We have experienced three cases of cervical cord or radicular symptoms caused by acupuncture needle migrating into the cervical spinal canal.
Two patients had cevical cord symptoms and the other one had radicular symptoms. The first case was a 63-year-old female, who noted numbness in her bilateral fingers, 5 years following her acupuncture treatment. The second case was a 52-year-old male, who had had a nuchal discomfort and treated himself with a needle. He unfortunately broke the needle. Two months following the event, numbness appeared in his bilateral upper and lower extremities. The last case was a 44-year-old male. He had felt radiating pain in the middle of his acupuncture treatment. He subsequently developed pain in the great occipital nerve area during neck rotation.
The needles were removed surgically, in all cases. The symptoms were dramatically resolved in the second and the third cases, In the first case, however, the neurological deficits did not improve after the operation, which seemed to be ascribable to the irreversible changes which had occured in the spinal cord.

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We had three patients (45-year-old male, 64-year-old female and 42-year-old female) on long-term hemodialysis who had cervical lesions suggestive of destructive spondylarthropathy and treated surgically. When they received surgical treatment, they had been on dialysis for an average of 17.3 years (10, 19 and 23 years). The mean preoperative Japanese orthopaedic association score for cervical myelopathy (JOA score) was 7.3 points (11, 4 and 7 points). The clinical symptoms were improved in all cases, and the mean postoperative JOA score was 11.7 points (14, 8 and 13 points) following 15, 7 and 4 months after the operations.
In one patient who had severe destructive change of the vertebral bodies combined with kyphotic deformity, subtotal spondylectomy of two vertebrae and anterior fixation with autobone graft and spinal plate were performed. Although halo vest jacket was applied for three months after the operation, loosening of screws and delayed union of the bone graft were occurred.
In other patients who had mild destructive changes, interbody fusion with autobone graft and spinal plate were performed. Solid union was obtained in these two cases.

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We evaluated the results of posterior decompression for the thoracic myelopathy due to ossification of spinal ligaments in seven patients (three male and four female) whose mean age at the time of the operation and duration of follow-up were 56.3 years (range, 43 to 76 years) and 2.7 years (range, one month to seven years), respectively. Four patients had ossification of the yellow ligament (T7-12: one, T10-12: two, T11-12: one), one had ossification of the posterior longitudinal ligament (T2-5), and two had both of them (T7-12: one, T10-12: one).
The patients rated on JOA score except points of upper extremity, and kyphosis was evaluated radiologically using Cobb's angle. The average score of 7.6 points postoperatively was significantly greater (p<0.05) than that of 5.8 points preoperatively. The recovery rate (Hirabayashi) averaged 35% and was significantly higher (p<0.05) in the patients with ossification of spinal ligaments of the upper thoracic spine than in those of the lower thoracic spine.
The average preoperative and postoperative Cobb's angles were 9.5° and 11.9°, respectively. Five of seven patients gained Cobb's angle after operation, however this increment of kyphosis was not significant.

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Femoral shaft fractures in children show rapid union and a high self-remodeling, and most can be satisfactorily treated by conservative treatment.
From April 1985 to April 1995, we treated 17 children by suspention traction. The average age at the time of injury was 6.8 years (range: 2∼10 years), and the average follow-up period was 12 months (6∼18 months).
Bone union was achieved in all. The fractured limb was a mean 8.6mm shorter than the opposite limb at the time of union. Angular malunion of over 15 degrees was noted in 1 case. Clinically, there was no evidence of rotational malunion.

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Twenty seven patients with acute avulsion fractures of the anterior talofibular ligaments were evaluated clinically. These were selected from 48 patients below 15 years of age who had acute injuries of the lateral collateral ligaments of the ankles.
In 6 of the cases, bone fragments were not visible on the initial plane or stress radiographs. Five of these 6 cases were below 10 years of age.
All 27 avulsion fractures were surgically treated, and bone fragments were fixed with tension band technique, wire suture, or suture with biodegradient material. Twenty six were asymtomatic in post oparative evaluation. Only 1 case showed slight loss of motion range of the ankle joint. Bone unions had been obtained in 25 cases. Only in 1 case there remained marked talar tilting.
We have concluded that in patients below 10 years of age, who have marked talar tiltings, avultion fractures should be suspected even if bone fragments are not visible on the radiographs. Surgical fixations can correct these injuries by in large.

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Over the past 11 years, we have treated distal tibial epihyseal injuries in 12 patients, and reviewed 11 of these cases in this paper.
There were 8 males and 3 females ranging in age from 6 to 14 years, with average of 11. By Salter-Harris classification, one patient had Type I, 5 Type II, 4 Type III, and one Type IV injury. The one undisplaced injury was treated in a below-knee plaster. Eight displaced injuries were treated by closed manipulation and percutaneous Kirshner wire fixation. Open reduction and internal fixation was necessary in 2 cases.
All patients except for one had equal leg length and no evidence of joint incongruity. One, Type III injury, caused pastial epiphyseal plate arrest with leg shortening and varus deformity of ankle. We are planning salvage operation for this case.

