• Archives of Plastic Surgery
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• 제36권1호
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• pp.56-60
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• 2009

Purpose: Palatal fracture and mandible fracture result in instability of dental arch. Because they divide the maxillary and mandibular alveolus sagittally and / or transversely and comminute the dentition, they permit rotation of dental alveolar segments and significantly increase the potential for fracture malalignment, complicating fracture treatment. Previous treatment of palatal fracture consisted of palatal splint application and rigid palatal vault stabilization. This procedure result in patient's oral discomfort and removal of palate and screw. Mandible fracture often results in malocclusion due to widening of posterior aspect of dental arch. So we introduce more simple method using intermolar traction wiring, which can protect the widening of dental arch and rotation of dental alveolar segment. Methods: Arch bar and intermolar traction wiring with wire 1 - 0, or 2 - 0 was applied. After exposure of fracture line, neutrooclusion was maintained with intermaxillary fixation. And then open reduction & internal fixation on maxillary fracture line, commonly maxillary buttress, alveolar ridge, pyriform aperture except palatal vault or mandibular fracture line. After 1 week, intermolar traction wiring was removed. We checked occlusion and postoperative radiologic finding. Results: From June of 2007 to October of 2007, 10 patient, who have maxillary fracture with palatal fracture and mandible fracture, underwent open reduction & internal fixation with intermolar traction wiring. All have satisfactory occlusion and there were no complication, like gingiva disease, mouth opening impairment and nonunion. Conclusion: The intermolar traction wiring accompany open reduction and internal fixation can be alternative method for restoration of dental arch in facial bone fracture.

• Clinics in Shoulder and Elbow
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• 제1권2호
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• pp.160-166
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• 1998

The purpose of this study was to assess the results of arthroscopic subacromial decompression in patients with chronic impingement and to evaluate the results according to the rotator cuff pathology. We evaluated the clinical results of treatment for chronic impingement syndrome in 28 patients from Feb 1996 to Feb 1997. There were twenty men and eight women in age from 24 to 72 years (mean age 51) with dominant arm involvement in sixteen patients. Follow up evaluations averaged 15(range 12-24)months. The average duration of symptoms were 15(range 6­60)months. The final diagnoses which were based on the physical examination, plain radiographs and arthroscopic findings, were stage II impingement in 16 patients and stage ill impingement in 12 patients. We excluded the patients with acromioclavicular arthritis or glenohumeral instability in this study. All patients were managed non-operatively a minimum of six months. During the operation we performed contouring and smoothing the acromial undersurface and only resecting of the anterolateral band of the coracoacromial ligament. The clinical results were quantitated using UCLA shoulder rating score. Satisfactory results were obtained in 23(80%) patients. Unsatisfactory results were obtained in 5(18%) patients with posterior cuff tear. The average UCLA pain score showed significant improvement from 2.8(constant pain) to 7.2(present during heavy activities) at final follow up. The function and active forward flexion scores also increased from their preoperative value. There was no significant differences according to the surface and severity of tear and NeeI' stage (P>0.05). These results compared favorably with those reported following open acromioplasty. While arthroscopic subacromial decompression is a demanding technique with a learning curve, it is a reliable treatment for chronic impingement syndrome. A less aggressive approach to subacromial decompression and preserving the posteromedial band of the coracoacromialligament does not appear to compromise results.

• 대한한의학회지
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• 제18권1호
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• pp.25-39
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• 1997

Shoulder hand syndrome is characterized by pain, vasomotor instability, and tenderness, mainly in the distal upper extremity. The pathophysiologic mechanism of this syndrome is not yet proved. The purpose of this study is to evaluate the usefulness of thermographic imaging on shoulder hand syndrome after stroke for early diagnosis and its clinical pattern analysis including acupuncture and electroacupuncture therapy. This study was performed from June to September in 1996 on 46 stroke patients who were admitted at Oriental hospital of Kyung Hee Medical Center. The study group were 23 patients with shoulder hand syndrome. The control group were 23 patients without shoulder hand syndrome. Skin temperatures on the both upper extremities were measured by Digital Infrared Thermographic Imaging(D.I.T.I.) before the study and 3 weeks later again. The results were as follows; 1. The shoulder hand syndrome group were significantly more restricted in shoulder passive range of motion than the control group. 2. The shoulder hand syndrome group showed significant temperature difference of both dorsal hands. 3. The electroacupunture therapy group were significantly more improved on the temperature difference of both dorsal hands than acupuncture therapy group in 3 weeks later. 4. Both posterior arms showed the biggest temperature difference from 11 to 30 days in shoulder hand syndrome group. 5. The lesser passive ROM(range of motion) of shoulder group showed significantly increased temperature difference of both hands. The above results show that measurement of shoulder passive range of motion and D.I.T.I. is a useful method for early diagnosis on shoulder hand syndrome and its clinical pattern analysis including evaluation of acupuncture and electroacupuncture therapy. Continuous study will be needed for more clinical application and evaluation on shoulder hand syndrome.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.42-47
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• 2018

