Three cases of the patellar tendon rupture were reported. Case 1 was patellar tendon rupture with avulsion fracture of the patella, and treated by McLaughlin's method. Case 2 was rerupture with avulsion fracture of the patella, and treated by sutures and augmented by artificial ligament (Dacron). Case 3 was patellar tendon avulsion from both patellae and tibial tuberosity which was repaired with sutures though the drill hole.
Since 1981, the Kodama-Yamamoto Knee Prostheses have been used in our hispital. We studied forty-nine knees in thirty-six patients whom we had been able to follow up for at least one year. Thirty knees in twenty-three patients were osteoarthritis, and nineteen in thirteen were rheumatoid arthritis. The average age of the patients in the study group was 66.7 years at the time of surgery. The average follow-up period was 3.0 years. There were thirty-four knees with a patellar replacement and fifteen without. Forty-three knees (87.8%) could obtain good or excellent clinical results, but the postoperative average flexion range of knee was 88.7°, which was not a satisfactory result. Furthermore clinical results were studied between the group of patellar replacement and the one without it. In the group of rheumatoid arthritis, some cases without patellar replacement complained of peripatellar pain postoperatively. No complication of patellar replacement was found in our study. The clinical results were good and stable in the group of patellar replacement. Therefore we recommend the patellar replacement for total knee prosthesis, especially in rheumatoid arthritic patients.
The results of 38 kness in 31 patients treated by Okayama knee prosthesis (Mark II) were evaluated by clinical and radiological findings and compared with 41 knees (Miller/Galante). An average age was 66.4 years old and the mean of follow-up period was 4.5 years. These were 19 knees in 17 patients with OA and 19 knees in 17 patients with RA. Using the criteria described by three universities, clinical score after surgery was 71.7 points gained by Mark II and 77.6 poins by M/G. Radiologically, an average femoro-tibial angle was 176.2° in the former and 174.0° in the latter. As a whole, there was no difference between the two clinically, but the range of motion obtained and the angle of positioning of the femoral and tibial components radiologically were different fairly between them. We discussed these ploblems.
We reported end-results of 19 cases (13 males and 6 females) with patellar fracture, who entered our clinic. These cases were 17 to 78 years old, and followed for 1 years and 8 months to 7 years and 10 months (mean, 4 years and 6 months). They were evaluated for the range of motion of the knee joint, Pain, limping, muscle atrophy of quadriceps and grade of satisfaction. The clinical results were excellent in 11 cases, good in 5, fair in 3 and poor in none. Their main complaint was fatigue of knee, and those patients had muscle atrophy of quadriceps. Comminuted fracture and the step-off of articular surface after treatment contributed to poor results.
Osgood-Schlatter disease is not rare, and it usually heals with conservative therapy. But some cases do not respond to conservative treatment. We call them So-Called Unresolved Osgood-Schlatter disease. 6 patients (7 knees) of So-Called Unresolved Osgood-Schlatter disease underwent surgical procedures to relieve their symptoms of three years duration. 6 patients (7 knees) had a distinct and separate fragment at the proximal aspect of the tibial tubercle. Resection of the fragment along with the adjacent bursa relieved its symptoms. Microscopic findings showed that all fragments were necrotic and were separated from the tubercle by a bursa or scar tissue. The symptoms were relieved after the surgery. Removal of the fragments is indicated in case of So-Called Unresolved Osgood-Schlatter disease.
The accuracy of the stress X-ray examination for the cruciate ligament deficient knee was studied. A stress device with the knee in 90 degrees of flexion was used. The examination was useful for the complete deficiency of the posterior Cruciate ligament. While for deficiency of the anterior cruciate ligament or imcomplete posterior ligament injury, this method was not accurate. For getting higher accuracy, we must use MRI, tomography of the cruciate ligament after arthrography and stress X-ray with the knee in 30-degree flexion position.
Three cases with combined anterior cruciate, posterior cruciate and collateral ligament injuries were treated by primary repairs. In all cases, satisfactory results that were almost full ROM, no disability of daily living, and good stability were obtained. But slight posterior cruciate ligament insufficiency still remained. In this report, we discuss our operative techniques and rehabilitation programs.
Injuries to meniscus were studied in 31 knees of 30 patients, of which 11 knees were male and 21 were Female Their ages ranged from 65 to 78 years old with an average being 68.9. The following observation were noted: 1) Of the 31 knees, 27 were surgically treated under arthroscopy only, and the remaining 4 were with additional intraarticular incision. 2) Medial meniscus injury was seen in 24 knees, lateral in 4 knees, and both in 3 knees. Total meniscectomy was carried out in 3 knees, extensive in 13 and partial in 18. 3) No obvious correlation between the meniscus injury and the degeneration of articular cartilage was shown. 4) Certain correlation between the X-ray findings of Injured Meniscus and the degeneration was noted. 5) No correlation between the injury and the difference in body weight or the medial deformity of knee joints was noted.
