• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.58-65
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• 2000

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.114-119
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• 2018

Background: The ideal absorbable plating system should provide sufficient rigidity and then be absorbed within a timely manner. The Resorb-X has been recently developed as a plating system with a mixture ratio of 50:50 poly(D, L-lactide). Methods: We present seven of 121 patients who experienced delayed degradation with this absorbable plate. One hundred twenty-one patients with facial bone fracture underwent surgical treatment from March 2011 to March 2015, and rigid fixation was achieved with the Resorb-X. Results: Of 121 patients, seven (5.8%) developed complications at the surgical sites. Six of 102 cases underwent fixation of the infraorbital rim and one of 73 underwent fixation of the frontozygomatic buttress; the other sites of fixation did not develop delayed degradation. Foreign body granuloma developed at the earliest by postoperative 20 months and at the latest by postoperative 28 months (average, 23.5 months). Conclusion: We observed that the use of absorbable plates in incision sites or areas with thin skin can increase the possibility of delayed degradation. When performing surgery in these areas, the normal skin above the fixed location should be covered sufficiently.

• Clinics in Shoulder and Elbow
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• 제16권2호
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• pp.123-129
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• 2013

서론: 불안정성 쇄골 원위부 골절에 대하여 변형된 경견봉 강선 고정술과 갈고리형 금속판 고정술을 시행 후 결과를 비교하였다. 대상 및 방법: Neer 분류 제 2형 골절에 대하여 경견봉 강선 고정술 혹은 갈고리형 금속판 고정술을 시행하고 1년 이상 추시가 가능하였던 24명을 대상으로 하였다. 경견봉 강선 고정술(group I)을 시행한 경우가 12명, 갈고리형 금속판 고정술(group II)을 시행한 경우가 12명이었다. 정복 및 골유합의 평가는 수술 직후 및 최종 방사선 사진을 이용하였고, 기능적 평가는 최종 추시 시의 UCLA score 및 Constant-Murley score를 측정하여 비교하였다. 결과: 수술 뒤 group I은 평균 10주, group II는 평균 11.7주에 모든 예에서 골유합을 관찰할 수 있었다. 최종 추시 시의 평균 UCLA score는 group I은 33점, group II는 32.8점이었으며, 평균 Constant score는 group I은 88.5점, group II는 88.8점으로 두 기능적 평가 결과 통계적으로 유의한 차이는 없었다. 결론: Neer 분류 제 2형 원위 쇄골 골절에서 경견봉 강선 고정술과 갈고리형 금속판 고정술은 만족할 만한 결과를 얻을 수 있어 모두 유용한 방법으로 생각된다.

• Journal of Trauma and Injury
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• 제23권2호
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• pp.175-179
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• 2010

Purpose: Sternal fractures after blunt thoracic trauma can cause significant pain and disability. They are relatively uncommon as a result of direct trauma to the sternum and open reduction is reserved for those with debilitating pain and fracture displacement. We reviewed consecutive 11 cases of open reduction and fixation of sternum and tried to find standard approach to the traumatic sternal fractures with severe displacement. Methods: From December 2008 to August 2010, the medical records of 11 patients who underwent surgical reduction and fixation of sternum for sternal fractures with severe displacement were reviewed. We investigated patients' characteristics, chest trauma, associated other injuries, type of open reduction and fixation, combined operations, preoerative ventilator support and postoperative complications. Results: The mean patient age was 59.3years (range, 41~79). The group comprised 6 male and 5 female subjects. Among 11 patients who underwent open reduction and fixation for sternal fracture with severe displacement, 6 cases had isolated sternal fractures and the other 5 patients had associated other injuries. Sternal fractures were caused by car accidents (9/11, 81.8%), falling down (1/11, 9.1%) and direct blunt trauma to the sternum (1/11, 9.1%), respectively. 3 of the 7 patients (42.9%) who underwent sternal plating with longitudinal plates showed loosening of fixation. Otherwise, none of the 4 patients who underwent surgical fixation using T-shaped plate had stable alignment of the fracture. Conclusion: Sternal fractures with severe displacement need to be repaired to prevent chronic pain, instability of the anterior chest wall, deformity of the sternum, and even kyphosis. In the present study, a T-shaped plate with a compression-tension mechanism constitutes the treatment of choice for displaced sternal fractures.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.138-144
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• 2018

