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The purposes of this study are to evaluate the clinical and radiological results of Harris Galante porous acetabular cup and to compare the results according to the fixation methods. In cementless total hip arthroplasty using Anatomic stems and Harris-Galante Porous acetabular components, 32 acetabular cups inserted line to line with several screws(Group I) and 21 acetabular cups fixated press fit without screws(Group II) were compared. The follow-up period was between 2 years and 4 years(average, 38 months). The mean Harris hip score at final follow-up was 88.7 for group I and 94.4 for group II(p=0.018). Initial gaps were present in nine hips(28%) of Group I and six hips(29%) of Group II. New radiolucencies on the 2-year follow-up radiograph were identified in group I(eight in zone I, four in zone II, and three in zone III), but there were no new radiolucencies developed in group II. Radiolucent lines at final follow-up were seen in nine hips(28%) of Group I, but there was no radiolucencies in Group II. This study demonstrates excellent clinical and radiographic performance of HGP acetabular components at 2-4 years in primary THA. The press-fit fixation could eliminate the problems associated with use of the screws. The clinical and radiologcial results have shown press fit group to be superior to the line to line fixation group using screw.
The purposes of this study are to document the effect of the undisplaced intra-operative fracture of the calcar area during primary cementless total hip arthroplasty and to compare the clinical result of primary cementless total hip arthroplasty in patients who sustained an intraoperative fracture of the calcar area with an unfractured control group. 7wenty-two patients of intraoperative undisplaced fracture of calcar area during cementless total hip arthroplasty matched by age, sex, diagnosis, type of the prosthesis, and length of follow-up were compared with 22 patients who had cemetless total hip arthroplasty without fracture. The fractutes were managed with the application of one or two cerclage wires with stability test. No statistically significant difference was found in clinical or radio- graphic results after cementless total hip arthroplasty between the calcar fracture group and control group. If initial stability of the implant is satisfactory, despite of intraoperaive fracture, good clinical results can be expected with cementless total hip arthroplasty. The subsidence of femoral stem and the unstable fixation/stability were noted in three hips of which the diagnosis was Stage IIIC or IV avascular necrosis of femoral head.
The traditionally useful coverage methods of the wrist and hand soft tissue defect are the chinese forearm flap, the ulnar forearm flap. But, this flaps are inevitably sacrifice major vessel to the hand. Advantages of the posterior interosseous artery island flap(PIA Flap) is no need to sacrifice blood supply to the hand and supply relatively large thin, good quality flap and more cosmetic than other forearm flaps. But, it is difficult to dissect and raise because of deep seat, close relation with the posterior interosseous nerve and anatomic variation. Authors evaluated 8 cases of 7 patients in the department of orthopaedic surgery, college of medicine, Hallym University from January, 1993 to December, 1995. The results are as follows: 1. The satisfactory coverage was achieved 7 cases and 1 case failed because of anatomic variation. 2 The pedicle length is average 9cm and the flap size is variable from 3cm by 4cm to 5cm by 8cm. 3. The donor site defect was repaired by direct closure in 5 cases, remained 3 cases combined with skin graft. From our experience we conclude that the PIA flap is one of the useful coverage methods of the wrist and hand soft tissue defect.
목적: 골다공증에 의한 동통성 추체 압박골절에 있어서 척추 성형술(vertebroplasty)과 풍선 성형술(kyphoplasty)의 방사선학적, 임상적 결과를 비교하였다. 대상 및 방법: 2002년 5월부터 2004년 4월까지 본원에서 제12 흉추 혹은 제1 요추에 척추 성형술과 풍선 성형술을 시행 받은 55명의 환자를 대상으로 하였다. 그 중 29명은 국소 마취하에 척추 성형술을 시행하였고, 그 중 15명은 2주 이내에, 14명은 2주 이후에 시행하였다. 나머지 26명은 전신 마취하에 풍선 성형술을 시행하였으며, 그 중 12명은 2주 이내에 나머지 14명은 2주 이후에 시행하였다. 방사선학적 계측은 수술 전 및 수술 후, 최종 추시 시의 측면 사진에서 척추 후만각과 추체의 압박 회복률을 구하여 시행하였다. 임상적 평가는 통증의 단계를 Visual analogue scale (VAS)를 이용하여 평가하였으며, 환자의 활동상태를 Oswestry disability index (ODI)를 사용하여 평가하였다. 결과: 척추 성형술을 시행한 환자군 중 2주 이내에 시술을 시행한 군과, 풍선 성형술을 2주 이내 혹은 2주 이후에 시행한 세 군에서 추체 중앙부의 압박 회복률은 58.4%, 62.3%, 58.5%로 통계적으로 유의한 차이 없이 모두 높게 나타났으나, 2주 이후에 척추 성형술을 시행한 군에서의 압박 회복률은 22.9%로 유의하게 낮게 나왔다. 네 군에서 통증은 유의하게 감소하였으며, 수술 후 기능회복도 네 군에서 비슷하게 이루어졌다. 결론: 척추 압박골절에서 시술 시점의 차이를 고려하지 않았을 시에는 풍선성형술이 척추 성형술보다 방사선학적 압박 회복률이 더 좋은 것으로 나타났으나, 척추 성형술을 2주 이내에 시행한 경우에는 풍선 성형술과 비슷한 방사선학적 결과를 가져왔다. 따라서 척추 압박골절에서 척추성형술을 조기에 시행하면, 추체 높이의 회복 및 통증의 감소, 환자의 기능회복에 있어서 2주 이후 척추성형술을 시행한 군보다는 상대적으로 양호한 결과를 가져올 수 있을 것으로 생각된다. Purpose: To compare the outcome of vertebroplasty with kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Materials and Methods: From May 2002 through April 2004, 55 patients were analyzed. Vertebroplasties were performed on 29 patients under local anesthesia. The patients were divided into two groups: group Ⅰ consisted of 15 patients who underwent vertebroplasties within two weeks from the onset of the fractures; group Ⅱ consisted of 14 patients who underwent kyphoplasties after two weeks from the onset of the fractures. Kyphoplasties were performed on 26 patients under general anesthesia. These patients were also divided into two groups, based on the same criteria as those patients who underwent vertebroplasties. For the radiological assessment, we measured the kyphotic angle with Cobb's method and the reduction rate in the anterior, middle, and posterior portions of the vertebral bodies. The clinical results were assessed with the Oswestry Disability Index and Visual Analogue Scale. Results: The reduction rates of the anterior and middle portions of the vertebral bodies were greater than 50 % in patients who underwent vertebroplasties within two weeks from the onset of the fractures and the patients who received kyphoplasty. The reduction rates of the anterior and middle parts of the vertebral bodies in patients who underwent vertebroplasties after two weeks from the onset of the fractures, was much less than in other three groups. There were no significant differences in clinical comparison among the 4 groups: i.e., all the patient had satisfactory results in terms of pain relief and pre-fracture activity levels. Conclusion: We obtained better results from kyphoplasties when we compared vertebroplasties with kyphoplasties, regardless of the operation dates. However, when we performed vertebroplasties within two weeks from the onset of the fractures, we obtained radiological results that were similar to those with kyphoplasties. In clinical comparison, there were no statistically significant differences among the 4 groups. The pain scores improved dramatically after the operations and pre-fracture activity levels resumed.