A Survey of Food and Nutrient Intakes of the Eged People in Rural Area, Gyeongbuk Yecheon

This research has done for 262 people of the aged men and women that are more than 65 years old who are live in 9 areas of Yecheon as target; through twice of face to face interview for 24 hours recall method, the result of food intake for 2 days is as following. In case of energy, the aged men (women) of sixties ingested 67.7 (72.0)% of Korean RDA by 1,369 (1264) kcal, for the ages of seventies and eighties, 68.9 (66.9)% of Korean RDA and 76.3 (65.8)% by each 1,309 (1104) kcal and 1,368 (1052) kcal. The aged men ingested protein 46.0~49.6 g (70.6~82.9% of RDA), and aged women ingested protein 32.7~40.2 g (59.4~73.0% of RDA). Calcium intake of aged men was 388.8 mg, 319.8 mg, 284.4 mg by age range, and aged women was 291.9 mg (41.6% of RDA), 246.5 mg (35.3% of RDA), 240.1 mg (34.3% of RDA). Iron intake of aged men was 8.6~8.9 mg (72~74% of RDA), and aged women ingested 8.6 mg (71.3% of RDA), 7.5 mg (62.6 of RDA%), 6.6 mg (55.4% of RDA) for iron by age range. Vitamin B1 intake of aged men was 0.62~0.71 mg (62~71% of RDA), and aged women's intake was 0.50~0.60 mg (50~60% of RDA). Vitamin B2 intake of aged men was 0.59~0.60 mg (49% of RDA), and aged women's intake was 0.45~0.50 mg (37~42% of RDA). Vitamin C intake by age range, in case of aged men (women) in sixties was 53.1 (48.9) mg, in seventies was 49.9 (33.2) mg and more than eighties was 34.1 (33.4) mg. The average food intake by age range, in aged men (women) of sixties was 828.9 (670.8) g and seventies was 726.8 (568.8) g and more than eighties was 656.0 (525.3) g. Plant food intake of aged men was 490.8~569.5 g and aged women was 417.9~537.7 g. Aged men (women) of MAR by age range, sixties was 0.60 (0.58), seventies was 0.59 (0.50) and more than eighties was 0.56 (0.49), respectively. INQ for protein, phosphorus, iron, vitamin A, vitamin B, niacin, vitamin C was more than 1 in 60's and 70's aged men, but there was no nutrients in eighties of aged women. Aged men and women's KDDS points represent average 3.14 and 3.04 (out of 5 points), and while intake of the milk was the most lacking, but intake of the fruit was the most lacking in DDS.

Revision Arthrodesis After Lumbar Fusion in Degenerative Lumbar Disease / 대한정형외과학회잡지

PURPOSE: To assess the etiologies, related factors and clinical outcomes of revision arthrodesis after lumbar fusion. MATERIALS AND METHODS: Eighteen patients who underwent revision arthrodesis after lumbar fusion for degenerative lumbar disease were analyzed retrospectively. The authors analyzed the radiologic and clinical findings and compared these with outcome. RESULTS: The causes of revision arthrodesis were adjacent segment degeneration in 14 cases (77.8%), pseudarthrosis in 4 cases (22.2%). A finding of adjacent segment degeneration was attributed to stenosis in 72.2% and instability in 44.4%. Of the 14 patients with adjacent segment degeneration: 12 patients (85.7%) underwent index fusion of more than two segments; 10 patients (71.4%) had lordosis of less than 20 degrees within index fusion segment; 12 patients (85.7%) had preexisting degeneration at the segment; and the lesion was found just above the affected segment in 11 patients (78.5%). The surgical treatments involved decompression, extension of instrumentation and anterior or posterior fusion. The clinical success rate was 72.2% after 2.9 years follow up. CONCLUSION: The multilevel arthrodesis, insufficient lordosis of the fused segment and underlying degenerative changes are related to adjacent segment degeneration. Immediately above the segment was the most common site of adjacent segment degeneration. These factors should be considered when deciding the fusion level.

