Expressions of Leukemia Inhibitory Factor (LIF): Comparison of Normal Pregnancy and Recurrent Abortion / 대한산부인과학회잡지

OBJECTIVE: Successful implantation depends on a complex interaction between the developing blastocyst and the endometrium. Among the steroid hormones, growth factors, and cytokines which participate in preparing the uterus for implantation, leukemia inhibitory factor (LIF) plays an essential role in implantation. We compared the expression of LIF in normal pregnancies to that of recurrent abortions in placenta to elucidate whether spontaneous abortion and expression of LIF has correlation. METHODS: Placental tissues from normal pregnancies and recurrent abortions were fixed and embedded in paraffin. Standard immunohistochemical staining was used to identify LIF. RESULTS: LIF expressions on cytotrophoblast of recurrent abortion were lower than those of normal pregnancy. There were no expressions on syncytiotrophoblast and stroma in the both groups. In the decidua and gland, LIF was expressed in mild degree and there were no differences in LIF expression between normal pregnancy and recurrent abortion. CONCLUSION: LIF expression on cytotrophoblast of recurrent abortion was lower than that of normal pregnancy. LIF may provide paracrine and autocrine signals to both embryonic tissues and uterine epithelium during implantation. The dysfunction of LIF production may be a cause of the unexplained recurrent abortions.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Total Hip Arthroplasty with Hydroxyapatite-coated ABG(R) Hip Prosthesis: Minimum 5 Year Follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip arthroplasty (THA) with a hydroxyapatite (HA)-coated ABG(R) (AnatomicalBenoist Giraud, Howmedica, Europe) hip prosthesis. MATERIALS AND METHODS: From March 1992 to December 1996, we performed 204 total hip arthroplasty with HA-coated hip prosthesis. This study included 142 hips. The causes of THA were osteonecrosis of the femoral head (122 hips), osteoarthritis (16 hips) and infectionsequalae (4 hips). Clinical results were evaluated using Harris hip score. We observed osteointegration, cortical hypertrophy, reactiveline around femoral stem, subsidence, polyethylene wear, osteolysis and radiolucent line around acetabular cup on the follow-up radiographs. RESULTS: Harris hip score was an average of 84.5 points at last follow-up. Only one femoral stem was revised for loosening. Reactive lines around uncoated portion of femoral stem was observed in 70 hips. The cortical hypertrophy was observed at zone 2, 3, 5 and 6 in 46hips. Forty-five acetabular cups (31.7%) were revised. The causes of cup revision were polyethylene liner wear and osteolysis (24 hips), loosening (19 hips) and recurrent dislocation (2 hips). CONCLUSION: We found that the HA-coated ABG(R) femoral stem had high survival rate at minimum 5 years follow-up after THA, but acetabularcup had high revision rate for loosening and osteolysis.

The Effects of Radiofrequency Energy on Human Articular Cartilage: The Effect of Power Setting and Mode of Treatment on Chondrocyte Viability / 대한정형외과학회잡지

PURPOSE: The objective of this study was to investigate the effects of radiofrequency energy on human chondrocyte viability, and to correlate confocal laser microscopy fluorescence to sulfate uptake and to the histological integrity of articular cartilage. MATERIALS AND METHODS: The chondroplasty procedure for chondromalacic articular cartilage was performed using a 3.0-mm ArthroWand (Arthroscopic Electrosurgery System, ArthroCare Corporation) on fresh human articular cartilage. Radiofrequency energy was applied to the cartilage surface through the probe at a velocity of 10-mm per second in contact and non-contact mode. Three power settings were used. The treated cartilage was analyzed for chondrocyte viability by confocal laser microscopy and (35)S uptake. RESULTS: Confocal laser microscopy demonstrated partial-thickness chondrocyte death irrespective of treatment method. No mode of treatment or radiofrequency energy power setting resulted in full-thickness chondrocyte death. The depth of cartilage ablation was increased in the treated areas in contact mode in proportion to the power level and the time of treatment. No statistically significant difference in radiolabeled sulfate uptake of the specimens was observed with respect to the treatment modes and power settings. CONCLUSION: The extent of chondrocyte death by radiofrequency energy was not as significant as reported previously when the probe was moved at the speed of 10 mm/sec. Radiofrequency energy may be useful to treat chondromalacic cartilage in a contact mode using a proper energy level and delivery time.

