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内藤 正俊, 黒木 健文, 合屋 忠信, 佐々木 春彦, 阿部 哲哉, 藤永 隆, 杉岡 洋一, 香月 一朗, 内藤 英俊, 河野 渉, 藤 ...
1985 年 33 巻 3 号 p.
801-803
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty patients whose grafts were still functioning twelve months after renal transplantation constitute this study. The patients-14 males 6 females-were aged from 14 to 41 years at the time of transplantation. They were followed-up for between 10 and 143 months after transplantation. Six (8 hips) of the twenty patients developed avascular bone necrosis in the femoral head. The interval between transplantation and the onset of pain over the affected hip varied between 5 and 24 months, with an average of 12.8 months. The total amounts of steroids given from the time of transplantation until the onset of the symptoms varied between 8.1 and 15.8g., with an average of 11.5g.. At the initial roentgenographical examination the patients with this complication were all classed as in Grade 1 or Grade 2 of the disease of the basis of the roentgenographic findings. During the first twelve months following transplantation there were no significant differences between the groups with and without this complication as regards the total intake of azathoprine or the total does of steroids.
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豊永 敏宏, 川島 圭司
1985 年 33 巻 3 号 p.
804-807
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
The authors investigated the muscle strength about the knee and hip joints in patients with unilateral femoral head necrosis, preoperatively and postoperatively. Results of preoperative (8 cases) and postoperative (7 cases) patients were also compared with those of normal and osteoarthritis groups using Cybex-II. The results were as follows;
1) Strength of all muscles except abductor and adductor both in the affected and the intact limbs of the two groups with femoral head necrosis was significantly less than that in normal group.
2) The muscle strength of lateral rotation in the affected limbs in the two groups was significantly less than that in the intact limbs. However, the distribution of the hip joint muscle strength was similar to that of the normal group, although the distribution-in the osteoarthritis group was poor.
3) It was suggested that muscle training for all joint muscles, especially extensor muscle strengthening in the prone position, both preoperatively and postoperatively is crucial to maintaining satisfactory joint function.
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山村 正統, 北川 敏夫, 高木 克公, 原田 正孝, 坂口 満, 城間 公博
1985 年 33 巻 3 号 p.
808-811
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Prosthetic replacement was performed on patients having malignant tumors. Case 1: A male, aged 27 years, suffered from osteogenic sarcoma of the right humeral head. Case 2: A male, aged 56 years, suffered from chondrosarcoma of the light humeral head. They were treated by prosthetic replacement. Tumorous parts of the humeral heads were completely resected, and they were replaced by artificial humeral heads made from ceramic implants.
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功能 重雄, 上崎 典雄, 志田原 哲, 谷村 俊次, 西崎 博己, 古賀 哲二, 村上 陽太郎, 清水 敦, 泊 真二
1985 年 33 巻 3 号 p.
812-814
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Ten hip arthroplasties for secondary osteoarthitis is seven yound adults using Bateman UPF prosthesis were undertaken. The average age of the patients at the time of surgery was 45 years, and all were female. Following surgery, all patients improved, especially as regards pain. We concluded that deepening of the acetabulm in the original site and use of self-locking stem were important.
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岩森 洋, 安達 長夫, 龍味 雅明, 藤本 吉範, 天野 幹三, 望月 由, 西川 公一郎, 津下 健哉
1985 年 33 巻 3 号 p.
815-820
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A review of 48 cases of Charnley total hip arthoplasty performed on 41 patients is presented. The follow-up period ranged from 1 to 10 years (average of 3 years and 9 months). Clinical evaluation shows that 27 patients (69.9 percent) had over 70 points according to the J. O. A. Hip Score system. On the other hand, from radiographic examination, loosening was found in 13 joints (27.1 percent), and these cases show significantly poorer clinical results. This study shows that the operative technique is the most important point in preventing any loosening. Especially, poor cementing of the stem ands etting the socket have a direct effect on the occurrence of loosening.
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池田 正樹, 山本 吉蔵, 豊島 良太, 平川 訓己, 前山 巌
1985 年 33 巻 3 号 p.
821-824
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Total joint replacement for rheumatoid arthritis was performed on 23 joints of 14 patients from 1977 to 1984 in our clinic; THR in 7 joints in 6 patients, TKR in 12 joints in 8 patients, TER in 3 joints in 2 patients, and TAR in 1 joint. Eight patients received multiple joint replacements, which were performed one after another (during a period of) 2 to 12 months. According to the follow-up study of these patients lasting from 2 to 85 months after the operation, there were no infections, no loosening and no revision cases. All the patients are satisfied with the results of their replacement surgery up to present. However, the follow-up study will have to be continued for a long time in future.
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高田 晃平, 都谷 治利, 廣谷 速人
1985 年 33 巻 3 号 p.
