The Treatment of Peritrochanteric Fracture of Femur with Proximal Femoral Nail: Comparative Study with Dynamic Hip Screw

PURPOSE: This study compared the results between PFN (Proximal Femoral Nail) and DHS (Dynamic Hip Screw)in the treatment of a peritrochanteric fracture of the proximal femur. MATERIALS AND METHODS: 33 patients with peritrochanteric fractures treated with PFN for a minimum follow-up of at least 12 months were analyzed retrospectively. The patients with PFN group (n=33, group I) were taken from operations between Jan. 2003 and Dec. 2004, and the DHS group (n=34, group II) were used as the control group. Both groups were compared with regard to the operation time, blood loss, transfusion, ICU care, drain amount, duration of admission, complications, the neck shaft angle, the sliding length of lag screws, radiological union, and the functional recovery grade using Jensen and Palmar and Parker's method. RESULTS: The mean operative times were 105 (group I) and 157 minutes (group II), blood losses were 540 and 840cc, transfusion volumes were 1.5 and 2.2 pints, ICU care was 6 and 30%, drain amounts were 36 and 203 cc, admission duration was 25 and 33 days, complications were 15 and 17%, reoperations by the failure of the reduction were 2 cases(6%) (group I) and 0 (group II), difference in the neck shaft angles were 3.70 and 3.87degrees, sliding length of the lag screws were 1.9 and 6.9 mm, radiological union was achieved in 17.5 and 18.9 weeks, function scores were 1.81 and 1.94, and the mobility scores were 6.51 and 6.16, respectively. These results show that there were advantages of PFN in terms of the operative times, blood loss, transfusion, ICU care, drain amounts, admission duration, sliding length of the lag screws and radiological union with statistical significance (p<0.05). CONCLUSION: Good clinical results can be achieved with PFN compared with the DHS for the treatment of peritrochanteric fractures of the proximal femur.

Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types

PURPOSE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types. MATERIALS AND METHODS: There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (0.05). CONCLUSION: Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

Diagnosis of Herniated Tibialis Anterior Muscle by Dynamic Ultrasonography: A Case Report / 대한정형외과학회잡지

Muscle herniation is a relatively common disorder in the extremities, particularly in the lower extremity where the tibialis anteior muscle is the most commonly affected. Usually muscle herniation is asymptomatic or mild but a few patients complain of cramping or severe pain. We report a case of a bilateral hernia of the tibialis anterior muscle that was confirmed by dynamic ultrasonography.

Clinical Results of Percutaneous Endoscopic Discectomy in Herniated Intervertebral disc of Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the clinical outcomes and roentgenographic changes after an percutaneous endoscopic discetomy of an intervertebral disc herniation of the lumbar spine. SUMMARY OF LITERATURE REVIEW: Percutaneous endoscopic discectomy can preserve normal posterior element in the treatment for herniated intervertebral disc of lumbar spine. MATERIALS AND METHODS: Fifty two patients (41 men, 11 women), who had been treated with percutaneous endoscopic discectomy due to a herniated intevertebral disc of the lubar spine and were followed at least 1 year, were enrolled in this study. The mean age was 26.5 years (21~45) and the mean follow-up period was 42 months (12~76). Fifteen, 28 and 9 herniated discs were extracted from L3-L4, L4-L5 and L5-S1, respectively. RESULTS: After the percutaneous endoscopic discectomy, excellent and good results were obtained in 71% (37 cases) of patients but 9% (5 cases) of patients reported poor results. A roentgenographic assessment at the final follow-up showed no instability and no degenerative spondylotic finding. However, the intervertebral disc space was decreased in only 1 case. CONCLUSION: An percutaneous endoscopic discectomy is an effective method for treating a herniated intervertebral disc of the lumbar spine. However, prudent patient selection is very important for achieving good results.

