Complication Rate and Clinical Result of One-Week Interval Staged Bilateral Total Knee Arthroplasty: Compared to Simultaneous and Several-Months Interval Staged Bilateral Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to compare the clinical results and the rates of complication among three groups that received the simultaneous total knee replacement (TKR), one-week interval staged bilateral TKR, or several-months interval staged TKR. MATERIALS AND METHODS: We conducted a retrospective study of patients who had been diagnosed with bilateral degenerative osteoarthritis undergoing bilateral TKR from 2004 May to 2012 March. We divided patients into three groups which received simultaneous TKR (Group A, n=84), one-week interval staged bilateral TKR (Group B, n=124), or several-months interval staged TKR (Group C, n=65). Hospital for special surgery (HSS) score and the rate of complication were evaluated and compared. RESULTS: Mean postoperative HSS score showed significant improvement in the three groups. No difference in postoperative HSS was observed among the three groups (p=0.325). The complication rate in Group A was lower than that in Group B (p=0.049) and that in Group A was similar to that in Group C (p=0.786). CONCLUSION: Group A had a better result than Group B and was similar to Group C in complication rate. One-week interval staged TKR can be good choice in patients with bilateral degenerative osteoarthritis.

Radical operation on Tetralogy of Fallot and its perioperative outcomes in different ages / 中华实用儿科临床杂志

Objective To explore the feasibility and advantages of early open-heart radical operation on infants and children with Tetralogy of Fallot(TOF) in different ages and to analyze its perioperative outcomes.Methods The clinical data of 390 infants and children with TOF were analyzed, who underwent extracorporeal circulation open-heart surgery from January 2007 to January 2014 at the Department of Cardiovascular Surgery,the Third Affiliated Hospital of Zhengzhou University.The operative age ranged from 3 months to 14 years(mean 3 years).There were 172 infants(＜ 1 year old)and 218 children(≥ 1 year old).Some accompanied abnormalities included atrial septal defect (33 cases),patent ductus arteriosus (17 cases),coronary artery anomalies (8 cases), and multiple ventricular septal defect (5 cases).Results Ten patients died, and the overall mortality during hospital stay was 2.56％.The mortality of the infants group and the children group was 2.32％ (4/172 cases) and 2.75 ％ (6/218 cases), respectively,and there was no significant difference (x2 =0.000, P =1.000).Extracorporeal circulation time was (89.16 ± 74.38) min and (83.14 ± 66.72)min, respectively, aortic clamping time was (59.75 ± 35.20) min and (54.70 ± 38.54)min respectively, operation time were (185.34 ± 168.64)min and (163.35 ± 150.15) min respectively, duration of postoperative ventilation were (57.17 ± 67.46) h and (47.50 ± 58.39) h, respectively, the hospitalization time in the Intensive Care Unit was (5.08 ± 7.93) d and (3.71 ± 5.40) d, respectively, and the postoperative stay averaged (13.82 ± 17.78) d and (9.52 ± 8.74) d respectively in the infants group and the children group;there was no significant differences between 2 groups (t =1.937,1.890, 1.991,1.887,1.951,1.931;P =0.259, 0.713, 0.194, 0.739,0.241,0.308).Conclusions The curative effect of early cardiac surgical treatment on infants with TOF is considerably good with low morbidity and mortality.Early cardiac surgical treatment can avoid delayed development and growth in children, hypoxemic spells,sudden death and some other kind of adverse events.

Clinical Results And Prognostic Factors for Thoracic Myelopathy Caused by Ossification of Yellow Ligament after Surgical Treatment

STUDY DESIGN: Retrospective study. OBJECTIVES: We analyzed the clinical results of thoracic myelopathy caused by ossification of yellow ligament (OYL) and to explore prognostic factors after surgical treatment. SUMMARY OF LITERATURE REVIEW: Thoracic myelopathy due to OYL is difficult to treat; surgery is considered as treatment of choice. However, studies of the clinical results and prognostic factors are few due to its rare presentation. MATERIALS AND METHODS: Twenty six patients who had surgery for thoracic myelopathy caused by OYL were evaluated from February 2002 to April 2012. We describe the analysis of the clinical results after surgery and prognostic factors. RESULTS: Modified Japanese orthopedic association (JOA) score was recorded in all patients by 5.7+/-1.3 points (range, 2-9 points) preoperatively, 7.8+/-1.7 points (range, 4-10 points) postoperatively, and 8.4+/-2.1 points (range, 5-11 points) at final follow-up. Hirabayashi recovery rate was recorded by 60.2+/-20.2% (range, 45.5-72.0%) postoperatively, 64.5+/-17.3% (range, 50.2-75.1%) at final follow-up. The Visual Analogue Scale (VAS) score was also improved by 7.6+/-1.8 points (range, 7-10 points) preoperatively, 4.5+/-1.3 points (range, 3-6 points) postoperatively, and 3.8+/-1.6 points (range, 2-5 points) at final follow-up. Both modified JOA score and VAS score improved significantly (p<0.05). In prognostic factor analysis, OYL type on CT axial image, duration of symptom, and preoperative severity of myelopathy was significant (p<0.05). CONCLUSION: We showed the effectiveness of surgery on patients who suffer from thoracic myelopathy caused by OYL and that OYL type identified by CT axial image, duration of symptom, and preoperative severity of myelopathy were significant prognostic factors.