825-827
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-nine patients had a Moore hip endoprosthesis during the period from October 1979 to April 1984. Average follow-up period was 21 months (range: 2 to 54 months). In 11 patients, endoprosthsis with cement was performed with satisfactory clinical results, especially in relation to pain relief and weight bearing ambulation. X-ray examinations revealed no upper migration and loosening. In eighteen patients, endoprosthesis without cement was performed. Nine patients complained of pain (50%). From roentgenograms, an increased tendency of loosening of the prosthesis was found in cases without cement.
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中嶋 裕, 池田 定倫, 岩崎 勝郎, 鈴木 良平, 一青 勝雄
1985 年 33 巻 3 号 p.
828-833
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We have experienced 11 cases of Lord Madréporique total hip arthroplasty; its prosthesis constitutes an irregular rough surface created by multitude of small beads which provide retentive support for newly formed bone, without the need for surgical bone cement. Acetabular component consists of a metallic ring made of chromium-colbalt alloy and a polyethylene core. The ages of our cases were younger than those of Charnley's THR, ranging from 34 to 68 years with an average age of 53.9 years. The acetabula of our cases were nondysplastic or slightly damaged. The most important factors of the surgical techniques were to set the screw ring at 45 degrees of tilt and 10 degrees of anteversion, and to set the stem at 10 degrees of anteversion. In this series there were two cases of postoperative luxation which had more than 55 degrees of tilt of the screw ring, and two cases of fracture in the trochanteric region and femoral shaft.
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草場 謙, 緒方 公介, 近藤 正一, 杉岡 洋一, 内藤 正俊, 黒木 健文, 小川 昭一郎
1985 年 33 巻 3 号 p.
834-837
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
In the past two years, we performed total knee replacement using three types of prostheses; Ceramic (13 patients), PCA (6), and ORTHOLOC (2) without cement. In the case of the ceramic total knee system, radiolucent line widely appeared around the components on the radiographs, and there was one case of fracture of the ceramic prosthesis. So we have discontinued to use this system recently. Both PCA and ORTHOLOC have a porous coating in order to stabilize the prosthesis by bony ingrowth. We analyzed merits and demerits in using bone cement in total knee replacement and we concluded that it is better to perform the total knee replacement without using cement.The follow-up periods of these series are too short to discuss the results, however, no serious complications have been encountered so far in the patients with PCA and ORTHOLOC knees.
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尾上 英俊, 高岸 直人, 葉 山泉, 木梨 博史
1985 年 33 巻 3 号 p.
838-840
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A seventeen-years-old girl who was diagnosed as suffering from tethered conus syndrome accompanied by lipoma in the lesion of spina bifida was investigated and treated in our institution.
This syndrome is rarely seen and usually diagnosed in childhood. In this case, diagnosis was made by computerised tomography, physical examination, plane X-p and myelography.
Computerised tomography was of great importance for the evaluation of invasion and also for confirmation of the level of the location of conus in the spinal canal.
Radical excision was necessary for this lipoma, although many authors state it is difficult to perform such an excision redically in most cases. Decompression of the spinal cord and releasing the fibrous band are essential for the treatment of this syndrome.
This paper reports a rare case of tethered conus syndrome acompanied by lipoma in the lesion of spina bifida, which was succesfully treated surgically.
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古瀬 清夫, 前山 巌, 森本 兼人, 山本 清司, 折戸 隆
1985 年 33 巻 3 号 p.
841-846
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
In this study, we review 40 lipogenic tumors, including 33 beign and 7 malignant ones. Thirty-three benign tumors consisted of 24 ordinary lipomas, 7 intra- and intermuscular lipomas, one pleomorphic lipoma and one angiolipoma. In our cases, if the clinicopathological findings of lipoma were understood, it was never difficult to diagnose immediately the lipoma and its variants. No recurrence has occurred following simple excision of the 33 begin tumors.
The seven liposarcomas were subclassified into well-differentiated type (one case), myxoid type (3 cases), pleomorphic type (2 cases) and mixed type (myxoid+pleomorphic type) (one case).
The most important findings in the diagnosis of liposarcoma is the identification of the lipoblasts. Additionally, special stains for cellular lipid, acid mucopolysaccharides in matrix, intracellular glycogen and intercellular reticulin meshwork may be of great value as an adjuvant diagnostic method. Two cases in our series could be mistaken for malignant fibrous histiocytoma, which is characterized the absence of lipoblasts, its cellular pleomorphism and striform pattern.
Recurrence after surgery occurred in 5 cases with the exception of one case, on whom autopsy was only performed, and metastasis in 6 cases, in which 4 cases died of the disease and 2 cases have continued to live with evidence of the disease. Only one case died from another disease.
Wide local resection is basically the best choice of treatment. However, its procedure may be often become incomplete as in cases of recurrence.
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横山 庫一郎, 中馬 広一, 篠原 典夫, 増田 祥男
1985 年 33 巻 3 号 p.
