• Journal of Acupuncture Research
• /
• 제24권6호
• /
• pp.1-14
• /
• 2007

Backgrounds : Rheumatoid Arthritis(RA) is known as the chronic inflammatory diseasethat induces persistent inflammation in the joint cavity. The destruction of cartilage occurs as the result of bones destoyed by pannus, several influential cytokines induced by the synovial capsulitis, varieties of proteinases, $O_2$ radicals, and the secondary degenerative changes of articular cartilage. The type 2 collagen-induced arthritis model is used in recent experimental research on rheumatoid arthritis. Cervus elaphus sibiricus (Nockyong) has the effect of relieving pain by nourishing the muscles, joints, and bones. It is also known to be efficacious in promoting and enhancing the immune system. The objective of this study was to investigate the effect of Cervus elaphus sibiricus herbal acupuncture to inhibit the generation of proinflammatory enzyme on type 2 collagen-induced arthritis. I investigated the inhibition of mRNA transcription of MIF(macrophage migration inhibitory factor), $TNF-{\alpha}$(Tumor necrosis $factor-{\alpha}$) and MMP-9 (matrix metalloproteinase-9) of Cervus elaphus sibiricus herbal acupuncture using an in vitro test. Also investigated was the inhibition of differentiation of Th 1 cells and activation of cytokines(MIF, $TNF-{\alpha}$, IL-6, MMP-9), which are known to cause initial RA ,and are also related to the morphology of the synovial membranes of the joint capsule, by an in vivo test, using CIA(collagen induced arthritis) model mice. Materials & methods : The laboratory animals used in this experiment were 4 week-old DBA female mice, weighing approximately 20 grams, and adjusted to the laboratory environment. The experiment was divided into the normal group(NOR)-no treated group, control group(CON)-CIA induced group, and sample group(SAM)-Cervus elaphus sibiricus herbal acupuncture treated group. RA was induced in the mice via injection of $50{\mu}{\ell}$ C II mixed CFA. The Cervus elaphus sibiricus herbal acupuncture solution was applied on $GB_{35}$(陽陵泉) for 26 days from the 3rd day of RA inducement. The concentration of the solution was determined via a MTT assay. To research the effect on the expression of MIF, $TNF-{\alpha}$ and MMP-9 mRNA, RT-PCR was performed on synovial membrane cells from the knee joint of CIA mice. C II induced RA knee joint's histo-chemical synovial membrane was observed using a specimen model via the Hematoxilin and Eosin dying technique. Results : The expression of mRNA of RA-related cytokines such as MIF, $TNF-{\alpha}$, and MMP-9 dosedependently decreased in the cell from the synovial membranes of the joint, which is treated with Cervus elaphus sibiricus herbal acupuncture solution. In mice treated with Cervus elaphus sibiricusherbal acupuncture, the damage of synovial membranes of the joint was lessened, and differentiation of Th 1 cells was suppressed. The activation of RA-related cytokines such as MIF was suppressed, and the generation of $TNF-{\alpha}$ and MMP-9 showed a statistically significant decreas. Conclusions : It is speculated that Cervus elaphus sibiricus herbal acupuncture has the therapeutic effect of palliating the damage of the tissue impaired by RA by inhibition of the initial RA progression and by regulating excessive differentiation of Th 1 cell as it suppresses the generation of RA-related cytokines during the highest stage of RA by acting on pro-inflammatory enzymes.

• Journal of Acupuncture Research
• /
• 제37권4호
• /
• pp.254-258
• /
• 2020

Background: Scapulohumeral periarthritis causes pain and stiffness, and limits movement but it is a treatable condition. This was a clinical study of acupotomy treatment for scapulohumeral periarthritis. Methods: There were 80 patients randomly assigned to the traditional Chinese Medicine group (acupotomy) and the Western medicine group (naproxen), with 40 cases in each group. All patients had adjunct physiotherapy exercises for 14 days. Patients received acupotomy treatment 3 times for 14 days (Day 0, 7 and 14) or naproxen (0.22 g capsule; a non-steroidal anti-inflammatory drug) 3 times a day, for 14 days. The visual analogue scale (VAS) scores, range of motion (ROM) values, and the Melle scale, together with the therapeutic standard of diseases and syndromes in traditional Chinese Medicine were used for diagnosis and evaluation. Results: There were significant differences in the VAS scores, ROM, Melle scores, cure rate and total effective rate in the group which took naproxen and the acupotomy group, before and after treatment (p < 0.01). There were significant differences in the changes in VAS, ROM and Melle scores between the 2 groups (p < 0.01), and the acupotomy group was better than the naproxen group. Conclusion: Traditional Chinese Medicine and Western medicine can improve functional activity and reduce the level of pain experienced by patients suffering from scapulohumeral periarthritis. However, improvement of functional activity of the shoulder joint following acupotomy treatment was more obvious than the use of a non-steroidal anti-inflammatory drug, and the cure rate, and total effective rate of acupotomy was better.

