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- 발행기관 : Journal of Bone and Joint Surgery (검색결과 15 건)
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The Effect of Distraction-Resisting Forces on the Tibia During Distraction Osteogenesis :
Shyam, Ashok K,Song, Hae-Ryong,An, Hyonggin,Isaac, Dileep,Shetty, Gautam M,Lee, Seok Hyun Journal of Bone and Joint Surgery 2009 Journal of bone and joint surgery Vol.91 No.7
<P>BACKGROUND: Distraction-resisting forces that are generated during distraction osteogenesis can be responsible for complications, including a lag effect on fibular distraction leading to a tibiofibular distraction difference, tibial axial deviation, and distraction at the proximal and distal tibiofibular joints. We investigated the nature of distraction-resisting forces by studying their correlation with these parameters. METHODS: One hundred and eleven tibial lengthening procedures in sixty-three patients were chosen. Seventy-six segments underwent lengthening with an Ilizarov ring fixator, and thirty-five segments had lengthening over an intramedullary nail. Serial radiographs were evaluated with regard to the amounts of tibiofibular distraction difference, proximal tibiofibular joint distraction, distal tibiofibular joint distraction, tibial axial deviation, and heel malalignment. Clinically, laxity at the knee was evaluated and fibular head instability was assessed. Variations in all of these parameters were evaluated with respect to tibiofibular joint fixation, etiology, skeletal maturity, lengthening over an intramedullary nail, and amount of lengthening. RESULTS: The mean tibiofibular distraction difference was 19.1 +/- 10.6 mm (range, 2 to 51 mm), the mean proximal tibiofibular joint distraction was 10.1 +/- 6.8 mm (range, 0 to 33 mm), and the mean tibial valgus angulation was 8.7 degrees +/- 4.4 degrees . At the time of the latest follow-up, twenty-eight segments (25%) had lateral knee joint laxity at 30 degrees of knee flexion and eight segments (7%) had fibular head subluxation at 90 degrees of knee flexion. Twenty-four (86%) of the twenty-eight cases of knee laxity were observed in skeletally immature patients. The tibiofibular distraction difference, proximal tibiofibular joint distraction, and tibial valgus angulation were significantly greater in the group without fixation of the proximal tibiofibular joint. A significant decrease in the tibial valgus angulation and knee laxity was found in patients with lengthening over an intramedullary nail. In the intramedullary nail group, after fixation of the proximal tibiofibular joint, the tibiofibular distraction difference and the proximal tibiofibular joint distraction decreased; however, the proportion of cases with clinically important tibial valgus angulation (>10 degrees ) increased significantly. CONCLUSIONS: Fixing both tibiofibular joints with a single Ilizarov wire decreases proximal tibiofibular joint distraction; however, more secure fixation would help to decrease the prevalence of delayed knee laxity. When tibial lengthening is performed over an intramedullary nail, avoiding proximal tibiofibular joint fixation will limit tibial valgus angulation. Limiting lengthening to <25% will decrease the proportion of cases with knee laxity, and limiting lengthening to <50% will significantly limit tibial valgus angulation.</P>
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Kim, Sung-Jae,Chang, Ji-Hoon,Kim, Tai-Won,Jo, Seung-Bae,Oh, Kyung-Soo Journal of Bone and Joint Surgery 2009 Journal of bone and joint surgery Vol.91 No.2
<P>BACKGROUND: In a patient with generalized ligamentous laxity, the risk of instability is greater with a conventionally reconstructed anterior cruciate ligament. The purpose of this study was to compare the clinical outcome of anterior cruciate ligament reconstruction done with a double-bundle technique with use of a quadriceps tendon-bone autograft and that of a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft in patients with generalized ligamentous laxity. METHODS: The records of sixty-one patients who underwent anterior cruciate ligament reconstruction between June 2002 and October 2005 were evaluated. Thirty-two patients underwent a single-bundle reconstruction (group 1), and twenty-nine patients underwent a double-bundle reconstruction (group 2). Clinical outcomes were determined from data obtained before surgery and at the twenty-four-month follow-up visit. RESULTS: Postoperatively, the mean side-to-side difference (and standard deviation) in anterior tibial translation, measured with use of a KT-2000 arthrometer, was greater for group 1 (3.37 +/- 1.76 mm; range, 1.00 to 8.00 mm) than for group 2 (2.03 +/- 1.11 mm; range, 0.00 to 3.50 mm) (p = 0.02). Three patients in group 1 had a grade-1+ pivot shift, while no patient in group 2 had an abnormal pivot shift. The mean score on the Hospital for Special Surgery knee ligament questionnaire was 90.8 in group 1 and 92.1 in group 2, and the mean Lysholm score was 89.4 in group 1 and 91.1 in group 2. CONCLUSIONS: On the basis of the evaluation of ligamentous laxity measured by the KT-2000 arthrometer, a double-bundle anterior cruciate ligament reconstruction with use of a quadriceps tendon-bone autograft allows less anterior translation than does a single-bundle reconstruction with use of a bone-patellar tendon-bone autograft. However, we could not identify a significant difference in the functional outcome between the two techniques.</P>
