• 한방재활의학과학회지
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• 제30권4호
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• pp.219-231
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• 2020

The objective of this study is to propose a Korean medical rehabilitation protocol for total knee replacement (TKR) and to report its effectiveness. This study was conducted as a retrospective study which analyzes the medical records of 4 patients undergoing Korean medical rehabilitation with protocol and continuous passive motion exercise for more than two weeks after TKR. We evaluated the outcome checking physical examination findings of the knee joint, numeric rating scale (NRS), Lysholm knee score (LKS) and walking state. After the treatment, we observed that the function of knee joint, NRS, LKS, walking state of patients were improved. This study showed that Korean medical rehabilitation protocol has effect on knee joint recovery after TKR. The limitation of this study was the insufficient number of cases and short-term follow up. Further studies should be done steadily to report the effectiveness of a Korean Medical rehabilitation protocol for TKR.

• 한국방사선학회논문지
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• 제7권5호
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• pp.313-320
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• 2013

류마티스성 관절염 등의 관절 질환이나 내반 변형 등을 동반한 환자에게 정형외과적으로 인공슬관절 치환술을 시행하는데 수술용 금속정을 삽입할 때 대퇴체부의 휨 정도로 인해 대퇴피질부에 손상을 주거나 2차 골절 등의 부작용을 유발하기도 한다. 이때 대퇴체부의 중심 좌표값을 알면 금속정이 해부학적 모양의 중심으로 삽입될 수 있어 이러한 부작용을 예방할 수 있을 것이다. 본 연구에서는 인공슬관절 치환술이 필요한 10명의 환자와 대퇴골 질환이 없는 정상군 10명의 대퇴부 단층촬영영상을 이용하여 3차원 좌표값을 찾은 후 Matlab을 이용하여 중심좌표값을 찾아 해부학적 모양을 반영한 그래프를 얻었고, 구간별 3차원 곡률반경 값을 구하였다. 그 결과 실험군의 대퇴골 평균 곡률반경과 표준편차는 $758.15{\pm}206.3mm$로 측정되었고, 정상군은 $1672.97{\pm}395.6mm$로 측정되었다. 측정된 결과는 통계적 유의성 확보를 위해 f-검정을 실행하여 두 집단간 평균의 차이를 검증하였다. 이 결과로 미루어 실험군의 대퇴체부 휨 정도가 더 심함을 확일할 수 있었으며 이러한 영상 분석방법을 이용하여 해부학적 중심점을 찾는다면 인공슬관절 치환술 같은 정형외과적 수술에 도움이 될 것이라 사료된다.

• 근관절건강학회지
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• 제12권2호
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• pp.143-154
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• 2005

Purpose: The aim of this study was to investigate the effects of home care exercise program on knee joint function(WOMAC) and the quality of life in patient with total knee replacement arthroplasty. Method: Forty-one subjects were sampled according to research criteria, and divided into two groups : 21 out of experimental group and 20 out of control group. The patients having treatment of total knee replacement arthroplasty were out of the hospital. After surgery executed, it took 8days for them to recovere their health conditions since 10th day, the experimental group received the home care exercise program per regularly four days interval. Results: 1) After applying home care exercise program, the total score on the WOMAC Index for the control group was $3.09{\pm}.76$. The score of the experimental group was $3.55{\pm}.55$ which is statistically higher than that of the control group. (P=.007). 2) After applying home care exercise program, the score of the quality of life for the control group was $3.09{\pm}.50$. The score of the experimental group was $3.46{\pm}.35$ Which is statistically higher than that of the control group. (P=.007). Conclusion: This figures show that home care exercise program has good results. These findings also indicate that the services of home care exercise program are alternatives for the hospitalization.

