Several methods to produce experimental scoliosis such as osteolathyrism, internal wiring to keep scoliotic posture for several weeks, as well as multiple unilateral rib resection have been adopted, and in most cases scoliosis have been occured. In those cases of scoliosis made by rib resection, it was observed that the grade of the curvature ranged from 30° to 95° degree, as Langenskiöld and Michelson had already reported. A kind of small halo-pelvic distraction apparatus for experimental use was devised for the normal and scoliotic rats. Considerable correction of the spinal derormity has been obtained in those cases that the distraction force had been kept effectively for several weeks. By the force of 100 to 300 percent of body weight given between head and pelvis, it was observed, the rat spinal column had been markedly extended especially in the region of the cervical spine, and sometimes found a epiphyseolysis in thoracic and lumbar vertebra were found. Autopsy of the rat which died in early stage of distraction revealed an haemorrhagic ulcer of the stomach, adrenal hyperaemia and pneumonia. Angiographic and histological finding of the spine and spinal cord was discussed.
Case. C. M., a 39 year old house wife, was admitted to our hospital on July 18, 1973. During 10 months preceeding admission, she complained of gluteal pain radiating to the left thigh with a relapsing history. Myelography showed complete block at the 2nd lumbar vertebra level. Laminectomy was performed on August 1, 1973. The tumor, consisted of a single mass measuring 1 by 1.5 by 3 centimeters, was seen arising from a root of cauda equina localized at the level of 2nd lumbar segment. On histological examination, the tumor was proved to be malignant schwannoma. There was no reccurence in 10 months.
On January 4, 1974. a 30-year-old man was admitted to our hospital with sudden onset of paraplegia. He could take standing position but was not able to walk. The Laségue test was negative bilaterally. There was hyporeflexia of both the Achilles and patellar jerks and sensory disturbance (hypalgesia) located in the right anterior tibial region. The Qieckenstedt test was markedly positive and cerebrospinal fluid (CSF) protein content was 3000mg/dl. X-Ray findings showed narrowing of L2-3 vertebral interspace and a posterior spur formation of L2 vertebral body. Myelography showed a complete block at this level. A total laminectomy of L2 and L3 was carried out. At the L2-3 vertebral interspace, midline disc protrusion was found and removed. 30 days after surgery, he was allowed to get up and was able to walk normally. He could return the former job.
Cases of Pilonidal sinus in communicated with the spinal canal are rare and only a few cases have been reported in Japan. Our cases were infants and they have had Pilonidal sinus in the sacral region. Two cases had suffered hemiplegia or paraplegia developing with meningeal involvement signs. Since then two patients were hospitalized in the pediatric department and they had reffered to our clinic. After several days laminectomy and drainage were carried out, symptoms are being improved. We discussed the symptoms and course of these cases, additionally study on the reported literature were done.
In a series of 25 spinal cord tumors at our clinic, 3 meningiomas were found. Case I, a 38-year-old man was treated with the extirpation of the intradural-extramedullary tumor diagnosed as a meningotheliomatous meningioma at the level cisterna-C2. Case 2, a 49-year-old man was treated with the exstirpation of the intradural-extramedullary tumor diagnosed as a angioblastic meningioma at the level C1-C3. Case 3, a 51-year-old woman was treated with the extirpation of the intradural-extra-medullary tumor diagnosed as a psammomatous meningioma at the level Th11.
A male, aged fifty-six, had sustained a anterior dislocation of the 5th cervical vertebra with lock of unilateral articular process by falling down from the head. There had been no clinical evidence of cord injury except for the 6th cervical root involvement of the right arm. After 10 hours of closed reduction, patient begun to complain sever back pain and symptoms of cord pressure slowly developed untill he could no longer move his extremities. The examination of cerebrospinal fluid revealed complete spinal canal block. Surgical treatment was attempted after 65 hours of reduction. Protrusion of ruptured cervical disc between 5th and 6th was found and excised, and 5 months after anterior spinal fusion almost all neurological signs have disappeared.
