Clinical Results and Efficacy of Selective Nerve Root Blocks with Vertebroplasty in Treatment of Patients with Osteoporotic Compression Fracture Accompanied by Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the efficacy of selective nerve root blocks with vertebroplasty in treatment of patients with osteoporotic compression fracture accompanied spinal stenosis showing neurogenic claudication. MATERIALS AND METHODS: Of 80 patients admitted to our orthopedic department for osteoporotic vertebral compression fracture accompanied by neurogenic claudication due to spinal stenosis between May 2010 and September 2011, 40 patients who underwent only vertebroplasty and 40 patients who also underwent an additional selective nerve block were studied with a minimum follow-up period of one year. The two groups were compared for their age, sex, grade of spinal stenosis, bone mineral density (BMD), lordotic angle, pelvic tilt, sacral slope, pelvic incidence, restoration rate of vertebral height, preexisting fracture, intradiscal cement leakage, and for new adjacent vertebral fractures during a follow-up period of at least one year. Statistical analysis was performed using SPSS version 17.0 and statistical significance was determined using the Student t-test and chi-square test with p or =0.05) in age sex, grade of spinal stenosis, BMD, lordotic angle, pelvic tilt, pelvic incidence, restoration of vertebral height, preexisting fracture, and intradiscal cement leakage was observed between the vertebroplasty only group and the additional selective root block group. However, the incidence of new adjacent vertebral fractures between the groups was 13 of 40 patients in the vertebroplasty only group and four of 40 patients in the selective nerve block addition group; a statistically significant reduction was observed in the nerve block group (p<0.05). CONCLUSION: In treatment of patients with osteoporotic compression fracture with neurogenic claudication due to spinal stenosis, addition of selective nerve block to vertebroplasty can lessen pain and the resulting postural change, thereby mitigating dynamic sagittal instability, which in turn results in reduced incidence of new adjacent vertebral fractures. As such, selective nerve block should be considered as a safe, simple, and effective tool for use in prevention of new adjacent vertebral fractures in patients with osteoporotic fracture who are suffering from neurogenic claudication.

Usefulness of Contralateral Indirect Decompression through Minimally Invasive Unilateral Transforaminal Lumbar Interbody Fusion

STUDY DESIGN: Retrospective study. PURPOSE: This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF). OVERVIEW OF LITERATURE: Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach. METHODS: The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively. RESULTS: Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p0.05). CONCLUSIONS: Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss.

Intervertebral Foraminal Widening Caused by the Tortuous Cervical Vertebral Artery / 대한정형외과학회잡지

Tortuousity of the vertebral artery is clinically uncommon because it rarely causes symptoms. We described a patient with pain in the neck and both upper extremities in whom diagnosis of intervertebral foraminal widening and deformity of the vertebral artery were suggested by results of radiography and magnetic resonance. We confirmed the tortuous vertebral artery by results of computed tomography angiography. Correlation of the patient's symptoms and abnormalities was not clear; conservative treatment was administered.

Difference of Fusion Rate in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Autobone and Hydroxyapatite according to Mixture Ratio and Amount of Bone Graft / 대한정형외과학회잡지

PURPOSE: The aim of this study is to analyze the fusion rate according to the mixture ratio and the amount of bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). MATERIALS AND METHODS: This study included 92 subjects who underwent MI-TLIF. Patients were classified into either group I, in which patients received transplantation with only autogenous bone, group II, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by more than 50%, or group III, in which patients received transplantation with hydroxyapatite mixed with autogenous bone by less than 50%. For analysis of the correlation of amount of bone graft with fusion rate, patients were divided into group A, having less than 12 ml of bone graft, and group B, having more than 12 ml of bone graft. Visual analogue scale and Oswestry disability index were used for clinical assessment, and Burkus' classification method was used for evaluation of bone fusion. RESULTS: Fusion rates of groups I, II, and III according to the mixture ratio were 90.9%, 86.5%, and 86.2%, respectively. The fusion rate increased as the autobone ratio became higher; however, no significant difference was found (p=0.16). The fusion rates were 81.5% and 92.5% in group A and group B, respectively, which were classified according to the volume of bone graft, showing a significant increase in groups with bone graft volume more than 12 ml (p=0.03). CONCLUSION: A significantly high fusion rate was observed when bone graft volume was more than 12 ml in MI-TLIF. More than 12 ml of bone graft volume is essential for achievement of a satisfactory fusion rate.

