Clinical Results after Corrective Osteotomy of the Kyphotic Deformity in Ankylosing Spondylitis / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of clinical results through questionnaire based instrument and radiologic changes after correction in ankylosing spondylitis. OBJECTIVES: To evaluate the radiographic changes and verify the clinical results of the extension osteotomy through pedicular subtraction and intracorporal decancellization in patients with ankylosing spondylitis who have severely fixed kyphotic deformity. MATERIALS AND METHODS: Total 45 patients were included in this study. In all cases, the deformity was corrected by a onestage pedicle subtraction extension osteotomy. Radiographic assessment for sagittal balance was performed on the criteria of thoracic kyphosis, lumbar lordosis, distance between the vertical line on anterosuperior point of T1 and that of S1 and sacrohorizontal angle. Finally clinical assessment for function, indoor activity, outdoor activity, psychosocial activity, pain and overall subjective satisfaction on the basis of patients' satisfaction(5 grade) were performed. RESULTS: The osteotomy was performed at single level in 43 cases, double levels in 2 cases. The mean follow-up was 36.2 months. The criteriae of radiographic assessment were changed on preoperative, postoperative 3 months and the last follow-up as follows; thoracic kyphosis: 50, 51 and 54 degrees, lumbar lordosis: 10, 46 and 44 degrees, distance between vertical lines of T1 and S1: 94, 15 and 8 mm, sacral inclination: 8, 28 and 24 degrees. At the last follow-up, clinical results were high as 3.2 in function, 2.8 in indoor activity, 3.3 in outdoor activity, 3.3 in psychosocial activity, 3.4 in pain and 3.2 in overall subjective satisfaction. There was no any serious complication, such as death or permanent neurologic deficit. CONCLUSIONS: Nearly all the patients have maintained good correction. Eighty five percent of patients have revealed self-satisfaction to corrective osteotomy. But in connection with the clinical results, the changes of parameters of radiographic assessment didn't revealed any significant correlation and so it should be traced much longer with care.

Toxic Shock Syndrome after Spinal Fusion: A Case Report / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the fatal case who had toxic shock syndrome after spinal fusion. OBJECTIVES: To call orthopaedic surgeon's attention to that toxic shock syndrome may be present despite the absence of clinically apparent infection after orthopaedic surgery. SUMMARY OF LITERATURE REVIEW: Toxic shock syndrome is an acute febrile illness with severe multisystem derangement and the rate of fatality is 10 to 15 percents. It develops most commonly in young women, and is usually associated with menstruating women who use tampons. Orthopaedic procedures have not been considered as risk factor of toxic shock syndrome, and there have been few reports of toxic shock syndrome associated with bone manipulation and implants. MATERIALS AND METHODS: A twenty-seven-year-old woman who was admitted for T12 bursting fracture, right hemothorax, and left distal radius fracture from traffic accident. After resolving of hemothorax, she recieved spinal fusion with pedicle screw instrumentation on three weeks after trauma. At perioperative period, she was in menstrual period and used the tampons. In the evening of the eighth postoperative day, the patient had a temperature elevated up to 39.3degree C, accompanied with malaise, chills, nausea, vomiting, and dehydration. Laboratory evaluation revealed pyuria on urinalysis, but the others were unremakable. The surgical wound had an entirely benign appearance without erythema, fluctuation, and drainage. RESULTS: The patient continued to do poorly, and then she died at ten days after the surgery. CONCLUSIONS: We report a fatal case with toxic shock syndrome after spinal surgery, and also serve to remind orthopaedic surgeons that toxin-producing organisms may be present despite the absence of surgical wound infection.