Two cases of the post-pregnancy osteoporosis is reported. Case 1. A house-wife of thirty-two years complained of back pain two months after labour without appearent cause. Case 2. A female of twenty-five years felt a sudden sharp pain in the lumbar region on straightening up from a bending posture about two months after normal delivery. Both of our cases showed typical and severe osteoporosis radiographically. No remarkable changes was recognized on laboratory studies. Some benefits, paticulary in radiographycal and clinical sign, were obtained by pharmaceutical therapy such as calcitonin, calcium, vitamin D and anabolic hormone in both cases.
Four cases of rigid and severe Scoliosis and two Kyphoscoliosis treated by Halo-Pelvic Distraction Apparatus were reported. (11 to 25 years old) An average curve measured before application was 95° and an average correction achieved was 32°. Slight and temporal neurological complication and superficial infection of the pelvic pin insertion were experienced in 4 and 2 cases respectively. The former complication was recovered as soon as a distraction force was reduced and the later by short course of antibiotics. Two female patients, both 25 years old, who have rigid severe spinal curve of congenital origin required spinal osteotomy and release operation in the course of distraction and good correction were obtained by further distraction.
Many severe deformities of skull and spine in cerebral palsy are frequently found out, as many authors have reported. 112 cerebral palsed patients were discussed in this report about the various factors which probably related with these deformities, after we measured skull deformity; plagiocephaly, measured by our radiographic method, spine deformity; scoliosis, with Cobb's method. It was suggested that scoliosis in cerebral palsy was perhaps related with intrauterine duration, type of cerebral palsy and skull deformity. It was also suggested that the skull deformity was probably effected by the condition of palsy in each individuals and type of cerebral palsy.
The correlation between dynamogram and discogram in 150 cases was studied on the cases of 1) L3-4, L4-5 and L5-S; Normal Discs 2) L3-4, L4-5; Normal Discs L5-S; Pathological Disc 3) K3-4; Normal Disc L4-5, L5-S; Pathological Discs 4) L3-4, L5-S; Normal Discs L4-5; Pathological Disc The results were as follows; 1) In cases with L3-4, L4-5, L5-S Normal Discs, the mobility of discs tends to increase in order of L5-S, L4-5 and L3-4. 2) Both L4-5 and L5-S discs tend to decrease the mobility with the progress of degenerative processes, particularly in L5-S discs.
Discography is one of the diagnostic technique for the lumbar disc lesion. The correlation between discogram and pain response were investigated on 362 discs in 161 cases. The results were as follows; 1. Most of normal discs did not reveal pain response. On the other hand, most of pathological discs, particularly in anterior and posterior protrusion revealed pain response. 2. Pain response tend to decrease with the progression of degenerative processes of discs. Therefore, it is important to evaluate the discogram itself and its pain response for the diagnosis of lumbar disc lesion.
1. Myelograms of the cervical cord injuries without damage to the vertebral column were analyzed and classified into five types due to the degree and the characteristics of its defect. 2. Relationship between myelograms and neurological types, and also factors causing cord lesions, i, e. disc rupture and protrusion, posterior spur, ossification of the longitudinal ligament and stenosis of the cervical canal, was discussed. 3. Cervical myelogram differs from the size of osteochondrotic rige and infolded ligamentum flavum, and the width of the cervical canal. 4. Cervical myelogram reflects and reveals the circumstances of the cord involved, therefore, cervical myelography is a useful procesure to diagnose the levels involved and decide to treat the case of cord injury without findings on the plain x-ray film either conservatively or operatively.
The spinal nerve stimulation in the spinal column injury are mainly classified the following three groups. (1) Injury of spinal cord by fracture and dislocation. (2) Compression of the nerve root (ventral root) by herniation of intervertebral disk. (3) Compression of the nerve root (mainly dorsal root) in narrowed foramen by intervertebral joint subluxation. The realities for the third matter are not clear as the former two. I thought that the realities are first revealed by cheiropractic. Segmental diagnosis of pain and numbness is explained by this treatment of pain. In the report I refer to adaptation of cheiropractic and intend to unify theoretically various treatments for pain.
In the seven-year period from 1967 through 1973, there were thirteen patients with the injury of the upper portion of the cervical spine treated in the Department of Orthopedic Surgery, Kyushu University and Kyushu Rosai Hospital. There is no diagnostic clinical syndrome of the injury of the upper portion of the cervical spine. Usually the immediate pain in severe, and is often referred into the occipital region of the scalp. The pain is accentuated by any attempt to move the head. The commonest neurological complication seen in the survivors of this injury is damage to the greater occipital nerve, giving the reffered pain in the occiput.
