ABSTRACT
PURPOSE: The purpose of this study was to evaluate the long-term results of cemented Muller prostheses using a 32 mm metal femoralhead. MATERIALS AND METHODS: We reviewed 43 (31 patients) of 76 (55 patients) consecutive THAs, which were performed between April 1978and September 1985. The average duration of follow-up was 148 months (range, 65-279 months). The average age at the time of indexoperation was 44.4 years. Preoperative diagnosis was osteonecrosis in 31 hips, posttraumatic osteonecrosis in 8 hips, osteoarthritis in 2hips, and rheumatoid arthritis in 2 hips. We assessed cases clinically by Harris hip scores and radiographically by loosening and osteolysis, and measured polyethylene wear by the Livermore method. Kaplan-Meier analysis was used to evaluate survivability. We analyzedthe relationship and the statistical difference between wear and age, weight, height, body mass index, diagnosis, polyethylenethickness, and cup inclination (Pearson correlation's analysis, Student t-test, ANOVA test). The p-value was set p50 degrees) (p<0.05). CONCLUSION: Cemented Muller THAs using a 32 mm metal head showed poor survivability after an average follow-up of 12 years, due to the high incidence of loosening, the high rate of polyethylene wear and osteolysis. These results seem to be due to the relatively largenumber of operation for osteonecrosis of the femoral head in young patients and shortcomings of curved femoral stem design and the first generation cementing technique.
Subject(s)
Humans , Arthritis, Rheumatoid , Arthroplasty, Replacement, Hip , Body Height , Body Mass Index , Diagnosis , Follow-Up Studies , Head , Hip , Incidence , Kaplan-Meier Estimate , Osteoarthritis , Osteolysis , Osteonecrosis , Polyethylene , Prostheses and Implants , Survival RateABSTRACT
Between 1989 and 1995, 14 patients with Kienbock's disease were treated with radial shortening or a radial wedge osteotomy. Clinical and radiological changes were classified according to Lichtman's stages and ulnar variance. Seven patients were male and seven were female. The mean age was 45 years, ranging from 29 to 64. The average follow-up period was 29 months, ranging from 12 to 61. Of the ten patients with negative ulnar variance who were treated by radial shortening, two cases were in Lichtman's stage II, six cases were stage III-a and two cases were stage III-b. Of the four patients with zero or positive ulnar variance who were treated by a radial wedge osteotomy, one case was stage 11 and three cases were stage III-a. The results were evaluated in terms of diminished wrist pain, increased grip strength, increased range of wrist motion and radiologic changes of the lunate. Wrist pain had diminished in all patients and grip strength had increased on average from 54% to 70% in the unaffected side. The range of arc of the wrist had increased on average from 59degrees preoperatively to 93 postoperatively. Sclerosis of the lunate improved in 43% of cases, cystic changes of the lunate improved in 57%, fragmentation of the lunate improved in 36% and the carpal height ratio increased in 50%. Of the 14 patients, 13 patients (93%) showed satisfactory results. One patient had an unsatisfactory result, according to Lichtman's criteria. These results suggest that radial shortening or a radial wedge osteotomy is recommended in patients with stage ll, III-a or III-b Kienb ck's disease, according to the ulnar variance. Early wrist pain reduction, increased range of motion and grip strength and improved avascularity of the lunate are all positive outcomes attainable with these treatment methods.
Subject(s)
Female , Humans , Male , Follow-Up Studies , Hand Strength , Osteonecrosis , Osteotomy , Range of Motion, Articular , Sclerosis , WristABSTRACT
he carpal tunnel syndrome is the most common perripheral nerve entrapment syndrome. Many tests have been used for diagnosis of carpal tunnel syndrome. A new test, called the instrumented carpal tunnel and the Tinel percussion test, the Phalen wrist-flexion test, tourniquet test, and the trodiagnostically proved carpal tunnel syndrome and in a group of 49 patients(79 hands) during the period from October 1994 to July 1995. The results were as follows; 1. The sensitivity, specificity and accuracy results of each provocative test were 53%, 88%, 70% on Tinel test, 72%, 66%, 69% on tourniquet test, 62%, 91%, 76% on Phalen test, 85%, 95%, 90% on the instrumented carpal compression test. 2. For the diagnosis of carpal tunnel syndrome, the instrumented carpal compression test was found to be the most sensitive, specific and accuracy results. 3. As a results, the new, instrumented carpal compression test with Durkan's CTS gauge was thought to be the most useful provocative diagnostic method & a simple, rapid & inexpensive technique for screening for carpal tunnel syndrome, and consisted of lightweight device.
