Total Hip Arthroplasties with High Dislocation in Tuberculous Hip and Developmental Dysplasia of the Hip / 대한정형외과학회잡지

PURPOSE: To confirm the effect of the frog leg lateral radiographs for determining the clinical indication of total hip arthroplasty for high riding dislocation and to discuss its theoretical background. MATERIALS AND METHODS: A consequent series of reconstructive THA were studied in 28 recent tuberculous hips. Twenty-three hips (17patients) with developmental dysplastic hip were compared. Preoperatively, frog-leg lateral radiographs were performed in all the patients, which were enhanced using a 2-dimensional computer model to predict the reattachment of the greater trochanter. RESULTS: The modified scores of Merle d'aubigne and Postel improved from a mean of 2.6 points preoperatively to a mean of 5.1 points. Sciatic nerve palsies occurred in three cases. In two cases, they fully recovered, but in one case, it did not. We confirmed that old high dislocation of the hip could be adopted in type 1 and 2 categories of frog leg lateral position. The reconstruction of hip was relatively simple in type 3, however, further study is necessary in type 5 due to unsuitable abduction contracture. CONCLUSION: We confirm that frog leg lateral radiography is effective for determining the operative indication of high riding dislocation. However irreducible frog leg lateral position is absolutely contraindirated for total hip arthroplasty.

Myoblast Transfer Therapy on mdxMouse / 대한정형외과학회잡지

PURPOSE: To observe dystrophin formation and histological improvement in dystrophic muscle of mdx mouse after normal myoblast injection. MATERIALS AND METHODS: Cultured myoblasts from genetically normal rats were injected into the right quadriceps femoris of a 6-week-old mdx mouse (n=9). dPBS was injected into the left quadriceps femoris as a control. One, 2, and 3 months after injection, The control and experimental group were compared histologically and by dystrophin immunostaining. RESULTS: When compared with controls 3 months postoperatively, quadriceps femoris in the experimental group exhibited greater cross-sectional area and total fiber number, and the experimental animals contained more normal-appearing and less abnormalappearing fibers than the control group. Most of the fibers in the experimental group showed positive results in dystrophin immunostaining, whereas immunostaining of mdx muscle fibers in the control group was completely negative. CONCLUSION: This study shows that normal myoblast injection improved the muscle architecture histologically and produced dystrophin protein in dystrophic muscle.

Incidence and Risk Factors of Pelvic Pain in Pregnancy / 대한척추외과학회지

STUDY DESIGN: An analysis was made of the questionnaire answers and pain drawings of postpartum women. OBJECTIVES: This study was done to evaluate the risk factors of pelvic pain in pregnancy and its incidence. SUMMARY OF LITERATURE REVIEW: Pelvic pain accounts for the major complaints among pregnancy women. The incidence and risk factors of pelvic pain during pregnancy in Korean women have not been defined fully. MATERIALS AND METHODS: Three hundreds thirty-two postpartum women were asked to fill out a questionnaire within one week after their parturition. Age, parity, body mass index(BMI; kg/cm(2)), weight gain during pregnancy, history of pelvic pain in previous pregnancy, level of exercise and vocational status during and before the pregnancy and baby's birth weight were asked and evaluated to determine risk factors. The correlation was tested by student t-test and logistic regression. RESULTS: The incidence of pelvic pain during pregnancy was 53.3%. The history of pelvic pain in previous pregnancy showed correlation with pelvic pain in pregnancy(p<0.05). CONCLUSION: It is suggested that women who experienced pelvic pain in previous pregnancies should be checked for pelvic pain before pregnancy. Effective intervention of pelvic pain will be needed in further studies.

