• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권2호
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• pp.180-185
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• 1995

TMJ ankylosis is classified with true and false type. A true ankylosis is defined as any condition that produces fibrous or bony adhesions between the articular surfaces of the temporomandibular joint. The main causes of true ankylosis are trauma or infection. A false ankylosis results from pathologic conditions outside the joint that limit mobility of the mandible such as myogenic disorders, coronoid impingement or rare direct bony fusion between maxilla and mandible. The treatment of choice of TMJ ankylosis is surgical intervention. We experienced the male patient with complete mouth opening limitation since 45 years before. This patient has true TMJ ankylosis and rare bony synostosis between maxilla and mandible in the right posterior region. We performed surgical intervention and had a favorable result.

• 대한족부족관절학회지
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• 제12권1호
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• pp.93-99
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• 2008

Purpose: To evaluate the result of the early exercise and rehabilitation after limited posterior operative treatment of the calcaneal fractures. Materials and Methods: Between May 2005 and December 2007, 43 cases with intraarticular calcaneal fractures were treated by open reduction with K-wires and Steinmann pins. Mean age and mean follow-up period were 42.5 years old and 15 months. All patients were treated with the same postoperative protocol, the early exercise of subtalar joint without short leg splint and cast was began after postoperative 1 day, non-weight bearing crutch ambulation did after 2 weeks, partial-weight bearing crutch ambulation did after 6 weeks, without crutch ambulation did after 10 weeks. The fractures was classified by Essex-Lopresti and Sanders classification using radiographs and the functional outcomes were evaluated by circle draw exercise, AOFAS score. Results: By Essex-Lopresti classification, the tongue type was 6 cases (14%), the joint depression type was 15 cases (35%), the combined type was 22 cases (51%). By Sanders classification, type II were 10 cases (23%), type III were 15 cases (58%), and type IV were 8 cases (19%). By AOFAS functional evaluation, the mean preoperative scores were 70.3 and 70.5 respectively, mean postoperative scores were 83.7 and 86.9 respectively. There were satisfactory results in 40 cases but 3 cases were unsatisfactory including on case of lateral impingement and 2 cases of traumatic arthritis of subtalar joint. Conclusion: We obtained satisfactory result of the early exercise of subtalar joint without short leg splint and cast and rehabilitation after limited posterior operative treatment of the calcaneal fractures.

• 대한관절경학회지
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• 제12권1호
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• pp.32-39
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• 2008

목적: 10시 방향 대퇴 터널의 전방십자인대 재건술 후 MRI 검사의 유용성을 알아보고자 하였다. 대상 및 방법: 자가 슬괵건을 이용한 전방 십자 인대 재건술 후 MRI 검사를 시행 받았던 29명의 소견을 분석하였다. 평균 술 후 MRI 검사까지의 기간은 18.9개월($7{\sim}40$개월)이었다. 이식건의 신호강도, 형태, 연속성, 대퇴터널 시작점, 대퇴터널 위치, 과간 절흔 충돌, 교차 핀 손상 및 위치에 대해 조사하였으며 KT-2000 검사, Lysholm 점수, 축회전 검사 등과 비교하였다. 결과: 이식건의 신호강도와 술후 MRI 검사까지의 기간은 유의한 상관관계가 없었다. 이식건의 형태와 연속성은 straight, well-preserved 가 대부분이었다. 대퇴 터널의 시작점은 zone 4가 13례, zone 3가 16례였으며 과간 절흔 충돌은 관찰되지 않았다. 교차 핀의 손상은 10례였고 이중 대퇴 후방 피질골 밖으로 빠진 경우가 5례였고, 방향이 후방을 향하는 경우가 9례였다. 교차 핀의 손상 여부와 임상 결과와의 상관 관계는 통계적으로 유의하지 않았다. 결론: 전방 십자 인대 재건술 후 MRI 검사는 이식건의 상태와 위치, 교차 핀의 위치 등을 파악하는데 유용하였다. 10시 방향 대퇴터널의 전방십자인대 재건술에서는 특이 교차 핀의 위치가 중요하므로 수술 시 교차 핀의 손상을 피하기 위한 세심한 주의를 요한다.

