Role of Vascular Endothelial Growth Factor in Diabetic Frozen Shoulder / 대한정형외과학회잡지

PURPOSE: To investigate the role of VEGF (vascular endothelial growth factor) and macrophage cells in the pathogenesis of diabetic frozen shoulders. MATERIALS AND METHODS: Five diabetic frozen shoulders which were resistant to conservative treatment were involved in this study. Synovial tissue was obtained during arthroscopic adhesiolysis. The synovial tissue of the shoulders from cadava dominators who had no history of shoulder joint disease was used for the control study. Immunohistochemical staining was performed with polyclonal antibodies against VEGF and CD68 macrophage/synovial antigen. RESULTS: Injection and hypertrophy of the synovium and thickening of the capsule were noted in all diabetic frozen shoulders. Strong immunostaining to VEGF and CD68 was observed in all diabetic frozen shoulders, whereas the control specimens showed little staining. CONCLUSION: From these results it would be postulated that the VEGF, synthesized and secreted by macrophage/synovial cells of the diabetic frozen shoulders stimulate regional angiogenesis which leads to synovitis and fibrosis could be one of the leading factors in the pathogenesis of frozen shoulders in diabetic patients.

Surgical Treatment for the Neglected Non-union of the Lateral Humeral Condyle / 대한정형외과학회잡지

PURPOSE: To assess the clinical results of surgical treatment for established nonunion of the lateral humeral condyle and to determine the factors necessary for successful outcome. MATERIALS AND METHODS: 12 patients with nonunion of the lateral humeral condyle underwent open reduction, autogenous iliac bone graft and internal fixation with two smooth or treated K-wires between 1994 and 1999. Mean age was 16 years and the mean follow-up period was 2 years and 8 months. RESULTS: All of the patients achieved solid union at the nonunion site and were free of pain in the elbow upon strenuous activities. Average union time was 7.2 weeks after the surgery. Aggressive anatomical reduction of the fragment must not be undertaken because it may disturb a well adapted joint congruity in adults. Rigid internal fixation with iliac bone graft and preservation of the blood supply of the distal fragment are important factors for a successful outcome. The range of motion of the elbow joint decreased 10.5 degrees on average after surgery. Valgus deformity improved in four of six patients. CONCLUSION: The patients with symptomatic established nonunion are good candidates for surgery, even adults.

The Usefulness of MRI in Evaluating the Shoulder Injury / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the accuracy and the usefulness of MRI in patients with shoulder injuries. MATERIALS AND METHODS: The sensitivity and the accuracy of MRI in the diagnosis of various lesion were evaluated in 20 patients with shoulder injuries. RESULTS: MRI enabled Bankart lesions and SLAP lesions to be accurately predicted with 100% sensitivity and 90% accuracy in both. However, for types of SLAP lesions, the sensitivity and the accuracy were 60% and 70%, respectively, and for full-thickness or partial-thickness tear of rotator cuff, the sensitivity and the accuracy were 75% in both. MRI was also effective at predicting rotator cuff tear with 100% sensitivity and 95% accuracy. Sensitivity and accuracy for the diagnosis of Hill-Sachs lesion were 91.7% and 90%, respectively. For all lesions except Hill-Sachs lesion, the negative prediction value was higher than the positive prediction value, which means MRI overestimated the lesions. CONCLUSION: MRI was accurate and useful in the prediction of prediction of rotator cuff tear, labral tear and Hill-Sachs lesions. However, for the identification of full-thickness or partial-thickness tear of rotator cuff, and types of SLAP lesions, it was less accurate and less useful.

Correction of Curve and Determination of Fixation Segment in Degenerative Lumbar Scoliosis / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to investigate the effectiveness of surgical procedure for degenerative lumbar scoliosis. OBJECTIVES: To evaluate surgical outcome on symptomatic degenerative lumbar scoliosis and to analyze the cause of decompensation of the curve at the above segment adjacent to fused vertebra. SUMMARY OF LITERATURE REVIEW: Few studies evaluated the surgical outcome of patients with symptomatic degenerative lumbar scoliosis, and observed the postoperative deompensation of the curve at adjacent segment. MATERIALS AND METHODS: Thirty patients were retrospectively reviewed. All patients underwent decompressive laminectomy, transpedicular screw fixation, and intertransverse fusion by autogenous bone graft. Scoliotic angle within curves and within fused segments were measured by Cobb's method. Changes of the adjacent segment were analyzed. RESULTS: The overall satisfactory clinical results was noted in 25(83%) of 30 patients. The curve preoperative averaged 13.3 degrees +/- 4.0 degrees, 5.5 degrees +/-3.2 degrees after surgery and curves at final follow-up 8.6 degrees +/-6.2 degrees. In six patients(20%) decompensation of the curve with more than 5degrees occurred at the adjacent segment above to the fused segments. This decompensation of the curve closely correlated to the lateral translation at adjacent segments and postoperative pain. Sagittal profile was not significantly improved following surgery. CONCLUSIONS: Uncorrected lateral translation at the unfused adjacent segment resulted in progression of the coronal deformity at upper adjacent segment to fused vertebrae. Therefore, in fusion operation upper end vertebra with lateral instability should be included to prevent the postoperative decompensation.