Anatomical Review and Clinical Effect of Psoas Compartment Block

OBJECTIVE: The purposes of this study were to evaluate the relation of the lumbar plexus with the psoas compartment, to measure the distance from skin to psoas compartment, and to determine the efficacy of psoas compartment block for the unilateral leg pain and/or low back pain. METHOD: Six cadavers were dissected and the computed tomography of the lumbar region were performed in 22 subjects. The psoas compartment block of 10 ml of 0.5 percent lidocaine were performed in 31 patients with unilateral leg pain and/or low back pain. Visual Analog Scale (VAS) and sensory, motor functions were assessed before the block and 5, 30 minutes, and 1, 2, 3 hours and 1 week after the block. The distance from skin to psoas compartment were measured during the procedure. The questionnaires on the procedure were completed after 1 week. RESULTS: Cadaver dissections demonstrated that the 3 main nerves of lumbar plexus were within the psoas compartment between the level of L4 and L5. Computed tomography provided that the average distances of anterior and posterior borders of psoas major from the low back skin were 10.8 & 6.3 cm and that of medial & lateral borders from the median sagital plane were 2.9 & 7.1 cm respectively. There were statistically significant correlations between distance from skin to psoas compartment and body weight, abdominal circumference as well as body mass index (p<0.0001). The VAS was 7.7 before the block and 5.4 1 week after the block (p<0.05) and satisfactory outcomes were shown in 71 percent of the subjects. CONCLUSION: Psoas compartment block was effective for the patients with unilateral leg pain and/or low back pain without major side effects and complications.

Status of Using Lower Extremity Orthoses in Patients with Chronic Stroke and Traumatic Brain Injury

OBJECTIVE: Lower extremity orthoses are important in the rehabilitation of the patients with stroke and traumatic brain injury. But it is unknown how much they are used in the social activity after the discharge from the hospital. This study was carried out to investigate the status of using orthosis in social activity and complaints about orthosis. METHOD: The questionnaires were given to 42 cases with stroke and 17 cases with traumatic brain injury. RESULTS: The user of lower extremity orthosis in social activity were 55.9%, and the causes of disuse were patient's poor condition, improved gait pattern, inappropriate design and defect of orthosis, and patient's refusal. The degree of satisfaction with orthosis for comfort, external appearance and weight were 79.3%, 86.2%, and 72.4%, respectively. CONCLUSION: Physiatrists should give more attention in orthosis at follow-up of patients with stroke and traumatic brain injury and make efforts to improve function and external appearance of orthosis.

A Study of Serum Lipid Profiles in Paraplegics

Generally, regular exercise is known to help to improve lipid metabolism. In the spinal cord injured, relative inactivity to able-bodied person causes altered lipid profiles and, in turn, possibly increases cardiovascular mortality. We performed this study to measure serum lipid profiles in paraplegics and to evaluate effect of regular exercise on lipid profiles. The subjects are 21 paraplegics, who are divided into 2 groups, 10 SCI athletes and 11 SCI non-athletes. The serum levels of lipoproteins in these subjects were measured and compared each other. The levels of serum HDL-cholesterol were lower in the order of, non-athlete group, athelte group, and normal control group, and there was a significant difference between athlete and non-athlete groups. The ratios of total cholesterol to HDL-cholesterol were higher in the order of non-athlete group, athlete group, and normal control group, and there was a significant difference between control and non-athlete groups. The serum levels of total cholesterol, LDL-cholesterol, and triglyceride in three groups showed no significant differences. In conclusion, serum levels of HDL-cholesterol were positively affected by regular exercise, and it is advised that the HDL-cholesterol levels of spinal cord injured should be checked regularly for follow-up examinations.