Effect of Critical Pathway of Lumbar Posterolateral Fusion in Spinal Stenosis / 대한정형외과학회잡지

PURPOSE: This study was conducted to identify the effects of the critical pathway (CP) on the quality of medical care, and to determine means of reducing costs for lumbar posterolateral fusion in patient with lumbar spinal stenosis. MATERIALS AND METHODS: The subjects were 25 control patients with lumbar posterolateral fusion, and 25 experimental patients with application of CP. We compared the patients' functional status using the Oswestry disability index, patients'satisfaction by quality patient care scale, the length of hospitalization and the medical charges between the two groups. RESULTS: Differences between the Oswestry disability index of the experimental and control groups were not significant. No differences were found between two groups regarding general care, but the experimental group was more satisfied with specific care related to spinal fusion. The mean length of stay of the experimental group was shorter than that of the control group, and the charge of medication and treatment of the experimental group was lower than that of the control group. CONCLUSION: Critical pathway improves the quality of care and reduces medical charges.

Change of Periprosthetic Bone Mineral Density after Cementless Total Hip Arthroplasty: Using Extensively Porous Coated Femoral Stem / 대한정형외과학회잡지

PURPOSE: To investigate the annual change of bone mineral density (BMD) around the femoral stem and identified the factors that influence the stress shielding effect in patients who have received extensively porous coated cementless stem. MATERIALS AND METHODS: We reviewed seventy-four patients who were followed up for longer than three years after unilateral primary total hip replacement arthroplasty. The BMD was measured annually using a DEXA QDR 4500(R) on the proximal femur according at the Gruen zone. We analyzed the relationship between the results and the possible variates of periprosthetic bone remodeling. RESULTS: In first year after operation, the BMDs of all Gruen zone decreased significantly. From the second year, the BMDs in Gruen zones 1, 2, and 7 were decreased significantly, but those in Gruen zones 3, 5, and 6 were increased. After three years, the BMD showed no significant change. Among the examined variables including sex, patient's age, stem size, and preoperative Singh's index, stem size and age were found to have strong predictive value. CONCLUSION: Our findings suggest that periprosthetic BMD decreased in all areas over first postsurgical year. From the third year, the BMD stabilized.

Arthroscopic ACL Reconstruction using Bone-patellar Tendon-bone Autograft and Bioabsorbable Interference Screw / 대한정형외과학회잡지

PURPOSE: We report the results of arthroscopic ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a bioab-sorbable interference screw (Bioscrew, poly L-lactic acid, Linvatec co., USA). MATERIALS AND METHODS: From January 1998 to December 1998, we performed 39 cases of arthroscopic ACL reconstruction using BPTB autograft and a bioabsorbable interference screw. The average follow-up period was 2 years and 8 months. We performed KT-2000 testing and measured the IKDC, Tegner and Lysholm scores preoperatively and compared these with the results of a final evalua-tion. We performed second-look arthroscopy on 4 cases and observed the degree of degradation of the bioabsorbable interference screw. RESULTS: Preoperative evaluation revealed an average range with a KT-2000 of 8.1 +/-3.4 mm, a Lysholm score of 66.2 +/-16.3, an IKDC score below C in all cases and a Tegner score of 3.7 +/-0.9, but final results showed a KT-2000 of 2.8 +/-2.2 mm, a Lysholm score of 91.7 +/-7.5, an IKDC score above B in all except 3 cases and a Tegner score of 6.9 +/-1.1. Second-look arthroscopy at 3 and 12 months post-operatively showed no degradation of the bioabsorbable interference screw, but there was partial degradation of the bioabsorbable inteference screw at 21 and 33 months. CONCLUSION: Bioabsorbable interference screws seems a reasonable alternative to metallic screws in ACL reconstruction. Bioab-sorbablescrew implanted in humans may take much longer to degrade than expected, more study is needed.

