소아에서의 화상 구축반혼으로 인한 수부변형에 대한 분석 및 치료

서현호,김민규 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.4

Though proper management of hand burns in children is provided, hypertrophic scars frequently cause various hand deformities or functional disturbances in growing hands. When correction principles have not been observed for the long term, contraction of the skin, tendon and joints has a serious influence on hand deformities and bone change occur in growing children and second, to determine when is the proper operative time to minimize hand deformities and recurrences. We reviewed 107 hands in 103 admitted pediatric patients who had postburn hands deformities by scar contracture. The analysis of severity of hand deformities was evaluated by assessment of our hospital scale. According to these data, we performed the operations and compared the final results. The results were as follows: The types of burn hand deformities among 107 involved hands of 103 patients included flexion contracture(39.3%), syndactyly(29.9%), extension contracture (10.3%), Boutonniere deformity (9.3%), claw hand deformity (5.6%), severe hypertrophic scar(3.7%), swan neck deformity (0.9%), and loss of digit (1.9%) etc. On 98 preoperative x-ray examinations, bone changes were common, including angular deformity(19.4%), epiphyseal plate loss(18.4%), osteoporosis (17.3%), bony erosion(17.3%), joint change(15.3%), and ankylosis (9.2%). Thus, early correction of postburn hand deformities is imperative in pediatric patients, even though there is a greater chance of secondary operation due to immature scars. All patients were operated on by our proposed protocol and postoperative results showed greatly improved finger joint motion than before. We concluded that early correction of Grade Ⅲ to Ⅴ postburn hand deformities is mandatory in rapidly growing pediatric patients.

Bone Drilling System for Quantifying Hand Feeling in Orthopedic Surgery

( C. -y. Wu ),( J. -y. Su ),( C. -s. Hsu ),( Y. -h. Chen ),( K. -f. Chang ),( C. -c. Huang ),( H. -m. Wu ),( Y. -c. Tsai ) 한국농업기계학회 2018 한국농업기계학회 학술발표논문집 Vol.23 No.1

In this work, a bone drilling system was designed to quantify “hand feeling”, which can benefit surgeons to be more acquainted with bone hardness. A bi-axial force/torque sensor is mounted on the bone drilling system in order to measure the thrust force and the torque caused by drilling in bones. The system is assembled with a motorized stage, which is directly integrated with a surgical handpiece by an adjustable holder, to drill into various bones (porcine mandible, porcine femur, porcine rib) at different feed speeds and spindle speeds. The results reveal that the feed speed is positively corresponded with force and torque. However, the effect of spindle speed on force and torque is negligible. In addition, drilling bones without spraying water can cause the drilling temperature to increase to 73.3°C. According to the data from the experiments, the exact force and torque during bone drilling can be predicted with the given parameters. Thus, surgeons are capable of preventing the use of excessive force during bone drilling.

Bone age estimation using deep learning and hand X-ray images

Jang Hyung Lee,Young Jae Kim,Kwang Gi Kim 대한의용생체공학회 2020 Biomedical Engineering Letters (BMEL) Vol.10 No.3

Bones during growth period undergo substantial changes in shape and size. X-ray imaging has been routinely used for bonegrowth diagnosis purpose. Hand has been the part of choice for X-ray imaging due to its high bone parts count and relativelylow radiation requirement. Traditionally, bone age estimation has been performed by referencing atlases of images of handbone regions where aging-related metamorphoses are most conspicuous. Tanner and Whitehouse’ and Greulich and Pyle’sare some well known ones. The process entails manual comparison of subject’s hand region images against a set of correspondingimages in the atlases. It is desired to estimate bone age from hand images in an automated manner, which wouldfacilitate more effi cient estimation in terms of time and labor cost and enables quantitative and objective assessments. Deeplearning method has proved to be a viable approach in a number of application domains. It is also gaining wider groundsin medical image analysis. A cascaded structure of layers can be trained to mimic the image-based cognitive and inferenceprocesses of human and other higher organisms. We employed a set of well known deep learning network architectures. Inthe current study, 3000 images were manually curated to mark feature points on hands. They were used as reference pointsin removing unnecessary image regions and to retain regions of interest (ROI) relevant to age estimation. Diff erent ROI’swere defi ned and used—that of rather small area mostly made up of carpal and metacarpal bones and that includes most ofphalanges in addition. Irrelevant intensity variation across cropped images was minimized by applying histogram equalization. In consideration of the established gender diff erence in growth rates, separate gender models were built. Certain agerange image data are far scarcer and exhibit rather large excursion in morphology from other age ranges—e.g. infancy andvery early childhood. Many studies excluded them and addressed only elder subjects in later developmental stages. Consideringinfant age group’s diagnosis demand is just as valid as elder groups’, we included entire age ranges for our study. A number of diff erent deep learning architectures were trained with varying region of interest defi nitions. Smallest meanabsolute diff erence error was 8.890 months for a test set of 400 images. This study was preliminary, and in the future, weplan to investigate alternative approaches not taken in the present study.

