Foreign bodies with infection in the pharyngeal region have been commonly reported. But, there are only a few report about foreign bodies which reached to cervical spine and vertebral artery through retropharyngeal wall by stab injuries. A three-year-old girl, when sitting on a chair with the tip of a pencil in her mouth, was ridden on her head from behind by her younger brother. The pencil penetrated through retropharyngeal space, and the tip of it reached to the left vertebral artery of C2/3 level. She had a high temperature over 40°C in four days. She was admitted to our hospital on the seventh day after injury. It was difficult to find the non-radiopaque fragments, in the plain X-rays. But a CT scan showed such foreign bodies, and also demonstrated their relationship to soft tissues around them giving us many informations about site, size and shape of them. The removal of it was immediately performed by anterior approach under general anesthesia. She has had good clinical course after operation and now, she has no problems.
We treated a case of Down Syndrome complicated with cervical myelopathy. This case is a 37 year-old man who was affected with quadriplegia on February 23, 1987 and visited our outpatient Department of Orthopedics on June 13, 1987. Roentgenographycally, developmental cervical stenosis was found. Myelography showed narrowed cervical spinal cord due to combined cervical canal stenosis followed by cervical disc degeneration. Laminectomy was done from C3 to C7, and he obtained a good ability of both arms and fingers, and possibility of gait by the aid of the arm 3 months postoperatively. Myelopathy in Down Syndrome is seldom reported, and most of all, found as a complication of atlanto-axial instability. On the point of etiological view, this is rare.
Atlanto-axial instability is a relatively frequent finding in a patient with Down syndrome. But there have been few reports of symptomatic atlanto-axial dislocation in Down syndrome. We report three cases of atlanto-axial dislocation associated with spinal cord compression. In addition, case reports and symptomtic atlanto-axial dislocation from the literature were analyzed. We conclude that an osseous malformation of the odontoid is the main cause of atlanto-axial instability and irreducibility of dislocation, and that appropriate surgical management, including posterior cervical spine fusion will in most instances result in a favorable outcome.
We reported the case of an elderly woman with odontoid fracture who received treatment of C1-C3 posterior fusion utilizing Luque instrumentation. The case was a 70-year-old woman who fell and struck her head at home, and complained of persistent neck pain and torticolis during past 2 months before initial diagnosis. Neurological examination was normal. She had a past history of cerebral infraction and senile dementia. Radiological studies showed an unstable odontoid fracture (Type II) with the atlas displaced 7mm anteriorly. Anatomical realignment was achieved and maintained with use of a Halo-brace. Posterior C1-C3 fusion utilizing Luque instrumentation was performed, and brief external fixation was applied after operation. On the last examination (10 months postoperatively), the patient was free from symptom, and the fusion appeared solid on a plain roentgenogram.
Iotrolan, an isotonic water-soluble non-ionic contrast medium, has recently been developed to improve the biological activity of Metrizamide. We used the contrast medium for myelography and CT-myelography, and examined its contrast effect, side effects and desirable examination techniques. A satisfactory contrast effect was obtained in other cases than 3 patients in which contrast was unsatisfactory probably due to technical errors during the early period of use. If the head-end of the examination table was elevated higher than required to prevent the contrast medium from flowing into the ventricule after myelography, the contrast effect became unsatisfactory when cervical CT-myelograms were taken. Therefore, we put pillows of 10cm-height under the head-end of the table to slightly elevate the head-end by ca. 5°, and we placed patients in the prone position for 10-20 seconds just before lumbar CT-myelography. These points seemed to be indispensable to take a good myelogram. Side-effects were mild, and no severe or so-called “major” side effects such as disturbance of consciousness, generalized convulsion fits, etc. were observed. It is concluded that Iotrolan is a good myelographic contrast medium well tolerated by patients, if a radiologist gets skilled in the examination technique.
Thirty cases diagnosed first as cervical spondylotic radiculopathy (CSR) were studied with Magnetic Resonance Imaging (MRI). Six cases were diagnosed as Myelopathy easily with MRI. In radiculopathy, 92.9% of cases were represented with T1-weighted images as disc herniation, or with T2-weighted images as low intensity of signals of nucleus. On the other hand, only 71.4% of cases were represented with plain radiograph as decrease of disc space. Our results suggested that MRI is effective in the screening of patients with CSR.
