Since July 1976, we have operated on 60 cases of cervical disorders including 24 cases of cervical anterior interbody fusion, 16 cases of cervical laminectomy, 5 cases of cervical enlargement, and 5 cases of anterior interbody fusion with anterolateral foraminotomy. Of these, three cases using posterior approach showed quadriplegia immediately following operation. I case due to haematoma in the laminectomy region, I case due to lack of numbers of laminectomy level, I case due to lack of laminectomy with extradural hematoma.
We studied the clinical results of operatuie treatments of 57 patients with acute central cervical cord injury. We used several common estimation scales and a new quantitative scale. The scale is adaptable to prospective as well as retrospective studies and provides means of comparing the effectiveness of differing treatment modalities. There was some effectiveness from operative treatment as judged by this scale according to recovery_ of both motor and sensory function, but it is necessary to compare our cases with other results following only conservative treatment.
Several methods of surgery have been reported for osteoplastic enlargement of the cervical canal, though the indication of this surgery is not clear. Up to date, we have performed this surgery upon seventy-five patients with cervical myelopathy due to ossification of the posterior longitudinal ligament, spondylotic myelopathy, discitis and cervical spinal cord tumor. This report evaluates the results of fifty-two patients postoperatively. Twenty-two of thirty patients with O. P. L. L. showed Excellent or Good results postoperatively. Sixteen of twenty-two cases with spondylotic myelopathy showed Excellent or Good Results. Good Result were obtained for cases of spondylotic myelopathy and O. P. L. L.
From 1977 through 1983, 71 patients were operated on at our hospital. They did not have spondylotic changes, that is, posterior spur formation, narrow foramen or deformities of the Luschka joints. These 71 cases, which included 36 cases with discogenic myelopathy, 31 with discogenic radiculopathy and 4 with local signs, were followed up. Results were as follows: 1) Age of onset was 40 years on the average, and that was 15 years younger than that of 111 patients with CSM and CSR who underwent surgery at our hospital. 2) The provocative rate was about 33 percent. Traumatic factors were: traffic accidents (7 cases), degradation accidents (5 cases), falling down (4 cases), contusion (2 cases) and sports injuries (1 case). 3) The frequencies of the lesion levels were, in order: C5/6 (54.4%), C4/5 (24.8%), C6/7 (14.9%), C3/4 (5.0%) and C7/Th1 (1.0%). This tends to be the same as for cervical spondylotic myelopathy and radiculopathy. 4) Narrow disc (56%), instability (54%), retrolisthesis (32%), angulation (22%) on the plain X-P were diagnostic changes of the cervical disc lesion. Clinical signs of these lesions were inclined to occur in the cases that were accompanied by narrow canal and anterior shift of the upper apex in the superior facet. 5) Myelography was very valuable as a diagnostic technique to determine the main foous, especially in cases with spondylosis on other levels. 6) Operation procedures were Cloward's method (38 cases), Simmons (31 cases) and Smith-Robinson (2 cases). The results of all were excellent. 24 cases (85.7%) of the 28 patients with myelopathy who could be followed up had more than 16 points using JOA standard of CSM.
Twent-three patients with progressive cervical spondylotic myelopathy were surgically treated and their post-operative courses were observed in detail during the time of their hospitalization. According to an evaluation of the post-operative results by questionaires, twenty cases (86.9%) improved within four weeks. While motor and sensory disturbance tended to improve within one week following surgery, tendon-reflexes remained still abnomal until about 8 weeks later. Moreover the results by means of anterior and posterior approaches are discussed.
Generally, cervical spondylotic myelopathy based on spinal degeneration is seen in ageb patients. They have various complications and suffer for a long time. Therefore, they have many problems during therapy. Since 1979, 21 aged patients of over sixty years of age ave been operated on in our clinic. Consequently, we understand that efficient operative results are obtained from cases wheve treatment is started within less than 2 years following onset. In any cace, aggravating myelopathic symptoms require some kind of early decompression surgery.
