A case of calcification of cervical disc in children is reported this time. The patient is a 5-year-old boy, complaining of neck pain and limited neck motion. Calcification at C 4/5 disc level is found on X-ray. We treated with analgesic and anti-inflammatory agent and glisson traction. After 2 weeks the clinical symtom was recovered. Ten months later, calcification was almost decreased.
A case of intervertebral calcification in cervico-thoracic region of a child is presented. A four-year-old boy visited our clinic with pain and limited motion of the neck. Examination gave no inflammatory findings and no abnormal neurological signs. An X-ray examination, however, showed multilevel calcification in the cervico-thoracic region. Immobilization with a neck brace seems to have been effective.
Two cases of cervical myelopathy caused by multiple calcified nodules in the yellow ligaments are presented. Case 1 was a 67-year-old woman who complained of numbness of the extremities. Roentgenological examination of the cervical spine showed radiopaque nodular lesions located in the paramedian portion of the posterior spinal canal. Myelogram showed a complete block at C 6-7 level and wide laminectomy was performed. Case 2 was a 67-year-old woman who also complained of numbness of the extremities. Roentgenological findings were very similar to those in Case 1. She was treated conservatively and died of heart failure eighteen months after admission. This report discussed these two cases associated with forty cases of comprehensive previous reports.
One hundred and twelve patients of OPLL in the cervical spine who had been treated conservatively were followed up clinically and radiologically. The progression of the ossification was seen in 46 of 63 cases followed up more than 5 years (73%) and in 28 of 49 cases less than 5 years (57%). In those who showed the progression of ossification, worsening or development of mye-lopathy were found likely to happen at the higher rate.
A case of cervical myelo-radiculopathy with athetoid cerebral palsy was reported. A 16-year-old male was admitted to our hospital complaining of muscle atrophy and weakness of left upper extremity. The radiographs of the cervical spine revealed kyphotic lesion (C3-5) which angle was 45° by the method of Cobb. Complete block on myelogram was seen in neutral position, but it disappeared in extension position. Alignment of the cervical column was corrected by anterior spinal fusion (C3-5) with halo-cast fixation. His symptoms were gradually reduced as a result of the operation. He got ability of walking with cruches after 16 months postoperatively.
We studied an autopsy case with tetraplegia histopathologically. The case, a 32-year-old male, had the upper thoracic laminectomy for the extirpation of the intramedullary hemangioblastoma in 1972. After the operation, the cervical lordosis increased step by step following the increasing thoracic kyphosis. The myelogram showed compression of the cervical spinal cord by step-formation of the cervical spine. The histopathological findings were a focal necrosis in posterior funiculi and spinal cord cyst near the central canal in C1/2, and mostly necrosis below the level.
Rheumatoid arthritic changes in the upper cervical spine was studied radiologically in 209 cases with RA. Atlanto-axial dislocation was found in 39% of them and vertical displacement of Cl in 11%. For diagnosis of vertical displacement of Cl, Ranawat's and Redlund-Johnell's methods were discussed.
We have recently experienced four cases of posterior fusion of Atlanto-Axial Subluxation due to RA. These operative indications were severe occipitalgia and neck pain in all cases. All cases were operated on by modified Brooks procedure, and in one case, posterior fusion including occiput was added. In peri-operative period, all four were fixed with BTA brace. Pain in all cases was diminished or disappeared postoperatively. Three of four cases, which had anterior subluxation, have had solid fusion, but in one case, which had, so called, superior migration, bone fusion was unclear. We have reviewed these cases, and measured SMO, which means “Superior Migration of Odontoid process” described by C. S. Ranawat et al in 1981, retrospectively. We found SMO was a very easy and available index of superior migration, that shows destruction of lateral mass of atlant-axial facet joint.
Posterior fusion with a Luque rectangular rod for atlanto-axial dislocation was reported. Four of the patients were operated on by this method with a satisfactory result. It is effective especially for unstable spine and to stabilization of the unstable spine and prevention of nonunion, because of the strong internal fixation.