Relationship between Popliteal Cyst and the Intra-articular Knee Disorders

PURPOSE: To evaluate the clinical symptoms and the associated intra-articular disorders of the polpliteal cyst. MATERIALS AND METHODS: We studied 56 patients, 60 cases of the popliteal cysts which. Had been treated with excision of the cyst after arthroscopy between May 1991 and February 2000. Arthroscopic findings and clinical results of the patients who had popliteal cyst were evaluated. RESULTS: Forty nine patients of the sixty patients of who had popliteal cyst showed intra-articular disorders. Tear of the meniscus and patello-femoral arthrosis with cartilage lesions were the most frequent intra-articular lesions. In 4 cases, recurrence of the popliteal cyst was noted. Two patients had tear of the meniscus and two had no intra-articular disorders. CONCLUSION: This study revealed that popliteal cysts frequently combined with intra-articular disorders. Arthroscopy of the knee joint seems worthwhile method for the patients who had popliteal cyst

The Significance of the Femoral Tunnel Position in PCL Reconstruction Using the Bone-Patellar tendon - Bone Graft

PURPOSE: We compared the clinical and radiological RESULTS of two patient-groups who had had PCL reconstruction for grade III PCL injury using the autogenous bone-patellar tendon-bone graft at the isometric point and at the anatomical point of femoral condyle. MATERIALS AND METHODS: Of 31 patients who were involved in this study, 20 patients had consecutive isometric PCL reconstructions between June 1993 and May 1995(group 1), And 11 patients had anatomi- cal PCL reconstructions between 1995 and 1997(group 2). We evaluated the clinical results using the Lysholm knee scoring system and measured the posterior translation of the tibial condyle on the posterior stress lateral radiographs. RESULT: The average posterior translation at the final follow-up was 7mm in group 1 and 5.9mm in group 2. The Lysholm knee score was 89 points in group 1, and 92 point in group 2. However, there wasn't any statistically significant difference in clinieal and radiological results between the two groups. SUMMARY: The clinical and radiological results can be influenced by several factors inherent to arthro-scopically assisted PCL reconstruction. Although it seems that initial knee kinematics can be improved by more distal PCL graft placement, there may be little effect to the final clinical and radiological results according to the femoral tunnel positions.

Anterior Spinal Instrumentation in Treatment of Spinal Tuberculosis / 대한정형외과학회잡지

OBJECTIVES: We performed anterior spinal fusion and instrumentation in treatment of spinal tuberculosis. The clinical results of this operation and metal-related complications were evaluated to determine the rationale of anterior instrumentation in active tuberculous lesion. METHODS: From July 1989 to February 1993, we treated twenty-one patients with spinal tuberculosis by radical resection of the tuberculous lesion and bone grafting, followed by anterior instrumentation using Zielke rod system. The changes in spinal deformity were measured from lateral spinal radiographs obtained preoperatively and postoperatively at 3 months, 6 months, 1 year, 2 years and final follow-up. The recurrence of infection and possible complications were also observed clinically and radiologically. RESULTS: The mean kyphotic angle was decreased preoperatively from 21 degrees to 16 degrees at final follow-up in patients with thoracolumbar tuberculous lesions. The mean deformity angle was corrected 7 degrees in thoracolumbar tuberculosis and 12 degrees in lumbar tuberculosis compared with the preoperative deformity angle. There was not any persistence or recurrence of infection possibly related to the instrumentation. All patients were allowed early ambulation with the aid of a light brace. CONCLUSION: The clinical and radiological results suggested that the anterior instrumentation seemed to be one of the rational approaches for providing immediate stability in treating severe spinal tuberculosis without any significant risk of persistence or recurrence of infection.

