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Biomedical subjects

C H Shih

Publications and source records attributed to C H Shih.

At least 91 records · Page 5Linked to original sources
PubMed1996

Reduction-fixation spinal system in spondylolisthesis.

Posterior transpedicular instrumentation with short segmental fixation represents a current trend in surgery for unstable spinal problems, such as spondylolisthesis. A reduction-fixation spinal system with 5.75- to 6.25-mm diameter pedicle screws of variable angles and an 8-mm diameter rod can achieve a rather rigid, short-segment fixation and satisfactory reduction of spondylolisthetic deformities. In clinical applications, 84% of 85 patients with spinal instability had good-to-excellent results for back pain, 88% for sciatica, and 86% for claudication; 91% achieved solid posterolateral fusion from the roentgenographic studies. This reduction-fixation system achieved a reduction of 71% +/- 5.3% of slipping width in this population. Posterior lumbar interbody fusion is mandatory for effective and lasting reduction. Complications from reduction fixation including pedicle-screw loosening (12%), pedicle screw breakage (7%), adjacent instability (7%), and nerve root injury (2%).

Adult↗
PubMed1996

[Metastatic spine disease: surgical treatment by anterior corpectomy and Ziekel's VDS fixation].

The spine is the common site of skeletal metastases. The goal of surgical treatment of metastatic spine disease is to improve the quality of remaining life, by relief of pain, the preservation or restoration of neurologic function, and reconstruction of the spinal stability. From 1984 through June 1993, 40 consecutive patients underwent surgical treatment by anterior corpectomy, and bone cement with VDS fixation for corporal metastatic diseases. There were 28 men and 12 women. The average age was 53.2 years, range from 21 to 76 years. Twenty-four patients had metastasis to the thoracic spine, 12 to the lumbar spine, and 4 had both thoracic and lumbar metastases. The primary malignancies were lung cancers in 10 cases, colorectal carcinomata in 6, hepatomas in 5, thyroid cancers in 4, cancer of stomach, renal, breast, nasopharynx, long bone, skin, cervical in 1 case respectively. A primary carcinoma was never identified in 8 patients. In the present series, 4 patients died within one month, 36 patients were allowed for follow-up study. Thirty-two patients (89%) attained pain relief. Thirty patients presented with neurologic compromise. After operation, neurologic improvement was noted in 21 (70%). No patient's neurologic function deteriorated secondary to surgical intervention. We conclude that anterior corpectomy to decompress neural encroachment with VDS and cement fixation to stabilize the collapsed spine is an adjunctive treatment to reduce pain and restore the neurologic function in these highly selected patients.

Adult↗
PubMed1995

Pulmonary tuberculosis as a source of infection after total hip arthroplasty. A report of two cases.

Two cases of septic loosening due to a tuberculosis infection occurred 18 months and 14 years after total hip arthroplasties. The primary source was pulmonary tuberculosis. Treatment was by removal of the prosthesis and radical debridement with the local implantation of gentamicin PMMA beads, followed by antituberculosis chemotherapy for one year. In the first case, a revision arthroplasty was carried out 20 months later; the second was reconstructed with a vastus lateralis transposition one month later. There was no recurrence of infection after a follow up of 3 and 2 years respectively. Although this is a rare complication, the possibility must be born in mind. Early diagnosis and treatment of pulmonary tuberculosis may prevent the secondary infection of a total hip arthroplasty.

Adult↗
PubMed1995

Double-rib composite free transfer to reconstruct a single-spared lower extremity defect.

The case of a 43-year-old man is reported in which a 15-cm defect of the tibia sustained 8 months previously was treated by the double-rib composite microvascular free transfer. The fracture site united, and the grafted ribs showed some hypertrophy at 1 year. He returned to his job. At 5 years follow-up, the x-ray film showed good hypertrophy of the grafted ribs.

Adult↗
PubMed1995

Prevalence of antibody to hepatitis E virus among healthy individuals in southern Taiwan.

The seroprevalence of hepatitis E virus (HEV) among 997 healthy individuals aged 6 to 84 years, collected between July 1993 and June 1994 at Kaohsiung-Pingtung area in Southern Taiwan was studied. Of the study populations of vegetable farmers, elementary school children, volunteer blood donors and college students, the prevalence of IgG anti-HEV ranged from 6.4% to 8.8%. In suburban elemantary school children of Mang-Chou Village at Pingtung-Hsien, the seroprevalence rate (9.6%) was significantly higher than the positive rate (1.5%) found in rural aboriginal elementary school of San-Min Village at Kaohsiung-Hsien. IgG anti-HEV antibodies were widely distributed among all age groups, with a significantly higher percentage (13.1%) in the age group of 46-55 years old.