In 42 cases with cervical myelopathy, MRI studies of the A-P diameter of the cervical cord and high intensity area in the cord were performed. They were 19 cases of cervical spondylotic myelopathy (male 14, female 5, age 50-81), 16 cases of OPLL (male 11, female 5, age 40-72) and 7 cases of cervical disk herniation (male 11, female 5, age 20-70). To compare with them, 20 cases without myelopathy (male 10, female 10, age 20-74) were examined by MRI. Results were as follows: 1. There was a significant difference in the narrowest diamater between myelopathy group and non-myelopathy group. 2. Severe cases in clinical findings had often narrow diamater of spinal cord. 3. Postoperatively, some cases who had poor enlargement of the spinal cord had tendency to little improvement of the clinical symptoms. 4. High intensity area in MRI did not relate to the improvement of the clinical findings.
Twenty-four cases of cervical myelopathy treated by conservative therapy were studied to judge its clinical effect. Clinical effects of conservative therapy for cervical myelopathy were found in 17 out of all 24 cases. The overall results were excellent in 6 cases, improved in 11 cases and unchanged in 7 cases. The results of conservative therapy were not always satisfactory in terms of ADL, and 14 cases needed surgical treatment eventually. Multivariated analysis about cervical spondylotic myelopathy (Kifune, M., 1988) were very useful to judge objectively the effects of conservative therapy.
We studied on clinical effects and problems of percutaneous epidural spinal cord stimulation (PESCS) in spinal spasticity. The subjects were 20 patients, consisting of 14 males and 6 females, ranging in age from 20 to 76 years old. There were 7 cases with spinal cord injury, 6 CSM, 4 OPLL and 3 intramedurally tumor. Under local anesthesia, the electrode was placed into epidural space at T12-L1 revel;, and parameters of stimulus were varied to get much better effect. Judgement of effectiveness was evaluated subjectively and objectively. Reduction of spasticity was objectively recognized in about 50% of the patients, recovery of motor function in 15%, and pain relief in 70%. We think that the application of PESCS to spinal spasticity, especially to postoperative case with paresthesia, is possible.
To perform decomporession of the spinal cord and stabilization of the cervical spine in the patients with cervical spondylotic myelopathy, anterior decompression and fusion of the cervical spine were carried out in our hospital since 1975. Although this procedure has been proved to be a useful method for the treatment of cervical spondylotic myelopathy, we have six cases with poor results. These six cases were analyzed with special reference to the following factors: 1) spinal canal diameter, 2) bone fusion of the grafted bone, 3) the number of fused vertebrae, and 4) instability of the unfusedsegment. We concluded that these factors affect the result of the treatment. The results of the cases which had narrow spinal canal and multi-segment involved were poor.
Long-Term results of multiply operated neck with cervical spondylotic myelopathy were studied. From 1975 through 1987, 173 patients with cervical spondylotic myelopathy were surgically treated in our clinic. Of these, nine were multiply operated cases. They were male and ages ranged from 46 to 62 years old (average, 54 years).Their overall results were not satisfactory; good results were obtained in only 3 cases at the time of follow-up study. We discussed several factors causing multiply operated neck in this report.
Postoperative long-term follow-up studies were conducted on patients with cervical myelopathy. We described clinical observations on operated 135 cases and computed-assisted myelographycal observations on 98 cases who were followed for more than 6 months. The final follow-up results were excellent in 34%, good in 33%, fair in 23%, poor in 4%, unchanged and worsened in 6%. Long-term results were influenced by the factors including the duration of the history and progression type of the disease, but not by spinal cord area measured from preoperative computed-assisted myelography.
