• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.791-798
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• 2021

Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI. Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study. Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039). Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.

• Journal of Korean Neurosurgical Society
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• 제66권1호
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• pp.90-94
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• 2023

Objective : Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. Methods : A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. Results : There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. Conclusion : In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

• Journal of Korean Neurosurgical Society
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• 제65권1호
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• pp.64-73
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• 2022

Objective : To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK). Methods : From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups. Results : Twenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups. Conclusion : In cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.

• 한국전통조경학회지
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• 제36권3호
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• pp.115-127
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• 2018

천연기념물 제214호 진안 평지리 이팝나무군의 고사(枯死) 및 쇠약(衰弱) 요인의 명확한 진단(診斷)과 처방(處方)을 통한 천연기념물로서의 가치 존속(存續) 방안을 강구하고자 시도된 본 연구의 결과는 다음과 같다. 첫째, 1968년 13그루의 천연기념물 지정 이후, 1973년을 시작으로 근년까지 계속적으로 고사가 진행되어 현재는 3주만 생존하고 있다. 특히 2010년 이후 마령초등학교 담장 후퇴 등 정비과정에서 복토된 토양의 일부 제거에도 불구하고, 계속적으로 고사가 이루어진 것으로 확인된다. 둘째, 지정목 중 1 3번 생존목 또한 고사된 가지가 많고, 잎이 왜소하며, 엽량이 적었다. 1번목은 수세가 '극히 불량'하고 다량의 가지가 이미 고사하였으며, 금년에는 단지 2개 가지에서만 개화가 이루어졌으며 엽량 또한 현저히 적은 상태이다. 2번목 또한 '불량'상태로 잎이 작고 엽밀도도 낮으며 수형의 변형이 이루어지는 등 수세가 쇠약한 상태이다. 현존하는 가장 큰 1번목은 논토양으로 추정되는 점질토가 복토되어 있어 우려를 더하고 있다. 셋째, 평지리 이팝나무군의 토성 분석결과, '미사질양토[微砂質壤土, Silt loam(SiL)]'로 밝혀짐에 따라 미사(Silt)의 성분비가 높음을 알 수 있다. 또한 1번목 북측의 토양산도는 pH 6.6으로 다른 부위의 흙과는 편차가 컸는데 이는 원지반 토양이 아닌 외부에서 반입된 토양으로 복토되었음에 기인한 것으로 판단된다. 더불어 유기물함량은 적정범위보다 높게 나타났는데 이는 보호관리를 위한 시비가 계속적으로 이루어진 결과가 반영된 것이라고 판단된다. 넷째, 진안 평지리 이팝나무군의 고사 및 생육 불량의 근본적 원인으로는 복토(覆土)로 인한 심각한 생리저하의 만성적 증후군으로 판단된다. 이는 신규로 식재된 후계목 또한 일부 고사된 것에서도 그 원인을 찾을 수 있다. 다섯째, 1차적으로 기존 고사의 원인으로 추정되는 복토 부분에 대한 점진적 제거가 시급하다. 무엇보다도 근계부에 복토된 점질토양의 제거를 건의한다. 복토부를 제거한 후 굵은 모래로 치환하고 뿌리의 호흡 개선을 위해 유공관을 설치한다. 그리고 고사한 4번 고사목과 5 6번의 고사흔적인 밑둥은 제근하고, 하층식생은 예초한다. 생존목은 상부 고사지를 제거, 수피 이탈부는 외과수술을 시행하는 한편 생장점 아래에서 전정하여 맹아의 발생을 유도해야 할 것이다. 여섯째, 지하부 뿌리를 확인하여 부패근 절단 및 토양호흡 개선방안을 마련한다. 근계 전반에 대한 추적 굴취 등으로 썩은 뿌리부를 단근하여 새 뿌리의 발생을 유도한다. 일곱째, 이후 잡초 발생과 답압 억제 그리고 토양 보습효과 유지를 위한 멀칭을 시도한다. 또한 지속적 영양공급을 위한 무기양료 엽면시비 및 영양제 나무주사, 무기양료의 토양관주를 고려한다. 향후 모니터링과 예찰방안을 마련하여 계속적으로 변화상을 체크해야 할 것이다.