The Journal of the Chugoku-Shikoku Orthopaedic Association
Online ISSN : 1347-5606
Print ISSN : 0915-2695
ISSN-L : 0915-2695
Volume 14, Issue 2
Displaying 1-14 of 14 articles from this issue
original paper
  • Youhei Ito, Masatoshi Tobita, Atsushi Iwata, Yuji Uchio, Yasuo Sakai, ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 117-120
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The authors report a rare case of solitary myeloma of the scapula. The patient was a 52 year-old man who complained of pain of the left shoulder without other symptoms. Plain radiographs showed an osteolytic and “bubbly” lesion only in the coracoid process and glenoid of the scapula. Serologically, the monoclonal component of Ig-G was elevated in electrophoresis. The patient’s urine did not contain the Bence-Jones protein.Because a giant cell tumor and aneurysmal bone cyst were suspected before operation, the authors performed curettage and bone grafting in November, 2000. The histological diagnosis was myeloma. The patient was subsequently treated with radiotherapy and chemotherapy. In the 10 months after operation, pain of left shoulder disappeared. The patient retained full range of motion of the shoulder and has not shown signs local recurrence or multiple myeloma to date.
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  • Masanori Sannomiya, Fumio Ichimura, Ippei Fujioka, Masahide Kawamura, ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 121-125
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Eosinophilic granuloma (EG) is a comparatively rare disease, which is more common in children than in adults. During the past 20 years, 5 cases of eosinophilic granuloma of the bone have been seen in our hospital. All were boys with an average age of 6 years (ranging from 2 to 11 years). Four patients had solitary lesions and one had multiple lesions. Among the isolated cases, two were in the pelvis and two were in the femur. In the multiple lesion cases, the primary lesion was in the femur, and the developed in lymph nodes and other bone lesions.
    Curettage was performed in the cases with primary lesions and all lesions were diagnosed as EG in pathologic histology. In the cases with solitary lesions no additional treatment was performed, and all lesions healed. Chemotherapy was performed in the multiple lesion case and the progress continues to be good to date.
    Many reports recommend watching the course of the disease in general in cases with solitary lesions. Therefore it is necessary to perform a proper biopsy in order to determine the histology. In multiple bone lesion cases, progressive lesion cases, and multiple lesions in other organs, chemotherapy is indicated.
    EG is a disease that should be considered in differential diagnoses of osteolytic lesions in children.
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  • Daisuke Tanino, Hideki Nagashima, Yoshiro Nanjo, Itsuro Yamane, Takesh ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 127-132
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The authors diagnosed five cases of malignant lymphoma that mimicked degenerative spinal disorders. This article describes how the differential diagnosises were made in the five cases.
    The patients were 3 women and 2 men, whose ages ranged from 55 to 77 years. Symptoms were leg pain diagnosed as radiculopathy in three cases and paraplegia in two cases. Only one patient had a history of malignant lymphoma. Using these symptoms and MR images, the authors had to differentiate malignant lymphoma from disc herniation in three cases, lumbar canal stenosis in one, and ossification of the yellow ligament in one.
    In three cases with leg pain, the mass was detected in the retroperitoneal space, using additional MR images in two cases, which were ordered to resolve a contradiction between clinical findings and images in two cases, and on a post operative CT scan in one case, which had been ordered due to a suspicion of acute peritonitis. Autopsy was required to obtain a definitive diagnosis of intramedullary malignant lymphoma of the spinal cord in the two cases with paraplegia that had intramedullary signal changes on MR images.
    In two cases, operations had been performed as a result of the misdiagnosis. Four patients received non-operative treatment for malignant lymphoma ; radiation for one ; both radiation and chemotherapy for three. All five cases finally died of malignant lymphoma.
    The physicians treating spinal disorders would do well to be aware of the possible existence such a rare condition when making differential diagnosises.
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  • Hiroko Inoue, Koichiro Ihara, Keiichi Muramatsu, Shinya Kawai
    Article type: original
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    2002 Volume 14 Issue 2 Pages 133-137
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Two patients with malignant pelvic tumors were treated at our institution. The first patient, a 68-year old man, had a metastatic tumor from renal cancer found out on Feburauary in 2001.
    The other was a 71-year-old woman with a malignant fibrous histocytoma found out on April in 2001.