Significance of Chin-brow Vertical Angle in Correction of Kyphotic Deformity of Ankylosing Spondylitis Patients / 대한척추외과학회지

STUDY DESIGN: Retrospective study of 34 ankylosing spondylitis patients with kyphotic deformity who performed correction osteotomy. OBJECTIVES: To assess significance of chin-brow vertical angle for planning and evaluating correction of kyphotic deformity with ankylosis of cervical spine in ankylosing spondylitis patients. SUMMARY OF LITERATURE REVIEW: Accurate assessment and measurement of spinal kyphotic deformity is required when planning treatment and assessing its results. The most reliable measure of trunk deformity is the chin-brow vertical angle. MATERIALS AND METHODS: Thirty-four ankylosing spondylitis patients with cervical ankylosis who had underwent pedicle subtraction extension osteotomy for correction of kyphotic deformity were studied. The patients consisted of 32 male and 2 female patients. Mean age was 35.7 years. Most common apex of kyphosis was T12 in 11 cases. The levels of osteotomy were L1 in 3 case, L2 in 4 cases, L3 in 17 cases, and L4 in 10 cases. Radiographic assessment for sagittal balance was performed by measuring thoracic kyphosis, lumbar lordosis, and distance between the vertical line on anterosuperior point of T1 and that of S1. Chin brow-vertical angle was measured on the preoperative and postoperative clinical photo of the patients. Clinical outcomes were assessed by questionnaire measuring changes in physical function, indoor activity, outdoor activity, psychosocial activity, pain, and patient 's satisfaction with the surgery. RESULTS: Chin brow-vertical angle was 35.5 degrees preoperatively and 1.8 degrees postoperatively. Final follow-up radiograph showed an increase in lumbar lordosis from 5.5 to 43.2 degrees(an increase of 37.7 degrees) while thoracic kyphosis remain stable from 50.4 to 50.2 degrees. Sagittal imbalance significantly improved from 101.5 to12.7 mm. Decreased chin-brow vertical angle correlated negatively with correction angle while chin-brow vertical angle did not correlate with overall clinical outcome. However, the patients with chin brow vertical angle greater than 10 degrees or less than -10 degree had significantly low score concerning the item of horizontal gaze. CONCLUSIONS: The ankylosing spondylitis patient with cervical ankylosis, who had chin-brow vertical angle ranging from -10 to 10 degrees, had better horizontal gaze. Based on the results of this study, measurement of chin-brow vertical angle was recom-mended for planning correction of kyphosis and accurate evaluation of treatment outcome.

Total Knee Arthroplasty in Complete or Partial Ankylosed Knee

PURPOSE: The purpose of this study is to analyse clinical and radiologic results of total knee arthroplasty in complete or partial ankylosed knee. MATERIALS AND METHODS: From July 1986 to August 1996, total knee arthroplasties were performed in 37 ankylosed knees. Of these, five patients were lost to follow-up. Thirty two patients were evaluated. The average follow up period was 5 years 2 months (2 years-11 years 10month). Average age of patients at the time of total knee arthroplasty was 40.4 years (20~63 years). There were seven men and twenty five women. Twenty patients had complete ankylosis and twelve patients had partial ankylosis. Quadriceps tendon was lengthened with the method of modified V-Y advancement technique in 10 cases. Tibial tubercle was proximally transferred in 3 cases. RESULTS: The postoperative average range of motion was 75.3 degrees (30 degrees - 115 degrees) in complete ankylosis, 98.7 degrees (60 degrees -130 degrees) in partial ankylosis. The average HSS knee score improved from 56.8 points preoperatively to 85.6 points postoperatively. Radiolucent line was observed in two knees with less than 2mm width in 3 years and 4 years postoperatively, but the patient had no pain. CONCLUSION: In patient selection, healthy extensor mechanism and adequate soft tissue condition are most important. With meticulous surgical technique and aggressive rehabilitation, patients can obtain reasonable restoration of function in ankylosed knee after total knee arthroplasty.