Background: Subacromial erosion remains a major concern after surgical fixation of acromioclavicular (AC) joint using a clavicular hook plate. To minimize postoperative subacromial erosion, we investigated the structural relationship between distal clavicle and acromion around the AC joint by considering the surgical fixation of the joint using the hook plate technique. Methods: Computed tomography scans of 101 AC joints without any inherent pathology were analyzed. The angle between the distal clavicle and acromion around the AC joint (AC angle), depth of the acromion, differences in height between distal clavicle and acromion (AC height difference), and thickness of distal clavicle and acromion at the AC joint were measured. Descriptive statistics were calculated for each anatomical parameter, and all results were compared between gender groups. Results: The mean AC angle was $17.1^{\circ}$(range, $-8.0^{\circ}$ to $39.0^{\circ}$), and the mean AC height difference was 3.5 mm (range, -0.7 to 8.7 mm). Both factors showed very high variability (coefficients of variation=62.6% and 46.6%, respectively). The mean AC angle was significantly higher in the female gender than in the male gender ($19.8^{\circ}$ vs. $13.8^{\circ}$, p=0.048). The mean acromion thickness and distal clavicular thickness were both significantly thinner in the female group than in the male group (p<0.001). Conclusions: Taken together, we believe our results might be helpful in minimizing postoperative subacromial erosion when performing surgical fixation of the AC joint using the hook plate, and be valuable in improving future design of the hook plate.

• Journal of Korean Neurosurgical Society
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• 제50권5호
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• pp.441-445
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• 2011

Objective : There are technical limitations of multi-level posterior pedicle screw fixation performed by the percutaneous technique. The purpose of this study was to describe the surgical technique and outcome of minimally invasive multi-level posterior lumbar interbody fusion (PLIF) and to determine its efficacy. Methods : Forty-two patients who underwent mini-open PLIF using the percutaneous screw fixation system were studied. The mean age of the patients was 59.1 (range, 23 to 78 years). Two levels were involved in 32 cases and three levels in 10 cases. The clinical outcome was assessed using the visual analog scale (VAS) and Low Back Outcome Score (LBOS). Achievement of radiological fusion, intra-operative blood loss, the midline surgical scar and procedure related complications were also analyzed. Results : The mean follow-up period was 25.3 months. The mean LBOS prior to surgery was 34.5, which was improved to 49.1 at the final follow up. The mean pain score (VAS) prior to surgery was 7.5 and it was decreased to 2.9 at the last follow up. The mean estimated blood loss was 238 mL (140-350) for the two level procedures and 387 mL (278-458) for three levels. The midline surgical scar was 6.27 cm for two levels and 8.25 cm for three level procedures. Complications included two cases of asymptomatic medial penetration of the pedicle border. However, there were no signs of neurological deterioration or fusion failure. Conclusion : Multi-level, minimally invasive PLIF can be performed effectively using the percutaneous transpedicular screw fixation system. It can be an alternative to the traditional open procedures.

• Archives of Plastic Surgery
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• 제38권3호
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• pp.257-262
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• 2011

Purpose: In neurofibromatosis patients, complete surgical excision of the mass is almost impossible and surgical treatment usually consists of multiple serial excisions that only result in a debulking effect. Remnant tumor mass has a gravitational effect on facial soft tissues that leads to sagging of skin and soft tissue, and eventually, facial disfigurement and asymmetry. The purpose of our surgical method is to perform soft tissue lifting with longer lasting effect with less surgical risk of damaging facial nerve and vessels. With external fixation using K-wire or surgical screw, the procedure only called for a short incision length and had additional adhesive properties that enabled anchoring of soft tissue in a lifted position for a longer postoperative period. Methods: A total of 5 neurofibromatosis patients (NF-1) visited our clinic for mass reduction and face lifting. The age of patients ranged from 13 to 42 (mean 28.8 years), and most patients had a long history of multiple excisions in the past. Face lifting was performed in 2 different areas, the periorbital area in 3 patients, and the midface in 2 patients. The materials used in fixation of retaining ligament were K-wire (n=3) and titanium screw (n=2). Results: Follow up period was from 5 month to 3 years and 1 month (mean=2 years and 1 month). All patients conveyed satisfaction with the results and no major complications were reported. The lifting effect lasted for as long as 3 years, and there were no complaints of relapse of soft tissue depression or sagging within the operated area. 1 patient (M/13) needed secondary k-wire insertion and additional mass excision in 1 year and 10 months postoperatively due to tumor growth. In two patients with K-wire fixation, mild dimpling and tenderness were observed in the follow up period, but in about 2 months postoperatively, dimpling was relieved and there was no need for removal of fixating material. Conclusion: Surgical lifting in neurofibromatosis patients can be challenging, for mass excision cannot be done completely and gravitational effect by residual mass can be persistent. External fixation of the retaining ligament in patients with neurofibromatosis can give satisfactory results-for incision length is relatively shorter, and the lifting effect can last longer compared to other various face lifting techniques.