Experimental Study for Defining Range of Motion Required for Daily Activities in Wrist Joint / 대한정형외과학회잡지

PURPOSE: The knowledge of characteristics of wrist joint motion is essential to develop the artificial joint because injury of wrist joint is common onset in industrialized world. MATERIALS AND METHODS: Total of 25 different daily activities were tested on 15 subjects who did not show any abnormality of their joint functions. RESULTS: For left (right) wrist joint, least functional range of motion were 36.7. +/- 16.5. (S.D) (47.4. +/- 15.6.) and 40.7. +/- 15.3. (S.D) (33.5. +/- 9.7.) for joint flexion and extension, and 26.3. +/- 11.3. (S.D) (30.5. +/- 7.5.) and 22.9. +/- 9.2. (S.D) (23.0. +/- 10.5.) for joint radial and ulnar deviation, respectively. CONCLUSION: Least range of motion obtained in this study can be used as a basic data to design artificial joint and set a goal for surgeon to achieve appropriate treatment from patients because results revealed that any significant differences were not found in least functional range of motion between left and right wrist joint to perform activity daily living (ADL) .

The Carrier Detection and Genetic Counseling of Duchenne and Becker Muscular Dystrophy Using Linkage Analysis / 대한정형외과학회잡지

PURPOSE: Restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) is a widely accepted method for carrier detection of Duchenne and Becker muscular dystrophy (DMD and BMD) . This study was done to evaluate the clinical value of linkage analysis of RFLP-PCR using five polymorphic markers selected and the heterozygote frequency of those markers in DMD/BMD patients and their family members. MATERIALS AND METHODS: RFLP-PCR test was performed in twenty clinically diagnosed male DMD/BMD patients from 13 families who have been confirmed to have dystrophin gene defect from 1994 to 1997 and their 47 female family members and the results were evaluated by linkage analysis to detect carriers. RESULTS: The heterozygote frequency of pERT 87-15/XmnI, pERT87-15/BamHI, pERT87-8/TaqI, 5'-dysIII (CA) and 3'-dys (CA) markers were 55%, 49%, 45%, 32% and 26% respectively. Fourty-four (91%) out of 47 female family members had heterozygosity to at least one of those five markers. Since the obligate carriers from two families showed homozygocity to all five markers, carrier detection was possible in eleven families (85%) by the linkage analysis. CONCLUSION: RFLP-PCR using markers with high heterozygote frequency could be the first line modality of carrier detection that is crucial in genetic counseling of DMD/BMD patients and their families.

Hemangioma of the Scapula Associated with High Scapular Deformity: Case Report / 대한정형외과학회잡지

A hemangioma doesn't often involve the scapula and concurrent high scapular deformity is also too. We present a case of capillary left scapula hemangioma at its superior angle with Cavendish grade 2 high scapular deformity treated by surgical intervention. Excision of the hemangioma and resection of the fibrous band attached to the superior angle of the scapula resulted in symptomatic and cosmetic improvement. Even though the causality between the two lesions is not clear, we cannot exclude the possibility that the hemangioma contributed to the development of high scapular deformity.

The Diagnosis of Duchenne and Becker Muscular Dystrophy: Multiplex-PCR methods / 대한정형외과학회잡지

PURPOSE: The objective of this study is to evaluate the value of multiple-PCR as a diagnostic modality in detection of dystrophin gene deletion by observing its detection rate and concordance rate with clinical diagnosis. MATERIALS AND METHODS: Fifty-two male patients who were clinically diagnosed as DMD or BMD (Duchenne or Becker muscular dystrophy) and received multiple-PCR from 1994 to 1997 at our center were included in this study. The relationship between clinical phenotype and the location of gene deletion were studied using reading-frame rule. Dystrophin protein analysis by immunocyto-chemical technique was done in 7 cases with negative multiplex-PCR. RESULTS: Out of fifty-two patients, thirty-four were DMD and eighteen as BMD clinically. Multiplex-PCR revealed dystrophin gene deletion in 19 patients (36%) consisting of twelve DMD and seven BMD cases. The locations of the gene deletion coincide with the clinical phenotype in 17 cases (89%). Among the 7 cases that underwent dystrophin protein analysis, 3 DMD and 2 BMD were confirmed. CONCLUSIONS: Though no substantial gene deletion detection rate was observed in this study, multiple-PCR could be used as a first-line diagnostic tool in detecting dystrophin gene deletion in DMD/BMD patients based on its high concordance rate with phenotype and favorable patient compliance and convenience.

