Complication and Treatment Outcome of Degenerative Spinal Deformity Surgery in Elderly Patients / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the complications, clinical outcome and any correlative risk factors of degenerative spinal deformity surgery in elderly patients. SUMMARY OF LITERATURE REVIEW: There is some controversy regarding the postoperative complications and the factors influencing them in the elderly patients who had undergone degenerative spinal deformity surgery. MATERIALS AND METHODS: Seventy eight patients, who underwent posterior decompression and posterolateral fusion requiring a minimum 3 level fusion for a degenerative spinal deformity associated with spinal stenosis between May, 2001 and May, 2006, were reviewed after a follow-up period of at least 1 year. This study compared the postoperative complications and clinical outcomes of patients over 65 years (group A) with patients between 50~64 years (group B). The risk factors that could influence the complications and clinical outcomes were evaluated and analyzed statistically. RESULTS: The postoperative complication rate was 53% in group A and 40% in group B without statistical significance. However, group A had a significantly higher frequency of minor complications than group B, particularly in urinary retention and postoperative delirium. There was an association between diabetes and deep wound infection as a major complication in groups A and B. Being male was a risk factor for urinary retention and longer surgery time, and abundant blood loss was significant risk factors for postoperative delirium in group A. CONCLUSION: There were no significant differences in the treatment result for degenerative spinal deformity between patients older than 65 and younger than 65. It is considered that the blood sugar should be controlled strictly before and after surgery, and appropriate management is needed for postoperative delirium and urinary retention in elderly patients.

Classification and Treatment of Unstable Intertrochanteric Fracture according to the Existence of Posterior Fragment : Preliminary Report

PURPOSE: To predict the feature and stability of intertrochanteric fractures with posterior fragment using preoperative 3D computed tomography and to investigate the importance of the posterior fragment in treatment of unstable intertrochanteric fracture. MATERIALS AND METHODS: 15 cases of unstable fractures with posterior fragment which were treated with nail only between October 2006 to August 2007 were classified into 2 groups: study group (5 cases with cannulated screw fixation of posterior fragment) and control group (10 cases without cannulated screw fixation). The average difference of neck-shaft angle, neck screw sliding distance and the complications in the two groups were compared retrospectively after a follow up of at least 3 months. RESULTS: The average difference of neck-shaft angle in study and control group was 3.8 and 7.5 degree (p>0.05), respectively. The average difference of neck screw sliding distance was 1.6 and 6.6 mm (p<0.05), respectively. Complication which required reoperation was not noted in study group and complications of 3 cases about neck screw lateral protrusion, proximal migration and Z-effect phenomenon were noted in control group. CONCLUSION: The recognition and fixation of the posterior wall was found to be an important predictive factor in unstable intertrochanteric fracture treatment.

The Effect of Human Amniotic Membrane, Epidermal Cells and Marrow Mesenchymal Stem Cells in Healing a Skin Defect / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to investigate the transplantation results of human amniotic membrane (HAM), epidermal cells, or marrow mesenchymal stem cells (MSCs) in healing a skin defect. MATERIALS AND METHODS: Defects (full-thickness) in rabbits were treated with HAM alone (group A), HAM injected with cultivated epidermal cells (group B), HAM injected with cultivated MSCs (group C), or Vaseline gauze (group D). Tissue granulation, regeneration, re-epithelization and healing time were measured. Defects and healed area were calculated 2 weeks after surgery. RESULTS: The mean healing area was 67.5%, 81.7%, 83.2% and 49.5% in each group, with all treatment groups significantly different than group D (p<0.01), and groups B and C compared higher than group A (p<0.05). The healing time of groups A, B, and C was 5.7 to 6.4 days faster than that of group D (p<0.01). Histologic analysis showed that the new epidermis covered nearly the whole wound surface in group B and C, and contained granulated tissue with fibroblasts, capillaries, and collagen. CONCLUSION: HAM grafts injected with cultivated epidermal cells or MSCs promoted healing of skin defects.

Cervical Rib Syndrome: 2 Cases Report / 대한정형외과학회잡지

Cerivical rib syndrome, one of four common causes of thoracic outlet syndromes, have similar symptoms which accidentally discovered in simple x-ray and needs to be distinguished with other syndromes. Thoracic outlet syndromes are classified according to anatomical structures that causes symptoms; cervical rib syndrome, scalenus anticus syndrome, costoclavicular syndrome and hyperabduction syndrome. Various treatments for thoracic outlet syndromes have been introduced, such as; conservative care, excision of cervical rib and first rib and release of anterior scalenus muscle by supraclavicular approach and excision of cervical rib and first rib by axillary approach. We would like to report a case on a 16 years old girl and a 21 years old man who had cervical rib syndrome and treated successfully without excision of the first rib but excised cervical rib and released anterior scalenus muscle by supraclavicular approach.

Cause and Treatment of Extraarticular Proximal Tibial Nonunion

PURPOSE: To analyze the factors affecting the nonunion of extraarticular proximal tibial fracture and the outcome of nonunion treatment. MATERIALS AND METHODS: We investigated 51 cases of extraarticular proximal tibial fractures from June 2002 to May 2006. The nonunion rate was assessed in relation to several risk factors and the treatment outcome of nonunion using plate fixation with bone graft was assessed by Klemm and BOrner functional rating system. RESULTS: 6 cases of nonunion (11.8%) was noted among 51 cases, and the risk factors examined, OTA A3 comminuted fracture was associated with a high nonunion rate with statistical significance and initial bone graft had a significant effect in bone healing. Excellent and good results were obtained in 5 cases (83.3%) and bone union was achieved in all nonunion cases. CONCLUSION: Comminution was found to be an important factor affecting the nonunion in extraarticular proximal tibial fracture, and bone graft in primary operation could reduce the chance of nonunion. Accurate plate fixation with bone graft is a reliable option in nonunion treatment.