The purpose of this paper is to compare the anterior approach and posterior approach for treatment of cervical myelopathy. Sixteen patients were followed up, who shared the same factors: 1) Operated on after 1971, 2) Central defect in myelogramat 2 or 3 levels, 3) Under 60 years of age, 4) Symptoms within 1 year, 5) Preoperation score; Jpn. Orthop. Ass. points from 6 to 12, 6) Hattori's classf ication of myelopathy; type III, 7) Canal stenosis (sagittal diameter within 14mm), 8) Without radiculopathy, thoracic and lumbar disease, and 9) Follow-up periods of more than 3 years. Anterior approach was performed in 8 cases and posterior approach was performed in 8 cases. Results of anterior approach at the time of discharge were excellent in 6 cases, good in 1 case and fair in 1 case, and at the time of time of follow-up were excellent in 7 cases and good in 1 case. Results of posrerior approach at the time of discharge were excellent in 5 cases and good in 3 cases, and at the time of follow-up were excellent in all cases. The results of both approaches are nearly the same at each time. The suitable operation methods, to which the surgeons are most accustomed, should be selected for each patient. Furthermore, we discuss the postoperative results in relation to operative time and operative bleeding volume.
Recently we experienced a patient with midline prolapse of intervertebral disc between L2 and L3·We found it was rare according to the literature. The patient was a 32-year-old male who had low back pain, bilateral sciatica and gait disturbance. Myelogram revealed a total block at intervertebral disc between L2 and L3. We thought it was due to the cauda compression by midline prolapse of intervertebral disc between L2 and L3 or to a tumor. During surgery, we found the cauda equina was compressed by midline prolapse of intervertebral disc between L2 and L3. It was completely removed and the symptoms disappeared after operation. It is difficult to distinguish between a midline prolapse of an intervertebral disc at high-level lumbar vertebra and a tumor.
In twelve cases of lumbar disc herniation, we measured nerve root blood flow after posterior nucleotomy using an electrochemically generated hydrogen clearance method. The blood flow of the nerve roots in these cases was 49±15ml/min/100g. We think this value is reasonable and this method can be used for measurement of blood flows in clinical cases.
We have recently studied 25 cases of redundant nerve roots in the cauda equina. Lumbar myelogram demonstrated 17 cases of complete block and 8 cases of incomplete block. Patients with positioning (flexion, extension, standing) showed the disappearance of a serpentine myelographic abnormality in the cauda equina. This radiographic redundancy seems to be congenital redundant nerve roots which are produced by spondylotic squeezing or gripping of the cauda equina. Surgery was carried out in 15 cases. The paraparesis was treated successfully by surgical decompression.
We treated two patients with lumbar disc herniation who also had a psychological problem. The first case was a 24-year-old male who complained of low back pain and numbness of right lower extremity. We diagnosed lumbar disc herniation of a level between lumbar five and sacrum. After conservative treatment, surgical treatment was performed consisting of extirpation of nucleus pulposus by Love's technique. After operation, the symptoms lessened but 3 weeks later, he again complained of severe low back pain. After six months, we performed a second operation. This was laminectomy of lumbar five. We continued conservative treatment. The symptoms decreased gradually. The second case was a 49-year-old female who complained of low back pain and numbness of right lower extremity. We diagnosed lumbar disc herniation of a level between lumbar four and five, lumbar five and sacrum. We treated her conservatively, because she had certain psychological factors. After long term treatment, the symptoms decreased gradually. In treatment of low back pain, we have to consider subjective and neurological symptoms, and also psychological factors.
I In response to questionnaires sent to 10, 116 male workors, effective answers were obtained from 8, 055 employees. The 8, 055 respondents were classified into either “A” group consisting of 4, 684 shop workers or “B” group consisting of 3371 clerical workers, who were further classified into four categories by severity of back pain as follows: 1) Those who have no back pain at all and are capable of heavy labor. 2) Those who are capable of daily work but have occasional back pain when performing heavy labor. 3) Those who have difficulty performing work in the stooped position due to a bad back. 4) Those who have difficulty even performing daily routines due to a bad back. Defining, in narrow terms, only (3) and (4) above as bad backs, 7.3% of the “A” group workers and 5.3% of the “B” group workers were found to fall into these categories. It was observed that with both the “A” group and “B” group, the number of workers complaining about bad backs would increase with age. Of the 520 workers falling into the narrow (3) and (4) categories, 140 were given direct physical examinations, faring poorly on the objectivecomment scale as compared with what they scored on the subjective-symptom and daily-life-activity scales.