Surgical Treatment of Kummell Disease with Neurologic Deficits: Posterolateral Decompression and Posterior Reconstruction / 대한척추외과학회지

STUDY DESIGN: Retrospective study was performed in eight patients with Kummell disease. OBJECTIVES: To access the results of posterolateral decompression and posterior reconstruction in Kummell disease with neurologic deficits. SUMMARY OF LITERATURE REVIEW: Severe osteoporosis is the most frequent cause of spinal compression fracture. Vertebral compression fracture in senile osteoporosis is characterized by the late development and slow progression of paraplegia. When conservative treatment for paraplegia proves ineffective, an early operation is recommended. MATERIALS AND METHODS: From June 1996 to February 2000, eight consecutive Kummell disease patients with neurologic deficits underwent posterolateral decompression and posterior reconstruction. We analyzed operation time, loss of blood through the medical records. Change of segmental kyphotic angle, bone union were assessed by plain radiographs, the clinical results were analyzed according to changes of pain and neurological status. RESULTS: Mean operation time was 217 minutes, mean bleeding loss was 682 ml. The mean preoperative segmental kyphotic angle measured 22.6 degrees, and decreased to 4.4 degrees at postoperative evaluation, and 6.8 degrees at final follow-up. Bony union was obtained in 9 months. At preoperative time, four cases showed Frankel grade C and four cases Frankel grade D. At last follow-up time, one case Frankel grade D and six cases Frankel grade E. CONCLUSIONS: We concluded that posterolateral decompression and posterior reconstruction is a useful method for the treatment of Kummell disease with neurologic deficits.

Root Injury after Percutaneous Vertebroplasty in Compression Fracture: Case Report / 대한척추외과학회지

The first image-guided percutaneous vertebroplasty was performed in France in 1984. Percutaneous vertebroplasty recently has been introduced as a therapeutic alternative for the treatment of pain associated with compression fracture. Several European reports have described excellent results for treatment of compression fracture, and complications were minor and infrequent. We experienced a case of root injury after percutaneous vertebroplasty in compression fracture, which was treated by posterior decompression and removal of the cement.

Future Development of Interbody Fusion Cages / 대한척추외과학회지

Interbody fusion using cages are becoming the popular procedure for the spinal fusion. To see the future of cages for interbody fusion, the current authors described history of interbody fusion and cages, biomechanics of cages, and kinds and problems of currently available cages. Based on the review of cages in the past and the present, current authors described requirements of future cages and future of the cages. Spinal fusion including interbody fusion using cages will exist as a major part of spinal surgery in the future. Development of surgical technique, medical engineering, and molecular biology will bring better outcome of interbody fusion.

Results of the Posterolateral Fusion Using a Pedicle Screw for the Spondylolisthesis / 대한정형외과학회잡지

PURPOSE: This is a retrospective study to analyze the clinical and radiological results of posterolateral fusion with a pedicle screw fixation for lumbar spondylolisthesis. MATERIAL AND METHOD: From January 1994 to June 1997, forty-seven patients with spondylolisthesis were treated by posterolateral fusion with pedicle screw fixation. The clinical results were analyzed according to Kirkaldy-Willis & Kim's criteria and radiological union, reduction of slippage, change of disc space, change of lumbar and segmental angle were assessed by simple X-ray. RESULTS: The good bony union rate of formation and satisfactory clinical results were obtained, but the reduction of slippage, the restoration of disc height and the change of sagittal angle were not sustained. There was a significant relationship between the clinical results and the loss of anterior disc height. CONCLUSIONS: The satisfactory clinical results were seen to be in follow-up observation, and the maintenance of anterior disc height significantly influenced clinical results. We think that the additional operation method is necessary in maintaining the disc height.

