Shoulder Motion after Scapulothoracic Arthrodesis of the Facioscapulohumeral Type of Progressive Muscular Dystrophy ( PMD ) / 대한정형외과학회잡지

Many patients who have facioscapulohumeral muscular dystrophy eventually have instability of the scapula due to weakness of the muscles which stabilize the scapula. However, a subset of these patients have sufficient strength in the supraspinatus and deltoid muscle to abduct the arm if the scapula has been stabilized. In four patients who had facioscapulohumeral type of progressive muscular dystrophy, scapulothoracic arthrodesis was done for the treatment of limited unstable shoulder motion, especially flexion and abduction and symptomatic winging of the scapula caused by the loss of scapular stability from July 1994 to Feb.1995. The purpose of this study was to report 5 cases who obtained permanent stability after the scapulothoracic arthrodesis and compare the pre- and postoperative glenohumeral motion. The average preoperative active abduction was 74 degrees, which was improved to l35 degrees at the last follow up in 4 cases except unsatisfied 1 case. The average preoperative active flexion was 66 degrees, which improved to 140 degrees at last follow up. The average preoperative UCLA shoulder score was 18.4 points, which improved to 29.6 points at the last follow up. They were doing well in activity of daily living except unsatisfied one case. The scapulothoracic arthrodesis in the facioscapulohumeral type of the progressive muscular dystrophy is successful in achieving scapular stability so it is valuable for selected patients, as it improves appearance, enhances function, and increases tolerance to exercise.

Magnetic Resonance Imaging of Radiographically Negative Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

Magnetic resonance imaging has been recognized as more suitable method than radiography and bone scan for the early detection of avascular necrosis of the femoral head. Segmental collapse is the most important factor in the prognosis of patient with avascular necrosis. The authors studied the appearance of avascular necrosis with both radiography and magnetic resonance imaging and then determined which lesions remained unchanged, progressed or led to collapse, as determined wih follow-up radiography in the 61 radiographically negative avascular necrosis of the femoral heads. 1. The necrosis-progression rates according to the extent were 36% in Extent A, 83% in Extent B, and 93% in Extent C. The necrosis-progression rate was significantly correlated with the extent of necrosis initially involved. 2. The necrosis-progression rates according to the location were 37% in Type I, 70% in Type II, and 95% in Type III. The necrosis-progression rate was significantly correlated with the weight bearing area of necrosis initially involved. 3. There was no correlation between necrosis-progression rate and signal intensity. 4.All of the cases which had combinations of the Extent C, and Type III location showed progression. 5. None of the femoral heads that had been treated at the radiographically negative stage was collapsed, but 35% of the femoral heads those had been treated at the radiographically positive stage were collapsed. 6. In the cases which were treated early, all of the Extent C, Type III were collapsed, but none of the Extent A, Type I were collapsed. In conclusion, magnetic resonance imaging is useful for evaluation of the risk of collapse or for anticipation of the prognosis of the affected hip joint as well as for the early diagnosis of radiographically negative avasular necrosis of the femoral head.