추간반 및 후관절의 퇴행 정도를 이용한 요추 불안정 판단의 임상적 유용성

이호범,박찬우,이상구,김우경,유찬종 대한척추신경외과학회 2009 Neurospine Vol.6 No.3

Objective: Treatment for symptomatic lumbar stenosis is usually surgical decompression and additional global fusion is recommended for patients with segmental instability. The aim of this article is to evaluate that degeneration degree of the disc and facet joint could be the indicator of judgment for segmental instability. Methods: We retrospectively reviewed 84 patients who underwent surgical treatment for lumbar spinal stenosis. Patients in Group 1 (30 patients) with radiological instability underwent decompression with global fusion, patients in Group 2 (54 patients) without radiological instability underwent decompression with global fusion or decompression only according to the existence and nonexistence of clinical instability. Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the facet joints degeneration from Grade 0 (normal) to Grade 3 (advanced). All patients were checked with the simple X-ray stress view and evaluated. Results: Severity of the disc degeneration had no significant association with the segmental instability, and no correlation with the facet joint degeneration. Severity of facet joint degeneration had significant correlation with the radiological instability. The segmental instability was increased with increasing severity of facet joint degeneration, especially translation. There was a significant association between facet joint degeneration and clinical instability. The facet joint degeneration was increased in patients with clinical instability. Conclusion: Our results suggest that the facet joint degeneration may be the useful indicator of judgment for segmental instability Objective: Treatment for symptomatic lumbar stenosis is usually surgical decompression and additional global fusion is recommended for patients with segmental instability. The aim of this article is to evaluate that degeneration degree of the disc and facet joint could be the indicator of judgment for segmental instability. Methods: We retrospectively reviewed 84 patients who underwent surgical treatment for lumbar spinal stenosis. Patients in Group 1 (30 patients) with radiological instability underwent decompression with global fusion, patients in Group 2 (54 patients) without radiological instability underwent decompression with global fusion or decompression only according to the existence and nonexistence of clinical instability. Magnetic resonance images were used to assess the disc degeneration from Grade I (normal) to Grade V (advanced) and the facet joints degeneration from Grade 0 (normal) to Grade 3 (advanced). All patients were checked with the simple X-ray stress view and evaluated. Results: Severity of the disc degeneration had no significant association with the segmental instability, and no correlation with the facet joint degeneration. Severity of facet joint degeneration had significant correlation with the radiological instability. The segmental instability was increased with increasing severity of facet joint degeneration, especially translation. There was a significant association between facet joint degeneration and clinical instability. The facet joint degeneration was increased in patients with clinical instability. Conclusion: Our results suggest that the facet joint degeneration may be the useful indicator of judgment for segmental instability

Effect of Muscle Taping and Joint Taping on Static and Dynamic Balance in Normal Adults with Chronic Ankle Instability

( Hyun-Sung Kim ),( Jae-young Park ) 대한통합의학회 2022 대한통합의학회지 Vol.10 No.1

Purpose : This study was conducted to investigate the effect of muscle taping and joint taping on static and dynamic balance in normal adults with chronic ankle instability. Methods : The subjects of this study were 32 people who met the inclusion criteria. This cross-sectional study was conducted using the Kinesio tape, an elastic tape, was used. Subjects were randomized to exclude the effect of sequence, and no taping, joint taping, and muscle taping were applied as taping interventions. One-leg standing test and a Functional reach test were conducted to measure static balance, and Y-balance test was conducted to measure dynamic balance. One way repeated ANOVA was performed to investigate the difference in balance ability according to the taping intervention. If there was a significant difference, a post-hoc was performed using the Bonferroni method. Results : In the case of static balance, joint taping showed more significant results than did no taping and muscle taping (p<.05), and muscle taping showed more significant results than did no taping (p<.05). In the case of dynamic balance, muscle taping showed significantly larger results than did no taping and joint taping (p<.05) and joint taping showed significantly larger results than did no taping (p<.05). Conclusion : This study found that mechanical stimulation of muscles and joint compression by elastic taping increased ankle stability and improved static and dynamic balance. In particular, for static balance, joint taping was more effective than muscle taping, and for dynamic balance, muscle taping was more effective than joint taping. Applying the appropriate taping method to individual subjects has the advantage of maximizing the therapeutic effect for the recovery of balance ability. Similarly, the application of various tapings to subjects with ankle instability will have a positive effect on functional improvement.