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at $90^{\circ}$ of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

• 한국운동역학회지
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• 제31권3호
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• pp.155-161
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• 2021

Objective: There is a lack of studies using the 3D-2D image registration techniques on the mechanism of a shoulder injury for ice hockey players. This study aimed to analyze in vivo 3D glenohumeral joint arthrokinematics in collegiate ice hockey athletes and compare shoulder scaption with or without a hockey stick using the 3D-2D image registration technique. Method: We recruited 12 male elite ice hockey players (age, 19.88 ± 0.65 years). For arthrokinematic analysis of the common shoulder abduction movements of the injury pathogenesis of ice hockey players, participants abducted their dominant arm along the scapular plane and then grabbed a stick using the same motion under C-arm fluoroscopy with 16 frames per second. Computed tomography (CT) scans of the shoulder complex were obtained with a 0.6-mm slice pitch. Data from the humerus translation distances, scapula upward rotation, anterior-posterior tilt, internal to external rotation angles, and scapulohumeral rhythm (SHR) ratio on glenohumeral (GH) joint kinematics were outputted using a MATLAB customized code. Results: The humeral translation in the stick hand compared to the bare hand moved more anterior and more superior until the abduction angle reached 40°. When the GH joint in the stick hand was at the maximal abduction of the scapula, the scapula was externally rotated 2~5° relative to 0°. The SHR ratio relative to the abduction along the scapular plane at 40° indicated a statistically significant difference between the two groups (p < 0.05). Conclusion: With arm loading with the stick, the humeral and scapular kinematics showed a significant correlation in the initial section of the SHR. Although these correlations might be difficult in clinical settings, ice hockey athletes can lead to the movement difference of the scapulohumeral joints with inherent instability.

• 한국운동역학회지
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• 제31권3호
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• pp.205-213
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• 2021

Objective: The aim of this study was to analyze body stability Joint coordination pattern though as bending stiffness of shoes during stance phase of running. Method: 47 male subjects (Age: 26.33 ± 2.11 years, Height: 177.32 ± 4.31 cm, Weight: 65.8 ± 3.87 kg) participated in this study. All subjects tested wearing the same type of running shoes by classifying bending stiffness (A shoes: 3.2~4.1 N, B shoes: 9.25~10.53 N, C shoes: 20.22~21.59 N). They ran 10 m at 3.3 m/s (SD ±3%) speed, and the speed was monitored by installing a speedometer at 3 m intervals between force plate, and the measured data were analyzed five times. During running, ankle joint, MTP joint, coupling angle, inclination angle (anterior-posterior, medial-lateral) was collected and analyzed. Vector coding methods were used to calculate vector angle of 2 joint couples during running: MTP-Ankle joint frontal plane. All analyses were performed with SPSS 21.0 and for repeated measured ANOVA and Post-hoc was Bonferroni. Results: Results indicated that there was an interaction between three shoes and phases for MTP (Metatarsalphalangeal) joint angle (p = .045), the phases in the three shoes showed difference with heel strike~impact peak (p1) (p = .000), impact peak~active peak (p2) (p = .002), from active peak to half the distance to take-off until take-off (p4) (p = .032) except for active peak~from active peak to half the distance to take-off (p3) (p = .155). ML IA (medial-lateral inclination angle) for C shoes was increased than other shoes. The coupling angle of ankle angle and MTP joint showed that there was significantly difference of p2 (p = .005), p4 (p = .045), and the characteristics of C shoes were that single-joint pattern (ankle-phase, MTP-phase) was shown in each phase. Conclusion: In conclusion, by wearing high bending stiffness shoes, their body instability was increased during running.

