Study Design: This retrospective study was conducted including 18 patients who underwent posterior-only stabilization and fusion procedure for pseudoarthrosis in the ankylosed spine from October 2007 to May 2015. Purpose: This study aimed to describe the treatment outcomes in 18 patients with Andersson lesion (AL) who were managed using the posterior-only approach. Literature Review: AL is an unstable, localized, vertebral, or discovertebral lesion of the spine. It is observed in patients with ankylosing spondylitis. The exact etiology of this disorder remains unclear, and the treatment guidelines are not clearly described. Methods: We analyzed 18 patients with AL who were treated with posterior long segment spinal fusion without any anterior interbody grafting or posterior osteotomy. Pre- and postoperative radiography, computed tomography, and recent follow-up images were examined. The pre- and postoperative Visual Analog Scale score and the Oswestry Disability Index score were evaluated for all patients. Whiteclouds' outcome analysis criteria were applied at the follow-up. Moreover, at study completion, patient feedback was collected; all the patients were asked to provide their opinion regarding the surgery and were asked whether they would recommend this procedure to other patients and them self undergo the same procedure again if required. Results: The most common site was the thoracolumbar junction. The symptom duration ranged from 1 month to 10 years preoperatively. Most patients experienced fusion by the end of 1 year, and the fusion mass could be observed as early as 4 months. Pseudoarthrosis void of up to 2.5 cm was noted to be healed in subsequent imaging. In addition, clinically, the patients reported good symptomatic relief. No patient required revision surgery. Whiteclouds' outcome analysis score at the latest follow-up revealed goodto-excellent outcomes in all patients. Conclusions: ALs can be treated using the posterior-only approach with long segment fixation and posterior spinal fusion. This is a safe, simple, and quick procedure that prevents the morbidity of anterior surgery.
Background: The primary objectives of mandibular surgery are to achieve optimal occlusion, low sensory disturbance, and adequate fixation with early movement. In-depth knowledge of the mandibular structure is required to achieve these goals. This study used computed tomography (CT) to evaluate the mandibular cortical thickness and cancellous space according to age and sex. Methods: We enrolled 230 consecutive patients, aged 20 to 50 years, who underwent CT scanning. The cortex and cancellous space centered around the inferior alveolar nerve (IAN) canal were measured at two specific locations: the lingula and second molar region. Statistical analysis of differences according to increasing age and sex was performed. Results: The t-test revealed that the cancellous space and cortical thickness differed significantly with respect to the threshold of 35 years of age. Both cortical thickness and cancellous space in the molar region were negatively correlated with age. Meanwhile, both cortical thickness and cancellous space in the lingula region showed a positive correlation with age. With respect to sex, significant differences in the cancellous space at the molar region and the cortical thickness at the lingula were observed. However, no further statistically significant differences were observed in other variables with respect to sex. The sum of each measurement on the mandibular body reflected the safe distance from the surface of the outer cortex to the IAN canal. The safe distances also showed statistically significant differences between those above and below 35 years of age. Conclusion: Knowledge of the anatomical structure of the mandible and of changes in bone structure is crucial to ensure optimal surgical outcomes and avoid damage to the IAN. CT examination is useful to identify changes in the bone structure, and these should be taken into account in the planning of surgery for older patients.
Ho Hyun Yun;Woo Seung Lee;Young Bin Shin;Tae Hyuck Yoon
Hip & pelvis
/
v.35
no.2
/
pp.88-98
/
2023
Purpose: The objectives of this study were to examine the prevalence and risk factors for development of periprosthetic occult femoral fractures during primary cementless total hip arthroplasty (THA) and to assess the clinical consequences of these fractures. Materials and Methods: A total of 199 hips were examined. Periprosthetic occult femoral fractures were defined as fractures not detected intraoperatively and on postoperative radiographs, but only observed on postoperative computed tomography (CT). Clinical, surgical, and radiographic analysis of variables was performed for identification of risk factors for periprosthetic occult femoral fractures. A comparison of stem subsidence, stem alignment, and thigh pain between the occult fracture group and the non-fracture group was also performed. Results: Periprosthetic occult femoral fractures were detected during the operation in 21 (10.6%) of 199 hips. Of eight hips with periprosthetic occult femoral fractures that were detected around the lesser trochanter, concurrent periprosthetic occult femoral fractures located at different levels were detected in six hips (75.0%). Only the female sex showed significant association with an increased risk of periprosthetic occult femoral fractures (odds ratio for males, 0.38; 95% confidence interval, 0.15-1.01; P=0.04). A significant difference in the incidence of thigh pain was observed between the occult fracture group and the non-fracture group (P<0.05). Conclusion: Occurrence of periprosthetic occult femoral fractures is relatively common during primary THA using tapered wedge stems. We recommend CT referral for female patients who report unexplained early postoperative thigh pain or developed periprosthetic intraoperative femoral fractures around the lesser trochanter during primary THA using tapered wedge stems.