Posterior Instability After Arthroscopically Assisted PCL Reconstruction using Bone - Patellar tendon - Bone Graft

The posterior cruciate ligament is an anatomically and biomechanically complex structure. PCL injuries are reported to occur in 1-40% of acute knee injuries, with isolated PCL tear, less common than PCL tears combined with other Iigament injuries. Controversy exists concerning the geatment of the PCL injures. Recently, arthroscopic techniques of PCL reconstruction are becoming nore refined and reproducible. Between July 1993 and May 1995, 25 operations for PCL rupture were performed in our hospital. At the follow-up examinations we noted mild to moderate posterior instablilty which was not noted at the time of operation and during the immediate postoperative period. We reviewed type (if injuries, amplitude of initial posterior tibia1 translation, surgical techniques, which seemcd to be in relation ivith the postoperative instabilities. At final follow-up, the mean Lysholm knee score was 86 points, and the posterior tibial translation 6.5mm on posterior stress radiographs. The ligament augmentation device provided no benefit. The ideal positioning and fixation of the graft and protection of the graft from abrasion seemed to be important to get a good results.

Combined Instrumentation with the Soft and Rigid Stabilizer in Degenerative Lumbar Disorders / 대한정형외과학회잡지

From January 1992 to May 1993, we performed a new method of spinal instrumentation, namely the combined instumentation with the soft and rigid stabilizer, to minimize the adverse effects induced by rigid multi-segment fixation and fusion in twenty patients with complex degenerative lumbar disorders. By using this combined method, we were able to preserve one or two more motion segments from the fusion. And we also expect that the rate of deterioration at the adjacent motion segments to the fusion level will decrease. Though the follow-up period is short, the clinical results were satisfactory in 80% of the patients. We think that this combined instrumentation can be a choice of treatment for complex multi-segment lumbar disorders.

Clinical and Radiological Analysis of THR Using AML Prosthesis / 대한정형외과학회잡지

We had replaced 159 hips in 130 patients with cementless porous-coated AML porsthesis at Kwang Ju Christian Hospital between April 1987 and Feb. 1992. Among them, 100 cases(80 patients) could be analyzed clinically and radiologically with an average follow-up of 38.5 months(range 10 months to 74 months). The purpose of this study was to evaluate the relationships of initial fit, follow up stability and clinical results. The results were as follows. 1. The average postoperative Harris hip score was 90 points(preop. 42) at the follow-up of 1 year or more, the pain score 41 points(preop. 15). 2. When the surgical fit of stem was achieved properly, fixation by bone ingrowth could be expected. Simultaneously adequate fit of acetabular cup provided stable fixation. 3. The incidence of thigh pain was high in patients with an unstable implant of stem and the hip pain was more common in group of a definitely unstable cup. 4. Stress shielding was seen in 44 cases(44%). Of the 44 cases, 38 cases(86%) revealed in bone ingrowth. In conclusion, this study showed good clinical result of THR using AML prosthesis at the average follow-up of 38.5 months and it seemed to be influenced by initial fit significantly. But long-term follow-up is needed for accurate clinical and radiological evaluation.

Surgical Treatment of Spondylolisthesis Using Transpedicular Fixation System / 대한정형외과학회잡지

We have analyzed clinical results of forty-five patients who had spondylolisthesis which were operated using transpedicular screw fixation devices (CD or Steffee VSP system) between June, 1987 and March, 1992 at the department of Orthopedic Surgery of Kwang-ju Christian Hospital. Simultaneously we compared the postoperative results between two groups. The results were as follows: 1. The ratio of man and woman was 1: 2.2 and mean age was 44.3 years (44.8 years in degenerative type and 42.5 years in isthmic type). 2. The most common level was L4 on L5 and two-third of all cases were isthmic type. 3. The clinical results were satisfactory in 91% (41 cases) according to anthors modified evaluation system. There was no significant difference between degenerative and isthmic type. 4. The mean % of slip was improved from 23.3% preoperatively to 7.4% postoperatively and the mean slip angle was improved from 3.5 degrees preoperatively to-5.4 degrees postoperatively. 5. The devices which were used for operation were C-D instrument in 21 cases and Steffee VSP system in 23 cases. There was no difference in radiographic examinaton and clinical result between two groups. 6. The anterior fusion was done for 9 active young patients. The results were significantly satisfactory. 7. We consider the transpedicular fixation system is the most recommandable method of treatment for spondylolisthesis in providing excellent reduction of slippage and maintenance of reduction with rigid fixation device.

