• Title/Summary/Keyword: Orthopedics

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Is Interventional Therapy Superior to Medical Treatment in Chronic Low Back Pain?: Yes, in Considerable Cases (만성요통의 치료에서 중재적인 치료가 보존적 치료보다 우세한가?: 긍정적인 입장에서)

  • Chang, Sang-Bum
    • Annals of Clinical Neurophysiology
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    • v.12 no.1
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    • pp.3-6
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    • 2010
  • The British guideline for early management of persistent low back pain, published in 2009, indicated that physicians should offer exercise or medication, rather than radiological interventions or injections, as first choice of treatment in the patients with chronic low back pain (CLBP). However, there had been great controversies regarding the effectiveness of interventional treatment of patients with CLBP. Both somatic (discogenic, instability, etc) and psychosocial factors contribute to the pathophysiology of chronic low back pain (CLBP). Although it can be difficult in many occasions, thorough interview with the patients and specific diagnostic approaches can help us to identify which is the main etiology in individual patient. With the recent progress in medical radiology and development of new therapeutic modalities, some subgroups of patients of CLBP caused by somatic factors appear to be good candidates of interventional therapy. Interventional therapy can be considered in patients with CLBP caused by annulus rupture, facet joint degeneration, disc degeneration, and vertebral column instability. Among other subgroups of CLBP, carefully selected patients with disc degeneration show the most favorable result by interventional therapy. In this regard, discogenic pain, either as a form of CLBP or acute discogenic radiculopathy, seems to be a good indication of interventional therapy. Because many spine specialists generally consider those with radiculopathy are easier to be treated, patients with CLBP tend to be subjects of conventional conservative therapy. For these reasons, clinicians should make their best effort to identify every possible somatic cause in patients with CLBP before regarding them as hypochondriacs. In this review, some of the recent evidence on the role of interventional treatment in patients with CLBP will be discussed, and some of our cases who showed favorable results by interventional therapy will be presented.

Acupotomy Treatment for Lumbar Disc Herniation

  • Xilin, Chen;Xinyi, Fu;Zhichao, Luo;Wenshan, Xin;Quangui, Wang;Mira, Lee;Changqing, Guo
    • Journal of Acupuncture Research
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    • v.37 no.3
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    • pp.177-180
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    • 2020
  • Background: The aim of this study was to examine whether the effects of acupotomy therapy were beneficial for the treatment of protrusion of lumbar intervertebral disc. Methods: The number of patients (n = 80) were equally assigned into treatment group and control group. Treatment group was given acupotomy therapy twice a week, and control group was given acupuncture 3 times a week, for 4 weeks. The beneficial effect and changes in score of the Japan Orthopedic Association (JOA) for low back pain were observed. Results: Among 40 cases in the treatment group, there were 25 (62.5%) with an excellent effect, 13 (32.5%) with good effect, 1 (2.5%) with a medium effect and 1 (2.5%) with poor effect, with the total experiencing an excellent/good effect of 95.0%. Among 40 cases in the control group, there were 11 (27.5%) with an excellent effect, 17 (42.5%) with good effect, 10 (25.0%) with a medium effect, and 2 (5.0%) with poor effect, with an excellent/good rate of 70.0%. The result of the rank sum test showed Z = -4.923, p < 0.05 in the comparison, indicating a significantly better outcome following acupotomy compared with acupuncture. JOA scores increased in both groups after treatment (p < 0.05), which was more significant in the acupotomy treatment group (p < 0.05). Conclusion: Acupotomy therapy has a beneficial effect on protrusion of lumbar intervertebral disc.

Incidence and Survival Rates among Pediatric Osteogenic Sarcoma Cases in Khon Kaen, Thailand, 1985-2010

  • Wiromrat, Pattara;Jetsrisuparb, Arunee;Komvilaisak, Patcharee;Sirichativapee, Winai;Kamsa-Ard, Supot;Wiangnon, Surapon
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.9
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    • pp.4281-4284
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    • 2012
  • Background: Osteosarcoma is the most common bone cancer in children, responsible for a high rate of amputation and death. This is the first long-term, population-based, epidemiologic and survival study in Thailand. Objective: To study the incidence and survival rates of pediatric osteosarcoma in Khon Kaen. Method: Childhood osteosarcoma cases (0-19 years) diagnosed between 1985-2010 were reviewed. The data were retrieved from the population-based data set of the Khon Kaen Cancer Registry and medical records from Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. All cases were censored until the end of April 2012. The age-standardized incidence rate (ASR) was calculated using the standard method. Survival experience was analyzed using the standard survival function (STATA 9.0) and presented with a Kaplan-Meier curve. Results: 58 cases were enrolled. The overall ASR was 14.1 per million. Males and females were equally affected. The peak incidence was for 15-19 year-olds in both sexes (ASR=10.4 per million in males and 8.5 in females). The 5-year overall survival rate was 27.6% (95% CI: 15.8-40.8%). The median survival time was 1.6 years (95% CI: 1.2-2.1). In a subgroup analysis, the patients who received only chemotherapy survived longer (5-year survival 45.7%, median survival time 4.1 years, p=0.12). Conclusion: The incidence rate for childhood osteosarcoma was slightly less than those reported for Western countries. The survival rate was also lower than reports from developed countries. Further evaluation of the treatment protocol and risk factor stratification is needed.

