• 대한족부족관절학회지
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• 제10권2호
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• pp.247-249
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• 2006

Purpose: The neural injuries by the sprain around the ankle joint may contribute the chronic pain. Authors analyzed the incidence and the contributing factor of the neural injuries in ankle sprain. Materials and Methods: 52 patients (54 cases) were involved in this retrospective study. Patient with diabetes or spinal disease were excluded. Plain radiograph and MR image were evaluated. Treatments were consisted of cast immobilization for 4 weeks with weight bearing ambulation following bracing for 8 weeks. Neurologic evaluation were performed at 3 months, 6 months, 12 months post-injury period and each neural injury were confirmed by electromyography or lidocaine block test. Results: The average age was 39 years old and 34 cases were male and 20 cases were female. Rupture of the anterior talofibular ligament was observed in 48 cases, distal anterior tibiofibular ligament in 37 cases, calcaneofibular ligament in 6 cases. One cases revealed no injury of the ligament. Neural injuries around ankle was observed in 13 cases ; superficial peroneal nerve in 9 cases, sural nerve in 5 cases, saphanous nerve in 1 case. Neural injury was not influenced by the degree of ligament injuries but by the incidence numbers of ankle sprain. All cases were treated conservatively and symptom was subsided in all but 2 cases. Conclusion : Although the incidence is relatively low, the neural injuries in ankle sprain may occur in the recurrent ankle sprain and conservative treatment for neural injuries is satisfactory.

• The Korean Journal of Physiology
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• 제24권2호
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• pp.389-402
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• 1990

The physiological characteristics of the neurons receiving the ventral root afferent inputs were investigated in the cat. A total of 70 cells were identified in the lumbosacral spinal cord. All these cells responded only to the C-strength stimulation of the distal stump of cut ventral root and the estimated conduction velocities of the VRA fibers were not faster than 4 m/sec. The majority of them were silent in resting state. For 49 cells, their peripheral receptive fields were characterized. Among them, 25 cells were exclusively excited by VRA inputs, 8 were inhibited and the remaining cells recevied both excitatory and inhibitory VRA inputs. According to the response pattern to the mechanical stimuli applied to their receptive fields, only a fourth of them were typical high threshold cell, a sixth, wide dynamic range cells, while remainings were a rather complex cells. Most of the cells receiving VRA inputs, received only the A ${\delta}-peripheral$ nerve inputs. Intravenous injection of morphine decreased the response of spinal cells to the VRA activation. The responses were abolished completely by counter irritation to the common peroneal nerve with C-strength-low frequency stimuli. These physiological properties of the spinal neurons receiving the VRA inputs are differ in some aspect from the spinal neurons receiving nociceptive inputs from the periphery, but still were consistent with the contention that VRA system might carry nociceptive informations arising from the spinal cord and/or neraby surrounding tissues.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.125-132
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• 2002

Objectives : Although the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) is important for correct prognostic evaluation and genetic counseling, the diagnosis is frequently missed or delayed. Our main aim on undertaking this study was to characterize the electrodiagnostic features of HNPP. Material and Methods : Clinical, electrophysiologic and molecular studies were performed on Korean HNPP patients with 17p11.2 deletion. The results of electrophysiologic studies were compared with those of Charcot-Marie-Tooth disease type 1A (CMT1A) patients carrying 17p11.2 duplication. Results : Eight HNPP (50 motor, 39 sensory nerves) and six CMT1A (28 motor, 16 sensory nerves) patients were included. The slowing of sensory conduction in nearly all nerves and the distal accentuation of motor conduction abnormalities are the main features of background polyneuropathy in HNPP. In contrast to CMT1A, where severity of nerve conduction slowing was not different among nerve groups, HNPP sensory nerve conduction was more slowed in the median and ulnar nerves than in the sural nerve (p<0.01), and DML was more prolonged in the median nerve than in the other motor nerves (p<0.01). TLIs were significantly lower in HNPP than in the normal control and CMT1A patients for the median and ulnar nerves (p<0.01), and were also significantly reduced for the peroneal nerve (p<0.05) compared with those of the normal controls. Conclusion : The distribution and severity of the background electrophysiologic abnormalities are closely related to the topography of common entrapment or compression sites, which suggests the possible pathogenetic role of subclinical pressure injury at these sites in the development of the distinct background polyneuropathy in HNPP.

