First rib resection for thoracic outlet syndrome had been performed on 35 cases (29 patients) for 4 years (Jan. 1972-Dec. 1975). In this report we analyzed the postoperative clinical status in 27 cases (22 patients) of these patients who were able to be followed up. Synthetic evaluation are classified as excellent 11 cases (41%), good 9 (33), fair 5 (19) and poor 2 (7). Subjective symptoms of upper limbs seem to improve more than that of scapular regions. Improvement of vascular signs was observed highly in Adson's test and abduction-external rotation test.
To estimate the relationship between obesity, general joint laxity and hypermobility of Chopart joint with flat foot in puberty, 3260 junior high school children's feet were analysed 1) Many cases with flat feet were revealed to have joint laxity or hypermability of Chopart joint, compared with normal foot. 2) Obesity itself was supposed to have no influence on the foot's arch, but when Chopart joint had hypermobility, obesity had a great influence on it.
For the purpose of measurement in residual adduction deformity in club foot, MTR angle is originated. Foot axis is drawn from the center of the second metatarsal head to the center of the talar head. The axis of the ankle is drawn between anterior margins of tibial and fibral malleolus. MTR angle is the medial angle produced by the junction of these two lines. Average MTR angle is 95 degrers in normal foot, 98 degrees in planovalgus foot and 75 degrees in club foot treated in our clinics. MTR angle less than 90 degrees is significant as sign of the adduction deformity.
The results of operations for 26 halluces valgus in 16 patients, including 10 of 6 rheumatoid patients, were obtained clinically and roentgenologically. Surgical procedures employed were correction osteotomy of the first metatarsal neck, release of the adductor hallucis or resection arthroplasty of the metatarso-phalangeal joints. Follow-up periods were 7 months to 13 years with an average of 5 years and 2 months. For hallux valgus, the results of correction osteotomy combined with release of the adductor muscles were better than release operation alone, which tended to recur, and the results of resection arthroplasty for hallux valgus with rheumatoid arthritis were satisfactory, however, those of correction osteotomy were poor.
Partial resection of Stenocleidomastoideus without postoperative plaster cast, performed in twenty-one children with congenital muscular torticollis, were reviewed three months to two year and four months after operation, in an attempt to asses its value comparing with “myotomy and postoperative plaster cast” method we had used. They are assorted according to the age at the operation; under 1 year, 1-3, 3-10, and over 10 years. Results were satisfactory in each group, but relief and hardness of the operated part seems to be different depending on the age. Younger children had tendency to regain normal relief and tenderness of the muscle while over three years of age lose the relief. Comparing with “myotomy and the cast” method, partial resection is preferable.
1. Among the three types of muscle contractures there were 24 quadriceps, 10 deltoids and 3 gluteal muscles to be presented. 2. Surgical treatments were performed to above cases with satisfactory result. 3. Importance of post operative physical therapy, orthotic application, continuous home programs and periodical follow-up are emphasized to gain good result.
The pathogenesis of Hydroarthrosis in old age is still obscure. It is well known that synovial fluid play an important role for nutrition of articular cartilage. In order to clarify the pathogenesis of osteoarthritis and hydroarthrosis in old age, an attempt has been made by author to determine the total protein levels in synovial fluid of patients with osteoarthritis and hydroarthrosis. 1) The total protein levels in synovial fluid of osteoarthritis or hydroarthrosis was approximately 2.8g/dl. 2) No relation was found between the total protein levels and the volume of synovial fluid. 3) The total protein in the synovial fluid in inflammatory osteoarthritis is higher than that in the non-inflammatory osteoarthritis.
Thirty patients with the ankylosed knee, including 21 complete and 9 incomplete ankyloses caused by arthrodesis, traumatic or arthritic lesions, were followed-up on the activities of daily lives. The patients were evaluated acording to the abilities of sitting, squatting, going up and down stairs etc. Eighteen patients, especially those with the complete ankylosed knee, were satisfied with their ADL, and majority of the patients could do their daily activities without gross troubles, except squatting. The ranges of motion of the lumbar spine and the hip joint were increased to compensate their disabilites, while 19 patients complained of slight low back pain.
