Epidural Block for the Treatment of Low Back Pain and Sciatica / 대한정형외과학회잡지

In spite of numerous dinical and patho-anatomical studies made in the past, there are still different opinions concerning the mechanism of low back pain. The sciatic symptoms in degenerative lumbar disc disease may arise from the direct mechanical effect of pressure exerted by protruding disc material on nerve roots, and that such symptoms may therefore be relieved by surgical decompression of the nerve roots, has been widely accepted for nearly 40 years. There is, however, a good deal of evidence, both from operative and histological findings as well as from indirect sources, which suggests that inflammatory changes present in and around affected nerve roots may also be of importance in the production of sciatic symptoms in lumbar disc disease. The possibility that, at least in some cases, these inflammatory changes could contribute significantly or even predominantly to the production and persistence of sciatic symptoms, has stimulated many attempts to treat sciatica by means of local antiinflammatory measures in particular, corticosteroid injections. We have studied the effect of the injection of mixture triamcinolone and local anesthetic (1% xylocaine or 0.5% marcaine) comparing with the effect of usual conservative treatment of low back pain and sciatica. Of the 92 patients suffered from lumbago & sciatica, who were treated from 1979. 7 to 1981. 7 in Korea and Jae Il general hospital, 44 patients were treated with intermittent epidural block, 12 patients with continuous epidural block and 36 patients were treated only with usual conservative treatment. The results of clinical observation were as follows: 1. The causative disease were herniated nucleus pulposus in 60 patients (64%), lumbar sprain in 12 (13%), degenerative joint disease of spine in 11 (12%),… 2. The epidural block cases were divided into acute group (symptoms less than 3 months) and chronic group (symptoms longer than 3 months). The over all improvement of the acute group was 22 of 27(81%) and of the chronic group was 22 of 29(76%). The duration of symptoms didnt influenced significantly the effect of epidural block. 3. Therapeutic effect of epidural block was as follows; complete relief 22 of 56(39%), marked relief 13 of 56(23%), slight relief 9 of 56(16%), no improvement 12 of 56(22%). The over all improvement was resulted in 44 of 56(78%): intermittent epidural block 34 of 44(77%), continuous epidural block 10 of 12(83%). 4. Therapeutic effect of conservative treatment was as follows; complete relief 10 of 36(28%), marked relief 7 of 36(19%), slight relief 4 of 36(11%), no improvement 15 of 36(42%). The over all improvement of symptoms was resulted in 21 of 36(58%). 5. Follow up period of epidural block patients were 3 months in average, and persistent relief of symptom were obtained in 12 out of 20 patients(60%), and recurrence of symptom were in 6 of 20 patients(30%). It is considered that epidural block will shorten the time of recovery from severe pain, avoid hospitalization or long periods of bed rest and allow earlier physiotherapy. In addition it may avoid the need for surgical intervention to produce rapid relief of acute pain and give to patient economic, psychologic benefit.

Primary Malignant Fibrous Histiocytoma in the Long Bones: 2 Cases / 대한정형외과학회잡지

Malignant fibrous histiocytama is currently defined as a malignant primary bone tumor, and that may contain fibromatoua, xanthomatous, or histiocytic elementa, varing widely in the degree of anaplasia that is present. The principal lesions to be considered in the differential diagnoais of malignant fibrous histiocytoma are osteogenic sarcoma and fibrosarcoma. Malignant fibrous histiocytoma is more sensitive to chemotherapeutic ageata than are osteosarcama and fibrosarcama. In this paper 2 cases sre reported, including the one in which the tumor arose in a midahaft of the femur and the other one arosein the upper metaphyseal portion of the tibla.

The Treatment of Femoral Shaft Fractures by Cast Brace / 대한정형외과학회잡지

10 cases of femoral shaft fractures were treated by cast brace during the past 5 years from May, 1975 to August, 1979 at the Department of Orthopedic Surgery, Korea General and Jae II Hospital, The results were summarized as follows; 1. Of the 10 cases, 8 cases were male and 2 were female, and age distribution was between 14 and 65. 2. 5 cases were treated by cast brace from the start as the primary treatment and the other 5 were by other method initially and followed by cast brace secondarily. 3. One of 5 cases treated by early cast brace developed delayed union and the other one of 5 cases treated by late cast brace secondarily developed non-union, which were treated by open reduction and internal fixation with cancellous bone graft. 4. The cast brace was applied within the first 6 weeks after fracture and average application time was 9. 7 weeks in the cases treated by early cast brace, which was compared with 12.5 weeks in the late cast brace group. 5. Average time of fracture healing was 13.5 weeks in the early cast brace group and 18. 5 weeks in the late cast brace group. 6. In three of 10 cases, counter traction was applied to reduce the limb shortening during bed rest.