    After extensive resection of the tumors in the ileum, reconstruction was performed using combined vascularized bone grafts from the iliac crest and fibula. The former were pedicular and the later were free grafts.
    Postoperative course of the first case was uneventful. The patient could walk with a crutch, and returned to his previous occupation. Despite a local recurrence in the second case, the integrity of her pelvis was maintained successfully.
    The authors used the pedicle iliac bone graft, because the corresponding area of the ilium could be saved for the tumor resection. Combined use of the two vascularized bone graft offers : increased stability, and both grafts can compensate for each other.
    Although the technique used in these cases limited indication, it has apparent advantage over the classic reconstruction.
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  • Shigeki Takasugi, Ikuo Uragami, Michihiro Oda, Tomoyuki Dan’ura, ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 139-142
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Thirty-nine tibial shaft fractures were treated using the AO Unreamed Tibial Nail (UTN) from November 1993 to March 2001.
    The average age of these patients (27 men, 12 women) was 47.4 years old. Thirty-six fractures were observed followed-up until they had healed.
    There were 13 open fractures, and UTN operation performed secondarily in these cases one or two weeks after injury. All fractures healed without septic complications. Surgery to remove static inter-locking bolts were planned and performed in 14 cases, and bone graft was performed in one closed fracture because union was delayed. No implant breakage occurred.
    The average time to full weight bearing was 98 days (14.1 weeks), and the average time to bone union was 125 days (17.8 weeks). These averages contain the case in which time to full weight bearing and to bone union were exceptionally long because the patient had other concurrent, serious multiple fractures.
    There were no significant differences in the average time to full weight bearing or to bone union between open fractures and closed fractures, or between AO type A fractures and other tibial fracture types. However, the average time to full weight bearing or to bone union of the open fractures were a little longer than those of closed fractures.
    Because of the safety and less invasiveness, UTN was very useful for the treatment of tibial shaft fractures in these cases.
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  • Kei Kawaguchi, Toru Okano, Tetsuya Otsuka, Ryota Teshima, Hideaki Kish ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 143-146
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    We studied 85 hips of 76 patients (74 woman, 2 men) affected by congenital dislocation of the hip (CDH) that were followed-up for more than 6 years treated only with the Pavlik harness. The average follow-up was 3.4 months (1 week to 10 months), and the average age of the patients at the last follow-up was 112 months (72 to 228 months). Severin’s classification, α angle at the first medial examination, severity of dislocation, the time when treatment was started, and the perioid until reduction of the dislocation were investigated. Satisfactory results (classes I and II of Severin’s classification) were obtained in 82%, and unsatisfactory results (classes III and IV of Severin’s classification) obtained in 18%. Avascular necrosis of the femoral head was 12% (10 hips). Although there was a significant difference (P < 0.05 : Mann-Whitney U test) in the α angle between classes I and II, and between classes III and IV, there were no significant differences in other factors between the two pairs of groups (Fisher’s exact probability test). It was conclueded that factors influencing the mid-term results of CDH reduced by Pavlik harness were not clarified, although α angel at the first examination might have influenced the results in our cases.
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  • Katsuhito Kiyasu, Toshiaki Takahashi, Hiroshi Yamamoto, Masahiro Otani
    Article type: original
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    2002 Volume 14 Issue 2 Pages 147-151
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The patient in this case of HTLV-I associated arthropathy (HAAP), was a 79-year-old woman who is a HTLV-I carrier with uveitis and hyperthyroidism. In October 2000, the patient complained of pain and severe swelling of the bilateral knees especially the left side and a slight fever. Both knees were treated by joint puncture and an injection of betamethasone (2.5 mg), but the symptoms did not improve. The authors then performed arthroscopic synovectomy of the left knee. After surgery, swelling and pain diminished in the left knee. The CRP value of 13.6 mg/dl was reduced to 4.0 mg/dl after prescription of oral predonine (5 mg) 6 months after the operation. The authors emphasize that nonspecific swelling of joint with inflammation in patients from a geographical area where HTLV-I is endemic may lead the physician to suspect HAAP.
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  • Naho Kamata, Fumio Ichimura, Ippei Fujioka, Masahide Kawamura, Masanor ...
