• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제41권3호
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• pp.133-138
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• 2015

Objectives: To evaluate the influence of the type of osteotomy in the inferior aspect of the mandible on the mechanical performance. Materials and Methods: The study was performed on 20 polyurethane hemimandibles. A sagittal split ramus osteotomy (SSRO) was designed in 10 hemimandibles (group 1) with a vertical osteotomy in the buccal side (second molar level) and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. For group 2, the same osteotomy technique was used, but an oblique osteotomy was done in the basilar aspect of the mandibular body, forming continuity with the sagittal cut in the basilar area. Using a surgical guide, osteosynthesis was performed with bicortical screws using an inverted L scheme. In both groups vertical compression tests were performed with a linear load of 1 mm/min on the central fossa of the first molar and tests were done with models made from photoelastic resin. Data were analyzed using Student's t-test, establishing a statistical significance when P<0.05. Results: A statistical difference was not observed in the maximum displacements obtained in the two osteotomies (P<0.05). In the extensiometric analysis, statistically significant differences were identified only in the middle screw of the fixation. The photoelastic resin models showed force dissipation towards the inferior aspect of the mandible in both SSRO models. Conclusion: We found that osteotomy of the inferior aspect did not influence the mechanical performance for osteosynthesis with an inverted L system.

• 대한족부족관절학회지
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• 제13권1호
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• pp.55-59
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• 2009

Purpose: We tried to evaluate the usefulness of the arthroscopy in the operative treatment of intra-articular calcaneal fracture. Materials and Methods: Between March 2005 and May 2008, 9 patients with intra-articular calcaneal fractures（Tongue type or Sanders type IIC) were treated with arthroscopically assisted percutaneous reduction and screw fixation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), preoperative and postoperative Bohler's angle and the rate of complication were evaluated. Results: AOFAS score at postoperative 1 year was 88.2 (range, 71-92), and mean VAS score was 2.8 (range, 1-4). Bohler angle was improved from preoperative mean $16.2^{\circ}$ to postoperative mean $29.7^{\circ}$. There were no complications such as wound problem, infection or nerve injury. Conclusion: Subtalar arthroscopy provides precise view of posterior facet during the operation. Therefore, it can be a useful tool in treating intra-articular calcaneus fractures, especially tongue type and Sanders type IIC fractures.

• 대한골관절종양학회지
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• 제4권2호
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• pp.81-87
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• 1998

Although autoclaved autogenous bone reconstruction is one of the established procedures, it may have some problems in bone regeneration and mechanical property. The purpose of this study is to evaluate the efficacy of more biologic and anatomical reconstruction where allograft is not readily available. From Aug.1991 to Feb. 1996 the authors analyzed 32 cases of reconstruction with autogenous low heat treated bone. Autogenous graft sites were humerus 4, tibia 4, pelvis 9, and 15 femur. Average follow-up period was 23(range;12-51) months. There were 49 graft-host junctional sites. Diaphysis was 22, metaphysis 10, and flat bone 17. Average duration of healing for the 38 united sites was 7 months. Average union time for each anatomical area 8 months in 19 diaphysis, 12 months in 7 metaphysis, and 12.7 months in 12 flat bone(pelvis). Eleven nonunion sites consisted of 3 diaphysis(3/22), 3 metaphysis(3/10), and 5 flat bone(5/17). Complications other than nonunion were local recurrence(4), bone resorption(3), graft fracture(2), osteomyelitis(1), metal failure(2), and wound infection(1). Initial bone quality and stable fixation technique was important for union rate. Plate and screw is a good method for diaphyseal lesion. Metaphyseal and flat bone are weak area for rigid fixation and one stage augmentation with iliac bone graft can be a salvage procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권6호
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• pp.472-479
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• 2002

Since $Br^{\circ}anemark$ introduced the osseointegrated implants, they have been granted for useful methods for the restoration of oral function. The original $Br^{\circ}anemark$ protocol recommended long stress-free healing periods to achieve the osseointegration of dental implants. However, many clinical and experimental studies have shown that the osseointegration is no wonder in almost cases and that early and immediate loading may lead to predictable osseointegration. So we are willing to introduce the Satellite Abutment newly invented for immediate loading. We think that it will make the occlusal forces dispersed to surrounding bone and that we can restore the oral function immediately after implant installation not disturbing osseointegration. In case of using Satellite abutment, stress concentrated to bone contact area of implant was distributed not only fixation plate and screws but also superior, middle portion of implant and cortical layer of jaw bone. It was clearly decreased on the bone contact surfaces around dental implants. 1. Stress was decreased more than 76.5% when satellite straight abutment was used. 2. Stress was decreased more than 50% when satellite angled abutment was used. 3. The stress around dental implant was well distributed along the cortical bone surface and the fixation plate and screw. This study concludes that satellite abutment can be used as all immediate loading implant prothesis because it was possible to distribute periimplant occlusal stress through implant contact bone surface and cortical layer of jaw bone.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권2호
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• pp.131-138
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• 1999

