The purposes of this study were to investigate the therapeutic effects of an early exercise program after mastectomy and to provide the early exercise program protocol for patients who had undergone mastectomy. The subjects were seventy women who were diagnosed with breast cancer. They were randomly as signed either to a experimental group (n=35) that received early postoperative exercise program or to a control group (n=35) that received only education by nurses. Data were obtained for each patient from goniometric measurements of shoulder flexion, abduction, external rotation, 10 elements of functional performance, and subjective pain evaluation using visual analogue scale (VAS). All variables were measured preoperatively, three days postoperatively, and one month postoperatively. Data were compared by groups using independent t-test and Mann-Whitney U test for parametric or non-parametric data, respectively. There were no significant differences between the groups for all variables preoperatively and at three days postoperatively. But there were significant differences at one month postoperatively. The experimental group showed a statistically significant increases in shoulder flexion, abduction, and external rotation and in the pain VAS at one month postoperatively (p<.05). Also, at one month postoperatively, the experimental group had less difficulty with three elements of functional performance-doing up a 'back' zippered article of clothing, reaching the ipsilateral scapula, and contralateral scapula with the fingers on the operated side-than the control group (p<.05). The results of this study suggest that, after mastectomy, the early exercise program conducted by a well-trained physical therapist can make a significant contribution to the return of more normal shoulder function and activities of daily living and to an increased quality of life.
Journal of the Korean Society of Physical Medicine
/
v.8
no.3
/
pp.369-378
/
2013
PURPOSE: The purpose of present study was to ascertain how the activity of the serratus anterior muscle, the upper trapezius muscle and the pectoral major muscle was affected while the upper arm was being flexed at 70, 90 and 110 degrees respectively in a closed kinetic chain exercise (wall push up plus) and an open kinetic chain exercise (static hug). METHODS: Sixteen healthy young men subjects participated in the study. Surface electromyography (EMG) data were collected from the dominant-side muscles during a closed kinetic chain exercise and an open kinetic chain exercise. The activity of each muscle was measured quantitatively, and by the use of the two-way repeated ANOVA, the data were compared with each other according to exercises and shoulder flexion angles. RESULTS: Results indicated that the closed kinetic chain exercise did not interact with the open kinetic chain exercise (p>.05). In both the closed kinetic chain exercise and the open kinetic chain exercise, the activity of the serratus anterior muscle became different significantly according to angles (p<.05). Its activity increased in order of 70, 90 and 110 degrees (p<.05). In both exercises and all angles, muscle activity was significantly higher in the serratus anterior muscle than in the upper trapezius muscle and the pectoral major muscle (p<.05). CONCLUSION: The above results show that there is a need to selectively control the exercise stress of the serratus anterior muscle in the case of the patients with the shoulder impingement syndrome characterized by the winged scapula, insufficient scapular protraction and upward rotation.
Background: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. Methods: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. Results: The mean flexion was $155.0^{\circ}$ (range, $90^{\circ}-180^{\circ}$), the mean internal rotation was T8 (range, T6-L2), and the mean external rotation was $66.8^{\circ}$ (range, $30^{\circ}-80^{\circ}$). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was $131.4^{\circ}$ at the 6-month follow-up. According to the Paavolainen method, "good" and "fair" radiographic results each accounted for 38 and 9 of the total patients, respectively. Conclusions: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.
Kim Young-Mo;Rhee Kwang-Jin;Shin Hyun-Dae;Byun Ki-Yong;Kim Kyung-Cheon;Hong Ui-Pyo
Clinics in Shoulder and Elbow
/
v.7
no.1
/
pp.30-34
/
2004
Purpose: To report our experience of treatment of rotator cuff tear and evaluate the mid-term outcome. Materials and Methods: We have performed 50 cases of mini-open rotator cuff repair from March 1996 to March 1999. Male to female ratio was 34:16, the average age 46.5(23∼57) years old, mean follow-up period was 78(62∼93) months. All-arthroscopic repair and open repair cases were excluded. Mean symptomatic period was 12.5(6∼38) months, operation was indicated in cases of no improvement by 6 months of conservative management. Preoperative simple radiographs and Magnetic resonance arthrography were obtained in all cases. We also observed the inflammation, synovitis, thickness of tear and associated pathology intraoperatively. We evaluated pain, function, and range of motion by UCLA score. Results: Overall UCLA score was mean 29.5 points. Excellent 25, good 18, poor 7 cases. Mean pain score was improved 2.6 to 7.5, 44 cases(88%) were improved and 6 cases(12%) were not improved. Mean functional score was improved 3.4 to 8.5, and activity at follow up, 25 cases(50%) were same, 8 cases(14%) were above, 17 cases(34%) were below compared with preoperative level. Mean active forward flexion was preoperative 112° to postoperative 160°, forward flexion strength was improved 3.8 to 4.7. 43 cases(86%) of patients were satisfied at the result, 7 cases(14%) were not satisfied or aggravated. Results: Mini-open rotator cuff repair was effective method in treating rotator cuff tear.
