Neurologically Symptomatic Epidural Hematoma after Lumbar Spine Surgery: Comparative Study for Risk Factors / 대한척추외과학회지

STUDY DESIGN: Retrospective and controlled study OBJECTIVES: To verify the risk factors, distinction of symptomatic and prognosis of the postoperative neurologically symptomatic epidural hematoma at the lumbar region. SUMMERY OF LITERATURE REVIEW: Even though an epidural hematoma is one of the well known causes of postoperative neuro-logical complications, the rarity makes it difficult to account for the causes of this phenomenon. MATERIAL AND METHODS: Eight patients who had a proven neurologically symptomatic epidural hematoma were reviewed. We analyzed the degrees of neurologic recovery according to the initial degree of the neurological deficit and the time to the hematoma evacuation. Two hundred four patients who underwent a lumbar operation during the months contemporary with the occurrence of each cases (ed note: I do not know what this means.) by the same surgeon, were selected as the control group. RESULTS: Among the 2,951 patients, 8 patients (0.027%) developed such complication. Using a simple logistic regression test, an increased amount of bleeding, a prolonged operation time, a decreased platelet count before and after surgery, hypertension and previous cardiovascular disease were recognized as significant risk factors, but the statistical significance was lost in all factors by multiple logistic regression test. There was no significant correlation between the neurological recovery and initial neurolog-ical deficit or retardation before the hematoma evacuation. CONCLUSIONS: Compressive epidural hematoma following lumbar spine surgery can cause serious neurological symptom. Significant risk factors were not demonstrated. Therefore, it can be developed in ordinary patients. All cases developed neurological symptom within the first 8 hours after surgery. Accordingly, cautious observation of the neurological changes at early period is important for detecting and treating such complication. The neurologically symptomatic epidural hematoma should be evacuated even in delayed cases, because neurological recovery can be expected.

Two-Stage Reimplantation in Infected Total Knee Arthroplasty

PURPOSE: We evaluated the usefulness of two-stage revision knee arthroplasty for treatment of infected total knee arthroplasty(TKA). MATERIALS AND METHODS: We retrospectively reviewed 13 cases treated by two-stage reimplantation among the 18 infected TKA cases from February 1993 to March 2003, which had been followed up for more than two years. We analyzed the results of treatment, knee society score before and after the two stage reimplantation, recurrence of infection, and other complications. RESULTS: The mean period between the time of primary TKA and that of diagnosis of deep infection was 1.7 years. The mean period from removal of infected primary prosthesis to the second stage reimplantation was 7.2 weeks. The mean range of motion increased from 60.3 degrees to 95.7 degrees after operation. The mean Knee Society Score increased from 50.2 points to 83.4 points. Infection recurred in two cases but immediately subsided by intravenous antibiotics therapy. One case with patella fracture was treated by total patellectomy. CONCLUSION: This procedure using antibiotics-impregnated cement spacer and complete debridement of necrotic tissues can control infection and improve functional results. The result of two-stage revision for deep infected total knee arthroplasty was satisfactory in view of eradication of infection and functional restoration of the knee.

Treatment of Femoral Fractures Following Total Knee Arthroplasty

PURPOSE: To analyse the results of the treatment of femoral fractures following total knee arthroplasty (TKA) and to discuss about factors determining operative methods. MATERIALS AND METHODS: Between August 1993 and March 2001, 11 knees in 11 patients were treated for femoral fracture following TKA in Seoul Sacred Heart General Hospital. Only one case was treated with cast immobilization and ten cases were treated with operative method. In operative cases, before choosing the fixation devices, we considered the location, displacement and comminution of fractures and general conditions of patients. We analyzed clinical results according to the tibiofemoral angle, range of motion(ROM), and the knee rating score of Hospital for Special Surgery(HSS). RESULTS: Among 1133 knees in 764 patients with primary TKA, eleven cases underwent femoral fractures following TKA. The incidence was 0.9%. Among ten cases which were treated operatively, four cases had severe displacement without osteoporosis and were treated with dynamic compression plate(DCP) and screws. Three cases had displaced comminuted fractures with ostoporosis and medical problems, so they were treated with Ender nailing. Two cases had mild displacement and comminution and were treated with retrograde interlocking IM nailing. One case was with uncomminuted fracture with cardiopulmonary insufficiency and old age. Because initial closed reduction was failed, open reduction was performed and cancellous screw fixation was done. The average follow up period after fracture was 19 months. Radiologically, tibiofemoral angle was valgus 6.2 degrees on an average before fracture and valgus 8.2 degrees at the last follow up. ROM was 109 degrees on an average before fracture and 98 degrees at the last follow up and HSS knee rating score averaged 84 points before fracture and 78 points at the last follow up. CONCLUSION: Selection of treatment methods and fixation devices according to fracture type was important for satisfactory functional results, patient's general conditions and medical problems must be considered.