Thrombolith of the Extradural Vertebral Venous Plexus as a Cause of Lumbar Radiculopathy: A case Report / 대한정형외과학회잡지

Lumbar radiculopathy may occur in the course of many diseases, but abnormalities or pathologic change of extradural vertebral venous plexus is a rare cause of the lumbar radiculopathy. We report a case of lumbar radiculopathy due to thrombolith of the extradural vertebral venous plexus diagnosed by CT and MRI and treated by hemilaminectomy and removal of thrombolith.

Influence of synovial Joint Fluid of Rheumatic and Osteoarthritic on Chondrocyte in vitro / 대한정형외과연구학회지

PURPOSE: Earlier work suggested that two cytokines inhibit synthesis of type II collagen and of aggrecans by chondrocytes and they depress chondrocyte proliferation, but there was little report how the chondrocyte is modulated by culture conditions such as the joint fluids of the rheumatoid arthritis and that of the osteoarthritis. The purpose of this investigation was to determine whether RA(rheumatic arthritis) or OA(Osteoarthritis) joint fluid influence proliferation and differentiation in cultured human articular chondrocytes. MATERIALS AND METHODS: Human chondrocytes were cultured in a standard media (DMEM and 10% FBS), RA and OA joint fluid were added to media at the concentration of 20, 40 and 60% respectively for 1, 3 and 6days. 3H-thymidine and 3H-uridine uptake of cultured chondrocytes were measured as indicators of cell proliferation. Synthesis of human collagen type I, II was estimated by the RT-PCR procedures. RESULTS: 3H-thymidine uptake of the chondrocyte cultured in RA SF(synovial fluid) medium at 2 and 4 days; its uptake in the group treated by RA SF 20%, 40%, 60% increased more significantly than that in control group (P0.05). 3H-uridine uptake of the chondrocyte cultured in RA SF medium at 2 and 4 days; its uptake of the group treated by RA SF 20%, 40%, 60% increased more significantly than that of control group (P0.05). Human type I collagen mRNA expressions of the chondrocyte markedly increased in RA and OA SF mixed groups. Human type II collagen mRNA expressions of the chondrocyte were reduced in RA and OA SF mixed groups, especially RA SF 60% mixed groups. CONCLUSION: RA and OA SF increased the proliferation of the articular chondrocyte, but its decreased the differentiation of the chondrocyte. RA and OA SF may change the phenotype of the articular chondrocyte and this phenomenon was more outstanding in RA SF.

Arthroscopic Meniscal Repair Using Inside-Out Technique under Minimized Skin Incision

PURPOSE: The purpose of this study was to investigate the effect of the Inside-Out arthroscopic repair technique using minimized skin incision for the peripheral tear of the meniscus. MATERIAL AND METHOD: We treated 44 meniscal tears of 39 patients with Inside-Out arthroscopic repair technique using minimized skin incision from December 1995 to November 1997 and evaluated the result retrospectively. Follow-up period was from 23 months to 50 months(average 34.5 months) and patient age was from 4 to 55(average 26.7). Twenty cases(45%) were injured during sports and 34 cases(77%) were chronically injured case. Ninteen cases(43%) were combined with ligament injuries and among them, 18 cases had an anterior cruciate ligament injury. All cases had peripheral tear and 12 cases were bucket handle tear and 8 cases were tear of discoid meniscus and 3 cases had meniscal cyst. RESULT: During follow-up period, 41 cases(95%) were satisfied and had excellent or good results which were based on the evaluation form of Tapper & Hoover's criteria. Recurrences of meniscal tear were occurred in two cases and they were resutured arthroscopically. As complications, three cases had skin dimplings at the suture site and they were treated with subcutaneous dissection at the out patient clinic. CONCLUSIONS: Even if not many cases and short follow-up periods, we obtained good result. Therefore, we recommend the Inside-Out arthroscopic repair technique using minimized skin incision for the periph-eral tear of the meniscus in any repairable condition.

