Signal Detection of Adverse Events Following Pneumococcal Vaccines from the Korea Adverse Event Reporting System Database, 2005–2016

PURPOSE: We aimed to analyze the surveillance reports of adverse events (AEs) due to different types of pneumococcal vaccines, in addition to detecting and validating signals of pneumococcal vaccines by comparing AEs with labels.MATERIALS AND METHODS: We analyzed the percentages of AEs according to vaccine type [pneumococcal polysaccharide vaccines (PPSVs) and pneumococcal conjugate vaccines (PCVs)] in children and adults using data from the Korea Adverse Event Reporting System (KAERS) database from 2005 to 2016. A signal was defined as an AE that met all three indices of data mining: proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). We validated the detected signals by calculating sensitivity, specificity, as well as positive and negative predictive values of the signals against label information.RESULTS: Of the 39933 AE reports on vaccination, 5718 (7.0%) were related to pneumococcal vaccine. The most frequent AE after vaccination with PPSV was fever (23.9%) in children and injection-site reaction in adults. The most frequent AE after vaccination with PCV in children was pharyngitis (26.2%). In total, 13 AEs met all three indices for signal detection. Among these, hypotension, apathy, sepsis, and increased serum glutamic oxaloacetic transaminase level were not listed on vaccine labels. In validation analysis, PRR and ROR performed slightly better than IC for adults who were vaccinated with PPSVs.CONCLUSION: Overall, 13 new signals of PPSVs, including four signals not listed on the labels, were detected. Further research based on additional AE reports is required to confirm the validity of these signals for children.

Lower-Pressure Percutaneous Vertebroplasty Using Larger-Diameter Bone-Cement Fillers

STUDY DESIGN: This is a retrospective, case-controlled study. OBJECTIVE: We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). SUMMARY OF THE LITERATURE REVIEW: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement. MATERIALS AND METHODS: With excluding Kummell's disease, 23 VCF's were treated with LP-PVP using 2.8mm-diameter cement fillers, 51 VCF's were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF's were treated with C-PVP using 1.4mm-diameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year. RESULTS: The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9+/-1.6ml for the LP-PVP, 5.9+/-1.9ml for the KP and 3.5+/-1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8+/-10.3%, 13.0+/-12.7% and 4.7+/-7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1+/-1.8%, 1.1+/-1.4% and 5.9+/-4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0+/-4.0degrees, 3.7+/-4.4degrees and 4.2+/-4.4degrees, respectively, in each group (p=0.528) with reduction loss of 1.0+/-0.9degrees, 0.1+/-1.7degrees and 3.5+/-2.8degrees, respectively, in each group (p=0.000). There was a reduction of the regional Cobb's angle by 4.3+/-2.6degrees, 3.1+/-4.7degrees and 2.9+/-3.8degrees, respectively, in each group (p=0.184) with a reduction loss of 3.6+/-4.5degrees, 0.1+/-1.5degrees and 1.0+/-4.1degrees, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP, in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030). CONCLUSION: The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.

The Influence of Symtomless Degenerative Changes of the Patellofemoral Joint on Clinical Results of Medial Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the influence of degenerative changes in the patellofemoral joint on the clinical results of medial unicompartmental knee arthroplasty (UKA). MATERIALS AND METHODS: Between January and December 2002, we operated on 180 cases of minimally invasive UKA using the Oxford(R) phase 3. Of the 180 cases, 156 were followed up for a minimum period of 5 years. Based on intraoperative degenerative findings of the patellofemoral joint, we classified cases into 4 groups (Group I-78 cases, Group II-40 cases, Group III-27 cases, Group IV-11 cases), and the clinical data were analyzed prospectively. RESULTS: During follow-up, which averaged 6 years and 2 months, the knee score, the knee function score, the range of knee motion and the tibiofemoral angle were improved significantly (p0.05). To date, no complication or failure involving the patellofemoral joint has been observed. CONCLUSION: Clinical results of UKA are satisfactory for all groups, and the severity of patellofemoral degeneration has no influence on clinical outcome. Symptomless degenerative arthritis of the patellofemoral joint is not a contraindication for medial UKA.

Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

BACKGROUND: To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion. METHODS: This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated. RESULTS: One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041). CONCLUSIONS: The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.

