Long segmental fixation with TSRH posterior instrumentation for 19 patients who had unstable thoracolumbar fracture was performed between October 1992 and April 1995. The patients were followed for an average of 22 months. Measurements of the deformity angle, kyphosis, vertebral height, and the intervertebral angle were made. The patients were divided into 2 groups according to configurations of instruments for lower segmental fixation. For one group, only hooks were used, and for the others group pedicular screws and lateral offset hooks were used together at the same segment. Therefore, the purpose of this study is to anlyze the correctability following long segmental fixation and to compare one segmental fixation using both screws and lateral offset hook systems with two segmental fixation using hook systems for distal fixation. There was an overall correction of kyphosis at follow-up of 6.9degrees (27.1%) after a loss of 4.3degrees from operative correction. Overall correction of deformity angle was 8.2degrees (32.2%). Loss of vertebral height at final follow-up was 4.4%. And loss of intervertebral angle was 2.0degrees at follow-up. There was no difference of overall results between the hook group and the pedicular screw with lateral offset hook group. However, there was a significant improvement of the correction of kyphosis and restoration of vertebral height in patients who underwent operation within 7 days after injury, as compared to delayed operation. Therefore, the timing of surgery is the most important factor in order to correct the deformity caused by unstable thoracolumbar fractures. There was no significant loss of correction and no metallic failure. Therefore, rodding long with the method of one segment distal fixation using screws and lateral offset hook together can provide excellent correctability, maintenance of correction, preservation of distal lumbar joints, prevention of implant failure and complication.
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Joints ; Kyphosis

No abstract available.
Pancreas*

Utile recently, osteotomy & reposition surgery of prominent zygoma have been performed by means of a coronal incision or intraoral preauricular incision. But penalties are paid, such as scar, the possibility of facial nerve injury and long operative time. Reflecting on our past experiences of facial bone surgery, we developed an alternative approach. In our method, the protrusion in the cheekbone is corrected by performing an osteotomy and reposition method through intraoral incision only. During the past 3 years we have operated on 23 patients of malar prominences. The amount of the bone to be removed is determined on preoperative interview, physical examination and x-rays. Intraoral incision provide access to the zygomatic body and lateral orbital rim. After L-shaped osteotomy, two paralle vertical and one transverse osteotomies, at medical part of the zygomatic body, the midsegment is removed. Posterior portion of zygomatic arch was approached through medical aspect and was outfractured using curved osteotome. After completion of triple osteotomy, the movable zygomatic complex was reduced medially and fixed with miniplates and screws on the zygomaticomaxillary buttress. The patients were followed for 9.5 months with acceptable result and little complication. The author concludes that this technique is effective and safe method in reduction malarpalsty.
Cicatrix ; Facial Bones ; Facial Nerve Injuries ; Humans ; Operative Time ; Orbit ; Osteotomy ; Physical Examination ; Zygoma

Bacteriological index(BI) was calculated by slit-skin smears taken from the earlobe and the dorsal surfaces of the proximal phalanges of the index finger and of the great toe in 110 lepromatous leprosy patients who have been treated regularly by antileprosy chemotherapy. The bacteriaI indices from the three sites were compared, and the results were as follows. 1) Sixteen patients whose BI of the earlobe smear was 4. 0 in average shawed the highest degree of positivity of M. leprae in the smears taken from the finger and the great toe. 2) ln seventy-four patients whose BI of the earlobe smear was l. 0 or higher, eight (10.8%) showed higher BI in smears taken from both the finger and the great toe, fifteen (20. 3%) and twenty-seven(36. 5%) showed approximately the same BI in smears taken from the finger and the great toe, respectively, 3) In thirty-six patients whose BI of the earlobe smear was negative, twelve (33. 3%) showed higher BI in smears taken from both the finger and the great toe. 4) The mean value of BI of the three sites was 3.7 in the earlobe, 3. 2 in the finger and 3. 0 in the great toe. Comparing the BI of the three sites, the finger and the great toe were found to have comparable BI with the earlobe, although the BI of the earlobe was highest. The authors concluded that it was quite reasonable to include the finger and the great toe in slit-skin smears for M. leprae identification, particularly when the BI of the earlobe was negative. A follow-up investigation seems mandatory.
Drug Therapy ; Fingers* ; Follow-Up Studies ; Humans ; Leprosy, Lepromatous ; Mycobacterium leprae* ; Mycobacterium* ; Skin* ; Toes*

