Effects of RGD Protein on the Bone Resorptive Activity of Osteoclast / 대한정형외과학회잡지

Osteoclasts resorb bone by the hydrogen ions and proteolytic enzymes in the localize environment under the ruffled border. Before releasing hydrogen ion and enzymes, osteoclast should attach to bone surface very tightly and make a room to release enzymes and hydrogen ion in the center. Specialized attachment molecule in the cell membrane, such as integrin, is associated with specific noncollagenous protein in the matrix, which has specific amino acid sequence (Arginine-Glycine- Aspartic acid sequence). We may speculate that osteoclast action would be decreased if the integrin is blocked by antibody or RGD protein. In this study, the osteoclasts were cultured on the coverslip or bone slice with or without RGD protein in the culture medium, and numbers of growing giant cells were much less in group with RGD protein. The number resorption pits, formed on mineralized bone slice, was also lower in the group adding RGD protein in the medium. And we made a conclusion that the osteoclastic bone resorption was inhibited by soluble RGD protein.

Significance of MRI Cord Signal Patterns in Acute Spinal Trauma / 대한정형외과학회잡지

In the diagnosis of acute spinal trauma, meticulous physical examination and history taking is the most important tool and auxilliary support support can be given by plain X-ray, CT or myelography, etc. But these cannot show the state of cord injury directly. On the contrary, MRI shows the cord directly as well as the soft and bony tissues. We analysed retrospectively 39 patients who suffered from acute spinal trauma at the level of cervical and thoracic spine and had their spine MRI taken. We verified the meaningful correlation between the signal change in the spinal cord on MRI and the degree of neurologic deficit and prognosis, using Frankel classification and trauma motor index at the time of admission and the final follow-up.

Herniated Intervertebral Disc of Lumbar Spine in the Teenager / 대한정형외과학회잡지

Herniated intervertebral disc(HIVD) of the lumbar spine has been known to be relatively uncommon in the teenager and frequently be associated with trauma. However, with the changing life style and increasing sports activities, and most of all, with the advent of new imaging modalities, the incidence seems to be increasing gradually. In order to define the characteristic pattern of HIVD of teenager in the era of MRI, and to clarify the associated lesions, such as apophyseal ring fractures, authors performed this retrospective study in 55 teenager patients with HIVD(77 discs), in which MRI was used as main diagnostic modality. The following results were obtained 1) The incidence of the HIVD in teenager was 9.6%(55 patients) of total HIVD patients(575 patients) for 4 years from December 1989 to December 1993. 2) According to MRI findings, HIVD of the teenager could be classified into 3 distinct patterns; simple HIVD, lumbar apophyseal ring fracture(LARF), and vertebral rim lesion. 3) In simple HIVD, as for the MRI classification, protruded type was most frequent type and there was no sequestered type 4) In LARF, the incidence was 14.4% of teenager's HIVD and posterocephalad margin of L5 was the most common site of involvement. 5) Exophytic bony protrusion from the posterior margin of vertebral body, which we called vertebral rim lesion, could be defined on MR sagittal view in 6 cases.

Ninety / 대한정형외과학회잡지

Treatment of femoral shaft fractures in children is varying according to age. Satisfactory results have been obtained with longitudinal skin traction, split Russell traction, ordinary Russell traction, 90-90 skeletal traction, and immediate application of a spica cast(2,4,6,11,15). Most authors use one or more techinques routinely. It is safe and convenient to use single treatment protocol to treat all fractures of same type, Distal femoral skeletal traction with the knee and hip flexed 90 degrees and with the thigh hanging free, using the trunk as counter traction, has been used routinely for femoral shaft fractures in children(age 4-12). We reviewed 30 cases of femoral shaft fractures in children treated with 90-90 skeletal traction. 1. The average age of the patients was 6.8 years(range, 4-12 years), and almost all were caused by pedestrian injury. 2. The average time of traction was 48 days(range, 28-75), and 12 cases(40%) were treated without spica cast application. 3. Four among 30 cases developed angular deformity exceeding acceptable range(15° in AP view, 20° in lateral view), and three of them were proximal third fractures. 4. The older the patient, the longer the duration of limited activity and the more tendency of angular deformity. 5. 90-90 skeletal traction is easy, safe and convenient to treat all femoral shaft fractures of the children between four and ten years old.

