No abstract available.
Scoliosis*

Recent advance in the transplantation of human organs are widely applied in many fields, despite little progress was made in orthopedic surgery in the bone and joint transplantation. Experimental studies on bone or joint transplantation have been reported enormously with variable results. Many authors used only small part of cartilage, epiphyseal plate or osteochondral graft and some authors studied the fate of massive autogenous and homogenous bone graft including articular surfaces, but few workers have reported on transplantation of whole bone including articular cartilage, epiphyseal plate, cancellous and cortical bone, and compared the result with autograft and fresh and frozen homograft. This expermient was undertaken for the study of autogenous, and fresh and deep-freezed homogenous transplantation of distal portion of femur including articular cartilage and epiphyseal plate in rabbits. The distal femur was exposed and completely freed of its soft tissue attachment and osteotomized at a one and half centimeter above the epiphyseal plate. Eighty young rabbits were divided into three groups: thirty for autograft, thirty for fresh homograft and twenty for deepfreezed homograft. The distal femur was replaced in situ in autograft and exchanged between two animals in fresh homograft. In group of deep-freezed homograft, the distal femur which was stored at −20 degrees centigrade for two weeks before it was replaced in a rabbit of similar weight. These animals were sacrificed at intervals varying from one to twelve weeks and longitudinal section of distal half of femurs were prepared for histological examination, and the results were observed as followe.1. In the autograft, the articular cartilage retained normal appearance except for reduced stainability of the chondrocytes until eight weeks, and early fibrillary degeneration appeared in the periphery in twelve weeks. In the fresh and deep-freezed homograft, almost similar findings were observed, which suggest the articular cartilage were rather resistive to immune reaction. 2. The epiphyseal plate continued normal growth in early stages in all groups, but in fresh homograft, the germinal cell layer underwent necrosis in four weeks and eventually fused in twelve weeks, In deep-freezed homograft, normal growth continued until eight weeks and partially fused in twelve weeks, which findings are not much different from autograft. 3. In autograft, solid bony union at grafted site was obtained in eight weeks, and in fresh homograft, satisfactory union process continued until four weeks and then gradually delayed in healing with some necrosis at twelve weeks. In deep-freezed homograft, very little difference in the timing and character of the union was noted from autograft. 4. The satisfactory result in the growth at epiphyseal plate and in fracture healing in deep-freezed homograft are suggestive of deep-freezing may destroy the antigenicity of bone homograft.
Allografts ; Animals ; Autografts ; Cartilage, Articular ; Chondrocytes ; Epiphyses ; Femur ; Fracture Healing ; Growth Plate ; Humans ; Joints ; Necrosis ; Orthopedics ; Rabbits ; Transplants

Early detection of spine deformities by school screening has proven to be valuable for early diagnosis and prevention of severe deformities. Authors screened 1,620 middle and high school male students Seoul who were chosen arbitrarily, to determine the incidence rates of scoliosis. Authors diagnosed scoliosis on a combination of at least one positive physical sign and a lateral curvature more thar 5 degrees on an antero-posterior standing X-ray. According to this criteria 12 students were diagnosed as having scoliosis. They were analyzed for positive physical signs, etiology, degree of curvature. distribution of size of curvature, patterns of curvature, direction of curvation, and following results were obtained. 1. The overall incidence of scoliosis was 0.74%. 2. Idiopathic scoliosis was found in 10 students, congenital scoliosis in 1, and paralytic scoliosis in 1. 3. Rib humps, whose right to left ratio was 5, were found in 6 students, lumbar humps, whose right to left ratio was 0. 2. in 6 students, and shoulder elevation, whose direction were all to right, in 4 students. 4. Close observations were required for all the 12 students and treatment was required in 2 students who had more than 20 degrees, one for Milwaukee brace, and the other for surgical correction. 5. The most common pattern of curvature was thoracic curve. 6. in single curve right to left ratio was 2.7.
Braces ; Congenital Abnormalities ; Early Diagnosis ; Humans ; Incidence ; Korea ; Male ; Mass Screening ; Ribs ; Scoliosis ; Seoul ; Shoulder ; Spine

