Treatment of Long Tubular Bone Defect of Rabbit Using Autologous Cultured Osteoblasts Mixed with Fibrin / 대한정형외과연구학회지

PURPOSE: The osteogenic potential of autologous cultured osteoblasts mixed with fibrin when transplanted to bone defects was evaluated. MATERALS AND METHODS: Radial shaft defects over 15 mm were made in 30 New Zealand white rabbits. Fifteen rabbits in the control group underwent an iliac bone graft and 15 rabbits in the experimental group underwent an autologous cultured osteoblast injection mixed with fibrin. Both groups were compared radiologically and 5 rabbits in each group were sacrificed for histological evaluation using H-E and Masson's trichrome stains at 3, 6, and 9 weeks. RESULTS: Osteogenesis in the control group progressed more rapidly than in the experimental group. However, at 9 weeks, bone formation in both groups were similar and showed no significant difference in terms of the amount of bone formation and the quality of bone union. CONCLUSION: Autologous cultured osteoblast transplantation mixed with fibrin in bone defects was found to produce bone efficiently.

Bone Formation of Cultured Osteoblasts in Bone Defect of Radial Shaft of Rabbit / 대한정형외과학회잡지

PURPOSE: To evaluate the osteogenic potential of an autologous cultured osteoblast transplant to the bone defects. MATERIALS AND METHODS: Radial bone defects over 15 mm were made in 20 New Zealand white rabbits using the anterior approach. There were 10 rabbits in the control group, which underwent an iliac bone graft to the preformed bone defect 3 weeks from the initial operation. There were 10 rabbits in the experimental group that underwent an autologous cultured osteoblasts injection. After 9 weeks, both groups were compared radiologically and histologically. RESULTS: The osteogenesis in both groups were progressed similarly and there was no difference in terms of the amount of bone formation and the duration of the bone union. CONCLUSION: An autologous cultured osteoblast transplant to the bone defect produces bone efficiently.In addition, it can be applied to a wide field, which requires a bone grafting operation.

Clinical Applications of Autologous Cultured Osteoblasts: Case Report

We treated 3 cases of fracture and 1 case of avascular necrosis of femoral head using autologous cultured osteoblasts injection. The stromal cells from the bone marrow were cultured to differentiate to osteoblasts for 4 weeks. The fracture sites of each patients were right ulnar shaft, left radial shaft, and left 5th metatarsal base. All of the fractures showed callus formations after 1 week of osteoblasts injection to the fracture site. After 4 weeks, callus formations were progressed. Avascular necrosis of femoral head was bilateral and both were Ficat stage II. Core decompression and allograft impaction were performed to the left, and core decompression and autologous cultured osteoblasts injection percutaneously after 4 weeks of the decompression operation were done to the right femoral head. CT images of 1 year from the operations showed trabecular bone formation and well maintained femoral head contour of the right femur, but resorption of the grafted bone for the left.

Comparison of Bending Strength of Six Different Type of the First Metatarsal Osteotomies / 대한정형외과학회잡지

PURPOSE: We compare the sagittal stability of 6 different osteotomies of the metatarsal shaft : the proximal crescentic, proximal chevron, Mau, Scarf, Ludloff, and biplanar closing wedge osteotomies. MATERIALS AND METHODS: Ten fresh frozen, human cadaveric specimens were used for each osteotomy. All specimens were then dissected out en bloc as the first metatarsal -medial cuneiform complex which was fixed with 3 Kirschner wires and clamped to a MTS Mini Bionix load frame. Cantiliver bending load was applied until bony fracture, pull out of screw, or a displacement of osteotomy greater than 2 mm as measured by the extensometer was observed. The data was compared with Student's t-test. RESULTS: The average bending strength for 6 osteotomies were 199.56 kg/cm2 in proximal crescentic osteotomy, 205.3 kg/cm2 in proximal chevron osteotomy, 372.0 kg/cm2 in Ludloff osteotomy, 428.4 kg/cm2 in Scarf osteotomy, 508.8 kg/cm2 in biplanar closing osteotomy, and 530.0 kg/cm2 in Mau osteotomy. Statistical analysis revealed insignificant difference (P>0.01) between Ludloff and Scarf and biplanar closing wedge and Mau osteotomies. There were statistical differences between Mau or Scarf osteotomy and proximal chevron or crescentic osteotomy. CONCLUSION: Proximal chevron and proximal crescentic osteotomies need longer postoperative immobilization for the prevention of plantar angulation of first metatasus.