Adolescent↗
PubMed1995

Surgical treatment of tuberculous spondylitis. 50 patients followed for 2-8 years.

We treated 50 adult patients with tuberculous spondylitis surgically and followed them for a mean of 5 (2-8) years. All had persistent back pain, 32 had neurologic deficit, and 13 had gibbus deformity. Anterior debridement and fusion were the main operative procedures. Additional posterior stabilization was performed in 14 patients who had loss of a vertebral body or for correction of severe kyphosis. 30 of the 32 patients with neurological impairment had an improvement of 1-3 Frankel's grades after operation. All patients had some relief of pain. Solid bony union of the fusion was found in 46 patients and 4 had nonunion after anterior operation only. The average correction of the kyphotic angle was 10 degrees.

Adult↗
PubMed1995

The quantitative measurements of hip isometric muscle torques in Chinese young adults--a preliminary report.

A standard procedure for measurement of hip muscle strength (maximal isometric torque) with the Cybex 340 isokinetic dynamometer is presented. Twenty-two healthy males aged 30-40 years (average 34.3 years) were tested on hip flexors, extensors and abductors; in which the factors as sex, age, dominant side and testing session were all eliminated. The test was redone two weeks later on the same 10 males to evaluate its reproducibility. The results disclosed the maximal isometric torque of the hip flexors was stronger than that of extensors and abductors in both sides hips. The comparison between two sides hips showed only the abductors of right side hip significantly stronger than that of left side (P = 0.0259). The tests between the two different periods were quite compatible. The results have clinical implications for objective assessment of preoperative and postoperative hip strengths in patients with hip arthropathy and thus giving a reasonable guidance for physiotherapeutic management.

Adult↗
PubMed1995

Surgical treatment for deltoid contracture in adults.

In a retrospective study, 60 shoulders in 38 adults with deltoid contracture were surgically treated by proximal or distal releases. Twenty-three patients, representing 34 treated shoulders, were followed up for at least 2 years (median was 4 years). By the last follow-up, all patients achieved satisfactory outcomes: freedom from pain, full range of motion, and normal muscle power. The proximal release was used in patients with one-portion (one of the deltoid origins) involvement, and the distal release was used in patients with two- or three-portion involvement. Three shoulders (5%) had postoperative complications in the form of intramuscular hematomas, which were resorbed spontaneously within 3 weeks. The authors recommend surgical release to treat deltoid contracture whenever indicated.

Adult↗
PubMed1995

Ilizarov femoral lengthening in adults.

From January 1990 to December 1991, we treated 12 cases of length discrepancy due to femoral inequality with the technique of Ilizarov femoral lengthening. The patients' ages ranged from 20 to 33 years (average, 28 years). Of these, nine patients were men and three were women. Corticotomy was performed either at the distal metaphysis or at the junction of distal metaphysis and diaphysis. After a latency of seven to ten days, distraction commenced at a rate 0.25 mm every six to twelve hours. Bone generation was obtained in all patients without the need of bone grafting. The average length gained in femoral bone was 4.7 cms (range, 3 to 7 cms). The average duration of total treatment was 10.1 months (range, 7 to 15 months). The healing index was 2.2 (number of months per 1 cm elongation) on average. All patients were satisfied with the results, but all felt that it was an uncomfortable procedure. According to our experience, we conclude that the method of Ilizarov is an useful technique for femoral lengthening. However, it is an uncomfortable and tedious procedure.

Adult↗
PubMed1995

Back pain after thoracolumbar fracture treated with long instrumentation and short fusion.

The purposes of this retrospective study are to evaluate the degeneration of facets in unfused segments immobilized by Harrington rods and to see how often back pain developed after treatment with this method. Sixty patients with thoracolumbar fracture were treated with the Harrington rod long-fuse short technique. Harrington rods are removed an average of 14 months after initial surgery. Every case showed solid fusion during implant removal exploration. Thereafter, all cases were followed for a minimum of 5 years. Roentgenographic studies and a bone scan were performed to evaluate the degeneration of facet joints. Back pain complaint was found in 11 patients (18.3%). The degeneration of unfused facets was visualized in six patients by roentgenograms. Increased activity in the instrumented spine by bone scan examination also was noted in six patients: three cases were at unfused area, one at a fused area, and two at fused and unfused areas. In conclusion, degeneration in the immobilized and unfused segments after rod long and fused short was rarely seen clinically after long-term follow-up. Back pain was experienced in only 18.3% of the patients and seldom required medication.

Adolescent↗
PubMed1994

Incorporation of allograft for acetabular reconstruction. Single photon emission CT in 21 hip arthroplasties followed for 2.5-5 years.