Congenital kyphoscoliosis is an abnormal curvature of spine that is due to presence of vertebral anomalies which cause an imbalance in the longitudinal growth of the spine. Congenital kyphoscoliosis is often rigid and its correction can be difficult. It is often resistant to conservative treatment and more patients require surgical treatment than those with idiopathic curvature. The indication for the conservative treatment with Milwaukee brace is much limited. Largely Milwaukee brace is a delaying tactic to correct the spinal curvature until its growth is further advanced and it is more amenable for fusion. This paper was aimed to review our experience with 49 patients with congenital scoliosis, kyphosis and kyphoscoliosis who were treated surgically with various methods of preoperative correction, from Jan. 1968 to Dec. 1983, in special reference to new classification, proposed for common application to both kyphosis and scoliosis, and following results were obtained. 1.The average age when scoliosis was observed was 6.9 years, but the average age of surgery was deferred until 15.2 years. 2. The distribution of curve pattems were 1 cervicothoracic, 24 thoracic, 12 thoracolumbar, 7 lumbar and 1 lumbosacral curve in 45 scoliotic curves and 13 thoracic, 13 thoracolumbar and 4 lumbar curves in 30 kyphotic curves. The average degrees of deformity were most severe in thoracolumbar curves both in kyphosis and scoliosis. 3. The new morphological classification, which could be applicable to both kyphosis and scoliosis, was proposed. The type of unsegmented bar with contralateral hemivertebra was most common both in kyphosis and scoliosis. 4. Preoperative average degrees of scoliosis was 58.7 degrees and final correction was 20.6 degrees (35.1%) with loss of comection of 3.7 degrees (6.3%). Preoperative average degrees of kyphosis was 63.7 degrees and final correction was 20.1 degrees (42.5%) with loss of correction of 7.0 degrees (11.0%). 5. The surgical method with anterior and posterior fusion was the best treatment of severe kyphoscoliossis, in the aspect of final correction and loss of correction. 6. The lumbar curve was most amenable to treatment with the best final correction and the least loss of correction.
Braces ; Classification ; Congenital Abnormalities ; Humans ; Kyphosis ; Methods ; Scoliosis ; Spinal Curvatures ; Spine

A clinical observation in 8 cases of multiple laminectomies under the age of 16 years who had been followed for more than 3 years was carried out to analyze deformities and its results of treatment, and the following results were obtained. 1. Spinal deformities were developed in 5 cases-4 kyphosis and 1 lordosis. 2. The kyphosis was developed in 1 case at cervical spine, 1 at thoracic, 1 at thoracolumbar junction and 1 at lumbar, and the lordosis was developed in 1 case at lumbar spine. 3. Anterior interbody fusion was carried out on two cases of kyphosis who had severe pain and neurological symptoms and posterolateral spinal fusion was carried out on one case of lumbar lordosis, with satisfactory results in all cases. 4. Since the incidence of spinal deformities following multiple laminectomies in children is high, laminectomy should be performed only when it is definitely indicated, and when it is done, damage to the posterior complex should be minimized. 5. For the prevention and treatment of the spinal deformities, brace or close observation should be necessary postoperatively, and spinal fusion should be performed in increasing or severe deformities.
Animals ; Braces ; Child ; Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Laminectomy ; Lordosis ; Spinal Fusion ; Spine

One hundred patients with 119 curves with idiopathic scoliosis, age ranged from 2 to 32 years, were-treated at Seoul National University Hospital from 1968 to 1979. Of 100 patients, 63 were adolescent type, 20 juvenile, and 17 infantile. The distribution of curve-patterns was 49 right thoracic, 19 double major (Rt. thoracic & Lt. lumbar), 18 left thoracic, 12 thoracolumbar, and 2 left lumbar. Of these patients, 67 with 83 curves were treated with Milwaukee-brace for one to seven years with an average of three and one-half years. Seven patients were treated surgically because of a poor response to the brace or progression of the curve.Sixteen patients with 20 curves followed for average 4. 6 years after the completion of brace treatment showed some loss of correction: 2.8 degrees for thoracolumbar, 3.1 degrees for thoracic, 4.2 degrees for lumbar segments and 4, 9 degrees for thoracic segments of double major curves. The brace was more effective for curves with 6 to 9 involved vertebrae and of less than 40 degrees. Thirty three patients with 36 curves were treated with Harrington instrumentation and posterior spinal fusion and followed from 1 to 12 years with an average of six and one-half years. The initial preoperative curves ranged from 50 to 120 degrees with an average of 75.3 degrees. Immediate postoperative correction ranged from 30 to 70 degrees with an average of 36. 2 degrees (48.1%). The average loss of correction at follow-up was 1.5 degrees (2.8%) for curves of less than 60degrees and 1.4 degrees (1.3%) for those of more than 101 degrees. Varioua methods of preoperative correction were applied. Halofemoral traction was applied for rigid and severe curve in 9 patients, Cotrel traction for less rigid one in 11 patients, Risser localizer cast for flexible one in 9 patients, and no preoperative correction for mild and flexible one in 4 patients.
Adolescent ; Braces ; Follow-Up Studies ; Humans ; Scoliosis ; Seoul ; Spinal Fusion ; Spine ; Traction