The Efficacy of Kyphoplasty on Osteoporotic Vertebral Compression Fracture : A 1-Year Follow-up Study / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the risk factors for additional VCF. SUMMARY OF THE LITERATURE REVIEW: Successful pain relief with performing kyphoplasty for VCF has been well documented. However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty. MATERIALS AND METHODS: Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb's angle and the overall sagittal alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed. RESULTS: In terms of deformity correction, the collapsed vertebral height were restored (67.3+/-15.6% to 82.5+/-11.8%), the vertebral kyphotic angle was improved (12.1+/-6.9degrees to 8.1+/-5.3degrees ), the degree of the regional Cobb's angle was reduced (3.1+/-4.5degrees ) and the overall sagittal balance was improved (1.7+/-5.3 cm to 0.5+/-3.9 cm) with clinical satisfaction (VAS: 6.9+/-1.3 points to 2.3+/-0.9 points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height > 90%, the vertebral kyphotic angle and regional Cobb's angle reduction > 5degrees ). Additional VCF occurred in 10 patients (15.9%). The average BMD in the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall sagittal alignment and cement volume showed no relevance to additional VCF. CONCLUSION: Kyphoplasty was excellent for pain reduction, but it was unsatisfactory for correcting deformity. Vertebral height correction was more effectively performed under general anesthesia. Additional VCF was caused by severe osteoporosis.

The Surgical Treatment for Spinal Intradural Extramedullary Tumors

BACKGROUND: We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors. METHODS: The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred. RESULTS: The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r2 = 0.75, p = 0.010, Nurick's grade; r2 = 0.69, p = 0.019). One case of schwannoma recurred. CONCLUSIONS: The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.

Spinal Cord Injury Caused by Bone Cement after Percutaneous Vertebroplasty : One Case of Long-term Follow-up and the Result of Delayed Removal / 대한정형외과학회잡지

Among the complications of percutaneous vertebroplasty, bone cement leakage into the spinal canal doesn't happen very often, but this could provoke a severe neurologic deficit. It is not certain whether this neurologic deficit may be permanent or reversible. Yet if the bone cement is left in the spinal canal, trivial events such as minor trauma could worsen the neurologic symptoms. The authors treated a 75-year-old female patient with Nurick's grade IV neurologic deficit, which was due to cement leakage into the spinal canal after previous vertebroplasty of T8 and T9. She had been having a neurologic deficit for 9 years, and it became aggravated after a minor trauma to Nurick's grade V. After the cement in the spinal canal was removed, her neurologic symptoms were improved to Nurick's grade II. Leaving a cement mass in the spinal canal may be a risk factor for additional neurologic injury even when suffering only a minor trauma, and the neurologic symptoms can be improved after removal of the cement, even for the case with a long-term neurological defect.

Efficacy of High Intensity Laser Therapy in the Mild Osteoarthritis of the Knee: A Randomized Double-blind Controlled Trial / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to know the effect of high intensive laser therapy in patients with early stage of osteoarthritis of knee. MATERIALS AND METHODS: This study was a randomized, double blind controlled trial. 28 patients who had grade II osteoarthritis of Kellgren classification and knee pain were randomly divided into two groups. Patients underwent treatment 30 times, 5 times per week. the clinical evaluation was done by the pain, stiffness and functional score of the knee by the knee society clinical rating system, and the intensity of pain was measured also by a VAS (visual analogue scale), before and after the 1st sessions, Before and after the 2nd sessions and at 6 month after the 1st treatment. We checked hs-CRP and HA which was regarded as indexes of osteoarthritis activitiy. RESULTS: As a clinical result of high intensive laser therapy, VAS, pain and functional score were statistically more improved than those of before therapy, except stiffness (P<0.05). The results of the hs-CRP and HA which were not significantly different from those of before therapy. In the placebo group, all variables showed no difference. CONCLUSION: We concluded that Nd-YAG high intensive laser therapy in early stage of patient with osteoarthritis of knee would be helpful as noninvasive and conservative treatment for improvement clinical progress.

Comparative Study for the Results of Unicompartmental Knee Arthroplasty in Patients Younger and Older than 60 Years of Age / 대한정형외과학회잡지

PURPOSE: We wanted to assess the relations between age and the outcome of unicompartmental knee arthroplasty (UKA) based on a comparative study of UKA patients younger than 60 years and UKA patients older than 60 years of age. MATERIALS AND METHODS: Among the patients who underwent a UKA between January 2002 and June 2003, 230 cases (the group of patients with ages under sixty consisted of 89 knees - group I, and the group of patients with ages over sixty consisted of 141 knees - group II) were followed up for at least 5 years after the operation. Clinical assessments were made using the Knee Society Score (KSS) rating system. RESULTS: The average KSS knee and function scores improved from 54.2 and 57.1 preoperatively to 87.3 and 85.2 at the last follow-up in group I, and from 54.7 and 54.3 to 89.5 and 81.7 in group II, respectively. The mean range of knee motion also improved from 129.4degrees to 132.9degrees in group I and from 126.8degrees to 133.2degrees in group II, respectively. There were 5 cases of failed UKAs in each group, and the survival rate of the implant at 5 years was 94.7% in group I and 96.6% in group II. CONCLUSION: The clinical results of UKA were satisfactory in both age groups. Group I had better results on the knee function score at the last follow-up, but there was no significant difference between both age groups. UKA can be a one of the reliable methods for the treatment of osteoarthritis in patients younger than 60 years of age.