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Thirteen hips in 11 patients with avascular necrosis of the femoral head were treated with surgical implantation of bipolar hip prosthesis. The cases were assessed in terms of functional and radiographic results. These data were compared with the results of Austin-Moore-type head fixed prosthesis that were performed at our hospital before 1983. The preoperative hip score was 49.2 points on average and improved to 89.5 points at follow-up. The mean of follow-up duration was 4 years 8 months. The incidence of proximal migration of bipolar heads was significantly lower when compared with that observed in an Austin-Moore-type head fixed group (0/13 versus 5/10). In conclusion, the results indicate that the bipolar hip prosthesis are preferred for the treatment of advanced AMFH, provided that stable initial fixation can be achieved.

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Since March, 1994, 12 preoperatively deposited autologous transfusions with erythropoietin have been performed. Although the patients were of advanced age, we could obtain a sufficient volume of blood according to plan with the use of erythropoietin. All operations were completed, using only deposited autologous blood.
No severe side effects were experienced. The increase of hemoglobin over a weekly period was -0.03g/dl (after blood was first obtained), +0.34g/dl (after obtaining blood for the second time), +0.96g/dl (after obtaining blood for the third time).
The current guidelines for preoperatively deposited autologous transfusions state that it is to be desired that the hemoglobin level before obtaining blood is more than 11.0g/dl. However, in elderly people hemoglobin is often less than 11.0g/dl when blood is obtained. Five of our 12 cases did not satisfy the guidelines (>hemaglobin 11.0g/dl) in the course of blood deposition. It was attempted to obtain the planned 400ml of blood by carefully observing the patient's condition and were successful. It was concluded that hemoglobin levels continue to increase as time passes because of the effect of erythropoietin, therefore with the use of erythropoietin, obtaining the planned amount of autolognus blood from older patients, can be performed relatively safely even if hemoglobin is less than 11.0g/dl.

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A patient who sustained stress fracture of the femoral neck following unicondylar knee arthroplasty (UKA) is reported. A 76-year-old female patient, who had been treated as osteoarthritis of the right knee for 15 years, underwent UKA in March 1995. Two months after UKA, she complained of right hip pain without a history of significant trauma. Because initial radiographic findings are minimal, bone scintigraphy and MRI are useful methods for diagnosis. We consider that osteoporosis, a biomechanical change and an increase in the patient's activity level after joint reconstruction were the possible cause of the stress fracture.

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We report a result in treatment for 6 cases of augumented tibial components in bone defects of tibial codyles.
The mean age of TKA operation was 72.3 years old and the mean period of follow-up study was 12.8 months. The average JOA score improved from 45 to 76.7 points. Therefore, we believe that augumenting tibial components is one effective method of treatment in bone defects of tibial condyles.

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Six patients who each received total knee arthroplasty with a Miller-Galante (M-G) I prosthesis and 16 patients who had 21 arthroplasties with M-G II prostheses were evaluated clinically and radiographically, between a year and 5 years 5 months after surgery. The clinical results were evaluated by the functional evaluation score system proposed by the three universities. The average score at the time of follow-up was 74.7 points for patients with M-G I and 81.3 for patients with M-G II prostheses. At the time of follow-up a radiolucent line at the bone-prosthesis interface was detected in 3 knees fitted with an M-G I prosthesis without cement. There were no radiolucent lines in any knees fitted with M-G II prostheses.
Subluxation of the pattelo-femoral joint was seen in 3 knees with M-G I prostheses and in one knee with a M-G II prosthesis.

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We evaluated bone atrophy and femoral neck morphology in 65 female patients with hip fractures (31 trochanteric, 34 neck) and 26 healthy female controls by radiographic morphometry.
Regarding bone atrophy, the Singh index was significantly lower in the two fracture groups than in the controls. The ratio of width of calcar femorale to neck width was significantly lower in the neck fracture patients than that in either the controls or the trochanteric fracture group. The ratio of cortical width 3cm below the lesser trochanter and that at the midshaft of the femur to overall width were significantly lower in the trochanteric fracture patients than in the controls. Regarding femoral neck morphology, there was no significant difference in any of the measurements of proximal femoral geometry (i.e. femoral neck angle, hip axis length and the ratio of neck width to head and trochanteric width) among the three groups.
We speculate that low cortical bone mass at the calcar is associated with neck fracture risk, and that 3cm below the lesser trochanter in associated with trochanteric fracture risk, but geometric characteristics of the femoral neck in Japanese women are not so associated with overall risks of hip fracture.

