Effects of Mattresses and Positioning on Interface Pressure and Skin Blood Flow

OBJECTIVE: To determine the effects of mattresses and positioning on interface pressure (IP) and skin blood flow in young healthy persons. METHOD: Ten healthy subjects were included. Three types of mattresses including standard hospital mattress, alternating pressure pump and pad, and alternating pressure air mattress (APAM) and four positions including supine, 30 degree trunk elevation, 30 degree leg elevation, and right 90 degree lateral position were evaluated. IP over the buttock was measured with force sensing array (FSA) pressure mapping system for every subjects lying in four positions on each mattresses. Skin blood flow was measured with laser doppler flowmeter probes that placed over the sacrum and right greater trochanter. RESULTS: IP was significantly lower on the APAM than on the other types of mattresses in all positions. In the right 90 degree lateral position, the IP was significantly higher on all mattresses than that in the other positions, and in the 30 degree leg elevation, the IP was significantly lower on standard hospital mattress and APAM than that in the supine position. There were significant differences in the skin blood flow over the greater trochanter between the APAM and the other types of mattresses, while there were no significant differences over the sacrum on all mattresses. CONCLUSION: APAM is likely to be the most effective as a preventive and treating measure for pressure ulcers. However, combined use of the APAMs with periodic position change might be necessary over the trochanter for effective pressure relief.

Comparison of the Results between Standard Discectomy and Microdiscectomy of the Herniated Lumbar Disc / 대한척추외과학회지

STUDY DESIGN: This study is a prospective evaluation of the results of the standard discectomy and microdiscectomy of the herniated lumbar disc. OBJECTIVES: The purpose of this study is to compare the clinical results between the standard discectomy and microdiscectomy groups in the herniated lumbar disc. SUMMARY OF LITERATURE REVIEW: Many spine surgeons believe that everything that can be accomplished through the standard discectomy can be accomplished more easily with the assistance of the microscope. So the standard laminectomy and discectomy is gradually being replaced by the microdiscectomy. MATERIALS AND METHODS: One hundred and seventy-three patients with lumbar disc herniations were evaluated. Ninty-six patients were operated through the standard method and seventy-seven patients were operated with the aim of the microscope. These operations were taken by one surgeon and the clinical results were undertaken by a doctor who was not involved in the operation using a proven outcome assessment scale. RESULTS: There were significant differences between the standard discectomy and the microdiscectomy groups in terms of complications and revision rates. In microdiscectomy group, clinical result was less favorable than standard discectomy group. CONCLUSION: In microdiscectomy groups the incidence of infection and rate of revision operation were higher than in standard discectomy groups. The standard discectomy is still thought better than the microdiscectomy in the operative treatment of herniated lumbar disc.

Pain Patterns of Experimental Muscle Pain Using Hypertonic Saline

OBJECTIVE: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain. METHOD: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group. RESULTS: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale. CONCLUSION: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.

Pain and Psychometric Characteristics Related to Disability Evaluation in Patients with Chronic Low Back Pain

OBJECTIVE: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics. METHOD: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not). RESULTS: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group. CONCLUSION: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.

Prophylaxis of Postoperative Deep Vein Thrombosis and Thromboembolism with Low Molecular Weight Heparin ( Nadroparin Calcium ) after Hip Arthroplasty: Comparison with Warfarin and Low Molecular Weight Dextran / 대한정형외과학회잡지

