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1.Surgical Treatment of Lower Cervical Spine Injury.

The Journal of the Korean Orthopaedic Association 1999;34(1):117-126

PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Central Cord Syndrome ; Classification ; Decompression ; Diskectomy ; Dislocations ; Duodenal Ulcer ; Humans ; Immobilization ; Incidence ; Kyphosis ; Male ; Medical Records ; Neck Pain ; Neurologic Manifestations ; Pathology ; Phylogeny ; Pressure Ulcer ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Injuries ; Spine* ; Urinary Bladder, Neurogenic ; Wound Infection ; Zygapophyseal Joint

2.Clinical Review of Ten Years' Pediatric Surgical Diseases.

Soo Jin Na CHOI ; Sang Young CHUNG ; Shin Kon KIM

Journal of the Korean Association of Pediatric Surgeons 1998;4(2):110-116

A clinical review was made on 2,191 cases of general pediatric surgery under the age of 15 years which were operated upon at the Divisionof Pediatric Surgery, Department of Surgery, Chonnam University Hospital from January 1988 to December 1997. The number of operations in pediatric age were 13,144 (13.2%) out of total 99,555 operations at Chonnam University Hospital and the most prevalent age group was under 1 year of age (14.3%). The number of operations in Divisionof General Pediatric Surgery were 2,191 (16.7%) out of total 13,144 operations in pediatric age and the incidence of patients under 1 year of age in general pediatric surgery was 42.9% (941/2,191). The prevalent diseases under 1 month of age were anorectal malformations (20.6%) and hypertrophic pyloric stenosis (20.3%) and between 1 month to 1 year of age were inguinal hernia (32.4%) and intussusception (19.6%). The total motality rate in neonatal intensive care unit was 31.3%. Gastroschisis presented highest mortality.
Gastroschisis ; Hernia, Inguinal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Intussusception ; Jeollanam-do ; Mortality ; Pyloric Stenosis, Hypertrophic

A muscular calf is esthetically unappealing in Asian women. Treatment by liposuction alone has poroven to be difficult due to a small amount of fat. We established a new method of transecting half of the gastrocnemius tendon in order to improve the contour of the calf. Thirty-five patients were operated on during the past 3 years. The medial or lateral half of the gastrocnemius tendon was cut using an endoscopic-guided 3M AGEE blade through a 1cm-sized incision. The portion of the muscle above the site of the transection was elevated from the underlying soleus muscles. We checked the calf circumference and evaluated the clinical results at 6 months postoperatively. An average 10% reduction in calf circumfernce was measured, showing a significant esthetic improvement. There were no significant changes in gait analysis or in the Cybex test. There were no specific complications related to the procedure. Through our clinical experience in 35 cases, we were able to prove that tenotomy is a effective, simple and easy method without severe morbidity.
Asian Continental Ancestry Group ; Female ; Gait ; Humans ; Lipectomy ; Muscles ; Tendons ; Tenotomy*