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重盛 廉, 行田 義仁, 駿河 保彰, 前田 宏志
1989 年 38 巻 2 号 p.
619-622
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Bone grafting of tibial defects in primary total knee arthroplasty was performed in four knees (3 patients). All three patients had rheumatoid arthritis and had been treated by intra-articular steroid injection. All tibial defects were in medial plateau and were filled with bone from the adjacent femoral condyle. The bone was held in place by a screw and/or K-wires. In all knees, clinically bony union was seen and no collapse was present.
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束野 通志, 東 真理, 山城 健一, 坂本 公宣, 赤崎 幸二, 園田 英器, 伊勢 紘平, 広田 耕三, 松原 三郎, 益田 郁子
1989 年 38 巻 2 号 p.
623-626
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The results and problems with 46 knees in 35 cases of total knee replacement were investigated. Definite or classical rheumatoid arthritis were diagnosed preoperatively in all of these cases. We used Okayama Mark II TKR in 22 knees, Miller-Galante TKR in 19 knees, Kinematic TKR in 4 knees and PCA TKR in 1 knee.
The prognosis was affected by preoperative limitation of range of motion, postoperative complications which disturb the progression of physical therapy, and infection
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中村 雅彦, 佐竹 孝之, 高嶋 明彦, 加治 浩三, 鳥巣 岳彦, 池辺 修二
1989 年 38 巻 2 号 p.
627-634
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Five patients with infantile type of Blount's disease were observed. All patients were treated conservatively. One patient with Langenskiöld's stage II was healed spontaneously without brace. Four patients were treated with a long-leg brace. Three of them had good results but one patient progressed to Langenskiöld's stage III.
We observed the radiographic change of femorotibial angle (FTA) and metaphyseal-diaphyseal angle (MDA). It was concluded that MDA is more reproducible than FTA, and is a useful marker for early diagnosis and treatment of infantile type of Blount's disease.
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西 百香里, 酒匂 崇, 貴島 稔, 上原 裕史
1989 年 38 巻 2 号 p.
635-637
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We studied the meniscal findings in 63 cases which were examined by arthrography and arthroscopy. In 52 cases we had the coincidence completely in the findings of both examinations. False positive cases were 4 and false negative were 2. About these cases, we investigated more minutely and discussed the pitfalls in arthrography. We agree with the value of arthrography. We emphasised the need of arthroscopy on the decision of operative method finally.
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関節裂隙の変化について
鱸 俊朗, 根津 勝, 上原 信生
1989 年 38 巻 2 号 p.
638-641
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The alignment of the knee and the change in the joint space were evaluated in 26 knees after high tibial osteotomy for varus osteoarthrosis of the knee. Femoro-tibial angle (FTA), passing poit of Mikulicz line (ppM) and lateral opening angle (LOA) were measured for this evaluation. LOA is the angle which is made between the line connecting bilateral femoral condyles and the line connecting bilateral tibial plateaus in A-P view. LOA of postoperative standing view in all except 2 knees decreased as compared with that of preoperative standing view. All knees corrected under 166° (FTA) or over lateral 50% (ppM) decreased over 2° in LOA. LOA of postoperative standing view were almost equal to that of preoperative supine view. The change in LOA between preoperative standing view and postoperative standing view correlated the preoperative joint instability. This suggests that the correct angle in high tibial osteotomy had better be determined from the preoperative A-P view of supine position especially in the case with joint instability, and that best corrective alignment was about 166° (FTA) or lateral 50% (ppM).
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藤川 勝正
1989 年 38 巻 2 号 p.
642-646
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A new conservative treatment for subluxation of joints in knee-joint injuries was explained on three cases.
The first case developed internal rotation of femoral condyle and prolapse of medial meniscus after the treatment for fracture of upper femoral after the treatment for fracture of upper femoral condyle. In such a case as this, subluxation of knee-joints showed a close relation to the prognosis of anterior cruciate ligament injury and meniscus injuries.
In the other two cases, drop-back sign of the tibia was noticed. This syndrome is caused mainly by joint-laxity. Therefore, together with treatment for subluxation of knee-joint, lesion of neurotic circuit, the cause of joint-laxity, and especially lesion of cervical lateral cord should be considered, which was referred to here.
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千田 治道, 野村 一俊, 平野 真子, 小田 光義, 匂坂 正明, 水岡 二郎
1989 年 38 巻 2 号 p.
647-651
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
From July 1985 to May 1988, arthroscopic partial meniscectomy was performed in 29 patients (32 knees) of degenerative medial meniscal tear. Of these, 27 patients (30 knees) were available for follow-up. The average follow-up period was 21.1 months with a range from 6 to 46 months. There were 10 females and 17 males. The average age of the patients was 52.1 years with a range from 29 to 78 years.
