64 cases of arthroscopic surgery performed from August'90 to August'91 in our hospital were reviewed retrospectively. Operations were performed with 18 meniscectomies, 4 meniscal sutures, 2 anterior cruciate ligament reconstructions, 4 loose body enucleations, 5 joint mobilizations, 9 plicaresections, 11 arthroscopic arthroplasties, and 12 synovectomies. Of all the cases, osteoarthritic cartilage degeneration was found in 40 cases. Of the twelve synovectomies, 9 were performed for synovial proliferation in osteoarthritis, while 3 were for joint synovitis. Synovectomy was very effective treatment for joint hydrops in joint synovitis including gout, while in osteoarthritis its effectiveness on relief of pain was not so sussessful. All the performance except one improved ADL, relieved knee pain, and patients satisfied to do the arthroscopic surgery. One patient with osteoarthritis had been treated with synovectomy, had gonalgia worse. He was suffered with candidiasis of the knee joint Meniscectomy and meniscal suture demonstrated no significant difference in pain relief, improve of the ADL, and satisfaction in short term follow-up. Arthroscopic arthroplasty relieved knee pain, however, its effectiveness was minimized when tibial articular cartilage was completely eburnated. In conclusion, arthroscopic surgery is the safe, less-invasive treatment for knee patients, and therefore gives satisfactory result if careful attention for cartilage damage and contamination is paid.

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Arthrodesis of the knee is not commonly used currently by orthopaedic surgeons. During the last 10 years we have treated eight knees with knee arthrodesis.
The average age of the patients at the time of the operation was 61.1 years, ranging from 29 to 74 years. The mean follow-up period was one year and 9 months (5 months to 3 years and 4 months in range).
We have used the compression method, employings the AO tubular system. In all cases, we obtained satisfactory results. There was fusion in all knees. The fusion process was apparently not delayed in any of the patients.

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From 1984 to 1991, 46, patients (57 knees) received total knee replacements in our department. The 19 patients (23 knees) over 70 years old were followed for an average of 2.6 years. The clinical results were evaluated using the criteria of three universities proposal.
At the follow-up examination, the mean knee score improved from 45.8 points preoperatively to 65.0 points postoperatively.

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Arthroscopic meniscal repar is being performed with increasing frequency recently. Since 1990, we have used arthroscopic meniscal repair for meniscus injuries in 33 knees. The follow-up period after surgery averaged 5.8 months (ranging from 4 months to 11 months). The clinical results were evaluated using the scoring system created by the Japan Orthopedic Association (JOA score). The average pre-oprative and post-operative scores were 49 and 84 points. All repaired knees were impruved.
The group performed meniscal repair was compared with the group performed arthroscopic partial menisectomy. We have used arthroscopic menisectomy in 30 knees. The follow-up period after surgery averaged 6.2 months (ranging from 3 months to 13 months). The average pre-operative and post-operative scores were 38 and 81 points. These knees were impruved except a knee.
However, due to short period of follow-up in our study, careful observation is still needed before making any conclusion.

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We have experienced two patients with discoid medial menisci.
(Case 1) The patient was a 55-year-old man and consulted us with pain in the left knee. The radiogram was normal and the clinical impression was torn medial meniscus. A diagnostic arthroscopy revealed an unusually large medial discoid meniscus with a horizontal cleavage. Open excision was performed.
(Case 2) A 25-year-old man presented with left knee pain of 6 months duration. There was no history of trauma. The examination revealed medial joint line tenderness. The Mcmurray test was positive. The clinical impression was torn medial meniscus, and an arthroscopy revealed a horizonsal cleavage of a large discoid medial meniscus. Open excision was performed. The postoperative course was uncomplicated. Two years after surgery, the patients were completely asymptomatic.

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Bone atrophy accompanying spinal cord injury (SCI) progresses over time.
We assessed bone atrophy in eight SCI patients, using the following parameters: serum calcium, phosphorus, parathormone, calcitonin, vitamin D and osteocalcin; urinary calcium, phosphorus and hydroxyproline; and QCT.
All our results show that the patients lacked vitamin D and their bone metabolism was high because of high osteocalcin levels, while their bone mass was less than that of controls.

