• 제목/요약/키워드: ventral fixation

검색결과 16건 처리시간 0.025초

Safe Margin beyond Dens Tips to Ventral Dura in Anterior Odontoid Screw Fixation : Analysis of Three-Dimensional Computed Tomography Scan of Odontoid Process

  • Sung, Min-Jae;Kim, Kyoung-Tae;Hwang, Jeong-Hyun;Sung, Joo-Kyung;Cho, Dae-Chul
    • Journal of Korean Neurosurgical Society
    • /
    • 제61권4호
    • /
    • pp.503-508
    • /
    • 2018
  • Objective : Anterior odontoid screw fixation is a safe and effective method for the treatment of odontoid fractures. The surgical technique is recommended for perforation of the apical cortex of the dens by the lag screw. However, overpenetration of the apical cortex may lead to potentially serious complications such as damages of adjacent vascular and neural structures. The purpose of this study was to assess the role of three-dimensional computed tomography (CT) scan to evaluate the safe margin beyond dens tip to ventral dura for anterior odontoid screw fixation. Methods : We retrospectively analyzed the three-dimensional CT scans of the cervical spines in 55 consecutive patients at our trauma center. The patients included 38 males and 17 females aged between 22 and 73 years (mean age${\pm}$standard deviation, $45.8{\pm}14.2years$). Using sagittal images of 3-dimensional CT scan, the safe margins beyond dens tip to ventral dura as well as the appropriate screw length were measured. Results : The mean width of the apical dens tip was $9.6{\pm}1.1mm$. The mean lengths from the screw entry point to the apical dens tip and posterior end of dens tip were $39.2{\pm}2.6mm$ and $36.6{\pm}2.4mm$. The safe margin beyond apical dens tip to ventral dura was $7.7{\pm}1.7mm$. However, the safe margin beyond the posterior end of dens tip to ventral dura was decreased to $2.1{\pm}3.2mm$, which was statistically significant (p<0.01). There were no significant differences of safe margins beyond dens tip to ventral dura with patient gender and age. Conclusion : Extension by several millimeters beyond the dens tip is safe, if the trajectory of anterior odontoid screw is targeted at the apical dens tip. However, if the trajectory of the screw is targeted to the posterior end of dens tip, extension beyond dens tip may lead to damage immediately adjacent to the vental dura mater.

환축추 아탈구 견에서 투시기 유도를 통한 복측 나사 고정술 (Ventral Fixation of Atlantoaxial Joint under Fluoroscopic Guidance Using Screws in a Chihuahua Dog)

  • 이재훈;양희택;양우종;정다정;강은희;엄기동;최치봉;장화석;김휘율
    • 한국임상수의학회지
    • /
    • 제25권2호
    • /
    • pp.131-135
    • /
    • 2008
  • 5연령의 치와와 견이 사지 부전마비를 평가하기 위해서 내원하였다. 내원 시에 보행이 불가능한 사지 부전마비와 목 부위 통증을 보였다. 방사선 상에서 환축추 아탈구와 C1 등쪽의 추궁과 C2의 가시돌기의 거리가 증가 된 소견을 보였다. 외과적 고정은 투시기 유도 하에서 복측 접근을 통하여 2개의 나사(screw)를 사용하여 실시하였으며, 외부 고정(neck brace)을 3주 동안 실시하였다. 수술 후 4주 후 임상증상이 개선되어 보행이 가능 하였으며, 방사선 상에서 고정을 유지하고 있었으며, 나사의 이주 소견은 없었다. 4개월 후에 임상증상이 완전히 회복되었다. 본 증례에서는 복측 나사 고정을 투시기 유도하에서 실시함으로, 나사의 적합한 각도로 위치 시킬 수 있었다.

