Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Differences in complications and asymmetry in patients who did not receive a balancing procedure in two-stage and direct-to-implant breast reconstruction

Background@#Implant-based immediate breast reconstruction surgery with nipple-sparing mastectomy has recently been favored by patients. However, in patients who do not wish to undergo balancing procedures, it is difficult to select the appropriate implant size, making it challenging to achieve a symmetrical breast shape. Therefore, this study investigated the differences in breast asymmetry and other complications in patients who underwent a two-stage procedure or direct-to-implant (DTI) breast reconstruction to determine whether the two-stage procedure can produce more favorable outcomes. @*Methods@#The participants of this study were patients who underwent immediate two-stage breast reconstruction or DTI breast reconstruction from May 2018 to April 2022, did not receive postoperative radiotherapy, and did not wish to undergo any balancing procedures. An acellular dermal matrix was used for breast reconstruction in all patients, and a single reconstructive surgeon performed all the operations. Statistical significance was set at P<0.05. @*Results@#No significant differences in complications were found between the patients who underwent DTI breast reconstruction and those who underwent two-stage breast reconstruction. In the two-stage breast reconstruction group, breast volume asymmetry was observed in 18.4% (seven patients), which was significantly lower than the percentage of 44.7% (17 patients) observed in the DTI group. @*Conclusions@#Breast asymmetry was observed in a significant proportion of the patients in both groups. However, because breast volume asymmetry was more common in the DTI group than in the two-stage breast reconstruction group, two-stage breast reconstruction may be a favorable method for patients who do not wish to undergo balancing procedures.

Two Schwannomas Derived from the Ulnar Nerve Confirmed by Ultrasonography

Schwannoma is a rare tumor from the peripheral nerve and is mainly found alone. Diagnosis is made by ultrasonography or magnetic resonance imaging, and magnetic resonance imaging is preferred to ultrasonography for differential diagnosis of mass. After diagnosis, treatment is performed through surgical excision. In this case, a very small-sized neuropathy-causing lesion was identified through ultrasonography with electrodiagnostic study, and the other mass in the same nerve was discovered by chance through ultrasonography. Both masses were identified as schwannoma originating from the ulnar nerve and were successfully excised. We confirmed the advantages of ultrasonography in the rare diagnosis and again showed that ultrasonography has a diagnostic value that is not inferior to magnetic resonance imaging. Also, cases of multiple schwannomas confined to the ulnar nerve are rare and have been rarely reported worldwide. Therefore, it is reported together with the previous reports.

Reconstruction of temporal hollowing deformities using silicone implants made using a toy-clay model: a report of three cases

Severe temporal hollowing deformities can occur in patients who undergo craniectomy after intracranial hemorrhage. Reconstruction surgery for cosmetic purposes using silicone implants in patients with temporal hollowing deformities after craniectomy is advantageous because the procedure is simple and rapid, with a short recovery time, resulting in lower overall treatment costs. Of paramount importance, this option yields highly satisfactory results for patients. The authors present three cases of simple and fast surgery using silicone implants where highly satisfactory outcomes were obtained.

Frequency of reoperation in patients who underwent breast reconstruction using Allergan implants after an interview about breast implant-associated anaplastic large cell lymphoma

Background@#In recent years, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has emerged as an important concern. At our institution, patients who received breast reconstruction using Allergan implants were informed individually about BIA-ALCL. The present study analyzed correlations between patients’ level of satisfaction with their breast shape and whether they chose to undergo reoperation (implant removal or replacement). @*Methods@#Breast reconstruction with Allergan implants was performed between December 2014 and April 2018. In total, 107 patients were interviewed, excluding those who had died, were unreachable, or had already undergone reoperation. The mean follow-up period was 53 months (range, 26–73 months). @*Results@#After the interviews, 68 patients postponed reoperation, 29 had their implant replaced, and 10 had their implant removed. Nearly one-fifth (18.9%) of patients who were satisfied with their breast shape (13 out of 69) underwent reoperation due to anxiety over ALCL. Meanwhile, 68.4% of patients who were not satisfied due to capsular contracture or scar contracture (26 out of 38) underwent reoperation. Sixteen of the 30 patients who received postoperative radiotherapy (53.3%) chose to undergo reoperation. @*Conclusions@#Satisfaction with the cosmetic outcomes of implant placement played a meaningful role in patients’ decisions to undergo reoperation. This tendency may be linked to postoperative radiotherapy, which is a major contributor to complications such as contracture. Nonetheless, a substantial proportion of patients who were satisfied with the outcomes chose to undergo reoperation due to concerns regarding ALCL.

