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Atypical Spondylolysis of the Fifth Lumbar Vertebra in Baseball Players: Two Cases Report
Korean J Sports Med 2021;39:193-197
Published online December 1, 2021;  https://doi.org/10.5763/kjsm.2021.39.4.193
© 2021 The Korean Society of Sports Medicine.

Hyung Lae Cho, Doo Yeol Kim, Hong Ki Jin, Ji Hoon Kim

Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea
Correspondence to: Hong Ki Jin
Department of Orthopaedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 47007, Korea
Tel: +82-51-310-9537, Fax: +82-51-310-9348, E-mail: hongiroom@naver.com
Received June 9, 2021; Revised August 8, 2021; Accepted August 31, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Lumbar spondylolysis is a frequent cause of low back pain especially in adolescents involved in sporting activities. It is considered as a fatigue-type defect in the pars interarticularis or isthmus resulted from repetitive hyperextension and rotation on the spine; however, there is still confusion in regard to imaging findings of the location and direction of the defect. We report two unique cases of fifth lumbar spondylolysis in professional baseball hitter and adolescent pitcher; early-stage unilateral incomplete isthmus fracture and bilateral fracture in a different configuration, respectively. Computed tomography demonstrated vertical and more coronally oriented fracture lines compared with typical spondylolytic defect, and repetitive rotation in the same direction of pitching might cause a different type of fracture on the contralateral isthmus with the preexisting unilateral defect. Intriguingly, early-stage unilateral fracture in hitter was united after only 6 weeks of rest and rehabilitation and able to return to the game.
Keywords : Low back pain, Spondylolysis, Atypical, Stress fracture, Isthmus
꽌 濡

泥숈텛遺꾨━利앹 쑀냼뀈씠굹 泥냼뀈湲 留뚯꽦 슂넻쓽 쓷븳 썝씤쑝濡 꽑泥쒖쟻 궡吏뒗 쑀쟾쟻 냼씤뿉 湲곗씤븷 닔룄 엳쑝굹1, 泥숈텛쓽 怨쇰룄븳 떊쟾씠굹 쉶쟾 슫룞쓣 쑀諛쒗븯뒗 뒪룷痢 꽑닔뿉꽌 泥숈텛 썑沅 愿젅媛꾨(pars interarticularis) 삉뒗 삊遺쓽 뵾濡 怨⑥젅濡 씤븳 寃쎌슦媛 留롫떎2.

븯遺 슂異, 듅엳 젣5슂異(the fifth lumbar vertebra, L5)뿉 쓷븯怨 뼇痢≪꽦씤 寃쎌슦媛 留롮쑝硫, 二쇰줈 媛愿젅 삎깭쓽 吏꾪뻾맂 떒怨꾩뿉꽌 諛쒓껄맂떎3. 洹몃윭굹 泥숈텛遺꾨━利앹씠 꽦씤뿉꽌 湲됱꽦쑝濡 諛쒖깮븳 寃쎌슦뒗 뱶臾쇰ʼn4, 泥숈텛遺꾨━利앹쓽 諛쒕퀝 湲곗쟾씠 떊꽑 怨⑥젅怨 떖由 뵾濡 怨⑥젅엫쓣 媛먯븞븯硫 珥덇린 諛쒖깮떒怨 떆 삊遺쓽 怨⑥젅 떆옉 遺쐞굹 怨⑥젅쓽 吏꾪뻾 諛⑺뼢, 삉븳 뼇痢≪꽦 泥숈텛遺꾨━利앹쓽 寃쎌슦 뼇痢 뵾濡 怨⑥젅遺쓽 삎깭쟻 李⑥씠 愿젴븳 援궡 蹂닿퀬뒗 李얠븘蹂닿린 옒뱾떎.

옄뱾 媛곴컖 봽濡쒖빞援 꽑닔뿉꽌 諛쒖깮븳 珥덇린 렪痢≪꽦 泥숈텛遺꾨━利앷낵, 泥냼뀈 빞援 꽑닔뿉꽌 諛쒖깮븳 醫뚯슦 삊遺 뵾濡 怨⑥젅쓽 삎깭媛 긽씠븳 듅씠븳 泥숈텛遺꾨━利앹쓣 寃쏀뿕븯湲곗뿉 臾명뿄 怨좎같怨 븿猿 蹂닿퀬븯怨좎옄 븳떎.

