Scoliosis Induced by Anterior and Posterior Rhizotomy / 대한정형외과학회잡지

This paper presents the result and statistical analysis of the experiment, in which selective anterior or posterior rhizotomy were carried out under microscopic surgery. The materials used for the experiment were 48 young rabbits, and they were divided into four groups. The group I, which was used as control, was subjected to lower dorsal bilateral laminectomies with dural incision, the group II to laminectomies with three right posterior rhizotomies, the group III to laminectomies with three right anterior rhizotomies, and the group IV to laminectomies with three right anterior and posterior rhizotomies. Scoliosis was induced in group Il, Ill and IV. There was no significant statistical difference in the degrees of curvatures among these three groups. The convexity of the curvature faced to the side of the divided roots. In group III and IV, scoliotic curvatures were obvious within two weeks, but there were no considerable changes thereafter. In group Il, the curves progressed slowly up to the 12th week. They were statistically significant at the 4th week and increased continuously thereafter. The histological findings in the group III and IV showed denervation atrophy of the paravertebral muscles at the apex of the curvature, but there was little or no muscle atrophy in the group I and II. We came to a conclusion from the experimental results that scoliosis may be induced not only by anterior root paralysis but also by selective posterior root paralysis.

Scoliosis in Neurofibromatosis / 대한정형외과학회잡지

Neurofibromatosis is a disease which involves both neuroectodermal and mesodermal tissue, and is characterized by cafe-au-lait spot, multiple subcutaneous neurofibromas, elephantiasis neuromatosa, a positive family history, and specific dystrophic osseous changes such as scoliosis, penciling of ribs, vertebral scalloping, a paravertebral soft tissue tumor, and congenital pseudarthrosis. The classic type of scoliosis in neurofibromatosis was known as a sharp localized short curve that is often rapidly progressive and produces severe deformity with dystrophic changes, but another form with long gentle curve is reported. Since conservative treatment is usually unsuccessful, posterior fusion with or without Harrington instrumentation is the treatment of choice even in young age when the curve is progressive. This paper was aimed to review our experience with 11 patients having neurofibromatosis and scoliosis, who were treated with posterior fusion and Harrington instrumentation from Jan. 1971 to Dec. 1980, and the results were as follows: 1. The average age that spinal deformity was observed was 7.7 years old, but the average age at treatment was 14.4. 2. Cafe-au-lait spot was observed in all cases, subcutaneous nodule in 7 cases, local gigantism in 2 cases, and positive family history in 3 cases. 2 cases were combined with congenital spinal anormalies. 3. Specific pattern in spinal deformity was not significant. There were 7 short curves less than 5 vertebrae involved and 6 long curves more than 6 vertebrae involved. 4. There were 5 kyphosis which had more than 50°, and those were usually combined with severe scoliosis. 5. Preoperative average degree of scoliosis was 93.8, and the final correction was 41.2° (43.9%) with loss of correction 5.3°(5.7%) after 3.2 year follow-up in average. 6. It shouid be educated for early detection at home and school, and for the importance of early treatment for the scoliosis, to prevent rapid increase of scoliosis in neurofibromatosis.

A Study on the Laboratory Findings in Experimental Osteomyelitis Caused by Staphylococcus aureus / 대한정형외과학회잡지

Even though various kinds of diagnostic and therapeutic measures have been used for the detection and cure of the acute osteomyelitis, this disease is difficult to be eradicated in many clinical cases. However it is rather easy to treat once this disease can be detected in early stage. So far radiological examination and many kinds of maneuvers including blood culture, clinical laboratory, xeroradiography, computed tomography have been performed for the early detection of this disease but invalid in the most cases. Recently some authors reported that the bone scanning was useful for the early detection of acute osteomyelitis, but this method also had difficulty in differential diagnosis and uncertaninty of its activity. This study aims to try to find methods of early detection of acute osteomyelitis. Experimental osteomyelitis was developed by the inoculation of Staphylococcus aureus to proximal tibias of 39 young rabbits already sclerosed by solution of sodium morrhuate. By comparing the clinical, radiological, bacteriological and laboratory findings in sequence from 2 days to 7 weeks after inoculation, the following results were obtained. 1. The incidence of experimental osteomyelitis after inoculation of staphylococcus aureus SNUH-S-188 in suspension of 1×10(7) colony forming units was 84%, 74%, and 79% in radiological, blood culture and pathologic examination respectively. 2. The leucocytosis was noticed only in early stage and slight degree of anemia was found during the 1st and 2nd weeks after inoculation. The sedimentation rate was increased only in early acute stage and same was eosinophil count. The leucocyte alkaline phosphatase(LAP) and platelet count. showed no significant abnormal changes. 3. Lymphocyte and eosinophil turned over from normal and eosinophil was predominant in experimental osteomyelitis. 4. Serum calcium, phosphorus, total protein and albumin showed significant decrease in all stages and was conversely paralle1 to changes in groin temperature. The level of BUN was normal indicating normal kidney function in experimental osteomyelitis. 5. Even though the enzymes of which showed no significant changes enrolled alkaline phosphatase and serumgluiamicoxalic-transaminase(S-GOT), but some increa.e was attained to 27% and 44% respectively. 6. It is important and significant to find continuous increase of lactic dehydrogenase (LDH) and creatine phosphokinase (CPK) since 48 hours after inoculation and author, think these will be the reliable and sensitive indices in early detection of the development of osteomyelitis and efficacy of therapeutic measures.