The results were evaluated by Helge-Appel X ray grade, Kurosawa's score and JOA's score. The results were as follows.
grade 0 (17 knees): JOA's score; 96.5±5.9 (mean±SD)
Kurosawa's score; 9.8±0.5 (mean±SD)
grade 1 (6 knees): JOA's score; 83.3±8.5 (mean±SD)
Kurosawa's score; 7.5±1.5 (mean±SD)
grade 2 (4 knees): JOA's score; 60.0±23.2 (mean±SD)
Kurosawa's score; 3.5±2.6 (mean±SD)
grade 3 (4 knees): JOA's score; 46.7±22.5 (mean±SD)
Kurosawa's score; 3.3±2.0 (mean±SD)
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北川 守, 朝長 圀夫, 江川 正, 中村 泰, 後藤 正治, 三原 茂
1989 年 38 巻 2 号 p.
652-656
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A comparative study was conducted on the 20 knees of 10 females with normal knee joints (age, 22-35 years) and on 7 knees of 7 patients with subluxation syndrome (age, 15-24 years), using axial radiography and CT. In axial radiography where the angle of knee flexion was 30° or 60°, no significant difference was recognized between the two groups with respect to tilting angle, patellofemoral angle, congruence angle and lateral shift. However, a significant difference was found using CT. Thus, CT was considered useful for diagnosis. Because of these results, all 7 cases underwent surgery for detachment of the lateral side and tightening of the medial side. Three cases underwent shifting of the tibial tuberosity to the anteromedial side, resulting in a favourable outcome. Here, we report the study.
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野村 一俊, 匂坂 正明, 小田 光義, 平野 真子, 千田 治道
1989 年 38 巻 2 号 p.
657-660
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
During the past five years, arthroscopic lateral release was performed on 22 knees in 21 patients. There were 18 females and 3 males and their average age was 19.7 years with a range from 12 to 50 years. All patients were available for follow-up. The average duration of follow-up was 2 years and 5 months with a range from 9 months to 5 years. Nine patients were graded as excellent, 7 patients as good, 4 patients as fair and one patient as poor. In three patients graded as fair, arthroscopic medial reefing was performed at the reoperation and satisfactory results were obtained in all patients at the time of follow-up. One patient graded as poor had distal realignment.
All of the knees that needed reoperation had more instability of patello-femoral joint than other cases. Since the degree of patello-femoral instability seemed to be a significant prognostic factor, medial reefing should be added in such knees even if good congruity is obtained by lateral release.
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原 道也, 足達 裕, 本重 博史, 古賀 哲二, 高岸 直人
1989 年 38 巻 2 号 p.
661-666
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We have raised the diagnostic rate by magnetic resonance imaging (MRI). MRI was performed in 23 knees: 9 knees of ACL injuries, 3 knees of PCL injuries, 3 knees of ACL+PCL injuries, another 4 traumatic knees and 4 normal knees.
The presence of torn ligaments in injured knees was confirmed by arthroscopy or arthrotomy in 19 injured knees except for 4 normal knees.
We concluded that MRI was much useful as one of the helpful diagnostic methods.
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井原 秀俊, 久我 哲也, 中山 彰一, 三輪 恵, 高柳 清美
1989 年 38 巻 2 号 p.
667-670
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Complete acute ruptures of the posterior cruciate ligament (PCL) of four patients were allowed to heal with early mobilization without operation nor without immobilization. All patients were examined arthroscopically and tried to reposition the ruptured fibres of the PCL extra-synovially on day 5 on the average following injury. The knees were mobilized on day 5 after arthroscopy with a knee brace having double traction system to give physiological stress and avoid exessive stress to the PCL. The patients were followed for an average of 6.5 months.
Results showed as follows: On stress X-rays with posterior strain taken after five months, one case was improved dramatically, two were sligthtly, and one having slight posterior drawer at injury was not changed. On athroscopic finding examined on week 5 after the first arthroscopy, fibers of the PCL protruded inta-synovially appeared like a scar tissue, but the tension of the PCL was good in two cases and poor in two cases. On sport activity, one patient could play fully in baseball club, two prepared to return to sport, and one could not do.
It is suggested that acute rupture of the PCL can be treated from the beginning with early mobilization with the knee brace having double traction system without operation nor immobilization.
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佐久間 克彦, 水田 博志, 久保田 健治, 甲斐 功一, 高木 克公
1989 年 38 巻 2 号 p.
671-675
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We studied the short-term results of the anterior cruciate ligament with a Dacron Ligament prosthesis in 7 cases. Our series consisted of three males and four females ranging in age from 17 to 40 years old with an average of 32.3 years old. Follow-up ranged from 3.5 to 12.5 months (average, 9 months). All had chronic anterior cruciate ligament deficient knees. The reconstruction led to complete improvement of giving way phenomenon. Although subjectively all of the patients considered the results satisfactory, objectively we recognized a case of a rupture of intra-articular ligaments and a case whose laxity was gradually increasing. From this study, the short-term results of the anterior cruciate ligament with a Dacron ligament prosthesis did not give us enough satisfaction.
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古賀 哲二, 浅野 正也, 足達 裕, 有永 誠, 副島 修, 深堀 雄蔵, 池田 宏, 池田 実, 菊地 哲次郎, 佐井 伸男, 高岸 直 ...
1989 年 38 巻 2 号 p.
