The Radiographic Comparative Study of the Unicompartmental Knee Arthroplasty: Manual versus Navigation System / 대한정형외과학회잡지

PURPOSE: To compare the radiographic results of unicompartmental knee arthroplasty using a navigation system with those using a manual alignment system. MATERIALS AND METHODS: The results of 50 cases (46 patients) of unicompartmental knee arthroplasty using a navigation system (24 patients, 25 cases) and using a manual alignment system (22 patients, 25 cases) were evaluated. Knee anteroposterior, lateral, and weight-bearing full-length lower extremity radiographs before and after the arthroplasty were used for the measurements. RESULTS: The mean postoperative femorotibial alignment was 3.6 degrees of valgus in the manual alignment group and 5.4 degrees of valgus in the navigation group. The postoperative mechanical axis measured using Kennedy and White's method was located at zone 1 in 4 cases (16%), at zone 2 or C in 21 cases (84%) in the manual group, and at zone C for all cases in the navigation group (p=0.001). In the coronal axis of the femoral component, 11 cases (44%) were excellent, 7 cases (28%) were good and, 7 cases (28%) were poor in the manual alignment group. In the navigation group, 15 cases (60%) were excellent and 10 cases (40%) were good and there were no poor results (p0.05). In the sagittal axis of the tibial component, 9 cases (36%) showed poor results in manual group and there were no poor results in the navigation group (p<0.05). CONCLUSION: Unicompartmental knee arthroplasty using navigation produced better results in restoring the alignment of the prosthesis and the mechanical axis of the lower extremity than that using manual alignment.

Optimal Trajectories of C1 Lateral Mass Screws and C2 Pars-Pedicle Screws / 대한척추외과학회지

STUDY DESIGN: Surgical simulation using CT images of the cervical spine and computers. OBJECTIVES: The optimal trajectories for C1 lateral mass screws and C2 pars-pedicle screws were sought, and their accuracy evaluated. LITERATURE REVIEW SUMMARY: There have been a few suggestions for the trajectories of the screws listed above, but these are somewhat vague or impractical. MATERIALS AND METHODS: Using 1 mm-sliced CT scan images of 128 patients, and a V-works spine surgery simulator 4.0 (Cybermed, Inc., Korea), the optimal trajectories with which 4.0 mm screws can be inserted without breaching bone cortices were determined. The anatomical characteristics of the cases having a cortical perforation were analyzed. RESULTS: The insertion point suggested for a C1 screw was 1 mm lateral to the middle of the junction of the posterior arch and posterior inferior part of the lateral mass. The screw was directed 15 degrees medially and toward the junction of the superior 2/3 and inferior 1/3 of the anterior tubercle in the lateral fluoroscopic view. The C2 screw was directed 30 degrees medially, and toward the anterior end of the superior articular process, in the lateral fluoroscopic view. The insertion point was one where the screw was inserted close to the superomedial border of the pedicle. Using these trajectories, all (256/256) of the C1 screws were inserted safely. However, 6.3% (16/256) of the C2 screws breached the inferolateral cortices of the pedicles, due to the pedicles being either too narrow or too medially angulated. CONCLUSIONS: Herein, more practical and safe screw trajectories have been suggested. Using these trajectories, all the C1 and most of the C2 screws were able to be inserted safely. However, there were some cases in which the C2 screws could not be inserted without breaching the vertebral artery groove. Therefore, preoperative thin-slice CT scanning, with three-dimensional reconstruction and/or three-dimensional CT-angiography, is recommended for these cases.

Optimal Trajectories of C1 Lateral Mass Screws and C2 Pars-Pedicle Screws / 대한척추외과학회지