• 대한정형외과학회지
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• 제55권1호
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• pp.85-89
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• 2020

보우 헌터 증후군은 경추의 운동 시 척추동맥의 동적 폐쇄나 협착으로 인해 척추기저동맥의 혈행 장애의 증상을 나타내는 드문 질환이다. 증례의 59세 남자 환자는 복시, 이명, 보행장애를 주소로 응급실에 내원하였다. 뇌 자기공명영상 및 뇌혈관조영술상 다발성 소뇌 경색이 있었다. 우측 척추동맥은 이미 완전 폐쇄되었고 좌측 척추동맥은 경추 신전 시에 동적 폐쇄가 발생함이 확인되었다. 경색이 악화되어 혈전 제거술을 시행하였으며 좌측 척추동맥에 대해 제5-6 경추간 후방 감압술 및 유합술을 시행하였다. 수술 중 및 수술 후 시행한 혈관조영술상 좌측 척추동맥의 혈행이 원활함이 확인되었으며 수술 후 6개월 추적관찰 동안 증상의 재발은 없었다. 경추 불안정증이 있을 경우, 경추 신전 시 척추동맥이 패쇄되어 척추기저동맥 혈행 장애를 유발할 수 있으므로 진단에 유의해야 한다.

• 대한관절경학회지
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• 제5권2호
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• pp.69-73
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• 2001

목 적 : 대퇴부의 고정을 위해 새로이 고안된 Ligament Anchor(LA) 나사와 슬괵건을 이용한 전방십자인대 재건술 후 임상결과와 골터널의 확장을 평가하고자 하였다. 대상 및 방법 : 슬괵건 4가닥과 LA 나사를 이용하여 전방십자인대 재건술 후 최소 2년 이상 추시 가능하였던 58예를 대상으로 하였다. 이식건의 고정으로 대퇴골측은 LA나사를, 경골측은 생흡수성 간섭나사를 이용하였다 평균 추시기간은 28개월이었다. 임상적 결과로는 Lachmann 검사와 Lysholm 점수를 이용하였으며 방사선학적 결과로는 골터널의 확대정도와 $Telos^{\circledR}$ 기기(Telos stress device; Austin & Associates, Inc., Polston, US)를 이용한 전방 전위 방사선 사진을 촬영하여 건측과의 전방이완도 차이를 평가하였다. 결과 : Lysholm 점수는 술 전 평균 60에서 술 후 평균 94.0점으로 호전되었으며, 술 전 Lachmann 검사상 16예에서 경도의 양성, 24예에서 중등도, 18예에서 고도의 양성 소견을 보였으며, 술 후 Lachmann 검사상 50예는 음성이었으며, 8예에서만 경도의 양성소견을 보였다. $Telos^{\circledR}$ 기기를 이용한 전방전위 검사상 건측과의 차이는 술전 평균 12.9mm에서 최종 추시상 3.1mm로 호전되었다(p<0.05). 대퇴 터널은 전후방 방사선 사진상 수술직후 10.6mm에서 최종 추시상 12.7mm$(21.1\%)$로 확장되었으며, 측면 방사선 사진상 술 후 10.7mm에서 최종 추시상 12.4mm$(16.5\%)$로 확장되었다(p<0.05). 경골 터널은 전후방 방사선 사진상 술 후 9.8mm에서 최종 추시상 11.8mm$(20.7\%)$로 확장되었으며 측면 방사선 사진상 술 후 9.9mm에서 최종 추시상 11.7mm$(18.9\%)$로 확장되었다(p<0.05). 결론 : LA나사와 슬괵건을 이용한 전방십자인대 재건술은 골터널의 확장이 적으며 임상 성적도 우수하여 슬관절의 전방 안정성을 회복하는데 좋은 이식물 및 내고정물이라 생각된다.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.21-25
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• 2002

