The goals of treatment of the slipped capital femoral eiphysis(SCFE) are to stabilize the slipped epiphysis, prevent further slipping and induce early closure of the epiphyseal plate. Mutiple pinning was used for the treatment but in recent years, percutaneous in-situ fixation technique with 1 or 2 cannulated screws is preferred due to the advantages of low rate of complication such as pin penetration. We report the results of experimental study and the functional results after percutaneous pinning. The purpose of the experimental study was the investigation for changes of the screw length and the site of screw entry point according to the degree of slipping by bony model. The entry point of the screw was changed toward anterior and proximal portion of femoral neck and the length of inserting screw was changed to be shorter according to the degree of slip. We have treated 10 patients(13 hips) with slipped capital femoral epiphysis(SCFE) at our department since Jan. 1989. Among them, 6 patients(7 hips) could be followed for more than 2 years. There were 5 boys and 1 girl. One case was affected on the both hip. The average age at operation was 11.8 year old. All cases were obese. Degree of slipping was showed 6 cases in mild and 1 case in moderate. The slipping of acute onset was 3 cases, acute-on chronic 3 cases and chronic 1 case. In radiographic results, 6 cases were showing in Grade 0, 1 case was in Grade II. In functional results, 3 cases were excellent, 3 cases in good and 1 case in poor. One poor functional result was a case complicated by chondrolysis.
Epiphyses ; Female ; Femur ; Femur Neck ; Growth Plate ; Hip ; Humans ; Slipped Capital Femoral Epiphyses

The subluxation of the femoral head is one of important prognostic factors in LCPD and current treatment of LCPD is based on the premise that adequate containment of the vulnerable femoral head within the acetabulum during the process of repair should result in a more spherical femoral head and a more congruous joint than if treatments were not provided.We analised the arthrographic findings of 18 hips in unilateral LCPD in order to determine the changes of the femoral head and acetabulum, degree of the subluxation and containment of the femoral head in various position of hip. The results were as follows: 1. According to the result of sphericity, the femoral head was deformed mainly in coronal plane in LCPD. 2. Average medial joint space of normal hip was about 3.8mm in the AP view of hip, but it was more increased in any position of LCPD. 3. In abduction with internal rotation, average subluxation ratio was 7.5% in normal hip and 10.9% in LCPD. In abduction with external rotation, it was 8.3% in normal hip and 12.4% in LCPD. 4. In normal hip, the containment ratio was more than 1.0 in any position of hip, but the containment ratio was 1.03 in abduction with internal rotation and 0.95 in abduction with external rotation of hip in LCPD. 5. On the basis of these results, efficacy of the Scottish Rite orthosis was doubtful in most hips of LCPD.
Acetabulum ; Arthrography ; Containment of Biohazards ; Head ; Hip ; Joints ; Legg-Calve-Perthes Disease ; Orthotic Devices

Component fixation on the acetabular side is not as much of a problem because of the simpler geometry and loading configuration. It is generally accepted that hemispheric component design is preferable and immediate implant stability can be achieved by using screws or spikes in the porous coated implants. The authors reviewed 130 primary noncemented porouscoated, press fit acetabular component in 110 patients; 84 were AML (Anatomical Medullary Locking) and 46 were HarrisGalante acetabular component. Radiologic analysis at a minimum of 3 years(average 4.5 years) was done with special regards to the vertical and medial migration, screw size and numbers, change of the radiolucent line and its zone with its fate and acetabular cup angles on the acetabular component by the 2 observers. Progressive radiolucent line at the component-bone intersurface were found in 14 cases(11%), frequently located in zone I and zone I & II. No significant vertical, medial migration and change of the acetabular cup angle were found. No screw and spike failure had occurred. No component had to be revised because of loosening. As a whole, in our 3-years experience we report excellent results with porous coated acetabular component although it dose not ensure long-term sucess.
Acetabulum ; Hip ; Humans