A clinical and radiological study was carried out in forty-three patients of symptomatic degenerative spondylolisthesis of the spine. Evaluations of the clinical symptoms were done on the four items. Radiograms were checked and measured on the fifteen items in each patient. The results of the analysis disclosed that the angle which vertebral body and lamina made and the angle which vertebral body and intervertebral joint line made were decreased in the slipped vertebra more those in the other vertebrae. The angle which the two vertebrae at the slipped area made and the height of the disc were also decreased. On the other hand, cineradiographic examination revealed that hypermobility of the intervertebral segment at the slipped area was not noticed. Clinical evaluations were not correlated so well with the degrees of the abnormal changes on the radiograms. Factor analysis drew three independent factors, which suggested abnormal changes of the posterior and anterior elements of the spine on the radiograms and neurological element on the clinical evaluations such as weakness of the muscles.
In order to study the pathogenesis of degenerative spondylolisthesis, 205 cases (148 females, 57males), who had consulted our hospital between 1966 and 1982, were investigated clinically and radiologically. The average slipping rate was 14.2% by Marique-Taillard's method. O. A. changes in zygapophyseal joints and increases in pedicle-facet angles were observed more significantly than the same changes in 50 cases with spondylosis deformans. The degree of slipping, O. A. in L4-5 zygapophyseal joints and narrowing of the L4-5 intervertebral space were investigated in 64 cases who were followed conservatively for more than one year with an average of 6.5 years. Both an advancement of slipping rate of more than 5% and an increase of O. A. changes in L4-5 zygapophyseal joints were observed in 27% of all cases. An advancement of narrowing of L4-5 intervertebral space was found in 49%.
A follow-up study of 12 patients who had had surgical treatment for lumbosacral spondylolisthesis is reported. From a series of 12 patients, 7 patients were treated by reduction and fusion with or without instrumentation. These methods involved preliminary modified Vidal traction followed by anterior interbody fusion. Four patients were treated by anterior interbody fusion in situ, and the other one patient was treated by posterior decompression and posterolateral intertransverse fusion.
The Slot kyphosis-distraction system was developed for the correction of kyphosis. It consists of distraction system and implants for fixation of the obtained correction, a variation of Zielke's V. D. S. Its advantages are easy application and rigid fixation. We treated four cases of burst fracture of the thoracolumbar spine with the Slot system. We think that burst fracture with severe damage of posterior complex needs anterior and posterior decompression, reduction and fusion by use of Harrington instrumentation. When we operate on such cases with the Slot system, we can remove anterior fragments primarily and fix the injured spine by the distraction system. Its fixation is tolerable for Harrington instrumentation. In cases with mild damage to posterior complex or where fusion of two discs is required we can treat them by anterior fusion only. Rigid fixation is obtained by Slot implants. Introduction of the Slot system in the surgical treatment of burst fracture gives us safety and rigid fixation.
Diagnosis and operative treatment for nine old burst fractures of thoracolumbar spine are reported. Weakness of the injured vertebral body resulted in kyphotic deformity, and caused lumbago and neurological deficits. We aimed at decompression of the spinal canal, correction of kyphotic deformity and fixed fusion. So We operated on these cases by means of anterior interbody fusion and posterior spinal fusion using Harrington instrumentation.
The radiological features of ante-position type instability, as defined by Knutsson, were studied in 34 cases and compared with those prevalent in cases of degenerative spondylolistheses. Of the 34 cases, 32 were women and 2 were men. Their ages ranged from 35 to 84 years with an average age of 65. In 27 patients, the instability occured at the L4 level. The slip was induced upon flexion of the lumbar spine in 33 patients. The average slip rate at maximum flexion or extension was 9.8%. The slip was almost non-existent in the neutral position. There was a remarkable predominance of severe facet degeneration. (57.6%) In conclusion, the radiological features of ante-position type instability are almost the same as those of definite degenerative spondylolisthes.
A 15-year-old boy with known recessive dystrophic epidermolysis bullosa was admitted to our hospital for surgery to his mitten hand. The thumb was contracted in adduction, and all other four fingers were fused with flexion contracture of the MP joint. Bilateral fingers were freed surgically with open method, and only the right hand was immobilized with a special apparatus in the early post-operative period. But flexion deformity of DIP joint at left middle and ring finger could not be freed because of its capsular and ligamentous contracture.
