• 대한통합의학회지
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• 제11권2호
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• pp.159-168
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• 2023

Purpose : This study aimed to investigate how neuromuscular electrical stimulation (NMES) affects the balance ability of patients who have undergone total knee arthroplasty owing to osteoarthritis. Methods : Thirty patients who had undergone total knee arthroplasty were randomized to an experimental group (n=15) and a control group (n=15). The experimental group received conventional physical therapy for 50 minutes and NMES treatment for 30 minutes, whereas the control group received conventional physical therapy for 50 minutes and active range of motion (AROM) exercises for 30 minutes. Within-group and between-group changes in static and dynamic balance ability before and after the 4-week intervention were analyzed. Results : In the within-group comparison, sway velocity in the center of gravity and total distance were significantly improved in both the experimental and control groups (p<.05), with no significant differences between the groups (p>.05). In the within-group comparison, both the experimental and control groups showed significant improvement in the functional reach test and movement velosity (p<.05). In the between-group comparison, the experimental group showed a significantly better improvement than the control group in the functional reach test (p<.05), but there was no significant difference in the movement velosity test (p>.05). Conclusion : In this study, NMES improved the static and dynamic balance in patients who had undergone total knee arthroplasty. Compared with AROM exercises, there was a greater effect on dynamic balance partially; however, the overall effect was similar. Therefore, NMES may be one option among various interventions to improve the balance ability in patients who have undergone total knee arthroplasty. In particular, this method may be effective when it is difficult to apply balance training for patients with total knee arthroplasty in a clinical setting.

• 대한물리의학회지
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• 제19권1호
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• pp.95-105
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• 2024

PURPOSE: This study aimed to utilize the International Classification of Functioning, Disability, and Health (ICF) tool to identify a problem list and explore intervention effects using proprioceptive neuromuscular facilitation (PNF) for improving the crosswalk performance of patients who have undergone a bilateral hip arthroplasty. METHODS: The subject of this study was a 43-year-old male who had undergone a bilateral hip arthroplasty. To address the subject's functional status, a clinical decision-making process was carried out in the order of examination, evaluation, diagnosis, prognosis, intervention, and outcome. Patient information during the examination was collected using the ICF core set. The evaluation involved listing the items of each problem using the ICF assessment sheet and identifying the interaction between activity limitations and the impairment level. The diagnosis explicitly described the causal relationships derived from the evaluation using ICF terminology. The prognosis presented activity goals, body function, and structured goals in terms of the activity and participation levels that needed to be achieved for an individual's functional status. The intervention approached problems through the four components of the PNF philosophy, namely basic principles and procedures, techniques, and patterns, in an indirect-direct-task sequence. Results were compared before and after the intervention using the ICF evaluation display. RESULTS: The results of the study showed that the primary activity limitation, which was the walking time across the crosswalk, showed improvement, and the trunk's counter rotation and the weight-bearing capacity of both the lower limbs, which were impairment level indicators, were enhanced. CONCLUSION: This study suggests that PNF intervention strategies will serve as a positive approach for improving crosswalk walking in patients with bilateral hip arthroplasty.

• 한국전문물리치료학회지
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• 제23권1호
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• pp.20-30
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• 2016

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC ($n_1$=19) or the QIIC ($n_2$=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

• 대한관절경학회지
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• 제10권1호
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• pp.77-82
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• 2006

