• Investigative Magnetic Resonance Imaging
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• 제18권3호
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• pp.225-231
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• 2014

목적: 슬관절에서 대퇴이두건과 외측 측부인대는 병합건을 형성하여 비골에 붙는다고 알려져있다. 그러나 대퇴이두건과 외측 측부인대는 여러 형태로 비골두에 붙는다. 우리는 자기공명영상을 이용하여 대퇴이두건과 외측 측부인대의 부착 형태를 분류하였고 외측 측부인대가 비골두에 붙는지 여부를 분석하였다. 대상과 방법: 2012년 7월부터 2012년 12월 사이에 슬관절 자기공명영상을 촬영한 470명의 환자의 총 494개의 자기공명영상을 후향적으로 평가하였다. 224명의 남자, 246명의 여자가 포함되었으며 나이는 10세에서 88세(평균, 48.6세) 범위였다. 배제기준은 이전의 수술을 받거나 영상질이 나쁜 경우였다. 3T 지방억제 수소밀도 강조영상을 이용하여 대퇴이두건과 외측 측부인대의 비골부착 형태를 다음과 같이 분류하였다: 유형 I (외측 측부인대가 대퇴이두건 장골의 전방팔과 직접팔 사이로 지나간다), 유형 II (외측 측부인대가 대퇴이두건 장골의 전방팔과 합쳐진다), 유형 III (대퇴이두건과 외측 측부인대가 병합건을 형성한다), 유형 IV (외측 측부인대가 대퇴이두건의 전방으로 돌아 외측으로 지나간다), 유형 V (외측측부인대가 대퇴이두건 장골의 직접팔의 후방으로 지나간다). 결과: 슬관절 자기공명영상의 494 증례 가운데, 유형 I이 433 (87.65%)예, 유형 II가 21 (4.25%)예, 유형 III이 2 (0.4%)예, 유형 IV가 16 (3.23%)예, 유형 V가 22 (4.45%)예 였다. 대퇴이두건과 외측 측부인대가 비골두에 붙지않는 경우는 26 (5.26%)예 였다. 결론: 대퇴이두건과 외측 측부인대의 비골두 부착은 자기공명영상에서 다양한 형태를보인다. 외측 측부인대는 어떤 환자에서는 비골두에 부착하지 않는다.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.19-25
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• 1999

Background & Objectives : In cerebral palsy, spastic paraplegia is one of the most crippling motor manifestations. Reducing the spasticity may improve gait and decrease the incidence of lower-extremity deformities. The spasticity may result from abnormally increased afferent signals via dorsal roots onto interneurons and anterior horn and spreading of reflex activation to other muscle groups. To assess the influence of dorsal rhizotomy to spasticity, the authors analyzed five cerebral palsy patients with spastic paraplegia. Methods : The operation entailed and L1-2 laminectomy, ultrasonographic localization of conus medullaris and identification of lumbosacral dorsal roots. The innervation patterns of each dorsal root were examined by electromyography (EMG) responses to electrical stimulation. Tetanic stimulation was applied to individual rootlets of each root after reflex threshold was determined. the reflex responses were graded and rootlets producing high grade response were selected and cut. Short-term postoperative evaluations were performed. Results : Intraoperative EMG monitoring was satisfactorily performed in all five cases. One month after the operations, all patients showed greatly reduced spasticity which was measured by the instrumental gait analysis. Bilateral knee and ankle jerks were normalized and tip-toe gait with scissoring disappeared in all patients. Conclusion : Intraoperative EMG monitoring seems useful for the selective dorsal rhizotomy to reduce spasticity.

• The Journal of Korean Physical Therapy
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• 제22권5호
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• pp.57-61
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• 2010

Purpose: The purpose of this study was to identify the effect of active foot arch support on the muscles of lower extremity electromyographic activity during squat exercise in persons with pronated foot. Methods: The study subjects were 16 persons with pronated foot. They have no history of surgery in lower extremity and trunk and limitation of range of motion or pain when performing squat exercise. Each subject was measured the navicular drop (ND) to determine the pronated foot. And then the subjects were asked to perform three repetitions of a $90^{\circ}$ knee flexion squat in both conditions which are 1) preferred squat and 2) squat with active foot arch support. Results: Paired t-test revealed that squat with active foot arch support produced significantly greater EMG activities in abductor hallucis (p=0.00), proneus longus (p=0.03) and gluteus medius (p=0.04) than preferred squat. But the EMG activities of tibialis anterior, vastus medialis oblique and vastus lateralis were not showed significantly different between the both squat conditions. Conclusion: The findings of this study suggest that active foot arch support during squat increase the activities of lower extremity muscles which are the abductor hallucis, proneus longus and gluteus medius. Also, the abductor hallucis which is one of the planter intrinsic muscle and peroneus longus play a role in support of the foot arch and active foot arch support induced the increase of the activity of gluteus medius. Therefore active foot arch support can change the lower extremity biomechanics as well as passive foot support such as foot orthotics and taping.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.509-515
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• 2018

