• 대한한방내과학회지
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• 제43권5호
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• pp.891-900
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• 2022

Purpose: The purpose of this paper is to report the improvement of a patient with amyotrophic lateral sclerosis after long-term combined Korean medical treatment. Methods: A patient diagnosed with amyotrophic lateral sclerosis was treated with herbal medicine, acupuncture, pharmacopuncture, moxibustion, and rehabilitation for four separate hospital stays. To evaluate their respiratory discomfort and limb weakness, we used Manual Muscle Testing, the Pulmonary Function Test, and the Korean Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised. Results: The weakness of the muscles of the lower extremities and respiratory function was improved. Conclusion: We consider that combined Korean medicine treatments might be an effective treatment for muscle weakness and respiratory discomfort of amyotrophic lateral sclerosis. To verify the effectiveness of these treatments, further research is required.

• 대한정형도수물리치료학회지
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• 제29권1호
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• pp.41-52
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• 2023

Background: Bulgarian split squat (BSS) is beneficial to improve dynamic balance ability and muscle activity of lower extremities, however its effects have not been fully investigated. Therefore, this study aimed to compare changes in dynamic balance ability and muscle properties according to various modifications of BSS exercises. Methods: Thirty healthy male volunteers participated in this study, and they were randomly divided into three different groups. The subjects performed the BSS exercise either on a stable surface with the eyes opened (n=10) or eyes closed (n=10), and on an unstable support plane with eyes opened (n=10) conditions, respectively. Dynamic balance ability was measured via Biodex balance system under the eyes-opened and closed conditions. Additionally, muscle properties of the rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL) were evaluated. Results: Dynamic balance ability did not show the significant differences among the groups that performed the BSS exercises. However, in the Unstable group, there were significant differences in the overall stability index and anterior posterior stability index under the eyes-closed condition between pre-exercise and post-exercise. In comparison of muscle properties according to the groups, RF muscle showed a significant difference in amount of change of elasticity (p=.038). Additionally, there were significant changes in post measurements of VM muscle tone (p=.016), stiffness (p=.012) and elasticity (p=.002). VL muscle, however had no significant differences in muscle properties. Conclusion: These results indicate that BSS exercises could induce the alteration of RF and VM muscle properties, in particular VM muscle which is susceptible to weakness. Thus, BSS could be applied in various ways as an effective rehabilitation exercise.

• 대한정형외과학회지
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• 제54권2호
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• pp.192-196
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• 2019

저칼슘혈증은 신생아에서 흔하게 발견되며 대개 정맥 내 칼슘 투여를 통해 교정할 수 있다. 이 과정에서 발생할 수 있는 의인성 피부 석회화증은 칼슘 제제의 정맥 투여에 기인하는 것으로 알려져 있다. 저자들은 칼슘 글루코네이트의 혈관 외 유출로 인하여 신생아의 상지나 하지를 침범한 피부 석회화증 3예를 보고하고자 한다. 신생아 집중치료실에서 칼슘 글루코네이트의 정맥 내 투여와 관련하여 발생한 경화성 피부 결절을 보이는 생후 2주 여아, 생후 4주 남아 및 여아, 총 3명의 신생아가 협진 의뢰되었다. 초기 발견 후 각각 3주, 4주, 6개월에 방사선 사진 및 신체 검진상 만져지는 결절과 석회화의 완전한 관해가 이루어졌다. 또한 3명 모두에게서 점진적인 치유양상을 보였으며 기능적, 미용적 합병증은 발생하지 않았다. 환자들의 일반 양성 질환에 대한 인식이 높아짐에 따라 의인성 피부 석회침착증의 조기 진단을 내리고, 질환에 대한 충분한 설명과 이해를 바탕으로 불필요한 치료를 피함으로써 의료 과실 분쟁을 줄일 수 있을 것으로 생각된다.

• 대한정형외과학회지
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• 제54권4호
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• pp.293-301
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• 2019