목적: 40세 이상의 성인에서 발견된 외측 원판형 연골의 임상적 특징에 대해서 분석하고자 한다. 재료 및 방법: 1994년 3월부터 2004년 3월까지 40세 이상에서 원판형 연골이 발견되어 관절경적 치료후 1년 이상 추시가 가능한 48명의 환자 53예를 대상으로 하였고 환자의 평균 연령은 48.4세($40{\sim}62$세)였다. 환자군을 대상으로 이학적 검사 소견, 단순 방사선 및 MRI 소견, 관절경 소견을 분석하였다. 결과: 전체 53예중 증상 이환 기간은 1년이내가 42예(79.2%)로 대부분을 차지하였고 26예(49.1%)에서 외상의 기왕력이 있었으며, 방사선학적 검사상 대퇴골 외과의 편평화, 외측 구획의 퇴행성 변화가 37예(69.8%)에서 관찰되었다. 또한 내측 구획의 퇴행성 변화는 16예(30.2%)에서 관찰되었다. 슬관절경 검사상 45예(84.9%)에서 원판형 연골의 파열이 관찰되었고 파열이 없었던 경우는 8예(15.1%)였다. 파열형태는 복합형(18예, 40.0%)의 파열 형태가 가장 흔하게 나타났으며 그외 종파열(longitudinal) 12예(26.7%), 수평파열(horizontal) 11예(24.4%), 횡파열(transverse) 4예(8.9%)가 관찰되었고, 내측 연골판 파열을 동반하는 경우는 7예(13.2%)였다. 치료 방법으로는 관절경하 연골판 성형술이 46예(86.8%), 이중 6예에서 연골판 성형술 후 부분적 봉합술을 함께 시행하였으며 연골판 아절제술이 5예(9.4%), 연골판 전절제술이 1예(1.9%), 1예(1.9%)에서 관절경 검사후 슬관절 전치환술을 시행하였다. 결론: 성인의 원판형 연골은 소아의 경우와는 달리 외상의 기왕력을 가지고 있는 빈도가 높으며 가벼운 외상에 의해 증상이 발현된다. 또한 슬관절 내 외측 구획의 퇴행성 변화 등 방사선학적인 변화를 관찰할 수 있어 가능한 보존적인 수술적 치료가 필요할 것으로 사료된다.

• The Journal of Korean Physical Therapy
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• 제13권3호
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• pp.585-596
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• 2001

The twenty one individuals with total knee replacement who were admitted to Kang-Dong Hospital for comprehensive physical therapy were studied in order to demonstrate the effectiveness of an isokinetic test program using the Cybex 6000 machine. The subjects were divided into three groups with the isometric exercise group receiving isometric exercise, the isokinetic eccentric exercise group, and isokinetic concentric exercise group receivind isokinetic exercise(eccentric, concentric) to knee flexors and extensors muscles for a six weeks' period using the Cybex 6000. The results are follow: 1. The extensors were increased significantly at all groups after 6 weeks training(p<.05). The flexors were increased significantly at isokinetic eccentric and isokinetic concentric group but no significantly differences at isometric group(p>.05) 2. At the effect of extensors and flexors after 6 weeks training. higher to 30$^{\circ}$ /sec of isokinetic concentric exercise, lower to 120$^{\circ}$ /sec of isometric exercise. 3. The peak torque was more increased significantly in the flexors and extensors of the isokinetic conccentric exercise among three groups. 4. The total work was more increased significantly in the flexors and extensors of the isokinetic conccentric exercise among three groups. 5. The ratio of peak torque to body weight were more increased significantly in the flexors and extensors of the isikinetic conccentric exercise among three groups. 6. The average power was more increased significantly in the flexors and extensors of the isikinetic conccentric exercise among three groups. 7. The average R.O.M in the pre-exercise and post-exercise was not different significantly in all three groups. According to the above results, In the muscle strength recovery for total knee replacement patients, isokinetic concentric exercise group was significantly greater than the isokinetic eccentric and isometric exercise groups after a six weeks training.

• 근관절건강학회지
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• 제3권2호
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• pp.135-150
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• 1996

This study was performed to analyze the patient's experience during the progress of disease in the patients with osteoarthritis, who are taken the replacement surgery of knee Joint. The examine was consisted of five patients with osteoarthritis, who are taken the replacement surgery of knee joint from Dec. 4. 1995 to May, 20, 1996 at C university hospital. After hospitalization, the physical and psycho-logical status of the patients during preoperation, postoperation and discharge was examined. The data were examined according to the ethnographic method. The results are as follows. The patients experienced the periods of embarrasment, conflict, before surgery suffering, acceptance period after surgery. In the embarrasment period, the patients take a multiple medication therapy including hospital treatment, oriental medication and folk medication to ameliorate joint pain after first diagnosis on arthritis. The embarrasment period includes compulsive drug medication, oriental medication, folk medication, trouble some, sadness and survey of hospitals. In the conflict period, the patients consider the operation of knee because of working difficulty and severe Joint Pain, while they feel anxiety about the surgery. They condemn their physical situations. They have the conflict and anxiety on surgical operation. they consider the quality of life. They hope the surgery makes patients to improve walking ability. This period includes self-condemned, sorry, tiresomeness, expectation, worrisomeness, anxiety and hesitance. In the suffering period, the patients experience post operation physical discomfort after the total knee replacement. They do physical exercise, including extension and straight leg raising to maintain walking ability, while they endure to wait approximately 6 months for normal walking movements and they are also unstable to environmental people's sight. This period includes postoperative pain, continuous discomfort, inability and communication difficulty to other's people. In the acceptance period, the patients consider longerity of artificial Joint and also endure mild remaining joint pain. Some of them have religions for their wellbeing of life. This period include a self-protesting policy, abandonment, self-consolation, dependence on religions. According to the result from this study I suggested these shown below. 1) After replacement surgery of knee joint, continuous investigation on outcome patient is necessary. 2) It is also necessary to analyze on patient's experiences, who are taken the replacement surgery of hip Joint. 3) Study on disease experiences of patients with rhematoid arthritis, who take drug medication and physical therapy alone without surgery, is necessary. 4) Investigation on patient's favorable folk medication may be helpful to analyze disease experience of patients with osteoarthritis.