Through the clinicopathologic study of pathergy test sites of 16 patients with Behrets disease in the active or inactive stage, the following results were obtained; 1. In the active stage, six of 16 patients (37.5%) showed positive reactions in clinical pathergy tests, which are much higher than that in the inactive stage when only one patient showed a positive reaction. The severity of the ciniral pathergy reaction was directly related to the activity of the disease. 2. The characteristic histopathologic finding in the active stag was a dermal inflammatory cellular infiltration composed mainly of polymorphonuclear lukocytes and of lymphomononuclear cells accompanied by leukoctocylasia. Two of 16 patients showed true leukocytoclastic vasculitis. 3. Although the type of disease and the reactivity of the clinical pathergy test were related in terms of the severity of the histopathologic findings, there were some notible histopathologic changes even in the cases with negative clinical pathergy reactions. We concluded that the histopathologic findings of the pathergy test sites were more reliable for the diagnosis of Behcet's disease than the clinical findinigs.
Diagnosis ; Humans ; Vasculitis

One of various decompression methods in treatment of spinal stenosis is the indirect instrumental decompression. Theoretically, the distraction of the disc space can widen the intervertebral foramen of the stenotic segment and even increase the canal diameter by distracting the posterior annulus as well as reduce the extent of decompressive laminectomy site. The indirect instrumental decompression, however, was not guaranteed to maintain the restored discal height because of the loss of fixation strength between rod and screw, viscoelasticity of vertebra itself, bone density, type of screw and rod, and operative technique. As well the magnitude of the stresses on the instrumentation particularly at the rod-screw interface may depend on rod-contouring in order to make mormal sagittal curvature of the lumbar spines. Therefore, the aim of this experimental study was to evaluate the effect of different rod-contour on the axial sliding strength in Compact Cotrel-Dubousset (CCD) instrumentation. Axial sliding strength was tested by Universal Test Machine (Instron). Test was performed for 3 groups of different rodcontouring on the biomechanical axial strength: straight rod (no contour), 10 and 20 contouring rod. The length of contact surface between rod and screw was measured with Fuji pressure sensitive film. The study was performed using 6.5 mm open body screws and 7 mm rods of CCD instrumentation. Axial sliding strength of straight rod was 2518.6N, 1871.8N in 10 and 1528.8N in 20 contouring rod. The length of contact surface between rod and screw significantly decreased according to degree of rod contouring; 9.88mm in straight rod, 9.08mm in 10 and 8.57mm in 20 contouring rod. There was a statistically significant linear correlation (R=0.96) between failure load and length of contact surface. Therefore, this study has shown that excessive contour of the rod in order to make normal sagittal curvature of the lumbar spine using CCD instrumentation cannot provide sufficient axial sliding strength. That may be a cause of loss of restored disc space height after surgery.
Bone Density ; Decompression ; Laminectomy ; Spinal Stenosis ; Spine

With an aging population, osteoporotic vertebral collapse is an increasingly common condition. This compression fractures has been considered a benign entity, quite responsive to conservative treatment. In a rare patients, however, a major neurologic complication and painful kyphosis despite conservative treatment can develop. Therefore, the purpose of this present study is to analyze the surgical results of 14 patients with severe back pain, an increasing kyphosis and neurologic deficits caused hy osteoporotic vertebral collapse following minor trauma, who were treated surgically. Presenting signs and symptoms included severe back pain with progression of kyphosis in 6 patients and increasing neural deficit in 8 patients. Of 14 patients, eight patients had an intravertebral cleft sign (vacuum sign). Indications for surgery included increasing kyphotic deformity, intractable pain, or increasing neurologic deficit. There was no correlation between intravertebral cleft sign and neurologic deficit. However, patients who had intravertebral cleft sign had not well respond to conservative treatment. As treatments, combined anterior and posterior fusion in 8, anterior fusion in 4, posterior instrumentation, and wide decompressive laminectomry in one patient, respectively, were carried out. The final correction of the deformity averaged 0.3 degrees. Therefore. correction of kyphosis was not favorably maintained because of variable surgical methods, and sinking of graft bone or instrumentation into the osteoporotic vertebral bodies. However, pain was reduced significantly in all patients. In addition neurological symptoms improved in 7 patients. One patient underwent reoperation with nnterior inierbody tusion together with anterior instrument because of an increasing kyphosis, neurologic. iymptoms and scvcre hack pain following wide decompressive laminectomy. There was no complication relatecl to instruments. The authors strongly helieved that surgical intervention has highly satisfactory results in patients who have intravertehral cleft sign with persistent back pain despite conservative treatment, and proressive or persistent neurologic deficits following osteoporotic vertebral collapse.
Aging ; Back Pain ; Congenital Abnormalities ; Fractures, Compression ; Humans ; Kyphosis ; Laminectomy ; Neurologic Manifestations ; Osteoporosis ; Pain, Intractable ; Reoperation ; Transplants