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We present a method of internal fixation for large avulsion fracture of the anterior cruciate ligament (ACL) using arthroscopy and its result. Our method was for the internal fixation of an avulsed fragment together with the attachment of the ACL. We treated a 36-year-old man.
The technique for treating an avulsed fragment with the ACL was follows. Firstly, reduction of the avulsed fragment was performed using a probe. Then one tunnel was made from just medial to the tibial tubercle to the avulsed fragment using 2.4mm Kirshner wire. The fragment was fixed securely using AO small cancellous bone screw.
Now, at 14 months after the operation, the patient has no symptom, and can take part in sports.

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Arthroscopic surgery has the advantage of less morbidity and more detailed observation of the knee joint than conventional open procedures. In this paper, an arthroscopic tenchnique for the anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and the preliminary results of the procedure are reported. Since 1999, four patients underwent arthroscopic reconstruction of the ACL. All patients were evaluated at more six months postoperatively. None of them had experiented giving way of the operated knee. Lachman test was negative in 3 patients. Loss of full extension by 5 degrees was seen in 2 cases. Arthroscopic reconstruction of the ACL is thus comparable to conventional open procedures with regard to the short-term results.

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A 57-year-old female with bilateral highly dislocated hips underwent bilateral total hip replacement (THR). On the left side, skeletal traction was conducted following muscle release, femur was pulled down 4cm and no complication prior to THR could be found. On the right side, muscle release, pulling down the femur and THR were performed simultaneously, since this would not be attended by any complication on the left side. On the both sides, components fitting the narrow acetabulums and femurs were selected and the socket was placed at the site of the original acetabulum. The patient has been able to walk with the aid of only a cane without pain for 2 years and 10 months on the left side and 2 years and 3 months on the right following the operation.

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Intra-osseous ganglia occurs in the subchondral bone adjacent to joint and involves the upper and lower end of tibia, the upper end of femur, carpal bones and acetabulum most frequently. Although the ganglion's pathogenesis is still uncertain, intramedullary vascular disturbance due to mechanical stress and repeated minor stress is considered as an important cause. We experienced a rare case of intra-osseous ganglia that arised in patella.
A 64-year-old female struck her left knee 10 years ago and had gonalgia after walking. A radiolucent lesion existed in her left patella. This lesion was diagnosed as intra-osseous ganglia at the operation and histological finding. Ganglion was localized in bone and there was no connection with the knee joint and the surrounding soft tissue. Avascular necrosis of bone was found near intra-osseous ganglia histologically. This finding suggests that a localized vascular disturbance is a cause of intra-osseous ganglia.

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A case of intragluteal hematoma that presented with symptoms similar to sciatic neuralgia is described. The patient was a 67-years-old male who developed pain in the left gluteal region after injection at this site and developed dysbasia. Angiography, plain CT, contrast-enhanced CT, and MRI suggested a tumor in the soft tissue, and the lesion was surgically resected. Pathological examination showed that the lesion was a hematoma.
Intramuscular hematoma is caused by trauma or bleeding tendancy. This patient had no history of trauma, and no abnormalities were observed by postoperative blood coagulation tests. Therefore the gluteal hematoma in this case was considered to have been caused by the intramuscular injection.

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To examine prognostic factors of the femoral neck fracture in the aged, we investigated the relation between pre- and post-traumatic complications and walking ability.
From 1986 to 1990, wa have treated 189 patients (41 males and 148 females) with the femoral neck fracture. The age of the patients ranged from 65 to 97 years, with an average age of 80.9 years. Thirty-eight patients were impossible to walk at the discharge from our hospital, and half of them had senile dementia. Twenty-four patients died during hospitalization, and the cause of death was mainly pneumonia.
It is suggested that the prevention of complications, especially senile dementia and pneumonia, is important for the improvement of prognosis in the elderly patients with femoral neck fracture.

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A 61-year-old woman with monostotic Paget's disease of the third lumbar vertebra was reported with MR image findings. Lateral plain radiograph of the vertebra showed a classic picture-frame appearance. By MR imagings cortical thickening was depicted as hypointense regions on both T1-weighted and T2-weighted images. Areas of slightly increased signal intensity was recognized within the hypointense areas on T2-weighted images. Round or oval foci of reduced signal intensity and foci of high signal intensity were seen in the medullary cavity on T1-weighted images. The spinal process was apparently hypointense on T1-weighted images and slighty hyperintense on T2-weighted images. The basivertebral vein showed hypointensity on T1-weighted images, implying an increase in blood flow. Biopsy specimens taken from the spinal process revealed a characteristic mosaic pattern, with an increased activity of osteoclasts and osteoblasts, and replacement of the marrow cavity by fibrous connective tissue having some edematous zones.