    Article type: original
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    2002 Volume 14 Issue 2 Pages 153-157
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The authors report the treatment of a hemodialysis patient who developed a rare case of carpal bone tuberculosis. A 63-year-old woman on hemodialysis for 3 months, beginning in January 2000, complained of swelling and pain in her right hand and a fever of unknown origin. A prolonged unexplained fever that lasted for 2 weeks had occurred before the beginning of right hand pain. Radiographs showed an extensive cystic lesion of carpal bone thought to be due to osteomyelitis. The lesion was incised and evacuated. The aspirated fluid proved sterile on culture. For 2 weeks cefazolin sodium antibiotic substance was given, but the local symptoms did not improve. Curettage and drainage were performed. Histological examination revealed granulomas with central necrosis, epithelioid cells and multinucleated giant cells of Langhans type. Cultures revealed Mycobacterium tuberculosis. Antitubercular drugs were given postoperatively.
    The hemodialysis patients have low cellular immunity, and are likely to suffer from tuberculosis more often than healthy persons. Tuberculosis should be considered, when a hemodialysis patient has osteolysis and fever of unknown origin.
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  • Suguru Kuwata, Masato Takao, Yuji Uchio, Tetsuya Nishikiori, Kenzo Kaw ...
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 159-163
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The authors report two rare cases of children with osteochondral lesions located on the central portion of the talar dome. They were a 9-year-old boy and an 8-year-old boy. They complained of ankle pain after ankle sprain. Physical examination showed tenderness at the central talar dome and restricted of range-of-motion of their affected ankles. Plain X-ray and magnetic resonance images showed that the osteochondral lesions located on the central talar dome. Two months of conservative treatment with weight limitation and antiphlogistics gave no relief. We performed arthroscopic retrograde drilling, Kirschner wire was inserted using a drill guide by drilling from the lateral edge of the Achilles tendon to their lesions. Nine months after operation both patients were free of symptoms.
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  • Akihiko Inufusa, Shigeta Yorimitsu, Toru Hasegawa, Yoshihiro Mikawa
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 165-170
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    We reported 7 patients with an epiconus syndrome presenting with radicular type neurological features. The patients, six men and one women, ranged in age from 45 to 80 years. The causes of epiconus syndrome were ossification of the ligamentum flavum, thoracic disc herniation, spinal cord tumor, spine tumor, and spine injuries. All patients had radicular type sensory disturbance with out radicular pain. Five patients had lower extremity muscle atrophy which seemed to be lumbar radiculopathy. Absence of lower extremity deep tendon reflexes were found in 4 patients, and Babinski reflex was found in 2 patients.
    The level of epiconus compromise detected on MRI ranged from the T11—12 intervertebral disc level to T12-L1 disc level. The presence of atypical neurological features related to epiconus compromise should be carefully diagnosed with reference to the anatomical relationships between the level of compromise and termination of the spinal cord.
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  • Teruaki Okuda, Yoshinori Fujimoto, Shinichi Oka, Yoshikazu Ikuta, Koic ...
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 171-180
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Objective : Spinal dural arteriovenous fistula (D-AVF) are rare, and mainly occurs in the thoracolumbar junction. Due to slow progress of symptoms, versatile symptoms of dysesthesia, weakness, and muscle atrophy in the lower limbs, accurate diagnosis is often delayed in many cases. In the current study, the diagnosis and treatment methods for spinal D-AVF were analyzed in terms of characteristic preoperative symptoms, the correlation between sensory disturbances and magnetic resonance imaging (MRI), and the factors that infuluenced the postoperative results.
    Materials and Methods : Of the 10 spinal D-AVFs, those with the lesion in the cervical or upper thoracic levels were excluded, and the remaining seven patients, five men and two women, were included in the current study. The mean age of these patients at the time of operation was 64 years old. The duration of symptoms was from 6 months to 5 years (mean 3 years), and the mean postoperative period was 2 years and 6 months. Before operation, MRI were used to show the intramedullary high intensity zone (HIZ), and selective spinal angiography (SSA) was carried out to detect a feeder of spinal D-AVF. T2-weighted MRI indicated high signal intensity from the midthoracic area to the conus of the spinal cord. SSA and the intraoperative findings indicated D-AVF were fed by the T7 intercostal artery to the L2 lumbar artery.