There are many reports about ruptures of the extesor pollicis longus tendon, caused by RA, by trauma, by radial bone fracture etc. We experienced a case of steroid induced rupture of the tendon. Case report; a 16-year-old, female. Chief complaint; disorder of the right thumb. She began working for a stocking manufacturing plant in April 1983. In August she complained of right wrist pain. She was diagnosed as having tendonitis, and was infitrated with steroid four times during two months without immobilization. In October, shee noticed a disorder of the right thumb suddenly when she was washing dishes. Immediately she consulted our hospital. There she was diagnosed as having a rupture of E. P. L. tendon. She was treated surgically. Duving surgery, E. P. L. tendon was ruptured completely and the ends were split finely. They were sutured end-to-end, and immobilised in plaster. The plaster was removed eight weeks after the operation. She could return to the same co pany. We consider the causes of rupture to be delayed healing following steroid injection and mechanical stress over this. We have had a new appreciation of an adverse reactionof steroid and the need for immobilization.
We review 21 cases of injuries to the flexor tendons including FPL and FDP, and to the nerves in the forearm. The Patients' ages ranged from 1 to 51 years old, with an average of 26.0 years old. Of these, 11 cases were operated on within 24 hours of injuriy, 5 cases within 2 months and 5 cases over 2 months later. Primary suture of FDS was performed in 13 cases. Results of the children were excellent in all cases. There was no difference in the clinical results between the cases operated on within 24 hours and those within 2 months of injury. Finger motion and recovery of hand grasping power in the cases where FDS were primarily sutured was better than those in which FDS were not sutured.
Eight patients with adherent flexor tendons of the hand were operated by tenolysis 4 to 6 months after primary operation. Six showed considerable improvement, but two had tendon ruptures following tenolysis. The optimal interval between primary surgery and tenolysis is discussed in this paper. The optimal timing is regarded about 3 months conventionally, but we consider it between 4 and 6 months in which scar formation subside sufficiently.
We treated ten patients with Zone 5-7 extensor tendon ruptures (RA 5 cases; crush type 3; clear cut 2;) by means of early controlled mobilization using a dynamic splint. Only active flexion was allowed after a few days, but overflexion was blocked by a plaster volar splint. We think that early controlled mobilization contributes to lack of complaints in PIP joint, decreasing of edema, prevention of intrinsic muscle contracture and active exercise of tendon excursion.
We reviewed twenty-three cases of carpal navicular fracture visited our clinic in the past ten years. The length of follow up were one to seven years, with an average of fourty-five months. Prognosis of proximal part fractures were the worst (one fair and one poor) in comparison to that of middle and distal part. Eight cases, all of which were the symptomatic delayed union or non-union, were operated by the bone graft with or without the styloidectomy. The results of operated cases were four good, three fair and one poor. On the other hand, nontreated cases were all evaluated as good and excellent, but most of them had little symptoms when they visited our clinic. The characteristics of their roentogenograms were the absence of bone absorption at the fracture site and the stability in stress roentogenograms. Although many authors refered the carpal osteoarthritis following unstable non-union of the navicula, the result in this series may suggest that surgeons must be prudent in treatment of asymptomatic and stable non-union.
Aseptic necrosis of the capitate bone is considered to be comparatively rare. A recent case is presented. The patient was a 21-year-old male costruction worker. His chief complaint was swelling and pain in the left wrist. Physical examination revealed limitation of range of motion in the left wrist, with swelling and tenderness of the central dorsal hand. Roentgenograms revealed absorptive changes in the proximal portion of the left capitate bone and sclerotic changes in the distal portion. Total resection of the capitate bone and intercarpal fusion was performed. Histopathologically, bone necrosis was seen. Postoperatively, limitation of range of motion of left wrist joint persisted. However, there was no swelling or pain in the wrist. An uneventful course is predicted.
We experienced a case of lunate dislocation together with carpal tunnel syndrome. This in jury is rare for most surgeons outside specialist. Previously published literature about this injury is reviewed.