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We describe the case of a 19-year-old man with lower back pain, suffering from Ewing's sarcoma of the second lumbar vertebra. We treated him with intra-arterial infusion of chemotherapy with satisfactory results.
We selectively catheterized the left first, second and third lumbar arteries by the femoral route, delivering 125mg of Cisdiammine Dichloroplatinum (CDDP). The next day, he felt no lower back pain and suffered no side effects. On the Magnetic Resonance Imaging (MRI) taken two weeks later, the size of the tumor was found to have decreased in size. Three weeks later, using the same method, we delivered 130mg of CDDP and three times at three-week intervals carried out Rosen T-11 protocol by selective catheterization. A surgical excision was followed by chemotherapy. Pathohistologic evaluation proved that the tumor had become extinct.
Intra-arterial infusion of chemotherapy with CDDP is considered a useful method in the treatment of Ewing's sarcoma.

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There have been rarely described multiple neurilemoma in the literature. We report here two cases of multiple neurilemoma in peripheral nerves.
In case 1, three tumors were found in the tiblial nerve, the common peroneal nerve, and the muscle berry of the extensor digitorum longus which had no clear connection with the nerve bundle.
Case 2 had two tumors in the median nerve and the ulnar nerve.
The histological feature revealed both Antoni A type and B type neurilemoma.
At 14 months after operation in case 1 and 6 months in case 2, there is no neurological deficit and no recurrence.

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The Achilles tendon is frequently calcified, but rarely ossified. Calcific tendonitis is an entity commonly seen in a general orthopedic practice. This para-articular calcification is usually reported about the shoulder, elbow, wrist, hip, or knee, which may be painful or entirely asymptomatic. The etiology of para-articular ossification and calcification may be secondary to macrotrauma or microtrauma, previous surgery on the tendon or one of a wide variety of systemic, metabolic, or inflammatory diseases.
The following is an unusual case report of a 51-year old woman who had ossified Achilles tendon on both sides, and sustained a rupture of an ossified segment of the right Achilles tendon. The ossification was removed, and the tendon was sutured. This is the first reported case of this condition of woman in the Japanese literature.

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Mycobacterium nonchromogenigum complex may be a causative agent in human infection. We report a case of tenosynovitis of the wrist flexor tendons due to this mycobacterium.
A man, sixty-six years old, complained of swelling in the volar side of left forearm. Surgery disclosed chronic granulomatous tenosynovitis in the forearm and hand. Microscopic examination of the specimen revealed granulomatous changes. In cultured tissue, slowly growing colonies were identified as Mycobaterium nonchromogenicum complex.

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We experienced a case of xanthoma of the bilateral Achilles tendons with sitosterolemia, which is rare even in cases with hyperlipidemia. The tumorous tissue including almost whole part of the tendon was removed marginally, followed with reconstructive surgery using V-Y-advancement conbinding Lindholm's procedure. Diagnosis, treatment, and prognosis of the disease were discussed.

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We present a case of multiple osteonecrosis experienced during treatment for idiopathic thrombocytopenic purpula. The patient was a 51 year-old woman. A diagnosis of ITP was made in Dec. 1981, and she had received a large dose of steroids (9280mg) for five years. From 1982 to 1991, osteonecrosis appeared in the right femoral head and another nine sites. Roentgenogram, bone scan, and MRI demonstrated necrotic lesions. Pathological examination revealed that a biopsy specimen was necrotic tissue. Many cases of steroid induced osteonecrosis have been reported, but such a case induced by steroid treatment for ITP is rare.

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We reported here five cases of the ossification of yellow ligament of the thoracic spine. The average age of the patients was 56 years, ranging from 44 to 77 years. The average follow-up period was 3.3 years, ranging from 0.5 up to 6 years.
It was difficult to identify affected levels of the spine in 4 out of the 5 cases which had ossification in other parts of the spine. We found difficulty in some cases in performing decompression of the ossified spinal lesions.
Clinical results were satisfactory in 4 cases except one with the ossification of posterior longitudinal ligament.

