A Comparative Study of the Navigated and Radiographic Measurements in Open and Closed Wedge High Tibial Osteotomy with Computer Assisted Surgery / 대한정형외과학회잡지

PURPOSE: We wanted to identify the difference of the measured values between a navigation system and radiographs when performing open and closed wedge high tibial osteotomy (HTO) under the control of a navigation system. MATERIALS AND METHODS: Thirty-two open wedge HTOs and 51 closed wedge HTOs were performed using a navigation system. The postoperative mechanical axis percent, which was planned on the navigation system, was 62%. The mechanical axis (MA) was measured before osteotomy and after fixation on the navigation system, and these were compared with the measured values from the radiographs. The difference of the postoperative MA between the navigation system and the radiographs was compared according to the type of HTO. The alteration of the tibial posterior slope angle was also compared. RESULTS: For the open wedge HTO, the mean MA after fixation was valgus 2.7degrees on the navigation system and the postoperative MA was valgus 4.0degrees on the radiograph. For the closed wedge HTO, the mean MA after fixation was valgus 3.5degrees on the navigation system and the postoperative MA was valgus 1.6degrees on the radiograph (p=0.000). The mean tibial posterior slope angle was increased by 5.3degrees after the open wedge HTO and it was decreased by 1.8degrees after closed wedge HTO (p=0.000). CONCLUSION: Performing HTO with a navigation system could increase the surgical accuracy because the navigation system checked the intraoperative correction angle in real time. Weight bearing makes a difference for the postoperative MA between the navigation system and radiographs. This should be taken into account, according to the type of HTO.

Survivorship of lateral closing wedge proximal tibial osteotomy / 中国矫形外科杂志

[Objective] To determine the long term survivorship and establish the idea I correction angle in proximal tibial osteotomy for primary osteoarthritis. [Method] Seventy-nine patients suffering from primary osteoarthritis (111 knees) were performed with proximal tibial valgus osteotomy from 1985 to 1997, among which 74 women (106 knees) and 5 men (5 knees). The age ranged from 37 to 70 years (mean, 55 years). Postoperatively, hospital for Special Surgery knee score (HSS) was used for clinical assessment. The femorotibial angle (FTA) was measured to classifiy patients to group Ⅰ of 61 knees with less than 7 of valgus; group Ⅱ of 23 knees with 7～9 of valgus; group Ⅲ of 27 knees with over 10 of valgus. Closed wedge osteotomy was performed in all cases. HSS was assessed pre-and post-operatively. [Result] The average follow-up period was 9 years and 6 months (2 years and 4 months to 14 years and 1 month). The HSS knee score averaged 60 points preoperatively, 94 after 1 year and 87 at the last follow-up. Falure I was the need for conversion of a proximal tibial osteotomy to a total knee arthrop lasty, and Failure Ⅱ was the need for conversion of HSS knee score of less than 60 points. The 4 and 14 years survival rates were 99% and 85% using the first definition of failure, and 96. 4% and 75.1% using the second. [Conclusion] Proximal tibial osteotomy is reliable for treating unicompartmental osteoarthritis, providing that the postoperative femorotibial angle is corrected to more than 7° of valgus and falls in the range of 10°～15°.

Navigation versus Radiographic Measurements in the Open-Wedge High Tibial Osteotomy using Computer Assisted Surgery (CAS) / 대한정형외과학회잡지

PURPOSE: To compare the measurements using a navigation system and radiographic measurement in an open wedge high tibial osteotomy under navigation control. MATERIALS AND METHODS: From July, 2005 to January, 2007, 32 open wedge high tibial osteotomies were performed using a navigation system for osteoarthritis of the knee. The postoperative mechanical axis % (MA%), which is planned on the navigation system, were 62%. The mechanical axis (MA) and MA% were measured on the navigation system. The preoperative and postoperative MA and MA% were measured on the radiographs. The angles measured with the navigation system and radiographs were compared. RESULTS: On the navigation system, the mean MA before osteotomy was varus 8.8degrees. The mean MA and MA% after fixation were valgus 2.9degrees and 57.7%. On the radiographs, the mean MA was varus 9.7degrees preoperatively and valgus 4.0degrees postoperatively. The mean MA% was 10.2% preoperatively and valgus 64.4% postoperatively. There were positive correlations between the values measured with the navigation system and the radiographs (r>0.5, p<0.001). CONCLUSION: There were significant correlations between the values measured with the navigation system and radiographs in an open wedge high tibial osteotomy using a navigation system. The correction angle from the navigation system is reliable, predictable and controllable during surgery.

