• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.597-603
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• 2017

Objective : Several surgical methods have been reported for treatment of ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine. Despite rapid innovation of instruments and techniques for spinal surgery, the postoperative outcomes are not always favorable. This article reports a minimally invasive anterior decompression technique without instrumented fusion, which was modified from the conventional procedure. The authors present 2 cases of huge beak-type OPLL. Patients underwent minimally invasive anterior decompression without fusion. This method created a space on the ventral side of the OPLL without violating global thoracic spinal stability. Via this space, the OPLL and anterior lateral side of the dural sac can be seen and manipulated directly. Then, total removal of the OPLL was accomplished. No orthosis was needed. In this article, we share our key technique and concepts for treatment of huge thoracic OPLL. Methods : Case 1. 51-year-old female was referred to our hospital with right lower limb radiating pain and paresis. Thoracic OPLL at T6-7 had been identified at our hospital, and conservative treatment had been tried without success. Case 2. This 54-year-old female with a 6-month history of progressive gait disturbance and bilateral lower extremity radiating pain (right>left) was admitted to our institute. She also had hypoesthesia in both lower legs. Her symptoms had been gradually progressing. Computed tomography scans showed massive OPLL at the T9-10 level. Magnetic resonance imaging of the thoracolumbar spine demonstrated ventral bony masses with severe anterior compression of the spinal cord at the same level. Results : We used this surgical method in 2 patients with a huge beaked-type OPLL in the thoracic level. Complete removal of the OPLL via anterior decompression without instrumented fusion was accomplished. The 1st case had no intraoperative or postoperative complications, and the 2nd case had 1 intraoperative complication (dural tear) and no postoperative complications. There were no residual symptoms of the lower extremities. Conclusion : This surgical technique allows the surgeon to safely and effectively perform minimally invasive anterior decompression without instrumented fusion via a transthoracic approach for thoracic OPLL. It can be applied at the mid and lower level of the thoracic spine and could become a standard procedure for treatment of huge beak-type thoracic OPLL.

• 대한정형외과학회지
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• 제53권6호
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• pp.466-477
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• 2018

정형외과는 인체의 모든 근골격계를 담당하기 때문에 3차원(3-dimensional, 3D) 프린팅 기술을 가장 많이 활용할 수 있는 분야이다. 구체적으로 관절염, 척추, 외상, 기형, 종양 등의 다양한 정형외과 질병에 대해 해부학적 모델, 수술용 가이드, 금속 임플란트, 바이오-세라믹 재건, 보조기 등의 형태로 활용될 수 있다. 특히 정형외과 종양 영역은 환자마다 종양의 발생 위치와 크기가 다양한 데 반하여 사지 보존 수술에 활용할 수 있는 기존의 수술 방법이 제한적이었기 때문에 3D 프린팅 기술의 활용이 매우 절실한 분야였다. 최근에 3D 프린팅 환자 맞춤형 임플란트를 짧은 시간 내에 쉽게 제작할 수 있게 되면서 기존 방법으로 골 재건이 어려웠던 부위에 대해서도 해부학적 재건이 가능하게 되었다. 3D 프린팅 기술을 의료 영역에서 더욱 폭넓게 사용하기 위해서는 디자인, 출력, 검증 과정에 필요한 많은 전문가들과 함께 수평적 위치에서 긴밀히 협력해야 한다. 의료계에서 3D 프린팅을 활용을 선도함으로써 다른 분야의 전문가 양성 및 3D 프린팅 관련 산업의 발달을 촉진시킬 수 있다고 판단한 정부도 규제보다는 활성화에 역점을 두고 적극적으로 지원하고 있는 추세이다. 앞으로 정형외과가 전체 의료계에서 3D 프린팅 기술의 도입과 활용을 선도해 가기를 기대하면서 골종양 수술에서 3D 프린팅 기술을 활용하였던 저자의 경험을 소개하고자 한다.