Meniscus Reconstruction in Partially Removed Meniscus with Reflected Synovio-capsular Flap in Rabbit / 대한정형외과학회잡지

PURPOSE: The purpose of this paper was to investigate whether the reflected synovio-capsular flap, covering one-third of the remaining peripheral after partial removal of two-thirds of the central medial meniscus of rabbit knee, contributes to the regeneration of meniscus. MATERIALS AND METHODS: Forty rabbits were used in this study. In each rabbit the right knee was used for the experimental group in which the synovio-capsular flap was reflected after a partial meniscectomy, while the left knee, with only a skin incision, was used for the control group. The width and thickness of the regenerated menisci were measured with the Vernier calliper, and evaluated grossly by Hematoxylin-Eosin (H-E) staining, histochemically by safranin-O staining, and subcellularly by transmission electron microscopy at 4, 8, 12 and 16 weeks after the operation. RESULTS: The width and thickness of reflected synovio-capsular flaps gradually decreased until reaching a normal size. After eight weeks, there was no statistical difference between the experimental and control group. Twelve weeks after the operation, immature fibrocartilage cells appeared in the central portion of the reflected synovio-capsular flaps in 7 out of 8 rabbit knees. Sixteen weeks after the operation, more mature cartilage cells and their halos, stained very deeply with safranin-O, appeared in 6 out of 8 rabbit knees. In electron microscopic examination of cell shape, normal cell process and nuclear shape were observed with the passage of time. Rough endoplasmic reticulum and chromatin transparence peaked at 12 weeks and gradually returned to normal shape at 16 weeks. CONCLUSIONS: The results showed that the reflected synovio-capsular flap in rabbit was incorporated with the remaining peripheral portion of the meniscus and became a normal meniscus-like structure.

In Vitro Effects of Threapeutic Low Energy Ultrasound on Cultured Humon Articular Chondrocyte / 대한정형외과학회잡지

Ultrasound has been applied therapeutically to accelerate connective tissue healing and healing of long bone fracture. We performed this study to evaluate the effect of therapeutic low energy ultrasound on cultured human articular chondrocyte. Chondrocytes were isolated from articular cartilage of knee joint of young adult during notchy plasty of ACL reconstructive procedure using collagenase and cultured in DMEM solution. Therapeutic ultrasounds ( Intensity ; 1W/cm2, 0.75W/cm2, 0.25W/cm2. Frequency ; 1 MHz) were applied at the cultured human articular cartilage for 0, 30, 60, 90 seconds, repectively. 3H-Thymidine uptake, 3H-Uridine uptake and production of collagen Type I, Type II were evaluated on 3 days, and 5 days of culture. Decreased cell proliferation, decreased thymidine and uridine uptake, decreased production of human collagen Type I and complete loss of production of human collagen Type II were showed after high dose ultrasound application( 1W/cm2, 0.75W/cm2, 1MHz). After low dose ultrasound application( 0.25W/cm2, 1MHz), there were increased cell proliferation and increased production of human collagen Type II and production of Type I collagen was not changed after 3 days and 5 days. In summary, this study showed that decreased cell proliferation and collagen synthesis were observed with application of high dose ultrasound, whereas, increased cell proliferation and human collagen Type II synthesis were observed with application of low dose ultrasound.

Rheumatoid Arthritis and HLA Class II Genotypes in Korean / 대한정형외과연구학회지

To determine which HLA antigens are associated with rheumatoid arthritis in Korean, we studied the HLA class II genotypes in 40 patients with rheumatoid arthritis and 35 normal healthy persons by the two step polymerase chain reaction. At first we designed 20 pairs of group specific primers followed by the alleles which have the same nucleotide sequences in the exon 2 region. We performed amplification reaction with these 20 pairs of primers for 32 cycles. Reaction products were electrophoresed and only specifically amplified products were reamplified for 15 cycles with total 76 pairs of allele specific primers. We typed the HLA class II genotypes with specific band patterns of each allele. The genotypes in patients were compared with those of normals. HLA-DR4 gave the highest relative risk for rheumatoid arthritis (RR=4), which was statistically significant (P0.05). Among HLA-DR4 subtypes, the frequency of Dwl4(0404) in patient group was relatively higher (19.2%) than that in normal control group(7.7%). The relative risk was high (2.85), although it was not statistically significant (P>0.05). From this study, HLA-DR4 was found to be highly associated while DRI was not associated with rheumatoid arthritis patients in Koreans.

Effect of Ginseng Saponin on Cultured Osteoblast / 대한정형외과학회잡지

Earlier work suggested that Ginseng saponin had an effect on healing of fracture and osteoporosis, hut there has heen no report on saponin effects on cultured osteoblast. The purpose of this study was to investigate the effect of saponin on cultured osteovlast of the mouse. Osteohlastic cells were isolated from periosteum-stripped parietal bones of neonatal rat calvaria, seeded at 4 x 10 4 cells/cm2 density, and cultured in standard medium and deficient medium, with addition of saponin (0(control), 10, 20, 50 microgram/ml concentration). Plating efficiency(adhesiveness), proliferation and the alkaline phosphatase activity of the osteohlasts were evaluated on 2 hours, days 2 and 7 of culture. Saponin was found to enhance the adhesiveness of seeded osteoblasts which were cultured with a deficient medium in comparison to the controls. It promoted cell proliferation of the osteoblasts cultured with a deficient medium in comparison to the controls. There was also a significantly enhanced increase of alkaline phosphatase levels in the presence of saponin during culture with deficient medium in comparison to the controls. In summary, the results showed that the saponin increased adhesiveness, proliferation and the alkaline phosphatase activity of the osteoblast cultured only in deficient medium.

