Outcomes of toric intraocular lens realignment surgery done using slit-lamp method and wavefront aberrometry method

Purpose: To compare the slit?lamp method and wavefront aberrometry method based on outcomes of toric realignment surgeries. Settings: Tertiary care ophthalmic hospital. Design: Retrospective study. Methods: This study included all eyes undergoing toric intraocular lens (TIOL) realignment surgery between January 2019 and December 2021 for which TIOL axis assessment by slit?lamp method and wavefront aberrometry method was available. Data were retrieved from electronic medical records, and we documented demographics, uncorrected visual acuity (UCVA), subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods on postoperative day 1 and day 14. In patients with misalignment, TIOL was realigned to the original position in group 1 (27 patients) and to an axis based on calculations provided by wavefront aberrometer in group 2 (25 patients). Post?realignment surgery, UCVA, subjective refraction, and TIOL axis by slit?lamp and wavefront aberrometry methods were assessed and analyzed. Results: We analyzed 52 eyes and found that the mean preoperative misalignment with the slit?lamp method (44.9° ±20.0°) and wavefront aberrometry (47.1° ±19.5°) was similar. The corresponding degrees of misalignment post?TIOL repositioning surgeries were 5.2° ±5.2° (slit?lamp method) and 4.7° ±5.1° (wavefront aberrometry) (P = 0.615). Both groups showed significant improvement in median log of minimum angle of resolution (logMAR) UCVA and reduction in median refractive cylinder. Conclusions: Slit?lamp method is as good as wavefront aberrometer method to assess TIOL axis. Toric realignment surgery is found to be safe, and realigning TIOL based on either slit?lamp method or wavefront aberrometer method equally improved UCVA and decreased residual refractive cylinder.

Resultado de tratamiento quirúrgico de la luxación recidivante de rótula mediante la técnica de Campbell / Result of surgical treatment of recurrent patella dislocation using the Campbell technique

Resumen: Introducción: La luxación recidivante de rótula es una condición en la cual no se mantiene la congruencia de la superficie de la rótula en su desplazamiento sobre el surco intercondíleo del fémur en los movimientos de flexoextensión de la rodilla. Los objetivos del trabajo son: mostrar la distribución de pacientes con luxación recidivante de rótula según diferentes variables sociodemográficas y evaluar los resultados con el uso de la técnica de Campbell. Material y métodos: Se llevó a cabo un estudio observacional en pacientes con luxación recidivante de rótula, en el período de Diciembre de 2017 a Diciembre de 2019. La recolección de datos se realizó con la revisión de las historias clínicas. La muestra fue de 19 pacientes, para la evaluación de la técnica quirúrgica se utilizó el sistema propuesto por los autores. El procesamiento de la información incluyó el cálculo de medidas de resumen para variables cualitativas, frecuencias absolutas y porcentajes. Resultados: El sexo femenino y el grupo de edad de 15 a 30 años fueron los más frecuentes, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en 84.3% de los pacientes operados. Conclusiones: Predominó el sexo femenino y el grupo de 15 a 30 años, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en los pacientes operados. A pesar de que la mayoría de los autores recomiendan la reparación del ligamento patelofemoral medial como técnica de elección o la técnica de Insall, la técnica de Campbell arroja buenos resultados cuando se aplica a luxación recidivante de rótula que necesita realineación proximal del mecanismo extensor.

Abstract: Introduction: the recurrent dislocation of the patella is a condition in which the congruence of the surface of the patella is not maintained in its displacement on the intercondyleal groove of the femur in the flexo-extension movements of the knee. The objectives of the study are: to show the distribution of patients with recurrent dislocation of patella according to different socio-demographic variables and to evaluate the results with the use of campbell's technique. Material and methods: An observational study was conducted in patients with recurrent patella dislocation in the period from December 2017 December 2019. Data collection was carried out with the review of medical records. The sample was 19 patients, the evaluation of the surgical technique was used the system proposed by the authors. Information processing included the calculation of summary measures for qualitative variables, absolute frequencies and percentages. Results: The female sex and the age group of 15 to 30 years were the most frequent, healing was poor in two patients, good results were obtained in 84.3% of the operated patients. Conclusions: Predominance of the female sex and the group of 15 to 30 years, the healing was bad in two patients, good results were obtained in the operated patients. Although most authors recommend medial patello-femoral ligament repair as a technique of choice or the Insall technique, Campbell's technique yields good results when applied to recurrent patella dislocation that need proximal realignment of the extensor mechanism.

