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Multiple Flexor Tendon Pulleys Injury in Korean Rock Climber
Korean J Sports Med 2022;40:270-273
Published online December 1, 2022;  https://doi.org/10.5763/kjsm.2022.40.4.270
© 2022 The Korean Society of Sports Medicine.

Jun Hyoung Park, Seok Woo Hong

Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Seok Woo Hong
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea
Tel: +82-2-2001-1788, Fax: +82-2-2001-2176
E-mail: sw84.hong@samsung.com
Received May 10, 2022; Revised August 23, 2022; Accepted October 30, 2022.
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
Owing to unique biomechanical loading on hand during rock climbing, finger flexor tendon pulleys injury commonly occurred in rock climbers. Although several previous reports showed clinical manifestations and treatment outcomes of flexor tendon pulleys injuries, it has not yet been reported in South Korea. The authors experienced a 29-year-old female patient who sustained digital flexor tendon pulleys injuries while rock climbing. Therefore, we reported this case with a literature review.
Keywords : Rock climbing, Pulley injury, Pulley reconstruction
꽌 濡

븫踰 벑諛섍뿉寃뚯꽌 옄二 諛쒖깮븯뒗 룓뇙꽦 援닿끝嫄 솢李 넀긽 븫踰 벑諛 以 넀媛씫뿉 媛빐吏뒗 깮泥 뿭븰쟻 遺븯뿉 쓽빐 굹굹뒗 寃껋쑝濡 븣젮졇 엳떎1,2. 씠 넀긽 痍⑤ 솢룞쑝濡 븫踰 벑諛섏씠 젏李 솢꽦솕릺硫댁꽌 1990뀈뿉 泥섏쓬쑝濡 利앸媛 蹂닿퀬릺뿀쑝硫3,4, 븫踰 벑諛 씤援ъ쓽 利앷 뜑遺덉뼱 移섎즺 寃곌낵뿉 븳 臾명뿄 蹂닿퀬媛 吏냽쟻쑝濡 씠猷⑥뼱吏怨 엳떎5,6. 븯吏留 븘吏 援궡뿉꽌뒗 븫踰 벑諛섍낵 愿젴맂 닔遺 援닿끝嫄 솢李 넀긽뿉 愿븳 利앸媛 蹂닿퀬맂 諛 뾾떎. 씠뿉 옄뱾 븳援씤 븫踰 벑諛섍뿉寃뚯꽌 諛쒖깮븳 룓뇙꽦 닔遺 援닿끝嫄 솢李 넀긽 利앸瑜 寃쏀뿕븯湲곗뿉 씠瑜 臾명뿄 怨좎같怨 븿猿 蹂닿퀬븯怨좎옄 븳떎. 蹂 뿰援щ뒗 媛뺣턿궪꽦蹂묒썝 湲곌깮紐낆쑄由ъ쐞썝쉶쓽 듅씤쓣 諛쏆븘 떆뻾븯떎(KBSMC-2022-03-037).

利 濡

29꽭 뿬옄媛 醫뚯륫 4닔吏쓽 슫룞 젣븳怨 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞쓣 二쇱냼濡 궡썝븯떎. 궡썝 3媛쒖썡 쟾 떎궡 븫踰 벑諛 룄以 醫뚯륫 4닔吏뿉 ‘슍’ 븯뒗 냼由ъ 븿猿 넻利 諛 遺醫낆씠 諛쒖깮븯쑝硫, 닔긽 吏곹썑뿉뒗 넻利 諛 遺醫낆뿉 쓽빐 愿젅 슫룞 踰붿쐞뿉 빟媛꾩쓽 젣븳씠 엳뿀吏留, 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞 愿李곕릺吏 븡븯떎. 蹂묒썝뿉꽌 넀媛씫 뿼醫뚯뿉 以븯뿬 2二쇨컙 븣猷⑤몃뒆 넀媛씫 遺紐 移섎즺瑜 洹쇱쐞吏 愿젅 0° 떊쟾쐞 긽깭뿉꽌 떎떆븳 썑 遺紐⑹쓣 젣嫄고븯떎. 遺紐 젣嫄 씠썑 遺醫낃낵 넻利앹 냼떎릺뿀쑝굹 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞씠 닔긽 썑 1媛쒖썡遺꽣 굹굹湲 떆옉븯쑝硫, 씠 援닿끝 援ъ텞 닔긽 썑 2媛쒖썡源뚯 꽌꽌엳 吏꾪뻾릺뿀떎.