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Spinal Growth Modulation with Use of a Tether in an Immature Porcine Model :
Newton, Peter O,Upasani, Vidyadhar V,Farnsworth, Christine L,Oka, Richard,Chambers, Reid C,Dwek, Jerry,Kim, Jung Ryul,Perry, Andrew,Mahar, Andrew T Journal of Bone and Joint Surgery 2008 Journal of bone and joint surgery Vol.90 No.12
<P>BACKGROUND: Spinal growth modulation by tethering the anterolateral aspect of the spine, as previously demonstrated in a nonscoliotic calf model, may be a viable fusionless treatment method for idiopathic scoliosis. The purpose of the present study was to evaluate the radiographic, histologic, and biomechanical results after six and twelve months of spinal growth modulation in a porcine model with a growth rate similar to that of adolescent patients. METHODS: Twelve seven-month-old mini-pigs underwent instrumentation with a vertebral staple-screw construct connected by a polyethylene tether over four consecutive thoracic vertebrae. The spines were harvested after six (n = 6) or twelve months (n = 6) of growth. Monthly radiographs, computed tomography and magnetic resonance imaging scans (made after the spines were harvested), histologic findings, and biomechanical findings were evaluated. Analysis of variance was used to compare preoperative, six-month postoperative, and twelve-month postoperative data. RESULTS: Radiographs demonstrated 14 degrees +/- 4 degrees of coronal deformity after six months and 30 degrees +/- 13 degrees after twelve months of growth. Coronal vertebral wedging was observed in all four tethered vertebrae and progressed throughout each animal's survival period. Disc wedging was also created; however, in contrast to the findings associated with vertebral wedging, the tethered side was taller than the untethered side. Magnetic resonance images revealed no evidence of disc degeneration; however, the nucleus pulposus had shifted toward the side of the tethering. Midcoronal undecalcified histologic sections showed intact bone-screw interfaces with no evidence of implant failure or loosening. With the tether cut, stiffness decreased and range of motion increased in lateral bending away from the tether at both time-points (p < 0.05). CONCLUSIONS: In this porcine model, mechanical tethering during growth altered spinal morphology in the coronal and sagittal planes, leading to vertebral and disc wedging proportional to the duration of tethering. The resulting concave thickening of the disc in response to the tether was not anticipated and may suggest a capacity for the nucleus pulposus to respond to the compressive loads created by growth against the tether.</P>
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Lee, Young-Kyun,Ha, Yong-Chan,Yoo, Jeong Joon,Koo, Kyung-Hoi,Yoon, Kang Sup,Kim, Hee Joong Journal of Bone and Joint Surgery 2010 Journal of bone and joint surgery Vol.92 No.8
<P>Abstract: We previously reported the five-to-six-year results of the use of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless total hip arthroplasties. This report presents the longer-term outcomes of these same bearings, at a minimum of ten years postoperatively. Eighty-six of eighty-eight hips available for the study retained the original bearings at the time of the latest follow-up. Thirteen hips were associated with noise, and six hips demonstrated fretting of the femoral neck on radiographs. Two hips required a change of the bearings because of a ceramic head fracture. The ten-year survival rate of the alumina-on-alumina total hip prostheses, with revision of any implant for any reason as the end point, was 99.0%. On the basis of those results, we concluded that the rate of survival of primary cementless total hip prostheses with third-generation alumina-on-alumina bearings is excellent at ten years. However, the risk of ceramic fracture, noise, and impingement between the metal neck and the ceramic liner should be a concern to surgeons, and patients should be informed of these risks before surgery. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.</P>
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Park, Kun Bo,Park, Hui Wan,Lee, Ki Seok,Joo, Sun Young,Kim, Hyun Woo Journal of Bone and Joint Surgery 2008 Journal of bone and joint surgery Vol.90 No.8
