A Research on the Management of Ventilatory Insufficiency in Patients with Neuromuscular Diseases

OBJECTIVE: To investigate the real condition of pulmonary rehabilitation for patients with advanced neuromuscular diseases (NMDs) on mechanical ventilation in Korea. METHOD: In order to estimate current state of pulmonary rehabilitative management, chart review and pulmonary function evaluation were conducted in a total of 267 NMD patients who had applied mechanical home ventilator in our center from March 2001 to December 2008. RESULTS: Total 267 patients were included: 95 with Duchenne muscular dystrophy, 69 with other types of myopathy, 83 with amyotrophic lateral sclerosis (ALS), 20 with spinal muscular atrophy. Among them, 18 who were previously intubated and 17 patients who had undergone tracheostomy were switched into volume-limited non-invasive ventilation (NIV). At the time of hospital discharge, 234 patients were applied NIV successfully. Twenty other patients who once used continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) ventilators inappropriately were switched into volume-limited NIV. However, 20 patients who had successfully applied NIV first underwent tracheostomy due to exacerbation of underlying disease. CONCLUSION: Adequate pulmonary management is the only promising method to prevent lethal complications, and to prolong life span of advanced NMD patients. We assume that more NMD patients can improve their quality of life and prolong their life through proper pulmonary rehabilitation including regular pulmonary function check-ups and ventilatory state monitoring as well as early NIV application.

A Biomechanical Study of Two Kinds of Tapered Pedicle Screws in Osteoporotic Lumber Spine / 대한정형외과학회잡지

PURPOSE: To compare the pullout strength and insertion torque of proximally tapered screw (PT) with fully tapered screw (FT) and to investigate the correlation between the pullout strength and bone mineral density, morphology of pedicle, and insertion torque of the screw in osteoporotic lumbar spine. MATERIALS AND METHODS: Fifteen osteoporotic lumbar vertebrae from four white human cadavers were used. Bone mineral density, pullout strength and insertion torque were measured by dual energy x-ray absorptiometry, MTS and torque screw driver individually. RESULTS: The FT screw provided greater pullout force and insertion torque than the PT screw in 12 of 15 vertebrae tested (p<0.01). Pullout strength was correlated with insertion torque in PT (r=0.666, P=0.0006) and FT (r=0.464, P=0.19) screws. CONCLUSIONS: Results of this study indicate that the FT screws provide higher pullout strength and insertion torque than PT screws in osteoporotic lumbar spine and suggest that the development of tapered minor diameter may lead to an improved pedicle screw with high pullout strength and insertion torque. Nevertheless, further study is needed to investigate the effect of tapering the minor diameter on the mechanical bending strength of the screw.

Measurement of BMD ( Bone Mineral Density ) and Hip Axis Length for Predicting Hip Fracture / 대한정형외과학회잡지

Osteoporosis is a disease characterized by excessive bone loss or osteopenia particulary in the axial skeleton at the site of fracture, such as the spine and proximal femur. Since the strength of both spine and femur is directly proportional to the bone mass, this osteoporosis always increases the risk of fracture. In this study, to evaluate whether a simple measurement of femoral geometry and BMD value are related with hip fracture, we obtained DEXA Scan (Lunar Expert-XL) of hip by retrospective study. DEXA scan was measured on 70 control people and 17 hip fracture patients aged 50 or older. The result is I. The mean Ward BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.52g/cm2, Control group: 0.67g/cm2 P=0.0001) 2. The mean L-spine BMD value of hip fracture group is significantly lower than control group (Hip fracture group: 0.81g/cm, Control group: 0.97g/cm2 P=0.0002) 3. The mean femur axis length of hip fracture group is longer than control group (Hip fracture group: 6.77g/cm2, Control group: 6.57g/cm2 P=0.006) As a conclusion, the measurement of BMD and hip axis length in DEXA scan is an effective method for screening the hip fracture risk patient and BMD value of femur, hip axis length and L- spine BMD value are strongly associated with hip fracture.

Synovial fluid osmolarlity of human knee

No abstract available.

Reconstruction of the posterior cruciate ligament

No abstract available.

Ipsilateral Tibial Shaft Fractures and Knee Ligament Injuries / 대한정형외과학회잡지

Nine patients with ipsilateral tibial shaft fractures and knee ligament injuries were retrospectively reviewed to determine the methods of the diagnosis and the results of the treatment. The incidence of this combined injuries was 5% in one hundred and eighty two tibial shaft fractures. The injuries of posterior cruciate ligament were combined most freqently. Five of nine patients were open fractures. Bone union was obtained in all cases and the mean duration of bone union was 22.5 weeks. Athroscopy and stress X-ray for the cruciate ligament were helpful to diagnose this combined injures. The ligament injuries were surgically managed in eight and conservatively in one. Better results were obtained when this combined injuries were operated early, but four of nine patients were disabled. The results suggest that the examination of the knee is necessary to document ligamentous injuries that occur with tibial shaft fractures.

An Anatomical Study on the Variations of the First Cervical Dorsal Root

To investigate the variations of the dorsal root of the first cervical nerve and its anastomosis with the spinal accessory nerve, a total of 74 anatomical dissections has been performed in 37 cases of Korean human fetus. The anastomotic connections between the dorsal roots and the spinal accessory nerve have fitted into five main types. The central course of the sensory fibers of the first cervical nerve and the neurosurgical significance of the variations have been discussed. Often the only pathway for the sensory fibers of the first cervical nerve to reach the spinal cord is through the rootlets of the spinal accessory nerve.