An examination was made on the results of the operative treatment performed on 51 patients with the cervical osteochondrosis in our clinic from 1957 to 1969. The operative methods performed were laminectomy, Robinson-Smith's method, Cloward's method, and the foraminectomy of Frykholm. In the 51 patients, the spinal cord compression syndrome was observed in 21 patients and the radicular syndrome in 30. Generally, the methods of Robinson-Smith and Cloward produced better results than those of laminectomy in both the groups with the spinal cord compression syndrome and with the radicular syndrome. Both Robinson-Smith's method and Cloward's method were effective for the patients with the radicular syndrome, and generally the latter were better than the former. Especally in the cases with the cervical spondylosis (e. g., posterior spur formation), the latter was definitely better. For the cases with radicular syndrome, the partial laminectomy, like foraminectomy, produced good results, but for the cases with the disc degeneration, we take the vertebral body fusion as the first choice of the methods. In our experience, the results of the operative treatment were better in the cases with the spinal cord compression syndrome than those with the radicular syndrome. Therefore the reasons were discussed, and it was emphasized to select the indication strictly. In the cases with the spinal cord compresseion syndrome, the relationship between the clinical findings and the results of the operative treatment was examined. The results were generally unsatisfactory in the following cases; i. e., the cases with the syndrome for a long-lasting period, severe spastic paralysis in the lower extremities, and the severe cervical spndylosis in many vertebra. About the X-ray findings of the cervical vertebra on which the vertebral body fusion had been performed, a discussion was made on the state of the bony fusion, localized kyphosis, and the compensatory changes of the upper and lower discs of the fused vertebral body.
1650 fractures in 1190 in-patients were treated at the Department of Orthopedic Surgery, Kurume University Hospital, during the last 10 years. The author analysed locations of the fractures and presented the method of treatment of his choice. He also introduced briefly some experimental studies concerning the fracture treatment. He concluded that an epoch-making method of fracture treatment, such as Küntscher's intramedullary nailing, may not be developed in future, but every effort for obtaining better results should be still continued.
A 47-year-old man had been sufferring from the pain and swelling in his left thumb for a month. Roentgenograms revealed the enlarged terminal phalanx with distended and thinned cortex. By the surgical operation, the radial portion of the cortex was perforated. The content of this cyst was a semisolid, cheesy one as seen in the atheroma. The inner surface of the cyst-wall was lined by the thinn and soft membrane, which was consist of the stratified squamous epithelium and sud surrounding connective tissue without hair, sebaceous gland and sweat duct. For these reason this cyst was diagnosed as epidermoid cyst. Although a small portion of the attenuated cortex seemed to be destroyed roentogenologically, judging from surgical finding, the cyst was not suposed to occure outside the phalangeal bone, but inside the bone. Therefore, if the epidermoid cyst is originated from the deeply buried skin, the trauma should be serious one in this case. In spite of this, the patient remembers no traumatic lesion in his thumb.
A man, 72 years old, who had suffered from the tumor in the right arm since 3 years. The tumor increased in size since last summer. The tumor was removed, and examined pathologically in our clinic. Pathological findings: by H. E. staining, there was seen the connective tissue neoplasm fasciculated in structure, with bands of tissue crossing each other in the most varied manner. As regards cytology, the tumor revealed the fusiform cells with nuclei of various sizes. When stained by Azan's method for collagen, the fibrillary intercellular substance was distinctly visible. This disease occurs with the same frequency in both sexes. The favorite sites of the disease are the abdomen, thorax, inguinal fold and extremities. In most cases, the tumor had already existed for five years before the beginning of treatment, and they received treatment between the age of 30-60. It is not yet possible to form an idea of the malignancy of a dermatofibrosarcoma either by its age or by its histologic structure. The prognosis of this tumor is incomparably less serious than for other sarcoma. It has been previously noted that the diagnosis of dermatofibrosarcoma protuberans as a neoplastic entity is more readily made on the basis of the clinical history and appearance than it is on microscopic examination.