Arthroscopic Total Synovectomy Using Transposterior Septal Portal / 대한정형외과학회잡지

Arthroscopic synovectomy has some limitations for adequate posterior visualization, and it is difficult to establish the posterior portal because of potential damage to neurovascular structures. The purpose of this study is to introduce a newly designed arthroscopic technique passing through posterior septum and to review the arthroscopic synovectomy using transposterior septal portal in the knee. Routine arthroscopic examination of the knee joint is performed using standard anterolateral and anteromedial portals. Posterior arthroscopic technique is divided into four steps. The first step is to make a posteromedial portal. The second step is to make a posterolateral portal. The third step is to make a hole at the posterior septum and to examine the posterolateral compartment. The fourth step is to examine the posteromedial compartment by switching the arthroscope to the posterolateral portal in the same manner. This technique provides complete visualization of the posterior compartment of the knee joint including the posterior aspect of the medial and lateral femoral condyles, posterior horn of both menisci, the posterior cruciate ligament(PCL), the meniscofemoral ligament, posterior aspect of the popliteal tendon, and the posterior capsule. We reviewed 47 cases(of 43 patients) of arthroscopic synovectomy using anterolateral, anteromedial and transposterior septal portal. The results were assessed with follow up of at least 1 year using the criteria of pain, synovitis, effusion, and range of motion. In 15 case rheumatoid arthritis, we had good result in 14 cases, but 1 case of recurrence was noted at 2 months after surgery. Non specific synovitis, 11 cases, had the similar result of rheumatoid arthritis. In 9 cases with hemophilic arthritis, pain and effusion were improved, but range of motion was improved minimally. In 2 cases with gouty arthritis, 2 cases with tuberculous arthritis, and I case with pigmented villonodular synovitis(PVNS), range of motion was rather reduced. It is considered that arthroscopic technique using transposterior septal portal is safe procedure without damaging the PCL, posterior capsule, neurovascular structures, and very efficient method in removing hypertrophied synovium or debris of persistent synovitis or arthritis of the knee joint and helpful in removing encapsulated loose bodies located behind the PCL.

A Biomechanical Study of Screw Designs of Transpedicular Screw on the Fixation Strength / 대한정형외과학회잡지

INTRODUCTION: The fixation strength of transpedicular screw system in the vertebral hody relied on bone quality and anatomical characteristics of vertebral pedicle, designs of screw and types of connection(rod or plate) with screw. The purpose of this study is to verify the biomechanical nature of the transpedicular fixation in spine under various conditions with porcine vertebrae. MATERIAL AND METHOD: Fresh porcine vertebrae and the custom-made screws were used in this experiment. To reduce the errors caused by vertebral bodies of different size and quality, vertebral bodies having regular range of pedicular width(10.0 to 11.5mm) and hone density(more than 1.0 gm/cm2) were used. The pedicle screws were inserted in the same procedure and axial pull out test was performed with using the Material Testing System(lntron8511, Canton, USA). The experiments were performed in four types to assess the difference of strength accroding to designs of the screw hy using two group of screws. The first group of screw was designed according to the outer and inner diameter and the second group was designed according to the shape, pitch, and thread profile of screw. Experiment I was perfomed to evaluate the effect of screw diameters on the biomechanical pull-out strength hy using the first group of custom-made pedicle screw which fixed all other factors except the diameter of screw. Experiment I was to verify the effect of screw shape, experiment III to verify the effect of pitch and experiment IV to verify the effect of thread profile. RESULTS: The results of experiments were summarized as follows: Experiment I showed that the screw of larger outer diameter had greater holding strength. Experiment II showed that the holding strength of cylindrical shaped screw is superior to that of conical shaped screw. Experiment III showed that there is no statistical significance between different modes of pitch. Experiment IV showed that the holding strength of buttress shape of thread profile is superior to that of V-shape. CONCLUSION: It seemed that the fixation strength of the screw was more powerful with 1 mm increment of outer diameter in 4-7mm of outer diameter, 3mm of pitch and buttress shape of thread of the screw with the same operation technique.

Deep Vein Thrombosis and Pulmonary Embolism after Cementless Total Hip Arthroplasty / 대한정형외과학회잡지

Thromboembolism is the most common serious complication following total hip arthroplasty and most common cause of death after total hip arthroplasty. A prospective randomized study in 170 cases of elective cementless total hip arthroplasty was carried out to examine the incidence of deep vein thrombosis and pulmonary embolism after cementless total hip arthroplasty from Aug. 1993 to May 1995. Laboratory study, clinical symptoms and signs, chest roentgenograph and precipitating factors were analysed. Venography and lung perfusion scan using radionuclide scan were used for this study. The weight, height, sex, habitus of alcohol and smoking, hypertension, diabetes mellitus, previous operation history of ipsilateral lower extremity, etiology of hip joint disease, and transfusion of blood were not precipitating factors, but the age over 40 and previous history of pulmonary embolism had a significant effect on the incidence of deep vein thrombosis. There was no significant relationship between the incidence of deep vein thrombosis and the laboratory assay, clinical symptoms and signs. Deep vein thrombosis was detected in 29 cases(17.0%), pulmonary embolism in 22 cases(12.9%), and fatal pulmonary embolism in 1 case(0.6%). The most common location of deep vein thrombosis was the popliteal area.