利 濡

蹂 利앸 蹂닿퀬뒗 꽦쓽猷뚯옱떒쓽 엫긽뿰援ъ떖쓽쑄由ъ쐞썝쉶쓽 듅씤(No. GGAH 2021-03, 2021-05) 썑 吏꾪뻾븯떎.

1. 利앸 1

30꽭 궓옄 봽濡쒖빞援 쇅빞닔(떊옣 186 cm, 泥댁쨷 101 kg, 슦닾슦)媛 궡썝 1媛쒖썡 쟾遺꽣 諛쒖깮븳 뿀由 넻利앹쓣 二쇱냼濡 궡썝븯떎. 븯吏 諛⑹궗넻씠굹 빞媛꾪넻, 븞젙 떆쓽 룞넻 뾾뿀쑝굹 寃 떆 泥닿컙 쉶쟾씠굹 듃젅씠떇 룞옉 以 뒪荑쇳듃 옄꽭뿉꽌 슂넻씠 諛쒖깮븯怨, 理쒓렐 1二쇱씪 룞븞 븙솕릺뼱 떆利 떆옉 뿏듃由ъ뿉꽌 젣쇅릺뿀떎. 닔닠젰씠굹 쇅긽젰 뾾뿀怨, 븯吏 洹쇰젰씠굹 媛먭컖쓣 룷븿븳 떊寃쏀븰쟻 寃궗 삁븸 닚솚 젙긽씠뿀떎. 醫뚯륫 븯遺 슂異 湲곕┰洹 二쇱쐞濡 寃쎈명븳 븬넻씠 엳뿀쑝硫 븯吏 吏곴굅긽 寃궗긽쓽 젣븳 뾾뿀떎. 떒닚 諛⑹궗꽑寃궗뿉꽌 듅씠 냼寃ъ 뾾뿀怨, 썝뿉꽌 珥ъ쁺븳 옄湲곌났紐낆쁺긽뿉꽌 異붽컙뙋쓽 깉異쒖 뾾뿀쑝굹 吏諛 뼲젣 떆긽硫 쁺긽뿉꽌 젙긽쟻씤 嫄댁륫(Fig. 1A)怨쇰뒗 떖由 L5 醫뚯륫 泥숈텛 寃쎄낵 긽룎湲 遺쐞뿉 怨좉컯룄 떊샇쓽 怨⑥닔 遺醫낆씠 媛뺣룄 떊샇쓽 怨⑥젅 꽑 二쇱쐞濡 愿李곕릺뿀떎(Fig. 1B). 쟾궛솕떒痢듭눋쁺 닔룊硫 긽 L5 醫뚯륫 삊遺뿉 씤젒븯뿬 怨⑥젅꽑씠 愿李곕릺뿀뒗뜲(Fig. 2A), 씠뒗 넻긽쟻씤 泥숈텛遺꾨━利앹쓽 삊遺 寃곗넀遺蹂대떎 쟾諛⑹뿉 쐞移섑븯怨 떆긽硫 긽 嫄댁륫뿉 鍮꾪빐 泥숈텛 寃 썑븯諛 뵾吏덇낏쓽 遺遺 떒젅 뼇긽씠뿀떎(Fig. 2B and C). 뵾濡 怨⑥젅濡 씤븳 렪痢≪꽦 泥숈텛遺꾨━利앹쑝濡 吏꾨떒븯怨 썕젴씠굹 듃젅씠떇쓣 젣븳븯쑝硫 蹂댁“湲 怨좎젙 蹂꾨룄濡 떆뻾븯吏 븡븯떎. 吏꾨떒 3二 썑 泥숈텛 쉶쟾 떆 넻利앹씠 뾾뼱 媛踰쇱슫 떚諛고똿쓣 떆옉븯怨 以묒떖 븞젙꽦 슫룞쓣 蹂묓뻾븯떎. 5二쇱뿉 닔鍮 湲곗닠 썕젴怨 寃 썕젴쓣 떆옉븯뒗뜲 옣嫄곕━ 닾援 떆뿉룄 넻利앹씠 뾾뿀쑝硫, 蹂듦 쟾 떆뻾븳 쟾궛솕떒痢듭눋쁺 닔룊硫(Fig. 3A) 諛 떆긽硫 긽(Fig. 3B)뿉꽌 뵾濡 怨⑥젅遺뒗 쑀빀릺뼱 6二쇱뿉 젙긽쟻씤 寃쎄린 李몄뿬媛 媛뒫븯떎.