• 대한물리치료과학회지
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• 제28권2호
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• pp.30-39
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• 2021

Background: The purpose of this study was to compare the differences in gait and mobility according to the types of assistive device for ankle joint including ankle foot orthosis (AFO), non-elastic tape, elastic tape, and high ankle shoes in chronic hemiplegic stroke survivors. Design: A cross-over design. Methods: Twelve hemiplegic stroke survivors participated in this study, and they walked under 5 different conditions including bare feet, wearing a AFO, wearing a non-elastic tape, wearing a elastic tape, and wearing a high ankle shoes. During the participants walked, the spatio-temporal gait analysis and mobility examinations were performed. For the spatio-temporal gait analysis (gait velocity and cadence, step length, stride length, and single and double leg support time) and mobility examinations, the gait mat, TUG and TUDS were used. Results: As s results, on the AFO, non-elastic tape, elastic tape, and high ankle shoes, there were significantly differences in the all spatio-temporal gait parameters, TUG, and TUDS compared to barefoot (p<0.05). In particular, all spatio-temporal gait parameters, TUG, TUDS were significantly improved with AFO compared to barefoot. TUG was significantly improved with AFO compared to non-elastic tape, TUG and TUDS were significantly improved with AFO compared to elastic tape, gait velocity was significantly improved with non-elastic tape compared to high ankle shoes, gait velocity and TUG were significantly improved with elastic tape compared to high ankle shoes, and TUDS was significantly improved with non-elastic tape compared to elastic tape. Conclusion: The AFO, non-elastic tape, elastic tape, and high ankle shoes showed a positive effect on gait and mobility compared to barefoot, and among them, wearing AFO was most effective for improving gait and mobility of chronic hemiplegic stroke survivors.

• 대한족부족관절학회지
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• 제26권2호
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• pp.88-94
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• 2022

Purpose: This study was based on the Korean Foot and Ankle Society (KFAS) member survey and aimed to report the current trends in the epidemiology, diagnosis, and management of acute Achilles tendon rupture (AATR) over the past few decades. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in October 2021. The questions were mainly related to the clinical experience and preferred management of patients with AATR. Answers with a prevalence ≥50% of the respondents were considered a tendency. Results: Seventy-one (12.9%) of the 550 members responded to the survey. The male sex ratio in AATR was answered mean 78%, and the most common age groups were 30~40 years (n=49; 69.0%), and 40~50 years (n=37; 52.1%), in that order. The most common seasons for the occurrence of AATR were spring (37 cases; 52.1%) and autumn (27 cases; 38.0%). Also, sports-related rupture had an average occurrence of 76.2%. The most important clinical factor to determine the type of treatment was the history of previous injuries, and 75.9% of respondents started conservative treatment in the 2010s. The most preferred protocol of conservative treatment was an orthosis capable of ankle range of motion after casting (68.5%), and 53.7% 'satisfied' and 1.9% 'very satisfied' with conservative treatment. The most preferred surgical method was open repair (80.3%), and the Krackow method (60.6%), and 49.3% of treated patients responded 'satisfied' and 45.1% 'very satisfied' with this treatment. Conclusion: This study gives updated information concerning the current trend of epidemiology, diagnosis, and treatment of AATR in Korea. Both consensus and variation in the approach to AATR were identified using this survey study. This study may raise the awareness of various possible approaches toward AATR and should be used to further establish a standard protocol for the management of this injury.

• Clinical Pain
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• 제19권2호
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• pp.70-79
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• 2020

Objective: We evaluated the efficacy of a newly-developed spinal orthoses (V-LSO) by comparing the stabilizing effect, abdominal pressure, and comfort of 3 different semirigid LSOs (classic LSO, V-LSO, and Cybertech^®) during various body movements. Method: Thirty healthy volunteers (23~47 years, 24 males, 6 females) were selected. A dual inclinometer measured the range of motion (ROM) while the participants performed flexion/extension and lateral flexion of the lumbar spine with 3 LSOs. The LSO's pressure on the abdominal surface was measured using 9 pressure sensors while lying, sitting, standing, flexion/extension, lateral flexion, axial rotation, and lifting a box. Comfort and subjective immobilization were analyzed by a questionnaire. Results: V-LSO had a statistically significant effect on flexion over Cybertech^®. No significant differences were noted during extension and lateral flexion between the 3 LSOs. The abdominal pressure showed no significant differences while supine. While sitting, standing, and lifting a box, the mean abdominal pressure for V-LSO were significantly higher than those for Cybertech^®. During lumbar flexion, the mean abdominal pressures for classic LSO and V-LSO were significantly higher than that of Cybertech^®. For extension, lateral flexion and axial rotation, the abdominal pressure for V-LSO was significantly higher than those of classic LSO and Cybertech^®. In the subjective analysis, V-LSO and Cybertech^® scored best for comfort. Conclusion: The V-LSO and Cybertech^® were more comfortable than the classic LSO, and hence, may have improved compliance with decreased discomfort. V-LSO may be superior to the other LSOs in restricting lumbar movement and increasing intraabdominal pressure.