Musculoskeletal Models to Predict Patient-specific Gait Patterns Using Function-based Morphing Technique (기능기반 형상변형기술을 응용한 환자맞춤형 근골격 모델의 보행패턴 예측에 관한 연구)

  • Park, Byoung-Keon;Koo, Bon-Yeol;Park, Eun-Joo;Chae, Jae-Wook;Lee, Soon-Hyuk;Kim, Jae-Jung
    • Korean Journal of Computational Design and Engineering
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    • v.17 no.6
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    • pp.443-455
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    • 2012
  • The configuration of a musculoskeletal (MS) system is closely related to the individual motions of the human body. Many researches have been focused on evaluating the associations between the MS configuration and the individual motion using patient-specific MS models, but it still remains a challenging issue to accurately predict the motion by differed configurations of the MS system. The main objective of this paper is to predict the changes of a patient-specific gait by altering the geometric parameters of the hip joint using function-based morphing method (FBM). FBM is suitable for motion analysis since this method provide a robust way to morph a MS model while preserving the biomechanical functions of the bones. Computed-muscle control technique is used to calculate the muscle excitations to reproduce the targeted motion within a digital MS model without the motion-captured data. We applied this approach to a patient who has an abnormal gait pattern. Results showed that the femoral neck length and the angle significantly affect to the motion especially for the hip abduction angle during gait, and that this approach is suitable for gait prediction.

PSYCHIATRIC CONSULTATION IN A CHILDREN'S HOSPITAL (소아병원에서의 정신과 자문)

  • Lee, Young-Sik;Hong, Kang-E
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.1 no.1
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    • pp.108-116
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    • 1990
  • Child Psychiatric consultations on 92 patients hospitalized at the Seoul National Childrens Hospistal were analyzed retrospectively. The main referral sources were Pedictrics(77.2%), Neurosurgery(8.91%) and Orthopedics(3.96%) Consultation rate was 0.81% for the Hospital, 1.41% for Department of Pediatrics, 3.54% for Neurosurgery and 0.3% for the other department were made for the differential diagnosis raher than for the treatment or intervention. The diagnosis of referred patients were somatoform disorder(25%), organic mental disorder(18.5%), developmental disorder(14.1), conduct disorder(6.5%), anxiety disorder(6.5%).

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Effect of Weight Ball Throw Training on Weight Shifting of Lower Body, Head Speed of Club, and Driving Distance of Amateur Golfers

  • Choi, Woo-Jin;Kim, Tack-Hoon;Oh, Dong-Sik
    • Journal of the Korean Society of Physical Medicine
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    • v.12 no.3
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    • pp.111-117
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    • 2017
  • PURPOSE: To determine the effect of weight ball throw training as a preparatory exercise before golf practice for 8 weeks on back muscle strength, weight shifting of lower body, head speed of club, and driving distance of amateur golfers. METHODS: A total of 18 subjects were randomly assigned to the experimental group (n=9) and the control group (n=9), respectively. For the experimental group, Weight ball throw training was provided to the height of waist and shoulder similar to golf swing with the following schedule: 3 kg weight ball throw training from the first week to the 4th week; 5 kg weight ball throw training from the 5th week to the 8th week. Before and after 8 weeks of training, back muscle strength, weight shifting of lower body, head speed of club, and driving distance of subjects in the two groups were measured. RESULTS: The experimental group showed significant differences in rotational back extension torque, weight shifting of lower body, head speed of club, and driving distance during golf swing (p<.05). However, the control group only showed significant difference in driving distance during golf swing (p<.05). Back extension torque, weight shifting of lower body, and head speed of club showed significant differences between the two groups during golf swing (p<.05). CONCLUSION: Weight ball throw training can positively change rotational back muscle strength, weight shifting of lower body, head speed of club, and driving distance of amateur golfers. Therefore, it might be used as an effective warming up exercise for amateur golfers.

Sacral Insufficiency Fractures : How to Classify?

