Extraspinal canal lumbar disectomy: Via transverse pediculotransverse process approach technique.

This study reviews the developed technique of pediculoteansverse process approach for extraspinal lumbar disectomy which performs at lateral aspect near the posterior of lumbar disc space. This technique specifies only the soft tissue operation. Thus, it is different from the conventional disectomy. The technique can avoid epidural fibrosis, that compresses nerve roots, excision of the bone at the posterior part of lumbar spine and also surgical trauma to the lumbar nerves in the spinal canal. During November 1992- October 1993, the pediculoransverse process approach technique of lumbar disectomy was performed in 33 patients who suffered lumbar disc herniation, consisted of 10 females and 23 males, with age ranged 22-59 years old. The lesions were comfirmed by MRI as contained lumbar disc herniation and no extrusion of disc material into the spinal canal. The level of the lesions were two L 3-4, twenty – four L4-5 and seven L5 S1 levels. The results were that the hossptalization were only 2-3 days. The radicular pain to the leg disappeared immediately one day postoperation. Back pain improved about 80-90 percentage at the first day after operation and no residual back pain at two week later. The sensory deficit recovered about 80-90 percentage in one day and completely recovered in 1-2 weeks. The motor power and reflex changes recovered about 2 months. No complications were found in this series except only two patients had reoperation. The first one was operated at L4-5 disc space ans had symptoms free for 3 weeks. Afterwards he suffered low back pain and radicular pain to the fight leg again. The same operative technique was performed and it was found that the retained disc material compressed the same fifth lumbar nerve root. The other one suffered again low back pain and radicular pain, after symptoms free for six months. The diagnosis was spinal stenosis at L4-5 level and decompressive total laminectomy at L4-5 was done and radicular pain was improved except the back pain still persisted. The x-ray of lumbar spine showd postlaminectomy L4-5 spondylodisthesis and his back pain could be relieved by lumbosacral support. During 8 months to 1 year and 4 months follow up, the clinical evaluation found that all of 33 patients were graded in the good results.

The use of the simple designed bone awl to facilitate the bankart operation.

This study reviews the results of using the simply designed bone awl to simplify the Bankart operation. The awl is characterized by a handle connected to the curved part in a bayonet position. The curve is 2.5 cm. In diameter, 2-3 mm. thick, with a sharp tip, as in a trocar point. During 1987-1989, this instrument was used to perform the Bankart operation in 13 patients with recument dislocation of the shoulder. The patient’s ages ranged from 18-31 years, twelve were males and one was female. Eleven patients suffered dislocation of the right shoulder and two of suffered dislocation of the left. In the operation, the awl could perform 3 holes at the edge of the glenoid. Three millimeters from the glenoid edge was the proper area to make the inlet hole. The canal was curve and 2 mm. in diameter. The outlet hole through the articular suface was 2 mm. below the glenoid edge. The time spent boring one hole was about 2 minutes and the hole could provide adequate strength to suture the anterior capsule to the glenoid edge without breakage of the hole. The use of the awl minimizes the duration of the operation and decreases the surgical trauma. The clinical results of five year follow-up showed that the patients could move the shoulder joint in full range of motion in two and a half months, and could do heavy duty work and play the sport in about three and a half months with no re-dislocation.

The stable upper tibial osteotomy for treatment of osteoarthritic knee (part III): The simplified medial opening step wedge technique.

This study reviews the simplified medial opening step wedge technique for upper tibial osteotomy by performing the operation without osteotomy of fibula and using narrow straight plate instead of T-plate fixation of the tibia. During 1991-1993, this simplified osteotomy technique was used in 19 patients 2 males and 19 females with age ranged 51-69 years old, whose 21 knees had degenerative varus osteoarthritic, 15 right and 6 left knees. Among these 19 patients, both joint debridement of the knees and the osteotomy were done in 2 patients suffered from osteoarthritic knees with excessive osteophytes near the joint surface. The result of 1-2 year follow up showed that the technique provided increased stability of osteotomy site, decreased postoperative swelling and pain during exercise and ragne of motion of the knees. Moreover, it could reduce the operative time. For the union of osteotomy, radiologic changing appearance of the knees and used the knees in daily activities were similar to the results of the treatment of osteoarthritic knees by technique of medial opening and lateral closing step wedge upper tibial soteotomy.

The stable upper tibial osteotomy for the treatment of osteoarthritic knee: Madial opening step wedge technique (part II).

This study reviews the results of the osteotomy technique of the upper tibia as medial opening step wedge using two iliac bone grafts fixed with a T-plate for the treatment of degenerative varus osteoarthritic knee. The technique was used in 32 patients twenty six females and six males with ages ranging from 50-65 years. During the two to four years postoperative follow up, we found that postoperative casting was nit necessary. The patients could move their knees after 3-5 days and a full range of motion was noted in one-and-a half months. However in 8 cases who had coincidentally suffered joint debridement, the full range of motion was obtained in about two and half months. The union of the graft osteotomy took one and a half months. Most importantly there was no alteration in the angle the corrected joint. Roentgeon appearances of the knees after one year showed the widening of the medial joint space, the decrease of subchondral bone sclerosis and the size of osteophytes and the knee joints were stable.

The stable upper tibial osteotomy for the treatment of osteoarthritis knee: Lateral closing step wedge osteotomy (part I).

This study reviews the results of the lateral closing step wedge technique for upper tibial osteotomy and fixation with an osteotomy plate for the treatment of degenerative various osteoarthritic knee. This technique of osteotomy was used in 10 patients, two males and eight females whose ages ranged from 52-66 years. During the five years postoperative follow up, we found that postoperative casting was not necessary and the patients could move the knees after 3-5 days and full range of motion was noted in one and a half months. Among these 10 patients, both joint debridement and osteotomy were done in 4 patients suffered from osteoarthritis knees with excessive osteophytes and loose bodies in the joint cavity, the full range of motion was obtained in about two and a half months. The union of the osteotomy took two months in all 10 patients and between 2-8 months they could return to their daily activities with some intermittent knee pain which relieved by analgesic drugs or using a cane. After 8 months – 5 years, nine of ten patients had no knee pain, only one patent persisted mild knee pain. Roentgen appearances of the knees after one year showed a decrease of subchondrol bone sclerosis, and the widening of the medial joint space as well as stable knee joints.