STUDY DESIGN: Thirty-four cases of surgically treated spinal stenosis which were followed up for more than 5 yeras were analysed. OBJECTIVES: To know the relationship between long-term clinical results and various clinical factors. SUMMARY OF LITERATURE REVIEW: Pedicle screw fixation is a common procedure after wide decompression for spinal stenosis. But, there is few report showing its long-term result. MATERIALS AND METHODS: We evaluated the long term results of surgically treated spinal stenosis patients according to the sex, method of fusion, level of fusion, radiologic change of adjacent level, hardware problem and complication. There were 11 males and 23 females. Average age was 53.2 years(range 34-68 years). Radiographically follow up was averaged 72 months(range 60-104 months). Clinically follow up period was averaged 76 months(range 60-113 months). Eight patients were operated with PLIF and 26 patients were with posterolateral fusion. One level surgery was done in 18 patient and more than two level in 16 patients. RESULTS: Twenty-seven patients(79%) showed satisfactory result at 2year and 5 year follow-up. Two patients showed change of clinical result during follow-up. Clinical result was much better in monosegmental surgery and in male sex. Six patients showed narrowing of disc space at non-surgery level and 2 patients had compression fracture. Complications were 1 deep infection, 2 dural tears, 9 donor site pain, 2 metal failures and 1 metal pull-out. CONCLUSIONS: We concluded that there is no significant change of clinical results between two year follow-up and five year follow-up. Clinical complications and metal problems are not related with the unsatisfactory results. Multiple level surgery and female sex are two variables related with the unsatisfactory clinical outcome.
Decompression* ; Female ; Follow-Up Studies* ; Fractures, Compression ; Humans ; Male ; Spinal Stenosis* ; Tissue Donors

STUDY DESIGN: Thirty-fiye thoracolumbar and lumbar burst fractures treated with pedicle screw instrumentation were assessed on loss reduction. OBJECTIVE: To compare the mechanical results of simple posterior fixation and posterior fixation with anterior augmentation by anterior interbody fusion, disc space fusion or longer construct. SUMMARY OF BACKGROUND DATA: Althrough the pedicle screw instrumentation provides good mechanical stability, two segment fixation without anterior column augmentation may not be adequate to withstand the repeated axial load. METHODS: Fifteen patients were treated with two segment fixation alone(Group 1), seven with anterior interbody fusion(Group 2), another seven with disc space fusion(Group 3) and remaining six with longer construct involving two segments abode the fracture(Croup 4). Change of anterior body height, upper disc height, lower disc height, kyphotic angle, inter-screw angle and gross screw bend- ing were measured using post-operative and follow-up lateral radiographs. RESULTS: Comparing the two groups(Croup 1 Ys. Group 2, 3, 4), the Group 1 showed definitely more loss of reduction than those groups which had anterior augmentation. But, loss of anterior body height was not significantly different. Comparing the four groups, loss at upper and lower disc height was significantly greater in the Group 1 than the Group 2. Change of kyphotic angle was significantly higher in the Group 1 than the Group 4 and change of inter-screw angle was also higher in the group 1 than every other group. Seyen patients in the Group 1 showed gross screw bending, but none in the Group 2, 3 and 4. All the seven patients with screw bending showed loss of inter-screw angle more than 5 . CONCLUSIONS: These results mean that anterior column augmentation is necessary for the treatment of thoraco-lumbar burst fracture. All the three methods(Group 2,3,4) are effective to prevent excessive loss of correction and screw bending. The best method should be selected considering the characters of each fracture.
Body Height ; Follow-Up Studies ; Humans