• PNF and Movement
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• 제21권1호
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• pp.27-35
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• 2023

Purpose: Hallux valgus (HV) is one of the most common chronic foot disorders, occurring when the first toe deviates laterally toward the other toe. HV impairs muscle strength and affects gait function (postural sway and gait speed). Thus, this study aims to investigate using the FDM system the effect of wearing braces on gait while wearing a virtual reality (VR) device. Methods: This study was conducted on 28 healthy adults with HV of 15 degrees or more. To compare differences in walking, depending on whether a toe brace can be worn, the subject walked without wearing anything, walked after wearing the VR device, and walked after wearing the VR device and the toe brace, and the FDM system was used for the gait ability measurement analysis. Results: As a result of a one-way repeated analysis of variance, the walking speed-related variables (cadence, velocity, etc.) in the HV group were higher during comfortable walking. In addition, walking while wearing a VR device and walking while wearing a VR device and a toe brace demonstrated more significant values in terms of six gait parameters (double stance phase, loading response, stage, stage, stage, and stage). The maximum pressure of the forefoot was significantly reduced when walking while wearing a VR device and a toe brace compared to comfortable walking, but in all variables, there was no statistically significant difference between walking while wearing a VR device and walking while wearing a VR device and a toe brace. Conclusion: Orthosis with a VR device during gait (OVG) and gait with a VR device (GVR) affect gait in HV patients. However, there was no significant difference between GVR and OVG. Thus, it is necessary to conduct experiments on various HV angles and increase the duration of wearing the toe brace.

• 대한정형외과학회지
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• 제54권4호
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• pp.336-342
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• 2019

목적: 자기공명영상(magnetic resonance imaging, MRI)을 이용하여 보존적 치료를 시행한 흉요추부 골다공증성 압박 골절 환자에서 후만 변형의 예측 인자를 조사하고자 하였다. 대상 및 방법: 2007년 1월부터 2016년 3월까지 흉요추 압박 골절 의심하에 진료를 본 환자들 중 보존적 치료를 시행한 환자를 따로 분류하였고 그들 중 골밀도 -2.0 미만의 골감소증 및 골다공증, 단일 분절 골절을 가진 환자 89명을 대상으로 후향적 연구를 시행하였다. 골절된 척추체에서 전·후종 인대 손상, 상부 또는 하부 종판 파열, 상부 또는 하부 추간판 손상, T2 강조 영상에서 저 신호 강도의 존재, 척추체의 골 부종 정도를 MRI를 통해 확인하였다. 결과: 상부 종판이 파열된 사례나 척추체 골 부종 수준이 높은 사례의 경우 후만각, 설상각, 전방 척추 압박이 현저하게 진행되었다. 전종 인대 손상이나 상부 추간판 손상이 있는 경우에는 후만각만 현저하게 진행되었다. T2 강조 영상에서 저 신호 강도의 병변을 보인 경우 설상각과 전방 척추 압박이 높게 나타났다. 그러나 후종 인대 손상과 하부 종판 파열 및 하부 추간판 손상의 경우는 후만 변형 및 척추 압박의 진행과 유의미한 상관관계는 없었다. 후만각이 5° 이상 증가될 위험 요인으로는 전종 인대의 손상 유무, 상부 종판 파열, 상부 추간판 손상이 있는데 손상 받지 않은 사례에 비해 각각 21.3, 5.1, 8.5배 위험했고 골 부종 수준에 따라 각각 위험도가 달랐다. 결론: 골감소증 및 흉요추부 골다공증성 압박 골절일지라도 전종 인대 손상, 상부 종판 및 추간판 손상 또는 MRI상 높은 수준의 부종이 있을 경우 후만 변형의 위험도가 증가한다.