Percutaneous Decompression in the carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome due to compression of the median nerve at the wrist. Division of the transverse carpal ligament for median nerve compression in patients with carpal tunnel syndrome is a common and successful procedure. A variety procedures exist to release the transverse carpal ligament the classic open release, limmited open or percutaneous release, and endoscopic release. From February 1994 to January 1996, 39 carpal tunnel releases were performed by percutaneous method in 30 patients (3 males and 27 females) at the Chonnam University Hospital. The patients age ranged from 42 to 67 years (average 54.8 years). The duration of the symptoms ranged from 3 months to 10 years. According to Brown's outcome analysis, results were as follows. 1. Persistent pain and paresthesia were noted in only 3 cases (7.7%) at 24 week postoperatively. 2. Two-Point discrimination on the index finger was improved significantly at 12 week postoperatively (p<0.05). In electromyographic study, conduction delay of motor and sensory fibers was diminished significantly at 4 week postoperatively (p<0.05). 3. Functional outcomes (grip strength, pinch strength, scar tenderness and return to work) were showed good and excellent result. We concluded that percutaneous decompression is one of the less morbid method for decompressing the carpal canal and relief of symptoms for the patient.

Short Segment Transpedicular Cotrel-Dubousset Instrumentation including Involved Vertebra for Fractures of Thoracic and Lumbar Spine / 대한정형외과학회잡지

To minimize the numbers of vertebral segments in the fusion area and to prevent the metal failure and recurrence of deformity in the surgical treatment of the fracture and dislocations of the thoracic and lumbar vertebra, short segment transpedicular C-D instrumentation including upper and lower adjacent vertebra and also the involved vertebra had been performed in 56 patients, from 1989 to 1991 and the minimum follow-up period was one years. Fractured vertebra was screwed for the reposition of the compressed upper end plate and its maintainance. The purpose of this study is to report the satisfactory results the procedure in stability and deformity correction. The mechanisms of injuries were fracture-dislocation in 17, compression in 10, burst in 8 and seat belt in 8. Levels of the lesion were between T10 and L4. Extent of fusion was one to 4 motion segments(Av. 2. 1 segments). Ambulation was started Av. 3.8. days after operation. External support of TLSO was applied for 3 months. Complications of metal failure, loss of fixation and the recurrence of the kyphotic deformity were not occurred during follow up period. Anterior vertebral height in average compared to normal vertebra were 69% preoperatively, 89% post operatively and 85% at the end of follow up. Angle of kyphotic deformity in average were 25 preoperatively, 8 post-operatively and 11 at the end of follow up. From the above results, the authors concluded that the short segment transpedicular C-D instrumentation including involved vertebra is a highly successful method of treatment with good correction of deformity and rigid stability, while the operation could be confined in minimum extent.

Prosthetic Reconstruction of Vertebra with Titanium Mesh Cylinder in Malignant Spine Tumors / 대한정형외과학회잡지

The purpose of the prosthetic reconstruction of vertebral body after excision of malignant spine tumors is to provide the immediate and long term stability. The authors have experienced eight cases of prosthetic replacement with a titanium mesh cylinder and additional instrumentation in malignant spine tumors with neurologic deficit. There were three cervical, three thoracic and two lumbar lesions. Among them, five cases were instrumented by combined anterior and posterior procedures at one stage. Postoperatively, all cases showed excellent immediate stability. Ambulation was started within one week with minimal or no external support. Neurologic deficit observed in 7 cases were improved in all but one complete paraplegia. Major complications such as loss of fixation, recurrence or progression of deformity, and neurologic deterioration were not observed. Five patients could return to their previous occupation. Five patients with autogenous bone graft in the cylinder showed solid incorporation of prosthesis into the host bone. It is concluded that a titanium mesh cylinder replacement of vertebral defect after excision of the malignant spine tumors provides adequate immediate as well as long term stability when combined with bone graft.