Corrección de la altura patelar en inestabilidad rotuliana / Correction of patellar height in patellofemoral instability

El manejo de la inestabilidad patelofemoral se basa en una adecuada evaluación de alteraciones anatómicas predisponentes. Patela alta es una de las causas más importantes de inestabilidad objetiva. La alteración biomecánica que ésta produce puede conducir a luxación patelar recurrente, dolor y cambios degenerativos focales. El examen físico es fundamental en la toma de decisiones. La evaluación imagenológica ha evolucionado desde métodos basados en radiografía hacia mediciones en resonancia magnética, que permiten una orientación más acabada de la relación existente entre la rótula y la tróclea femoral. El tratamiento se fundamenta en la corrección selectiva de los factores causales, donde la osteotomía de descenso de la tuberosidad anterior de la tibia y la reconstrucción del ligamento patelofemoral medial son herramientas que deben considerarse racionalmente. Este artículo realiza una revisión de la literatura, otorgando los fundamentos quirúrgicos que explican la importancia del tratamiento específico de patela alta en inestabilidad rotuliana.

Patellofemoral instability management is based on a thorough evaluation of predisposing anatomical factors. Patella alta is one of the utmost causes of objective instability. As a result, biomechanical disturbance can lead to recurrent patellar instability, pain, and focal degenerative changes. Physical examination is paramount in decision making. Imaging evaluation has evolved from X-rays based methods to magnetic resonance measurements, which allows a more accurate assessment of the patellotrochlear relationship. Treatment is based on a selective risk factors correction, where tibial tubercle distalization osteotomy and medial patellofemoral ligament reconstruction must be considered altogether. This article reviews the surgical rationale of patella alta treatment in patellofemoral instability.

Clinical evaluation of cases of lower genitourinary tract trauma with special reference to primary realignment in cases of posterior urethral distraction defect

Background: The exact management strategy for lower genitourinary tract trauma remains controversial. Primary realignment with/without suprapubic catheterization provides definitive procedure with low complications and avoids the need for further open surgeries.Methods: This was a prospective longitudinal study done on 31 cases with different complaints related to lower tract genitourinary trauma. All patients underwent suprapubic catheterization and/or primary realignment. The outcome was measured in the terms of time for discharge, urinary incontinence, stricture formation, erectile dysfunction and impotence.Results: Maximum proportion of patients with lower genitourinary injuries in the study was in 10-20 years age group (48.4%). Blunt trauma was accounted for 93.6% of lower genitourinary injuries. Road traffic accidents were the most common cause (90.32%) of lower genitourinary injuries. Urinary bladder injuries accounted for 41.9% of all lower genitourinary injuries. Blood at meatus is present in only about half of the significant urethral injuries. Primary realignment of urethral injury results in lesser duration of hospital stay (9.24±2.44 days), shorter length of suprapubic catheterization (11.67±4.78 days) and early spontaneous voiding (40.93±15.79 days). The stricture rate following primary realignment is low (31.25%). Erectile dysfunction was noted only in two patients (16.6%).Conclusions: Management of traumatic urethral disruption by primary realignment serves as ultimate therapy in majority of patients.

Disparity In Morphology Of Papillary Muscles Of The Mitral Valve Complex With Surgical Significance