Causes and Treatments of the Early Failure after Unicompartmental Knee Arthroplasty

PURPOSE: We wanted to evaluate the causes, treatments and preventive measures for early failure of unicompartmental knee arthroplasty (UKA) by performing an analysis of the cases. MATERIALS AND METHODS: We retrospectively analyzed 687 cases of UKA that had been performed from January 2002 to December 2006. There are 622 cases of the meniscal bearing type, 31 cases of the tracked bearing type and 34 cases of the fixed bearing type. All of the cases were performed by minimally invasive surgery. RESULTS: Early failures after UKA were seen in 36 cases, and these failures occurred from 4 months postoperatively to 5 years 7 months postoperatively. There were 20 mobile bearing dislocations, 18 femoral or tibial component loosenings, 4 infections, 1 medial tibial condylar fracture and 1 case of pain of unknown origin. The most common cause of the failed cases of the meniscal bearing type was bearing dislocation. All of the failed cases of the tracked and fixed types were from loosening of the component. Simple dislocations of bearing were treated by bearing change. All of the other cases were treated with revision TKA or UKA. CONCLUSION: Selection of an appropriate prosthesis and accurate surgical technique are needed to improve the clinical results and reduce failures. Open bearing change can be done for the cases of simple bearing dislocation, and revision TKA is needed if this is accompanied by other complications.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

PURPOSE: A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia. METHODS: The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group. RESULTS: The mean follow-up period was 64.1+/-29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8+/-26.9 months. The stereopsis was significantly worse in the deteriorated group (p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group (p=0.003). CONCLUSIONS: This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

Posterior Lumbar Interbody Fusion with Cage and Local Bone Graft in Spondylolisthesis: Unilateral-caged versus Bilateral-caged / 대한척추외과학회지

STUDY DESIGN: Retrospective, controlled study OBJECTIVE: To compare one and two-caged posterior lumbar interbody fusion (PLIF) with local bone grafting for spondylolisthesis. SUMMARY OF LITERATURE REVIEW: Even though there are many reports on PLIF using cages and local bone grafting, Studies comparing one and two-caged PLIFs are rare. MATERIALS AND METHODS: Sixty-three patients who underwent pedicle screw fixated PLIF using cages and local bone grafts were followed for more than 1 year. Twenty-five patients had one cage (group I), and 38 patients had two cages (group II). Sampling error, disc height, sagittal Cobb angle, coronal Cobb angle, fusion rate, Oswestry disability index (ODI), operation time, blood loss, and neurologic complications were assessed. RESULTS: There was no sampling error between the two groups, except with regard to diagnosis: degenerative spondylolisthesis, 15 cases in group I and 9 cases in group II; spondylolytic spondylolisthesis, 10 cases in group I and 29 cases in group II (p=0.004). Fusion rates were 87.5% and 88.2% for groups I and II, respectively (p=1.000). More disc height loss occurred in group I (0.6 mm) than in group II (0.0 mm) (p=0.041). Over-3mm-disc height-losses were noted more frequently in group I (20%) than in group II (2.6%) (p=0.022). ODI improved from 28.1 to 12.3 (72.1% improvement) in group I and from 29.2 to 12.7 (79.3% improvement) in group II. There were no significant differences in operation time, amount of blood loss, or neurologic complications between the two groups. CONCLUSION: Unilateral one-caged PLIF with local bone grafting and posterior instrumentation was no different from bilateral two-caged PLIF with regard to fusion rates or radiologic or clinical results. The statistically significant differences in disc height seemed to be clinically insignificant. Disc height loss of greater than 3 mm was much more common in group I, with one-caged PLIF.