외상성 흉요추접합부 파열골절의 전측방경유법에 의한 신경감압 및 기구고정술 (Anterolateral Surgical Decompression and Instrumentation in Thoracolumbar Bursting Fracture)

  • 배장호
    • Journal of Yeungnam Medical Science
    • /
    • 제13권2호
    • /
    • pp.234-242
    • /
    • 1996
  • 영남대학교 의과대학 부속병원 신경외과에서 1994년 l월부터 1994년 12월까지 1년간 흉요추접합부 파열골절로 입원한 환자중 전측방경유법으로 10례를 수술로 치료경험 하였던 바, 척추골절이 척수원추 상부이면서 전방의 골편에 의해 척수신경이 압박되고 있는 불안정 파열골절시는 전방도달술에 의한 늑골 골융합 및 Kaneda기기내고정술로 좋은 결과를 기대할 수 있겠고, 척수 후주의 심한 손상이나 또는 3 column을 전체가 손상된 불안정 파열골절의 경우에는 후방접근법이나 후측방접근법으로 신경감압 및 내고정술 시행하는 것이 좋은 치료법이라 할 수 있겠다.

  • PDF

Decompressive Surgery in a Patient with Posttraumatic Syringomyelia

  • Byun, Min-Seok;Shin, Jun-Jae;Hwang, Yong-Soon;Park, Sang-Keun
    • Journal of Korean Neurosurgical Society
    • /
    • 제47권3호
    • /
    • pp.228-231
    • /
    • 2010
  • Posttraumatic syringomyelia may result from a variety of inherent conditions and traumatic events, or from some combination of these. Many hypotheses have arisen to explain this complex disorder, but no consensus has emerged. A 28-year-old man presented with progressive lower extremity weakness, spasticity, and decreased sensation below the T4 dermatome five years after an initial trauma. Magnetic resonance imaging (MRI) revealed a large, multi-septate syrinx cavity extending from C5 to L1, with a retropulsed bony fragment of L2. We performed an L2 corpectomy, L1-L3 interbody fusion using a mesh cage and screw fixation, and a wide decompression and release of the ventral portion of the spinal cord with an operating microscope. The patient showed complete resolution of his neurological symptoms, including the bilateral leg weakness and dysesthesia. Postoperative MRI confirmed the collapse of the syrinx and restoration of subarachnoid cerebrospinal fluid (CSF) flow. These findings indicate a good correlation between syrinx collapse and symptomatic improvement. This case showed that syringomyelia may develop through obstruction of the subarachnoid CSF space by a bony fracture and kyphotic deformity. Ventral decompression of the obstructed subarachnoid space, with restoration of spinal alignment, effectively treated the spinal canal encroachment and post-traumatic syringomyelia.

하악각 골절의 치료 방법에 따른 하악골의 응력 분포 및 변위에 관한 삼차원 유한요소법적 연구 (THE THREE DIMENSIONAL FINITE ELEMENT ANALYSIS OF STRESS DISTRIBUTION AND DISPLACEMENT IN MANDIBLE ACCORDING TO TREATMENT MODALITIES OF MANDIBULAR ANGLE FRACTURES)

  • 구제훈;김일규;장재원;양정은;사시카라 바라라만;왕붕
    • Maxillofacial Plastic and Reconstructive Surgery
    • /
    • 제32권3호
    • /
    • pp.207-217
    • /
    • 2010
  • The purpose of this study was to evaluate the effects of the stress distribution and displacement in mandible according to treatment modalities of mandibular angle fractures, using a three dimensional finite element analysis. A mechanical model of an edentulous mandible was generated from 3D scan. A 100-N axial load and four masticatory muscular supporting system were applied to this model. According to the number, location and materials of titanium and biodegradable polymer plates, the experimental groups were divided into five types. Type I had a single titanium plate in the superior border of mandibular angle, type II had two titanium plates in the superior tension border and in the inferior compression border of mandibular angle, type III had a single titanium plate in the ventral area of mandibular angle, type IV had a single biodegradable polymer plate in the superior border of mandibular angle, type V had a single biodegradable polymer plate in the ventral area of mandibular angle. The results obtained from this study were follows: 1. Stress was concentrated on the condylar neck of the fractured side except Type III. 2. The values of von-Mises stress of the screws were the highest in the just-posterior screw of the fracture line, and in the just-anterior screw of Type III. 3. The displacement of mandible in Type III was 0.04 mm, and in Type I, II, IV, and V were 0.10 mm. 4. The plates were the most stable in the ventral area of mandibular angle (Type III, V). In conclusion, the ventral area of mandibular angle is the most stable location in the fixation of mandibular angle fractures, and the just- posterior and/or the just-anterior screws of the fracture line must be longer than the other, and surgeons have to fix accurately these screws, and the biodegradable polymer plate also was suitable for the treatment of mandible angle fracture.