The purpose of this study is to evaluate the effects of resorbable plate in the healing process of mandibular fracture. Reduction and rigid fixation was carried out on the artificial mandibular fracture site of the rabbits, using a resorbable screw, 1.5mm in diameter and 4.0mm in length, and an absorbable plate 1.5mm in thickness(Lactosorb$^{(R)}$). En block tissue specimens with plate were taken from the rabbits at 4, 6, 8, and 10 weeks intervals and specimen were observed with light microscope under the hematoxylin-eosin staining, to observe the inflammatory reaction and tissue healing process. The following conclusions were drawn: 1. The subject displayed good healing with no signs of detachment of the fixation plate. 2. At 4 weeks, the plate was covered by the connective tissue. Then at 6 weeks, bone regeneration was discovered around the plate. 3. During the period of healing, no inflammatory reaction or foreign body reaction, as a result of using resorbable plate, were observed. 4. At 8 weeks, the initial phase of the absorption of the plate was observed. Then at 10 weeks, macrophage were observed around the plate, indicating the absorption phase was in process. From the above results, it can be determined that when the resorbable plate is applied to rabbit, full recuperation occurs naturally in the absence of inflammatory reaction and foreign body reaction. The selected study is clinically valuable in proving this procedure.

• Journal of Korean Neurosurgical Society
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• 제64권6호
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• pp.922-932
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• 2021

Objective : It is challenging to make solid fusion by posterior screw fixation and laminectomy with posterolateral fusion (PLF) in thoracic and thoracolumbar (TL) diseases. In this study, we report our experience and follow-up results with a new surgical technique entitled posterior thoracic cage interbody fusion (PTCIF) for thoracic and TL spine in comparison with conventional PLF. Methods : After institutional review board approval, a total of 57 patients who underwent PTCIF (n=30) and conventional PLF (n=27) for decompression and fusion in thoracic and TL spine between 2004 and 2019 were analyzed. Clinical outcomes and radiological parameters, including bone fusion, regional Cobb angle, and proximal junctional Cobb angle, were evaluated. Results : In PTCIF and conventional PLF, the mean age was 61.2 and 58.2 years (p=0.46), and the numbers of levels fused were 2.8 and 3.1 (p=0.46), respectively. Every patient showed functional improvement except one case of PTCIF. Postoperative hematoma as a perioperative complication occurred in one and three cases, respectively. The mean difference in the regional Cobb angle immediately after surgery compared with that of the last follow-up was 1.4° in PTCIF and 7.6° in conventional PLF (p=0.003), respectively. The mean durations of postoperative follow-up were 35.6 months in PTCIF and 37.3 months in conventional PLF (p=0.86). Conclusion : PTCIF is an effective fusion method in decompression and fixation surgery with good clinical outcomes for various spinal diseases in the thoracic and TL spine. It provides more stable bone fusion than conventional PLF by anterior column support.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.494-502
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• 2018

Objective : The loosening of pedicle screws (PS) is one of the frequent problems of spinal surgery in the patients with osteoporosis. Previous studies had revealed that intermittent injection of teriparatide could reduce PS loosening by improving bone mass and quality when their patients took parathyroid hormone for a considerable duration before surgery. However, although the teriparatide is usually used after spine surgery in most clinical situations, there was no report on the efficacy of teriparatide treatment started after spine surgery. The purpose of this retrospective study was to examine the efficacy of teriparatide treatment started immediately after lumbar spinal surgery to prevent pedicle screw loosening in patients with osteoporosis. Methods : We included 84 patients with osteoporosis and degenerative lumbar disease who underwent transforaminal interbody fusion and PS fixation and received parathyroid hormone or bisphosphonate (BP) postoperatively. They were divided into teriparatide group (daily injection of $20{\mu}g$ of teriparatide for 6 months, 33 patients, 172 screws) and BP group (weekly oral administration of 35 mg of risedronate, 51 patients, 262 screws). Both groups received calcium (500 mg/day) and cholecalciferol (1000 IU/day) together. The screw loosening was evaluated with simple radiographic exams at 6 and 12 months after the surgery. We counted the number of patients with PS loosening and the number of loosened PS, and compared them between the two groups. Clinical outcomes were evaluated using visual analog scale (VAS) and Oswestry disability index (ODI) preoperatively, and at 12 months after surgery. Results : There was no significant difference in the age, sex, diabetes, smoking, bone mineral density, body mass index, and the number of fusion levels between the two groups. The number of PS loosening within 6 months after surgery did not show a significant difference between the teriparatide group (6.9%, 12/172) and the BP group (6.8%, 18/272). However, during 6-12 months after surgery, it was significantly lower in the teriparatide group (2.3%, 4/172) than the BP group (9.2%, 24/272) (p<0.05). There was no significant difference in the number of patients showing PS loosening between the teriparatide and BP groups. The teriparatide group showed a significantly higher degree of improvement of the bone mineral density (T-score) than that of BP group (p<0.05). There was no significant difference in the pre- and post-operative VAS and ODI between the groups. Conclusion : Our data suggest that the teriparatide treatment starting immediately after lumbar spinal fusion surgery could reduce PS loosening compared to BP.

