The tenography of the first dorsal compartment has been received little attention. This paper describes its clinical value in diagnosing de Quervain's stenosing tenosynovitis.
The tenography of the first dorsal compartment was performed for 10 hands in 10 unaffected volunteers and 41 hands in 39 patients exhibiting positive Finkelstein signs. Using a 27-G needle, 0.5-1.0 ml of Urographin was injected into the first dorsal compartment under an image-intensifier. In 30 out of 41 hands, Dexamethasone was added to the contrast material.
A normal tenogram was shown as a smooth bar which had a small pooling shadow at the proximal and distal ends. In the cases with de Quervain's disease, free passage of the contrast medium was seen in 15%, obstructions in 57.5% and narrowings of the tunnel in 27.5%.
The 19 hands which failed to show any improvement within 3-4 weeks after conservative treatment were operated on. In the group in which tenographical obstructions were evident, 65% of the hands had to undergo surgery. In the other group, that in which free passage was demonstrated, only 24% of the hands needed surgery. As to the results of the conservative treatment, there was little difference between those in which a steroid was injected and those treated without steroids. Operative findings showed that even fibrous septum dividing sheath types, positive (pathological) findings in tenogram were also pathognomonic.

抄録全体を表示

The Swan-Neck Deformity is one of the most common deformities in the Rheumatoid hand. Despite this prevalence, many patients are left untreated, and disabilities are numerous in advanced cases. Therefore a simple orthotic device which permits functional movement, and can prevent and correct the deformity is desireable. During the last two years, a simple PIP extension block splint has been used in the treatment of the Swan-Neck Deformity and IP's hyperextension deformity of the thumb.
This simple PIP extension block splint, which was originally designed by Iren Hollis, O.T.R., prevents hyperextension and lateral instability, but does not interfere with full joint flexion.
The Swan-Neck Deformity was classified into 4 types according to Nallebuff's classification. Type 4 was excluded from this series. IP's hyperextension deformity was divided into group A; with instability, and group B; without instability. Information on improvement of A.D.L. with the splint, wearing time and overall satisfaction was collected using a questionnare. Pinch power (tip, pulp, tripod, key) and grip power were measured with and without the splint.
As the disturbance of function is negligible in type 1 and in some of the type 2 cases, these patients did not experience much benefit in terms of function and therefore often felt uncomfortable with the splint. Yet even with these patients, a high level of compliance in wearing the splint was gained by educating them about the nature of the deformity. Significant improvement in function and great satisfaction was obtained in type 3 case and in cases of IP's deformity of the thumb.
Because the number of cases was small, and follow-up time was short, we cannot make conclusions as to the effectiveness of the splint as it relates to prevention of the deformity. In addition to being easy to make, simple, inexpensive, and easy to apply, the main benefit of this splint is that it prevents persistent faulty position and permits a normal plane of motion. Therefore this splint is very useful in the treatment of the Swan-Neck Deformity and IP's hyperextension deformity of the thumb.

抄録全体を表示

We had experienced a high incidence of post-operative liver (functional) disturbance after total hip replacement, and so paid attention to blood transfusion and anesthesia as probable factors connected with it. Total hip replacements were performed on 33 patients from April 1981 to February 1982. 21 of them were operated on under spinal (lumber) anesthesia, and 10 of them were transfused only autologous blood. Concerning with blood transfusion methods, 19 autologous blood transfusion, and 10 cases only autologous blood transfusion itself.
Four patients after surgery had a liver functional disturbance. In all of them surgery was performed under G. O. F, anesthesia, and 3 of the 4 cases were considered to probably have hepatitis. This incidence of post-operative liver functional disturbance was less than half of that in the 4 years before then.
We began the reservation of autologous blood 3 weeks before surgery on 24 cases who had more than 12.0g/dl of Hb-volumes, and were able to reserve a maximum blood volume of 1200ml. The Hb-volume decreased after drawing blood, and the volume after that would increase to less than that before drawing blood. We saw that the rate of increase varied patient to patient but could not see the reason for those differences.