Two cases of traumatic subluxation of the distal radio-ulnar joint were reported. The patients, aged six and nine, fell down with out-stretched hand but precise mechanism of the injury was not known. On examination, the wrist was held in slight pronation and there was slight prominence of the ulnar head. Swelling about the wrist was scarcely detectable. There was slight pain, much increased by attempt to supinate the forearm. There was full movement of the radio-carpal, fingers and elbow joint. Anteroposterior laxity of the distal radioulnar joint could be demonstrated by manipulation. Radiograms did not show any abnormality. The ulnar head was reduced with a palpable click easily by direct pressure over it in pronation. But when the pressure took off, the ulnar head subluxated dorsally again, whereas the wrist was stable after reduction in supination. The wrist was immobilized in an aboveelbow plaster with forearm in maximum supination. Immobilization was continued for three weeks. A week after removal of the plaster full range of motion of the forearm and wrist has been recovered and there was no instability of the distal radio-ulnar joint. The authors thought that these cases were dorsal subluxation of the radio-ulnar joint by a probable hyperpronation injury.
For osteoarthritis of the elbow, Kashiwagi-Outerbridge arthroplasty has been mainly employed at the Nagasaki University Hospital. This procedure however has several problems. The soft tissue in the anterior component cause flexion contracture and cannot be treated, also the osteophyte and loosebodies in the anterior parts cannot be eliminated completely, because its approach is a posterior one. Therefore, the anterior approach has been most often employed recently. In this paper, surgical techniques, results and indications are discussed. This procedure was employed in 5 elbows of 5 patients who had limitation of elbow flexion as a result of osteophytes of the coronoid process and loosebodies in the anterior parts. In two cases where they also involved the posterior element, an opening in the coronoid fossa was added. All patients were male and their ages averaged 39.4 years (range, 35 to 44 years). Preoperative range of motion, 99 degrees in flexion and -16 degrees in extension changed to 137 degrees in flexion and -5 degrees in extension on average following suvgery. Pain was eliminated in 4 cases and decreased in one case. Although there are some misgivings about using the anterior approach for the elbow, mainly because of possible injury to the nerve and vessels, such serious complications were not experienced in this series. The anterior approach for osteoarthritis of the elbow has many benefits, so this procedure is recommended.
There are merely three surgical methods for treating spastic hands in cerebral palsy: These methods are release of the spastic muscles, tendon transfer and arthrodesis. We have not found it advisable or necessary to carry out tendon transfer and arthrodesis. For the correction of a deformity in the upper extremity, we applied proximal muscle release and fractional lengthening of the musculotendinous junction. This method was carried out in 11 cases. The results showed that, 1) wrist and finger flexion contracture were remarkably improved by fractional lengthening of the musculotendinous junction, and, 2) thumb -in-palm deformity was not improved at all by the lengthening of the flexor pollicis longus.
A case of subcutaneous rupture of the pes anserinus is reported in this paper with some references to previously published literature. The case was a male aged 37. years. whilst riding a bicycle, he fell and bruised the medial side of the left knee on July 10, 1983. He visited our hospital, complaining of continuing pain over the medial side of the left knee and gait disturbance on July 27, 1983. On examination slight swelling was seen at the medial side of the left knee, with tenderness of the anterior part of the medial tibial condyle, and a possible rupture of the end of pes anserinus was palpated in the same region. No wounds or scars were seen on the skin around the pes anserinus. There was no finding of damage to the meniscus and the ligament. An end to end suture of the pes anserinus was performed and a cast fixation was applied for three weeks after operation, followed by functional exercise with good results.
We experienced six cases of meniscal cysts, and recection was performed in five cases. Five cases were on the lateral side, and one on the medial side. Four cases were associated with meniscus tear and three cases with parrot-beak tear. Computed tomography was used in examining four cases. Cysts were recognized as low density areas. In diagnosing cysts computed tomography is very useful.
Lateral non-discoid meniscal tear in a three-year-old girl was treated with partial meniscectomy. The tear was noticed peripherally extending from the body to the posterior horn of the meniscus. Postoperatively the sympotoms have improved without recurrence.
