The Effect of Distal Hooks in Thoracolumbar Fusion Using a Pedicle Screw in Elderly Patients / 대한정형외과학회잡지

PURPOSE: To investigate the clinical outcomes of distal hook augmentation using a pedicle screw in thoracolumbar fusion in elderly patients. MATERIALS AND METHODS: This retrospective multicenter study recruited 20 patients aged 65 years or older, who underwent anterior support and long level posterior fusion in the thoracolumbar junction with a follow-up of one year. To assess the effect of distal hook augmentation, the patients were divided into two groups; the pedicle screw with hook group (PH group, n=10) and the pedicle screw alone group (PA group, n=10). RESULTS: The average age was 72.4 years (65–83 years). The average fusion segment was 4.6 segments (3–6 segments). There were no significant differences in age, sex, causative diseases, bone mineral density of lumbar and proximal femur, number of patients with osteoporosis, and number of fused segments between the two groups (p≥0.05). At 1 year follow-up after surgery, parameters related with distal screw pullout were significantly worse in the PA group. No patients in the PH group had distal screw pullout. However, six patients (60%, 6/10) in the PA group had distal screw pullout. There were no significant differences in the progression of distal junctional kyphosis between the two groups. CONCLUSION: Distal hook augmentation is an effective procedure in protecting distal pedicle screws against the pullout when long level thoracolumbar fusion was performed in elderly patients aged 65 years or older.

Surgical Treatment of Clavicle Midshaft Fractures Using a Locking Compression Plate: Conventional Open Reduction and Plating with Internal Fixation versus Minimal Invasive Plate Osteosynthesis / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to make a comparison between minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and plating (COP) to treat displaced clavicle shaft fractures. MATERIALS AND METHODS: We retrospectively reviewed patients with clavicle shaft fractures, who underwent surgery by using a locking plate between May 2011 and August 2016. The inclusion criteria were: 1) displaced ≥20 mm, 2) acute fracture of less than 2 weeks from injury, 3) skeletally mature patients, and 4) follow-up of at least 6 months. The demographic data and clinical outcomes, including operation time, fracture union rate, union time, shortening of clavicle, shoulder functional score (University of California at Los Angeles score), and complications, were evaluated. The clavicle length ratio was measured to evaluate shortening. We compared the clinical outcomes between two groups: the COP group that included 21 patients treated with COP (group 1) and the MIPO group that included 19 patients treated with MIPO (group 2). RESULTS: In all cases, union of fractures was successfully achieved. The mean union time was 14.9 weeks in group 1 and 14.2 weeks in group 2 (p=0.713). Both groups had good functional scores (34.0 vs. 33.7, p=0.658). Group 2 had shorter operation time and less bleeding. There were no secondary interventions or infections. The clavicle length ratio was similar between the two groups; and all patients in both groups showed no shortening (less than 3%). There were no implant failures in either group. CONCLUSION: The clinical and radiologic outcomes were satisfactory in both groups. We suggest that MIPO may be a safe and effective method for displaced clavicle shaft fractures.

MMPI Profiles of the Patients with Bruxism / 신경정신의학

OBJECTIVES: The aim of this study was to evaluate the psychological characteristics of the patients with bruxism by Minnesota Multiphase Personality Inventory(MMPI). METHODS: MMPI was administered to 87 patients(46 bruxism group and 41 control group) who had visited a local dental clinic from January to August 1998. RESULTS: The bruxism group had a higher score than control group in Masculinity-Femininity(Mf) scale. There were no differences between bruxism group and control group on the distribution of Depression(D), Psychopatic Deviate(Pd), Paranoia(Pa), Psychasthenia(Pt) scales. The bruxism group with the family history showed higher score than the bruxism group without family history in Pd scale. Male bruxism group had a higher score than female bruxism group in Defensiveness(K) scale and female bruxism group had higher score than male bruxism group in Pa scale. The bruxism group of clenching type had higher score than the bruxism group of mixed type in Social Introversion(Si) scale. There were no differences in MMPI score between those who had and did not have symptoms such as masticatory musle pain, neck pain and headache. CONCLUSION: It is concluded that individualized approach may be effective to the evaluation of psychological disturbances which might be related to sex, family history and, type of bruxism, while we did not find significant differences in personality charateristics between the bruxism and control groups.