Rotation & Orientation 진행상황

• The purpose of this study – To provoke the attention for the concept

of orientation and rotation to orthopedic surgeons

– Demonstrate the practical guideline for deformity correction by affine geometry.

• 3 simulations– Simplified motion of shoulder joint using

affine geometry– Simplified cylinder model for deformity

correction of a long bone– Proximal femoral derotational

osteotomy(FDO) using 3D reconstruction model of femur

　 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 900 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 05 0 0.218443 0.437719 0.658673 0.882177 1.109143 1.340536 1.577396 1.820854 2.072157 2.332697 2.60404 2.887973 3.186553 3.50217 3.837636 4.196286 4.582122 5

10 0 0.437719 0.877097 1.319819 1.767619 2.222313 2.685823 3.160215 3.647737 4.150866 4.672359 5.215321 5.783288 6.380322 7.011143 7.681282 8.397298 9.167038 1015 0 0.658673 1.319819 1.985946 2.659638 3.343595 4.040677 4.753952 5.486755 6.242752 7.026023 7.841151 8.693343 9.588569 10.53375 11.53696 12.60776 13.75753 1520 0 0.882177 1.767619 2.659638 3.561642 4.47719 5.410047 6.364244 7.344159 8.354592 9.400871 10.48897 11.62565 12.81864 14.07686 15.41071 16.83238 18.35637 2025 0 1.109143 2.222313 3.343595 4.47719 5.627478 6.799082 7.996949 9.226433 10.49339 11.80431 13.16641 14.58788 16.07801 17.64746 19.3086 21.07586 22.96626 2530 0 1.340536 2.685823 4.040677 5.410047 6.799082 8.213211 9.658225 11.14037 12.66647 14.24403 15.8814 17.58795 19.37432 21.2526 23.23674 25.34289 27.58991 3035 0 1.577396 3.160215 4.753952 6.364244 7.996949 9.658225 11.35462 13.09318 14.88155 16.72812 18.64217 20.63406 22.71543 24.89949 27.20128 29.6381 32.22993 3540 0 1.820854 3.647737 5.486755 7.344159 9.226433 11.14037 13.09318 15.09256 17.14685 19.26514 21.45741 23.73474 26.10947 28.59547 31.20842 33.96611 36.88887 4045 0 2.072157 4.150866 6.242752 8.354592 10.49339 12.66647 14.88155 17.14685 19.47122 21.86422 24.33631 26.89895 29.56484 32.34807 35.26439 38.33147 41.5692 4550 0 2.332697 4.672359 7.026023 9.400871 11.80431 14.24403 16.72812 19.26514 21.86422 24.53519 27.28864 30.13613 33.09029 36.16498 39.37548 42.73868 46.27329 5055 0 2.60404 5.215321 7.841151 10.48897 13.16641 15.8814 18.64217 21.45741 24.33631 27.28864 30.32487 33.45625 36.69494 40.0541 43.548 47.19214 51.00339 5560 0 2.887973 5.783288 8.693343 11.62565 14.58788 17.58795 20.63406 23.73474 26.89895 30.13613 33.45625 36.8699 40.38833 44.02352 47.78826 51.69614 55.76163 6065 0 3.186553 6.380322 9.588569 12.81864 16.07801 19.37432 22.71543 26.10947 29.56484 33.09029 36.69494 40.38833 44.18039 48.08152 52.10258 56.25484 60.54997 6570 0 3.50217 7.011143 10.53375 14.07686 17.64746 21.2526 24.89949 28.59547 32.34807 36.16498 40.0541 44.02352 48.08152 52.23656 56.49722 60.87221 65.37025 7075 0 3.837636 7.681282 11.53696 15.41071 19.3086 23.23674 27.20128 31.20842 35.26439 39.37548 43.548 47.78826 52.10258 56.49722 60.97836 65.55204 70.22407 7580 0 4.196286 8.397298 12.60776 16.83238 21.07586 25.34289 29.6381 33.96611 38.33147 42.73868 47.19214 51.69614 56.25484 60.87221 65.55204 70.29785 75.11287 8085 0 4.582122 9.167038 13.75753 18.35637 22.96626 27.58991 32.22993 36.88887 41.5692 46.27329 51.00339 55.76163 60.54997 65.37025 70.22407 75.11287 80.03786 8590 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90