Expression of Estrogen Receptor on Ligamentum Flavum and Facet Joint Capsule in Degenerative Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: To investigate whether tissue-specific expression of estrogen receptor affects morphologic difference of degenerative spinal stenosis. MATERIALS AND METHODS: Forty female patients, who were diagnosed as degenerative spinal stenosis and had undergone spinal surgery, were included in this study. During the surgery, ligamentum flavum and facet joint capsule were harvested. Each tissue was divided into two groups according to axial computed tomography findings. For ligamentum flavum, tissues with thickness of more than 4 mm were put into the hypertrophy group and the others less than 4 mm were put into the control group. Facet joints with one or more signs of osteophyte formation, hypertrophy and destructive change were considered as a degenerative group, the others were considered as a control group. Expression of estrogen receptor was evaluated by immunohistochemistry and enzyme immunoassay using anti-estrogen receptor. The expressions of estrogen receptor were analyzed between the groups at each tissue. RESULTS: Increased expressions of estrogen receptor were observed in the hypertrophy group of ligamentum flavum or in the degenerative group of facet joint capsule. At the ligamentum flavum, the amounts of estrogen receptor were 8.7 +/- 1.5 fmol/mL in hypertrophy group and 5.7 +/- 3.4 fmol/mL in control group. The difference was statistically significant (p<0.05) . In facet joint capsule, the amounts of estrogen receptor were 8.1 +/- 4.5 fmol/mL for the degenerative group versus 4.9 +/- 3.3 fmol/mL for the control group, which was significantly different (p<0.05) . CONCLUSION: We suggest that different expressions of estrogen receptor in ligamtum flavum and facet joint capsule may relate to morphological differences in degenerative lumbar stenosis.

Effect of Estrogen Receptor on Degenerative Change and Displacement of Facet Joint / 대한척추외과학회지

STUDY DESIGN: Thirty-two postmenopausal female patients, with the facet angle less than 40 degrees, were selected for this study. All patients underwent spinal surgery. Displacement group, diagnosed by the displacement of facet joint above 2mm was noted in 15 patients. Control group had 17 patients and was defined when the displacement of facet joint was less than 2mm. OBJECTIVES: Our study evaluated the expression of estrogen receptor and degenerative change depending on the displacement of facet joints. SUMMARY OF LITERATURE REVIEW : Despite the fact that degenerative spondylolisthesis is more common in female than in male, a few attempts have been made to evaluate estrogen as one of the predisposing factors for displacement of facet joint. MATERIALS AND METHODS: After harvesting the articular cartilage of facet joint, the expression of estrogen receptors was evaluated with immunohistochemical staining, and the degenerative change of the articular cartilage with hematoxylin-eosin and alcian blue staining. RESULTS: All facets showed a positive correlation between the estrogen receptor scores and histological-histochemical scores(r=0.78, p<0.05). The average score of the estrogen receptors was 9.1+/-0.4SEM in displacement group, and 5.0+/-0.6SEM in control group(p<0.05). The histological-histochemical grading of cartilage lesion was 12.4+/-0.6SEM in displacement group, 8.0+/-0.3SEM in control group(p<0.05). CONCLUSIONS : This study suggest that a high expression of estrogen receptors, which affected the severity of degenerative changes in facet articular cartilage, might be one of the predisposing factors for the displacement of facet joint.

Effect of Estrogen Receptor on Degenerative Change of Articular Cartilage in Adult Rabbit Knee / 대한정형외과학회잡지