In 1832 v. Recklinghausen made public his opinion that the disease which is characterized by multiple nodules and pigmentation of the skin and tumor of nerve trunk is neurofibromatosis. Since then, this disease has been known to have extremely varied clinical features and some hereditary relations. Recently, we have encountered a case of neurofibromatosis. The patient is a girl of 11 years old, and there were 7 other cases of this diseases in four generations of her family. She has pigmentation all over the body, subcutaneous tumors of left breast, severe deformities of thorax and spinal column, and spinal paralysis. Pigmentation of the skin was already noticed at the time of birth. By the age of 8 deformities of the thorax and spinal column had developed, at 11 she became unable to walk and also spastic paralysis of lower extremities and disturbance of the bladder and rectum appeared. After admitting to our department, laminectomy were perfomed. Her tumor under the skin of left breast was diagnosed as plexiform neurofibromatosis by pathologic examination.
We had studied the therapeutic results of four cases of fibrous dysplasia in our clinic. Two cases of them were monostotic and the others were polyostotic fibrous dysplasia. There was no Albright's syndrome. Curettages with bone graft were carried out at six times in total. One of bone grafts was autograft and five were heterograft. In the treated bone lesions described above, there were three lesions recurred within a year. The recurrence developed in adolescent patients and there was no recurrence in adult patient despite with recurrent condition. In one of the patients, a postradiation osteogenic sarcoma had developed and the patient died after six months of malignant change.
We have recently seen one case of alveolar soft part sarcoma that was first described by Christopherson in 1952, and had been reported as “malignant granular cell myoblastoma” or “malignant nonchromaffin paraganglioma” by some authors. An Indonesian man, thirty five years old, was admitted to this hospital in April 1967, with the chief complaint of swelling in the distal half in his left leg for six years. Physical examination revealed no abnormality except diffuse swelling about the distal half of the left leg. A roentgenogram revealed an osteolytic lesion in the distal metaphysis of the left fibula and a solitary lesion in his left lung field. Exploring the lesion in the leg, two tumors were located in the soleus muscle and flexor hallucis longus muscle respectively, and moreover, the latter tumor invaded the distal part of the fibula. The left lower extremity was amputated above the knee. The specimen consisted of oval, rubbery soft mass capsulated with a thin membrane, having grayish-yellow cut surface with several small cystic areas and zone of hemorrhage. Histological examination revealed an alveolar patter arranged in fairly uniform islands surrounded by fibrous septa. The basic cells are oval in most areas, and the cytoplasm is light eosinophilic and finely granulated with distinct cytoplasmic membrane. Nuclei are eccentrically placed. Regarding to a solitary pulmonary lesion that is suspected for metastasis, a subsegmental resection of the left lower lobe is planned to be carried out within a few days.
Our present cases are 1, 3, 4, 7 and 38 years old female whose main complaints are retardation of growth and bow leg. The characteristic laboratoric finding of the cases are increased alkaline phosphatase activity, decreased inorganic phosphorus in serum and lowered tubular reabsorption of phosphorus less than sixty per cent. The curable dosis of vitamin D which varies with each cases is decided by try and error, using serum calcium level within 11.5mg/dl, serum inorganic phosphorus above 3mg/dl, urinary calcium excretion below 400mg/day and toxic signs as indicators. The troublesome case to control the effective dosis of vitamin D has a narrow range between toxic dosis and therapeutic one, but it is not clear if the range is constant with individuals through life or is changeable according to the age of patient. In such case the toxic signs tend to appear easily. When the serum calcium increased, corticosteroid was given intramuscularly which acts antagonistically to hypercalcemia. However, its lowering effect for serum calcium was not remarkable in our series. It is rather difficult to normalize serum inorganic phosphorus without hypercalcemia even under vitamin D administration. Otherwise, renal tubular reabsorption of phosphorus could not be kept up between the normal range. In one case, the TRP as well as the serum phosphorus remains at remarkably low level even under hypercalcemia. Even if serum inorganic phosphorus does not increase, the rachitic change on X ray film can recover, following slowly lowered activity of serum alkaline phosphatase.