Fig. 1. Fat-suppressed sagittal magnetic resonance imaging in case 1. (A) Compared to the normal right posterior elements, (B) high signal intensity bone marrow edema (arrow) in pedicle and superior articular process around low signal intensity vertical fracture line in the left isthmus of the fifth lumbar vertebra (L5). Inner boxes are scout images.

Fig. 2. Initial computed tomographic imaging in case 1. (A) Axial image of the fifth lumbar vertebra (L5) demonstrated linear fracture line (arrows) in anterior portion of the sclerotic isthmus. (B) Compared to the intact right isthmus in sagittal reconstructed image, (C) focal caudal cortical disruption (arrow) was located in ventral portion of the sclerotic isthmus (arrowhead). Inner boxes are scout images.

Fig. 3. Six-week follow-up computed tomographic imaging in case 1 showed complete healing of the previous left isthmic fracture (arrows) of the fifth lumbar vertebra (L5) on (A) axial and (B) sagittal reconstructed images. Inner boxes are scout images.

2. 利앸 2

14꽭 以묓븰援 2븰뀈 궓옄 닾닔濡(떊옣 166 cm, 泥댁쨷 72 kg, 슦닾슦) 7媛쒖썡 쟾遺꽣 닾援 떆 媛꾪뿉쟻쑝濡 諛쒖깮븳 슂넻 諛 醫뚯륫 몦遺넻, 醫 뒳洹쇱쓽 寃쎌쭅媛먯쓣 二쇱냼濡 궡썝븯떎. 슂넻 궡썝 1媛쒖썡 쟾 룞怨 썕젴 떆 븙솕릺뼱 썕젴뿉 遺덉갭븯怨 궗꽕 슫룞꽱꽣뿉꽌 옱솢 以묒씠뿀떎. 吏꾩같 떆 醫뚯륫 썑諛 옣怨⑤뒫 遺쐞濡 븬넻씠 엳뿀쑝硫 븯吏 吏곴굅긽 寃궗긽 醫뚯륫씠 80°濡 젣븳릺뼱 엳뿀떎. 떊寃쏀븰쟻 씠긽 愿李곕릺吏 븡븯怨, 醫뚯륫 렪媛 湲곕┰ 寃궗 떆 醫뚯륫 렪뼢쓣 蹂댁쑝硫 옄꽭 쑀吏뿉 뼱젮씠 엳뿀떎. 궗硫 떒닚 諛⑹궗꽑 寃궗뿉꽌 슦痢≪ L5 삊遺뿉 쟾삎쟻씤 Scotty dog 寃곗넀씠 愿李곕릺뿀쑝굹(Fig. 4A), 醫뚯륫 삊遺 寃곗넀 뾾씠 븯愿젅 룎湲곕줈 怨⑥젅꽑씠 뿰옣릺뼱 엳뿀떎(Fig. 4B). 옄湲곌났紐낆쁺긽뿉꽌 L5 슦痢 삊遺뒗 怨좉컯룄 떊샇쓽 寃곗넀쓣 蹂댁쑝굹(Fig. 5A), 醫뚯륫 泥숈텛寃 遺쐞濡 怨좉컯룄 떊샇쓽 怨⑥닔 遺醫낃낵 媛뺣룄 떊샇쓽 怨⑥젅꽑씠 愿李곕릺뿀떎(Fig. 5B). 怨⑥젅 뼇긽 쟾궛솕떒痢듭눋쁺 닔룊硫 긽 L5 슦痢 삊遺뒗 썑痢〓갑 諛⑺뼢, 醫뚯륫 슒痢 諛⑺뼢씠뿀쑝硫(Fig. 6A), 떆긽硫 긽뿉꽌룄 쟾삎쟻씤 궗꽑삎 諛곕났 諛⑺뼢(dorsoventral)쓽 슦痢 寃곗넀(Fig. 6B)怨쇰뒗 떖由 醫뚯륫 닔吏 諛⑺뼢쑝濡 긽遺 썑愿젅源뚯 뿰옣릺뼱 엳뿀떎(Fig. 6C). 怨⑥젅꽑씠 삁由ы븯吏 븡怨 怨⑥젅遺 二쇱쐞 寃쏀솕긽怨 怨 씉닔 냼寃ъ씠 샎옱릺뼱 湲됱꽦 怨⑥젅濡쒕뒗 뙋떒릺吏 븡븘 닔닠씠굹 蹂댁“湲 怨좎젙 떆뻾븯吏 븡븯쑝硫, 닾援 쑕떇怨 븿猿 뒳洹 寃쎌쭅쓣 셿솕떆궎怨 슂異붾 쑀뿰꽦怨 泥닿컙쓽 以묒떖 븞젙꽦쓣 媛뺥솕븯뒗 諛⑺뼢쑝濡 옱솢쓣 떆뻾븯떎. 슂넻 諛 醫뚯륫 몦遺넻 移섎즺 떆옉 4二쇱뿉 샇쟾쓣 蹂댁쑝硫, 8二쇱뿉 뒳洹 寃쎌쭅 利앹긽怨 렪媛 湲곕┰ 寃궗쓽 샇쟾쓣 蹂댁뿬 湲곌컙 닾援 봽濡쒓렇옩쓣 吏꾪뻾븯怨 3媛쒖썡뿉 젏吏꾩쟻 닾援 蹂듦媛 媛뒫븯떎. 異붿떆 쁺긽 珥ъ쁺 썝븯吏 븡븯쑝硫 6媛쒖썡 寃쎄낵 썑뿉룄 利앹긽 옱諛쒖 뾾뼱 쇅옒 異붿떆 愿李 以묒뿉 엳떎.