• 대한정형외과학회지
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• 제54권3호
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• pp.254-260
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• 2019

목적: 슬관절 전 치환술 시, 90° 굴곡과 신전 시의 간격(gap) 차이와 술 후 1년째의 슬관절 기능과의 관계를 알아보고자 하였다. 대상 및 방법: 2017년 3월부터 6월까지 골관절염 환자를 대상으로 하여 시행된 내비게이션을 이용한 전치환술의 연속된 82예를 대상으로 시행된 전향적 연구이다. 간격 측정은 내비게이션을 이용하였으며, 슬개골을 towel clip을 이용하여 정복한 이후 간격을 측정하였다. 신전 시의 내측과 외측 간격의 평균과 90° 굴곡 시의 내측과 외측 간격의 평균값을 구한 이후 간격 차이(90° 굴곡 시의 간격-신전 간격)를 계산하였다. 간격 차이<0 mm, 0 mm≤간격 차이<2 mm, 2 mm≤간격 차이를 각각 1군, 2군, 3군으로 나누었다. 술 후 1년째, Knee Society score (KSS)와 함께 무릎의 최대 굴곡 각도를 측정한 이후, 각 군 간의 값을 비교하였다. 결과: 간격 차이의 값에 따라 나눈 군의 수는 1군이 37예, 2군이 29예, 3군이 16예였다. 술 후 1년째의 KSS knee는 평균 81.21±8.31, KSS function은 71.34±9.84, 그리고 무릎의 최대 굴곡 각도는 126.48°±7.28°였다. 간격 차이에 따른 1년 후의 KSS의 값은 통계적으로 유의한 차이가 없었다. Mann-Whitney test를 이용한 두 군 간의 비교에서 2 mm≤간격 차이를 보이는 3군이 1군과 2군에 비하여 통계적으로 유의하게 큰 최대 무릎 굴곡 각도를 보였다. 결론: 슬관절 전 치환술 시, 90° 굴곡 시의 간격이 신전 시의 간격보다 2 mm 이상 큰 경우에서 다른 군에 비하여 술 후 1년째의 최대 무릎 굴곡 각도가 통계적으로 유의하게 높았다.

• 대한정형외과학회지
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• 제54권4호
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• pp.317-326
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• 2019

목적: 인공관절 치환술 및 고관절 골절 환자에서 시행한 2가지 정맥혈전 색전증 예방요법의 준수율을 비교 분석하고자 하였다. 수술 후 발생하는 정맥혈전 색전증은 인공 슬관절 치환술이나 인공 고관절 치환술 및 고관절 골절 수술 후 발생하는 가장 심각한 합병증이다. 이에 대한 적절한 예방이 무엇보다 중요하기 때문에 항응고제 사용의 필요성 또한 증가하고 있다. 대상 및 방법: 2009년 3월부터 2011년 2월, 2012년 3월부터 2014년 2월까지 순천향대학교 부속 서울병원에서 인공 슬관절 치환술, 고관절 전치환술 및 고관절 골절로 고관절 반치환술 및 내고정술을 시행받은 환자들을 의무 기록과 영상 검사를 검토하여 각각 American College of Chest Physicians (ACCP) 가이드라인과 American College of Orthopedic Surgeons (AAOS) 가이드라인에 따라 시행한 정맥혈전 색전증 예방요법의 준수율을 후향적으로 비교 분석하였다. 결과: 인공관절 치환술 및 고관절 골절 환자에서 정맥혈전 색전증 예방을 위한 가이드라인이 적용되고 있으며 실제로 ACCP 가이드 라인에 따라 준수하고 있는 경우가 화학적 요법에서는 수술 전에 56.0%, 수술 후에는 67.0%, 물리적 요법에서는 80.5%의 준수율을 보였다. 또한 AAOS 가이드라인에 따라 준수하고 있는 경우가 화학적 요법에서는 74.1%, 물리적 요법에서는 88.3%의 준수율을 보이며 ACCP 가이드라인에 비해 높은 준수율을 보였다. ACCP 가이드라인의 수술 전 후 화학적 예방요법과 물리적 예방요법의 준수율과 AAOS 가이드라인의 화학적 예방요법과 물리적 예방요법의 준수율을 비교 분석하였으며, 인공 슬관절 치환술의 수술 전과 후, 고관절 골절 수술의 수술 전과 후, 전체 고위험군 수술에서 수술 전과 후 유의한 차이를 보였다(p<0.05). 결론: 정맥혈전 색전증 고위험군 수술에서 정맥혈전 색전증 예방요법의 가이드라인에 따른 준수율을 전반적으로 높여서 적절한 예방이 이루어지도록 해야 하며, 일선 정형외과의를 위한 통일된 방향의 가이드라인이 필요할 것이다.