• Journal of Yeungnam Medical Science
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• 제11권2호
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• pp.284-292
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• 1994

1992년 12월부터 1994년 6월까지 영남대학교 의과대학 부속병원 정형외과에 내원한 대퇴골두무혈성 괴사 환자 28명, 31 고관절에 대해 시행한 경전자간 회전 절골술의 결과는 다음과 같다. 1. 대상 환자는 한명을 제외하고는 모두 남자였으며, 평균 연령은 44.3세로 삼, 사십대가 대부분이었다. 2. 무혈성 괴사의 원인은 과다한 음주에 의한 것이 18례로 가장 많았고, 괴사의 정도는 Ficat와 Arlet의 분류에 의하면 II a가 16례로 가장 많았다. 3. 절골술 후 고정 방법으로는 screw가 15례, DHS가 16례였고, 고정 방법에 따른 대퇴경간각의 변화로는, screw를 사용한 경우는 술전에 비해 내반고 되는 경향을 보였고, DHS를 사용한 경우는 외반고 되는 경향을 보였다. 4. 술전 대퇴골두 측면 방사선 사진에서 측정한 대퇴골두 전체 관절면에 대한 건전한 관절면의 비는 1/3이하가 8례, 1/3 이상이 23례(74%)이었다. 5. 술후 고관절의 전후면 방사선 사진에서 측정한 비구의 체중 부하면에 대한 전위된 건전한 대퇴골두의 관절면 비는 36% 이상이 24례(78%), 21-35%가 6례, 20% 이하가 1례였다.

• Journal of Korean Neurosurgical Society
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• 제29권4호
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• pp.507-513
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• 2000

Objective : Posterior lumbar interbody fusion(PLIF) with transpedicular screw fixation(TPSF) have many merits in the treatment of spondylolisthesis. The aim of this study was to compare cage PLIF group(PLIF using cage and TPSF) with chip PLIF group(PLIF using autologous bone chips and TPSF) as surgical treatment of spondyloisthesis. Methods : PLIF and TPSF were performed in 44 patients with spondylolisthesis from January 1994 to December 1998. The surgical methods were divided into two groups. One group was cage PLIF(20 patients), and the other group was chip PLIF(24 patients). We analyzed the change of anterior translation, change of intervertebral space height, fusion rate, clinical outcomes, and postoperative complications in two groups. Result : There was no significant difference in reduction and maintenance of anterior translation between two groups. Intervertebral space height was increased in the two groups at immediate postoperative state. At last followup, it was decreased compared to preoperative height in chip PLIF group. In cage PLIF group, last follow-up height was decreased compared to immedate postoperative height, but it was significantly increased compared to preoperative height. Fusion rates were 70.9% and 90% in chip PLIF group and cage PLIF group, respectively. Excellent and good clinical outcomes were 79.2% in chip PLIF group and 85% in cage PLIF group, but there was no statistical significance. Complications were screw fracture(1 case), CSF leakage(1 case) in chip PLIF group and screw loosening and retropulsion of cage(1 case), CSF leakage(2 cases) in cage PLIF group. Conclusion : PLIF using cage is better than PLIF using autologous bone chips in the maintenance of intervertebral space height and fusion rate. But there is no statistical difference of the clinical outcomes between the two groups. Further studies, especially on long term follow-up, should be considered.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.196-205
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• 2023

Purpose: Surgical stabilization of rib fractures (SSRF) is widely used in patients with flail chests, and several studies have reported the efficacy of SSRF even in multiple rib fractures. However, few reports have discussed the hardware failure (HF) of implanted plates. We aimed to evaluate the clinical characteristics of patients with HF after SSRF and further investigate the related factors. Methods: We retrospectively reviewed the electronic medical records of patients who underwent SSRF for multiple rib fractures at a level I trauma center in Korea between January 2014 and January 2021. We defined HF as the unintentional loosening of screws, dislocation, or breakage of the implanted plates. The baseline characteristics, surgical outcomes, and types of HF were assessed. Results: During the study period, 728 patients underwent SSRF, of whom 80 (10.9%) were diagnosed with HF. The mean age of HF patients was 56.5±13.6 years, and 66 (82.5%) were men. There were 59 cases (73.8%) of screw loosening, 21 (26.3%) of plate breakage, 17 (21.3%) of screw migration, and seven (8.8%) of plate dislocation. Nine patients (11.3%) experienced wound infection, and 35 patients (43.8%) experienced chronic pain. A total of 21 patients (26.3%) underwent reoperation for plate removal. The patients in the reoperation group were significantly younger, had fewer fractures and plates, underwent costal fixation, and had a longer follow-up. There were no significant differences in subjective chest symptoms or lung capacity. Conclusions: HF after SSRF occurred in 10.9% of the cases, and screw loosening was the most common. Further longitudinal studies are needed to identify risk factors for SSRF failure.