Rotator Cuff Repair using Mini - open Technique with Minimized Arthroscopic Acromioplasty / 대한정형외과학회잡지

Treatment of rotator cuff tears by open subacromial decompression has known successful in decreasing pain and restoring function in patients who have failed nonoperative treatment. But, open rotator cuff repair may result in significant deficits in strength and active motion by deltoid separation from the acromion. Deltoid detachment may be avoided by repair using mini-open technique. Arthroscopic subacromial decompression and the rotator cuff repair revel satisfactory results. Subacromial decompression involves decompression of the coracoacromial arch including routine release or resection of the coracoacromial ligament. Recent ligament-cutting studies have confirmed the role of the coracoacromial ligament as a static restraint to superior humeral head displacement. Complete resection of the coracoacromial ligament may be avoided through minimized arthroscopic acromioplasty. We evaluated all 11 patients with rotator cuff tears who underwent arthroscopic minimized subacromial decompression and rotator cuff repairs using mini-open technique. Their average age was 53 years (26 to 64 years); and the average follow-up was 13 months. Preoperatively, all patients complained pain and weakness. Follow-up using modified Hospital for Special Surgery shoulder score showed good to excellent results in 10 cases and poor results in 1 case an average 13 months postoperatively. We found that arthroscopic minimized subacromial decompression and repair using mini-open technique are safe, effective procedure for addressing cuff tears of a wide range of sizes.

Operative Treatment Using Minimized Internal Fixation and Tension Band Technique on Proximal Humeral Fracture / 대한정형외과학회잡지

Most proximal humeral fractures respond satisfactorily to simple conservative treatment, but operative treatment is recommended in cases where poor results are anticipated by prolonged immobilization, or because of severe displacement and comminution. We used a minimal internal fixation and tension band technique in severely displaced and comminuted cases to achieve firm fixation and avoid subacromial impingement. Passive range of motion of the involved shoulder began within the first postoperative day and active range of motion exercise was encouraged as soon as possible within the first postoperative week. Between February 1996 and November 1997, we operated using this technique on 15 patients ranging in age from 16 to 71 years (average 52). Follow-up averaged 13 months. During the follow-up period, all patients except one patient, had a active full range of motion on the affected limb. According to the evaluation on the 10 patients who had follow- up periods over 12 months by Hawkins rating scale of shoulder function, 6 patients had achieved a good result and 4 patients had achieved a fair result at the last follow up. In conclusion, tension band technique with minimal internal fixation could afford sufficient fracture stability to allow early, aggressive rehabilitation. As a method of internal fixation on a proximal humerus fracture, this technique may have particular advantages in elderly osteoporotic patients.

Effect of Ginseng Saponin on Human Chondrocyte / 대한정형외과학회잡지

Earlier work suggested that Ginseng saponin had an effect on osteoblast and other cells, but there has been no report on saponin effects on chondrocyte. The purpose of this study was to investigate the effect of saponin on cultured human chondrocyte. The chondrocyte was isolated from human articular cartilage of knee joint during notchplasty of ACL reconstructive procedure using collagenase, and cultured in standard medium and serum free deficient medium, with addition of saponin(0(control), 10, 20, 50 microgram/ml concentration). DNA, RNA synthesis of chondrocyte was estimated on 36 hours and 5 days of culture by measuring of thymidine and uridine uptake. Human collagen type I and II synthesis was estimated by reverse transcriptation-polymerase chain reaction on 36 hours of culture. Low dose saponin was found to enhance DNA, RNA, and collagen synthesis of chondrocytes which were cultured with a deficient medium in comparison to the controls. It promoted cell proliferation of the osteoblasts cultured with a deficient medium in comparison to the controls. But, high dose saponin was found to diminish the synthesis of DNA, RNA and collagen. In summary, the results showed that the saponin increased proliferation and differentiation of the chondrocyte cultured in deficient medium. Therefore saponin seemed to act as a physiologic stimulant on human chondrocyte. But further study should be done.

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.

Morphological change of radial head in cubitus varus deformity / 대한정형외과학회잡지

No abstract available.