• Journal of Korean Neurosurgical Society
• /
• 제54권3호
• /
• pp.225-231
• /
• 2013

Objective : Spinal dysraphism defects span wide spectrum. Wound dehiscence is a common postoperative complication, and is a challenge in the current management of cerebrospinal fluid (CSF) leaks and wound healing. The purpose of this study is to evaluate the risks of CSF-related morbidity in the surgical treatment of spinal dysraphism. Methods : Ten patients with spinal dysraphism were included in this retrospective study. The median age of the cohort was 4.8 months. To assess the risk of CSF morbidity, we measured the skin lesion area and the percentage of the skin lesion area relative to the back surface for each patient. We then analyzed the relationship between morbidity and the measured skin lesion area or related factors. Results : The overall median skin lesion area was 36.2 $cm^2$ (n=10). The percentage of the skin lesion area relative to the back surface ranged from 0.6% to 18.1%. During surgical reconstruction, 4 patients required subsequent operations to repair CSF morbidity. The comparison of the mean area of skin lesions between the CSF morbidity group and the non-CSF morbidity group was statistically significant (average volume skin lesion of $64.4{\pm}32.5cm^2$ versus $27.7{\pm}27.8cm^2$, p<0.05). CSF morbidity tended to occur either when the skin lesion area was up to 44.2 $cm^2$ or there was preexisting fibrosis before revision with an accompanying broad-based dural defect. Conclusion : Measuring the lesion area, including the skin, dura, and related surgical parameters, offers useful information for predicting wound challenges and selecting appropriate reconstructive surgery methods.

• Journal of Korean Neurosurgical Society
• /
• 제40권2호
• /
• pp.79-83
• /
• 2006

Objective : The purpose of this study was to describe a surgical technique of axillary approach of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation and its preliminary results. Methods : From July 2002 to September 2003, 101 patients with lumbar radiculopathy due to L5-S1 disc herniation, who were treated by percutaneous interlaminar endoscopic discectomy, were retrospectively reviewed. There were 57 males and 44 females with a mean age of 44.8 years [range, 18 to 62 years]. The surgery consisted of needle insertion into the epidural space via the interlaminar space, sequential dilatation, and endoscopic discectomy through the axillary area of the S1 root. Results : The mean follow-up period was 14.5 months and the average surgical time was 41 min. According to the modified Macnab criteria, 44 patients [43.6%] had excellent outcomes, 49 [48.5%] had good results and only 8 [78%] had fair or poor outcomes. Four patients had a revision microdiscectomy due to incomplete removal of disc fragment. There were no major complications related to this surgical approach. Conclusion : Axillary approach of percutaneous endoscopic interlaminar discectomy is safe and effective procedure for the treatment of L5-Sl disc herniation. It combines the advantages of MED and conventional percutaneous endoscopic discectomy.

• Journal of Korean Neurosurgical Society
• /
• 제54권4호
• /
• pp.317-322
• /
• 2013

Objective : The surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA. Methods : From February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects. Results : The mean tumor volume was 11.7 $cm^3$, and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis. Conclusion : The endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.

• Journal of Korean Neurosurgical Society
• /
• 제60권2호
• /
• pp.174-180
• /
• 2017

Objective : Proximal junctional kyphosis (PJK) is radiologic finding, and is defined as kyphosis of >$10^{\circ}$ at the proximal end of a construct. The aim of this study is to identify factors associated with PJK after segmental spinal instrumented fusion in adults with spinal deformity with a minimum follow-up of 2 years. Methods : A total of 49 cases of adult spinal deformity treated by segmental spinal instrumented fusion at two university hospitals from 2004 to 2011 were enrolled in this study. All enrolled cases included at least 4 or more levels from L5 or the sacral level. The patients were divided into two groups based on the presence of PJK during follow-up, and these two groups were compared to identify factors related to PJK. Results : PJK was observed in 16 of the 49 cases. Age, sex and mean follow-up duration were not statistically different between two groups. However, mean bone marrow density (BMD) and mean back muscle volume at the T10 to L2 level was significantly lower in the PJK group. Preoperatively, the distance between the C7 plumb line and uppermost instrumented vertebra (UIV) were no different in the two groups, but at final follow-up a significant intergroup difference was observed. Interestingly, spinal instrumentation factors, such as, receipt of a revision operation, the use of a cross-link, and screw fracture were no different in the two groups at final follow-up. Conclusion : Preoperative BMD, sagittal imbalance at UIV, and thoracolumbar muscle volume were found to be strongly associated with the presence of PJK.