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A follow-up study of osteosynthesis using cancellous screw was conducted in 15 women with intracapsular femoral neck fracture, aged 51-76 (mean 65 years). The average follow-up period was 2.8 years (range: 1.5 to 12 years).
On follow-up radiograph, the interval until fusion and the frequency of late segmental collapse (LSC) were examined. (1) The type of fracture (Garden's classification), (2) the distance from the top of the cancellous screw to end plate, and (3) the collodiaphyseal angle in LSC⁽⁺⁾ group were compared to those in LSC^(-) group.
Fracture union was obtained in all cases a mean period of 3.9 months after surgery. LSC occurred in 5 cases average 12 months after surgery. (1) Two cases were in stage II, 1 in stage III and 2 in stage IV in LSC⁽⁺⁾ group, while 5 cases were in stage I, 2 in stage II and 3 in stage III in LSC^(-) group. (2) The mean distance from the top of the screw to end plate was 9.5mm in LSC⁽⁺⁾ group, and 6.9mm in LSC^(-) group. The collodiaphysealangle was 142.8°in LSC⁽⁺⁾ group and 147.6°in LSC^(-) group.
It was concluded that the most important factor in the occurrence of LSC was the staging of displacement of the femoral head (Garden).

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From 1988 through 1993, 75 hips in 75 patients had Bipolar endoprosthesis (BEP) for fractures of the femoral neck. Until 1990 we used uncemented Harris/Galante porous stems (Zimmer) in 35 patients (uncemented group). Then cemented Centralign System stems (Zimmer) were used in 40 patients (cemented group). The mean age at BEP was 75.3 years in the uncemented group and 79.0 years in the cemented group. The average postoperative follow-up period was 4.8 years in the uncemented group and 2.7 years in the cemented group.
The rate of postoperative thigh pain and the duration of hospitalization were compared between these two groups. We observed increases in the rate of thigh pain and in the duration of hospitalization after uncemented BEP although the differences were not significant.
It may be advantageous to use cemented BEP for fractures of the femoral neck in aged patients.

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Out of 38 patients treated with Gamma nails for trochanteric fractures and followed for 3 months or more after surgery, 3 suffered refracture in a fall or other accident. This communication reports on the follow-up of these three patients. They included one man and two women ranging in age from 84 to 88 years. Two patients who had not been inserted distal locking screws developed subtrochanteric spiral fractures and were then treated by the insertion of distal locking screws. One of them subsequently sustained a fracture of the shaft of the femur in a fall 4 months later, which was repaired using a long version of Intramedullary hip screw. The remaining patient was initially inserted distal locking screws, but suffered a spiral fracture around the nail. Since using of a Gamma nail without distal locking screws can give rise to rotational instability, we make it a rule to use distal locking screws in the treatment of all trochanteric fractures.

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During a five-year-period, from January 1990 till December 1994, we surgically treated 39 patients with trochanteric fractures of the femur. According to Evans classification, 20 of these patients had a stable fracture; those with mild varus displacement were treated by anatomical taxis followed by Jewett nail fixation, while cases with severe varus dislocation were treated by Jewett nail fixation in a slight varus and slight overcorrection position. On the other hand, 19 patients had unstable fracture, and were treated by Dimon modified method (or technique). Regardless of the fracture type (i. e., stable or unstable), Jewett nail fixation after anatomical taxis was done in all young patients.
Regarding these patients, we analyzed the operation time, intraoperative bleeding amount, postoperative X-p, and time required to start total weight bearing. We also analyzed their walking ability before fracture and on discharge from hospital to evaluate the activities of daily living (ADL).
By such therapeutic method, no reduction of 5mm or more was observed postoperatively in patients with stable fracture except in one case, and no evident displacement was observed in any case with unstable fracture.
As reduction of the fracture was done under direct vision, we can not say that the operative stress of Dimon method is small, but the weight bearing started shortly after the operation, no re-displacement occurred, and the functional outcome was satisfactory.

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We evaluated the radiological outcome of 87 patients with patella partita treated conservatively in our clinic and retrospectively investigated the influence of the stages of patella partita, chronological and bone age at presentation, patella brace, and limitation of sports activities on healing. There were 85 boys and two girls. At the time of this study, all but ten were active in sports. The mean age at presentation was 11.4 years (8 to 17). Healing was attained in 63 of 127 knees by conservative manegement, for a mean period of 14.8 months. The healing rate was 66.7% of the patients with early stage lesion (n=36), 47.4% of progressive stage (n=78), and 23.1% of terminal stage (n=13); 80% of patients in the 8-9 age group (n=15), 53.5% for those in the 10-11 age group (n=71), 43.3% for those in the 12-13 age group (n=30) and 0% for those in the 14 or elder age group (n=11); 62.5% of the group treated with the patella brace designed by us (n=64) and 53.3% of those who did not use the patella brace (n=30); 57.6% of patients who limited their sports activities (n=52) and 51.2% of those who continued with their sports activities (n=43).
From these results we may conclude that early diagnosis and treatment contribute to the healing of lesion.