蹂몄썝 궡썝 썑 떆뻾븳 씠븰쟻 寃吏 긽 醫뚯륫 젣 4닔吏 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞씠 80°, 썑냽 援닿끝씠 95°濡 痢≪젙릺뿀쑝硫, 伊먭린 룞옉(grip position) 떆 4닔吏 泥⑤ 넀諛붾떏 궗씠뿉 빟 0.5 cm쓽 嫄곕━媛 솗씤릺뿀떎. 삉븳 4닔吏쓽 닔옣 痢≪쑝濡 紐낇솗븳 援닿끝嫄댁쓽 솢以 쁽긽씠 愿李곕릺뿀떎(Fig. 1). 洹몃윭굹 援닿끝 援ъ텞 諛 슫룞 젣븳 씠쇅뿉 떎瑜 씠븰쟻 씠긽 냼寃ъ 諛쒓껄릺吏 븡븯쑝硫, 떒닚 諛⑹궗꽑 寃궗뿉꽌룄 듅蹂꾪븳 씠긽 냼寃ъ 뾾뿀떎(Fig. 2). 怨쇨굅젰 긽 醫뚯륫 4닔吏쓽 쇅긽젰 뾾뿀怨, 떊寃쎄렐쑁吏덊솚, 瑜섎쭏떚뒪꽦 愿젅뿼 諛 눜뻾꽦 愿젅뿼쓽 蹂묐젰룄 뾾뿀쑝硫 궡怨쇱쟻 吏덊솚룄 媛吏怨 엳吏 븡븯떎. 異붽쟻씤 룊媛瑜 쐞븯뿬 옄湲곌났紐낆쁺긽(magnetic resonance imaging, MRI) 寃궗瑜 떆뻾븯怨, 泥쒖닔吏 援닿끝嫄닿낵 떖닔吏 援닿끝嫄댁 넀긽 뾾씠 뿰寃곗꽦쓣 쑀吏븯怨 엳뿀쑝굹, A2, A3, A4 솢李⑥쓽 떎諛쒖꽦 넀긽뿉 쓽븳 援닿끝嫄댁쓽 솢以 쁽긽쓣 솗씤븷 닔 엳뿀떎(Fig. 3).

Fig. 1. Preoperative clinical photographs of the patient’s left ring finger. A 70° of flexion contracture and bowstring phenomenon was observed.

Fig. 2. Preoperative anteroposterior (A) and lateral (B) radiographs of the left ring finger of the patient. Definite bony abnormality was not observed.

Fig. 3. Preoperative magnetic resonance images of the left ring finger. (A) T1-weighted sagittal, (B) T1-weighted axial, and (C) T2-weighted axial images showed bowstring of flexor tendons but no evidence of tendon injury.

