검사한 영상을 정량적으로 평가하기 위해서, 관절와(glenoid fossa)의 관절면이 상완골두에 겹치는 정도와 오훼돌기가 쇄골에 겹치는 정도 그리고 오훼돌기와 상완골두의 간격 등을 경력 5년차 이상의 방사선사 3명이 각각 측정하였다. 정성적 평가는 영상의학과 전임의 1명과 전공의 1명이 5점 척도를 이용하여 평가하였다. 통계학적 검정은 Medcalc version 14를 이용하였고, 정량적 평가는 Paired Student t-test, 정성적 평가는 Wilcoxon signed rank test를 이용하여 비교 분석하였다. p-value<0.001일 때 통계적으로 유의한 차이가 있는 것으로 평가하였다. 결 과:보조기구 사용 전과 후의 영상을 분석한 결과 1) 관절와의 관절면의 길이는 보조기구 사용 전 평균값이 12.9 mm, 사용 후 9.9mm로 2.9 mm 감소하여 어깨관절이 더 열려져 보였다. 2) 오훼돌기가 쇄골 위로 보이는 길이는 보조기구 사용 전 평균값이 13.9 mm, 사용 후 16.3 mm로 2.3 mm 증가하여, 오훼돌기가 쇄골 위로 잘 보였다. 3) 상완골두와 오훼돌기의 간격은 보조기구 사용 전 평균값이 6.3 mm, 사용 후 평균값이 7.9 mm로 1.6mm 증가하였고, 오훼돌기가 상완골두와 겹침 없이 잘 나타났다. 보조기구 사용 전과 후의 정량적 평가와 정성적 평가에서 모두 통계적으로 유의한 차이를 보였다(p<0.0001). 결 론:Shoulder supero-inferior axial 검사에서 보조기구를 사용함으로써, 어깨관절과 오훼돌기 그리고 상완골두를 통해 봉우리빗장관절이 뚜렷하게 보여 보조기구를 사용하기 전영상보다 진단적 가치와 영상의 질이 높게 평가 되었다. 뿐만 아니라, 환자에게 쉽게 적용가능하고, 편의성을 제공하여 환자의 만족도를 향상시킬 수 있을 것으로 사료된다. Purpose:Rotatorcuff tear, Frozen shoulder, trauma patients are in trouble with shoulder abduction, there is certain limitation examining Shoulder axial x-ray. In this study, newly- developed assist device is adapted to examine shoulder supero-inferior axial to evaluate utility of it. Materials and Methods:From November 2016 to January 2017, 32 patients with rotatorcuff tear, frozen shoulder, trauma are thesis objects. The patients who barely reached 90° below in abduction position had been examined for shoulder supero- inferior axial using assist device(below AD). To evaluate images using AD or not, three radiation technicians who have five or more years of experience measure glenoid fossa joint overlapped with humerus head, overlapped space of coracoid and clavicle and distance between coracoid and humerus head. Radiology specialist and radiology resident evaluate those images by 1-5 point criterion in quantitative evaluation way. Statistical test was done by Medcalc version 14, Student t-test had been used for quantitative evaluation and Wilcoxon signed rank test had been used for qualitative evaluation for statistical significance. When p-value is 0.001 under (p<0.001), statistical significance is confirmed. Result:The results of experiment images of AD and non-AD 1) The length of glenoid fossa joint space is average 12.9 mm in non-AD and 9.9 mm in AD. 2.8 mm gap is opened. 2) Coracoid length between the edge of it and clavicle is average 13.9 mm in non-AD and 16.3 mm in AD. 2.3 mm longer length makes coracoid process appeared more clear. 3) Distance between coracoid and humerus head is 6.3 mm in non-AD and 7.9 mm in AD. 1.6 mm increased. Coracoid process looks better without overlap with humerus head. All evaluation items represent statistical significance after using AD. Conclusion:Using AD on shoulder supero-inferior axial makes shoulder joints, coracoid process and acromioclavicle joint more visible and upgrades image quality. Also, it is easier to adapt to patients and meet patients satisfaction.