The authors report their experience with the use of a method of internal metal plate fixation combined with anterior interbody fusion in 18 patients with cervical spine disorder. In most of the cases, the insertion of the metal plate was very simple and maintained the block bone in satisfactory position. There was a complication with the use of this method in two cases. This method of internal fixation of the cervical spine allowed very early mobilization and shortened the hospital stay. The change of length of the fused segment with the passage of time after surgery is discussed.
Since March 1980, the trapezial osteosynthetic plate was used in 13 anterior cervical interbody fusions for rigid fixation. There were 8 spondylotic myelopathies, 2 cervical herniations and 3 ossifications of posterior longitudinal ligament, which involved 2 pseudarthrosis after anterior cervical interbody fusion. Follow-up averaged 10.5 months. The results were as follows. 1. A postoperative recumbency was within 7 days in all cases. 2. In all cases, a solid fusion was achieved. 3. Loosening of the fixation screws was seen in 3 cases, 3 screws, which were all inserted in interbody of anterior cervical fusions. No loosening of the fixation screw was seen, which was inserted in vertebral bodies.
After the cervical spinal decompression, we use full thickness of iliac bone for fusion material. To avoid the dislodging and to get good bony fusion, we take a long time of bed rest and strict immobilization of the cervical spine with our orthosis. To get an early active daily life, we introduce a new method. This is as follows; divide a full thickness of iliac bone in two pieces and turn round, then insert into a decompression area. By this method, we can regulate the size of a graft bone and the contact areas of a graft bone to decompression area are all spongiosa. So we can expect a stability and early bony fusion. We tried color attachment at two weeks after operation and then walking exercise. Six weeks after operation, patients were discharged. Seven of nine cases, good bony fusions were obtained twelve weeks after operation.
We pertormed anterior cervical fusion by use of two pieces of iliac bone. Unicortical or bicortical bone was put into the decompression area vertically by two pieces. This method gave good stability to the cervical spine and allowed the patients to sit up with conventional cervical collar 5-10 days after the operation. 42 patients operated on by this method were reviewed radiographically. 38 patients suffered from cervical injury and 4 patients from degenerative disease. The man follow-up was 6 months. The mean loss of angle from immediate postoperation to solid fusion was 6.2° but all of them gained local aligment. There was no marked dislodegment of the grafted bone. This method was beneficial to facilitate early rehabilitation and obtain bony union.
Segmental instability often occurs at the level adjacent to intervertebral fusion after surgery. The cause is mainly due to disc degeneration at the level, however, the facet joint might play a role as one of the main structural components of a segmental motor segment. This report is to elucidate the relation between segmental instability and the facet joint. Angles of inclination of the facet joints are measured as a indicator for this study. The subjects are 26 cases with cervical spondylotic myelopathy who have had anterior interbody fusion in our clinic. There are 15 males and 11 females, and the average age is 50 years old. The average follow-up period after surgery is 6 years. Before surgery various angles of inclination of the facet joint were observed, but at the time of follow-up they tended to be nearly same showing decreased angles at the lower surface of the joint and increased angles at the upper surface, which produces so-called posterior widening of the joint space. This results suggest that facet inclination might be secondary reaction to segmental instability of the level.
Surgical cervical canal enlargement by modified Hirabayashi's method has been performed for twenty-seven patients with cervical myelopathy due to spondylosis and ossification of posterior longitudinal ligament. Post-operative results were as follows: 1) Cervical canal was enlarged by 7.3mm in sagittal diameter and 66% in the rate. 2) Cervical canal was stabilized at about 6 montes after operation. 3) Improvement points with JOA Standard were about four. 4) Enlargement rate in the sagittal diamter was not correlated with the clinical improving rate by Hirabayashi's evaluating method.
