침 시술 이후 발생한 경추 척수 손상

우영하(Young-Ha Woo),이지민(Ji-Min Lee),심대무(Dae-Moo Shim),배혁(Hyuk Bae) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.6

침술은 치료적 목적으로 신체의 특정부위에 바늘을 삽입하는 시술로 근골격계 질환의 증상 완화 목적으로 대중적으로 행해지는 술기이다. 침술 이후 심각한 합병증은 20만 예 중 1예 가량으로 발생률이 낮고 대부분의 경우 증상이 가볍고 일시적이므로 비교적 안전하다. 하지만 신경계 손상, 감염, 혈종, 폐기종 등 심각한 합병증이 발생할 수 있다. 저자들은 침술 이후 발생한 경추 척수 손상을 유발한 1예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다. Acupuncture, which is a procedure of inserting needles in a specific portion of the body to control pain, is conducted widely. The procedure is considered relatively safe because of its minimal side effects and low occurrence (1 in 200,000). On the other hand, its side effects include neurological damage, infection, hematoma, emphysema, etc . The authors report a case of cervical neurological damage that occurred after an acupuncture procedure.

최대하운동시 스키지도자의 혈중젖산농도 및 체표면 온도 변화 분석

우영하(Woo Young-Ha),이원재(Lee Won-Jae),강명훈(Kang Myung-Hun) 한국체육과학회 2008 한국체육과학회지 Vol.17 No.2

This study is to know how the exposure to the skiing ground environment on the normal temperature will have influence on bloodstream and distribution. So we chose A group is composed of 7men in their twenties(who has experience in teaching skiing) and B group is composed of 7 men in their twenties(who have take any experience) and have analyzed their lactic acid concentration in blood and body temperature on submaximal exercise. At the result of this study, we obtained following results. In the case of heart rate change and lactic acid concentration change when we compare two groups, we could find a difference(p<.001). In the case of an arrival time of expected heart rate and faceㆍchest surface temperature change there was no special difference but in the specific figure. AS we generalize outcome, Although regular long-term working under the low temperature does not have difference with working under the normal temperature, in the specific figure, there is difference in some field. As a result of these study, we could know that A group's physiological reaction when they work during a slack season. So I consider this study would be basic data for other studies such as how human can adopt new environment and what kind of physiological reaction will be happening from working out under the various environment.

태권도 품새 수련이 여성고령자의 건강체력과 체표면 온도 변화에 미치는 영향

우영하(Woo Young-Ha),한승완(Han Seung-Wan),이원재(Lee Won-Jae) 한국체육과학회 2009 한국체육과학회지 Vol.18 No.3

This study was performed by applying Taekwondo Pumsae training program to the female senior citizens who are deficient of social characteristics because of the reduced physical activities and weakened sports functions to make comparative analysis of the effects of the program on the physical strength. The results are as follows; Although it was not significantly different in Pumsae training group, blood pressure decreased in number. Comparison group showed a little increase in diastolic blood pressure. Although both groups did not show significant difference in resting heart rate, Taekwondo Pumsae training group showed decrease after the training, while the control group did not show any changes. In the comparison of face temperature, both groups did not show statistically significant difference between before and after dumbbell exercises. However, in the comparison after 12 weeks between before and after dumbbell exercises, Taekwondo group showed statistically significant increase (p<.001), while control group did not show significant difference. In the comparison between before and after 12 weeks before dumbbell exercise, both groups showed statistically significant decrease (p<.001). Also in the comparison between before and after 12 weeks after dumbbell exercise, both groups showed statistically significant decrease (p<.001). Regarding the comparison of chest temperature, both of training (p<.001) and comparison group (p<.05) showed significant decrease in the comparison between before and after dumbbell exercise. In the comparison between pre and post dumbbell exercise after 12 weeks, both groups showed significant decrease (p<.001). In the comparison between before and after 12 weeks before dumbbell exercise, both groups showed statistically significant decrease (p<.001). In the comparison between before and after 12 weeks after dumbbell exercise, both groups showed statistically significant decrease (p<.001). In the changes in physical strength, there was no statistically significant difference in the grip of the left hand. In the grip of the right hand and back muscle strength, Taekwondo group showed significant increase (p<.001). In bending forward in the seated posture and bending backward, Taekwondo group showed significant increase (p<.05). In bending backward, control group, also, showed significant increase (p<.05). In push-up, Taekwondo group showed significantly higher value than comparison group (p<.05).

