Morphologic Feasibility of Pedicle Screw Insertion in Korean / 대한정형외과학회잡지

PURPOSE: This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. MATERIALS AND METHODS: The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. RESULTS: Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were <5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. CONCLUSION: The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

The Use of Second Metacarpal Vascular Pedicle Graft and Temporary Scaphotrapeziotrapezoid Fixation for the Treatment of Kienbock's Disease / 대한정형외과학회잡지

PURPOSE: Revascularization is a useful method for treating Kienbock's disease. The aim of this study was to evaluate the use of the second dorsal metacarpal vascular pedicle to treat Kienbock's disease. MATERIALS AND METHODS: A retrospective study was carried out on 9 patients who had undergone vascular pedicle graft for Kienbock's disease between 1999 and 2003. The mean follow up period was 35 months. At the time of surgery, 2 patients were graded as stage II, 6 as IIIa and 1 as IIIb. The ulnar variance was neutral in all cases. A vascular pedicle graft using second dorsal metacarpal vessel were performed and temporary scaphotrapeziotrapezoid (STT) fixation were applied for 6 months. RESULTS: Wrist motion except for the radial deviation and grip strength had improved significantly. The patients returned to work after an average of 22 weeks. Resorption of the sclerosis was observed in 7 cases, but lunate collapse was observed in the simple radiograph in 6 cases. According to Lichtman's criteria, 7 cases were satisfactory but 2 cases with a relative old age were unsatisfactory. According to Nakamura's classification, 5 cases were good, 3 cases were fair and 1 case was poor. CONCLUSION: In Kienbock's disease with neutral ulnar variance, a revascularization procedure of vascular pedicle graft with temporary STT fixation is a good treatment method but the patient's age should be considered when determining the revascularization procedure. A prospective study will be needed to determine the optimal duration of temporary STT fixation.

Sural Nerve Graftafter Resection of a Schwannoma in the Sciatic Nerve : A Case Report / 대한정형외과학회잡지

A schwannoma is one of the most common neoplasms in the central and peripheral nervous systems, but schwannomas of the sciatic nerve are rare. Treatment is a surgical excision and the overall prognosis is good. But functional loss occurs when a neurectomy is performed with inevitable cause. We report one case of a successful sural nerve graft after resection of a schwannoma in a sciatic nerve and we present a brief review of the literature.

Effect of the Hyaluronic Acid on Osteoarthritis of the Knee

PURPOSE: The Purpose was to evaulate the efficacy of sodium hyaluronate (HA) according to the degree of osteoarthritis, body mass index and tibiofemoral alignment. MATERIALS AND METHODS: 53 of 73 patients who had osteoarthritis of the knee were underwent intraarticular injection weekly for 5 weeks with hyaluronic acid (HA, hyruan(R), MW:1MDa) and 20 of 73 patients with placebo (normal saline). The patients were followed for 27 weeks. Results were evaluated with visual analogue scale for pain, Lequesne algofunctional index for functional severity and Tegner activity score for activity. The degree of severity of osteoarthrtis of knee was stratified by Kellgren classification. RESULTS: In the group treated with HA, the patients classified as Kellgren classification II and III showed much better improvement in efficacy for pain, function and activity compared with group IV. In the femorotibial alignment, neutral and valgus alignment group showed better results than varus group. There is no statistical significance in the knee pain and function between normal and overweight group. Best symptomatic improvement according to the subjective symptom revealed at 3 week in 25 patients (47.2%). Placebo treated patients had slight pain and improved functional perfomance but less effect in compared with HA treated patients. CONCLUSION: Intraarticular administration of HA relieve the symptom of osteoarthritis and improve the function of knee joint. Especially, the patients classified with Kellgren classification II, III and valgus, neutral tibiofemoral alignmen groups showed much better improvement than grade IV and varus group.