Minimally Invasive Surgery for Fracture-dislocation of the Lumbar Spine with Neurologic Deficit and Hemodynamic Instability: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: In patients with fracture-dislocation of the lumbar spine with neurologic deficit and hemodynamic instability, minimally invasive surgery made/produced good clinical results. So the authors have reported the results with literature review. SUMMARY OF LITERATURE REVIEW: In patients with unstable lumbar spine fracture-dislocation, early surgical treatment has been preferred due to its many advantages of anatomical reduction, nerve decompression, recovery of nerve function, and early rehabilitation, etc. But for patients with unstable lumbar spine fracture-dislocation and who are hemodynamically unstable, the surgical treatment is generally delayed, so there are many cases that cannot fulfill the expectation of neurologic recovery. MATERIALS AND METHODS: In patients with unstable lumbar 2-3 spine fracture-dislocation and who are hemodynamically unstable, applying the concept of stage operation, postural reduction and minimal invasive percutaneous pedicle screw fixation were conducted as soon as possible. Then after recover of general condition, decompression and posterior fusion were conducted as a second stage operation. RESULTS: After the first stage operation, motor grade was improved from 3 to 4 below the L3 spine level in postoperative physical examination. The second stage operation was conducted two weeks later and neurologic symptom was more improved after the second stage operation. CONCLUSIONS: In patients with lumbar spine fracture-dislocation having hemodynamic instability and neurologic deficit, early minimally invasive fixation for reducing complications of open reduction and internal fixation may contribute to improving general conditions and recovery of neurologic deficits.

Perioperative Safety and Efficacy of Multilevel Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparison with Conventional Open Surgery / 대한정형외과학회잡지

PURPOSE: This study was aimed to examine the ways to reduce bleeding through minimally invasive multi-segmental fusion by comparing the results of minimally invasive transforaminal lumbar interbody fusion versus those of conventional posterior interbody fusion depending on the number of fused segment. Moreover, the study identified how the new method of fusion contributed to reducing postoperative complications and to fast recovery. MATERIALS AND METHODS: This is a retrospective study conducted on 367 spinal stenosis patients who had been followed up for at least one year (170 patients underwent minimally invasive transforaminal lumbar interbody fusion and 197 patients underwent conventional posterior interbody fusion). The study examined blood loss volume, postoperative drainage volume, operation time, visual analogue scale score, pre- and post-operative levels of protein and albumin, as well as postoperative bed rest period between the two groups. Moreover, the study analyzed the presence of complications during the peri-operative period. RESULTS: The minimally invasive fusion group exhibited a statistically significant decrease in intraoperative bleeding than the conventional infusion group when the number of fused segments in each group was compared. In addition, the difference in the two groups showed a statistically significant increase as the numbers of fused segments rose (p<0.05). On the other hand, a statistically significant increase was shown in the operation time between the minimally invasive fusion group and the conventional fusion group. The difference in the two groups showed a statistically significant increase as the distance of fused segments was extended (p<0.05). CONCLUSION: Minimally invasive transforaminal lumbar interbody fusion is thought to be a useful surgical method to minimize bleeding when the limitations of minimal invasive fusion are supplemented by shortening the operation time.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty. OVERVIEW OF LITERATURE: Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty. METHODS: One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted. RESULTS: Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05). CONCLUSIONS: The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.

Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients with Low Grade Spondylolisthesis: Comparison of the Unilateral and Bilateral Approaches / 대한정형외과학회잡지

PURPOSE: We wanted to analyze the clinical and radiological results of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients with low grade spondylolisthesis, and we also compared the unilateral and bilateral approaches. MATERIALS AND METHODS: This study examined a consecutive series of 27 patients who underwent one-level MI-TLIF (16 cases of the unilateral approach and 11 cases of the bilateral approach) and the follow-up data was compared with a minimum 1-year follow-up. The amount of intraoperative blood loss, the postoperative drainage, the transfusion requirement and the surgery time were investigated. The clinical outcomes were analyzed using the visual analogue scale (VAS), the Oswestry disability index (ODI) and the SF-36 Physical Composite Score (SF-36). The preoperative, postoperative and last follow-up changes in the height of the disc, the degree of the slipping and the slip angle in the fused segments were radiologically analyzed. RESULTS: There were no significant differences between the two groups in terms of the clinical and radiological results at the last follow-up. But the unilateral approach-group was found to have less blood loss, less postoperative drainage, a lesser requirement for transfusion and a shorter duration of surgery. During the reduction process in 1 patient among the cases that had the unilateral approach used, the pedicle screw fixed to the vertebral body fell out. CONCLUSION: The unilateral MI-TLIF can shorten the operation time and reduce the blood loss as compared to the bilateral approa

Minimal Invasive Unilateral Transforaminal Lumbar Interbody Fusion by Sublaminar Decompression: Comparison to Bilateral Approach / 대한정형외과학회잡지

PURPOSE: This is a comparison of the unilateral and bilateral approaches for minimal invasive transforaminal lumbar interbody fusion (TLIF), and we did so by measuring the clinical and radiological results. MATERIALS AND METHODS: This study examined a consecutive series of 47 patients who underwent one-level TLIF (26 cases of the unilateral approach and 21 cases of the bilateral approach to the lumbar spine) and the follow-up data was compared with a minimum 1-year follow-up. Sublaminar decompression and contralateral foraminectomy were done in all the case of using the unilateral approach. The age of each patient, the amount of intraoperative blood loss, the postoperative drainage, the transfusion requirement and the surgery time were investigated. The clinical outcomes were analyzed using the visual analogue scale, the SF-36 Physical Composite Score (PCS) and the Oswestry disability index (ODI). The preoperative, postoperative & last follow-up changes in the height and angles of the disc in the fused segments and the lumbar lordotic angles were radiologically analyzed. RESULTS: There was no statistical difference between the two groups in terms of the clinical and radiographic results at the last follow-up. But the unilateral approach-group was found to have a less blood loss, less postoperative drainage, a lesser requirement for transfusion and a shorter surgery time. CONCLUSION: This study confirms that the unilateral approach can be the better way if the technical problems are solved.

The Effect of Vertebral Wedge Angle to the Change of Kyphotic Angle by the Posterior Instrumentation Method in Thoracolumbar Spine Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To examine the effect of transpedicular screw fixation on fractured vertebrae about the vertebral wedge angle (VWA) after posterior instrumentation of the thoracolumbar fracture, determine the effect of reduced VWA on the change in the Kyphotic angle (KA), and minimize loss of reduction of KA. SUMMARY OF THE LITERATURE REVIEW: Maintenance of the KA of a thoracolumbar fracture after surgery is important for the radiologic and functional outcome. MATERIALS AND METHODS: Forty patients, who had undergone posterior instrumentation in a thoracolumbar fracture between February 2006 and February 2008 and followed-up for more than one year, were enrolled in this study. The patients were divided into two groups according to transpedicular screw fixation (Group A) or not (Group B) including fractured vertebrae. The evaluation was performed by measuring the changes in the KA and VWA taken after the injury, immediate after surgery and 1 year after surgery. RESULTS: There was correlation between groups A (transpedicular screw fixation on fractured vertebrae) and B (no transpedicular screw fixation on the fractured vertebrae) regarding the correction of the VWA and the loss of correction KA, (p<0.05). CONCLUSIONS: Reduction of the VWA is an important factor for preventing reduction loss of the KA, and transpedicular screw fixation including fractured vertebrae would help reduce the VWA. Therefore, the operator must pay attention to the increase in VWA to maintain the KA through short segment transpedicular screw fixation including fractured vertebrae.