Treatment of Supracondylar Fractures Following Total Knee Arthroplasty

PURPOSE: To analyze clinical and radiological results of patients who underwent treatment for a femur supracondyle fracture following total knee arthrosplasty(TKA). MATERIALS AND METHODS: Between January 1991 and March 2005, A total of 33 knees of 30 patients(2 male, 31 female knees) were treated for periprosthetic supracondyle fractures following TKA. The mean age of patients was 60.5 years and the mean follow-up period was 3.5 years(range, 1 year~9 years and 1 month). In accordance with the modified Neer classification, 3 cases were classified as Type 1; 23 cases, Type 2; 4 cases, Type 3; and 3 cases, Type 4. Treatment methods included closed reduction and cast immobilization in 8 cases, Ender nailing in 8 cases, open reduction and internal fixation in 14 cases, and total knee arthroplasty using a long stem in 3 cases. RESULTS: Among 2,325 knees with primary TKA, 33 cases occurred a supracondylar fracture. The incidence of 1.4%. The range of motion reduced from the mean of 113.1 degrees before the fracture to the mean of 94.3 degrees at the last follow-up. The conservative group reduced from 112.3 degrees to 71.9 degrees while the operative group decreased from 113.3 degrees to 102.0 degrees. The HSS knee rating score declined from the mean of 88.1 points before the fracture to the mean of 81.4 points at the last follow-up. The score of the conservative group was down to 70 points from 87.5 points and that of the operative group decreased to 85.4 points from 88.3 points. The femorotibial angle, which was 6.39 degrees of varus before the fracture, was measured 3.07 degrees of varus at the last follow-up. The femorotibial angle decreased from 6.2 degrees to 1.1 degrees of valgus in the conservative group and from 6.5 degrees to 3.7 degrees of valgus in the operative group. Only one of the total 33 cases had nonunion. CONCLUSION: In the treatment for the supracondylar fractures of TKA, the decreased amount of postoperative ROM, HSS score and femorotial angle were all less in an operative treatment than conservative treatment. Revision arthroplasty using a long stem showed satisfactory results in patients with component loosening.

The Clinical Effects of Nicorandil during Percutaneous Coronary Intervention in Patients with Unstable Angina

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the clinical effect of Nicorandil during percutaneous coronary intervention (PCI) in patients with unstable angina (UA). SUBJECTS AND METHODS: Two hundred patients (61+/-10 years, male 143) with UA were randomly assigned to two groups: intravenous Isosorbide dinitrate (Group I, n=100) and intravenous Nicorandil (Group II, n=100). PCI was performed 12-48 hours after infusion of the agents. The post-procedural cardiac enzymes, 6-month MACE (major adverse cardiac event) and left ventricular ejection fraction (LVEF) were compared between the two groups. RESULTS: Successful PCI was performed in 96 patients (Group I=54, Group II=42). Patients requiring either emergent coronary angiography, temporary pacemaker or platelet glycoprotein IIb/IIIa receptor blocker were excluded. No significant differences were observed between the two groups in terms of the clinical and coronary angiographic characteristics. The level of creatine kinase-MB was elevated in 9 (17%) and 6 patients (14%), troponin T in 16 (30%) and 6 (14%) and troponin I in 25 (46%) and 9 (21%) patients of Groups I and II, respectively, after the PCI. The elevation of all troponins was lower in Group II (28 vs. 10 patients, p=0.01). MACE developed in 9 (17%) and 5 (12%) patients of Groups I and II (p=NS), respectively, during the 6-month clinical follow-up. The LVEF was higher in Group II than in Group I on follow-up echocardiography (65.4+/-7.2% vs. 71.0+/-6.7%, p=0.003). CONCLUSION: Nicorandil may have a myocardial protective effect during PCI in patients with UA.

The Long-Term Clinical Results of a Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab : ReoPro(R)) Coated Stent in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The inhibition of coronary restenosis with an Abciximab (ReoPro(R))-coated stent has previously been reported by us. This study investigated the clinical outcomes of patients with acute myocardial infarction (AMI) treated with ReoPro-coated stents. SUBJECTS AND METHOD: A prospective randomized trial was conducted to compare two types of stent for the revascularization in 63 patients [Group I (ReoPro(r)-coated stent):n=32, 53.7+/-11.8 years, 27 male, and Group II (control stent):n=31, 55.4+/-12.1 years, 27 male] with AMI. The primary effective end points were major adverse coronary events (MACE):cardiac death, acute myocardial infarction, target lesion revascularization (TLR), in-stent restenosis and late lumen loss at the 1 year clinical and angiographic follow-ups. RESULTS: Baseline clinical characteristics and diameters of stenosis and the minimal luminal diameters were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in group II. Follow-up coronary angiograms were performed in 71.9 (23/32) and 77.4% (24/31) of groups I and II, respectively. The diameter of stenosis and late loss were significantly lower in group I than group II (19.4+/-5.1 vs. 34.8+/-5.9%, p=0.013;and 0.39+/-0.26 vs. 0.89+/-0.45 mm;p=0.008, respectively). However, the restenosis rates were no different between the two groups (21.7 vs. 37.5%, p=0.341). One year clinical follow-ups were possible in 98.4% (62/63), and there were two AMI found in group II, but none in group I. The TLR rates and total MACE of group I were relatively lower compared with group II [12.9 (4/31) vs. 29.0% (9/31);p=0.122 and 12.9 (4/31) vs. 35.5% (11/31), p=0.038, respectively]. CONCLUSION: The ReoPro(R)-coated stent was safe, with no stent thrombosis, and effective in patients with AMI.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.