Effects of Psychiatric Factors on Patient-Reported Outcomes after Surgical Correction of Lumbar Degenerative Kyphosis

STUDY DESIGN: A prospective study. PURPOSE: To identify associations between psychiatric factors and patient-reported outcomes after corrective surgery in patients with lumbar degenerative kyphosis (LDK). OVERVIEW OF LITERATURE: Thus far, to the best of our knowledge, patient factors that may help predict patient-reported outcomes after corrective surgery for LDK have not been studied. METHODS: We prospectively investigated 46 patients with LDK who underwent surgical correction with a minimum follow-up of 2 years. Demographic data were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Scoliosis Research Society-22 (SRS-22) scores, and Roland-Morris Disability Questionnaire (RMDQ) scores were determined before the surgery and after 2 years of follow-up. Psychiatric conditions were preoperatively evaluated using the Zung depression scale (ZDS) and Zung anxiety scale (ZAS). Patients were divided into two groups (with or without psychiatric issues), according to baseline ZDS and ZAS scores. RESULTS: Patients included 43 women and 3 men. Twelve patients were deemed to have psychiatric problems (P group) and 34 patients had no psychiatric problems (NP group). No significant intergroup differences were found in MCS, PCS, SRS-22, and RMDQ scores preoperatively. However, at the 2-year follow-up, a significant intergroup difference was observed between PCS and RMDQ scores. Multiple regression analysis revealed that only the presence of a preoperative psychiatric problem can predict PCS and RMDQ scores. Other factors, such as, gender, age, body mass index, bone mineral density, osteotomy site, number of fusion segments, and instrumented levels did not affect PCS or RMDQ scores. CONCLUSIONS: The presence of a psychiatric factor may be an important risk factor underlying poor physical and pain scores after corrective surgery in patients with LDK. The findings presented here suggest that psychiatric factors should be evaluated prior to surgery for determining the risk of a poor outcome.

Surgical Treatment of Partial Closure of Growth Plate: Physeal Bar Resection and Free Fat Graft / 대한정형외과학회잡지

PURPOSE: To evaluate the results of physeal bar resection and free fat graft as a treatment method for partial epiphyseal closure. MATERIALS AND METHODS: Thirteen cases of partial epiphyseal closure (4 of the distal femur, 8 of the distal tibia and one of the distal radius) were subjected to physeal bar resection. All of the cases were caused by trauma. The physeal bar was central in 3 cases, peripheral in 9, and mixed (central-peripheral) in 1. Mean patient age at surgery was 10.7 years and mean follow-up period was 47 months. Final results were evaluated by a modified Williamson-Staheli classification. RESULTS: Results at final follow-up were as follows: 6 satisfactory (3 excellent and 3 good) and 7 unsatisfactory (5 fair and 2 poor). Satisfactory results according to location and region of the physeal bar were as follows: distal tibia, 5 of 8 cases; distal femur, 1 of 4; central, 1 of 3; peripheral, 4 of 9; and mixed, 1 of 1. When considered by areal extent, physeal bars occupying 30% or less of the bone's cross-sectional area showed satisfactory results in 5 of 7 cases, while in 6 cases with the physeal bar over 30%, 5 were unsatisfactory. CONCLUSION: Accurate preoperative evaluation of the size and type of the physeal bar, and meticulous surgical technique, are important predictors of satisfactory outcome of physeal bar resection. Cases where the physeal bar extent exceeded 30% had mostly unsatisfactory results.

Identification of cDNAs of Genes Suppressed during the Process of Atrophy in Rat Skeletal Muscle / 대한정형외과연구학회지

PURPOSE: To elucidate the molecular basis of muscle atrophy in cellular adaptation point of view, gene expression profiling in rat muscle atrophy model was performed. The functions changed by muscle atrophy were analyzed. MATERIAL AND METHODS: Sciatic nerve and femoral nerve were resected in right leg to make muscle atrophy model in rat. The left leg was considered as a compensatory hypertrophy model. The suppression subtractive hybridization (SSH) was done to identify the profile of differential gene expression during muscle atrophy followed by nerve injury in rat. The DNA fragments obtained in SSH were labeled with biotin and used as cDNA tags for isolation of full-length cDNA from cDNA library. Differentially expressed genes were confirmed by reverse dot blot hybridization. RESULTS: Down regulation of genes were much more predominant than up regulation. The profile of down regulated genes were composed of genes coding muscle contractile proteins, enzymes involving carbohydrate metabolism including glycolysis and glycogenolysis, enzymes in oxidative phoshorylation, and proteins related with calcium release. The target genes were isolated by enrichment using cDNA tags from cDNA library for further functional studies. We identified some novel genes related with muscle atrophy by nerve injury. CONCLUSION: During the process of muscle atrophy, genes coding muscle contractile proteins, enzymes in carbohydrate metabolism, enzymes in oxidative phosphorylation, and proteins related with calcium release were down regulated.

Epiphyseal Fractures of the Distal Radius in the Children

PURPOSE: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children. MATERIALS AND METHODS: 23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria. RESULTS: Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna. CONCLUSION: Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.

Comparison of Bone Formation between Allogenic Periosteum-Derived Mesenchymal Stem Cells and Cultured Osteoblasts Transplanted into Long-Bone Defects of Rabbits / 대한정형외과연구학회지

PURPOSE: To analyze the bone formation between allogenic periosteum-derived mesenchymal stem cells and cultured osteoblasts transplanted into rabbit long-bone defects. MATERIALS AND METHODS: Forty white rabbits were grouped according to the material transplanted into their tibial bone defects: stem cells plus agar (group 1); osteoblasts plus agar (group 2); osteoblasts plus gelfoam (group 3). Bone formation was evaluated radiologically, histologically, and using serum osteoblastic markers during 8 weeks following transplantation. RESULTS: Group 1 and 2 both showed satisfactory bone formation, with group 2 showing thicker and more abundant bone trabeculae than group 1. Rabbits in group 3 showed worse bone formation than group 1 and 2. CONCLUSION: These results demonstrate that rabbits implanted with osteoblasts (with agar) showed more satisfactory bone formation than those inserted with stem cells; thus osteoblasts may be useful in the treatment of bone defects.

Idiopathic Intradural Arachnoid Cyst: A Case Report / 대한정형외과학회잡지

An intradural arachnoid cyst is a relatively rare condition. Idiopathic arachnoid cysts are rare lesions that are not associated with trauma or other inflammatory insults. This report describes one case of an idiopathic arachnoid cyst treated by posterior laminectomy and an excision of the mass with a brief review of the relevant literature.

The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring

PURPOSE: To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture. MATERIALS AND METHODS: Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria. RESULTS: In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results. CONCLUSION: The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.