Clinical Experience of Automated Percutaneous Lumbar Discectomy / 대한정형외과학회잡지

One hundred and twenty patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy(APLD) from June 1988 to October 1989 in Seoul National University Hospital. Among them, 95 patients were followed up for more than 6 months. Number of male patients was 58 and female 37. Age ranged from 15 to 57 years with average 28 years. L4-L5 was the most commomly involved level comprising 80%, and 2 level involvement was 9%. Average duration of procedure was 38 minutes, and average amount of tissue aspirated was 5.2 grams and average hospital stay was 2.4 days. The average follw up was 10.8 months. Eighty seven percent of patients were satisfactory and 13% unsatisfactory and there was no major complication. There was no significant disc space narrowing in all the cases and the size of herniation revealed no significant change in all the patients, even the patient had a satisfactory result. APLD was compared with chemonucleolysis performed during 1988 in terms of clinical results, disc space narrowing on plain films and herniation size change on follw up CT. Chemonucleolysis also had satisfactory result in 89% with reduction of herniation size in 41% but induced significant disc space narrowing in 84%. Authors experienced some special cases, which are generally considered poor indication for percutaneous discectomy. Those were degenerative, calcified and possibly ruptured discs. Satisfactory results were obtained in 10 of 14 these patients.

Cotrel / 대한정형외과학회잡지

Stabilization of the unstable spine created by the posterior decompression is as important as the decompression itself in the treatment of spinal stenosis. The purpose of this study is to evaluate the effectiveness of C-D pedicle screw fixation in stabilization after lumbar decompression, in reduction of spondylolisthesis and in restoration of the lumbar sagittal curvature. C-D pedicle screw fixation was performed in 102 spinal stenosis patients after posterior lumbar decompression and fusion during the period from March 1987 to December 1988. Their age ranged from 15 to 72 years with an average of 49.1 years. There were 34 males and 68 females. The follow up was from 6 to 21 months with an average of 12.5 months. The causes of spinal stenosis were degenerative in 50 patients, spondylolisthesis in 39, iatrogenic in 9 and degenerative lumbar scoliosis in 4. Objective clinical results showed significant improvement of claudication, SLR limitation, motor weakness, sensory and DTR changes in most patients. Following results were obtained from the study of C-D pedicle screw fixation after posterior decompression in lumbar spinal stenosis.1. C-D pedicle screws provide the secure fixation that allows early ambulation and shorter hospital stay. 2. C-D pedicle screws enable the reduction of spodylolisthesis at the time of posterior stabilization. 3. C-D pedicle screw fixation is successful in the restoration and maintenance of sagittal curvature of the lumbar spine. 4. C-D pedicle screw fixation enables the correction of scoliosis at the time of posterior decompression.

Camptodactyly / 대한정형외과학회잡지

Camptodactyly is a non-traumatic flexion deformity of the PIP joint of the digit (except thumb) and one of rare congenital anomalies of the hand. It may be a clinical manifestation of some other syndrome and may not be a disease of its own right. It is very difficult for this particular problem to get satisfactory results. We analysed 36 digits of 19 patients, whom we treated and followed up for an average of 1.7 years from 1982 to 1988 at the Department of Orthopedic Surgery, Seoul National University Hospital. The following results were obtained. 1. Male to Female ratio is 8: 11 and age ranged from 14 months to 32 years old. 2. Unilateral and single digit involvement is twice more commonly found than bilateral and multiple digit involvement respectively. 3. Third digit is the most frequently involved one in our series. 4. Besides soft tissue contractures on the volar aspects of the PIP joints, other pathologic findings are thick reddish glistening palmar skin in 6 patients, tendon problems in 4 patients and bone-joint hypoplasia in 1 patient. 5. We have done 3 types of operation, that is, skin graft, flexor tenotomy with skin Z-plasty, extensor reconstruction with flexor tenotomy and skin Z-plasty. The results of operations ranged from good to poor, however most cases showed above fair results at the final follow-up. 6. Camptodactyly seems to be a disease of various etiologies and pathologies. And it is strongly suggested that the treatment of this syndrome should be individualized according to their pathologies found at surgery.

