• Journal of Oral Medicine and Pain
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• 제20권2호
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• pp.257-267
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• 1995

An Epidemiologic study was carried out on 77 TMD patients with degenerative joint disease who had visited the Orofacial Pain Clinic in Pusan National University Hospital. Al subjects were interviewed and examined clinically and radiologically using a standardized examination form. As related to gender and duration, subjective and objective sysmptoms in DJD patients were studied. The obtained results were as follows : 1. There were much more patients in the twenties or thirties, women and histories such as chronic duration and microtrauma. 2. Most patients responded positively more often to the questions of jaw function, unilateral chewing in habits, poot appetite and depression in behavioral response and shoulder pain in worsening prognosis 3. While the most common reasons for treatment were pain, noise, and limitation of opening, the associated symptoms such as headache, neckache, earache, jaw dysfunction, neck dysfunction, acute bite change and dizziness, ringing or fullness in the ears as secondary CNS excitatory effects were complained. 4. Opening the mouth in 25 to 40mm, soft end feel and deflective incisal pathway were seen and more tenderness to lateral or dorsal capsule of joint than intra or extra oral muscles were complained. 5. While there appeared no click, crepitus and single click in acute group, in chronic group, crepitus, single click and no click appeared in order of sequence. 6. Tomogram or bone scan revealed more bony changes than panorama and transcranial view.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.173-189
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• 2000

The purpose of this study was to evaluate the effect of specific head positions on the mandibular rotational torque movements in maximum mouth opening, protrusion and lateral excursion. Thirty dental students without any sign or symptom of temporomandibular disorders(TMDs) were included as a control group and 90 patients with TMDs were selected and examined by routine diagnostic procedure for TMDs including radiographs and were classified into 3 subgroups : disc displacement with reduction, disc displacement without reduction, and degenerative joint disease. Mandibular rotational torque movements were observed in four head postures: upright head posture(NHP), upward head posture(UHP), downward head posture(DHP), and forward head posture(FHP). For UHP, the head was inclined 30 degrees upward: for DHP, the head was inclined 30 degrees downward: for FHP, the head was positioned 4cm forward. These positions were adjusted with the use of cervical range-of-motion instrumentation(CROM, Performance Attainment Inc., St. Paul, U.S.A.). Mandibular rotational torque movements were monitored with the Rotate program of BioPAK system (Bioresearch Inc., WI, U.S.A.). The rotational torque movements in frontal and horizontal plane during mandibular border movement were recorded with two parameters: frontal rotational torque angle and horizontal rotational torque angle. The data obtained was analyzed by the SAS/Stat program. The obtained results were as follows : 1. The control group showed significantly larger mandibular rotational angles in UHP than those in DHP and FHP during maximum mouth opening in both frontal and horizontal planes. Disc displacement with reduction group showed significantly larger mandibular rotational angles in DHP and FHP than those in NHP during lateral excursion to the affected and non-affected sides in both frontal and horizontal planes(p<0.05). 2. Disc displacement without reduction group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening as well as lateral excursion to the affected and non-affected sides in both frontal and horizontal planes. Degenerative joint disease group showed significantly larger mandibular rotational angles in FHP than those in any other head postures during maximum mouth opening, protrusion and lateral excursion in both frontal and horizontal planes(p<0.05). 3. In NHP, mandibular rotational angle of the control group was significantly larger than that of any other patient subgroups. Mandibular rotational angle of disc displacement with reduction group was significantly larger than that of disc displacement without reduction group during maximum mouth opening in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group or degenerative joint disease group during maximum mouth opening in the horizontal plane(p<0.05). 4. In NHP, mandibular rotational angles of disc displacement without reduction group were significantly larger than those of the control group or disc displacement with reduction group during lateral excursion to the affected side in both frontal and horizontal planes. Mandibular rotational angle of disc displacement without reduction group was significantly smaller than that of the control group during lateral excursion to the non-affected side in frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of disc displacement with reduction group during lateral excursion to the non-affected side in the horizontal plane(p<0.05). 5. In NHP, mandibular rotational angle of the control group was significantly smaller than that of disc displacement with reduction group or disc displacement without reduction group during protrusion in the frontal plane. Mandibular rotational angle of disc displacement without reduction group was significantly larger than that of the disc displacement with reduction group or degenerative joint disease group during protrusion in the horizontal plane. Mandibular rotational angle of the control group was significantly smaller than that of disc displacement without reduction group or degenerative joint disease group during protrusion in the horizontal plane(p<0.05). 6. In NHP, disc displacement without reduction group and degenerative joint disease group showed significantly larger mandibular rotational angles during lateral excursion to the affected side than during lateral excursion to the non-affected side in both frontal and horizontal planes(p<0.05). The findings indicate that changes in head posture can influence mandibular rotational torque movements. The more advanced state is a progressive stage of TMDs, the more influenced by FHP are mandibular rotational torque movements of the patients with TMDs.