The clinical Results of Graf Instrumentation in Unstable Lumbar Spinal Disordors / 대한정형외과학회잡지

Various kinds of spinal instruments have been developed for the treatment of lumbar spinal disordors. Recently, the Graf instrument as soft stabilizer has been introduced in treating lumbar spinal disordors associated with instability. To determine the reliability of Graf instrument providung spinal stability we have analysed 19 cases of unstable lumbar degenerative disease treated with adequate decompression and Graf instrumentation between May 1991 and March 1992. There were 15 females and 4 males. Average age at operation was 50.8 years (Range, 35 to 70). Minimum follow up was 14 months. The main surgical indication was serious limitation of daily activity caused by intractable symptoms and signs with spinal instability. Clinical assesment based on authors modified criteria revealed satisfactory (Exellent/Good) in 16 cases (84.2%). The Graf instrument has many advantages over rigid implant such as enough stability without arthrodesis after extensive surgical decompression, rapid rehabilitation, less operative risk and preservation of spinal motion. These results suggests Graf instrument instead of rigid implant is highly recommendable in managing unstable lumbar disordors.

Alveolar soft part Sarcoma with Metastasis to Bone: A Case Report / 대한정형외과학회잡지

Alveolar soft part sarcoma is a clinically and morphologically distinct soft tissue tumor that was first defined and named by Christopherson et al in 1952. Since 1953, alveolar soft part sarcoma invading bone have been reported sporadically. We experienced a case of alveolar soft part sarcoma with metastasis to femoral shaft, which was treated by wide resection & vascularized fibular strut graft.

Reconstruction of chronic ACL insufficiency using gore-tex prosthetic ligament substitute / 대한정형외과학회잡지

No abstract available.

Femoral Head Replacement with Ceramic Head Prosthesis / 대한정형외과학회잡지

Authors report the preliminary result of 86 consecutive femoral head replacements with ceramic head performed at Chonnam University Hospital(73 hips) and Kwangju Christian Hospital(13 hips) during the period of 2 years and 6 months between January 1985 and June 1987. The results were as follows ; l. Eighty-three patients were comprised of 41 men(44 hips) and 42 women(42 hips). 2. Their average age at operation was 62.8 years, the oldest being 86 and the youngest being 24 years and 57 patients(68.7%) of them were over 60 years of age. 3. The causative diseases of the femoral head were hip fracture and its related conditions in 74 hips, and idiopathic avascular necrosis in 12 hips. 4. Associated general diseases, a total of 69 in number, could be diagnosed in 54 patients of them. These included hypertension(18 patients), cardiovascular disease(10 patients), and diabetes mellitus(8 patients). 5. The average diameters of the ceramic head were 49.8 mm in men and 45.1 mm in women. 6. The types of femoral stem were cemented stem(Xenophor 900 stem) in 45 hips and noncemented stem(Autophor 900S stem) in 41 hips. 7. The early postoperative complications, a total of 9 in number, were encountered and these included death in hospital(3 patients), trochanteric fracture(2 patients), pneumonia (1 patient), and others(3 patients). 8. The late postoperative complications, a total of 9 in number, were encountered and these included acetabular erosion(4 hips) and heterotopic ossification(5 hips). 9. Forty-nine hips could be followed more than 1 year with average follow-up of 19.9 months. The hip function of these 49 hips were excellent in 13 hips, good in 24 hips, fair in 8 hips, poor in 3 hips and bad in 1 hip. 10. In conclusion, it can be stated that the femoral head replacement with ceramic head prosthesis is very promising in reducing the incidence of acetabular erosion and maintaining the regained hip function.

A Wide Muscle-splitting Approach to the Lumbosacral Spine / 대한정형외과학회잡지

20 patients with lumbosacral disorder underwent anterior spinal fusion using wide muscle splitting approach. The approach has considerable advantages over the usual muscle cutting approach or the transperitoneal approach commonly employed for this incision. The advantages of this approach are as follows: 1. The approach to the lesion site is safe and accurate. 2. The operation field is wide. 3. It is less destructive to the abdominal wall. 4, The defect left in iliac crest after removal of bone graft can be covered with external oblique layer. 5. The exposure given to the Ls-S1 intervertebral disc is superior to that given by the Rutherford Morrison approach.