Scoliosis Induced by Anterior and Posterior Rhizotomy / 대한정형외과학회잡지

This paper presents the result and statistical analysis of the experiment, in which selective anterior or posterior rhizotomy were carried out under microscopic surgery. The materials used for the experiment were 48 young rabbits, and they were divided into four groups. The group I, which was used as control, was subjected to lower dorsal bilateral laminectomies with dural incision, the group II to laminectomies with three right posterior rhizotomies, the group III to laminectomies with three right anterior rhizotomies, and the group IV to laminectomies with three right anterior and posterior rhizotomies. Scoliosis was induced in group Il, Ill and IV. There was no significant statistical difference in the degrees of curvatures among these three groups. The convexity of the curvature faced to the side of the divided roots. In group III and IV, scoliotic curvatures were obvious within two weeks, but there were no considerable changes thereafter. In group Il, the curves progressed slowly up to the 12th week. They were statistically significant at the 4th week and increased continuously thereafter. The histological findings in the group III and IV showed denervation atrophy of the paravertebral muscles at the apex of the curvature, but there was little or no muscle atrophy in the group I and II. We came to a conclusion from the experimental results that scoliosis may be induced not only by anterior root paralysis but also by selective posterior root paralysis.

Scoliosis and Congenital Heart disease / 대한정형외과학회잡지

Authors reviewed about scoliosis the chest films of 325 congenitalheart diseasepatients who visited Seoul National University Hospital during the period of Jan. 1986 to Dec. 1987 to find out the incidence of scoliosis in congenital heart disease patients and to define the nature of scoliosis associated with congenital heart disease and came to following conclusions. 1. When curvatures of 10 degrees or more on chest P-A was classified as scoliosis, the incidence of scoliosis was 14.4%. It was more than 6 times the prevalence of scoliosis of 2. 3% in general population in Korea. 2. There was no difference in the incidence of scoliosis between the cyanotic and acyanotic heart diseases (P < 0.05). 3. There was no difference in the incidence of scoliosis between individual heart diseases (P < 0.05). 4. The scoliosis associated with congenital heart diseases showed a relative male preponderance. The male to female ratio of scoliosis was 1: 2.1 in patients with congenital heart disease while male to female ratio of idiopathic scoliosis in in general populationwas 1: 8.7 in Korea. 5. The curve pattern of scoliosis associated with congenital heart disease was predominantly right sided, comprising 74.5%. There was no difference of curve pattern between the scoliosis associated with congenital heart disease and the scoliosis in the general population. 6. The curve pattern of scoliosis was influenced neither by the side of the aortic arch nor the thoracotomy incision.

Normal Segmental Sagittal angle of the Lower Dorsal and Lumbosacral spine in Korean Adult / 대한정형외과학회잡지

Authors developed a new method of measuring spinal sagittal curve that is easy and and practical using the lower border of the vertebral body. The intersecting angle was defined as the angle formed bythe perpendicular line drawn from the lower margin of the upper vertebral body with the lower margin of the lower vertebral body which is nearer to the vertebral body. The segmental angle was defined as the intersecting angle minus 90 degrees. A positive segmental angle meant lordosis and negative segmental angle, kyphosis. Authors studied standing lateral thoracolumbosacral films of 80 back pain and deformity free Korean adults who visited Seoul National Universty Hospital during the period of Jan. 1988 to Jun. 1988 using this method to determine the normal segmental sagittal angle and the kypholordotic junction. With statistical analysis of the results, we came to following conclusions. l. Indivdual segments showed its typical sagittal angle. There was no age and sex difference in segments T10 to L5. 2. The gross lordosis of the lumbosacral spine from Ll to Sl showed no age and sex difference. But the Sl segment was more lordotic in males with no age difference. 3. The Ll segment was the kypholordotic junction which was in slight kyphosis 4. The normal ranges of sagittai ourve obtained in this experiment can be used as a guideline to contouring spinal internal fixation device in the sagittal plane.