• 대한정형도수물리치료학회지
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• 제18권1호
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• pp.57-63
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• 2012

Background: The number of old people with degenerative osteoarthritis one of the chronic disease, were constantly increased. Many researchers have made a great effort to verify the effects of ultrasound and laser therapy in degenerative osteoarthritis treatment. This study applied ultrasound-laser integration therapy on knee joint degenerative osteoarthritis and compared its effect with ultrasound and laser. Methods: We assigned 60 patients age 65 to 85 who had been diagnosed as knee joint degenerative osteoarthritis in G nursing home in Daejeon city. Randomization was done in blocks of three, holding twenty people per each group to receive either ultrasound, laser, ultrasound-laser integration therapy. This study carried out the experiment for 6 weeks to from April 17, 2010. We measured variables using visual analog scale (VAS) and pressure threshold meter (PTM) of the effects by before and after exercise. Results: It has been found that VAS was reduced and PTM was increased in all three groups. Compare with the other groups, Ultrasound-laser integration therapy group had lower VAS and higher PTM than ultrasound therapy and laser therapy group. Conclusions: These results lead us to the conclusion that ultrasound-laser integration have influenced the pain reduction of the knee degenerative osteoarthritis.

• 대한치과교정학회지
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• 제25권6호
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• pp.665-674
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• 1995

The purpose of this study is to investigate the cephalometric characteristics of the open-bite patients with DJD of TMJ. The DJD open-bite cases were compared with normal samples and Class II open-bite cases with normal TMJ respectively. Twenty three open-bite patients with bilateral DJD of TMJ($13.9\~35.3$ yens old, Group I) were selected from the Department of Orthodontics, SNUDH. Group ll consisted of thirteen Class II open-bite cases($13.2\~27.4$ years old) with no TMD signs/symtoms and good condylar shapes. Group III samples were the forty eight healthy dental students who have Class I molar relationships with no history of orthodontic treatment, good facial balance and no TMD symptoms($20.0\~26.8$ years old). First, sixty measurements in the lateral cephalometric radiographs and analysis of variance(P<0.05, Scheffe) were used to compare these three groups. The seven measurements showed significant difference(p<0.05) between Group I and Group II. After analysis of variance, six of them were used for the discriminant analysis(Wilks' stepwise analysis) and the discrminant function for Group I/Group II was obtained. The results and conclusions were as follows : In most of the measurments, Group I and Group II showed the same skeletal and dental characteristics. But seven of the sixty measurements(FH-PP angle, SNB, FH-ArGo angle, articulare angle, genial angle, upper gonial angle and Ar-Go length) were significantly different(p<0.05) between Group I and Group II. These differences may be explained by the fact that in DJD cases the mandible rotated backward due to the shortening of the ramus following the degenerative destruction of condylar head and its surrounding structures. The resulting discriminant function was : $D={-0.120X}_1+{0.066X}_2+{0.144X}_3-{0.058X}_4+2000,\;where\;X_1=ArGo\;length(mm),\;X_2=SArGo\;angle(degree),\;X_3=FH-PP\;angle(degree),\;X_4=Gonial\;angle(degree)$. Mean of the group centroids was -0.555 and percent of the 'grouped' cases correctly classified was $88.89\%$.