Statistical Study of the Lumosacral Angles in Lumbago Patients / 대한정형외과학회잡지

The purpose of this study is to assess the differences of the lumbosacral angles between the lying and standing position among Iumbago patients. Among Iumbago patients the following diseases with known causes were exclused in this study; spondylolisthesis, spondylolysis, pure herniated nucleus pulposus, tuberculous spondylitis, congenltal anomalies, trauma and psychosis etc. Only the following with unknown causes were included; idlopatic lumbago, hernlated nucleus pulposus with bone and joint changes, instability and degenerative osteoarthritis. The following lumbosacral angles were measured and evaluated in 460 lumbago patients; 271 patients in the lying position and 189 patients in the standing position. 1. Ferguson angle 2. Sacrovertebral angle (Mitchell angle) 3. LS horlzontal angle 4. Promonotorium angle 5. Line of weight bearing The results were summarized as follows; 1. Ferguson angle Lying position 38.4 Standing positon 35.3 Sacrovertebral angle 140.7 142 L5 horizontal angle 20.4 17.4 Promontorlum angle 134.4 134.9 2. Ferguson and L5 horizontal angles in lumbago patients were increased in the lying position and decreased in the standing position as compared with the angles in normal individuals (control group). 3. Sacrovertebral angle In lumbago patients was decreased in the lying position. 4. Promonotorium angle in lumbago patients was increased in the lying and standing position. 5. Judging by the Iine of weight bearing, Iumbago patients in the:lying position showed more instability as compared with that in the standing position group.

Modified High Tibial Osteotomy / 대한정형외과학회잡지

Treatment of unstable cervical spine fracture by skull traction is time consuming procedure, and treatment by Halo appratus has many advantages but it is very expensive. Bone cement has been applied occasionally as an adjunct to metallic internal fixation in treating patient with malignancy, i.e. limited life expectancy. Internal fixation with bone cement in addition to routine posterior fusion with bone graft is tried eliminate the need of application of complicated external immobilization in treating unstable cervical spine fracture of young patient. We experienced two cases of posterior cervical fusion using bone cement with satisfactory results. The advantages of this method are: 1. Rapid and solid fixation 2. Early ambulation 3. Reduce complicated external support 4. Reduce the date of hospitalization.

Pollicization: Two Cases report / 대한정형외과학회잡지

Absence of the thumb, either traumatic or congenical, causes a severe deficiency in hand function; in fact grasp and pinch are almost impossible. Thus when the thumb is partially or totally absent, reconstructive surgery is appealing. Usually the thumb should be reconstructed only when amputation has been at the metacarpophal-angeal joint or at a more proximal level. The procedures for reconstruction of the thumb are well known. They include transposition of a digit, procedures to lengthen the thumb metacarpal and methods of total reconstruction including a pedicle graft to obtain sensibility. Although pollicization (transposition of a finger to replace an absent thumb) endangers the finger, that is worthwhile, especially in complete bilateral absence of the thumb or in bilateral traumatic amputation. The each finger with a part or the whole of the metacarpal, has been transplanted to the stump of the metacarpal of the thumb or the trapezium. When all of the fingers are normal, the index finger is the best choice for thumb replacement because of its circumferential size, phalangeal length, independent motion and proximity to the thenar eminence. Recently this operation has been done with conservation of all nerves, vessels, tendons and muscles. We have had two pollicization operations (transposition of index finger) in the patient of bilateral traumatic amputation of the thumbs. Four months later excellent pinch and grasp with normal sensibility in the reconstructed thumbs were obtained with all remaining digits.

Cystic Hygroma: A Case Report / 대한정형외과학회잡지

Cystic hygroma is a rare, endothelial lined cystic lesion of lymphatic origin which is encountered most often in children, usually at birth or early in life. The tumor is usually found in the neck and axilla. It is a soft, nontender, semifluctuant freely movable tumor of varying size filled with lymphatic fluid. The mass is sometimes pedunculated and is uaually multilocular, althouh it may be monolocular. The cystic hygroma of the right axilla and the upper arm, in a 4 month-old female infant, is presented with a review of the literature.