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Forty-seven patients with surgically confirmed lumbar disc herniation were studied retrospectively to compare the diagnostic accuracy of magnetic resonance imaging (MRI) with that of myelography and CT-myelography. MRI findings of the disc herniation were classified into five groups according to Tachi's classification. MRI showed a correct diagnosis in 41 of 47 patients, an accuracy of 87.2%. Myelography showed a correct diagnosis in 39 of 45 patients (86.7% accuracy). CT-myelography showed a correct diagnosis in 36 of 43 patients (83.7% accuracy). MRI was more accurate examination in three examinations. MRI findings of multi-level disc herniation were diagnosed in 20 of 47 patients (47.2%). We conclude that MRI is a first choice for the diagnosis of lumbar disc herniation. In the case of multi-level disc herniation, however, myelography and CT-myelography are necessary.

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Thirty two cases of lumbar canal stenosis with drop foot (twenty three males and nine females) were reviewed. The average age at the time of the operation was 59.2 years, ranging from 36 to 82. The follow-up period after operation averaged 31.9 months, ranging from 3 months to 120 months.
We have devised two types of classification, according to the neurological symptoms of lumbar canal stenosis. Twenty one cases were cauda equina type and eleven cases were nerve root type. For the cauda equina type, laminectomy was performed in eighteen cases, fenestration was performed in two cases, and Luque's S. S. I. was performed in one case whose radiographs showed instability. For the nerve root type, fenestration was performed in eight cases, and laminectomy was performed in three cases.
Operative results were assesed by JOA score and Hirabayashi's method. The average score before operation was 9.3 points, and after operation was 21.7 points. The average recovery rate was 61.9%. The main factors which decided the prognosis were morbidity period, bladder bowel disturbance, and the strength of the tibial anterior muscle. Nine cases of drop foot remained after the operation.
The operation was not so effective for the recovery of drop foot, but was enough for that of intermittent claudication and lower extremity pain. Because the symptoms of lumbar canal stenosis are progressive, the operation should be done as soon as possible even with elder patients.

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Hallux varus is a deformity in which the big toe is angled medially at the metatarsophalangeal joint. We encountered a case of congenital hallux varus. The patient was treated by Farmer's operation when he was 14 months old. The patient, with dual corrections, complains of no foot problems post-operatively. The appearance and function of both feet are normal. We believe this technique is effective in correcting this deformity.

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Since 1989, Six patients (one male, five females) with chronic lateral instability of the ankle were treated by reconstructive surgery using the extensor digitorum longus tendon. Four patients (four females) were examined at a mean of 16 months (range 10 to 23) after operation. The patients' ages ranged from 13 to 48 years, with a mean of 27 years. Three patients of the injuries were sports related. All patients had no giving way, instability, or no subjective pain. They returned to full recreational, athletic activities.
Our reconstructive surgery has cosmetic merits because of its short incision. And the routes of grafted tendon are anatomical. Our surgical procedure can preserve the peroneus brevis tendon which have important function as an extraarticular stabilizer.

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Fifty-two cases were treated by arthroscopic reconstuction of the anterior cruciate ligament from 1985 to 1991. Thirty-six cases are evaluated in this paper. There were twenty-two male and fourteen female cases and the average age was 27.6 years-old. The average follow-up period was three years. The material used for reconstruction was Leeds-Keio artificial ligament in thirty cases and patellar tendon autograft in six cases.
Clinical result were excellent in 74.2%, good in 6.5%, fair in 6.5% and poor in 12.9%. Post-operative arthroscopy was performed in eighteen of Leeds-Keio artificial ligament cases. Good scar formation was seen in 10 case but partial exposure of the artificialligament was seen in three cases and no scar formation in three cases. Complete rupture of the ligament was obserbed in two cases.
We have changed the material from Leeds-Keio artificial ligament to patella tendon bacause the long term results are not known for the artificial ligament and because ligament rupture were seen in some cases.

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Three cases of the posterior interosseous nerve palsy treated by neurolysis are presented. The palsy was caused by direct trauma in two cases, and by a ganglion cyst in the other. They were all treated by neurolysis following unsuccessful conservative treatments. The cases with trumatic etiology showed clincal signs of recovery in the early postoperative period. In the case with a ganglion, however, recovery began as late as three months after the surgery probably because of a delay in the correct diagnosis and surgical decompression. It was suggested that prompt diagnosis utilizing imaging techniques such as CT was necessory for early detection of a space occupying lesion in posterior interosseous nerve palsy.

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We examined 132 disordered knees of athletes arthroscopically. Meniscal lesions were found in about half of all cases. The incidence of discoid lateral meniscal disorder was higher in school-age athletes.
A characteristic pattern of knee disorders was noticed in each sport. Injuries of ACL and disorders of the patellofemoral joints were found especially in volleyball and basketball players, and complex ligamentous injuries were common in contact sports such as soccer and rugby. We discuss the mechanism of the disorders found in each sport.