The Quantitative Analysis of Back Muscle Degeneration after Posterior Lumbar Fusion: Comparison of Minimally Invasive and Conventional Open Surgery

STUDY DESIGN: Prospective controlled study. PURPOSE: The results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration. OVERVIEW OF LITERATURE: MI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery. METHODS: This study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery. RESULTS: A comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results. CONCLUSIONS: A comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.

Surgical Treatment of Spontaneous Spinal Epidural Hematoma: A Case Report / 대한척추외과학회지

Spontaneous spinal epidural hematomas without any risk factors, such as spinal tap, trauma, pregnancy, bleeding diathesis, vascular malformations, hypertension, etc. are relatively rare clinical entities. In addition, the clinical suspicion is quite difficult because there are various clinical symptoms according to the size and location of hematoma. However, the speed of diagnosis and initiation of the appropriate treatment are important because the outcome for patients is usually determined by the location and degree of neurological deficits and the duration of dural compression. We report the diagnosis and treatment of spontaneous spinal epidural hematoma in this case with a review of the relevant literature.

Usefulness of Coronal MR Image in Diagnosis of Foraminal and Extraforaminal Disc Herniation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: The coronal MR images were carefully evaluated to document the efficacy of diagnosing foraminal and extraforaminal disc herniations. SUMMARY OF LITERATURE REVIEW: Extraforaminal disc herniations constitute 1~11.7% of all disc herniations. The diagnosis of it demands great caution because it must be distinguished from intraspinal canal disc herniation. Diagnosing extraforaminal disc herniations can be neglected with using ordinary diagnostic methods. MATERIALS AND METHODS: A retrospective analysis was performed on 24 patients, (26 cases) that underwent lumbar spine MRI, with the T2 coronal images, for the evaluation of disc herniations from March 2006 to March 2007. Every MRI image of each patient who had foraminal or extraforaminal disc herniations was graded according to the Pfirrmann's classification of diagnostic efficacy by two spinal surgery specialists and two radiology specialists. RESULTS: There were 13 cases of foraminal disc herniation and 13 cases of extraforaminal disc herniation in all 26 cases that were diagnosed by MRI. The coronal and axial images were more effective than the sagittal images for the discrimination of a compressed root. Especially, for the extraforaminal disc herniation, all of the coronal images were graded as grade 3; on the other hand, all of the sagittal images were not helpful for the assessment and the axial images were graded as grade 2 for 38.5% of the and as grade 3 for 61.5%. So, the coronal images were most effective for making the diagnosis of extraforaminal disc herniation and this was statistically significant (p<0.05). CONCLUSION: For the accurate discrimination of the location and the grading of foraminal and extraforaminal disc herniation, MRI, and especially the coronal images, is an effective and useful method in addition to conducting a physical examination.

Neurologic Complication after Percutaneous Vertebroplasty with Polymethylmethacrylate: A Case Report / 대한척추외과학회지

In recent years, percutaneous vertebroplasty has frequently been used to treat osteoporotic compression fractures. This procedure is generally known to be safe because of the rare occurrence of complications. However, it is accompanied by the risk of cement leakage, and the cement can be easily removed using a surgical technique. Most neurological complications occurred due to extravasation of cement into the spinal canal. Comparatively, there were no reports of neurological complications due to the extravasation of cement into the paravertebral area. Here, we report a case of right-exiting L1 spinal root compression after percutaneous vertebroplasty with polymethylmethacrylate (PMMA). We proceeded to cement removal and nerve root decompression by a paraspinal open microsurgical technique in the event of neurological complication.

Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty

PURPOSE: To evaluate the risk factors related to the development of new fractures in adjacent vertebrae after vertebroplasty. MATERIALS AND METHODS: The study was conducted on 46 patients in whom 296 patients were performed during last 9 years. We were especially concerned with the restoration rate of vertebral height and kyphotic angle and estimated them on simple X-ray films. RESULTS: In patients experienced subsequent vertebral fractures and no subsequent vertebral fractures after vertebroplasty, the mean height restoration rate of treated vertebra were 16.7% and 7.07%, and the kyphotic angle difference were 2.53 degree and 4.2 degree. The greater degree of height restoration of the vertebral body, especially in middle vertebral height and the lesser degree of kyphotic angle difference increased the risk of adjacent vertebral fracture risk. This results were available statistically (all p<0.05, Logistic regression test, SPSS 13.0). CONCLUSION: It may be thought that the vertebral body height restoration rate will become risk factor of adjacent vertebral fractures.

Long Term Results of LCS Mobile Bearing Knee System in Total Knee Arthroplasty

PURPOSE: To evaluate the long-term (over 10 years) clinical and radiologic results of LCS (low contact stress, Depuy, USA) total knee arthroplasty (TKA) retrospectively. MATERIALS AND METHODS: Out of 57 cases who underwent TKA with LCS knee system between June 1994 and August 1995, 33 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survival rate were evaluated. RESULTS: Average flexion contracture was improved from 10.0degrees preoperatively to 3.7degrees at final followup and average ROM was improved from 104.0degrees preoperatively to 115.3degrees at final follow-up (p<0.05). Average HSS score was improved from 49.5 preoperatively to 80.1 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 3.3degrees varus preoperatively to 3.5degrees valgus at final follow-up. There were 4 complications, including infection in two cases and fracture dislocation of polyethylene implant in two cases respectively. Ten year survival rate was 94.1 percent. CONCLUSION: LCS TKA showed excellent results and good survival rate at more than ten years followup. However, more cases should be necessary for statistic significance.

Arthroscopic Osteochondroplasty of the Osteochonral Lesion of the Talus / 대한족부족관절학회지

PURPOSE: To evaluate the clinical characteristics and the functional results of the osteochondral lesions of the talus (OLT) treated with arthroscopic osteochondroplasty. MATERIALS AND METHODS: The study was based on 25 cases (25 feet) of osteochondral lesion of talus that were treated with arthroscopic osteochondroplasty from May 1997 to June 2005 with at least 1 year follow-up. Follow-up period was average 21.8 months. The average age was 37.2 years old. Male patients were 22 while female were 3. Postoperative evaluation was performed with American Orthopedic Foot and Ankle Society (AOFAS) Functional score, patient satisfaction and complications. RESULTS: Ninety-two percent of patients had trauma history. Seventy-two percent of the lesions were located at the medial dome. As for the cartilage classification, 56% were fibrillation/fissure lesions while 44% were flap tears. Visual analogue scale (VAS) pain score improved from 6.8 points to 2.2 points, and AOFAS score improved from 71.3 points to 87.3 points. Eighty-eight percent of the patients were satisfied with the surgery and average period of returning to previous job was 6.5 weeks. CONCLUSION: We concluded that the arthroscopic osteochondroplasty is a viable surgical option for the osteochondral lesion of the talus.