676-680
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Fifteen patients who underwent primary repair of the acutely torn anterior cruciate ligament (ACL) were followed and short-term results were estimated. The subjects were 12 men and 3 women. Combined ligamentous injuries consisted of medial collateral ligament tear in 4 knees, posterior cruciate ligament tear and others tear in 5 kness. Follow-up term ranged from 12 to 40 months, with the average of 20.9 months. All patients were evaluated subjectively and objectively by Kobayashi scoring system. Most of the patients with an isolated ACL tear had good results. However, it was difficult to have good results in both ROM and stability.
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市川 誠, 力田 忠義, 倉田 利威, 平松 伸夫, 梶谷 典正, 吉岡 薫
1989 年 38 巻 2 号 p.
681-684
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A case of spastic paraplegia was reported. The patient was a 41-year-old male who complained of back pain at the onset and gradually developed paraplegia. Myelography showed no findings, but CTM and MRI showed that the posterior epidural space at the level of th2-th5 was widened abnormally. Laminectomy from th2 to th5 revealed the veins in the epidural fat tissue were dilated remarkably. The dura was opened, but there was no finding in the dura. So we resected the dilated veins by coagulating them. At present four months after surgery, muscle weakness and spastic gait are improved.
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原田 昭, 吉岡 薫, 上田 久司, 生田 義和, 原田 雅弘
1989 年 38 巻 2 号 p.
685-689
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Thoracic disk herniation is rare and the upper thoracic disk herniation is extremely rare.
Recently, we treated the thoracic disk herniation at Th2/3. In addition to myelogram, myelo-CT and MRI were useful for the diagnosis.
The posterior procedure was conducted. Rhyzotomy and transdural approach were usefel for averting the spinal cord from injuring. The clinical results were satisfactory.
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伊藤 孝, 津江 和哉, 種窪 康, 浦野 正之, 伊藤 裕
1989 年 38 巻 2 号 p.
690-692
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Degenerative changes or spondylosis are encountered less frequently in thoracic region than in lumbar or cervical spine, We reported three cases which led to anterior cord compression at the lower thoracic spine: case 1 with myelopathy due to thoracic spondylosis, case 2 with thoracic disc herniation, and case 3 with spinal cord compression due to posterior separation of the ring apophysis: Case 3 showed the symptoms of flaccid paralysis like the Charcot-Marie-Tooth disease.
Case 3 had the lesion at the T11-12 level, where couns was compressed. Therefore, we considered, that this case offered lower motor neuron disorder.
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後藤 正治, 江川 正, 朝長 圀夫, 中村 泰, 北川 守, 三原 茂, 植松 伸久
1989 年 38 巻 2 号 p.
693-696
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Spinal tumors in the region of the thoracic vertebrae may be detected by an abnormal shadow in the thorax on X-ray. We report 3 cases we encountered, together with a discussion of the literature.
Case 1 was a 49-year-old man who was incidentally found to have an abnormal shadow of the left lung and diagnosed as a tumor of the posterior mediastinum. At surgery, a neurilemmoma, a dumbbell tumor of extradural-paravertebral type was found at Th 11/12.
Case 2 was a 27-year-old man whose abnormal shadow was diagnosed as a mediastinal tumor. At surgery, a ganglioneuroma, a dumbbell tumor of the foraminal-paravertebral type was found at Th 1/2.
Case 3 was a 64-year-old man whose abnomal shadow was suspected as a spinal tumor. At surgery, it was found to be a paravertebral neurilemmoma, occurring at Th 1/2.
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窪田 秀明, 奥江 章, 石崎 知樹, 松口 信行, 進藤 隆康, 田原 敬士, 江崎 幸雄
1989 年 38 巻 2 号 p.
697-700
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A case of spinal cord compression by an osteochondroma with multiple osteochondromas was reported.
A 10-year-old boy was admitted to our hospital with 6-month history of spastic gait in the right leg.
Neurological examination demonstrated mild weakness of the right lower extremity. There were relative hyper-reflexes in the right leg. Plain roentgenograms were unremarkable. Myelography and enhanced computerized tomography showed extradural spinal cord compression at the 3rd thracic level by a bone tumor. But magnetic resonance imaging showed high density area form C7 to Th6 in addition to the Th3 tumor image. We puzzled these data.
We performed surgical removal of this tumor by laminectomy of Th3 and Th4. The high density area of MRI was recognized to be proliferative fatty tissue. Pathologic examination revealed that it was typical of osteochondroma. He could walk normally 3 months postoperatively.
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橋本 伸朗, 中村 孝文, 大橋 浩太郎, 佐々木 彰, 前田 勇一, 高木 克公
1989 年 38 巻 2 号 p.
701-705
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The purpose of this paper is to clarify the corrective effect of a weight (5kg) which is held by the patiant with mild idiopathic scoliosis. The subjects consisted of twenty-five patients (6 boys and 19 girls) whose ages ranged from 13 years to 15 years (mean, 14.4 years). Fourteen cases were of thoracolumbar scoliosis and others were of thoracic scoliosis. The change of Cobb angles, vertebral deviation and tilting of the pelvis were examined on the right side holding film and the left side holding film. Results showed that the curvatures of all the patients with thoracolumbar scoliosis were corrected when they held a weight on the convex side of their thoracic curve. Those of the r-thoracic scoliosis were corrected in the same way. But only 1-thoracic curve disobeyed this law.