847-850
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Eight patients with rhabdomyosarcoma of an extremity or buttock were treated with one of several combinations of surgery, chemotherapy, and radiotherapy, depending upon the stage of disease at diagnosis. Patients even with Stage I extremity (hand) tumor treated by earlier approaches had a less favorable survival than those treated more recently. Two survivors undergoing treatment, though only of seven and nine months duration respectively, in the latter group seem to attest to the efficacy of current combined modality therapy for non-disseminated tumors. Two of the eight patients with embryonal histology, (with a survival beyond two years) had a tendency to local recurrences prior to distant metastasis. Finally, the use of surgery alone or with insufficient chemotherapy, even for apparently localized and fully resectable tumors, must be discouraged because of the early dissemination of micrometastases among patients with rhabdomyosarcoma of any site. This is well illustrated by one of the patients in our series, whose affected extremity was amputated. Systemic chemotherapy is therefore warranted in all cases of rhabdomyosarcoma.
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田中 宏和, 岩崎 勝郎, 鈴木 良平, 神代 敏之, 長岡 徳三
1985 年 33 巻 3 号 p.
851-856
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Three cases of malignant bone tumors which took an interesting clinical course immunologically, are reported.
Case 1. A case of malignant lymphoma which had spontaneous regression.
Case 2. A case of osteosarcoma where it was considered that the malignant activity might be increased by pregnancy. (anergy induced by pregnancy).
Case 3. A case of osteosarcoma where it was considered that the malignant activity might be increased by a decrease in local resistance induced by multi-operations.
We discuss the clinical courses of these cases from an immunological view, regarding host-tumor relationship. The concept of cancer immunology is not always recognized in the clinical field, however, and there are many reports describing that radiotherapy, chemotherapy and operative therapy depress the immune response of the host. Although it may be nonspecific, immunostimulant therapy should be employed in treating malignant tumors.
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後藤 武史, 井上 明生, 稗田 寛, 宮崎 正樹, 百田 耕
1985 年 33 巻 3 号 p.
857-859
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Xanthoma of the Achiles tendon is a rather rare orthopedic condition, but it has important ramifications in internal medicine because the lesion is associated with a specific disturbance in lipid metabolism. Three cases of patients with xanthoma of the Achilles tendon and associated hyperlipoproteinemia are reported. All patients complained of painful thickening or mass of both Achilles tendons. There was no history of trauma to the heel cord. In one of the cases, xanthomas of bilateral Achilles tendons were partially removed because of painful irritation from shoe. The other two cases were treated by conservative therapy. The early recognition and evaluation of patients with hyperlipoproteinemia is important because of an increased incidence of atheromatous coronary heart disease, manifesting at an early age.
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脇田 重明, 粟屋 梧老, 清水 克時, 松田 文秀, 前川 正毅, 藤田 一之
1985 年 33 巻 3 号 p.
860-862
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of osteosclerotic myeloma associated with polyneuropathy in both a fifty-five-year-old man and a forty-one-year-old man are presented. Clinical features and etiology are discussed.
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小西 淳二, 柴田 陽三, 久保山 昌宏, 森久 喜八郎, 柴田 玄彦, 和田 研, 藤田 芳憲
1985 年 33 巻 3 号 p.
863-865
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We present the case of a five-year-old boy with a metastatic neuroblastoma of the left femur. At first, he was diagnosed as having osteomyelitis and treated with chemotherapy for about one month. But he did not recover. Following bone marrow puncture, he was diagnosed as having metastasis of neuroblastoma. After extirpation of the adrenal gland and cis-platin administration, the bone lesion healed and no recurrence has been observed after two years.
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山本 清司, 崎長 靖生, 川上 俊文, 前山 巌
1985 年 33 巻 3 号 p.
866-869
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A case of osteoid osteoma in the 3rd lumbar vertebra is reported and previously published literature is veviewed. The patient was a 13-yars-old girl who had an 8-month history of low back pain and scoliosis. Roentgenographic studies showed a radiodense area with surrounding radiolucency in the left pars interarticularis of the 3rd lumbar vertebrae. Following diagnosis of primary bone tumor, surgical removal was performed. From microscopic study the diagnosis of osteoid osteoma was confirmed. After the operation she was relieved of symptoms immediately.
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伊藤 博史, 森本 典夫, 野口 義夫, 山口 正男
1985 年 33 巻 3 号 p.
870-872
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Recurrence of giant-cell tumor of bone is often seen within the five years following surgery. Recently, we experienced a rare case where begin giant-cell tumor recurred in the right radius sixteen years following surgery. The patient was a 34-years-old male. In 1967, excision of the tumor and arthrodesis of the right wrist joint was carried out. Recurrence of the tumor was not evident upon radiological examination during the three years following surgery. In 1983, he sustained a pathological fracture of the end of the right radius due to the recurrence of the tumor. Wide resection of the radius and bone grafting along with electrical stimulation with direct current were carried out. Bony union was achieved successfully with no recurrence of the tumor. No malignant transformation was found in the histological examination.