Arthroscopic Internal Fixation of Displaced Tibial EminenceFracture Using Cannulated Screw / 대한정형외과학회잡지

PURPOSE: This study examined the outcome of arthroscopic internal fixation for types II and III tibial eminence fractures in children using a cannulated screw. MATERIALS AND METHODS: A series of 10 cases of displaced fractures of tibial eminence of the tibia that were treated with an arthroscopic cannulated screw fixation from February, 1997 to October, 2005 were examined. Four patients had a type II and six patients had a type III tibial eminence fracture according to the Meyer and McKeever's classification. All the patients were reviewed radiographically and clinically for bone union, instability and the range of motion after an average follow-up of 22.4 months (range, 12 to 81 months). RESULTS: There were no cases of nonunion. The clinical examination showed that, all the patients with types II and III lesions had a negative Lachman test, and a full range of motion with the exception of one patient with a type III fracture. The average Lysholm functional score was 96.3 (mim 92.6-max 99.0) for all types II and III lesions. CONCLUSION: Arthroscopic internal fixation with a cannulated screw for types II and III avulsion fractures of the tibial eminence in children can provide a satisfactory outcome through firm fixation of the fragment and an early start of the range of motion.

Treatment Outcome of Reoperative Lumbar Disc Herniation / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze the causes and treatment outcomes of reoperation after a lumbar discectomy. SUMMARY OF LITERATURE REVIEW: The major causes of reoperation after a lumbar disc surgery is recurrent disc herniation. Satisfactory outcomes can be obtained with reoperation for patients still requiring treatment. MATERIALS AND METHODS: Fifty two patients, who had undergone reoperations after lumbar discectomies with a minimum followup period of one year, were reviewed. The causes of the reoperation were analyzed according to the physical examination and conventional radiographic evaluation. The surgical outcome was assessed using the JOA score and Kirkaldy-Willis criteria, and the recovery rate was calculated according to the JOA score. Statistical analysis was carried out to evaluate the factors that might influence the outcome of reoperation. RESULTS: The causes of reoperation after lumbar disc surgery included 46 cases of recurrent disc herniation, each two cases of the wrong level, spinal canal stenosis and lumbar instability. The average JOA score increased from 11 to 24, and the average recovery rate was approximately 72%. According to the Kirkaldy-Willis criteria, the results were excellent and good in approximately 85% of cases. Statistical analysis revealed that the factors associated with a successful outcome were a single previous surgical procedure (p.0.02), a preoperative JOA score over 10 points (p.0.01), and a pain-free interval of more than 12 months after the previous operation(p.0.01). CONCLUSION: The treatment outcomes of reoperative lumbar disc herniation were satisfactory. Factors, such as the low number of prior procedures, high preoperative JOA score, and long pain-free interval after a previous operation, can lead to a successful treatment outcome of reoperation.

Relation of Postoperative Deformity with Clinical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: This study was designed to compare the clinical results, with the correction of the lumbar lordotic and scoliotic angles, in degenerative lumbar scoliosis patients, with spinal stenosis, who underwent an operation. SUMMARY OF LITERATURE REVIEW: Few studies have compared the postoperative lordotic angle with the clinical results in degenerative lumbar scoliosis, with spinal stenosis. SUBJECTS AND METHODS: Out of 68 cases, where the patients underwent posterior decompression, pedicle screw fixation and fusion, due to the degenerative lumbar scoliosis with spinal stenosis, between February 1997 and February 2001, 59 cases, with the possible follow-ups for over 2 year, were studied and are herein reported. The decompression was carried out over a segment that showed the neurological symptom and occlusion of the spinal canal or the compression on the nerve root observed on CT or MRI scans. The pedicle screw fixation and fusion were carried out over the segment that received the decompression. The average age of the patients was 63.4, ranging from 51 to 76 years, and the average follow-up period was 38, ranging from 24 to 56 months. The measurements were performed in relation to the vertebral rotation, scoliotic and lumbar lordotic angles preoperatively, postoperatively and at the time of the final follow-ups, respectively. The clinical results were classified by the Kirkaldy-Willis questionnaire, and the statistical calculations performed through chi-squared and Pearson's correlation tests. RESULTS: The average lumbar scoliotic angles preoperatively, postoperatively and at the time of the final follow-ups were 15.7+/-4.9, 8.9+/-3.1 and 10.8+/-4.7 degrees, respectively. The average lumbar lordotic angles were 14.2+/-6.1, 20.1+/-7.3 and 19.4+/-7.2 degrees, respectively. The vertebral rotation degrees were 0.88, 0.62 and 0.64, respectively. The clinical results by the Kirkaldy- Willis questionnaire indicated over 73% satisfactory results, showing 9 excellent, 34 good, 13 fair and 3 poor cases. The lumbar lordotic angle was statistically correlated with the clinical results (p=0.04), while the scoliotic angle (p=0.41) and the vertebral rotation degree (p=0.29) were not. The scoliotic and lordotic angles had negative correlations, but these were not statistically significant (r=-0.09 and p>0.05). CONCLUSION: It is my belief that the correction of the lumbar lordotic angle, in patients having spinal stenosis, with degenerative lumbar scoliosis, is associated with an improvement in the clinical results.