• 융합정보논문지
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• 제10권5호
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• pp.188-197
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• 2020

본 연구는 관절가동술 후 두 가지 유형의 전기치료 방법을 각각 적용하였을 때 유방암 환자의 어깨 가쪽돌림 가동범위와 통증에 미치는 효과를 알아보기 위해 실시하였다. 유방절제술을 시행한 유방암 환자 30명을 STMG (관절가동술+비침습적 무통증 신호 전기치료) 15명과 TENMG (관절가동술+경피신경전기자극) 15명으로 나누었다. 중재는 4주간 주 3회, 1회당 1시간씩 실시하였다. 측정은 어깨 가쪽 돌림 관절가동범위(Range of motion, ROM), 통증(Visual analog scale)을 측정하였다. 중재 전·후 두 군 모두 어깨 가쪽돌림 관절가동범위, 통증에서 유의한 차이가 있었다(p<.05). STMG는 어깨 가쪽 돌림 관절가동범위를 제외하고 TENMG보다 통증 감소에서 더욱 효과적이었다(p<.05). 유방암 절제술 환자의 통증을 경감시키기 위해서는 STMG이 TENMG보다 더욱 효과가 있다는 것을 확인할 수 있었다. 다양한 차이를 확인하기 위해 대조군을 더하고, 더 많은 대상자가 필요할 것으로 사료된다.

• 대한물리의학회지
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• 제6권4호
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• pp.369-379
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• 2011

Purpose : The purpose of this study is to compare the initial effect of nerve mobilization (NM), static stretching (SS), and contract-relax (CR) techniques to find the best method in improving hamstring flexibility and gait function in patients with hemiplegia. Methods : Eleven patients with hemiplegia were included in this study. Passive knee extension (PKE) range of motion and the sit and reach (SR) test were used to measure hamstring flexibility, while timed up and go (TUG) and the 10m walking (10MW) test were used to measure the subject's gait. Measurements on each test were assessed prior to the experiment, immediately following the experiment, and 30 minutes after the experiment. Analysis of the results utilized a repeated measures analysis of variance to examine hamstring flexibility and the difference in walking ability. Results : The results suggest significant increases in NM, SS, and CR techniques as they relate to hamstring flexibility (p<.05) following (both immediate and 30 minutes post experiment) PKE range of motion and the SR test, but post-hoc showed no significant difference between the three techniques (p>.05). Additionally, the results suggest significant increases in NM, SS, and CR techniques as they relate to gait function (p<.05) following the TUG test, but found no significant difference in the 10MW test (p>.05). Post-hoc analysis between the three techniques suggests that only the NM technique significantly changed gait function. The time of TUG and 10MW test showed no significant difference between the three techniques before an experiment, just after an experiment, and 30 minutes following the experiment according to the measurement points in time (p>.05). Conclusion : This study suggests NM, SS, and CR techniques immediately improve hamstring length and flexibility while improving gait function in patients with hemiplegia.

• 한국전문물리치료학회지
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• 제27권1호
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• pp.70-77
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• 2020

Background: Neck pain can be caused by any structure in the neck, such as intervertebral discs, ligaments, muscles, facet joints, dura mater, and nerve roots. The hyoid bone is a structure that is also related to head and neck posture, neck movement and pain, but there are no studies on hyoid deviation, neck pain, and range of motion (ROM). Objects: The purpose of this study was to investigate the effect of fascia relaxation and mobilization of the hyoid bone on the ROM, pain, and lateral deviation of the hyoid bone. Methods: Twenty-five patients with neck pain identified by the lateral motion test (10 males [35.13 ± 7.67 years, 172.69 ± 3.90 cm, 78.77 ± 6.96 kg] and 15 females [35.13 ± 10.05 years, 161.11 ± 4.09 cm, 52.59 ± 2.98 kg]) was chosen randomly. Baseline values for pain, neck ROM, and lateral deviation in the hyoid bone were recorded using a visual analogue scale (VAS), goniometer, and tape measure. Then, each patient was treated with hyoid fascia relaxation and mobilization, and all results were recorded after intervention. Comparison of the results before and after intervention was analyzed using paird t-test (p < 0.05). Results: Right rotation, extension, VAS, and rotational asymmetry statistically significant differences (p < 0.05). Right rotation and extension increased ROM, rotational asymmetry ratio and VAS decreased. However, there was no significant difference in flexion, left rotation, center point (p > 0.05). Conclusion: Fascia relaxation and hyoid mobilization could improve the ROM of cervical extension, asymmetry of the cervical rotation and neck pain.

