• Journal of Chest Surgery
• /
• 제43권1호
• /
• pp.53-57
• /
• 2010

배경: 이 연구는 늑골 수상 후 발생하는 늑간 신경병증에 대한 평가를 위하여 숫자통증등급, 통증 기간 및 체질량 지수에 따른 늑간 신경병증에 대한 심한 정도를 알고자 하였다. 대상 및 방법: 늑골 골절 수상 후 3개월 이상 동안 보존적인 치료에도 불구하고 심한 통증을 호소하는 환자 47명을 대상으로 근전도 검사를 시행하여 흉부의 늑간 및 척추 주위 근육에 대한 평가를 하였다. 결과: 47명 중에서 11명에 대하여 늑간 신경병증의 진단을 얻을 수 있었으며, 남자 8명과 여자 3명이었으며, 그 연령은 직업적으로 활동적인 연령대였다. 늑간 신경병증이 호발하는 부위는 7번부터 12번 부위 늑골 골절의 늑간이었다. 그 빈도는 단일 골절보다는 다발성 골절과 밀접한 상관 관계를 알 수 있었다. 그 증상으로는 흉통(90.9%), 감각이상(81.8%), 무감각(63.6%), 후부 흉통(27.2%), 그리고 근위축(18.2%) 순이었다. 근전도에 의한 숫자통증등급, 통증 기간 및 체질량 지수와 관계는 없었다. 결론: 늑골 골절수상 후 3개월 이상 지속적인 통증을 호소하는 환자에서 지속적인 늑간 신경통에 대한 진단을 위한 평가로 근전도가 도움이 될 수 있다.

• Archives of Plastic Surgery
• /
• 제40권4호
• /
• pp.359-366
• /
• 2013

Background Pedicled transverse rectus abdominis musculocutaneous flaps typically sacrifice the entire muscle. In our experience, the lateral strip of the rectus abdominis muscle can be spared in an attempt to maintain function and reduce morbidity. When the intercostal nerves are injured, muscle atrophy appears with time. The severed intercostal nerve was reinserted into the remnant lateral strip of the rectus abdominis muscle to reduce muscle atrophy. Methods The authors retrospectively reviewed 9 neurotized cases and 10 non-neurotized cases. Abdominal computed tomography was performed to determine the area of the rectus muscles. Electromyography (EMG) was performed to check contractile function of the remnant muscle. A single investigator measured the mean areas of randomly selected locations (second lumbar spine) using ImageJ software in a series of 10 cross-sectional slices. We compared the Hounsfield unit (HU) pre- and postoperatively to evaluate regeneration quality. Results In the neurotization group, 7 of 9 cases maintained the mass of remnant muscle. However, in the non-neurotization group, 8 of 10 lost their mass. The number of totally atrophied muscles in each of the two groups was significantly different (P=0.027). All of the remnant muscles showed contractile function on EMG. The 9 remaining remnant rectus abdominis muscles showed declined the HU value after surgery but also within a normal range of muscle. Conclusions Neurotization was found to be effective in maintaining the mass of remnant muscle. Neurotized remnant muscle had contractile function on EMG and no fatty degeneration by HU value.

• Journal of Chest Surgery
• /
• 제51권5호
• /
• pp.344-349
• /
• 2018

Background: We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. Methods: Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). Results: Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. Conclusion: Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon's experience, for appropriately selected patients.