Man 63. years old. After he was attacked by cerebral apoplexy in 1963, the right spasmodic paresis remained with him and he has not been able to rise to his feet since about July in 1972. I suspected that he suffered from tumor of spinal cord but as a result of myelogram complete blocking were found at the tenth thoracic vertebra. Then, by tomography, I diagnosed his disease as spinal paralysis caused by the calcification of ligamentum flavum and I performed laminectomy. At the center of lamina synostosis of the calcified ligamentum fiavum and lamina was found. As I compared that view with the clinical symptom and also another example 11 in the Japanese paper, I found that those symptoms were presented, in most cases by old age and man, in all cases in thoracic vertebra. And as for the cause I thought that those symptoms in this case were caused by the calcification of ligamentum flavum, and the cause of the calcification is responsible to trauma and senior degeneration.
There are some diseases which the main symptom is pain under the first metatarsal head. We have studied on roentgenograms of the first metatarsal sesamoid of 27 patients whose main symptom is pain under the head of the first metatarsal, betweeen 1966 and 1973. In these patients studied here, there found partition of the sesamoid in 16 patients and mottling of the sesamoid in 2 patients. A 16-year-old boy complained of pain under the left first metatarsal head. The axial view of the first metatarsal sesamoid showed “mottling” and this boy was made a diagnosis of “aseptic necrosis of the lateral sesamoid of the first metatarsal”. Conservative treatment for two months was unsuccessful and excision of the involved sesamoid was performed with excellent result. The postoperative diagnosis was “aseptic necrosis of the lateral sesamoid of the first metatarsal.”
Rupture of the pectoralis major muscle is not common. This was first described in 1822 by Patissier. This was not yet described in Japanese literature, We would like to add our two cases to the previously reported thirty two cases and discuss etiology, location of rupture, treatment etc.
One case, male, 37 years old, suffering from pain and restriction of joint motion of bilateral hips and shoulders was reported. Roentgenograms of bilateral hips showed marked deformity of the femoral heads due to destruction of the subchondral bone matrix. Intraosseous venography showed marked retardation of venous return. Total hip replacement (W-Huggler type) was performed on the right hip with success. Left hip will be treated with W. -Huggler total hip replacement. In microscopic observation of the excised femoral head, osteoblasts, osteoclasts and foreign body giant cells were observed. The intima of arterioles in the joint capsule showed peculiar thickening, differing from atherosclerosis.
The radiographic appearances of aseptic necrosis of bone caused by decompression were first described by Bornstein and Plate (1911) and independently by Bassoe (1911). We operat ed a caisson worker's hip joint and found that the head of the femur was the avasucular necrosis. Dens area lesions were found at his heads of the humerus. We found that 6 of 11 caisson workers had bone lesion caused by decompression. Pathological findings and Prevention were mentined.
86 cases of several kinds of bone and joint diseases were scanned with 99mTc-pyrophosphate as bone imaging agent, and evaluated in comparison with clinical and radiological findings. These include 9 cases of inflammatory disease of bone, 5 cases of rheumatoid arthritis, 11 cases of osteoarthritis of knee, 8 cases of avascular femoral head necrosis, 15 cases of primary bone tumor (benign 10 and malignant 5), 32 patients with cancer and 6 cases of the other diseases. Using Hitachi dual 5 in. whole body scanner and Nuclear Chicago Pho/gamma camera, bone scans have been carried out routinely 3-5 hours after intravenous administration of 5-10mCi of 99mTc-pyrophosphate. The image obtained with 99mTc-pyrophosphate is more sensitive and effective than those of 85Sr, 87mSr and 18F. High concentration of tracer was more clearly demonstrated in the presence of abnormal X-ray views as inflammatory disease, bone necrosis, degenerative joint disease and malignant bone tumor. However, even in little or no evidence of definite X-ray view, abnormal uptake of 99mTc could early represent the existence of bone involvement and its extent. With 99mTc-bone scanning, the beneficial informations were obtained in early diagnosis, activity or process of the diseases.
This study is based on the analysis of the results of 152 peripheral nerve palsies in the upper extremity treated by neurorrhaphy or neurolysis from 1960 to 1972. There were 81 neurolysises, 69 neurorrhaphies and 2 nerve grafts. The assessment of recovery was made on a neurological basis according to the British method. The results of neurolysis and neurorrhaphy were analyzed with respect to the level of injury, delay of repair, age of patient. The results of 2 nerve grafts were also assessed.
