We studied on 25 cases of chondrosarcoma clinically, radiologically and histopathologically. Then prognostic factors to the survival rate were examined. These cases comprised 17 males and 8 females (primary chondrosarcoma: 17 cases, secondary: 8 cases). Five chondrosarcomas occurred in the scapula, 4 in the femur, 4 in the humerus, and 3 in the pelvis and other bones. Radiologically, calcification was observed in all cases and periosteal reaction in 3 cases. High uptake of RI was observed in all cases with Tc-bone scintigraphy. Five years cumulative survival rate of 25 cases was 68% and ten years survival rate 61%. Significant difference was found in 5 years survival rate between primary chondrosarcomas and secondary chondrosarcomas, and between the cases with high value of serum alkaline phosphatase and the cases with normal value.
We had experienced three cases of limb-salvage operation on the knee joint. The first case was a 9-year-old female. She had a osteosarcoma of her right femur. Following 5 times of CDDP 100mg/m2, she underwent local wide excision and replacement of her femoral distal region with the ceramic implant. 31 months postoperatively she was free from disease, but her right leg was shortened by 5cm, and medio-lateral instability was moderate. The evaluation by Enneking (1982) was poor. The second case was a 12-year-old female. She had an aneurysmal bone cyst of her right femur. She underwent curettage of the femoral lesion. The lesion was again curetted and filled with the bone-cement. But the recurrence was shown on the X-ray. She was treated by excision and replacement of her knee joint with the ceramic implants. 23 months after the last operation, she had a good function of her right knee joint. The evaluation by Enneking was fair. The third case was a 74-year-old male. He had a osteosarcoma of his right tibia. Following two times of ADR 50mg/body (ia), He underwent the local wide excision, replacement of his right tibial proximal region and reconstraction of the medial and lateral collateral ligaments and patellar ligament. 17 months postoperatively, evaluation by Enneking was fair. However, he died of disseminated intravascular coagulation after the operation for a metastasis of the 7th thoracic vertebral body.
The authors reported four cases of fracture of the humeral shaft caused by throwing action of the softball, that has been reported in a few papers. They all were softball players at the age of sixteen, consisting of three females and one male. The fractures were of spiral type accompanying a third fragment in two. Two of them were treated conservatively and others operatively. All showed good results.
Traumatic myositis ossificans is well known to occur in the muscle hematoma as a result of a contusion or a strain. An 18-year-old male of traumatic myosits ossificans after contusion on his right anterior thigh while playing rugby football was reported. Five and seven days after the first injury he played rugby football and reinjured the same area. Three weeks after the reinjury he had increased anterior thigh pain and limited motion of the knee. When examined, the right quardriceps was tender and swollen in the antero-mid thigh. Flexion of the knee was about 80 degrees due to pain. Roentgenograms showed linear and cloudy calcification in the quardriceps muscle. His knee was immobilized, and he was given a non-steroid antiinflamatory agent for two weeks. After pain relief rehabilitation began with exercise to increase the range of motion. Four months after the first injury, the patient had no pain and limitation of knee flexion. Adolescents actively involved in contact sports are at risk for muscle trauma, which can results in myositis ossificans. The development of traumatic myositis ossificans is related to the severity of the quardriceps contusion. Recognition and appropriate therapy can reduce the associate disability.
Chondral fracture of the adolescent knee is very rare because of anatomical characteristics. We experienced chondral fracture occurring in both knees of a fourteen years old boy belonging to a volley ball club. Arthroscopic examination revealed white free bodies and chondral defect of the medial femoral condyles in both knees. The free bodies were removed and the area showing chondral defect were treated with drilling. Histologically, the free bodies were mainly composed of degenerated articular cartilage with partial fibrillation and dystrophic calcification but no osseous structure was seen.
We reported a case of 16-year-old monozygotic twins who had multiple stress fractures for one and half year after they participated in rugby football club. One of the twins sustained stress fractures at the middle third of the left tibia and the upper third and middle third of the left fibula. The other had at the upper third of the left fibula, and the second and third right metatarsals. In addition, we did questionnaire for 144 high school rugby football players to clarify the causes of stress fracture in athletes. The causes seem to have relation to the method and time of the trainings, no holiday a week, and individual anatomical features.