Fig. 4. Both oblique plain radiographs in case 2 showed (A) typical Scotty dog defect (arrows) in the right isthmus of the fifth lumbar vertebra (L5); however, (B) the left isthmus was relatively intact and oblique fracture line (arrows) was seen on anterior portion of the left inferior articular process of L5.

Fig. 5. Fat-suppressed sagittal magnetic resonance imaging in case 2. (A) Compared to typical high signal intensity right isthmic defect (arrow) of the fifth lumbar vertebra (L5), (B) high signal intensity bone marrow edema (arrowheads) in the left pedicle of the L5 anterior to low signal intensity fracture line (arrows). Inner boxes are scout images.

Fig. 6. Initial computed tomographic imaging in case 2. (A) Axial image of the fifth lumbar vertebra (L5) demonstrated horizontally directed left isthmic fracture line (arrowhead) compared to posterolaterally oriented right fracture line (arrows). (B) Compared to typical oblique dorsoventral right isthmic defect of the L5 (arrows) in sagittal reconstructed image, (C) coronally oriented vertical fracture line of left isthmus of L5 (arrows) was extended to upper facet joint. Inner boxes are scout images.
怨 李

泥숈텛遺꾨━利앹 泥냼뀈湲 슫룞 꽑닔 슂넻쓽 以묒슂븳 썝씤쑝濡, 湲됱꽦 삉뒗 留뚯꽦 援щ텇뾾씠 뿭룄, 泥댁“, 쑁긽 꽑닔 벑뿉꽌 40% 媛源뚯씠 愿李곕릺뒗 吏덊솚씠떎4,5. 洹몃윭굹 빞援 꽑닔뿉 븳 蹂닿퀬뒗 뱶臾쇰ʼn, 듅엳 援궡 봽濡쒖빞援 꽑닔뿉 븳 옄猷뚮굹 蹂닿퀬媛 뾾뼱 吏꾨즺 떆 李멸퀬븯湲곌 뼱졄떎. 泥숈텛遺꾨━利앹 吏꾪뻾 떒怨꾩뿉 뵲씪 珥덇린, 吏꾪뻾湲, 醫낅쭚湲곕줈 援щ텇릺뒗뜲4, 꽦씤 泥숈텛遺꾨━利앹쓽 遺遺꾩 삊遺 怨⑥젅쓽 遺덉쑀빀꽦 媛愿젅 삎깭씤 醫낅쭚湲곗뿉꽌 諛쒓껄맂떎. 洹몃윭굹 Tezuka 벑4 슫룞 꽑닔뿉꽌 湲됱꽦씠굹 븘湲됱꽦 뵾濡 怨⑥젅 삎깭쓽 泥숈텛遺꾨━利 11삁瑜 蹂닿퀬븯뒗뜲, 봽濡쒖텞援(3삁), 쑁긽(4삁), 泥댁“(1삁) 꽑닔瑜 젣쇅븯怨 봽濡쒖빞援 꽑닔媛 3삁(21–25꽭)濡, 怨쇰룄븳 닾援 뿰뒿쓣 뻽嫄곕굹 닾援 뤌쓣 蹂寃쏀븳 닾닔 寃 썕젴 以묒씤 룷닔뿉꽌 諛쒖깮븯怨, 怨⑥젅쓽 삎깭룄 蹂 利앸 1怨 쑀궗븳 렪痢≪꽦 珥덇린 삊遺 뵾濡 怨⑥젅肉먮쭔 븘땲씪, 湲곗〈쓽 렪痢 泥숈텛遺꾨━利앹쓣 媛吏 긽깭뿉꽌 諛섎痢 삊遺뿉 諛쒖깮븳 怨⑥젅, 븯遺 슂異붿쓽 泥숈텛遺꾨━利앹뿉 異붽濡 諛쒖깮맂 긽遺 슂異붿쓽 삊遺 怨⑥젅 벑 뿬윭 삎깭媛 엳쓣 닔 엳떎怨 븯떎.