Ten cases of juvenile muscular atrophy of unilateral or rarely bilateral upper limbs were reported. All patients have not familial incidence. Predominantly males in teen-agers are affected. Juvenile onset, localized unilateral or rarely bilateral muscular atrophy showing unique distribution in the upper limb and non-progressive course in the stage are characteristic features of this disorder. Objective sensory in all patients is not. Electromyogram shows high amplitude action potentials and muscular biopsy the picture of neurogenic atrophy.
During from Janualy 1968 to December 1972, 145 babies with congenital dislocation of the hip were treated with Pavlik's bandage in our clinic and 68 cases were investigated. It consists of 77 dislocated hips and 22 dysplasic hips. Majority of the hips were reduced and have shown satisfactory develoment of the hip but 11 cases (13 dislocated hips) could not be reduced. All of them were treated with combination of Lorenz's plaster cast Pavlik's and bandage after manual reduction. But open reduction with derotation osteotomy was performed in two of these cases and only derotation osteotomy was performed in three cases as additional treatment.
We have performed 22 lower extremity amputations with immediate post-surgical prosthetic fitting since November 1966. Among the causes of these amputations, 9 were of malignant bone tumors, 8 of gangrens due to peripheral vascular disease and 5 of other causes such as traumas and congenital malformation. In general, very early ambulation after surgery, early completion of final prosthetic fitting, and marked shortning of hospitalization have resulted from this technique. The authors however want to emphasize that very precise cautions will be needed in order to be successful in primary wound healing in the case of the amputation due to peripheral vascular disease.
From September 1971 to August 1973, 13 cases of shoulder lesion were operated upon in our department. 4 cases of rotator cuff ruptures have excellent result but one of them who had complete ruptures of supraspinatus, infraspinatus, and subscapularis with tabes dorsalis for 10 years had 50 degrees abduction after 5 months of pedicle deltoid transfer with acromion and died by apoplectic stroke. Anterior acromioplasty by Neer II for rotator cuff tendinitis were done in 3 cases. Only one case was good result. The case of the dislocation of the acromioclavicular joint which was treated by Weaver's method has excellent result. One shoulder prosthesis for the cancer metastasis to the proximal head of humerus has followed the good physical condition but no active good range of shoulder motion.
Simultaneous EDX microanalysis of Ca, P and S in the cartilage matrix was performed using the upper tibial epiphyseal growth plate of normal puppies. The peak distribution of S is marked in the reserve cell zone and the proliferative zone. Peaks of Ca and P concentrations come to appear as the S peak distribution is decreased at the top area of the hypertrophic zone, where no crystalline apatite was observed even by transmission electron microscope. The results of this analysis suggest the presence of amorphous calcium-phosphate complex in the hypertrophic zone as a precursor of crystalline apatite.
We have treated three cases of shotgun injury of the extremities. They were 43, 50 and 67 years old males. Generally, the shotgun injury of the extremities somewhat differs from that of the other parts according to the condition of the wounds and the method of treatment. These wounds are usually associated with massive tissue destruction. From our experience, we would recommend extensive débridement, internal fixation of fractures and primary would closure with split-thickness skingraft.
Two cases of injuries of the popliteal arteries followed by fractures at proximal part of the tibia were reported. Clinical phases of the legs were ischemic, and the arteriographic findings revealed complete blockage of the popliteal arteries at the level of fractures. For one case, the injured artery was reconstructed with venous autograft 13 hours after injury, while the other case was operated on by fasciecotomy of anterior tibial component 3 days after injury. The different two procedures were resulted in success and the legs are full functional conditions.
Clinical effectiveness of porcine Calcitonin on bone diseases was proved in six cases of old aged patients; 4 fractures, multiple myeloma and osteoporosis. Calcitonin was administered 40 or 50 MRC U/day intramuscularly for about 40 days in each cases. From the roentgenographic changings of 4 cases of fractures, it was suggested that calcitonin inhibited bone absorption and increased new-bone formation, because bone union was accelerated even in the cases of delayed union by calcitonin. In a case of multiple myeloma or osteoporosis, positive roentgenographic changes were not observed, it might be of therapeutic value, because the patients were freed from pain by the administration of calcitonin.