Operation was performed on the growing rabbits of average 600 gramms weight. After the knee joint was opened by an incision, the meniscus, articular cartilage of the tibia, subchondral bone were resected, but both the proximal growth plate and the epiphyseal bone plate were left unoperated. Concluded results were as follows: In three weeks after operation over sized cells were in sight in the germinal cell layer, both proliferation and normal maturation of the cells of the growth plate were slowed and the cartilage increased in thickness. In four weeks after operation many germinal cells degenerated under the influence of either a physical stimulus of the articular unconformity and the incomplete revascuralization, devided and proliferated to the granulation in the articular space.
This experiment is one step to clarify dynamic mechanical properties of bones, especially femurs. Material: four dry femurs. We designed a method that a mechanical impulse was exerted on a femoral head along the functional axis of femur with a pendulum. Then a femur, whose condyle is fixed and head is free, is placed horizontally. When a mechanical impulse was exerted on a femur in the above position, a bone vibration was developed. This vibration was analyzed, and was similar to a summation of a high- and a low-frequency component. Therefore, we picked out separately the high- and the low-frequency component with a filter circuit. There were vibrations with logarithmic decrement. The vibrations had a natural frequency themselves—the high was about 500cps and the low was about 100cps. Now, a solution of a sort of a second-order differential equation Md2x/dt2+Sdx/dt+Kx=F(t)is also a damping vibration with logarithmic decrement. Then, we added two second-order differential equations with two different constant coefficients, using a desk-top ANALOG computor. Using this solution yielded a similar wave to a bone vibration. Therefore, we think now that a bone vibration under the above conditions may be expressed as a summation of two ordinary second-order differential equations. Furthermore, analysing many more bone-vibrations, we will compare the difference of the damping ratio and the natural frequency of vibration between many bones.
Familial occurrence of Perthes disease was reported by Hagen in 1939, by Stephens & Kerby in 1964, and by Goff in 1954. Recently we have observed three brothers with Perthes disease in a family. The parents of the patients were examined roentgenologically, showing no pathological sign. No evidence has been provided for its hereditary relation and it is suggested, however, that the disease in these three patients may have been related to certain constitutional and hereditary factors.
I investigated the postoperative course of triceps surae muscle power of 52 cases with subcutaneous ruptured achilles tendon. The majority of the patients were men in their thirties. The most cause of the injury was sports. Observing the function of triceps surae muscle power postoperatively, I found some results as follows. The recovery of tiptoe standing ability with injured leg needed the shortest period and the recovery of running ability needs the longest period postoperatively in both fresh and old cases. Perfect recovery of running ability in old cases was not observed. Leg pain after walking and paresthesia and hypertrophy of the injured area were found. 43.2% cases of all did not complain of any trouble postoperatively. The circumference of the injured leg are one centimeter shorter than sound one and the difference did not recover in both fresh and old cases. The ergograph was taken to observe the triceps surae muscle power which recovered gradually as time went by postoperatively in both fresh and old cases. But the recovery in old cases was worse than fresh, especially that of the old cases who had the period of more than two months before operation was the worst.
Five patients with the bicipital tendon rupture of the upper arm were reported by us during the past six months. Their age ranged between 39 and 72 years old. In four cases, two were fresh and two were late one, the tendon rupture occurred when they lifted up the light material. Three cases were treated operatively and the other one conservatively. The osteoarthritic changes were recognized in the shoulder joint in the two of four cases by the X-ray examination and in three cases the abnormalities were found by the arthrography. There was one who was complained of the swelling and pain of the shoulder joint without any proximate cause and was diagnosed a idiopathic rupture of the biceps tendon. This was treated operatively. In this case the osteoarthritic change was in high degree and the synovial fluid was about 30ml, yellowish and clear. The histological findings of the ruptured tendon was degenerated and infiltrated one and increasing of the synovial cell and senile elastosis of the subsynovial tissue was observed. A month after the operation he had no pain and swelling of the shoulder joint, but a limited the functional use. The end-to-end suture of the tendon in four cases were impossible and the ruptured tendon was fixed to the coracoid process.