PURPOSE: To evaluate the preventive effect of deep vein thrombosis (DVT) by low molecular weight heparin (LMWH) after hip arthroplasty. MATERIALS AND METHODS: We analyzed 98 consecutive patients (107 cases) who were older than forty years of age and were scheduled to have elective primary or revision hip arthroplasty from August 1996 to March 1998. All of them received prophylactic LMWH, Nadroparin calcium (Fraxi-parine, Sanofi France). The effectiveness and safety of LMWH were evaluated in a prospective randomized trial. LMWH was injected subcutaneously once daily, from twelve hours before the operation to the tenth postoperative day with fixed dosage according to patient s body weight. For the detection of DVT after hip arthroplasty, patients were evaluated with color doppler image (CDI) preoperatively, postoperatively 7-10 days and six weeks consecutively. RESULTS: DVT was detected in six patients (5.61%) and no symptomatic pulmonary embolism occurred. Asymptomatic isolated calf vein thrombosis was identified in four patients, they had no therapeutic treatment for the thrombosis but the thrombi were resolved spontaneously without any proximal propagation. Proximal vein DVT was identified in two patients and the thrombi were resolved within 6 weeks with additional treatment using Nadroparin calciurn administration. In three cases, late developing thrombi was detected at follow-up CDI carried out at the sixth postoperative week. There were three cases of bleeding complications. CONCLUSIONS: Compared to our previous report of the incidence of DVT using low molecular weight dextran (12.2%) and warfarin (16.6%) with the incidence of DVT using low molecular weight heparin (5.61%), we considered that prophylaxis with LMWH is more effective in preventing DVT after hip arthroplasty. We also found that asymptomatic isolated calf vein thrombosis is resolved spontaneously. For the detection of late developing thrombosis, we recommend consecutive follow-up CDI.

Sympathetic Skin Response and Heart Rate Variation in Spinal Cord Injured Patients

OBJECTIVE: Most spinal cord injured patients suffered form various autonomic dysfunction. The purpose of this study is evaluation of sympathetic skin response (SSR) and R-R interval variability (RRIV) as a method of autonomic function test in spinal cord injured patients. METHOD: Thirty-six spinal cord injured patients were enrolled in this study. SSR was recorded in the palm and sole by electrical stimulation of right median nerve and RRIV during rest, deep breathing and Valsalva maneuver for 1 minute. RESULTS: The higher level of spinal cord injury, the higher rate of the abnormal sympathetic skin response in the palm and sole and more reduced values of Valsalva ratio (p<0.05). The parameters of sympathetic skin response and R-R interval variability were not correlated with injury severity of spinal cord and their autonomic symptoms. CONCLUSION: Evaluation of SSR and RRIV could be helpful methods to evaluate autonomic function in the spinal cord injured patients.

The Role of Intraoperative Frozen Section as a Guide to Sepsis in Hip Arthroplasty for Teatment of painful Hip Disease / 대한정형외과학회잡지

We performed a retrospective analysis of twenty-four consecutive hip arthroplasties (Total Hip Arthroplasty 18, Bipolar Arthroplasty 1, Cup revision 5) during which intraoperative frozen sections were analyzed to identify the occult active infection. We also reviewed the data such as laboratory findings (ESR, CRP), intraoperative culture, hip joint sonographic evaluation and permanent histologic section. Among the twenty-four patients those who received hip arthroplasties, 10 cases received revisional hip arthroplasties due to painful hip prosthesis loosening, 9 cases with infected hip prosthesis, 3 cases with infection after open reduction and internal fixation due to hip fracture and 2 cases with septic hip sequelae. Intraoperative frozen section had been obtained during staged revisional hip arthroplasties to determine the presence of active infection. We considered positive for infection if it shows more than 10 PML/HPF (Polymorphonuclear leukocyte /high power field) in at least 5 distinct microscopic fields from intraoperative tissue frozen section and postponed implantation of prosthesis. If it shows less than 5 PML/HPF, we performed revisional hip prosthesis implantation. We decided the implantation based on patient's condition, laboratory findings and intraoperative tissue conditions if it shows between 5 and 10 PML/HPF from intraoperative frozen section. At last follow up, 20 of 21 patients who had a revisional hip arthroplasties as below 10 PML/HPF from intraoperative frozen section remained free of infection (Specificity; 95%). We concluded that analysis of the intraoperative frozen sections is a reliable predictor as a guide to sepsis for the successful hip joint arthroplasties.