Corelation between the Treatment Result and Causative Bacteria in Amputation of Diabetic Foot / 대한족부족관절학회지

PURPOSE: To evaluate correlation between the clinical results and causative bacteria in diabetic foot patients with lower extremity amputation. MATERIALS AND METHODS: One hundred twenty nine patients(131 feet) of diabetic foot amputations were followed for more than one year. Wound cultures were done by deep tissue or bone debris at first visit to our clinics. Retrospective analysis was performed using chart review and interview with the patients. Depending on the culture result, level of amputation, reinfection, duration of treatment, death rate, patient satisfaction and admission dates were evaluated. RESULTS: Microorganisms were confirmed in 114 cases. In the other 17 cases, there were no cultured microorganisms. In bacterial growth group, Methicillin-sensitive Staphylococcus aureus was the most common pathogen and accounted for 34 cases. As other common pathogens, there were Methicillin-resistant Staphylococcus aureus(24 cases) and mixed infection(14 cases). Mortality is no difference in each infected group. Mixed bacterial infected patients have higher reinfection, longer hospital day and duration of treatment, but there is no difference in patients satisfaction and pain at last follow up. CONCLUSION: The most common pathogen in diabetic foot patients with lower extremity amputation was Methicillin-sensitive Staphylococcus aureus, and mixed bacterial infected patients have higher reinfection rate, longer admission date and duration of treatment than other bacterial infected patients.

Surgical Treatment of Ankle Fractures in the Elderly / 대한족부족관절학회지

PURPOSE: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. MATERIALS AND METHODS: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. RESULTS: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. CONCLUSION: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

Clinical Results of Various Surgical Techniques for Isolated Fracture of Greater Tuberosity of Humerus

PURPOSE: To compare the clinical and radiologic outcomes of various surgical techniques for an isolated fracture of greater tuberosity of the humerus. MATERIALS AND METHODS: From February 2001 to December 2008, 31 patients, who underwent an operation for isolated greater tuberosity fracture and were followed up for more than 1 year, were enrolled in this study. The mean age at the time of operation was 49.3 years (range, 23-73 years). The operation methods included in this study were as follows: a transosseous suture using nonabsorbable suture material (16 cases), a fixation by cannulated screws (10 cases), tension band wiring (2 cases), bony fragment excision with rotator cuff repair (2 cases), and percutaneous pinning (1 case). RESULTS: At the last follow-up, the average Constant score was 79.4 and Korean Shoulder Score (KSS) was 81.2. Among the various operation methods used in this study, the transosseous suture had the highest scores with 82.5 in Constant score and 89.3 in KSS. Bone union was achieved at average 10.3 weeks (range, 7-15 weeks), and there were 2 cases in which the reoperation was required due to internal fixation failure. Postoperative shoulder stiffness occurred in 3 cases, and all the cases were done with the deltopectoral approach. CONCLUSION: Clinically and radiologically satisfactory results were obtained using various operation techniques for an isolated greater tuberosity fracture of the humerus. The transosseous suture showed relatively better results than the other methods used in this study. To achieve favorable clinical and radiologic results, it is important to select an appropriate surgical approach and fixation method according to the fracture site, degree of displacement, and size of fragment.