Authors performed a retrospective clinical and radiologic comparative study for 43 uncemented primary total hip arthroplasty which include 20 hips without lateral porous pad and 23 hips with lateral porous pad in same kinds of implant(Zimmer Anatomic") to investigate the role and significance of the lateral porous pad. The average follow up was 35 months and 38 months for without and with lateral porous pad respectively. The results were as followings: 1. Clinical and radiological results of group with and without lateral pad were similar together except incidence of radiolucency at zone 1 on anteroposterior radiograph in group without lateral pad was markedly higher compare to that in group with lateral pad. 2. The extent of lateral porous pad was not sufficiently enough to make better clinical and radiological results in stem with lateral pad compare to stem without lateral pad. 3. Stems without lateral porous pad had no evidence of bone ingrowth on lateral pad while stems with lateral pad had bone ingrowth on lateral pad with more than 50% in incidence. So, we think that presence and increase of extent of porous pad would have better clinical and radiological results.
Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Incidence ; Retrospective Studies

Vertebral stabilization using transpedicular screw fixation device is widely used in the surgical treatment of degenerative lumber diseases such as spinal stenosis, pseudospondylolisthesis, and spinal instability. The use of transpedicular screw fixation devices provides substantial advantages with regard to an increase of the rate of solid arthrodesis, early rehabilitation, short segment spinal fusion, and restoration of sagittal lumbar lordosis. The authors analyzed 11 patients showing definite postoperative loss of the lumbar sagittal lordosis in a total of 110 surgical cases of degenerative lumbar diseases who underwent segmental spinal fusion using transpedicular screws from January 1981 to December 1993. The purpose of this study was to analyze the causes of loss of lumbar sagittal lordosis in the instrumented segments and to present some precautions in transpedicular screw fixation for surgical patients with degenerative lumbar spines to maintain corrected lumbar sagittal lordosis. The results from this study were as follows: 1. By standard Cobb lateral measurements, eleven cases in a total of 110 patients showed definite loss of lumbar sagittal lordosis more than 4 degrees. 2. The period reflecting loss of lordosis was roughly within postoperative four months which were critical fusion time of the grafted bone mass, which lasted an average of 4.8 months in this study. 3. The implants led to loss of lordosis consisted of 6 cases in 53 Diapasons, 4 cases in 32 Wiltses, and a case in 15 Steffee plate systems. Diapason & Steffee plate systems were classified as a rigid type and Wiltse system as a flexible one. 4. The causes of postoperative loss of lordosis were recognized as 2 cases of screw toggling, 5 cases of screw-rod locking failure and 4 cases of rod bending. 5. The group resulted in more loss of lordosis in degrees was related to significant change between preoperative and postoperative lordosis, distraction of disc space during operation, extensive discectomy, and reduction of degenerative spondylolisthesis which were the cases of the anterior column deficiency.
Animals ; Arthrodesis ; Diskectomy ; Humans ; Lordosis ; Rehabilitation ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Transplants

When.direct approximation of the ends of the injured nerves is impossible, nerve autografting is widely used in these days. Authors tried to observe nerve regeneration in time sequence of nerve autografting and tried to find out the most optimal time for nerve autografting in experimental study. The Sprague-Dawley mice were used in performing nerve autografting and it performed with the segment of the opposite sciatic nerve as a donor nerve after resection of a sciatic nerve. The results obtained were as follows: 1. The regeneration of axon can be observed well in the first observation of 2 weeks after nerve autografting within 2 days, but active myelination can be observed apparently 4 weeks after grafting. 2. The groups of grafting within 2 days after nerve resection showed more rapid nerve regeneration and less atrophy of the reinnervated skeletal muscle than the groups of grafting over 1 week after nerve resection did. 3. In case which has been grafted at 4 weeks after nerve resection, there was abundant axonal proliferation at 4 weeks after grafting. 4. Changes of the reinnervated skeletal muscle in the groups of grafting within 2 days were subtle, but the groups of grafting after 1 week showed irregular neurogenic atrophy although nerve regeneration has been active at 8 weeks after grafting. 5. Although the functional effect can not be evaluated exactly, the result of autograft showed relatively good evidence of nerve regeneration even after grafting has been performed 16 weeks after the nerve injury.
Animals ; Atrophy ; Autografts ; Axons ; Humans ; Mice ; Muscle, Skeletal ; Myelin Sheath ; Nerve Regeneration ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Sciatic Nerve ; Tissue Donors ; Transplantation, Autologous ; Transplants

