1) The Responses of thoraco-lumbar and lumbar curve of 31 cases with idiopathic scoliosis were analysed by roentgenographic which were taken by several correction methods such as supine position, supine side bending, modified “Baranscoire” traction and just after correction operation. 2) The patients with single major curves, whose lumbar curves were considered to to be compensatory curves, had the best response to the supine side bending. The patients with other scoliotic curve Patterns of thoraco-lumbar and lumbar curve obtained the best correction by the operative correction, 3) The V. D. S. Method, the Harrington instrumentation, the D. T. T. methods and other methods were discussed for it's effectiveness of the correction of the lumbar curve.
Although Harrington instrumentation is the most popularized surgical method for scoliosis, there is frequently a loss of correction curve after this method of treatment. In regard to causes of a loss of correction curve, one need take into account the way of postoperative external fixation, misreading of range of fixation, failure in fusion, problem in metal material for fixation, growth of bone as well as elastisty of bone. This is the report of postoperative loss of correction curve after Harrington instrumentation surgery in 29 cases with a special attention to the relation with α, γ and T angles after Onimus et al. We found that the decrease in α angle is prominent in the cases with a big loss in correction curve and there was a tendency that it is big in the cases of holding loss. γ-angle showed considerable amount of change irrespective of a loss of correction curve. T-angle showed minimal amount of change in relation to the loss of correction curve. A significant change in T angle was found in the cases with increased lumbar curve caused by error in evaluation of range of fixation.
One hundred seventy five scoliosis patients have been treated by surgically by using Harrington instrumentation or Dwyer technique at Tokushima University Hospital. Out of them, 68 patients with idiopathic scoliosis has been followed up for the average period of 4 years and 6 month. In the group of the cases whose curves were corrected with single Harrington distraction rod, 6 degrees of average loss of correction was noticed. Our results showed that combination with the distraction and the compression system is necessary to maintaine the satisfactory correction effect.
We evaluateed pulmonary and cardiac function before and after the operation of circumferential incision of the diaphragma done for the purpose of dissecting thoracolumbar bodies anteriorly in a series of seven cases in our clinic for these two years. Scoliosis was in four cases, kyphoscoliosis in one and thraco-lumbar fracture in two. It is generally said that this operation has a tendency to provoke a high rate of complications because of developing two major cavities at the same time. Nevertheless, there have been found neither serious complication nor remarkable decrease in respiratory function after the operation in our series. We are certain that this procedure will not be so dangerous if proper and intensive postoperative managements can be provided.
In Japan, we had used to take a roentgenogram only one direction when we made a examination for the shoulder complaints until last decade. As you might be experienced, one direction roentgenogram of the bone and joint include the shoulder cases causes often misdiagnosis. We presented such many shoulder cases and showed which direction's roentgenogram should be chosen for the examination about the each cases of the shoulder disease. We recommend the multidirectional roentgenogram—at least 2 directions—for the examination of the shoulder, too.
Nineteen cases of anterior recurrent dislocation of the shoulder were operated by Bristow McMurray reconstruction procedure from 1967 to 1980 in our clinic. These cases consisted of one female and eighteen males. The age of the patients ranged from 16 to 63 and average age was 26 years. The first dislocation of the shoulder occured traumatically in all cases, but the immobilization after reduction was not carried out except one. X-ray examination showed the postero-lateral defects of the humeral head in 18 cases when the picture was taken with the arm rotated internally. After follow up studies with periods ranging from 3 months to 13 years it was not seen any cases of recurrence of the dislocation.
We reported anatomic studies in the thoracic outlet region of 22 cadavers. Anomalous fibromuscular bands were observed and classified according to the Roos' classification of types. The results were as follows. 1) Anomalies were found in the 25 sides (57%) in 44 thoracic outlet dissections. 2) Anomalous bands of type 3, 5 and 6 were found in more higher frequency. 3) In most cases with the anomalous bands, the lower brachial plexus were found to be compressed or constricted strongly by these anomalous fibromuscular tissues.
Recently in these two years, we experienced five cases of osteomyelitis in childhood in our clinic. The age of the patients varied from one month to eight years. The duration from the onset of symptoms to their admission to our hospital was from 10 to 55 days. The treatment was carried out as follows, administration of drugs only in one case, drainage in one, and curettage and continuous closed irrigation in threee. These procedures brought about good recovery of symptoms and radiological findings. Continuous closed irrigation can be indicated well to the subacute or chronic stage if the bone is affected diffuse.
Three patients with chronic osteomyelitis have been treated by intra-arterial infusion with antibiotics and associated curettage and bone grafting. All three patients have healed. This combined modality is useful adjunct and its advantage have been outlined and discussed. Higher doses of antibiotics have been delivered to local bleeding blood levels by intra-arterial infusion than intra-venous therapy.
