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

No abstract available.
Osteotomy*

PURPOSE: The purpose of this study was to evaluate the prevalence of leg length discrepancy (LLD) in hemiplegic cerebral palsy and to assess the gait pattern of hemiplegic patients with LLD. MATERIALS AND METHODS: 189 patients with hemiplegic cerebral palsy were included in this study. We evaluated the prevalence of LLD of more than 1.5 cm and compared the results of 3-dimensional gait analysis of a group with LLD (Group I) and a group without LLD (Group II). RESULTS: A leg length discrepancy exceeding 1.5 cm was noted in 25 patients (13.2%). In spastic type, the prevalence of LLD was highest in Winter type IV patients (30.8%) than any other type (6.7-13.0%), and the prevalence in patients older than 12 years of age (27.5%) was higher than that in younger patients (8.0%). According to 3-dimensional gait analysis, there were significant decreases in the range of motion of the hip and ankle in the sagittal plane of Group I compared with Group II, and the muscles of the Group I were affected more severely than those of Group II. CONCLUSION: Prevalence of LLD in hemiplegic tcerebral palsy was higher than that in the normal population, and the discrepancy increased with skeletal maturity. When muscles were affected more severely, the prevalence of LLD increased.
Ankle ; Cerebral Palsy* ; Gait* ; Hemiplegia ; Hip ; Humans ; Leg* ; Muscle Spasticity ; Muscles ; Paralysis ; Prevalence* ; Range of Motion, Articular

PURPOSE: To understand the relationship between the gait patterns in transverse plane and the torsional deformities (TD). MATERIALS AND METHODS: We evaluated the clinical, radiological, and three-dimensional gait analysis data of 55 spastic hemiplegics with TD. We define the TD as follows: 1) femoral anteversion > or =30degrees, 2) thigh foot angle < or = -5degrees or > or =25degrees, 3) severe foot deformities that could affect the foot progression angle (FPA). RESULTS: There were 35 males and 20 females with an average age of 8.4 years. 49 patients (89.1%) showed pelvic compensation (PC). In the PC group, 27 patients (55.1%) showed physiologic FPA. However, 22 patients (44.9%) still showed in-toeing (19 patients) or out-toeing (3 patients) gait. Out of the 6 patients (10.9%) who did not showed PC, we could observe in-toeing, out-toeing gait, and physiologic FPA from 3, 2, and 1 patients, respectively. 51 patients (92.7%) had increased femoral anteversion. There were 11 patients (19.6%) with an internal (2 patients) or an external tibial torsion (9 patients), and 30 patients (54.5%) with foot deformities. CONCLUSION: We classified the gait patterns and analyzed the relationship between each gait pattern and types of torsional deformities.
Cerebral Palsy ; Compensation and Redress ; Congenital Abnormalities* ; Female ; Foot ; Foot Deformities ; Gait* ; Hemiplegia* ; Humans ; Male ; Muscle Spasticity* ; Thigh

Ameloblastic fibrosarcoma is an extremely rare variety of odontogenic tumor. It has not previously been reported in Korea. The tumor is composed of benign odontogenic epithelium with a mesenchymal part which exhibits the histologic features of fibrosarcoma. We have reported a case of amloblastic fibrosarcoma of the mandible in a 26-year-old man with swelling of right mandible for 2 weeks. The tumor showed yellowish ill-demarcated ulcerating mass involving right premolar and molar area. Light microscopy revealed irregularly arranged strands and islands of odontogenic epithelium surrounded by abundant mesenchymal tissue with the feature of fibrosarcoma. The fibrosarcoma cells were strong positive on immunostain for vimentin and ameloblastic cells were weakly positive for cytokeratin. S-100 and CEA were negative in both epithelial and sarcoma cells. The sarcoma cells were corresponding to fibroblasts on the electron microscopy with abundancy of RER and mitochondria and covering of basal lamina. Two types of virus like particles were distributed in the cytoplasm and nuclei of sarcoma cells. We treated the patient with surgery and chemotherapy. The recovery was uneventful and the prognosis is under observation.
Male ; Humans