Morphological and historogical examination of the injured discoid menisci were investigated by means of scanning electron microscopy. The surface of the meniscus was covered with fine collagen fibrils which showed randamly arranged network. The substance of the meniscus consisted of the layers of collagen fiber bundles arranged horizontally from anterior to posterior segment. There were few vertically oriented fibers. This structure appears to play an important role in producing horizontal tear of the discoid meniscus in addition to the degeneration of the central portion and mechanical stress such as direct compression, anteroposterior and rotatory strain.
CT can evaluate the hardness of the subchondral bone, because its hardness is associated with the thickness of the bone plate and trabeculae. 47 patients with patello-femoral arthralgia were examined by CT, arthroscopy and/or arthorotomy. They were divided into normal and abnormal cartilage groups, and the latter was subdivided into 3 groups. The measured sites of the hardness of the subchondral bone using CT were the center of the lateral facet. the median ridge and the center of the medial facet. The shape of the subchondral bone was classified into 5 types. The hardness was lowest in the medial facet in the abnormal group, and stiffness gradient existed between the median ridge and medial facet in the abnormal group. The shape of the subchondral bone was relatively high at the center of the lateral facet, and thin and irregular in the abnormal. group. The hardness between the lateral facet and the median ridge, in which most of the lesions of the cartilage existed in our cases, was not significantly different. The stiffness gradient and shape of the subchondral bone could be related with the lesions of the patellar cartilage, or vice versa.
Diagnosis of patello-femoral osteoarthritis, PFOA, is based on narrowing of joint space. In search of pathogenesis of PFOA, radiological findings were analysed with computed tomography. It was found that PFOA can be classified into two types; type A is characterised by marked subchondral sclerosis and osteophyte and type B by subluxed patella with little sclerosis. In FTOA, especially in medial FTOA, the tibia has been observed externally rotated relative to the femur. Consequently the patella shifts laterally and so-called excessive lateral pressure syndrome will result in type A. In subluxation of the patella, type B will develop with a narrowing of joint space.
We report a case of familial spastic paraplegia accompained by recurrent dislocation of the patella who received a patellectomy to relieve the knee pain. The patient is a 55 years old female, and has weakness and numbness in both lower legs which started to appear when she was 20 years old, gradually changing to a deformity of the X legs. The traumatic dislocation of the patella in the right knee at the age of 24, triggered the recurrent dislocation and chondromalacia patellae. In order to relieve the motion pain of the knee and to improve ADL disturbance, we performed a patellectomy following the method of West and Soto-Hall which is better for maintaining the function of the quadriceps muscle. As a result, the patient became able to raise the right leg straight. Now the patient has acquired the ability to walk as before the operation by the use of a knee brace. Familial spastic paraplegia is a progressive disease, so someday she may become completely unable to walk by herself, but she is satisfied with the results of the operation which was selected carefully.
Sixty limbs in thirty bowlegged children under the age of 27 months were examined roentgenographically in the standing position at first clinical visit and then followed up. Femorotibial angle, which is defined as the lateral angle between the long axis of the tibial diaphysis and of the femoral diaphysis, was evaluated. Proximal tibial metaphyseal angle, which is the angle created by the intersection of the long axis of the tibial diaphysis with a line perpendicular to the line connecting the medial and lateral ends of the proximal tibial metaphysis, was evaluated. Femorotibial angle is useful for judging the degree of deformity of genu varum. Proximal tibial metaphyseal angle is able to represent the degree of deformity of the proximal end of the tibia. These angles allow us to follow up bowlegged children. We cannot yet comment whether their prognoses are progressive or not.
Acute ligamentous injuries to the knee joint should be diagnosed in the early stage, and proper surgical repair will result in a satisfactory recovery of the knee function, if the instability is not remarkable. A follow-up study was made of 36 patients with acute ligamentous injuries to the knee joint in our clinic, 16 of whom were treated surgically and the rest conservatively. Treatment of isolated ligamentous injuries provides good results without any problems during ADL and sports activies. The patients with combined ligamentous injuries should be surgically treated; however some of them could not return to full sports activities. So, careful management is necessary in treating acute ligamentous injuries to the knee joint.