We observed about 100 patients of hip disorder, clinically and by roentogenogram. At the same time, observed biomechanical effect of hip joint to knee joint. 25% of hip disorder patients complained pain on knee joint, and 17% of patients had lateral instability of knee joint. Case of abducter hip arthorodesis, there were many case of “genu varum”, and case of adducter arthorodesis, there were many case of “genu valgum”. By biomechanical observation, we observed (1) All case of hip disorder patients, avarage F. T. A of affected side is smaller than normal side. (2) Allmost all of the case of arthorosis deformans, F. T. A of unilateral standing is larger than F. T. A of bilateral standing.
Out of 44 cases of fracture of shaft of the femur and around the knee joint treated in our department, 8 case had left severe contracture of the knee joint, after more than 3 months' rehabilitation. Thompson's quadricepsplasty was operated on in six stiff knees. In four cases the tendon of the quadriceps muscle was lengthened. Nine months after surgery, the evaluation of the result were excellent in five and fair in one by Amako's criteria.
Since 1966 the knee mobilisations have been performed upon 29 cases of high degree contructure due to delaied union fracture of the femur. The authors tried some new devises in this series. The contents of new devises are as follow: 1) Prolongative incision of the fascias of vastus lateralis and medialis. 2) Useing of the frontal fascia of patella. 3) Useing of DMPS films to prevent re-adhesion, and etc. The result were very satisfactoric.
We used Hannover orthosis and active corrective brace in conservative treatment of scoliosis. Hannover orthosis is a new type of orthosis for scoliosis which was deviced by Dr. Hauberg. This orthosis have particular advantagees. That is pneumatic extension, head support permitting movement in all direction and good lateral support. We used this orthosis for two cases. They are suffering from paralytic scoliosis for poliomyelitis. Active corrective brace was developed at Tokushima University. This brace utilizes postural righting seflex. We used this brace for two cases. One is idiopathic scoliosis, the other is paralytic scoliosis by poliomyelitis. We have got good correction by two braces.
We have 153 cases in which water-soluble contrast agents were used for lumbosacral myelography during the last year. Of these 153 cases, Conray was used in 41 and Dimer-X in the other 112. Side-effects attending the radiodiagnostic procedure using these contrast media reportedly are irritation of meninges, nerve root and spinal cord. The mechanism of development of these adverse effects may be divided roughly into 2 categories; one is mechanical effects produced by the injection of a contrast agent into the subarachnoid space (through lumbar puncture) with a consequent change in cerebrospinal pressure and the other is a direct pharmacologic action of iodine on the spinal cord. The latter mechanism explains clonic convulsions seen in 3 (7.3%) of cases with Conray and in 3 (2.6%) of those with Dimer-X (the incidence of side-effects in our series was 6/41 with the former contrast agent and 11/112 with the latter. Since Dimer-X is reasonably, but not entirely, free from adverse side effects, it is recommendable not to use it in an amount of more than 5ml. The use of diazepam, orally or by injection, for its potent anticonvulsant effect prior to the radiodiagnostic procedure is of great prophylactic value. Myelography with the use of this contrast agent does not entail any permanent changes in the spinal cord even if performed repeatedly and, accordingly, tends to be done rather frequently. Since the agent is a radiculographic one intended for filling the subdural space, roentgenologic examination by its use always requires multi-directional projections for adequate visualization of a diseased area. The remote operation of an X-ray apparatus by means of 4π scope proves to be very useful in preventing the physician from being exposed to x-ray.
The preoperative myelographic findings of 131 patients operated for cervical osteochondrosis (105 operated by anterior fusion, 24 by laminectomy and 8 by foraminotomy) were compared with postoperative myelographic findings. There is generally a satisfactory correlation between the postoperative myelographic findings and the improvement of the clinical status of these patients. Both anterior fusior and laminectomy showed excellent or good improvement (more than 80%) of postoperative myelographic findings. It is necessary for getting satisfactory findings of post-operative myelography in anterior fusion to remove the posterior osteophytes and to correct alignment of the cervical spine.
