턱관절균형의학에서 편차발생현상의 신경과학 및 재료역학적 해석과 일반화

지규용,Gyoo-yong Chi 턱관절균형의학회 2022 턱관절균형의학회지 Vol.12 No.1

Objectives: For the deviation phenomenon occurring during the treatment process in temporo-mandibular balancing medicine (TBM), hypotheses were established regarding the cause and mechanism of formation from the perspective of neuro-science and material mechanics, and a verification method was proposed. Methods: The deviation phenomenon was theoretically analyzed based on the structure theories of material mechanics of the joint and the neurological pain mechanism. Results: Deviation occurs due to temporary yield by the accumulation of heterogeneous stress in the temporo-mandibular joint and the affected joint. Because the joint structures are corresponding with material mechanics showing compressive and tensile properties. The size of the deviation is expressed in terms of strain. The occlusal surface of the teeth is level with the axial joint. Since the magnitude of the deviation has a proportional relationship with the degree of abnormality of the temporo-mandibular joint, the magnitude of the deviation calculated by the balance measurement can be replaced by the strain. The major variables involved in the occurrence of deviations are the strength of joint structures and neurological conditions. Therefore plastic deformation and adaptation occur as a long-term depression of neural circuits is strengthened in different ways at different locations each time in various clinical situations. This is the reason why the sequence of the restoration process while correcting deviations is following reverse order of the accumulation in many layers in the muscular nervous system. Conclusions: From the above results, it can be inferred that the occurrence and correction of the deviations are corresponding with the plastic deformation and neuro-plasticity.

Weak Ligaments and Sloping Joints: A New Hypothesis for Development of Congenital Atlantoaxial Dislocation and Basilar Invagination

Avnish K. Chauhan,P. Sarat Chandra,Nishant Goyal,Madhumita R. Chowdhury,Jyotirmoy Banerjee,Manjari Tripathi,Madhulika Kabra 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Objective: Developmental bony craniovertebral junction (CVJ) anomalies seem to have a genetic basis and also abnormal joint morphology causing atlantoaxial dislocation (AAD) and basilar invagination (BI). Methods: DNA extracted polymerase chain reaction single-stranded conformation polymorphism (SSCP) performed for mutation screening of FBN1 gene (n=50 cases+ 50 age/sex-matched normal; total: 100). Samples with a deviated pattern of bands in SSCP were sequenced to detect the type of variation. Computed tomography (CT) scans of 100 patients (15–45 years old) compared with an equal number of age/sex-matched controls (21.9±8.2 years). Joint parameters studied: sagittal joint inclination (SI), craniocervical tilt (CCT), coronal joint inclination (CI). Results: Thirty-nine samples (78%) showed sequence variants. Exon 25, 26, 27, and 28 showed variable patterns of DNA bands in SSCP, which on sequencing gives various types of DNA sequence variations in intronic region of the FBN1 gene in 14%, 14%, 6%, and 44% respectively. CT radiology:SI and CCT correlated with both BI and AAD (p<0.01). The mean SI value in controls: 83.35°±8.65°, and in patients with BI and AAD:129°±24.05°. Mean CCT in controls: 60.2°±9.2°, and in patients with BI and AAD: 86.0°±18.1°. Mean CI in controls:110.3°±4.23°, and in cases: 125.15°±16.4°. Conclusion: The study showed mutations in FBN1 gene (reported in Marfan syndrome). There is also an alteration of joint morphology, correlating with AAD and BI severity. Hence, we propose a double-hit hypothesis: the presence of weak ligaments (due to FB1 gene alterations) and abnormal joint morphology may contribute to AAD and BI.

Craniovertebral Junction Instability: A Review of Facts about Facets

Atul Goel 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability.

딥러닝 기반 디자인 선호도 예측 및 추천시스템: 자동차 휠 설계 사례

이성희(Sunghee Lee),강남우(Namwoo Kang) 대한기계학회 2020 대한기계학회 춘추학술대회 Vol.2020 No.12

두개경추이행부 병변 및 환축추탈구에 대한 경구적 접근법

조기홍,조경기,정남 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

Although the operation for the ventral lesion of craniovertebral junction and atlantoaxial area is considered difficult to perform. the transoral approach made it safer and easier The authors report 10 cases(9 patients) treated by the transoral approach for the lesion of craniovertebral juncion over the past 13 years at the Ajou University Hospital and the Presbyterian Medical Center. Of these 10 cases, there were 4 odontoid type Ⅱ fractures, 1 atlantoaxial dislocation, 1 as odontoideum. 1 chordoma at lower clival area, 1 rheumatoid arthritis. 1 epidural abscess and 1 wound revision due to slippage of grafted bone after clivoaxial fusion. The surgical methods included 4 cases of anterior decompression and clivoaxial fusion. 2 cases of anterior decompression and C1-2 interarticular joint fusion, 1 case of anterior decompression and clivoaxial fusion followed by posterior fusion, and 3 cases of anterior decompression and posterior fusion. In nonreducible atlantoaxial dislocation or ventral cord compression lesion. if the clivoaxial angle was less than 120 degree. the transoral approach was selected. The appropriate surgical approach must be selected according to the degree of compression of the neural tissue involving the craniovertebral junction and atlantoaxial dislocation.