목적: 슬괵건과 대퇴부의고정을 위해새로이 고안된Ligament Anchor (LA) 나사를이용한전방십자인대재건술후 임상결과에평가하고자하였다. 대상및방법: 슬괵건4가닥과LA 나사를이용하여전방십자인대재건술후최소2년이상추시가능하였던 58예를대상으로하였다. 이식건의 고정으로 대퇴골측은 LA나사를, 경골측은 생흡수성 간섭나사를 이용하였다. 평균 추시기간은 28개월이었다. 임상적결과로는 Lachmann 검사와Lysholm 점수를이용하였으며 방사선학적 결과로는 Telos(R) 기기(Telos stress device; Austin & Associates, Inc., Polston, US)를 이용한 전방 전위방사선 사진을 촬영하여 건측과의 전방이완도 차이와 골터널확대정도를평가하였다. 결과: Lysholm 점수는술전평균6 0점에서술후평균94.0점으로호전되었으며, 술전Lachmann 검사상 16예에서 경도의양성, 24예에서중등도, 18예에서 고도의 양성 소견을 보였으며, 술 후 Lachmann 검사상50예는 음성이었으며, 8예에서만 경도의 양성소견을 보였다. Telos(R) 기기를 이용한 전방전위 검사상 건측과의 차이는 술 전 평균12.9 mm에서 최종 추시상 3.1 mm로호전되었다(p<0.05). 대퇴터널은전후방방사선사진상수술직후10.6 mm에서최종추시상12.7 mm(21.1$\%$ )로확장되었으며, 측면방사선사진상술후10.7 mm에서최종추시상12.4 mm(16.5$\%$)로확장되었다(p<0.05). 경골터널은전후방방사선사진상술후9.8 mm에서최종추시상11.8 mm(20.7$\%$)로확장되었으며측면방사선사진상술후9.9 mm에서최종추시상11.7 mm(18.9$\%$)로확장되었다(p<0.05) .결론: 슬괵건과L A나사를이용한전방십자인대재건술은임상성적이우수하며, 슬관절전방동통이나골터널확장등의합병증이적어슬관절의전방안정성을회복하는데좋은이식물및내고정물이라생각된다.

• 대한정형외과학회지
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• 제54권5호
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• pp.418-426
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• 2019

목적: 고령의 탈구가 동반된 회전근 개 대파열 및 광범위 파열에서 상완골두 탈중심화의 특징을 분석하고자 한다. 또한 견관절 불안 정성 및 치료에 대해서도 살펴보고자 한다. 대상 및 방법: 2005년 5월부터 2017년 2월까지 65세 이상의 견관절 탈구가 동반된 회전근개 대파열 및 광범위 파열의 45명, 45견 관절 A군과 탈구를 동반하지 않은 회전근 개 대파열 및 광범위 파열의 45명, 45견관절 B군을 대상으로 하였다. 평균 연령은 각각 73.2세, 72.1세였으며 평균 추시 기간은 각각 30.7개월, 31.3개월이었다. A군의 21예(46.7%)에서 관절경적 회전근 개 봉합술만을 시행 받았고 8예(17.8%)에서 회전근 개 봉합술과 함께 전방 관절와순 복원술을 시행 받았다. 16예(35.6%)에서 회전근 개 파열 관절병증으로 역행성 인공관절 전치환술을 시행 받았다. B군의 45예(100%)에서 관절경하 회전근 개 봉합술을 시행 받았다. 저자들은 두 군의 술 전 자기공명영상에서 상완골두 중심부이탈과 상완골두 상승을 측정하였다. 두 군의 시각통증등급 점수, American Shoulder and Elbow Surgeons (ASES) 점수 및 University of California Los Angeles (UCLA) 점수가 각각 분석되었다. 결과: A군과 B군의 상완골두 중심부이탈은 평균 후방 7.41 mm와 평균 후방 2.02 mm (p=0.03)였고, 상완골두 상승은 평균 상방 6.66 mm와 평균 상방 2.44 mm (p=0.02)였다. A군과 B군의 ASES 점수는 술 전 평균 32.8점과 평균 33.4점에서 술 후 평균 77.1점(p=0.02)과 78.1점(p=0.02)이었고, 두 군 사이에 통계적으로 유의한 차이가 없었다(p=0.18). UCLA 점수는 술 전 평균 13.1점과 12.8점에서 술 후 평균 28.9점(p=0.02)과 29.5점(p=0.01)으로 향상되었으며. 두 군 사이에 통계적으로 유의한 차이가 없었다(p=0.15). 결론: 65세 이상 고령의 회전근 개 대파열 및 광범위 파열에서 견관절 탈구가 있는 환자들은 없는 환자들보다 술 전 자기공명영상에서 상완골두 중심부이탈과 상완골두 상승이 더 크게 측정되었다. 이러한 측정 방법은 견관절 불안정성을 예상하는 데 도움을 줄 수 있다. 되도록 조기에 회전근 개 봉합술을 시행하며, 전방 관절와순 복원술, 역행성 인공관절 전치환술 등의 다른 치료도 동시에 적극적으로 고려되어야 한다.