• 대한관절경학회지
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• 제13권1호
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• pp.82-85
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• 2009

목적: 전방 십자 인대 재건술시 잔류조직 보존은 이식건 치유를 향상시키고 고유수용 감각 기능을 보존할 수 있어 저자들은 10시 혹은 2시 방향 경경골 대퇴 터널을 천공하고 잔류조직을 보존하는 술기를 소개하고자 한다. 수술 술기: 잔류조직은 가능한 많이 보존하고자 하였으며 그 중에서 경골 부착부위 전방부와 후방 십자 인대와 연결된 활액막 및 잔류조직은 반드시 보존하여 잔류조직의 장력을 어느정도 유지하고 흘러내림을 방지하여 과간 절흔의 충돌을 방지 하였다. 경골 drill guide의 각도를 40~45도로 하고 관절 내 guide tip을 고식적인 위치보다 1 mm씩 전방 및 내측으로 이동하였다. 경골에서 유도 강선의 시작점은 거위발 건의 근위부, 내측 측부 인대의 전방부로 하였다. 경골 터널은 먼저 이식건의 두께보다 1 mm 작은 확공기를 이용하여 만들되, 경골 관절면의 피질골에 닿으면 조심스럽게 진행하여 피질골을 뚫자마자 멈춤으로써 가능한 잔류조직에 손상이 가지 않도록 하였으며, 다시 이식물과 같은 크기의 확공기를 이용하여 경골 터널과 10시 혹은 2시 방향의 대퇴 터널을 완성하였다. 결론: 전방 십자 인대 재건술시 10시 혹은 2시 방향 경경골 대퇴 터널을 천공하고 잔류조직을 보존하는 술기를 소개하였다.

• 대한정형외과스포츠의학회지
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• 제7권2호
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• pp.67-74
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• 2008

반복적으로 던지는 동작은 주관절에 심한 기계적인 스트레스를 주며, 주된 기전은 외반력이며 그 결과 내측 인장력과 외측 압박력, 후방부의 충돌현상이 발생한다. 성장기나 청년기에 지속적인 스트레스는 주관절에 해부학적 변화를 유발할 수 있다는 위험성을 운동선수와 가족, 코치들은 반드시 잘 이해하고 있어야 한다. 스포츠와 관련된 주관절 손상을 막기 위하여 적절한 운동법 교육, 워밍업, 의학적 전문 지식, 보호 장구 등이 필요하다. 또한 손상 예방과 재활은 적절한 투구 동작, 근력 강화, 견갑골에 대한 조절, 관절 운동 범위의 적절한 유지가 필수적이다.

• 대한물리의학회지
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• 제10권4호
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• pp.1-7
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• 2015

PURPOSE: The purpose of this study was to compare the effects of cross-body stretching (CBS) and modified cross-body stretching (MCBS) on the range of motion (ROM) of glenohumeral joint (GHJ) in healthy subjects. METHODS: Thirty subjects were randomly assigned to 1 of 2 groups: CBS group without stabilization of scapula (n=15) and MCBS group with stabilization of scapula (n=15). We measured horizontal adduction and internal rotation ROM of GHJ in pre- and post-intervention. The data were analyzed using the analyses of covariate (ANCOVA) and least significant difference (LSD) post hoc tests (p=.05). RESULTS: In the post-intervention, the MCBS group had a significantly greater increase in horizontal adduction ROM (mean ${\pm}$ SD, $11.46^{\circ}{\pm}0.83^{\circ}$) compared to the CBS group ($7.81^{\circ}{\pm}0.83^{\circ}$) (p=.007) and a greater increase in internal rotation ROM ($62.27^{\circ}{\pm}0.74^{\circ}$) compared to the CBS group ($59.20^{\circ}{\pm}0.74^{\circ}$) (p=.004). CONCLUSION: A single session application of an MCBS provides immediate more improvements in both horizontal adduction and internal rotation ROM than CBS. These results suggest that application of MCBS with stabilization of scapula may be a more useful to gain ROM of GHJ than CBS without stabilization of scapula.

• 대한족부족관절학회지
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• 제17권4호
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• pp.294-301
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• 2013