This paper reports a study of 66 fractures of long bones in children treated at Miyazaki Prefectural Hospital, Miyazaki, during the five years from 1967 to 1971. The results were as follows. 1) The functions of the injured extremities were all. normal. 2) The angular deformities of the fractured bone in less than 20 degree could undergo the spontaneous correction. 3) Generally accepted that up to 1.5 centimeters overlap of the fragment is desirable, however we do not completely agree with it, because overgrowth of the fractured bone was not so frequent in our cases.
We have experienced 15 cases of fractures of the carpal navicular during past 10 years. 9 cases of them were followed up for 4 months to 40 months. 7 cases of 9 were diagnosed as fractures of the carpal navicular within 1 month after the accident. Bony fusion was obtained in 5 cases which were treated conservatively by plaster fixation for 4 weeks to 2 months. Surgical therapy was employed in 4 cases; one with excision of the proximal row of carpal bones, one with excision of the proximal fragment of the carpal navicular and lunate bone and two with bone-grafting. One of two bone-grafting cases was not united despite of 10 weeks plaster fixation, but there is no disability in the wrist.
Recently we performed the Russ's operation in three patients with pseudarthrosis in the scaphoid bone. They had pains and disfunction in the wrist for a long time. They were all male and young adults. The interval between the date of the accident and operation varied from six months to two years and six months. The interval after operation ranges from six months to two years and three months. In all fractures, almost complete bony union was seen three months after operation. They had no pains and the function of wrist improved before operation.
Dislocation of the scaphoid is very rare. The case presented here had a fracture of the triquetrum additionally. N. W. male. aged. 54 years, a worker, was injured on May. 22nd 1973. by belt conveyer. Radiographs showed that the scaphoid dislocated to the side of the capitate. Under general anesthesia, the scaphoid was reduced by forced ulnar deviation of the hand with digital pressure over the scaphoid.
Von 29 Fällen, wobei operative Osteosynthese zum Oberschenkelschaftbrüche in meiner Klinik vorgenommen wurden, wurden die Behandlungsergebnisse beforscht and betrachtet. Sogar bei Querbruch in Schaftmitte, die mit Küntschersche Nagel allein befriedigend die stabile Fixation erreichen kann, ist die Vereinigung in den meisten Fällen verzögert, da zu dünner Nagel angewandt worden war. An der Weite der Markhöhle, wurden die Brüche mit einer zusätzlichen Platte fixiert. Ebenso wurden die Brüche mit Ausbruch eines Biegungs oder Drehkeils mit einige zusätzlichen Drahtschlinge (nach Lambott) fixiert. Die Ergebnisse dieses beides sind nicht immer nachstehend. Meine operative Verfahren an den Oberschenkelschaftbrüche sind im Allgemeinen gegen die Theorie und die Technik von Küntscher. Meine Verfahren soll übergelegt werden um Resultat zu erheben.
This follow-up study was designed to investigate about the results of 34 patients which were suffered from the dislocated intra-articular os calsis fracture. Their age and period of treatment were from 24 years old to 73 years old, average 44 years old, and from I year to 10 years and 8 months, average 4 year, respectivily. Among 34 cases, 15 cases were treated by the operative reposition and 3 cases were treated by the wire traction, but remains were not treated any repositive procedure. Almost all cases which the adaptation of posterior talo-calcaneal joint surface wrer recovered completely, showed excellent results, but the results of insufficient cases were same comparing with the results of the group which was not treated by orthopaedic reposition. The Böhler angle showed the good indicator to judge the recovery of adaptation of the posterior talo-calcaneal joint surface except for depression type fracture. Comparing with the group not tried reposition, the group tried reposition showed markedly good results. This study suggested that the reduction of mobility of the talo-calcaneal joint caused to deteriorate the results and the period of fixation was better within 8 weeks.
We have performed synovectomy of the knee joints for about 50 cases and recently a follow up study was done in 19 cases. This report will be presented some radiologic changes after synovectomy of these 19 cases. The age of study group ranged from 5 to 66 and follow up period from 3 to 15 years. Original diseases of study group consisted of rheumatoid arthritis, osteoarthritis, pigmented villonodular synovitis, chronic synovitis, hemoangioma and tuberculosis. Radiologic findings used for check-up point and comparison in pre and post operation were rarefaction, periosteal elevation, narrowing of joint space, erosion, subchondral structural changes and spur formation. The results we obtained as followed; (1) Post operative radiologic changes were minimal in younger group and growth of bones were normally observed. (2) In cases showed the minor radiologic changes in preoperation, the less changes observed in post operation. (3) In cases of osteoarthritis, radiological changes increased gradually by aging but did not turn for the worse progressively by synovectomy.