Four patients with the congenital atlanto-axial dislocation or basilar impresion were received the decompression and the occipito vertebral fusion. These patients have either or both of the neurological and circulatory disturbance. Two patients were recieved the decompression and the posterior fusion with the bone graft and wiring. Other two patients were received the decompression and the posterior fusion with the bone graft, wiring and acrylic fixation. One of these patients was failed because of the absorption of bone graft and the rupture of wiring, but others showed good fixation.
62 cases of cervical disorders were operated on by anterior or posterior approach. These cervical disorders were myelopathy and radiculopathy with cervical spondylosis, disc herniation, fracture-dislocation, calcification of the posterior longitudinal ligament, angulation myelopathy after laminectomy and spinal arachnoiditis. [Results] In the cervical spondylotic myelopathy, as the duration of symptoms prior to surgery elapsed longer than 2 years, the results of operation were worse. In disc herniation and fracture-dislocation which were operated by anterior approach, the results were better. The cephalo-caudal extent of laminectomy was carried out from C2 or C3 to C6 or C7, and facetectomy was extented about 5mm laterally into the neural foramina. The sensation of numbness or paresthesia remained relatively unimproved.
70 cases of Lumbar Spinal Canal Stenosis were operated on for past 2 years. Clinical and roentgenographic investigations were performed about 43 cases of these operative cases and histological examinations of lig. flavum were performed about 9 cases. [Results] 1. Most of cases were from 40 to 69 years old. As the operative findings, there were hyperplasia of lig. flavum at 82%. 2. The measurement of canal to body ratio revealed 1: 4.0 in lumbar stenosis. 3. Histological findings of ligament flavum revealed calcification in 7 cases. Calcification was seen in connective tissue. The elastic fiber obviously revealed degenerative changes.
Long term follow up study of spondylolisthesis without isthmus defect in our clinic (37 cases) have led to the following conclusion. 1. Poor clinical results have been obtaind in a half of our cases and most of cases treated conservatively. 2. Surgical treatment seems to be indicated when conservative treatment is not effective in these poor clinical results. 3. In most cases, there were narrowing of disc and intervertebral joint between the displaced vertebra and lower next vertebra. 4. Correlation was not clear between clinical symptome and radiological findings.
A consecutive series of 41 patients with unstable lumbo-sacral spine (spondylolysis, spondylolisthesis, disc lesion et al.) treated by a technique of posterolateral fusion resulted in a high percentage of good roentgenographic and clinical results. Twenty-nine patients were male, and twelve were female (15-50 years). The longest term follow-up was 3 years, and the shortest was ten months, the average being one year and six months. Solid union occured in 90 per cent for fusion of single intervertebral joint roentgenographicly, but only 62 per cent for two or more levels. However, a good clinical result was achieved in 83 per cent.
14 cases of clatilagious bone tumor (5 enchondroma, a benign chondroblastoma, 3 chondromyxoid fibroma and 5 chondrosarcoma) were tried to differentiate by the cytological diagnostic procedure. More than 15 smears per one cases were prepared, and at least 5 were stained by May-Grünwald and Giemsa's method which gave us the most reliable morphological picture. The residual smears were reserved for additional special stains, such as PAS, sudan III, alkaline phosphatase and acid phosphatase. Besides morphological details, appreciatable items for the differential diagnosis among each tumors were 1) difference in staining intensity of materials, 2) grade of exfoliation of tumor cells, 3) extracellular substance, 4) cytoplasmic component, and 5) characteristic grouping of tumor cells. Generally, non-epithelial tumor cell show variegated forms and some benign, caltilagious tumors such as chondromyxoid fibroma and benign chondroblastoma have mimic signs to cancer cells, but such tumors are rather easily distinguished from their own characteristic cytologic pictures.
A nineteen-year-old girl was admitted with complaint of severe low back pain referred to the left leg. Roentgenograms revealed irregular lytic destruction of pedicle of the 5th lumbar vertebra and multiple punched out areas in the skull and both iliac bones. The spinal posterior fusion was carried out following curettage and the lesion was diagnosed histologically as eosinophilic granuloma. Four months after the operation she was able to return to previous occupation.