Influence of Surface Fluid during Photorefractive Keratectomy Using a 213-nm Solid-State Laser

PURPOSE: To investigate the effect of surface fluid on the ablation rate and efficacy of 213-nm solid-state laser during photorefractive keratectomy (PRK). METHODS: Twelve rabbits (24 eyes) underwent myopic PRK for the correction of 10 diopters using 213-nm solid-state laser. Photoablation was performed with removal of corneal surface fluid using the Weckcel(R) sponge every 5 seconds in one eye and without removal of corneal surface fluid in the control eye. The mean central corneal thickness (CCT) was evaluated preoperatively, and at 1 week, 4 weeks postoperatively. RESULTS: The mean CCT of group 1 (with removal of corneal surface fluid) were 361.3+/-13.9 micrometer preoperatively and 321.4+/-18.5 micrometer at 4 weeks postoperatively. The mean CCT of group 2 (without removal of surface fluid) were 358.7+/-8.9 micrometer preoperatively and 338.4+/-12.0 micrometer at 4 weeks postoperatively. The mean ablation depths were 39.8+/-7.4 micrometer in group 1 and 20.3+/-5.8 micrometer in group 2 at 4 weeks postoperatively p<0.05). CONCLUSIONS: Induced corneal surface fluid during PRK may influence the ablation efficacy and accuracy of solid-state laser. This result should be considered in clinical trialswith 213-nm solid-state laser, especially in high myopes.

Unicompartmental versus Total Knee Arthroplasty in the Same Patient / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiographic results of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. MATERIALS AND METHODS: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. RESULTS: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7degrees to 133.2degrees in the UKA knee, and from 122.5degrees to 127.1degrees in the TKA knee. The tibiofemoral angle changed from 0.3degrees of varus to 5.6degrees of valgus in the UKA knee, and from 2.4degrees of varus to 5.8degrees of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being nvery satisfied' or nsatisfied' with both knees. CONCLUSION: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.

Oxford Phase 3 Unicompartmental Knee Arthroplasty: Minimum 5-year Follow-up Results

PURPOSE: We wanted to evaluate the postoperative clinical results, the complications and the survival rate of Oxford phase 3 unicompartmental knee arthroplasty (UKA), based on a prospective analysis and the follow-up study. MATERIALS AND METHODS: We operated on 142 patients, 180 cases of UKA using the Oxford phase 3 prosthesis from January 2002 to December 2002. Clinical assessments were made using the Knee Society score rating system. Among those, 152 cases (121 patients) were able to be followed up for at least 5 years after the operation. The mean patient age at the time of surgery was 61.1 years and the mean duration of follow-up was 5.5 years. RESULTS: For these 152 knees, the mean preoperative knee and function scores were 53.5 and 55.8, respectively, and they were improved to 88.7 and 83.1, respectively, at the last follow-up. The mean range of knee motion recovered to 133.1degrees and the mean tibiofemoral angle was changed to 4.9degrees of valgus. When we asked patients about their level of satisfaction, 88% of the patients said they were 'very satisfied' or 'satisfied'. There were 7 postoperative complications and the survival rate of the implant at 5 years was 96.8%. CONCLUSION: The Oxford phase 3 UKA was satisfactory for improving the clinical results, the subjective satisfaction of the patients and the survival rate of the implant.

Total Knee Arthroplasty using a Medial Pivot Knee: Minimum 2-year Follow-up Results

PURPOSE: To evaluate short-term clinical and radiologic outcomes after Advance(R) total knee arthroplasty (TKA). MATERIALS AND METHODS: We evaluated 226 patients who underwent 348 TKAs using medial pivot knees and who were followed up for more than 2 years. The average follow-up period was 40.6 months. We evaluated clinical outcomes based on range of motion (ROM), Knee Society score, and functional score. Radiographic outcomesand complications were also recorded. RESULTS: The average flexion contracture improved from a preoperative value of 6.2degrees to a last follow-up value of 1.3degrees. The average knee flexion was 114degrees preoperatively and 109degrees at last follow-up. The average knee and functional scores were 43.1 and 50.8, respectively, in the preoperative period and 86.2 and 77.9, respectively, in the postoperative period. Complications included 3 avulsion fractures of the medial collateral ligament, 2 delayed infections, 2 periprosthetic fractures, and 1 patellar dislocation. CONCLUSION: The short-term clinical results associated with medial pivot TKA were acceptable. However, more experience and long-term follow-up will be necessary to better determine the efficacy of this procedure.

Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication: Transpedicular Bone Graft and Pedicle Screw Fixation / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the efficacy of transpedicular bone graft and pedicle screw fixation in delayed collapse of osteoporotic vertebral fracture with claudication. SUMMARY OF LITERTURE REVIEW: Delayed collapse of osteoporotic vertebral fracture may result in seemingly unrelenting back pain and neurologic deficits. Though there are many surgical options for such cases, comprehensive improvement of symptoms is uncertain. MATERIALS AND METHODS: Nineteen patients who underwent operation and were followed-up for more than 2 years were studied. The regional sagittal angle, restoration ratio of the vertebral body, standing sagittal balance, and additional fracture were assessed. Improvement of back and leg pain was assessed using 10 point Visual Analog Scales (VAS). The causes of sustained clinical symptoms were analyzed. RESULTS: The regional sagittal angle was corrected from 25.2+/-13.9degrees to 12.4+/-10.4degrees (p=0.000). The vertebral body ratio was restored from 36+/-14.1% to 72+/-16.7% (p=0.000). Six cases were found to be neutral and 13 cases showed a positive sagittal balance. Additional fractures were found in 11 cases. The VAS value for leg pain was improved from 6.6+/-1.0 to 1.0+/-1.1 (p=0.000), while that for back pain was not improved (6.4+/-1.7 to 7.1+/-2.3, p=0.474). Positive sagittal balance was a significant risk factor (p=0.037, odds ratio=58.084) for sustained back pain. CONCLUSION: For the treatment of delayed collapse of osteoporotic vertebral fracture with claudication, transpedicular bone graft and pedicle screw fixation was effective in improving claudication and restoring the vertebral body and regional sagittal angle. However, it was not capable of alleviating back pain. Positive sagittal balance was considered to be a cause of sustained back pain.

Results of Cruciate-Retaining Total Knee Arthroplasty with Maxim(R) System : More than 5-Year Follow Up

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of Maxim(R) (Biomet, Warsaw, USA) Cruciate Retaining total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: Between Feb. 1997 and Nov. 2000, 103 knees in 65 patients who had been followed up for 5 years after TKRA with Maxim(R) Cruciate Retaining were evaluated retrospectively for clinical and radiologic results. RESULTS: The average range of motion increased from 114degrees (80~130degrees) preoperatively to 128degrees (105~130degrees) at the last follow-up. The average range of flexion contracture decreased from 6.5degrees preoperatively to 0.8degrees (0~15degrees) at the last follow- up. In patients with osteoarthritis, the mean preoperative knee score (59.2) and functional score (40.7) improved to 88.6 and 90.1, respectively. In rheumatoid arthritis patients, the mean knee score and functional score also improved from 47.4 and 39.2 to 80.6 and 88.3. Roentgenographic evaluation revealed a radiolucency rate of 19.5%. Complications were deep infection in 2 cases and periprosthetic fractures in 3 cases. The former had received reimplantations. CONCLUSION: The mid-term results of Maxim(R) Cruciate Retaining total knee replacement arthroplasty were reliable and satisfactory in terms of improvements of range of motion, restoration of function, and rare complications. However, long-term follow-up evaluation is necessary.

Postnatal Development of the Anterior Skull Base and Nasal Septum: CT Study

PURPOSE: To know the normal CT appearance of the anterior skull base and nasal septum after birth. MATERIALS AND METHODS: Coronal CT scans with a helical mode were performed from the nasal bone to the sphenoid sinus in 99 children whose ages ranged from 27 days to 14 years. We investigated the CT appearance of the developing anterior skull base and nasal septum with particular attention to the anteroposterior length of the anterior skull base and the ossification patterns of the cribriform plate, perpendicular plate, crista galli, and vomer. RESULTS: The anteroposterior length of the anterior skull base statistically significantly increased with age. The cribriform plate showed partial or complete ossification in at least one segment at more than 3 months of age and in all three segments at more than 6 months of age. Ossification of the cribriform plate occurred earlier in the middle segment than in the anterior and posterior segments. It began exclusively in the region of the lateral mass of the ethmoid and proceeded medially toward the crista galli. Partial ossification of the perpendicular plate was noted as early as 9 months of age, and complete ossification as early as 13 months of age. All children at 18 months and older showed at least partial ossification of the perpendicular plate. Partial ossification of the crista galli was noted as early as 27 days of age, and complete ossification as early as 3 months of age. CT showed complete ossification of the crista galli in all but two children at 6 months and older. The superior aspect of the vomer exhibited a V- or Y-shape on all CT scans in 66%(65/99) of children at any age. It appeared as an undivided single lump anteriorly and a V or Y posteriorly in 34%(34/99). CONCLUSION: Knowledge of the normal developing patterns of ossification of the anterior skull base and nasal septum could help prevent errors in interpreting CT scans in this region, especially in infants and young children.