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Effectiveness of a program for the use of autologous blood was evaluated in 32 patients.
Autologous blood was deposited preoperatively in all patients, and intraoperative autologous blood through cell saver was used in 29 patients. An average of 603 milliliters of the autologous blood was deposited. An average of 338 milliliters of the intraoperative autologous blood was saved and reinfused. The intraoperative harvest was 30.8per cent of the average intraoperative total blood loss. Transfusion of homologous blood was not necessary in fifteen cases (47%). On the other hand, homologous blood transfusion was necessary in seventeen cases, using average amount of 505 milliliters.
Usage of the autologous blood transfusion was effective for reduing homologous blood transfusion which has various clinical troubles.

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Cervical spondylotic radiculopathy (CSR) has been caused by instability and degenerative changes of cervical spine. We report the result of surgical treatment for CSR for 3 years. Material is 12 paients, 9 women and 3 men. The average age of the patients at the time of surgery was 51.8 (range, 26-70 years). The method of surgery is anterior fusion for 6 cases and enlargement of spinal canal by splitting of spinous process for 6 cases. We have judged 4 major symptoms. That is brachialgia, nape pain & occipitalgia, muscle weakness, and sensory disturbance. 11 cases of all have 4 major symptoms. Radiologically, there are 3 cases with instability. In 2 cases, pincer phenomenon is showed and developmental canal stenosis is demonstrated in 5 cases by plain X-P. High signal intensity of spinal cord is showed in one by MRI. Most involved spinal level is both C4/5 and C5/6. About aftected cervical spinal root, C6 root is 6cases and C5 root is 5. In anterior surgery, 4 cases is one level and 2 cases are 2 levels. In posterior intervention, hydroxylapatite block is used for 4 cases as spacer. Evaluation of result is according to Murakami's criteria. The average of improvement ratio was 90.9% in anterior cases and 78.9% in posterior cases. All cases were improved in symptom satisfactorily.

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We report one case of spinal epidural hematoma. She is a 66-years-old female. She felt severe back pain without an inducing factor. The next day, she became unable to walk and use her left upper extremity. She also showed urinary incontinentia. Her muscle weakness improved a little bit by bed rest. But the 4th day after onset, her paralysis increased, and the decompression surgery was performed. Post operative course is good and now she is able to work as a keeper of her shop. We describe the great value of MRI diagnosing this lesion. The factors indicating the post operative course in this lesion were discussed. The severity of pre-operative palsy showed a high relationship to the prognosis.

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We present four cases of delayed myelopathy following kyphosis in adults. One case is congenital kyphosis due to hemivertebra. The other three cases of kyphosis occured after tuberculosis of spine. In the case of congenital kyphosis, minor movement at apex of the kyphosis was suspected in the radiographs and MRI. Thus we considered that myelopathy was resulted from abnormal mobility with the kyphosis. In one of the three tuberculosis, we observed the destroyed vertebrae in MRI and signs of inflammation, which were caused by the recurrence of tuberculosis. In the other two cases the most kyphotic vertebrae were fused, so that dynamic factor was not the cause of myelopathy and other factors causing myelopathy were suspected. Further examination showed syrinx by CT and MRI in one case, and ossification of the ligamentum flavum by tomography and CT in the other case.
Dynamic factor in the most kyphotic area should be checked at first in the cases with kyphotic myelopathy. If no instability in the spines, further examinations will be necessary for searching other causes of myelopathy.

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The results produced by bipolar endoprosthesis with or without cement for avascular necrosis of the femoral head was examined. The prosthesis used Omnifit system, usually without cement except 4 joints. Eighteen joints which consisted of 14 of men and 4 of women followed up with the average duration of 29 months (range: 14 to 48). The average age at surgery was 48 years (range: 24 to 75). The preoperative radiological condition of the hip joint was classified as stage III in 11 joints and stage IV in 7. According to the clinical evaluation system of the Japanese Orthopedic Association (JOA), the mean scores were 49 points preoperatively and 86 points at follow up examination. Radiologically, the migration over 4mm of the outher head proximally or of the prosthetic stem distally was demonstrated in one joint, and in three joints, respectively. The magnitude of the migration was considered to relate to such factors as preoperative articular deterioration, steroid therapy, and thineer femoral cortical bone. Although those radiological findings did not seem to affect the clinical evaluation of this short term, they will be the important factors which influence the long term results.