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佐藤 直人, 吉田 健治, 田中 博之, 永田 見生, 井上 明生
1989 年 38 巻 2 号 p.
706-709
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of the congenital block vertebra in the thoracic spine, which had been suspected of tuberculous spondylitis because of roentgenographic findings, were reported. The sixth and seventh thoracic vertebrae were involved in a 29-year-old male patient and the third and fourth thoracic vertebrae in a 40-year-old female patient. X-rays revealed that the intervertebral disc was narrow and the vertebral lamina was fused and intervertebral foramen was narrow, which was thought to be a cause of the back pain. In the first case foraminotomy was performed with satisfactory results. In the second case conservative treatment was selected because of less severe symptoms.
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桜田 和之, 村上 哲朗, 中原 庸夫, 豊田 耕一郎, 田中 慎一
1989 年 38 巻 2 号 p.
710-712
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We report two cases of Charcot spine: one case due to traumatic paraplegia, and other due to tabes dorsalis.
Case 1 was a 50-year-old man who had been treated for tabes dolsalis since January 1986. He noticed only low back pain in November. The diagnosis of Charcot spine was made by the characteristic X-P findings of L2, 5 and his past history. He was treated with corset and his lumbar spine was reconstructed in May 1988.
Case 2 was a 45-year-old man who had paraplegia below T10 due to a T11-T12 dislocation scince 1964. He complained of an increasing lumbar deformity and abnormal crepitation with movement in November, 1986. He was treated with Harrington compression rod and posterior fusion from L2-L4. Two years later, the fusion between L2-3 progressed to almost complete healing.
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松原 好宏, 佐々木 邦雄, 松尾 圭介, 松本 直之, 田丸 卓弥, 岸川 陽一
1989 年 38 巻 2 号 p.
713-716
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We report a case of a 16-year-old man who suffered from lt L5, S1 root injuries due to the sacral fracture. Roentgenograms and computed tomography scans showed that the fracture line ran vertically through the sacral foramens with the lateral fragement displaced proximally, the rupture of pelvic ring and retroperitoneal bleeding. The L5 nerve was caught between the displaced lateral sacral fragement (vertical shear) and the transverse process of L5 in what was called a “traumatic far-out syndrome.” The involvement of the L5 nerve with drop foot was immediately recovered conservatively by skeletal traction and pelvic suspension. As the sensory disturbance of S1 root region remained, we performed decompression of that at the sacral foramen, and allowed the patient functional recovery. Specific pelvic roentgenograms and computed tomography scans are crucial for understanding the injury like this.
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栄 四男, 今給黎 尚典, 児嶋 貴久, 別府 徹己, 酒匂 崇
1989 年 38 巻 2 号 p.
717-720
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Ten patients with acute, unstable fracture-dislocations of the thoracolumbar spine were treated with posterior spinal instrumentation and fusion. Nine of the ten patients sustained a neural injury. Seven sutained complete spinal cord injury and two had imcomplete neurological deficits. There were five rotatory fracture-dislocations and three fracture-dislocations and two burst fractures. The Harrington instrumentation was used three times and Harrington-Luque instrumentation was used seven times. Two patients had improved from Frankel Grade C to E post-operatively. The use of Harrington instrumentation is an effective means to obtain the reduction of fracture-dislocation and maintenance of alignment. But a patient with burst fracture had significant loss of correction. Anterior spinal fusion should be recommended to this case.
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小西 宏昭, 鳥越 雄喜, 高須賀 良一, 実松 義昭, 竹迫 純亨, 小田 純爾, 中西 秀二, 西村 行政, 角 光宏, 近藤 晴彦
1989 年 38 巻 2 号 p.
721-724
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Thoracolumbar vertebral rotations were measured for 27 thoracolumbar spinal injuries and 10 controls by using an auxiliary tool.
Normal range of rotation was about 70 degrees. On the other hand, in the spinal injury group, range of rotation was decreased. Especially, range of rotation in the operated group was smaller than that in the conservatively treated group.
And another result showed that there was a relationship between the range of rotation and the grade of injury. Patients of severe neurological involvement had small range of rotation.
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石橋 裕一, 芝 啓一郎, 香月 正昭, 植田 尊善, 白澤 建蔵, 村尾 哲, 森 英治, 吉村 豊暢, 劉 成萬
1989 年 38 巻 2 号 p.
725-728
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Six patients who had unsuccessful anterior spinal fusion for thoracolumbar fractures and degenerative lumbar diseases were treated by transpedicular fixation with posterior and posterolateral bone grafting. In four patients anterior bone fusion was confirmed by disappearance of clear zones observed preoperatively, and in two patients, though clear zones were observed, posterior and posterolateral bone fusion was confirmed by dynamic radiograms during a mean postoperative period of 9.7 months. Instrumentation failure occurred in one patient. We found that satisfactory bone union can be obtained for non-union or delayed union following anterior thoracic and lumbar spinal fusion by transpedicular fixation with posterior and posterolateral bone grafting.
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中野 伴子, 後藤 琢也, 大橋 輝明, 酒井 亮
1989 年 38 巻 2 号 p.