견관절 Superoinferior axial 검사 시 Tiltable standing detector의 유용성에 관한 고찰

이동희,김병기,김기정,김민현,이민우,김순배,김경수,Lee, Dong-Hee,Kim, Byung-Ki,Kim, Ki-Jung,Kim, Min-Hyun,Lee, Min-Woo,Kim, Sun-Bae,Kim, Gyeong-Soo 대한디지털의료영상학회 2009 대한디지털의료영상학회논문지 Vol.11 No.1

In this study, we compared the alteration of test positions according to various test equipments when testing shoulder joint superoinferior axial to estimate the clinical usefulness of tiltable standing detector. Our objectives were patients who visited our hospital. Among them we chose patients who were prescribed to get a shoulder axial test, again we selected 30 patients whose abduction is more than 90 degree.(2008. Nov.$\sim$2009 Jan.) With the patients cooperation, we used CR(Agfa, Belgium), fixed-detector(Canon, japan), Tiltable-detector(Philips, Netherlands). Tested with only one equipment(tiltable detector), and posed with the other two. We surveyed 5 inspectors and 30 patients, asking them to rate the convenience of test position. Also, we checked how long it takes to have the image appear on screen after testing with the equipment We provided a standard for an assessment of the image to an expert in bone radiology, an orthopedist and a radiologist with 5 years experience. When the patients were asked about the convenience of the equipments, 15 people(50%) answered CR is convenient and 14 people(46.7%) answered the Tilting detector is convenient, showing not much difference. However, when the inspectors were asked the same question, 4people(80%) out of 5 answered that the Tilting detector is more convenient The time test showed that CR takes 2 minutes and 50 seconds, the Fixed detector 1minute and 48 seconds andor had no distortion showing the shoulder joint space. However, even though the Fixed detector showed ac the Tilting detector takes 1 minute and 43 seconds to bring the image to the screen after the position. The results of the value of image taken by each equipment, CR and the Tilting detectromion, coracoid process, due to the unstable pose, they were quite distorted and scored poor in observing glenoid fossa. By this study, we can see that testing the shoulder joint superoinferior axial projection with a detector that has a tilting device would be more convenient than testing it with a CR.

Shoulder Axial 검사 시 Modified Lawrence Method의 유용성 고찰

신원철(Won-Chul Shin),이양섭(Yang-Sub Lee),정시몬(Si-Mon Chung),원대연(Dae-Yeon Won),전종안(Jong-Ahn Chun),신기용(Ki-Yong Shin),박재근(Jae-Keun Park),임동성(Dong-Sung Lim),유재헌(Jae-Hyeon Lyoo) 대한영상의학기술학회 2013 대한영상의학기술학회 논문지 Vol.2013 No.-