Musculocutaneous and Median Neuropathy after MiraDry Ⓡ Procedure for Axillary Hyperhidrosis

MiraDryⓇ , a microwave thermolysis device, is comparably new non-surgical agent in the field of eradication of sweat glands for treating axillary hyperhidrosis and osmidrosis. So far, altered sensation, swelling, and compensatory sweating are widely known as adverse effects of MiraDryⓇ . Of the few reported MiraDryⓇ -induced neuropathy cases, median and ulnar neuropathies are common. Although, one case has described radial nerve and posterior cord damage with maximized stimulation intensity, musculocutaneous nerve damage induced by MiraDryⓇ has not been reported. Here, we report a case of a 30-year-old woman experiencing left hand weakness after receiving MiraDryⓇ at a local dermatology clinic. Left brachial plexopathy, mainly involving the median nerve and the musculocutaneous nerve with partial axonotmesis, was confirmed by electrodiagnostic studies.Ultrasound evaluation showed corresponding results. This is the first case report of the musculocutaneous neuropathy by MiraDry>Ⓡ

Volumetric change of the latissimus dorsi muscle after postoperative chemotherapy and radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap: final results from serial studies

Background@#Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap. @*Methods@#This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance. @*Results@#The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05). @*Conclusions@#Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

The Korean Dysphagia Society (KDS) Position Statement for Oropharyngeal Dysphagia / 대한연하장애학회지

Oropharyngeal dysphagia is a clinical condition caused by various underlying diseases and is characterized by difficulty in swallowing. Diagnosis and treatment of oropharyngeal dysphagia require multidisciplinary consultations. This position statement for oropharyngeal dysphagia was developed by The Korean Dysphagia Society (KDS) to outline its position on oropharyngeal dysphagia. The clinical practice guideline, position statements, a recent meta-analysis, a systematic review, and randomized controlled trials for oropharyngeal dysphagia were all performed. An expert Delphi survey was also done to achieve a consensus of opinion on this position statement. This position statement for oropharyngeal dysphagia aims to help make evidence-based decisions in clinical practice, improve clinical evaluation and manage oropharyngeal dysphagia in Korea.

Tracheoesophageal Fistula by Chemoradiotherapy after a Total Laryngectomy in a Laryngeal Cancer Patient: A Case Report / 대한연하장애학회지

An acquired tracheoesophageal fistula (TEF) is a rare complication that can occur in the treatment of laryngeal cancer. Explosive coughing from the tracheostomy-opening site after swallowing is a warning sign of the TEF. A 68-year old male laryngeal cancer patient showed delayed TEF after chemoradiotherapy with a total laryngectomy.The clinicians carrying out a videofluoroscopic swallowing study should be familiar with the total laryngectomy state, as well as the findings and initial general management of TEF. This report discusses the pathophysiology and management of TEF and the needs for dysphagia care team after chemoradiation in laryngeal cancer patients.

Comparison of breast volume change between oncoplastic breast-conserving surgery with radiation therapy and a simultaneous contralateral balancing procedure through the inverted-T scar technique

Background@#Reduction mammoplasty or mastopexy is performed as an additional balancing procedure in patients with large or ptotic breasts who undergo breast-conserving surgery (BCS). Radiation therapy on breasts that have undergone surgery may result in changes in the volume. This study presents a comparative analysis of patients who received post-BCS balancing procedures to determine whether volume changes were larger in breasts that received radiation therapy than on the contralateral side. @*Methods@#Thirty-six participants were selected among patients who received BCS using the inverted-T scar technique between September 2012 and July 2017, were followed up for 2 or more years, and had pre-radiation therapy computed tomography images and post-radiation therapy images taken between 12 and 18 months after completion. The average age of the participants was 53.5 years, their average body mass index was 26.62 kg/m2. @*Results@#The pre- and post-radiation therapy volumes of the breasts receiving BCS were 666.08±147.48 mL and 649.33±130.35 mL, respectively. In the contralateral breasts, the volume before radiation therapy was 637.69±145.72 mL, which decreased to 628.14±166.41 mL after therapy. The volume ratio of the affected to the contralateral breasts was 1.05±0.10 before radiation therapy and 1.06±0.12 after radiation therapy. @*Conclusions@#The ratio of the volume between the two breasts immediately after surgery and at roughly 18 months postoperatively was not significantly different (P=0.98). For these reasons, we recommend a simultaneous single-stage balancing procedure as a reasonable option for patients who require radiation therapy after BCS without concerns regarding volume change.