Post-operative results of 99 cases with multiple disc lesion in cervical spondylotic myelopathy were analysed. The results are as follows. 1. Excellent or good results were obtained in more than 80% of the cases in anterior approach and enlargement of the spinal posterior approach, and were maintained for long period up to an average of 6 years of were inferior to that in other methods. This was mostly due to difference of indication for the laminectomy. 2. Changes of alignment of the cervical spine after posterior approaches occurred in nearly half of the cases, but the degree was generally slight and did not affect the follow-up results. 3. Posterior approaches are effective and useful procedures for multiple disc lesion in CSM, especially in enlargement of the sinal canal. However, in oder to obtain more accurate and better results, selection of the operative method is most essential, and for the cases with mal-alignment of the cervical spine. Posterior approaches are applied carefully or anterior approach should be taken.
Anterior surgical procedure (AIF) for multisegmental cervical myelopathy was evaluated on a follow-up study of 3I cases. Surgical results were determined by using a score proposed by the Japanese Orthopedic Associatin. Final rate of recovery (%) was 53.4% in two disc levels of AIF and 63.4% in three disc levels of AIF. There was no apparent difference in the results between these two groups. Eleven cases showed unsatisfactory results of percent recovery less than 49%. Causative factors of these cases were related to insufficient decompressive procedures and narrow canal. Our anterior procedures using Smith-Robinson's modified technique were useful in the following cases of multi-segmental cervical myelopathy. Those cases were disc diseases within three discc levels combined sagittal cervical canal diameter wider than I3mm. In the case of sagittal cervical canal diameter of less than I2mm, we believe that one stage posterior decompression and anterior fusion or laminoplasty is the procedure of choice.
Referred pain on flexion or extension of cervical spine was a significant sign for the clinical diagnosis of cervical spondylotic radiculopathy. Although, in the cases of cervical spondylotic myelopathy (CSM), referred pain to the lower extrimity on flexion or extension of cervical spine was found in rare cases. Since 1981, of 76 cases of cervical spondylotic myelopathy had operative treatment, 3 cases (4.2%) had referred pain to the lower extrimity on movement of cervical spine. The referred pain of these cases disappeared after anterior bony fusion of cervical spine. This suggests that the referred pain to the lower extrimity was caused by any stimulation to spinal cord on cervical movement. We suspect that the referred pain to the lower extremity of the cases was caused by stimulation of spino-tharamicus tract or posterior tract due to strain force on the spinal cord by cervical movement.
Recently we have experimented two cases of thoracic arachnoiditis. A 31-year-old woman presented with gradually progressive acsendent numbness and weakness in her feet and legs for a period of 25 years. Another 52-year-old man did for a period of about 30 years. We operated on them, but laminectomy and removal of the ossification was followed by no resolution of the neurological deficit.
A case of tuberculosis in thoracic spine was reported. Onset of this case was acute spinal paralysis. Myelogram showed a complete block from Th 6/7 to Th 9/10. The anterior spinal fusion was performed. The post-operative recovery seemed pessimistic. But 9 months after surgery, active movement of lower extremities returned.
Three patients of adhesive arachnoiditis after removal of lumbar disc herniation (2 cases) and posterior fusion (1 case) were operated on. All of them underwent neurolysis of cauda equina with postero-lateral fusion. They all showed a relatively good result postoperatively although the folow-up period was short.
We have experienced a case of extra foraminal lateral lumbar disc herniation between L3 and L4. Preoperative L3 radiculography revealed communication to the L3/L4 disc space. For surgery with posterion approach, left L3/4 facetectomy and L3/4 discotomy were carried out, and, for the stability of the lumbar spine, the interbody fusion and the spinal plate immobilization were added. Ten months post operatively, he has no complaints, the X-ray showing a solid fusion.
Since 1979, 147 patients of lumbar disc herniation have been operated on in our clinic. In these cases, we experienced 3 cases (2.0%) of the hidden zone lumbar disc herniation. These cases had severe motion pain, sciatic scoliosis and straight leg raising test. But myelograms showed false negative findings. Therefore, herniation of this type has a tendency of the failed back. So, sufficient recognition must be done in therapy.