Primary Eosinophilic Granuloma of Adult Cervical Spine Presenting as a Radiculomyelopathy

  • Bang, Woo-Seok;Kim, Kyoung-Tae;Cho, Dae-Chul;Sung, Joo-Kyung
    • Journal of Korean Neurosurgical Society
    • /
    • 제54권1호
    • /
    • pp.54-57
    • /
    • 2013
  • We report a case of 29-year-old man diagnosed as a primary eosinophilic granuloma (EG) lesion of the seventh cervical vertebra. He had paresthesia on both arms, and grasping weakness for 10 days. Cervical magnetic resonance image (MRI) showed an enhancing mass with ventral epidural bulging and cord compression on the seventh cervical vertebra. Additionally, we performed spine series MRI, bone scan and positive emission tomography for confirmation of other bone lesions. These studies showed no other pathological lesions. He underwent anterior cervical corpectomy of the seventh cervical vertebra and plate fixation with iliac bone graft. After surgical management, neurological symptoms were much improved. Histopathologic evaluation confirmed the diagnosis of EG. There was no evidence of tumor recurrence at 12 months postoperative cervical MRI follow-up. We reported symptomatic primary EG of cervical spine successfully treated with surgical resection.

새로운 합성 농약인 KH-502의 급성 지연성 신경독성 시험에 관한 연구 (A Study on Acute Delayed Neurotoxicity of KH-502, A Newly Synthesized Insecticide)

  • 박재학;서광원;남기환;한상섭;이영순
    • Toxicological Research
    • /
    • 제13권4호
    • /
    • pp.317-322
    • /
    • 1997
  • Acute delayed neurotoxicity of KH-502 [O.O-Diethyl O-(1-phenyyl-3-trifluoromethyl-5-pyrazoyl) thiophosphoric acid ester], an insecticide synthesized newly in Korea, was studied in White Leghorn hens. The doses were determined on the basis of preliminary $LD_{50}$ study. High, middle and low doses were determined to be 1123 mg/kg, 762 mg/kg and 518 mg/kg, respectively. The animals were pretreated with atropine (30 mg/kg) prior to administration of KH-502. The chemical was administrated at the first and 21st day of the study. As positive controls, animals were admlnistrated with triorthocresylphosphate (TOCP 1000 mg/kg and 500 mg/kg). Animals administrated with TOCP or KH-502 were sacrificed by perfusion-fixation at 21st and 42nd day of the study, respectively. The central and peripheral nerve tissues were routinely treated for microscopic observation. As results, eight, three, one, and one chickens died within 2 day after adminiatration with signs of cholinergic acute toxicity in high, middle low and TOCP dose-group (500 mg/kg), respectively. No abnormal clinical signs were observed in the survived chickens administrated with KH-502 in the duration of the study. The chickens in positive control groups showed ataxia and incoordination at the 14th day after administration of TOCP. From necropsy, macroscopic changes were not observed in all groups including positive control groups. Histopathologically, oxonal swelling with myelin loss, focal gliosis, distention around axonal space were observed in the spinal cords of the chickens administrated with TOCP 1000 mg/kg. The lesions were distinct in the dorsal and lateral funiculi of cervical spinal cord, in the lateral and ventral funiculi of thoracic spinal cord and in ventral funiculi of lumbosacral spinal cord. Axonal swelling and mlcrogliosis were infrequently observed in the chickens of other groups including negative control one. However, they were nonspecifically distributed in the spinal cords. In this study, we concluded that the new chemical, KH-502 did not have acute delayed neurotoxicity in White Leghorn hens.

  • PDF

가물치의 위장내 기생하는 흡충(Azygia속) 및 선충(Pingus속)의 동정과 감염상황 (Identification and prevalence of trematode(Gen Azygia) and nematode(Gen Pingus) in Ophicephalus argus)