Effect of wrist-wearing distal radioulnar joint stabilizer on distal radioulnar joint instability using a forearm finite element model

Batbayar Khuyagbaatar,이상진,천마로,Temuujin Batbayar,Danaa Ganbat,김윤혁 대한기계학회 2019 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.33 No.5

Instability of the distal radioulnar joint (DRUJ) is a common clinical problem due to a fall on the outstretched hand or unexpected forcible wrist rotations. Although there are many surgical treatments available for DRUJ instabilities, many of injuries can be managed conservatively, such as the wrist-wearing DRUJ stabilizer to provide the stability of the joint. However, there is a lack of research regarding use of the stabilizer on wrist joint biomechanics. In this study, a finite element (FE) model of the forearm was developed to investigate the effects of the stabilizer on DRUJ stability. The effect of the stabilizer on joint stability was quantified by laxity and rotation tests. Our results showed that use of a stabilizer may help to provide stability for the joint by reducing dorsal-volar translation of the radius and ulna, which might be helpful to prevent reoccurrence of a wrist joint injury related with instability.

Short-term effects of joint mobilization with versus without voluntary movement in patients with chronic ankle instability: A single-blind randomized controlled trial

Hyunjoong Kim,Seonghyeok Song,Sangbong Lee,Seungwon Lee 물리치료재활과학회 2021 Physical therapy rehabilitation science Vol.10 No.1

Objective: Joint mobilization for arthrokinematics altered by the positional fault of chronic ankle instability (CAI) is an effective intervention for stabilization. In this study, we compared the effects of ankle dorsi flexion range of motion (DFROM) and dynamic balance ability (DBA) in CAI patients via passive joint mobilization (PJM), a method traditionally performed in previous studies, and active joint mobilization (AJM), a method that can have a greater effect on cortical excitability with spontaneous movements. Design: Single-blind two-arm randomized controlled trial Methods: A total of 30 participants were registered: 15 each to the PJM and AJM groups. Each participant received a total of 10 intervention sessions, 10 minutes per session, 5 times a week for 2 weeks. PJM used Maitland s mobilization method to apply joint mobilization with talus in the posterior direction and AJM used an angular joint motion to induce patient s voluntary motion of medial malleolus anterior gliding and lateral malleolus posterior gliding, respectively. DFROM of the ankle was measured by using tape and DBA was evaluated by using the balance system. Results: Significant improvement was observed after intervention in both the PJM and AJM groups except for the DBA-anterior and DBA-right variables of the PJM group. There were statistically significant differences between the AJM and PJM groups in the DFROM, DBA-anterior, DBA-posterior, and DBA-right variables. Conclusions: The overall improvement of DFROM and DBA was found to be more effective in joint mobilization including voluntary movement. When it is accompanied by voluntary movement, it further affects the neuromuscular system of the ankle.

Radiographic Parameters of Segmental Instability in Lumbar Spine Using Kinetic MRI

Jang, Se-Youn,Kong, Min-Ho,Hymanson, Henry J.,Jin, Tae-Kyung,Song, Kwan-Young,Wang, Jeffrey C. The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.45 No.1

Objective : To investigate the effectiveness of radiographic parameters on segmental instability in the lumbar spine using Kinetic magnetic resonance imaging (MRI). Methods : Segmental motion, defined as excessive (more than 3 mm) translational motion from flexion to extension, was investigated in 309 subjects (927 segments) using Kinetic MRI. Radiographic parameters which can help indicate segmental instability include disc degeneration (DD), facet joint osteoarthritis (FJO), and ligament flavum hypertrophy (LFH). These three radiographic parameters were simultaneously evaluated, and the combinations corresponding to significant segmental instability at each level were determined. Results : The overall incidence of segmental instability was 10.5% at L3-L4, 16.5% at L4-L5, and 7.3% at L5-S1. DD and LFH at L3-L4 and FJO and LFH at L4-L5 were individually associated with segmental instability (p<0.05). At L4-L5, the following combinations had a higher incidence of segmental instability (p<0.05) when compared to other segments : (1) Grade IV DD with grade 3 FJO, (2) Grade 2 or 3 FJO with the presence of LFH, and (3) Grade IV DD with the presence of LFH. At L5-S1, the group with Grade III disc and Grade 3 FJO had a higher incidence of segmental instability than the group with Grade I or II DD and Grade 1 FJO. Conclusion : This study showed that the presences of either Grade IV DD or grade 3 FJO with LFH at L4-L5 were good indicators for segmental instability. Therefore, using these parameters simultaneously in patients with segmental instability would be useful for determining candidacy for surgical treatment.

슬개대퇴 관절 불안정성의 진단 및 치료

최윤성,왕준호 대한의사협회 2023 대한의사협회지 Vol.66 No.8

Background: Patellofemoral instability, by definition, is a condition where the patella bone pathologically disarticulates out from the patellofemoral joint, either through subluxation or complete dislocation. The overall incidence of patellofemoral instability ranges between 5.8 and 29 per 100,000. Over time, patients with patellar instability can have debilitating pain, limitations in basic function, and long-term arthritis. Current Concepts: Risk factors for patellofemoral instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate for chronic instability, which usually necessitates surgical treatment. Today’s common surgical treatments focus on fixing anatomical defects, relieving symptoms of instability, and allowing patients to return to a suitable level of activity. Discussion and Conclusion: In this review, we summarize the relevant pathophysiology, categorization, clinical features, physical examination, imaging, and treatment options for patellofemoral instability.