분할 아킬레스 동종건을 이용한 관절경적 이중다발 후방십자인대 재건술 후 임상적 결과와 운동력 회복 평가

박진영 ( Jin Young Park ),전철홍 ( Churl Hong Chun ),양정환 ( Jung Hwan Yang ),우영하 ( Young Ha Woo ) 대한스포츠의학회 2008 대한스포츠의학회지 Vol.26 No.2

We evaluated the clinical result and recovery of sports activity of arthroscopic double-bundle PCL reconstruction using Achilles allograft tendon and transtibial technique. From Feb. 2003 to Mar. 2005, there were 22 patients who have taken arthroscopic double bundle reconstruction using split Achilles allograft tendon on PCL injury. The average age was 29.7 years and the average follow-up period was 18.2 months. The clinical result has been evaluated by using Telos stress arthrometer, Lysholm knee score, Tegner activity scores, and IKDC scores. The quadriceps and hamstrings strength were measured using Biodex System II (Biodex, New York, NY). The clinical results showed that significant improvement. Peak torque and total work at postoperative were significantly greater than at preoperative. The PCL injuries were successfully treated with arthroscopic double-bundle reconstruction using split Achilles allograft. But long term follow up with large number of cases will be necessary.

요추 주위 근육 계측에 대한 자기공명영상검사와 초음파의 비교

김창수(Chang Su Kim),우영하(Young Ha Woo),심대무(Dae Moo Shim),김태균(Tae Kyun Kim),이정미(Jeong Mi Lee),장봉준(Bong Jun Jang),유병민(Byung Min Yoo) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 요통의 원인 중 하나인 요추 주위 근육 위축에 대한 계측에 있어서 자기공명영상검사와 초음파를 비교하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 2015년 3월에서 2015년 8월까지 요추부 통증을 주소로 원광대학병원 외래에 내원하여 요추부 자기공명영상검사를 시행한 환자 82명을 대상으로 하여 요추 4/5번, 3/4번의 양측에 위치한 대요근 및 요추 신전근의 근육 단면과 두께는 자기공명영상검사로 측정하였고, 초음파검사의 이미지는 자기공명영상검사가 시행된 곳에서 대요근 및 신전근의 두께를 양측에서 분석 하였다. 결과: 대요근을 자기공명영상검사로 측정한 근육 단면과 초음파로 측정한 근육 두께의 상관분석 결과, L4/5 좌측은 상관계수가 0.136 (p=0.64), L3/4 Rt는 0.070 (p=0.81), L3/4 Lt는 0.288 (p=0.32)로 의미있는 값을 도출하지는 못하였으나, L4/5 우측에서는 상관계수가 0.559로 양의 상관관계가 있는 것으로 나타났다(p=0.04). 대요근의 두께를 자기공명영상검사와 초음파로 측정한 값의 상관계수는 L4/5 Rt는 0.316 (p=0.27), L4/5 Lt는 0.022 (p=0.94), L3/4 Rt는 0.236 (p=0.41), L3/4 Lt는 0.287 (p=0.31)로 유의한 값을 도출하지는 못하였고, 요추 신전근의 근육 두께를 측정한 값의 상관계수도 L4/5 Rt는 0.207 (p=0.49), L4/5 Lt는 0.051(p=0.86), L3/4 Rt는 0.048 (p=0.87), L3/4 Lt는 0.154 (p=0.61)로 유의한 값을 얻지 못하였다. 결론: 초음파 검사를 통해 얻어진 요추 주위 근육의 용적이 근육의 단면적인 모습을 평가하는 데 유용하다. Purpose: The purpose of this study was to compare magnetic resonance imaging (MRI) and ultrasonography measurement of peri-lumbar muscle atrophy which is thought to be a cause of low back pain. Materials and Methods: Eighty-two patients (44 males, 38 females) who visited Wonkang University Hospital from March, 2015 to August, 2015 complaining of lumbar back pain and underwent lumbar MRI were enrolled in this study. Cross section area (CSAMRI) and muscle thickness (MTMRI) of psoas major (PS) and lumbar extensor (LM) located on both sides of L4/5 and L3/4 was measured by MRI, and sono measurement of thickness of the same muscle (MTUS) at the same level of that MRI measurement were analyzed. Results: In correlation analysis of PS CSAMRI and PS MTUS is the correlation coefficient of L4/5 was 0.136 (p=0.64), L3/4 right (Rt) was 0.070 (p=0.81), and L3/4 left (Lt) was 0.288 (p=0.32). PS CSAMRI at L4/5 Rt showed that correlation coefficient of PS MTUS showed a positive correlation to 0.559 (p=0.04). In analysis of the PS MTMRI and PS MTUS, the correlation coefficient of L4/5 Rt was measured by a 0.316 (p=0.27), L4/5 Lt was 0.022 (p=0.94), L3/4 Rt was 0.236 (p=0.41), and L3/4 Lt did not show a significant result with 0.287 (p=0.31). In the results of correlation analysis of the LM MTMRI and LM MTUS, the correlation coefficient of L4/5 Rt was 0.207 (p=0.49), L4/5 Lt was 0.051 (p=0.86), and L3/4 was Rt 0.048 (p=0.87), L3/4 Lt did not show a significant value with 0.154 (p=0.61). Conclusion: This study proved that muscle volume obtained from ultrasono is effective for evaluation of cross-sectional area of lumbar muscle.