We studied 21 hips in 20 patients who had acetabular reconstruction with a femoral head allograft in primary (n 2) and secondary (n 19) total hip arthroplasty. The fate of the graft was evaluated by serial bone SPECTs (single photon emission computed tomography). With a mean follow-up period of 37 (30-60) months, 14 of the 21 hips showed evidence of incorporation at earliest 13 (6-18) months after operation. There was no correlation between the fate of allograft and the compatibility of A, B, O blood typing between host and donor, the use of bone cement in the fixation of acetabular component, or loosening of the acetabular component.

Acetabulum↗
PubMed1994

Comparison of dynamic compression plating and reamed intramedullary nailing in the treatment of aseptic tibial shaft nonunions.

Among 105 tibial shaft aseptic nonunions followed for a mean of 32 months, 30 were treated with dynamic compression plating and 75 were treated with either Küntscher or Grosse-Kempf interlocking intramedullary nailing. With the plating technique, the union rate was 90.0% (27/30), the period of time to union was 5.2 +/- 1.7 months, the complication rate was 16.7% (5/30), the infection rate was 13.3% (4/30), and the surgical time was 110 +/- 30 minutes. With the intramedullary nailing technique, the union rate was 93.3% (70/75), the period of time to union was 5.0 +/- 1.6 months, the complication rate was 17.3% (13/75), the infection rate was 13.3% (10/75), and the surgical time was 70 +/- 30 minutes. Thus, while the union rate was high with both techniques, the complication rate also was high, especially deep infection. However, the technique for nailing was simpler and required less surgical time than plating (p less than 0.001). With open reamed intramedullary nailing, a higher infection rate was noted in the cases initially treated with an external fixator than for cases in which other forms of treatment initially were used (p less than 0.05).

Adolescent↗
PubMed1994

Acetabular allograft reconstruction in total hip arthroplasty: preliminary report with clinical, roentgenographic and scintigraphic analyses.

From January 1986 to June 1991, we used structural allografts to augment major acetabular deficiencies during primary or revision total hip arthroplasty (THA) in 54 patients. Forty-four patients (46 hips) with a minimal follow-up of two years were reviewed. The average patient age was 50.2 years. The diagnosis was loose THA component in 36 hips, six failed Austin-Moores, three septic hip sequelae, and one failed bipolar hemiarthroplasty. Their preoperative hip ratings (modified d'Aubigne and Postel rating system) averaged 10.7 points. Forty-five allografts (98%) united roentgenographically with an average union period of 11.8 months. Five acetabular components (10.9%) developed aseptic loosening; one of them underwent revision using a healing allograft and one hip needed further acetabular reconstruction with allograft due to complete necrosis of the original allograft. One additional hip required resection arthroplasty for septic loosening. The 43 surviving hips had a mean hip score of 16.7 points at the latest follow-up. Radiographic evidence of graft resorption was seen in eight hips, which was not correlated with acetabular loosening. Serial single photon emission computed tomography (SPECT) study was employed postoperatively in 20 patients (21 hips) to assess the healing process and graft viability. Seven allografts (33.3%) were nonviable on serial SPECT studies, while 14 allografts (66.7%) were viable. The compatibility of host-donor A, B, O blood typing and the use of cement did not correlate with allograft viability. Allograft viability did not contribute to the failure of cup components. Considering the major acetabular deficiency and the absence of sufficient autograft material, the use of frozen allografts appears to be justified.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1994

[Floating shoulder (ipsilateral scapular neck and clavicle fracture)--two cases report].

Fracture of either clavicle or scapular neck alone are generally stable and have satisfactory results by conservative treatment. However, displaced scapular neck and ipsilateral clavicle fractures are relatively unstable. Those sequelae as drooping shoulder and limited range of motion may develop if treated conservatively. Surgical intervention either fixation of clavicle alone or fixation of clavicle and scapular neck simultaneously can achieve stable reduction of the fractures and prevent those sequelae. We present two cases of floating shoulder treated surgically with excellent results.

Adult↗
PubMed1994

Irreducible volar rotatory dislocation of the proximal interphalangeal joint.

Volar rotatory dislocation of the proximal interphalangeal (PIP) joint often cannot be reduced by closed manipulation because of interposition of soft tissues. In this case, the condyle of the proximal phalanx was trapped between the central slip and the lateral band. This case is reported to reemphasize the importance of recognizing serious injuries involving the soft tissues around the PIP joint. Deprival of its normal dorsal stabilizing forces can cause a loss of both static and dynamic joint support. Secondary scarring and contractures affect all damaged structures of the joint.

Adult↗