• Clinics in Shoulder and Elbow
• /
• 제14권1호
• /
• pp.146-152
• /
• 2011

목적: 주관절 전지환 성형술의 최근 수술 결과와 합병증에 대하여 문헌을 토대로 기술하고자 한다. 대상 및 방법: 주관절 전치환술의 적응증은 다른 수술 방법으로 관절 기능의 회복이 불가능한 류마토이드 관절염, 외상후 관절염, 관절 강직, 종양 제거 후 상태, 그리고 고령의 원위 상완골 분쇄 골절 등이 있다. 합병증으로는 가장 심각한 합병증인 감염을 비롯하여 삽입물 이완, 삽입물 골절, 삽입물 주위 골절, 척골 신경병증, 이소성 골화, 상완 삼두근 손상, 탈구를 포함한 불안정, bushing의 마모 등이 있다. 결과 및 결론: 재치환술을 기준으로 한 주관절 치환술의 수명은 10년을 기준으로 85% 정도인 것으로 알려져 있다. 염증성 관절염이 가장 예후가 좋으며 외상후 관절염의 이완율이 비교적 높다. 합병증은 다른 관절의 치환술에 비해 많이 발생하는 경향이 있으며 특히 심부 감염은 3~5% 정도로 높은 편이다. 주관절 치환술은 재건술로 관절 기능을 회복할 가능성이 없는 활동력이 높지 않은 환자에 대해 신중하고 적절하게 시행한다면 만족스러운 기능 회복을 기대할 수 있다.

• 보건행정학회지
• /
• 제7권2호
• /
• pp.46-64
• /
• 1997

Background & Objectives : Korea is face with the social need for health care technology assessment so that it is urgently needed to found principles and methodology in technology assessment in health care. As a groundwork for health care technology assessment, we tried to prioritize medical technology for assessment. Among medical technologies, procedure is somewhat difficult to assess, compared to drug or equipment. In this study, we aimed at the prioritisation of medical procedure to be assessed, in terms of efficay, safety, and adequacy. Method : For the standardized classification of medical procedure, ICD-9-CM(International Classification of Diseases 9th edition - Clinical Modification) was used. Among the list the procedures coming under otorhinolaringjology and thoracic surgery were selected by three family physicians. The list of procedure was mailed to the board certified surgeons of both disciplines, with the question asking about the necessity for assessment in terms of efficay, safety, and adequacy. Replied questionnaires were analyzed in each procedure. Results : Of 560 otorhinolaryngologist and 480 thoracic surgeon, 114 surgeons replied. Of otorhinolaryngological procedure, incision, excision, and destruction of inner ear : fenestration of inner ear : stapedectomy and its revision were the most urgent technology to assess in the aspect of safety. For adequacy, operations on Eustachian tube: fenestration of inner ear: incision, excision, and destruction of inner ear were highly ranked in necessity, and for efficary, operations on Eustachian tube; external maxillary antrotomy; fenestration of inner ear. Thoracic surgeons replied thoracic procedures, lung transplantation; heart transplantation; implantation of heart assist system [pump] are most important for evaluation in terms of safety; and heart transplantation; Lung transplantation; Implantation of heart assist system [pump] in terms of adequacy, and surgical collapse of lung [Artificia니 pnemothorax or pnuexoperitoeum]; lung transplantation; periarterial sympathectomy in terms of efficacy. As a whole, surgeons regard safety evaluation is more urgent than adequacy or efficary. In addition, otorhinolaryngological surgeons regard evaluation of their procedures more urgent than thoracic surgeons regard theirs. Conclusion : By the questionnaire to board certified physicians, we get some preliminary data for prioritisation of technologies to assess. Through the questionnaire like this, much information would be gathered for technology assessment, especially for medical procedure, if not enough. In the near future, well structured expert opinion gathering research, such as modified Delphi or nominal group technique, should be done succeedingly.

• Archives of Plastic Surgery
• /
• 제46권5호
• /
• pp.426-432
• /
• 2019

Background The mandible is an important structure that is located in the lower third of the face. Large mandibular defects after tumor resection cause loss of its function. This study assessed the outcomes and tumor recurrence after immediate mandibular reconstruction using a free fibula osteocutaneous flap following radical resection of ameloblastoma. Methods This is a retrospective non-randomized study of outcomes and tumor recurrence of all patients diagnosed with mandibular ameloblastoma from August 1997 until August 2017 (20 years) requiring free fibula osteocutaneous flap reconstruction at a single institution. The patients were identified through an electronic operative database; subsequently, their medical records and photo documentation were retrieved. Results Twenty-seven patients were included in this study. Eighteen patients were male, while nine were female. The majority of the patients (48.1%) were in their third decade of life when they were diagnosed with ameloblastoma. All of them underwent radical resection of the tumor with a surgical margin of 2 cm (hemimandibulectomy in cases with a large tumor) and immediate mandibular reconstruction with a free fibula osteocutaneous flap. Two patients required revision of a vascular anastomosis due to venous thrombosis postoperatively, while one patient developed a flap recipient site infection. The flap success rate was 100%. There was no tumor recurrence during a mean follow-up period of 5.6 years. Conclusions Mandibular ameloblastoma should be treated with segmental mandibulectomy (with a surgical margin of 2 cm) to reduce the risk of recurrence. Subsequent mandibular and adjacent soft tissue defects should be reconstructed immediately with a free fibula osteocutaneous flap.