729-731
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Spinal cord injury in children is relatively uncommon. There are many different characteristics in comparison with adults' spinal cord injury, in particular, about type of palsy, level of spine lesion, complication and therapy. We have experienced problems during the therapy because of their physical and mental immaturity. In this report, we presented a 4-year-old and a 9-year-old girl who were injured by traffic accidents and had complete paraplegia without osseous spine fracture. The therapy for children with spinal cord injury required long period and consultation with orthopedists, experienced nurses, PTs and psychological counselors.
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吉村 豊暢, 芝 啓一郎, 香月 正昭, 植田 尊善, 白澤 建蔵, 村尾 哲, 森 英治, 石橋 裕一, 劉 成萬
1989 年 38 巻 2 号 p.
732-736
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Baclofen, aγ-aminobutyric acid (GABA) analogue, is useful in the treatment of spasticity of spinal cord origin. However, severe spasticity is not adequately alleviated with oral baclofen. So we have tried intrathecal baclofen infusion. We found that within four hours the muscle tone was reduced to normal levels and spasm was eliminared.
However this effect have disappered after thirty-six hours, so we think that we'll try coneinuous spinal intrathecal infusion of baclofen, in the future.
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佐々木 彰, 中村 孝文, 前田 勇一, 橋本 伸朗, 高木 克公, 松川 昭博
1989 年 38 巻 2 号 p.
737-739
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
There are a few reports about surgery of foramen magnum tumors by the anterior approach. We report a case of foramen magnum meningioma who was treated by transoral extirpation and had a good result. A 77-year-old woman was admitted to the Kumamoto University Hospital on June 9th, 1988. 10 year prior to the admission she noticed the numbness in the hands and legs. In 1984 she suffered from pain and dysesthesia in the right chest. In May 1988 she could not walk at all. MRI disclosed an intradural and extramedullary tumor at the level of foramen magnum. The tumor was resected completely by transoral approach and a posterior occipito-C2 fusion by Luque rectangular rod was added. After the operation her pain in the right chest faded away and muscle strength improved gradually. Five months after the operation she is doing standing exercise.
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北平 裕史, 馬場 逸志, 石田 了久, 住田 忠幸, 西川 公一郎, 田中 信, 三好 勝海, 進藤 明
1989 年 38 巻 2 号 p.
740-742
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Between 1983 and 1988, osteoplastic laminotomy was performed in six cases after tumor extirpation of the cauda equina. Histological examinations of the tumor proved that five were Schwannoma and one was benign cystic teratoma. Surgical procedures were determined by size and location of the tumor. Four cases were treatd by the operative technique reported in 1976 by Raimondi et al. In one case, after extirpation of the left side dumb-bell type Schwannoma between the third and fourth lumbar vertbra, excised spinous process was used for coverage of the spinal canal and postero-lateral fusion was also performed in the affected side. A small and localized tumor was excised with partial hemilaminectomy and resection of the reconstructed spinous process. Reconstruction of posterior part of the lumbar vertebra is important to prevent postoperative kyphosis, anterior subluxation, and instability of the spine especially in children.
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具志堅 功, 西平 竹志, 仲宗根 朝洋, 伊佐 真, 金城 幸雄, 茨木 邦夫, 高良 宏明, 大城 豊, 大城 隆
1989 年 38 巻 2 号 p.
743-748
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We studied 17 cases of spinal cord tumors using magnetic resonance imaging. According to the intensity of image and histological feature of spinal cord tumors, we identified two groups in T2 weighted imaging. One was a hypointensity group showing cystic or vascular tumors, and the other was hyperintensity group of solid tumors. Preoperative images of swelling, narrowing, deviation of the spinal cord were remained after the operations. Grafted free fatty tissue for the prevention of adhesion was recognized well also after the operation. Postoperative imagings sometime showed pseudo-deviation of the spinal cord which was easy to be mistaken as the remains of tumors and narrowing of the spinal cord. In conclusions, The magnetic resonance imaging makes very early detection of spinal cord tumors possible, and it is valuable for a diagnosis of the spinal cord tumor associated with brain tumor.
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宮薗 一樹, 米村 憲輔, 加藤 悌二, 高木 克公, 樽美 光一
1989 年 38 巻 2 号 p.
749-751
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Chondroma of soft parts occrus primarily in the hands and feet and its occurrence at other sites such as the trunk or the head and neck is relatively uncommon. In many cases the tumor is associated with tendon, tendon sheath, or the joint capsule. This report is a case of chondroma occurred in the soft parts of the knee.
A 35-year-old woman had a tumor in the medial side of her left knee. The tumor was 4cm in diameter, bony hard and well cicusmcribed. CT and MRT showed lobulated tumor located close to the femur. The biopsy revealed a chondroma of soft parts. At operation, the tumor was firmly attached to the tendon of m. quadricipitis femoris, and was considered to arise from it.
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井上 治, 茨木 邦夫, 乗松 尋道, 富山 聡, 座間味 伸, 新垣 宜貞, 仲間 健
1989 年 38 巻 2 号 p.