Three hundred knees were examined under arthroscopy over a thirty-month period. Since thirty knees with a tear of the posterior cruciate ligament were encountered, twenty-six of these knees were examined arthroscopically. Since initially an anterolatral approach was employed using a O-degree telescope in nine knees, the entire length of the posterior cruciate ligament was not visible except for the knee with the attenuated anterior cruciate ligament. However, the use of an anteromedial or central approach using a 30-degree telescope made the diagnosis of tears of the posterior cruciate ligament easier even for the old cases. In those cases, a hook must be used to judge the tension of the ligament and to decide the exact portion of the ruptured fibers. Using this method, fifteen of the seventeen knees were diagnosed correctly.
Three cases of old PCL insufficiency were treated by bone-block transfer of the medial head of the gastro-cnemius as presented by J. N. Insall in 1982. The mean follow-up time was twelve months. The results were evaluated following the scoring scale advocated by Lysholm and Gillquist. Case 1 was marked 92 points, case 2, 75 points and case 3, 70 points. The most improved were concerning instability and pain during gait. Static instability was not improved. The functional improvement of the knee is speculated to be due to the dynamic function of the medial head of the gastrocnemius which tends to reduce the upper tibia anterioly during gait and running.
We made a statistical study of the complicated articular injuries of the meniscus and cartilage in relation to 31 cases with anterior cruciate ligament (ACL) insufficiency and 20 cases with posterior cruciate ligament (PCL) insufficiency for whom arthroscope and ligament reconstruction had been performed in both our hospital and others during the period of of 1981 to 1984. Cases with multiple ligament injuries were excluded from this study. ACL insufficiency: Most of the patients with ACL insufficiency were injured during sports activities such as basketball, gymnastics and so on. Their average age was 24.8 years old. The articular injuries of the meniscus and cartilage increased as the post-injured duration became longer. The post-injured duration for most of the patients with lateral meniscus tears became was short. The number of patients with medial meniscus tears increased as post-injured duration longer. Most of the articular cartilage injuries were situated on the medial femoral condyle and the patella. PCL insufficiency: Main causes of PCL insufficiency were traffic accidents, falling and so on. The patients were 37.6 years old on average and older than those with ACL insufficiency. The post-injured duration for most of the patients with meniscus tears was short. The articular cartilage injuries incresed mainly on the patella as the post-injured duration became longer.
We performed arthroscopic surgery on the knee joints of 82 patients from June 1981 to April 1984. Meniscectomy was performed in 41 cases. (medial meniscectomy; 14 cases; lateral meniscectomy: 25 cases, of which 16 cases were discoid meniscus; medial, and, lateral meniscectomy: 2 cases.) Synovectomy was performed in 15 cases. (rheumatoid arthritis: 9 cases; pyogenic arthritis: 3 cases; unknown: 3 cases.) Shelf operation was performed in 10 cases. Joint mobilization was performed in 6 cases. Removal of loose body was undertaken in cases and other operations were performed in 5 cases. We used Watanade 21 CL and CLM arthroscope and performed surgery by two point method in the majority of cases of meniscectomy. But posterior horn of medial meniscus was cut by the three point method in some cases. At popliteal tendon portion, the rest of the meniscus after partial meniscectomy was frequently unstable, especially in the case of complete discoid meniscus. There were no technical problems in the shelf operations. Joint mobilization was a simple and useful method for treating the stiff joint if performed within 2 or 3 months after the previous operation.
The utilities of television system in arthroscopy of the knee joint were reported. The arthroscope was connected to Shinko's MODEL SK-1057 and standard television was connected to it with a cable. The examination was tried in 51 cases. We think that the television system is very useful because one can see dynamic arthroscopy by a videocorder and monitor television at any time and any place and physicians can talk with the patients about treatment and diagnosis.
Arthroscopic surgery was performed in two cases of knee joints containing foreign bodies. Case 1: 46-year-old female. Broken glass penetrated into her right knee joint and 6 years later, her right knee suffered from septic arthritis, so we performed arthroscopic removal of the glass. Case 2: 6-year-old male. A needle penetrated into his left knee joint, so we performed arthroscopic removal of the needle. Arthroscopic removal of foreign bodies in the knee joint is more useful than large incision removal.
Forty-two knees were studied concerning loose bodies of the knee. (Osteochondral fracture; 12 knees, Synovial osteochondromatosis; 11 knees, and others). Arthrography and Arthroscopy were useful in diagnosing loose bodies of the knee. Some cases with poor or fair results had several kinds of complications.