The aim of this study was to compare widely used quantitative sensory tests to evaluate the diabetic neuropathy(DN). We tested plantar sensation of 40 patients with diabetes mellitus(Group I: 20 with neuropathic symtom, Group II: 20 without symptom) using Semmes-Weinstein monofilament(touch sensation), Biothesiometer(vibration sensation) and EMG. This result was also compared with that of the control group. Eighty percent of Group I and thirty percent of Group II had abnormal EMG findings. Group I had decreased vibration and touch sensation. Comparison of vibration perception threshold(Biothesiometer) with touch pressure sensation(Semmes-Weinstein monofilament) showed that the test with Biothesiometer was relatively accurate, however it was complicated, time consuming and that the test with monofilament was simple and easily performed in the field even though it was relatively crude. 5.07 monofilament could be very effective in the eearly detection of diabetic neumpathy. In conclusion, we recommend 5.07 monofilament as a screening method of diabetic neuropathy and biothesiometer as its follow-up method.
Diabetic Neuropathies ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Peripheral Nervous System Diseases ; Sensation ; Vibration

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

Osteoporosis is defined as a pathologic condition that there occurs no change in the chemical composition of the bone, while bone resorption is abnormally increased, compared with osteogenesis, leading to a decrease in bone amount. Though many varieties of therapy have been tried, no definitely effective method has been found. Ginseng saponin is an importanat component of Korean ginseng and many studies have been performed for investigating its effectiveness. But there has been no report on saponin effects to osteoporosis. The purpose of this studies is to find out the effect of saponin in osteoporosis induced by ovariectomy in rats. For the study, 30 rats underwent sham operation(group I) and 90 rats were ovariectomized. In group ll (30 rats), only ovariectomy was performed. In group III (30 rats), 50mg/kg/day ginseng saponin was administered per oral route and group IV (30 rats) was administrated 150mg/kg/day saponin. All the rats were sacrificed at the 16th week. The sections of the femoral shaft were stained using Villanueva bone stain and the sections of the tibia were stained with hematoxylin-eosin. The femoral shaft and metaphyseal region were applied to compression device for measurements of bone consistency. The effect of saponin increased weight of the femur. The cross sectional area and cortical area of the femoral shaft were significantly higher in 50mg saponin group(group III) than osteoporosis group. But there was no significant difference in the size and number of osteoclast and the percentage of trabecular bone between saponin group(group III ,IV)and osteoporosis group. In the biomechanical test, the consistency of cortical bone was significantly increased in 50mg saponin group than osteoporosis group. In conclusion, saponin had an effect on experimental osteoporosis induced by ovariectomy in rats. As though its precise mechanism was unknown, we considered that its action mechanism was due to osteoblastic activity resulting in a correction of bone mass deficit in osteoporotic rats.
Animals ; Bone Resorption ; Female ; Femur ; Methods ; Osteoblasts ; Osteoclasts ; Osteogenesis ; Osteoporosis ; Ovariectomy ; Panax ; Rats ; Saponins ; Tibia

The various biomechanical responses such as stress distribution, facet contact force and nucleus pressure change in the lumbar spine under vertical static and dynamic loading conditions were. Investigated with a nonlinear three dimensional finite element model. Finite element model of one motion segment, consisted of two vertebral bodies(L3-4) with one disc, was developed from 1 mm thick transverse CT cross-sections. Geometrical nonlinearity was also considered for the large deformation on the disc. ABACUS package was used for calculation and its results were verified comparing with the existing in-vitro experimental data. Clinically useful results could be obtained with this analysis. Stress was concentrated on the endplate under static and dynamic loading condition, especially posterior and anterior aspect and central portion along midsagittal plane. The facet contact force showed some discontinuity when Δt/2=0.03 sec. This discontinuity was considered to de due to the vibration of upper vertebra. Relatively smooth contact force profile was detected when t/2=0.1342 sec. Intradiscal pressure and stress pattern changes on the vertebra were also analyzed.
Spine ; Vibration