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金 隆志, 藤巻 悦夫, 宮岡 英世, 小谷 貢一, 森田 一史, 中西 俊郎, 山崎 富士雄
1985 年 33 巻 3 号 p.
873-875
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Recently, we experienced a solitary bone cyst of the hamatum. Our case was a nineteen-year-old female. Her chief complaint was pain of the left wrist joint due to fracture of the end of the left radius. Upon examination, we discovered a cystic lesion in her left hamatum. During surgery, this cystic lesion was separated into two parts through the septum. One had liquid and connective tissue, the other was empty. This cystic lesion was diagnosed as a solitary bone cyst by histological examination. No recurrence has been found two years after operation.
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下村 義文, 山村 正統, 国崎 正二, 緒方 正光, 原田 正孝, 北川 敏夫, 小川 頼之
1985 年 33 巻 3 号 p.
876-879
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Calcined bone was reported by Kurosawa et al., in 1979. Its properties are composition of hydroxy-apatite and maintenance of original bone structure. In an experimental study, calcined bone was seen to have a good affinity to the host bone and to have characteristics of promoting of new bone formation. Recently, we experienced three cases of atypical bone cysts, and treated them by curretage and calcined bone inplants. These patients have been observed carefully under radiographic follow-up.
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田丸 卓弥, 直野 敬, 藤本 祥治, 孫田 明, 今村 正純, 筒井 秀樹, 徳久 銀一郎, 吉井 元
1985 年 33 巻 3 号 p.
880-882
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A subungual exostosis is a benign bone tumor occurring on the distal phalanx beneath the nail. Of the four cases, three were female and one was male. The mean age of the patients at the time of diagnosis was 14.8 years (range, 11 to 24 years). Two of the tumors occurred on the great toe, two were found on the hand, that is the thumb and the little finger. None of them had any history of significant trauma. Radiographically, all lesions occurred on the dorsal surface of the distal phalanx and they occurred at a site away from the epiphyseal line and were not connected in any way to it. Histologically, the cartilage cap was composed of fibrocartilage. The causative factors in the development of subungual exostosis have been unknown. Pardo Castello (1947) states that subungual exostoses are not true tumors, and are probably caused by major trauma or repeated causative factors though without any direct evidence. But there was no history of major trauma in our cases.
The four cases were successfully treated by local excision.
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田口 敏彦, 河合 伸也, 今釜 哲男, 豊海 隆, 伊原 公一郎, 市本 裕康, 石田 洋一郎
1985 年 33 巻 3 号 p.
883-886
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Because of our interesting in the good hitocompatibility of Al
2O
3 filler, as a new imimplant material, we performed an experiment on rats and rabbits to determine what kind of clinical application could be made. These results were presented at the 3rd. Orthopaedic Ceramic Implants Meeting in 1983.
In this paper, we will report on 8 clinical cases counducted using results from previous experiments as a base.
(Case) Eight clinical cases include 3 cases of bone cyst, 2 cases of giant cell tumor, 2 cases of benign chondroblastoma and a case of osteomyelitis. Follow up period is from 6 months to 2 years 11 months, average 1 year 5 months.
(Result) From results of our experiments, we found that a ratio of 1 to 1 mixture of Al
2O
3 filler and autobone produced the best results when implanted to the site of bone lesion. This was the method used in our clinical cases. Radiographically, implant lesions became homogenous at 2 months to 12 months after surgery, average 4 months. These cases have no recurrence and good clinical course.
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郡家 則之, 平野 英二, 今村 宏太郎, 菅 尚義, 小西 宏昭
1985 年 33 巻 3 号 p.
887-890
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report two cases of ulnar nerve compression secondary to traumatic false aneurysm at the Guyon's canal, and discuss the mechanism of ulnar nerve palsy in 6 cases, consisting of 2 of our own cases and 4 cases from previously published literature. According to Sea's classification these 6 cases were classifed into 4 cases of Type I and 2 cases of Type III. We, however, could not find any case of Type II. This may be due to the occurring mechanism of traumatic false aneurysm and the anatomical peculiarity of the ulnar nerve root at the Guyon's canal.
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塚原 純, 鈴木 勝己, 伊地知 正光, 大谷 洋, 古川 英樹, 野間 慎朗, 丹羽 真理子, 中島 民治
1985 年 33 巻 3 号 p.
891-899
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
The supracondyloid process of the humerus, one of the normal variants, is a bony process about five centimeters above the medial epicondyle. It is a vestige of the entepicondylar foramen in primitive reptiles, which persists in some mammals.
Its incidence in Caucasian's humeri is 0.5-1.2%, while that in Japanese' humeri is 0.1-0.3%.