• Journal of Korean Neurosurgical Society
• /
• 제59권4호
• /
• pp.374-378
• /
• 2016

Objective : A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy (PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF. Methods : We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis (C2-T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale (VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment. Results : The PCIFs were performed between April 2007 and March 2011 on 46 patients (32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients (84.7%), and VAS score decreased from $6.82{\pm}1.9$ to $2.19{\pm}1.9$. Posterior neck pain also improved in 25 patients (71.4%) among 35 patients, and VAS score decreased from $4.97{\pm}2.0$ to $2.71{\pm}1.9$. The mean disc-space heights of treated segment were $5.41{\pm}1.03mm$ preoperatively and decreased to $5.17{\pm}1.12mm$ postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period (Cox proportional hazards analysis and Student t-test, p>0.05). Conclusion : The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance.

• Clinics in Shoulder and Elbow
• /
• 제19권3호
• /
• pp.155-162
• /
• 2016

Background: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. Methods: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. Results: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. Conclusions: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

• 한국전문물리치료학회지
• /
• 제23권3호
• /
• pp.68-75
• /
• 2016

Background: Shoulder horizontal adduction (HA) is performed in many activities of daily living. The limited range of motion (LROM) of HA is affected by the tightness of the posterior deltoid, infraspinatus, teres major, and posterior capsule of glenohumeral joint. The LROM of shoulder HA contributes to excessive scapular abduction. Objects: The aim of this study is to compare the scapular abduction distance and three-dimensional displacement of the scapula during shoulder horizontal adduction between subjects with and without the LROM of shoulder HA. Methods: 24 subjects (12 people in LROM group and 12 people in normal ROM group) participated. Subjects with less than $115^{\circ}$ of HA ROM were included in LROM group. Shoulder HA was performed 3 times for measuring scapular abduction distance and three-dimensional displacement of the scapula. Tape measure was used for measuring scapular abduction distance. Scapular abduction distance was normalized by dividing the scapular size. Polhemus Liberty was used for measuring the three-dimensional displacement of the scapula. Results: Normalized scapular abduction distance was significantly greater in LROM group than normal ROM group (p<.001). Three-dimensional displacement of the scapula during shoulder HA was greater in LROM group than normal ROM group (p<.05). Conclusion: LROM group had a greater scapular abduction and three-dimensional displacement of the scapula during shoulder HA compared to normal ROM group.

• 대한골관절종양학회지
• /
• 제3권2호
• /
• pp.119-126
• /
• 1997

1980년부터 1997년까지 본 대학부속 성모병원에서 치료한 동측 대퇴골에 발생한 골육종 3예의 도약전이를 경험하였다. 도약전이는 골육종 환자 총 19례중 3례(15%)에서 발견되었고, 방사선 골주사나 자기공명영상이 진단에 필수적이었고, 고관절 이단술로 치료하였다. 도약전이의 기전은 확실하지 않았으나, 이시발생(metachronous) 기전의 초기단계로 보는것이 타당한 것으로 사료되었다. 증례 수가 적어 통계적 의미는 부여할 수 없으나, 도약전이가 있는 장관골의 골육종의 치료는 그 예후가 특히 불량하므로, 확실한 항암요법이 보장되지 않는 한 원발 종양이 발생한 장관골의 전체를 절제하거나 병소 상부관절에서 이단술을 시행하는 것이 바람직하다고 판단되었다.