STUDY DESIGN: Surgical simulation using CT images of the cervical spine and computers. OBJECTIVES: The optimal trajectories for C1 lateral mass screws and C2 pars-pedicle screws were sought, and their accuracy evaluated. LITERATURE REVIEW SUMMARY: There have been a few suggestions for the trajectories of the screws listed above, but these are somewhat vague or impractical. MATERIALS AND METHODS: Using 1 mm-sliced CT scan images of 128 patients, and a V-works spine surgery simulator 4.0 (Cybermed, Inc., Korea), the optimal trajectories with which 4.0 mm screws can be inserted without breaching bone cortices were determined. The anatomical characteristics of the cases having a cortical perforation were analyzed. RESULTS: The insertion point suggested for a C1 screw was 1 mm lateral to the middle of the junction of the posterior arch and posterior inferior part of the lateral mass. The screw was directed 15 degrees medially and toward the junction of the superior 2/3 and inferior 1/3 of the anterior tubercle in the lateral fluoroscopic view. The C2 screw was directed 30 degrees medially, and toward the anterior end of the superior articular process, in the lateral fluoroscopic view. The insertion point was one where the screw was inserted close to the superomedial border of the pedicle. Using these trajectories, all (256/256) of the C1 screws were inserted safely. However, 6.3% (16/256) of the C2 screws breached the inferolateral cortices of the pedicles, due to the pedicles being either too narrow or too medially angulated. CONCLUSIONS: Herein, more practical and safe screw trajectories have been suggested. Using these trajectories, all the C1 and most of the C2 screws were able to be inserted safely. However, there were some cases in which the C2 screws could not be inserted without breaching the vertebral artery groove. Therefore, preoperative thin-slice CT scanning, with three-dimensional reconstruction and/or three-dimensional CT-angiography, is recommended for these cases.

Central Venous Obstruction in Hemodialysis Patients: The Usefulness of Percutaneous Treatment

PURPOSE: To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. MATERIALS AND METHODS: In 100 patients, 107 central venous strictures [56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23, stenosis:28)] were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion were also determined. RESULTS: We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2- and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). CONCLUSION: In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required.

The Study of beta-Glucuronidase Activity in Selected Orthopaedic Disease / 대한류마티스학회지

OBJECTIVES: The purpose of this study was to get help in order to diagnose orthopaedic disease, measure its activity and determine treatment plan by measuring the beta-glucuronidase activity in urine, serum and joint fluid. METHODS: The beta-glucuronidase activity was determined in the serum, urine and joint fluid of the patients with degenerative arthritis, rheumatoid arthritis, osteomyelitis and osteogenic sarcoma, and some other disease to study the change of the enzyme activity. These values of each specimen were calculated by standard curve and treated by statistical analysis. RESULTS: The results obtained were summarized as follows. 1. The beta-glucuronidase activity in the serum, urine and joint fluid was increased in patients with degenerative arthritis, rheumatoid arthritis, osteomyelitis and osteogenic sarcoma etc. 2. The increased beta-glucuronidase activity in the serum and joint fluid of each disease does not show a specific finding about respective disease, but the increased beta-glucuronidase activity was statistically significant in the urine of all disease groups(male:p=0. 0041, female:p=0. 0001). CONCLUSIONS: On the basis of these results, it was suggested that beta-glucuronidase activity was affected by the orthopaedic disease and differed according to each specimen.

The Clinical Observation on Acetabular Fracture / 대한정형외과학회잡지

The clinical observation was performed on 32 patients of acetabular fracture, who had been admitted and treated at Department of Orthopedic Surgery, College of Medicine, Busan National University from January 1980 to December 1983. The results obtained were as follows. 1. The prevalent age ranged from 20 to 50 years, which comprised 71.9% and the ratio between males and females was 2.6: l. 2. The causes of injury were 16 cases of traffic accident, which comprised the highest incidence, 10 falling down and 6 direct blow. 3. According to Letournels classification, 21 cases (65.6%) were simple fractures, llcases(34.4%) were associated fractures. 4. Total patients associated injuries of another part of body were 24 cases#{75.0%) among them pelvic bone fracture was the most common fractured case and cerebral concussion was the most common soft tissue injury. 5. 2 types of treatment were performed, one was 18 conservative treatment and the other was 14 surgical treatment which was performed by open reduction and internal fixation. 6. The satisfactory result of conservative treatment was 61.6% and surgical treatment was 85.7. 7. The complications were 7 cases(21.9) of degenerative arthritis, ectopic ossification in 2cases (6.3%), avascular necrosis, superficial infection, and secondary displacement of fracture site in 1 case(3.1%) respectively. 8. The anatomical reduction and internal fixation was an important factor in treatment of acetabular fracture, especially in severe displaced articular fracture.