Treatment of Simple Bone Cyst / 대한정형외과학회잡지

Supracondylar fracture of the humerus is the one of the commonest elbow fracture in children. There are much controversies surrounding the method of treatment for various and frequent complications such as cubitus varus and joint stiffness, etc. For the period of 2 years and 8 months from Jan. 1987 to Aug. 1989, 32 patients had undergone treatment at the Department of Orthopaedic Surgery, Choongang Gil Hospital. Ten cases among them were treated with close reduction and cast, 8 cases were treated with close reduction and pinning, and 14 cases were treated with open reduction and internal fixation. The results obtained are as follows; l. Of all fractures, extension type was 96.9%, and flexion type was 3.1%. According to the Holmberg classification, 5 cases belong to Group I (15.6%), 10 to Group II (31.3%), 7 to Group III (21.9%), and 10 to Group IV (31.3%). 2. Radial nerve injuries which now are thought to be neuropraxia were the most common form of concomitant injuries. 3. All fractures were found to obtain bone union with mean duration of bone union about 40.9 days. 4. There were 7 cases (21.9%) who had more than 10 degrees of elbow motion limitation. Three cases (9.4%) showed the change of carrying angle over 10 degrees in Group IV by Holmberg classification. 5. By the modified Mitchell and Adams' criteria for grading results, Excellent was 22 cases (68.7%), Good was 7 cases (21.9%), Fair was 2 cases (6.3%), and Poor was 1 case (3.1%). 6. In Holmberg classification, the higher severity, the longer mean duration of bone union and the higher joint stiffness made the prognosis worse.

Clinical Study of ankylosing Spondylitis / 대한정형외과학회잡지

Ankylosing spondylitis is an inflammatory disorder of unknown etiology that primarily affect, the spine, the axial skeleton, and the large proximal joints of the body with striking tendancy toward fibrosis with secondary ossification and ankylosis of involved joints. This study was carried out to analyse clinical manifestation, evaluate disease activity indicator and set up diagnostic work-up. 38 cases of ankylosing spondylitis were studied at Department of Orthopedic Surgery, Seoul National University from Oct. 1987 to Mar. 1989. Following results were obtained. l. Average age was 28.5 years and all patients were male. 2. Low back pain was the most frequent symptom(63%) and back stiffness was next(13%). 3. S-I joint change on x-ray was the most frequently found abnormalities(100%) and HLA B27 (+) was next(97%). 4. SI/S ratio was inversely correlated with duration of symptom and seems to be significant durng the early phase of disease. 5. As a disease activity indicator, CRP was more reliable than ESR during follow up.

Surgical Treatment of Spine Tumors Part 1 : Surgical Treatment of Primary Spine Tmors: Review of 45 Cases / 대한정형외과학회잡지

Forty-five patients with primary neoplasm of the spine, disgnosed and operated at Dept. of Orthopedic Surgery, Seoul National University Hospital, from 1970 to 1988, were reviewed in an attempt to analyze the incidence of the primary spine tumors and effectiveness of surgical treatment. Mean follow-up was 2.5 years. Among 29 benign tumors, 7 cases of osteoid osteoma, 6 cases of giant cell tumor, 4 cases of osteoblastoma and aneurysmal bone cyst, and 2 cases of fibrous dysplasia and osteochondroma, and others were identified. Of 16 malignant tumors, 6 cases of eosinophilic granuloms, 4 cases of chordoma, 3 cases of solitary plasmacytoms, and others were noted. 17 cases occurred in the anterior compartment, 18 cases in the posterior compartment, and 10 cases involved both compartments. Surgical treatment consisted of complete or near complete excision, decompression, and additional stabilization procedure when the stability of the vertebral column was compromised. Stablization was achieved either by fusion, strut bone graft, or by additional Zielke, Cotrel-Dubousset, or Luque-Harringtion instrumentation. The results were astisfactory in most of the cases with benign tumors except cases of giant cell tumor. The results in malignant tumor were satisfactory especially in eosinophilic granuloma and solitary plasmacytoma with respects to symptoms and survival, and this fact was attaibuted to good response to adjuvant chemotherapy and radiation therapy. Recent application of Cotrol-Dubousset or Zielke instrumentation after agressive resection made early ambulation a clinical reality.

