• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.691-700
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• 2017

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

• Journal of Acupuncture Research
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• 제23권1호
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• pp.165-177
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• 2006

Objectives : 1. Clinical trial for the efficacy evaluation of Korean acupuncture techniques in treating frozen shoulder. 2. Development of the standard clinical guidelines of the acupuncture treatment for the frozen shoulder. 3. Development of the new clinical protocol for the acupuncture treatments. 4. Verification of the hypothesis that treating at both the remote and the nearby acupoints according to the meridian theory is more effective than treating at only the nearby acupoints. Methods : 1. Research designed as Single blind, Randomized, Sham acupuncture controlled clinical Trial. 2. Assignment of 86 patients to one of three groups treated at nearby acupoints(group A), remote & nearby acupoints(group B), and sham points(group C) respectively. 3. Trial conducted at KIOM CRC of Dunsan oriental medical hospital, Daejeon Univ. 4. Estimation of the recovery rate of the frozen shoulder in subjects aged over 40. 5. Efficacy evaluation using VAS, SPADI, ROM and Improvement rate. Results : 1. There was no significant difference in VAS among the three groups. 2. Pain related scores in SPADI of the group B were significantly lower than those of the group A. 3. There was no significant difference in disability related scores of SPADI among the three groups. 4. External rotation of upper arm in the group B was significantly improved in comparison with that in the group C. 5. Abduction of upper arm in group A was improved with weak statistical significance in comparison with that in the group C. Conclusion : Acupuncture at both the remote and the nearby acupoints according to the meridian theory is effective to improve external rotation of frozen shoulder, and acupuncture at the nearby acupoints is effective to improve adduction of frozen shoulder. However it is not clear that acupuncture treatment at both the remote and the nearby acupoints according to the meridian theory is more effective than treating at only the nearby acupoints in the treatment of frozen shoulder. Since our study was a short term trial, a long term trial for a more precise evaluation of acupuncture treatment for frozen shoulder will be needed in the future.

• 대한치과마취과학회지
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• 제7권2호
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• pp.114-119
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• 2007

Background: Dental disabilities mean the poor cooperation for dental treatment because of patient's inherent disability, severe fear and anxiety, and communication problem. Sedation and general anesthesia are usually used for behavioral control in dentally disabled patients. In particular, sedation (conscious and deep) can help them to tolerate the proper dental treatment effectively and safely. Methods: From March 2002 to September 2007, total 35 sedation were carried out in 33 patients (male : female = 20 : 13) with dental disabilities at Seoul National University Dental Hospital and Hanyang University Medical Center. Patients' dental charts and sedation records were retrospectively reviewed. Results: Tooth extraction (19 cases) was the most common dental treatment performed under intravenous sedation (30 cases). Occasionally, inhalation sedation using Sevoflurane 1-2% was adapted (5 cases). Deep sedation (28 cases) was carried out using midazolam 2-3 mg bolus injection and propofol infusion via TCI (4.2 ${\pm}$ 0.9 mg/kg/h), and conscious sedation (7 cases) was carried out using midazolam bolus onlywithout severe complications. The duration of dental treatment was 25.5 ${\pm}$ 12.3 min and that of sedation was 43.2 ${\pm}$ 9.7 min. Conclusion: Sedation for dentally disabledpatients should be selected for effective behavioral control in conjunction with general anesthesia, considering the duration and pain-evoking potentials of dental treatment, the type and severity of patients' disabilities, and the experience of dental anesthesiologists altogether.

• 한국콘텐츠학회논문지
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• 제20권3호
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• pp.678-686
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• 2020

본 연구는 유도선수의 성별, 체급 및 연령에 따른 신체적 기능과 심리적 기능을 비교하기 위해 시행되었다. 연구의 대상자는 고등학생, 대학생, 실업팀 선수 124명이 참가하였으며, 신체적 검사로 무릎기능 검사지, 발목기능 검사지, 허리 검사지를 자기 기술하여 신체적 검사를 측정하고, 심리적 검사로 기분상태 질문지, 운동선수 자기관리행동 질문지, 운동 대처기술 검사지를 측정하였다. 신체적, 심리적 기능의 성별, 체급별, 연령별 기능을 비교한 결과, 성별에 따른 신체적 검사의 결과에서는 무릎과 허리에서 남녀의 차이가 있었고, 심리적 검사에서는 기분 상태 중 활력과 자기관리행동, 스포츠 대처기술에는 차이가 있었다. 체급별 신체적 검사의 결과, 무릎의 통증과 스포츠 항목에서 체급별 차이가 있었고, 심리적 검사의 결과 기분상태는 활력을 제외한 모든 항목에서 체급별 차이가 있었다. 연령별 신체적 검사는 무릎, 발목, 허리에서 연령별 차이가 있었고, 심리적 검사의 결과, 기분상태검사 중 긴장과 활력을 제외한 모든 항목에서 차이가 있었으며, 자기관리행동 중 몸관리 문항에서만 연령별 유의한 차이가 있었다. 본 연구 결과는 향후 유도선수의 성별, 체급 및 연령에 따른 스포츠 상해 관련 훈련 프로그램 및 의학 기술 개발 관련 기초자료로 활용될 수 있을 것으로 예상한다.