The purpose of this paper is to describe the postoperative results of aged patients more than 70 years old with cervical spondylotic myelopathy (CSM). In this report, 20 cases were picked up of all 300 cases with CSM and were compared with all cases. They consist of 13 males and 7 females. Duration of symptoms varied from 2 months to 60 months, the average being 18 months. Nine patients underwent anterior approach and 11 patients did posterior. Aged patients' group was evaluated with regard to 8 factors: duration of symptom, severity, clinical course, surgical methods, personal history, postoperative complications, duration of bed rest, and postoperative results. The results were as follows: 1) The postoperative results were excellent in 15% and good in 25% in aged patients, and in 40% and in 32% in all patients. 2) Aged patients under 10 point in JOA score were 13 cases (65%). 3) Cases with short preoperative periods of deteriorated symptoms gained good results, but cases with chronic course or long duration from a rapid change gained poor results. These results shows that important factors which influence the postoperative results in aged patients are duration of symptoms and severity more than age, and that aged patients should be operated as early as possible, not to lose an opportunity, if indicated.
Measurements of bone mass were carried out by X-ray microdensitometry of the second metacarpus in 120 cases of OPLL in the cervical spine and 61 cases of control. Bone density was significantly higher in the non-myelopathy group of OPLL, but significantly lower in the severe myelopathy group of OPLL than in the control group. There was no difference between the group of continuous and mixed type and that of segmental type.
We studied radiologically the progression of ossification between the OPLL and the OALL in 52 cases of cervical OPLL patients who had been treated conservatively. Remarkable progression of the OALL was seen in 27 of 52 cases (52%). Considering corelation between the type of OPLL and the progression of OALL, remarkable progression of OALL was seen in 80% of mixed type, 50% of continuous type, 37% of segmental type in all of the patienis. In the cases followed for more than five years, remarkable progression was seen in 90% of mixed type, 60% of continuous type, 80% of segmental type. There was a tendency of remarkable progression of OALL in group of remarkable progression of OPLL. It was suggested that there is some corelation between the OPLL and the OALL in progression.
Relatively younger cases of OPLL, which were under 45 years old were evaluated. In terms of age distribution, 13 percents of all OPLL patients were under 45 years old, and 4 percents were under 40. The youngest one was 29 years old at the onset of the symptoms. They had relatively short affected periods. The proportion of continuous type in relatively younger group exceeded that in all patients. This might suggest that OPLL is related to predisposition of ossification. In relatively younger group, they had high incidence of accident at the onset and some cases had operations for prevention of worsening. Postoperative results in relatively younger cases were similar to that in all cases. When we eliminated those cases associated with accidents or preventative operations, postoperative results of relatively younger cases were excellent.
A Case of cervical myelopathy caused by multiple calcified nodules in the yellow ligament is presented. The patient 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 C2-7 laminae of the spine. Myelogram showed extradural compression corresponding to the C4-5 nodules. Wide laminectomy was performed from C3 through C6 and good results were obtained. Pathologically, there was calcification in the moderately degenerated connective tissues.
We report a case of human T-cell lymphotropic virus type-I associated myelopathy (HAM) with ossification of the thoracic yellow ligament. The patient was a 49-year-old woman who had a 7-year history of low back pain, gait disturbance and bladder dysfunction. On physical examinations range of her lumbar motion was severely limited, and hypesthesia below the level of Th8, hyper reflexia of the upper and lower extremities and spastic gait were observed. Lateral tomography disclosed a ossification of yellow ligament at the level of Th10, 11 and Th12, also a mild atrophy of the spinal cord was recognized. on MRI. Antibodies to HTLV-I was elavated in her serum and cerebro-spinal fluid. Considering these results, it was proper to make her diagnosis as HAM.
Magnetic resonance imaging (MRI), in only a few years, has had a dramatic effect on the diagnosis of the spinal disorders. We report a case of dumbbell type spinal tumor effectively evaluated with MRI. The patient was a 25 years old male and complained of slowly progressive low back pain. On MRI, intra- and extradural tumor extension through the Th12/L1 neural foramen on the left was clearly depicted. These findings were confirmed by myelogram and CTM. Hemilaminectomy and facetectomy of Th12 on the left was performed and the tumor was completely extirpated. Histopathological examination revealed that the specimen was neurinoma composed of both Antoni A and B types.
