ผลงานวิจัยปีงบประมาณ 2546
Reliability of the Finger Angle Measurement with a Goniometer

Clinical Predictors for outcome of treatment of lumbar herniated nucleus palposus

Boonsin Buranapanitkit, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Krerksak Taotrakul, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Apiradee Lim, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University,
Hat Yai, Thailand.
Alan Geater, Epidemiology Unit, Faculty of Medicine, Prince of Songkla University,
Hat Yai, Thailand.
Udom Chomchan, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.

Published : Journal of Musculoskeletal Research, Vol 7, No.1(2003) 61-69
Key word : Predictor; Outcome; Herniated nucleus plaposus.
Abstrscts :

Herniated nucleus plapoosus is a common and important cause of low back pain. Despite over 90 % of the patients responding to conservative treatment, some patients still need operation. This study aimed to analyze the clinical predictors for the outcome of conservative treatment in herniated nucleus palposus. Two hundred and fifty-one patients who were diagnosed as lumbar herniated nucleus palposus and admitted to Prince of Songkla University during the period of 1995-2000 were included in the study. Patients who had absolute indications for surgery or had previous back surgery were excluded. Data were collected on demographic characteristics (age, sex, occupation, level of study, marital status), patient symptoms (including duration, characteristic and severity of pain) and result of physical examination (including result of straight leg raising test (SLRT), cross SLRT, motor power, sensory deficit and reflex). The mean age of the patients was 38 years and the mean duration of pain was 4.1 months. Eighty percent of the patients had positive SLRT and abnormal neurological function was found in 73 %. One hundred and eighty-six patients underwent surgery owing to failure of conservative treatment. From multivariate logistic analysis, five independent factors affecting failure of conservative treatment of herniated nucleus palposus were pain intensity, duration of symptoms, positive cross SLRT, grade of muscle power and number of dermatome deficit. When constructing the parameters into a scoring system, we found that if the patient had a score less than 45, 80% of them respond to conservative treatment, in contrast to those who scored more than 65, the probability of conservative failure was 80%. This study implies that clinical predictors can be used for determining probability of conservative failure in herniated mucleus palposus.

VALIDITY OF CLINICAL PARAMETERS FOR MENISCAL INJURY IN CHRONIC ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEES

Tanarat Boonriong, MD., Department of Orthopaedic Surgery , Faculty of Medicine,
Prince of Songkla Unversity, Hat Yai, Thailand
Piya Pinsornsak, MD., Department of Orthopaedic Surgery , Faculty of Medicine,
Prince of Songkla Unversity, Hat Yai, Thailand

Published : Thai J Orthop Surge : 28(1) March 2003 : 9-16.
Keywords : anterior cruciate ligament, meniscus, diagnostic test, clinical parameters
Abstracts :

The validity of various clinical parameters of meniscal injury was performed in 85 patients who were diagnosed as chronic anterior cruciate ligament (ACL) deficient knees and was confirmed arthroscopically in all cases. There were 79 males and 6 females, whose ages ranged from 18 to 43 years. Clinical parameters of meniscal injury included locking, giving way, snapping, joint effusion, joint line tenderness, and McMurray’s test were determined. Using arthroscopic diagnosis as the gold standard, each clinical parameter was analyzed for its sensitivity, specificity, accuracy, positive predictive values, negative predictive value and likelihood ratio. Combination of parameters were analyzed in parallel multiple test using a scoring system. The results showed that of all 85 patients, the incidence of associated meniscal tear was 68.2%; 22.3% lateral ; 36.5% medial and 9.4% for both meniscal tears. Joint line tenderness had the highest positive predictive value (88.6%), whereas negative predictive value was 46.0%. Joint effusion had the highest specificity (92.2%). Giving-way had the highest sensitivity (86.2%). The parameters that had statistically significant likelihood ratio of positive test were joint line tenderness and joint effusion. When analyzed by parallel multiple tests, the weighed score of joint line tenderness yielded 2, twice as high that of other parameters. A score of ?4 indicated a significant probability of meniscal injuries (0.86).

The competency of general practitioners in radiographic diagnosis of musculoskeletal
injuries : Pre-and post fracture diagnostic workshop evaluation (ความสามารถในการวินิจฉัยการบาดเจ็บของกระดูกและข้อจากภาพถ่ายรังสีของแพทย์เวชปฏิบัติทั่วไป : ก่อนและหลังการอบรมเชิงปฏิบัติการเรื่องการวินิจฉัยการบาดเจ็บของกระดูกและข้อ)

Anuntaseree S, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Boonriong T, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Kietsiriroje N, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Buranaphanitkit B, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Kriwattanapong C, M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.
Juteedumrongphan S. M.D., Department of Orthopaedic Surgery, Faculty of Medicine,
Prince of Songkla University, Hat Yai, Thailand.

Published : Songkla Med J 2003, 21(2):145-149
Key words : Fracture diagnosis, radiographic interpretation, medical education.
Abstrscts :

Objective : To evaluate the competency of general practitioners in radiographic diagnosis of musculoskeletal injuries and the outcome of a fracture diagnostic workshop.
Design : Prospective analytic study
Materials and methods : A workshop for radiographic diagnosis of musculoskeletal injuries was held for general practitioners on 22-25 January 2002 at Price of Songkla University. Each participant did a pre-test of interpretating ten plain radiographs of commonly missdiagnosed bone and joint injuries. The post-test was done on the same films after completing the workshop.
Results : Of eighty-one participants, twenty-nine (35.8 %) completed both pre-and post-tests. All of them had a higher post-test score than pre-test. The mean pre-test score was 2.81/10 (range 1-5, SD=1.16) and the post-test was 6.8/10 ( range 5.50-9.00, SD= 1.20) . The diagnostic competency was sinificantly improved after the workshop (P < 0.001). The most common errors of diagnosis were found in fractures in children, wrist injuries, non-displaced femoral neck fracture and osteochondral fracture of the knee.
Conclusion : General practitioners may have deficiencies in radiographic diagnosis of musculoskeletal injuries. Practical workshop can effectively improve their competency.

The Effect of Ethelene Oxide Sterilization on Inhibition Effect of Custom-Made Fosfomycin Impregnated Polymethylmethacrylate

Boonsin Buranapanitkit, M.D., Department of Orthopaedic and Physical Surgery, Faculty of Medicine,
Prince of Songkla University, HatYai, Songkhla, Thailand
Natnicha Ingviya, Bsc, Microbiology unit, Department of Pathology, Faculty of Medicine,
Prince of Songkla University, HatYai, Songkhla, Thailand

Published : Thai J Orthop Surge : 28(2) September 2003 : 76-78.
Key word : Ethelene Oxide, Effect of Custom-Made Fosfomycin Impregnated Polymethylmethacrylate
Abstrscts :

Local antibiotic beads have been approved for treatment of various orthopaedic infections. Fosfomycin impregnated with polymethylmethacrylate can inhibit most gram-positive organisms in othopaedic infections. This study compared the inhibitive effect against Staphylococcus aureus and MRSA (methicillin-resistant Staphylococcal aureus) between with and without sterilization by using ethylene oxide. The results showed that ethelene oxide sterilization caused no deterioration on the inhibitive effect of custom-made fosfomycin impregnated with polymethylmethacrylate for one month. In conclusion, this study shows that ethelene oxide is an option for sterilization of custom-made fosfomycin beads.