Clinical Results of Lumbar Spinal Fusion in Degenerative Spine Disease in Patients over 75 Years Old: Comparative Study of Patients over 65 Years Old and Patients less than 75 Years Old / 대한정형외과학회잡지

PURPOSE: The elderly patients have been known for high incidence of postoperative complications following a lumbar fusion surgery. This study was conducted to determine the results of clinical outcomes after a lumbar fusion surgery in patients older than 75 years and to compare with those in patients between 65 and 74 years old. MATERIALS AND METHODS: One hundred twenty-five patients who underwent lumbar fusion were enrolled. The mean follow-up was 22.5+/-15.7 months. Preoperative diagnosis was spinal stenosis in 113 patients and degenerative spondylolisthesis in 12 patients. Revision surgery or multi-level spinal fusion (>4 segments) was excluded. There were 27 patients in group A (>75 years) and 98 patients in group B (65-74 years). Preoperative American Society of Anesthesiologists (ASA) scores, visual analog scale (VAS), Oswestry disability index (ODI), postoperative complications, and bone union rate were compared. RESULTS: The mean age was 78.6 years and 68.8 years in Group A and Group B, respectively. The mean preoperative ASA score was statistically different between group A and group B (p=0.025). The mean bone mineral density T score in group A was higher than that in group B (p=0.002). The mean VAS did not show a difference between the groups (p=0.171). There was no difference in the mean ODI between the groups in the improvement of VAS and ODI. The major and minor complications of early complications and late complications were observed without any statistical difference. CONCLUSION: Although preoperative ASA score was higher and osteoporosis was severe in the elderly patients (>75 years old), the improvement of clinical outcome was satisfactory as much as younger patients (65-74 years old) following a lumbar fusion surgery for degenerative spinal disease.

Correlations between the Clinical Results and Radiologic Evaluation after Surgical Treatment of Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the correlation factors for prognosis of calcaneal fractures. MATERIALS AND METHODS: 120 cases (feet) of calcaneal fractures, all of them followed up for more than 1 year after surgical procedures, consisted of 101 men (105 feet) and 13 women (15 feet) were reviewed retrospectively. The collected clinical data were as follows : injury mechanism, surgical procedures, time to procedure, time to work and the radiologic data: Bohler angle, heel width, displacement of posterior facet. AOFAS hindfoot score and VAS score were checked. With ANOVA test and multiple regression analysis, the data processed statistically. RESULTS: According Sanders classification, type II was 37 cases (31%), type III 66 cases (55%), and type IV 17 cases (14%). On plane radiography, the Bohler angle improved to average 28.4 degree from 5.6 degree, and the displacement of posterior facet was corrected to average 1.2 mm. AOFAS hindfoot score was checked average 81.7 points postoperatively, and the meaningful difference existed between types of Sanders classification. The Bohler angle represented the outline of the calcaneus had the better correlation with the clinical outcome of calcaneal fractures rather than the anatomical reduction of the posterior facet did. And the width of calcaneus had good correlation with the clinical score. CONCLUSION: We should also concern about the outline of calcaneus, the width of calcaneus and the Bohler angle representing anatomical reduction, not only the acute reduction of the posterior facet.

Minimally Invasive Transforaminal Lumbar Interbody Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To introduce the technique of minimally invasive transforaminal lumbar interbody fusion and examine its clinical and radiologic results. SUMMARY OF LITERATURE REVIEW: Transforaminal lumbar interbody fusion with a mini-incision using a tubular retractor was recently developed. The aim of this procedure is to reduce the approach-related morbidity and achieve better results in an effective and safe manner. MATERIALS AND METHODS: Thirty eight patients were followed up for more than 1 year. Their mean age was 57 years and the mean follow-up was 19 months. The diagnosis was spinal stenosis, spondylolisthesis and recurred herniated nucleus pulposus in 22, 14 and 2 patients, respectively. The Oswestry disability index, intervertebral disc space height, fusion rate and complications were evaluated. RESULTS: The Oswestry disability index improved from 30 points (range, 50~16 points) to 10 points (range, 2-24 points) at the last follow-up. Thirty-four patients (90%) showed excellent or good results. The intervertebral disc space height increased from 8.7 mm to 10.8 mm. Two cases showed nonunion but the clinical results were good. Complications included one case of infectious spondylitis requiring antibiotics, one case of cage dislodgement requiring additional surgery and one case of a pedicle screw malposition showing no clinical symptoms. CONCLUSIONS: Minimally invasive transforaminal lumbar interbody fusion reduced the soft tissue injury and blood loss and shortened the recovery period compared to the traditional open techniques.