Between 1980 and 1985, 147 patients with lumbar disc herniations were treated by discectomy and/or foraminotomy., We investigated preoperative clinical and myelographic findings. Lasegue's sign was positive in 50% of cases. It was positive more frequency in younger patients. Diagnosis of the clinical level of L4/5 disc herniation was more accurate than of L5/, S1 disc herniation. The average sagittal diameter of all dural tubes was 13.8mm and that of the dural tubes with complete block was 11.6mm. Ventral defect of L4/5 disc herniation was larger than that of L5/S1 disc herniation.
Five cases of our experience in herniation of the intervertebral disc at L1-2 is summarized in the present paper. One of the five patients with paresis is a woman and the others are men. The majority of patients complained first of lower back or lower extremity pain or both. There was anterior thigh pain in two patients, perineal pain in other two patients, and posterior thigh pain in other. Pain was aggravated during standing or walking. Other symptoms were paresthesia of both lower extremities in one patient, numbness of lower extremity in other one, and paresthesia of both soles in three. Depression of knee reflex, quadriceps muscular atrophy and positive femoral nerve stretch test are common with disc herniation at L1-2. Sensory changes are common over subgroin to sole and perineum. There were occult bladder dysfunction in two patients. Standing myelography and CTM are the most helpful test in localizing disc disease at the upper lumbar levels. Removal of the disc and intervertebral body fusion resulted in excellent recovery in one, good in three, and no change in one. The patients of long pretherapeutic period showed poor prognosis.
The purpose of this paper is to discuss the use of the thiopentone pain study as a test to determine whether a patient's disability is physiogenic or psychogenic. The record of 70 patients who had thyopentone pain study performed at the Wellesley Hospital for assessment of psychogenic and physiogenic low back pain between 1975 and 1985, comprised the material for this report. The basis of this test lies in the fact that, at the stage of light anesthesia although the patient is unconscious, he is still capable of demonstrating primitive reactions to pain. This test was performed on each patient with the results that 26 patients showed a physiogenic response, 17 patients showed a combined physiogenic and psychogenic response and 27 patients showed a psychogenic response. Final proof of the validity of this test depends upon its value in predicting the outcome of treatment. At present the thiopentone pain study is the only investigation which assesses directly the patient's reaction to pain and as such has a difinite role in the evaluation of patients with chronic low back pain.
The authors report on a retrospective analysis of 32 patients undergoing posterior approach surgery for the clinico-radiological diagnosis of lumbar stenosis. Patients had a medial facetectomy, a hemilaminectomy and a wide laminectomy. The patient who had a medial facetectomy showed tendency to get better results than that who had a wide laminectomy. Postoperative vertebral subluxation with pain and restricted movement occurred following extensive wide laminectomy especially when degenerative spondylolisthesis had been presented. We recommended a medial facetectomy for lumbar canal stenosis especially with degenerative spondylolisthesis. Further study is necessary to make a comparison between a medial facetectomy and a wide laminectomy with fusion.
Seventy-two patients with lumbar spinal canal stenosis had wide laminectomy in our hospital from 1975 to 1985. Fifty-eight patients of seventy-two were examined in this study with assessment of treatment for low back pain by Japanese Orthopaedic Assosiation and radiographs. The patients were divided into two groups; the first group with posterolateral fusion and the second group without. We have adopted posterolateral fusion with wide laminectomy for the patients that have instability of lumbar spine and/or spondylolisthesis. In this study, the results between the two groups showed no differences. Poor results were coursed by narrowness of laminectomy and severe instability of another lumbar lesion that became worse after posterolateral fusion.