Thirty-eight corrective osteotomies for varus and valgus deformities of the elbow caused by supracondylar and lateral condyle fracture of the humerus were carried out for the past 19 years. The mean age at the operation was 12 years and 6 months. Twenty-five cases were examined clinically and roentgenologically on an average of 7 years and 6 months after the operation. The authors concluded that there was no limited age indication for the osteotomy and the remaining carring angles within 5 degrees in varus and 10 degrees in valgus deformity were negligible for the satisfactory results.
The authors have evaluated the late results in 22 patients on whom arthroplasty of the elbow using the J-K Membrane had been performed during the year 1950 to 1969. An average of 14 years following operation, these patients had an average range of motion of 53 degrees with good stability and muscle strength. The end results among the group of patients whose ankylosis followed an infective arthritis were inferior to those among the group in rhematoid arthritis and trauma. Excellent results have been obtained among the patients who had undergone arthroplasty within a few years after the onset of ankylosis. The functional results, with few exceptions, showed little change after the first year following operation. Roentgenographycally, there was hypertrophy of the coronoid process in many instances.
Based on the clinical experience by Harrington Instrumentation techuique on twenty one cases with scoliosis deformites, a reconstructive surgery using Harrington Instrumentation was performed succesfully for three cases with spinal deformities due to spine and spinal cord injury, having secure reduction and immediate fixation. Case 1: 14 years old boy. Lumbosacral spondylolisthesis was reduced by two distraction rods and fused posteriorly. Case 2: 7 years old boy. Kyphotic collaps spine due to thoracic spinal cord injury was corrected by a pair of compression rods with posterior short fusion. Case 3: 32 years old woman. Dislocation of lumbar spine was reduced by using a distraction rod and sacral bar and fused posteriorly.
Spinal microangiography was performed at autopsy examinations on 6 dead cases of cervical cord injuries. The anterior radicular arteries, anterior spinal artery and vasa corona were well visualized. The penetrating branches of the pial arterial plexus or vasa corona were not demonstrated in some areas surrounding the injured site correspondingly to the degree of injury. Extravasations of the contrast media at the lesioned site can be experimentally observed soon after suffering the lesion. But in one case died 6 days after suffering, no figures of extravasation were obtained because the contrast media could not be filled due to the necrosis brought about in the destructed blood vessel. In the acute phase, vasomotor paralysis was seen and markedly edematous sites were very difficult to be present on microangiogram. In so far known cases, injured sites of the spinal cord and hemorrhagic necrosis and edematous necrosis were no visualized on microangiogram.
1) 50 cases of injuries of the thoracic and lumbar spine were reviewed and analysed radiologically. 2) These injuries at onset were clasifled into 4 types on an anatomical basis of the severity and the site of spinal damage. 3) The “functional” results were discussed according to the degree of “anatomical” deformity of the spine. 4) The results of wedge compression fractures are usually good with or without correction by the sling method if there is no severe malalignment of the spine. 5) Severe compression fracture, comminuted fracture and fracture-dislocation may be evaluated as a good result if intervertebral stability occurs or if alignment of the spine is not severely disturbed. 6) Spinal fusion is indicated for the unstable injuries with incorrigible severe malalignment of the spine. 7) Malalignment of the spine after treatment causes painin the lumbosacral region.
Out of 393 cases of low back pain with sciatica treated surgically, 55 (14%) cases were teenagers. Protruded discs were removed in 41 cases and caudal tumors in 3 cases, and in the remaining 11 cases no abnormal findings were found in the spinal canal. The results of operations were obtained in 40 cases, of which 36 cases (90%) showed satisfactory results, being far superior to those of cases treated conservatively.
28 cases of myelopathy, 61 cases of radiculopathy of cervical osteocondrosis and 93 cases of cervico-omo-brachialgia have been examined. In each case, the follow-up study on X-ray findings and clinical findings were performed. Agreement as to correlation between X-ray findings and clinical findings was 72% in myelopathy, 44% in radiculopathy and 47% in cervico-omo-brachialaia. Almost cases of myelopathy with narrowing spinal canal were became worse.