Histomorphometry of Osteogenesis Imperfecta I / 대한내분비학회지

Osteoporosis imperfecta (OI) is a genetic disorder characterized by fragility of bone, deafness, blue sclerae; and laxity of joints. Four types of OI are distinguished by clinical findings. Although mutations affecting collagen I are responsible for the disease in the most patients, the mechanism by which the genetic defects cause abnormal bone development has not been well established. Therefore we evaluated static and dynamic bone histomorphometry of type I OI in the case study of a 15 year old boy with OI who had blue sclerae, a history of frequent fracture and a familial history of blue sclerae. Biopsy of the ilium showed loss of connection between the cortical bone and trabecular bones. The Harversian system in the cortical bone was poorly developed. In the trabecular bones, the lamellar pattern was poorly developed. Mineral apposition rate of the cortical bone was 1.0 m/day and of the trabecular bone was 0.79 m/day. Thus OI might be regard as a disease whereby abnormal collagen synthesis interferes with bone strength by multiple mechanisms.

Clinical Characteristics of Isolated Meniscal Tear / 대한정형외과학회잡지

PURPOSE: Of all meniscal tears, isolated meniscal tear accounted for about 20%~30%. Also only a few reports in the literature dealt with isolated meniscal tear, which has a lower repairability and healing rate compared to patients with meniscal tear associated with ACL rupture. This study was undertaken to evaluate the clinical characteristics of isolated meniscal tear. MATERIALS AND METHODS: Between June, 1996 and May, 1999, 170 cases confirmed to have a meniscal tear by arthroscopy, were included in this study. We analysed clinical characteristics, according to the type of injury, medial meniscal tear versus lateral meniscal tear, type and site of meniscal tear, as well as possibility of repair. RESULTS: The frequency of medial meniscus tear is more common than that of lateral meniscus tear. Additionally, the most common cause of meniscal tear was non- contact injury. Of the total isolated meniscal tears, 20.5% were repaired. CONCLUSION: In our case, the incidence of medial meniscus tear is higher than that of the lateral meniscus tear, but this study noted a significantly low incidence of repairablity in isolated meniscal tear. Based on preliminary findings in this study, we consider degenerative change of meniscus as the most important factor explaining the clinical characteristics of meniscus tear in patients, especially, over the age of 30.

Diagnostic Value of Arthrometer (KT-2000) in Patients with Anterior Knee Instability / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to present the usefulness of arthrometer (KT-2000) in patients with anterior knee instability and to assist in evaluating an objective prognosis after anterior cruciate ligament reconstruction. MATERIAL AND METHOD: We analyzed the manual maximum anterior displacement, passive anterior displacement at 30Ib force and compliance index between 15Ib and 30Ib, measured by KT-2000 in 82 cases of patient who had unilateral anterior knee instability and 40 cases of volunteers, as control group, who had no history of knee injury. We used the Paired and Independent t-test for statistical analysis. RESULTS: In control group, the mean value of manual maximum anterior displacement is 0.8 +/- 0.9mm, passive anterior displacement, 1.4 +/- 1.3mm and compliance index, 1.1 +/- 1.1mm. In patient group, the mean value of manual maximum anterior displacement is 7.1 +/- 2.7mm, passive displacement, 6.1 +/- 2.6mm and compliance index, 3.8 +/- 1.8mm. We found that the patient group was revealed much higher degree of anterior displacement than the control group (p<0.005) . CONCLUSION: KT-2000 is objective and quantitative in diagnosis of anterior knee instability.

Posterolateral Decompression and Posterior Instrumentation in Lumbar and Thoracolumbar Burst Fracture with Neurologic Deficit / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the postoperative outcome of posterolateral decompression and posterior instrumentation in lumbar and thoracolumbar burst fracture with neurologic deficit. SUMMARY OF LITERATURE REVIEW: There are several methods to decompress the spinal canal following fracture. The use of posterolateral decompression had been limited due to several reasons including postoperative instability and further neurologic injury. The development of fixation system and new designed impactor solved the limitation of posterolateral decompression. MATERIALS AND METHODS: 11 posterolateral decompression and pedicle screw instrumentation in burst fractures were performed. We measured canal compromise, reduction of sagittal curve and recovery of neurologic condition before and after surgery and at final follow-up. RESULTS: Canal compromise was reduced from 60.4% to 12.8% postoperatively. The sagittal index was 24.5 .preoperatively, 2.3 . postoperatively and 7.4 .at final follow-up. The recovery of neurologic condition was 1.1 degree in Frankel grade. CONCLUSION: Single-stage posterolateral decompression and posterior instrumentation is an effective technique to obtain neurologic recovery and rigid stabilization in the management of a lumbar and thoracolumbar burst fracture with neurologic deficit.