• Archives of Plastic Surgery
• /
• 제37권6호
• /
• pp.839-842
• /
• 2010

Purpose: Ganglion cysts of peripheral nerve are uncommon. Ganglion cysts located within the nerve and extraneural ganglia that cause symptomatic nerve compression have been reported. We report an unusual case of epineural ganglion cyst confined to the epineurium of the sural nerve at the foot. Methods: A 45-year-old woman was referred because of a mass on the foot. She had six months' history of pain and numbness in the right small toe. During the examination of the lesion, multinodular cystic mass was identified arising from the epineurium of the sural nerve. The nerve fascicles were compressed by the cyst, but the cyst wall clearly did not invade the fascicle. With the aid of surgical microscope, the epineural cyst was completely excised along with epineural tissue to which it was attached, and the sural nerve was decompressed. There was no relationship between the cyst and either the joint capsule or tendon sheath. Since the cyst was on the periphery of the nerve it was possible to remove the cyst intact without damaging the underlying fascicles. Results: The postoperative course was uneventful. Pathologic examination showed a ganglion cyst with a degenerated collagen fibers and contained a yellowish, jelly-like mucinous substance. No neural elements were identified within the cystic wall. Her sensory impairment improved progressively. At the 15 months follow-up, she was asymptomatic with no neurological deficits. Conclusion: Rarely, ganglion cysts can involve peripheral nerves, leading to varing degrees of neurological deficits. Intraneural intrafascicular ganglion may be difficult to separate from the neural elements without nerve injury. Epineural ganglion, subcategorized as intraneural extrafascicular ganglion, can be removed without damage to the underlying nerve.

• 대한정형외과스포츠의학회지
• /
• 제11권2호
• /
• pp.69-74
• /
• 2012

목적: 슬관절의 신전 또는 굴곡 시 슬와 동맥의 위치 변화를 확인하고 슬관절의 후방 관절낭 유리술을 시행 후의 슬와 동맥의 위치 변화를 측정하여 슬관절 수술 시 슬와 동맥의 손상을 최소화 할 수 있는 자세 및 후방 관절낭 유리술의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 중년의 남성 및 여성, 총 2구의 신선 동결 전신 사체로서, 모두 4례의 슬관절을 대상으로 하였다. 슬관절을 0도, 30도, 60도, 90도 각도로 굴곡하여, 각각의 각도에서 관절면 및 관절면으로부터 원위 1 cm 및 2 cm에서 경골 후방 피질골로 부터 슬와 동맥과의 거리를 측정하였다. 관절경을 이용하여 후방 관절낭 유리술을 시행하였고, 같은 방법으로 경골 후방 피질골로부터 슬와 동맥과의 거리를 측정하였다. 결과: 슬와 동맥에서 후방 경골 피질까지의 거리는 관절면, 관절면 원위 1 cm, 관절면 원위 2 cm에서 0도 굴곡 시 평균 6.3 mm (4.5~7), 4.6 mm (3.6~6), 4.9 mm (3.9~5.8), 30도 굴곡 시 평균 7.4 mm (5.2~9), 4.9 mm (3.6~7.2), 5.3 mm (3.8~6.6), 60도 굴곡 시 평균 8.7 mm (5.4~11), 5.2 mm (4.9~7.3), 6.2 mm (5.4~9.6), 90도 굴곡 시 9.8 mm (5.8~12.1), 5.5 mm (5.1~7.4), 6.5 mm (5.4~10.7) 이었다. 후방 관절낭 유리술 시행 후에는 관절면, 관절면 원위 1 cm, 관절면 원위 2 cm에서 0도 굴곡 시 6.5 mm (5.5~7.5), 5.8 mm (3.9~7.2), 5.2 mm (3.8~7.0), 30도 굴곡 시 7.7 mm (5.5~9,1), 7.1 mm (4.6~7.6), 5.5 mm (4.1~6.9), 60도 굴곡 시 8.9 mm (5.7~11.2), 8.5 mm (5.5~9.2), 6.4 mm (5.3~10.1), 90도 굴곡 시 10.2 mm (6.3~13.6), 9.5 mm (6.5~11), 6.6 mm (5.9~9.8)로 측정되었다. 결론: 슬관절을 굴곡시킬수록 슬관절 관절면에서 관절면 원위 2 cm 사이에서는 경골 후방 피질골과 슬와 동맥 사이의 거리를 증가되어 슬관절 수술시 슬와 동맥 손상을 줄일 수 있다. 또한 후방 관절낭 유리술을 시행하게 되면 경골 후방 피질골과 슬와 동맥 사이의 거리를 더 증가시켜 슬와 동맥 손상을 보다 더 줄일 수 있을 것이다.