Subject(s)
Carpal Tunnel Syndrome , Diagnosis , Mass Screening , Methods , Nerve Compression Syndromes , Percussion , Sensitivity and Specificity , TourniquetsABSTRACT
In thirteen adult male patient with scaphoid nonunion associated with DISI(Dorsal intercalated Segment Instability) defined as scapholunate angle is greater than 70 degrees of the radiolunate angle is greater than 10 degrees, anterior interpostitional bone grafting has been performed. Surgical procedure: 1) Closed reduction of lunate(reduction of DISI) by volar flexing of the wrist and holding the position by Kirschner wire inserted obliquely through the radial styloid to lunate. 2) Radical curettage of nonunion site and intraoperative measurement of the gap in the scaphoid through volar approach. 3) A bicortical wedge shaped graft from the iliac crest was then impacted between the fragments. 4) Temporary K-wire fixation of the grafted scaphoid from the scaphoid tubercle to prevent distortion of nonunion site and loss of fixation. 5) A Herbert screw was then inserted. Results: Mean patient age was 24.5 years, and mean duration of nonunion before surgery was 19.4 months. Mean follow-up time was 22.6 months. The nonunion involved the middle one-third of scaphoid in 11 patients and distal one-third in 2 patients. The mean postoperative grip strength was 39.4kg by Dynamometer(PC-5303J). The mean postoperative range of motion was volar flexion 50.5 degrees; dorsiflexion 47.3 degrees. The scaphlunate angle decreased from a mean of 78.8 preoperatively to 52.9 degrees postoperatively. The radiolunate angle was decresed from a mean of 16.8 degrees prope- ratively to a mean of 1.8 degrees postoperatively. Union was obtained in all 13 cases, According to Herbert and Fisher's formulation, 2 excellent, 10 good and 1 fair results were obtained from our study. The results of the series suggest that treatment of scaphoid nonunion associated with DISI by this method is an effective method that reconstitutes scaphoid anatomy and promotes excellent wrist function.
Subject(s)
Adult , Humans , Male , Bone Transplantation , Curettage , Follow-Up Studies , Hand Strength , Methods , Range of Motion, Articular , Transplants , WristABSTRACT
The subluxation of the femoral head is one of important prognostic factors in LCPD and current treatment of LCPD is based on the premise that adequate containment of the vulnerable femoral head within the acetabulum during the process of repair should result in a more spherical femoral head and a more congruous joint than if treatments were not provided.We analised the arthrographic findings of 18 hips in unilateral LCPD in order to determine the changes of the femoral head and acetabulum, degree of the subluxation and containment of the femoral head in various position of hip. The results were as follows: 1. According to the result of sphericity, the femoral head was deformed mainly in coronal plane in LCPD. 2. Average medial joint space of normal hip was about 3.8mm in the AP view of hip, but it was more increased in any position of LCPD. 3. In abduction with internal rotation, average subluxation ratio was 7.5% in normal hip and 10.9% in LCPD. In abduction with external rotation, it was 8.3% in normal hip and 12.4% in LCPD. 4. In normal hip, the containment ratio was more than 1.0 in any position of hip, but the containment ratio was 1.03 in abduction with internal rotation and 0.95 in abduction with external rotation of hip in LCPD. 5. On the basis of these results, efficacy of the Scottish Rite orthosis was doubtful in most hips of LCPD.
Subject(s)
Acetabulum , Arthrography , Containment of Biohazards , Head , Hip , Joints , Legg-Calve-Perthes Disease , Orthotic DevicesABSTRACT
Between 1982 and 1991, 33 cases(47 patients) with Ficat stage I and II avascular necrosis of the femoral head which had decompression with fibular strut grafting were followed up for average 62 months ranging from 36 to 136 months, The authors analyzed the results by Harris Hip Score(H.H.S) clinically and according to Ficat stage progression radiologically and evaluated the effectivencess of this procedure in the early stage of atraumatic avascular necrosis of the femoral head. The results were as follows. 29 hips were mon, 4 hips were women and 11 patients were bilateral. The ages ranged from 26 to 75 years and the mean age was 46.6 years. By the radiological classification of Japnese Investigation Committee, 23 hips(79%) of stage II showed diffuse involvement of the femoral heads(type 1-C, 2, 3-B). By Ficat stage, stage I were 4(12%) and stage II were 29(88%). At follow up, 2 hips were in stage I(6%), 15 hips were in stage II(46%), 11 hips were in stage III(33%) and 5 hips showed stage IV (15%). Two hips were converted to total hip arthroplasty due to failure. Preoperative Harris Hip Score was 84 points in average and at most recent follow up, the score was 89 points in average. The clinical surccess rate was 73% and radiological success rate was 52%, but 83% of the patients were satisfied with the procedure subjectively. There noted some disparity between the clinical and raiological results, but the effect of the decompression with fibular strut grafting will be known if more long term follow up is available.