752-755
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
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大多和 聡, 中野 哲雄, 益川 真一, 米村 憲輔, 加藤 悌二
1989 年 38 巻 2 号 p.
756-758
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
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白石 雅也, 平野 徹, 岩崎 勝郎, 鈴木 良平, 門前 芳夫
1989 年 38 巻 2 号 p.
759-762
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-six patients with soft tissue sarcomas in the extremities who had been treated by a conservative surgery and radiotherapy were reviewed on the complications due to irradiation.
The significant complications appeared in 11 patients.: limited range of motion of the joint (8 limbs), nerve damage (5 limbs), edema of the distal extremities (4 limbs), fibrosis (3 limbs), etc. These complications developed frequently in the patients with the dosage more than 50 Gy and the radiation field which included entire circumference of the limb. The higher incidence of complications was also seen in the proximal site of the limbs such as the hip joint and thigh.
Careful planning of a radiotherapy would be necessary to avoid significant complications.
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森 修, 高木 克公, 米村 憲輔, 森沢 佳三, 山鹿 真紀夫, 片岡 泰文, 佐保 修二, 福山 紳, 宮薗 一樹, 西田 公明, 北村 ...
1989 年 38 巻 2 号 p.
763-765
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We evaluated an Immunosuppressive acidic protein (IAP) in 240 cases of a disease of bone and joint. The IAP positive rate of a primary malignant tumor of bone was 60% and the mean was 591μg/ml. This rate of metastatic bone tumor was 67% and the mean was 578μg/ml. This rate of a benign tumor of bone was 10% and the mean was 382μg/ml. IAP may represent a tumor marker in malignant tumors of bone like carcinoma in other organ. The IAP positive rate of RA was 80% and the mean was 704μg/ml. All of the cases of gout had abnormal high value of IAP on attack. All of the cases of OA had normal value.
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小宮 節郎, 山元 三郎, 中島 雅典, 柳田 巌, 井上 明生, 笹栗 靖之, 森松 稔
1989 年 38 巻 2 号 p.
766-769
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The effect of eel calcitonin (ECT) on cultured mononuclear cells from giant cell tumor of bone was examined morphologically. The cells were found to possess receptors for ECT by immunohistochemical techniques, and intracellular cyclic AMP (cAMP) content increased by ECT treatment. Fresh medium containing 1.0U of ECT was changed daily, which continued for 10 or 20 days. Whether the cells were affected morphologically by ECT was examined using transmission and scanning electron microscope. Neither degenerative changes nor necrosis was seen.
The effect of ECT on multinucleated giant cells and mononuclear cells seen in vivo was not produced in vitro. One of the reasons for this result seemed to be the absence of multinucleated giant cells in passaged cultures.
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小宮 節郎, 中島 雅典, 山元 三郎, 柳田 巌, 井上 明生, 笹栗 靖之, 森松 稔
1989 年 38 巻 2 号 p.
770-774
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A Cell line of mononuclear cells from giant cell tumor of bone was examined for its response to hyperthermic exposure. The cells were treated by water bath immersion while maintained in suspension culture in glass tubes. The suspension was gassed with 95% air plus 5% CO
2 overnight prior to hyperthermic treatment. Hyperthermic treatment was carried out at temperatures of 43.5°C and 45.6°C, and survival cells were counted. Using a flow cytometry possessing rate of monocyte antigens of the cells and DNA pattern were analysed at both temperatures. The higher the temperature and the longer the time, the lesser the survival cells and the lesser the expression of the monocytic phenotype. None of the cells could be survived at a temperature of 45.6°C for 120min.
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安部 淳, 遠藤 俊哉, 樋口 理, 小宮 節郎, 中島 雅典
1989 年 38 巻 2 号 p.
775-778
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Tumors of the patella are uncommon, and aneurysmal bone cysts there are very rate. We had a case of an aneurysmal bone cyst of the patella. The patient was a 25-year-old female. She complained of pain and slight swelling of the right patella of 2 years' duration which followed minor injury. A radiograph showed a multiloculated cyst like lesion. The patella was found to be cavitated and filled with unclotted blood. Histological diagnosis was an aneurysmal bone cyst. The cavity was curetted and filled with bone graft.
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中村 昌一, 吉良 秀秋, 新村 哲也, 山口 善久, 須山 弘文, 池田 高良, 松尾 武, 高島 一彦
1989 年 38 巻 2 号 p.
779-784
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Solitary Bone Cyst (S. B. C.), which is classified as a tumorous condition of bone, is comparatively encountered in an ordinal case.
Treatment and etiology are not established, so we could have some difficulty for the countermeasure because of the fact that we find many cases in a young generation and the relapse rate is quite high.
We have encountered four cases of S. B. C. recently. In two cases out of four, we have analysed Agarose immunoelectrophoresis pattern of bone cyst. As the result, we ascertained that it contains various sorts of component like a serum, as many reports show. Also, as Case 4 shows, we encountered unusual case in which S. B. C. exists in the ilium and the femur. According to the experiment we had, the abnormality of the venous circulation system was implied as the etiology. But we can't explain the case when we find abnormality in a local part.
Although curettage and bone grafting, which is not always the best treatment, is the general treatment, we should not undertake with ease.