    Operative Procedure : A posterior approach was used in the operation to identify the location of the D-AVF. The intradural portion of the fistula was clipped for 15 minutes under spinal cord monitoring using evoked spinal cord potentials. When clipped, arterial pulsative sounds of dorsal coronary vein disappeared under Doppler examination. After the integrity of spinal cord function was confirmed by the unchanged potentials, the D-AVF was coagulated and excised.
    Results and Conclusions : The Japanese Orthopaedic Association (JOA) score improved from 4.8 preoperatively to 6.5 postoperatively with an improvement rate of 31%. Paroxismal weakness and aggravation of the symptoms in the lower extremities after bathing or drinking are preoperative characteristic symptoms that were useful for the diagnosis. The region showing intramedullary HIZ extended proximal to the sensory disturbance level, which was considered to have made the differentiation of this disease from other thoracolumbar diseases difficult. HIZ disappeared in 6 cases after operation, suggest that spinal cord edema was the underlying pathology of the HIZ in these cases. Pre-operative severity of symptoms influenced the post-operative result. The postoperative result seems to be also influenced by the level of the lesion, duration of gait disturbance, and type of palsy.
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  • Koji Asaumi, Yoshitaka Takei, Hiroaki Kadota, Shinnosuke Nakahara
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 181-185
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Isolated spinal cavernous hemangioma without vertebral involvement is rare. We report a case of a spinal epidural cavernous hemangioma extending in the intraand extravertebral space through the intervertebral foramen. A 52-year-old female was treated. Magnetic resonance imaging (MRI) showed an epidural mass at the level of Th10-L2. The mass was isointense to the spinal cord on T1WI, hyperintense on T2WI. Marked enhancement was shown on postgadlinium T1WI. Angiograms revealed no tumor stain. Surgical resection was performed. Pathological diagnosis was a cavernous hemangioma. It was dumbbell shaped spinal epidural cavernous hemangioma, but did not show enlargement of the intervertebral foramen, a common sign that is thought to be helpful in the diagnosis of spinal neurinoma. Postgadlinium T1WI was very usefull to diagnose a cavernous hemangioma.
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  • Takashi Imagama, Toshihiko Taguchi, Kazuo Kaneko, Kouichirou Toyoda, S ...
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 187-191
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    The patient in this case of spondyloptosis associated with dural ectasia in von Recklinghausen disease was a 15-year-old girl with a family history of the disease. In May 1999, she complained of pain in the lumbar and the left side gluteal regions. The straight leg rising test was positive at 60° for the left leg. The manual muscle test result was good at dorsal flexion of right first toe. No sensory abnormality was noted. She had a widening of the spinal canal from L4 to S1 with vertebral scalloping between the L3 and S1 levels, scoliosis (cobb angle 30°), and spondyloptosis (L5/S1) on radiographs and computer tomography and myelography. A magnetic resonance image showed a wide spinal canal, a normal cord, and dural ectasia in the lumbosacral area.
    Treatment was successfully accomplished in August 2000 by a posterior spinal instrumentation from the T8 to the S1 level using the Galveston method followed by a posterolateral fusion and posterior lumbar interbody fusion (L5/S1). The preoperative Cobb angle was 30° and the postoperative angle was 9°. The patient had complete relief of lumbar and gluteal pain at the 18-month follow-up.
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  • Naoyoshi Hanaoka, Koichi Sairyo, Shinsuke Katoh, Shinji Komatsubara, N ...
    Article type: original
    Subject area:
    2002 Volume 14 Issue 2 Pages 193-196
    Published: 2002
    Released on J-STAGE: July 22, 2003
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    Although ectopic calcification is a common complication of hemodlalysis (HD), it is unlikely to occur in the epidural space. We describe a patient, who developed lumbar radiculopathy due to epidural ectopic calcification as a complication of longterm HD. A 50-year-old woman visited our clinic with a 2-year-history of right leg pain. She had been under HD for 12 years. Plain radlographs, MRIs, myelograms and CTs revealed a calcified epidural mass that compressed the nerve root. Muscle weakness and drop foot had developed in the right side. The ectopic calcification was successfully extirpated using a spinal endoscope and a small skin incision of 1.6 cm in length, according to the method of microendoscopic discectomy. After the operation, the leg pain decreased, and weakness improved to some extent. The endoscopic surgery, which is less Invasive than the conventional open technique, is useful technique for patients under long-term HD, since such patients are in poor general conditions.
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