• 대한골관절종양학회지
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• 제12권1호
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• pp.63-70
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• 2006

목적: 이 연구의 목적은 말단 신경을 침범하는 결절종을 가진 환자의 수술적 치료를 고찰하는 데 있다. 대상 및 방법: 1995년부터 2000년까지 결절종으로 인한 신경적 증상을 가지고 있었고 수술적으로 치료받았던 12예의 환자를 대상으로 하였다. 평균 나이는 44.3(15-71)세였다. 압박 받았던 신경은 경골 신경이 3예로 가장 많았고 견갑상 신경, 총 비골 신경, 요골 신경, 척골 신경이 각각 2예, 정중 신경이 1예였다. 동통은 6명의 환자에서 있었고, 감각 이상이나 운동력 저하가 각각 7예의 환자에서 보였고 4명의 환자에서는 이 두 증상이 동시에 있었다. 결과: 술전 동통을 호소하였던 6명 모두 술후 동통은 소실되었다. 술전 감각 이상이 있었던 7명의 환자 중 5명에서 호전이 있었으며 술전 운동력 약화를 보였던 환자 모두 호전이 있었다. 술전 감각 이상과 운동력 약화를 동시에 보였던 환자 4명 중 2명만이 완전한 감각의 회복을 보였고 이는 불량한 예후 인자를 암시한다. 결론: 이러한 압박 신경병증을 일으키는 결절종의 정확한 조기 진단 및 절제는 우수한 임상적 결과를 보인다.

• Archives of Reconstructive Microsurgery
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• 제8권1호
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• pp.77-83
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• 1999

전북대학교병원 정형외과에서 1993년 8월부터 1997년 8월까지 족부 및 수부 손상 5례에 대하여 족 배 유리 피부판 이식술을 시행하고, 1999년 3월까지 최소 19개월부터 최장 67개월간 추시하여 다음과 같은 결과를 얻었다. 1. 나이별로는 9세부터 35세까지로 평균 23세 이었으며, 성별로는 전례가 남자이었으며, 족부에서 시행하였던 예가 4례, 수부에서 1례이었다. 2. 족부의 손상 원인은 교통사고 2례, 기계 사고 1례, 자전거 바퀴 사고 1례 이었으며, 수부에서는 교통사고에 의하여 전완부 요골의 개방성 골절이 동반되고 수부 배부의 다발성 신전 건 파열 및 피부 괴사에 의한 신전 건 노출 1례이었다. 3. 수여 동맥은 족 배 동맥 2례, 전 경골 동맥 1례, 후 경골 동맥 1례 그리고 척골 동맥이었으며, 수여 정맥은 족부 4례에서 2개 정맥을 문합하였으며, 5례(100%) 전례에서 성공하였다. 4. 추시 결과 유리 피판 이식술 후 외양(exterior)과 일상생활시 피부판이 손상되는 분쇄(maceration) 정도는 우수하였으나, 감각 회복 정토는 불량하였다. 5. 제공 부위인 족 배부는 유리 피판 이식술 3주 후 전층 식피술을 시행하여 완전 접착되었으며, 추시상 유병율없이 우수한 결과를 보였다.

• 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.

• The Korean Journal of Pain
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• 제23권3호
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• pp.186-189
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• 2010

Background: Neuropathic pain resulting from diverse causes is a chronic condition for which effective treatment is lacking. The goal of this study was to test whether dexamethasone exerts a preemptive analgesic effect with bupivacaine when injected perineurally in the spared nerve injury model. Methods: Fifty rats were randomly divided into five groups. Group 1 (control) was ligated but received no drugs. Group 2 was perineurally infiltrated (tibial and common peroneal nerves) with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 3 was infiltrated with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) after surgery. Group 4 was infiltrated with normal saline (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 5 was infiltrated with only 0.4% bupivacaine (0.2 ml) before surgery. Rat paw withdrawal thresholds were measured using the von Frey hair test before surgery as a baseline measurement and on postoperative days 3, 6, 9, 12, 15, 18 and 21. Results: In the group injected preoperatively with dexamethasone and bupivacaine, mechanical allodynia did not develop and mechanical threshold forces were significantly different compared with other groups, especially between postoperative days 3 and 9 (P < 0.05). Conclusions: In conclusion, preoperative infiltration of both dexamethasone and bupivacaine showed a significantly better analgesic effect than did infiltration of bupivacaine or dexamethasone alone in the spared nerve injury model, especially early on after surgery.