Revision Arthroplasty using Thtoplast - HA Composites for Acetabular Bone Deficiencies / 대한정형외과학회잡지

Sixty-eight revisions of total hip arthroplasties from sixty-one patients were performed using allogenic cancellous chip bone and fine granules of HA for bone deficiencies of the acetabulum at two hospitals in Seoul since September 1992. In our practice, acetabular deficiencies were classified into two broad categories, which were based on our provisional treatment protocol. For the segmental deficiencies of the acetabulum, we employed the method of using the cemented acetabular component. In the mean time, Ling technique of impaction graft with PMMA cement were also employed. For the cavitary deficiencies of the acetabulum, we used several types of uncemented ingrowth cups with HA granules and Tutoplast was used to further ameliorate the bony integration. In addition, we obtained good results in cavitary deficiencies of the acetabulum with C.L.S. Expansion Cup and Ringloc fin Cups which seem that initial stability during the cup installation were remarkable. Unfortunately, we had 5 cases of clinical failure, which consist of bone graft incorporation, where eventual resorption of the graft and implant migration were resulted. Nevertheless electromicroscopic finding of interface taken from failure showed partial new trabecular formation and physicochemical bonding near the host bone bed in some cases. Although primary stability of reconstructive surgery was acceptable, Tutoplast - HA granule composites have similar effect of incorporation to host bone compared with other method of allogenic bonegraft storage, which remodeled after 5 years. Thus, this phenomenon requires further investigation of molecular biological role of tissue substance known as cytokine, as well as microscopic histology.

Meaurement of the Muscle Fatigue Patterns using Electromyography Technique / 대한정형외과학회잡지

Injuries and pains of musculoskeletal joint in human body is common onset in industrialized world. However, muscle fatigue plays a very significant role in contributing causes of many pains associated with musculoskeletal joints. Based on this hypothesis, degree of muscle fatigue was investigated using electromyography measurement technique during isometric and concentric/eccentric muscle contractions. Different response of the muscle fatigue between two different muscle contractions (isometric and concentric/eccentric contractions) was examined by comparison of parameters which were median frequency, median power and RMS value. Healthy 16 young persons without previous musculoskeletal diesease history were tested with Noraxon Myosystem 2000 EMG measurement system. In this study, two different exercises were performed. First exercise was concentric/eccentric exercise. Second exercise was isometric muscle contraction. In the case of the isometric exercise, median frequency was decreased, but median power and RMS were increased. However, during the concentric/eccentric exercse, median frequency was increased, but median power and RMS were decreased. Both of those revealed that the pattern of the median frequency was W type, but median power and RMS were M type as time passed. In this study, the patterns of the muscle fatigue during concentric/eccentric exercise as well as isometric exercise were identified. It will be helpful to prevent musculoskeletal injury from over-working andexercising.

Biomechanical Motion Characteristics of Lumbar Motion Segments : Effects of Radial Tear of the Annulus Fibrosus / 대한척추외과학회지