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山元 三郎, 中島 雅典, 小宮 節郎, 生田 久年, 井上 明生, 牛嶋 潤一郎, 森松 稔
1989 年 38 巻 2 号 p.
785-789
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We presented one case of chondromyxoid fibroma of the left second proximal phalanx of toe. The patient was a nine-years-old girl. The roentgenographic findings were like enchondroma. Curettage was performed and the pathological diagnosis was chondromyxoid fibroma. But, recurrence of the tumor was recognized after one year. Curettage was performed again. Recurrence was not recognized one year and a half after the second curettage.
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石橋 和順, 中島 雅典, 小宮 節郎, 生田 久年, 松浦 豪, 柳田 巌, 井上 明生
1989 年 38 巻 2 号 p.
790-792
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Freeze-dried bone chips were implanted in 20 patients with defects after curettage of bone tumor. Patients were followed for 2 to 36 months. Diagnoses of the tumors were as follows: enchondroma (11 cases), solitary bone cyst (5 cases), aneurymal bone cyst (2 cases), and others. The evaluation of the result was made by new bone formation on roentgenogram and the immune response. All bone lesions were found to be remodelled to some degree within 7 months. And no immune response had occurred with the exception of a case showing fever-up.
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蒲地 龍太郎, 高岸 直人, 葉 山泉, 原 道也, 本重 博史, 有水 淳
1989 年 38 巻 2 号 p.
793-797
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Experience with 14 malignant bone and soft tissue tumors of the chest wall during the past 12 years was reviewed.
There were 10 male and 4 female patients with their ages ranging from 30 to 71 years (average, 60). Of the 14 patients, 10 had tumors of the rib, 2 the clavicula, one the sternum, and one the intercostal muscle. Follow-up period ranged from a month to 5 years and 11 months. Three patients had the primary tumors, eleven had the metastatic and invasive tumors. Primary tumors included two chondrosarcoma and one neurogenic sarcoma.
Two patients with chondrosarcoma who were disease free during 6 months to 2 years and 2 months after surgery, were treated with wide excision without recurrence or metastasis, but one with neurogenisarcoma died of local recurrence. Ten patients of eleven metastatic and invasive tumors were dead after surgery, but one is disease free during 6 years.
On the basis of our analysis, we believe that all tumors of the chest wall should be considered malignant until proven otherwise and that wide excision should be carried out.
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中川 洋, 三河 義弘, 渡辺 良, 長谷川 徹
1989 年 38 巻 2 号 p.
798-800
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
When the anterior chest wall is resected widely, it is necessary to reconstruct it in order to restore pulmonary function. We reported a case with metastatic renal cancer of the sternum. Whose anterior chest wall was reconstructed by means of acrylic resin plate following wide resection of the tumor.
A 58-year-old male presented to our hospital because of painful swelling in the left sternoclavicular region. The specimen of open biopsy revealed metastasis of renal cancer. The upper half of the syernum, the medial portion of the bilateral 1st, 2nd, and 3rd ribs, and the medial part of the bilateral clavicles were resected. The defect of the anterior chest wall following the resection was reconstructed by means of acrylic resin plate with wire fixation. Ten months after the operation, the patient had no symptom, and there has been no recurrence to date. The range of motion of the shoulders is almost normal, and the patient is satisfied with his chest appearance.
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古瀬 清夫, 吉川 暢一, 隅坂 修身, 竹花 努, 岸本 宏之, 池田 貢, 福井 甫, 島田 誠, 中谷 藻, 石田 暗玲, 山根 明文
1989 年 38 巻 2 号 p.
801-803
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We analyzed present status of patients (pts) with metastatic bone tumor (MBT) and discussed role of orthopedists for them. In 5 years between 1983 and 1987, 16pts with MBT first visited our orthopedic clinic, while 50pts with MBT, more than three times of the 16, were treated at our clinics in the same period. Of the 50, MTB was diagnosed in 8 (57.1%) of 14 prostatic cancers, 5 (20.0%) of 25 breast cancers treated with surgery, 31 (14.6%) of 212 lung cancers and 6 (3.0%) of 203 gastric cancers. Role of orthopedic surgeons is to advise other doctors of the diagnosis of MBT and have a quality of their lives improve by selecting more reasonable treatments and evaluating the therapeutic response for bony lesions.
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福岡 真二, 野村 茂治, 帖佐 博文, 富田 茂, 牛島 正博, 増田 祥男, 杉岡 洋一, 石井 栄一, 中山 秀樹, 権藤 健二郎
1989 年 38 巻 2 号 p.
804-807
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We report a 5-year-old boy with Ewing sarcoma who presented significant diagnostic problems. He complained of 2 months of progressive spontanous pain of the right thigh, but no back pain. X-ray showed radiolucent area and collapse of the 5th lumbar vertebral body. E. S. R, was 18mm per hour and C. R. P. was 2+. We made a diagnosis of eosinophilic granuloma, but pathological diagnosis was Ewing sarcoma.
Because of the wide spectrum of radiologic presentations of spinal Ewing sarcoma, early biopsy is urged.