This variant usually remains asymptomatic, but occasionally causes pain and paresthesia in the arm and hand, compressing the median or ulnar nerve, or the brachial artery or its branch.
In this paper, we present such a case of “processes supracondyloideus humeri syndrome”.
The case was a forty-two-year-old Japanese man, who complained of pain in the left shoulder and elbow. The examination revealed a tender bony protrusion in his left upper arm about five centimeters above the medial epicondyle. Percussion on the protrusion elicited pain and paresthesia in the forearm and radial three fingers. Supination of the forearm with the elbow in extension exacerbated the pain.
Hypesthesia and hypalgesia was discovered in the left thumb, index and middle finger.
Roentgenography revealed the supracondyloid process, about sixteen milimeters in length.
At surgery, we found a fibrous membrane, expanding from the tip of the process toward the intermuscular septum. The median nerve, which had been compressed by the membrane, was released when the latter was thoroughly incised.
After the operation, the pain, paresthesia and hypesthesia disappeared completely.
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吉田 健治, 田中 宏道, 膳所 正和, 小宮 節郎, 後藤 武史
1985 年 33 巻 3 号 p.
900-903
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A rare case of paralysis of deep branch of the radial nerve caused by neurilemmoma is reported. The patient was a man aged thirty, who noticed disability in extension of the right thumb and index finger with intact sensation. A palpable lump was present under the muscle mass of the brachioradialis and was thought to be the symptoms. Examination revealed no additional abnormalities except for electromyographical changes. During surgery two months after the onset, the tumor was seen to be arising from within the deep branch of the radial nerve just proximal to the arcade of Frohse, and there were funiculi stretched over its surface. These were dissected free without damage, allowing the tumor to be shelled out. Histologically the tumor was diagnosed as a neurilemmoma showing Antoni type A and type B pattern. Removal of the tumor enabled a slow recovery from his paralysis. Function was completely restored sixteen months after operation.
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喜友名 修, 茨木 邦夫, 嘉陽 宗俊, 新垣 晃, 国吉 真也, 松元 悟
1985 年 33 巻 3 号 p.
904-907
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of posterior interosseous nerve palsy following Monteggia fractures are reported in 2 boys, aged eight and ten years. They had been treated for simple ulnar fractures for six months before they visited our clinic, where they complained of disturbance in extension of their left fingers. During operation, posterior interosseous nerve was found to be translocated to the dorsoulnar side of radial head which was dislocated anterolaterally. The nerve formed a neuroma at the site of entrapment between the radius and the ulna, and peripheral degeneration of posterior interosseous nerve was recognized. The malpositioned annular ligament and the joint capsule prevented the reduction of the radial head. It is suggested that, irreversible posterior interosseous nerve palsy occurs very rarely following Monteggia fracture where the radial nerve is entrapped between the radius and the ulna.
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上平 用, 大月 健二, 林 正郎, 阿藤 孝二郎, 大森 敏雄, 奥野 誠
1985 年 33 巻 3 号 p.
908-912
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Fifty-one cases including thirty-four cases of cubital tunnel syndrome and fifteen cases of carpal tunnel syndrome underwent decompression of the nerve for entrapment neuropathy of the upper extremity at the National Misasa-Onsen hospital.
The authors compared the functional recovery of the cubital tunnel syndrome and the carpal tunnel syndrome, and in addition, investigated the factors causing irreversible changes of the nerve.
The following results were obtained:
1) The functional recovery of the cubital tunnel syndrome was relatively worse than that of the carpal tunnel syndrome.
2) Those cases who had worsening factors of the nerve and had suffered for a long period, developed irreversible changes of the nerve.
3) The functional prognosis of entrapment neuropathy with upper neurological disorders, e. g. cervical spondylosis, was also poor.
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今村 宏太郎, 平野 英二, 伊藤 信之, 草場 英介
1985 年 33 巻 3 号 p.
913-916
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Traumatic pseudoaneurysm associated with nerve palsy is very rare in Japan. In this report a 22-year-old female who had right brachial plexus palsy caused by pseudoaneurysm of the brachial artery is described. On 20 Aug. 1982 she was injured in her right shoulder by a knife. About 5 hours after the injury, she had right radial nerve palsy but palsy of her other nerves was not seen. The pulsation of radial and uluar artery was palpable. About 1 month after the injury, when she started to exercise her shoulder, a pulsatile mass had appeared in her right shoulder. At that time, brachial plexus palsy occurred and progressed to complete palsy within a few days. Arteriography revealed an aneurysm of the barchial artery. On 14 Oct. 1982, the aneurysm was resected and the artery was repaired primarily without a graft. During surgery, there was no evidence of direct injury to the plexus. Three months after surgery, she had a near complete return of sensation but recovery of motor function was delayed. Seventeen months after surgery, complete return of neurologic function was noted.