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Five patients with unstable comminuted fractures of the distal radius were treated by Clyburn external fixation. Two extra-articular fractures of them were A3 according to AO classification. Three intra-articular fractures of them were comminuted Colles according to Saito's method, corresponding to Melone's type IV. The intra-articular fragments were fixed intrernally with K-wire or AO small screw to restore the joint surface. We combinated bone grafts to prevent for collapse of the fragments, if necessary. The average follow-up duration was 10 months ranging from 6 to 20 months.
The results were excellent in 2, good in one, fair in 2 according to Saito' s evaluation system.
The intra-articular fractures in which the fragments were small and difficult to fix with plates, and the extra-articular fractures with severely comminuted metaphysis demanded external fixation. Clyburn external fixation was very useful to allow early motion of the wrist in the frame.

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Thermographic studies were performed in 30 cases with lumbar spinal canal stenosis. Two weeks after oral administration of 150mg/day Eperisone hydrochloride, 13 cases showed improvment in clinical complaints and elevation of skin temparature in both legs was observed. 17 cases showed neither clinical improvement and nor apparent elevation of skin temparature. The 13 improved cases showed further elevation of temparature two weeks after administration of Eperisone hydrochloride, with characteristically selective elevation on the posterior side of affected lower leg. The other 17 cases, showed some clinical improvement, but almost no apparent elevation of skin temparature of legs following the two weeks combined administration of 600mg/day Tiaprofenic acid with Eperizon hydrochloride.

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A consecutive series of 96 aged patients with hip fractures (mean age of 81 years) were studied concerning patient backgrounds, and measures of prevention of femoral neck fractures were considered.
Elderly patients are liable to be ill-balanced and injured early in the morning. Of the patients of the age group below 75 years, most were injured in their own home, of the patients over 75 years, most were injured either in the hospitals or in the old-age-homes.
It is considered that the injuries may have occurred because of (1) Ill-balance, (2) Osteoporosis, (3) Muscle weakness of legs, (4) Maladjustment of the facilities.

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Young people sometimes suffer from mallet finger after a distal phalanx fracture, but in some cases satisfactory results are not achieved. Since 1987, we have treated 14 mallet fingers after a distal phalanx fracture using both conservative and surgical methods. They were studied retrospectively, and clinical results were evaluated in ROM recovery and roentgenographic alignment.
Five cases were treated conservatively with splint and brace. ROM limitation remained in 2 cases, especially with extension. Malalignment of the joint surface was also detected in 3 cases.
Nine cases were treated surgically. Five were treated by the pull-out wiring method (1987-1988), and 4 by the tension band wiring method (1988-1990). Flexion was limited in 4 of the pull-out wiring method cases and in 1 of the tension band wiring method case. Malalignment of the joint surface was not detected in these surgical cases. The results of the tension band wiring method cases were better than those of the pull-out wiring method cases.

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Since 1987, twenty patients with infection after primary treatment of the crushed wound were treated with hyperbaric oxygen (HBO). Of these patients, 12 patients had open fractures. The HBO therapy was performed under the condition of 2 atmospheres absolute pressure (ATA) for 60 minutes. The therapy was done continuously 7 to 29 times (mean 14 times) for 7 to 24 days (mean 16 days). In all patients, infections were remarkably improved within 2 to 3 weeks.
We concluded that the HBO therapy remarkably improved infection and enhanced wound healing.

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Transcondylar fractures of the humerus (distal humerus A2.3 type according to ASIF classification) in the elderly require surgical treatment because they are intra-capsular fractures and the distal fragments are under rotational stress. However, osteoporosis makes rigid internal fixation difficuit. Therefore, functional results have been reported to be rather poor still after surgical treatment.
During the last 3 years, we have treated 6 cases A2.3 type fractures. ASIF small cancellous screws were used to achieve compression of the fracture line by vertically transfixing that line. The results were divided into 4 good and 2 fair according to the classification by Jupiter et al. Using this procedure, rigid fixation and early exercise can be done.