The impressive quality of its images, negligible risk, and multiplanar capabilities have spurred the use of magnetic resonance (MR) imaging for studying the spine. This study is intended to assess the accuracy of MR imaging in the evaluation of lumbar spinal disease. Forty-one preoperative patients were studied with MR, conventional myelography and CT myelography. In patients of degenerative disc disease, MR was at least as diagnostic as myelography. But according to the evaluation of the root compression, MR was inferior to myelography. Compared with CT myelography, MR was equivalent. The existence of epidural vein or fat was not always confirmed in operation at the site of high intensity area in MR imaging. Operative findings also showed that it was not easy to distinguish between epidural vein and fat with MR imaging. Because of the poor ability to show the condition of roots, in the present condition, it seems to be too early to use MR imaging as the preoperative final examination without myelography.
Thirty-two patients with lumbar disk herniation were studied by comparing MRI with X-P, myelography, CTM, so as to clear part of MRI in lumbar disk herniation. The results in this study proved well the value of MRI. We think that we can take operative steps by MRI only, if MRI findings are in accord with neurological findings, except for cases with MRI findings of multiple disk herniations.
The purpose of this paper is to compare MRI with Myelogram in 31 lumbar disorders, and evaluate the utility of them. The results of our study showed that both MRI and Myelogram had same findings in 30 (97%) of 31 cases, but that in comparison with operative findings Myelogram had same ones in 22 (88%) of 25 cases and MRI had same ones in 23 (92%). In the ability of diagnosis MRI and Myelogram were almost equal. But as regards dynamic factor Myelogram was superior and as regards intervertebral disk MRI was superior. Moreover, though Myelogram cannot diagnose the extraforaminal lesion, MRI can do it by its axial view. At the present time MRI and Myelogram have almost same ability in diagnosis but further advances in MRI technology and adequate choices of sections, pulse sequence and slice thickness can be expected to diagnose the lesion at the level of nerve roots.
Twenty-five patients were studied by MRI. Of them, 15 were men and 10 were women, ranging in age from 34 to 83 years old (mean, 58.4 years). Their spinal diseases included 5 tuberculous spondylitis, 2 other spondylitis, 7 malignant spinal tumor, 1 benign spinal tumor and 10 primary osteoporosis. We tried to classify the body lesion signal intensity into 4 types; low, iso, high and mixed signal intensity. Results were as follows: 1. Short SE image seems to be sensitive in the detection of abnormal spinal lesions. 2. Spinal tumor can be distinguished from inflammatory spondylitis by the lack of involvement of the disc space. 3. On the T2-weighted image, the signal intesity of spinal tumors was not consistent although tumor cells had a prolonged T2 relaxation time. 4. Osteoporotic compression fracture did not necessarily show iso signal intensity on MRI at acute or subacute phase.
In order to determine the indication of surgical treatment, follow-up study of lumbar disc herniation was performed. Fifty-two cases were divided into two groups. One group consisted of 29 cases (20 males and 9 females) aged between 16 and 64 years old (average; 32 years old) was treated conservatively. Another group comprising 23 cases (19 males and 4 females) aged between 14 and 61 years old (average; 30 years old) was assigned to surgical therapy, after conservative therapy. The results were as follows. 1. The final results of two groups did not show a statistically significant difference. 2. The change of JOA score was good indicator to decide the indication of surgical treatment: that is; the surgically treated group obtained poor effects than the conservatively treated group. 3. The first choice of therapeutic measures for lumbar disc herniation is the conservative treatment. But, in those cases who showed a low degree of response to the pelvic traction for 3 weeks, the surgical treatment should be considered.
Tight hamstrings is spastic contracture of hamstring muscles, but its mechanism has not been well known. We studied about growth factors including age, sex and height when we measured SLR, FFD, Looseness test in 3219 healthy young people (age range, 5-18years). The hamstrings in male were tighter than those in female in each age, which was same in cases with Tight hamstrings. The time of peak of SLR in healthy male and female is seen at the same period as the time of growth spurt. Tight hamstrings tend to appear in this time, and SLR, FFD are severely restricted if some factors of lumbosacral regions are mixed.
As time passes, spur formation may occur at the damaged ring apophysis part in the lumbar disc herniation in teenagers. Thus, the formed spur was comparatively reviewed with the so-called traction spur observed in adults. As a result, even in the so-called traction spur, there was much damage at the ring apophysis site in young people.