슫룞 꽑닔뿉꽌 諛쒖깮븯뒗 삊遺 뵾濡 怨⑥젅쓽 썝씤 紐낇솗븯吏뒗 븡쑝굹 삊遺쓽 빐遺븰쟻 痍⑥빟꽦怨 泥숈텛쓽 援댁떊 諛 쉶쟾 떆뿉 삊遺뿉 媛빐吏뒗 쓳젰 吏묒쨷怨 愿젴씠 엳떎2,6. 듅엳 옣젰쓣 媛吏 利앸 1 꽑닔쓽 鍮꾩슦꽭痢≪씤 醫뚯륫 삊遺뿉 諛쒖깮븳 젏쑝濡 蹂댁븘, 寃 룞옉 떆 怨쇰룄븳 泥닿컙 쉶쟾쑝濡 쑀諛쒕릺뒗 鍮꾩슦꽭痢≪쓽 궡蹂듭궗洹 뙆뿴怨 쑀궗븳 湲곗쟾쑝濡 湲곌퀎쟻 痍⑥빟遺씤 삊遺 븯諛⑹뿉 遺븯媛 媛빐吏뒗 寃껋쑝濡 깮媛곹븷 닔 엳떎7. 삉븳 Sairyo 벑6쓽 쑀븳 슂냼 紐⑤뜽 뿰援ъ뿉 쓽븯硫 렪痢 泥숈텛遺꾨━利앹씠 엳뒗 寃쎌슦 젙긽 泥숈텛뿉 鍮꾪빐 諛섎痢 삊遺굹 泥숈텛寃쎌뿉 媛빐吏뒗 遺븯媛 12.6諛곕줈 利앷븳떎怨 븯怨, Yamashita 벑8룄 뼇痢≪쓽 吏꾪뻾 떒怨꾧 긽씠븳 泥냼뀈 슫룞 꽑닔 泥숈텛遺꾨━利 5삁(9–20꽭) 蹂닿퀬뿉꽌 醫낅쭚湲 삊遺 寃곗넀痢〓낫떎 珥덇린 寃곗넀痢≪씠 利앹긽쓣 쑀諛쒗븯뒗 二쇰맂 썝씤씠씪怨 븯떎. 蹂 利앸 2쓽 寃쎌슦 슂넻怨 뜑遺덉뼱 醫뚯륫 몦遺넻怨 醫뚯뒳洹 寃쎌쭅媛, 醫뚯륫 렪媛 湲곕┰ 寃궗긽쓽 씠긽쓣 蹂댁씤 寃껋 쟾쐞媛 떎냼 吏꾪뻾맂 留뚯꽦쟻 슦痢 삊遺 寃곗넀뿉 鍮꾪빐 怨⑥젅꽑쓽 삎깭濡 蹂댁븘 湲됱꽦 븘땲吏留 슦痢〓낫떎 뒭寃 諛쒖깮븳 鍮꾩슦꽭痢 醫뚯륫 삊遺 怨⑥젅濡 씤빐 쑀諛쒕맂 寃껋쑝濡 뙋떒맂떎.