Low back pain accompanied with degenerative lumbar spine is an important problem as well as cauda equina syndrome for lumbar spinal canal stenosis. The purpose of the surgical intervention is to decompress the neural stractures without spoiling stability of the lumbar spine. In point of this purpose, Wedge's osteotomy is one of the ideal methods for laminectomy. Multiple fenestration at the narrow interlaminar segments is a new method. We treated nineteen cases of the lumbar spinal canal stenosis surgically from 1982 o 1986 in our hospital. Central laminectomy was done in one case, Modified Wedge's osteotomy in eleven cases, multiple fenestration in five cases, anterior interbody fusion in two cases. Posterior spinal fusion was done in three cases of laminectomy, and in all cases of multiple fenestration. Harrignton distraction rod was employed in two cases, Harrignton compression rod in one case, and L-type rod in two cases. Good results were obtained concerning involvement of the cauda equina. But one case accompanied with cervical spondylotic myelopathy and one case with thoracic spinal cord tumor developed left paraparesis as sequelae due to spinal cord involvement. Low back pain was deteriorated postoperatively in two cases of laminectomy without fusion. One was a case of degenerative spondylolisthesis. In another one, postoperative stress ulcar occurred and long period of rest in bed was required. Instrumentation gave stability to the spinal column immediately after surgery and was able to make postoperative care easy.
We experienced a patient who suffered from fracture of L4 after the lumbar wide laminectomy. A 72-year-old male was operated on by wide laminectomy from L3 to L5 under the diagonosis of lumbar spinal stenosis. 2 months later, during the rehabilitation, he complained of severe lumbago and right lower extremity pain. L4 transverse fracture with marked displacement was found by plain K-P. It showed marked instability due to loss of all stabilizer. We performed Luque instrumentation from Th12 to sacrum by the use of Galvestone technique and PLF. 6 months after the operation, sinking and instability developed in the fractured area without bony union. But he was able to walk with brace and complained of mild lumbago.
In this paper, effect of P-L fusion was studied on the fixed intervertebral space and other lumbar intervertebral spaces in 20 patients who had gotten good union at L4/5 level. We regard P-L fusion as not a fixed operation but a breakage operation. With regard to radiological approach, we applied Pierre's method to measure the angle of displacement, horizontal displacement and disc space height. Evenly increase of motion angle was recognized at L2/3, L3/4 and L5/S1 levels respectively. At fixed intervertebral space, motion angle remained a little. Therefore, P-L fusion is not a completely fixed operative method but gives a small range of motion, which is very beneficial for other intervertebral spaces. Namely “breakage effect” protects other intervertebral spaces from new instability.
One hundred and forty-seven patients underwent anterior interbody fusion for lumbar disc derangement and lumbar spondylolisthesis. The gross fusion rate was 93% of the disc derangement and 71.5% of the spondylolisthesis. The fusion rate was related to the level of operation and to the number of discs operated on. In the patients with fifth lumbar spondylolisthesis, nonunion occurred in 50% and fusion rate was lowest. In those patients with slip rate above 30%, anterior spinal fusion with segmental spinal fusion seemed to be much better than without this. For improvement of the fusion rate, the Baycast spica is the most effective in restricting the mobility of the lower part of the lumbosacral spine. Baycast spica is used chiefly postoperatively.
15 cases over 1 year after antero-posterior combined operation f or degenerative spondylolisthesis were clinically investigated. Indication of this operation was the cases in which instability and posterolateral compression had been combined. Preoperative and postoperative mean slipping rates were 16% and 8.4% respectively. Bone union was obtained in all cases. Postoperative results were satisfactory in 14 of 15 cases.
Roentgenographic examination was carried out in 100 shoulders of 50 patients with rheumatoid arthritis. We used roentgenographic evaluation of the Larsen's method. The results were following: stage 1; 34%, stage 2; 23%, stage 3; 25%, stage 4; 12%, stage 5; 3%. We selected 25 shoulders of Stage 3 and classified these into progressive type and nonprogressive type according to three points.
Recently, we have experienced thirteen cases of extensor tendon ruptures in rheumatoid hands. All the patients, two men and eleven wemen, had classical rheumatoid arthritis with advanced Steinbrocker's stage. All the ruptured tendons were classified into four groups of extension disturbance: three cases of the first finger, three cases of the third, fourth, and fifth fingers, six cases of the fourth and fifth fingers, and one case of the third and fourth fingers. two cases were treated by end to end tendon suture and the others by transfer. In ten cases of all, synovectomy of the wrist and Darrach's procedure were carried out simmultaneously. We observed from four months to eight years and obtained the following results: good in seven, satisfactory in two, poor in two cases except two cases, which were not followed up. We conclude that satisfactory results are obtained by means of tendon transfer combined with synovectomy and Darrach's procedure.
