Objective : Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. Methods : The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. Results : Mean follow-up was 23.6 months. During follow-up, $2.08{\pm}1.65^{\circ}$ and $6.96{\pm}2.08^{\circ}$ of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was $4.02{\pm}2.83mm$. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. Conclusion : TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.
Park, Jong-Hwa;Hyun, Seung-Jae;Kim, Ki-Jeong;Jahng, Tae-Ahn
Journal of Korean Neurosurgical Society
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제58권6호
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pp.578-581
/
2015
A rigid spino-pelvic fixation to anchor long constructs is crucial to maintain the stability of long fusion in spinal deformity surgery. Besides obtaining immediate stability and proper biomechanical strength of constructs, the S2 alar-iliac (S2AI) screws have some more advantages. Four Korean fresh-frozen human cadavers were procured. Free hand S2AI screw placement is performed using anatomic landmarks. The starting point of the S2AI screw is located at the midpoint between the S1 and S2 foramen and 2 mm medial to the lateral sacral crest. Gearshift was advanced from the desired starting point toward the sacro-iliac joint directing approximately $20^{\circ}$ angulation caudally in sagittal plane and $30^{\circ}$ angulation horizontally in the coronal plane connecting the posterior superior iliac spine (PSIS). We made a S2AI screw trajectory through the cancellous channel using the gearshift. We measured caudal angle in the sagittal plane and horizontal angle in the coronal plane. A total of eight S2AI screws were inserted in four cadavers. All screws inserted into the iliac crest were evaluated by C-arm and naked eye examination by two spine surgeons. Among 8 S2AI screws, all screws were accurately placed (100%). The average caudal angle in the sagittal plane was $17.3{\pm}5.4^{\circ}$. The average horizontal angle in the coronal plane connecting the PSIS was $32.0{\pm}1.8^{\circ}$. The placement of S2AI screws using the free hand technique without any radiographic guidance appears to an acceptable method of insertion without more radiation or time consuming.
This study investigated the effect of a load of 15% body weight on trunk, pelvis and hip joint coordination and angle variability in subjects with and without chronic low back pain (CLBP) during an anterior load carriage task. Thirty volunteers participated in the study (15 without CLBP, 15 with CLBP). All participants were asked to perform an anterior carriage task with a load of 15% body weight. The outcome measures included the means and standard deviations for measurements of three-dimensional coordination and angle variability of the trunk, pelvis and hip joint. As CLBP patient group .06, control group .70, the correlation coefficient between the groups showed a significant difference only in trunk-pelvic in the sagittal plane (p<.05). Angle variability of CLBP patient group increased significantly in the trunk in frontal plane, the pelvis in all sagittal plane, frontal plane, transverse plane, and the hip in sagittal plane, the hip in frontal plane than angle variability of control group (p<.05). This results mean that the CLBP patient group showed a disconnected coordination pattern in the trunk-pelvis in the sagittal plane, an increased pelvic angle variability in all three planes, and hip angle variability in the sagittal, and frontal planes. The CLBP patient group may have developed a compensatory movement of the pelvis and hip joint arising from the changed stability due to the abnormal coordination patterns of the trunk-pelvic in the sagittal plane. Therefore, CLBP symptoms can potentially worsen in the pelvis and adjacent hip joint in CLBP patients who perform weight-related behaviors in their daily lives. Further research is needed to determine the three-dimensional characteristics of the electromyography and neuromuscular aspects of subjects with CLBP.
This study was designed to determine the effect of ankle taping and short period of walking on the treadmill on the range of motion (ROM) and proprioception at the ankle joint. Twenty healthy male subjects (mean age=24.2 yr) participated in this study. Goniometry and videotape replaying method were used to measure the ankle ROM. Passive sagittal and frontal plane motions were measured. The difference in degree between the stimulus point and the reproduced point was defined as an angular error. The measurements were performed at four different phases: pre-taping (PRT), post-taping immediately (POT), post-5 minute walking with taping (P5M), and post-10 minute walking with taping (P10M). The ankle of dominant limb was taped by a certified athletic trainer using a closed basket weave technique. Participants walked on the treadmill at 2.5 mph. The results showed that the mean of the sagittal plane motion at PRT, POT, P5M, and P10M was 53.0, 30.5, 36.2, and 40.2 degrees, respectively. The frontal plane motion at PRT, POT, P5M, and P10M was 33.6, 13.9, 15.7, and 18.6 degrees, respectively. The angular error at PRT, POT, P5M, and P10M was 5.5, 1.6, 1.8, and 1.9 degrees, respectively. After 10 minutes of walking, the sagittal plane motion and frontal plane motion was increased by 9.7 and 4.7 degrees compared with POT, respectively. The proprioception was significantly improved after the application of ankle taping. Both the restriction of frontal plane motion and proprioception improvement at the ankle joint may contribute to ankle stability during walking.