Our experience is presented in performing arthroscopic partial menisectomy for the treatment of 130 knees for the medial osteoarthritis. The patients were 39 men (42 knees) and 83 women (88 knees), and aged 39 to 83 years old (the mean: 64.3 years old). The follow-up period ranged from six months to three years and three months (the mean: one year and six months). We used the Hokudai classification for the roentgenographic classification, and the partly modified Fujisawa's classification for the arthroscopic grade. The comparative investigation of pre-and post-operation was conducted applying the scoreing of JOA knee evaluation in each of the following items: the roentgenographic stage, the grade, FTA. The good result was obtaind in the mean score in all cases, which was increased from 72.5 in preoperative score to 84.3 in post-operative one. The significant improvement was obtained in stage I and II but no significant difference in stage III and IV because the scores were sporadical. As the grade was advancing, the obtained score was decreasing in meniscus and especially in articular surface with the marked tendency.
Severe osteoarthritic varus deformity of the knee in a male patient aged 63 years was operated by a corrective osteotomy. The varus deformity of approximate 40 degrees was corrected with supracondylar closing osteotomy of the femur and high tibial opening osteotomy. After 8 months, he was able to easily walk 2km without knee brace and satisfied with the result.
Osteoarthritis of the knee is a chronic disease based on the degenerative change of articular cartilage. We performed the intra-articular injection therapy of high molecular weight sodium hyaluronate (SPH) for OA of the knee. We evaluated the clinical finding before and after injecting SPH in comparison with the arthrographic finding. In arthrography we observed the degenerative change of articular cartilage at the femoral condyle, and the degeneration and the tear of the meniscus. We classified the degenerative change of articular cartilage into six stages (normal, irregularities, erosion, ulcer, cartilage defect and bone defect). As the result of this study, SPH was clinically effective for the stages of irregularities and erosion of articular cartilage and for the slight degeneration at the posteior part of the medial meniscus.
We reported three cases of RSD treated with difficulty. In the first case, occurred after stripping of the lower leg varix. In the second case, it occurred after arthroscopy of the knee. In the second case, it occurred after sciatica. All three cases were treated by the sympathetic blockade. Their periods from the onset to the start of the sympathetic blockade were about nine months, five months and six months respectively. The long period was thought to be the most major cause of difficulty in treatment.
Clinical and radiographic examinations of fibular osteotomy sites were performed on one hundred knees in 68 patients who underwent high tibial osteotomy. An average follow-up period was 4 years and 10 months. Nonunions of the fibula were seen in 21 knees. Hypertrophic nonunions were seen in 15 knees and atrophic nonunions in 6 knees. The group of patients who had nonunions of the fibula showed higher rate of positive symptoms in gait pain and tenderness at the fibular osteotomy sites than those who had unions. The group of patients who underwent the ostrotomy of the fibula at its middle one third showed higher rate of positive symptoms than those who underwent osteotomy at its proximal one third of the fibula. Most patients who developed symptoms at the fibular osteotomy sites had hypertrophic nonunions. No patients who developed symptoms had atrophic nonunions. Our latest technique of the high tibial osteotomy includes bone chip graft to the fibular osteotomy sites to promote bone unions of the fibula.
Twelve knees in eleven patients with osteoarthritis were treated by high tibial osteotomy using Watanabe's Guide. We could get smooth curved surface in osteotomy and good correction. We introduced Watanabe's Guide.
Loss of correction due to lack of fixation rigidity of staples still remains a problem after high tibial osteotomy. Ogata has developed a new design of staple which is characterized by the blade-like inserting portion and the addition of one cortical screw at the distal portion. This study was carried out to compare the fixation rigidity of standard stepped staples with Ogata's staple. High tibial osteotomy was done for 30 saw bones which were divided into three groups fixed by one stepped staple, two stepped staples, and one Ogata's staple. The proximal part of the tibia was mounted and bending load was applied antero-posteriorly and latero-medially at 20cm distal point to the osteotomy site by using the mechanical test machine. Ultimate moment of three groups were compared statistically. In the antero-posterior loading test, mean moments of three groups were 5.1, 10.6, and 11.1Nm, respectively and in the latero-medial loading test, theywere 11.7, 17.4, and 22.1Nm, respectively. Ogata's staple showed the statistically equivalent fixation rigidity to two stepped staples, while use of only one stepped staple was singnificantly weak. Although the stepped staple was loosened and eventually taken off with loading, Ogata's staple remained stable. The conclusion of this study is that Ogata's staple has adequate fixation rigidity and prevent loosening of the staple.