Background: The mitral valve apparatus, consisting of the mitral valve leaflets and commissures and subvalvular apparatus- papillary muscles and chordae tendinae; is one of the most complex and intricately designedstructures present in the human body and therefore the understanding of anatomical variations of papillarymuscles becomes important for surgical interventional procedures, in response to the increasing incidence ofvalvular heart defects. The aim of the cadaveric analysis was to identify the disparity in the morphometry of thepapillary muscles of the mitral valve complex. Therefore this study was taken up with an effort to extend theconcepts previously presented as well as to overcome deficiencies in the knowledge of gross architecture andpositional nomenclature of the papillary muscles.Materials and methods: Fifty formalinized cadaveric hearts were the material for study. Papillary muscles of leftventricle were classified according to a system developed by Berdajs et al., (2005), by precisely measuringshapes lengths and widths.Results: The significant outcome of this study indicates that no two papillary muscles out of the 50 specimenshad the same size, shape or position. All the hearts had two distinct groups of muscles – anterolateral andposteromedial. Specific analysis of each group revealed data regarding the muscles. In the antero-lateral groupof the specimens, the maximum height and width of the muscles was 37.40mm and 17.06mm respectively and inthe postero-lateral group, 33.86 and 26.90mm respectively. Conical shaped muscles were the most commonlyfound muscles owing to the minimum obstruction posed by them to blood flow.Implication: Better understanding of morphological variations can help cardiothoracic surgeons to customizesurgical procedures according to the papillary muscle pattern of the individual patient

Realineamiento Proximal del Mecanismo Extensor en la Luxación Congénita de la Rótula en Niños y Adolescentes / Proximal Realignment of the Extensor Mechanism in Congenital Dislocation of the Knee in Children And Adolescents

Introducción La luxación congénita de la rótula (LCR) es una entidad poco frecuente. El diagnóstico precoz suele ser difícil porque la rótula en el recién nacido es pequeña y de difícil palpación. El tratamiento no quirúrgico ha demostrado ser ineficaz. El enfoque terapéutico de esta patología requiere de la liberación externa y extensa del cuádriceps, el avance del vasto interno oblicuo y de la transferencia o hemitransferencia del aparato extensor. Materiales y métodos se busca evaluar la funcionalidad de los pacientes tratados quirúrgicamente mediante realineamiento proximal del mecanismo extensor por la técnica descrita por Green y modificada por los autores. Desde el año 2000 hasta el año 2015 se recolectaron 15 pacientes (20 rodillas) con diagnóstico de LCR tratados quirúrgicamente mediante la técnica descrita. Resultados Los resultados postoperatorios fueron evaluados mediante el cuestionario Kujala: 93.8/100 en promedio. Discusión El tratamiento de la LCR es un desafío y más aún si se encuentra asociada a retracción idiopática del recto anterior. Los resultados clínicos y funcionales obtenidos sugieren que la recolocación anatómica y estable de la rótula dentro de la tróclea femoral permite una satisfactoria alineación extensora del cuádriceps, desapareciendo su acción flexora inicial, lo que permite la elongación progresiva del mecanismo extensor durante las fases postoperatorias de rehabilitación. La técnica quirúrgica descrita ofrece una buena alternativa para el tratamiento de esta infrecuente patología congénita de la rodilla.

Background Congenital dislocation of the patella (CDP) is a rare condition. The early diagnosis is difficult, as the patella in the newborns is small and also difficult to recognise. The therapeutic approach of this disorder requires the extended and external release of the quadriceps, the forward movement of the internal oblique vastus, and the transfer or hemi-transfer of the extensor compartment. Methods To review the functionality of those patients who have received surgical treatment with proximal realignment of the extensor mechanism using Green's surgical technique and the one modified by the author. Between the years 2000 and 2015, a total of 15 patients with 20 knees found to have had congenital dislocation of the patella, and had received the abovementioned surgical treatment. Results The post-operative results were evaluated using the Kujala questionnaire, which gave a mean result of 93.8 / 100. Discussion The CDP treatment is a challenge, and even more so if it is associated with an idiopathic retraction of the anterior rectus. The clinical and functional results obtained suggest that an anatomic and stable realignment of the patella in the femoral trochlea allows a satisfactory extensor alignment of the quadriceps. This leads to the disappearance its initial flexor action, which allows the gradual elongation of the extensor mechanism during the postoperative phases of rehabilitation. The surgical technique described offers a good alternative for the treatment of this rare congenital disorder of the knee.