Sciatic Nerve Palsy Complicating Gluteal Compartment Syndrome due to Rhabdomyolysis: A Case Report / 대한정형외과학회잡지

Rhabdomyolysis is an acute disorder resulting from skeletal muscle injury in which intracellular contents are released into extracellular space and plasma. The condition may result from drug or alcohol abuse, infection, collagen disease or intensive excersice, trauma and longstanding comatous mentality. We report a case of sciatic nerve palsy complicating gluteal compartment syndrome due to rhabdomyolysis.

Differential Expression of Somatostatin Receptor Subtype 2 in Dorsal Root Ganglia after Ischemic Injury in the Rat / 대한정형외과학회잡지

PURPOSE: The somatostatin has been suggested to play a role in the transmission of neurotransmitters and the modulation of pain. Therefore, this study was carried out to investigate the spatial and temporal alterations of sstr2 (somatostatin receptors 2) immunoreactivity after an ischemic injury in rats. MATERIALS AND METHODS: Fifty-five rats (Sprague-Dawley, 200-250 g) were assigned to the experimental group, the other five to the control group. In the experimental group, an occlusion of the left common iliac artery was made using an aneurysm clip. Ten groups were classified according to the time after ischemiareperfusion. Dorsal root ganglia (DRG) cells in the L4, L5, L6 levels of the spinal cord, from the rats were examined the sstr2 using an immunohistochemistry technique. RESULTS: The sstr2A/B immunoreactivity (IR) appeared in the DRG after ischemia-reperfusion. The number of sstr2A- and sstr2B-IR neurons were markedly lower in the group of rats 12 hours after ischemia-reperfusion. In the group of rats one day after ischemia-reperfusion, the sstr2A- and sstr2B-IR neurons began to recover in both number and immunoreactivity. Furthermore, 3 days after ischemia-reperfusion, sstr2A/B immunoreactivity decreased in number and immunoreactivity, and 7 days after ischemia-reperfusion, very weak immunoreactivity was observed in the cytoplasm. CONCLUSION: The sstr2A/B immunoreactivity of the DRG exhibited different appearance according to the post-traumatic compartment syndrome or ischemic injury of the leg. In addition, the chronological alterations of sstr2A and sstr2B immunoreactivities may be important in controlling the pain after a transient ischemia-reperfusion event.

Immunoreactivity of Somatostatin Receptor Subtype 2 in Dorsal Root Ganglia in the Rat / 대한정형외과학회잡지

PURPOSE: Somatostatin has been suggested to play a role in the transmission of neurotransmitters and in the modulation of pain. Of the different subtypes of somatostatin receptors 2, sstr2A and sstr2B are important in the modulation and transmission of pain. The present study was carried out to investigate sstr2 immunoreactivity in rat. MATERIALS AND METHODS: Dorsal root ganglia (DRG) cells at the L4-L6 levels of the spinal cord of 10 rats (Sprague-Dawley, 200-250 g) were examined for sstr2 by immunohistochemistry. RESULTS: In the control group, sstr2A immunoreactivity was strongly positive in the dense network within laminae I and II of the dorsal horn at spinal levels (L4-L6). In contrast to sstr2A, sstr2B immunoreactivity was observed throughout laminae III-VI. In the DRG, sstr2A and sstr2B immunoreactivities were mainly found in medium-sized neurons. CONCLUSIONS: The distribution of sstr2A immunoreactive cells among sstr2 in the dorsal root ganglia (L4-6) resembles that of somatostatin. Incontrast to sstr2A, sstr2B immunoreactivity showed a different distribution. The presence of sstr2A at laminae I and II, and sstr2B at laminae III-VI of the dorsal horn may modulate sensory functions at these different regions of the spinal cord. Considering different actions according to the receptors of the neurotransmitter, the functions of the isoforms of sstr2 appear variable in terms of modulating and transmitting pain.

