No abstract available.
Child* ; Gait* ; Humans

It is known that the toe-flexors exert some power generation in ankle plantar flexion. However, there has been no paper published in which the power generation was quantified. The purpose of this paper, therefore, is to quantify the amount of contribution of the toe-flexors to the ankle plantar-flexion in normal and rapid walking using the kinetic data of three dimensional gait analysis system. In order to restrict the action of the toe-flexors, we designed special braces which can be applied to the forefeet of the examinee during walking. We performed the gait analysis in ten normal adult volunteers with and without braces, and evaluated the moment and power of toe-flexors during terminal stance and pre-swing phase of gait cycle. Gait analysis was done with the VICON 3-dimensional motion analysis system (VICON, Oxford Metrics, Oxford, England) and 2 force plates (AMTI, Advanced Mechanical Technoiogy, Newton, MA, U.S.A,). The kinetic results are as follows: l. Average speeds of normal and rapid walking were 1.12m/sec and 1.41m/sec respectiveIy. 2. In normal walking, peak ankle plantar-tlexion moment decreased 5.5% with braces, and sum of ankle plantar-flexion moment decreased 12.3% with braces. Both of the results were not significant statistically (p>0.05). Peak ankle power generation decreased 11.0% with braces, and sum of ankle power generation decreased 10.4% with braces. These decreases were also insignificant statistically (p>0.05). 3. In rapid walking, peak ankle plantarflexion moment decreased 26.7% with braces. The decrease was horderline significant statistically (p=0.062). The sum of ankle plantar-tlexion moment decreased 26.6% with braces, but the decrease was not significant statistically (p>0.05). Peak ankle power generation decreased 40.2% with braces, and sum of ankle power generation decreased 37.9% with braces. These decreases showed borderline significance statistically (p=0.062). In conclusion, toe-flexors may contribute about 10% of the total ankle plantar-flexion power generation, and the contribution will be increased with increase of walking velocity. We must be very careful to sacrifice the toe-flexors in cases with weak triceps power.
Adult ; Ankle* ; Braces ; Gait ; Humans ; Toes* ; Volunteers ; Walking*

We evaluated the scapular shape, dispiacement and rotation in 10 cases of Sprengel deformity using three-dimensional computed tomography in order to investigate its clinical usefulness. Standard views, including trunk posterior view, scapular true posterior view and medial view, were taken, and the 3-D image was rotated in three axes to visualize the omovertebral bony connection. In the trunk posterior view, the amount of superior displacement of the affected scapula was measured using the glenoid level as reference, and the rotational deformity by the tilting of the base of scapular spine. Scapular dysplasia was evaluated in the scapular true posterior and medial views. The presence, size, and anchoring points of omovertebral bone were assessed in various view points. There was a tendency of inverse correlation hetween superior displacement and rotational deformity of scapula. In most cases, the affected scapulae were convex at their medial borders and concave at their lateral borders, with increased width/height ratio. The anchoring point of omovertebral connection appeared to determine the scapular shape, level, and amount of rotation. Three-dimensional CT was helpful in preoperative planning.
Congenital Abnormalities* ; Imaging, Three-Dimensional ; Scapula ; Spine

It is well known that the incidence of revision arthroplasty for the loosened total hip has been progressively increasing recently. And the problem is that the loosening rate of revision arthroplasty for the failed total hip replacement is much higher as compared with that of primary total hip replacement. In revision arthroplasty, Amstutz, in 1982, reported 9% incidence of mechanical failure and 43% incidence of femoral and 61% incidence of acetabular progressive radiolucencies with follow-up for an average of 2.1 years, and Pellicci, in 1985, reported 29% incidence of failure for total hip replacement that have been revised once in the radiolucent zone with the follow-up for an average 8.1 years, and Kavanagh, in 1985, reported that probable loosening occurred in 25% of revised acetabular components with follow-up for an average of 4.5 years. Cementless total hip replacement is successful in more than 90 of the primary cases for the last 5 years in our department. Therefore, not only in primary total hip replacement but also in the revision, it seems to be reasonable to perform the cementless total hip replacement as an alternative, particularlly, in young age group. During the period from April 1982 to December 1984, we have revised 12 loosened total hip replacement with cementless type. Average follow up was 1 year and 7 months. The age range of the patients was 23 to 64. The results are very promising without any evidence of loosening in all cases.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Humans ; Incidence