• 척추신경추나의학회지
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• 제3권1호
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• pp.55-64
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• 2008

Objective : Spondylothesis is a disease which sagittal facet of vertebral body's invariable alignment is being broken and vertebral body being pushed forward. Main pattern of spondylothesis is isthmic spondylothesis by isthmus defect or fracture, degenerative spondylothesis occurred by desiccated change of intervertebral disc or vertebral condyle joint's ligament. The purpose of this study is to assess the difference of the Pelvic angles, Lumbosacral angles, Pelvic tilt, and Lumbar lordotic angles of the spondylothesis patients. Methods : We analyzed the lateral view of lumbar spine of 49 isthmic spondylothesis patients, 45 degenerative spondylothesis patients and 26 patients who haven't been diagnosed as vertebra disease. We investigated each patient's pelvic angle, lumbosacral angle, pelvic tilt and lumbar lordotic angle. Results and Conclusion : 1. Pelvic incidence, in cases of degenerate spondylothesis patients, is higher than spondylothesis patients but shows less significance. On the contrary significance is higher than the group haven't been diagnosed as vertebra disease. 2. Lumbosacral incidence, in cases of isthmic spondylothesis patients, shows higher significance than degenerative spondylothesis patients and the group haven't been diagnosed as vertebra disease. 3 Pelvic tilt, in cases of degenerative spondylothesis patients, shows higher significance than isthmic spondylothesis patients and the group haven't been diagnosed as vertebra disease. 4. Lumbar lordotic angle, in cases of isthmic spondylothesis patients, shows higher significance than degenerative spondylothesis patients and the group haven't been diagnosed as vertebra disease. 5. Degenerative spondylothesis patient shows specific impression, a forwardly moved high femoral axial and as a result of large lumbrosacral angle and lumbar lordotic angle shows specific impression, an increased weight pressure on sacrum.

• 대한정형외과스포츠의학회지
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• 제11권1호
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• pp.30-36
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• 2012

목적: 내반 변형을 지닌 내측 반월 연골판 후방 골 기시부 퇴행성 파열 환자에 대해 관절경적 반월 연골판 절제술을 시행 중 개방형 경골 근위부 절골술을 시행하는 경우와 하지 않는 경우에서의 임상적 및 방사선학 결과를 비교 하고자 하였다. 대상 및 방법: $3^{\circ}$ 이상 내반 변형과 내측 반월 연골판 후방 골 기시부 퇴행성 파열을 지닌 환자에 대해 관절경적 반월 연골판 절제술을 시행받고, 최소 3년 이상 추시가 가능한 환자 42명을 대상으로 하였다. 그 중 30명에 대해서는 개방형 근위 경골 절골술을 함께 시행하였으며, 나머지 12명에 대해서는 반월 연골판 절제술만 시행하였었다. 평균 추시 시간은 52.5개월 (36.0~76.6)이었다. 최종 추시 상 두 군간에 수술 전 증상의 소실 유무, 수술에 대한 환자의 만족도, 및 HSS 점수에 대한 임상적 결과를 비교하였다. 또한 최종 추시 상 방사선학적 퇴행성 관절염의 진행 유무를 비교하였다. 결과: 증상의 호전은 근위 경골 절골술을 함께 시행한 군(83.3%, 25예)에서 의의있게 관절경적 반월 연골판 부분 절제술만을 시행한 군(66.7%, 8예)보다 호전을 보였다. 환자 만족도 역시 근위 경골 절골술을 함께 시행한 군(83.3%, 25예)에서 반월상부분 절제술만 시행한 군(58.3%, 7예)보다 의의있게 높게 나타났다. HSS 점수는 근위 경골 절골술을 같이 시행한 군은 술 전 56.9점에서 술 후 90.8점으로 향상되었으며, 반월 연골판 부분 절제술만을 시행한 군에서는 술 전 67.9점에서 술 후 89.0점으로 향상되었으나, 양군간의 통계학적 차이는 관찰할 수 없었다. WOMAC 점수 역시 양군간의 통계학적 차이는 관찰할 수 없었다. 최종 추시 상 방사선학적 퇴행성 관절염의 진행에 있어서 두 군간에 의의 있는 차이는 없었다. 결론: 내반 변형을 지닌 반월 연골판 후방 골 기시부 퇴행성 파열 환자의 치료에 있어 좋은 임상적 결과를 위해서는 근위 경골절골술이 반드시 필요할 것으로 생각된다. 그러나 퇴행성 관절염의 결과에 미치는 영향에 대해서는 장기적인 추시가 필요할 것으로 생각된다.