The purpose of this study was to ascertain the relationship between age and C19 androgen (androstenedione and dehydroepiandrosterone-sulfate). The study was carried out on 38 men and 53 women. In men plasma androstenedione and dehydroepiandrosterone-sulfate increased from 10 to 20 years of age and peaked during their 20's, falling gradually afterwards. This roughly parallels the increase and decline of bone mineral content. For women our study has thus far only covered those in the 40 to 80 years of age range. These subjects showed a very gradual drop in plasma androstenedione and dehydroepiandrogen-sulfate levels from age 40 onwards.
It is generally known that untreated congenital thyroid deficiency is characterized by lack of statural growth and by mental retardation with sluggishness and absence of emotional response. Two cases of adult cretins untreated for many years since their birth were recently encountered. The purpose of this report is to discuss the roentgenologic features of untreated adult cretins with the review of some literatures. The cases were the 53 years old female and the 33 years old male. The ages of the begining of thyroid therapy were 53 years old and 17 years old respectively. The former showed more characteristic bone changes than the latter. Particulaly, osteoarthropatic changes were observed in her elbows, knees, and hip joints. Thyroid deficiency induces the disturbance of enchondral ossification in epiphysis, therefore, bone changes in adult cretins show residual growth plate, epiphyseal dysgenesis, cortical thickness, etc. in whole bones. The early and continuous treatment from infancy is sure to be most important so as to protect and improve bone changes and mental retardation.
Renal osteodystrophy is the common problem in chronic dialysis patients. We checked the roentgenograms of fifty-seven chronic hemodialysis patients, and the degree of bone atrophy was analysed using the microdensitometry method. The average duration of the dialysis was 130 months. The average age was fifty-three. In plain reontgenograms, findings due to secondary hyperparathyroidism were much more common than findings due to osteomalacia. In dialysis patients, bone atrophy was more severe than that in the same aged control group. The M. C. I. in patients whose dialysis period was longer than ten years tended to be lower than that less than ten years.
We experienced traumatic myositis ossificans affecting triceps on the left elbow in a 17-year-old boy. His elbow joint was dislocated by a fall in Judo. After one week, he was treated by over-vigorous massage and passive stretching. Ectopic calcification and ossification were induced on his elbow three months after dislocation, and he visited our hospital. To this patient, we administered 1000mg EHDP (Disodium ethane-1-hydroxy-1, 1-diphosphonate) for two months and 600mg EHDP for next one month. During the treatment his elbow joint motion was gradually improved, and serial X-rays showed a resolution of ectopic calcification. He showed no side effects during and after EHDP administration.
We reported that 1, 25(OH)2D3 (1, 25D) and calcitonin ([Asu1, 7]-eel calcitonin, ECT) promote calcification in the widened growth plate of the HEBP-induced rickets in rats. The experiment lasted 2 weeks and female weanling Wistar King-A rats 4 weeks old were used. 60mg/kg of HEBP was administered subcutaneously daily for 7 days, then the drug was stopped (HEBP rat). 250ng/kg of 1, 25D was given to the HEBP rat for the 14 consecutive days (2), or for the former 7 days (f), or for the latter 7 days (1), that made up 3 groups. 40U/kg of ECT was given in the same 3 ways. In the result, we found that 1, 25D (2) and ECT (2) groups promoted calcification in the growth plate, but when the administration was separated to the former and latter 7 days, only 1, 25D (1) and ECT (f) groups showed enhanced calcification and the rest groups did not. In the present work we observed the spatial extension of the calcification in the growth plate in HEBP rats given 1, 25D or ECT. The growth plate was dissected with a razor, embedded undecalcified, and sectioned in the frontal plane consecutively at a width of 10μ, and the preparation was stained with von Kossa & HE or Safranin-O. In the 1, 25D (1) group, linear calcified zone was in the upper hypertrophic cell zone, while in the ECT (f) group, calcification exists in the lower hypertrophic cell zone.
2-Thiophenecarboxylic acid was shown to produce hypocalcemic and hypoglycemic effects in rats by Lloyd (1969). We reported previously that 2-TCA enhanced calcification in growth cartilage of rat in HEBP induced rickets. This action of 2-TCA was very similar to that of calcitonin. In this study, diltiazem, a calcium antagonist, suppressed the accelerated calcification due to 2-TCA in the growth cartilage. Eguchi had reported that diltiazem inhibited calcification promoted by calcitonin in the same experimental model. These results suggested that intracellular concentrations of calcium might play an important role in the occurrence of accelerated calcification due to 2-TCA and calcitonin in the HEBP induced rachitic rats.