No abstract available.
Purpura, Schoenlein-Henoch* ; Streptococcal Infections*

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

llizarov technique is versatile enough to afford simultaneous or staged correction of complex deformities of the long bone. According to the conventional llizarov method, angulation, shortening, rotation and translation deformities are corrected sequentially in that order. Appropriate placement of the hinges enables simultaneous correction of angulation, shortening along with translation. However, when additional rotational correction is needed, major modification of the frame is mandatory and moreover, undesirable shearing force ensues on the newly formed regenerate bone. Inclined hinges composed of universal joints in llizarov frame has inherent potentiality to provide simultaneous correction of the angular and rotational deformities. The authors geometrically analyzed the inclined hinge technique. Table and graph were presented to determine the exact values of surgical parameters for a given deformity. When the hinge axis was displaced from the center of deformity maintaining its orientation and inclination, simultaneous correction of translation and/or shortening in addition to angulation and rotation occurred, which was confirmed by computer graphic simulation study; 1. An inclined hinge axis displaced along the longitudinal bisector line resulted in translation along the direction perpendicular to the hinge axis projected on the horizontal plane. 2. An inclined hinge axis displaced along the transverse bisector line resulted in translation along the direction of the hinge axis projected on the horizontal plane as well as lengthening or shortening. Therefore, judicious placement of inclined hinge axis enables, theoretically, simultaneous correction of angular, rotational, translational deformities along with shortening in particular cases. In practical application, the inclined hinge technique helps lessen the number of subsequent frame modifications or at least reduce the amount of residual deformities to be corrected by next step.
Computer Graphics ; Congenital Abnormalities ; Ilizarov Technique ; Joints ; Methods

In order to group the pelvic obliquity into clinically useful classification and to develop appropriate guidelines for treatment, we evaluated 55 patients who had been treated between 1985 and 1993 for pelvic obliquity after poliomyelitis. Age at surgery ranged from 15 years to 49 years (average 27 years). Fixed pelvic obliquity after poliomyelitis was classified into two major types according to the level of the pelvis relative to the short limb and into four subtypes in each type according to the direction and severity of scoliosis. Forty-six patients had obliquity with the pelvis down (type I), and nine patients had the pelvis up (type II) on the short limb side. Subtype A: straight spine with localized lower lumbar compensatory angulation, mainly at the L4-5 intervertebral space. Subtype B: mild scoliosis with convexity to the short limb side, Subtype C: mild scoliosis with convexity opposite to the short limb side. Subtype D: moderate to severe paralytic scoliosis, which has a convexity to the short limb side in type I and opposite to the short limb side in type II. In the pelvis of type I-A, I-B and I-C deformities, abduction contracture of the hip was released on the side of affected short limb, and lumbodorsal fasciotomy was performed on the contralateral side of short limb, where iliolumbar angle converged and the pelvis was elevated, if necessary. In most cases, hip instability existed on the side of short limb and it was treated with triple innominate osteotomy, which also contributed to leg length equalization by lengthening. In type II-A, II-B and II-C deformities, it was necessary to perform a triple innominate osteotomy on the side of affected short limb with adducted unstable hip in most cases. Lumbodorsal fasciotomy was performed above the iliac crest of elevated hemi-pelvis with short limb, where iliolumbar angle converged. In case of abduction contracture of contralateral hip, contracted fascia was released. In the pelvis that had a type I-D or type II-D deformities, treatment might include bony surgeries such as spinal fusion or triple innominate osteotomy, with appropriate soft tissue release. We propose a systemic and comprehensive classification for fixed pelvic obliquity after poliomyelitis. According to this classification, we and decide to combine corrective surgeries, and find the side where the surgery should be performed.
Classification ; Congenital Abnormalities ; Contracture ; Extremities ; Fascia ; Hip ; Humans ; Leg ; Osteotomy ; Pelvis ; Poliomyelitis ; Scoliosis ; Spinal Fusion ; Spine