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菅 政和, 冨田 満夫
1985 年 33 巻 3 号 p.
917-919
発行日: 1985/03/25
公開日: 2010/02/25
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フリー
A woman aged 67 was admitted with one month's history of anaglgesia of foot and imcomplete foot drop. Examination revealed involvement of the peroneal nerve at the level of neck of the fibula. During surgery the common peroneal nerve was found to be distended and adhered to ganglion. This had no connection with the superior tibiofibular joint and was diagnosed as intraneural ganglion. The patient's progress was good and she has had full recovery of sensibility and motor function. We discuss the origin of ganglion, whether of intraneural or perineural type.
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離脱中及び治療終了者の検討
三浦 裕正, 秋山 徹, 柴田 堅一郎, 小野 哲男, 角田 信昭, 佐々木 邦雄
1985 年 33 巻 3 号 p.
920-923
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
This study represents the end results of K. U. U. B. treatment of 51 patients with idiopathic scoliosis, who had either finished treatment (21) or were wearing the brace at night only (30). Their age when bracing began ranged from 5 years and 8 months to 17 years and 5 months. The mean initial curvature was 25.3 degrees. The average percent correction at end-result evaluation was 19.9%, which was equivalent to Milwaukee brace treatment. K. U. U. B. is more effective in controlling and correcting mild to moderate curves. Age, curve pattern and Harrington factor correlated with the response to brace treatment. That is, the factors contributing to better correction include young age of patients (under 14 years old), curvature below middle thoracic (especially thoracolumbar curves) and long curvatures.
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高松 徹, 山中 健輔, 金 敬夫, 松山 雅人, 有吉 護, 白浜 正博
1985 年 33 巻 3 号 p.
924-927
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
In functional bracing for idiopathic scoliosis, the role of the lateral pad acting through the ribs is very important. There are few reports, however, about the inclination of the ribs and the effectiveness of the brace. The relationship of the rib-vertebral angle (R. V. A.) on a level with the apex vertebra to the final correction was examined in thirtyfive patients (4 males and 31 females). Average age in scoliotic group was 12 years and 11 months at time of first examination. A lateral curvature of 29.7 degrees of Gobb's angle at pre-bracing was finally restored to 21.1 degrees. (29.3 per cent as correction rate). Final correction rate was 41.9 per cent in the group (7 patients) with larger R. V. A. than control, while 26.1 per cent in the group (28 patients) with smaller R. V. A.. We conclude from the results described above that measurement of the R. V. A. of the apex vertebra is useful in estimating the effectiveness of under arm bracing.
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特に装具療法について
中村 誠司, 田島 直也, 川野 桂一郎, 平川 俊一, 脇山 尚登, 木村 千仭
1985 年 33 巻 3 号 p.
928-931
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Recently, patients with scoliosis seem to be diagnosed earlier due to progression in its screening method. Therefore, the importance of conservative treatment, especially brace therapy has increased gradually. We investigated 37 patients with scoliosis who were followed up for between six months and three years in some aspects. We divided them into three groups (A, B, C) accoding to Cobb's angle.
A group: 10°-19°with flexibility-Exercise
B group: 20°-29°-Exercise and underarm brace
C group: 30°--EDF casting and underarm brace
The results were as follows:
1) Generally, both A and B groups tended to decrease the Cobb's angle, while C group tended to increase it.
2) Approximately, half of both A and B groups were recognised as “improvement”, while in C group only a few. On the contrary, about a half of C group were recognised as “exacerbation”.
3) In the curve type of thoracic scoliosis and in the period of so-called growth spurt, the scoliosis showed “exacerbation” in C group.
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平川 俊一, 田島 直也, 川野 桂一郎, 脇山 尚登, 中村 誠司, 木村 千仭
1985 年 33 巻 3 号 p.
932-935
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Fifteen patients with scoliosis were treated with body cast, simultaneously measured distraction forces and lateral forces. Of these patients, 12 cases had idiopathic scoliosis and 3 had symptomatic scoliosis. There were 13 females and 2 males. Their mean age was 13.9 years old. The cast was applied on Risser frame according to the E. D. F. cast. Distraction forces varied from 20 to 60kg (77-114 per cent in comparison with body weight) and lateral forces from 7 to 15kg (19-44 per cent). The mean Cobb's angle of the scoliosis in the 15 patients was 46.7 degrees before the cast and 25.4 degrees afters it. They obtained a correction of 45.7 per cent. The correction of the thoracolumbar curve was better than that of the thoracic curve. There was a signi ficant correlation between the correction by cost and by lying. Distraction forces acted more effectively on patients with severe scoliosis.
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小川 知彦, 枝重 恭一, 藤原 紘郎, 中原 進之介, 那須 正義, 川村 正英, 町田 博久, 田辺 剛造
1985 年 33 巻 3 号 p.