Three cases of polymyalgia rheumatica syndrome were reported. The first case experienced typical primary polymyalgia rheumatica. The second and third cases had prodromal rheumatoid arthritis. The diagnosis of polymyalgia rheumatica should not be made soonly. The other diseases should be considered at all times because several serious disease states may begin with clinically typical polymyalgia rheumatica. Relationship to temporal arteritis is important because it has a predilrection for ophthalmic arteries with resultant blindness.
In recent years, plasmapheresis has been performed on patients with rheumatoid arthritis (RA) with favorable symptomatic relief and receiving great attention as a new treatment. In this paper, the results of thermocryo-technique using double filtration system investigated in RA patients were described. Four MRA and three RA patients were approached 25 times in total. Venous blood was drawn and separated by passing through the first filter previously warmed at 37°C into Corpuscles and plasma. The plasma was cooled at 0°C to 4°C and high molecular weight components were removed by the second filter. As to clinical symptoms, such as morning stiffness, grip power and painful joint score, were improved depending on the frequency of treatment. However, a strong rebound phenomenon occurred in some patients. Serologically, improvement of ESR, RA test, RAHA and decrease of immunoglobulin were observed. Total protein and albumin levels decreased about 1 to 2g/dl after treatment. However, plasma supplements were almost unnecessary and other severe complications were not encountered.
We experienced a patient of the simultaneous dislocation of the ipsilateral shoulder and elbow. A 38-year-old woman was admitted to our 20 hospital because of the right shoulder and elbow pain. She fell down on the floor from 30cm height. X-ray examination showed subcoracoid dislocation of the shoulder and posterior dislocation of the elbow. Closed reduction was carried out satisfactorily in the order of the elbow and the shoulder. After 9 months, ROM was almost full. Dislocation mechanism of this injury was discussed.
A fall on the outstretched hand may cause injury to the carpus, the distal or proximal end of the radius, or the distal or proximal end of the humerus. Much the most common injury is a Colles fracture or displacement of the distal radial epiphysis. When the carpus and distal portions of the radius do not fracture and the force transmitted to the elbow, a fracture of the radial head or neck may occur. We have reviewed 30 cases of injury to the radial head or neck out of the 66 in which 8 cases were treated operatively from October 1981 to February 1986 and 58 cases treated conservatively from Decembar 1982 to February 1986. They were classified into 5 types and 2 types of them were concerned with the fracture of the radial head and neck in adults and the other 3 concerned with the fracture of the neck in childern. Subsequently, we evaluated the results of the 30 cases. We also made some additional literary considerations and reported what we treated chiefly concerning cases cared operatively.
Eighteen cases of elbow dislocation treated at our hospital (15 males and 3 females and 14 left elbows and 4 right) were reviewed clinically. Treatment of these cases consisted of 13 non-operative procedures after reduction (5 slings, 4 plaster casts and 4 plaster splints) and 4 surgical procedures (1 osteosynthesis, 2 tendon reproduction etc.). Dislocation of the elbow joint is frequent, and its treatment standard, but something has been focused on the complications after treatment. In some complication, an instability is noticed just after reduction. The cases which had little instability were treated with slings. The cases with instability usually were treated with 3 weeks of plaster cast fixation. The younger male patients, who were engaged in muscular labor tended to be treated with surgical procedures and there was no bad result after the operation.