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Seven elderly patients with displaced fractures of the distal radius have been treated by intramedullary fixation using acrylic cement since 1994. All patients were women and were 71 to 84 years of age (average age, 80.0 years). All patients were followed up for at least 6 months after surgery, and the average period was 11 months. At the follow-up examinations, 6 out of 7 patients did not complain of pain, 6 patients had no limitation of wrist motion, and 6 patients had satisfactory clinical results. Follow-up radiographs showed that all fractures were united, and an assessment of dorsal and radial tilt and radial length showed 5 out of 7 fractures had been reduced satisfactorily. There were no refractures, and no problems with the bone cement. This treatment may be useful for elderly patients with distal radial fractures.

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To evaluate the efficacy of an endoscopic procedure for treatment of carpal tunnel syndrome, carpal tunnel pressure and distal motor latency of the median nerve were measured in 7 afflicted patients (9 hands) before and after subcutaneous transverse carpal ligament release. Postoperative mean carpal tunnel pressure and distal motor latency of median nerve were significantly improved. Clinical symptoms, including sensory disturbances, disappeared in all patients about 30 days after the operation. These results revealed that transverse carpal ligaments were able to be completely released by the endoscopic operative procedure.

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Cubitus varus deformity is the most common complication of fractures of distal humerus in children. We performed a retrospective study of the surgical outcomes of 12 elbows operated on by the technique described by French (1959) from 1982 to 1994. The age of patients ranged from 3 years to 12 years with a mean of 6 years and 10 months. There were 7 boys and 5 girls. The follow-up period ranged from 1 year to 8 years with a mean of 4 years and 1 month. Carrying angle, Baumann's angle and Forward tilting angle on radiogram could all be corrected by the operation and had been restored at follow-up time, except in one patient with epiphyseal injury. The range of motion was also improved. And, the function of the elbow joint was assessed by JOA score at preoperation and at follow-up time.
We concluded that French's method is a good surgical procedure for the correction of cubitus varus deformity.

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This paper discribes two cases of metastatic sacral malignancy causing severe sacralgia, which were surgically treated with a satisfactory result.
Case 1. 67-year-old female suffered from the gait disturbance with a severe buttock pain. CT and MRI demonstrated an osteoclastic tumorous lesion in the sacrum. The tumor was excised with a part of the sacrum. Histologically, the tumor was metastasis of thyroid cancer. Three years after surgery, she has almost normal ADL with a low dose of analgesics.
Case 2. 63-year-old male, who had undergone surgery for rectal cancer 3 years ago, complained of severe sacralgia. In this case also, CT and MRI demonstrated an osteoclastic tumor in the sacrum. With the suggestion of oncologists, the tumor was resected with a distal part of the sacrum. Histological diagnosis was metastasis of rectal cancer. One and a half years after surgery, he has almost normal walking ability without a pain.
As there is no definite strategy for such a metastatic sacral tumor as causing severe sacralgia, the resection of the tumor and a part of the sacrum will be indicated when the remaining life expectancy is considered sufficiently long from the oncologic point of view.

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Recently, surgery has been actively conducted in many patients for treatment of pathological fractures resulting from metastases of malignant tumors. There are two operative methods; the first is a palliative approach where osteosynthesis is performed without excising the metastatic lesion, and the second is a radical approach where the metastatic lesion is actively resected and osteoplasty is done. From January 1989 till December 1994, we performed palliative surgery in four patients with pathological fractures of the proximal femur resulting from bone metastases of malignant tumors. After internal resection of the tumor (or intratumoral resection), fixation was done using AO condylar plate. There is no general consensus regarding the choice between the palliative or radical approach. Nonetheless, on applying the preoperative severity determination criteria (developed by Tokubashi et al.) for pathological fractures of the long bones caused by metastatic bone tumors on the patients of the present report, a good matching was observed. Consequently, we think that these criteria may be used fin the preoperative assessment of the patients.
Concerning the postoperative results, the quality of life (QOL) of the four patients of the present report improved.

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It is well known that chondrosarcoma is diffidcult to be distinguished from chondroma histologically. We report two cases which were first diagnosed as enchondroma and later identified as chondrosarcoma histologically.
The two patients were a 58-year-old male and a 78-year-old female who had some pain around the knee joints. Radiographics of the patients showed radiolucent areas at the distal end of the fomur. The tumors were biopsied and diagnosed as enchondroma. After the tumor of one patient was biopsied again and the other was curetted, both of them were diagnosed as chondrosarcoma.
In conclusion, if chondrosarcoma is suspected, several tissue from different portions should be collected at the time of biopsy.

