ABSTRACT
OBJECTIVE: To analyze the clinical outcomes of computed tomography (CT) fluoroscopy-guided selective nerve root block (SNRB) for severe arm pain caused by acute cervical disc herniation. METHODS: The authors analyzed the data obtained from 25 consecutive patients who underwent CT fluoroscopy-guided SNRB for severe arm pain, i.e., a visual analogue scale (VAS) score of 8 points or more, caused by acute soft cervical disc herniation. Patients with chronic arm pain, motor weakness, and/or hard disc herniation were excluded. RESULTS: The series comprised 19 men and 6 women whose mean age was 48.1 years (range 35-72 years). The mean symptom duration was 17.5 days (range 4-56 days) and the treated level was at C5-6 in 13 patients, C6-7 in 9, and both C5-6 and C6-7 in 3. Twenty-three patients underwent SNRB in 1 session and 2 underwent the procedure in 2 sessions. No complications related to the procedures occurred. At a mean follow-up duration of 11.5 months (range 6-22 months), the mean VAS score and NDI significantly improved from 9 and 58.2 to 3.4 and 28.1, respectively. Eighteen out of 25 patients (72%) showed successful clinical results. Seven patients (28%) did not improve after the procedure, and 5 of these 7 underwent subsequent anterior cervical discectomy and fusion. CONCLUSION: CT fluoroscopy-guided SNRB may play a role as a primary conservative treatment for severe arm pain caused by acute cervical disc herniation.
Subject(s)
Female , Humans , Male , Arm , Cervical Vertebrae , Diskectomy , Follow-Up Studies , Intervertebral Disc , Nerve BlockABSTRACT
PURPOSE: We wanted to evaluate the results of fracture fixation with using Gamma nails and Proximal Femoral Nails (PFN) for treating intertrochanteric fractures. MATERIALS AND METHODS: From January 2003 to December 2005, we reviewed 77 patients who suffered with intertrochanteric fractures (35 cases of Gamma nails and 42 cases of PFNs). We evaluated the intraoperative blood loss, the operation time, the presence of stable reduction and the varus reduction rate, the union time, cutting-out, the screw head position, the status of the fracture reduction and the complications. The pre- and post-operative difference in the patients' ambulatory ability was also investigated. RESULTS: The mean operation time with using Gamma nails was shorter and the screw with using Gamma nails was located more centrally than that with using PFNs. The other factors were not statistically different. Cutting-out was not noted with Gamma nails, but 2 cases of cutting out were noted with using PFNs. 8 cases of proximal migration were noted with Gamma nails and 6 cases of lateral protrusion of the proximal pin were noted with using PFNs. CONCLUSION: The Gamma nail for which a single lag screw was inserted centrally had no case of cutting-out, which was in contrast to using PFNs for which two lag screws were used, although there was no statistically significant difference. In addition to this, the shorter operative time makes Gamma nails more appropriate for the operative treatment of femoral intertrochanteric fracture.
Subject(s)
Humans , Femur , Fracture Fixation , Head , Hip Fractures , Operative TimeABSTRACT
Open calcaneal fracture with more than lateral half of bone loss and soft tissue defect occurred in 17 year-old male patient due to motor vehicle accident. Soft tissue defect included heel pad, peroneal tendon. Bone loss involved mainly most part of inferior tuberosity but not subtalar joint. Open dressing and debridement were done daily in operating room and antibiotics administration was started. After granulation tissue formed, femoral head allograft was performed and fixed with 6.0 mm screws to replace bone defect. Soft tissue defect was covered with latissimus dorsi musculocutaneous free flap. No sign of infection nor major osteolysis was observed in 15 months follow up period. Soft tissue defect was covered with latissimus dorsi musculocutaneous free flap.