  • Bakker, Gesa;Hattingen, Joerg;Stuetzer, Hartmut;Isenberg, Joerg
    • Journal of Korean Neurosurgical Society
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    • v.61 no.2
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    • pp.258-266
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    • 2018
  • Objective : The diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention. Methods : Between January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified. Results : Patients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption ("bone bruise") (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal. Conclusion : The new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

Clinical Study on Admission Patients of North Korean Refugees at a Department of Korean Internal Medicine (1개 한방병원 한방내과에 입원한 북한이탈주민 환자에 대한 임상적 분석)

  • Park, So-Im;Cho, A-Ram;Kang, Da-Hyun;Kim, Jin-Won
    • The Journal of Internal Korean Medicine
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    • v.35 no.4
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    • pp.407-415
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    • 2014
  • Objectives: The purpose of this study was to investigate the health status of hospitalized North Korean refugees in a department of Korean internal medicine. Methods: From March 1st, 2011 to June 30th, 2014, 57 North Korean refugee patients were hospitalized 96 times in a department of Korean internal medicine. Their demographic and medical information was approached retrospectively. Results: Among the 57 North Korean refugees, 46 (80.7%) were women, 11 (19.3%) were men and their average age was 49.7. Except for 3 people, the other 54 (94.7%) have been to an outpatient hospital of Department of Western Medicine, National Medical Center. Orthopedics, Neurology and Gastroenterology were most frequently visited and hospitalized. Among the total 96 times of hospitalization in a Department of Korean internal medicine, low back pain was the majority chief complaint. Among the 96, 78 (80.4%) took herbal medicine and tonifying and replenishing formula (補益劑) was most frequently prescribed. As western medication, 32 (33.0%) took ones related to the musculo-skeletal system and 30 (31.0%) took ones related to the nervous system. Qi stasis was highest among 8 types of pattern identification and Deficiency pattern (虛症) was more frequent than Excess pattern (實證). Conclusions: There are several factors that have aggravated the health status of North Korean refugees, and Korean medicine can perform a proper role to improve their health.

Dopaminergic Inhibition of Dorsal Horn Cell Activity in the Cat

  • Kim, Kyung-Chul;Shin, Hong-Kee;Kim, Kee-Soon
    • The Korean Journal of Physiology and Pharmacology
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    • v.2 no.6
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    • pp.661-670
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    • 1998
  • Dopamine has been generally known to exert antinociceptive action in behavioral pain test, such as tail flick and hot plate test, but there appears to be a great variance in the reports on the antinociceptive effect of dopamine depending on the dosage and route of drug administration and type of animal preparation. In the present study, the effects of dopamine on the responses of wide dynamic range (WDR) cells to mechanical, thermal and graded electrical stimuli were investigated, and the dopamine-induced changes in WDR cell responses were compared between animals with an intact spinal cord and the spinal animals. Spinal application of dopamine (1.3 & 2.6 mM) produced a dose-dependent inhibiton of WDR cell responses to afferent inputs, the pinch-induced or the C-fiber evoked responses being more strongly depressed than the brush-induced or the A-fiber evoked responses. The dopamine-induced inhibition was more pronounced in the spinal cat than in the cat with intact spinal cord. The responses of WDR cell to thermal stimulation were also strongly inhibited. Dopamine $D_2$ receptor antagonist, sulpiride, but not $D_1$ receptor antagonist, significantly blocked the inhibitory action of dopamine on the C-fiber and thermal responses of dorsal horn cells. These findings suggest that dopamine strongly suppresses the responses of WDR cells to afferent signals mainly through spinal dopamine $D_2$ receptors and that spinal dopaminergic processes are under the tonic inhibitory action of the descending supraspinal pathways.

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The relation between idiopathic scoliosis and the frontal and lateral facial form

  • Kim, Tae-Hwan;Kim, Joo-Hwan;Kim, Yae-Jin;Cho, Il-Sik;Lim, Yong-Kyu;Lee, Dong-Yul
    • The korean journal of orthodontics
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    • v.44 no.5
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    • pp.254-262
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    • 2014
  • Objective: The purpose of this study was to evaluate the relation between idiopathic scoliosis and facial deformity in the horizontal, vertical, and anteroposterior planes. Methods: A total of 123 female patients aged 14 years or older, who visited the Spine Clinic at the Department of Orthopedics, Korea University Guro Hospital for treatment of idiopathic scoliosis, were enrolled. Whole-spine anteroposterior and lateral radiographs were taken with the patient in a naturally erect position, and frontal and lateral cephalograms were taken in an erect position with the Frankfort horizontal line parallel to the floor. Scoliosis was classified according to the Cobb angle and Lenke classification of six curve types. Cephalometric tracing in all cases was carried out with V-Ceph 5.5 by the same orthodontist. The Kruskal-Wallis test was performed to determine whether any relation existed between each group of the idiopathic scoliosis classification and the cephalometric measurements of frontal and lateral cephalograms. Results: The measurements did not reveal any significant association between the Cobb angle and cephalometric measurements and between the curve type based on the Lenke classification and cephalometric measurements. Conclusions: Based on the results of this study, no apparent relation was observed between the severity of scoliosis and facial form variations in idiopathic scoliosis patients.