Arthroscopic-assisted Treatment of the Tibial Condylar Fracture

PURPOSE: Recently, there are many good reports on the arthroscopic management of tibial condylar fractures. But, it may be appropriate for selected tibial condylar fractures and also needs a skilled technique. So we report the results of the tibial condylar fractures treated by the arthroscopy and limited percutaneous fixation or the arthroscopic-assisted management with conventional internal fixation without arthrotomy. MATERIALS AND METHODS: From June 1996 to December 1997, we treated 22 cases of the tibial condy- lar fractures including relatively comminuted one and analysed the results of patients who have been observed at least 1 year with Porters knee evaluation criteria. RESULTS: In 18 out of 22 cases, the results were Acceptable on symptoms(excellent 3, good 15, fair 4), in 18, on function(excellent 10, good 8, fair 3), in 21, on appearance(excellent 12, good 9, fair 1) and in 20, on radiographic appearance(excellent 11, good 9, fair 2). Overall results were Acceptable in 18 cases(82%) and Unacceptable in 4 cases(18%). CONCLUSION: The arthroscopic-assisted management with conventional internal fixation without arthrotomy can be the recommendable treatment for the tibial condylar fractures, including relatively comminuted one, without complications.

Clinical Diagnosis of Meniscus Injury of Knee Joint / 대한정형외과학회잡지

PURPOSE: To report the differences between previous articles in Korea on the common occurence of lateral meniscus tears and our cases, and also which clinical symptoms and signs are the most reliable for diagnosis of meniscal tear. MATERIALS AND METHODS: We analysed 118 patients who were confirmed to have a meniscal tear by arthroscopy from May 1996 to May 1998. The Chi-Square test was used for statistical analysis. RESULTS: There is no statistical difference of frequency between tears of the medial meniscus and those of the lateral meniscus. The most frequent clinical symptom is feeling of subluxation and sign is McMurray test. A combination of McMurray and squatting test is the most frequent positive sign of meniscal tear in our cases. CONCLUSIONS: In our cases, the frequency of medial meniscus tears is more common than those of the previous articles in Korea. To increase the accuracy of clinical diagnosis of meniscal tear, repeated and accurate history taking and physical examination, including above symptoms and signs are very important.

Different Patterns of Meniscal Tears in Recent Anterior Cruciate Ligament ( ACL ) Ruptures and Chronic ACL-deficient Knees / 대한정형외과학회잡지

PURPOSE: We tried to outline the incidence and characteristics of meniscal tears in recent lesions and chronic insufficiency of the ACL. MATERIALS AND METHODS: Through this retrospective study of 103 reconstructions of the anterior cruciate ligament (ACL) performed between Jun 1996 to Sep 1998, according to a more accurate evaluation, ACL-deficient knees can be classified into two different stages (recent, chronic injuries). RESULTS: Overall, there was a significantly increasing incidence of meniscal tears in chronic injuries (P<0.05). A predominance of lateral meniscal tears were demonstrated with recent injuries, whereas the incidence of medial meniscal tears increased significantly with chronic injuries (P<0.05). CONCLUSIONS: This study highlights the increase of lateral meniscal lesion in recent ACL rupture and increase of severe meniscal lesion, especially medial meniscus, with progressive worsening of knee instability after an ACL injury. Although not significant, meniscal tears in the recent injuries were more amenable to repair. The results suggest that maximal meniscal preservation is best achieved with ACL reconstruction shortly after injury.