A man, 64-year-old, with the chief complaint of complete paraplegia was operated on laminectomy followed by the death one month after surgery. Preoperative x-ray examination revealed irregular compression and disappearance of left vertebral arch, during operation almost complete disappearance of left vertebral arch of Th8 replaced by tumorous tissue was observed. On autopsy revealed an enlarged liver with cirrhosis Tumorous metastases were found in lung, spleen, sternum, rib, ilium and spinal column. Histologically the diagnosis of mature hepatoma, consisted of the cells resembling liver cells was ascertained.
The chondrosarcoma of short tublar bone is very rare. We have recently experienced the chondrosarcoma in the proximal of thumb. A female, aged 77 years, had continuous pain and swelling in the first proximal thumb for a six monthes and year period while. The radiograph reveald the significant osteolytic lesion. After the disarticulation of the carpo-metacarpal joint, this tumor was diagnosed as chondrosarcoma on microscopic examination. Postoperative course was very satisfactory.
One case of Nodular tenosynovitis in the ankle region was reported. Nodular tenosynovitis, in the great majority of the cases, the lesion is to be observed in the fingers. Sometimes the lesion is found at the ankle. In Japan, 5 cases has been reported at the ankle past ten years. Man, thirty years old, noticed the mass of the right ankle region since August 1969. The mass which gradually developed, was surgically removed on July 1973. Since operation the patient has remained free from Symptoms. Histological examination confirmed the diagnosis of pigmented villonodular Synovitis.
This patient is 67-year-old man, had a open fracture of the right femur at a battlefield, 1938. Afterward he had osteomyelitis, which revised two times. He visited our clinic complaining pain and tumor on his right medial thigh, 1 year ago. We diagnosed as recrudescence of osteomyelitis and gave antibiotics, but the tumor grew larger sige, we excised it. Microscopic section of the specimen showed malignant hemangioendothelioma.
5 cases, especially malignant, among bone tumors treated during the last 3 years. CASE 1. -A woman aged 73, tumor of the illiac bone, histological diagnosis, liposarcoma. CASE 2. -A man aged 61, tumor of the right elbow joint, histological diagnosis, synovialsarcoma. CASE 3. -A man aged 16, tumor of the left femur, histological diagnosis, osteosarcoma. CASE 4. -A man aged 41, metastatic tumor of the both tibia, histological diagnosis, malignant melanoma. CASE 5. -A man aged 60, tumor of the 5, 6 and 7th thoracic vertebra, and 6 and 7th rib, histological diagnosis, chondrosarcoma. For any treatment had done to the these cases, prognosis was very poor.
Eighty-five cases with secondary malignant disease of bone were reviewed to confirm their primary source. Primary source was fairly easily detected in 50 cases of patients with known malignant disease in their histories. Difficulty arised when a bone lesion was detected clinically and radiologically, but no primary source was known. Many kinds of investigation were performed to discover the primary lesion; scanning with radio-isotope in 9 cases, bone biopsy in 9 cases, organ biopsy in 6 cases and necropsy in 3 cases. As the result, the primary lesion was confirmed in 59 cases, but remained unknown in 26 cases.
The volume doubling time and tumor duration time of pulmonary metastatic nodules in our fifteen cases of osteosarcoma were calculated by Collins' chart and Wollin's formula. Results were as follows. 1. The volume doubling time of osteosclerosing osteosarcoma was generally longer than that of osteolytic osteosarcoma. 2. The chemotherapy for pulmonary metastases prolonged their volume doubling time remarkably. 3. The tumor duration time was ranged from 0.86 to 8.15 years (average 3.32 years). It was suggested that the metastasis of osteosarcoma to the lung might be 2.7 years in average prior to the onset of symptoms of primary lesion. 4. Regarding the growth rate of pulmonary metastases of our cases, the Collins' hypothesis seemed to be considerably acceptable.