Hemoperfusion and oxygen saturation were investigated by tissue reflection spectra in forty-one cases with rheumatoid arthritis and osteo-arthritis who received intraarterial injection. Forty-one cases were classified into three groups based on the method of intraarterial injection; 20ml of 20% glucose and active VB1 (10mg) through the femoral artery (Group A), and cubital artery (Group B), and 20ml of physiological saline solution and active VB1 (10mg) through the femoral artery (Group C). It has been confirmed that initial I-SO2 (Index of SO2) of Group B is more than 2 times as high as those of Group A and Group C (P<0.001), and that the local Hb oxygen saturation is higher in the upper limbs. Initial values of I-Hb (Index of Hb) obtained before the intraarterial injection in Group B, Group A and Group C are high in this order, but the difference in values between Groups B, A and C is not so great as that in I-SO2 values.
An animal model of the compartmental syndrome is presented to study the acute effect of elevated intracompartmental pressure on muscle blood flow. Latex balloon was inserted into the anterior compartment of rabbits and the pressure was controlled by an adjustable water column. The slit catheter technique wes employed for continuous pressure monitoring of the compartment. Blood flow to the muscle of the compartment was determined using the hydrogen washout technique, which allowed repeated blood flow measurements. At pressures between 22 and 56 millimeters of mercury, blood flow to the muscle was found to be completely stopped in all animals. The percentage of the critical pressures of the compartment as compared to the systolic pressures of the femoral artery ranged from 22 to 51 percent with an average of 42.2 percent. The results in these experiments helped to identify a critical pressure at which fasciotomy should be performed in patients with a threatened compartment syndrome.
In vitro, disks of serum coated or serum uncoated biomaterials were exposed to the slime producing Staphylococcus to study the effects of serum on bacterial attachment to biomaterials. Direct scanning electron microscopic observation showed that fibrous strands interconnected the adherent bacteria and extensive background matrix enclosed bacterial colonies. This adherent mode of growth may reduce the susceptibility of bacteria to host clearance mechanisms and antibiotic therapy and thus may be a fundamental factor in biomaterial induced infection. We have tested the ability of bacteria to adhere to serum coated or serum uncoated PMMA and SUS 316L. Adherence assays revealed that bacterial adherence to serum coated PMMA was about two folds higher than serum uncoated PMMA. Bacterial adherence to serum uncoated SUS 316L was almost same as serum coated SUS 316L. These results suggest that serum has an effect on the bacterial adherence to PMMA, but no effect on the bacterial adherence to SUS 316L.
Seven patients with suppurative arthritis of the knee have been surgically treated from 1979 to 1986 in our hospital. The factors of joint infection were the intra-articular injection of corticosteroid (5 cases), skeletal traction (one case), and hemotogenous infection (one case). The infection organisms were staphylococus aureus in three patients, pseudomonas aeruginosa in one, and unknown in three. Follow-up lasted from seven months to six years. Six cases out of seven have had no relapse due to suctionirrigation and chemotherapy. One case after more than one year since his operation has suffered a relapse. Post synovectomy, advanced age, and delaying of operation were seriously poor prognoses.
19 cases of pyogenic arthritis of the knee in adults were treated in the last 10 years. There were 5 males and 14 females. The mean age of patients was 69 years old. The most important predisposing factor was intraarticular administration of corticosteroid, which was given frequently to 12 cases of osteoarthritis and one case of pseudogout of the knee. The organisms cultured from the synovial fluid were Staphylococcus aureus in 11, Streptococci in 5, Pseudomonas in 1 case and cultures were negative in 2 cases. 14 cases were treated by synovectomy and continuous irrigation followed by early passive motion. Of the 15 cases which were examined for the presence of pain and the ROM of the knees, 7 who had good results were operated on in an average of 7 days after onset, 5 who had fair results were operated on in an average of 31 days after onset and two had poor results (one was a recurrent case of chronic pyogenic arthritis and another had candida infection). Surgical intervention for pyogenic arthritis of the knee in adult should be performed as early as possible to improve the functional results.