• 대한족부족관절학회지
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• 제17권1호
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• pp.11-16
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• 2013

Freiberg's disease is a osteochondrosis of a metatarsal head that is recognized as primarily a disorder of the second metatarsal. It is seen more often in girls. Pain and limitation of motion of the affected joint is the predominant clincal feature. The radiographic appearance demonstrates from osteosclerosis in the early stage to osteolysis with collapse in the later stage. Conservative therapy may take the form of rest, a stiff shoe, and even a cast support to decrease the stress across the joint. Surgical intervention may also be of benefit. Surgery have been attempted either to modify the diseae process or to salvage the situation once the metatarsophalangeal joint develops degenerative changes. Metatarsophalangeal joint instability is common cause of forefoot pain that can develop in association with a traumatic episode and inflamatory tissue disorders as well as neighboring toe deformities. The second ray is by far the most frequently involved. The diagnosis can be made by clinical observation and physical examination including drawer test. Many surgical procedures have beem recommended when conservative treatment has failed. Procedures described range from soft tissue releases and tendon trasfer to the direct plantar plate repair combined with a Weil osteotomy.

• Journal of Oral Medicine and Pain
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• 제20권2호
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• pp.407-420
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• 1995

This study was performed to evaluate and compare conservative treatment results by several parameters such as age, sex, symptom duration, type and timing of joint sound, parafunctional habits, splint type, and diagnostic classification. There have been too many articles reporting long term results of conservative treatment but articles related to comparison of treatment results by patients' self-evaluation have been rarely reported. For this study 258 patients with temporomandibular disorders(TMDs) were selected and examined by routine diagnostic procedure for TMDs. The subjects were classified into 5 TMDs subgroups ad treated with conservative treatments involving splints, physical modalities, jaw exercises, and counseling. Visual analogue scale(VAS) about pain, joint sound, and mouth opening limitation was recorded respectively during treatment period. From the VAS data and treatment duration, VAS treatment index(VAS Ti) was calculated. The obtained results were as follows : 1. Pain was the most frequent main symptom in subjects with temporomandibular disorders, and main symptom for mouth opening limitation was comparatively less than for pain or sound in disk displacement with reduction group or in degenerative joint disease group. 2. Degenerative joint disease group had the most poor treatment results and highest occlusal index of Helkim's index. 3. Good prognosis for conservative treatment was observed in acute group, under 6 months than chronic group, 6months over in symptom duration, and subjects with 40 years over in age showed the most poor prognosis. 4. Subjects treated with anterior repositioning splint had better treatment results than subjects treated with centric relation splint, but statistical significance in VAS Ti and treatment duration was not observed. 5. Treatment results according to affected side, types and point of joint sound did not show consistent statistical results. 6. The result for conservative treatment was observed poor in subjects with bruxism and clenching. 7. In studying coincidence between preferred chewing and affected side, frequency of preferred chewing side, in unilateral affection, was higher in ipsilateral than in contralateral side.