Clinical observation on the treatment of cervical spondylotic radiculopathy by the pulsed radiofrequency combined with the fixed-point lateral flexion and rotation realignment cervical manipulation / 国际生物医学工程杂志

Objective To observe the clinical efficacy of pulsed radiofrequency combined with fixed-point lateral flexion and rotation realignment cervical manipulation in the treatment of cervical spondylotic radiculopathy (CSR). Methods Sixty-three patients with CSR were randomly divided into observation group (n=32) and control group (n=31). The observation group was given pulse radiofrequency combined with fixed-point lateral flexion and rotation realignment cervical manipulation, and the control group was given the pulsed radiofrequency treatment. Visual analog scale (VAS) and Japanese Orthopaedic Association (JOA) scores were obtained before the treatment, 7 days and 3 months after the treatment. The temperature differences of bilateral upper limbs infrared thermal imaging were observed before and 3 months after the treatment in the two groups. The clinical efficacy of the two groups was evaluated by using TCM disease and syndrome diagnosis criteria. Results After 7 days and 3 months of the treatment, the VAS scores of the two groups were lower than those before treatments, the VAS scores of the observation group were lower than the control group, and all the differences were statistically significant (all P<0.05). The JOA scores in the two groups were higher than those before treatment, the JOA scores of the observation group were higher than the control group , and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the infrared temperature difference between the upper limbs of the observation group and the control group before treatments [(0.83±0.27) °C vs (0.87±0.29) °C, P>0.05]. Three months after the treatment, the temperature difference of infrared thermography in the upper limbs of the observation group was better than that of the control group (P<0.05), and the cure rate of the observation group was better than that of the control group, and the difference was statistically significant (68.75％vs 22.58％, P<0.05). There was no statistically significant difference in the total effective rate between the two groups (93.75％vs 90.32％, P>0.05). Conclusions The pulsed radiofrequency combined with the fixed-point lateral flexion and rotation realignment cervical manipulation in the treatment of radiculopathic cervical spondylosis was effective in improving pain, function and infrared imaging temperature of upper limbs.

Clinical comparative study of urethral anastomoses and ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure / 中国医师进修杂志

Objective To investigate the clinical effects and safety of urethral anastomoses and ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure. Methods Ninety patients with urethral straddle injury and catheter placement failure were chosen and divided into A group (45 patients, choosing urethral anastomoses) and B group (45 patients, choosing ureteroscopy urethral realignment). The operation time, intraoperative blood loss, hospital staying time and peri-operation complications in both groups were compared. Results The operation time, intraoperative blood loss, hospital staying time in B group were significantly lower than those in A group: (26.15 ± 10.41) min vs. (71.93 ± 14.50) min, (22.37 ± 7.41) ml vs. (50.70 ± 13.25) ml, (3.22 ± 0.97) d vs. (5.19 ± 1.43) d, P<0.05. After 6 months′follow-up, the clinical indicators in peri-operation period of B group were significantly better than those in A group (P<0.05). The complications incidence in B group was significantly lower than that in A group: 2.22%(1/45) vs. 13.33%(6/45), P <0.05. Conclusions The technology of ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure can efficiently shorten the operation time, reduce the degree of trauma and accelerate the rehabilitation process, and it is helpful to reduce the risk of complications in peri-operation period.

Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases / 中华男科学杂志

<p><b>Objective</b>To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.</p><p><b>METHODS</b>We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.</p><p><b>RESULTS</b>The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.</p><p><b>CONCLUSIONS</b>Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.</p>

Analysis and Improvement of Functional MRI Image Registration Method Based on SPM / 中国医学影像学杂志

As a new neuroimaging method, functional magnetic resonance (fMRI) with its importance of data processing has been widely recognized by neurology and cognitive psychology. Focusing on the realignment section in fMRI image preprocessing, this paper comprehensively describes the registration principle of SPM, an internationally-known software package which is specially designed for cerebral function imaging. An improved registration method is presented which effectively increases the accuracy. In addition, choosing the ratio of SSD and NMI as the registration measure can compensate for the limitation of using single measurement, which improves the robustness and reliability of the registration process. Experimental results prove the feasibility of this method.