抄録全体を表示

In the orthopaedic field, there have been few reports on post-operative liver dysfunction, which may be disadvantageons for patients who need post-operative physiotherapy. A retrospective study of 78 cases of total hip replacement (T. H. R.) from 1978 to 1981, showed a post-operative liver dysfunction rate of 26.9 per cent. All the patients with post-operative liver dysfunction had had T. H. R. under G. O. F. anesthesia and blood transfusion. In order to clarify the effects of anesthesics and blood transfusion on post-operative liver dysfunction and for prevent it, we have performed as many T. H. R. s as possible under lumber anesthesia and autologous blood transfusions since 1981. As a result the rate of post-operative liver dysfunction in patients who had T. H. R, decreased to 15.7 per cent. This suggests that G. O. F. anesthesia and homologous blood transfusion may play a role in the aetiology or pathogenesis of post-operative liver dysfunction.
A delay in post-operative physiotherapy and prolongation of hospitalization were found in patients who had post-operative liver dysfunction. The duration from the start of post-operative physiotherapy to the stage of walking with a cane and discharge is twice as long as other cases in those with post-operative liver dysfunction. There was no significant difference in the clinical elimination (based on the Japanese Orthopaedic Association) of three and six months after T.H.R. between those with post-operative liver dysfunction and those without it.

抄録全体を表示

From 1972 to 1984, total hip replacements THR were performed on 185 joints in 146 cases suffering from rheumatoid arthritis. This paper reports on the risk of loosening and the post-operative mortality rate after THR. Preoperative X-rays were evaluated with respect to 4 points: 1) stage of RA. 2) bone atrophy, 3) protrusio acetabuli, and 4) destruction of the femoral head. These four points were determined by the clear zones on X-rays after operation and the Steinbrocker's-stage of the hip joint. The cases of loosening were mainly concentrated in those in the late stage and/or with severe bone atrophy and/or severe destruction of the femoral head or the acetabulum. The relationship between protrusio acetabuli and loosening was not significant. The mortality rates of those receiving THR for rheumatoid arthritis were 21.6% after 5 years and 37% after 10 years. These THR patients in this series haven't had long life times.

抄録全体を表示

We experienced a case of Charnley flat back stem breakage. The stem had been put 12 years ago in a 67 year-old female suffering from osteoarthritis of the hip joint. Radiography showed it had been inserted into the femoral shaft at a neutral position. The cementing, however, had not been sufficient at the proximal medial part of the stem and two years after the operation, bone resorption at the calcar femorale and a so-called clear zone at the greater trochanter were visible. At that time, it seemed that the Charnley stem had become loose at the proximal part. Eleven years after surgery, these phenomena could be recognized in a more advanced stage with radiology. On the other hand, the distal part of the stem had remained stable and no sign of loosening was noticed.
Revision surgery was performed, and the proximal piece of the broken stem was removed easily by hand. After its removal, the inside of the proximal femur was found to be covered by a metalozic black granulation tissue accompanied with many foreign body giant cells seen histologically. The surfaces of both ends, at the point of breakage, were smooth from frictional movements on each other following the breakage. In some areas of the surface, however, in the postero-lateral area, irregular“tide mark”-like striations could be clearly seen. On the basis of these observations, we concluded that it was a stem fatigue fracture resulting from bending cantilever.

抄録全体を表示

Surgical reconstruction in 4 patients with old rupture of the posterior cruciate ligament is reported on. All patients presented typical signs and symptoms of old rupture of P.C.L., such as posterior drawer sign and instability. Particularly, X-ray measurements at the posterior drawing state of the knee revealed marked posterior deviation of the tibia.
Surgical reconstruction of P. C. L. using semitendinosus tendon, sometimes with additional use of gracilis, led to remarkable improvement in all cases.
It is concluded that the surgical reconstruction of P. C. L. is well indicated for the patient complaining of instability of the knee.

抄録全体を表示

Seventeen knees with severe flexion contractures resulting from rheumatoid arthritis were treated conservatively and surgically at the Kobe University Hospital between 1966 and 1982. The severity of flexion contracture ranged from 40 to 145 degrees with an average of 72 degrees. Contractures of an average of 38 degrees were corrected by the conservative treatments such as serial plaster cast wedging and skeletal traction. However, all but one of those knees required further posterior soft tissue release. Since in patients with rheumatiod arthritis the main problem is a flexion contracture caused by fibrosis of the posterior capsule and tightness of the hamstrings, it was inevitable to release the posterior structure of the knee in order to correct the flexion contracture. The knees operated on could be extended to 11 degrees on an average. About four years after initial posterior soft tissue release, fourteen knees required further reconstructive surgery such as total knee replacement arthroplasty. It was clear that early systemic treatment in rheumatoid patients is very important to prevent such severe flexion deformity.

抄録全体を表示

Total knee replacement was performed on thirteen severely destructed knees of 7 non-ambulatory patients with rheumatoid arthritis. The causes of the inability to walk in the 7 patients were: 1) severe varus or valgus deformity with marked bone defect in 3 patients, 2) severe flexion deformity (mean: 65 degrees) in 3 patients and 3) extension contracture and pain on standing in both knees in one patient.
The operations were performed with additional surgical procedures as follows: 1) bone grafting for the medial tibial condyle with bone defect in 2 knees, 2) posterior release in 6 knees, and 3) quadriceps plasty (Thompson's method) in 2 knees.
The results from 3 to 49 months (mean: 37 months) were almost satisfactory in each case. Six patients became able to walk without a cane, and the other patient needed a walker for her indoor gait because of an extension lag in both knees.