The purpose of this paper is to evaluate lumbosacral radicular symptoms in more than 60 years old patients by nerve root infiltration. Radicular symptoms are classified into 3 groups: pain symptom, paralytic symptom and combined symptom group. In pain symptom group, main symptom is low back and/or leg pain. In paralytic symptom group, main symptom is numbness and/or muscle weakness in legs. In combined symptom group, symptom is combination of pain and paralytic symptom. According to manifestation of their symptoms, patients are also classified into 3 group: dynamic type, static type and combined type. Patients in dynamic type have no symptoms at rest but have radicular symptoms in walking. Patients in static type have radicular symptoms at rest and do not change their symptoms in walking. Patients in combined type have radicular symptoms at rest and increase their symptoms in walking. The main results found in this study were as follows; 1) Dynamic type is common in patients with spondylosis, whereas static type is common in patients with lumbar disc herniation. Combinede type is common in patients with spondylolisthesis. 2) Although aged people seem to have various radicular symptoms, one involved nerve root in 75% of them can be localized by nerve root infiltration. 3) Nerve root infiltration is very effective to patients with dynamic type and pain symptom. 4) Neurologically, root tension sign is not severe. Sensory disturbance shows considerably the involved nerve root but deep tendon reflex is not diagnostic in aged people.
Usually degenerative spine showed narrowing of the discs and formation of osteophytes. We studied the clinical significance of the osteophyte compressing the nerve in extra foraminal zone. Forty cases who suffered from lumbago and/or leg symptoms were reviewed in computed tomography. Eight cases had osteophytes which were located in a posterolateral corner of the caudal part of the vertebra. All of them complained of severe pain in the buttock and/or lower extremity which markedly disturbed their walking. They suffered from night pain and rest pain. These symptom seemed to arise from dorsal root ganglion near the osteophyte. Compression to the dorsal root ganglion, which produces the substance P, may induce severe pain. In some cases with degenerative changes, these conditions may be caused by bony lesion. We must consider these conditions in the treatment of lumbar diseases.
Thirteen patients with femoral neuralgia or paresis underwent operation since 1985. The 13 patients treated consisted of 11 males and 2 females with a mean age of 51 years. The causative diseases were as follows: 6 patients with upper lumbar disc herniation, 2 with lumbar canal stenosis, 3 with tumor (extradural arachnoid cyst from T11 to L1, dumbbell type neurinoma arised in the L3 root, and retroperitoneal leiomyosarcoma), one with entrapment neuropathy at the inguinal scar, and one with tuberculous spondylitis at the L1/2. Femoral nerve stretching test was positive in 7 patients. Sensory disturbance was seen in 11 patients. Muscle atrophy in the thigh was seen in 6 patients. In follow-up studies over an average of 15 months, recovery of the femoral nerve function without ADL disturbance was obtained in 10 patients.
we have described 12 cases of lumbar disc herniation presenting special symptoms or operative findings. This includes 3 cases of extraforaminal herniation, 4 cases presenting drop foot, 1 case with vesicorectal disturbance, 1 case of intradural herniation, 2 cases of sequestrated herniation behind dural sac and 1 case of extruded herniation from the other side, out of 205 operated cases of lumbar disc herniation. For extraforaminal herniation, CT—discography is most valuable and can give us the selection of operative procedures. Two types of the pathomechanism for producing drop foot are considered: lateral root entrapment and central caudal compression. In each of them, some additional factors, for example, neural canal stenosis must be considered. Intradural herniation is rare but we have to be suspicious by preoperative diagnostic methods, and the palpation of dura is necessary not to overlook this condition.