한국인 다운증후군 환자의 수부기형 및 골 연령에 관한 연구

박신,양원용,류경남 大韓成形外科學會 1999 Archives of Plastic Surgery Vol.26 No.3

The purpose of this study was to evaluate the bone age and hand anomaly in Down syndrome patients. We reviewed radiographs in 52 children and youths with Down syndrome, aged from 2 to 23 years. The characteristic findings of hand anomaly were observed in the middle phalanx of the fifth finger, with the following incidence; brachymesophalangia(44%), clinodactyly(48%), and dysmesophalangia(15%). Pseudoepiphysis(21%) was found typically at the distal end of the first metacarpal bone and proximal end of the second metacarpal bone. Up to 8.5 years of age, bone maturation was retarded and thereafter bone age accelarated in advance of chronologic age. These findings may provide valuable information relative to the diagnosis and treatment of hand anomaly in Down syndrome.

Hand Bone Image Segmentation Using Watershed Transform With Multistage Merging

Tran Thi My Hue,Min Gyu Song,Jin Young Kim,Seung Ho Choi 한국정보기술학회 2011 한국정보기술학회논문지 Vol.9 No.5

Bone segmentation in radiographic imaging is an intermediate level processing stage for an automated vision system for the skeletal assessment of children. It is one of the challenging problems in medical image analysis due to high noise levels, and low contrast with non-uniform and complex intensity distribution of radiographic image. In this paper, we present an algorithm for automatically segmenting bone from hand radiograph using watershed transform (WT) with multistage merging. WT and image preprocessing are first utilized for initializing the primitive (homogeneous) regions. Next, the merging process with two stages is applied to generate the final segmentation result. The first merging stage is performed to remove unnecessary regions between tissue and background in order to enhance the accuracy of the merging. The second stage is used to detect bones in X-Ray image. A merging criteria based on the variation of intensities along the common boundary between the pair of adjacent regions is utilized to control the merging process. Experiments are carried out on X-ray images of hand bone. The experimental results show that through the combination of WT and multistage merging, an accurate and robust segmentation can be achieved .

Split hand/foot malformation with long-bone deficiency and BHLHA9 duplication : A prenatal diagnosis report

In Ae Cho,Ji Kwon Park,Jong Chul Baek,A Na Ha,Min Young Kang,Jae Ik Lee,Ji Eun Park,Jeong Kyu Shin,Won Jun Choi,Soon Ae Lee,Jong Hak Lee,Won Young Paik 대한의학유전학회 2015 대한의학유전학회지 Vol.12 No.2

Distal limb deformities are congenital malformations with phenotypic variability and high genetic heterogeneity. Split hand/ foot malformation, also known as ectrodactyly, is a congenital limb malformation characterized by a defect of the central rays of the hands and/or feet. Split hand/foot malformation with long-bone deficiency (SHFLD) is a rare condition related to a 17p13.3 duplication. Recently, genomic duplications encompassing BHLHA9 have been associated with SHFLD. We report a case of SHFLD presenting with campomelia of the right femur, bilateral agenesis of fibulae, bilateral club feet, and oligosyndactyly of the hands and feet, that was associated with a 17p13.3 duplication, as determined prenatally using array comparative genomic hybridization.

Split hand/foot malformation with long-bone deἀciency and BHLHA9 duplication: A prenatal diagnosis report

In Ae Cho,박지권,Jong Chul Baek,A Na Ha,Min Young Kang,Jae Ik Lee,Ji Eun Park,신정규,최원준,이순애,이종학,백원영 대한의학유전학회 2015 대한의학유전학회지 Vol.12 No.2

Distal limb deformities are congenital malformations with phenotypic variability and high genetic heterogeneity. Split hand/foot malformation, also known as ectrodactyly, is a congenital limb malformation characterized by a defect of the central rays of the hands and/or feet. Split hand/foot malformation with long-bone deficiency (SHFLD) is a rare condition related to a 17p13.3 duplication. Recently, genomic duplications encompassing BHLHA9 have been associated with SHFLD. We report a case of SHFLD presenting with campomelia of the right femur, bilateral agenesis of ἀbulae, bilateral club feet, and oligosyndactyly of the hands and feet, that was associated with a 17p13.3 duplication, as determined prenatally using array comparative genomic hybridization.