Treatment of urethral complete broken injury with double ureteroscopic urethral realignment / 中国医师进修杂志

Objective To investigate the efficacy and safety of treatment of urethral complete broken injury with double ureteroscopic urethral realignment.Methods A clinical data of 26 cases of urethral complete broken injury who had underwent double ureteroscopic urethral realignment were retrospectively analyzed.Results The patients were confirmed by urinary tract imaging for urethral complete broken injury.The catheters were inserted successfully into bladders and removed at 6 weeks after operations.The operative time was 25-53 (39.0 ± 12.4) min.Twenty patients gained fluent urination after removal of catheter,with maximum urine flow 17-28 ml/s after 6 weeks.Six cases had urethral stricture.Among them,2 cases received urethral expansion,3 cases received transurethral cold knife incision,and 1 case received urethral anastomosis.All of them gained fluent urination.Conclusion Treatment of urethral complete broken injury with double ureteroscopic urethral realignment is feasible,superior and reproducible.

Urethral realignment for treating early urethral injury under the guidance of ureteroscope / 中国医师进修杂志

Objective To summarize the clinical experience of urethral realignment for treating early urethral injury under the guidance of ureteroscope,and evaluate its curative effect.Methods Twenty-nine male patients with urethral injury were selected,and 12 patients of posterior urethral injury,17 patients of former urethral injury.All the patients were treated with urethral realignment under the guidance of ureteroscope,postoperative indwelling catheter 3-8 weeks,every 7-16 days changed diameter increase 2 F the catheter 1 time.Results The 29 patients with urethral injury were a indwelling catheter success,all patients were no incontinence after operation 3 months.In the 29 patients,27 patients were urination unobstructed after catheter removal,2 patients were appeared urine line slim after 2 weeks,the 2 patients were normal urination after short urethral expansion.Conclusions The urethral realignment for treating early urethral injury under the guidance of ureteroscope has simple,lower complication,rapid recovery,better effect.The continuous flexible progressive urethral expansion and the strict nursing,which can effectively reduce the occurrence of urethral stricture.

Clinical observation for emergency realignment of urethra with straddle injury under the guidance of ureteroscope / 中国中西医结合急救杂志

Objective To evaluate the effectiveness and safety of emergency realignment of urethra with straddle injury under the guidance of ureteroscope. Methods The clinical results of 39 patients with urethra straddle injury having the failure of inputting a urethral catheter from August 2007 to August 2013 in Central People's Hospital of Tengzhou City,Shandong province were retrospectively investigated,and according to the difference in method of operation,the patients were divided into two groups. In group A,there were 27 patients who underwent the first stage perineal urethra repair and anastomosis operation,and in group B,there were 12 patients who underwent urethral realignment operation and insertion of a catheter under the guidance of ureteroscope. The operation time, amount of bleeding in operation,incidence of complications such as urethral stricture,erectile dysfunction,as well as postoperative hospital stay were compared between the two groups. In addition,we searched PubMed/MEDLINE, EMBASE,Wanfang database,China journal full-text database(CNKI),VIP database and China outstanding master's/doctoral dissertation database from which we selected research literatures from 2000 to 2013 on emergency realignment of urethra with straddle injury and conducted Meta-analysis by Revman 5.2 software. Results Compared to group A, the operation time and postoperative hospital stay were significantly shortened in group B〔operation time(minutes):26±15 vs. 71±18,postoperative hospital stay(days):2.6±1.2 vs. 5.2±1.9,both P0.05〕. And patients suffering from urethral stenosis were treated with postoperative transurethral expansion and followed up for 6 to 12 months,including 1 case of urethra expansion invalid to switch to open surgery. Related literatures were researched for Meta-analysis,and 4 literatures were enrolled. Meta-analysis results further confirmed that urethral realignment was more effective than urethral anastomosis for urethral injury〔odds ratio(OR)=2.30,95% confidence interval(95%CI)1.07 - 4.95,P=0.03〕. Conclusion Performing urethral realignment operation under the guidance of ureteroscopy is a better operation in the treatment of urethral straddle injury,having the advantages of shorter operation time,less trauma,quicker recovery and fewer complications.