Long term prediction of surgical result of skeletal class III has not been evaluated adequately because the stability of orthognathic surgery would be affected by not only set back amount of mandible but also many other factors like skeletal pattern, hyoid position, and airway size. The aimof this study is to discriminate the factors which affect the stability of post-treatment result of surgical outcome of sagittal split ramus osteotomy. We have collected 37 patients (male: 17, female: 20) from patients who have been treated at Orthodontic Department in Dankook University. The patients underwent 3 times Cephalometric X-ray taking at pre-, post-orthognathic surgery and after 12 months retention. The subjects were divided into 2 groups (Stable group: 21, Relapse group: 16) according to their relapse amount. We have taken following results from Students t-test and discriminant analysis. The discriminant factors which discern relapse and stable groupe among treatment change variables were BX and Ba-HY. Hyoid bone moved to posterior and inferior position due to surgery and repositioned superiorly and posteriorly during retention period. Skeletal patterns of the relapse group are smaller mandibular plane angle, anterior mandibular position, and greater distance from hyoid bone to cervical bone and mandible respectively.
Osman Kucukcakir;Nilufer Ersan;Yunus Ziya Arslan;Erol Cansiz
대한치과교정학회지
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제54권4호
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pp.247-256
/
2024
Objective: This retrospective study evaluated the mandibular condyle position before and after bimaxillary orthognathic surgery performed with the mandibular condyle positioned manually in patients with mandibular prognathism using cone-beam computed tomography. Methods: Overall, 88 mandibular condyles from 44 adult patients (20 female and 24 male) diagnosed with mandibular prognathism due to skeletal Class III malocclusion who underwent bilateral sagittal split ramus osteotomy (BSSRO) and Le Fort I performed using the manual condyle positioning method were included. Cone-beam computed tomography images obtained 1-2 weeks before (T0) and approximately 6 months after (T1) surgery were analyzed in three planes using 3D Slicer software. Statistical significance was set at P < 0.05 level. Results: Significant inward rotation of the left mandibular condyle and significant outward rotation of the right mandibular condyle were observed in the axial and coronal planes (P < 0.05). The positions of the right and left condyles in the sagittal plane and the distance between the most medial points of the condyles in the coronal plane did not differ significantly (P > 0.05). Conclusions: While the change in the sagittal plane can be maintained as before surgery with manual positioning during the BSSRO procedure, significant inward and outward rotation was observed in the axial and coronal planes, respectively, even in the absence of concomitant temporomandibular joint disorder before or after the operation. Further long-term studies are needed to correlate these findings with possible clinical consequences.
Objective: The Star Excursion Balance Test (SEBT) and Y-Balance Test (YBT) have been commonly applied to measure dynamic postural stability ability. These two tests are utilized interchangeably in various settings. However, they could in fact require different movements to assess dynamic postural stability, as one uses a platform and different measuring techniques than the other. The purpose of this study was to determine if there was a significant difference in the kinematic patterns in physically active population while performing the SEBT and the YBT. Method: Seventy participants performed in the Anterior (AN), Posteromedial (PM), and Posterolateral (PL) directions of the SEBT and the YBT. The kinematics of hip, knee, and ankle in sagittal plane was calculated and analyzed. Paired-sample t-tests were performed to compare joint angular displacement in the ankle, knee, and hip between the SEBT and the YBT. Results: Significant differences in angular displacement at the hip, knee, and ankle joints in the sagittal plane between performance on the SEBT and on the YBT were observed. Conclusion: Clinicians and researchers should not apply these dynamic postural control tasks interchangeably from one task to another. There appear to be kinematic pattern differences between tests in healthy physical active population.