Carpal scaphoid fractures are most frequently seen in carpal bone fractures because of suffering from external forces. Simultanous fracture of carpal scaphoid and adjacent bones are seen sometimes according to the direction of forces and the position of carpal bones. We experienced 44 carpal scaphid fractures from 1971 to 1985. Of these patients, 12 patients had adjacent bone fractures simultanously. (radial end; 2 cases, radial styloid; 5 cases, ulnar styloid; 5 cases, lunatum; 2 cases, triquetrum; 3 cases, perilunate dislocation; 3 cases.) The cases having adjacent bone fracture simultanously were relatively young, and injury forces were relatively severe (such as traffic accident and fall from height). Non-union cases showed tendency to remarkable carpal instability. The cases having adjacent bone fractures simultanously have high instability of fracture site, so have tendency to carpal instability and result in non-union.
Twenty-seven cases of so-called Colles' fracture treated conservatively were studied. All cases were immobilized by plaster cast or splint in a position of ulnal and palmar flexion after manual reduction, and some displacement developed within 2 weeks in 16 cases (59%). In 8 cases, of which the position was changed in a neutral position in 2 weeks, the displacement occured in 7 cases (88%). Out of 18 cases followed up, clinical results were unsatisfactory in 12 cases with shortening of the radius on X-rays, showing limitation of pronation and supination. While the clinical results were not so poor as the X-ray findings, an anatomical reduction was considered to be desirable.
Primary suture for flexor tendon rupture in zone II has become popular and we have experienced 76 fingers of 62 cases in the past 6 years and 6 months. Primary suture has been done by Tsuge's method using 4-0 or 5-0 looped nylon. Postoperatively, either plaster fixation for three weeks or Kleinert's early controlled exercise method has been done. Functional results of flexor tendon suture were assessed in 58 fingers of 46 cases followed over 6 months postoperatively. The results were evaluated with methods of both %TAM (proposed by Evaluation Comittee of the Japanese Society for Surgery of the Hand) and Buck-Gramcko's. Results are as follows: 1) Either excellent or good results were obtained in 27.6 %according to the %TAM, and 72.4 %according to the method of Buck-Gramcko. 2) Children had better results than infants and adults. 3) Rupture on the proximal side had better results than that on the distal side. 4) There was no significant difference among the methods of primary, delayed primary and secondary sutures. 5) Cases with bone and joint injuries, crush injuries, infections and reruptures had poor results. 6) Cases with FDS repair had better results than that without FDS repair. 7) Cases performed early exercise had better results.
We have performed tendon transfers do 28 traumatic or subcutaneous ruptured tendons of 17 patients for recent 9 years. We did follow up study on 20 tendons of 13 patients. As a result, 8 patients were excellent, 4 patients were good, and a patient was poor. In our procedure, we transfer the tendon to the recipient digit preserving original tension with neutral position of the wrist and extended position of the fingers. We anastomose the transferred tendon overlapping to the central slip at the distal portion of the MP joint in case of extensor tendon rupture. In conclusions, our procedure of tendon transfer is simple to perform, and has beneficial effects to standardize the tension of the transferred tendon and to make extension power act directly on the MP joint.
Dislocation of the extensor tendon at the MP joint is uncommon. We reported dislocations of both long-finger and ring-finger extensor tendons ulnarward, and the left little finger radialward. Most authors found the lesion to be tear of expansion hood or intertendinous fascia. But, our patient had thinning of radial expansion hood of the left long-finger, normal expansion hood of the right long and ring-fingers. And, both intertendinous connection between the index and long fingers were absent. So, we find that the lesion is not tear of expansion hood but absence of intertendinous connection. We treated dislocation of extensor tendons operatively with intertendinous connection. No recurrence of dislocation is present 10 months after surgery.
We describe a case of ulnar nerve compression due to an anomalous muscle and a ganglion. The anomalous muscle arised from the tendon of palmaris longus and attached to both the pisiform bone and abductor digiti minimi muscle. Ulnar nerve was compressed at the proximal portion of the canal of Guyon. At operation, the anomalous muscle which seemed to be an accessory palmaris, and the ganglion were resected. The postoperative course was uneventful.