We have treated chronic osteomyelitis and osteitis by Papineau's technique, which consists of an excision of infected bone followed by cancellous bone graft. The results of 8 Papineau operations, showed taht the healing was obtained in all cases.
We have reported six cases of open wounds with infection, and showed our methods or directions for local therapy of these wounds. Our methods are as follows. 1) To keep wounds clean, we let them take warm-water bathing and washing as frequently as possible. 2) We change gauze with liq. acrinol at least twice a day, and for wounds with much exudate, we use wet and dry dressings. 3) We usually use silver sulfa-diadin cream, or excise the necrotic tissue as soon as possible if the wounds are attached with thick necrotized tissue. 4) We use liq. acrinol gauze for wet and dry dressings on the wounds attached with little pieces of necrotized tissue, expecting effects of debridement. 5) For infected granulation, we excise it with leather cutter or use steroid cream in order to prevent multiplies of granulation. 6) For bleeding wounds, we use steroid cream and silicon gauze in order to prevent adhesion to the bandage. 7) We use isodine solution 3 or 4 times per day and keep wounds open for shallow ones to make them dry.
Two Cases of a variant of the motor branch of the median nerve was reported in this paper. Case 1 was a 29-year-old man who noticed thenar muscle atrophy for 1 year, but no numbness. At operation, two motor branches were found. Proximal branch arose from volar aspect of median nerve at carpal tunnel and distal branch curved at an acute angle from distal margin of flexor retinaculum. The retinaculum and fascia which compressed the nerve was devided. Case 2 was a 39-year-old woman who noticed hypesthesia in the distribution of both median nerves for 6 years and also noticed weakness of both thumbs for 2 years. On examination, there was total functional loss of the opponens pollicis and abductor pollicis brevis, and sensory signs of median nerve compression, which were far less significant than the severe motor loss. At operation, there was two motor branches which penetrared the flexor retinaculum. The retinaculum and fascia which compressed the nerve was devided.
A fifty-year-old woman first noted pain and numbness over the plantar aspect of the foot six months ago. The pain and numbness progressed and she consulted our hospital. Inspection of the foot revealed atrophy of abductor hullucis muscle, and there weas hypesthesia over the sensory distribution of the medial plantar nerve. Palpation of the medial aspect of the ankle revealed elastic mass just distal of tarsal tunnel. Percussion over this indurated area produced shooting pain in the soles of the foot. The preoperative diagnosis was medial plantar nerve palsy caused by ganglion. At operation, medial plantar nerve was compressed by ganglion. The ganglion was resected and the medial plantar nerve was mobilished. Six months after operation there was slight recovery of abductor hullucis muscle atroply and was no longer hypesthesia and shootiny pain.
A 28-year-old man with recurrent ulcers of the right foot and the little finger was reported. He has been most easily suffering from bruises, cuts and burns at the limbs since childhood. His sensory loss occurred in the distal aspects of limbs, but the motor and circulatory disturbances were not present. The diagnosis of Hereditary Sensory Neuropathy was made for this case and the skin graft was transplanted to the wound and decompressive device was set for the foot.
Among 124 patients with cervical spondylosis who were operated on during the past 6 years at our clinic, cervical spondylotic amyotrophy was noted in 5 patients (4.0%). Severe weakness with marked muscle atrophy in the segmental distribution was a cardinal sign of neurological findings in all cases. But two cases out of five had long tract sign and four cases had minimal sensory disorder. Myelography and selective angiography were performed on all cases. The level of muscle atrophy corresponded well with that of block found in the cervical myelogram. The gap of levels between muscle atrophy and myelogram, however, was observed in one case. The gap of those levels and the findings of angiogram suggested that the circulatory failure of spinal cord, not only compression, perticipates in the mechanism of CSAM. In our opinion, putting the operative findings together, there are 3 types of lesions impaired in CSAM: ventral horn cell, anterior root, and both ventral horn cell and anterior root.
Operative treatment was performed on five patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy. Four patients were treated by an anterior and posterior spinal fusion and only one patient was treated by laminectomy and posterolateral fusion, because the deformity of the cervical spine was wide. The halo-brace was used in each patient from preoperative days in order to immobilize the cervical spine and almost good bony fusion was obtained in all, but two patients showed a kyphotic change of the cervical spine. Symptoms improved in all five patients, but a little. We think that an anterior and posterior spinal fusions with modified Rogers' method is a good surgical treatments to obtain a good bony fusion for these patients.
