연성 추간판탈출증성과 척추증성 경추 신경근병증의 보존치료 효과 비교

조윤우 대한재활의학회 2007 Annals of Rehabilitation Medicine Vol.31 No.1

척수손상 흰 쥐의 운동기능 회복에 미치는 손상부위 직접자극을 통한 기능적 자기자극치료 효과

조윤우,김수정,박해운,서정민,황세진,장성호,이동규,안상호,Cho, Yun-Woo,Kim, Su-Jeong,Park, Hea-Woon,Seo, Jeong-Min,Hwang, Se-Jin,Jang, Sung-Ho,Lee, Dong-Gyu,Ahn, Sang-Ho 대한물리치료학회 2011 대한물리치료학회지 Vol.23 No.1

Purpose: The purpose of this study was to determine the effect of direct functional magnetic stimulation (FMS) of affected spinal cord on motor recovery following spinal cord injury in rats. Methods: After a contusion injury at the spinal level T9 using an NYU Impactor, functional magnetic stimulation was delivered by a magnetic stimulator through a round prototype coil (7 cm in diameter). Stimulation parameters were set as follows: repetition rate = 50 Hz (stimulus intensity 100% = 0.18 T), stimulation time = 20 min. Functional magnetic stimulation was administered twice a day, 5 days per week for 8 weeks starting 4 days after spinal cord injury. Functional magnetic stimulationwas delivered directly to the affected spinal cord. Outcomes of locomotor performance were assessed by the Basso Beattie Bresnahan (BBB) locomotor rating scale and by an inclined plane test weekly for 8 weeks. Results: In the BBB test, hindlimb motor function in the Functional magnetic stimulation group improved significantly more compared to the control group at 3, 4, 6, 7, and 8 weeks (p<0.05). In the inclined plane test, the angle of the plane in the functional magnetic stimulation group increased significantly more compared to the control group at 4, 5, 7, and 8 weeks (p<0.05). Conclusion: Our results demonstrate that direct Functional magnetic stimulation of the lesional site may have beneficial effects on motor improvement after spinal cord injury.

추간공외 요추간판 탈출의 적극적 보존 치료 효과 - 1년 전향적 추적연구

조윤우 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.1

Objective: To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. Method: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. Results: Follow-up VAS and ODI significantly decreased since post-treatment one month (p<0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p<0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p<0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. Conclusion: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months. Objective: To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. Method: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. Results: Follow-up VAS and ODI significantly decreased since post-treatment one month (p<0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p<0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p<0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. Conclusion: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months.

족부질환과 운동

조윤우,Jo, Yun-U 사단법인 한국당뇨협회 2007 당뇨 Vol.213 No.-

당뇨병성 족부질환은 크게 당뇨병성 족부 혈관병증, 당뇨병성 족부 신경병증, 당뇨병성 족부궤양 등으로 나누어지며, 당뇨병환자에서 하지에 궤양 및 괴사가 발생 위험도는 정상인에 비하여 15~17배나 높다. 이러한 당뇨병성 족부질환을 제대로 치료하지 않으면 발의 일부나 전부를 절단하게 되며, 외상에 의한 절단을 제외하면 하지 절단의 가장 주요한 원인이 된다. 당뇨병성 족부질환으로 인해 불가피하게 절단이 되었다 하더라도 수술 직후부터 적극적인 약물치료 및 재활치료는 정상인과 거의 동일하게 일상생활 수행 및 독립보행이 가능하며, 스포츠를 포함한 여가활동까지 가능하다.

추간판 탈출증 흰 쥐 모델에서 척수후각에서의 MCP-1의 발현

조윤우,박해운,김수정,서정민,도성진,안상호,Cho, Yun-Woo,Park, Hea-Woon,Kim, Su-Jeong,Seo, Jeong-Min,Do, Sung-Jin,Ahn, Sang-Ho 대한물리치료학회 2009 대한물리치료학회지 Vol.21 No.3

Purpose: This study evaluates MCP-1 expression in the dorsal horn of a rat model of lumbar disc herniation by an autograft of the nucleus pulposus to the spinal nerve. Methods: After a coccygeal nucleus pulposus graft to the left $5^{th}$ lumbar spinal nerve, proximal to dorsal root ganglion, mechanical allodynia and thermal hyperalgesia were assessed 1 day before surgery, and 1, 10, 20, 30 days after surgery. The mRNA of MCP-1 in the dorsal horn was assessed by real time PCR to compare the temporal pattern of neuropathic pain of the lumbar disc herniation model. Results: In the ipsilateral side of the lumbar disc herniation models, mechanical allodynia and thermal hyperalgesia reached a maximum at 10 days after surgery with significant difference from the control group. Pain was also provoked in the contralateral side of the lumbar disc herniation models with less intensity than the ipsilateral side. The level of MCP-1 mRNA expression in the dorsal horn reached a peak at 20 days after surgery. Conclusion: Mechanical allodynia and thermal hyperalgesia was induced by nucleus pulposus in a rat lumbar disc herniation model, similar to a previously reported peripheral nerve injury model. The level of MCP-1 expression was higher in the dorsal horn of the ipsilateral and contralateral sides. These results suggest that MCP-1 might play a role in the maintenance of neuropathic pain.