Purpose : DR을 이용한 견관절의 축방향 촬영에서 영상의 질을 높이고 검사의 편의성과 검사 소요시간을 단축시킬 수 있는 변형된 촬영법을 적용하여 유용성을 알아보고자 하였다. Materials and Methods : 2012년 8월부터 2012년 10월까지 본원에 내원하여 견관절 축방향 검사를 시행한 환자 중 견관절의 수술병력이 없고 운동가동범위가 외전이 50° 이상 가능한 20명(남자 12명, 여자 8명)을 대상으로 하였다. Modified Lawrence method 1은선 자세에서 검사측 손은 지지대를 붙잡고 머리와 가슴을 45~90° 구부린 자세로 하였고, 중심 X선은 상완골두의 관절로 머리쪽을 향해서 수직으로 입사하였다. Modified Lawrence method 2는 동일한 자세에서 입사각을 15~20°로 수직 입사하여 영상을 획득하였다. Lawrence method는 기존의 촬영법과 같았고, tiltable standing DR method는 환자가 앉은 자세에서 검출기 위에 팔을 올리고 중심 X선은 상완골두의 관절을 향해 검출기와 평행한 상태에서 X선관을 5~15° 기울여서 수직으로 입사하였다. 설문지는 4개의 영상과 8개 항목으로 구성되었고, 영상의학과 의사 2명, 정형외과 의사 4명, 방사선사 14명에게 4점 척도로 평가하여 평균을 산출하였다. 촬영법에 대해서는 blind test를 하였다 Rseults : 각 검사의 평균소요시간은 modified Lawrence method 1과 2가 각각 52초와 56초, tiltable standing DR method는 1분 43초, Lawrence method는 3분 9초가 소요되 었다. Modified Lawrence method1이 tiltable standing DR method보다 51초, Lawrence method 보다 2분17초가 단축되었다. Modified Lawrence method 2가 평균 62.75점으로 가장 우수한 영상으로 평가되었고, modified Lawrence method 1이 50.13점, tiltable standing DR method가 48.36점, Lawrence method가 38.75점 순으로 나타났다. Modified Lawrence method 2가 8개 평가항목 중 6개 항목에서 가장 우수하다고 하였고, 전체적인 액와의 구조가 가장 잘 관찰되는 것으로 평가되었다.Conclusion : 선 자세에서 DR을 이용한 modified Lawrence method 촬영법은 단순하고 쉽게 적용할 수 있는 검사법으로서 기존 검사에 비해서 양질의 우수한 영상을 획득할 수 있었고, 검사소요시간을 단축할 수 있는 유용한 검사법이라고 사료된다. Purpose : The usefulness of a modified method of shoulder axial projection using DR was evaluated to improve image quality and to shorten the time for the examination. Materials and Methods : Of the patients who visit to out hospital and underwent an axial examination of shoulder joint from August 2012 to October 2012, twenty people(twelve men and eight women) that over 50° of shoulder abduction is possible with no operation history of shoulder joint participated in the study. In standing position, 45∼50° bending posture of upper body with the exam-side hand on a support stand and the incident X-ray toward the joint of humeral head and detector vertically was defined as modified Lawrence method 1. In the same position, the incident X-ray of 15∼20° off the vertical was defined as modified Lawrence method 2. In sitting position, the incident X-ray toward the humeral head and 5∼15° off the vertical of the detector with the arm on the table detector was defined as tiltable standing DR method. The questionnaire composed of 4 images and 8 items was evaluated by 2 radiologists, 4 orthopedic surgeons, and 14 radiological technologists on a 4-point scale. Results : The mean times for modified Lawrence method 1 and 2 were 52 seconds and 56 seconds respectively. Tiltable standing DR method was 1.43minutes, and Lawrence method was as 2.09minutes. Modified Lawrence method 1 was shortened by 51 seconds in comparison with tiltable standing DR method, and 2.28 minutes compared to Lawrence method. Modified Lawrence method 2 was evaluated as the best image quality with 62.75 point on the mean. Modified Lawrence method 1 was 50.13 point, tiltable standing method was 48.36 point, and Lawrence method was 38.75 point each. Modified Lawrence method 2 was evaluated that it showed the overall axillary structure well and represented excellence on 6 items out of 8 items of questionnaire. Conclusion : Modified Lawrence method using DR system in standing position was easily applicable, and would be useful in that showed better image quality than the

Role of Scroll Shoulder and Pin Designs on Axial Force, Material Flow and Mechanical Properties of Friction Stir Welded Al–Mg–Si Alloy

Krishna Kishore Mugada,Kumar Adepu 대한금속·재료학회 2021 METALS AND MATERIALS International Vol.27 No.8

Understanding the flow of plasticized material during friction stir welding was critical for producing quality welds. The toolgeometry such as shoulder and pin designs play a significant role in altering the material flow characteristics. In the presentinvestigation, scroll shoulder design with varying pins were addressed in the aspects of tool axial force, material flow andmechanical properties. Marker insert method was used to study the flow of plasticized material with copper as inserts. Theresults show that the pin geometry variation has showed a significant change in the axial force plot in the welding phase. The taper cylindrical pin tool (TS) facilitated a constant force, hexagonal pin (TS)H and pentagonal pin (TS)P tools facilitateda decreasing force behavior, and triangular pin designed tool (TS)T facilitated an increasing behavior of force in the weldingphase. The material flow experiments showed that the scroll shoulder with triangular pin shaped tool (TS)T completely shearedthe marker inserts in both parallel and perpendicular to weld conditions compared to other pin shapes. The sheared copperfragments were uniformly distributed on both advancing and retreating sides of the weld for (TS)T tool. Superior mechanicalproperties were noticed for (TS)T tool with a tensile strength of 184 MPa and Microhardness of 78 HV at stir zone.

The Effect of Tool Shape on the Al6061-T6 Stationary Shoulder Friction Stirred Weldment for Axial Force and Torque Reduction

Yeong Gil Jo,Jason Cheon 대한기계학회 2023 대한기계학회 춘추학술대회 Vol.2023 No.11

Incidence analysis of axial and lower extremity deviations based on the physical characteristics between domestic and foreign college students

Jangwon Lee 한국운동재활학회 2018 JER Vol.14 No.4