• Clinics in Shoulder and Elbow
• /
• 제27권1호
• /
• pp.3-10
• /
• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• 대한정형외과학회지
• /
• 제56권1호
• /
• pp.26-33
• /
• 2021

목적: 슬관절 전치환술 후 발생한 대퇴 삽입물 주위 골절에 이중 금속판을 이용한 고정술 후 결과를 평가하고자 한다. 대상 및 방법: 2007년 10월부터 2013년 2월까지 슬관절 전치환술 후 발생한 대퇴골 삽입물 주위 골절 23예 중 Lewis와 Rorabeck의 분류상 II형으로 삽입물 이완은 없으나 과상부 분쇄골절이거나 골절선이 외상과까지 연장됐거나 주대(stem)가 있어 편측 고정만으로 골절부의 안정성을 얻을 수 없다고 판단한 경우에 내, 외측 이중 금속판을 이용하여 내고정술을 시행하고 최소 1년 이상 추시가 가능했던 13예를 대상으로 하였다. 환자의 평균 연령은 72세(65-82세)였고 여자가 11예, 남자가 2예였다. 수상 기전은 낙상이 9예, 교통사고가 4예였다. 류마티스관절염 1예를 제외하고 12예에서 골관절염으로 슬관절 전치환술을 받았고 3예에서 재치환술 등의 이유로 주대가 있었다. 슬관절 전치환술 후 골절 발생까지의 평균 기간은 28개월(1-108개월)이었고, 술 전 환자의 평균 골밀도는 T score -3.2 (-1.7에서 -4.4)였으며, 평균 추시기간은 23개월(12-65개월)이었다. 수술법은 골절부의 내측에 먼저 광근 하방으로 접근하여 해부학적 정복을 시행하고 금속판으로 내고정을 시행한 후 추가로 외측에 최소 절개법을 통해 잠김 압박 금속판을 사용하여 내고정하였다. 골유합 기간 및 합병증, 최종 추시 시 Hospital for Special Surgery Knee Score (HSS)를 평가하였다. 결과: 평균 골유합 기간은 17.4주(7-40주)였으며 2예에서 지연 유합이 발생하였으나 추가적 수술 없이 36주와 40주에 골유합을 얻었다. 1예에서 불유합이 발생하여 재고정술 및 자가골 이식술을 시행 후 3개월에 완전한 골유합을 얻었다. 최종 추시 시 전후방각형성은 평균 2.86도(0-4.9도), 내외반 각형성은 평균 1.67도(-1.2-4.9도)로 전체 예에서 부정 유합은 없었다. 최종 추시 시 슬관절 운동 범위는 평균 90도였고, HSS 점수는 평균 85점(70-95점)이었다. 결론: 슬관절 전치환술 후 발생한 대퇴골 삽입물 주위 골절 시 편측 고정만으로 골절부의 안정성을 얻을 수 없는 경우 이중 금속판을 이용한 내고정술은 안정적인 고정으로 빠른 재활이 가능하고 임상적으로 양호한 결과를 얻을 수 있는 방법으로 생각된다.

• 대한정형외과학회지
• /
• 제54권1호
• /
• pp.52-58
• /
• 2019

목적: 슬관절 전치환술 후 진균에 의한 감염은 드물지만 심각한 합병증으로 알려져 있으며 그 치료에 있어 항진균제 투여 기간이나 수술의 방법에 대해서는 이견이 있다. 이에 저자들은 인공 관절 주위 진균 감염에 대한 치료 결과 및 임상경과를 알아보고자 하였다. 대상 및 방법: 2006년부터 2017년까지 슬관절 전치환술 후 진균 감염으로 계명대학교 동산의료원에서 2단계 재치환술을 시행받은 10명의 환자를 같은 기간 비진균 인공 슬관절 주위 감염으로 치료받은 119명의 환자와 비교하였다. 임상적 평가는 2단계 재치환술에 의한 감염 조절의 실패율과 감염의 재발률 및 정주용 항생제 및 항진균제 사용기간, 2단계 재치환술 후 관절 운동 범위, 한국형 슬관절 점수(Korean knee score, KKS), 적혈구 침강속도(erythrocyte sedimentation rate, ESR), C-반응성 단백질(C-reactive protein, CRP)을 평가하였다. 결과: 진균이 동정된 군 총 10예 중 7예(70.0%)에서 감염조절의 실패를 보였고 일반 감염군 119예 중 7예(5.9%)에서 감염조절의 실패를 보였다(p=0.04). 진균이 동정된 군에서는 정주용 항진균제의 평균 사용기간은 15.3주로 일반 감염군에서의 정주용 항생제 평균 사용기간인 6.2주에 비해 9.1주 더 길었다(p<0.001). 감염 조절술 시행 전 슬관절 운동 범위는 두 군에서 모두 증가하였다(p=0.265). 최종 추시 시 KKS는 일반 감염군에서 평균 71.01점으로 나타났고 진균이 동정된 군에서 61.3점이었다(p=0.012). ESR과 CRP는 두 군에서 모두 감소하였으나 CRP만 두 군 간에 유의한 차이를 보였다(p=0.007). 결론: 슬관절 전치환술 후 발생한 인공관절 주위 진균 감염에 대한 수술적 치료는 일률적으로 양호한 결과를 보이지 않으므로 감염 조절술 시행 시 항진균제 혼합 시멘트 삽입과 재치환술 후 경구용 항진균제 사용을 고려하는 것이 필요하다.