The Effect of Extracellular Collagen on Synthesis of Extracellular Matrix in a 3-Dimensional Culture of Intervertebral Disc Cells / 대한척추외과학회지

STUDY DESIGN: In-vitro experimental study. OBJECTIVES: To determine the proteoglycan synthesis of the rabbit nucleus pulposus cells in various concentration of extracellular collagen type I and II under the stimulation of TGF-beta1. SUMMARY OF LITERATURE REVIEW: Therapeutic effect of growth factor and gene therapy can be altered by composition of extracellular matrix. However, the effect of extracellular collagen types I and II on synthetic activity of intervertebral disc cells is not thoroughly studied before. MATERIALS AND METHODS: The nucleus pulposus cells were isolated and cultured from 10 skeletally mature rabbits. Cultures were trypsinized and incorporated into alginate beads with different concentration of extracellular collagen type I and II (0.5%, 1.0% and 1.5%). Those cultures with TGF-beta1 (10 ng/ml) served stimulated condition of matrix synthesis. Newly synthesized proteoglycans were assessed by 35 S-sulfate incorporation using chromatography on Sephadex G-25 in PD-10 columns. Scintillation count was normalized with DNA content by Hoechst dye method. RESULTS: In basal condition, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II were statistically insignificant. In stimulated condition with TGF-beta1, difference in proteoglycan synthesis in given concentration of extracellular collagen type I and II was also statistically insignificant. However, cultures in stimulated condition with TGF-beta1 showed increased amount of newly synthesized proteoglycans compared to those of basal condition regardless of the concentration of extracellular collagen type I and II (p < 0.05). CONCLUSION: Anabolic response of rabbit nucleus pulposus cells is relatively insensitive to extracellular matrix composition, which facilitates application of gene therapy in various conditions of disc degeneration.

The Distribution of CGRP Containing Cells Innervating the Calcaneal Tendon in Rat Dorsal Root Ganglia / 대한해부학회지

This study was performed to investigate origins of the dorsal root ganglion cells containing calcitonin gene -related peptide (CGRP) which innervate the calcaneal tendon in the rat. We used the horseradish peroxidase (HRP) or fluoro -gold (FG) to trace retrogradely somatic afferents in dorsal root ganglion cells after unilateral injections into the rat calcaneal tendon. HRP or fluoro -gold labeled DRG cells for the calcaneal tendon were seen generaaly in lumbosacral (L1 to S1) DRGs ipsilaterally. In lumbosacral DRGs, the largest number of labeled cells were found in the L6 DRG. Many DRG cell bodies contained the CGRP throughout the L1~S1. A plenty of HRP -or FG -labeled cells innervating the calcaneal tendon were also identified to contain the CGRP in L1~S1 DRGs. These FG +/- CGRP DRG cells innervating the calcaneal tendon were primarily found in the L6 DRG. These results suggest that the main sensory DRG for the calcaneal tendon is the L6. This fact may be available in diagnosis and treatment of neurogenic pain in the calcaneal tendon.

Origins of Dorsal Root Ganglion Cells with CGRP innervating Quadriceps Femoris Tendon of Rat / 대한정형외과학회잡지

PURPOSE: This study was undertaken to determine the origins of dorsal root ganglion (DRG) cells containing calcitonin gene-related peptide (CGRP) which innervate the quadriceps femoris tendon in the rat. MATERIALS AND METHODS: DRG cells containing CGRP, which innervate the quadriceps femoris tendon, from 25 rats (Sprague-Dawley, 200-250 g) were examined using the retrograde tracing technique (neural tracers: horseradish peroxidase and fluorogold) combined with immunohistochemistry. RESULTS: Injection of horseradish peroxidase (HRP) or fluoro-gold (FG) into the quadriceps femoris tendon resulted in the ipsilaterally labelling of cells between L1 and L6 DRGs. However, a large number of the labelled cells innervating the quadriceps femoris tendon were found in the L3 and L4 DRGs. Many DRG cells were immunostained with CGRP antibody in the L1-6 DRGs. The number of CGRP immunoreactive cells in the lumbar DRGs was larger than in the sacral DRG. FG labelled cells containing CGRP immunoreactivity (FG+CGRP cells) were found in the lumbosacral DRGs. Many FG+CGRP cells innervating the quadriceps femoris tendon were located in the L3 and L4 DRGs. CONCLUSION: These results show that the main DRG origin for the sensory innervation of the quadriceps femoris tendon is L3 or L4. The neurogenic pain of the quadriceps femoris tendon may originate from this region, and suggests that this may be important for the release of neurogenic pain.