During from 24 Oct. 1971 to 31 Aug. 1980, 6461 newborn babies were examined. Click sign was noted in 119 new borns (1.84%). All of them were treated with abduction pillow, usually 1-4 weeks. These treatment was good results. Late diagnosis was 7 cases. In these examination, we considered that these late diagnosis cases were not over-looked, because familial joint laxitic tendency was very high.
Many Methods have been reported for determination of the anteversion of the femur. It could be classified in three groups. Group 1: Measure from Axial View Group 2: Measure from Fluoroscopic View Group 3: Measure from Biplane View Now we reported here a new Biplane View Method, That is, antero-postero roentgenogram and 45° abduction roentgenogram.
Clinical and radiological results of the surgical treatment of twenty-two patients with obsolete congenital dislocation of the hip were reviewed. These 22 patients, one male and 21 females, were operated on by three different surgical methods. 4 patients were treated by the open reduction and the shelf operation. (Jinnaka's method): Group A. 6 patients were treated by the shelf operation. (Spitzy and Katayama's method): Group B. 12 patients were treated by the angular osteotomy.: Group C. Compared with these three groups each other, A. B. C. comes in the order of evaluation of long term results. The results of surgical treatment for the patient with unilateral lesion were relative good and poor for those with bilateral lesions.
There are further problems about functional evaluation of the hip joint. We have advocated the faces method as a manner of the evaluation, and tried to examine the properiety of correspondence between parameters and portion of a face by multiple regression analysis. Furthermore, we have investigated which parameter most contributes to an improvement of the total score after operation. In the faces method, the correspondence of the pain to the eye and of ADL to the mouth was unchanged, but the correspondence of the gait to the eyeblow and of the ROM to the nose was replaced each other. The reason of this result was perhaps derived from the distribution of the point in evaluation table of Japanese Orthopedic association. Which parameter most contributes to an improvement of the total score after operation was indicated by standard regression value. The value of the gait was the greatest in THR, the pain was the greatest in osteotomy and arthrodesis. So, we found out the difference of the standard regression value among the operative techniques.
210 patients with Perthes' disease were seen at the our clinic from 1960 to 1980. 63 patients with A-P and Lauenstein X-ray view were selected, and were able to be follow up. The roentgenograms of 63 patients were classified with respect to femoral head and metaphyseal lesion. Patients of Catterall Groups III and IV were impressed at the fact that most of them could not obey our orders, for example, attachment of brace in the first stage of treatment. Therefore, difference in the classification of Catterall Groups is decided by the method of the first stage of treatment Abduction bracing for all Catterall Groups is important method.
We have operatively treated 26 cases (39 hips) of aseptic necrosis of the femeoral head in our clinic since 1973. The follow-up studies were carried out. Surgical procedures were as follows, Bone grafting in four hips, rotational osteotomy in four, arthrodesis in two, simple femoral prothesis in three, cup and socket arthroplasty in four, T. H. R. in seven and vascular bundle transplantation in twelve. The result of the artificial arthroplasty was effective. Recently we prefer to apply vascular bundle transplantation to idiopathic and steroid-induced aseptic necrosis. The results of this procedure seem to be good in the short term follow-up study.
By means of two-dimensional photoelastic stess analysis, we studied surface stress distribution of the acetabulum and proximal of the femur following the intertrochanteric double osteotomy for the treatment of coxa vara. One normal hip joint as a creterition and 2 cases of coxa vara with limp and positive Trendelenburg sign were studied. The plat model of the bony parts of the hip joint was made of epoxy resin, and that of the cartilainous portion was made of cilicon. The model was loaded by a loading apparatus consisted of the resultant hip joint force and the power of abductor muscle pull. The results are as follows. 1. The stress on surface of the hip joint neither increased nor concentrated after intertrocanteric double osteotomy. 2. The remarkable normalization on principal stress trajectories in femoral neck was found after surgery, because of the anatomical correction of the proximal femur.
In Japan there are many cases of secondary osteoarthritis of the hip caused by LCC or dysplasia of acetabular roof. We discussed the principle of the treatment for the adolescent or young adult patients with dysplastic painful hips. Up to this time the operation such as varus osteotomy of the femur, shelf operation or Chiari's pelvic osteotomy have been performed for them. From the standpoint of anatomical and functional treatment, we prefer “rotational acetabular osteotomy” among these various procedures. It seems to be the best treatment for teen-agers or young adults, in which the femoral head is able to be placed more centrally and covered fully by the rotated acetabulum. A typical case was presented here.