요추 추간공 협착증에서 일측성 양방향 내시경적 측부 추간공 감압술의 효과

이지민(Ji-Min Lee),우영하(Young-Ha Woo),유성호(Seong-Ho Yoo),김영준(Young-Jun Kim),서진혁(Jin-Hyuk Seo),배혁(Hyuk Bae) 대한정형외과학회 2020 대한정형외과학회지 Vol.55 No.5

목적: 양방향 내시경적 감압술(unilateral biportal endoscopic decompression, UBE)의 유용성을 증명하기 위해 수술의 임상적, 영상학적 결과를 보고하고자 한다. 대상 및 방법: 요추 추간공 협착증으로 일측성 양방향 내시경적 측부 추간공 감압술(unilateral biportal endoscopic far-lateral decompression, UBEFLD)을 시행받은 20명의 환자들을 분석하였다. 임상적으로 시각통증척도(visual analogue scale, VAS), modified Macnab criteria, Oswestry Disability Index (ODI), 영상학적으로 수술 전후 단순영상을 비교하여 intervertebral angle (IVA), percentage slip, disc height index (DHI), foraminal height index (FHI)를 분석하였다. 결과: VAS는 평균적으로 술 전 6.20에서 술 후 1개월 2.05, 3개월 1.75, 1년 1.45로 호전을 보였다(p<0.001). Modified Macnab criteria는 술 후 1개월 70.0%, 3개월 80.0%, 1년 85.0%의 환자들에서 good 혹은 excellent 판정을 받았다(p=0.034). ODI는 술 전 59.8%, 1개월 35.8%, 3개월 33.2%, 1년 17.1%로 호전을 보였다(p<0.001). IVA는 술 후 평균 0.40도 증가(p=0.057), percentage slip은 술 후 0.19% 증가하였다(p=0.134). DHI는 술 전 0.49에서 술 후 0.62로 증가(p=0.359), FHI 또한 술 전 0.71에서 술 후 0.79로 증가하였다(p<0.001). 결론: UBEFLD는 임상학적 및 영상학적으로 모두 만족스러운 결과를 보였으며 종래의 척추 유합술이나 현미경 추간공 성형술의 훌륭한 대체가 될 수 있음을 의미한다. Purpose: This paper reports the short-term clinical and radiological results of unilateral biportal endoscopic decompression (UBE) to prove its efficacy. Materials and Methods: Twenty patients who received unilateral biportal endoscopic far-lateral decompression (UBEFLD) were analyzed statistically using the visual analogue scale (VAS), modified Macnab criteria and Oswestry Disability Index (ODI) clinically. Radiologically, their intervertebral angle (IVA), percentage slip, disc height index (DHI) and foraminal height index (FHI) were analyzed pre- and postoperatively. Results: The VAS scores were 6.20 preoperatively, which improved to 2.05, 1.75 and 1.45 at postoperative one month, three months and one year, respectively (p<0.001). The modified macnab criteria in both the good or excellent category was 70.0%, 80.0% and 85.0% at postoperative one month, three months and one year, respectively (p=0.034). The ODI improved from 59.8% preoperatively to 35.8%, 33.2%, and 17.1% at postoperative one month, three months, and one year, respectively (p<0.001). The IVA was increased 0.40±0.88 after a surgery (p=0.057). Percentage slip was increased 0.19% after surgery (p=0.134). The DHI changed from 0.49 preoperatively to 0.62 postoperatively (p=0.359), and the FHI changed from 0.71 preoperatively to 0.79 postoperatively (p<0.001). Conclusion: UBEFLD displayed satisfactory results. Such a result highlights the potential of UBEFLD as an excellent alternative to spinal fusion or microscopic surgery.