  • 문무홍;이은우
    • 대한수의학회지
    • /
    • 제38권1호
    • /
    • pp.147-159
    • /
    • 1998
  • A survey of the internal parasites in 115 fishes of Ophicephalus argus was carried out in Kyungpook province during the period from January 1995 to November 1997. A species of trematode from the stomach and a species of nematode from the caeca of the fishes was discovered respectively. The trematode was identified as Azygia hwangtsinyi (Tsin, 1993) and the nematode as Pingus sinensis ($Hs\ddot{u}$, 1993). The fluke was pressed at thick of 0.1mm~0.2mm between slide glasses and fixed in 70% ethyl alcohol solution. The fluke was washed with tap water after fixation and stained with hematoxylin-carmin and mounted in balsam through routine methods. The nematode was fixed in 5% formalin solution and mounted with lactophnol or glycerine jelly. Morphology : Arygia hwantsinyi ; The fluke is elongate body with approximately parallel margins and rounded extremities in pressed preparations(Fig 1). The cuticle is unarmed. The oral sucker is ventro-subterminal in position. The ventral sucker is slightly smaller than oral sucker and positioned at 14.2% of body length from the oral sucker. The cirrus sac and genital pore is in mid-ventral line, slightly anterior to the ventral sucker. The oral sucker is succeeded by a well developed muscular pharynx. It is succeeded by a short inverted Y-shaped oesophagus. The inner wall of oesophagus is consisted of many fine folded membrane. The fine tubes of esophagus pass into the intestinal heads which are distended and presented a marked borderline between the fine tube and intestinal heads. The Intestinal heads start at level of pharynx and pass caudad in a zigzag course to end quite near caudal margin. The uterine coils occupy the intercecal area between the level of the cephalic margin of the ovary and about the level of the ventral sucker. The uterus is filled with many eggs. The testes are round or oval and placed one behind the other generally a little diagonally. The posterior testis is placed at level of 75.1% of body length. The ovary is oval, placed ahead the anterior testis. The shell gland not discernible outline is contacted with ovary ahead it. The vitelline glands are consisted of small oval vesicles. The vesicles occupy extracecal regions and between a little posterior of the ventral sucker and near caudal margin. Pingus sinensis : Female ; The cuticle is smooth and the cervical alae are well developed. The mouth opening is small, triangular, and without lips. The anterior end bears four sub-medial papillae. The oesophagus is divided into a muscular and glandular portion. The nerve ring is situated just at the junction of the muscular and glandular portions of the oesophagus. The vulva which has a prominent flap, is placed behind the middle of the body about one-third of the length of the worm from the posterior extremity. The vagina is strongly muscularised and after running anteriorly about $68{\mu}$, divides itself into two broad uterine tubes with an anterior and a posterior one. There are a few eggs in the uterine tubes. The tail is slender, straight and pointed. The ovary extends almost to the posterior extremity. Male : Male is smaller than female. The tail is pointed, curved and carrying well-developed caudal alae. A prominent muscular precloacal sucker is characteristic. The spicules are equal and short. There are four pairs of pedunculated pre-anal papillae, of which the most anterior pair are situated just at the level anterior to the muscular sucker. Two pairs of pedunculated papillae are present before the anus. There are five pairs of post-anal papillae of which the most anterior pair and the second counted from the posterior end are ventral and more marked than the ones which are situated laterally.

  • PDF

중쇠뼈 찢김골절로 인한 고리중쇠 관절 불안정의 교정 (Correction of Atlanto-axial Instability by Avulsion Fracture of the Axis in a Dog)

  • 황용현;김민경;박정현;진소영;박기태;이희천;이재훈
    • 한국임상수의학회지
    • /
    • 제30권6호
    • /
    • pp.499-502
    • /
    • 2013
  • 목 부위에 교상을 입은 8살의 중성화된 수컷 푸들이 내원하였다. 신체 검사에서, 보행이 불가능하였고 심부통증이 있는 사지의 불완전 마비로 UML 증상을 보였다. 방사선과 CT 검사에서 경추 1번의 횡돌기의 골절, 경추 2번의 가시돌기의 골절이 관찰 되었다. 보존적 처지를 1주일 실시 하였으나 증상이 완화 되지 않아 수술적 교정이 선택되었다. 수술적 안정은, 배쪽으로 접근하여 나사, K-wires 와 bone cement를 이용하여 내원 7일차에 실시 되었다. 수술 후 4주 이후 혼자 설 수 있었으며, 6주 이후 보행이 가능하였다. 본 증례에서는 등쪽과 배쪽 부위 중쇠뼈 골절을 교정하기 위하여 배쪽 복합 고정을 실시하였으며, 좋은 예후를 보였다.