We have two principles for treatment of severe dislocation of the spine. 1. No instability should remain. 2. No neurological damage should be added. For this purpose, moderate and very carefull reduction and spinal fusion were employed, following correction of angulation. 3 cases of severe spinal dislocation, including a cervical, a thoracolumbar and a lumbar case, were treated satisfactory with moderate reduction by Halo Pelvic traction and open reduction.
Rotary fixation and locking rotary dislocation of atlanto-axial joint after inflammation or trauma are well known as a cause of the wry neck. Authors report each case of the rotary fixation and locking rotary dislocation treated recently and discuss some clinical problems.
Cervical disorder producing a radiculopathy or a myelopathy is often difficult in its diagnose. Three interesting cases on the cervical spinal disorders were reported. Case 1: A 49-year-old man with disc herniation just posterior of the cervical spinal body. Case 2: A 57-year-old female with cervical spinal tumor and ossification of posterior longitudinal ligament of the cervical and thoracic spine. Case: A 60-year-old female with cervical spondylosis without sensory disturbance. Prior to an operation, myelography and electromyography were helpful in a diagnosis and a localization of the level although these were not uniformly helpful.
We experienced 8 patients with central spinal cord injury who displayed motor and sensory impairment involved only in the upper limbs. Roentgenograms of these patients showed narrowness of the antero-posterior diameter of the spinal canal measured at the level of 5th cervical spine. We think that the mechanism of the injury is due to cervical hyperextension. These symptoms (motor and sensory impairment) were ascribed to injury of anterior horn cells and poeterior horn cells. Motor and sensory impairment of our cases was transient, and it disappeared by 7 weeks (average) after injury. These patients were treated with conservative method. These cases were compared with type I (our classification) of myelopathy in cervical osteochondrosis.
Since 1957, 239 cases of tuberculous spondylitis have been treated in the authors' clinic. The affected sites were 3 in cervical, 72 in thoracic, 56 in dorsolumbar, 79 in lumbar, 27 in lumbosacral, 2 in sacral. Cervical affections are rare in these sites and few cases have been reported. Authors represent 3 cases of cervical tuberculous spondylitis and discuss on some clinical problems.
Since 1967, 120 patients with the ossification of the posterior longitudinal ligaments in the cervical spine have been treated in our clinic. 84 cases out of 120 had been followed up. Narrowing of the cervical canal in sagittal diameter due to the ossification, was 37 per cent in average in myelopathy and 24 per cent in non-myelopathy. The incidence of the level of the maximal ossificaticn were located in as the following order, C5, C6, C4, C3, C7 and C2. Conservative treatments were not so effective in most patients, but a few cases. Decompressive surgery should be taken into consideration before the patients with myelopathy had been fallen into severe disability.
About sixty cases of lumbar canal stenosis have been operated on in our clinic. Some of these patients, who had interesting clinical manifestations, were presented and the problems to do with this condition were discussed. Low back pain, sciatic pain and intermittent claudication had developed commonly in this disease, but priapism and neurotrophic dermal ulcer were found in a few cases. Recently we have been examining intrathecal condition on laminectomy, and the adhesion of the arachinoidal membrane were found more or less in many patients and some of them showed a higher degree of adhesive arachinoiditis.
We have a series of 110 patients with lumbar spinal stenosis who were treated by surgical procedure from September 1971 to March 1976. In these series 4 cases revealed poor results. Poor cases and their causes are suggested as follows; 1. A 42-year old woman with degenerative stenosis increased cauda equina lesion after operation with some recovery following wide laminectomy and facetectomy. This case seemed to be caused in further damage of cauda equina due to transdural nucleotomy through so-called key-hole laminotomy. 2. A 62-year old woman with degenerative stenosis and scoliotic deformity developed a postoperative hemorrhage causing cauda equina paralysis owing to the unstable hypertension with only slight recovery following removal of the blood clot and extensive laminectomy. 3. A 66-year old woman with L4 spondylolisthesis had saddle anaesthesia following decompressive laminectomy without spinal fusion with gradual recovery of saddle anaesthesia. In this case anterior approach seemed to have been better procedure. 4. A 47-year old woman with post-laminectomy stenosis had twice recurrence during 3 years. This case seemed to be caused in inadequate decompressive laminectomy and facetectomy owing to the prominent heaping of facets and hyperplasia of neural arches.