Dislocation after Hip Arthroplasty: Analysis of the Cause Factors / 대한정형외과학회잡지

We reviewed 174 total hip arthroplasty (25 were revision procedure) and 65 bipolar hemiarthroplasty procedure followed by more than 6 months at Chungnam National University Hospital from July, 1992 to March, 1995. These were performed on 189 male and 50 female patients. We have followed up average 45.8 months and obtained following results; The dislocation rate is 3.76% (9 of 239 cases) and the dislocation rate of revision arthroplasties (16%: 4 of 25 cases) is higher than those of primary hip arthroplasties (2.6%: 5 of 214 cases). Among Nine dislocations, 8 cases (89%) were between fifth and seventh decade and all cases are men. All dislocations occured within 5 weeks postoperatively. Because 6 of 9 cases were due to poor compliance, the patient's cooperation during postoperative recovery is essential to prevent postoperative dislocation. The capsulectomy, surgical approach, or immobilization of patients after operation are unrelated to dislocaton. For the prosthetic factors, 7 cases dislocated posteriorly is appeared that the plane of the cup was between 3 and 9 degrees of anteversion, and also less than the normal range. Stable outcome without surgical operation was achieved in 7 of 9 dislocation. Among 2 patients who had recurrent dislocation after optimum conservative treatment, one had infected arthroplasty and the other had a impinged anterior thick capsule formation around the head. We concluded that the predisposing factors for dislocation after hip arthroplasty is multifactorial.

Deep Venous Thrombosis after hip Arthroplasty / 대한정형외과학회잡지

A randomized, prospective study was conducted between October, 1994 and April, 1996 to compare the efficacy and safety of warfarin (group I) with dextran (group II) for the prevention of DVT after hip arthroplasty. 109 cases in 106 patients were included in the study. There were 60 cases in group I and 49 cases in group IL Risk factor for DVT were analysed before surgery and prophylactic modalities were performed. Color doppler was performed to all patients by one muskuloskeletal radiologist on 5th 8th post operative day and on 6 weeks after operation. DVT occurred in ten ( 16.6% ) of the 60 patients in group I, six ( 12.2% ) of the 49 patients in group II. but, this difference was not significant ( p= 0.582 ). Statistical analysis for the risk factors of age, sex, operation time, anesthetic method and operation method were performed and there were no statistical difference. Only statistical significance was a higher rates of DVT in cemented hip arthroplasty (p=0.028). There were seven proximal thigh DVT and nine calf DVT. We confirmed with sequential color doppler image that all cases of DVT except two complicated cases were resolved within 8 weeks after treatment: one case was expired for the reason of PE, and the other case had thigh hematoma during the treatment with warfarin. We could detect only one case of late onset DVT.

Effects of Temperature on Motor Unit Action Potentials

This study was performed to evaluate of temperature effects on motor unit action potentials by automatic method in twenty healthy adults. Twenty separate motor unit action potentials were recorded in the biceps brachii with concentric needle electrodes at the three different skin temperatures. The skin temperature of the arm was cooled with coldpack below 24oC and warmed with infrared above 38.5oC. The measured parameters of motor unit action potentials were amplitude, duration, area, spike duration, spike area and number of phases and turns. As the skin temperature was decreased, all parameters except number of turns were increased(p<0.05). And the larger changes were developed by cooling than warming. At three temperature settings, rise time was inverse relationship with amplitude and number of phases and turns. And in general other parameters of motor unit action potentials showed significant positive correlation. Therefore the temperature is a very important considering factor and must be standardized or controlied during analysis of motor unit action potentials.

