Revision Arthroplasty using Thtoplast - HA Composites for Acetabular Bone Deficiencies / 대한정형외과학회잡지

Sixty-eight revisions of total hip arthroplasties from sixty-one patients were performed using allogenic cancellous chip bone and fine granules of HA for bone deficiencies of the acetabulum at two hospitals in Seoul since September 1992. In our practice, acetabular deficiencies were classified into two broad categories, which were based on our provisional treatment protocol. For the segmental deficiencies of the acetabulum, we employed the method of using the cemented acetabular component. In the mean time, Ling technique of impaction graft with PMMA cement were also employed. For the cavitary deficiencies of the acetabulum, we used several types of uncemented ingrowth cups with HA granules and Tutoplast was used to further ameliorate the bony integration. In addition, we obtained good results in cavitary deficiencies of the acetabulum with C.L.S. Expansion Cup and Ringloc fin Cups which seem that initial stability during the cup installation were remarkable. Unfortunately, we had 5 cases of clinical failure, which consist of bone graft incorporation, where eventual resorption of the graft and implant migration were resulted. Nevertheless electromicroscopic finding of interface taken from failure showed partial new trabecular formation and physicochemical bonding near the host bone bed in some cases. Although primary stability of reconstructive surgery was acceptable, Tutoplast - HA granule composites have similar effect of incorporation to host bone compared with other method of allogenic bonegraft storage, which remodeled after 5 years. Thus, this phenomenon requires further investigation of molecular biological role of tissue substance known as cytokine, as well as microscopic histology.

Endoscopic Optic Canal Decompression

The visual loss owing to acute optic nerve injury after blunt head trauma has been reported about 5% at the incidence. But it has been real circumstances that we still don`t have the exact knowlege about surgical indication, operation time and steroid dosage for this candidate. Lately, endoscopic surgery was introduced for treatment of orbital disease instead of classic external approach and we have performed and report endoscoic endonasal optic canal decompression followed by megadose steroid injection in 5 patients who experienced visual loss due to optic canal fracture following trauma.

Clinical Evaluation of the Graft Rejection after Penetrating Keratoplasty

In order to evaluate risk factors (sex, age, preoperative diagnoses, graft size, neovascularization of the recipient cornea, bilaterality, history of the previous graft failure, doner corneal preservation method, phakic status, glaucoma and enucleation time after death) influencing graft rejection, we reviewed 96 eyes underwent penetrating keratoplasty at the Chonnam University Hospital from May 1992 to December 1995, retrospectively. The rate of the graft rejection in penetrating keratoplasty was 34.3% (33 eyes). In detail, graft rejection occurred in 16 eyes(47%) among 34 vascularized corneas of recipient(R=18.0, P=0.000), 23 eyes(69.7%) among 33 vascularized orneas of donor side after operation (R=0.3, P=0.010), 5 eyes(35.7%) among 14 bilateral grafts, 4 eyes (57.1%) among 7 eyes having a history of graft failure, 6 eyes(40.0%) among 15 aphakic eyes(R=3.84, P=0.033), and 14 eyes among 32 eyes enucleated longer than 6 hours after death (R=10.1, P=0.002). In contrast, graft rejection occurred in 13 eyes (76.5%) among 17 postoperative glaucomatous eyes and in 20 eyes (25.3%) among 79 postoperative non-glaucomatous eyes, there was no statistically significant difference between two groups(P>0.05). These results suggest that neovascularzation of the either donor or recipient cornea, aphakic status of the recipient eyes, and enucleation time longer than 6 hours after death are high risk factors for graft rejection.

Pseudoexotropia and Ectopic Macula

Ectopic macula is a condition in which the macula is displaced markedly from its normal position. It can be unilateral or bilateral, and the macula can be displaced in any direction, though it is displaced temporally in more than 90% cases. The occurrence of small variation of the position of the macula in relation to the pupillary axis of the eye is evidenced by the variability of the angle K. The most common cause of ectopic macula is probably retinopathy of prematurity and other causes are trauma, chorioretinitis, and angioma. The authors experienced six patients who had ectopic macula. They presented apparent exptropia on Hirschberg test, but no fixation movement on cover test. Fundus examination showed temporal displacement of macula and traction vessel. Pseudoexotropia result from positive angle kappa. It is dangerous to measure the deviation amount by only Hirschberg test or Krimsky test for the uncooperated young patients who have history of prematurity especially. We must check the fundus photographs. With regards to cosmetic surery, each case must be handled individually. Evaluation should include age, visual acuity, the status of binocular vision, and the angle of squint.

Comparative Studies of Management on Traumatic Hyphema

In order to see whether the binocular patching with cycloplegia improves the prognosis in the treatmet of traumatic hyphema, we studied prospectively 77 patients with nonperforating traumatic hyphema who were admitted and treated at the Chonnam University Hospital between January 1994 and July 1995. We analyzed the clearance time of blood clot in the anterior chamber, the incidence of rebleeding and the final visual acuity. The patients were divided into four groups : group I, of 17 patients treated by monocular patching ; group II, of 19 patients treated by monocular patching with cycloplegia ; group III, of 20 patients treated by absolute bed rest with binocular patching ; group IV, of 21 patients treated by absolute bed rest with binocular patching and cycloplegia. The average clearance time of blood clot was 7.4 days in group I, 7.4 days in group II, 6.9 days in group III and 7.5 days in group IV. The incidence of rebleeding was 5.8% (n=1) in group I, 10.5% (n=2) in group II, 0% (n=0) in group III, 14.3% (n=3) in group IV. The final visual acuity of 0.6 or better was achieved in 10 patients (58.8%) of group I, 13 patients (68.4%) of group II, 13 patients (65.0%) of group III, 14 patients (66.7%) of group IV. In the treatment of traumatic hyphema, binocular and monocular groups as well as cycloplegic and non-cycloplegic groups showed no significant difference from each other in the clearance time of blood clot, incidence of rebleeding and the final visual acuity.

Clinical Evaluation of the Traumatic Optic Neuropathy

The nineteen patients(20 eyes) of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvernent in the early treatment of this disease. The relationships between the affected region and visual improvement, the interval to treatment and final visual acuity, the initial visual acuity and final visual acuity were studied. 250mg of methylprednisolone was administered intravenously every 6 hours followed by tapering using oral prednisone. The optic canal decompression was performed in five patients suspected swelling of optic nerve or optic canal fracture revealed by orbital CT. It is difficult to know the relationships between the affected region and visual improvement, the interval to treatment and final visual acuity. The vision was improved in nine of eleven patients who had an initial visual acuity of above light perception, but in the two of nine patients who had an initial visual acuity of no light perception. The two of five patients treated with a combina tion of high dose corticosteroid and optic canal decompression showed improved visual function. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effective and combined optic canal decompression was helpful, if indicated.