No abstract available in English.
Ankle ; Foot

Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.
Amputation ; Angiography ; Arteries ; Clinical Study ; Diabetes Mellitus ; Extremities ; Female ; Gangrene ; Humans ; Incidence ; Knee ; Male ; Methods ; Mortality ; Orthopedics ; Prostheses and Implants ; Skin ; Skin Temperature ; Transplants ; Walking ; Weight-Bearing ; Wound Healing

After developement of antimicrobial chemotherapy, morbidity and mortality from pyogenic arthritis has been reduced dramatically, but still this disease has remained as a serious and life threatening infectious disease of childhood or late sequelae in surviving patients. For the period of 6 years from January 1978 to December 1983, seventy nine patients, eigthy one cases who were treated as pyogenic arthritis at Severance Hospital and Yong Dong Hospital were studied retrospectively and the results are summerized as follows. 1. We thought that the main pathogeny of septic arthritis of knee joint are trauma and direct invasion of microorganism, because the frequency of pyogenic arthritis in knee joint are proportional to the age and history of accupuncture therapy and trauma are common. 2. In thirty three cases (40.7%) underlying causes were found, composed of infectious focus in eleven cases(13.6%) correspondent to hematologic transmission, osteomyelitis in seven cases(8.7%), trauma and accupuncture in six cases(7.4%) and eight cases(9.9%) corresponding to direct invasion. 3. In forty five cases(55.6%) microorganism are identified, among which coagulase positive staphylococci are in forty cases(88.9%) . 4. Tc-99m-MDP(Medronate) whole body bone scan were taken at twelve patients and positive findings were eleven cases. 5. In thirty eight cases(46.9%) the complications were appeared: Osteomyelitis of tibia in ankle joint and periarticular or subarticular bone defects in knee joints were common. 6. There were complications in every cases that the duration was more than eleven days, no exceptional.
Ankle Joint ; Arthritis ; Arthritis, Infectious ; Clinical Study ; Coagulase ; Communicable Diseases ; Drug Therapy ; Humans ; Knee Joint ; Mortality ; Osteomyelitis ; Retrospective Studies ; Tibia

Acute pyogenic osteomyelitis is frequent in infants and children, usually hematogenous, and predominant in male. The etiology of acute osteomyelitis is of 3 types: hematogenous, direct innoculation, or postoperative. Acute pyogenic hematogenous osteomyelitis is the most frequent type in children. This study consisted of 119 cases of acute pyogenic osteomyelitis which were studied at the department of orthopedic surgery, Yonsei university, Severance hospital and Youngdong hospital for 10 years from Jan. 1974 to Dec. 1983. The result were as follows. 1. There were tendency to decrease the frequency of this disease graduaUy since 1973 except 1978. 2. 20 patient (16.8%) had the history of trauma and 43 patients (36.1%) had the entry site of infecting organism. 3. The most frequent involved sites were femur and tibia. 4. E.S.R. was definitely increased in 90.4% of male, in 100% of female. 5. 59.6% of patients revealed the definite bone change at admission on X-ray findings. 6. Staphylococcus coagulase positive was the most frequent organism isolated (95%). 7. The most sensitive antibiotics was cephalosporin and the most resistant was penicillin (90.2%). 8. The antibiotics treatment with immobilization of involved site was initially tried, if there was no symptomatic improvement, the various surgical process was performed with satisfactory result.
Anti-Bacterial Agents ; Child ; Clinical Study ; Coagulase ; Female ; Femur ; Humans ; Immobilization ; Infant ; Male ; Orthopedics ; Osteomyelitis ; Penicillins ; Staphylococcus ; Tibia

The treatment of pain in the back and extremities remains empirical. The application of surface electrodes to the dorsal columns of the spinal cord has been used by Shealy. The rationale. for dorsal column stimulation has been the “gate control theory” of pain proposed by Melzack and Wall. Transcutaneous electrical nerve stimulation is well recognized for its effectiveness in pain relief. The authors studied 48 cases of group A (physiotherapy, medication) and compared them with 43 cases of group B(physiotherapy, medication 'and diadynamic current), in the Department of Orthopedic Surgery, Yonsei University Hospital, from April, 1983, to June, 1984. The results were as follows: 1. Significant relief of pain was noted in group B in long term follow up of acute pain in the back and extremities. 2. In long term follow-up of group B, there was more improvement than in group A, especially when there was radiating pain in the extermities with or without back pain. 3. In long term follow-up according to the causes of the pain, there was more improvement in group B than in group A in cases of herniated nucleus pulposus and low back syndrome. From a consideration of these studies, it was concluded that satisfactory results were obtained from diadynamic current treatment for the patient with pain in the back and extremities.
Acute Pain ; Back Pain ; Electrodes ; Extremities ; Follow-Up Studies ; Humans ; Orthopedics ; Spinal Cord ; Transcutaneous Electric Nerve Stimulation

