The Analgesic Effects of Epidural Dexamethasone after Simple Lumbar Discectomy / 대한마취과학회지

BACKGROUND: Epidural steroids have been suggested to prevent postoperative epidural fibrosis after lumbar laminectomy. The purpose of this prospective study was to compare the degree of postoperative pain in patients undergoing simple lumbar discectomy with and without epidural dexamethasone administration. METHODS: Thirty-six patients undergoing simple lumbar discectomy were randomly allocated to two groups to be given the following agents, just after the end of surgery via an epidural lumbar catheter previously inserted by the surgeon: normal saline 6 ml (group I), and a total of 6 ml normal saline with dexamethasone 5 mg (group II). The outcome measures included pain scores at 1, 2, 6, 12, and 24h and total morphine consumption over the first 24 postoperative hours. RESULTS: There were significant differences in the postoperative visual analogue scale (VAS) score at 1 and 2 h between the two Groups, and the 24h total morphine consumption in Group II was significantly lower than in Group I. CONCLUSIONS: Epidural administration of dexamethasone decreased the degree of postoperative pain after simple lumbar discectomy.

Total Hip replacement with AML Prosthesis for Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of the primary total hip arthroplasty with uncemented AML (anatomic medullary locking) hip prosthesis for avascular necrosis of the femoral head. MATERIALS AND METHODS: Forty-nine patients (65 hips) had a primary total hip arthroplasty between May 1987 and March 1992. Average follow-up was 9.6 years. The mean age of the patients was 46.9 years. The canal fit of the stem at the proximal canal and isthmus level was obtained from postoperative radiograph. Components stability, stress shielding, polyethylene wear and periprosthetic osteolysis were evaluated from serial follow up radiographs. RESULTS: The average Harris Hip Score was to 92.1 points at the last follow-up. Twelve hips (18.5%) had a good fit at both the proximal canal and isthmus level and 15 hips (23.1%) had a poor fit at both levels. All twelve hips that had a good fit at both the proximal canal and isthmus level had bone ingrowth. Thirty-three hips (56.3%) had femoral osteolysis. Twenty-one hips (32.3%) had acetabular osteolysis. Fourteen hips had acetabular and femoral osteolysis. The overall rate of revision was 16.7% (11 hips). Ten cases were revised because of excessive polyethylene wear and osteolysis. Revision of the femoral component for aseptic loosening was only one case. CONCLUSION: The result of our study suggests that total hip arthroplasty using the AML hip prosthesis with an ACS (acetabular cup system) polyethylene liner should be monitored closely for catastrophic wear of the polyethylene liner. We recommend early revision arthroplasty in case of excessive wear of the ACS polyethylene liner.