Six cases of rupture of the extensor pollicis tendon were reported. Three of them were of open rupture, and other 3 cases were of spontaneous rupture after the Colles' fracture. Of the six patients who had operative repair of the ruptured tendon, one complained of discomfort. Excellent function could be restored by joining the tendon with a free tendon graft taken from the palmaris longus of three cases and by transferring it's distal end to the tendon of the extensor indicis proprius of the above two cases. One patient had operative repair of the ruptured tendon by pull- out wire method. It was infected after the operation, the result was unsatisfactory.
It is the purpose of this paper to follow up the results on our cases of the fractures of the long bone in the lower extremity. We have treated 154 cases during recent five years (1962-1967). Most fractures were caused dy traffic accident. The results obtained are excellent in 70%, good in 10%, fair in 20% in 42 cases of the diaphyseal fracuture of the femur. On the other hand, we have obtained excellent in 94% good in 3%, poor in 3% in 86 cases of the lower leg fracture. We have had 5 cases of the delayed union and 1 case of the pseudarthrosis in the femur; 3 cases of the pseudarthrosis, 4 cases of the osteomyelitis, and 2 cases of the delayed union in the tibia on treatment.
Regeneration of the reticuloendothelial tissue in the bone marrow following intramedullary nailing has been observed using iodine-131-labelled-Collargol (RES blocking agent) by ordinary histological method and microautoradiography. The results obtained up-to-date experiments were reported.
Though various methods stimulating the bony fusion due to compression has been devised for osteosynthesis, the appliance for compression is needed in these methods and a hole has to he provided in the bone for its application. A new compression plate for osteosynthesis has been developed in our clinic, which needs no appliance. This plate decreases in its use the damage to the bone and soft tissues. This compression plate has its characteristics in the groove of the screw of the Scherman type. When the screw is turned in the fractured surfaces of the proximal and distal fragments draw near and are compressed. The mean weight applied to the fractured surface is 60kg per square of cross section in plate with a strain gauge, and the maximum weight 125kg. In 19 cases of femoral and tibial shaft fracture, the sign of bony fusion has been showed between 40 to 70 days in using the compression plate.
A man aged thirty-two, pharmaceutist, had begun to play the golf and had been continuing to exercise from April 20, 1966, who sustained the severe pain in his neck and back after a golf-swing on May 12. He was admitted on July 7 because of persistent tenderness, pain in motions and crepitus, which were revealed on the spinous process of the seventh cervical vertebra by examination. Radiographs showed two round shadows at the level of the seventh cervical vertebra in anteroposterior projection and the fracture in the middle of the spinous process in lateral projection. A fragment of the fracture dislocated downwards. On July 8 the process was removed and disclosed the fibrous union and the slight formation of the new bone histologically, Eleven months after operation the patient has no complaint except slight dullness of the shoulder, and has begun to play the golf again from the post-operative second month. The fracture of the spinous process has been known as the shovellers' fracture, while only two cases were reported as the lesion by the golfswing which will occur more often hereafter.