Subject(s)
Female , Humans , Arthroplasty, Replacement, Hip , Classification , Decompression , Follow-Up Studies , Head , Hip , Necrosis , TransplantsABSTRACT
Anatomically flexor pollicis longus is different from deep finger flexors. Flexor pollicis longus tendon is unique in that it may be advanced without disturbing its blood supply, since it has no vinculum. From January 1990 to December 1992, 17 cases of patients with laceration of the flexor pollicis longus tendon were treated at Kyungpook National University Hospital. The follow up period ranged from 3 to 36 months. The results were as follows; 1. agents causing the laceration were broken bottles in 10 cases(58.8%), knives in 3 cases(17.6%) and machinary like saw in 2 cases(11.8%). 2. Totally 17 cases, 9 cases of them were located at distal to metacarpophalageal joint. 3. As associated injuries, digital nerve injuries were 4 cases(23.5%) and the recurrent branch of median nerve injuries was 1 case. 4. The surgical treatment was direct suture with or without proximal lengthening in 13 cases(76%) as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases(24%) as secondary repair. 5. Distal to metacarpophalangeal joint, the surgical treatment was direct suture with or without proximal lengthening in 3 cases as primary or secondary repair and distal advancement with or without proximal lengthening in 4 cases as secondary repair. 6. The result by Urbaniak method was excellent in 8 cases(47.0%), good in 7 cases(41.2%) and fair in 2 cases(11.8%). 7. Based on the results in these patients, it was recommended that secondary treatment for lacerations distal to the metacarpophalangeal at the wrist, as needed is bettewr than free tendon graft.
Subject(s)
Humans , Fingers , Follow-Up Studies , Joints , Lacerations , Median Nerve , Metacarpophalangeal Joint , Methods , Sutures , Tendon Injuries , Tendons , Transplants , WristABSTRACT
The change of venous capacitance has an influence on venous return to the heart and cardiac output, and causes the alteration of preload, cardiac filling pressure and myocardial wall tension. Venous capacitance is assesed by measuring the mean circulatory filling pressure (MCFP), and MCFP is measured during brief periods of circulatory arrest produced by inflating an indwelling balloon in the right atrium It is important to know the effects of vasodilator and anesthetic drugs on venous capacitance. Therefore, this study was performed to know the effects of nitroglycerin and diltiazem on venous capacitance in rats. Rats were anesthetized with ketamine 125 mg/kg given intraperitoneally and added 10 mg/kg every 30 minutes. Their mean arterial pressure (MAP) was lowered to 60 mmHg by intravenous injection of 0.82+/-0.36 mg/kg nitroglycerin and/or 6.7+/-1.5 mg/kg diltiazem. Hemodynamic parameters such as MAP, heart rate, central venous pressure and MCFP were measured before and after drug-injection. Hemodynamic values measured before drug-injection in two groups were little differences statistically. However, the MCFP of nitroglycerin was significantly decreased (p<0.01) from 7.3+/-0.61 mmHg to 5.4+/-0.58 mmHg after drug-injection, and that of diltiazem was not significantly changed from 7.1+/-0.54 mmHg to 6.9+/-0.63 mmHg. The results suggested that nitroglycerin was predominantly a venous dilator in terms of MCFP but diltiazem had little effect of venodilation.
Subject(s)
Animals , Rats , Anesthetics , Arterial Pressure , Cardiac Output , Central Venous Pressure , Diltiazem , Equidae , Heart , Heart Atria , Heart Rate , Hemodynamics , Injections, Intravenous , Ketamine , NitroglycerinABSTRACT
This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.
Subject(s)
Animals , Dogs , Alprostadil , Anesthesia , Baroreflex , Heart Rate , Hemorrhage , Hypotension , Isoflurane , Nitroprusside , Pressoreceptors , Reflex , SodiumABSTRACT
This study was Uesigned to evaluate the reflexive heart rate response to acute blood loss during sodium nitroprusside and prostaglandin E1 induced-hypotension in isoflurane anesthetized dogs. The results were as follows: 1) Reflexive increase in heart rate during induced hypotension was significantly greater in sodium nitroprusside than prostaglandin E1. 2) Reflexive increase in heart rate during induced hypotension was significantly greater prostaglandin E1 induced-hypotension than during that wih sodium nitroprusside. From these results, it suggest that prostaglandin E1 induced-hypotension provides a safer margin than with sodium nitroprusside when rapid bleeding occurs during anesthesia and surgery.