Lumbar spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canals or intervertebral foramina. It may be local, segmental or generalized and may be caused by the encroachment of bone or soft tissue. The narrowing may involve the bony canal alone or the dural sac or both. Routine conventional radiographs or sagittal tomographs cannot accurately assess the midsagittal diameters of the lumbar canal or detect encroachment on the canal by osteoarthritis articular facets. However, myelography and computed tomography provide a means for distinguishing between herniation of a disc and bony encroachment on the spinal cord. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurological functi ions. The surgical strategy is based on the patients symptoms and roentgenographic findings. Eighty-two operative cases of lumbar spinal stenosis were analyzed who were admitted in the Department of Orthopedic Surgery at Yonsei University College of Medicine from January, 1979, to July, 1984. The male female ratio was 1.3:1 and 66 cases (80.5%) included in their 50's and 60's. The results of the study are as follows: 1. Clinical symptoms included aggravation of pain during back extension (28.0%); back pain with radiating pain (22.0%); paresthesia of extremities (18.3%); back pain only (13.4%); and claudication (12.2%). 2. On physical examination, the straight leg raising test showed positive results in 25.6%, motor changes occurred in 24.4%, sensory changes in 20.7%, and DTR changes in 11.0%. 3. The most frequent level of spinal stenosis, L5-Sl invertebral space, was found in 68.3%(56cases) followed by L4-L5 intervertebral space found in 61.0% (50 cases). 4. Operative findings induded 31 lesions (46.3%) identified as herniated or ruptured discs,20 lesions (29.9%) identified as thickening of lamina and ligamentum flavum, and 5 lesions (7.5%) as compression of a nerve root by scar adhesion. 5. Of the 67 patients (81.7%) operated through the posterior surgical approach, 52 cases (77.6%) were effective; and of the 15 patients operated on by the anterior surgical approach, 9 cases (60.0%) were effective. 6. When the duration of symptoms was less than 1 year and the involved level of spinal stenosis was less than 2, operative results were satisfactory. 7. When there was a degenerative type of stenosis without a herniated or ruptured disc, operative results were excellent. 8. For post operative external support, 32 cases (39.0%) wore body jacket cast and 38 cases (46.3%) wore back braces.
Back Pain ; Braces ; Cicatrix ; Clinical Study ; Constriction, Pathologic ; Dental Pulp Cavity ; Extremities ; Female ; Humans ; Ions ; Leg ; Ligamentum Flavum ; Male ; Myelography ; Orthopedics ; Osteoarthritis ; Paresthesia ; Physical Examination ; Spinal Canal ; Spinal Cord ; Spinal Stenosis

No abstract available.
Knee*

No abstract avaiable.
Glucose* ; Homeostasis*

No abstract available.
Posterior Cruciate Ligament*

Treatment modalities for herniated lumbar intervertebral disc are the conservative method, chemonucleolysis, percutaneous diskectomy and operation. Conservative treatment is effective in 70–80% of the acute stage and the other 20% requires chemonucleolysis, percutaneous diskectomy or operation. Indications for operation are cases not improved after conservative treatment, recurrent cases and cauda equina syndrome. Mixter and Barr(1934) demonstrated that laminectomy and surgical removal of disc material could relieve symptoms, but spinal segmental instability, incomplete removal of the disc and postoperative adhesion of the nerve root caused low back pain after long-term follow up. Thus, the authors evaluated the plain X-ray and computed tomographic findings in 21 cases of failed laminectomy to determine the cause of failure. The results were as follows ; 1. Among 21 cases, 18 cases complained of low back pain with sciatica and 3 cases complained of low back pain. 2. In all cases, disc space narrowing was detected on plain X-ray. Total laminectomy and diskectomy promote insufficiency and instability of the lumbar and lumbosacral spine. Whenever one attempts to do total laminectomy and diskectomy, it is recommended that spine fusion be performed in same operating field. 3. Several findings were detected on CT scan : 8 disc protrusions in the operation site, 6 disc protrusions in the operation site and spinal stenosis, 4 extradural scars, 1 extradural scar and other site disc protrusion and 2 cases of spinal stenosis and spondyloisthesis. 4. Computed tomography in cases of failed laminectomy offers more information than has been available by any other imaging method.
Cicatrix ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Low Back Pain ; Methods ; Polyradiculopathy ; Sciatica ; Spinal Stenosis ; Spine ; Tomography, X-Ray Computed