Postoperative results were discussed in a series of 34 patients with lumbar spinal stenosis, treated by surgical procedure. Although most of them showed no evidence of remarkable neurological deficits, their chief complaints were low back pain, sensation of tingling on the legs, sciatics and intermittent claudication. Continuous priapismus and decbital sore in two cases were reported respectively. Decompressive laminectomy and facetectomy were effective for the relief of these symptoms. The diagnosis of lumbar spinal stenosis is usually suggested by the patient's symptoms but it can be determined by myelography.
In the lumbar disc herniations, the case of the canal mice that the nucleus runs into the spinal canal or into the intervertebral foramen is very rare. We reported the case of a man of 23 year-old who developed suddunly the paralysis of bilateral lower extremities after he sat coughing in a chair. And he recovered enough to walk by himself by the decompression's operation. In this case, the nucleus that starts at IV/V lumbar intervertebral disc runs into the height of the middle part of III lumbar vertebral body. And extripated uncleus was about 6×2 cm and 1.5g. And its histological finding was the fibrous cartilage. In this case, it is important that we differentiate fully the metastatic carcinoma, the tumor, the obstruction of anterior spinal artery and the malformation of spinal vessels. We can expect good prognosis by making a precise diagnosis by liquor, myelogram and discogram and also by operating the removal and decompression early.
Lumbar disc herniation is frequent disease. Of these diseases the herniation which compress many cauda equina is very rare. Recently we have experienced 3 cases of these herniations. Case 1. A forty-nine years old man was admitted with inability to extend lumbar region and walk because of pain and numbness of both legs. Case 2, A thirty-eight years old man was admitted with severe low back pain and inability to walk because of both leg pains. Case 3. A Forty-three years old man was admitted with urinary retention and inability to walk because of both leg pains. In 3 cases myelogram revealed the complete block at the disc lesion level and operation findings revealed the central massive protrusion.
Posterolateral fusion of the lumbar spine was performed on forty patients in a period from May 1971 to February 1975. A follow-up study of clinical and roentgenographic findings were conducted on 25 cases for one to four years following the surgery. This study revealed that solid fusion was attained in 20 cases, or 80per cent, and pseudoarthrosis in five cases, or 20per cent. As far as Kono's clinical evaluation is concerned, the result was satisfactory in 80per cent of solid fusion group, but unsatisfactory in 20per cent in spite of solid fusion. Needless to say, clinical result of pseudoarthrosis was unsatisfactory in 80per cent.
The authors investigated twelve cases of recurrent dislocation of the Shoulder for recent ten years. Among these cases, eleven cases were anterior dislocation and one case was posterior dislocation of the shoulder. Anterior dislocation were treated with bone block operation (Bristow-McMurray method: 6 cases and Oudard-Jinnaka method: 5 cases). Posterior dislocation was treated with modified Boyd's method, that is to say, posterior transfer of the biceps long tendon, posterior bone block method and overlapping suture of the infraspinatus muscle. The results of the treatment were satisfactory.
Radiation necrosis of the femoral neck in the postirradiated carcinoma of the cervix is well known. But, Radionecrosis of the iliac bone is rare. We have recently experienced a case. A woman, forty-six years old, had the treatment of irradiation for the carcinoma of the cervix, eight years ago. In January 1975, she noticed the pain in the left leg. Roentgenogram of the pelvis showed the fine sclerosis, fanning into the left ilium from the sacroiliac joint. After seven months from the onset of the pain, it showed the oblique fracture in the left iliac wing. Following the concervative therapy for four months, osteosynthesis of the iliac wing was done, when the callus formation of the lesion was seen. The patient was crutch-walking four months after.
Among our 34 hightibial osteotomy cases, We make a follow up survey of 24 cases, extending, on an average, 2 years 5 months, with special emphasis on cases with poor results and unsettled evaluation. Results 1) While patients gained pot-soperatively suitable correction show always the good results, patients with ober- and under correction, and post-operative complication, have a strong tendency to poor prognosis. 2) There are some cases which are subject to various unsettled post-operative evaluation year after year, so that the long-term observation of the post-operatve course is necessary. 3) Cases with sub-luxution have rather the indication to Prosthesis Replacement.
Macroscopic observations were made upon 61 hip and 104 knee joints. Two types of change were found. One was the change, in which the articular surface was smooth and had thin, translucent appearance as it were worn out. The other was localized degenerative change. The changes had their characteristic localization in the hip joint respectively. In the weight-bearing area of the femoral condyles, the degenerative changes were found more frequently in the medial side than in the lateral side. On the tibial surface under the posterior horn of the lateral menisci was found a characteristic change in about 1/3 cases.