Purpose : To analyze the clinical results of treatment for the osteochondritis dissecans of femoral condyle by age, the type of lesion and method of treatment. Methods : From March 1991 to February 2000, 17 patients (20 cases) with osteochondritis dissecans of the femoral condyle were followed up over 1 year. Three patients had bilateral lesion. There were 12 cases with trauma history (9 cases with sports injury and 3 cases with direct trauma). The initial symptoms were pain, clicking, locking, giving way in the order of frequency, pain was revealed in all cases. Clinical evaluation of IKDC and Hughston method were used for subjective and objective function. Results : The number of male patient was 12, and the mean age was 19.8 year old (11$\~$50). The location of the lesion was 14 cases in medial femoral condyle and 6 cases in lateral femoral condyle. The arthroscopic findings of the lesion in 15 cases were as follows, early separation in 6 cases, partially detachment in 4 cases, and crators and complete detachment in 5 cases. 5 cases were treated with mutiple drilling and 5 cases with Herbert screw fixation, 3 cases with Herbert screw fixation and bone graft. In early stage, 7 cases were treated with conservative method. In the grading of Hughston score, 6 cases were graded as excellent, 9 cases as good, 15 cases were graded as good to excellent. Based on the IKDC scale, 1 case was graded as normal, 6 as nearly normal, and 10 as abnormal. Conclusions : The trauma seemed to be important factor in occurrence of osteochondritis dissecans of the femoral condyle. The clinical results of juvenile period showed better than adolescence and adult period, it is necessary to detect the lesion as soon as possible. The result of subjective evaluation was worse than the Hughston evaluation. It was caused by limiting involvement of sports activity and limited activity in the adolescence.
The acute irradiation effect on rat Purkinje cell was carried out. Anesthetized rats, weighing 200-250g each, were exposed their heads to the linear accelerator (ML-4MV) with the doses of 3,000 rads or 6,000 rads respectively. Irradiated rats were sacrificed by perfusion fixation under anesthesia, six hours, two days and six days following the irradiations. Rats were perfused with the fixative of 1% glutaraldehyde-1% paraformaldehyde solution (pH 7.4). Small pieces of cerebellar cortices were taken out. Tissue blocks were washed out, and were refixed in the 2% osmium tetroxide solution. After dehydration, tissues were embedded in the araldite mixture. Ultrathin sections stained with uranyl acetate-lead citrate solution, were examined with an electron microscope. The results observed were as follow; 1. Many dark Purkinje cells exhibited most severe cellular alterations on 6 hours. But after the 2 or 6 days, the cells exhibited only some alterations of cytoplasmic organelles. 2. Many granular and agranular endoplasmic reticula exhibited the fusion of cisterns. These reticular alterations were most severe on 6 hours following irradiation. But the alterations were hardly found on 6 days. 3. In the Golgi region, alterations including the adhesion of lamelliform cisterns, enlarged saccules, and increased number of vesicles, etc, were seen on 6 hours. But the Golgi complexes were almost recovered on 6 days. 4. Lysosomes were abundant on 6 hours or 2 days, but some residual bodies were found on 6 days. 5. Mitochondrial changes were also most severe at on hours, and they were recovered thereafter. From the results, it was concluded that the cerebellar Purkinje cells reacted to the high doses of irradiation by hyperactive protein synthesis, autolytic activities and energy metabolism. The reaction was most active in the early stage. It implies that motor-control function of Purkinje cells are severely disturbed in the early stage of irradiation.
