• 한방재활의학과학회지
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• 제27권2호
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• pp.39-54
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• 2017

Objectives This study aimed to search the Chinese literature on acupotomy for lumbar disc herniation and to analyze their methodologies. Methods Using 4 Chinese databases (CBM [www.sinomed.ac.cn], CNKI [www.cnki.net], WANFANG [www.wanfangdata.com], and WEIPU [www.cqvip.com]), we searched for clinical trials conducted in China over the past 10 years on acupotomy for lumbar disc herniation. The search terms used were "(腰椎椎間板脫出症 or 椎間板脫出症 or 椎間板脫出) and (针刀or 针刀松解术)" and we selected only meta-analyses that were published before December 2016. From among these meta-analyses, we excluded duplicates and selected the remaining 36 randomized controlled trials (RCTs) for our final analysis. Results The largest numbers of acupotomy papers were published in 2008 and 2013 (8 papers each). The average number of subjects was 120; the most common treatment method used for the control group was standard acupuncture (in 11 papers), and the most common concurrent treatment in the treatment group was massage (in 10 papers). The most common site of needle insertion was between the spinous processes, or at less than 0.5 cm on either side of the spinous processes (in 24 papers). The most common site of adhesion lysis was at the transverse process (in 24 papers). Two studies were blinded, and the mean Jadad score was 1.17. Conclusions A large number of RCTs on the use of acupotomy for lumbar disc herniation are conducted every year in China, and the procedure has been shown to be very effective, with few adverse effects. However, the average quality of the studies was not very high. Based on our study, we expect several high-quality clinical trials on acupotomy to be conducted in Korea in the future.

• The Korean Journal of Pain
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• 제26권4호
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• pp.396-400
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• 2013

Conventional transcrural CPB via the "walking off" the vertebra technique may injure vital organs while attempting to proximally spread injectate around the celiac plexus. Therefore, we attempted the CT-simulated fluoroscopy-guided transdiscal approach to carry out transcrural CPB in a safer manner, spreading the injectate more completely and closely within the celiac plexus area. A 54-year-old male patient with pancreatic cancer suffered from severe epigastric pain. The conventional transcrural approach was simulated, but the needle pathway was impeded by the kidney on the right side and by the aorta on the left side. After simulating the transdiscal pathway through the T11-12 intervertebral disc, we predetermined the optimal insertion point (3.6 cm from the midline), insertion angle (18 degrees), and advancement plane, as well as the proper depth. With the transdiscal approach, we successfully performed transcrural CPB within a narrow angle, and the bilateral approach was not necessary as we were able to achieve the bilateral spread of the injectate with the single approach.

• Journal of Oral Medicine and Pain
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• 제25권2호
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• pp.191-203
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• 2000

This study was performed to investigate the relationship between vertical dimension during swallowing and speech pattern in patients with temporomandibular disorders. For this study, 33 patients with temporomandibular disorders(TMDs), namely, 17 patients with disc displacement with reduction and 16 patients with disc displacement without reduction, and 30 normal subjects without any signs and symptoms in the masticatory system were selected as the patient group and as the normal group, respectively. Biopak $system^{(R)}$(Bioresearch Inc., Milwaukee, USA) was used for recording of electromyographic(EMG) activity(${\mu}V$) of the anterior temporalis, the superficial masseter, the sternocleidomastoideus and the trapezius insertion muscle during swallowing, and of mandibular positional change with function time(sec.) during swallowing and speech. A sentence of 'Sue is missing her house' was used for observing of speech pattern. Comparison between the two groups and relationship of the mandibular positional change and the function time between during swallowing and during speech were analysed by SPSS windows program. The results of this study were as follows : 1. Mean EMG activity of the trapezius insertion during swallowing was higher in the patient group, and the value was $3.4{\mu}V$ in patients and $2.1{\mu}V$ in normal subjects. 2. Vertica1 dimension(VD) at mandibular rest position before swallowing was slightly higher in the patient group, but VD at swallowing-late stage and at rest position after swallowing were not different between the two groups. 3. Swallowing time were 2.1 sec. in the patient group, and 1.5 sec. in the normal group, and the difference was significant. 4. VD during speech were generally higher in the normal group. In this case, speaking position showing the most difference between the two groups was 'her' position. The distance from habitual intercuspal position to 'her' position was 4.9mm in the patient group, and 6.6mm in the normal group. Speaking time was also longer in the patient group. 5. There were no difference in all observed items between the two categories of the patient group according to reduction of disc displacement. 6. Relationship between the positional changes during swallowing and speech were different between the patient group and the normal group. And in the normal group, VD at rest position before swallowing was negatively correlated with speaking time.