Volumetric change of the latissimus dorsi muscle after postoperative radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap

Background@#This study aimed to determine the magnitude of volume reduction of the latissimus dorsi (LD) muscle after treatment using only postoperative radiotherapy (PORTx) in patients who underwent immediate breast reconstruction using an extended LD musculocutaneous (eLDMC) flap after partial mastectomy. @*Methods@#We retrospectively reviewed 28 patients who underwent partial mastectomy and an eLDMC flap, received only PORTx, and underwent chest computed tomography (CT) 7 to 10 days after surgery and 18±4 months after the end of radiotherapy, from March 2011 to June 2016. The motor nerve to the LD was resected in all patients. One plastic surgeon performed the procedures, and the follow-up period was at least 36 months (mean, 46.6 months). The author obtained LD measurements from axial CT views, and the measurements were verified by an experienced radiologist. The threshold for statistical significance was set at P<0.05. @*Results@#A statistically significant decrease in the LD volume was found after the end of PORTx (range, 61.19%–80.82%; mean, 69.04%) in comparison to the measurements obtained 7 to 10 days postoperatively (P<0.05). All cases were observed clinically for over 3 years. @*Conclusions@#The size of an eLDMC flap should be determined considering an average LD reduction of 69% after PORTx. Particular care should be taken in determining the size of an eLDMC flap if the LD is thick or if it occupies a large portion of the flap.

Attachment distribution of pectoral muscle origins identified in dual-plane breast implant insertion

Background@#Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes. @*Methods@#This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences. @*Results@#There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect. @*Conclusions@#The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

Effect of lidocaine on pain caused by nasal pack removal after closed reduction of nasal bone fractures

Background@#Pain caused by nasal pack removal after closed reduction of nasal bone fractures is a common problem. This study investigated the effect of infiltrating lidocaine into nasal packs on the pain caused by pack removal after closed reduction of nasal bone fractures. @*Methods@#Seventy-five patients who underwent closed reduction of nasal bone fractures between March 2016 and March 2018 were enrolled in this prospective, randomized, single-blind study. Merocel (hydroxylated polyvinyl acetate) packs were applied bilaterally and retained for 5 days. Twenty minutes before removal, both packs were rehydrated with 6 mL of 2% lidocaine in 26 patients and with 6 mL of saline in 24 patients; the packs were not rehydrated in 25 patients. Visual analog scale (VAS) scores for pain on removal were recorded. @*Results@#The mean VAS score was 5.3±2.0 in all patients, 3.8±1.5 in the lidocaine group, 5.8±1.4 in the saline group, and 6.3±2.1 in the non-rehydrated group. There was a significant difference in the pain score between the lidocaine and saline groups (P<0.001) but not between the saline and non-rehydrated groups (P=0.186). @*Conclusions@#Infiltration of lidocaine into Merocel packs reduced the pain caused by pack removal after closed reduction of nasal bone fractures.

Value of the Frontal Assessment Battery Tool for Assessing the Frontal Lobe Function in Stroke Patients

Objective@#To examine the correlation between the Frontal Assessment Battery (FAB) test, which is used to assess the frontal lobe function, and anatomical lesions as well as the ability of the test to detect frontal lobe dysfunction. @*Methods@#Records of stroke patients undergoing a FAB test and Mini-Mental State Examination (MMSE) were retrospectively reviewed. The patients were divided into three groups according to the lesions determined by an imaging study: frontal lobe cortex lesions, frontal subcortical circuit lesions, and other lesions. The FAB scores of the three groups were compared using the Kruskal-Wallis test. The validity of the FAB test to detect frontal lobe dysfunction was assessed by a comparison with the Computerized Neuropsychological Function Test (CNT) using the Spearman correlation coefficient. The correlation coefficients between the FAB test and MMSE were analyzed further based on the MMSE cutoff score. @*Results@#Patients with frontal cortex lesions had significantly lower total and subtest scores according to the FAB test than the other patients. The FAB test correlated better with the CNT than the MMSE, particularly in the executive function and memory domains. A high MMSE score (r=0.435) indicated a lower correlation with the FAB test score than a low MMSE score (r=0.714). @*Conclusion@#The FAB test could differentiate frontal lobe lesions from others in stroke patients and showed a good correlation with the CNT. Moreover, the FAB test can be used in patients with high MMSE scores to detect frontal lobe dysfunction and determine the treatment strategies for stroke patients.

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. MATERIALS AND METHODS: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. RESULTS: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up. CONCLUSIONS: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.

Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. MATERIALS AND METHODS: Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. RESULTS: The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). CONCLUSION: We note high success rates following fixation methods were selected based on the GT fracture type.

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks

OBJECTIVES@#The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed.SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails.@*MATERIALS AND METHODS@#In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure.@*RESULTS@#Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up.@*CONCLUSIONS@#The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.