To perform decompression of the spinal cord and stabilization of the cervical spine in the patients with multisegmental cervical myelopathy, one stage posterior decompression and anterior fusion of the cervical spine were carried out in 8 cases. The operation consited of two main procedures: one was a decompression of the spinal cord by enlargement of the cervical lamina, and the second was a spinal fusion by anterior interbody fusion. In 2 cases, this method was used for narrow cervical canal combined with anterior spondylotic change and instability. In 6 cases, it was used for cervical spondylotic myelopathy associated with multisegmental involvements above 3 discs and instability. The patients' symptoms improved significantly after the operation. There was no cases that showed severe operative complications.
Strength of the neck muscles may diminish after surgery of the cervical spine. There are few reports concerning the measurement of the strength. The authors measured the isometric strength of the neck muscles preoperatively and postoperatively for 28 cervical disorders (CSM-16 cases, CSR -2 cases, OPLL-10 cases), and simultaneously calculated the muscle cross-sectional area and the mean density on CT-scan. A group of cases performed anterior interbody fusion showed generally less power than a group of posterior decompression at the early postoperative time of 1-2 months (mean, 6 weeks), while at the late postoperative time of 3-6 months, (mean, 15 weeks), loss of neck extension power was persistently noticed in the group of posterior decompression. CT-scan performed at an average of 8 weeks postoperatively showed enlarged intermuscular low density areas of nuchal muscles and decreased mean density of post-laminar muscles in the group of posterior approach.
The purpose of this paper is to describe the factors which influence the postoperative long-term results of cervical spondylotic myelopathy. In this report, 128 patients were studied. There were 86 males and 42 females. The mean age of this group of patients was 50 years with a range from 28 to 72 years. Ninety-one patients underwent anterior approach operation and 37 patients did posterior approach operation. The duration of follow-up varied from 5 years to 29 years, the average being 10 years. The follow-up results were divided into five groups according to the Japanese Orthopaedic Association Score: excellent, good, fair, unchanged and worse. Each group was evaluated with regard to 15 major factors: age, sex, dysfunction of extremities, type of myelopathy, urinary bladder dysfunction, ROM of neck, antero-posterior diameter of cervical canal, cervical lordosis, the number of involved cervical discs, surgical method and so on. The main results found in this study were as follows: 1) The results at the time of final follow-up were excellent and good in 76% in the anterior approach, and in 65% in the posterior approach. 2) Long-term results were influenced by the factors of the age and the duration of symptoms in the anterior and the posterior approach operation. 3) In the posterior approach operation, the cervical lordosis was an important factor whether patients have good prognosis or not. These results show that our operative indication in anterior and posterior approaches is appropriate, Namely anterior approach is better than the posterior approach in less than three involved discs and the posterior approach is better than the anterior approach in more than three involved discs and narrow cervical canal. In patients with local kyphosis, anterior approach is better according to results of this study.
Long-term follow-up study of surgical treatment of 128 cases of cervical spondylotic myelopathy (CSM) was presented Results were estimated periodically by using JOA scoring system for CSM. Factors that might have affected the long-term results were investigated and the followings were ascertained: 1) Results were improved post-operatively up to 3 years and then deteriorated gradually after 4 years. 2) Results of posteriorly approached cases were inferior to those of anteriorly approached cases only at the time of discharge and more than 11 years after the operations. 3) Results of cases with less than 6 months of suffering period, age of forties, one intervertebral lesion or full JOA score of results at the time of discharge were relatively less worsened even 11 years after the operation. 4) Results of cases with more than 2 years of suffering period, ages of thirties, fifties and sixties, less than 13mm of sagittal diameter of the canal at C-5 level, less than 9 points of JOA score before the operation or less than 14 points of JOA score at the time of discharge were worsened relatively more in number or even at earlier period.