Different types of spondyloepiphyseal dysplasia were reported. Case 1. A 14-year-old girl whose parents were psychosis was a dwarfism (height 95.5cm.) with kyphoscoliosis, marked-lumbar lordosis and myopia. X-rays revealed marked coxa vara, knock knees and tongue-like deformity of the eleventh thoracic vertebral body. Laboratory tests showed no excretion of keratan sulfate in urine. Case 2. A 8-year-old girl whose parents were blood relative had showed initially abnormal gait and knock knees in the third year of life. She was a dwarfism (height 102cm.) with pigeon chest and corneal clouding, and her X-rays showed generalized platyspondyly, coxa valga and underdeveloped carpal bones. Keratan sulfate was found in urine. The case 1. was diagnosed as Spondyloepiphyseal dysplasia congenita and the case 2. as Morquio's disease.
The patient is a 68-year-old female. For the past five years, she has suffered her left ulnar, left femoral, right tibial, and fibular fractures for the cause of minor trauma, for example, after she pushed up herself on the one side with an arm, or after she crossed her legs for bed-making. Looser's line was found out at her left ulna, right tibia, fibulas, and at the bilateral ribs. The treatment was done with Vitamine D. A little dose of it had no effect, did much and continuous medication.
Four patients with arthrogryposis multiplex congenita were treated in our clinic. There is a very high incidence of recurrence of deformity at the ankle and foot after correction by manuplation, cast and brace. In two cases softtissue release operation was performed, but there was tendecy to relapse later. So talectomy was done in these cases in order to obtain the well aligned and stable joints. It was concluded that talectomy had a useful place in the mangement of severe and rigid equinovarus deformity without recurrece, although follow-up period was short at present.
During from January 1970 to March 1974, 3190 infants were born in the Obstetric Unit of National Kurume Hospital. All newborn babies have been routinely examined by Ortolani's technique, and Barlow or Palmén's provocation test within the first week of life. This test was positive in the 4 cases (male 0, female 4) were treated with Pavlik's band and Hanausek's apparatus. The questionnairing was conducted on other infants. In 1037 infants, 16 cases of acetabular dysplasia and 8 cases luxation (0.77%) were fonud.
The Luxation Bandage treatment was done to 30 cases with lateralisation of femoral head after the treatment of the congenital dislocation of hip since 1967. The brace has pelvic band, thigh cuff, free hip joint and a pad which compresses the greater trochanter. With this pad, reduction of the dislocated head is expected and centralization of the head into the acetabulum is maintained functionally during walk. A twister for internal rotation of the femur is attached for the case with marked anteversion of the neck of the femur. Of the 33 joints in 30 cases, 32 joints revealed satisfactoric result with this Luxation Bandage treatment.
A 57 years old housewife appeared at first on January 13, 1974, complaining of deformity of the right toes, ulceration of the right sole, tumor of the right knee, and hypesthesia on burn of the right hand since 29 years old. At the age of 39, ulceration of the right sole and left sole appeared. At the age of 52, amputation of the left lower leg was performed, and deformity of the left toes were appeared. Roentgenogram of the bones were characteristic. They were as follows: 1) osteolysis of the first metatarsal bone 2) osteolysis of the first, second and fifth proximal pharangeal bones. 3) Hypertrophy and deformity of the fifthmetatarsal bone 4) osteophyte of the spine (dorsal vertebra). Sensory disturbance of the lower legs and right forearm were proved, but sensory dissociation were not proved. The results of the routine laboratory tests remained within normal, and leprosy bacillus were not proved.
X-ray examination of the cervical spine were performed on twenty-one hospitalized patients and fourty-two ambulatory patients complaining of neck pains with rheumatoid arthritis. Abnormal atlanto-odontoid separation was found in twenty-four patients and pseudo-basilar impression in thirteen. One of them showed maximum upward transposition of the dens of 10mm above Macgregor's baseline. In addition subluxation of subaxial levels, endoplate erosions and erosions of apophyseal joint were found frequently at the level of C2-3 to C4-5. Atlantoaxial posterior fusion by R. W. McGraw was carried out on a case suffering from severe occipital pain and trigeminal neuralgia associated with sublu xation of the atlano-axial joint on March 15 1974. Three months after operation she had relieved of occipital pain and hyperalgesia on limb and trunk.