Relationship between Lumbar Extensor Muscle Degeneration Classification and Osteoporotic Vertebral Compression Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate the reliability of the lumbar extensor muscle degeneration classification as an indicator of potential risk for osteoporotic vertebral compression fractures (OVCF). SUMMARY OF LITERATURE REVIEW: Fatty degeneration of lumbar extensor muscles has attracted increased interest in the literature as a risk factor for OVCF. MATERIALS AND METHODS: Ninety-one patients with OVCF (group 1) and 60 patients without OVCF (group 2) were investigated. Magnetic resonance imaging was used to measure and to analyze the muscle mass and fatty degeneration of the lumbar extensor muscle. The degree of fatty degeneration of the lumbar extensor muscle was classified into 4 stages: less than 10%, 10%–25%, 25%–50%, and more than 50%. RESULTS: Fatty degeneration of the lumbar extensor muscle and the bone mineral density T-score were 29.66%±12.28% and −3.56±1.13 in group 1 and 24.04%±13.29% and −2.27±1.46 in group 2, which were statistically significant differences (p < 0.05). Logistic regression analysis revealed that as the fatty degeneration of the lumbar extensor muscle increased, the risk of OVCF increased (odds ratio [OR]=1.21; p=0.01). The risk of OVCF increased as the lumbar extensor muscle degeneration classification scores increased (OR=13.53; p=0.02). Furthermore, as the muscle mass of the multifidus decreased, lumbar lordosis and sacral inclination decreased (β=0.33; p=0.01 and β=0.25; p=0.04, respectively). However, no factor affected thoracic kyphosis. CONCLUSIONS: Fatty degeneration of the lumbar extensor muscle was correlated with OVCF. A lumbar extensor muscle degeneration classification higher than stage 3 should be considered a risk factor of OVCF.

Relationship between Lumbar Extensor Muscle Degeneration Classification and Osteoporotic Vertebral Compression Fracture

OBJECTIVES@#To investigate the reliability of the lumbar extensor muscle degeneration classification as an indicator of potential risk for osteoporotic vertebral compression fractures (OVCF).SUMMARY OF LITERATURE REVIEW: Fatty degeneration of lumbar extensor muscles has attracted increased interest in the literature as a risk factor for OVCF.@*MATERIALS AND METHODS@#Ninety-one patients with OVCF (group 1) and 60 patients without OVCF (group 2) were investigated. Magnetic resonance imaging was used to measure and to analyze the muscle mass and fatty degeneration of the lumbar extensor muscle. The degree of fatty degeneration of the lumbar extensor muscle was classified into 4 stages: less than 10%, 10%–25%, 25%–50%, and more than 50%.@*RESULTS@#Fatty degeneration of the lumbar extensor muscle and the bone mineral density T-score were 29.66%±12.28% and −3.56±1.13 in group 1 and 24.04%±13.29% and −2.27±1.46 in group 2, which were statistically significant differences (p < 0.05). Logistic regression analysis revealed that as the fatty degeneration of the lumbar extensor muscle increased, the risk of OVCF increased (odds ratio [OR]=1.21; p=0.01). The risk of OVCF increased as the lumbar extensor muscle degeneration classification scores increased (OR=13.53; p=0.02). Furthermore, as the muscle mass of the multifidus decreased, lumbar lordosis and sacral inclination decreased (β=0.33; p=0.01 and β=0.25; p=0.04, respectively). However, no factor affected thoracic kyphosis.@*CONCLUSIONS@#Fatty degeneration of the lumbar extensor muscle was correlated with OVCF. A lumbar extensor muscle degeneration classification higher than stage 3 should be considered a risk factor of OVCF.

Total Hip Arthroplasty Using Ceramic-on-ceramic Bearing Surfaces: Long-term Assessment of Squeaking Sounds / 대한고관절학회지

PURPOSE: This study was performed to characterize the natural history of squeaking sounds that occur following total hip arthroplasty (THA) using ceramic-on-ceramic bearing surfaces and its potential correlation with clinical and/or radiological results. MATERIALS AND METHODS: This study included 47 patients who underwent THA between April 1999 and April 2005, and had at least 10 years of follow up from the time of the operation. Squeaking sounds were detected in 10 out of the 47 cases (21.3%). Squeaking-associated factors (i.e., cause, time of onset, inducing motions, and continuity of the sound) were assessed. RESULTS: Squeaking sounds: i) were detected an average of 46.2 months after operation, ii) occurred more frequently in patients with a high body mass index (BMI) compared to those with low BMI, and iii) most frequently detected when deep flexion of hip joint followed extension. In all 10 cases, the squeaking sound remained through the follow up period; 6 cases experienced no change in frequency and pitch, 4 cases experienced a decrease in frequency and pitch over time. The cause(s) of changes to squeaking sounds could not be determined. CONCLUSION: The frequency and pitch of the squeaking sounds changed over time in a subset of patients. The squeaking sound did not appear to correlate with clinical results or survival of the prosthesis.