The Clinical and Electrophysiological Study of the Suprascapular Nerve Palsy

The medical records of twenty-one patients with suprascapular nerve palsy were reviewed retrospectively. Nine patients had isolated suprascapular nerve lesions and twelve patients accompanied axillary nerve lesions. In trauma cases, combined nerve lesions were common and severe. In three cases isolated suprascapular nerve lesions were noted spontaneously. Isolated infraspinatus muscle lesions were noted in four cases which were due to compressions of suprascapular nerves at the spinoglenoid notch, and in one case from ganglionic cyst was diagnosed by ultrasonography. At initial examination, three patients showed complete and eighteen patients showed incomplete lesion. Eight patients with incomplete lesion and one patient with complete lesion were followed up. Seven patients with incomplete lesion showed regeneration between 1-7 months after injury. Therefore electrodiagnostic study is necessary to evaluate severity and level of nerve lesion and regeneration.

The Effectiveness of Selective Posterior Rhizotomy for the Rehabilitation in Children with Cerebral Palsy

Selective posterior rhizotomy (SPR) is a neurosurgical procedure designed to alleviate spasticity and has been successfully used for children with spastic cerebral palsy. We evaluated eleven children who had follow up over 6 months after SPR among sixteen children who underwent SPR from August 1995 to July 1996. The authors have analyzed the status of the children with spastic cerebral palsy before and after operation to determine the effects of this therapy on muscle tone, functional grade, gross motor function and gait pattern. Gross motor function was measured by gross motor function measure(GMFM) scale. Postoperative tests showed reduction in muscle tone in all cases compared with preoperative assessments. Functional grade was increased in 90% of the cases more than one grade. The total gross motor mean score change between the preoperative and 6 months postoperative score was 16. Gross motor scores were analysed in each of 5 dimensions(88 conditions), i.e., lying and rolling, sitting, crawling and kneeling, standing, and walking, running, jumping. Gross motor score for each dimension improved in all cases. The greatest improvement was seen in sitting scores. The results of gait analysis of 2 ambulatory patients showed increased range of motion of hip and knee joints throughout the gait cycle and increased ankle dorsiflexion during swing phase. These results showed that SPR combined with intensive postoperative rehabilitation for children with spastic cerebral palsy had a significant positive effect on gross motor function.

Prevalence and Diagnostic Value of Nerve Conduction Study as a Screening of Carpal Tunnel Syndrome in Industry

Carpal tunnel syndrome, the entrapment neuropathy of median nerve within the carpal tunnel of the wrist, is a kind of cumulative trauma disorders, and major problem in occupational health, particularly in occupations requ iring highly repetitive hand motions. We examined 337 telephone operators, 674 hands to detect the incidence and the risk factors of carpal tunnel syndrome, and the efficient screening electrodiagnostic method. The symptomatic hands without slowing were 53 hands(7.9%) and the asymptomatic slowing hands were 30(4.5). 44 hands(6.5%) had symptoms or signs of carpal tunnel syndrome with slowing on nerve conduction, so diagnosed as carpal tunnel syndrome. The age, obesity and wrist dimension were risk factors of carpal tunnel syndrome. The hands with symptoms or slowing had lower grip strength and higher vibration threshold in the middle finger tip compared to normal group. The most sensitive method of nerve conduction was latency of median nerve at palm to wrist. This method was reliable and efficient nerve conduction study so can be recommended as screening procedure for identification of carpal tunnel syndrome in industrial settings.

A clinical study of core decompression in osteonecrosis of the femoral head / 대한정형외과학회잡지

No abstract available.

Neuropathic thoracic spine due to fractured of ankylosing spondylitis and tabes dorsalis: A case report / 대한정형외과학회잡지

No abstract available.

Cosed, semiclosed, open intramedullary nailing in segmental fractures of fmoral shaft / 대한정형외과학회잡지

No abstract available.

Disc excision and anterior lumber interbody fusion for internal disc derangement at the lumbar and lumbosacral intervertebral space / 대한정형외과학회잡지

No abstract available.

Treatment of unstable lower cervical spine trauma with Rogers wiring and posterior fusion / 대한정형외과학회잡지

No abstract available.

Traumatic dislocation of peroneal tendons: one case report / 대한정형외과학회잡지

No abstract available.

Analysis of normal gait with a 3-dimensional motion analyzer

No abstract available.