Purpose: To report the clinical outcomes and complications of flexor hallucis longus (FHL) tendoscopy using 3 portals. Materials and Methods: Between January 2012 and April 2013, 10 patients (10 ankles) received tendoscopic surgery for the treatment of FHL tenosynovitis. Patients complaining of pain and tenderness along the course of FHL despite over 6 months of conservative treatments were indicated for surgery. The mean age was 41.7 years (range: 18-57) and the follow up period was 12.7 months (range: 6-20). Tendoscopy was performed using posteromedial, posterolateral, and plantar portals. Clinical evaluations included preoperative and postoperative visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) score, and patients' satisfaction. Results: Tendoscopic findings included tenosynovitis in 10 cases, degenerated vinculae in 6 cases, stenosis of the tendon at its entrance into the fibro-osseous tunnel in 5 cases, and degenerative partial tendon tear in 3 cases. Two cases had associated symptomatic os trigonum and 3 cases had posterior ankle impingement syndrome. Preoperative pain decreased from median VAS 6 (range: 4-10) to 2.1 (range: 1-5) at the last follow up and AOFAS score improved from 50.1 (range: 36-63) to 82.1 (range: 61-89) (p<0.05). Nine patients were satisfied or very satisfied with the outcome. Injury of the lateral plantar nerve occurred in one case. Conclusion: FHL tendoscopy using 3 portals is a feasible and useful minimal invasive surgical technique for the management of FHL tenosynovitis.

• 대한의용생체공학회:의공학회지
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• 제43권4호
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• pp.241-250
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• 2022

It is known that chronic pain and injury of upper limb joint tissue in manual wheelchair users is usually caused by muscle imbalance, and the propulsion speed is reported to increase this muscle imbalance. In this study, kinematic variables, electromyography, and ultrasonographic images of the upper limb were measured and analyzed at two different propulsion speeds to provide a quantitative basis for the risk of upper extremity joint injury. Eleven patients with spinal cord injury for the experimental group (G_E) and 27 healthy adults for the control group (G_C) participated in this study. Joint angles and electromyography were measured while subjects performed self-selected comfortable and fast-speed wheelchair propulsion. Ultrasound images were recorded before and after each propulsion task to measure the acromiohumeral distance (AHD). The range of motion of the shoulder (14.35 deg in G_E; 20.24 deg in G_C) and elbow (5.25 deg in G_E; 2.57 deg in G_C) joints were significantly decreased (p<0.001). Muscle activation levels of the anterior deltoid, posterior deltoid, biceps brachii, and triceps brachii increased at fast propulsion. Specifically, triceps brachii showed a significant increase in muscle activation at fast propulsion. AHD decreased at fast propulsion. Moreover, the AHD of G_E was already narrowed by about 60% compared to the G_C from the pre-tests. Increased load on wheelchair propulsion, such as fast propulsion, is considered to cause upper limb joint impingement and soft tissue injury due to overuse of the extensor muscles in a narrow joint space. It is expected that the results of this study can be a quantitative and objective basis for training and rehabilitation for manual wheelchair users to prevent joint pain and damage.

• Hip & pelvis
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• 제36권1호
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• pp.26-36
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• 2024

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

• 대한족부족관절학회지
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• 제8권1호
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• pp.46-51
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• 2004

Purpose: Problematic late sequelae are common following a calcaneal fracture regardless of the initial treatment. We retrospectively evaluated the painful conditions and reviewed the results of the operative treatment in patients with previously treated calcaneal fractures. Materials and Methods: Between October 1996 and September 2001, forty-three patients who underwent subsequent surgical treatment for late sequelae of calcaneal fracture were reviewed. The initial treatment consisted of only immobilization in a cast in 7 patients, closed reduction with pin fixation (Essex-Lopresti technique) in 22 and open reduction and internal fixation in 14. Painful conditions in the hind foot included subtalar arthritis in 31 patients, calcaneofibular impingement in 13, peroneal tendinitis in 6, displaced posterior bony fragment in 3, sural neuritis in 2, subtalar and midtarsal arthritis in 1 and displaced plantar bony fragment in 1. The surgical procedures for the late complications were performed at a mean of 19 months (range, 6 to 35 months) after the injury and consisted of lateral wall ostectomy and in situ subtalar fusion in 28 patients, only lateral wall ostectomy in 5 patients, lateral wall ostectomy and subtalar distraction arthrodesis in 3, removal of displaced posterior bony fragment in 3, sural nerve transposition in the peroneus brevis in 2, triple arthrodesis in 1 and removal of displaced plantar bony fragment in 1. Mean postoperative follow up period was 57 months (range, 33 to 82 months). The results of treatment were evaluated on the basis of pain, improvement in the ability to perform activities of daily living, to return to work or to a pre-injury level of activity. Results: Pain was partially relieved in 38 patients (88%), but not relieved in 5. Function improved in 34 patients (79%), and 32 (74%) returned to work or to a pre-injury level of activity. There was a trend that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. Conclusion: Meticulous physical examination and intensive prompt treatment for remaining pain after initial treatment of calcaneal fractures are recommended for patient's satisfaction and returning to work.