Comparison of Energy Consumption According to The Joint Deformities of The Lower Extremity in Sagittal Plane / 대한정형외과학회잡지

Background. Ultimate goal for the treatment of the deformities in the lower extremities is to minimize the energy requirement and conserve the energy on walking and daily living. The normal energy saving mechanism is usually broken down in the patients with the deformities in the lower extremity, and they need more energy consumption. This is the reason why they feel fatigue frequently. It is well known that the deformity in the lower extremity cause excessive energy consumption. Objectives. There is no report that compared the energy consumption according to the deformities of the lower extremity. When we decide the priority of the treatment in cases of multiple deformities, it will be important to understand the energy demand according to each deformity. Therefore, it is the purpose of this study that assess the energy consumption according to the various types of lower extremity deformities. Method. We induced the multiple deformities in ten normal adults with the brace artificially. The induced deformities are as follows: Equinus deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Knee flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees), Hip flexion deformity; mild (10degrees), moderate (20degrees), severe (30degrees). For the control group, same braces were applied without any deformity. Oxygen consumption was measured for the energy consumption with the Oxygen Consumption Meter (Morgan Oxylog II, Morgan Ltd. England). Heart rate was checked with the Telemonitor (Dynascope, Fukuda Ltd, Japan). We evaluated the inspired volume, oxygen rate, oxygen cost, and heart rate in each group and compared the data among the groups. Result. Energy consumption was higher in the hip deformity group, in the knee deformity group, and in the ankle deformity group in that order. Conclusion. When there are concomitant deformities in hip, knee and ankle, the priority of treatment may be hip, knee and ankle, in that order in terms of energy consumption.

The Influence of Lumbar Fractional Curve Rotation on Fusion Level of King Type III Adolescent Idiopathic Scoliosis ( AIS ) / 대한정형외과학회잡지

Study design. This retrospective study analyzes the influence of lumber rotation on fusion extent in King type III AIS treatment by CD instrumentation. Objectives. To establish a guideline for fusion in King type III AIS Summary Study of background data. Rotational characteristics of the lumber curve may significantly affect the postoperativ e behavior of uninstrumented lumbar curve thus calling for a different lumbar rotation. Methods. Sixteen King type III AIS treated with CD were divided into two groups by the direction of lumbar curve rotation. It was opposite direction (OD) to the rotation of the major curve in 9 and same direction (SD) in 7. In OD, 6 were treated by selective thoracic fusion (TF) and 3 were fused to the stable vertebra (SV). In SD, 6 were treated by TF and 1 was fused to the SV. They were evaluated for balance, major and fractional curve correction after a minimum follow up of 2 years. Result. In OD, all curves were balanced regardless of the fusion extent with satisfactory curve correction. In SD-TF, all were clinically balanced with major curve correction of 75%, but all the fractional curve were overcorrected, adding on the major curve. In SD-SV, the curve was balanced with stable lumbar curve. Conclusion. In King type III curve with lumbar curve rotated to the opposite direction, selective thoracic fusion is sufficient. However, when the fractional curve is rotated in the same direction, fusion to the stable vertebra may be a safer choice.