This study was conducted to evaluate the association of work posture with cervical spine abnormality toward 106 microwave-oven assemblers. A self-administered questionnaire was used to obtain a general characteristics and a work history of workers. The posture of neck and shoulder joint of workers were measured with video tape recording and the simple X-ray of cervical spine was checked-up to observe the X-ray abnormality including degenerative change, curvature abnormality, disc space narrowing or disc canal narrowing. The result were as follows. 1. The prevalence of degenerative change among cervicobrachial disorder workers was 44.3% (47 persons), curvature abnormality was 43.4%(46 persons), disc space narrowing was 21.7%(23 persons), and disc canal narrowing was 21.7%(23 persons). 2. The prevalence of degenerative change at cervical spine was increased with the degree of neck flexion(flexed versus neutral, odds ratio [OR]=2.7), the total work posture of neck(mild or severe awkward versus neutral ; OR=1.2, 3.4). 3. The prevalence of degenerative change at cervical spine was increased with the degree of the right shoulder flexion, the heaviness of the materials carried by the right hand and the degree of awkwardness at the total work posture of right shoulder(p<0.05). 4. There was no evidence of association between curvature abnormality, disc space narrowing, disc canal narrowing and work posture. In conclusion the awkward work posture was related with degenerative change of cervical spine among microwave oven assembling workers and the further study in these field must be made to prove the association objectively.
Song, Si-Jung;Jeong, Tae-Ho;Moon, Jung-Wha;Park, Han-Vit;Lee, Si Yung;Koh, Kyoung-Hwan
Clinics in Shoulder and Elbow
/
v.21
no.1
/
pp.15-21
/
2018
Background: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well. Methods: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM. Results: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], -0.255 [p=0.077], 0.068 [p=0.642], and -0.188 [p=0.196], respectively). Conclusions: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.
Purpose: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. Materials and Methods: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. Results: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of $8^{\circ}$ and $16^{\circ}$ less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. Conclusion: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.
Lee Kwang-Won;Ryu Chang-Soo;Kim Ha-Yong;Kim Byung-Sung;Choy Won-Sik
Journal of the Korean Arthroscopy Society
/
v.5
no.1
/
pp.27-31
/
2001
Purpose : The purpose of this study was to evaluate results of the arthroscopic treatment of calcific tendinitis of the shoulder resistant to conservative treatment. Materials and Methods : From March, 1996 to June, 1998, fourteen patients underwent shoulder arthroscopy to treat resistant calcific tendinitis of the rotator cuff despite conservative treatment for more than 6 months. Calcium deposits were localized to the supraspinatus tendon only in eleven patients, the supraspinatus and infraspinatus tendon in two patients, and to the supraspinatus and subscapularis tendon in one patient. Each shoulder was evaluated with UCLA shoulder rating scale and Constant-Murley score Results : The Constant-Murley pain score improved from average score 3.2 before surgery to average score 8.3 after surgery, and the UCLA functional average score improved from 4.5 preoperatively to 8.3 postoperatively. Preoperative ROM averaged $110^{\circ}$ of flexion, $45^{\circ}$ of external rotation, $90^{\circ}$ of abduction, and internal rotation with the thumb reaching to the spinous process of the third lumbar vertebra, but postoperative range of motion averages improved as follows: $170^{\circ}$ or flexion, $50^{\circ}$ of external rotation, $140^{\circ}$ abduction, and internal rotation with the spinous process of the twelveth thoracic vertebra. Overall 3 patients were rated excellentm 9 were good, 2 were fair. Conclusion : Shoulder arthroscopy is an effective treatment in patients with refractory calcific tendinitis.
Kim, Kun-Hyung;Lee, Ro-Min;Nam, Dong-Woo;Kim, Jong-In;Lim, Sabina;Lee, Doo-Ik;Choi, Do-Young;Lee, Yun-Ho;Lee, Jae-Dong
Journal of Acupuncture Research
/
v.23
no.5
/
pp.219-228
/
2006
Objectives : To observe the effect of acupuncture treatment on Digital Infrared Thermographic Imaging(DITI) in frozen shoulder patients. Methods : 17 voluntary patients received acupuncture treatment on LI15, TE14, GB21 and Master Dong's acupuncture points, Shin-gwan and Gyun-joong, twice a week for 4 weeks. The patients were instructed to practice self exercise during their daily lives. Evaluations were made before treatment, after 1 week of treatment, after 2 weeks, 3 weeks and after 4 weeks of treatment. Constant Shoulder Assessment(CSA), Shoulder Pain and Disability Index(SPADI), Range of Motion(ROM) and the patient's satisfaction concerning the treatment was measured by Visual Analogue Scale(VAS). DITI was measured before treatment and after 4weeks of treatment. The obtained data was analyzed. Results : CSA, SPADI, VAS, adduction and extension showed significant(p<0.05) improvement. Abduction and flexion both improved after 4 weeks of treatment, but the improvement was statistically insignificant(p>0.05). DITI showed improvement but the improvement was insignificant(p>0.05). Conclusion : 4 weeks of acupuncture treatment significantly improved CSA, SPADI, VAS, adduction and extension in frozen shoulder patients(p<0.05). The improvement of abduction and flexion after 4 weeks of acupuncture treatment was insignificant(p>0.05). DITI results improved after 4 weeks of acupuncture treatment. But the change of thermal difference was insignificant(p>0.05).
Kim, Eugene;Park, Se-Jin;Lee, Ho-Seok;Park, Jai-Hyung;Park, Jong Kuen;Ha, Sang Hoon;Murase, Tsuyoshi;Sugamoto, Kazuomi
Clinics in Shoulder and Elbow
/
v.21
no.3
/
pp.151-157
/
2018
Background: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. Methods: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, $90^{\circ}$ flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. Results: Ulno-humeral joint moved to the varus on the coronal plane during flexion, $25.45^{\circ}$ in the non-united cubitus valgus group and $-2.03^{\circ}$ in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane $-26.75^{\circ}$ in the non-united cubitus valgus group and $-3.09^{\circ}$ in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. Conclusions: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.