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We analysed the effect of cisplatin, which is the most common anti-neoplastic agent for the treatment of malignant bone and soft tissue tumors, on regeneration of the peripheral nerve.
Left sciatic nerve of Wister rat was elected for Site of neurorrhaphy. Three groups of rats were prepared as follows, Group 1: Cisplatin of 6mg/kg was weekly administrated throgh the tail vein after neurorrhaphy. Group 2: The dosage of cisplatin was 1.5mg/kg, it was administrated in the same manner. Group 3: Saline were injected in the same manner as a control. Each group consists of 12 rats, and they were functinally assessed by sciatic functional index 6 weeks after neurorrhaphy. After sacrifice, each specimen was histrogically evaluated.
The results showed no significant differences among three groups so far, and any adverse effect of cisplatin on nerve regeneration was proved.

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In the case of unilateral muscular atrophy of upper limb there are several causes. These include Hirayama disease, SPMA and Syringomyelia.
We would like to illustrate one of these diseases with a 29 year old female who had Syringomyelia. She complained of left hand muscle atrophy with minor disturbance.
SNAP and SCV of bilateral ulnar and median nerve were normal.
MCV of bilateral ulnar nerve was normal, but amplitude of M wave of left hypothenar was diminished.
Normal MCV with low amplitude of M wave showed large α-motorneuron and loss of same α-motorneuron.
In the case of Hirayama disease, amplitude of M wave was decreased with slow MCV.
Slow MCV with low amplitude meant loss of α-motorneuron.
We think a diminished mechanism of α-motorneuron in this case is different from the Hirayama disease.

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This report describes the clinical courses of cases of ectopic ossification (E. O.) diagnosed by roentgenogram on 25 sites on the upper and lower limbs of 18 patients (13 males and 5 females). The average age at the time of diagnosis was 43 years, ranging from 3 to 75. These cases were classified into three groups by etiology. There were 8 cases of traumatic E. O., 7 cases of paralytic E. O., and 3 cases of idiopathic E. O..
Six out of 12 patients who received blood examination (50%) had a slightly elevated level of serum alkaline phosphatase (ALP). ALP, which was examined periodically in the 2 cases of paralytic E. O., began to rise before the appearance of clinical manifestations, after which the patients were diagnosed by roentgenorgram. The clinical characteristics are the following. The traumatic E. O. includes a solitary lesion, limited range of motion, pain, swelling and local heat. The paralytic E. O. includes multiple lesions and were located in the paralytic big joints. The idiopathic E. O. includes a solitary lesion. Conservative therapy was performed in 9 cases, and the operation was performed in 9 cases. Clinical results were evaluated in 13 cases, which had a follow-up period of more than 6 months. With coservative therapy ossification was reduced in 3 cases and was constant in 3 cases. The reduced section of E. O. was opaque by roentgenogram. The operation was effective in 3 while 4 cases sufferd recurrence, 3 of which received the operation again.
At present the etiology and clinical courses of E. O. are unknown. We think that it is useful for early detection of E. O. to measure ALP periodically and that the section of E. O. which is opaque by roentgenogram can be reduced.

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It is unusual for vertebral burst fractures based on osteoporosis of the vertebral bodies to cause paresis. As the detailed etiology of the paresis still remains to be elucidated, various therapies have been applied for such cases. This report mainly describes the therapy we have applied in six cases.
The mean age of the patients was 74, ranging from 51 to 86. They included three males and three females. Anterior decompression and fusion was performed on two patients and posterior decompression on one. Conservative therapy was performed on three patients. Mean follow up time after therapy was 8 months (1∼19 months). The paresis has receded (Frankel C→D, E) in every patient except one who is still in bed with pneumonia.
In principle we should choose anterior decompression and fusion in all cases of burst fracture. However, considering the osteoporosis as well as advanced ages of such patients, it is not always justified to choose anterior surgeries instead of posterior surgeries or conservative treatments. We must follow up each case for a long time.

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A rare case of giant cell tumor originated in the first lumbar vertebra is reported in the present paper.
The patient was 27years old female with buttock pain without any inducing factor, beginning since August, 1989. She became unable to walk in October. MRI and CT examinations showed tumorous lesions at the first lumbar vertebral body and the right pedicle. On November 9, 1989 yellow and firm tumor including Th12 and L1 nerve roots was removed through posterolateral costtransversectomy under a magnifying glass. At the same time, we reconstructed her spinal column with Harrington's instrumentation and autoiliac bone graft. One and a half years after the surgery, she returned to normal home life without any recurrence signs on X-ray examinations.
In discussing the prognosis of this lesion in 66 cases as previously reported, 44 cases had good results and only 6 cases showed recurrance. Operative treatment for giant cell tumor of the spine showed relatively better results in the tumorous lesion of the spine. Improved results can be achieved by more better surgical technique at the time of extirpation.

