Primary Subacute Pyogenic Osteomyelitis of Long Bones / 대한정형외과학회잡지

Primary subacute pyogenic osteomyelitis is defined as a bone infection of insidious onset lasting for more than several weeks without any acute systemic toxic reactions and is known to have the problem of diagnosis because there is no inflammatory symptoms or signs and X-ray findings are similar to various bone tumors. Authors reviewed 29 cases of primary subacute pyogenic osteomyelitis of long bones admitted at Fatima hospital during the years between 1976 and 1984. The osteomyelitis of infants and the osteomyelitis modified by antibiotics were excluded. The diagnosis of the cases was confirmed by bacteriological examination and/or tissue examination. The results were as follows. 1. The cases were 18 males and 11 females and 19 adults and 10 children. Male predominence was noted in children. 2. The involved bones were 11 tibias, 10 femurs and all other long bones. The involved sites were 18 metaphysis and 11 shafts. 3. All of the cases has insidious onset of local pain without any acute systemic symptoms and most of the cases has local tenderness but local deep swelling noted in about half of the cases. 4. There were many cases with elevated ESR and a few cases of slight leukocytosis. 5. The confirmed infecting organism was all staphylococcus in 16 cases of the cultures from the 25 lesions. 6. The X-ray findings were Brodies abscess in 10, illdefined cavity in 3, diffuse bones absorption in 5, diaphyseal lesion of adult with localized cortical sclerosis in 5 and with localized medullary abscess in 3 and diaphyseal lesion of children with localized medullary abscess and periosteal reaction in 3 cases. 7. All of the cases cured rapidly with rare recurrence after treatment by simple local excision in 4 and curettage in 22 cases combined with antibiotic therapy and local immobilization.

Surgical Treatment of the Spondylolisthesis with Sciatica / 대한정형외과학회잡지

Low back pain and radiating pain in the leg are the main symptoms of the spondylolisthesis and various surgical treatments are recommended after having enough conservative treatments. The spinal fusion in situ either posterior, posterolateral or anterior route is the usual method for symtomatic spondylolisthesis or to prevent progression of slipping but the neurogenic symptoms in the legs are not well solved, so the decompression procedures are necessary. The authors reviewed 26 cases of isthmic spondylolisthesis having low back pain and sciatica which are operated during the 10 years since 1973 at Fatima Hospital and the followings are obtained. 1. There were 15 males and 11 females with ages from 18 years to 63 years having average 40.1 years. 2. The displaced vertebrae were 5th lumbar in 18 and 4th lumbar in 8 cases and the degree of displacement was Grade I in 14, Grade II in 10, Grade III in 1 and no slipping in 1 case. 3. The types of surgery were decompression and H-graft in 22, simple posterior fusion in 3 and Gll's procedure in 1 case. 4. The laminas were considerably loose in all cases and there were small fibrous mass at the pars area in half of the cases. .5. The spine became very stable immediately after H-grafting and the intervertebral foramen became widened freeing nerve root. 6. Bony union obtained in 88% and satisfactory result in 85% at the follow-up from 6 months to 7 years and 2 months with average 1 year and 7 months. 7. The decompression is necessary for the radiating pain in the leg and H-grafting is satisfactory and simple procedure after decompression laminectomy.