The Treatment of Spinal Pseudarthrosis in Ankylosing Spondylitis / 대한정형외과학회잡지

PURPOSE: To report the clinical findings and results of the surgical treatment of the spinal pseudarthrosis in ankylosing spondylitis patients. MATERIALS AND METHODS: We reviewed 24 destructive vertebral lesions in 15 patient with ankylosing spondylitis who underwent pseudarthrosis repair and/or correction of kyphotic deformity. We assessed the clinical, laboratory, pathological and radiological findings. We performed anterior interbody fusion with or without Smith-Petersen osteotomy (SPO) at the level of pseudarthrosis. Pedicle subtraction osteotomy (PSO) was performed additively at lumbar spine in severe kyphotic patients. Clinical outcomes and complications were assessed. RESULTS: Traumatic history and inflammatory reaction were not universal findings. Histopathological specimens showed fibrous degeneration with sclerotic bony spicules and mild chronic inflammation. We performed AIF with SPO in 12 kyphotic patient with additional PSO in 6 patients. Posterior interbody fusion was performed in non-kyphotic patients. Radiolographic results demonstrated solid union of pseudarthrosis at average 4.2 months after operation and sagittal imbalance was improved from 24 cm to 4.2 cm at follow up. The subjective satisfactions of the patients at the last follow up were excellent or good in all of the cases. CONCLUSION: The principal etiology of pseudarthrosis in ankylosing spondylitis thought to be a mechanical weakness of unfused segment. Most of patients have had good clinical results by surgical stabilization of destructed anterior column with or without correction of deformity in combination with SPO and PSO.

Total Knee Arthroplasty in the Valgus Knee / 대한정형외과학회잡지

PURPOSE: To analyze the clinical and radiographic results after total knee arthroplasty (TKA) in the valgus knee. MATERIALS AND METHODS: Thirty six knees in 27 patients with a valgus alignment of more than 10 degrees of femorotibial angle underwent TKA. The average follow-up period was 7 years 2 months (1 year to 14 years 5 months). 18 (50%) knees were implanted with a cruciate retaining prosthesis, 17 (47.2%) knees with a posterior stabilized prosthesis, and one (2.8%) knee with a constrained condylar prosthesis. In knees with a preoperative 15 degrees or greater femorotibial angle, the posterior stabilized prostheses were necessary in 85%. Medial parapatellar approach was used in 27 knees with a preoperative valgus 20 degrees or lesser femorotibial angle. With 20 to 29 degrees valgus, medial parapatellar approach was used in 5 knees and lateral parapatellar approach in 2 knees. With 30 degrees or greater valgus, lateral parapatellar approach was used in 2 knees. RESULTS: The mean postoperative Hospital for Special Surgery knee scores were 89.5 points. Postoperative range of motion averaged 114.4 degrees. Postoperative alignment averaged 6.5 degrees valgus. Radiolucent line or loosening was not seen in any knee. There were 2 deep infection in patients whose preoperative femorotibial angle was greater than valgus 20 degrees using lateral parapatellar approach. CONCLUSION: Clinical and functional results after TKA in valgus knee were similar to those in varus. But, prevention of deep infection in patients with marked valgus angle was important, especially using lateral parapatellar approach. Cruciate retaining, posterior stabilized and constrained condylar prostheses were used in our cases. A more constrained prosthesis was frequently used in more significant valgus deformity. Both medial and lateral parapatellar approaches were used in our cases. But, in severe valgus knee more than 30 degrees, lateral parapatellar approach was necessary.

Prevertebral Soft Tissue Swelling After Anterior Cervical Discectomy and Fusion / 대한척추외과학회지

STUDY DESIGN: Prospective study of 87 patients OBJECTIVES: To identify the natural course of the prevertebral soft tissue swelling after a one- or two-level anterior cervical discectomy and fusion (ACDF) and to help prevent potentially lethal airway complications after an ACDF. SUMMARY OF LITERATURE REVIEW: Airway complication after anterior cervical surgery is rare but potentially lethal. MATERIALS AND METHODS: Eighty-seven patients who underwent a one- or two-level ACDF with a plate and screws were examined. Cervical spine lateral radiography was taken preoperatively, on the immediate postoperative day, 1st, 2nd, 3rd, 4th and 5th day after surgery. Prevertebral soft tissue was measured from C2 to C6 on the cervical spine lateral radiography. RESULTS: Prevertebral soft tissue swelling occurred postoperatively and increased markedly on the second day after surgery. The peak prevertebral soft tissue swelling was observed on the second and third day after surgery. The prevertebral soft tissue swelling was decreased gradually from the 4th day after surgery. Prominent swelling of the prevertebral soft tissue was found at the 2nd, 3rd and 4th cervical spine. There were no significant differences in the prevertebral soft tissue swelling between the one-level and two-level ACDF group. Only one patient required reintubation (1.1%) CONCLUSIONS: The peak prevertebral soft tissue swelling was observed on the second and third day after surgery. Therefore, maintaining intubation for 3 or 4 days after surgery would be helpful in high-risk patients.

The Relationship between Psychologic Factors and Motivation for Weight Loss in Childhood Obesity / 신경정신의학

OBJECTIVES: The aim of the present study was to evaluate the relationship between the psychosocial variables such as emotional, character and motivation factors for weight loss in children with obesity. METHODS: Thirty seven children between the ages of 7 and 12 who had entered the summer camp pngram for childhood obesity and their parents participated in this study. The questionnaire for eating habit and life style of the child, the Child Behavioral Checklist (CBCL), and the Child Character Inventory (CCI) were completed by parents. The children with obesity completed the Child Depression Inventory (CDI) and the Parental Bonding Instrument (PBI). We evaluated their motivation to lose weight with the Weight Loss Readiness Test (WLRT). Then, we analyzed correlation between the psychological variables and the items of the WLRT. RESULTS: The 'emotional instability' in the CBCL was correlated significantly with the item of 'emotional eating' of the WLRT (r=0.336, p=0.042), and the 'vharm avoidance' of the CCI was negatively correlated significantly with the item of 'exercise patterns and attitudes' of the WLRT (r=-0.047, p=0.014). However, no significant correlation was found between each of the severity scores of the depressive symptoms assessed with the CDI and the other psychological variables, and each of the six items of the WLRT. CONCLUSION: Our findings suggest that the emotional instability and the 'harm avoidance' of the CCI of the children are related to the motivation for weight loss in childhood obesity.