Periacetabular Osteotomy for Treatment of Acetabular Dysplasia through Iliofemoral approach

PURPOSE: To evaluate the clinical and radiologic results of periacetabular osteotomy, for treating acetabular dysplasia through iliofemoral approach. MATERIALS AND METHODS: We evaluated the results of 17 periacetabular osteotomies performed in 17 patients (12 female, 4 male). The osteotomies were performed through an iliofemoral approach in 17 hips. The mean age of the patients at the time of surgery was 34.7 years (range: 14~61 years). The average follow-up period was 26 months (range: 12~48 months). The D'Aubigine and Postel score was used for clinical evaluation. Radiological changes of acetabular head index, the CE angle (lateral and anterior), and the sharp angle were measured, respectively. RESULTS: Clinically, the mean D'Aubigine and Postel scores improved from 12.7 preoperatively to 15.1 postoperatively. All four radiological measurements improved significantly after surgery (Wilcoxon Rank Sum test: p< 0.05). The following complications were noted: posterior column fracture in 2 hips and peripheral nerve dysfunction was noted in 5 patients. Of these nerve palsy, lateral femoral cutaneous nerve palsy in 3 patients, 1 patient complained troublesome, transient sciatic nerve palsy and femoral nerve palsy in 1 patient. There were no vascular complications or heterotopic bone formation and conversion to total hip arthroplasty. CONCLUSION: Periacetabular osteotomy by the iliofemoral approach is an effective surgical treatment for acetabular dysplasia in adults, but should be careful nerve injuries.

Cementless Acetabular Revision using microporocoated Hemispherical Cup / 대한정형외과학회잡지

Late aseptic loosening of the acetabular component following total hip arthroplasty become increasing frequently after about 10 years and has become a more severe problem both in frequency and severity than femoral component loosening. The complexity of acetabular revision depends largely on the reconstruction required to restore normal anatomy due to acetabular bone loss. The clinical and radiologic results of acetabular revision using a porocoated acetabular component fixed to the pelvis with screws were studied in 36 patients (40 hips) who had moderate or severe acetabular loss. Acetabular revision in patients whose bone stock had already been destroyed provied more formidable problems at revision surgery. The mean Harris hip score was improved 46 to 84. Bone graft union was achieved by 7.4 months and incorporated by 16 months. The graft bone resorption was noted minor degree lateral to the cup. Of 40 cases, 2 cases required re-revision of acetabular cup for identifiable failure of fixation and one was showed probable loosening. The results of the present study suggest that revision of the acetabulum with use of a hemispherical cementless component stabilized with multiple screws and morselized bone grafts filling bone defects appears to be successful in restoring bone stock and providing a stable, pain-free reconstruction.

Treatment of Cerebral Aneurysms and Aneurysm Surgery under Hypotension

Authors have experienced 104 cases of the intracranial aneurysms with subarachnoid hemorrhage, who were proved to have aneurysms by cerebral angiography for past 8 years. Aneurysms surgery under controlled hypotension has shown far better result than that of surgery under hypothermia, carotid ligation or conservative treatment. Of the 104 cases, the site distribution of aneurysms and the result of various treatment are analyzed. Followings are the results. 1. Anterior communication aneurysm was 44 per cent of the cases and it was most common site of the intracranial aneurysms. 19 per cent of aneurysms located on internal carotid artery at the posterior communicating artery, and middle cerebral artery aneurysm was 16%. The site distribution of aneurysms in Korean has shown marked difference from the reports of other countries. 2. Of 40 cases, who received conservative therapy, 15 cases (375% ) were expired, and most of them were dead due to rebleeding from aneurysms. 3. The direct attack of aneurysms through intracranial approach was performed under moderate hypothermia till 1970, and controlled hypotension was introduced thereafter. In 19 cases of intracranial aneurysm surgery, 7(14.2%) were expired following surgery. 4. Mortality of the carotid ligation for 15 cases of the intracranial aneurysms was 40 per cent. Cerebral ischemia or rebleeding was cause of death. 5. Intracranial aneurysm surgery under hypotension was carried out in 16 cases, and one cases (6.2%) was expired. Induced hypotension and careful identification of aneurysm and neighbouring structures by magnify operating glasses promoted operative result in aneurysm surgery.