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The difference between human spinal ligaments and those of animal is obscure. Histological and biomechanical properties of anterior and posterior ligaments were studied. Anterior and posterior longitudinal ligaments resembled those of human histologically. Both ligaments consisted of deep and superficial layers. Both deep layers attached to the adjacent margins of the vertebral bodies. Posterior longitudinal ligament attached loosely to the mass of the posterior bodies. Both ligaments attached firmly to intervertebral disc.
In tension failure test, anterior longitudinal ligament was remarkably stiffer than posterior longitudinal ligament. Anterior longitudinal ligament was stiffest at lower thoracic level. There was little variation in strength with vertebral level for the posterior longitudinal ligament.

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Intermittent claudication is one of the most important characteristics of Lumber Canal Stenosis (LCS). We analyzed 54 partients who suffered from intermittent claudication and divided these patients into 2 groups. The patients who became non-ambulatory mainly because of severe pain will be referred to as the Pain Grop. The patients who became non-ambulatory mainly because of numbness will be referred to as the Numbness Group.
The population of the pain group was 23 or 43% of the cases, the population of the numbness group was 31 or 57% of the cases. We discoverd some characteristic differences between the 2 groups. 87% of the patients who were over 70 years old belonged to the numbness group. Acording to the internatinal classification of LCS, the ratio of the combined type is high in the pain group. The period from the onset to surgery for the pain group was a short one (on average 2 yrs. 9 mos.), while the period for the numbness group was a long one (avg. 4 yrs.). The period from onset to intermittent claudication for the pain proup was a short one (avg. 1 yr. 3 mos.). 65% of the pain group experienced weakness of muscle strength compared to 78% of the numbness group. With regards to sensory disturbance and weakness of muscle strength, the pain group tended to be unilateral while the numbness group tended to be bilateral.
As for the improvment of intermittent claudication after surgery, using the JOA score, the pain group had a better score than the numbness group.
We believe that symptoms for members of the pain group tended to appear in the early stage of LCS while the symptoms for the numbness group tended to appear in the later stage. The reason for this is that stimulation and inflamation of nerve cause pain in the early stage while nerve degeneration progressed and caused numbness in the later stage.
In conclusion we have to consider the situation of the cauda equina and the lumbar nerve root in order to treat claudication.

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We measured bone mineral density in lumbar spine for healthy people by DEXA. BMD is decrease with ages in female, and lateral BMD is more sensitive than frontal BMD. There is also high coefficient of correlation between frontal and lateral, lateral and cancellous BMD. But we have some problems (position, etc) in measuring lateral BMD, so we will have more trials.

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A new apparatus for automated percutaneous discectomy was developed by Onik in 1985. This small probe has the advantage of minimal tissue damage. In this series, assessment of 12 displacements of intervertebral discs in 11 patients was made by the JOA Score. The degree of lumbar disc displacement was assessed by classifying conditions into four grades.
The observed intervertebral disc displacement included 8 displacement at L_4-5 and 4 displacements at L₅-S₁.
There were 3 Grade I displacement and 9 Grade II displacements. The range of follow-up was 1 to 11 months with an average of 3.8 months for percutaneous nucleotomy. An excellent success rate was achived with a statistical mean rate of 96.5%, and 6 patients completely recovered with a success rate of 100%. No complications were observed in any of the patients. Regarding these results, we suggest that the automated percutaneous nucleotomy is an efficient and safe method if the patient has a Grade I or II displacement.

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During 10 years after 1981, a follow-up study was performed in 110 cases of proximal humerus fractures. There were 29 male and 81 female patients. The mean age of patients was 64.4, ranging from 6 to 91. The average follow-up period was 6.4 months, with a range of 1 month to 5 years.
The cases were classified according to Neer's four-segment classification, and consisted of 41 cases of minimal displacement, 52 cases of two-part fracture, 13 cases of three-part fracture, 1 case of four-part fracture and 3 cases of fracture-dislocation.
Various treatments (conservative or operative treatment) were performed. But the results of treatment were unsatisfactory on the whole. In particular for the hanging cast method which was applied in 42 cases, “Fair” or “Poor” results were obtained in 26 cases (62%).
At present, the treatment of proximal humerus fractures is difficult, especially in the elderly, and so it is necessary to select an adequate treatment, considering their age, occupation, life style, general condition, grade of osteoporosis and type of fracture.

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