Symmetrical gangrene of the digits caused by DIC is rare. Recently, we have experienced one case which has suffered from DIC. The patient was a 56-year-old woman who developed Raynawd's phenomenon on in her digits. She was admitted to the hospital with emergency because of symmetrical vascular involvements of the digits and gangrene of the bilateral fingers. Coagulation screening revealed characteristic findings of DIC. Severe dental periodontal disease was found in her mouth. It was suggested that DIC was associated with dental periodontal disease. DIC and symmetrical gangrene of the fingers were treated by heparin and prostaglandin E1. DIC was recovered, but gangrene did not heal, therefore, amputation of the distal fingers was performed unfortunately. The postoperative prognosis is good. The patient was discharged with good recovery. This presentation is to report the clinical course of this rare DIC case.
Three cases of the carpal tunnel syndrome (CTS) associated with Kienböck disease are reported: Case 1, a 55-year-old woman, Case 2, a 34-year-old man, and Case 3, a 71-year-woman. Case 1 and case 2 showed the regional hypesthesia of the fingers and case 3 had the atrophy of the thenar eminence with loss of the opposition of the thumb. In all cases symptoms of the Kienböck disease were not serious. X-rays, however, showed the progressive stage, which was characterized by the sclerosis and collapse and fragmentation of the lunate bone and the intercarpal and radiocarpal arthrosis. Especially the volar projection of the fragment of the lunate and the spur of the volar lip of the radius were marked. The loss of capacity of the carpal tunnel and the flexor tenosynovitis would produce the CTS. The restricted movement of the wrist and the pain, however, may result in the dysfunction of the hand and then decrease of the flexor tenosynovitis. This probably will cause the low incidence of the CTS associated with the Kienböck disease.
Six cases of the hemangioma in the hand and one case of arteriovenous fistula in the forearm have been treated surgically for the past ten years. These were diagnosed histologically as follows: venous hemangioma, cavernous hemangioma, capillary hemangioma, A-V malformation, hemangioma racemose and venous malformation, however we have differentiated these clinically to the next three groups: hemangioma, venous malformation and A-V fistula. This differentiation is very valuable at the operation. We had already reported one case with macrodactyly of the foot in which CUSA (Cavitron Ultrasonic Aspirater) was utilized. We utilized this equipment for an 11-year-old boy with a cavernous hemangioma of the foot. Consequently this hemangioma was completely removed protecting a neuro-vascular bundle approximating to this one from injury. Even though the operation for removal of the hemangioma is performed under the microsurgical technique, it is very difficult to control bleeding from the surrounding organs. At the present time, we consider an adequate compression dressing the most effective to this bleeding.
The course of the repair of the rotator cuff rupture has not been fully clarified in comparison with that of other tendons. The purpose of this study is to deliniate the repair of the canine rotator cuff rupture histologically in two instances; 1) only resection of the rotator cuff tendon, 2) tendon to bone repair after cuff resection. Twenty-four adult mongrel dogs (12-17kg) were used. The study was divided into two groups: group I. Only resection of the rotator cuff; rotator cuff was resected 15mm in width and 1mm in length. Group II. Tendon to bone repair after cuff resection; the stump of the cuff was anchored into the trough cut at the greater tuberosity. After operation, a plaster cast was applied for three weeks. Dogs were killed at regular intervals and specimens including the cuff and the greater tuberosity were obtained. These were fixed, decalcified, embedded in paraffin, sectioned and stained with hematoxylin and eosin and with Malloryazan. The gross and microscopic changes were investigated. Group I. After 1 week, scar tissue formation was present, but not completely, at the gap between the proximal stump and the greater tuberosity. After 2 weeks, the gap was completely filled with scar tissue. After 6 weeks, orientation of fibers was at randon with many proliferating vessels. Group II. After 2 weeks, orientation of the fibers were at random with proliferation of blood vessels. At the tendo-osseous junction, proliferation of cartilage tissue was noted. After 24 weeks, orientation of collagen fibers and appearance of tendo-osseous junction were similar to those seen in normal rotator cuff.