During a two-year period from January 1986 to December 1987, 54 patients underwent lumbar discectomy for herniated nucleus pulposus. Five patients (9.8%) were diagnosed as having an extraforaminal disc herniation. ‹Materials› There were 3 male patients and 2 female patients. The age was 20-53 years old, the average being 36 years old. The site of nucleus pulposus were 4 cases at the L5-S1 intervertebral disc and one case at the L4-L5 intervertebral disc. ‹Diagnosis› Clinically, the involved nerve root level could be easily identified but the point of compression was relatively difficult to decide. All patients were evaluated with myelography, computerized tomography, discography enhanced computerized tomography (Disco-CT) and nerve root infiltration. In all cases, myelography did not show any abnormalities. Disco-CT was very useful for accurate diagnosis of the extraforaminal disc herniation. ‹Treatment› All patients had osteoplastic hemilateral laminectomy. This method was different from conventional laminectomy. To briefly reviewing this technique, the lamina is cut diagonally at the interarticular part and the spinous process is cut longitudinally with an osteotome from back to front. The lamina is removed in one piece and superior facet is cut in the medial one fourth and upper one fourth. The result of this procedure is that the extraf oraminal disc herniation can be easily identified and removed. After that, lamina is replaced and fixed with 5 silk threads. The advantages of this method are; 1) the operating area is wide and extraforaminal disc herniation can be removed safely and completely; 2) the intervertebral joints need not be sacrificed and spinal instrumentation is not necessary; 3) the posterior elements are kept intact and there will be no dead space. Follow-up study, the average being 13 months, showed good results. Osteoplastic hemilateral laminectomy is an effective method of management.
One hundred forty cases of lumbar disc herniation treated by Love's operation without bone fusion were reviewed. The follow-up time at the Out-patient clinic was more than six months (average, 2. 3 years). Fifty-four per cent of the patients had a herniation of the disc between the fourth and fifth lumbar vertebrae, whereas thirty-seven percent had between the fifth lumbar vertebra and the first sacrum. The average improvement rate by the Japanese Orthopaedic Association Score was seventy-five percent. Sciatica and Lasegue sign were more improvable than other symptoms.
Recently, we treated two cases of postoperative pulmonary thromboembolism after lumbar spinal surgery. Pulmonary thromboembolism is responsible for one of the greatest dangers in orthopaedic surgery. Case 1 was a 30-year-old man. There was a disc herniation of L4/5 and Love's operation was done. Six days after the surgery, he complained of chest pain, tachypnea, cough and bloody sputum. Case 2 was a 41-year-old man. There was a disc herniation of L4/5 and Love's operation and postero-lateral fusion were done. Thirteen days after the surgery, he complained of bloody sputum, tachypnea, chest pain and cough. The early signs of pulmonary thromboembolism are often difficult to detect, especially when it occurs in a patient remaining in bed. The diagnosis of the pulmonary thromboembolism was not easily made by chest X-ray findings and blood biochemical tests. Analysis of arterial blood gas and respiratory gas will be a most reliable method to differentiate pulmonary thromboembolism from other respiratory diseases.
An association between degenerative spondylolisthesis and osteoporosis is suggested. The CT number at the site of cancellous bone in the L3 vertebral body are studied in 97 female patients with degenerative spondylolisthesis and 64 female patients without degenerative spondylolisthesis. But our study indicated that osteoporosis is not only the cause of spondylolisthesis but also the factor of progression of spondylolisthesis.
As a result of a radiological prospective study carried out in 121 cases in 19 years on the average, degenerative spondylolisthesis was found in 22 cases. The type of the zygapophysial joint in a group of the spondylolisthesis in 22 cases was M type or W type, but was not X type. In a group of the spondylolisthesis in 22 cases, the pedicle-facet angle and the zygapophysal joint angle had enlarged before spondylolisthesis. We think that the cause of spondylolisthesis was associated with the type of the zygapophyseal joint, the pedicle-facet angle and the zygapophyseal angle.
Selective radiculography and block (SRB) were carried out on 150 cases with cervical and lumbar radicular symptoms. Of 150 cases with SRB, 74 subsequently had surgical exploration of the suspected lesion, when SRB was helpful to determine the level of symptoms. Eleven cases (7.3%) were improved for more than one month. SRB was occasionally useful as a therapeutic method.
There are many patients suffering from low back pain who are uncontrolled by usual conservative therapy. For 26 cases of those patients, we performed facet and sacro-iliac joint mobilization therapy and got excellent results in 10 cases (38%), good results in 8 cases (31%), fair results in 2 cases (8%), unchanged results in 6 cases (23%), and poor result in none. For patients suffering from low back pain originated in facet and sacro-iliac disorders, this technique is considered to be simple and a very effective therapy.