• Archives of Reconstructive Microsurgery
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• 제6권1호
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• pp.73-79
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• 1997

Complete denervation after severe brachial plexus injury make significant muscle atrophy with loss of proper function. It is much helpful to reconstruct the essential function of the elbow flexion movement in patient with total loss of elbow flexion motion after brachial plexus lesion which was not recovered with nerve surgery or long term conservative treatment from onset. In whole arm type brachial plexus injury, if there were no response to neurotization or neglected from injury, the volume of the denervated muscle is significantely reduced month by month. About 18 months most of the muscle fibers change to fibrous tissues and markedly atrophied irreversibly, further waiting is no more meaningful from that period. Authors performed 14 cases of functioning gracilis muscle transfer from 1981 to 1995 with microneurovascular technique, neuromusculocutaneous free flaps were performed for reconstruction of lost elbow flexion function. Average follow-up period was 5 years and 6 months. We used couple of intercostal nerves as a recipient nerve which were anastomosed to muscular nerve from obturator nerve in all cases. Recipient vessels were three deep brachial artery and eleven brachial artery which were anastomosed to medial femoral circumflex artery with end to end or end to side fashion. Average resting length of the transplanted gracilis were 24 cm. We can get average 54 degree flexion range of elbow with fair muscle power from flail elbow. There were one case of muscle necrosis with lately developed thrombosis of microvascular anastomosed site which comes from insufficient recipient arterial condition, 3 cases of partial marginal necrosis of distal skin of the transplanted part which were not significant problem with spontaneously solved with time goes by gracilis muscle has constant neurovascular pattern with relatively easy harvesting donor with minimal donor morbidity. Especially it has similar length and shape with biceps brachii muscle of upper arm and longer nerve pedicle which can neurorrhaphy with intercostal nerve without nerve graft if sufficient mobilization of the nerves from both sides of gracilis and intercostal region. Authors can propose gracilis muscle transplantation with intercostal nerves neurotization is helpful method with minimal donor morbidity for neglected brachial plexus palsy patients.

• 한국전문물리치료학회지
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• 제3권2호
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• pp.95-105
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• 1996

지금까지의 내용을 요약하면 먼저, 인체의 각 관절 주위에는 관절의 움직임과 위치를 파악하는 감지기 역할을 하는 기계적 감수기가 있다. 이러한 감수기는 크게 네가지로 구분되어지는데 대개 I형 감수기, II형 감수기 등의 용어를 사용한다. 각각의 감수기의 특성(표 2.)을 알아보면, 루피니(Ruffini)감각기와 유사한 모양을 하고 있는 I형 관절감수기는 주로 운동의 속도(speed)와 방향(direction)을 감지(detection) 하며, 파시니안(Pacinian)감각기와 유사한 형태를 하고 있는 II형 관절감수기는 매우 작은 움직임에 대한 감지를 하는데, 예를 들어 속도가 가속(acceleration)되는 것과 같은 움직임 등을 알아낸다. 이외에 골지건과 비슷한 모습을 하고 있는 III형 관절감수기는 운동의 자세(position)와 방향에 대한 정보를 전달하게 된다 (Carpanter, 1990). 관절의 자세 유지 혹은 안정성 즉, 정적(static) 운동에 주로 관여하는 I형 관절감수기와, 역동적(dynamic)인 운동에 감지를 주로 하는 II형 관절감수기는 진동(oscillation)자극에 잘 촉진된다. 이러한 자극은 동통이 심하게 발생된 관절에 나타나는 근육의 과긴장(hypertonicity)과 동통을 경감시킬 수 있다. III형 관절감수기는 억제 (inhibitory)감수기라 할 수 있는데, 골지건(golgi tendon organ)의 기능과 매우 관련이 깊다. 이 감수기는 관절의 가동범위를 기계적인 자극으로 증가시키기 위해 관절의 가동 끝범위에서 강한 신장(strong strectch)이나 thrust 기술로 감수기를 촉진할 수 있다. 이러한 자극은 결국 근육에 이완을 얻게 할 수 있다. 위에서 언급한 관절 주위의 조직에 분포한 특별한 기계적 감지를 환자들의 임상 증상에 따라 선택적으로 자극하는 치료를 적용할 수 있다면, 현재 물리치료사들이 적용하고 있는 관절 가동운동을 좀더 전문적인 수준으로 수행할 수 있을 것이다.