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Nine patients with liposarcoma were treated at our institute from 1975 to 1995. There were 1 male and 8 female patients with an average age of 51 years old (ranging from 22 to 65 years old). Five patients had their initial operation at our department and 4 patients had recurrent tumors which had previously been treated at other hospitals. The surgical margin of the operation was evaluated as wide excision in 6 and marginal excision in 3. Local recurrence was observed in 1 patient who underwent marginal excision for a recurrent tumor in the thoracic dorsum. She developed pulmonary metastases and died within 4 years. No local recurrence was observed in the patients who received wide excision of the tumors. Treatment results were no evidence of disease in 8 patients and dead in 1. It is important to perform the first operation with an adequate surgical margin to achieve a good treatment results for patients with liposarcoma.

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Two cases of ankle osteoarthrosis in the elderly were treated by percutaneous arthrodesis with the “dowel technique.” On the first step, in each case, a bone gragt was taken from the iliac bone. On the second step, under X-ray television screen, the talocrural joint was reamed with a reamer, where the reamed hole was 14mm in diameter. On the third step, the iliac bone graft was introduced into the hole. The gap between the reamed hole and the graft bone was packed with cancellous chips of the iliac bone. On the final step, a short leg cast was applied.
In case 1, the 73-year-old female patient had been kept, for 6 weeks, load-free in the operated ankle. The cast was removed 12 weeks after the operation. In case 2, the operated ankle being reinforced by percutaneous 2 malleolar screws, we permitted, 2 weeks after the operation, the 76-year-old female patient to bear weight. The cast was removed 10 weeks after the operation.
The postoperative clinical courses have been functionally good for 2 years in case 1 and for one year in case 2.

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Since 1990, we have treated fifteen displaced intra-articular calcaneal fractures by open reduction through the lateral approach using Kirschner wire (Tsurumi, K. et al., 1963). Results were evaluated according to Maxfield's assessment. Fourteen out of 15 (93%) were exellent or very good in his criteria. There are six postoperative complications (4 cases had transient sural nerve palsy and 2 cases had peroneal tendinitis).
We conclude that open reduction for displaced intra-articular calcaneal fractures provides good results.

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Systemic lupus erythematosus is known as multiple organ disease and has a limited prognosis. At present steroid therapy is a satisfactory and specific medical treatment and can be recommended for this disease. However, the various sites of osteonecrosis associated with systemic lupus erythematosus are developed by prolonged steroid therapy. We present two cases about 3 knee-joints with osteonecrosis of the femoral condyle. We found the progression and extension of these lesions after 3 years following up with conservative therapy. On the other side, arthroscopic debridement reduced symptoms and improved the mobility of these knee-joints. Therefore, we have a plan for the management of these complications as follows. The patients in early or asymptomatic stage require no surgical procedure. In suffering from pain, arthroscopic debridement is a very usefull treatment. Unicompartmental knee arthroplasty, high tibial osteotomy or total knee arthroplasty should be warranted in the late stage patients.

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Valgus deformity of the osteoarthrotic knee is much less common than varus deformity, especially in Japan. We treated 2 patients by varus-inducing osteotomy for valgus knee. One case underwent proximal tibial osteotomy and the other was managed by distal femoral osteotomy. Distal femoral varus-inducing osteotomy is a common surgical approach for the valgus knee. Because of the inherent valgus angulation of the distal femur, a medial-based proximal tibial osteotomy results in an oblique joint line tilted superolaterally. Such tilting leads to a shear force across the knee, while the distal femur appears to fall off the medial tibial plateau, but if the angle between the anatomic femoral axis and the tibial mechanical axis was less than about 15 degrees of valgus or if the plane of the joint was expected to postoperatively deviate from the horizontal by less than 10 degrees, proximal tibial osteotomy was performed. Varus osteotomy for valgus deformity has been successful in patients satisfying appropriate indications.

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We studied the postoperative peroneal nerve palsy after high tibial dome osteotomy with the use of external fixation of Steinmann pins and Charnley clamp. Out of 74 operated knees, 24 suffered postoperative sensory or motor disturbance associated with the palsy of the peroneal nerve. In this paper, we assessed the relation between the incidence of postoperative nerve palsy and the distal pinning site, or the fibular osteotomy site or the correction angle. Our results were in accordance with the anatomical study performed by Kirgis et al. who pointed out the dangerous site for pinning or fibular osteotomy.
We concluded that the insertion of Steinmann pins, placed between 60 and 80mm distal to the lateral tibia plateau, may avoid postoperative deficit of the peroneal nerve.

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Twenty-four knees of fifteen patients who underwent high tibial osteotomy (HTO) for medial osteoarthritis (OA) of the knee were followed clinically and radiologically for 10 to 19 years. Average patient age was sixty years at the time of surgery. Procedures involved wedge osteotomy and staple fixation.
The femorotibial angle (FTA), tibial plateau angle (TPA), Mikulicz line (M line) and Koshino's OA grade were measured on radiographs in the standing position. Clinical results were evaluated using the Japan Orthopaedic Association score (JOA score). No sighnificant correlation was found in FTA, TPA, M line, Koshino's OA grade, and JOA score respectively. Although recurrent varus knee occurred in most patients, more than sixty percent of patients showed no progression in koshino's OA grade at the time of follow up.

