Prognostic Factors Affecting the Results of the Surgery for Cervical Spondylotic Myelopathy / 대한척추외과학회지

STUDY DESIGN: This retrospective study was designed to investigate and define the factors affecting the results of surgery for cervical spondylotic myelopathy. OBJECTIVE: This study was performed in an attempt to investigate and define the factors affecting the results of surgery for cervical spondylotic myelopathy. SUMMARY OF THE LITERATURE REVIEW: There have been few studies about the factors affecting the results of surgery for cervical myelopathy, including MEP (Motor evoked potential) studies and gait analysis, so we investigated the factors that affect the results of surgery for cervical myelopathy. MATERIALS AND METHODS: We retrospectively studied 59 cervical spondylotic myelopathy patients who underwent operation from Nov. 1994 to Oct. 2002. We analyzed 13 prognostic factors: age, disease duration, the pre-op JOA score, the pre-op. AP canal diameter, the Pavlov ratio, disease level, the AP and lateral cord diameter, the transverse area and the compression ratio at the level of the maximal cord compression on MRI, the cord signal changes on MRI, the MEP(Motor evoked potential) and the gait analysis. The mean follow up period was 29 months. The clinical results were evaluated according to the JOA score. Statistical analysis was performed using the Pearson correlation test, ANOVA and the Kruskal-Wallis test. RESULTS: The mean pre-op JOA score was 11.1 and the post-op. JOA score was improved to 14.7. The average recovery rate was 67%. The following factors were proved to an influence on the surgical outcomes: age and multiplicity of involvement, and the signal changes of the cord on MRI showed a negative correlation with the recovery rate. The pre-op JOA score, the mean sagittal diameter and the transverse area of the spinal cord at the level of maximum compression showed a positive correlation with the recovery rate. Spasticity on the gait analysis and central conduction block on MEP had an influence on the surgical outcomes. CONCLUSIONS: The prognostic factors affecting the results of surgery for cervical myelopathy are age, the pre-op JOA score, the disease level, the mean sagittal diameter and the transverse area of the spinal cord at the level of maximum compression, signal change of the cord on MRI, spasticity on the gait analysis and central conduction block on MEP.

Evaluation of the Elmslie-Trillat-Marquet Procedure for Recurrent Patellar Subluxation or Dislocation / 대한정형외과학회잡지

PURPOSE: To assess the clinical and radiographic results of the Elmslie-Trillat-Marquet procedure used to treat recurrent patellar subluxation or dislocation with patellar malalignment. MATERIALS AND METHODS: A total of 15 knees in 14 patients were evaluated at an average of 54.5 months (12 to 106) following the Elmslie-Trillat-Marquet procedure; carried out between May 1993 and March 2000. The evaluation included subjective, objective and radiographic assessments. RESULTS: The causes of recurrent patella dislocation were patella alta (11 knees), tight lateral retinaculum (8 knees), patella dysplasia (7 knees), femoral condyle dysplasia (13 knees) and joint hyperlaxity (1 case). The average preoperative Q-angle was 28.5degrees and the postoperative angle 13 degrees. Subjective evaluation using Cox's criteria showed excellent or good results in 13 knees (87%), and the objective evaluation using Fulkerson's functional knee score showed excellent or good results in 14 knees (93%). The mean anterior tibial tubercle displacement was 8 mm (7-11 mm), and the patella congruence angle and Insall-Salvati index were significantly corrected (p<0.001). Lateral subluxation and patellar tilt angle were corrected in all cases. The only complication was an irritation due to nonabsorbable suture material. There were no redislocations, infections, nonunions, or fractures of the transferred tibial tubercle during the follow-up period. CONCLUSION: The Elmslie-Trillat-Marquet procedure for recurrent patellar subluxation or dislocation can basically correct malalignment tridimensionally.