1. Examined seventy-seven normal subjects ranging from twenty to fifty years of age were classified as follows; twenties-22, thirties-20, forties-22, and fifties-13. 2. Radiographic studies of motion in the sagittal plane were made as the subjects fully flexed and extented the cervical spine. 3. The greatest range of motion of the cervical spine occurred at the C5-6 intervertebral space and the least one at the C2-3 in all cases and in each age group. 4. In the sagittal views a ratio of diameter of the spinal canal to each vertebral body was computed. There were no remarkable differences among the groups classified by age. 5. In seventy-seven cases the step-formation was noted at the C2-3 and C3-4 interspaces during flexion and at the C4-5 and C5-6 during extension.
Fifty-three patients with the radiculopathy of the cervical osteochondrosis have been checked up in our clinic. Sensory disturbance in the upper limb was noticed in twentysix of the patients and was divided into five types, which were the type of similar to the ulnar nerve, medial nerve, radial nerve, axillar nerve and brachial plexus lesions. The purpose of this paper is to describe the essential points of differencial diagnosis between the cervical osteochondrosis and the peripheral nerve lesions. The peripheral nerve lesion of the upper limb, which is sometimes confused with the cervical osteochondrosis in mild case, is not so difficult to diagnosis by having a familiarity with the diseases. Tests of inducing the symptoms is often necessary if the patients complain of a numb-feeling in the affected region. And nerve conduction test is useful to determine the site of an imcomplete lesion.
The cyst-like shadows are observed in 19 cases out of 823 cases of osteoarthritic knee joints roentgenographically. These cysts are located adjacent to the articular cartilage, most frequently in the medial femoral condyle and also in the medial tibial plateau. Such lesions are considered to be related to a increased stress through the closed side of the joint as in genu varus due to osteoarthritis. On histological examination of the 2 operated cases, the articular cartilage overlying the cyst is severely degenerated, and the inner wall of the cyst is lined by a thin layer of fibrous tissue containing both necrotic and newly-forming bone.
Past ten years, thirty-nine patients of osteoaritis of the hip were treated in our hospital. Twenty-three of the patients were followed for one year or longer after surgery, the longest follow up was 7 years, with an average follow up 3 years. The operation methods employed were osteotomy in 9 cases, arthrodesis in 2 cases, muscle release operation in 1 case, prosthesis replacement in 2 cases, cup mold arthroplasty in 1 case and total hip replacement in 9 cases. Evaluation by patients were as follows. “a” is 12 cases, “b” is 6 cases, “c” is 2 cases, and “d” is 3 cases.
Joint constituents from secondary osteoarthritis is not rarely known to be highly destroyed by the age of thirty to forty. However, the patients of total hip replacement, such as, that by Charnley' model, still preferably selected among the advanced age. Cup & socket arthroplasty was selectively done among the relatively younger age group from secondary osteoarthritis. Cup & socket arthroplasty is combined cup (mould) covered the femoral head with hip socket in the acetabulum. The original model of the cup (concentric type) and socket (Urist' hip socket) was modified by us at several times. As far as the clinical result is concerned, six cases at over six month following up period, can walk painlessly, but, range of motion is limited about two-third that of normal mobility. The probleme raises how long this cup and socket is durable.
Twenty-three mold arthroplasties in twenty-one patients with osteoarthritis or rheumatoid arthritis of the hip were done in our clinic. The results were evaluated by the criteria of the Japanese Orthopaedic Association for the osteoarthritis of the hip. In the osteoarthritis, the results were 55% excellent or good, 36% fair and 9% poor, In the rheumatoid arthritis 86% had relief of pain. 88% of the patients were satisfied with the result of the mold arthroplasty in their hips.
Case I: A woman of 37 years old, complained pain and swelling in the lesion of the left hip during five months. Roentgenogram revealed diffuse osteolytic lesion with pathological fracture in the upper end of the left femur. En bloc total excision of the tumor was performed and a specially designed prosthesis was inserted. Microscopic diagnosis was giant cell tumor. Range of movement of the left hip joint was almost normal 3 years later. Case II: A girl of 17 years old, was diagnosed as the diffuse giant cell tumor of the right femur. Two years after curettage and bonegrafting, the tumor recurred, and the same prosthesis as in Case I was inserted.