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It was difficult for a baseball player to recover completely from a frontal dislocated shoulder or subluxation even though an operation was performed because it limits the range of motion of the shoulder. However, recently many baseball players wish for complete recovery. Our team has been making efforts to meet their wishes. This is a report of some cases we have treated. We define a complete recovery as a state when a player can throw a ball fast enough to play on a team without experiencing pain.

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In 75 patients with anterior cruciate ligament (ACL) rupture, we retrospectively examined meniscal lesions using magnetic resonance imaging (MRI). Depending on the time from their ligamentous injury to the performance of MRI, the patients were divided into three groups: the acute group (less than 1 month, n=25), the subacute group (between 1 and 12 months, n=30), and the chronic group (12 months or more, n=20). Almost all meniscal signal changes were detected in the same locations of the posterior horn of the meniscus. The incidence of medial and lateral meniscal signal changes was higher in the acute group than in the other groups. The incidence of Miuk's grade 1 and 2 meniscal signal changes was highest in the acute group. In the medial meniscus, the incidence of grade 3 was highest in the chronic group. These results suggest that meniscal lesions develop following the injury to the ACL and ACL instability may affect the grade of these lesions.

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We have examined the relationship between knee extension torque and anterior tibial displacement in 54 female high school basketball players. The measurement knee extension torque was used the Musttrun isokinetic dynamometer and anterior tibial displacement was measured KT-2000 knee ligament arthrometer.
The knee extension torque of this group was not larger than the other basketball groups, such as national team, collegiate team, recreational players, and junior high school players. The anterior tibial displacement of the right knee was significantly larger than that of the left knee, though the reason is unclear. There was no significant corelation between the knee extension torque and anterior tibial displacement.

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We have reported the results of treatment for 14 cases of lumbar disc herniation with dysuria experienced for the past 20 years.
There were 13 males and one female aged from 29 to 66 years (average 44.5).
Postperative myelography showed complete block in 13 cases and incomplete block in one.
Preoperative results were excellent in seven, good in two and poor in five with their urinary retention unimproved. Of these five cases with poor results, two had the operation performed more than a week after the onset of dysuria. In the remaining three patients, who had suffered from severe paralysis of their bilateral lower extremities as well as bladder and rectal dysfunctions, their urinary retention did not improve, despite such early operations as within 24 hours. It follows that the patients showing distinct lower limb weakness accompanied with the complete or incomplete block on myelogram should be operated on as early as possible, even when their bladder dysfunction is not severe.

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We report our clinical results from 105 patients who were treated with automated percutaneous lumbar discectomy (APLD) for lumbar disc herniation. Average improvement rate of JOA scores for all types of lumbar disc herniations treated by APLD was 83.2%. When the herniations were classified into 3 types primarily based on the discogram, the average improvement rates were 93.7%, 83.7%, and 71.4% for protrusions, subligamentous extrusions, and transligamentous extrusions, respectively.
We further subclassified subligamentous extrusion type herniations into S1 and S2, and transligamentous extusion type herniations into T1, T2 and T3. The descriptions of each are as follows. S1: The pulpy nucleus extrudes at the disc level. S2: The pulpy nucleus extrudes 5mm above or below the edge of the vertebra. T1: The PLL is ruptured, but the center of the herniation is within the PLL. T2: The center of the herniation is outside of the PLL at the disc level. T3: The center of the herniation is under the PLL, but the pulpy nucleus extrudes 5mm above or below the edge of the vertebra.
Categorized in this way the average improvement rates of JOA score were 88.5%, 61.5%, 89.3%, 18.8%, and 71.0% for S1, S2, T1, T2, and T3, respectively.
Therefore, S1, T1 and T3 type herniations are suitable for APLD, but S2 and T2 type herniations are not.

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Twenty seven patients with lumbar spinal canal stenosis (LCS) over 65 years old who underwent decompressive surgery and were followed more than a year postoperatively were reviewed to investigate indications for spinal fusion in elderly patients.
The mean age was 71 years old, and mean follow up period was 3 years and 3 months. Twelve patients of those underwent decompressive surgery combined with posterolateral fusion (Control group), and the remainings (15 patients) unedrwent decompressive surgery alone. We divided the 15 patients who underwent decompressive surgery only into 2 groups as follws; Group A: those who showed spondylolisthesis radiologically, Group B: those without spondylolisthesis. The Clinical results were evaluated by the recovery rate of the Japanese Orthopaedic Association (JOA) score.
The recovery rates of JOA score were, Group A; 46.9%, Group B; 63.7%, Control group; 63.2%., and differences were not significant. In Group A, low back pain and lower leg symptoms remained, though intermittent claudication improved. Radiological instability did not appear or increase postoperatively. These were supposed to reveal the existence of “invisible instablity”.
In patients with LCS wih spondylolisthesis, spinal fusion should be performed regardless of age.