Objective : In Asians, kneeling and squatting are the postures that are most often induce common peroneal neuropathy. However, we could not identify a compatible compression site of the common peroneal nerve (CPN) during hyper-flexion of knees. To evaluate the course of the CPN at the popliteal area related with compressive neuropathy using magnetic resonance imaging (MRI) scans of healthy Koreans. Methods : 1.5-Tesla knee MRI scans were obtained from enrolled patients and were retrospectively reviewed. The normal populations were divided into two groups according to the anatomical course of the CPN. Type I included subjects with the CPN situated superficial to the lateral gastocnemius muscle (LGCM). Type II included subjects with the CPN between the short head of biceps femoris muscle (SHBFM) and the LGCM. We calculated the thickness of the SHBFM and posterior elongation of this muscle, and the LGCM at the level of femoral condyles. In type II, the length of popliteal tunnel where the CPN passes was measured. Results : The 93 normal subjects were included in this study. The CPN passed through the "popliteal tunnel" formed between the SHBFM and the LGCM in 36 subjects (38.7% type II). The thicknesses of SHBFM and posterior portions of this muscle were statistically significantly increased in type II subjects. The LGCM thickness was comparable in both groups. In 78.8% of the "popliteal tunnel", a length of 21 mm to <40 mm was measured. Conclusion : In Korean population, the course of the CPN through the "popliteal tunnel" was about 40%, which is higher than the Western results. This anatomical characteristic may be helpful for understanding the mechanism of the CPNe by posture.

• 대한의용생체공학회:의공학회지
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• 제27권6호
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• pp.392-401
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• 2006

Image Guided Surgery (IGS) system which has variously tried in medical engineering fields is able to give a surgeon objective information of operation process like decision making and surgical planning. This information is displayed through 3D images which are acquired from image modalities like CT and MRI for pre-operation. The technique of image registration is necessary to construct IGS system. Image registration means that 3D model and the object operated by a surgeon are matched on the common frame. Major techniques of registration in IGS system have been used by recognizing fiducial markers placed on the object. However, this method has been criticized due to additional trauma, its invasive protocol inserting fiducial markers in patient's bone and generating noise data when 2D slice images are acquired by image modality because many markers are made of metal. Therefore, this paper developed shape-based registration technique to improve the limitation of fiducial marker based IGS system. Iterative Closest Points (ICP) algorithm was used to match corresponding points and quaternion based rotation and translation transformation using closed form solution applied to find the optimized cost function of transformation. we assumed that this algorithm were used in Total Knee replacement (TKR) operation. Accordingly, we have developed region-based 3D registration technique based on anatomical landmarks and this registration algorithm was evaluated in a femur model. It was found that region-based algorithm can improve the accuracy in 3D registration.

• 대한관절경학회지
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• 제12권3호
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• pp.159-166
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• 2008

연골 세포는 무혈관성, 신경과 림프계가 없는 해부학적 특성으로 인해 연골 손상에 대한 치료가 어렵다. 연골 손상에 대한 수술적 치료는 간단한 변연 절제술로부터 천공술, 미세 골절술, 연골 이식술, 자가 연골 이식술 등 다양한 방법이있으며 이들 중 자가 연골 세포 이식술은 장기적 예후에서 여러 가지 이점이 기대되는 수술로 신체적 활동 요구도가 높은 15 ~ 55 세의 환자에게 좋은 적응이 된다. 자가 연골 세포 이식술은 1984년 Peterson 등의 동물 실험 결과를 토대로 발전하여 1994년에 사람을 대상으로 한 임상 실험에서 좋은 결과를 보였다. 성공적인 수술 결과를 얻기 위해서는 시술자는 자가 연골 세포 이식술의 적응증, 수술 술기 등을 잘 숙지하여야 하며, 수술 후 연골 세포의 재생 과정에 따른 술 후의 관리 및 환자 교육이 필요하다.

• 대한관절경학회지
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• 제15권2호
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• pp.146-154
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• 2011

슬관절 후외방부 구조의 손상은 흔치 않으나 심한 불안정성과 관절 연골의 손상을 초래하여 심각한 장애가 생길 수 있다. 그러나 아직까지 이에 대한 해부학적 구조 및 진단과 치료 방법이 확실하게 정립되어 있지 않다. 후외방부 구조의 손상은 주로 십자인대 손상과 동반되어 나타나며 후외방 불안정성을 치료하지 않고 그냥 두었을 경우에 십자인대 재건술의 결과에 영향을 미쳐 실패에 이르게 하는 주요한 원인으로 인식되고 있다. 후외방부 구조의 손상의 진단은 신체 검진, 방사선 소견, 자기공명영상 및 관절경 소견을 종합하여 이루어 진다. 후외방부 구조 손상의 치료 방법은 손상 시기 및 손상 정도에 따라서 정해지게 된다. 최근의 해부학적 재건술은 다양한 결과를 보이던 이전의 비해부학적인 재건술에 비하여 임상적인 측면에서 대부분에서 좋은 임상 결과를 보이고 있으나 장기 추시를 시행한 임상 연구들의 뒷받침이 필요하다. 저자는 후외방부 구조와 관련되어 최근까지 발표된 문헌들을 정리하고 진단과 치료에 대하여 알아보고자 한다.