Authors treated 86 cases of patella fracture during 3 year period from June 1989 to March 1992 at the Dept. of Orthopaedic surgery, Soonchunhyang University. Forty cases of patella fracture showed hypertrophy of longitudinal and transverse diameter of patella during follow-up which were checked by simple radiographs. Completely documented cases were only forty-six, which were followed more than a year and preop. and postop. and final follow-up radiographs were reviewed. Authors measured longitudinal and transverse diameter of patella using preop. and postop and final simple radiographs to observe the morphological changes of patella after treatemnt. The purpose of this paper is to observe. 1. How much the patella was hypertrophied. 2. What kind of factors influence the hypertrophy of the patella, 3. What is the clinical correlation between the hypertrophy of patella and the clinical outcome. The results were as follows 1. Average hypertrophy of longitudinal and transverse diameter were 1.0±2.3mm and 2.5±1.2mm respectively. 2. Only fracture type(simple. vs comminuted.) was significantly related with the changes of longitudinal and transverse diameter of patella(p < 0.1), Other factors(cast immobilization period, operation method and age) show no significant relationship statistically(p>0. 5). And there is no relationship between longitudinal and transverse diameter statistically(p>0.4). 3. Those who showed change of longitudinal diameter between 0-10mm had good knee joint motion(99°±2). But those who showed shortening or lengthening over 10mm of longitudinal diameter had poor knee joint motion(37°±3, 60°±8 respectively). And change of transverse diameter was not related with the clinical result (p>0. 7).
Clinical Study ; Follow-Up Studies ; Hypertrophy ; Immobilization ; Knee Joint ; Methods ; Patella

No abstract available.
Talus*

Calcaneus is the largest tarsal bone and serves weight bearing of the body. The calcaneus has a pattern of cancellous bone enclosed with a very thin cortical shell. It is difficult to reduce the bony fragments accurately when there are comminution and displacement on the calcaneal fractures. Retrospective study was carried out of 18 patients(21 feet) of calcaneus fractures after axial fixation in Soonchunhyang University Hospital from July, 1982 to July, 1988. Minimum follow up period was 8 months(average 2 years 6 months). The clinical analysis of them are reported with a review of the literature and the results are follows:l. According to the Rowe's unit system, the results of treatment were excellent or good in 9 cases of 13 tongue types and 5 cases of 8 joint depression types. 2. The results were satisfactory in the calcaneal fractures of well reestablished Bohler angle to 21-30 degrees. 3. The results were excellent or good in 5 cases operated within post-trauma 1 week and in 9 cases operated from 1 week to 2 weeks. 4. The results were poor in the 2 joint depression type with severe comminution. And subtalar joint fusion was performed on the previous 2 cases. Then pain on the lateral malleolar area was subsided.
Calcaneus ; Depression ; Follow-Up Studies ; Joints ; Retrospective Studies ; Subtalar Joint ; Tarsal Bones ; Tongue ; Weight-Bearing

Malignant neuroepithelioma is a rare neoplasm arising within the peripheral nervous system and usually occurs in the lower extremities. It may involve patients in any age group and have no gender predisposition. In adolescents and adults the tumor must be distinguished from other malignant round-cell tumors. The poor prognosis and the need for aggressive, combined surgical and chemotherapeutic modalities in treating this tumor necessitate a prompt and accurate diagnosis. Authors have experienced a case of malignant neuroepithelioma developed in left sciatic nerve. The diagnosis was confirmed by CT scan, M.R.I., light and electron microscopic findings.
Adolescent ; Adult ; Diagnosis ; Humans ; Lower Extremity ; Neuroectodermal Tumors, Primitive, Peripheral ; Peripheral Nervous System ; Prognosis ; Sciatic Nerve ; Tomography, X-Ray Computed

STUDY DESIGN: Surgically treated thirty-five Denis type B thoracolumbar and lumbar burst fractures were assessed to compare the differences of fracture patterns by the level of fracture. OBJECTIVE: To know the major surgical indications according to the level of fracture. SUMMARY OF BACKGROUND DATA: General operative indications of thoracolumbar and lumbar burst fractures were collapse of anterior body height more than 40-50%, kyphotic deformity more than 30 degrees, canal encroachment more than 50% and neurologic deficit. But we could not apply the same surgical indications to the whole thoraco]embar and lumbar burst fractures because their fracture patterns are different. METHODS: We compared the collapse of anterior body height, collapse of posterior body height, Cobb angle, wedge angle, canal encroachment and incidence of posterior injury according to the level of fracture. RESULTS: The higher the level of fracture, the more the collapse of anterior body height, Cobb angle, wedge angle and incidence of posterior injury But the lower the level of fracture, the more the canal encroachment. CONCLUSIONS: These results mean that the primary surgical indications for thoracolumbar junction are collapse of anterior body height, possibility of posterior injury and increased kyphosis, while for the lower lumbar fractures, amount of canal encroachment is an important factor to make decision for surgery.
Body Height ; Congenital Abnormalities ; Incidence ; Kyphosis ; Neurologic Manifestations