특발성 신경통으로 오인된 환축추관절 증후군 - 증례 보고 -

홍성준 ( Seong Joon Hong ),이정범 ( Jeong Beom Lee ),정승원 ( Seung Won Jung ),김일석 ( Il Seok Kim ),임소영 ( So Young Lim ),신근만 ( Keun Man Shin ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.1

Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion

Rishi Anil Aggarwal,Ashok Keshav Rathod,Kshitij Subhash Chaudhary 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures.

C2 Superior Facetal Osteotomy: A Novel Technique in Complex Craniovertebral Junction Surgery for C1 Lateral Mass Screw Placement

Deepak Kumar Singh,Shankar Diwakar,Vipin Kumar Chand,Singh Rakesh Kumar,Singh Neha 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.6

Complex craniovertebral junction (CVJ) defects account for a considerable proportion of CVJ diseases. Given the heavily assimilated C1, an unfavorable C1–C2 joint orientation, an overriding C2 superior facet, a low-hanging occiput, and an abnormal vertebral artery course with a high-riding vertebral artery, placement of C1 lateral mass screws might be difficult. To address this, a novel technique for placing C1 lateral mass screws that avoid vertebral artery injury, low-hanging occiput, and overriding C2 superior facet was developed in this study. This approach enables firm fixation of C1–C2 even in difficult situations where the placement of the C1 lateral mass is challenging.

Anterior Atlantodental and Posterior Atlantodental Intervals on Plain Radiography, Multidetector CT, and MRI

윤기보,차승우,류정아,박동우,이승훈,주경빈 대한영상의학회 2015 대한영상의학회지 Vol.72 No.1

Purpose: To determine the normal values of the anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI) on plain radiography, multidetector CT (MDCT) and MRI, as well as the dural sac width and spinal cord diameter at the atlantoaxial joint level on MRI. Materials and Methods: In total, 60 subjects underwent plain radiography, MRI and MDCT. We obtained values for AADI and PADI on plain radiography, MDCT, and MRI, and for dural sac width and spinal cord diameter on MRI. Two radiologists independently measured each value and a consensus was reached. Results: The average AADI was 1.5 ± 0.5 mm on plain radiography, 1.4 ± 0.3 mm on MDCT, and 1.6 ± 0.5 mm on MRI. The average PADI was 20.6 ± 2.4 mm on plain radiography, 18.0 ± 2.1 mm on MDCT, and 17.7 ± 1.9 mm on MRI. The dural sac width was 13.7 ± 1.8 mm, and the spinal cord diameter was 7.8 ± 0.7 mm. Interobserver agreement was 0.701–0.927 and intraobserver agreement was 0.681–0.937. Conclusion: AADI values obtained on MDCT are significantly lower than those obtained on plain radiography or MRI. PADI values obtained on plain radiography are significantly higher than those obtained on MDCT or MRI. The dural sac width is most closely correlated with PADI values on MDCT. PADI seems to be easier to measure, more relevant, and clinically useful than AADI.

Grisel Syndrome: Pathophysiological Evidence from Magnetic Resonance Imaging Findings

박시현,박성희,이상희 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.5

Grisel syndrome is a condition of uncertain etiology characterized by a non-traumatic atlantoaxial subluxation following an infection in the head and neck region. Although first described in 1830, the exact pathophysiology of Grisel syndrome remains unclear. We present a case of atlantoaxial subluxation after acute lymphadenitis diagnosed with a dynamic computed tomography (CT) and magnetic resonance imaging (MRI). A previously healthy 9-year-old male patient presented with torticollis of sudden onset. Dynamic CT and MR imaging showed rotary atlantoaxial subluxation and inflammation surrounding the cervical spinal ligaments. A follow-up MRI of the cervical spine, taken 3 weeks after the onset of symptoms, showed a complete resolution of subluxation and inflammation surrounding the cervical spinal ligaments. In this case report, we support the hypothesis that an inflammation-induced laxity of the cervical ligaments is the pathologic key to Grisel syndrome using radiologic findings.