The Early diagnostic Significance of Bone Marrow Pressure in Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

The early diagnosis of osteonecrosis of the femoral head is difficult because the radiologic change usually appears after some pregression of the disease process. The value of bone marrow pressure measurement for esily detection of the osteonecrosis has been studied by many authors. We measured bone marrow pressure in avascular femoral head and compared with patient's age, stage of osteonecrosis and radiological types. And also we measured bone marrow pressure in osteoarthritic hip. The results were following:l. In 95% of osteonecrosis of the femoral head, BMP is increased. 2. There is no correlative change between BMP and radiological stage. 3. In steroid induced osteonecrosis, BMP increase is predominent after provocative test. 4. Radiological type seems to influence more significant BMP change than radiological stage. 5. The diagnostic accuracy of the early stage of osteonecrosis of the femoral head is 97% in average. 6. Osteoarthritic hip also shows increased BMP. 7. Baseline pressure is highest in greater trochanteric area, but subchondral area shows most sensitive change. 8. The provocative pressure is lower than baseline pressure in the necrotic center of the head. The increase of the BMP of the femoral head osteonecrosis not specific butvery sensitive. But the measurement of BMP of the femoral head is very useful method for early detection of AVN of the femoral head.

Free Vascularized Epiphyseal Transplantation, for Epiphyseal Injury in Children / 대한정형외과학회잡지

It is difficult to treat the children with the growing deformity of long bone due toepiphysealloss or absence, because resulting deformith and discrepancy of limb length is progressive. There were many conventional treating methods including the lengthening and shortening, corrective osteotomy, and epiphysiodesis. But these procedures result in inadequate results, and there are limitation in treatment of these children. We tried the free vascularized epiphyseal transplantation using the proximal fibular epiphysis in 3 patients with epiphyseal injury or loss due to old tauma, wide excision of multiple exostosis and congenital clubhand. The duration of follow-up was from 20 months to 57 months, and the lengthening of the transplantedepiphyses was evaluated by the scanogram inregular interval. As final radiologic check, each transplanted epiphyseal growth was 1cm for 24months in case 1, 0.9 cm for 10 months in case 2, 1 cm for 24 months in case 3 (av. 1.3cm for 24 months) and the adjacent joint function was good. There was no gross deformity.