The talus is a bone with unique biomechanical features and vascular supply. Although fractures of the talus are not common, the complications of the displaced fractures or dislocation are frequent and resulting disabilities are so severe that the importance of proper management is emphasized. Authors analyzed 17 cases of fracture-dislocation of the talus, treated at Soon Chun Hyang University Hospital from January 1983 to December 1988. The results were as follows:l. Among the 17 cases, there were 15 males and 2 females and the average age was 28 years old, ranged from 21 years to 58 years. 2. The causes were fall from height in 10 cases, traffic accident in 6 and others in one. 3. According to Marti-Weber classification, 2 cases were type I, 5 in type II, 7 in type III and 3 type IV. 4. Among the 17 cases, 9 cases in type I and II were treated conservatively, and 8 cases in thpe III and IV were treated operatively. 5. Complications were avascular necrosis in 3 cases, degenerative arthritis in 4 and nonunion in 1. 6. Final results, evaluated by the criteria of Mindell et al., were as follows: excellent in 7 cases, good in 5, fair in 3 and poor in 2.
Accidents, Traffic ; Classification ; Clinical Study ; Dislocations ; Female ; Humans ; Male ; Necrosis ; Osteoarthritis ; Talus

Unilateral absence of the articular process at a lumbar vertebra is a rare anomaly. The etiology of the congenital absence of articular process is not precisely determined yet, but it was explained as some of the possible embryologic bases. Absence of the articular process at the level of L5-Sl have been reported a few, but anomaly above L4 is rare. We are reporting a case of absence of articular process at the level of the 4th lumbar vertebra.
Spine

Surgical reconstruction of the anterior cruciate ligament is undergoing constant evolution. The variable success of these procedures can be attributed to many factors including graft selection, graft placement, graft tensioning, graft remodelling and rehabilitation program. Rigid fixation is probably the most important factor in the success of these procedures during the initial stages of healing. Arthroscopically assisted reconstruction of the ACL-deficient knee using a bone-patellar tendon-bone graft(two-incision technique) is a reliable and evolving technique. Rosenberg et al, described a one-incision technique that allows endosteal fixation of bone plugs within their femoral tunnels intraarticularly via the intercondylar notch. These two techniques are different from their femoral tunnel direction and bone plug placement. The present study was designed to develop a swine model for in vitro biomechanical testing of the bone-patellar tendon-bone ACL autograft to compare the pull-out strength of Outside-In technique and Inside-Out technique. The result were as follows: 1. Normal ACL(N=10 knees) pull-out tensile strength tests showed a maximum tensile strength of 1295.34(N), a stiffness of 120.95(N/mm), and a linear load of 1104.26(N). The failure sites were all tibial attachments. 2. Femoral and Tibial interference fit pull-out tensile strength tests(N=10 knees) showed a maximum tensile strength of 463.23±42.27(N), a stiffness of 33.62±3.18(N/mm), and a linear load of 392.51±95.42(N). The failure sites were all in the tibial tunnel area(N=9 knees), except for one which femoral tunnel area. 3. Inside-Out technique(N=15 knees) showed a maximum tensile strength of 1250.64±75.67(N), a stiffness of 94.31±26.44(N/mm), and a linear load of 1046.92±367.55(N), but the Outside-In tech-nique(N=15 knees) showed a maximum tensile strength of 805.35±54.61(N), a stiffness of 83.33±10.98(N/mm), and a linear load of 685.99±86.32(N)(p < 0.0001). The failure sites were all in the femoral tunnel area. 4. Tensile testing demonstrated that the Inside-Out technique was significantlly stronger than Outside-In technique for maximum tensile strength, stiffness and a linear load.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; In Vitro Techniques ; Knee ; Rehabilitation ; Swine ; Tensile Strength ; Transplants