• Journal of Korean Neurosurgical Society
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• 제62권4호
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• pp.367-375
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• 2019

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.

• 한국임상수의학회지
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• 제22권4호
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• pp.302-308
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• 2005

적외선 체열촬영술은 생리적, 기능적 이상유무를 평가하기 위해 수의와 인의에서 최근 사용되고 있다. 이 연구에서는 디지털 적외선 이미지 시스템을 사용하여 개의 등에서 피부의 절대온도와 상하 그리고 좌우 온도차를 알아보고, 실험적으로 유발한 척수 손상 시 적외선 체열촬영술의 임상적 유용성을 조사하기 위하여 실시되었다. 33마리의 건강한 비글견에서 등쪽 부분을 삭모한 후 정상체열상을 촬영하였으며, 7마리의 건강한 암컷에서 경막외 풍선카테터를 이용하여 척수손상을 유발하였다. 정상군은 체열영상에서 등고선과 같은 일정하면서도 대칭적인 양상을 보였으며, 상하, 좌우에 관계없이 유의적인 피부 온도차가 관찰되지 않았다 이와는 달리, 척수 손상군의 경우 척수손상부위 주위로 대칭적인 온도 감소가 있었다. 좌우의 온도차는 거의 없었으며 매우 안정적인 경향을 보였다. 특이한 점은 상하의 온도차 중에서 흉추부와 요추부 사이의 온도차가 현저하게 나타났으며, 수술 후 4주가 경과했을 때 거의 정상으로 회복되는 경향이 있었다. 이상의 결과로 보아 적외선 체열촬영술은 개의 척수 손상 시 진단 및 예후 평가를 위한 유용한 진단기법이며, 비정상 부위를 찾아내는 데 상하좌우의 정상 피부 온도차가 매우 유용할 것으로 사료된다. 또한 병변이 양측성인 경우, 좌우의 비교보다는 인접한 부위의 상하 온도차를 비교하는 것이 더 적절한 방법일 것으로 사료된다.

• Journal of Trauma and Injury
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• 제21권1호
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• pp.46-52
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• 2008

Purpose: This study was to evaluate the effect of arterial embolization on survival in patients with pelvic bone fractures and arterial bleeding. Methods: From January 2001 to December 2007, in all, 18 patients with pelvic bone fractures that had been treated with interventional arterial embolization were included in this retrospective study. The Injury Severity Score (ISS), the Revised Trauma Score (RTS), the initial hemodynamic status, the blood gas analysis, blood transfusion data, and mortality were the main outcome measurements. Results: Pelvic bone fractures were classified into lateral compression (LC), antero-posterior compression (APC), vertical shear (VS), and combined (CM) type according to the Young-Burgess classification. The Survivor group included 11 patients (61.1%), and the non-survivor group included 7 patients (38.9%). The mean ages for the survivor and the non-survivor groups were 40.0 and 45.6 years (p=0.517). The types of pelvic bone fractures were LC 11 (61.1%), APC 6 (33.3%), and VS 1 (5.6%): LC 7 (63.6%), and APC 4 (36.4%) in the survivor group and LC 4 (57.1%), APC 2 (28.6%), and VS 1 (14.3%) in the non-survivor group. The internal iliac artery was the predominant injured vessel among both the survivors (n = 5, 45.5%) and the non-survivors (n = 4, 57.1%). No differences in initial blood pressures, ISS, and RTS existed between the two groups, but the arterial pH was lower in the non-survivor group (pH 7.09 (${\pm}0.20$) vs 7.30 (${\pm}0.08$), p=0.018). The number of transfused 24-hour units of packed RBC was greater in the non-survivor group ($24.1{\pm}12.5$ vs $14.4{\pm}6.8$, p=0.046). Conclusion: No differences in initial blood pressure and trauma scores existed between survivors and non-survivors with pelvic bone fractures, who had been treated with arterial embolization, but arterial pH was lower the in non-survivors.

• 대한정형외과스포츠의학회지
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• 제11권2호
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• pp.92-95
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• 2012

장골근 파열은 매우 드물게 발생하는 손상으로 고에너지 외상이나 혈액 응고 기능 장애, 항혈액응고제 사용자, 혈우병 환자 등 출혈경향이 있는 환자에서 저에너지 손상을 받는 경우에 발생할 수 있다. 장골근의 파열로 인한 혈종의 압박에 의해 발생한 대퇴 신경 마비가 국내에도 드물게 보고된 바가 있다. 자기공명영상 검사로 병변 부위를 확진하고 신경전도 검사 및 근전도 검사로 대퇴신경 마비의 범위를 평가할 수 있고 혈액응고 기능에 문제가 있거나 출혈경향이 있는 환자를 선별하기 위해 반드시 혈액학적인 검사가 선행되어야 한다. 저자들은 정상적인 32세 남자가 축구 경기 도중 공을 차는 동작에서 발생한 장골근 파열 및 혈종의 압박으로 인한 부분적인 대퇴신경 마비의 증례를 경험하고 6개월간 추시 관찰하였으며, 양호한 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.90-94
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• 2006