In order to judge the indication for surgical procedures and prognosis of the peripheral nerve injuries, the authors carry out most often nerve conduction test as one of electrodiagnostic methods. And in addition, recently, in seven cases of peripheral nerve injuries, we have conducted the neurographic studies to estimate the indication of surgical procedures. The authors compared the neurographic studies with the nerve conduction tests, and the following results were obtained: 1) Nerve conduction test: It is one of the excellent diagnostic methods of peripheral nerve injuries to decide the degree (neurapraxia, Wallerian degeneration or mixed type), localization, and the presence of continuity, partially continuity or discontinuity of lesion of the nerve. Therefore, this method is useful for the judgement of the prognosis and for the early decision of the opportunity for surgical procedures and method. 2) Neurography: This method is also useful as one of the diagnostic methods, especially may be more beneficial to confirm whether the nerve sutures or the transposition of nerve are satisfactory or not. However, we must have in mind the secondary reaction, because the contrast medium used was not absorbed for a long time in some cases by our experience.
Transplantation of the inner hamstring muscles (sometimes semitendinosus only) at their distal attachment and myotomy of the adductor were undertaken in cerebral palsy with higher grade scissor posture. Pre-and postoperative training was done by use of training apparatus combined bracing for the night. The hypertonicity of the muscles in the lower extremities was analysed by means of stretch reflexes and indication of the operative procedure was researched. Higher grade scissor posture was treated by operation and training, whereas mild cases was by training only. The flexion and extension of dynamic excercise by use of the apparatus took out training spirit of children. Clinical and electromyographic analysis of the muscle hypertonicity in cerebral palsy sorted out rigo-spastic patients into the RIGO-spastic type and rigo-SPASTIC type. Also in each patient, individual muscle was different in the distribution of rigid and spastic element. Most of patients with higher grade scissor posture belonged to RIGO-spastic type and rigid element was abundant in the adductor and hamstring than in the gastrocnemius. In these patients modified Eggers' operation was more effective than Baker's operation.
Immediate post-surgical prosthetic fitting is a procedure to apply a temporary prosthesis immediately after amputation. According to Dr. Weiss's methods with a little modification we have treated 7 patients. Postoperative schedule was planned as following; Standing was allowed at 1st post-operative day, gait traing started at 2nd day, stump molding was made at 14th day, temporary prosthesis with permanent stump sockt was applied at 21st day, and patients were discharged with permanent prosthesis after complete gait training after 1 month post-operatively.
Since vertebral osteoporosis is roentgenographically characterized by an increase in the bone permeability, the vertebral density of the different aged from the young up to the old was observed using roentgenographic measurements and some informations were obtained about its age differences. The subjects examined were 156 cases (_??_73, _??_83) with low back pain without any evidence of tuberculosis and tumors, from age 13 to 79, who had recently visited our clinic. In addition, out of them 16 cases of compression fracture were also investigated. In both sexes, the vertebral density increares with the age, and it is characteristic that the female shows a comparatively high density from the forties. This period of age corresponds to menopause and it seems to be attributable to the fall of anabolic hormon. The cases with the compression fracture are most common in the fifties and sixties, and next in seventies. As regards to the relationship between the vertebral density and fracture, it is demonstrated that the higher the vertebral density is, the more often the fracture occurs.
There are 25 patients with paraplegia or tetraplegia due to trauma or orthopedic spinal diseases in CHIKUHO Labour Accident Hospital. 22 cases of them are in need of medical treatment or care, because of their paralysis or disturbance of activity of daily life. For their health control blood, urine (sediment and urinary bacterial test are involved), renal function and radiological views are regulary examined. The results of examinations for the recent eight months are summarized as follows: 1. Many cases show hypochromic anemia (Hemoglobin under 90% or hematocrit under 45% are found in 72%, respectively). 2. Usually, urine are acid, and leucocytes, opacity or epithelial cells are found in over 70%. 3. Positive Urocheck test are obtained in 77% and positive bacterial culture are succeed in 61%. In 80%, both agree in views. 4. Although 72% show under 1.018 of the maximum spcific gravity in the thirst test or hyposthenuria, the results of phenolsulfonphthalein test are almost normal. 5. Regions of bony lesions have usually healed by osseous intention, but one case shows complete ankylosing spondilitis. Cystograms are revealed: the reflux in three of 16 cases (two are unilateral and one is bilateral), Schramm's phenomen in 11 of 16 cases and the beam-formation or diverticulum in 10 of 16 cases. In the intervenous pyelogram, caliectasis and ureteral dilatation are impotant. Paranephritic abscess and intermittent hydronephrosis with floating kidney have need of urologist's advice.