• Journal of Oral Medicine and Pain
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• 제16권1호
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• pp.33-72
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• 1991

The purpose of this study was to investigate the stress distribution and the displacement in the temporomandibular joints following the teeth loss patterns. The three dimensional finite element method was used for a mathematical model. The finite element model was composed of 1,632 elements and 2,411 nodes in the mandible with articular disc and mandibular fossa of the temporal bone. The masseter, the temporal and the internal pterygoid muscle forces were applied at each insertion site, bisecting point of gonion and antegonion, tip of the coronoid process, and gonion at the ration of 2:2:1 respectively. The directions of muscles force were obtained from frontal and lateral cephalometric tracings using bony landmarks of the skull. The results were as follows : 1. In control model, the minimum principal stresses were concentrated on the region of anterosuperior part of the condyle head and articular disc, and maximum principal stresses on the anterior part of the condyle head and posterolateral part of the articular disc. 2. In case of unilateral teeth loss, the greater principal stress appeared at the teeth loss side and the principal stresses increased at the teeth loss side as the number of the posterior teeth loss went up. 3. In case of bilateral teeth loss, the principal stresses were greater than those of the control model and as the number of the posterior teeth loss increased, the grater principal stresses on the temporomandibular joints appeared at the both side. 4. When the posterior teeth existed bilateral, the principal stress patterns were similar to those of the control model. 5. The displacement ws directed mainly upward and backward in the upper part of the temporomandibular joints and upward and forward in the largest part of the condyle head. The displacement increased as the number of the posterior teeth loss went up.

• 구강회복응용과학지
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• 제17권2호
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• pp.75-84
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• 2001

The purpose of this study is to to analyze the mechanical stress on articular disk of the dentated skull with the condition of unilateral posterior molar missing. For this study, the three dimensional finite element model of human skull scanned by means of computed tomography. (G.E. 8800 Quick, USA) was constructed. The finite element model of jaws is composed of 98,394 elements and 38,321 nodes, and it consists of articular disc, maxilla, mandible, teeth, periodontal ligament and cranium. Boundary condition included rigid restraints at the first molar and endosteal cortical surfaces of the insertion points of temporal bone. The data derived from Nelson's study were used for the loading conditions of mandible during clenchings and for maxilla, new loading and constraint conditions were applied. A clenching task during intercuspal position was modeled to the three dimensional finite element model. The stress level and displacement of articualr disc on the model with unilateral posterior molar missing under bilateral clenching task can be analyzed. During bilateral clenchings, the compressive stress level and diplacement of the articular disk on the side of unilateral posterior molar missing is greater than that on the case with full dentition, whereas a higher stress was found on the disk on the balancing side of the full dentition. Although this kind of study is not enough to explain the role of occlusion as an etiologic factor of TMD, there may be a possibiliy that the condition of posterior molar missings may contribute in part to the TMJ biomechanics.

• 한국산학기술학회논문지
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• 제20권10호
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• pp.303-308
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• 2019

65세 남자환자에서 전신마취하 관절경 어깨 수술후 갑자기 발생한 사지 마비 증례를 보고하고자 한다. 환자는 술 후 급격한 사지 마비 증상을 보였으며 마취 관리상 특별한 문제는 없었다. 환자의 수술시 자세와 관련하여 마취 유도시에 기관삽관을 위한 과도한 경추 신전은 시행되지 않았으며 수술중 자세에서도 경추부의 과도한 회전이나 신전 또한 진행되지 않았다. 그러나 수술이 종료된 후 근이완의 완전한 회복과 의식 및 자발호흡은 확인되었으나 사지 마비 증상 및 배뇨장애 증상을 보였다. 신속히 시행한 경추부 자기공명 영상에서 경추간판에 의한 척수 신경 압박 소견 보이는 척추성 경추증 증상을 보였다. 환자는 21일간의 고농도 스테로이드 정주 요법을 포함한 보존적 치료 후에 감각 및 운동신경의 완전한 회복을 보이고 다른 신경학적 이상 소견은 보이지 않은 채로 퇴원하였다. 외상과 관련 없이 사지 마비로 나타나는 수술후 척추성 경추증의 발생은 흔하지 않다. 본 증례를 통해 수술후 발생한 비외상성 척추성 경추증 발생에 대해 타 증례 보고와 비교 분석하여 고찰해 보고자 한다. 임상 의사는 60세 이상의 노년층에서의 수술후 사지 마비에 대해 척추성 경추증의 원인 기여에 대해서도 고려하기를 권고한다.

• 한국정밀공학회지
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• 제21권8호
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• pp.157-163
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• 2004

Scoliosis is a complex musculoskeletal dieses requiring 3-D treatment with surgical instrumentation. To investigate the effects of correction surgery, a finite element model of personalized model of the scoliotic spine that will allow the design of clinical test providing optimal estimation of the post-operation results was developed. Three dimensional skeletal parts, such as vertebrae, clavicle and scapular were modeled as rigid bodies with keeping their morphologies. Kinematical joints and spring elements were adapted to represent the inter-vertebral disc and ligaments respectively. With this model, two types of surgery procedure, distraction procedure with Harrington device and rod derotation procedure with pedicle screw and rod system had been carried out. The obtained simulation results were comparatively corresponding to the post operational outcomes and successfully demonstrated qualitative analysis of surgical effectiveness. From this analysis, it has been found that the preparing of appropriate rod curvature and its insertion was more important than just performing the excessive derotation for scoliosis correction.