추간공외 요추간판 탈출의 적극적 보존 치료 효과 : 1년 전향적 추적연구

대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.1

온실 지붕면의 적설 하중 수치해석을 위한 CFD-DEM 결합 모델 개발

조윤우 ( Yun-woo Cho ),이인복 ( In-bok Lee ),조정화 ( Jeong-hwa Cho ),최영배 ( Young-bae Choi ),정효혁 ( Hyo-hyeog Jeong ),강솔뫼 ( Sol-moe Kang ),김다인 ( Da-in Kim ),이은주 ( Eun-ju Lee ) 한국농공학회 2023 한국농공학회 학술대회초록집 Vol.2023 No.0

온실은 일반 건축물에 비해 안전율이 낮고 대부분이 바람과 적설 하중에 취약한 경량구조로 이루어져 있다. 최근 이상 기후에 의한 폭설의 빈도가 증가함에 따라 온실에 발생하는 피해가 증가하고 있고, 이는 경제손실, 작물생산 중단 등 농민에게 2차적인 피해를 발생시킨다. 폭설에 의한 온실의 피해를 줄이기 위해 눈의 특성과 온실 지붕면의 적설 분포를 파악하는 것이 중요하다. 따라서 본 연구에서는 눈의 특성을 고려한 온실 지붕면의 적설 분포를 DEM 모델을 이용하여 분석하였다. 또한 CFD-DEM 결합 모델을 개발하여 풍 환경에 따른 온실 지붕면의 적설 분포와 이에 따른 압력 분포를 분석하였다. 모형실험과 수치해석기법을 이용하여 실험 환경을 제어하고, 다양한 데이터 측정 지점을 설정하여 적설분포를 모 의하였다. 경사판 (15°, 45°)과 1/25로 축소된 온실모형 (양지붕형, 복숭아형)으로 모형실험을 진행하였으며 DEM을 기반으로 한 수치해석 모델을 개발하였다. 모형실험은 농촌진흥청 농업공학부에 위치한 적설 모의실험 시설에서 눈의 밀도 및 모형에 적설 되는 눈의 분포 특성을 파악하였고, 획득한 데이터를 통해 개발된 수치해석모델을 검증하였다. 검증 결과, 15° 경사판은 0.9631, 45° 경사판은 0.9746, 양지붕형 온실모형은 0.9922, 복숭아형 온실모형은 0.9962의 R²을 나타내어 설계한 DEM 모델을 통해 적설 분포 예측이 가능할 것으로 판단되었다. 검증된 모델을 통해 풍 환경, 온실의 폭, 지붕면의 경사각, 연동 수를 고려한 실제 온실사이즈에 대한 수치해석을 진행하였다. 분석 결과, 평균 적설 하중은 양지붕형 연동온실에서 59.77Pa로 가장 높았고, 최대 하중은 복숭아형 연동온실에서 193.62Pa로 나타났다. 또한, 풍 하측의 적설 하중이 풍 상측 적설 하중보다 증가함을 나타냈다. 그러나 풍 하측의 적설하중은 풍속이 증가함에 따라 감소함을 보였다. 이러한 시뮬레이션 결과는 온실 설계 기준에 대한 참고 자료로 활용될 수 있을 것으로 판단된다.

신경근 조영 증강 유무에 따른 경추간공 경막외 스테로이드 주사의 효과

도성진,조윤우,심대섭,조희경,김한선,장성호,안상호 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.2

Objective: To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p<0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p<0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p<0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients’ symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208) Objective: To determine the efficacy of transforaminal epidural steroid injections according to nerve root enhancement in lumbar disc herniations. Method: Twenty seven patients who had extruded or seques tered lumbar disc herniations on enhanced MR imaging were investigated: fifteen patients with corresponding nerve root enhancement (enhanced group), and twelve patients without enhancement (non-enhanced group). All patients received transforaminal epidural steroid injection. Clinical outcomes were measured by visual analogue scale (VAS) for back and radicular pain, Oswestry disability index (ODI) before treatment and one month after injection. Results: The averages of VAS for lower extremity and back pain in both groups one month after injection significantly reduced compared to that of pretreatment, respectively (p<0.001). The amount of decrease in pain in enhanced group was larger than that of non-enhanced group (p<0.05). The averages of ODI in both group one month after injection significantly reduced compared to that of pretreatment (p<0.0001), however, there was no difference between the two groups. Conclusion: The nerve root enhancement on contrast-enhanced MR imaging indicates the presence of severe inflammatory reaction of nerve root, which means well-responsiveness to anti-inflammatory treatment such as transforaminal epidural steroid injection, even if patients’ symptom is very severe. (J Korean Acad Rehab Med 2010; 34: 204-208)

