Normal Segmental Sagittal angle of the Lower Dorsal and Lumbosacral spine in Korean Adult / 대한정형외과학회잡지

Authors developed a new method of measuring spinal sagittal curve that is easy and and practical using the lower border of the vertebral body. The intersecting angle was defined as the angle formed bythe perpendicular line drawn from the lower margin of the upper vertebral body with the lower margin of the lower vertebral body which is nearer to the vertebral body. The segmental angle was defined as the intersecting angle minus 90 degrees. A positive segmental angle meant lordosis and negative segmental angle, kyphosis. Authors studied standing lateral thoracolumbosacral films of 80 back pain and deformity free Korean adults who visited Seoul National Universty Hospital during the period of Jan. 1988 to Jun. 1988 using this method to determine the normal segmental sagittal angle and the kypholordotic junction. With statistical analysis of the results, we came to following conclusions. l. Indivdual segments showed its typical sagittal angle. There was no age and sex difference in segments T10 to L5. 2. The gross lordosis of the lumbosacral spine from Ll to Sl showed no age and sex difference. But the Sl segment was more lordotic in males with no age difference. 3. The Ll segment was the kypholordotic junction which was in slight kyphosis 4. The normal ranges of sagittai ourve obtained in this experiment can be used as a guideline to contouring spinal internal fixation device in the sagittal plane.

Synovial Hypertrophy in Discoid Meniscus / 대한정형외과학회잡지

Arthroscopic surgery of the knee is now a widely performed orthopedic technique. Of this, arthrosoopic surgery of discoid meniscus is one of the most technically demanding procedures of this field. In our experience, discoid meniscus was appeared to be frequently accompanied with villous hypertrophied synovium, which obstructed the arthroscopic view. The purpose of this study is to prove the presence of synovial hypertrophy in discoid meniscus and to develop an adequate portal of entry for successful arthroscopic surgery of discoid meniscus. 155 cases of arthroscopy of the knee were performed at the Department of Orthopedic Surgery, College of Medicine, Seoul National University between January 1987 and March 1988. Of these, 25 cases were discoid menisci and they were all lateral. Operative findings were observed through arthroscopy and they were also reviewed by recorded video tapes in 25 cases of arthroscopic surgery of discoid meniscus and 57 cases of non-discoid meniscal lesions for the presence of synovial hypertrophy. Synovial biopsy was performed in selected cases with synovial hypertrophy for observation of histological findings. Hypertrophied synovium in discoid meniscus was mainly localized in anterior compartment and intercondylar area of tibia. Therefore, when conventional anterolateral or anteromedial portals were used, much difficulty was confronted because hypertrophied synovium obstructed the visual field and crowding with surgical instruments was occurred in restricted space of discoid meniscus. Much more clear visual field was obtained when the medial midpatellar portal was used instead of conventional portals. The conclusions of this study are as follows : 1. The incidence of discoid meniscus was 16.1%. 2. Synovial hypertrophy was present in all 25 cases of discoid meniscus and 21 cases among 57 non-discoid meniscal lesions(35%) on operative findings 3. Synovial biopsy of hypertrophied synovium showed irritative nonspecific inflammatory lesions but there was no histologicsl differences between discoid and non-discoid meniscus. 4. Medial midpatellar portal is considered to be better approach than conventional portals for clear visual field and less crowding with instruments in arthroscopic surgery of lateral discoid meniscus.

Effects of Vasoactive Drugs on Blood Flow in Rabbits: Photoplethysmographic Assessment / 대한정형외과학회잡지

The dynamic blood flow is regulated by the numerous complex mechanisms. Since blood flow varies directly with the radius of the vessel, blood flow is markedly affected by small changes in the caliber of the vessels. Using the hotoplethysmography, we assessed the relative changes of blood flow after topical application of the vasoactive drugs to the femoral arteries of the rabbits. It is the purpose of this study to evaluate the immediate and delayed effects of the vasoactive drugs such as epinephrine, methylergonovine, chymopapain, and lidocaine in course of time when the drugs applied topically to the vessel. 60 rabbits were divided into 6 experimental groups. In group I, the femoral artery was surgically exposed only. In Group g-A, epinephrine was applied to the femoral artery after surgical exposure. In Group Il-B, after spplication of epinephrine, the effect of epiniphrine was reversed with lidocaine. Another drugs were applied as follows methylergonovine in Group Hl-A, methylergonovine and lidocaine in Group Ill-B as in group Il-B, Chymopapain in Group lV. The relstive changes of blood flow were measured by the photoplethymograph for 3 weeks. The results are as follows ; 1. The amplitude of the photoplethysmographic wave decreased immediately after the topical application of epinephrine, methylergonovine and chymopapain. Such an effect could be observed until the 3rd week after the topical application of the drugs, 2. The delayed dffect of reducing the amplitude could be seen during the 1st week in the epinephrine and methylergonovine treated groups. However, it was seen after 1st week in the chymopapain treated group. 3. The delayed effect of epinephrine and methylergonovine could be reversed with lidocaine. 4. It seems that lidocaine can be used clinically to preyent the delayed effect of epinephrine and methylergonovine.

Treatment of the Established Compartment Syndrome in the Forearm / 대한정형외과학회잡지

The treatment of the established compartment syndrome in the forearm varies along the degree of the severity. We reviewed 17 cases of the established compartment syndrome in the forearm treated at Seoul National University Hospital from February 1979 to July 1985. Follow-up was performed more than one year in 14 cases. And the mean follow-up period was 30 months. Out of 17 cases operated on, mild involvement were found in 5 cases. Moderate and severe involvements were observed in 6 and 6 cases respectively. Tenolysis-tendon lengthening was done for 7 cases and proximal release (muscle-sliding operation) was performed in 8 cases. In two cases, living muscle and skin were transfered using microsurgical technique. In mildly to moderately affected, functional improvements can be obtained in most cases. The proximal release was superior to the tenolysis-tendon lengthening in this category of involvement. However, in severely involved group, the functional gain after the operation is slight in spite of the time consuming, difficult surgery including free muscle transfer. The neurological problems could be gradually improved without treatment in almost all cases.

Volar Interdigital flap in the Treatment of Syndactyly / 대한정형외과학회잡지

Syndactyly is one of most common congenital anomalies of the limb. We reviewed 89 webs of 40 patient with syndactyly which had been treated at Seoul National University Hospital from 1979 to November 1984. It is the purpose of this article to compare the operative methods used in the treatment of syndactyly. In our hands, using the volar interdigital flap in the treatment of syndactyly gives the most excellent postoperative result in both function and cosmesis.