Total Hip Replacement for Ankylosed and Deformed Hip / 대한정형외과학회잡지

It is well known that the merit of total hip replacement is to provide rather satisfactory range of motion with relief of pain among reconstructive procedures. Therefore it is presumed that the ankylosed hip could gain range of motion by reconstruction of artificial joint, it the muscles around the hip is adequate. Furthermore when the patient has some problems in the back or knee secondary to ankylosed and deformed hip, any kind of reconstructive surgery, maybe total hip replacement is necessary which gives range of motion and correct deformity of the hip. Our result total hip replacements for fifteen ankylos d hips of twelve patients that were followed more than one year is gratifying to all patients with relief of pain and relatively satisfactory range of motion.

Total Hip Arthroplasty on Paralytic Hips: Two Case Report on Poliomyelitic and Cerebral Palsied Hips / 대한정형외과학회잡지

We performed total hip arthroplasty on a young male adult with paralytic dislocation of the hip due to poliomyelitis. Because of extreme shortening, as well as instability and weakness, the patient was unable to bear weight on the limb. Pastoperative course was complicated by ectopic ossification that compromised the hip and knee motion. Another young male adult with severe spastic cerebral palsy underwent total hip arthroplasty because of an intractable pain due to degenerative arthritis. Initial attempt coupled with adductor tenotomy and obtuator neurectomy ended in gross loosening and acetabular protrusion. Revision consisted of extensive soft tissue release and bone grafting of acetabular defect and use of a protrusion cup and an extra-long stem. Postoperative course was complicated by long-standing serous aseptic discharge from the wound which was controlled by antibiotics and prolonged recumbency. Indications for total hip arthroplasty in paralytic hips are rare and should be reserved for the most crippling conditions and one must be prepared fvr technical difficulties and a variety of complications with a prospecs for less than optimum results.

A Clinical Observation on Idiopathic Scoliosis / 대한정형외과학회잡지

One hundred patients with 119 curves with idiopathic scoliosis, age ranged from 2 to 32 years, were-treated at Seoul National University Hospital from 1968 to 1979. Of 100 patients, 63 were adolescent type, 20 juvenile, and 17 infantile. The distribution of curve-patterns was 49 right thoracic, 19 double major (Rt. thoracic & Lt. lumbar), 18 left thoracic, 12 thoracolumbar, and 2 left lumbar. Of these patients, 67 with 83 curves were treated with Milwaukee-brace for one to seven years with an average of three and one-half years. Seven patients were treated surgically because of a poor response to the brace or progression of the curve.Sixteen patients with 20 curves followed for average 4. 6 years after the completion of brace treatment showed some loss of correction: 2.8 degrees for thoracolumbar, 3.1 degrees for thoracic, 4.2 degrees for lumbar segments and 4, 9 degrees for thoracic segments of double major curves. The brace was more effective for curves with 6 to 9 involved vertebrae and of less than 40 degrees. Thirty three patients with 36 curves were treated with Harrington instrumentation and posterior spinal fusion and followed from 1 to 12 years with an average of six and one-half years. The initial preoperative curves ranged from 50 to 120 degrees with an average of 75.3 degrees. Immediate postoperative correction ranged from 30 to 70 degrees with an average of 36. 2 degrees (48.1%). The average loss of correction at follow-up was 1.5 degrees (2.8%) for curves of less than 60degrees and 1.4 degrees (1.3%) for those of more than 101 degrees. Varioua methods of preoperative correction were applied. Halofemoral traction was applied for rigid and severe curve in 9 patients, Cotrel traction for less rigid one in 11 patients, Risser localizer cast for flexible one in 9 patients, and no preoperative correction for mild and flexible one in 4 patients.