Pênis curvo congênito chordee / Congenital penile curvature chordee

O chordee é a causa mais comum de curvatura ventral na hipospadia e também em muitos casos de curvatura ventral sem hipospadia esta última não é muito assinalada. A curvatura ventral sem hipospadia é um defeito congênito decorrente da ação insuficiente dos hormônios produzidos pelos testículos, os quais estimulam o desenvolvimento masculino. Clinicamente, chordee sem hipospadia é uma curvatura ventral entretanto, o meato da uretra está localizado em sua posição normal na glande e o tecido fibroso é o principal responsável pelo encurvamento. Para a correção da angulação do pênis, várias técnicas cirúrgicas têm sido descritas. Todavia, adotando um conceito diferente sobre a curvatura ventral, tenho utilizado o método progressivo para corrigir a deformidade. Acredito que, em princípio, a clássica excisão do tecido fibroso da face ventral até o meato uretral é o procedimento mais apropriado e frequentemente será suficiente para conseguir a adequada retificação do falo.

Nasal Tip Plasty on the Bulbous Nose Revisited

Correction of bulbous nasal tip in rhinoplasty is a difficult subject, particularly in Asian. Since first published an article on the correction of bulbous nasal tip in 1999, we have accumulated more experiences and improved our result in refining nasal tip. We had 17 patients for the correction of bulbous nasal tip. Age ranged from 20 to 39 years old (Mean age, 26.7 years old) and 6 males and 11 females. We were able to follow up from 1 month to 6 years. We classified our patients into three groups according to the shapes of nasal tip and surgical procedures implicated. Group 1: Simple bulbous nasal tip requiring excision of subdermal soft tissue and rearrangement. Group 2: Bulbous nasal tip with flat dorsum of nose, requiring augmentation of dorsum of nose with silicone implant and augmentation of nasal tip with onlay graft with conchal cartilage. Group 3: Bulbous nasal tip with short columella, requiring nasal tip plasty and lengthening of columella with composite graft using helix of ear. Open rhinoplasty technique was applied in all patients with excising subdermal fibrous tissue from nasal tip, and realignment and fixation of alar cartilage with interdomal sutures. Pressure splint was applied on 7th postoperative days and maintained for a couple of months. Proper preoperative diagnosis, subdermal soft tissue excision, realignment and fixation of alar cartilage, cartilage graft, augmentation of dorsum of nose, columella lengthening, postoperative splint and combinations of these are the key of successful results.

Clinical Research of Realignment Treatment for Cervical Vertigo via Point Pressing Muscle Relaxation / 浙江中医药大学学报

Cervical vertigo is one of the main clinical symptoms of cervical spondylosis with cervical artery blood circulation deficiency.The author had treated 108 cases of cervical vertigo who had such symptoms as:deviated cervical vertebrae line and cervical spinal process,tenderness of cervical spinal process,accompanying with asymmetry and limited cervical movement,distending pain of spinal cervical muscle of limited side,etc.By the application of neck traction of four-tailed bandage,one finger point pressing,combining with melioration,realignment and medication,60 patients’ clinical symptoms were alleviated,35 patients had obvious effectiveness,and 9 patients were improved,4 patients gained no effectiveness,the total effective rate was 96.2%.

Arthroscopic Treatment for Acute or Subacute Patellar Dislocation

PURPOSE: The acute or subacute patellar dislocation is frequently neglected. Arthoscopy has provided a new method of both diagnosis and treatment of the patellofemoral instability. In our series, we performed proximal realignment including lateral retinacular release and medial capsular imbrication under arthroscopic alone on the patients who had normal skeletal alignment with Q angle less than 20 degree. The clinical and radiographic results of the procedure was assessed. MATERIAL AND METHODS: 21 knees in 20 patients were evaluated at an average 36 months following arthroscopic procedures alone. The average patient's age was 25 years old and the mean follow-up period was 18 months. The patients had been treated surgically after conservative management for mean three weeks from initial trauma. Medial patellar osteochondral fractures and loose bodies in 7 knees of 6 patients and osteochondral defect of lateral femoral condyle in 1 knee of 1 patient were confirmed radialologically and intraoperatively. We performed additional treatments for the associated disease. The radiologic results of Insall-Salvati index, congruence angle for subluxation and lateral patellofemoral angle (LPFA) for tilt on preoperative, postoperative and last follow-up and clinical outcome were assessed, according to Crosby and Insall's criteria. RESULTS: Congruence angle(+10.8 to -0.5), LPFA(+7.2 to -7.3) and Insall-Salvati index(0.82 to 1.05) were radiologically normalized. Clinically, results were excellent to good results in 19 knees(90.5%). CONCLUSION: The arthroscopic proximal realignment was done by minimal surgical exposure and was effective on relief of the patellofemoral pain after acute or subacute dislocation, it also proved the less pain, rapid rehabilitation and ability to diagnose the other intraarticular disorders.

