Résumé
Carpal tunnel syndrome is known as the most common peripheral nerve entrapment neuropathy which results from compression of the median nerve within the carpal tunnel. Recently, endoscopic carpal tunnel release was introduced as an alternative of open carpal tunnel release. The purpose of this study is to find out the clinical usefulness of endoscopic carpal tunnel release through analyzing results of symptom, physical sign and E.M.G. finding. We analyzed 20 patients (29 cases) who had been treated by endoscopic carpal tunnel release, and followed up over 6 mos at Department of Orthopedic Surgery, Bongseng Memorial Hospital from August 1994 to December 1996. The results were excellent or good in 27 cases (93%) in Cseuz criteria, poor in only 1 case. Grip strength recovered to preoperative strength level in 28 cases (96.6%) at 3 mos postoperatively. The EMG checked postoperatively demonstrated improvement in both sensory and motor function. In conclusion, although endoscopic carpal tunnel release is a technically demanding procedure and the learning curve in steep, it has the advantage of lesser palmar scarring, lesser ulnar pillar pain, rapid and complete return of strength and to work. Therefore, endoscopic carpal tunnel release can be a good method in the treatment of carpal tunnel syndrome.
Sujets)
Humains , Syndrome du canal carpien , Cicatrice , Force de la main , Courbe d'apprentissage , Nerf médian , Orthopédie , Nerfs périphériquesRésumé
Spinal stenosis is defined as diminition in the size of the spinal canal that produces nerve entrapment resulting in symptoms, the most common of which is low back pain & radiating pain to leg. The central spinal canal contains the dura and other meninges, and inside these, the nerves of the cauda equina. The nerve root canal contains the spinal nerve from the point which the dura leaves the intervertebral foramina. Each foramen is a door through which the nerve enters to the nerve root canal. In its canal the nerve passes behind the disc and then in front of the superior articular process of the lower vertebra. Pathological and anatomical changes by various cases can produce narrowing of the central and nerve root canal. But they are sometimes not important because they are not severe enough to cause nerve entrapment and such medical treatment, Spinal stenosis is only significant when nerves are entraped, indicated by severe leg pain and sometime by sensory and motor changes. Spinal stenosis is classified into two groups: congenital and acquired. Among acquired groups, the combined type is most common and significant. Authors have experienced 61 cases of spinal stenosis and among these, 58 cases were treated surgically between 1981 and 1984 at the Department of Orthopaedic Surgery, Eulji Glneral Hospital, Daejeon. The following results were obtained. 1. There were 52 males and 33 females, and peak incidence in 5th and 6th decade(69%) 2. The most common type by Arnoldi's etiological classification was combined type(69%) 3. The most common chief complaint on admission was low back pain and radiating pain to leg (43%) 4. The most common sign was limitation of lumbar hyperextension (75.9%) and S.L.R.test was positive in only 12 cases(20.7%). 5. The common findings of myelography were hour glss appearance (39.7%) and complete block (27.6%), and simple radiologic findings were hypertrophy of facet joint, osteophyte formation in the periphery of vertebral bodies involved and narrowing of disc speace. 6. The A-P diameter of spinal canal was between 14.44 mm and 14.97 mm in simple findings, and the A-P diameter of dural sac between 8.10 mm and 9.19 mm in myelography. The spinal index was between 1:4.90 and 1:5.60. 7. Decompressive surgery was done in the 2 levels in 39 cases (67.3%), 3 levels in 10 cases (17.2%) and 1 level in 9 cases (15.5%). Discectomy was done in 40 cases (69%) and partial laminectomy was done in 58 cases (100%). 8. The most common site was L3,4-L4,5 (36.2%).
Sujets)
Femelle , Humains , Mâle , Queue de cheval , Classification , Cavité pulpaire de la dent , Discectomie , Hypertrophie , Incidence , Laminectomie , Jambe , Lombalgie , Méninges , Myélographie , Syndromes de compression nerveuse , Ostéophyte , Canal vertébral , Nerfs spinaux , Sténose du canal vertébral , Rachis , Articulation zygapophysaireRésumé
Open fractures of the shaft of the tibia occur frequently because of the progression of industrialization, Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. The reports, published until recently, have differed with respect to rates of morbidity and end results. With this in mind, we reviewed a consecutive series of 30 open fractures of the tibia at the Department of Orthopedic Surgery of the Eulji General Hospital between 1981 and 1983 by a variety of methods. The following results were obtained. 1. The highest incidence of fractures was encountered in 3rd decades(43.3%) and male to female ratio was 4: 1. 2. The most common cause of fractures was traffic accident(66.6%). 3. The most common anatomical level of fractures was middle third of the shaft(46.7%). 4. The severity of injury was classified according to the Ellis classification as follows. Minor group, 8 cases(40%), Moderate group, 8 cases(26.7%,), Major group, 10 cases(33.3%). 5. The most common associated injury was ipsilateral fibular fracture. 6. Of 30 cases, 11 patients(36.6%) had an open wound more than 5cm in length, 10(33.3%.) between 2.5 and Scm and 4(13.4%) below 2.5cm, and primary closure after thorough debridement and copious irrigation was done in 17 cases(56.7%). 7. Pin and plaster method was applied in 3 cases of minor group and 3 of moderate group, intramedullary nailing was applied in 9 of minor group and 5 of moderate group, and Hoffmann device was applied in 10 of major group. 8. The majority of cases(66.7%) were operated on within 1 week after injury, 9(30%) between 1 and 2 weeks and 1(3.3%) between 2 and 3 weeks. 9. The fractures in middle third of the shaft of the tibia treated with intramedullary nailing revea.ed the shortest healing time(average 13 weeks). 10. Complications such as delayed union, infection and disabled joint shiffness were encountered mainly in cases with severe soft tissue injuries.