Anterior Interbody Fusion using a Horizontal Cylinder Cage in a Degenerative Lumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the surgical effect of anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine. MATERIALS AND METHODS: We evaluated 16 patients (at 20 levels) who received anterior interbody fusion using a horizontal cylinder cage in a degenerative lumbar spine or in secondary segmental lumbar instability following decompression at the same level from May 1997 to May 1998. Preoperative, postoperative, and follow-up radiographs were taken to compare the posterior disc height, neuroforaminal area, and the neuroforaminal volume. Fusion rates and clinical results were also reviewed. RESULTS: Posterior disc height (mm), neuroforaminal area (mm2) and neuroforaminal volume (mm3) were increased and maintained during the follow-up period. Radiological fusion was noted in 17 levels (85%) at a postoperative 1 year. Satisfactory clinical results were also obtained in 17 levels (85%). CONCLUSION: Anterior interbody fusion using a horizontal cylinder cage might be an effective method in the surgical treatment of degenerative lumbar spine or secondary segmental lumbar instability.

A Prospective Comparison of Surgical Approach for Lateral Retroperitoneal L4-5 Fusion: Laparoscopic Versus Mini-ALIF / 대한척추외과학회지

STUDY DESIGN: We have analyzed the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion. OBJECTIVES: To prospectively compare the laparoscopic lateral retroperitoneal approach of the L4-5 interspace to the miniopen retroperitoneal approach for lateral lumbar interbody fusion Summary of Background Data : The introduction of laparoscopic techniques in 1993 has stimulated a great deal of discussion regarding the risks and benefits of such minimally invasive approaches. In many centers the anterior endoscopic approach to L5-S1 has become routine. However exposure at L4-5 can be much more difficult. MATERIALS AND METHODS: From 1997 to 1999 thirty eight patients were entered into a prospective study. These patients were all undergoing anterior interbody fusion at the L4-5 level. The patients were divided into two groups for analysis. Group I patients underwent anterior interbody fusion utilizing threaded interbody devices placed via laparoscopic lateral retroperitoneal approach. Group II patients underwent anterior lumbar interbody fusion using threaded interbody devices placed via a miniopen retroperitoneal approach. RESULTS: In Group I, Operation time was 48 minutes longer than Group II (p=0.035) but there were no significant statistical differences in bleeding amount and hospitalization period. Parethesia and tingling sensation of thigh were developed in two cases of Group I patients, one case of Group II patients but they were gradually diminished. In Group I, only one cage was inserted in five cases of patients (28%) who had an inadequate exposure of L4-5 area. However, all of the patients in Group II (100%) had an adequate exposure of L4-5 area. CONCLUSION: The surgical results of laparoscopic technique was not superior to miniopen technique.

Long Term Follow-up of Osteoporotic Vertebral Fractures According to the Morphologic Analysis of Fracture Pattern / 대한척추외과학회지