Split hand/foot malformation with long-bone deficiency and BHLHA9 duplication: A prenatal diagnosis report

Cho, In Ae,Park, Ji Kwon,Baek, Jong Chul,Ha, A Na,Kang, Min Young,Lee, Jae Ik,Park, Ji Eun,Shin, Jeong Kyu,Choi, Won Jun,Lee, Soon Ae,Lee, Jong Hak,Paik, Won Young Korean Society of Medical Genetics and Genomics 2015 대한의학유전학회지 Vol.12 No.2

Distal limb deformities are congenital malformations with phenotypic variability and high genetic heterogeneity. Split hand/foot malformation, also known as ectrodactyly, is a congenital limb malformation characterized by a defect of the central rays of the hands and/or feet. Split hand/foot malformation with long-bone deficiency (SHFLD) is a rare condition related to a 17p13.3 duplication. Recently, genomic duplications encompassing BHLHA9 have been associated with SHFLD. We report a case of SHFLD presenting with campomelia of the right femur, bilateral agenesis of fibulae, bilateral club feet, and oligosyndactyly of the hands and feet, that was associated with a 17p13.3 duplication, as determined prenatally using array comparative genomic hybridization.

Effect of Cross-Sex Hormones on Body Composition, Bone Mineral Density, and Muscle Strength in Trans Women

윤여울,김동영,이은실 대한골대사학회 2021 대한골대사학회지 Vol.28 No.1

Background: Cross-sex hormone therapy (CHT) changes the physical characteristics of transgender women to match their gender identity and expression. This study aimed to determine the effects of feminizing cross-sex hormones on body composition, bone mineral density (BMD) and muscle strength in transgender women. Methods: A prospective observational study assessed 11 participants who underwent feminizing CHT. Dual energy X-ray absorptiometry (DXA), and handgrip strength were measured before CHT and after 6-months of CHT. Fat mass, lean body mass (LBM), and BMD were measured by DXA and handgrip strength was measured by hand-dynamometer. Results: Regional body fat in the trunk, legs, and gynoid region increased by 18%, 27.4%, and 27.2%, respectively after 6 months of CHT. Total body fat increased by 16.2%, while the fat mass ratio decreased by 7.2%. Although body fat increased, the android/gynoid fat ratio decreased; BMD in the lumbar spine significantly increased by 3.9% (P=0.0051), but changes in the femoral neck (P=0.1969) and total femur (P=0.4769) were not significant. Changes in LBM ranged from -3% (trunk) to -8% (arm region). Right-hand grip strength also significantly decreased by 7.7% (P=0.0467). Conclusions: After 6 months of CHT, transgender women showed a general increase in fat mass and a decreased in overall LBM and handgrip strength. Increase in fat mass percentage were more remarkable in gynoid region, leading to a more “female” body fat distribution.

다발성 K-강선을 이용한 수부 골절의 치료

홍성재,서형교,황종익,조상헌 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.3

Purpose: We reported results of percutaneous multiple K-wire fixation technique without passing through the joint in patients with a hand fracture. Methods: We evaluated a total of 116 cases in 94 patients who underwent percutaneous multiple K-wire fixation on dorsal cortex over a 10-year period between 2001 and 2010. The treatment outcomes were evaluated based on total active motion (TAM), as proposed by Widegrow. Results: Our clinical series of patients achieved good functional outcomes. Of total patients, 89% (84/94) had excellent TAM, 2% (2/94) did good TAM and 9% (8/94) did poor TAM. Postoperatively, our clinical series of patients had such a good compliance as to achieve a TAM of >181 when performing the early active movement. There were no notable postoperative complications during the follow- up period. Conclusion: Our results indicate that percutaneous multiple K-wire fixation technique without passing through the joint from normal bone density patients is effective in providing the rigid fixation. Thus, our patients could perform the early movement as promptly as possible and maintaining the full mobility of the rest of the hand. 목적: 정상 골밀도 소견을 보이는 환자군의 수부 골절 치료에 있어 다발성 K-강선을 이용하여 관절면의 통과 없이 고정한 결과를 보고하고자 한다. 대상 및 방법: 2001년부터 2010년까지 94명 116예의 수부골절 환자들을 대상으로 다발성 K-강선을 이용하여 배측 피질골에 고정을 시행하였으며 Widegrow가 제안한 총능동운동(total active motion, TAM)으로 수술 후 결과를 측정,평가하였다. 결과: 대부분의 환자에서 만족할 만한 결과를 보였다. 89% (84/94)에서 TAM ≥250。를 보였으며 2% (2/94)에서 181。<TAM<250。, 그리고 9% (8/94)에서 TAM <180。의 결과를 보였다. 견고한 고정 후 조기운동을 실시한 환자군에서TAM >181。의 좋은 결과를 얻었다. 추적기간 동안 합병증은 발생하지 않았다. 결론: 정상 골밀도 소견을 보이는 환자의 수부 골절 치료에 있어 다발성 K-강선을 이용하여 관절면의 관통없이 골절편을 견고하게 고정한다면 조기에 능동 및 수동운동을 시행할 수 있으며 이것은 수부의 빠른 기능 회복에 도움을 줄 것으로 생각된다.