The three dimensional intervertebral movements of fourteen patients with lumbar instability were measured. These movements of a group of six normal subjects were also measured. The CT scan in rotation to the left and to the right was used to investigate the axial rotational instability of the lumbar spine. MRI was used to determine the grade of disc degeneration. The relations between the axial rotational instability and other dimensional movements, the grade of disc degeneration and physical signs were analyzed. The facet of the lumbar spine with rotational instability showed hypertrophy, subluxation and joint laxity. The intervertebral disc of the lumbar spine with rotational instability showed the grade 3-4 disc degeneration. When facet degeneration increases in addition to disc degeneration, rotational instability may occur, and then rotational deformity may narrow the lumbar canal.
A sixteen-year-old female basketball player in high school complained of pain on medial aspect of both groins. During examination, she had a pain to palpation over inferior public ramus and motion pain caused by hip abduction stress in both sides. Initial radiograph showed fracture line of bilateral inferior public rami clearly, and callus formation on the right side. We diagnosed stress fracture of bilateral inferior public rami and prohibited her from all of sports activities. Fourteen weeks later, her pain gradually decreased, and the radiograph showed abundant callus formation in both sides. We discussed the factors that caused this fracture.
With the boom of the sports and fitness exercise in recent years, the trouble caused by sports tends to increase, so we are highly concerned with the sports injuries. A cycling race is one of the recently popular sports. In this paper, we presented two professional cycle racers who had a medial femoral neck fracture and a traumatic dislocation of the hip with femoral head fracture during a race. These two cases were supposed to be in a critical condition, but they recovered in a year. We report the plastic-surgical injuries of the professional cycle racer together with the process of their rehabilitation.
An experience of functional brace treatment for the fresh Achilles tendon rupture was reported. We developed a new functional brace and applied it for 2 cases of gastrocunemius rupture and for 6 cases with Achilles tendon rupture. The brace is designed to be able to endure early weight-bearing walk. It will be useful for the prevention of muscle weakness and for the improvement of ADL.
Stress fracture of the sesamoid bone are quite uncommon. Specially the fibular sesamoid is more rarely injured. We experienced two stress fractures of the sesamoid bone of the great toe. The cause is a repeated microtrauma. The treatment consisted of compression bandaging and non-weight bearing. But when clinical sign continued, surgical treatment is necessary.
The hallux sesamoids which are small can be the site of disabling pathology for the athletes. Bipartita sesamoid, stress fracture, and osteonecrosis have been reported in the athletes. Four young athletes, three females and one male, who presented with disorders of the hallux sesamoid were reported. All patients complained of pain during walking and running and had localized tenderness over the medial sesamoid and the pain was aggravated by dorsiflexing the great toe. Roentgenographic examination revealed separation or fragmentation of the medial sesamoid, respectively. All patients had been kept under observation with conservative treatment consisting of pad. In one of the patients, treatment consisting of metatarsal pad did not give any relief and operation was performed.
The patient with cervical column and cord injuries due to sports in middle and high school, who might be rapidly growing physically but still immature mentally, were analyzed from different angles. In addition, the measures of its prevention were discussed. All of the 12 patients were male; 2 middle school boys and 10 high school boys. The sorts of sports, mechanism of injury and levels of injury were demonstrated. One patient had occipitoatlantal dislocation related to Judo practice. One patient had atlantoaxial subluxation related to traffic accident during jogging. Two patients had atlantoaxial dislocation with os odontoideum; one of whom related to throwing in Sumo and another one kicking in soccer. One patient had hangman-like fracture by extension-axial compression force related to falling in gymnastics. Two patients had C5 vertebral bursting fracture related to diving in the sea. One patient had C4 & 5 vertebral compression fracture related to falling in skateboard. One patient had C4-5 anterior dislocation by hyperflexion mechanism related to falling in gymnastics. One patient had C5 & 6 compression fracture related to falling in gymnastics. One patient had C6 bursting fracture by axial compression force related to sliding in baseball. One patient had C6-7 unilateral anterior dislocation by flexion-rotation force related to scrumming in rugby-foot-ball. One patient died from respiratory-circulatory failure resulting from the damage of the brainstem and the upper cervical cord. One of the 2 patients with complete paralysis returned home and another one was moved to rehabilitation center. 9 patients with incomplete paralysis returned to school 3 to 4 months after injury. The measures toward its prevention were discussed from the viewpoints of the characteristics and sports ability of individual person, athletic environment, protective gear and rules of contact sports and roles of coach, trainer and doctor who train the passive students with insufficient judgement.