During the period from 1979 to 1987, bone bridge connecting epiphysis to metaphysis was removed and replaced with a free fat transplant for partial epiphyseal plate closure in 7 patients. Bone bridge resection and free fat interposition was repeated in one patient. Average age of the patients was 9.2 years and sites of epiphyseal plate closure were distal femur in 6 patients and proximal tibia in one patient. The causes of closure were physeal fracture(4), infection(2) and a complication of intramedullary nailing(1). The mean follow-up period was 3 years 9months. Tomograms specifically determine the location and the extent of bone bridge. Successful results which mean spontaneous correction of angular deformity or decreased limb length discrepancy, were obtained in 3 patients. Although deformity recurred or limb length discrepancy was increased somehow, some benefits were obtained in another 2 patients. Benefits from the procedure was negligible or questionable in 2 patients. The poor results were seemingly related to physeal closure following infection and larga size of bone bridge. Bone bridge resection and free fat interposition was considered to be effective method for the treatment of the partial epiphyseal plate closure in the selected cases.
Congenital Abnormalities ; Epiphyses ; Extremities ; Femur ; Follow-Up Studies ; Growth Plate ; Humans ; Methods ; Tibia

Photoplethysmography(PPG) employs an infrared light-emitting diode to transmit light into the skin noninvasively. Light reflected from blood cells is received by a photocell or phototrotransistor which permits recording of the pulsatile cutaneous microcirculation. The use of PPG for vascular measurements in extremities is not new. Since Hertzmann, in 1938, first described the technique to measure skin blood flow, a few investigators have used PPG for clinical application. However, experimental reports on the photoplethysmographic assessment of blood flow after arterial reanastomosis are rare. We assessed the changes of blood flow after reanastomosis of the femoral artery in rabbits using photoplethysmography. We divided 20 rabbits into 3 experimental groups. In Group I, the femoral artery was surgically exposed and clamped for 60 minutes. In Group II, the femoral artery was surgically exposed and clamped, as in Group I, and then severed and anastomosed crudely in order to creat thrombus formation. In Group IU, the femoral artery was prepared as Group II and then anastomosed carefully to ensure patency. Blood flow was measured by photoplethysmography on the anteromedial aspect of the right hind leg, every 15 minutes for the fisrt 2 hours, at the 3rd day, I week, and II weeks post-operatively. The following results were obtained l. After the removal of vascular clamp, the mean time for the pulse wave to return to normal form was 63±24.0 minutes in Group I and 63±18.7 minutes in Group III. There was no statistically significant difference beween the two groups. When the wave form was normalized, it remained so continuously. 2. After the removal of vascular clamp, the mean time for the wave amplitude to return to normal was 108±11.2 minutes in Group I and 102±16.4 minutes in Group III. There was no statistically significant difference between the two groups. 3. The thrombosis which obstructed blood flow was formed within the first 60 minutes(mean time: 49±12.4 minutes) in all the animals in Group II. When the thrombosis was formed, it was readily detected by the change of wave form and by decrease in amplitude. 4. It is concluded from this experiments the changes of blood flow after reanastomosis of the femoral artery in rabbits were accurately assessed by PPG. It is suggested that PPG can be used clinically in monitoring blood flow after arterial reanastomosis.
Animals ; Blood Cells ; Extremities ; Femoral Artery ; Humans ; Leg ; Microcirculation ; Photoplethysmography ; Rabbits ; Research Personnel ; Skin ; Thrombosis

No abstract available.