Clinical Observations on Acute Pyogenic Osteomyelitis and Arthritis in Infancy / 대한정형외과학회잡지

Clinical observations of 11 cases of acute pyogenic osteomyelitls and 14 cases of acute pyogenic arthritis in infancy during past 11 years were carried out and following results obtained. 1. The highest age incidence was less than 3 months after birth (70.6%). 2. Average duration of symptoms was 7.8 days. 3. The most important underlying cause was multiple femorai vessel puncture (23.5%). 4. The chief symptom or sign on admission was pseudoparalysis or limitation of motion (82.4%), and local swelling (82.4%). But high fever on admission was present in only 29.4% of cases. 5. The femur was the most common site in acute pyogenic osteomyelitis (36.4%), and the hip joint in acute pyogenic arthritis (42.9%). 6. Leucocyte count was Increased more than 20,000/mm in 60.0% of the cases. Erythrocyte sedimentation rate was increased more than 21 mm/hr in 72.0% of cases. The positive result on bacteriologic culture was 76.0%. Coagulase-positive Staphylococcus aureus was cultured in 4 cases of acute pyogenic osteomyelitis and 5 cases of acute pyogenic arthritls. a-hemolytic Streptococcus was cultured in 2 cases of acute pyogenic osteomyelitls and 1 case of acute pyogenic arthritis. Hemophilus influenzae was cultured in 1 case of acute pyogenic osteomyelitls and 2 cases of acute pyogenic arthritis. 7. 45.5% of acute pyogenic osteomyelitis was combined with acute pyogenic arthritis. 8. The longer the duration of symptoms was, the longer the abnormal hematologic picture lasted. Erythrocyte sedimentation rate was the most accurate index of activity in acute infection of bone and joint. 9. Shortening or deformity due to epiphyseal plate damage occured in 1 case of acute pyogenlc osteo-myelitis, and 3 cases of acute pyogenic arthritis. Those complications could be minimized wlth early diagnosis and treatment.

A Clinical Observation on Infectious Cystic Lesions in the Metaphysis of Long Bones / 대한정형외과학회잡지

A clinical observation of 30 cases of pyogenic abscess and 18 cases of tuberculous abscess in the metaphysis of long bones during the past 15 years was carried out and following results were obtained. 1. The highest age incidence was the second decade (53.3%) in pyogenic abscess and the first decade (44.4%) in tuberculous abscess. 2. Average duration of symptoms were 1.6 years in pyogenic abscess and 2.3 years in tuberculous abscess. 3. Chief complaint on admission was pain both in pyogenic abscess (56.7%) and in tuberculous abscess (27.8%). 4. The tibia was the most common site in pyogenic abscess and the femur in tuberculous abscess. 5. Leucocyte count was increased more than 15, 000/mm in 23.3% of pyogenic abscess and 22. 2% of tuberculous abscess. 6. Erythrocyte sedimentation rate was increased more than 21mm/hr in 60.0% of pyogenic abscess and in 44.4% of tuberculous abecess. 7. Epiphysis was involved in 23.3% of pyogenic abscess and 38.9% of tuberculous abscess. 8. The positive result on bacteriologic culture was 46.7% in pyogenic abscess and 22.2% in tuberculous abscess. Coagulase positive staphylococcus aureus was cultured in 12 cases and other organisms were cultured in 2 cases. 9. Differential diagnosis between pyogenic, tuberculous abscess, and cystic tumors was not easy in many cases. Preoperatively, 5 cases of pyogenic abscess were misdiagnosed as tuberculosis and 2 cases as osteod osteoid osteoma. 3 cases of tuberculous abscess were misdiagnosed as pyogenics and 1 case as giant cell tumor. 10. Various methods of surgery including saucerization, curettage and bone graft, resection of bony focus, and arthrodesis were carried out. There was no difference in the end result between them. 11. Shortening or deformity due to epiphyseal plate damage was occurred in 3 cases (10.0%) in pyogenic abscess and 4 cases (22.2%) in tuberculous abscess. Those complications could be minimized with meticulous surgery not damaging the epiphyseal plate.