닔긽 썑 3媛쒖썡씠 吏궗쑝硫, 洹쇱쐞吏 愿젅뿉 80°뿉 씠瑜대뒗 怨좎젙맂 援닿끝 援ъ텞씠 엳怨 MRI 寃궗뿉꽌 援닿끝嫄댁쓽 솢以 쁽긽怨 룞諛섎맂 떎諛쒖꽦 솢李 넀긽 냼寃ъ씠 엳뼱 諛섑쓷 議곗쭅 젣嫄 諛 쑀李 諛뺣━닠, 洹몃━怨 A2, A4 솢李 옱嫄댁닠쓣 떆뻾븯湲곕줈 寃곗젙븯떎. 쟾떊留덉랬 븯뿉 닔遺瑜 쟾셿遺 쉶쇅 긽깭濡 쐞移섏떆궓 썑 닔옣 痢 A1 솢李⑥쓽 썝쐞遺뿉꽌遺꽣 썝쐞吏 愿젅 쐞移섍퉴吏 釉뚮(꼫 삎깭쓽 젅媛쒕 媛븯떎. 뿰遺 議곗쭅 諛뺣━ 썑 援닿끝嫄댁쓽 솢以 쁽긽怨 A2, A3, A4 솢李⑥쓽 셿쟾 뙆뿴 諛 뙆뿴 썑 諛쒖깮븳 諛섑쓷 議곗쭅 삎꽦뿉 쓽븳 쑀李⑹쑝濡 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞씠 쑀諛쒕릺뒗 긽깭엫쓣 솗씤븷 닔 엳뿀떎. 諛섑쓷 議곗쭅 젣嫄 諛 愿젅 쑀由ъ닠쓣 떆뻾븯怨 씠썑 닔吏쓽 愿젅 媛룞踰붿쐞媛 셿쟾엳 쉶蹂듬릺뒗 寃껋쓣 솗씤븯떎(Fig. 4A). 諛섑쓷 議곗쭅 젣嫄 떆 솢李 옱嫄댁쓣 쐞빐 A2 A4 솢李⑥쓽 怨 遺李⑸ 옍뿬 媛옣옄由 議곗쭅쓣 궓寃쇰떎. 솢李 옱嫄댁쓣 쐞빐 옣 옣洹쇱쓣 梨꾩랬븳 뮘 A2 솢李⑥ A4 솢李⑥쓽 옍뿬 꽟쑀꽦 媛옣옄由 議곗쭅뿉 梨꾩랬븳 옣 옣洹쇱쓣 媛곴컖 넻怨쇱떆耳, A2 솢李⑤뒗 3寃뱀쑝濡 吏곸“븯怨 A4 솢李⑤뒗 1寃뱀쑝濡 吏곸“븯뒗 鍮꾨몢瑜닿린닠떇(nonencircling)쑝濡 솢李 옱嫄댁닠쓣 떆뻾븯떎(Fig. 4B and C). 옱嫄댁닠 썑 援닿끝嫄댁쓽 솢以 쁽긽 諛 4닔吏쓽 愿젅 슫룞 踰붿쐞 젣븳씠 빐寃곕릺뿀떎. 닠 썑 3씪媛 떒긽吏 꽍怨 遺紐⑹쓣 씠슜븯뿬 怨좎젙븯怨, 씠썑 遺紐⑹쓣 젣嫄고븯怨 媛뒫븳 踰붿쐞 궡뿉꽌쓽 뒫룞쟻 愿젅 슫룞쓣 떆옉븯떎. 닠 썑 2二쇱㎏ 遊됲빀궗瑜 젣嫄고븯쑝硫 닠 썑 24二쇱㎏ 씠븰쟻 寃吏꾩뿉꽌 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞 10°, 썑냽 援닿끝 90°濡 愿젅슫룞 踰붿쐞媛 샇쟾맂 寃껋쓣 솗씤븷 닔 엳뿀떎.

Fig. 4. (A) Intraoperative clinical photograph showed full range of motion achievement after adhesiolysis. (B) Intraoperative clinical photograph showing post-pulley reconstructed status. The white arrow indicates the reconstructed A2 pulley and the black arrow indicates the reconstructed A4 pulley. (C) Illustration showing tendon weave technique for reconstruction of A2 pulley using palmaris longus tendon graft.
怨 李

븫踰 벑諛 떆 궗슜븯뒗 닔遺쓽 듅吏뺤쟻씤 븬李 洹몃┰(crimp grip) 옄꽭뒗 떖닔吏 援닿끝嫄닿낵 泥쒖닔吏 援닿끝嫄댁뿉 겙 옒쓣 諛쒖깮떆궎硫, 썝쐞吏 愿젅 怨쇱떊쟾릺怨 洹쇱쐞吏 愿젅 90°뿉꽌 100° 媛웾 援닿끝릺寃 맂떎. 씠뒗 怨좊━삎쓽 솢李⑥뿉 겙 깮泥 뿭븰쟻 遺븯瑜 씪쑝궎寃 릺怨 씠濡 씤빐 룓뇙꽦 援닿끝嫄 솢李 넀긽씠 諛쒖깮븯寃 맂떎7. 씠 以 A2 A4 솢李⑤뒗 怨⑥뿉 吏곸젒 遺李⑸릺뒗 꼻怨 듉듉븳 솢李⑤줈꽌, 援닿끝嫄댁씠 닔吏怨⑤줈遺꽣 닔옣 痢≪쑝濡 쟾쐞릺뒗 솢以 쁽긽쓣 諛⑹븯뒗 뜲뿉 媛옣 以묒슂븳 援ъ“臾쇰줈 뿬寃⑥쭊떎8. 援닿끝嫄 솢李 넀긽 젣4닔吏 젣3닔吏 닚쑝濡 쓷븯寃 굹굹怨, 遺遺꾩쓽 寃쎌슦 A2뿉꽌 A4 솢李⑥뿉 넀긽씠 諛쒖깮븳떎9. 蹂 利앸쓽 寃쎌슦뿉꽌룄 븫踰 벑諛 以 젣4닔吏뿉 룓뇙꽦쑝濡 諛쒖깮븳 A2, A3, A4 솢李⑥쓽 떎諛쒖꽦 넀긽쓣 솗씤븷 닔 엳뿀떎.