Experimentally, an electrical, wide open synovectomy, using a ring-formed electrode analogous to the loop of electric resectoscope, was performed for the rabbit knee joints, in which experimental arthritis was induced by oval albumin. No specific abnormal finding was revealed systematically as well as locally particulary due to the electrical synovectomy. Pathological findings in the synovium and cartilage were compared between the group of the rabbits which were injected 1% osmic acid into the joint preoperatively and of control. There seemed to be a tendency that synovial regeneration was slightly retarded in the process of repair up to six week in the knee joints in which 1% osmic acid was injected preoperatively. However, there is no apparent discrepancy between the findings after that, small suprapatellar pouch is formed around the six week and the regenerated lining cell appeared in both groups up to the twelfth week. Degenerative change of the cartilage appeared apparently in both groups up to the fourth week after surgery and the formation of the pannus and invassion of granulation tissue into the osseous tissue were observed as well.
Many inveseigators have made efforts to produce a model arthritis, which is consistently reproducible in animals, with the aim at further investigation into the pathogenesis of osteoarthritis. We have challenged to produce the ostearthritic conditions by making unstable joints in rabbit knees with surgical procedure. Degenerative changes were studied not only histochemically but also utilizing the cryoscanning E. M. and T. E. M. and were reported for the past two times. On this occation, we have compared the findings of the experimental osteoarthritic cartilage, five to seven weeks postoperatively, with those of human osteoarthritic cartilage. Some similarities; i. e, the characteristic features of osteoarthritis namely fibrillation, and fissuring of articular cartilage with loss of acid mucopolysaccharide stainning were observed in both of them.
Gait pattern could be evaluated with a simple method consisted of the popular clinical equipments, such as clinical E. M. G. kit, electrogoniometer and telemeter system. Obvious differences between healthy men and hemiplegia patients were observed. These results strongly suggested that the method might be convenient and clinically useful. This paper was described about the method and the results.
We studied on the relation between primitive reflexes and motor development by means of taking movie. Primitive reflexes (Moro reflex, Asymmetrical tonic neck reflex, Crossed extension reflex. Babinshi reflex ete) activate all kinds of automatic movement integrated by higher brainstem, and furthermore these reflexes activate development of righting reaction, parachute reaction, balance reaction and voluntarity. Namely, primitive reflexes activate mainly automatic movement but these reflexes exert too promotive influence on the development in the early stage learning anti-gravitic posture and normal sensori-motor pattern in each motordevelopmental stage.
The incidence of the dislocation of the hip in cerebral palsy was reported by some authors, from 2.3per cent to 23per cent, and higher than in congenital dislocation of the hip. But the dislocation of the hip is rare in cerebral palsed infants and increased in childhood. Shaft-neck angle and anteversion of the femur were investigated in 151 cerebral palsed infants used the Rippstein method. The value of the Rippstein was satisfactory in hip screening in cerebral palsy. The results were follows: 1. Shaft-neck angle and femoral anteversion were large in cerebral palsy. 2. Increased femoral anteversion and decreased CE angle were observed in hip adductor contractured cases. 3. No marked differences was obtained in typing studies. 4. Shaft-neck angle was decreased in walking infants. 5. Growth alterations in the hemiplegic infants were examimed in 34 cases. Femoral anteversion was large in affected side. CE angle was large in unaffected or less in affected side. No clear differences was obtained in shaft-neck angle.
Since January 1972 it has become a routine to take roentgenograms of hip joints at the check-up examination of the babies three months after their birth. This report is the result of roentgenographic study on those 675 babies. Of 1200 babies who were examined as the newborns, 1116 came for check-up one month later, 93per cent, and only 675, or 56per cent, returned at the end of third month. There were 19 babies, 2.8per cent, including 7 boys and 12 girls who had clinical diagnosis of restricted flexion and abduction in mild degree without demonstrable roentgenographic abnormality. Dysplasia of the acetabulum was found in 32 babies, or 4.7per cent, including 4 boys and 28 girls, although 21 babies, or 3.1per cent did not present any clinical findings until the examination at the end of the third months. Dislocation was found in 5 cases, or 0.7per cent. Nine dysplasia cases and five dislocation cases had to wear RB apparates, all female babies. Of those RB-wearing babies, 14 in total consisting 2.1per cent, two cases, 0.3per cent, were diagnosed on roentgenograms without clinical symptoms, one was dislocation and another dysplasia of the acetabulum.