In the surgical treatment of ruptured cervical intervertebral discs, the operation of vertebral body fusion following subtotal removal of the disc had been employed from March 1982 to November 1986. An anterior approach to the cervical intervertebral disc was carried out on 26 patients. We examined the postoperative results and roentgenograms. Their ages ranged from 19 to 67 years. Seventy-three percent of the patients were in the 3rd, 4th and 5th decade. There were 17 males and 9 females. Three patients gave a history of injury. Three patients had an anomaly of cervical vertebral body. Eighty per cent of all disc lesion were found at C4-5 and C5-6. According to the improve ratio of Hirabayashi, 90 per cent of the patients showed excellent or good results. Malalignment of cervical spine and non-union of fused vertebral body gave no influence on the postoperative results. Cloward's anterior interbody fusion is a safe and effective approach in the surgical treatment of cervical soft disc herniation.
We reported a sixty-year-old woman with rheumatoid arthritis in whom involvement of the Ist lumbar vertebra occurred. She had a history of seropositive rheumatoid arthritis for 24 years. Low back pain attacked her and it increased gradually, and she felt too painful to sit on bed for few minutes. Radiograph showed a progressive destructive lesion in L1 and myelography did almost complete obstruction at the L1 level. An anterior decompression with interbody fusion from Th12 to L2 was performed. At operation, granulation tissue was found in L1 body and histological examination of it showed chronic non-specific granulomatous inflammation. Five months after operation, low back pain had settled and she was able to sit on bed easily.
Many cases of senile round back have chronic backache. The lesion of backache is obscure yet. We have done facet block on 39 cases of senile round back (9 males, 30 females, age range from 60 to 80 years). The block was effective in 30 cases. The level of block was mainly L2-3 and L3-4. It was slightly lower than the level of the endvertebra of round back, and many cases had local scoliosis in those levels.
Cervical myelopathy is often combined with lesions of other levels in the spine. In such cases, lumbar lesion is often observed. Since 1979, We had experienced 13 cases of these double lesions at cervical spine and lumbar spine. Consequently, they all underwent decompressive surgeries of two stages, while they showed no efficient results compared with those of cervical myelopathy only.
In evaluating the circulatory condition of the lower extremity in patients with the lumbar spinal canal Stenosis (L. C. S.), we used reflectance spectrophotometry in 20 cases of L. C. S. and 10 cases of control. The results were summarized as follows: 1) Concerning O2-saturation and hemoglobin concentration, the rate of increase after walking was smaller in L. C. S group than in control. 2) The circulatory disturbance of the lower extremity was found in L. C. S. 3) The reflectance spectrophotometry was useful in evaluating the circulatory condition of L. C. S.
The efficacy of flexion brace in the treatment of lumbar cannal stenosis was evaluated on 42 patients (questionnaire, 42; consultation, 26). Improvement of symptoms was obtained in 78.6% of them. Intermittent claudication was favorably relieved after the bracing and an average walking distance had increased from 220m to 1013m. Radiographic assessment of 25 patients who had worn the flexion brace revealed that most of them showed slight blocking of lumbar extension and mild decrease in lumbar lordosis. The results in patients with spodylosis deformans were significantly good compared with degenerative spodylolisthesis or spondylolytic spondylolisthesis.
OPLL of the lumbar spine have been reported less than that of the cervical spine. OPLL leads to one of the causative factors of canal stenosis, but it is low incidence that the patients develop symptoms due to OPLL. We studied clinically 8 patients who had OPLL of the lumbar spine with low back pain, lower limb pain, sensory disturbance, and/or intermittent claudication. Five cases were male and three were female with the age range from 35 to 65 years old (average, 52 years). We diagnosed clinically and radiologically 5 of them as OPLL and the other as lumbar disc herniation. To assess the symptoms due to OPLL, we attempted to compare with the former group and the latter group. In spite of their existence of OPLL, it may or may not have clinical symptoms and signs, so careful attention must be taken to observe the condition.