사지와 몸통의 연부조직 종양은 정형외과 의사가 직면할 수 있는 흔한 문제이다. 비록 연부조직 종양은 대부분 양성이지만 정형외과 의사는 양성과 악성 종양을 구별할 수 있는 특징을 알고 있어야 한다. 연부조직 종양의 임상적 특징 및 역학을 이해하게 되면 올바른 진단 및 수술적인 치료를 할 수 있게 된다. 종양의 크기와 깊이는 종양의 진단을 위해 가장 중요한 요소이다. 종양의 감별 진단을 하기 위해서 우선적으로 상세한 병력청취와 자세한 신체 검사가 필요하며, 이후 단순 방사선 촬영, 초음파, 자기공명영상(magnetic resonance imaging), 양전자 방출 단층촬영술(positron emission tomography), 컴퓨터 단층촬영(computed tomography), 뼈 스캔, 혈관 조영술 등의 다양한 영상 촬영법을 사용하여 종양을 진단하고 진단된 종양의 특성을 확인하여야 한다. 특히 초음파 검사는 외래에서도 쉽게 수행할 수 있어 유용하다. 그러나 검사자의 숙련도에 따라 검사 정확도의 차이가 발생할 수 있다는 단점이 있다. 종양의 생검을 통한 조직검사는 종양에 대한 모든 영상 검사를 시행한 후 최종적으로 시행하는 것이 원칙이다. 조직 검사를 시행할 때는 세심한 주의를 기울여야 하며, 최종적인 진단 후에는 치료를 위해 다각적인 접근을 시행하여야 하며 필요한 경우에는 경험 있는 근골격계 종양전문의사에게 의뢰하는 것이 필요하다.

• 대한정형외과학회지
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• 제54권3호
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• pp.211-218
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• 2019

추간판 탈출증이란 추간판이 정상적으로 위치해야 할 자리에서부터 추간판 내부의 수핵이나 섬유륜이 탈출하는 질환을 지칭하며, 대부분 양호한 자연 경과를 거친다. 하지만 심각한 신경학적 증상이 있거나, 악화되는 신경 증상, 마미 증후군이 동반된 경우, 보존적 치료에 반응하지 않는 경우 등에 대해서는 수술적 치료가 권고된다. 수술 방법에는 고식적인 관혈적 방법, 현미경을 이용한 방법, 통형 견인기(tubular retractor)를 이용한 방법, 그리고 내시경을 이용한 방법에 이르기까지 다양한 방법들이 소개되었는데, 그 중 현미경적 추간판 제거술이 현재 표준 치료로 간주되고 있다. 내시경을 이용한 방법 중에서 두 개의 입구를 통한 내시경 척추 수술(biportal endoscopic spinal surgery, BESS)의 경우, 다른 방법에 비해 수술 기구들의 독자적인 움직임이 가능하여 자유로운 조작이 가능하며, 재발된 추간판 탈출증에 대해서도 추간판 제거가 비교적 수월하게 시행되고, 작은 피부 절개로 넓은 시야 확보가 가능하며, 지속적인 생리식염수의 세척으로써 습기나 안개를 지속적으로 제거해야 되는 번거로움을 덜 수 있고 술 후 감염률을 낮추는 효과도 있다. 기존의 관절경 및 척추 수술 기구들을 그대로 쓸 수 있다는 장점도 있으며, 약 2,700-6,700 lux의 밝은 조도 하에 최대 28-35배로 확대된 영상으로 수술하기 때문에 섬세한 조작이 가능하다. 따라서 이러한 장점을 지닌 두 개의 입구를 통한 BESS는 요추부 추간판 탈출증에 대한 이상적인 수술 방법으로 생각된다.

• 한국노년학
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• 제29권4호
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• pp.1261-1275
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• 2009

노화로 인한 근력, 균형 및 보행능력의 감소가 노인의 신체활동 저하를 일으킨다. 가상현실운동은 노인의 기능적 균형과 움직임을 회복하는데 사용되고 있다. 본 연구의 목적은 비디오게임을 이용한 가상현실운동프로그램(VR)이 노인의 근력, 균형 및 보행능력에 미치는 영향을 알아보는 것이다. 48명의 노인을 대상으로 VR군(남자 11명, 여자 14명, 나이 68.4세)과 대조군(남자 10명, 여자 13명, 나이 67.6세)으로 무작위 추출하였다. VR군은 가상현실 운동을 8주 동안 주 2회 실시하였으며 대조군은 특별한 운동을 실시하지 않았다. 가상현실운동프로그램은 준비운동(10분), 가상현실프로그램(40분), 정리운동(10분)으로 구성되었으며 가상현실프로그램은 상하지의 움직임뿐만 아니라 시청각피드백을 제공하는 플레이스테이션 아이토이플레이로 수행되었다. 운동 전·후의 변화를 비교하기 위하여 하지의 근력, 힘판을 이용한 정적균형능력, 기능적 팔 뻗기와 일어나 걸어가기 검사로 구성된 동적균형능력과 10m 보행검사와 6분 보행검사로 이루어진 보행능력을 사전, 사후로 측정하였다. VR군은 하지 근력과 정적균형능력, 동적균형능력, 보행능력에서 모두 유의하게 향상되었다(p<.05). 결론적으로 가상현실운동프로그램이 노인의 근력, 균형 및 보행능력의 개선에 효과가 있는 것으로 나타났다.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.187-195
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• 2023

Purpose: This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity. Methods: The Emergency Department-based Injury In-depth Surveillance (EDIIS) data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMRISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups. Results: In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39-60 years) and 45 years (range, 27-56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279-2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263-0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418-1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively. Conclusions: Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.