만성 발목 불안정성, 코퍼, 건강 대조군의 발목 느슨함, 자가 발목 기능, 인지적 불안정성 분석

이홍석 ( Hongsuk Lee ),김현수 ( Hyunsoo Kim ),타이홉킨스 ( Ty Hopkins ),손성준 ( S. Jun Son ) 한국운동생리학회(구 한국운동과학회) 2021 운동과학 Vol.30 No.1

PURPOSE: This study aimed to identify differences in ankle laxity in chronic ankle instability (CAI), coper, and control groups, and a correlation between ankle laxity, self-reported function, and perceived instability. METHODS: Sixty-six participants (22 CAI patients, 22 copers, and 22 controls) selected by recommendations of the International Ankle Consortium volunteered for this study. Foot and Ankle Ability Measure Activities of Daily Living (FAAM-ADL), FAAM-Sports, and Ankle Instability Instrument (AII) were used to assess participants’ self-reported function and perceived instability. The FAAM-ADL and FAAM-Sports are reported as a percentage. Higher scores indicate better function. The AII is reported as “yes” responses while more “yes” responses indicate higher instability. Three trials of anterior/posterior (A/P) displacement and inversion/eversion (I/E) displacement were assessed by an instrumented ankle arthrometer. Greater displacement indicates higher laxity. The ankle positioned in sagittal- and frontal-plane neutral while A/P and I/E displacement were assessed with 125 N and 4 N-m, respectively. The means of three trials were used for data analysis. One-way ANOVA and Tukey post-hoc comparisons (α=0.05) were performed to identify differences in ankle laxity between groups. Pearson correlation analysis was performed to identify a relationship between ankle laxity, self-reported function, and perceived instability. RESULTS: CAI patients show greater A/P displacement compared to control group (p<.03), and greater I/E displacement compared to coper and control groups (p<.03). Several positive and negative correlations were found between ankle laxity, self-reported function, and perceived instability (p<.00). CONCLUSIONS: As self-reported function and perceived instability are correlated with greater laxity (I/E displacement), improving static stability (ankle laxity) may play an important role in improving perceived ankle function and instability in CAI.

Broström 술식과 비골 골막 젖힘 보강술로 치료한 구상 발목관절에 동반된 족근관절 외측 불안정증: 증례 보고

신우진,조홍만,박지연 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.2

We report on the case of a patient with chronic instability of the ball-and-socket ankle joint. The patient, a 21-year-old male, was diagnosed 10 years previously with chronic instability of the ball-and-socket ankle joint. He underwent Broström procedure and augmentation using a periosteal turn down from the fibula for this chronic instability despite having received conservative treatment since the diagnosis. After the procedure, the clinical symptoms of ankle instability were improved and the patient is being periodically followedup. We report on this case of using a Broström procedure as a treatment option for patients with instability of the ball-and-socket ankle joint with normal range of foot and normal ankle joint alignment without damage in the joint and cartilage.

Broström 술식과 비골 골막 젖힘 보강술로 치료한 구상 발목관절에 동반된 족근관절 외측 불안정증: 증례 보고

신우진,조홍만,박지연,Shin, Woojin,Cho, Hong Man,Park, Jiyeon 대한족부족관절학회 2020 대한족부족관절학회지 Vol.24 No.2

We report on the case of a patient with chronic instability of the ball-and-socket ankle joint. The patient, a 21-year-old male, was diagnosed 10 years previously with chronic instability of the ball-and-socket ankle joint. He underwent Broström procedure and augmentation using a periosteal turn down from the fibula for this chronic instability despite having received conservative treatment since the diagnosis. After the procedure, the clinical symptoms of ankle instability were improved and the patient is being periodically followed-up. We report on this case of using a Broström procedure as a treatment option for patients with instability of the ball-and-socket ankle joint with normal range of foot and normal ankle joint alignment without damage in the joint and cartilage.

Impact of Chronic Lateral Ankle Instability with Lateral Collateral Ligament Injuries on Biochemical Alterations in the Cartilage of the Subtalar and Midtarsal Joints Based on MRI T2 Mapping

Tao Hongyue,Hu Yiwen,Lu Rong,Zhang Yuyang,Xie Yuxue,Chen Tianwu,Chen Shuang 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.3

Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping. Materials and Methods: This study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student’s t test, and Pearson’s correlation coefficient. Results: T2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = -0.687, p = 0.007; r = -0.609, p = 0.021, respectively). Conclusion: CLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.