STUDY DESIGN: We have analyzed vertebral fractures caused by osteoporosis to find the clinical correlations with fracture types, level of lesion sites, numbers of involved vertebrae, age of patients, and the degree of osteoporosis. OBJECTIVES: To analyze osteoporotic vertebral fractures clinically and it help us to increase our understandings of osteoporotic vertebral fractures and treat the patients more effectively. SUMMARY OF BACKGROUND DATA: There are increasing number of patients with osteoporotic vertebral fractures. However, there are few articles analyzing patients according to their correlating factors. MATERIALS AND METHODS: We evaluated sixty-three patients who were diagnosed and treated conservatively with osteoporotic compression fractures from January 1995 to June 1997. Plain radiographs and DEXA were taken to compare wedge compression ratio, biconcavity ratio, crush ratio according to fracture pattern, level of injury, number of injured vertebral body, and bone mineral density(BMD). All datas were statistically analyzed. RESULTS: There were no significant differences among fracture pattern, level of injury and BMD. However, BMD was more sig-nificantly decreased in patients who was fractured their back at thoracic spine. BMD was lowered at multiply(3 or more vertebral bodies)injured, continuously involved(2 level or more) vertebral bodies. CONCLUSION: We have concluded that careful observation and the efforts to differentiate osteoporotic compression fractures according to fracture pattern, injury level, BMD, and any objective clinical datas would be needed to manage these osteoporotic patients effectively.

The Results of the Surgical Treatment using Posterior Spinal instrumentation for Tuberculous Spondylitis / 대한척추외과학회지

STUDY DESIGN: Twenty-nine patients with spinal tuberculousis were evaluated according to the surgical treatment methods using posterior spinal instrumentation and conventional anterior excision and interbody fusion methods without posterior spinal instrumentation. OBJECTIVE: To confirm the effectiveness of the surgical treatment methods using posterior spinal instrumentation (combined with anterior radical excision and anterior interbody fusion ) in tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: Relatively good results(maintaining corrected kyphotic angle , short fusion time, rapid rehabilitation etc.)were obtained in posterior spinal instrumetnation group, especially at thoracic and thoracolumbar spine, but no specific benefits of posterior instrumentation at low lumbar spine during follow-up period. METHODS: Twenty-nine patients with tuberculous spondylitis were divided into two groups depending on their use of posterior spinal instrument in surgical treatment methods ; one group consisted of 18 cases which were treated by anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation(Group I), and the other groups consisted of 11 cases which were treated by anterior radical excision of involved body and anterior interbody fusion(Group II). Change of corrected kyphotic angle according to the level of lesion, number of involved body and complications were measured using pre-, post-operative, and follow-up radiographs and chart review. RESULTS: Comparing the two groups, relatively short fusion time, less kyphotic angle loss, and low complication rates were obtained in posterior spinal instrumentation group(Group I) during the follow up period, especilally, at thoracic and thoracolumbar spine. However, there were no significant postoperative and follow-up results in both groups at low lumbar spine. CONCLUSIONS: Tuberculous spondylitis can be treated, and correction can be maintained with anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation during follow up period.

Radiographic Comparison of Stable Burst Fractures with Compression Fractures in Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective study was designed to evaluate the radiographic diagnostic method to detect any abnormal findings and differentiate stable burst fractures with compression fractures at thoracolumbar spine. OBJECTIVES: To evaluate diagnostic sensitivity of radiographic analysis and confirm the effectiveness of the radiographic diagnostic methods to differentiate stable burst fractures with pure compression fractures. SUMMARY OF BACKGROUND DATA: A data showed that the diagnostic sensitivity using radiographic analysis was 83%. The greater sensitivity was obtained at high posterior superior vertebral angle and PSVA/PIVA > 1.3. MATERIALS AND METHODS: Thirty-one patients with thoracolumbar spine fractures were evaluate to differentiate stable burst fractures with pure compression fractures. All patients were taken X-ray and CT. The PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA were checked using lateral plain radiographs during follow-up period, and the final data was analysed using radiological & statistical methods. RESULTS: Middle column failure of stable burst fractures was greatly observed at high PSVA(especially >100degree) and high PSVA/PIVA ratio(> 1.3). CONCLUSION: The radiographic analysis using PSVA(Posterior superior vertebral angle), PIVA(Posterior inferior vertebral angle), PSVA/PIVA might be the one of useful methods to differentiate stable burst fractures with pure compression fractures at thoracolumbar spine during follow-up period.