Objective : Acute vertebral burst fractures warrant extensive fixation and fusion on the spine. Osteoplasty [vertebroplasty with high density resin without vertebral expansion] has been used to treat osteoporotic vertebral compression fractures. We report our experiences with osteoplasty in acute vertebral burst fractures. Methods : Twenty-eight cases of acute vertebral burst fracture were operated with osteoplasty. Eighteen patients had osteoporosis concurrently. Preoperative MRI was performed in all cases to find fracture level and to evaluate the severity of injury. Preoperative CT revealed burst fracture in the series. The patients with severe ligament injury or spinal canal compromise were excluded from indication. Osteoplasty was performed under local anesthesia and high density polymethylmethacrylate[PMMA] was injected carefully avoiding cement leakage into spinal canal. The procedure was performed unilaterally in 21 cases and bilaterally in 7 cases. The patients were allowed to ambulate right after surgery. Most patients discharged within 5 days and followed up at least 6 months. Results : There were 12 men and 16 women with average age of 45.3[28-82]. Five patients had 2 level fractures and 2 patients had 3 level fractures. The average injection volume was 5.6cc per level Average VAS [Visual Analogue Scale] improved 26mm after surgery. The immediate postoperative X-ray showed 2 cases of filler spillage into spinal canal and 4 cases of leakage into the retroperitoneal space. One patient with intraspinal leakage was underwent the laminectomy to remove the resin. Conclusion : Osteoplasty is a safe and new treatment option in the burst fractures. Osteoplasty with minimally invasive technique reduced the hospital stay and recovery time in vertebral fracture patients.

• Neurospine
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• 제15권4호
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• pp.368-375
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• 2018

Objective: To evaluate the results of operative management of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion with a cervical locking plate and autologous bone-filled titanium mesh cage. Methods: This study included 23 patients with a subaxial spine injury who matched the inclusion criteria, underwent 2-level anterior cervical corpectomy and fusion at our institution between 2013 and 2016, and were followed up for neurological recovery, axial pain, fusion, pseudarthrosis, and implant failure. Results: According to Allen and Ferguson classification, there were 9 cases of distractive extension; 4 of compressive extension; 3 each of compressive flexion, vertical compression, and distractive flexion; and 1 of lateral flexion. Sixteen patients had a score of 6 on the Subaxial Injury Classification system, and the rest had a score of more than 6. The mean follow-up period was 19 months (range, 12-48 months). Neurological recovery was observed in most of the patients (78.21%). All patients experienced relief of axial pain. None of the patients received a blood transfusion. Twenty-one patients (91.3%) showed solid fusion and 2 (8.69%) showed possible pseudarthrosis, with no complications related to the cage or plate. Conclusion: Two-level anterior cervical corpectomy and fusion, along with stabilization with a cervical locking plate and autologous bone graft-filled titanium mesh cage, can be considered a feasible and safe method for treating specific subaxial spine injuries, with the benefits of high primary stability, anatomical reduction, and direct decompression of the spinal cord.

• 대한정형외과학회지
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• 제54권2호
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• pp.187-191
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• 2019

척추 경막외 혈종은 자연적으로 혹은 외상에 의해 발생할 수 있으며 혈관구조 이상이나 응고장애의 기저질환을 갖고 있는 환자에서 호발한다. 대부분의 척추 경막외 혈종은 명확한 이유 없이 자연적으로 발생하며 외상에 의해 발생하는 경막외 혈종은 전체 척추 손상의 1.0%-1.7% 미만으로 흔하지 않다. 저 에너지 손상에 의한 골다공증성 척추 압박골절 이후 지연성으로 발생한 척추 경막외 혈종이 마미증후군을 일으키는 사례는 드물게 보고되고 있다. 저자들은 고령에서 저 에너지 손상에 의한 척추 압박골절로 인해 지연성으로 혈종발생 후 마미증후군이 발생한 사례를 경험하였고 아직 국내에 보고된 사례가 없어 이를 문헌 고찰과 함께 보고하고자 한다.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1055-1062
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• 2000

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

• Tuberculosis and Respiratory Diseases
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• 제51권2호
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• pp.161-165
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• 2001

저자 등은 다량의 흉막유출로 반대측 폐의 일부 허탈과 폐부종을 보이는 만성 간질환 환자의 호흡곤란의 경감을 위하여 시행한 흉강천자 후 발생한 양측성 재팽창성 폐부종(reexpansion pulmonary edema)과 이로 인한 급성호흡곤란증후군을 경험하고 이를 문헌고찰과 함께 보고하는 바이다.

• 대한족부족관절학회지
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• 제7권1호
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• pp.109-114
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• 2003

Purpose: The purpose of this study is to evaluate the effectiveness and indications of the modified Essex-Lopresti reduction in calcaneal fractures. Materials and Methods: We reviewed retrospectively 41 cases of displaced intraarticular calcaneal fractures. The fracture was reduced with Essex-Lopresti technique with modification in compression of the lateral wall with the specially designed compression device instead of the operator's hands. We evaluated the results of treatment by AOFAS scale and the radiographic parameters including the Bohler's angle, calcaneal width, calcaneofibular distance and the congruency of the posterior facet. Results: Boler's angle was restored from 11 to 29.6 degrees on average, heel width was reduced to 112% of contralateral value, the calcaneofibular gap was restored up to 87.9% of contralateral side, and the articular surface of the posterior facet was restored less than 2 mm of step off and less than 2 mm of gap. AOFAS scale averaged 87 points. The quality of reduction was best in Sander's type II fractures. Small sized fragments in type III fractures could not be reduced. The results were better when the reductions were performed within 24 hours of injury. Conclusion: The modified Essex-Lopresti reduction was less invasive, easy to perform, and the results of treatment were similar to those of open reduction; it seemed to be a reasonable alternative for the selected intraarticular calcaneal fractures.