• The Korean Journal of Pain
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• 제35권4호
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• pp.413-422
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• 2022

Background: The neocortex, including the medial prefrontal cortex (mPFC), contains many neurons expressing nitric oxide synthase (NOS). In addition, increasing evidence shows that the nitric oxide (NO) and opioid systems interact in the brain. However, there have been no studies on the interaction of the opioid and NO systems in the mPFC. The objective of this study was to investigate the effects of administrating L-arginine (L-Arg, a precursor of NO) and N(gamma)-nitro-L-arginine methyl ester (L-NAME, an inhibitor of NOS) into the mPFC for neuropathic pain in rats. Also, we used selective opioid receptor antagonists to clarify the possible participation of the opioid mechanism. Methods: Complete transection of the peroneal and tibial branches of the sciatic nerve was applied to induce neuropathic pain, and seven days later, the mPFC was cannulated bilaterally. The paw withdrawal threshold fifty percent (50% PWT) was recorded on the 14th day. Results: Microinjection of L-Arg (2.87, 11.5 and 45.92 nmol per 0.25 µL) increased 50% PWT. L-NAME (17.15 nmol per 0.25 µL) and naloxonazine (an antagonist of mu opioid receptors, 1.54 nmol per 0.25 µL) inhibited anti-allodynia induced by L-Arg (45.92 nmol per 0.25 µL). Naltrindole (a delta opioid receptor antagonist, 2.45 nmol per 0.25 µL) and nor-binaltorphimine (a kappa opioid receptor antagonist, 1.36 nmol per 0.25 µL) were unable to prevent L-Arg (45.92 nmol per 0.25 µL)-induced antiallodynia. Conclusions: Our results indicate that the NO system in the mPFC regulates neuropathic pain. Mu opioid receptors of this area might participate in pain relief caused by L-Arg.

• The Korean Journal of Pain
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• 제22권1호
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• pp.16-20
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• 2009

Background: Zaprinast is an inhibitor of phosphodiesterase 5, 6 and 9. Phosphodiesterase inhibitors could produce anti-nociceptive effects by promoting the accumulation of cGMP. We hypothesized that intrathecal zaprinast could attenuate the allodynia induced by chronic constriction injury of the sciatic nerve in rat. Methods: Sprague-Dawley rats were prepared with four loose ligations of the left sciatic nerve just proximal to the trifurcation into the sural, peroneal and tibial nerve branches. Tactile allodynia was measured by applying von Frey filaments to the lesioned hindpaw. The thresholds for the withdrawal responses were assessed. Zaprinast ($3-100{\mu}g$) was administered intrathecally by the direct lumbar puncture method to obtain the dose-response curve and the 50% effective dose ($ED_{50}$). Measurements were taken before and 15, 30, 45, 60, 90, 120, and 180 min after the intrathecal doses of zaprinast. The side effects were also observed. Results: Intrathecal zaprinast resulted in a dose-dependent antiallodynic effect. The maximal effects occurred within 15-30 min and then they gradually decreased down to the baseline level over time in all the groups. There was a dose dependent increase in the magnitude and duration of the effect. The $ED_{50}$ value was $17.4{\mu}g$ (95% confidence intervals; $14.7-20.5{\mu}g$). No severe motor weakness or sedation was observed in any of the rats. Conclusions: Intrathecally administered zaprinast produced a dose-dependent antiallodynic effect in the chronic constriction injury neuropathic pain model. These findings suggest that spinal phosphodiesterase 5, 6 and 9 may play an important role in the modulation of neuropathic pain.

• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.52-56
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• 2013

Purpose: We had proceeded seven iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defects and followed-up average for 5 years and 9 months to evaluate the survival rate, neurosensory function and cosmesis in final results. Materials and Methods: From January 1999 through October 2012, we have performed iIpsilateral dorsalis pedis vascularized pedicle flaps in the distal leg and foot to cover the restricted size defect (average around $3.6{\times}2.4cm$) in 7 cases and average age was 41.6 years (21.5 to 59.0 years). Lesion site was posterior heel in 4 cases, distal anterior leg in 3 cases. Donor structure was the dorsalis pedis artery and the first dorsal metatarsal vessel and deep peroneal nerve in 3 cases and the dorsalis pedis artery and the first dorsal metatarsal vessel in 4 cases. Results: Seven cases (100%) were survived and defect area was healed with continuous dressing without skin graft. The sensory function in the neurovascular flap was restored to normal in 3 cases. Cosmesis was good and fair in 7 cases (85.7%). Conclusion: Ipsilateral dorsalis pedis vascularized pedicle flap in the distal leg and foot is one of the choice to cover the exposed bone and soft tissues without microsurgical procedure.