The Journal of the Korean bone and joint tumor society
/
v.16
no.2
/
pp.80-86
/
2010
Purpose: The skeleton is commonly affected by metastatic cancer. The purpose of this study was to evaluate the results of treating metastatic pathologic fractures in lower extremities using locking plates. Materials and Methods: Between 2004 and 2010, we evaluated 12 patients (13 cases) of metastatic pathologic fractures in lower extremities, treated with the locking plate. Mean patient age was 62.2 years (range, 50-81 years), the locations of the fractures were; proximal femur in 2 cases, femoral mid-shaft in 3, distal femur in 3, proximal tibia in 4, and distal tibia in 1 case. The interval to wheelchair ambulation, pain relief and complications were evaluated. Additionally, we assessed operation time and postoperative blood loss. Results: Mean time from operation to wheelchair ambulation was 3.2 days (range, 1-6 days). Mean VAS scores improved from a preoperative score of 8.1 points (range, 7-9 points) to a score of 2.7 points (range, 2-4 points) at 1 week postoperatively. No early complications associated with surgery were encountered. Mean operation time was 88.4 minutes (range, 70-105 minutes), and mean postoperative blood loss was 246.5 ml (range, 130-320 ml). Conclusion: Internal fixation of metastatic pathologic fractures using a locking plate in the lower extremity can be an effective treatment option in the meta- or diaphyseal area of long bones with massive bony destruction or poor bone stock by offering early ambulation, pain relief and low postoperative complications.
Journal of the korean academy of Pediatric Dentistry
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v.26
no.2
/
pp.310-316
/
1999
In the traumatized teeth, the major complications are pulp necrosis, and root resorption. The factors influencing to prognosis are the state of root development, type of injuries, quality of fixation. There are good prognosis in the case of immature teeth, minor luxation injuries. To minimize of occurrence of these complication, it is very important to determine the pulp vitality. This can help us decide whether or not to treat the teeth endodontically. But, it is difficult to determine of pulp vitality in immature teeth or traumatized teeth. In this case, pulp vitality test was done periodically on the traumatized upper central incisors, and the results were different among cold test, electric pulp test, and laser Doppler flowmetry. The conclusions were obtained from this case can be summarized as follows; 1. Pulp vitality of traumatized teeth should be negative early, but with time going, pulp vitality could be recovered. 2. The positive response of pulp vitality test was detected earlier in laser Doppler flowmetry. 3. Between cold test and electric pulp test, cold test was more reliable in determining pulp vitality.
This study looks into historical genealogy of autonomy in art criticism on modernism and presents the view of the judgment and correction about that. A matter of autonomy in art appeared in the attempt to totally reconsider and upset the theory of 'Mimesis' or 'Representation' which was the basis of traditional aesthetic theory. In the traditional theory of representation, they assumed primary image exists first and then tried to obtain visual similarity to it through art works. However, in the theory of autonomy in modernism, they maintained the reduction to pure form' or medium', regarding what art works represents and how similar to primary image are not the true essence of art. In the early 20th century, C. Bell laid the foundation stone of the theory of Formalism', providing that a matter of autonomy is significant form', which is the combination of lines and colors Aesthetic autonomy theory came to a climax by C. Greenberg, who systemized art criticism on modernism in the middle 20th century. According to his theory, the pursuit of the essence of form resulted in the specificity of medium' and flatness. They thought that the autonomy of art would be achieved by eliminating outward social factors from art works. This theory ended by Minimalism preventing the instructive function of art work and only emphasizing its material property. Since the middle 20th century, the autonomy theory was confronted with the limit and intense attack because it resulted in this fixed canon and materialism, so they began laying emphasis on those extrinsic factors around art works such as human life, society, history, and so on. This study focuses on arguing and complementing the limit of autonomy such as the adhesive and fixed canon, and then defining the more dynamic area of it. For this, first, I introduced the view of T. J. Clark and T. Crow who criticized the aesthetic autonomy theory. They denied the transcendental structure of form, and found form only in the association with substantial life and society. And they insisted the dynamism of form by emphasizing form as a result of negation insisted by avant-garde. Second, I researched the view of A. C, Danto and M. Fried, who complemented the traditional autonomy theory. They made autonomy emerge from the fixation of form like flatness through connecting essentialism with historical view. In conclusion, I insist that autonomic position of art make it possible to connect or mediate between material form and human or social elements. Therefore, autonomy should not be reduced to the axis of form or that of society but make interaction between two heterogeneous axes.