In nine cases of advanced rheumatoid arthritic hip, total hip replacements combined bone grafting in medial acetabular wall were tryed to prevent central migration of socket. 1) For protrusio acetabuli, the resected femoral head and neck or the iliac bone were used as a graft, If necessary, the bone paste from reaming the acetabulum was packed in a space of the graft and acetabular floor. 2) For deep acetabulum, a medial half of the femoral head which was not removed were used in situ insted of graft. 3) Serial radiographs after operation in all cases showed fast union of the graft, and no complication has been encountered for a follow-up period in an average of 17 months.
We attempted to perform clinical and radiographic examinations of the knees joints for 396 students from 13 to 15-years-old of a junior high school in Kurayoshi city. Boys were 207 and girls were 189. Number of the students with the complaint in their knees was 126, which was larger in girl than boy. Girls had more hypermobility of patella and increased Q-angle. 23 knees (6 per cent of total students) were clinically diagnosed as patellofemoral disorder.
Since 1971, we have experience on eight joints with congenital dislocation of patella in five patients, that were classified as follows by the Kataoka's classification: 1) Three habitual dislocations 2) One recurrent dislocation 3) Four permanent dislocations The age of the patients ranged from eight to eighteen years, two were males and three were females. The interval between onset and operation averaged five years. The following procedures were performed: a) Modified Hauser's method: one joint b) Campbell's and Roux-Goldthwait's method: two joints c) Semitendinosus transfer: three joints The follow up period ranged from one to fifty one months, and averaged 24.4 months. The results were rated by the Macnab's criteria. All cases were rated as “excellent.” Many procedures had been advocated for congenital dislocation of the patella, but all of these methods only maintained the patella statically in normal position. In 1971, Uesaki, et al. described a new procedure for recurrent dislocation of the patella. The characteristic of this method was to maintain the patella dynamically in normal position by transfer of the semitendinosus tendon. In the phase of knee flexion which usually patella dislocates, the transferred semitendinosus (which originally acts as the knee flexor) maintains the patella “dynamically” in normal position.
Femoral fractures sometimes cause stiff knees. Most of them are treated with non-operative method, but there are some cases we have to treat with an operative method. Experienced ten cases of stiff knees were operated by Nicoll's, Kono's, Judet's and Thompson's methods. Preoperative R. O. M. of 45 improved to 95 in average postoperatively.
1. Our clinical study seemed to indicate that the intra-articular injection of dexamethasone phosphate is much more effective in relieving the knee symptoms of rheumatoid arthritic and osteoarthritic patients. 2. Dexamethasone phosphate was much more easily hydrolysed in the synovial fluid than in dexamethasone sulfate. 3. Intra-articular injections of glycosaminoglycanpolysulphate appeared to have some favorable effects on the degenerated articular cartilages, however, they did not limit the progression of the degenerative changes in the experimental osteoarthrosis of rabbit knee. 4. Double-blind controlled trials confirmed that the intra-articular injection of glycosaminoglycanpolysulphate was useful for osteoarthrosis of the knee. The trials also indicated that the dosage of 50mg was more useful than that of 25mg or 100mg. 5. Intra-articular injections of superoxide dismutase did not cause any marked changes of the articular and semilunar cartilages of a rabbit knee.
Total knee replacements were performed in 10 cases of osteoarthritis. Age at operation ranged 68 to 84, with an average 76. Good results were obtained in 9 cases. Our indication for operation and some problems associated with the artificial joint were discussed.
This paper reports the case of Charcot's joints who was affected on the right hip, the left knee and the right ankle joints. The patient was a 67-year-old woman who had had swelling and slight pain in the right hip. It showed big destructive change on the X-ray of the hip joint in spite of feeling slight pain. Her left knee and right ankle were also affected, but she had no complain on the both joint. Roentgenograms on the both joint demonstrated the significant hypertrophic change.
Ulnar nerve palsy combined with hypoplasia of the trochlea is rare. We have experienced three such cases with ganglion, which seemed to play a part of role causing the palsy. In the first and the second case, neulolysis and extripation of the ganglion were carried out, and in the third case anterior deep transposition was made simultaneously with moderate recovery except for the second case. As etiological factors of the palsy, joint laxity due to hypoplasia of the trochlea, abnormal running of the ulnar nerve, abnormal movement of the ulnar nerve at the elbow motion and compression by the ganglion were considered.
Since 1973, when the outbreak of many quadriceps shortnings was found in Yamanashi Prefecture, a large number of muscle shortnings caused by intramuscular injection have been reported. In Itsuwamachi, muscle disorders among school children have become an issue since 1978. We investigated muscle disorders there on January 1979 and February 1980, and found so much muscle shortnings. Among the 203 examined children, quadriceps shortning was found in 20 children, deltoideus shortning in 59, and triceps brachii shortning in 2. Acoording to the detailed information particularly about the injection history, we draw a conclusion that the cause of muscle disorders was repeatedly performed intramuscular injection.