Fifteen operative cases of degenerative spondylolisthesis were examined in our department. There were 4 male and 11 female patients whose ages ranged from 33 to 75 years (average, 51 years). The involved levels of the lumbar spine were as follows; L3:1, L4:12, L5:1, and both L4 and L5:1. In each case, clinical symptoms, X-ray findings, operative findings, etc. were reviewed. Clinical symptoms were evaluated by JOA score system. Subjective symptoms were scored 3.8 points per 9 on the average, always with a score of 1 point for lower limb pain or numbness. Objective findings were scored with an average of 4.1 points per 6. On the X-ray, slipping ratio ranged from 5 to 40% (average, 13.4%). The canal diameter of L4 was measured by the plain X-P with a value from 15 to 21mm (average, 17.5mm). Instability could be detected in 13 cases by functional X-ray analysis on the lateral view. Concerning operative findings, such a hypertrophy of the facet joint and yellow ligament as that of the degenerative type of lumbar canal stenosis usually compressed the dural tube and nerve roots from posterolateral side. Both clinical symptoms and X-ray findings were compared with those of conservative cases. Though there were no significant differences in X-ray findings, clinical symptoms of the operative cases were severely damaged, especially the subjective symptoms. Thus, the decision for surgery has been indicated mainly due to extent of impairment of patients.
Between Jan. 1986 and Oct. 1986, 55 patients with lumbar disc herniation were operated on at Nagasaki Municipal Hospital. Extraforaminal lateral lumbar disc herniation (E. F. D. H.) occurred in two of the patients. Although there were complaints of lumbago and painful extremities in the E. F. D. H. patients, the condition was not recognized by myelography. Selective radiculography and block, discography and computed tomography were extremely useful in measuring E. F. D. H..
Lumbo-Sacral selective radiculography and nerve root block were carried out on 16 cases with lumbar radicular symptoms, one of which was bilateral case, to examine the affected nerve root levels. Six of 16 cases were ones with lumbar disc herniation, 6 with L. S. C. S. and 4 with Spondylolisthesis. The clinical results of nerve root block were excellent in 4 cases, good in 4 cases, fair in 2 cases and poor in 7 cases. The poor cases were treated operatively. Selective radiculography and block were useful to decide the level of lumbar radicular symptoms comparing with myelogram. Nerve root block was also useful as a conservative treatment for lumbar_radicular symptoms.
Recently the technique of CT scanning was developed remarkably and proved to be more reliable examination in the area of spinal surgery. As the result of improvement of resolution of plain CT, soft tissue structure within the vertebral canal can be differentiated. Whereas the development of other diagnotic examinations such as CT discography and NRI gives some confusion for the diagnotic value of plain CT. The purpose of this article is to analyze the role of plain CT in the diagnosis of lumbar disc herniation compared with other imaging techniques.
Five patients with compression of dorsal root ganglion are reported. Straight leg raising was limited in the affected limb in four patients. There was muscle weakness in three patients and sensory disturbance was present in four patients. Myelograms showed tapering of the theca in three. CT scans were done in three patients. In one patient, CT scan showed the presence of proximally placed dorsal root ganglia. All patients underwent surgical decompression. Decompression of the symptomatic ganglia resulted in satisfactory relief in 40% of these patients. Postoperatively root blocks were caried out in two patients and the leg pain was relieved in all.
The effect of postern-lateral spinal fusion was studied on the fixed intervertebral space and other lumbar intervertebral spaces in 15 patients who obtained solid union at L5/S1 level, and was compared with P-L fusion of L4/5 level. With regard to radiological approach, we have measured the angle displacement, horizontal displacement and disc space height using Dupuis' method. It was recognized that there was evenly increased motion angle for other lumbar intervertebral spaces. It was called “distribution effect”. In comparison with P-L fusion of L4/5 level, motion angle in L5/S1 level decreased slightly. Nevertheless, there was no difference as to “distribution effect” between L4/5 level and L4/5 level.
Alkaptonuria is a congenital metabolic disease of autosomal recessive inheritance which causes homogentisic acid deposition in cartilages and connective tissues in defect of tyrosine and phenylalamine oxidase, leading to the onset of ocronotic arthropathy after middle age. There have been reported a comparatively small number of cases of the present disease involved in the hip joint, and Hasegawa, Hokujo, Hotokebuchi, Ishikawa and others are its reporters in Japan. However, few cases are available, which present comparatively high and rapidadvancing degenerations as reported by R. Lagier, P. J. Stephen, A Peretz and others. This time we reported a case, which seemed to have been subjected to capital destruction in a comparatively rapid way, together with both radiological and histological findings. The present case, which seems to show 3-generation autosomal recessive inheritance, was affected by ocronotic arthropathy not only of the hip joint but also of the spine and the shoulder joint.