No abstract available.
Rabbits*

Heel cord advancement(HCA), which has been applied for the correction of equinus deformity in spastic cerebral palsy, has some theoretical advantages. However, HCA has also theoretical disadvantage that the procedure remove the tensile force exerting to the calcaneal apophysis. In order to evaluate the effect of HCA on the calcaneal growth, we compared the changes of calcaneal and foot lengths between the operated feet and non-operated feet after HCA. Among the 54 patients who had been treated with HCA at Seoul National University Childrens Hospital from March 1990 to August 1995, we excluded the cases who had been treated bilaterally, and also excluded hemiplegic patients in whom the ipsilateral feet were already shortened and the growth rates are different between the ipsilateral and contralateral foot. Seven patients who met the criterior of this study were included for the evaluation. There were 3 diplegics and 4 paraplegics, and average age at operation was 10 years and 6 months(range; 7 year 8 months-16 year 5 months). Average follow-up period was 3 years and 5 months(range; 2 years-4 years 9 mos). Total calcaneal lengths, anterior and posterior part of calcaneal lengths were measured on the standing lateral radiographs of the foot and ankle. Ratios of the operated limb over the non-operated limb were calculated for the three parameters. Ratios of posterior part of calcaneal lengths decreased significantly(P=0.031). Ratios of total calcaneal lengths decreased and ratios of anterior part of calcaneal lengths increased. However, the changes of two ratios were not significant. Ratios of posterior part calcaeal lengths over total calcaneal length decreases significantly(P=0.016). In conclusion, HCA can cause calcaneal growth retardation, especially posterior part of calcaneus, due to removal of physiologic tensile force of Achilles tendon.
Achilles Tendon ; Ankle ; Calcaneus ; Cerebral Palsy* ; Child ; Equinus Deformity ; Extremities ; Follow-Up Studies ; Foot ; Heel* ; Humans ; Muscle Spasticity* ; Seoul

To evaluate the effect of intertrochanteric femoral derotational osteotomy(IFDO) on the sagittal plane kinematics and kinetics of the hip and pelvis in spastic cerebral palsy, we compared the preoperative and post-operative results of 3 dimensional gait analysis. Intertrochanteric femoral derotational osteotomy alone without psoas procedure was performed in 34 hips of cerebral palsy patients with increased femoral anterversion regardless of preoperative dynamic or static hip flexion contracture. Those who had other concomitant hip procedures were excluded. There were 24 diplegics and 10 hemiplegics. Mean age of the patients at the time of operation was 9.1 years (range, 4.9 to 22). They were divided into three subgroups according to the degree of dynamic hip flexion contracture; 13 patients with normal hip extension in terminal stance (group I), 13 patients with maximum hip extension in terminal stance between 0 and 15 degrees (group II), and 8 patients with maximum hip extension in terminal stance of more than 15 degrees (group III). The gait analysis included clinical assessment, video-taping, 3D-kinematics and kinetics, and dynamic EMG. Linear parameters of gait, kinematic parameters, sagittal plane hip moment parameters, and total hip energy parameters were compared. Postoperatively, cadence and double support time decreased, whereas walking velocity and stride length increased in all groups. Maximum and minimum pelvic tilt were improved in all groups. The range of pelvic tilt improved in all groups except group I. Hip flexion-extension curve shifted into extension in all groups. Marked improvement in maximum hip extension in stance and the range of hip motion were observed in all groups. The sum of extensor moment decreased, whereas that of flexor moment increased significantly in all groups. The conversion timing from extensor to flexor moment significantly improved in group I and II. The decrease of power generations of Hl and the increase of power absorptions of H2 were significant in all groups. However, there were no significant changes in power generation of H3 in all groups. The changes of peak power generation timing of H3 was not consistent among the groups. Femoral derotational osteotomy at the intertrochanteric level brings the lesser trochanter forward resulting in iliopsoas lengthening effect. We found significant improvement of the sagittal plane kinematics and kinetics of the hip and pelvis when IFDO alone was performed without psoas tenotomy. The psoas lengthening procedure may be considered secondarily at the time of hardware removal after full evaluation of the psoas lengthening effect.
Absorption ; Biomechanical Phenomena ; Cerebral Palsy* ; Contracture ; Family Characteristics ; Femur ; Gait ; Hip* ; Humans ; Kinetics ; Muscle Spasticity* ; Osteotomy* ; Pelvis* ; Tenotomy ; Walking