We have three cases of muscular contractures due to intramuscular injections. The three cases are followings; 1. 18 years old girl, who has mild contracture of bilateral rectus femoris muscles with cutaneous nerve entrapment, 2. 6 years old girl, who has severe contracture of left rectus femoris muscle with abnormal ossification of the origin of the rectus femoris, 3. 17 years old boy, who has severe contracture of bilateral gluteal muscles with sciatic nerve disturbance. We will discuss about the new complaints of the muscle contracture, risks of the conservative treatment and suitable age of surgical treatment for gluteal muscle contracture.
CT-scan findings of 87 cerebral palsied children were studied. They consist of 23 cases of spastic quadriplegia, 9 cases of diplegia, 12 cases of paraplegia, 24 cases of athetosis and mixed type, and 19 cases of hemiplegia. In the former four types, ventricular dilatation and cortical atrophy were measured and abnormal changes in cerebral substance and cerebellar atrophy were observed. Spastic quadriplegia showed most intense changes in every aspect of the abnorma-lities, while paraplegia had almost normal appearance. Athetosis and mixed type had moderate changes, Hemiplegia always showed asymmetrical view on CT-scan, dilatation of lateral ventricle or atrophy of hemisphere in contralateral side being observed.
Distal elongation of the Hamstrings was performed for contracture due to neurogenic disorders in forty-three patients. A follow-up study on twenty-eight of the patients with cerebral palsy is reported here. The success of the operation was judged by functional evaluation including joint measurement and gait analysis with T-V recorder. The disadvantages of this operation especially about genu recuirvatum and the need for prolonged aftercare are discussed. In the thirty-two knees, the spastic knee-flexion deformity was corrected, gait was improved, and a longer in eleven knees. It seemed that pre-operative ability for knee extension and ankle dorsi-flexion and age at operation were concerned to genu recuirvatum. In the five knees, recuirvatum was improved by fixed-ankle below-the-knee orthoses.
Recently the gonorrheal arthritis, caused by intravascular infection of the gonococcus, becomes rare for propagation of a chemical treatment. The patient reported was 24 years old male who had an extensive and painful swelling over the both knee joints and given the chemical treatment and leg traction under the diagnosis of gonorrheal arthritis. He got complete recovery by their treatments. Especially, the conclusive factor for our diagnosis in this case is that the gonococcal complement-fixation was positive in serum and its titer tended to decrease with a remission of the symptoms.
A 69-year-old man with gout associated with psedogout is reported. On April, 1980, there were acute attacks in the left wrist, left ankle and metatarsophalangeal joints and he was first seen at our allied hospital. Roentgenogram showed typical puntate or linear calcification in the menisci, wrist, shoulder, ankle and synphis pubis. Synovial fluid revealed weakly positive birefringent monoclinic and triclinic CPPD crystals and strongly negative birefringent monosodium urate crystals by compensated polarized light microscopy. Serum urate was 8.8mg/dl. Acute attacks disappeared by 6 doses of Colchicin. These symptoms and roentgenographic and laboratory findings satisfied the criteria of gout and pseudogout.
Two cases of tophi were reported. One of them (38-year-old male patient) was diagnosed erroneously as a malignant tumor from synovial origin because of its roentogenological marked destractive bone changes of first MP joint of left foot, another (71-year-old male patient) was as a xanthomata of tendon sheath. Both cases were diagnosed as gouty tophi immediately after skin incision. Those facts teaches us that gout should be kept in mind in diagnosing tumor of foot or hand.
For the analysis of long-term dose, 45 rheumatoid patients who received D-penicillamine more than one year and 6 months were evaluated. Retrospectively, these were devided into two groups, one with effective maintenance and the other with the tendency of recurrence. In 19 of 45 patients, the therapeutic effect of D-penicillamine diminished within one year and 6 months. In the group with transient improvement, the improvement of LFT and Warrer-Rose reaction was slow and turned to get worse at about one year. The adverse reactions appeared in 53.3% of 45 patients. The protein-uria was most serious. One of 7 patients with protein-uric developed nephrotic syndrome, and heavy protein-uria persisted in 3 patients.
X-P Findings on the lung of the patients with Rheumatoid Arthritis (RA) were studied. At Kumamoto Municipal Hospital, about 300 patients were treated with RA, 90 patients had sufficient data to include them in this review. The patients ages ranged from 24 years to 80 years, and average age was 53.8. About 70 percent of RA patient, some abnormal findings were seen on the chest plane film.