• Physical Therapy Rehabilitation Science
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• 제13권1호
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• pp.53-70
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• 2024

Background: The conventional deadlift is a popular exercise for enhancing trunk, core, and lower extremity strength. However, its use in sports medicine is constrained by concerns of lumbar injuries, despite evidence supporting its safety and rehabilitative benefits. To optimize muscle activation using resistive bands in variable resistance therapy, we explored their feasibility in the deadlift. Design: Comparative experimental design Methods: Surface electromyography recorded muscle activity in the trunk and lower extremities during lifting, with normalization to the isometric Floor Lift using Maximal Voluntary Contraction. Kinematics were measured using inclinometer sensors to track hip and trunk sagittal plane angles. To prevent fatigue, each subject only used one of the three pairs of bands employed in the study. Results: Our study involved 45 healthy subjects (mean age: 30.4 ± 6.3 years) with similar baseline characteristics, except for years of lifting and strength-to-years-of-lifting ratio. Various resistance band groups exhibited significantly higher muscle activity than conventional deadlifts during different phases. The minimal resistance band group had notably higher muscle activity in the trunk, core, and lower extremity muscles, particularly in the end phase. The moderate resistance band group showed increased muscle activity in the mid-and end-phases. The maximum resistance band group demonstrated greater muscle activity in specific muscles during the early phase and overall higher activity in all trunk and lower extremity muscles in the mid and end phases of the deadlift (p<0.05). Conclusion: Our findings provide valuable insights into muscle activation with various resistance bands during deadlift exercise in clinical and gym settings. There appears to be a dose-response relationship between increased resistance bandwidth, external load, myoelectric activation, and range.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.234-250
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• 2024

Background The impact of diabetes on complication rates following free flap (FF), pedicled flap (PF), and amputation (AMP) procedures on the lower extremity (LE) is examined. Methods Patients who underwent LE PF, FF, and AMP procedures were identified from the 2010 to 2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using Current Procedural Terminology and International Classification of Diseases-9/10 codes, excluding cases for non-LE pathologies. The cohort was divided into diabetics and nondiabetics. Univariate and adjusted multivariable logistic regression analyses were performed. Results Among 38,998 patients undergoing LE procedures, 58% were diabetic. Among diabetics, 95% underwent AMP, 5% underwent PF, and <1% underwent FF. Across all procedure types, noninsulin-dependent (NIDDM) and insulin-dependent diabetes mellitus (IDDM) were associated with significantly greater all-cause complication rates compared with absence of diabetes, and IDDM was generally higher risk than NIDDM. Among diabetics, complication rates were not significantly different across procedure types (IDDM: p = 0.5969; NIDDM: p = 0.1902). On adjusted subgroup analysis by diabetic status, flap procedures were not associated with higher odds of complications compared with amputation for IDDM and NIDDM patients. Length of stay > 30 days was statistically associated with IDDM, particularly those undergoing FF (AMP: 5%, PF: 7%, FF: 14%, p = 0.0004). Conclusion Our study highlights the importance of preoperative diabetic optimization prior to LE procedures. For diabetic patients, there were few significant differences in complication rates across procedure type, suggesting that diabetic patients are not at higher risk of complications when attempting limb salvage instead of amputation.

• 대한한방내과학회지
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• 제45권2호
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• pp.208-218
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• 2024

We report a case of generalized dystonia that developed from oromandibular dystonia and improved following Korean medicine treatment. The patient was hospitalized for 18 days and treated with herbal medicine, mainly Hyeongbangsabaek-san and Soyangbowi-tang, acupuncture, electroacupuncture, pharmacopuncture, cupping, and moxibustion. To evaluate the clinical effects of the treatment, we used the Unified Dystonia Rating Scale (UDRS) and Global Dystonia Severity Rating Scale (GDS) and checked dyskinesia occurrence in a diary recorded by the patient's guardian. After 18 days of hospitalization, the UDRS for the trunk, upper extremities, and lower face improved by more than 50%, and the GDS for the whole region, except the larynx and lower face, also improved. In addition, the maximum duration of dystonia decreased from 6 hours to 3 hours, and the pain and numbness associated with dystonia disappeared. This case suggests that Korean medicine treatment is effective in treating generalized dystonia.