• 대한정형외과학회지
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• 제54권3호
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• pp.254-260
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• 2019

목적: 슬관절 전 치환술 시, 90° 굴곡과 신전 시의 간격(gap) 차이와 술 후 1년째의 슬관절 기능과의 관계를 알아보고자 하였다. 대상 및 방법: 2017년 3월부터 6월까지 골관절염 환자를 대상으로 하여 시행된 내비게이션을 이용한 전치환술의 연속된 82예를 대상으로 시행된 전향적 연구이다. 간격 측정은 내비게이션을 이용하였으며, 슬개골을 towel clip을 이용하여 정복한 이후 간격을 측정하였다. 신전 시의 내측과 외측 간격의 평균과 90° 굴곡 시의 내측과 외측 간격의 평균값을 구한 이후 간격 차이(90° 굴곡 시의 간격-신전 간격)를 계산하였다. 간격 차이<0 mm, 0 mm≤간격 차이<2 mm, 2 mm≤간격 차이를 각각 1군, 2군, 3군으로 나누었다. 술 후 1년째, Knee Society score (KSS)와 함께 무릎의 최대 굴곡 각도를 측정한 이후, 각 군 간의 값을 비교하였다. 결과: 간격 차이의 값에 따라 나눈 군의 수는 1군이 37예, 2군이 29예, 3군이 16예였다. 술 후 1년째의 KSS knee는 평균 81.21±8.31, KSS function은 71.34±9.84, 그리고 무릎의 최대 굴곡 각도는 126.48°±7.28°였다. 간격 차이에 따른 1년 후의 KSS의 값은 통계적으로 유의한 차이가 없었다. Mann-Whitney test를 이용한 두 군 간의 비교에서 2 mm≤간격 차이를 보이는 3군이 1군과 2군에 비하여 통계적으로 유의하게 큰 최대 무릎 굴곡 각도를 보였다. 결론: 슬관절 전 치환술 시, 90° 굴곡 시의 간격이 신전 시의 간격보다 2 mm 이상 큰 경우에서 다른 군에 비하여 술 후 1년째의 최대 무릎 굴곡 각도가 통계적으로 유의하게 높았다.

• The Journal of Korean Physical Therapy
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• 제13권1호
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• pp.19-31
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• 2001

The twenty one individuals with total knee replacement who were admitted to Kang-Dong Hospital for comprehensive physical therapy were studied in order to demonstrate the effectiveness of an isokinetic test program using the Cybex 6000 machine. The subjects were divided into three groups with the isometric exercise group receiving isometric exercise. the isokinetic eccentric exercise group, and isokinetic eccentric exorcise group receiving isokinetic exercise(eccentric. concentric) to knee flexors and extensors muscles for a six weeks period using the Cybex 6000. The results were follow :1 . The peak torque was increased significantly in the flexors and extensors of the isokinetic conccentric exorcise among three groups(p<.05). 2. The progress of peak torque was increased significantly in the flexors and extensors of the isokinetic conccentric exercise among three groups(p<.05). 3. The total work was more increased significantly in the flexors and extensors of the isokinetic conccentric exercise among three groups(p<.05). 4. The progress of total work was more increased significantly in the flexors and extensors of the isokinetic conccentric exercise among three groups(p<;.05). 5. The ratio of endurance was not increased significantly in all three groups. 6. The extensors in the peak torque was likely to recover rapidly than the flexors. 7.The average R.O.M in the pre-exercise and post-exercise was not different significantly in all three groups. According to the above results, In the muscle strength recovery for total knee replacement patients, isokinetic concentric exercise group was significantly greater than the isokinetic eccentric and isometric exercise groups after a six weeks training.

• 지역사회간호학회지
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• 제28권4호
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• pp.494-503
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• 2017

Purpose: This study is to grasp factors influencing the quality of life in older adults after total knee replacement. Methods: This study was conducted with 165 older adults who had TKR at four orthopedic hospitals in D city. Data were analyzed using one-way ANOVA, independent t-test, Pearson's correlation, and stepwise multiple linear regression with SPSS 19.0 software. Results: Pain and depression were negatively correlated with range of motion, social support, while sense of coherence was positively correlated with quality of life. Sense of coherence (43%, ${\beta}=.40$), pain (8%, ${\beta}=-.30$), and depression (3%, ${\beta}=-.20$) on the Physical Component Summary in the quality of life have significant explanatory power of 54%. Sense of coherence (49%, ${\beta}=.44$), social support (6%, ${\beta}=.25$), and depression (3%, ${\beta}=-.22$) on the Mental Component Summary in the quality of life have significant explanatory power of 58%. Conclusion: This study suggests developing a program to improve the quality of life in older adults who had TKR, considering factors such as sense of coherence.