珥덇린 떒怨꾩쓽 泥숈텛遺꾨━利앹 吏꾨떒씠 돺吏 븡뜲, 쓷엳 슂넻쓣 蹂댁씠뒗 꽦씤 슫룞 꽑닔쓽 寃쎌슦 異붽컙뙋 吏덊솚쓽 뿬遺留뚯쓣 솗씤븯뒗 寃쎌슦媛 留롮쑝굹 利앸 1怨 媛숈씠 옄湲곌났紐낆쁺긽뿉꽌 泥숈텛寃 二쇰쓽 怨좉컯룄 떊샇 蹂솕뒗 삊遺 뵾濡 怨⑥젅쓣 쓽떖븷 닔 엳뒗 以묒슂 냼寃ъ씠떎8. 而댄벂꽣떒痢듭눋쁺 怨⑥젅遺쓽 삎깭肉 븘땲씪 吏덊솚쓽 떒怨꾨 뙋떒븷 닔 엳뒗 쑀슜븳 寃궗씠硫, 듅엳 利앸 1쓽 寃쎌슦 遺遺 怨⑥젅遺媛 떆긽硫닿낵 긽뿉꽌 湲곗〈쓽 삊遺蹂대떎 떎냼 쟾븯諛⑹뿉 쐞移섑븯뿬 泥숈텛寃쎌쓽 뵾濡 怨⑥젅濡쒕룄 삤씤븷 닔 엳떎. 몢 利앸 紐⑤몢 二쇰맂 利앹긽쓣 쑀諛쒗븯뒗 醫뚯륫 삊遺쓽 怨⑥젅硫댁씠 泥숈텛 떆긽硫댁쓣 湲곗쑝濡 긽븯 諛⑺뼢씠怨, 듅엳 利앸 2뒗 怨⑥젅硫댁씠 泥숈텛 愿긽硫 諛⑺뼢씤 슒痢≪쑝濡 諛쒖깮븳 젏 씠 利앸뱾씠 湲곗〈쓽 泥숈텛遺꾨━利앹뿉 鍮꾪빐 鍮꾩쟾삎쟻씠硫 듅씠븯떎怨 븷 닔 엳뒗뜲, 깮뿭븰쟻 뿰援ъ긽 諛섎났쟻씤 닾援щ굹 寃 룞옉 떆 븯泥대줈遺꽣 쟾떖릺뒗 뿉꼫吏媛 슂異붿쓽 쉶쟾 諛 떊쟾쑝濡 씤빐 쟾떒젰씠 뜑빐졇 愿긽硫 諛⑺뼢쓽 怨⑥젅쓣 뜑 留롮씠 쑀諛쒗븷 닔 엳떎뒗 蹂닿퀬媛 엳떎9.

泥숈텛遺꾨━利앹 蹂댁〈 移섎즺媛 슦꽑쟻씠硫 珥덇린 吏꾪뻾湲 삊遺 怨⑥젅쓽 씪諛섏쟻 쑀빀 떆湲곌 媛곴컖 3媛쒖썡, 6媛쒖썡 젙룄엫쓣 媛먯븞븯硫4,10, 利앸 1 鍮꾧탳쟻 鍮좊Ⅸ 궡썝 6二쇱뿉 쑀빀쓣 뼸쓣 닔 엳뿀뒗뜲, 씠뒗 吏덊솚쓽 議곌린 吏꾨떒씠 以묒슂븳 뿭븷쓣 븳 寃껋쑝濡 깮媛곷맂떎. 鍮꾨줉 利앸 2쓽 異붿떆 쁺긽 遺옱濡 쑀빀 뿬遺瑜 솗씤븷 닔 뾾쑝굹 醫낅쭚湲곗뿉 媛源뚯슫 怨⑥젅씠誘濡 쑀빀 湲곕븯湲 뼱젮썱쓣 寃껋쑝濡 깮媛곷맂떎. 삉븳 옣湲곗쟻씤 異붿떆瑜 넻빐 遺덉쑀빀씠 吏냽릺뼱 泥숈텛 쟾諛⑹쟾쐞利앹쑝濡 吏꾪뻾븯嫄곕굹 씠濡 씤븳 떊寃쏀븰쟻 씠긽씠굹 蹂댁〈쟻쑝濡 議곗젅릺吏 븡뒗 슂넻씠 1뀈 씠긽 吏냽맆 寃쎌슦 泥숈텛쑀빀닠쓽 쟻쓳씠 맆 닔 엳쓣 寃껋쑝濡 깮媛곹븳떎5,10. 옄뱾 씠踰 利앸瑜 넻빐 泥냼뀈 빞援 꽑닔 諛 꽦씤 봽濡쒖빞援 꽑닔뿉꽌 諛쒖깮븯뒗 泥숈텛遺꾨━利앹쓽 湲곗쟾怨 삎깭쟻 떎뼇꽦쓣 蹂닿퀬븿쑝濡쒖뜥 쟻젅븳 吏꾨떒怨 移섎즺瑜 넻븳 議곌린 蹂듦뿉 李멸퀬 옄猷뚭 맆 닔 엳쓣 寃껋쑝濡 깮媛곷맂떎.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Conceptualization: HKJ. Methodology: JHK. Writing–original draft: HLC. Writing–review & editing: DYK.

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