Histological and clinical study of artificial dermis implantation for restoration of soft tissue defects

The present study was aimed to compare the resorption rate and the histological change of the autogenous dermis and the artificial dermis (Terudermis(R).) after the transplantation, and to report the clinical results of the use of Terudermis(R). in order to restore the soft tissue defect. Twenty mature rabbits, weighing about 2 kg, were used for the experimental study. The autogenous dermis and the Terudermis(R). size 1 x 1 cm were transplanted to the space between the external abdominal oblique muscle and the external abdominal oblique fascia of the each rabbits. They were divided into 4 groups (n=5 each) and gathered at 1, 2, 4, and 8 weeks after the transplantation. The resorption rate was calculated, and H-E stain was preformed to observe the histological changes. The chart review of the 17 patients who received Terudermis(R). graft to the facial soft tissue defects was conducted for the clinical study. The resorption rate at 8 weeks after the transplantation was 21.5% for the autogenous dermis, and 36.4% Terudermis(R). In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. The neovascularization and the progressive growth of the new fibroblast were shown in the Terudermis(R). graft. In clinical data of 17 patients, the size of the grafted Terudermis(R). was from 1.5 cm2 to 7.5 cm2 (average 3.5 cm2). Follow-up ranged from 5 to 25 months. Fourteen patients with cleft palate demonstrated stability of the graft and unremarkable complications. But unstability of the graft and the partial relapse were observed in three patients received the vestibuloplasty. These results indicate that Terudermis(R). can be available substitute of autogenous dermis because of the stability about resorption, the histocompatibility, and the unremarkable clinical complications.

Clinical result of rotational hinge knee prosthesis in 30 TKAs / 中国矫形外科杂志

[Objective]To investigate the indications,complications and mid-term results of total knee arthroplasties using rotating hinge knee prosthesis. [Methods]Thirty total knee arthroplasties using rotating hinge prosthesis were performed in twenty-eight patients from July 1998 to July 2008.Seven patients were male and twenty-one patients were female.The average age was 62 years(42-75 years).The diagnosis included osteoarthritis in 8 patients,rheumatoid arthritis in 2 patients,traumatic arthritis in 3 patients,Paget's disease patient,serious genu valgum in 7 patients and 10 failure TKAs.All patients were followed up for 12 to 120 months.The patients were evaluated according to knee score system and the complications were observed.[Results]The pain was relieved and function was improved in all knees.The average knee pain score increased from 19.5 to 77.9,and knee function score from 22.5 to 50.5.Range of motion of knees increased from 58.4?to 72.8?.No revision was needed in all patients,The complications included anterior knee pain(8 cases),extension lag(5 cases),prosthesis broken(1 case) and patella tendon rupture(1 case).[Conclusion]The mid-term results of total knee arthroplasty using rotating hinge knee for severe knee deformity are satisfactory.Complications should be prevented carefully.

Comparison of Results of Total Knee Arthroplasty Performed using a Navigation System and the Conventional Technique / 대한정형외과학회잡지

PURPOSE: To compare the radiologic and clinical outcomes of total knee arthroplasty (TKA) performed using a navigation system with those obtained using the conventional technique. MATERIALS AND METHODS: Forty-one TKAs were performed using a navigation system (navigation group) and forty-eight by conventional surgery (conventional group). Radiologic results outside the range defined by +/-3degrees of optimum were classified as outliers. Range of motion and HSS scores at final follow-up were also compared. RESULTS: Mean mechanical axes were 0.3degrees valgus for navigation and 0.5degrees varus for the conventional group, which were not statistically different. However, two outliers occurred in the navigation group, which was significantly less than the 14 that occurred in the conventional group. Mean coronal inclination of the femoral component was significantly different in the two groups as were the outlier numbers. Although outlier numbers significantly differed in sagittal inclination of the femoral or tibial components or coronal inclination of the tibial component, there were no statistical differences in terms of mean values. Differences in ROM and HSS scores were also not observed between the two groups. CONCLUSION: The navigation system helped increase alignment accuracy of the lower extremity, but no significant difference was observed in clinical results between the two study groups.

Clinical Outcome of AO Type C Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: To study the clinical results of AO type C pelvic ring injuries and identify the prognostic factors. MATERIALS AND METHODS: 25 patients were treated for C type pelvic ring fractures between January 1995 and August 2002. The injury mechanism, associated injuries, time from injury to surgery, ICU care, Injury Severity Score, fracture site of posterior ring, displacement, surgical method, and complications were analyzed. Radiological and clinical evaluations of the results were conducted using the Majeed's score. Of the 25 patients, 16 were male, 9 were female, with an average age of 41.6 years. All except one patient had associated injuries and 12 patients had neurological complications. There were 17, 7 and 1 case of C1, C2 and C3 type injuries respectively. Twenty three cases underwent surgical treatment. RESULTS: The average Majeed's score was 66.6 points, and 15 patients (60%) had good or excellent results. The complications included 3 cases of non-union and 1 case of SI joint infection were complications. The clinical results were worse in those patients with neurological symptoms. CONCLUSION: Satisfactory results were obtained after surgical treatment of C type pelvic ring injuries. Neurological injuries affected the clinical outcome and appropriate fixation of the anterior ring was needed for stable fixation of C type pelvic ring injuries.