Diagnostic Accuracy of Percutaneous Needle Biopsy of Vertebral Lesions / 대한척추외과학회지

STUDY DESIGN: This retrospective study is to confirm the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions. OBJECTIVES: To evaluate the diagnostic accuracy of percutaneous needle biopsy and the clinical and pathological correlation of vertebral lesions. SUMMARY OF LITERATURE REVIEW: A review of previous articles showed that the diagnostic accuracy of percutaneous needle biopsy of vertebral lesions was between 77-94%. The greatest accuracy was achieved in diagnosis of metastatic disease or infection. MATERIALS AND METHODS: We performed 22 percutaneous needle biopsies in twenty vertebral bodies and two posterior elements under the CT guidance. All biopsies were performed with a 16-gauge Osty-cut bone biopsy needle. There were 1 cervical, 8 thoracic and 13 lumbar biopsies. Transpedicular approach was performed on 13 patients and paraspinal approach on 7 patients. There were 8 malignancies, 9 infections, 2 benign tumors, 2 compression fractures and 1 butterfly vertebra. RESULTS: An accurate diagnosis was made in 18 cases(81.8%) of all cases. Two of the 22 specimens were blood clots and two specimens of tuberculous spondylitis were insufficient for definite diagnosis. Bacteriological studies revealed a causative agent in 43% of pyogenic spondylitis. Histologic diagnosis confirming the clinical suspicion was obtained in 16(80%) of the 20 positive cases. There was no complication. CONCLUSION: Percutaneous needle biopsy under the CT guidance is a safe and accurate method for obtaining a diagnosis of vertebral lesions such as osteolytic lesion and infection.

Production of TGF-beta Transfected Fibroblast and Myoblast Stable Cell Lines and their Viability in Rabbit Achilles Tendon / 대한정형외과학회잡지

Transforming growth factor-beta (TGF-beta) has been suspected as a possible gene therapy candidate for orthopedic diseases. We demonstrated that the TGF-beta gene therapy can be applicable to orthopedic patients. After transfection of TGF-beta cDNA sequence to myoblasts [C2 (280)] and fibroblasts (NIH 3T3), stable cell lines with TGF-beta mRNA expression were selected by Northern analysis. To evaluate the possibility of clinical application of these cells to orthopedic diseases, the cells were injected into rabbit achilles tendon. Intratendinous injection was done to evaluate the viability of the cells and to determine the optimal concentration for in vivo expression. At 6 weeks after injection, the injected tendon was thickened with newly formed collagen. The results from this experiment indicates that these cells survived and stimulated matrix formation in rabbit achilles tendon. We concluded that TGF-beta cDNA transfected cells can be useful in the evaluation of TGF-beta biology in vivo.

TGF - beta Type II Receptor Anomaly and of Its Functional Restoration in Osteosarcoma Cell Lines / 대한정형외과학회잡지

TGF-p receptor mutation is now considered as one of the carcinogenic process of many tumors. To evaluate whether there is an abnormality in TGF-p type II receptor in osteosarcoma cell lines, we performed Northern analysis, cross-linking assay, luciferase activity and TGF-p growth inhibition assay in four osteosarcoma cell lines: G292, U202, HOS and SaOS. We also transfected the tumor cells with normal TGF-p type II receptor sequence to find if there is a possibility of gene therapy in osteosarcoma. In Northern analysis, Type II receptor expressions were decreased at SaOS, U202 and HOS cell lines. In cross-linking assay, all four cell lines didnt show type II receptor at their cell surface. The growth of these tumor cells were not suppressed by TGF-p. From these findings, we concluded that the normal production of TGF-p type II receptor was impaired in osteosarcoma. The transfection of these tumor cells with normal type II receptor sequence restored growth inhibition by TGF-p. This means even though TGF-p type II receptor is abnormal in osteosarcoma, we can restore its function by transfection of normal sequence. We think that the TGF-p type Il receptor gene therapy can be one of the treatment method for osteosarcoma in the future.