• 한국CDE학회논문집
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• 제18권6호
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• pp.385-398
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• 2013

Opening wedge high tibial osteotomy (OWHTO) is widely used to treat unicompartmental osteoarthritis of the knee caused by degenerative deformations of the anatomical axes of the leg. However, since it is difficult to accurately plan the surgical degrees of adjustment such as coronal correction angle and tibial posterior slope angle to align the axes before the actual procedure, a number of studies have proposed analytical models to solve this problem. While previous analytical models for OWHTO were limited to specific cases, this study proposes an analytical osteotomy model (AOM) and a surgical planning system (SPS) that are suitable for a wide range of tibial morphologies and tibia conditions. The validity and generality of the model were verified in a total of 60 OWHTO cases. Results of the test showed that, as predicted, surgical degrees are affected quite significantly by tibia shape and slope of the resected surface. Comparison of the required surgical degrees and the degrees estimated from virtual surgery simulations using AOM showed a very small average difference of $0.118^{\circ}$. SPS, based on AOM, allows the operating surgeon to easily calculate surgical parameters needed to treat a patient.

• 대한정형도수물리치료학회지
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• 제16권1호
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• pp.1-8
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• 2010

Purpose : This study aimed to examine the relationships among five clinical measures for functional alignment of the lower extremity. Methods : Thirty healthy subjects (15 males and 15 females) were recruited for the study. The five clinical measures of functional alignment of the lower extremity included navicular drop, quadriceps angle, internal rotation of hip, and anterior and lateral pelvic tilt angles. The level of navicular drop was calculated by the difference between the height of the navicular bone in the sitting (non-weight bearing) and standing (weight bearing) positions. The quadriceps angle and internal rotation of hip were measured using a standard goniometer with photographic markers while the subjects were lying in a prone position on a table with their knee at $90^{\circ}$ flexion. Anterior and lateral pelvic tilt angles were determined using a inclinometer. Results : Correlation and a simple linear regression analysis were used to assess relationships between the clinical measures. There were significant correlations between navicular drop and quadriceps angle (p<.05), between navicular drop and internal rotation of hip (p<.05), and between quadriceps angle and internal rotation of hip (p<.01). In simple linear regression analysis, the navicular drop appeared to be a factor affecting the quadriceps angle and internal rotation of hip (p<.05). The findings suggest that navicular drop has a great impact on lower extremity alignment. Conclusion : This study might help us to examine lower extremity function and clarify its role as a potential injury risk factor.

• Journal of Microbiology and Biotechnology
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• 제22권2호
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• pp.274-282
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• 2012

The object of this study was to assess the efficacy of Polycan from Aureobasidium pullulans SM-2001, which is composed mostly of beta-1,3-1,6-glucan, on osteoarthritis (OA)-induced by anterior cruciate ligament transection and partial medial meniscectomy (ACLT&PMM). Three different dosages of Polycan (85, 42.5, and 21.25 mg/kg) were orally administered once a day for 84 days to male rats a week after ACLT&PMM surgery. Changes in the circumference and maximum extension angle of each knee, and in cartilage histopathology were assessed using Mankin scores 12 weeks after Polycan administration. In addition, cartilage proliferation was evaluated using bromodeoxyuridine (BrdU). As the result of ACLT&PMM, classic OA was induced with increases in maximum extension angles, edematous knees changes, and capsule thickness, as well as decreases in chondrocyte proliferation, cartilages degenerative changes, and loss of articular cartilage. However, these changes (except for capsule thickness) were markedly inhibited in all Polycan- and diclofenac sodium-treated groups compared with OA control. Although diclofenac sodium did not influence BrdU uptake, BrdU-immunoreactive cells were increased with all dosages of Polycan, which means that Polycan treatment induced proliferation of chondrocytes in the surface articular cartilage of the tibia and femur. The results obtained in this study suggest that 84 days of continuous oral treatment of three different dosages of Polycan led to lesser degrees of articular stiffness and histological cartilage damage compared with OA controls 91 days after OA inducement, suggesting that the optimal Polycan dosage to treat OA is 42.5 mg/kg based on the present study.