We previously reported that synthesized eel calcitonine and 1α25(OH)2D3 each promote calcification in the widened growth plate in cases of EHDP induced rickets in the healing stage. In this experiment, in order to evaluate whether hypercalcemia contributed to the calcification observed in this model, calcium gluconate was administered to Fisher female rats with EHDP induced rickets. Calcium gluconate enhanced the calcification in the epiphyseal growth plate. This mode of calcification was like that of 1α25(OH)2D3.
We have already shown that 1, 25(OH)2D3 (D) and calcitonin ([Asu1.7]-eel calcitonin, CT) promotes calcification of the thickened growth plate in the healing stage of EHDP-induced rickets respectively. In the experiment female weanling Wistar King-A rats of 4 weeks of age were used and the experiment period was settled to be 2 weeks. Sixty mg/kg body weight of EHDP (ethane-1-hydroxy-1, 1-diphosphonate) was dosed subcutaneously, daily for the former 7 days and then they were left alone for the latter 7 days, that is the basic model, we have settled, of EHDP-induced rickets (EHDP rat). Forty U/kg body weight of CT was given to the EHDP rat for the 14 consecutive days (2), for the former 7 days (f), and the latter 7 days (1), that makes up 3 groups. 0.5μg/kg body weight of D was given in the same 3 ways. Our previous results showed that CT (2) and CT (f) groups promoted calcification in the growth plate, and D (2) and D (1) groups did so. Now in this study, both CT and D were admistered respectively either in the former 7 days or in the latter 7 days, making 4 groups. In the results, CT (f) D (f) group showed prominent calcification, whereas CT (f) D (1) group showed most massive calcification, and calcification was invisible except for the slightly narrowed plate in CT (1) D (f) group. These synergistic effects of CT and D, particularly shown in CT (f) D (1) group, are indicative of the difference of CT and D in the mode of calcification.
The influence of Cyclophosphamide (CY) on bone and cartilage tissue has been studied recently. We studied the effects of CY on rats and reported about the Osteopetro-Rickets' changes in tibia metaphysis. In this study, we examined the effects of CY on experimental tibia fractures. It was observed that CY 5mg/kg/day induced a delay in fracture healings and CY 10, 20mg/kg/day disturbed the fracture healings and induced pseudoarthrosis in them.
The effects of tilorone, which is known to suppress adjuvant arthritis, on collagen arthritis in rats were studied following oral administration of this drug at doses ranging from 6.25-25mg/kg/day for 15 days starting the day before type II collagen immunization. Combined date of the tilorone-treated rats show that there was an increased incidence of arthritis in the rats receiving tilorone treatment compared with the control group. In addition, treatment with tilorone caused a significant enhancement of the severity of collagen arthritis in a dose-dependeent manner. Although delayed-type hypersensitivity (DTH) skin test response to type II collagen was not affected by tilorone, humoral immune response to type II collagen was significantly enhanced in a dose-dependent manner. These data further support the concept that humoral immunity to type II collagen plays a predominant role in the development of collagen arthritis and also provide circumstantial evidence suggesting that collagen arthritis and adjuvant arthritis are distinctly different diseases mediated by different pathogenetic mechanisms.
The intraosseous pressure (IOP) of the patella was recorded in 12 immature dogs. The mean value of IOP at 90° flexion position of the knee was 12.5±4.7mmHg. The effects of the femoral vascular occulusion and intravenous infusion of adrenaline or noradrenaline on IOP were found to be the same as that of the other reports about the long bones. Application of dopamine slightly increased the IOP, though significant elevation of the systemic blood pressure was observed. During extension or flexion of the knee joint the IOP also increased. Especially, in full flexion this rose to about 1.5 times that in 90° flexion position. With the rise of intraarticular pressure (IAP) of the knee joint the IOP of the patella increesed continuously. But the changes of the IAP during extension or flexion of the knee hardly corresponded to those of the patellar IOP. The morphological condition of the infrapatellar fat pad was observed to be shifting with the motion of the knee, radiographically. Then, it was suggested that not only the elevation of the IAP of the knee but also the compression of the infrapatellar fat pad evoked the rise of the IOP of the patella with the knee movement as a result of venous obstruction.