• 한국임상수의학회지
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• 제25권3호
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• pp.215-217
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• 2008

Medical records from the Veterinary Medical Teaching Hospital of the University of Missouri-Columbia from 2004 to 2007 were available for 28 raptors that underwent long bone fracture repair. There were 14 owls, 10 hawks, 2 vultures, 1 eagle, and 1 falcon. Mean body weight was 780 g (ranged from 150 to 1400 g) for 14 owls; 650 g (ranged from 150 to 1270 g) for 10 hawks; 1760 g (ranged from 1520 to 2000 g) for 2 vultures; 5000 g for 1 eagle; and 130 g for 1 falcon. Of all 28 fracture cases, 11 cases (39%) and 1 case (3%) were related to hit-by-car and shooting respectively. Physical examination revealed dehydration in 18 raptors (64%) and lethargy in 12 raptors (42%). Forty one long bone fractures were included in 28 cases. The radiographs revealed 13 ulnar fractures (32%), 12 humeral fractures (30%), 10 radial fractures (25%), 4 tibiotarsal fractures (9%), 1 femoral fracture (2%), and 1 fibular fracture (2%). External skeletal fixation using polymethylmethacrylate (PMMA) combined with intramedullary fixation was used in 19 long bone fractures (46%). Intramedullary fixation using intramedullary Kirschner pin was used in 16 long bone fractures (39%). No surgical treatment was performed in 6 long bone fractures (15%). This study reported that many of raptors presented dehydration and lethargy when admitted for treatment. Therefore, proper hydration and nutrition are critical pre-surgical requirements. In addition, combination of internal fixation and external skeletal fixation using PMMA might be better option to treat raptors with comminuted fracture that results from mostly trauma of hit-by-car.

• Journal of Korean Neurosurgical Society
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• 제53권2호
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• pp.83-88
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• 2013

Objective : The authors reviewed their experiences of combined surgery (open door laminoplasty with unilateral screw fixation) for unstable multi-level cervical stenosis, to clarify the situation regarding the surgical approach most appropriate for the treatment of diffuse unstable multi-level cervical stenosis. Methods : From January 2011 to January 2012, combined surgery was performed for unstable multi-level cervical stenosis by one surgeon at our institution. The subjects of this study were 6 men of mean age 53.7 years (range, 48-71) with a mean follow-up of 9.3 (range, 3-14) months. All imaging studies showed severe multi-level cervical stenosis with spinal cord signal change, and instability or kyphotic deformity. A retrospective review of clinical, radiological, and surgical data was conducted. Results : Average laminoplasty level was 4.8 and the average screw fixation level was 5.0. Japanese Orthopedic Association score improved from an average of 5.2 to 11.2 points. According to Nurick's grades and Odom's criteria, symptom improvement was statistically significant. On the other hand, Cobb's angle changes were not significant. Average operation time was 5.86 hours with an average blood loss of 460 mL. No significant surgical complication was encountered. Conclusion : Despite the small cohort and the short follow-up duration, the present study demonstrates that laminoplasty with unilateral screw fixation is a safe and effective treatment for unstable multi-level cervical stenosis.

• 대한치과의사협회지
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• 제54권12호
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• pp.1045-1054
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• 2016

Purpose : Aim of this study is to describe and compare clinical results and complications epending on the surgical approaches for the mandibular subcondyle fracture Materials and methods : The patients who had been diagnosed as the mandibular subcondyle fracture and underwent open reduction and internal fixation from May 2009 to December 2014 were included. They were divided into two groups depending on the surgical approaches; endoscopically assisted transoral approach and retromandibular approach. Association between the preoperative fracture classification and post-operative results was reviewed depending on the surgical approaches. Results : The number of patients selected in this study was 33. Eighteen patients (male 7, female 11) underwent open reduction and internal fixation via retromandibular approach and fifteen patients (male 12, female 3) underwent open reduction and internal fixation via endoscopically assisted transoral approach. The mean age, follow up period, and operation time were $44.29{\pm}15.19years$, $9.97{\pm}7.82months$, and $161{\pm}89.44minutes$. Post-operative results were all "good" state in the retromandibular approach group regardless of the fracture classification but two patients in the endoscopically assisted transoral approach group underwent re-operation due to "poor" results. The fracture types of two were classified as displacement and lateral override at the same time. There was no statistically significant difference between two groups. Three patients in the retromandibular approach group had experienced facial nerve palsy (17%) temporarily. No one showed malocclusion in this study. There was no significant difference on the complications such as temporomandibular disorder, local infection, and condyle resorption depending on the surgical approaches. Conclusion : In this study, there was no significant difference on the complications between the two groups but retromandibular approach has advantage over endoscopically assisted transoral approach in case of the severely displaced subcondyle fracture.