• 한국콘텐츠학회논문지
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• 제12권11호
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• pp.267-277
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• 2012

본 연구는 낮병원 프로그램을 받은 뇌졸중 환자들의 일반적인 특성과 삶의 만족도 중 어떤 항목이 도구적 일상생활활동과 삶의 만족도에 가장 영향력을 미치는지 인과 관계 분석을 하였다. 국립재활병원에 입원한 환자 중 실험군 41명과 대조군 41명을 선정하여 도구적 일상생활활동수행능력을 평가하고 삶의 만족도 검사를 실시하였다. 연구 결과 실험군과 대조군의 도구적 일상생활활동수행능력 비교에서 실험군이 대조군 보다 높은 기능을 보였으며, 삶의 만족도 비교에서도 모든 항목에 대해 실험군이 대조군보다 높게 나타났다. K-ADL과 K-IADL 및 삶의 만족도에 일반적인 특성 항목 중 어떤 항목이 영향을 주는지 알아 본 결과 K-ADL과 K-IADL 모두 연령, 경제상태 순으로 나타났으며, 삶의 만족도에서는 경제상태, 학력, 혼인상태, 직업유무, 일상생활시 조력자 유무 순으로 나타났다. K-ADL과 K-IADL에 삶의 만족도 항목 중 어떤 항목이 영향을 주는지 알아 본 결과 K-ADL은 통증, 사회기능, 정신건강, 신체적 역할 순으로 나타났으며 K-IADL에서는 신체적 역할제한이 가장 설명력이 높은 것으로 나타났다. 이 연구를 통해 뇌졸중 장애인들이 병원에서 재활치료가 끝난 이후에 신체적 기능을 유지하고 이차 장애를 예방하며 사회통합과 삶의 만족도 향상을 도모하기 위해서 지속적인 재활치료가 강조되어야함을 알 수 있었다.

• Journal of Acupuncture Research
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• 제31권1호
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• pp.43-50
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• 2014

Objectives : The purpose of this study is to compare the effect of Shinbaro pharmacopuncture treatment and bee venom pharmacopuncture treatment on cervical disc herniation and whiplash injury induced by traffic accident. Methods : This study was carried out on the 59 patients with whiplash injury by traffic accident and diagnosed as cervical disc herniation. The patients were divided into 2 groups ; Shinbaro pharmacopuncture group was treated with Shinbaro pharmacopuncture along with herbal medicine and general acupuncture. Bee venom pharmacopuncture group was treated with bee venom pharmacopuncture along with herbal medicine and general acupuncture. We measured verbal numerical rating scale(VNRS) and neck disability index(NDI) before the treatment and 1, 2, 3 weeks afterwards. Results : Shinbaro pharmacopuncture group and Bee venom pharmacopuncture both showed significant decrease in VNRS and NDI. Shinbaro pharmacopuncture group showed significant decrease over Bee venom pharmacopuncture group in VNRS decrement in the first week, while Bee venom pharmacopuncture group showed significant decrease over Shinbaro pharmacopuncture group in the secone week of treatment. Conclusion : According to the result of this study, it is suggested that Shinbaro pharmacopuncture group is more effective in reducing pain in the earlier period of treatment. Also suggests that further study on the effect of Shinbaro pharmacopuncture on patients diagnosed as cervical disc herniation after traffic accident for longer period of treatment.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.413-429
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• 2021

Background: Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine. Methods: An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines. Results: The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study. Conclusion: Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.

