A Clinical Study of the Open Discectomy of the Herniated Lumbar Disc: Analysis of Relationship between Operative Indications and MRI Findings / 대한정형외과학회잡지

The purpose of this study is to evaluate the correlation between the operative indications and the MRI findings in the herniated lumbar disc. We reviewed the lumbar spine MRI and medical records in the 158 patients of the herniated lumbar disc which were removed by open discectomy. We assessed the herniated lumbar disc in the MRI by the Steinmetz s classification and the operative findings with postoperative results at least 6 months. 170 levels of the operated lumbar discs in these patients consisted of protruded discs in 41 levels, extruded subligamentous discs in 91 levels, extruded transligamentous discs in 27 levels, sequestered discs in 11 levels. We recognized especially in the operated protruded discs that were combined with the lateral recess stenosis in most cases. Postoperatively, 139 patients (88%) had excellent and good results. We concluded that the clinical operative indications were correlated with the cases which were more severe than extruded subligamentous discs or protruded discs combined with lateral recess stenosis in MRI findings.

Facet Joint Angle in Lumbar Spine: comparative study between HNP and spinal stenosis and control group / 대한정형외과학회잡지

The importance of facet joint asymmetry has been debated as a cause of the low back pain and sciatica. And many studies have been proposed about the relationship between facet joint angle or facet joint asymmetry and the development of the disc degeneration or disc herniation. In the diagnosis of the spinal disorder, we have been used mainly myelogram and computed tomography. Several years ago, more advancement has been achieved by use of magnetic resonance image (MRI). Author studied the relationship between the facet joint angle and facet joint asymmetry and the development of the herniated nucleus pulposis (HNP) or spinal stenosis by comparision of the facet joint angle and facet joint asymmetry in each groups. Author reviewed the patients who were diagnosed as HNP or spinal stenosis with computerized tomography (CT) or MRI and treated with operative method at the department of orthopaedic surgery, Dong-A University Hospital. Facet joint angles were measured on the mid-disc cut, which was parallel to the inferior vertebral end-plate of the superior vertebra. The angles were measured by a midsagittal line through the disc and intersecting lines formed by conneqting the two end points of each facet. Facet joint asymmetry was determined by the difference between right and left facet joint angles. The results were compared between each groups and comparison group and statistical analysis was performed with the Kruskal- Wallis test in 95% confidence interval. The patients had only one level involved and had no other spinal disorder. 85 cases of HNP (central in 35 cases and lateral in 50 cases) and 50 cases of spinal stenosis were evaluated. The results were as follows: l. At the level of L4-5, the mean facet joint angles (+/-SD) were 42.50+/-5.52 (Rt.), 46.71+/-9.68 (Lt.) in central HNP, 40.91+/-9.11 (Rt.), 41.23+/-8.51 (Lt.) in lateral HNP, 37.77+/-11.41 (Rt.), 37.95+/-11.91 (Lt.) in spinal stenosis and 42.38+/-5.07 (Rt.), 41.25+/-5.85 (Lt.) in control group. 2. At the level of LS-S1, the mean facet joint angles were 48.83+/-5.64 (Rt.), 48.17+/-4.62 (Lt.) in central HNP, 52.20+/-11.30 (Rt.), 51.60+/-9.06 (Lt.) in lateral HNP, 42.67+/-8.89 (Rt.), 43.50+/- 9.85 (Lt.) in spinal stenosis and 43.91+/-7.88 (Rt.), 43.76+/-7.81 (Lt.) in control group. 3. At the level of L4-5, the mean facet asymmery was 6.35+/-6.04 in central HNP, 6.95+/-6.76 in lateral HNP, 6.47+/-5.56 in spinal stenosis and 4.31+/-5.42 in control group. 4. At the level of L5-S1, the mean facet asymmetry was 4.95+/-5.18 in central HNP, 4.72+/-5.25 in lateral HNP, 5.50+/-4.83 in spinal stenosis and 4.42+/-4.96 in control group. In conclusion, there were no statistically significant relationships between the magnitude of the facet joint angle and development of the HNP and spinal stenosis, and between the facet asymmetry and development of the HNP and stenosis.

Operative Treatment of the Carpal Scaphoid Nonunions / 대한정형외과학회잡지

We had treated 24 patients who had nonunions of the carpal scaphoid from June 1987 to September 1995. 17 of 24 nonunions of carpal scaphoid were treated by K-wires fixation and autogenous iliac bone grafts. Another 7 cases were treated by Herbert screw fixation and autogenous iliac bone graft. 24 patients were followed up average 42.6 months and obtained following results; l. Among 24 cases, 23 cases were men and 19 cases were the third and fourth decade. Most common injury was the falling accidents (11 cases: 45.8%). 2. Most common pattern of fractures was waist type (20cases: 83.3%) in anatomical site and transverse type (15 cases: 75.0%) in pattern of fracture line. 3. Preoperative scapholunate angles (mean 52.9degrees: K-wires, 69.1degrees: Herbert screw) has been improved after open reduction and internal fixation by K-wires or Herbert screw (mean 46.2degrees: K-wires, 51.1degrees: Herbert screw). 6 cases had DISI deformity preoperatively with scapholunate angles over 70degrees (mean 80.0degrees: K-wires, 84.0degrees: Herbert screw) has been corrected after ORIF (mean 48.0: K-wires, 58.0: Herbert screw). 4. Bony unions were obtained in average 13.2 weeks in K-wires group and 9.8 weeks in Herbert screw group. 5. 13 cases (76.5%) in K-wires group and 6 cases (85.7%) in Herbert screw group were excellent and good result by Maudsley method. 6. The complications and sequalaes were present 4 cases in K-wires group with degenerative arthritis on radioscaphoidal and scapholunate joint and collapse of proximal pole and 1 case in Herbert screw group with screw malposition. So, We were thought that ORIF with K-wires and Herbert screw was effective treatment for nonunions of carpal scaphoid, especially Herbert screw fixation and autogenous iliac bone graft. In comparison of bony union and results of treatment, Herbert screw group was more effective than K- wires group.

The effects of ranitidine on T-lymphocyte subsets in septic patients

No abstract available.