태권도 품새 수련이 고령여성의 심혈관질환 유발요인과 당내인성 변인에 미치는 효과

한승완(Han Seung-Wan),우영하(Woo Young-Ha),김경한(Kim Kyoung-Han) 한국체육과학회 2010 한국체육과학회지 Vol.19 No.4

This study wasperformed by applying Taekwondopumsae trainingprogram to the female senior citizens who are deficient of social characteristics because of the reduced weakened sports functions to make comparative analysis of the effects of theprogram on thephysical strength, cardiovascular disease and sugar tolerance variables. The results are as follows; HDL-C increased significantly in Taekwondo group (p<.001). Both groups did not show statistically significant difference in LDL-C. They didn’t show any difference in either TG (triglyceride) or T-C. Fibrinogen decreased significantly in Taekwondo group (p<.001) while it did not show any significant difference in control group. Blood glucose was not significantly different in Taekwondo group, but it decreased in number. In control group, it decreased significantly (p<.05). While HbAlc increased in Taekwondo training group significantly (p<.05), there was no change in control group. Concluding from the above results, Taekwondo Pumsae training brought it will help the senior citizens to improve the status of fat in the blood, reduce fibrinogen, sugar tolerance factors and keep 4 kinds of CBC in normal range, which willprevent cardiovascular disease and coronary artery disease in elderly women. It will have important meaning in theprevention of age related disease of female senior citizens. Therefore it is very important to maintain and improve thephysical functions throughproper physical activities before the aging isprogressed too much in order to do healthyphysical activities in elderly women.

요추부 척추관 협착증 환자의 축성 압박장치를 이용한 자기공명영상에서 신경관 크기의 변화

정호연(Ho Yeon Jeong),김태균(Tae Kyun Kim),하대호(Dae Ho Ha),심대무(Dae Moo Shim),우영하(Young Ha Woo),주민수(Min Su Joo),장봉준(Bong Jun Jang),김성배(Saintpee Kim) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.6