Treatment of periprosthetic fractures following TKA / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of periprosthetic fracture treatments following total knee arthroplasty (TKA) . MATERIALS AND METHODS: Between Jan. 1991 and Jun. 1998, 16 knees in 15 patients were treated for periprosthetic fractures following TKA. Average age of the patients were 56 years (26-69 years) , and 14 patients were women and one was a man. The average follow-up period after fracture was 2 years 5 months (1 year - 8 years 2 months) . We analyzed clinical results according to the knee rating score of Hospital for Special Surgery (HSS) , bony union time and femorotibial angle. RESULTS: Among 980 knees in 633 patients with primary total knee arthroplasty, 16 knees in 15 patients developed periprosthetic fractures. The incidence was 1.6%. Three knees were treated with closed reduction and cast immobilization, seven knees were treated with Ender nailing, and six knees were treated with open reduction and internal fixation. Range of motion was 113 degrees on an average before fracture and 94 degrees at the last follow up, and HSS knee rating score averaged 88 points before fracture and 83 points at the last follow up. Radiologically, 15 knees had complete union and one knee had nonunion. CONCLUSION: The authors think that conservative management was not effective due to prolonged immobilization and late start of ROM exercise. Open reduction with internal fixations provided a better reduction of the fracture, preserving the alignment of fragment and restoring function. Also, Ender nailing was an alternative option of treatment considering less morbidity and satisfactory functional results.

Immunohistochemical Staining for Type II Collagen in Regenerated Cartilage after Microfracture Surgery / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to identify nature of regenerated articular cartilage after microfracture surgery. MATERIALS AND METHODS: From Oct. 1997 to Nov. 1998, 40 knees were treated for osteoarthritis by arthroscopic microfracture technique. In the 18 knees, during the second arthroscopic procedure, biopsy specimens extending to the subchondral bone were taken and immunohistochemical staining was done to identify type of collagen. One patient was man and 17 patients were women. Average age of the patients were 58 years (range, 40-75 years). RESULTS: Type II collagen in articular cartilage appeared to be brown color with this staining. Degree of staining were +3 in 4 knees(22%), +2 in 2 knees(11%), +1 in 7 knees(39%) and trace in 5 knees(28%). CONCLUSION: Microfracture surgery restores the function of the joint by forming predominantly hyaline-like cartilage containing type II collagen. As analyzing amounts of type II collagen with an immunohistochemical staining in regenerated cartilage, we can presume the prognosis of regenerated cartilage tissue after microfracture surgery.

Microfracture Surgery for Cartilage Regeneration in Degenerative Arthritis of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and histological results after microfracture surgery for degenerative arthritis of the knee. MATERIAL AND METHOD: Thirty-five patients, who had moderate to severe pain with no improvement after conservative treatment, moderate osteoarthritic change in standing AP radiogram, and no severe angular deformity, underwent microfracture surgery. Their mean age at the time of operation was 56 years (range, 33-75 years) and mean follow-up period was 1 year (range, 6-17 months) . In the 14 cases, 'second-look' arthroscopies and biopsies were performed at 6 months following microfracture for full thickness chondral lesions. At the last follow up clinical results were evaluated with Baumgaertner's scale. The specimens were stained with H-E, Safranin-O, and Masson's trichrome. RESULTS: Most of the patients showed significant improvement clinically. 'Second-look' showed that the chondral defect areas were covered with newly grown grayish white tissues. Histologically, the regenerated tissue appears to be a hybrid of hyaline cartilage and fibrocartilage. There are viable chondrocytes in lacunae with a uniform matrix. CONCLUSION: Microfracture surgery can induce chondral resurfacing for full thickness defects of osteoarthritic knee. However, the exact nature and fate of regenerated cartilagenous tissues need further long term follow-up study.

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.

Tuberculous Osteomyelitis on the Proximal Humerus after BCG vaccination: a case report / 대한정형외과학회잡지

Tuberculosis of the bone and joints is either one of the generalized manifestation or solitary localized lesion. The involvement of bone after Bacille Calmette Guerin (BCG) vaccination is very rare. We experienced a case of which developed tuberculous osteomyelitis after BCG vaccination. The case is a 14-month-old male. The patient had the history of BCG vaccination 1 year ago. The presenting symptoms were swelling, redness and discharge of the left shoulder. The lesion in the left proximal humerus was mainly erosive lesion with minimal periosteal reaction. We are going to report a case of 14-month-old child with tuberculous osteomyelitis after BCG vac-cination with brief review of literature.