The important role of the epiphyseal cartilage in the longitudial growth of long bones is universally accepted. Injury to the epiphyseal plate caused by surgically produced defects or trauma has been observed clinically and in experimental investigations. These growth retarding effect of defects seem to be proportional to the size of the defect, and are caused by the formation of a bone bridge connecting the epiphysis to the metaphysis. This investigation provides an explanation for the intimate relationship between the size of the defect and growth retarding effect. Central destruction of the distal femoral epiphyseal plates on 81 immature rabbits were performed by four different sized drills. Free flaps of vastus lateralis were inserted into the defect of the epiphyseal plate. Left limbs were used as the experimental group, and right limbs as the control. After 8 weeks of operation, animals were sacrificed, and roentgenological and histological observations were made. The results were observed as follows. 1. The amount of bony bridge connecting epiphysis and metaphysis was proportional to the size of the epiphyseal defect. 2. The amount of growth retardation at the distal femoral epiphyseal plate was proportional to the size of the defect produced in the epiphyseal plate. 3. Compensatory overgrowth at the proximal femoral epiphysis seems to be proportional to the size of the defect made in the epiphyseal plate. 4. Insertion of the free flap of vastus laterials into the epiphyseal defect diminished the formation of the bony bridge.
Animals ; Epiphyses ; Extremities ; Free Tissue Flaps ; Growth Plate ; Quadriceps Muscle ; Rabbits

Eosinophilic granuloma of bone is the most common variant of histiocytosis X. Most of the lesions occur in the skull, ribs, spine or long bone and may be single or multiple. The occurrence in a growing epiphysis is extremely rare and only seven cases have been reported in the literature. A 13 year old boy with eosinophilic granuloma occurring in proximal humeral epiphysis was seen at Seoul National University Hospital in Nov. 1984 and was treated with curettage and autogenous bone graft followed by radiotherapy. The patient was followed for 13 months and complete healing was obtained.
Curettage ; Eosinophilic Granuloma ; Eosinophils ; Epiphyses ; Histiocytosis, Langerhans-Cell ; Humans ; Male ; Radiotherapy ; Ribs ; Seoul ; Skull ; Spine ; Transplants

The authors treated twenty cases out of 62 scoliosis patients with Milwaukee brace from January 1968 to September 1972 at Department of Orthopedic Surgery, Seoul National University Hospital. The average age were 10.2 years old ranging from 4 to 15 years. Eleven cases were idiopathic, four were paralytic and five were cogenital. The average curvature before the Milwaukee brace application was 44.4 degrees, ranging from 21 to 67 degrees. The average follow up was 15.4 months with average correction of 11.1 degrees, correction rate 19.2 percent. Mild curvature recognized early could be treated successfully by the Milwaukee brace, and also severe curvature of growing period could be not only corrected, but make it more easy for the operative treatment later. Close cooperation with patients and parent are essential for successful trestmant with Milwaukee brace.
Braces ; Follow-Up Studies ; Humans ; Orthopedics ; Parents ; Scoliosis ; Seoul

Harrington instrumentation with posterior spinal fusion were caried out on 9 patients among 62 scoliotic patients at Department of Orthopedic Surgery, Seoul National University Hospital from January 1968 to September 1972. The youngest patient was 13 years old and the oldest was 17 Six cases were idiopathic and three cases were paralytic type. Preoperative localizer cast was applied and posterior window was made through which snrgery was performed. Harrington inatrumentation was applied in all cases with meticulous posterior fusion and massive autogenous iliac bone graft in Goldstein method. Postoperative immobilization in localizer cast was continued between 25 to 34 weeks, in average of 29.5 weeks. Average preoperative scoliotic curvature was 87.6 degrees ranging from 59 to 118 degrees. Correction obtained by preoperative localizer cast was 37.4 degrees with correction rate of 42.9 percent. Immediate postoperative correction by Harrington instrumentation was from 41 to 69 degrees with average of 50.1 degrees and correction rate of 63.5 percent. The loss of correction in average after two years follow up was 5.2 degrees with rate of 10.2 pecent. Solid bony union was obained in all cases with satifactory result. This treatment is considered excellent method of scoliosis correction and maintainence.
Follow-Up Studies ; Humans ; Immobilization ; Methods ; Orthopedics ; Scoliosis ; Seoul ; Spinal Fusion ; Transplants