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百田 靖, 森本 兼人, 山本 吉蔵
1989 年 38 巻 2 号 p.
808-812
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
Ewing's sarcoma has been traditionally known as a malignant bone tumor associated with a very poor prognosis. We have treated eight patients with diagnosis of Ewing's sarcoma from 1968 to 1988. Five of these were females and others males. Primary bony lesions of five patients were four trunks and one proximal extremity. Three were distal extremities. Before 1975, four patients were treated with surgery, radiation and one or two drugs' administration. In result, three of these died within two years. One's prognosis was uncertan. Since 1977, three of four patients were treated with Rosen's adjuvant chemotherapy, but one (female) was not treated because she refused this treatment. Consequently, three of four patients died within three years. Now, one (female) has been treated with Rosen's adjuvant chemotherapy (Tll) and radical operation. She has been alive without metastasis and recurrence of the tumor during eleven months. It has been reported that the therapeutic result of Rosen's adjuvant chemotherapy is good. And then our patients have been treated with the adjuvant chemotherapy.
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米村 憲輔, 土屋 立昭, 相良 孝昭, 高木 克公, 西田 公明, 中村 英一
1989 年 38 巻 2 号 p.
813-819
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The magnetic resonance imaging (MRI) characteristics of primary malignant bone tumors are evaluated in determination of the surgical margin. Fifteen patients were examined with Toshiba MR imager (0.22-T resistive magnet). Eight patients had osteosarcoma, three had chondrosarcoma, three had giant cell tumor of bone, and one had angiosarcoma of bone. All patients had CT scans available for comparison. The extra-and intra-osseous extension of the lesion were separately studied. MRI was considerably superior to CT in all cases with osteolytic lesion. MRI was, especially, superior to CT for demonstrating the extent of tumor in marrow. Moreover, MRI was extremely useful for the assessment in the lesion of thoracic wall. CT was only superior to MRI for depicting the extra-osseous extent in screlotic type of osteosarcoma. Above all, MRI was the imaging method of choice in determination of the surgical margin for malignant bone tumors.
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井上 治, 茨木 邦夫, 武内 正典, 古堅 隆司, 新垣 宜貞, 中野 政男, 末山 博男
1989 年 38 巻 2 号 p.
820-823
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
A new method of limb-saving for osteosarcoma is reported. After wide resection of the tumor, intra-operative irradiation of 50Gy to the resected bone was performed. Then, the radiated bone which had been curetted before radiation only preserving cortex, subchondral bone or ligamentous attachment, was re-implanted and fixed by a plate. Vascularized fibula with cancellous proximal portion was also implanted to facilitate bony union and to prevent bone necrosis. Cancellous bone chips were packed in subchondral region to prevent articular collapse. Articular ligaments were repaired to secure stability of the knee joint.
For osteosarcoma of the left proximal tibia in a 17-year-old girl, irradiation to the resected bone by Electron 12MeV, 50Gy was performed. Then, the ipsilateral fibula with vascular pedicle was translocated into the irradiated and re-implanted bone. Although the patella tendon was repaired, the patient walked well with good functioning quadriceps and good range of motion in spite of slight instability of the knee joint, which was rated as excellent by Ennekin's criteria.
Although intra-operative irradiation of 50Gy is proved to be curative for osteosarcoma by Yamamuro or others, curettage of the resected bone before the irradiation will eliminate the risk of recurrence of the tumor. Vascularized fibular graft facilitates the bony union, and with cancelous bone graft in subchondral region may prevent the collapse of articular surface.
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寺田 歩, 酒匂 崇, 松永 俊二, 伊藤 博史, 田中 信次, 鮫島 貞仁, 森本 典夫
1989 年 38 巻 2 号 p.
824-826
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
We reported two cases of the bone tumors involving the proximal humeri that were treated by limb salvage operation. The case of a thirteen years old girl who had suffered from parosteal osteosarcoma was managed by free fibule bone graft associated with electric stimulation after the wide resection. The other case of a forty-one years old man who had chondrosarcoma was treated with arthrodesis. Both cases have obtained good functional results. And they have no evidence of recurrence and metastasis.
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平野 徹, 岩崎 勝郎, 貞松 俊弘, 榎本 寛, 鈴木 良平
1989 年 38 巻 2 号 p.
827-831
発行日: 1989/10/25
公開日: 2010/02/25
ジャーナル
フリー
The response of osteosarcoma to preoperative treatment, which was classified by the degree of histologic tumor necrosis as good (4 cases), poor (5 cases) and fair (one case), was evaluated in 10 cases by using the value of serum alkaline phosphatase (sALP), conventional radiography,
99mTc-MDP scintigraphy, computed tomography (CT) and angiography before and after the treatment.
All of the good responding cases showed the findings of a decreased uptake in
99mTc-MDP scintigraphy. A shrinkage of soft tissue mass on CT was seen in only 2 good responding cases. Angiography in 3 good and one fair cases revealed a decrease in tumor vascularity. The change of sALP value and radiographic findings were not correlated with the degree of histologic tumor necrosis.
Therefore,
99mTc-MDF scintigraphy, CT and angiography would be of use for predicting the response of osteosarcoma to preoperative treatment.
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