STUDY DESIGN: Lumbar disc degeneration and segmental instability of the lumbar spine are causes of low back pain. Disc degeneration causes specific changes of the intervertebral disc, and could affect anatomic variations of end plate and vetebral body. However, the exact relationship between degenerative changes of the intervertebral disc and segmental motion characteristics is not known. It is known that radial tears of the annulus fibrosus initiate or accompany degenerative process of nucleus pulposus and the motion segment. It is hypothesis of this study that the existence of radial tear in the annulus fibrosis affects 3 dimension motion characteristics of motion segment. For the purpose, the degree of intervertebral disc degeneration is newly classified by existence of radial tear. Then, the resulting biomechanical motions are investigated. OBJECTIVES: To investigate effects of disc degeneration by the classification on kinematic motions of the motion segment from human lumbar spine and to suggest a quantified method to determine spinal instability in vivo. MATERIALS AND METHODS: A total of 60 spinal motion segments from human lumbar spine was used for this study. To measure 3 dimensioal motion of the motion segments, Vicon system(Oxford, England) with 3 cameras reflective markers and VAX station was used. 6 kinds of pure moments(flexion, extension, right and left axial rotation, and right and left lateral bending) were applied to the motion segments using dead weight for each loading step. At the end of test(maximum loading), motion segments were frozen for anatomical study. For making clear the degree of the degeneration of the disc, a new classification based on MRI results was used: Grade 1 is a normal young disc without tear; Grade 2 is a normal aging disc without radial tear; Grade 3 is a degenerative disc with radial tear; and Grade 4 is a severely degenerative disc with radial tear and other degeneration such as showing decreased disc height. RESULTS: The upper lumbar specimens with radial tears has increased flexion motions as compared to the normal group. Also, the right and left axial rotation in radial tear group increased as compared to the normal group. However, there were no statistical differences in other motions. For the lower lumbar specimens, there were no significant differences in measured motions in all directions between the normal and radial tear groups CONCLUSIONS: These results suggests that the segmental motions are affected by radial tear in the intervertebral disc. Thus, the radial tear in the annulus fibrosus of lumbar intervertebral disc could cause the instability of lumbar spine. Further research is required to determine the relationship between other structural changes and biomechanical characteristics, and future studies should include in vivo investigations to correlate these findings to patients'symptoms.

The Clinical analysis of Tibial Shaft Fracture at the Primary Trauma Hospital / 대한정형외과학회잡지

Tibia fractures are frequently occurred with increased traffic accident and industrial accident recently. And there are controversies in treatment of tibia fractures. From Jan. 1986 to Oct. 1988, tibial fractures of 107 cases in 105 patient, treated at the Department of Orthopedic Surgery of Dae Han Hospital, were analyzed. Results were obtained as follows. l. Of 105 patients, 85 patients were male & 20 patients were female. 2. The most common causes of fracture was traffic accident. 3. The most common level of fracture was middle one-third of tibial shaft. 4. Of 107 cases, conservative treatment was 35 cases and operative treatment in 72 cases. 5. Average union time was 16 weeks in conservative treatment & 18.5 weeks in operative treatment.

Regeneration of Full / 대한정형외과학회잡지

There are many controversies in ability of articular cartilage to heal full thickness defect. Generally, it is reported that full thickness defects of articular cartilage filled with organizing hematoma and granulation tissues, which converted to chondroid tissues. It is clear that the size of defect was related to the repair of articular cartilage. Though cartilagenous material fills the defect and restores the surface continuity, it may undergo degeneration, and lead to localized focus of osteoarthritis. Multiple drilling through subchondral bone could be a kind of treatment in articular cartilage defect. Author conducted an experiment for the full thickness defect of articular cartilage in rabbit. After multiple drilling of articular cartilage, the repair of defect was examined histologically until eighth week. Results were as followings ; l. At lst. week, the defect was repaired by fibrovascular proliferation and granulation tissue. 2. At 3rd. week, hyaline cartilage consisted of normal chondrocyte was formed. 3. At 8th. week, subchondral plste was regenerated completely. 4. All defects that were less than 3 mm. in diameter were healed. More repairs were observed in case with the wider defects if the defects were within 3mm. in diameter. 5. The metachromasia was observed with toluidine blue stain. The reformed cartilage shows slight purple(Grade II) to moderate purple(Grade III) at third week and near normal (Grade IV) at fourth week. In conclusion, multiple drilling may be an effective method of treatment in articular cartilage defect. It is considered that multiple drilling with a 3mm. Steinmann pin may be the most convenient and effective method of the cartilage healing.