The Distraction Effect of the Fracture Site on Insertion of the Distal Screw in Interlocking Intramedullary Nailing / 대한정형외과학회잡지

To study the development of distraction at the fracture site according to inaccurate insertion of the distal screw in treatment of femoral shaft fracture with interlocking intramedullary nail, we prepared 24 femoral bone model, fixed them with interlocking intramedullary nails after artificially making transverse fracture or spiral fracture at mid 1/3 of femoral shaft and distal 1/3 of femoral shaft. The cephalocaudal insertion angles of the distal screws ranged from 5.2 to 45.4. As the insertion angles increased, the distances between the fractured sites ranged from 0.1 to 8.2mm. Distractions splited more than 5mm were seen in the average insertion angle of 34.3+/-9.4 (28.2 -45.4 ). When the insertion was made few millimeter proximal from the center of the distal screw hole, which was parallel to the transverse section of the femur model, fracture distraction ranged from minimum 1.8mm to maximum 5.0mm. In conclusion, the cephalocaudal insertion angle or location of the distal screw can be reason for the distraction between the fractured sites in internal fixation with intramedullary nail in long bone like femur. To prevent the distraction of fractured site, it is important to make the insertion of the distal screw parallel to the transverse section of the femur and to insert into the center of the screw hole.

Sacral Perineural Cyst with Lumbar Disc Herniation: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report is presented of a symptomatic sacral perineural cyst with lumbar disc herniation that has reported a few case in the literature. We report the case of symptomatic perineural cyst with lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: Symptomatic sacral perineural cyst is rare and some cases of sacral perineural cyst associated with disc herniation were reported. But it is not well known that the correlation between clinical symptoms caused by mass itself and concomittant lumbar disc herniation. METHODS: A 34-year-old male presented with low back pain, both leg dysesthesia and bilateral radiating pain. Clincal sign and symptom, physical examination, diagnostic imaging studies including MRI, myelography and pathologic findings of surgical specimens were evaluated. RESULTS: After the decompressive partial laminectomy and discectomy, the patient who had diapnosed with herniated nucleus pulposus of L4-5 and L5-S1 complained residual both leg paesthesia and hypoesthesia. Patient's clinical symptom was correlated with sacral perineural cyst. So we removed the cyst. Postoperatively neurologic symptoms and signs were completely relieved. Pathologically, Sacral perineural cyst composed of meningoepithelial cell and neural tissue within cystic wall were confirmed. CONCLUSION: We could find that sacral perineural cyst sufficiently evoked a clinical symptom. So, careful observation was needed in that case of sacral perineural cyst associated with disc herniation.

Short- and Long-segment Pedicle Screw Fixation with Anterior Interbody Fusion with Short Bone Graft in Denis type B Burst Fractures / 대한척추외과학회지

STUDY DESIGN: The operative treatment methods of twenty-one patients with Denis type B burst fractures were evaluated according to the level of pedicle screw fixation. OBJECTIVE: To compare the results of short segment pedicle screw fixation with long segment pedicle screw fixation in Denis type B burst fractures treated anteriorly with short bone graft. SUMMARY OF BACK GROUND DATA: Relatively good results(Short fusion time, good union rate, less loss of lordosis postoperatively etc.) were obtained in long segment fixation group during follow-up period. METHODS: Twenty-one patients with Denis B type burst fractures of thoracolumbar and lumbar spine were divided into two groups depend on the level of pedicle screw fixation in operative treatment methods, one group consisted of 10 cases which were treated by posterior short segment pedicle screw fixation and anterior interbody fusion with short bone graft(Group I : one level above and below posteior pedicle screw fixation of the fracture site and upper end plate of fracture site was fused with autogenous iliac bone or rib to adjacent vertebral body anteriorly through involved disc space) and the other groups consisted of 11 cases which were treated by posterior long segment pedicle screw fixation and anterior interbody fusion with short bone graft (Group II : more than two level above and below posterior pedicle screw fixation of the fracture site and additionally, anterior interbody fusion with short bone graft performed same as Group I). Bony union rate, union period, changes of height of bone and disc, kyphotic angle loss, interscrew angle and complications were measured using pre-, post-operative and follow-up radiographs and chart review. RESULTS: Comparing the two groups, there were no significant postoperative and follow-up results in both groups, especially, change of body & disc height, change of kyphotic angle and change of interscrew angle. However, relatively short fusion time, good union rate, less kyphotic angle loss, and low complication rates were obtainecl and maintained during follow-up period in long segment fixation lion group(Group II). CONCLUSIONS: Long segment pedicle screw fixation and anterior interbody fusion with short bone graft group could effectiyely treat Denis B type burst fractures of thoracolumbar & lumbar spine and maintain their postoperative results during follow up peroid.