• 대한정형외과 초음파학회지
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• 제7권2호
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• pp.105-112
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• 2014

목적: 미추 경막외 차단술은 요통과 하지 방사통에 효과적으로 외래환자의 치료에 자주 사용되고 있으나 임상 경험이 풍부한 의사에 의해 시술되어도 25%의 실패율이 보고되고 있다. 저자들은 초음파 유도하 미추 경막외 차단술의 유효성을 추간판 탈출증 환자군과 척추관 협착증 환자군으로 나누어 결과를 비교하였다. 대상 및 방법: 요통과 하지 방사통을 호소하여 본원 외래에 내원한 55명의 환자를 대상으로 초음파 유도하 미추 경막외 차단술을 시행하였다. 환자를 복와위 자세로 눕힌 후 방사형 탐지자(round probe)를 이용하여 22게이지 바늘이 천-미추막을 통과한 것을 확인 후 약물을 투여하였다. 추간판 탈출증 환자군은 31명이었으며, 척추관 협착증 환자군은 24명이었다. 임상적 평가는 시각통증척도(VAS)를 이용하여 통증의 변화를 평가하였으며, 시행 전, 시행 후, 시행 2주 후, 시행 4주 후 전화 인터뷰와 외래 방문 시 조사하였다. 결과: 초음파 유도하 미추 경막외 차단술은 55예 중 53예에서 바늘이 성공적으로 삽입되어 96.4%의 성공률을 보였다. 추간판 탈출증 환자군과 척추관 협착증 환자군에서 성별의 차이는 없었으나 나이는 추간판 탈출증군에서 $42.3{\pm}10.8$세로 척추관 협착증군의 $62.8{\pm}15.1$세와 비교할 때 유의한 차이가 있었다(p<0.001). 시각통증척도는 추간판 탈출증 군에서 시행 전 6.8, 시행 후 3.1, 시행 2주 후 1.8, 시행 4주 후 1.77로 나타났으며, 척추관 협착증 군에서 시행 전6.9, 시행 후 3.6, 시행 2주 후 4.3, 시행 4주 후 4.9로 나타났다. 시행 전에 비해 시행 후 시각통증척도는 양 군에서 유의하게 호전되었으며(p<0.001), 나이를 보정한 후의 결과, 시간에 따라 양 군간 시각통증척도의 차이는 통계적으로 유의하였다(p<0.001). 결론: 초음파 유도하 미추 경막외 차단술은 높은 성공률을 보이며 척추관 협착증 환자군에 비해 추간판 탈출증 환자군에서 더 효과적인 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.343-347
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• 2014

Objective : To evaluate the relationship between postoperative increase in intervertebral disc space height (IVH) and posterior axial neck in cases of degenerative cervical disease treated with anterior cervical discectomy and fusion (ACDF). Methods : A total of 155 patients who underwent ACDF with more than 1 year follow up were included. Radiologically, IVH and interfacet distance (IFD) of the operated segment were measured preoperatively and postoperatively. We clinically evaluated neck and arm pains according to visual analogue scale (VAS) scores and assessed neck disability index (NDI) scores preoperatively, postoperatively, at 3 months, 6 months, and 1 year postoperatively. The relationship between radiological parameters, and clinical scores were analyzed using a regression analysis. Results : The mean increase in IVH was 2.62 mm, and the mean increase in IFD was 0.67 mm. The VAS scores for neck pain preoperatively, postoperatively, and at 3 months, 6 months, 1 year postoperatively were 4.46, 2.11, 2.07, 1.95, and 1.29; those for arm pain were 5.89, 3.24, 3.20, 3.03, and 2.18. The NDI scores were improved from 18.52 to 7.47. No significant relationship was observed between the radiological evaluation results regarding the increase in intervertebral height or interfacet distance and clinical changes in VAS or NDI scores. Conclusion : The increase in intervertebral space or interfacet distance by the insertion of a large graft material while performing ACDF for the treatment of degenerative cervical disease was not related with the change in VAS scores for neck and arm pains and NDI scores postoperatively and during the follow-up period.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.84-89
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• 2006

Objective : The purpose of this study is to compare the outcomes of two methods for stabilization and fusion : Postero-Lateral Fusion [PLF, pedicle screw fixation with bone graft] and Posterior Lumbar Interbody Fusion [PLIF, cage insertion] for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. Methods : Seventy one patients who underwent PLF [n=36] or PLIF [n=35] between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. Results : The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant [P value=0.05]. The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant [P value=0.0l7]. Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant [P value=0.193]. The PLIF group showed statistically significant improvement in Prolo functional scale [P value=0.003]. In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration [P value<0.001]. change of interbody space [P value<0.001], and range of segmental angle [P value<0.001]. Conclusion : Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors [fusion type, follow-up duration, change of interbody space, and range of segmental angle]. Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.