• 한국전문물리치료학회지
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• 제23권1호
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• pp.20-30
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• 2016

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC ($n_1$=19) or the QIIC ($n_2$=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

• 대한관절경학회지
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• 제10권1호
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• pp.77-82
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• 2006

목적: 40세 이상의 성인에서 발견된 외측 원판형 연골의 임상적 특징에 대해서 분석하고자 한다. 재료 및 방법: 1994년 3월부터 2004년 3월까지 40세 이상에서 원판형 연골이 발견되어 관절경적 치료후 1년 이상 추시가 가능한 48명의 환자 53예를 대상으로 하였고 환자의 평균 연령은 48.4세($40{\sim}62$세)였다. 환자군을 대상으로 이학적 검사 소견, 단순 방사선 및 MRI 소견, 관절경 소견을 분석하였다. 결과: 전체 53예중 증상 이환 기간은 1년이내가 42예(79.2%)로 대부분을 차지하였고 26예(49.1%)에서 외상의 기왕력이 있었으며, 방사선학적 검사상 대퇴골 외과의 편평화, 외측 구획의 퇴행성 변화가 37예(69.8%)에서 관찰되었다. 또한 내측 구획의 퇴행성 변화는 16예(30.2%)에서 관찰되었다. 슬관절경 검사상 45예(84.9%)에서 원판형 연골의 파열이 관찰되었고 파열이 없었던 경우는 8예(15.1%)였다. 파열형태는 복합형(18예, 40.0%)의 파열 형태가 가장 흔하게 나타났으며 그외 종파열(longitudinal) 12예(26.7%), 수평파열(horizontal) 11예(24.4%), 횡파열(transverse) 4예(8.9%)가 관찰되었고, 내측 연골판 파열을 동반하는 경우는 7예(13.2%)였다. 치료 방법으로는 관절경하 연골판 성형술이 46예(86.8%), 이중 6예에서 연골판 성형술 후 부분적 봉합술을 함께 시행하였으며 연골판 아절제술이 5예(9.4%), 연골판 전절제술이 1예(1.9%), 1예(1.9%)에서 관절경 검사후 슬관절 전치환술을 시행하였다. 결론: 성인의 원판형 연골은 소아의 경우와는 달리 외상의 기왕력을 가지고 있는 빈도가 높으며 가벼운 외상에 의해 증상이 발현된다. 또한 슬관절 내 외측 구획의 퇴행성 변화 등 방사선학적인 변화를 관찰할 수 있어 가능한 보존적인 수술적 치료가 필요할 것으로 사료된다.

• 한방재활의학과학회지
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• 제24권1호
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• pp.111-118
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• 2014

The objective of this study is to report the effectiveness of Korean medical rehabilitation for total knee replacement. Three female patients who had total knee replacement were treated by Korean medical rehabilitation with protocol. We evaluated the consequences by checking numeric rating scale (NRS), Lysholm knee score, physical examination of knee joint and walking state. After Korean medical rehabilitation, we find out that the pain and function were improved. NRS, Lysholm knee score, physical examination of knee joint, walking state of patients were also improved. Korean medical rehabilitation can be effectively used for total knee replacement patients. There is a limit that this study hasn't sufficient number of cases. Further studies are needed to set up a Korean medical rehabilitation protocol.

• 대한간호학회지
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• 제43권3호
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• pp.352-360
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• 2013

Purpose: In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia. Methods: This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals. Results: Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010). Conclusion: ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.