Since 1965 twenty-three cases of vertebral body biopsy have been done without any complication by the method of cross section drawing of the affected level. Among them 21 cases (91.5%) were succeeded in obtaining the desirable histological specimens. As preoperative preparations a full-size cross section at the level of the affected vertebra must be drawn from two X-ray pictures of A-P and lateral taken with a scale and from measurement of the skin curvature. The safest line for the trephine must be drawn on the paper. The line goes through the point 3 to 5milimeter lateral from the left pedicle and down 50 to the posterior frontal surface. The surgery can be performed by local anaesthesia. The patients lye usually on their right side. A special designed guide is used with which the distance from the posterior midline to the small incision for the trephine and the angle can be decided. Cylindrical specimen of 2.5 to 3.5mm×15mm is taken from the desired site by screwing the trephine into the vertebral body. In dorsal spine the trephine must be always guided between the neck of the upper and lower ribs. Exact knowledge of topographic anatomy is necessary. It could be emphasized to draw the accurate cross section and to do exact boring into the vertebral body on the drawing.
We report a case, collier of fourty-eight, sustained a severe fracture-dislocation of the second lumbal with motor paralysis but no sensory disturbance due to fall from the mine track car. The fracture-dislocation was reduced and fixed by surgery ten days after the injury. His motor paralysis gradually returned in its power and marked recovery obtained three months after operative procedure. At present he can walk without cane and has no trouble urouble urologically four months after the injury.
The 38 cases of spondylolisthesis and 48 of pseudospondylolisthesis were analysed based on clinical symptoms and functional radiograms. In spondylolisthesis, 17 patients complained of low-back pain alone, 10 complained of transient pain in the lower limbs, 6 complained of leg pain with decreased or disappeared ankle jerk, and 5 had sciatica with motor and sensory disturbances. 25 patients had stable lumbar spine and 10 had unstable spine. In Pseudospondylolisthesis, 12 patients complained of low-back pain alone, 11 complained of transient pain, 8 complained of leg pain with decreased ankle jerk and 9 had real radicular sciatica. The cases with sciatica with motor or sensory disturbances had the poorest result in conservative treatments. As for instability, the result of management had no relation in light worker but had poor result in heavy worker. In 14 out of 21 operatively treated cases, the causes of sciatica were identified: Arachinitis localisata in 3 cases, extradural scar tissue and thickened lig. flavum in 3 cases, adhesion of L5 nerve root or dura mater to the lysis part in two cases and no causes found in 5 cases.
We have experienced the treatment of 5 cases of the ossification of the posterior longitudinal ligament of the cervical spine for the past 2 years. All the cases were males in the age range of 40 and showed slight sensory disturbance and severe spastic motor disturbance, similar to the symptoms of cervical spondylotic myelopathy. Continuous cervical traction was performed on 2 cases and anterior spinal fusion on 3 severe cases. These postoperative course was quite setisfactory and impressive. It is undoubted that the appearance of myelopathy in this condition is concerned with the circulatory disturbance due to continuous compression of the cord by the ossified mass, strengthening by the slight extension movements of the intervertebral space accompanied with the movement of the cervical spine, therefore, it is assumed that anterior spinal fusion with the enlargement of the intervertebral space was effective to the improvement of the circulatory disturbance of the cord. As for the operative procedure for this condition, it is needless to describe that extensive decompressive laminectomy should be chosen; however, I should like to emphasize that anterior spinal fusion by safe and easy technique should be chosen at first even for the case with extensive ossification, which had showed no symptoms for a long time.