吏湲덇퉴吏 룓뇙꽦 援닿끝嫄 솢李 넀긽쓽 移섎즺뿉 븳 떎뼇븳 諛⑸쾿뱾씠 끉쓽릺뼱 솕떎. Bollen3 뀒씠븨쓣 넻븳 蹂댁〈쟻 移섎즺踰뺤쓣 젣떆븯쑝硫, Tropet 벑4 넀긽 諛쏆 솢李⑥쓽 씪李 遊됲빀닠쓣 넻븳 移섎즺瑜 蹂닿퀬븯떎. Schöffl 벑10 솢李 넀긽쓽 젙룄뿉 뵲瑜 벑湲 泥닿퀎瑜 젣떆븯怨 솢李⑥쓽 뿼醫뚮굹 떒룆 넀긽뿉뒗 蹂댁〈쟻 移섎즺媛, 떎諛쒖꽦 넀긽뿉뒗 닔닠쟻 移섎즺媛 븘슂븯떎怨 븯떎. 삉븳 Schneeberger怨 Schweizer6뒗 寃쎈룄쓽 솢李 넀긽 47삁뿉꽌 꽍怨 怨좎젙쓣 넻븳 蹂댁〈쟻 移섎즺濡 醫뗭 寃곌낵瑜 蹂닿퀬븳 諛 엳떎. 솢李 넀긽쓽 젙룄媛 寃쎈명븳 떒룆 솢李 넀긽 蹂댁〈쟻 移섎즺瑜 넻빐 醫뗭 寃곌낵瑜 湲곕빐 蹂 닔 엳寃좎쑝굹 떎諛쒖꽦 솢李 넀긽쓽 寃쎌슦 遺遺 닔닠쟻 移섎즺媛 븘슂븯硫, 留뚯빟 닔닠쟻 移섎즺瑜 떆뻾븯吏 븡 寃쎌슦 援닿끝嫄댁쓽 솢以 쁽긽 諛 넀긽맂 솢李⑥뿉 쓽븳 諛섑쓷 議곗쭅 삎꽦뿉 쓽븳 씠李⑥쟻씤 洹쇱쐞 吏媛 愿젅쓽 援ъ텞 吏꾪뻾 媛뒫꽦씠 엳떎9,10. 蹂 利앸쓽 寃쎌슦뿉룄 A2, A3, A4쓽 떎諛쒖꽦 솢李 넀긽쓣 엯 썑 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞씠 吏꾪뻾맂 寃껋쓣 솗씤븷 닔 엳뿀떎.