The purpose of this study is to determine whether magnetic resonance imaging(MRI) can assist in deci- sion-making in the treatment of acute posterolateral complex injuries. We reviewed retrospectively seven patients with acute posterolateral complex injury, among the 79 cases that had taken cruciate ligament recon- struction. MRI findings were then correlated with the results of examination under anesthesia or operi lateral reconstruction. Based on surgical and clinical findings, there were six complete and four partial posterolateral complex injuries. MRI was able to accurately describe the extent of injury in each case. All ten patients had concomitant anterior cruciate ligament tears, and seven were three posterior cruciate ligament injuries. The iliotibial band was avulsed from Gerdys tubercle in seven patients. In knees with complete tears, separation of the coronary ligament of the lateral meniscus was noted on MRI. A characteristic bone contusion on the anteromedial femoral condyle was present in nine patients. Popliteal tendon tearing was observed in eight cases, and biceps femoris was torn in six patients. In knee with complete tears, tears of the lateral collateral ligament complex was noted both on MRI and intraoperatively. A high-quality MRI in patients sustaining these injuries will assist the surgeon in directly applying surgical techniques in a timely fashion.
Anesthesia ; Anterior Cruciate Ligament ; Contusions ; Humans ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Retrospective Studies ; Tendons

One hundred and ninety-four consecutive patients with two hundred and one diaphyseal femur fractures were retrospectively reviewed to evaluate the frequencies, types and the results of treatments for the associated ipsilateral knee ligaments and menisci injuries from Oct. 1990 to Feb. 1997 at Eulji Medical Center. Fifteen patients had associated ipsilateral knee ligament injuries. There were eleven(73.3%) males and four(26.7%) females with an average age of 35.7(17-68) years. Thirteen(86.7%) patients were injured by traffic accident. Ten patients were followed for average of 38 months(12-73 months). There were five(33.4%) partial and two(13.3%) complete tears of anterior cruciate ligaments, three(20.0%) partial and four(26.7%) complete tears of posterior cruciate ligaments, one(6.7%) partial and four(26.7%) complete tears of medial collateral ligaments, one(6.7%) complete and three(20.0%) partial tears of lateral collateral ligaments, five(33.3%) tears of medial menisci and four(26.7%) tears of lateral menisci. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Better range of knee motion and HSS knee score was obtained when both the femur and ligament injuries were surgically managed. The invention of the MRI and the development of arthroscopic techniques have made it easy to diagnose and take care for ligament injuries. Early diagnosis and proper treatment on ruptured ligaments and tom meniscus combined with diaphyseal femur fractures seem to be important for good prognosis.
Accidents, Traffic ; Anterior Cruciate Ligament ; Collateral Ligaments ; Early Diagnosis ; Female ; Femoral Fractures* ; Femur ; Humans ; Inventions ; Knee* ; Lateral Ligament, Ankle ; Ligaments* ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prognosis ; Retrospective Studies

STUDY DESIGN: A retrospective analysis was performed on 40 patients who had had previous lux bar spine surgeries. OBJECTIVE: To determine what factors most influenced surgical outcome and to analyze results in a series of revision lumbar surgeries. SUMMARY OF BACKGROUND DATA: Satisfactory surgical outcome of the revision lumbar surgery range from 28% to 82% and are rarely comparable to primary surgery. Many factors predicting outcome from repeat lumbar surgery haute been listed. METHODS: Forty patients were analyzed who had had previous lumbar surgeries. The patients were classified into 5 groups according to diagnosis: 3 Infection,5 instability,8 nonunion, 14 HNP and 10 spinal stenosis. of 40 patients,33 patients(82.5%) underwent fusion with instrumentation for repeat surgery. Their clinical course was followed for a minimum of 1 year. The number of surgery on each mpatient was 1.3 times on an average. RESULTS: Overall, 80% of patients had a satisfactory result. Obviously extruded or sequestrated HNP in MRI findings, complete block of contrast with severe radiculopathy and/or myelopathy in spinal stenosis, complete decompression, neurolysi s and fusion with instrumentation, and longer than 6 month pain relief after precious surgery were correlated with satisfactory outcome. However, the number of precious operation, age, repair of pseudarthrosis , no abnormality at surgery and combined multiple degenerative joint disease were significantly correlated with poor surgical outcome. The most common complication during repeat surgery was dural tear in 5 cases(12.5%). CONCLUSIONS: Success rate of revision surgery was low as compared to primary operation. Therefore, erroneous diagnosis and faulty surgical technique understandably lead to failure, and precise attention to preoperative and intraoperative detail can minimize these sources of error.
Decompression ; Diagnosis ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Pseudarthrosis ; Radiculopathy ; Reoperation ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis ; Spine* ; Tears