목적: 현재의 자기공명영상은 일반적으로 누운 상태에서 촬영하여 서있는 상태의 요추부 영상과 다소 상이한 결과를 가져올 수 있다. 이에 요추부 척추관 협착증 환자에서 축성 압박을 가하여 직립상태를 구현하여 자기공명영상을 촬영하고, 신경관 계측치의 변화를 비교하고자 하였다. 대상 및 방법: 2010년 10월 1일에서 2011년 5월 31일까지 원광대학교병원 외래에 내원한 척추관 협착증이 의심되는 환자 중 축성압박장치를 이용한 자기공명영상을 촬영한 환자를 연구대상으로 하였다. 결과: 신경관 크기는 일반 앙와위 자기공명영상에서 요추 3-4번에서 남, 여 평균 195.57 ㎟, 203.20 ㎟, 요추 4-5번에서 194.64 ㎟, 211.43 ㎟, 요추 5-천추 1번에서 199.38 ㎟, 203.04 ㎟로 관찰되었다. 반면 축성 압박장치를 이용한 경우에는 요추 3-4번에서 166.43 ㎟, 174.27 ㎟, 요추 4-5번에서 154.81 ㎟, 158.67 ㎟, 요추 5-천추 1번에서 148.48 ㎟, 157.19 ㎟로 관찰되었다. 신경관 크기의 변화는 모두 통계적으로 유의한 수준의 변화를 보였다. 결론: 축성 압박장치로 재현된 직립상태에서의 신경관 크기의 변화는 유의한 수준의 변화가 관찰되었고 임상적 적용에도 의미가 있을 것으로 생각된다. Purpose: A conventional magnetic resonance imaging (MRI) was conducted in supine position, showing a slight different from that conducted in upright position. Therefore, we simulated the upright position by applying the axial load on a lumbar spinal stenosis patient and measured the change of neural tube size in axial load and standardized the data. Materials and Methods: We compared the axial loading MRI obtained from spinal stenosis patients who visited Wonkwang University Hospital outpatient clinic between October 2010 and May 2011 showing radiologic and physical symptoms. Results: Neural tube sizes by conventional MRI were as follows: 195.57 ㎟ and 203.20 ㎟ on average between the left and right sides in L3/4; 194.64 ㎟ and 211.43 ㎟ on average in L4/5; and 199.38 ㎟ and 203.04 ㎟ on average in L5/S1. Neural tube sizes by axial loading MRI were as follows: 166.43 ㎟ and 174.27 ㎟ on average between the left and right sides in L3/4; 154.81 ㎟ and 158.67 ㎟ on average in L4/5; and 148.48 ㎟ and 157.19 ㎟ on average in L5/S1. Changes of neural tube sizes in L3/4, L4/5, and L5/S1 had a significant correlation (p<0.05). Conclusion: The axial loading device was an excellent tool in simulating the upright position for spinal stenosis patients, and the change of neural tube sizes reproduced for the upright position was statistically significant. This is thought to be meaningful for clinical applicability.

척추성 하지 동통과 감별이 필요한 지단 홍통증

심대무(Dae Moo Shim),김태균(Tae Kyun Kim),박진영(Jin Young Park),오성균(Sung Kyun Oh),우영하(Young Ha Woo) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.3

지단 홍통증은 사지 특히 하지에 동통과 동반되는 발적, 온열감을 특징으로 하는 질환으로 그 임상적 특징이 척추성 하지 동통과 감별이 필요 할 정도로 유사한 경우가 많다. 69세 남자 환자가 재발되는 양측 하지 특히 족부에 타는 듯한 통증 및 부종, 열감을 주소로 내원하였다. 시행한 단순 방사선 검사, MRI 및 신경학적 검사상 특이 소견은 보이지 않았다. 그러나 따뜻한 물에 양측 족부를 담구었을 때 통증의 재현되고 평소 양말을 신으면 통증이 발생하여 잘 신고 다니지 않은 점으로 미루어 지단 홍통증을 진단하여 스테로이드와 3환계 항우울제를 사용하므로써 증상의 소실을 얻을 수 있었다. 본 저자들은 척추 질환에 의한 방사통과 비슷한 하지 통증으로 주소로 내원한 환자를 따뜻한 물에 담궈 통증으로 유발시키는 단순한 진단 검사법을 이용하여 지단 홍통증으로 진단하여 삼환계 항우울제와 스테로이드를 투여하여 증상의 호전을 경험하였기에 정형외과 영역에서도 염두해야 할 질환으로 사료되어 문헌 고찰과 함께 보고 하고자 한다. Erythromelalgia is a rare condition, of uncertain etiology, characterized by episodic erythema, intense burning pain and warmth of the hands and/or feet. We present here a case of erythromelalgia that was almost mistaken for lower leg pain of spinal origin. The diagnosis is based on a thorough history and physical exam during a painful episode along with diagnostic test to exclude other causes. A 69-year-old man developed recurrent attacks of redness, swelling and burning painful sensations of both feet. His symptom was aggravation of pain with warm water immersion. His symptom improved by antidepressant and steroid. To be learned an important general lesson is to pay attention to performing extensive diagnostic and therapeutic procedures. It should be appreciated that discontinuation of medication can also be used as a simple diagnostic test for clinical syndromes, such as erythermalgia.