• 대한치과교정학회지
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• 제23권4호
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• pp.455-474
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• 1993

Degenerative joint disease(DJD) has hun known as one of the diseases which affect the middleor old-aged people. But as orthodontists are getting interested in the adult orthodontics, it is not rare for them to meet the open-bite patients with the TMJ DJD in their clinics. The purpose of this article is to investigate the cephalometric characteristics of the open-bite cases with TMJ DJD. Twelve TMJ DJD patients($15.1\~39.5$ years old) were selected from the patients who visited Department of Orthodontics, Seoul National University Hospital. Cephalograms were taken and means from 60 measurements were compared by t-test with those of the fifty four healthy adults($20.0\~26.7$ years old) who have normal occlusion and TMJ. In this study male and female are compared respectively, for in the normal samples 26 measurements showed significant differences between the male and the female. The results and conclusions axe as follows: 1 In DJD group, ANB and Angle of convexity decreased, which means the retruding of the mandible. The interincisal angle was smaller than that of the normal group. The means of the overbite were -2.1mm in male and -3.0mm in female, and the means of the overjet were 5.6mm in male and 6.7mm in female. The profile was similar to that of Angle's Class II div.1 open-bite. 2. SN-GoMe and FMA increased in DJD but SN-PP and FH-PP did not show any significant difference. In TMJ DJD open-bite cases, the bony structure lower than the palatal plane seemed to play an important role in developing open-bite. 3. In DJD group, PH-ArGo, SArGo and Y-sxis angle increased significantly, but genial angle showed no significant difference. The means of hか were 50.1mm in male and 40.2mm in female, which were significantly smaller than those of the normal(56.5mm in male, 50.9mm in female). These findings seemed to indicate the posterior rotation of mandible resulted from the shortening of the ramus height. 4. Anterior faical height(AFH), upper anterior facial height(UAFH) and lower anterior facial height (LAEH) of DJD showed no significant increase as compared with those of the noraml group. There was no significant difference in the ratio of upper anterior facial height to lower anterior facial height(UAFH/LAFH). But, lower posterior facial height(LPFH) was significantly smaller than that of the normal group. 5. It was thought that the peculiar profile of the TMJ DJD open-bite was resulted from the posterior rotation of mandible as the ramus became short following the degerative destruction of of the condylar head and neck.

• 대한정형외과학회지
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• 제52권1호
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• pp.65-72
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• 2017

목적: 후관절 근접 낭종이 동반된 퇴행성 요추부 질환으로 수술 받은 23명의 환자를 대상으로 방사선적 특징과 임상적 결과를 분석하고자 한다. 대상 및 방법: 23명의 환자를 대상으로 척추관 협착증 동반 여부, 불안정성, 척추 전방 전위증 동반 여부, 낭종의 위치 및 방향, 후관절의 퇴행성 변화 정도, 후관절 각도, 추간판 퇴행 정도를 확인하였다. 모든 환자에게 광범위 감압술 및 기기고정 유합술을 시행하였다. 임상적 결과를 Oswestry low back pain disability questionnaire 및 visual analogue scale을 이용하여 평가하였다. 결과: 23예 중 19예(82.6%)에서 척추관 협착증이 동반되었고, 4예(17.4%)에서는 후관절 낭종이 독립적으로 존재하였다. 이 중 7예(30.4%)에서 불안정성과 전방 전위가 동반되었다. 낭종의 발생은 제4-5 요추간(69.6%)이 가장 많았으며 이환된 병변측의 후관절이 반대측에 비하여 심한 퇴행성 변화를 보였다. 후관절 각도는 좌 우측에 유의한 차이가 없었으며 해당 분절의 추간판은 17예(69.6%)에서 퇴행성 변화를 보였다. 임상적 결과는 수술 후 2년 추시 양호하였다. 결론: 낭종의 발생과 퇴행성 변화는 유의한 상관관계가 있었으며 후관절 낭종과 동반된 퇴행성 요추부 질환에서 광범위 감압술 및 유합술이 좋은 임상적 결과을 얻어 유용한 술식으로 생각된다.