• The Korean Journal of Pain
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• 제18권2호
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• pp.165-170
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• 2005

Background: It is difficult to treat tourniquet-induced hypertension despite adequate anesthesia, and the mechanism of that is not known. And it may be possible that intraoperative continuous infusion of opioid induces preemptive analgesia postoperatively. We investigated the effect of intraoperative continuous i.v. fentanyl on tourniquet induced cardiovascular changes and postoperative preemptive analgesia in total knee replacements. Methods: Sixty patients were randomly assigned to two groups; In study group ($1.5{\mu}g/kg$ loading and $0.5{\mu}g/kg/hr$ continuous infusion of fentanyl before skin incision and tourniquet inflation) and control group (no treatment). Anesthesia was maintained with enflurane (1-2 MAC) and 50% nitrous oxide in oxygen. Arterial pressure and heart rate were compared between two groups. They received postoperative pain treatment with patient-controlled analgesia (PCA) with fentanyl during the postoperative 48 hours after total knee replacement. Visual analog scale (VAS) scores at either rest or movement were used to assess pain. Total fentanyl dose delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. Results: There were no significant differences between the two groups on cardiovascular changes by tourniquet induced pain effect. VAS, PCA delivered dose and PCA demands at movement in the 24-48 hour decreased in study group compared with control group (P < 0.05). But there were no significant differences between the two groups on the other time periods except 24-48 hour's patient satisfaction and adverse events. Conclusions: We suggest that intraoperative continuous i.v. fentanyl infusion dose not affect cardiovascular change by tourniquet induced pain. But it may induce preemptive analgesia postoperatively.

• 대한의용생체공학회:의공학회지
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• 제19권5호
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• pp.503-511
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• 1998

본 연구에서는 동적충격하중 하에서 다양한 tibial component system의 하중전달현상 및 발생 가능한 실패기전을 관찰하기 위해 서로 다른 tibial component들에 대한 수치해석을 통한 응력분포를 관찰하고 또한 접합 상태에 따른 임플란트 시스템이 받는 영향을 비교 분석하였다. 따라서, 해석에 고려되는 모델은 정상 경골과 현재 가장 많이 적용되는 시스템인 시멘트형과 무시멘트형 metal-backed tibial component, 폴리에틸렌으로 된 시멘트형 tibial component, 그리고 골과 slew사이의 비접합상태를 가정한 metal-backed tibial component을 포함한다. 해석 결과 metal-backed tibial component의 stem 끝 부분에서는 시멘트형이 무시멘트형 보다 약간 더 놀은 최대 응력을 보였다. 반면, 폴리에틸렌으로 된 tibial component의 경우 stem 글 부분에서의 최대 응력은 metal-backed tibial component에 비해 차 반 정도로 줄었고, 전체적으로 정상 경골에 유사한 응답 특성을 보여주었다. 골과 stem 사이의 비접합을 가정한 경우 금속 tray 밑 부된에서의 응력은 완전히 접합된 경우 보다 3배 더 높았고, stem 끝부분에서는 시간에 따른 불안정한 응력이 관찰되어 이 현상은 임플란트 해리현상과 불완전한 골접합을 가중시키는 원인으로 사료된다. 따라서, 수직충격하중을 고려한 경우 골에 안정하게 고정되는 폴리에틸렌 tibial component가 가장 바람직하다.