抄録全体を表示

Patello-femoral malalignment can be the main factor necessitating revisional surgery in total knee replacement in spite of the femoro-tibial disorders such as loosening, destruction or displacement of implants.
Five revisional total knee arthroplasties and three cases of patellar tendon transfer (Groenveld's method) exhibited the subluxation or dislocation of patella occuring after total replacement in the rheumatoid knees with both varus and valgus deformities.
However, the mechanism of subluxation or dislocation of patella is quite different between varus and valgus deformity in the knee. In the case of varus deformity (genu varum), the complicated mechanism shown below, pushes up and out the patella to the lateral side to be dislocated, though in the valgus deformity simple physical forces work for patellar lateral dislocation: Mechanism of lateral patellar dislocation is that medial facet sinking and anterior cruciate ligament involvement of rheumatoid arthritis induce postero-medial rotational movement at the flexion of the knee, and the patella is pulled to the lateral femoral condyle or more laterally by the tension of quadriceps tendons.
This fact suggests that in the cases of rheumatoid arthritis with both varus or valgus deformity of knee, lateral retinacular release must be used to correct the patellar malalignment in total knee arthroplasty.

抄録全体を表示

The inside of a living body can be seen three-dimensionally by using the following procedure: Many cross-sectional pictures obtained by means of ultrasonic CT and NMR are collected. Each cross-sectional picture is positioned in accordance with an original cross section and many cross-sectional pictures are simultaneously observed. Thus the inside of a living body can be seen three-dimensionally. The method of to recording many cross-sectional pictures is called multiple-exposure holography.
Since the clinical application of CT, it has been possible to presume the three-dimensional internal construction of a living body easily from a clear two-dimensional picture, and thus detailed diagnoses with such pictures have been possible. However, in a certain sense CT is no more than a means for assuming three-dimensional configurations. In order to know further detailed shapes, site and positional relations, for example, in grasping the osteotomy for the femur or the pelvis three-dimensionally, or in designing an artificial bone or joint without using bone cement fixation, a multiple-exposure hologram which enables stereoscopic viewing is quite useful.
In many cases, with observations made on plain roentogenograms, cross-sectional pictures and pictures obtained with CT, it is difficult to determine an angle for three-dimensional osteotomy of the femur, an angle for rotation osteotomy, or whether it is necessity to combine pelvic osteotomy with femoral osteotomy, and what the angles should be for those osteotomies. Holography is a very effective tool for malcing such determinations. In addition, it makes it possible to grasp clinical courses correctly.

抄録全体を表示

A case is reported of psoriatic arthritis (PA) with involvement of the hip joint that was treated by total hip arthroplasty.
A 66-year-old female was admitted to our hospital due to left hip pain for one year. She had been suffering from psoriasis for 20 years, with polyarthralgia during last 8. On admission, her blood sedimentation rate was elevated and C-reactive protein was positive; however, the rheumatoid factor was negative. Histological examination of the synovial tissue and articular surface of the femoral head obtained at the time of surgery showed non-specific granulation and bone resorptive arthritis.
Though many cases of PA have been reported, involvement of the hip joint is rare. We discuss whether this case is a rheumatoid type of PA or a coincidental association of rheumatoid arthritis and psoriasis.

抄録全体を表示

Olisthesis or subluxation of the lower cervical spine is occasionally seen in rheumatoid patients with and without myelopathy. Neurological and radiological findings were investigated in seventy-three patients with rheumatoid arthritis. The series contained six men and sixty-seven women, and the average age was fifty-five years, with a range from twenty-six to seventy-five years. Neurological signs and symptoms were classified into three groups similar to the classification described by Ranawat et al.
Group I in which patients had no neurological symptoms or tingling only in their hands included 55 patients; Group II in which patients had neurological abnormalities such as hyperreflexia, pathological reflex and sensory deficits but no problems in daily living included 13 patients; Group III in which patients had hyperreflexia, sensory deficits, muscle weakness, gait disturbance and some disabilities in daily living included 5 patients. Anterolisthesis or posterolisthesis of the lower cervical spine was seen in 16 of the cases belonging to Groups II and III.
It was thought that in rheumatoid patients the frequency of myelopathy due to oisthesis of the lower cervical spine was higher than that due to upper cervical disorders such as atlantoaxial dislocation and vertical subluxation of the axis.

抄録全体を表示