<P>BACKGROUND: Calcaneal lengthening osteotomy and extra-articular arthrodesis of the subtalar joint are two methods used for the correction of valgus deformity of the heel and forefoot abduction. The purpose of this study was to compare the operative results of these procedures in patients with cerebral palsy who were able to walk. We focused primarily on changes in radiographic parameters and how altered mobility of the subtalar joint by the two operative methods would modify pressure distribution over the plantar surface of the foot. METHODS: A total of eighty-one feet in forty-seven patients were included in the study. The mean age at the time of surgery was eight years and one month, and the mean follow-up period was thirty-nine months. The subjects were divided into two groups; Group I consisted of thirty-seven feet in twenty-two patients who underwent a calcaneal lengthening osteotomy, and Group II comprised forty-four feet in twenty-five patients who underwent an extra-articular subtalar arthrodesis. Preoperative and final follow-up radiographs and dynamic pedobarographs were used to evaluate the results. RESULTS: The feet in both groups were found to be similarly deformed before surgery, by radiographic measurements and dynamic foot-pressure analysis. Both operative procedures led to improved radiographic indices; however, calcaneal pitch failed to improve after the subtalar arthrodesis. After surgery, the relative vertical impulse was decreased for the hallux, first metatarsal head, and medial aspect of the midfoot in both groups, while it was increased for the lateral aspect of the midfoot and calcaneus. On the other hand, postoperatively, the relative vertical impulse of the medial aspect of the midfoot was higher and the relative vertical impulse of the first through fourth metatarsal heads was lower in the group that had subtalar arthrodesis compared with the group that had a calcaneal lengthening osteotomy and the normal control subjects. CONCLUSIONS: Extra-articular subtalar arthrodesis appears to be an effective means to achieve predictable correction of severe valgus deformity of the heel in patients with cerebral palsy who are able to walk; however, supination deformity of the forefoot remains and calcaneal equinus is not corrected. On the other hand, we believe that the calcaneal lengthening osteotomy is the treatment of choice because postoperative foot-pressure distribution more closely approximates the normal foot-pressure distribution.</P>
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ANTI-APOPTOTIC EFFECTS OF CASPASE INHIBITORS ON RAT INTERVERTEBRAL DISC CELLS :
PARK, JONG-BEOM,PARK, IN-CHUL,PARK, SUNG-JIN,JIN, HYEON-OK,LEE, JIN-KYUNG,RIEW, K. DANIEL Journal of Bone and Joint Surgery 2006 Journal of bone and joint surgery Vol.88 No.4
<P>Apoptosis is thought to be a critical component of disc degeneration. Two main pathways of Fas-mediated apoptosis have been identified: Type I, which is the death-inducing signaling complex pathway, and Type II, which is the mitochondrial pathway. The apoptotic pathway for anulus fibrosus cells, which is phenotypically different from that of nucleus pulposus cells, has not been elucidated to our knowledge. The ultimate initiators or executioners of apoptosis are caspases. There are also inhibitors of caspases, which have the potential of being used as anti-apoptotic therapeutic agents. We therefore undertook this study to determine (1) the apoptotic pathway of anulus fibrosus cells and (2) the anti-apoptotic potential of caspase inhibitors.</P>
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Kim, Sung-Jae,Kim, Tai-Won,Kim, Sul-Gee,Kim, Hyeong-Pyo,Chun, Yong-Min Journal of Bone and Joint Surgery 2011 Journal of bone and joint surgery Vol.93 No.9
<P>The purpose of this study was to describe a one-stage operation for posterior cruciate ligament reconstruction with use of an Achilles tendon-bone allograft and a posterolateral corner reconstruction with use of two different methods, with a comparison of clinical outcomes in the two groups.</P>
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Yang, Jae Hyuk,Suh, Seung Woo,Modi, Hitesh N.,Ramani, Easwar T.,Hong, Jae Young,Hwang, Jin Ho,Jung, Woon Yong Journal of Bone and Joint Surgery 2013 Journal of bone and joint surgery Vol.95 No.9
<P>Spinal cord injury can occur following surgical procedures for correction of scoliosis and kyphosis, as these procedures produce lengthening of the vertebral column. The objective of this study was to cause spinal cord injury by vertebral column distraction and evaluate the histological changes in the spinal cord in relationship to the pattern of recovery from the spinal cord injury.</P>
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