The purpose of this study was to evaluate the effect of estrogen receptor on the degenerative change of articular cartilage by observation of different changes of histology, matrix glycosaminoglycan and chondrocyte proliferation. In sixty-four Newzealand rabbits, experimental instability was made to induce degenerative changes by sectioning the anterior cruciate ligament, medial collateral ligament and medial meniscus of the left knees. In the oophorectomy group (32 rabbits), knee surgery was performed at 6 weeks following bilateral oophorectomy. In the non-oophorectomy group (32 rabbits), knee surgery was performed without oophorectomy. Four rabbits were killed at 0, 1, 2, 4, 8, 12, 16, 20 weeks, respectively, after the knee operation. Total immunohistochemical scores of estrogen receptor were evaluated between the two groups. Histologic evaluation of H-E staining was conducted by alcian blue staining. Evaluation of chondrocyte proliferation was carried out by immunohistochemistry using monoclonal antibody to 5-bromo-2 -deoxyuridine. The stainability of each staining was calculated using semi-quantitative analysis and statistical differences were evaluat- ed by ANOVA test and LSD multiple comparison test. Total immunohistochemical scores of estrogen receptor in the non-oophorectomy group were higher than the oophorectomy group (P<0.05). In the non-oophorectomy group, the histologic scores and the histochemical scores of glycosaminoglycan were lower than the oophorectomy group after 4 weeks and 8 weeks respectively (P<0.05). The immunohistochemical score of BrdU was the highest at 2 week and then decreased after 4weeks in both groups. The immunohistologic scores of non-oophorectomy group was significant higher than oophorectomy group between 1 and 4 weeks (P<0.05). Our results suggested that the estrogen might aggravate the degenerative change of the knee joint in rabbits by decreasing matrix glycosaminoglycan and increasing chondrocyte proliferation.

Spontaneous Rupture of Quadriceps Tendon: Report of four knees / 대한정형외과학회잡지

Spontaneous rupture of the quadriceps tendon has heen rarely reported. We experienced four knees of 3 patients. Two patients with chronic renal failure(CRF) had been treated with peritoneal dialysis and the other patient was healthy without significant medical problem. In the CRF patients, laboratory studies were coincided with secondary hyperparathyoidism. Radiologic and operative findings suggested that the repeated minor trauma caused avulsion fracture of the bone near the insertion site of the tendon. Histologic findings revealed no elastosis of the tendon and no deposit of amyloid in the quadriceps tendon. In the non-CRF case, there was normal lahoratory data, and the rupture occurred at the musculotendinous junction, suggesting sudden contracture of the muscle causing failure without trauma history. All cases were treated successfully with open repair of the quadriceps tendon. It could be summarized that the site of spontaneous rupture in the CRF and normal patient were different.

Changes of Fixation Strength by Rod - Contouring of Compact Cotrel - Dubousset Instrumentation / 대한정형외과학회잡지

One of various decompression methods in treatment of spinal stenosis is the indirect instrumental decompression. Theoretically, the distraction of the disc space can widen the intervertebral foramen of the stenotic segment and even increase the canal diameter by distracting the posterior annulus as well as reduce the extent of decompressive laminectomy site. The indirect instrumental decompression, however, was not guaranteed to maintain the restored discal height because of the loss of fixation strength between rod and screw, viscoelasticity of vertebra itself, bone density, type of screw and rod, and operative technique. As well the magnitude of the stresses on the instrumentation particularly at the rod-screw interface may depend on rod-contouring in order to make mormal sagittal curvature of the lumbar spines. Therefore, the aim of this experimental study was to evaluate the effect of different rod-contour on the axial sliding strength in Compact Cotrel-Dubousset (CCD) instrumentation. Axial sliding strength was tested by Universal Test Machine (Instron). Test was performed for 3 groups of different rodcontouring on the biomechanical axial strength: straight rod (no contour), 10 and 20 contouring rod. The length of contact surface between rod and screw was measured with Fuji pressure sensitive film. The study was performed using 6.5 mm open body screws and 7 mm rods of CCD instrumentation. Axial sliding strength of straight rod was 2518.6N, 1871.8N in 10 and 1528.8N in 20 contouring rod. The length of contact surface between rod and screw significantly decreased according to degree of rod contouring; 9.88mm in straight rod, 9.08mm in 10 and 8.57mm in 20 contouring rod. There was a statistically significant linear correlation (R=0.96) between failure load and length of contact surface. Therefore, this study has shown that excessive contour of the rod in order to make normal sagittal curvature of the lumbar spine using CCD instrumentation cannot provide sufficient axial sliding strength. That may be a cause of loss of restored disc space height after surgery.

Fracture of Tibial Base Plate Following Total Knee Arthroplasty: Report of a Case / 대한정형외과학회잡지

Fracture of the metal base of tihial components of total knee arthroplasty has heen occasionally reportecl. The most common cause of the failure of the metal hase plate was known to be a fatigue fracture around the screw hole where the strength of the metal hase plate was the weakest. We experienced a case of the fracture of the metal hase plate secondary to the t'racture of the posteromedial corner of the metal tihial condyle which was weakened due to the shoil peg hole for the base plate of MG II implant. Since the proximal portion of the posterior tihial condyle was normally thin, cutting the hone for the base plate made it thinner and wcaker than normal. Therefore stress fracture of the bone occurred and the overlying metal plate was subsequently hroken. From this experience. we concluded that the posterior peg hole may cause unwanted failure of the posteromedial corner of the tibial base plate.