솢李 넀긽뿉 븳 닔닠쟻 移섎즺뒗 씪李⑥쟻 遊됲빀닠蹂대떎뒗 옄媛 옣 옣洹 삉뒗 떊쟾 吏吏瑜 씠슜븳 솢李 옱嫄댁닠씠 꽑샇맂떎1. 솢李 옱嫄댁쓽 諛⑸쾿 뿬윭 媛吏媛 냼媛쒕릺뼱 엳쑝굹 겕寃뚮뒗 솢李⑥쓽 꽟쑀꽦 怨 遺李 옍뿬 媛옣옄由 議곗쭅뿉 梨꾩랬븳 씠떇렪쓣 援먯감븯뿬 吏곸“븯뒗 諛⑸쾿怨 怨좊━ 삎깭濡 닔吏怨④낵 援닿끝嫄댁쓣 媛먯떥 솢李⑤ 옱嫄댄븯뒗 諛⑸쾿쑝濡 굹늻뼱 蹂 닔 엳떎5. 蹂 利앸뿉꽌뒗 옄媛 옣 옣嫄 씠떇렪쓣 솢李 怨 遺李 옍뿬遺뿉 援먯감븯뿬 吏곸“븯뒗 諛⑸쾿쓣 궗슜븯뿬 A2 솢李⑥뿉 븯뿬 꽭 寃뱀쑝濡 吏곸“븯뿬 媛먯떥怨, A4 솢李⑥뿉 븯뿬뒗 븳 寃뱀쑝濡 吏곸“븯뿬 媛먯떥뒗 諛⑹떇쑝濡 솢李⑤ 옱嫄댄븯떎. 씠 諛⑸쾿 옱嫄대맂 솢李⑥쓽 湲댁옣룄瑜 諛붾줈 꽕젙븷 닔 엳뒗 옣젏씠 엳怨, 꽟쑀꽦 옍뿬 媛옣옄由 議곗쭅씠 異⑸텇븯떎硫 鍮꾧탳쟻 돺寃 솢李⑤ 吏곸“븷 닔 엳湲 븣臾몄뿉 蹂 利앸쓽 솚옄뿉꽌 옱嫄댁쓽 諛⑸쾿쑝濡 꽑깮븯떎.

븫踰 벑諛섍쓽 룓뇙꽦 솢李 넀긽뿉 愿븳 떎뼇븳 利앸 移섎즺 寃곌낵媛 빐쇅 臾명뿄뿉꽌 吏냽쟻쑝濡 蹂닿퀬릺뼱솕쑝굹 븘吏곴퉴吏 援궡뿉꽌뒗 蹂닿퀬맂 諛붽 뾾뿀떎. 씠뒗 洹 룞븞 援궡뿉 븫踰 벑諛 씤援ш 鍮꾧탳쟻 쟻뼱 愿젴 吏덊솚뿉 븳 愿떖룄媛 궙븯湲 븣臾몄씠씪 異붿젙맂떎. 蹂 利앸뒗 援궡뿉꽌 理쒖큹濡 蹂닿퀬릺뒗 븫踰 벑諛섍쓽 룓뇙꽦 솢李 넀긽 利앸濡 理쒓렐 援궡뿉꽌룄 븫踰 벑諛, 뒪룷痢 겢씪씠諛 벑쓣 利먭린뒗 씤援ш 뒛뼱굹怨 엳뒗 젏쓣 怨좊젮빐 蹂댁븯쓣 븣 蹂 利앸瑜 넻빐 뼢썑 利앷릺뒗 넀媛씫쓽 룓뇙꽦 솢李 넀긽 솚옄뱾뿉 븳 쟻젅븳 吏꾨떒 諛 삱諛붾Ⅸ 移섎즺 諛⑺뼢 꽕젙뿉 룄쓣 以 닔 엳쓣 寃껋씠씪 깮媛곷맂떎.