요추간 수핵 이식 모델에서 신경병증성 방사통의 장기 지속 양상

김욱로,조윤우,조희경,김한선,김수정,서정민,안상호 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.4

Objective: To observe the long-lasting changes of pain progression with time course in an autologous nucleus pulposus model of rat. Method: The subjects were 25 Sprague-Dawley (Sprague- Dawley, 250 gm) male rats. They were randomly assigned into either the sham or experimental group. In the experimental group (n=15), autologous nucleus pulposus was harvested from the coccygeal intervertebral disc of the rat and this was grafted on the left L5 dorsal root ganglion. In the sham group (n=10), the left L4 and L5 nerve roots were exposed by laminectomy, but the nucleus pulposus was not grafted. All the rats were evaluated for mechanical allodynia and thermal hyperalgesia at 2 days before surgery, and on days 1, 5, 10, 20, 30, 40 and 50 after surgery. The morphological changes of the spinal nerves were assessed by toluidine blue staining on days 5 after surgery. Results: In the ipsilateral hindpaw of the experimental group, there was a dramatic drop of the mechanical withdrawal threshold and the thermal withdrawal latency on day 1 after surgery, which was maintained at day 50 after surgery. In morphological study, pathological findings such as swelling of the myelin sheath, demyelination, swelling and degeneration of the axoplasm were observed in the spinal nerve at day 5 after surgery. Conclusion: The long-lasting pattern of neuropathic radicular pain shown in a rat model of lumbar disc herniations is helpful to understand the natural history of neuropathic radicular pain due to ruptured nucleus pulposus. Objective: To observe the long-lasting changes of pain progression with time course in an autologous nucleus pulposus model of rat. Method: The subjects were 25 Sprague-Dawley (Sprague- Dawley, 250 gm) male rats. They were randomly assigned into either the sham or experimental group. In the experimental group (n=15), autologous nucleus pulposus was harvested from the coccygeal intervertebral disc of the rat and this was grafted on the left L5 dorsal root ganglion. In the sham group (n=10), the left L4 and L5 nerve roots were exposed by laminectomy, but the nucleus pulposus was not grafted. All the rats were evaluated for mechanical allodynia and thermal hyperalgesia at 2 days before surgery, and on days 1, 5, 10, 20, 30, 40 and 50 after surgery. The morphological changes of the spinal nerves were assessed by toluidine blue staining on days 5 after surgery. Results: In the ipsilateral hindpaw of the experimental group, there was a dramatic drop of the mechanical withdrawal threshold and the thermal withdrawal latency on day 1 after surgery, which was maintained at day 50 after surgery. In morphological study, pathological findings such as swelling of the myelin sheath, demyelination, swelling and degeneration of the axoplasm were observed in the spinal nerve at day 5 after surgery. Conclusion: The long-lasting pattern of neuropathic radicular pain shown in a rat model of lumbar disc herniations is helpful to understand the natural history of neuropathic radicular pain due to ruptured nucleus pulposus.

Sequential Changes of CX3CR1 in Dorsal Root Ganglion in a Rat Model of Lumbar Disc Herniation

서혜진,조윤우,나운우,윤승현,안상호,김수정,최규식,박해운,장성호,손수민 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.1

Objective To investigate the pain-related behaviors and the changes of CX3CR1 expression in the dorsal root ganglion (DRG) in a rat model of lumbar disc herniation. Method A total of 90 male Sprague-Dawley rats were used. A laminectomy was performed to expose left L5 nerve roots and corresponding DRG. Autologous nucleus puplosus was implanted on the left L5 nerve root proximal to the DRG without mechanical compression. Sham operation was also done with the same procedure as mentioned above. Thermal hyperalgesia and mechanical allodynia were assessed at 1, 5, 10, 20 and 30 days after surgery. Real time PCR and immunohistochemistry after behavioral test were performed. Results In the lumbar disc herniation rats, significant reduction of thermal withdrawal latency indicating thermal hyperalgesia was shown on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and peaked on day 10 (p<0.05) and maintained throughout day 30 (p<0.05). The reduction of mechanical allodynia threshold, indicating mechanical allodynia, was observed on the ipsilateral hindpaw on postoperative day 1 (p<0.01) and continued throughout day 30 (p<0.01). Real time PCR showed the decrease in mRNA expression of CX3CR1 in the ipsilateral DRG on day 1 (p<0.05) and the significant increase on day 20 (p<0.05). The immunoreactivity for CX3CR1 was also increased in ipsilateral DRG on day 10 and 20. Conclusion These data suggest that lumbar disc herniation induces thermal hyperalgesia and mechanical allodynia and upregulates the expression of CX3CR1 in dorsal root ganglion. Expression of CX3CR1 might be associated with subacute neuropathic pain after intervertebral disc herniation.