Synovial Hypertrophy in Discoid Meniscus / 대한정형외과학회잡지

Arthroscopic surgery of the knee is now a widely performed orthopedic technique. Of this, arthrosoopic surgery of discoid meniscus is one of the most technically demanding procedures of this field. In our experience, discoid meniscus was appeared to be frequently accompanied with villous hypertrophied synovium, which obstructed the arthroscopic view. The purpose of this study is to prove the presence of synovial hypertrophy in discoid meniscus and to develop an adequate portal of entry for successful arthroscopic surgery of discoid meniscus. 155 cases of arthroscopy of the knee were performed at the Department of Orthopedic Surgery, College of Medicine, Seoul National University between January 1987 and March 1988. Of these, 25 cases were discoid menisci and they were all lateral. Operative findings were observed through arthroscopy and they were also reviewed by recorded video tapes in 25 cases of arthroscopic surgery of discoid meniscus and 57 cases of non-discoid meniscal lesions for the presence of synovial hypertrophy. Synovial biopsy was performed in selected cases with synovial hypertrophy for observation of histological findings. Hypertrophied synovium in discoid meniscus was mainly localized in anterior compartment and intercondylar area of tibia. Therefore, when conventional anterolateral or anteromedial portals were used, much difficulty was confronted because hypertrophied synovium obstructed the visual field and crowding with surgical instruments was occurred in restricted space of discoid meniscus. Much more clear visual field was obtained when the medial midpatellar portal was used instead of conventional portals. The conclusions of this study are as follows : 1. The incidence of discoid meniscus was 16.1%. 2. Synovial hypertrophy was present in all 25 cases of discoid meniscus and 21 cases among 57 non-discoid meniscal lesions(35%) on operative findings 3. Synovial biopsy of hypertrophied synovium showed irritative nonspecific inflammatory lesions but there was no histologicsl differences between discoid and non-discoid meniscus. 4. Medial midpatellar portal is considered to be better approach than conventional portals for clear visual field and less crowding with instruments in arthroscopic surgery of lateral discoid meniscus.

Changes of Pulmonary Function after Surgical Correction in Scoliosis / 대한정형외과학회잡지

This study was performed by the necessity of objective information upon change of pulmonary function after surgical correction of spinal deformity in scoliotic patients. It is relatively well known that deformity of spinal curvature affects the pulmonary functions, especially lung volume or vital capacity, due to restriction of the thoracic cage. It is carried out the comparative study between preoperative and postoperative pulmonary functions in thirty two cases of thoracic scoliosis, all who were treated with Harrington instrumentation and posterior fusion at Department of Orthopedic Surgery, Seoul, National University Hospital from 1969 to 1983. The age distribution of patients was from 6 years to 21 years and female was more involved two times than male. Following observations were obtained: Following observations were obtained: 1. Pre-and postoperative angle of scoliosis were 77.5° and 39.2° with correction rate of 48.2%. 2. Preoperative vital capacity was 64.2% and postoperative value was 74.8%, 2 years and 2 months after operation in average. 3. Postoperative vital capacity was significantly increased compared to preoperative value in patients with scoliosis (p<0.05). 4. Ther was no definite pattern of obstructive pulmonary disease in patients with scoliotic deformity.