• 재활복지
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• 제21권1호
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• pp.141-171
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• 2017

본 연구는 지적장애인거주시설에서 근무하고 있는 생활재활교사의 직무 수행경험을 탐색하는데 그 목적이 있다. 즉, 생활재활교사들의 직무수행 경험에 대한 탐색을 통하여 이들의 역량을 강화하고 지적장애인거주시설 운영의 개선점을 모색할 수 있는 개입방안을 제시하고자 하였다. 이를 위해 최소 1년 이상 근무한 생활재활교사 7명이 연구 참여자로 참여하였다. 본 연구결과는 생활재활교사들의 직무수행과정에서 나타나는 경험의 의미를 진솔하게 나타내주고 있으며, 연구진행시 연구 참여자들의 솔직한 이야기를 통해 심층면담이 진행되면서 의미 있는 결과를 도출할 수 있었다. 연구 참여자들이 기술 한 자료에서 나타난 의미 있는 진술 중 의미가 중복된 진술을 제외한 60개의 주제, 15개 주제모음, 4개의 범주로 구성하였다. 4개의 범주로는 생활재활교사로의 시작, 생활재활교사로 적응, 생활재활교사의 아픔, 성장과 바람이었다. 본 연구결과는 지적장애인거주시설 생활재활교사들의 전문성 확보와 나아가 지적장애인거주시설 운영 개선방안 도출에도 기여할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.575-584
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• 2021

Objective : Cervical expansive laminoplasty is an effective surgical method to address multilevel cervical spinal stenosis. During surgery, the spinous processes of C2 and C7 are usually preserved to keep the insertion points of the cervical musculature and nuchal ligament intact. In this regard, dome-like laminectomy (undercutting of C7 lamina) instead of laminoplasty is performed on C7 in selected cases. However, resection of the lamina can weaken the C7 lamina, and stress fractures may occur, but this complication has not been characterized in the literature. The objective of the present study was to investigate the incidence and risk factors for C7 laminar fracture after C7 dome-like laminectomy and its impact on clinical and radiological outcomes. Methods : Patients who underwent cervical open-door laminoplasty combined with C7 dome-like laminectomy (n=123) were classified according to the presence of C7 laminar fracture. Clinical parameters (neck/arm pain score and neck disability index) and radiologic parameters (C2-7 angle, C2-7 sagittal vertical axis, and C7-T1 angle) were compared between the groups preoperatively and at postoperatively at 3, 6, 12, and 24 months. Risk factors for complications were evaluated, and a formula estimating C7 fracture risk was suggested. Results : C7 lamina fracture occurred in 32/123 (26%) patients and occurred at the bilateral isthmus in 29 patients and at the spinolaminar junction in three patients. All fractures appeared on X-ray within 3 months postoperatively, but patients did not present any neurological deterioration. The fracture spontaneously healed in 27/32 (84%) patients at 1 year and in 29/32 (91%) at 2 years. During follow-up, clinical outcomes were not significantly different between the groups. However, patients with C7 fractures showed a more lordotic C2-7 angle and kyphotic C7-T1 angle than patients without C7 fractures. C7 fracture was significantly associated with the extent of bone removal. By incorporating significant factors, the probability of C7 laminar fracture could be assessed with the formula 'Risk score = 1.08 × depth (%) + 1.03 × length (%, of the posterior height of C7 vertebral body)', and a cut-off value of 167.9% demonstrated a sensitivity of 90.3% and a specificity of 65.1% (area under the curve, 0.81). Conclusion : C7 laminar fracture can occur after C7 dome-like laminectomy when a substantial amount of lamina is resected. Although C7 fractures may not cause deleterious clinical outcomes, they can lead to an unharmonized cervical curvature. The chance of C7 fracture should be discussed in the shared decision-making process.

• PNF and Movement
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• 제10권2호
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• pp.9-16
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• 2012

본 연구는 43세 남성 환자의 관절가동술과 슬링을 이용한 유착성 관절낭염 환자의 치료사례를 조사하여 그 과정과 결과를 알아보고자 하였다. 어깨통증장애지수(shoulder pain and disability index) 측정과 어깨관절의 굽힘(flexion), 벌림(abduction), 바깥돌림(external rotation), 안쪽돌림(internal rotation)에 대한 관절가동범위를 측정하여 비교하였으며 견관절 주위에 비스테로이드 소염진통 주사 1회, 약물치료를 병행하며 주 3회 8주간 보존적인 물리치료인 온습포(hot pack)와 간섭파(ICT), 관절가동술, 그리고 슬링을 이용한 운동치료를 실시하였다. 결과는 관절가동술과 슬링운동치료의 적용이 유착성 관절낭염 환자의 통증을 줄이고 관절가동범위를 증진시키는데 효과가 있는 것으로 판단된다.