1. 538 joints of congenital dislocation of the hip were treated with Riemenbügel (Pavlik splint) between 1967 and 1971 in our clinic. Out of this sereis, 270 joints (123 dilocation, 147 dysplasia) were clinically and radiographically evaluated. Follow-up study covers average of 3 years and 11 months. 2. Of the 123 joints of dislocation, we obtained 78% (96 joints) excellent and good result, of the 147 joints of dysplasia, we obtained 95% (139-joints) excellent, good result. 3. We obtained 61 joints (49 dislocation, 12 displasia) of lateralization of femoral head after the treatment of congenital hip dislocation. Most of this lateralisation occured within 3-months after removal of Riemenbügel, and improved spontaneously within 5-6 months after occurence. In the case of clinical and experimental study, we suggest that major fatter of lateralization of congenital hip dislocation is contracture of the iliopsoas muscle which was forcefelly extended.
Fifty-four unreduced congenital dislocation of the hip in 45 infancies treated with Pavlik's bandage were treated during 1967 to 1972. Nine hips were treated by open reduction and the remaining were treated by Lorenz's method, combination of Lorenz's method and Pavlik's bandage, or other conservative methods. The follow-up results of 48 hips after 1 to 6 years showed anatomical healing in the 35 hips (73.0%), The causes of unsatisfactory results were considered to be mainly too long application of Pavlik's bandage to the unreduced hips.
Hanausek's apparatus (1942) was used as a conservative functional treatment for congenital dislocation of the hip from 1972. The advantages of this method are thought as follows: 1. The infants from 3 monthes to 3years of age can be indicated. 2. Mechanical reduction and stable retention are achieved without troubles to the femoral epiphysis. 3. The apparatus can be indicated to the cases unsuccessfully treated with Pavlik's bandage. 4. The apparatus can be easily used to the postoperative cases. 5. The method is hygienic because the treatment can be performed without plaster spica.
Two cases are brothers and their parents are consanguineous marriages. An early symptom was muscle weakness and atrophy in lower extremities. Muscle atrophy was involved symmetric and progressive. Deformities showed pes equinovarus and hallux valgus. Proximal muscles of upper and lower extremities have maintained muscle powers relatively. There were hypoactivity of deep tendon reflexes, no pathologicreflexes and normal sensory. One case was recognized fasciculation. Electromyography showed neurogenic pattern. Biopsy showed mixed type with neurogenic and myogenic degeneration. Conduction velocity of moter and sensory fibers in ulnar nerve delayed markedly. Digital plethysmography showed plateau wave with distal circulatory disturbance. There were normal of urine and blood examinations.
The clinical feature of the anterior tibial syndrome has been well known. It's chronic type was initially reported by Mayor in 1956. It is less known that the mascles of the deep crural compartment may be affected in a similar way: only eleven cases have reported by Puranen in 1974. He called the condition caused of chronic athletic injury as the Medial Tibial Syndrome. We have made the field study of this condition among high school students and founded that main complaint of questionable cases was pain over the inner border of the tibia. The incidence of the condition was 0.07%: six cases (eight legs) in 9015 students. The pain may be so sever as to make training impossible. Clinical and laboratory examination of these cases were free. Though the pathogenesis is not perfectly understood, it seemed to us that main facters have been local ischemia and traction periostitis secondary to exercise. We experienced one cases which was operated (decompression fasciotomy as described by Puranen), and was obtained in good result. The other cases are scheduled to be followed.
The patient is a 6-month-old boy with restricted adduction of hip joint on both sides. Division of the ilio-tibial tract and of the lateral intermuscular septum was performed on the right side, but no surgical intervention was attempted on the left joint. After one and a half year of follow-up, there is no difference of function found found between the right and the left hip joints, both having 25 degrees of adduction and presenting normal posture in walking.
The curve pattern response of idiopathic scoliosis during the treatment of Milwaukee Brace were discussed. Three types of the curve pattern responese, from single major curve to double structural curves, from single major curve to single major curve and from double major curves to double major curves, were mainly seen. Im 24 cases, initialy diagnosed single major curve, 11 cases were considered to be double structural curves in the final assesment and in the cases with thoracic major curve, the lumbar compensatory curve was apt to become into the structural one. Correction rate, Age-at-onset and Development of iliac apophysis at the start of the treatment were discussed.