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The purpose of this study is to evaluate radiological changes of lamina and ROM of lumbar spine using Xray, CTscan on 79 patients treated with osteoplastic laminectomy.
Subject included 46 males and 33 females with a mean age of 58.4 years (range: 18∼83 years), mean follow up was 15 months (range: 2∼52 months).
We recognized the hypertrophy of lamina (2.5%), non-union of lamina after osteotomy (9.5%), OA change of facet joint (38%).
However, there were no instability of lumbar spine and re-stenosis of enlar-gedcanal.

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In cerebral palsy, hip dislocation is either congenital or paralytic. Diagnosis and treatment of these two different conditions is thought to be difficult. Two infants suffering from cerebral palsy with congenital hip dislocation were reported.
Their hip dislocations were found at an early stage, 1 and 6 month old respectively. The affected hip joints could not be reduced conservatively. We reduced the joints operatively, and found inverted limbus. At last medical examination, it was found that 1 case, with ataxic diplegia, could walk at 4 years and 3 months. The other case, with spastic quadriplegia, was unable to sit at 2 years and 8 months. Their hip X-rays showed good concentricity with acetabular dysplasia.
The diagnosis of congenital dislocation was possible because of the early detection and operative findings. The earlier results were good. However they must be observed carefully for spasticity, coxa valga and magna, which can induce hip dislocation.

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Eight hips (6 cases) with acute and chronic slipped capital femoral epiphysis were treated according to the type of onset and the degree of displacement. Four hips with mild slips (under 30 degrees of posterior tilting angle) were treated with in situ pinning. Two of the three hips with acute slips were treated with pin fixation after manipulative reduction. Transtrochanteric anterior rotational osteotomy (ARO) with modified Kramer's method and Fish's cuneiform osteotomy were carried out for two hips with severe chronic slips.
After follow-ups ranging from 3 months to 17 years, two hips developed the following complications. One of chronic mild slips treated with in situ pinning developed a mild femoral head deformity. One of the two acute slips treated with manipulative reduction developed aseptic necrosis, and we could not follow the other because of her death 7 months after the operation.
We consider that pinning in situ is indicated for mild slips, and the intertrochanteric osteotomies, such as modified Kramer's method and ARO are indicated for moderate and severe slips.

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Luxatio axillaris erecta is compartively rare. There has been no report of a post reposition of Luxatio axillaris erecta in arthroscopic surgery, We report a case of luxatio axillaris erecta caused by traffic accident. The patient was a seventy-one years old male. Three weeks after reposition, ROM exercise was started. But, constricture was severe and the patient had much pain. Arthrography, CT-arthrography and MRI suggested a rotator cuff tear accompanied with laburum injury. Arthroscopic surgery and cuff repair (Mc Laughlin method) were performed. The result of the surgery was excellent and the patient experienced complete relief from pain and constricture after surgery.

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We have recently observed two patients suspected to have soft tissue tumors based on findings of MR imaging, but who were finally diagnosed with inflammatory disease.
Case 1: A 55-year-old woman visited our hospital with the principal complaint of pain in the lateral portion of the right thigh. On the basis of this symptom and findings of blood tests, she was diagnosed with acute myositis and treated with antibiotics.
Case 2: A 72-year-old man visited our hospital with the principal complaint of a tumor in the front portion of the right thigh. Based on the results of biopsy and pathologic examination, he was diagnosed with atopic chronic inflammatory disease.
These two patients had T1-weighted images almost the same as those of normal muscle on T1-weighted images, but heterogeneously high signal intensities on T2-weighted images.
Since similar signal changes on MR images occur in many cases of soft tissue tumors as well, differential diagnosis of these tumors and inflammations is frequently difficult. However, differentiation between them is possible when detailed comparison of images is combined with consideration of clinical symptoms and the results of other examinations.

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From 1990 to 1995, we treated ten cases of the MRSA infection. From the results, there were nine successful treatments and one unsuccessful.
In all ten cases, we reported a case of MRSA infection, which was caused by a instrument surgery for thoracic spinal injury. The surgical procedure involved anterior strut bone grafting of the spine using vascular pedicle rib and infusion of vancomycin.

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This paper describes 18 patients (18 joins) with pyogenic arthritis of the knee who underwent treatment at our department. The common causes were steroid injection into the knee joint and open injury, which were noted in 4 and 3 patients, respectively. The commonest causative organism was Staphylococcus aureus, which was isolated in 10 patients. Drainage by aspiration + washing, curettage, arthroscopic debridement, arthroscopic debridement + continuous washing + CPM were used for treatment in 8, 4, 2, 2, and 1 of the patients, respectively.
The surgical outcome was relatively favorable in patients with a duration of illness ≤ 1 week in whom X rays revealed no bone change at the first visit or mobilization therapy was initiated early. Arthroscopic surgery, with the advantages of low invasiveness and relatively easy removal of inflammatory exudate and debris from the joint, was considered to be effective for early cases with few bone changes.