Comparative Results of Total Knee Replacement in Rheumatoid Arthritis and Osteoarthritis / 대한정형외과학회잡지

At Orthopedic Department of Kyung Hee University Hospital, we performed 20 total knee replacements in 12 patients who had rheumatoid arthritis and 18 total knee replacements in 13 patients who had osteoarthritis during the period from August 1982 to May 1986. All patients were female. Comparative analysis was done between the two groups with a follow-up period ranging from 1 year to 4 years 8 months, average being 2 years and 3 months. The average age of rheumatoid arthritis patients was 10 years younger than osteoarthritis patients. The improvement of range of knee motion after total knee replacement was greater in rheumatoid arthritis comparing to osteoarthritis. Preoperative flexion contracture was more severe in rheumatoid arthritis than osteoarthritis, but after total knee replacement the average degree of flexion conrcacture was no significant difference between two groups. The average of preoperative Hospital Surgery Knee Rating Scale was low in rheumatoid arthritis group than in osteoarthritis group, but postoperative Knee Rating Scale was similar in both groups. It seems that the problem of wound was more frequent in rheumatoid arthritis than in osteoarthritis.

Clinical Study of Isolated Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

The anterior cruciate ligament injury is one of the most common ligament injury of the knee joint, and anterior cruciate ligament is as important structure for stabilization as a primary restraint. Noyes reported that the diagnosis of a tek of the anterior cruciate ligament was made by the original treating physician in only 6.8%. And there are many controversies in its treatment. It is certain thatearly diagnosis and treatment are th most important clue. Authors studied 48 patients of isolated anterior cruciate ligament injury who were diagnosed by same physician from Jan. 1983 to Dec. 1985 after follow ups ranging from six mnths to 4 years, average beimng one year and two months. The results were as followings: 1. The most common cause was sports injury. 2. The most common sign and symptom were hemarthrosis in acute injury and giving way in chronic injury. 3. Anterior drawer test without anesthesia had 25% of diagnostic accuracy but pivot shift test under anesthesia 95.8%. 4. 31 cases in 48 cases (64.8) had associated meniscal injury. 5. In acute torn ACL, the primajy repair was preparable but conservative treatment with arthroscopic partial menisectomy was eful in chronic case.

Supracondylar Fractures of the Femur Treated by Interlocking Nailing / 대한정형외과학회잡지

Between Jan. 1976 and May 1987, Sixteen supracondylar fractures of the femur were treated by interlocking nailing. Of the 16 cases, 7 cases were intercondylar, 12 cases were segmental fractures of the femur, 4 cases were open fractures in the type of wound. 1. The simple supracondylar fracture involving the distal 9cm of the femur can be treated by interlocking nailing which makes firm fixation and allows early ambulation. 2. If the supracondylar fracture is accompanied with intercondylar fracture, careful reduction and transcondylar fixation by means of tibial bolt or cancellous screws are essential before the insertion of the nail. 3. The shape of the bent nail must be depended on the type of the fracture. If the nail is to be inserted into the anterolateral aspect of the distal fragment, the degree of bending of the nail is 400cm, and posteromedial is 110cm in radius. 4. The authors made several sagittal holes the at dorsum of the nail. So the screw can be easily inserted to the nail perpendicularly or obliquely, when the insertion of the screw through the transverse holes is difficult. 5. Of the 15 cases treated by interlocking nailing, 5 cases were excellent, 4 cases were good, 2 cases were fair, 4 cases were failure by schatzker assessment.

Legg-Calve-Perthes Disease / 대한정형외과학회잡지

237 patients with Legg-Calve-Perthes disease were treated during past 12 years. Among them, a comparative study was done for 87 patients who were followed up over 2 years. They were analyzed according to Catteralls classification and divided into a group of conservative treatment and of surgical treatment. 74 patients were boys and 13 patients were girls and the ratio of boys to girls was 5.7 to 1. The mean age was about 6.9-year-old. Bilateral involvement was observed in 6 patients. According to Catterall classification. 1(1.1%) was classified as group I, 27(29.0%) as group II, and 36(38.7%) as group III, and 29(31.2%) as group IV. According to assessment by Harrison et al., satisfactory result was achieved in 63.2% of cases of conservative treatment and 34.3% of cases of operative treatment. The measurement of epiphyseal quotient and femoral head sphericity(by Mose) were considered meaningful methods for assessing the result of the treatment. The most frequent one of “Head-at-Risk” factors was lateral subluxation of femoral head. The result of treatment was not always coincided with the classification by Catterall. In bilateral involvement, the first affected hip had better prognosis than contralateral one.