Treatment of Intercondylar Fractures of Humerus with Y-plate

PURPOSE: To evaluate the results of the treatment of intercondylar fractures of the humerus using Y-plate. MATERIALS AND METHODS: The subjects were 17 patients with intercondylar fracture of humerus who were treated using the Y-plate. Nine cases were C1 type, 4 were C2 type, and the remaining 4 were C3 type. 11 subjects had accompanying fractures of another part of the body. The average age was 48.8. The average follow up period was 33 months. We used Mayo Elbow Performance Score and Risborough-Radin's rating score for each patient as the methods of rating. RESULTS: The average range of motion of the elbow was 105 degrees (50~150 degrees). According to Cassebaum's classification for elbow range of motion, 7 cases were rated very good, 1 cases were good, 4 cases were fair, and 1 cases were poor. According to Mayo Elbow Performance Score, 7 were excellent, 7 were good, 2 fair, and 1 poor. Of the 3 patients who were fair or poor in Mayo Elbow Performance Score, 2 were type C3 fractures, and all 3 had major accompanying fractures. No significant postoperative complications developed in all cases. CONCLUSION: The fixation with Y-plate can still be a relatively good modality of treatment for interconylar fractures of the humerus in selected cases, in spite of the known mechanical weakness of the Y-plate. The patients with severe intra-articular comminution showed relatively poor results. And we think that the age of the patient and the energy of the injury have more or less influence on the results of treatment.

A Clinical Analysis of 260 Percutaneous Vertebroplasty in the Treatment of Osteoporotic Compression Fracture

PURPOSE: To evaluate retrospectively the results regarding pain relief, complication after percutaneous vertebroplasty, for an osteoporotic compression fractures. MATERIALS AND METHODS: 260 patients (male 55, female 260, mean age 69.4 years old) treated by percutaneous vertebroplasty in Dankook University Hospital from July 1997 to July 2004 were reviewed. We performed percutaneous vertebroplasty and observed the degree of pain relief using pain scale pre-/postoperation. we evaluate the complication by plain radiographs and computed tomography, ABGA and chest X-ray. we evaluate pain relief and complication for 1 week by follow-up plain radiographs. we recommended BMD follow-up per 1 year and osteoporosis medication at least 2 years. A clinical result was evaluated as excellent, good, fair, poor and visual analogue scale (VAS 0~10) for 1 year. We prefaced a statistical analysis by T-test using SPSS (version 11.0) correlating 1 week and 1 years effects. RESULTS: 73 (28.3%) of the patients were evaluated as excellent: 123 (45.5%), as good: 45 (17.8%), as fair; and 23 (8.5%), as poor, show 73.8% over good in 1 week. 76 (29.3%) of the patients were evaluated as excellent; 120 (44.3%), as good; 43 (16.8%), as fair; and 25 (9.6%), as poor in 1 year, show 73.6% over good result. 1 week follow-up and 1 year follow-up show similar results. 1 patient had death (hemothorax), 4 patients had arrhythmia, 15 patients (21 vertebrae) had fracture around vertebroplasty. CONCLUSION: Percutaneous vertebroplasty using PMMA is valuable method in the treatment of osteoporotic compression fracture, providing immediately pain relief, long term pain relief, prevention of complication originated from long term traction and bed rest, unwearing brace and early ambulation.

Radiologic Measurement of Pelvic Sagittal Incidence and Lordosis in Young Korean Women / 대한정형외과학회잡지

PURPOSE: To determine the normative data for the pelvic morphology parameters in the young Korean female population. MATERIALS AND METHODS: Young Korean female patients in 20s and 30s who had visited the outpatient clinic for a first attack acute sprain underwent a telephone interview at a minimum of 1 year after their last hospital visit. Those who had recovered completely and had no back-related complaints were selected for the pelvic lordosis angle (PRS1)and pelvic angle of incidence (AOI)measurements (n=40 each age group). RESULTS: There was no age difference in both parameters. The PRS1 in the young female population was 38.7+/-8.3 degrees (range: 13.6-52.9 degrees and the AOI was 48.5 +/-9.4 degrees(range: 30.5-74.7 degrees, which shows a close correlation between the two parameters (correlation coefficient, r=-0.965). The linear regression equation obtained is as follow; Equation I: PRS1=79.909-0.850 x AOI, Equation II: AOI=90.902-1.096xPRS1 (linear regression analysis, p=0.000, R2 =0.931). CONCLUSION: The data obtained from the study may be used for future studies related to the sagittal spinopelvic balance.