Purpose: Orthognathic surgery is required in patients with severe skeletal disharmony and facial asymmetry, which results in functional and esthetic improvement. Recently, bimaxillary surgery has become generalized. Establishment of the occlusal plane among several other factors included in the surgery plan is a major consideration for the diagnosis and treatment plan and it is also an important factor for postoperative stability. Methods: In this study, we assessed postoperative stability of occlusal plane, B-point, and pogonion point on 20 patients who underwent two-jaw surgery in the Chosun Dental Hospital from 2000 to 2007. Preoperative and postoperative states and at least a one year postoperative follow-up were compared. Results: The postsurgical relapse volume of the occlusal plane to the SN plane and the FH plane was $-0.26{\pm}2.8^{\circ}$ and $-0.44{\pm}3.29^{\circ}$, respectively and after two-jaw surgery, the stability of occlusal plane was maintained. The horizontal relapse degree was $0.85{\pm}0.46$ mm and $0.76{\pm}0.48$ mm, respectively, and the vertical relapse degree was $1.16{\pm}0.36$ mm and $1.13{\pm}0.71$ mm of the B point and the Pogonion point at the time after minimal 1 year. Conclusion: The vertical relapse amount was shown to be slightly larger than the horizontal relapse amount.
Purpose: Proximal crescentic metatarsal osteotomy(PMO) is one of the most common procedures for correcting moderate to severe degree hallux valgus deformity. Although screw fixation is used for osteotomy site stability, loss of reduction can occur. The purpose of this study is to compare the sagittal plane stability of the conventional crescentic PMO fixed with a single screw with that of the crescentic PMO fixed with 1 screw and 2 supplemental K -wires. Material and Methods: Ten matched pairs of cadaveric foot specimens were used for the proximal crescentic metatarsal osteotomy. For one foot specimen of each pair, crescentic osteotomy was fixed with 4mm long threaded cannulated screw, while the matched pair was prepared by adding two axial 1.6mm K-wires to the conventionally fixed 4mm screw. The extensometer was used to measure the osteotomy gap as the metatarsal head was loaded continuously until failure using a servohydraulic MTS Mini Bionix test frame. The strength of fixation was normalized with the bone mineral density (BMD) of the paired specimen $(N{\times}cm^{2}/gm)$, Result: The average strength of the crescentic PMO with axial K-wire fixation ($458.8cm^{2}/gm$, S.D. 434.3) was significantly higher than the standard crescentic PMO ($367.5cm^{2}/gm$, S.D. 397,9) (p=0.05). Conclusion: Supplemental fixation with two axial K-wires can be added to the crescentic PMO to enhance the initial fixation stability to prevent the loss of reduction or dorsal malunion.
Journal of the Korean Association of Oral and Maxillofacial Surgeons
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제39권5호
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pp.217-223
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2013
Objectives: Buccal fracture of the mandibular proximal bone segment during bilateral sagittal split ramus osteotomy (SSRO) reduces the postoperative stability. The primary aim of this study is to evaluate the effect of this type of fracture on bone healing and postoperative stability after mandibular setback surgery. Materials and Methods: Ten patients who experienced buccal fracture during SSRO for mandibular setback movement were evaluated. We measured the amount of bone generation on a computed tomography scan, using an image analysis program, and compared the buccal fracture side to the opposite side in each patient. To investigate the effect on postoperative stability, we measured the postoperative relapse in lateral cephalograms, immediately following and six months after the surgery. The control group consisted of ten randomly-selected patients having a similar amount of set-back without buccal fracture. Results: Less bone generation was observed on the buccal fracture side compared with the opposite side (P<0.05). However, there was no significant difference in anterior-posterior postoperative relapse between the group with buccal fracture and the control group. The increased mandibular plane angle and anterior facial height after the surgery in the group with buccal fracture manifested as a postoperative clockwise rotation of the mandible. Conclusion: Bone generation was delayed compared to the opposite side. However, postoperative stability in the anterior-posterior direction could be maintained with rigid fixation.
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