It is noted that the therapy with the immunosuppressive drug is effective for rheumatoid arthritis. However, there are no definite indications of immunosuppressive drug and it's use. Cyclophosphamide and chelate preparations were used for 16 patients with classical rheumatoid arthritis which have had no effect by the treatment of the other anti-rheumatic drugs and chrysotherapy. Out of 10 patients which cyclophosphamide was given for six months or more, 4 patients were effective and 6 patients were no change or exercerbate. Out of 6 patients which chelat epreparation was given, 2 patients were effective and 4 patients were no change or exercerbate.
12 rats were compressed on 5kg/cm2 and were allowed to remain at this pressure for 4 hours and then decompressed. This experiment continued for 6 months repeatedly. Histopathological findings showed that occasional necrosis of chondrocytes in the deep layer of the articular cartilage of the humerus and femur were seen. Rough surface of a superficial layer of the articular cartilage were seen. Scattered necrosis of osteocytes in the shaft were found. Necrotic chondrocytes in the deep layer and necrotic osteocytes in the shaft did not show any positive histochemical reaction for LDH, MDH, SDH and NADHDH.
Bone blood circulation was studied by measuring intraosseous pressure experimentally and clinically. The following results were obtained. 1. Intraosseous pressure was determined by correlations between the rate of inflow and outflow. 2. The range of the variations of individual intraosseous pressure was very wide, and there were no correlations between carotid artery pressure and intraosseous pressure. 3. In some diseases of the hip, intraosseous pressure in the femoral head was consistently higher than that in the femoral neck. 4. In intraosseous pressure in necrotic area of the femoral head of the adults, pulsative waves were not found, but in the head of Perthes disease pulsative waves were always observed.
A method is described for producing a slowly progressing osteoarthritis-like condition and permitting examination of even the earliest phases of degeneration of the articular cartilage in rabbit knee joints. The method consists of making the joint unstable by surgical procedure; this produces a lesion of the same type as found in human osteoarthritis. Degenerative changes produced was examined photomicrographically and electromicrogr-aphically.
Ultrasonic imaging technique has advanced as important clinical examination for diagnosis of pathological processes within soft tissues. In this paper, significance of ultrasonic diagnosis of orthopedic diseases was discussed in comparison with clinical, radiological and pathological findings. The cases include benign or malignant tumor, tumorous condition, cyst, swelling and abscess in soft part, and additionally bone tumors. These tumors were scannd two-dimensionally with compound ultrasonic equipment. Sonic frequency is 2.25MHz. Ultrasonic displays of benign conditions were imaged as homologous transparent structure with clearly defined contour. In malignant tumors, multiple sonic reflection which showed abrupt linear pattern or spotted one were presented antithetically to benign conditions. These benign and malignant echo patterns were closedly analogous to tumor section and the finding at operation. Ultrasonotomographic displays received from different pathological processes give more useful diagnostic information in soft tissue diseases than that in bone tumors. On the other hand, ultrasonic visualisation of bone tumor enclosed in osseous structure does not prevail the roentgen diagnosis.
Thermography is a diagnostic method used to detect infrared radiation from the body. Increased infrared emission may be due to increased blood flow from infection, trauma, surperficial collateral circulation around a blocked artery or vein, or an underlying thrombophlebitis. Recently we used JTG-MA thermoviewer for 159 cases of orthopedic disorders. In the inflammation, peripheral nerve lesions and vascular disorders, the thermograms showed increased warmth over the lesions well. However, in the autonomic nerve symptoms of the spinal disorders, thermograms at rest condition were positive in 1/3 cases, and at cold and ischemic condition, positive in 2/3 cases.
We have many patients with C. P and spinal cord injury who can not walk alone and using wheelchairs. Wheelchairs are apt to make contractures of hip and knee joints. The other way, hand propelled tilting prone boards are not only valuable for daily living but also privent deformities as well as correct contractures. Now, we developed a new prone board conbination wheelchair, which is easily changeable each other quickly and securely. When we change the unit from wheelchair to a prone board, lift the lever behind the chair, then the backrest falls down and the leg-rest arises simultaneusly. After fully recline the back, ajust the caster alignment.