936-939
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Though there are several methods of instrumental surgery for scoliosis, we tried Luque Spinal Segmental Instrumentation (L-S. S. I.) on two cases of neuromuscular scoliosis. One is a spinal deformity caused by cerebral palsy, and the other is a case of the cervical cord injury with tetraplegia. Both cases got better condition than that before operation. L-S. S. I. provides secure internal fixation and correction force over conventional Harrington Instrumentation, so no external fixation is needed after surgery. Even if the patient has sensory disturbance, this instrumentation makes its maintenance easy. Spasticity with neuromuscular disease causes hook-bone stress or fracture and rod migration easily in Harrington Instrumentation. But in L-S. S. I. such cases are few. Compared with Harrington Instrumentation, loss of correction, ocurrence of pseudarthrosis are less in L-S. S. I.. And some reports mention that L-S. S. I. does not require bone graft. Selection of the length of spine to be instrumented, control for head decompensation, trunk shift and pelvic obliquity are other problems. But taking all things into consideration, we think that L-S. S. I. is a useful method for neuromuscular scoliosis.
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鈴木 悠史, 酒匂 崇, 牧 信哉, 米 和徳, 上原 裕史, 伊藤 博史, 園田 昭彦, 川内 義久, 森元 保
1985 年 33 巻 3 号 p.
940-941
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We present two cases who developed palsy two years and six years following fracture of the lumber spine. Radiological examination revealed an old bursting fracture in the lumbar vertebra. Anterior decompression thorough subtotal vertebrectomy and anterior fusion were performed, with good post-operative results. We conclude that anterior decompression and reconstruction of the spinal column are important in treating this type of lesion.
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小西 明, 今井 健, 角南 義文
1985 年 33 巻 3 号 p.
942-945
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
The case of a 19-year-old girl who developed paraplegia following spinal epidural hematoma is reported.
This case had no obvious causal diseases, for example, abnormality of blood coagulation, spinal A-V malformation etc.
The signs and symptoms were sudden onset of pain in the back with radicular pain, followed by flaccid paralysis and sensory impairment below the affected spinal segment. Bladder and bowel disturbance were also present.
Myelography is of definite diagnotic value and the findings show complete or incomplete block and dorsal compression in most cases according to previously published literature.
The only surgical treatment available is the removal of the hematoma following laminectomy. Our case was operated on two days after complete paralysis, but her recovery was very good.
Early diagnosis and emergency operation is the best treatment. Results are better following early operations than delayed ones.
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大浜 満, 新宮 彦助, 木村 功, 那須 吉郎, 塩谷 彰秀, 倉信 耕爾, 川上 伸
1985 年 33 巻 3 号 p.
946-950
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of sylingomyelia were treated surgically. One case, associated with an intradual and extramedullar neurinoma on the upper cervical spinal cord was treated by microsurgical extirpation, and post-operative CT myelogram showed the loss of syrinx.
The other case was associated with Arnold-Chiari malformation (type 1). This case was treated by posterior fossa craniectomy and laminectomy, and had a dropping of the cerebellar tonsil lowered. Post-operative CT myelogram showed a reduction of syrinx and the subjective symptoms were decreased.
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藤井 博昭, 江川 正, 朝長 圀夫, 茅野 丈二
1985 年 33 巻 3 号 p.
951-953
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
The first case was a 37-year-old male. He was admitted complaining of muscle atrophy and weakness of the right leg. When we performed myelography, we found a large tumor which occupied the spinal canal between Th12 and L1, and it was pathologically confirmed as schwannoma. The second case was a 34-year-old male. He had been suffering from low back pain for 7 or 8 years, and had been treated for protruded intervertebral discs. Myelography revealed complete block at the level of Th12 and the pathological finding were identical with the first case. In many cases, cauda equina tumors show various symptoms: therefore, they are sometimes diagnosed erroneously and overlooked for a long time.
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長嶺 功一, 上江洌 邦弘, 親川 勝, 上原 健志, 上原 敏則, 宮城 能久
1985 年 33 巻 3 号 p.
954-957
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Spinal root anastomosis was performed in one paraplegic patient who had traumatic lesions of the conus medullaris and cauda equinus. The purpose was to re-innervate the paralyzed urinary bladder. During surgery, the functioning left T11 nerve root was transected distal to the ganglion and anastomosed to the S2 and S3 ventral and dorsal roots emerging from the injured cord area. About 8 months following surgery, the patient did not show any restoration of bladder function. About 2 years postoperatively, he demonstrated restoration of function as recorded by cystometrogram. He could feel the urge to void and could urinate spontaneously. Residual volume was zero. It is very difficult to determine whether this relatively good restoration of the bladder function is the result of this reconstruction or spontaneous recovery of the partially injured nerve.
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山崎 博信, 河合 伸也, 表 寛治郎, 野村 耕三, 田丸 幸一, 篠田 陽健, 斎木 勝彦
1985 年 33 巻 3 号 p.
