Comparison of the Bone Union Rates Using a Local Autobone and Bone Graft Substitute Mixed Graft in Lumbar Posterolateral Fusion / 대한정형외과학회잡지

Purpose@#To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft. @*Materials and Methods@#The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using b-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs. @*Results@#According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft. @*Conclusion@#Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

Comparison of the Clinical Outcomes of a Single Injection Adductor Canal Block with the Concomitant Use of Transdermal Buprenorphine and Continuous Adductor Canal Block after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of single injection adductor canal block (SACB), continuous adductor canal block (CACB), and the concomitant use of transdermal buprenorphine after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 125 patients who underwent TKA were divided into three groups and the clinical results were retrospecitively compared. Group I was comprised of patients with pain controlled by SACB (n=41). Group II consisted of patients with pain controlled by both SACB and transdermal buprenorphine (10 µg/h) (n=44). Group III contained patients with pain controlled by CACB (n=40). The visual analogue scale (VAS) was used as the pain control indicator and the patients were measured on a VAS for resting on the bed (VAS-Rest) at 12 hours, 24 hours, and 48 hours after surgery. The VAS while doing continuous passive motion (VAS-CPM) on the first and second postoperative day was also measured. In addition, the total amount of medications used (Butopahn, Tridol, and Ketorac) for the intravenous patient controlled analgesia (PCA) was counted for 48 hours after surgery. As the indicator of the functional recovery outcome, the incidence of nausea and vomiting was observed for 48 hours after surgery. The maximum knee joint flexion range and maximum walking distance on the first and second postoperative day, and the total length of stay at the hospital were compared. RESULTS: The VAS-Rest was similar in the three groups at 12 hours after surgery, but at 24 hours and 48 hours after surgery, group II and III a lower VAS-CPM and total amount of medications used for PCA than group I (p<0.05). The three groups showed a low incidence of nausea and vomiting, maximum knee joint flexion range, and similar walking distance and total length of stay at the hospital. CONCLUSION: The combination of SACB and transdermal buprenorphine has great pain control effect initially. On the other hand, it is not associated with catheter complications and it is convenient to use and safety toward the renal function. Therefore, the concomitant use of SACB and transdermal buprenorphine can be an effective pain control method after TKA.

Analysis of the Risk Factors for Posterior Migration of Single Cage after Transforminal Lumbar Interbody Fusion / 대한정형외과학회잡지

PURPOSE: To analyze the risk factors for posterior migration of a single cage after transforminal lumbar interbody fusion (TLIF). MATERIALS AND METHODS: This study was conducted retrospectively on 48 patients (60 discs) who were followed-up for 1 year after TLIF from January 2015 to January 2017. The patients were divided into two groups: group 1 containing 16 patients (17 discs) with cage migration and group 2 containing 32 patients (43 discs) without it. Information related to cage migration, such as the demographic factors, shape of disc, level and location of the cage inserted, and disc height change, was acquired from the medical records and radiologic images, and the possibility for generating posterior migration of cage was evaluated statistically. RESULTS: The demographic factors and cage-inserted level were similar in the two groups (16 patients in group 1, 32 patients in group 2). In the migration group, number of patients with a pear-type disc, 9 patients, was significantly larger; the disc height change, 1.8 mm, was significantly smaller; and the cage was located frequently on non-center in the anteriorposterior view and center in the lateral view in 9 and 15 out of 16 patients, respectively. CONCLUSION: A pear-type disc shape, small disc height change, cage with non-center on the anteriorposterior view and non-anterior on the lateral view are the risk factors for posterior migration. These factors are important for preventing posterior migration of the cage.

A Comparison of the Results from Femoral Nerve Block Using Different Concentration of Ropivacaine after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Peripheral nerve block is one of the many options available to reduce pain after total knee arthroplasty. Among the various kinds of peripheral nerve block procedure, femoral nerve block (FNB) using ropivacaine is a very effective method for reducing pain. However, it has been known to cause weakness in the quadriceps femoris, resulting in an increased risk of fall during ambulation after surgery. The purpose of this study was to compare the effectiveness of FNB on pain and muscle strength with different concentrations of ropivacaine. MATERIALS AND METHODS: Our study was performed on 120 patients with knee osteoarthritis who had undergone total knee arthroplasty between January 2016 and December 2016. Patients were divided to 3 groups depending on the concentration of ropivacaine: Group 1 received 0.125% ropivacaine 6 ml FNB; group 2 received 0.2% ropivacaine 6 ml FNB; group 3 received normal saline 6 ml FNB. FNB with 1% lidocaine 10 ml and 0.75% ropivacaine 10 ml was performed to all groups at 3 hours after surgery. From the day after surgery, each group of patients were injected 4 times with FNB on their own designated concentration of ropivacaine with an interval of 6 hours. The severity of pain was estimated by visual analogue scale (VAS) and the strength of quadriceps femoris was measured using medical research council (MRC) grade and knee extension angle. RESULTS: VAS score in group 3 was significantly higher compared to other groups; MRC grade in group 2 was significantly lower than in other grades, and knee extension angle in group 2 was significantly lower than in other groups at 6 pm on the day of and at 6 am on the day after surgery. VAS score, MRC grade, and extension angle of all groups showed no significantly difference at other times. CONCLUSION: FNB with 0.125% ropivacaine after total knee arthroplasty shows effective reduction of pain without inducing quadriceps femoris weakness.

Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Adjacent Lumbar Disc Herniation after Lumbar Posterolateral Fusion by Radiologic Evaluations

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. SUMMARY OF LITERATURE REVIEW: PELD minimizes posterior structural damage, allowing rapid rehabilitation. SUBJECTS AND METHODS: This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD. RESULTS: Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least “good,” and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the “fair” or “poor” group, and the rate of spinal stenosis on MRI was also higher in the “fair” or “poor” group. CONCLUSION: The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.

Twenty-Year Single Surgeon Experience with Radical Perineal Prostatectomy: Oncologic, Functional Outcomes and Perioperative Complications

PURPOSE: To evaluate oncologic, functional outcomes and complications in patients with prostate cancer (PCa) who underwent radical perineal prostatectomy (RPP). MATERIALS AND METHODS: A retrospective review of patients who underwent RPP by a single surgeon between 1995 and 2014 was performed. We analyze clinicopathologic characteristics and postoperative complications including urinary continence and erectile function. Kaplan-Meier survival analysis was used to access biochemical recurrence (BCR)-free survival (BFS) and cancer-specific survival (CSS) and log-rank test was applied. Complications were stratified by the Clavien-Dindo classification system. RESULTS: A total of 816 patients were included in this study. The mean prostate-specific antigen and prostate volume was 8.89 ng/mL and 30.8 mL. Positive surgical margin was identified in 174 patients (21.3%) after RPP. During a mean follow-up of 58.7 months, 173 patients (21.2%) experienced BCR. Overall, 44 patients (5.4%) died, of which 15 (1.8%) died from PCa. The 5-year BFS in patients with T2, T3a, and T3b were 84.8%, 69.7%, and 46.7% (p<0.001), respectively. The 10-year CSS in patients with same groups were 98.9%, 98.2%, and 79.5% (p<0.001), respectively. At 12 months after RPP, recovery of urinary continence and erectile function was identified in 88.3% and 63.7% of patients. Wound dehiscence (8.9%) was the most common complication. However, approximately 78% of complications were grade I or II. CONCLUSIONS: Our study indicates that RPP shows acceptable outcomes in terms of oncologic results and complications in patients with PCa. Careful attention is required to prevent wound dehiscence.

High Intensity Focused Ultrasound Treatment-Induced Tumor Lysis Syndrome in Uterine Myoma Patient

Tumor lysis syndrome is one of the major oncological emergency. It causes complications such as acute kidney injury, cardiac arrhythmia, and death. However, it is rare in solid tumors. We report on a case of a patient with myoma of uterus who developed tumor lysis syndrome and acute kidney injury after high intensity focused ultrasound (HIFU) treatment. The potential complications of tumor lysis syndrome should be considered in HIFU treatment.

A Case of Osmotic Demyelination Presenting with Severe Hypernatremia

Osmotic demyelination syndrome is a demyelinating disorder associated with rapid correction of hyponatremia. But, it rarely occurs in acute hypernatremia, and it leads to permanent neurologic symptoms and is associated with high mortality. A 44-year-old woman treated with alternative medicine was admitted with a history of drowsy mental status. Severe hypernatremia (197mEq/L) with hyperosmolality (415mOsm/kgH2O) was evident initially and magnetic resonance imaging revealed a high signal intensity lesion in the pons, consistent with central pontine myelinolysis. She was treated with 0.45% saline and 5% dextrose water and intravenous corticosteroids. Serum sodium normalized and her clinical course gradually improved. Brain lesion of myelinolysis also improved in a follow-up imaging study. This is the first report of a successful treatment of hypernatremia caused by iatrogenic salt intake, and it confirms the importance of adequate fluid supplementation in severe hypernatremia.