Background: Bovine pericardium treated with glutaraldehyde(GA) is one of the most popular prosthetic materials. However, its late calcific degeneration after implantation results in early failure of the prosthesis. Therefore, we investigated the effects of combined treatment with sodium dodecyl sulfate(SDS) and glutamate on calcific degeneration of GA treated bovine pericardium. Material and Method: Sixty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2.6H2O as a control group (group 1). Sixty pieces pretreated with 1% SDS (group 2) and sixty pieces posttreated with 8% glutamate (group 3) were also fixed in the same GA solution. Sixty pieces pretreated with 1% SDS and posttrated with 8% glutamate were also fixed in the same GA solution (group 4). After 1 month of fixation, the pieces were implanted into the belly of sixty Sprague-Dawley rat subdermally and were extracted 1 month, 2 months and 3 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited. Result: The calcium deposition in 1 month was 2.01$\pm$0.13 mg/g in group 1, 1.45$\pm$0.31 mg/g in group 2, 2.49$\pm$0.15 mg/g in group 3 and 0.75$\pm$0.27 mg/g in group 4. In 2 months, it was 3.57$\pm$0.15 mg/g in group 1, 0.98$\pm$0.30 mg/g in group 2, 3.46$\pm$0.12 mg/g in group 3, and 1.48$\pm$0.39 mg/g in group 4, and 5.45$\pm$0.42 mg/g in group 1, 2.43$\pm$0.53 mg/g in group 2, 4.20$\pm$0.55 mg/g in group 3, and 1.02$\pm$0.27 mg/g in group 4 in 3 months. The calcium depositions in group 2 and 4 were less than those of group 1 and 3 in 1 month 2, months, and 3 months(p<0.01). The calcium depositions in group 1, 2 and 3 increased with time. However, they remained unchanged in group 4, which was statistically significant(p<0.01). Conclusion: Pretreatment with SDS is effective in reducing calcification of GA treated bovine pericardium, and the combined method of pretreatment with SDS and posttreatment with glutamate was more effective than the other methods.
Kim, Taik-Seon;Kang, Kyu-Bok;Kang, Jong-Woo;Kim, Hak-Jun
Journal of Korean Foot and Ankle Society
/
v.12
no.1
/
pp.26-30
/
2008
Purpose: The authors evaluated the differences between K-wires and Bold screw for fixing the proximal metatarsal chevron osteotomy of moderate and severe hallux valgus. Materials and Methods: There were 59 patients (81 feet) who were moderate and severe degree hallux valgus according to the classification of Mann. They all got the proximal chevron osteotomy when correcting the deformity. All patients were followed up at least 6 months. We divided the patients into 2 groups, K-wires fixed group as A, Bold screw fixed group as B. Group A were 42 patients (63 feet) and Group B were 18 patients (19 feet). Among the Group B, 2 feet who were failed to fix the oetotomy site with Bold screw, were fixed with K-wires during operation. We measured the AOFAS score preoperatively, postoperatively and at final follow-up, VAS score at 2 weeks after the operation. Also preoperative, postoperative and follow-up hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured for each patients. Results: Mean follow up period was 1.34 year (range: 6 months-6.16 years). Mean VAS score of group A was $3.21{\pm}1.7$ and group B $1.76{\pm}1.0$. Preoperative mean AOFAS score of group A was $45.61{\pm}8.3$, group B $44.41{\pm}8.9$, the final mean score of group A was $88.87{\pm}8.3$ and group B $92.47{\pm}4.4$. Preoperative mean HVA was $30.82{\pm}6.6$ degrees in group A and $32.88{\pm}14.5$ degrees in group B, the final mean angle of group A was $14.89{\pm}8.3$ degrees and group B $17{\pm}4.4$ degrees. The preoperative mean IMA of group A was $13.69{\pm}3.6 $degrees and group B $12.35{\pm}5.2$, the final mean angle of group A was $9.26{\pm}3.6$ degrees and group B $12.35{\pm}5.8$ degrees. Conclusion: There were no statistical differences in radiologic and clinical results (p>0.05) but, group B exceeded group A in VAS score (p=0.0007) and had no statistical significance in terms of reduction angle loss (p=0.06). Early returning to normal life activity may be possible for patients using Bold screws.
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