It has been generally accepted that the osteotomy corrects the varus or valgus deformity of the knee and the elbow joint for relief from pain. The technique which removes wedgewidely the bone at the proximal tibia or distal humerus has been usually available for correction. We tried a new modified technique to correct the deformity by the Z like frontal osteotomy and the following results were obtained. The results of this technique were excellent in the case of osteoarthritis of the knee joint. Contrary to the wedge osteotomy, this procedure could be done very easily with firm internal fixation. The bone union was accomplisshed quickly because of the wide osteotomized surface and the sufficient correction could be achieved near the joint surface. In the elbow joints, the step-formation on which was made on the osteotomized level was not found by this procedure. Some problems to be improved in this new modified technique were still remained. How is it done, for example, safer and firmer for the internal fixation?
Myositis assificans traumatica is the localized formation of heterotopic, non-neoplastic bone or cartilage that results from physical trauma and usually occurs in or adjacent to muscle and in proximity to bone. The pathogenesis is not perfectly understood. We have experienced a case occured in right brachialis muscle and absorbed by application of microwave alone.
The cases with contracture of the joints from muscle shortening are presented in this report. 1) Six children: Extension contracture of the knee from shortening of quadriceps muscle. a) 4 cases are operated with the method of tenotomy or Z-lengthening of rectus femoris. b) Conservative treatment was done in a case with successful result. 2) Two cases: Abduction contracture of the shoulder from shortening of the intermediate part of the deltoid. Removal of the fibrous intermediate part of the deltoid was successful in an adult female, the other case was treated conservatively by the method with moist heat and R. O. M. Ex.. 3) A case with extension contracture of the hip from shortening of gluteus maximus was also treated by removal of fibrous part in the muscle. 4) Two cases, one is the contracture of quadriceps and the other contracture of sartorius are under the consideration of surgical procedure.
It may be difficult to differenciate between neurogenic and myogenic disorders by means of a clinical examination. Our biopsies have been taken from twenty one cases with neuromuscular disorder during ten years. Especially we discussed on electromyograms and histological changes occurring in the affected muscles of the patient with Charcot-Marie-Tooth's disease or polymyositis.
A clinical and electro-diagnostic examination was made in thirty-two cases of tardy ulnar neuritis, and the result of medical treatment was investigated in twenty-six cases after surgery. On the other hand, using the experimental constricting sciatic nerves of rabbits, the authors made a scanning electron microscopic study of the mechanism of paralysis of tardy ulnar neuritis and related syndromes. Above mentioned studies lead to the following conclusion: If paralysis is long-standing and serious, decompression fails to relieve the symptoms completely. Thereby, in the early stage of compression, surgical decompression such as division of the band of fibrous tissue bridging the two heads of M. flexor carpi ulnaris (so-called neurolysis) or excision of the medial epicondyle becomes mandatory.
From the resting position, the movements of flexion, extension and abduction of the shoulder joint were performed. The muscles tested were the trapezius, deltoideus, pectoralis major, coracobrachialis, latissimus dorsi, and biceps brachii muscles. The electromyography and joint movement were recorded simultaneously using a FM data recorder. The regression line of electromyogram on joint movement was plotted with a computer, and the coefficient of regression of electromyogram on joint movement was computed. The regression lines were clasified into six types according to the electromyograms of the beginning and the end of the movements.
A. S., a woman, aged twenty years, has had recurrent shoulder joint dislocation due to joint laxity, since eleven years of her age. Many kinds of operation were performed with unsuccesseful results. Thereafter, dislocation occurred repeatedly on both the hips, the kness and the mandibular joints. She was diagnosed as arthrocharasis multiplex congenita and was treated by some kinds of medicament but they were not effective. After her admission into our hospital, recurrent dislocation of the right scapula was found. With snapping sounds it was able to be reduced, but neither deformity of the scapula nor paresis of the muscles was found. Presumably, it would be due to hyperlaxity of the muscles.
This paper reports a study of 95 fractures of the clavicle in adult treated at Kyushu Rosai Hospital during the 8 years from 1966 to 1973. Among 95 cases, fractures of the outer end of the claricle were 24 cases, body were 70 cases and inner end was 1 case. The results were as follows. (1) Of 24 cases of outer end fracture, non union occured in 4 cases. (16%) (2) Of 56 cases of body fracture, non union occured in 9 cases. (16%) (3) Of 1 cases of inner end fracture, non union didn't occur. (0%)