958-961
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Spinal evoked potential (SEP) was measured in 59 patiants with cervical myelopathy.
Segmental and ascending conductive SEP were obtained in 29 patiants at C4-5, C5-6 and C6-7 levels.
In the myelopathy type I (Hattori's classification), in which the damage was limited in the gray matter, segmental SEP showed abnormal waves and ascending conductive SEP were normal.
In type II and III, in which the damage extended to the white matter, the tindings of segmental and ascending conductive SEP were abnormal. Correlation between clinical findings and SEP were discussed.
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井上 廣, 真島 隆三, 近藤 正行, 田中 宏和, 伊藤 信之
1985 年 33 巻 3 号 p.
962-965
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Survival of a patient with traumatic occipito-atlantal dislocation is rate. We present two cases. The first case is an eight-year-old girl who is now surviving. The second is an eight-years-old boy, who could not survive. We describe the roentgenograhic findings of lateral view and the anatomical anglization, and we discuss other previously published treatments. We treated the girl by manual reduction. That method proved good for her, and she survives now.
We reported a rate case of traumatic Occipito-Atlantal Dislocation where the patient could survive.
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園田 英器, 広田 耕三, 伊勢 紘平, 赤崎 幸二, 束野 通志, 坂本 公宣
1985 年 33 巻 3 号 p.
966-968
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Thirty-three patients with cervical disc lesions complained of dizziness. Twenty-one of were treated with cervical traction and hotpack. These tratment proved successful for 81% of them.
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水野 秀夫, 前川 清継, 森田 直, 津留 隆行, 緒方 正光
1985 年 33 巻 3 号 p.
969-972
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report two cases of cervical myelopathy caused by calcification of ligamenta flava. The patients were a 74-year-old woman and a 58-year-old woman. They complained of dysesthesia in the four extremities and gait disturbance. Cervical laminec tomies were performed and good results were obtained.
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斉鹿 稔, 河合 伸也, 今釜 哲男, 小田 裕胤, 城戸 研二, 坂本 正, 田中 浩
1985 年 33 巻 3 号 p.
973-975
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
Radiographical mesurement of the ossified area of the spinal ligaments was performed in 94 cases with cervical myelopathy due to ossification of the posterior longitudinal ligament. The cases were selected where lateral views of the radiogram were able to take in the entire spine.
The ossified spinal ligaments measured, were the anterior longitudinal ligament (OALL), the posterior longitudinal ligament (OPLL), the yellow ligament (OYL) and the supraspinous ligament (OSSL). Ossified areas of the entire spine were plotted and analyzed on a computerized digitizer. The average ossified areas measured 1.78cm
2 in OPLL, 4.73cm
2 in OALL, 0.79cm
2 in OYL and 2.63cm
2 in OSSL. According to the volume and localization of the ossified area in the spinal ligaments, we classified them all into four types, that is, complete type, anterior type, posterior type and incomplete type. In the complete type and anterior type there tends to be a higher hyperostotic status. It was suggested that the formation of ossification of the spinal ligaments was influenced by many factors, such as genetic factors, continuous minor traumas to the ligaments and others.
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上原 裕史, 酒匂 崇, 武田 洋吉, 米 和徳, 大平 博人
1985 年 33 巻 3 号 p.
976-978
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
A quantitative analysis of hormones in human plasma was carried out for nineteen cases of OPLL and compared with those from seven cases of cervical spondylosis. Estrone of the male OPLL and cervical spondysis cases was significantly higher than that of the control group (P<0.01). In six cases of OPLL, the PTH level was not detectable. Six of the seven cases who under-gone Ellsworth-Howard test showed a decline in response, and this suggests disorder of receptors.
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川上 不二夫, 河合 伸也, 丘 茂樹, 田中 浩, 石田 洋一郎
1985 年 33 巻 3 号 p.
979-981
発行日: 1985/03/25
公開日: 2010/02/25
ジャーナル
フリー
We observed thoracic ligamentum flavums which had been surgically removed, by use of a scanning electron microscope and transmission electron microscope. They were from 8 cases of ossification of thoracic ligamentum flavums and 9 cases of spinal canal stenosis or spinal tumors with no other ossification in roentgenograms for the control. These specimens were further observed by Toluidine blue staining and Van Gieson staining. In the case of ossification of the thoracic ligamentum flavum, close to the site of ossification, various degenerative changes were observed such as wavy pattern of elastic fibres, increase of chollagen fibres, irregular patterns, and appearance of oval and rosen-shaped granular particles. Nearer the site of ossification, appearance of chondrocyte and calcification of marix were observed. At the site of ossification, Haversian systems with osteogenecity were observed. These findings could show that ossification of thoracic ligamentum flavum may be the result of a course of endochondral ossification. We discuss more about the course of ossification from the viewpoint of degeneration of ligaments.
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