• International journal of advanced smart convergence
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• 제12권2호
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• pp.167-172
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• 2023

In this study, the absolute and relative strength of six upper extremity resistance exercises were measured by classifying resistance exercise experts and non-experts. As a result, the skilled group showed higher absolute and relative muscle strength than the unskilled group in the 6 upper extremity resistance exercises. These results are judged to be the hypertrophy of fast-twith muscles, the mobilization of motor units, and the increase in the speed of nerve conduction while the skilled person consistently performs resistance exercise. Experts use intermuscular coordination efficiently to stably perform the load according to the movement and exercise intensity performed during exercise, whereas the inexperienced person uses relatively large muscle groups rather than efficiently using intermuscular coordination. It is considered that exercise motion and load were performed by mobilizing. In addition, as a result of comparing the absolute and relative muscle strength between the 6 types of upper limb resistance exercises, there was a difference between the 6 types of upper limb resistance exercises in the two groups. It can be judged that greater muscle strength and endurance were created through liver coordination.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1508-1515
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• 1992

Between 1975 and 1992, forty five patients with trachea stenosis received tracheoplasty for relief of obstruction. The causes of airway problem are brain contusion[19 cases, 40%], cerebrovascular disease[3 cases, 7%], drug intoxication[8 cases, 18%], psychotic problem[2 cases, 4%], trachea tumor[3 cases, 7%], adult respiratory distress syndrome[9 cases, 20%] and direct trauma[1 case, 2%]. Direct causes of trachea stenosis were complications of tracheostomy[36 cases, 80%], complications of nasotracheal intubation[5 cases, 11%], tumor[3 cases, 6%] and trauma[1 case, 2%]. Thirty one patients underwent the sleeve resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Forteen patients received the Montgomery T-tube for relief of airway obstruction. Four patients have done simple excision of granulation tissue. Two, subglottic stenosis patients were received Rethi procedure[anterior division of cricoid cartilage, wedge partial resection of lower thyroid cartilage and Montgomery T-tube molding] and the other subglottic stenosis patient underwent permanent trachea fenestration. Including cervical flexion in all patients postoperatively, additional surgical techniques for obtain tension-free anastomosis were hyoid bone release technique in two cases, and hilar mobilization, division of inferior pulmonary ligament and mobilization of pulmonary vessel at the pericardium were performed in one case. Cervical approach was used in 39 cases, cervicomediastinal in 12 cases and transthoracic in one case. Complications of tracheoplasty were formation of granulation tissue at the anastomosis site[3 cases], restenosis[9 cases], trachea-innominate artery fistula[2 cases], wound infection[2 cases], separation of anastomosis[2 cases], air leakage[3 cases], injury to a recurrent laryngeal nerve[temporary 8 cases, permanent 2 cases] and hypoxemia[1 case]. Surgical mortality for resection with primary reconstruction was 6.7%, with one death due to postoperative respiratory failure and two deaths due to tracheo-innominate artery fistula.