Arthroscopic Evaluation for Acute Traumatic Anterior Dislocation of the Shoulder / 대한정형외과학회잡지

There are many complications after traumatic shoulder dislocation including redislocation, dislocation capsulitis especially in the older age and dislocation arthropathy. Redislocation rates have been primarily related to age at the time of initial dislocation, to lesser degree, athletic participation, length of immobilization, rehabilitative exercises, and time hefore return to sports or full activity. So we wanted to confirm the difference of the lesion between the young and the old at the initial dislocation. Arthroscopic evaluation of the twelve patients with an acute traumatic anterior dislocation of the shoulder was done to identify the intraarticular pathology within 10 days of the initial injury. All patients were taken MRI and evaluated under anesthesia. We classified these shoulders into two groups based on the age of patient. Young agegroup under 30 were seven patients and old age-group over 40 were five patients. And the following results were ohtained; 1. The detachment of the anterior labrum with the inferior glenohumeral ligament from the glenoid rim was primary finding and might cause the shoulder unstable under anesthesia in the young age-group under 30. 2. In the age-group over 40, there were the capsular tears with no labral lesion and these shoulders were stable under anesthesia 3. In acute traumatic anterior dislocation, examination under anesthesia was more closely related to the prediction of the extent of labro-ligamental detachment than MRI examination. 4. We believe that arthroscopic surgical intervention after the initial shoulder dislocation should be considered as a treatment option

Magnetic Resonance Arthrography in the evaluation of Anterior Glenohumeral Instability / 대한정형외과학회잡지

Anterior glenohumeral instability is mainly due to the Bankart lesion and capsular stretch. The differentiation between the Bankart lesion and capsular laxity may not be readily apparent on clinical examination. So, increasing attention has been directed toward preoperative evaluation of the labral lesion and capsular laxity. MRI and MR Arthrogram of 55 shoulders, 40 stable shoulders and 15 unstable shoulders that were confirmed by arthroscopic surgery, were reviewed to evaluate the labral and capsular shapes, especially the lesions of labroligamentous complex. To evaluate and compare the capsular laxity, we measured the anterior capsular insertion type, capsular ballooning, capsular insertion angle and anterior band of inferior glenohumeral ligament. And the following results were obtained; 1) The shape of anterior labrum was varied in the superior, middle and inferior potions in 40 stable shoulders. The anterior labral lesions were shown as torn(eight cases), displaced(six cases) and no detectable labrum(one case), in 15 unstable shoulders. Also, there were a significant di fference in the evaluation of the anteior labrum shape between MRI and MR arthrography. 2) There were not a significant difference in the type III capsular insertion type, capsular ballooning and capsular insertion angle between the stable and unstable shoulders. However, it was found that the shape of the anterior band of the inferior glenohumeral ligament had definite difference between the two groups. And so, more experience and attention should be given for the accurate preoperative evaluation of the anterior labroligamentous complex in shoulder instability.