Surgical Treatments and Clinical Outcomes for Idiopathic Osteoarthritis of the Tarsometatarsal Joints / 대한족부족관절학회지

PURPOSE: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. MATERIALS AND METHODS: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). RESULTS: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. CONCLUSION: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.

Results of Primary Endoscopic Urethral Realignment as a Treatment of Urethral Injury According to the Injury Site / 대한비뇨기과학회지

PURPOSE: There are a variety of open surgical and endoscopic methods to the treatment of urethral injuries. The objective of our study is to evaluate the efficacy of primary endoscopic urethral realignment according to the injury site. MATERIALS AND METHODS: Twenty eight patients with urethral injuries(23 anterior and 5 posterior) were treated by primary endoscopic urethral realignment from March 1990 to August 1997. According to the injury site, age distribution, etiology of injury, associated injuries, time to operation, operating time, duration of urethral Foley catheterization, maximal flow rate, postoperative complications and treatment of post-realignment stricture were reviewed. RESULTS: The age range of our patients was from 20 to 86 years(mean 45.0). Among the 28 patients, 23 were anterior and 5 were posterior urethral injuries. Pelvic bone fracture was associated in 1 patient(20.0%) in the anterior urethral injury group, while 5 patients(100%) in the posterior urethral injury group. The mean time after injury to realignment was 1.9 days (range 0 to 9) and the mean operating time was 53.9 minutes in the anterior urethral injury group(range 20-190) and 79.0 minutes in the posterior urethral injury group(range 25-170). The mean duration of urethral Foley catheterization was 24.5 days in the anterior urethral injury group and 61.4 days in the posterior urethral injury group. The mean maximal flow rate after catheter removal was 31.4ml/sec in the anterior urethral injury group and 24.6ml/sec in the posterior urethral injury group. Of the 23 patients, 9 patients(39.1%) had post-realignment strictures in the anterior urethral injury group and 8 were treated with visual urethrotomy, and only one patient was required open urethroplasty. Of the 5 patients, 4 patients(80.0%) had post-realignment strictures in the posterior urethral injury group and treated with visual urethrotomy. CONCLUSIONS: Primary endoscopic urethral realignment is a safe and simple technique with minimal mobidity regardless of injury site. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for open surgical methods. Finally, most post-realignment strictures can be treated successfully with visual internal urethrotomy with or without occasional sound dilation.

Early Urethroscopic Realignment of Ruptured Bulbous Urethra / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy of early urethroscopic realignment compared to initial suprapubic cystostomy in the management of bulbous urethral rupture caused by straddle injury. MATERIALS AND METHODS: From May 1995 to June 1996, early urethroscopic realignment was attempted on 16 consecutive patients with bulbous urethral rupture caused by straddle injury. These results were compared with those of 10 consecutive such patients who were managed initially with suprapubic cystostomy between July 1994 and April 1995. RESULTS: Thirteen of the 16 patients(81%), including 1 with a complete rupture, had successful early urethroscopic realignment of the urethra and catheter placement. Ten of these 13 patients(77%), including 9 of 12 partial ruptures and 1 of 1 complete rupture, did not develop stricture after catheter removal. Of the 6 patients with partial rupture who were managed with initial suprapubic cystostomy, 2(33%) had no secondary stricture. All 4 patients with complete rupture managed with initial suprapubic cystostomy alone had resulting stricture. CONCLUSIONS: Early urethroscopic realignment of the ruptured urethra is a simple, safe, rapid, and nontraumatic technique that can be done with sedation and intraurethral topical anesthesia, It reduces the incidence of secondary urethral stricture compared with initial suprapubic cystostomy alone. Therefore, it could be a valuable alternative in the management of bulbous urethral rupture caused by straddle injury.