Percutaneous Vertebroplasty for Osteoporotic Compression Fractures / 대한정형외과학회잡지

PURPOSE: To evaluate the results of percutaneous vertebroplasty using PMMA (polymethylmethacrylate) in the treatment of osteoporotic compression fractures. MATERIALS AND METHODS: A retrospective review was conducted of 38 patients with 64 vertebrae treated by percutaneous vertebroplasty from June 1999 to May 2000. The patients had symptomatic, osteoporotic fractures and had failed medical therapy. Immediate and long-term pain responses and complications of the percutaneous vertebroplasty with PMMA were evaluated. RESULTS: Thirty-three (86.8%) of the 38 patients reported pain improvement within the first 48 hours. Seventeen (44.8%) were evaluated as excellent; eleven (28.9%), as good; six (15.8%), as fair; and four (10.5%), as poor. Fourteen (36.8%) patients had cement extrusion into a disc, paravertebral vessels or epidural space without significant systemic symptoms. CONCLUSION: Percutaneuos vertebroplasty using PMMA provided significant pain relief in a high percentage of patients with osteoporotic compression fractures. It is considered to be an alternative method of treating patients with osteoporotic compression fractures of vertebral bodies who do not respond to conservative treatment.

Angiographic Embolization as a Treatment of Postoperative Bleeding / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of the angiographic embolization for the treatment of postoperative bleeding. MATERIALS AND METHODS: Six patients who suffered massive postoperative bleeding underwent angiographic embolization from March 1998 to June 1999. The initial diagnosis was femoral fractures in 4 patients, infected total hip arthroplasty in a patient, and open humerus fracture in a patient. When angiography revealed arterial tear, embolization was performed. The authors evaluated the effectiveness and the complication of angiographic embolization. RESULT: Five patients had arterial tear and one patient had diffuse bleeding from the granulation tissue. Angiographic embolization was performed in all patients. There were 3 cases of injury of the deep femoral artery, a case of injury of a branch of the subclavian artery, and a case of injury of the superior gluteal artery. After the procedure swelling subsided and the amount of transfusion diminished in all patients. There was no complication related to angiographic embolization. CONCLUSION: When there is suspicion of arterial injury after the operation, angiographic embolization can be used to confirm arterial injury and to control bleeding.

The Treatment of intertrochanteric Fractures of the Femur using Compression Hip Screw / 대한정형외과학회잡지

The intertrochanteric fracture of the femur occurs frequently in the elderly who has osteoporosis. These fractures had been treated with many fixation devices. Recently dynamic hip screws been commomly used. But, some complications were reported by this fixation the patients who were osteoporotic and/or who had unstable type fracture. We have analysed the roentgenograms and the medical records to study impaction degree and change of neck-shaft angle according to fracture type and degree of osteoporosis in the 35 patiensts wit minimum 1 year follow-up who have intertrochanteric fracture of the femur treated with dynamic hip screws, from Jhn. 1989 to Jun. 1993, retrospectively. The results obtained were as follows; 1. The most common fracture type by Bord-Griffin classification was type I, 19 cases(57%), and the most common osteoporotic by Sight's index was grade II, 21 cases(60%). 2. There were no significant differences of impaction degree and neck-shaft angle according to the fracture types or osteoporosis degrees. 3. The mean impaction degree of fracture site was 9.3mm and the mean neck-shaft angle change was 0.8。 of varus angulation.