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The osteopetrosis is characterized by the osteosclerosis of the whole body and is a rare disease. We reported a case of subtrochanteric fracture of the femur accompanied by osteopetrosis on a female aged 62.
When operating, we had difficulty in drilling and tapping because the bone was very hard. Moreover, the cancellous bone was hardly able to be gathered from the iliac bone though the bone graft was done. We had another operation in seven months after the first operation because the fracture part had become a pseudoarthrosis.
The patient is not obtaining the bone union and are kept under observation.

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Three-dimensional (3-D) images of complex and comminuted bony displacements of four patients were evaluated for their clinical valuse. These patients respectively suspected to have fracture of ankle, pelvis, coracoid process and calcaneus. 3-D reconstructed images of contiguous CT sections demonstrated accurately the special relationships of the affected lesions, providing valuable information for surgical treatment.

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We have encountered seven patients with severe crushed wounds of the lower limbs (eight lower limbs), and here we report the course of management.
The final outcome was amputation of five lower limbs and preservation of the other three. We compared the morphology of each wound. Regarding the condition of the wound at the time of injury, crush injury was observed in four limbs of the amputation group, and degloving injury in the fifth limb. In the limb-preservation group, incised wound was observed in one limb and crushed wound in two limbs.
Infection was the cause of amputation in all cases. We think that cause of infection can be attributed to the extent of wound contamination at the time of injury, and severity of crushing of the soft tissue especially the muscles. Moreover, selection of proper antibiotics should be considered till the causative bacteria can be proved. The systemic complications, patient's pain and functional prognosis of the lower limb should be taken in consideration to determine whether amputation is necessary or not.

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Radiographical evaluation was performed on 11 total shoulder replacements (TSR) in 10 patients with rheumatoid arthritis (RA) at an average follow-up of 3.7 years. According to the modified Larsen's classification, 3 shoulders were calssified as grade 3, 6 shoulders as grade 4 and 2 shoulders as grade 5, respectively. No remarkable malposition of glenoid component was demonstrated more often about glenoid component compared with humeral component. However, loosening of implanto was not noted in both components. Malposition of components and incidence of clear zone were not correlated with pre-operative radiographical assessment.

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We report the radiological analysis of toe plasty for forefoot deformity of rheumatoid arthritis in fourteen feet of nine patients. All patients were females and ranging from 42 to 65 years old (average 56.2 y.o.). Follow-up ranged from 6 months to 84 months (average period 31 months). They were divided into two groups. Swanson flexible hinge toe implant was performed for the hallux in all cases. For lesser toes, resection arthroplasty was performed in five feet of three patients (first group), while shortening oblique osteotomy was performed in nine feet of six patients (second group).
Second group showed better improvement of spread foot than first group. And shortening of forefoot was well prevented in second group. Our results suggest that shortening oblique osteotomy of metatarsal bone for the lesser toes is more effective for forefoot deformity of rheumatoid arthritis than resction arthroplasty.

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The importance of measuring quality of life (QOL) has increased with greater emphasis on efficiency and on judgements of clinical effectiveness of therapies for patients with chronic disease. We measured QOL of rheumatoid arthritic patients using Kawai's method. This method was very simple and it took only a few minutes to answer the questions. In our study, QOL score correlated with the duration of rheumatic diseases (r=0.46) and the Lansbury score (r=0.43). The difference of QOL score between stage III and IV in Steinbrocker classification was significant (p<0.05). Also the difference between class II and III was significant (p<0.05). These results were similar to those using other complex methods. Kawai's method appears to be useful for evaluation of QOL of rheumatoid arthritic patients in outpatient clinics.

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We used posterior displacement acromioplasty for surgical repair in 19 patients who had complete or incomplete rotator cuff tears. Seventeen cases with follow-up periods of greater than 6 months were evaluated using the (JOA) scoring system. The patients consisted of 12 men and 5 women. None of these patients had a bilateral repair performed. The average age at the time of surgery was 54 years (range 40 to 70 years). There were complete tears in 13 cases and incomplete tears in 4 cases. The mean duration of follow-up was 29 months (range 6 to 57 months). The McLaughlin procedure and acromioplasty were performed in all patients. The total score improved from an average of 65.2 points preoperatively to 88.5 poists postoperatively. The average pain score improved from 5.3 to 27.8 points. In 16 cases, the strength of the abductor muscle of the shoulder reached above level 4 with manual muscle testing at 6 months postoperatively. Posterior displacement acromioplasty provides better exposure and facilitates appropriate surgical repair without weakening the lever arm of the deltoid muscle.

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