Internal Rotation

Cutting plane 10 20 30 40 50 60

5

3D angle 0.870 1.734 2.585 3.416 4.222 4.995

Valgus 0.076 0.300 0.667 1.166 1.781 2.495

Extension 0.867 1.708 2.498 3.212 3.830 4.333

10

3D angle 1.734 3.456 5.152 6.810 8.417 9.962

Valgus 0.149 0.592 1.318 2.307 3.534 4.962

Extension 1.728 3.405 4.982 6.414 7.659 8.681

15

3D angle 2.585 5.152 7.682 10.157 12.559 14.871

Valgus 0.218 0.867 1.936 3.401 5.228 7.369

Extension 2.576 5.079 7.440 9.593 11.482 13.057

20

3D angle 3.416 6.810 10.157 13.435 16.622 19.693

Valgus 0.280 1.118 2.505 4.421 6.832 9.686

Extension 3.405 6.719 9.856 12.737 15.292 17.464

25

3D angle 4.222 8.417 12.559 16.622 20.577 24.398

Valgus 0.334 1.338 3.009 5.343 8.315 11.876

Extension 4.209 8.313 12.215 15.828 19.076 21.895

30

3D angle 4.995 9.962 14.871 19.693 24.396 28.955

Valgus 0.378 1.519 3.435 6.141 9.639 13.898

Extension 4.981 9.850 14.502 18.848 22.811 26.330

35

3D angle 5.731 11.432 17.075 22.627 28.057 33.332

Valgus 0.411 1.656 3.767 6.791 10.768 15.705

Extension 5.716 11.318 16.700 21.773 26.469 30.733

40

3D angle 6.423 12.817 19.153 25.400 31.525 37.494

Valgus 0.431 1.744 3.995 7.268 11.659 17.240

Extension 6.409 12.706 18.790 24.579 30.013 35.054

45

3D angle 7.067 14.106 21.091 27.991 34.775 41.410

Valgus 0.439 1.781 4.107 7.546 12.268 18.435

Extension 7.053 14.002 20.754 27.236 33.403 39.232

50

3D angle 7.656 15.289 22.871 30.378 37.779 45.042

Valgus 0.432 1.763 4.095 7.606 12.546 19.210

Extension 7.644 15.196 22.573 29.716 36.592 43.195

55

3D angle 8.188 16.355 24.481 32.540 40.509 48.356

Valgus 0.413 1.691 3.957 7.429 12.448 19.470

Extension 8.178 16.277 24.229 31.989 39.534 46.872

60

3D angle 8.685 17.298 25.905 34.459 42.938 51.318

Valgus 0.381 1.567 3.690 7.005 11.930 19.107

Extension 8.649 17.235 25.705 34.025 42.183 50.194

External Rotation of distal fragment

10 20 30 40 50 60

intertrochanter

3D angle 1.566 3.121 4.655 6.157 7.612 7.613

Varus 1.364 2.841 4.387 5.957 7.505 7.505

Extension 0.769 1.295 1.563 1.563 1.292 1.292

진행방향

• Deformity correction 에 대해 ..– Preoperative planning– Intraoperative guidence

보행모델에서 족부 디자인

Key joint?

Short lever arm

Operation for planovalgus

Operation for cavovarus

• Key joint 로서 talonavicular joint

• 2 part foot model

Spasticity 에 따른 보행모델 적용

GMFCS level I

GMFCS level II

GMFCS level III

• Spasticity 에 따른 보행 예측• 수술 후 보행 예측