Comparison of surgical approach and outcome for the treatment of cystic lesion on lower jaw

OBJECTIVES: Curettage and enucleation are two of the most common procedures performed in oral and maxillofacial surgery units. To access a cystic lesion, the buccal cortical plate is removed. The no reposition (NR) group underwent surgery without repositioning the buccal cortical plate. The reposition (R) group underwent surgery with a repositioning of the buccal cortical plate. This study compared the two surgical procedures in terms of bone healing and complications. MATERIALS AND METHODS: Patients who underwent curettage and enucleation surgery were enrolled in this study. Panoramic radiographs of the patients in both the NR group (n=26) and R group (n=34) were taken at the baseline and at 6, 12 and 24 months after surgery. The radiolucent area was calculated to evaluate bony healing in each radiograph. The complications were analyzed through a review of the medical records. RESULTS: The correlation between bony healing and surgical approach was not significant in the 6th, 12th, and 24th month (P<0.05). The complication rate was not associated with gender, graft material, bone graft and drain insertion (P<0.05). On the other hand, the R group had a higher complication rate (35.3%) than the NR group (0%). The difference in the mean lesion size between the NR group (37,024+/-3,617 pixel) and R group (92,863+/-15,931 pixel) was significant (independent t test, P=0.004). CONCLUSION: Although the reposition method is chosen when the lesion size is large, it is associated with more complications. Indeed, infection, discomfort and recurrence of the lesion were the most common complications in the R group. Furthermore, the R method does not have a strong point in terms of bone healing compared to the NR method. Therefore, the R method cannot be considered an ideal approach and should be used in limited cases.

Assessment of Treatment Outcome after Using Temporary Mandibular Advancement Devices in Obstructive Sleep Apnea Patients

50% Apnea-Hypopnea Index (AHI) reduction plus post-MAD AHI <10, and the non-response group was defined as <50% AHI reduction. The lateral cephalogram was analysed including SNA, SNB, UL, MPH, PAS, PASU, and PAST using V-ceph(TM) (Cybermed, USA).RESULTS: The responsers were 23 patients, and non-responsers were 5 patients. The AHI was significantly reduced with temporary MAD (8.08+/-7.93) compared with baseline (28.51+/-20.56) in the response group (n=23). No significant difference was observed between pre MAD and post MAD except SNB on cephalometric analysis. Among 11 patients successfully treated with the temporary device, 9 patients said that using permanent device brings better effect too.CONCLUSION: These results indicate that the Temporary MAD could not be the only effective tools on OSA but also be used to predict patient's reactivity about permanent appliance treatment. Further studies are warranted to evaluate the relations between temporary MAD and permanent MAD.

Comparison of healing pattern with or without bone graft after odontogenic cyst enucleation

INTRODUCTION: Bone defects in the jaw are frequently observed after odontogenic cyst enucleation. The success of bone healing appears to be related to the size of the bone defect, the anatomical location, the patient's age and other parameters. The use of bone grafting material is dependent on the operator's preference. No evidence-based definite treatment protocol has been established. This study evaluated the effect of a bone graft into the defect after odontogenic cyst enucleation. MATERIALS AND METHODS: A total of 55 patients, who had been treated for an odontogenic cyst with cyst enucleation from 2000 to 2009 at the department of Oral and Maxillofacial Surgery, Samsung Medical Center, were included in this study. Patients who were followed-up for more than 1 year were included. Two groups were defined according to the bone graft (with or without a bone graft) after cyst enucleation. The differences in the healing periods and patterns of bone healing were compared clinically and radiologically. The postoperative 1 year radiographs were analyzed for bone healing and density. Statistical analysis was performed using a Pearson chi square test and Wilcoxon rank-sum test. RESULTS: More infection signs were observed in the bone graft group than in the other group, but there was no statistically significant difference. Radiographically, there was also no significant difference in the size of the radiolucent lesions between the two groups. CONCLUSION: There was no significant difference in healing between the groups with a bone graft and without bone graft after cyst enucleation.

Reliability and Validity of the Korean Version of Obsessive-Compulsive Inventory-Revised in a Non-clinical Sample

PURPOSE: The reliability and validity of a Korean version of the Obsessive-Compulsive-Inventory-Revised (OCI-R) was examined in non-clinical student samples. MATERIALS AND METHODS: The Korean version of OCI-R was administered to a total of 228 Korean college students. The Maudsley Obsessive Compulsive Inventory (MOCI), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI) were administered to 228 students. RESULTS: The total and each of subscale of the Korean OCI-R demonstrated excellent internal consistency, good test-retest reliability, moderate convergent validity and good divergent validity. CONCLUSION: It was concluded that the Korean version of the OCI-R has strong psychometric properties as the original version.