룓뇙꽦 援닿끝嫄 솢李 넀긽뿉 愿븳 꽑뻾 뿰援 諛 利앸蹂닿퀬뱾 솚옄뱾씠 닔긽 썑 넀媛씫쓽 솢以 쁽긽씠굹 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞 利앹긽쓣 씤吏븯怨 쓽猷뚭린愿뿉 궡썝븯湲곌퉴吏 鍮좊Ⅴ硫 5씪뿉꽌 湲멸쾶뒗 4二 씠궡쓽 湲곌컙씠 냼슂릺뿀떎怨 蹂닿퀬븯떎4,6. 洹몃윭굹 蹂 利앸쓽 솚옄뒗 씠쟾쓽 뿬윭 利앸蹂닿퀬뒗 떖由 珥덇린뿉뒗 넻利 諛 遺醫낆쓽 利앹긽留 엳뿀怨, 솢以 쁽긽怨 洹쇱쐞吏 愿젅쓽 援닿끝 援ъ텞 닔긽 썑 1媛쒖썡뿉꽌 2媛쒖썡뿉 嫄몄퀜 꽌꽌엳 諛쒗쁽릺뿀떎. 씠뒗 닔긽 吏곹썑 蹂묒썝뿉 궡썝븯뿬 넀媛씫 뿼醫뚯뿉 以빐 떆뻾븳 2二쇨컙쓽 븣猷⑤몃뒆 넀媛씫 遺紐 怨좎젙씠 뼱뒓 젙룄 利앹긽 諛쒗쁽쓣 뒭異붾뒗 뜲뿉 쁺뼢쓣 誘몄낀湲 븣臾몄쑝濡 깮媛곷맂떎. 蹂 利앸 媛숈 룓뇙꽦 솢李 넀긽 쓽떖븯吏 븡쑝硫 吏꾨떒븯湲 뼱젮슫 吏덊솚 以 븯굹濡쒖꽌, 넀媛씫 뿼醫뚮굹 痢〓 씤 넀긽 媛숈 쓷븯寃 諛쒖깮븯뒗 닔遺 넀긽쑝濡 옒紐 吏꾨떒븯湲 돺湲 븣臾몄뿉 빆긽 媛먮퀎 吏꾨떒 以 븯굹濡 뿼몢뿉 몢뼱빞 븳떎.

蹂 利앸쓽 젣븳젏쑝濡쒕뒗 癒쇱 異붿떆 愿李 湲곌컙씠 24二쇰줈 鍮꾧탳쟻 吏㏐퀬, 떒씪 利앸뿉 븳 蹂닿퀬濡쒖꽌 利앸쓽 닔媛 異⑸텇븯吏 븡븯떎뒗 젏씠떎. 삉븳 닔닠 쟾썑 솚옄쓽 엫긽쟻 샇쟾쓣 룊媛븷 닔 엳뒗 吏몴媛 洹쇱쐞吏 愿젅쓽 愿젅 슫룞 踰붿쐞濡 븳젙릺뿀떎. 留덉留됱쑝濡 솢李 옱嫄 떆 媛곸꽦 닔닠쓣 떆뻾븯吏 븡븯湲 븣臾몄뿉 닔닠 以 옱嫄대맂 솢李⑥쓽 쟻젅븳 湲댁옣룄瑜 留욎텛湲 뼱젮썱떎. 뼢썑 븫踰 벑諛 愿젴 뒪룷痢 넀긽쓽 利앸媛 뒛뼱궇 寃껋쑝濡 삁긽릺뒗 留뚰겮, 異뷀썑뿉뒗 씠윭븳 젣븳젏뱾쓣 蹂댁셿븳 썑냽 뿰援ш 븘슂븷 寃껋쑝濡 깮媛곷맂떎.

옄뱾 븫踰 벑諛섍뿉寃 諛쒖깮븳 떎諛쒖꽦 援닿끝嫄 솢李 넀긽쓽 利앸瑜 寃쏀뿕븯떎. 븫踰 벑諛섏씠굹 뒪룷痢 겢씪씠諛띻낵 媛숈 슫룞 以 넀媛씫쓽 넻利앷낵 遺醫낆쓣 룞諛섑븳 솚옄媛 궡썝븷 寃쎌슦 珥덇린遺꽣 援닿끝嫄 솢李 넀긽쓣 쓽떖븯怨 뿰遺 議곗쭅쓣 룊媛븷 닔 엳뒗 珥덉쓬뙆굹 MRI 벑쓣 넻빐 솢李 넀긽쓣 吏꾨떒븯뒗 怨쇱젙씠 븘슂븯硫, 떎諛쒖꽦 솢李 넀긽쓽 寃쎌슦 솢李 옱嫄댁닠쓣 넻븳 닔닠쟻 移섎즺瑜 怨좊젮빐빞 븳떎.

Conflict of Interest

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

Author Contributions

Conceptualization: SWH. Investigation: JHP. Data curation: JHP, SWH. Formal analysis: SWH. Methodology: JHP, SWH. Resources: SWH. Validation: SWH. Writing뱋riginal draft: JHP, SWH. Writing뱑eview & editing: JHP, SWH.

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