Luque Instrumentation / 대한정형외과학회잡지

Luque introduced new posterior spinal instrumentation by segmental sublaminar wiring for spinal deformity in 1976. This system initially developed for the treatment of paralytic scoliosis, but now its application was extended to treatment of other types of scolisis, spinal fractures and spondylolysthesis. Advantages of this system in scoliosis are better correction force and secure internal fixation enabling early ambulation without external support. Disadvantages include longer operation time, possibilities of epidural bleeding and dural laceration. Luque instrumentation in thoracic and lumbar spine fracture is an effective means of obtaining following goals: provide reduction, maintenance of alignment, restoration of stability, prevention of deformity, low pseudarthrosis rate and early mobilization without external support. Luque instrumentation were carried out in 5 cases at Dept. of O.S. at SNUH from Oct. 1983 to Feb. 1984 with excellent results. The average follow-up period was 7.4 months and there was no complication. Two cases of unstable thoracic and lumbar spine fractures were treated with Luque instrumentation with fusion. The use of double sublaminar wiring with Luque rods, two levels above and two levels below on area of fracture provided early stabilization to allow rehabilitation without external immobilization. Three cases of paralytic scoliosis underwent Luque instrumentation by a modification of the Galveston technique with fusion. Average preoperative curve was 110°(ranged from 101° to 126°). Immediate postoperative correction was 58.7°(46.6%) and average 7 months-following result was 56.3°(48.3%). Operation time averaged 6hr 7min and blood loss was averaged 12 pints. Those patients required instrumentation from the pelvis to middorsal segment, in an effort to control the curve and associated pelvic tilting. In early follow-up the author obtained remarkable correction in paralytic curves, and the pelvic obliquity were well corrected with a pelvis and provid ing with better sitting balance.

Treatment of Acetabular Fractures / 대한정형외과학회잡지

Acetabular fractures are usually caused by violent external force such as car clash and commonly accompany injuries of the other parts of the body. And there has been long controversy between conservative and operative treatments. A clinical analysis was performed on the 29 patients with acetabular fractures, who had been treated at seoul National University Hospital from 1973 to 1982, mainly focussed on the result of treatment. Followings are the summary of the result. 1. Conservative treatment was done in 52% and operative treatment in 48%. 2. Mean follow-up period was 1 year and 8 months. 3. The result of treatment was good or fair in 53% of conservative treatment group comparedto 71 in operative treatment group. 4. Primary total hip replacement was done in one case of bursting fracture combined with fracture of femur neck and the result was good. 5. Superior and bursting fractures showed the worst result(poor in 83%). 6. Degenerative arthritis with or without avascular necrosis was the most common complication (45 %) and it was more common in conservative treatment group (60 vs. 29%). 7. From above results it could be said that operative treatment in acetabular fractures, if carefully done with reasonable indications, would improve the result and decrease the rate of degenerative arthritis.

Follow-up Study of Cementless Total Hip Replacement Arthroplasty / 대한정형외과학회잡지

No abstract available in English.

The Association Between Degenerative Arthritis of the Lumbar Spine and Obesity / 대한정형외과학회잡지

Degenerative arthritis of the lumbar spine is one of the main causes of the low back pain over the fifth decade of life. Nowadays, it seems that the number of obese person increases gradually and the role of Obesity in the development of articular degeneration remains controversial. The authors studied 100 cases of the primary degenerative arthritis of the lumbar spine clinically and statistically and compared 50 cases among these with 2 control groups, with and without low back pain, from Mar. 1982 to Sep. 1982. The results were as follows: 1. Among the patients with the degenerative arthritis of the lumbar spine, the ratio of male to female was 1:4, and the age group with the highest frequency was the 6th decade (47%) 2. 44% was obese in the arthritis group and 26% in the control group with low back pain and 12% in the control group without low back pain. 3. The relative risk of the hypothesis that the arthritic patient is obeser than the patient with low back pain but without degenerative changes on X-ray was 2.3, but the hyposthesis was proved to be statistically insignificant. The relative risk of the hypothesis that the arthriticpatient was obeser than the patient without low back pain and degenerative changes on X-ray was 6.3 and proved to be statistically significant.