The Effect of Load Sharing Wiring on the Fixation of Transverse Fracture of Porcine Patella / 대한정형외과연구학회지

Among many kinds of internal fixation techniques for the transverse fracture of the patella, AO modified tension band wiring technique and Pyrford technique have been widely used. However, it seems that those techniques are not strong enough to withstand immediate full weight bearing and full range of motion exercise postoperatively. Instead, a load sharing wiring technique seems to be more effective fixation technique. A comparative study was performed to evaluate the load sharing wiring technique using porcine patellae. Transverse fractures of thirty knees were made and were fixed with 3 different fixation technique. 1) AO modified tension band wiring technique, 2) Pyrford technique, and 3) Load sharing wiring technique. Then, those knees were mounted on the material testing system (Instron 4204(R)) and longitudinal traction was applied. The result showed that the separation of the fracture fragments was much less with the load sharing wiring technique than with the AO modified tension band wiring technique and the Pyrford tehchnique when 5 kg to 25 kg of traction was applied(P<0.05). The load sharing wiring technique showed less than 0.4mm of separation at 25~50kg of traction, where other techniques led specimen to failure. From this study, it was suggested that the load sharing wiring technique was proved to be more effective fixation technique compared to other techniques.

Multiply Operated Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis was performed on 40 patients who had had previous lux bar spine surgeries. OBJECTIVE: To determine what factors most influenced surgical outcome and to analyze results in a series of revision lumbar surgeries. SUMMARY OF BACKGROUND DATA: Satisfactory surgical outcome of the revision lumbar surgery range from 28% to 82% and are rarely comparable to primary surgery. Many factors predicting outcome from repeat lumbar surgery haute been listed. METHODS: Forty patients were analyzed who had had previous lumbar surgeries. The patients were classified into 5 groups according to diagnosis: 3 Infection,5 instability,8 nonunion, 14 HNP and 10 spinal stenosis. of 40 patients,33 patients(82.5%) underwent fusion with instrumentation for repeat surgery. Their clinical course was followed for a minimum of 1 year. The number of surgery on each mpatient was 1.3 times on an average. RESULTS: Overall, 80% of patients had a satisfactory result. Obviously extruded or sequestrated HNP in MRI findings, complete block of contrast with severe radiculopathy and/or myelopathy in spinal stenosis, complete decompression, neurolysi s and fusion with instrumentation, and longer than 6 month pain relief after precious surgery were correlated with satisfactory outcome. However, the number of precious operation, age, repair of pseudarthrosis , no abnormality at surgery and combined multiple degenerative joint disease were significantly correlated with poor surgical outcome. The most common complication during repeat surgery was dural tear in 5 cases(12.5%). CONCLUSIONS: Success rate of revision surgery was low as compared to primary operation. Therefore, erroneous diagnosis and faulty surgical technique understandably lead to failure, and precise attention to preoperative and intraoperative detail can minimize these sources of error.

Surgery for Degenerative Lumbar Stenosis in an Extreme Aged / 대한척추외과학회지

No abstract available.

Occipito-Cervical Fusion Reinforced by C-D Occipitocervical Loop / 대한정형외과학회잡지

We reviewed four patients who underwent posterior C-D occipitocervical loop and autogenous bone graft. The mean postoperative follow-up period was 16 months. The indications for surgery were progressive neurological deficit, atlantoaxial instability and intractable pain. Of the four patients, one had os odontoideum, two rheumatoid arthritis and suboccipital dislocation combined fractures of C1 and C2. Bong union was confirmed in all cases at approximately 4 months postoperatively. Final outcome result was satisfactory in three patients and unsatisfactory in one patient. The cause of unsatisfactory result was recurrent neck pain secondary to swan neck deformity. The neurologic deficit were improved or remained same as preoperative status. Three patient were out of bed on average of the 14th day postoperatively. One patient could not ambulate due to tetraplegia who needed an artificial ventilator. There was no complication related to instrumentation.

Multifocal osteogenic sarcoma in the femur: Two cases report / 대한정형외과학회잡지

No abstract available.