대퇴 골두 골 괴사에 대한 자가 지방조직 유래 중간엽 줄기 세포 이식술의 효과

학위논문 (석사)-- 서울대학교 대학원 : 의학과 정형외과학 전공, 2016. 2. 윤강섭.Introduction Outcomes of traditional treatment for osteonecrosis of femoral head (ONFH) like core decompression or multiple drilling are not always satisfactory, and cell supplementation therapy has been recently attempted to facilitate the regeneration of the necrotic tissue. Adipose-derived mesenchymal stem cell (AD MSC) has several potential advantages over bone marrow-derived MSCs, but the outcomes of AD MSC implantation for ONFH has not well been investigated. The current study sought to determine the 2-year radiologic and clinical outcomes of the of AD MSC implantation combined with core decompression in ONFH. Materials & Methods Eighteen hips with large ONFH (≥30% of femoral head) were included in the study. AD MSCs were harvested with liposuction and culture-expanded for 3weeks and 3 passages. With core decompression, AD MSCs were implanted into the necrotic zone of the femoral head. All patients underwent MRI, SPECT/CT at screening, 6 months, 12 months and 24 months after surgery. Clinical scores were also measured at each visit. The primary outcome of was the change in lesion size on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion to total hip arthroplasty was defined as the endpoint. Results Preoperatively, the mean extent of the necrotic lesions was 63.0% (range, 38.4% to 96.7%) of the femoral head. The mean Harris hip score was 89.2 ± 8.2. The mean UCLA score was 5.6 ± 2.4, and the mean WOMAC score was 79.4 ± 14.7. Three patients received total hip arthroplasty during follow-up, and one patient died in an accident in the course of the study. Finally, 11 patients (14 hips) were available for 2-year follow-up evaluations. At the latest follow-up, there were no surgery-related complications, and 14 of 17 hips (82%) were able to perform daily activities without the need for total hip arthroplasty. There was no significant decrease in lesion size between any two intervals on MRI. Eleven of 14 hips (79%) showed increased vascularity in SPECT/CT at 2 years after surgery. There was no significant difference between preoperative and 24-month mean HHS (89.2 to 88.6), WOMAC (79.4 to 75.7), and UCLA score (5.6 to 6.2). Conclusions At 2-year follow-up, autologous AD MSCs implantation for ONFH with a large necrotic lesion was safe without any complications. The majority of the cases (82%) did not show symptomatic femoral head collapse and did not require additional surgery. Although there was no significant lesion size change on MRI, increased uptake on SPECT/CT observed in the majority of cases may indicate increased vascularity in the necrotic area. Despite limitations, the outcomes of the current study suggest that AD MSC implantation in ONFH could be a viable option.Introduction 1 Materials & Methods 3 Study design & subjects 3 MSC preparation 4 Surgical technique & rehabilitation 5 Outcome measures 9 Results 11 Demography and preoperative characteristics of patients 11 Case presentation 16 Discussion 24 Conclusion 30 References 31 국문 초록 37Maste

International Transfer of Tacit Knowledge: The Transmission of Shipbuilding Skills from Scotland to South Korea in the Early 1970s

This article analyzes the transfer of tacit knowledge between countries and continents, based on a case from the shipbuilding industry. The South Korean shipbuilder Hyundai Heavy Industries (HHI) was established in the early 1970s and had by the late 1980s become the world's leading shipbuilder. Aided by foreign loan capital, HHI acquired technology through foreign licenses and imported equipment. However, shipbuilding is about more than hardware. This article presents and analyzes another important means of knowledge transfer: the acquisition of tacit knowledge in the form of shipbuilding skills, including shipyard processes and operations. This transfer was mainly accomplished through the "import" of foreign managers and the dispatch abroad of South Korean employees. One important element, which we investigate in detail, was the Korean personnel that HHI sent in 1972 to the Scott Lithgow shipyards in Scotland to observe and learn. Based on archival sources and interviews, we detail the manner in which tacit knowledge could be transferred across language and cultural barriers