• 대한정형도수물리치료학회지
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• 제2권1호
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• pp.9-19
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• 1996

지금까지의 내용을 요약하면 먼저, 인체의 각 관절 주위에는 관절의 움직임과 위치를 파악하는 감지기 역할을 하는 기계적 감수기가 있다. 이러한 감수기는 크게 네가지로 구분되어지는데 대개 I 형 감수기, II 형 감수기 등의 용어를 사용한다. 각각의 감수기의 특성(표 2.)을 알아보면, 루피니(Ruffini)감각기와 유사한 모양을 하고 있는 I 형 관절감수기는 주로 운동의 속도(speed)와 방향(direction)을 감지(detection)하며, 파시니안(Pacinian)감각기와 유사한 형태를 하고 있는 II 형 관절감수기는 매우 작은 움직임에 대한 감지를 하는데, 예를 들어 속도가 가속(acceleration)되는 것과 같은 움직임 등을 알아낸다. 이외에 골지건과 비슷한 모습을 하고 있는 II 형 관절감수기는 운동의 자세(position)와 방향에 대한 정보를 전달하게 된다. 관절의 자세 유지 혹은 안정성 즉, 정적(static) 운동에 주로 관여하는 I 형 관절감수기와, 역동적(dynamic)인 운동에 감지를 주로하는 II 형 관절감수기는 진동(oscillation)자극에 잘 촉진된다. 이러한 자극은 동통이 심하게 발생된 관절에 나타나는 근육의 과긴장(hypertonicity)과 동통을 경감시킬 수 있다. III 형 관절감수기는 억제(inhibitory)감수기라 할수 있는데, 골지건(Golgi tendon organ)의 기능과 매우 관련이 깊다. 이 감수기는 관절의 가동범위를 기계적인 자극으로 증가시키기 위해 관절의 가동 끝범위에서 강한 신장(strong stretch)이나 thrust 기술로 감수기를 촉진할 수 있다. 이러한 자극은 결국 근육에 이완을 얻게 할 수 있다. 위에서 언급한 관절 주위의 조직에 분포한 특별한 기계적 감지를 환자들의 임상 중상에 따라 선택적으로 자극하는 치료를 적용할 수 있다면, 현재 물리치료사들이 적용하고 있는 관절 가동운동을 좀 더 전문적인 수준으로 수행할 수 있을 것이다.

• Archives of Reconstructive Microsurgery
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• 제10권2호
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• pp.93-98
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• 2001

Purpose : This describes our experience with a tenocutaneous free flap from the dorsum of the foot or radial forearm to reconstruct the dorsal skin and extensor tendons of the hand. Material and Methods : Between february 1987 and July 1998, we treated 9 patients with composite tissue loss on the dorsal hand caused by crushing injury. Nine men had an average age of 26.4 years(range, $19{\sim}47$). We treated 5 patients with the free dorsalis pedis flap including the extensor tendons and the superficial peroneal nerve and 4 patients with reverse forearm flap including the brachioradialis tendon and/or superficial radial nerve. Flap size was average 4.4(3,2cm. Evaluation of the results was based on the survived flap rate, the recovery rates for range of motion of the metacarpophalageal joints in the operated fingers. two-point discrimination. Results : All flaps were well vascularized and survived completely. Recovery rates for range of motion of the metacarpophalageal joints in operated fingers range from $78%{\sim}99%$(average, 90%). Two-point discrimination of the transferred flaps in 5 patients average $20{\pm}3.5mm$. Conclusion : The advantages of this procedure are mass action reconstruction with tendon, one-stage operation, faster healing with less adhesion formation, and early mobilization.

• Advances in pediatric surgery
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• 제13권1호
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• pp.76-80
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• 2007

The authors applied anterior sagittal transrectal apporach (ASTRA) for the repair of urethrovaginal fistula which developed after total repair of persistent cloaca. The patient had been diagnosed to have persistent cloaca, double uterus and double vagina, and received PSARP, excision of right-side uterus and vagina, and left vaginal switch operation at 22 months old. After operation, the patient admitted several times due to frequent urinary tract infection and ectopic stone formation in bladder and neovagina. Urethro-neovaginal fistula was confirmed by cystoscopy and corrected with ASTRA. Postoperative voiding cystourethrogram showed no fistula tract. ASTRA showed improved surgical field, minimized ureterocystic damage, and preserved perirectal nerve due to limited incision of rectum.