• 한국전문물리치료학회지
• /
• 제18권1호
• /
• pp.83-92
• /
• 2011

Osteoarthritis is a degenerative joint disease and is led to physical disability. Yet the development of effective disease-modifying treatments has lagged. In this study, I examined the effect of physical therapeutic intervention through microcurrent stimulation and attempt to find which degree of intensity, either 25 ${\mu}A$ or 500 ${\mu}A$ with a regular 5 pps pulse, is more effective in the osteoarthritis. Osteoarthritis was induced with a mixture of 2% carrageenan and 2% kaolin in 26 male Sprague-Dawley rats. The mixture (0.1 $m{\ell}$) was injected into the intra-articular capsule of knee joint once a week for three weeks. Five animals did not show degenerative changes by radiological findings and excluded in the following experiment. Osteoarthritic animals were randomly divided into 3 groups ($n_1$, $n_2$, $n_3$=7/each): untreated, treated with 25 ${\mu}A$, treated with 500 ${\mu}A$. All experimental groups received microcurrent stimulation for four weeks (15 min/day, 5 days/week). The ethological inspection of foot print analysis on the walking corridor was accomplished every week. Histological preparations and immunohistochemical staining with insulin-like growth factor-1 were also done in the articular cartilages. All of these parameters were compared with those of osteoarthritic control group (n=7). The ethological inspection of foot print analysis revealed that changes of walking track (paw width) and stride length was significantly increased in both experimental groups. The better results were observed in experimental group treated with 25 ${\mu}A$ intensity without significance than group treated with 500 ${\mu}A$. Histological preparations disclosed that routine hyaline cartilage of articular surface were altered to fibrous cartilage in untreated group and experimental group treated with 500 ${\mu}A$ intensity. But a little changes were seen in experimental group treated with 25 ${\mu}A$ intensity. Immunolocalization of insulin-like growth factor-1 was simultaneously decreased according to the duration of osteoarthritis, and did not show significant difference among the groups. In this study discovered that the microcurrent stimulation, especially 25 ${\mu}A$ intensity, had a positive effect by the ethological inspection, histological and immunohistochemical stainings. These results suggest that microcurrent stimulation with low-intensity might be effective in the promotion of healing process for the osteoarthritis.

• 동국한의학연구소논문집
• /
• 제7권2호
• /
• pp.107-120
• /
• 1999

본 연구는 관절염 유발시 일어나는 관절낭의 형태학적 변화를 조사하기위해 lipopolysaccharide(LPS) 주사로 인위적 관절낭 염증을 유발시킨 후 시간경과에 따른 윤활관절막과 섬유관절막의 향태 변화를 관찰하였다. BALB/C 암컷 생쥐 오른쪽 무릎관절낭에 LPS $300{\mu}g/kg$를 주사한 후 3, 7 그리고 14일에 무릎관절을 얻었다. 무릎관절은 4주동안 EDTA용액에 탈회한 후 통상적 방법으로 paraffin에 포매하였다. 또한 윤활관절막의 미세구조변화는 embed812로 포매한 후 관찰하였다. LPS 주사후 관절연골인접부위의 윤활관절막에서 시작된 세포과형성(hyperplasia)은 시간 경과후 전체 윤활관절막으로 확대되었다. 윤활관절막내의 미세구조의 변화로는 윤활포식세포(type I)가 관절강내로의 많은 돌기(filopodia)를 내었고, 잘 발달된 과립형질내세망을 가지는 type 2 윤활분비세포의 숫적 증가가 보였다. 한편 LPS 주사후 섬유관절막에서 나타나는 형태학적 변화는 collagen fiber 생성에 의한 섬유화가 증가되며, 이러한 섬유화를 주도하는 섬유모세포의 이주증가가 관찰되었다. 또한 혈관 주위에서는 백혈구의 이주 증가가 나타났으며, 탈과립형(degranulated type) 비만세포가 많이 관찰되었다. 이상의 결과로 LPS 주사로 관절낭에서 염증이 유발되어 윤활관절막과 섬유관절막에서 헝태학적 변화가 나타났다. 이러한 일련의 형태학적 변화는 발병초기 류마티스성 관절염에서 나타나는 병리학적 소견과 동일한 결과로서, 앞으로 진행될 치료제 개발과 유발기전에 관한 해석을 위한 in vivo 실험의 적절한 모델로 기여할 것으로 기대된다.