A Clinical Review of Grice Extra / 대한정형외과학회잡지

Grice extra-articular subtalar arthrodesis has been performed as either a temporizing or a definite procedure in young children to correct the dynamic hindfoot valgus deformity without affecting subsequent growth of the foot. Fifty eight extra-articular subtalar arthrodesis in thirty patients, performed at Seoul National University Children's Hospital from setpember 1985 to June 1989, were retrospectively reviewed to evaluate the clinical and radiographic results. There were 52 valgus feet in 26 patients and 6 varus feet in 4 patients secondary to cerebral palsy, meningomyelocele, congenital snomalies, and other neuromuscular diseases. In many instances, additional tendon surgeries were also required to correct deformities or achieve the muscle balance. The review consisted of personal interview, physical examination, and radiological assessment. On physical examination, preoperative hindfoot valgus deformty(mean: 14.3°clinically) was well corrected, postoperative hindfoot valgus ranging from neutral to valgus 5°clinically in 35 of 52 cases(67.3%). Correction of the lateral talocalcaneal angle on standing lateral radiographic view averaged 8.5 degrees(from 57.3 degrees preoperatively to 37.6 degrees postoperatively). In valgus feet, there were 3 cases with mild pain around the ankle joint. There were 5 cases of graft resorption and 2 cases of nonunion. Graft failure was more frequent when the proximal end of the graft was directed anterior to the weight bearing axis. With original Grice subtalar arthrodesis, satisfactory results were obtained in 34 of 52(65.4%) hindfoot valgus feet. In 6 varus feet, there were 1 undercorrection and 2 recurrence of varus deformity. We re-emphasize the importance of strict operative technique to obtain satisfactory results. We also believe that Grice procedure may be used for the correction of subtalar instability in selected cases of varus foot before muscle baancing procedures.

Treatment of Fibrous Dysplasia / 대한정형외과학회잡지

Authors have reviewed a series of 41 cases of fibrous dysplasia which were treated surgically at the Department of Orthopedic Surgery, College of Medicine, Seoul National University. After mean follow-up of 25 months, we summarized the results as follows; 1. Among the 41 patients, 20 were male patients(M:F= 1:1.05). The average age was 20.2 years old. It was the most common in the 2nd decade(44%). The most common site was femur (53.6%) followed by tibia (28.6%) in monostotic type. Each polyototic patient had 3.8 locations in average. 2. The results were better in skeletally mature patients (86%) than in immature patients (42%). 3. Satisfactory results seemed to be expected in monostotic type (71%) than polyostotic type(33 %) 4. Satisfactory results seemed to be expected in sclerotic type(78%) than cystic type(50%) or ground glass appearance type (62%). 5. Autograft(71%) was superior to xenograft(40%) in our study. However, xenograft only or xenograft with autograft can be a recommendable method of treatment for a very large lesion or for a patient with insufficient graft donor site.

Peroperative Administration of Epidural Morphine for postoperative Analgesia in Spinal Surgery (A double blind study) / 대한정형외과학회잡지

These days, the epidural administration. of morphine is commonly used for postoperative pain re lief because even small amount of morphine (3mg) is enough to have an effect on specific opiates receptors of the spinal canal. We report a prospective double blind study of the efficacy of a single epidural dose of morphine on pain after spinal decompression. Postoperative pain was assessed by a linear analogue pain score and by the additional require ment for systemic analgesics. The results obtained are as follows:l. In spinal decompression, the adminitration of epidural morphine is easy, effective and safe because the epidural space has been already exposured during operation. 2. After operation the epidural route of morphine administration will give pain relief for up to 12 hours excellently. 3. When epidural morphine is given at the time of operations, the use of systemic analgesics is much reduced. 4. The side effects of epidural morphine are much reduced due to the small amount of morphine required. This simple procedure is recommended as an effective and safe method of reducing postoperative pain.

Cotrel / 대한정형외과학회잡지

Stabilization of the unstable spine created by the posterior decompression is as important as the decompression itself in the treatment of spinal stenosis. The purpose of this study is to evaluate the effectiveness of C-D pedicle screw fixation in stabilization after lumbar decompression, in reduction of spondylolisthesis and in restoration of the lumbar sagittal curvature. C-D pedicle screw fixation was performed in 102 spinal stenosis patients after posterior lumbar decompression and fusion during the period from March 1987 to December 1988. Their age ranged from 15 to 72 years with an average of 49.1 years. There were 34 males and 68 females. The follow up was from 6 to 21 months with an average of 12.5 months. The causes of spinal stenosis were degenerative in 50 patients, spondylolisthesis in 39, iatrogenic in 9 and degenerative lumbar scoliosis in 4. Objective clinical results showed significant improvement of claudication, SLR limitation, motor weakness, sensory and DTR changes in most patients. Following results were obtained from the study of C-D pedicle screw fixation after posterior decompression in lumbar spinal stenosis.1. C-D pedicle screws provide the secure fixation that allows early ambulation and shorter hospital stay. 2. C-D pedicle screws enable the reduction of spodylolisthesis at the time of posterior stabilization. 3. C-D pedicle screw fixation is successful in the restoration and maintenance of sagittal curvature of the lumbar spine. 4. C-D pedicle screw fixation enables the correction of scoliosis at the time of posterior decompression.

A New Method for Measurement of Femoral Anteversion: A Comparative Study with Other Roentgenographic Methods / 대한정형외과학회잡지

The authors designed a new biplanar method of measuring femoral anteversion, which may be considered a modified Magilligan's method. In addition to true A-P view, a true lateral view is taken, instead of trans-cervical lateral view in the Magilligan's technique. Acute angles(α and r) between the long axis of the femoral shaft and the femoral neck on both the A-P and lateral films are measured. The true angle (r1) of anteversion is calculated by substituting the values of tan(90-α) and tan (90-r) for the trigonometric formula tan r1 = tan(90-α)/tan(90-r). The measurement by the Magilligan's and the author's methods and the conventional CT method were compared with direct measurement for their accuracy in 20 sdult dried femora. Also correlativity among these three methods were analyzed clinically in 40 femora of 20 children. Following results were obtained, 1. Compared with the direct measurement, the Magilligan's, suthor's methods and CT method deviated an average of + 6.050 degrees, + 3.600 degrees and −1.150 degrees, respectively, all three being statistically accurate(p>0.05). The values for the latter two were closer to that of direct measurement. However, there was no statistical difference between the two. 2. The Magilligan's method overestimated in 95% and underestimated in 5% of the cases, and there was over-or under- estimation of less than 5 degrees in 20% and less than 10 degrees in 95%. The author's method overestimated in 70% and underestimated in 0% of the cases, and there was over-or under-estimation of less than 5 degrees in 55% and less than 10 degrees in 100%. The CT method overestimsted in 30% and underestimated in 60% of the cases, and there was over-or under-estimation of less than 5 degrees in 95 and less than 10 degrees in 100%. Both Magilligan's and autor's methods tended to overestimate and the CT method tended to underestimate(p<0.05). 3. The correlation coefficients among the Magilligan's and author's methods, the Magilligan's and CT methods, and author's and CT methods were 0.830, 0.592, 0.478 respectively, in clinical aspects. It is concluded that author's new method of biplanar measurement of femoral anteversion is more accurate than the Magilligan's method, while it is not less accurate than the conventional CT method.