The incidence of avascular necrosis following renal transplantation in chronic renal failure is high, but avascular necrosis of the femoral head occurring in chronic hemodialysis is very rare. This paper reports one patient with avascular necrosis as a complication of chronic renal failure. The case was a 39-year-old woman who had been treated by hemodialysis for eleven years. Corticosteroids have never been administered in her history. The bone radiographs showed marked decalcification of whole body due to renal osteodystrophy, and slight collapse and deformity of the femoral head ati the time of admission in Autumn of 1985. Aluminum was demonstrated at the site of calcification front by histochernical study of iliac bone, and necrosis of the trabeculae and medullary fibrosis were seen in the biopsy specimen of the femoral head.
Three generations of one family with multiple epiphyseal dysplasia were evaluated with identification of three affected individuals. One patient treated by transtrochanteric anterior rotational osteotomy of the femoral head for osteoarthritis of the hip was reported.
A premature degenerative osteoarthrosis of the hip joint secondary to a severe dysplastic or subluxated hip can occur early in relatively young patients. In the dysplastic acetabulum the weight-bearing area is diminished and the shallow acetabulum is directed to a vertical position. On purpose not only to restore a more anatomical relationship between the acetabulum and the femoral head, but also to prevent progression of osteoarthrosis of the hip, 22 hips in 20 patients were treated with acetabular osteotomy by Wagner. This paper reports on operative indications and radiological results at a mean follow-up of 9.5 months.
We presented two cases of a high-riding dislocation of the hip who were treated by joint replacement using Biarticular Hip Prosthesis and reviewed them. Those were combined with bone grafting acetabuloplasty. The satisfactory results were obtained. The pull-down of the femoral head by 4cm did not cause disturbance of the nerves and vessels.
The purpose of this study is to clarify the cause of pain at the thigh region after Batemen UPF. The 35 patients evaluated have an average follow-up of 24 months. The age range is from 23 to 88 with an average of 62.1 years. Pain occurred frequently in the cases which Curved Moore type was used and the stem was inserted in varus position. On the other hand, there were no patients with pain in cemented cases. Bone reaction of the stem tip was extremely differed between curved type and straight type. The cause of pain at the thigh region was abnormal movement and the shape of the stem tip.
Revision total and universal hip replacement has become a major important problem. In this present study, 10 hips of 9 patients with THR and 11 hips of 11 patients with UHR underwent revision arthroplasty during the period from 1980 to 1985. Except for 2 cases of infection, the most common causes for revision arthroplasty in THR and UHR were femoral component loosening (resulting from technical failure and incongruity of the stem) and central migration respectively. Revision arthroplasty was performed by cementless prosthesis of the bipolar type and corticospongious bone grafting to provide bone stock. Results were considered satisfactory.
Among the changes in the femoral shaft after Charnley THR, hypertrophic change of the cortex was studied from the view point of bone remodeling and pathogenesis of cortex hypertrophy were discussed. The subjects were 23 femurs in which cortex hypertrophy occurred during the follow-up period after THR. Occurrence of cortex hypertrophy began two years after THR, and 91% of 23 femurs had it by 6 years after THR. In the cases with varus position of the stem, cortex hypertrophy was observed much more in lateral cortex, however, in the cases with valgus and neutral position of the stem, there was no consistent tendency in the location of the hypertrophy. The mean age at the time of THR in the cases with cortex hypertrophy was younger than that in the cases with atrophy. It was suspected that as the etiology of cortex hypertrophy after Charnley THR, a lot of factors such as activity after THR, body weight, stem position and bone remodeling, might be involved.
We are now faced with an every-increasing number of revision procedures for loosening of either the femoral stem or acetabular cup, and for fracture of the femoral stem. From June 1971 to July 1986, 266 total hip replacements (THR) were performed on 230 patients in our hospital. Of these THR, 108 cases (127 hips) were cemented THR, and 122 cases (133 hips) were cementless THR. We performed 13 total hip revisions with Prothese Totale sans ciment (R. Judet). The result showed that preopelative total average score of 55 points was improved to 86 points postoperatively, according to the J. O. A. Hip Score system. On the other hand, revisions of prosthetic replacement with PTs/c were performed on 10 patients. The result showed that preoperative total average score of 46 points was improved to 80 points postoperatively.