For reposition and maintenance of reduced position of the displaced proximal humeral fracture, K-pin was fixed at the ulnar, and continuous traction was made in the direction of zero-position. As a result, even the fractures of three or four parts have been favorably treated with the good evaluation.
Recently the orthopedic clinic has been visited by hemiplegic patients suffering from pain in the shoulder. On the x-ray film the shoulder subluxation is often revealed in the erect position. Hemiplegic shoulder subluxation is treated by using the conventional arm sling. To assess the effectiveness of N. M. E. S. program in the management of the shoulder subluxation, we conducted a study in which we compared the effectiveness of N. M. E. S. with that of the conventional arm sling. Twenty hemiplegic patients with shoulder subluxation were studied for 6 months. Ten of them were treated by using the arm sling only. The remaining 10 were treated by using both arm sling and N. M. E. S. in combination. As a result, the use of both arm sling and N. M. E. S. combined in the treatment of the hemiplegic shoulder subluxation was more effective than the use of an arm sling only.
Thirteen shoulders of twelve patients (7 male and 5 female) of recurrent anterior dislocation of the shoulder were operated on by modified Bristow methods, 7 cases were operated on by Bristow-McMurray procedure and 6 cases by Bristow-May procedure, from 1979 to 1988 in our clinic. The dicision of choosing the procedure is based on 3 factors: first is the status of the injured shoulder capsule determined by the arthrogram, second is the number of recurrent dislocations, and third is the occupation of the patient. In none of our patients was there a recurrence. Only one complication was a broken screw which produced no problem to the patient. The patients operated by Bristow-May procedure had more limitation of the motion especially in external rotation than those operated by Bristow-McMurray procedure. Nevertheless all patients stated that they could resume various activities which they had not been able to do because of recurrent dislocations.
The case was a 17-year-old male, southpaw pitcher. Since his age of 9 he had been playing an active part as a pitcher in baseball games throughout his primary, middle and high school days. In Autumn 1987 he experienced pain in his left shoulder while throwing a ball. Because shoulder pain on throwing a ball continued he was admitted to our department ward in May 1988. No abnormalities were noted on plain x-ray and arthrography, but arthroscopic examination revealed a tear of glenoid labrum in its postero-superior portion and an abnormal bandle which arose posterior to the long biceps tendon and attached to the joint capsule above. These lesions, being judged as the cause of the pain, were resected. Postoperative management which consisted of ROM exercise and muscle training supplemented with a pitching rehabilitation program using PNF technique, was initiated on the 2nd postoperative day. 6 weeks postoperatively the patient returned to his work as a pitcher and now, 6 months after operation, he is playing baseball without experiencing any pain on pitching.
Arthroscopic examination was performed on 33 cases, 35 shoulders. Twenty were male and fourteen were female. The average age was 47.8 years. Examination was done under general anesthesia in 34 shoulders and epidural block in one shoulder. Subacromial bursa was examined through postero-lateral approach. Posterior approach was used for glenohumeral joint. The technique of arthroscopy of the shoulder joint has been studied.
The case was a 55-year-old muscular laborer. Because of intensification of left shoulder pain he consulted a neighbouring doctor, from whom he received treatment with local injection. Two days later there occurred swelling, redness and local heat sensation in the affected shoulder, with which he visited another doctor, by whom the patient was referred to us under a suspected diagnosis of pyogenic arthritis of the shoulder. Five days after his hospitalization he underwent arthroscopic debridement with subsequent 3-week continuous irrigation of the joint via a tubing held in place through the puncture site for arthroscopy. One month after operation there no longer was serologic evidence of inflammation; 2 months postoperatively the ROM was restored to the premorbid level and the patient was freed from pain. In pyogenic arthritis, a delay in diagnosis and treatment may greatly affect prognosis. Use of arthroscopy seems to permit quick and correct diagnosis and treatment and thereby improve the outcome of therapy particularly with respect to ROM.