With an acoustical technique, the authors analysed 84 knee joints of normal subjects who were students at University of Occupational and Environmental Health. Inside an anechoic chamber, the sounds were collected from a Brüel & Kjær precision condenser microphones, and analysed by a narrow band spectrum analyzer and computer. The subjects were asked to swing their leg actively or passively at about 90° from 0° flexion as a movement on nonweight bearing. In the weight bearing, they repeated the motion of crouching down and standing up. The motion rate was about 2.3 seconds per a cycle and cotrolled with a very low noise electric leg model. This analysis revealed that weight bearing caused the increase of sound level from 0.5kHz to 1kHz. From this study, we believe that friction noise of normal joints is very small and low frequency components of their sounds are increased.
The purpose of this study is to evaluate the results of surgery for the patients with rotator cuff tear. Sixty-two shoulders were treated in our hospital from 1980 to 1989. The surgical procedure was composed of cuff reapir (McLaughlin's method), with partical lateral acromionectomy and resection of coraco-acromial ligament. At the first day postoperatively, the patient was placed in a plaster cast at zero position. When the power of shoulder abductor increased, the cast was removed. The assessment using the criteria from Japanese Orthopaedic Association showed the average score of 93.5 and the good results were not related to the age of the patients and the size of cuff tear.
Ruptures of full-thickness rotator cuff were repaired in twenty-four patients (twenty-five shoulders), using one of four repair methods including side to side suture in 6 shoulders and three direct sutures (5 circular defect repairs, 10 L-shaped repairs and 4 shoe tie repairs). Postoperative evaluations of JOA score and the range of motion were made between the cuff defect size and repair method. The average JOA shoulder scores increased from 52.4 points preoperatively to 89.0 points postoperatively in 25 shoulders. Postoperative score in connection with suture methods were 88.4 points in L-shaped repair, 92.4 in circular defect repair, 82.7 in shoe tie repair and 90.8 in side to side repair. The percentage of active motion in the operated shoulder compared with the control was more than 90% in abduction and flexion, but less than 90% in adduction and extention. No significant differences were found postoperatively in JOA score and range of motion between short tears and long tears repaired with direct suture.
From December 1986 to December 1989, forty-three shoulders in forty-one patients were evaluated at the Kumamoto National Hospital for shoulder pain with daiagnosis of tear of the rotator cuff which was confirmed by arthrography. We sent out questionnaires to these patients. And we could follow up 33 shoulders in 31 patients. Twenty shoulders were conservatively treated (mean age, 64.3 years old: follow up period, 25.4 months), whereas 13 shoulders were operated (mean age, 57.9 years old: follow up period, 23.3 months). We evaluated conservative group and operated group by J. O. A. score. The score of operated group was better than conservative group. In conservative gpoup, the score at the follow-up was better than that of the first evaluation. Especially in the pain score, the differences between conservative treatment and operative treatment were large. In muscle strength and ROM score, there were not so large differences. Conservatively treated patients who manifested bad score were seven. Three cases were more than 70 years old. Two cases were laborer whose age were about 50 years old. Conservatively treated patients who manifested good score had some charactaristics, that is non traumatic, with minimal ROM limitation and with short duration from onset to the first examination.
Thirty-one patients with proximal humeral fracture have been treated in our clinic in the past ten years. The average age was 54.4 years with a range from 9 to 80 years and the average follow-up period was 4.2 years (range, 8 months to 9.2 years). Of 31 cases which were classified according to Neer's classification, 23 cases were type III and 8 cases were type IV. In these cases, 26 cases were treated conservatively, and 5 cases were treated surgically. Relationships between the displacement after treatment and their prognosis were examined with respect to the type of frature and malunion on X rays.
We have operated on 52 shoulders with the impingement syndrome for these two and a half years, and eight of them could be considerd as so called freezing or frozen shoulder because of the severe contracture. A retrospective study was carried out on the analysis of the preoperative R. O. M. and arthrographs, and their operative findings. The results are as follows. 1. The condition named Frozen Shoulder may be another goal of the subacromial impingement than the rotator cuff tear described by Neer. 2. It seems that an important factor developing the Frozen Shoulder is the social or familial background encouraging the patient in their impatience of pain and unwillingness to move the joint. 3. The main purpose of the surgery of the Frozen Shoulder should be the dissolution impingement. Neer's anterior acromioplasty is an essential procedure. 4. It was demonstrated that the cases with cuff tear had better R. O. M. than those without tear. Cuff tear should be considered as a possible event, when the R. O. M. is improved by a conservative or manipulative therapy in the case of the Frozen Shoulder.
We had seven cases with multi-directional instability of the shoulder joint associated with neurological or vascular disorders. Six cases had numbness and dullness in their ulnar side of the forearm and hand, and weakness of grip power. One had edematous swelling and cyanosis in the forearm and hand. At first, we treated them conservatively. For these patients, muscle strengthening exercise sometimes causes shoulder pain and apprehension of the shoulder joint. So only two cases could get good results. But we did use the Kumanoto University Scapular Fixed Band for these patients, and we could get better results. Five cases recovered. Only one of them was treated surgically. In these patients, neurobundle-graphy of the brachial plexus showed stretching figures. From the findings of the neurobundle-graphy and the clinical findings, we suspect that severe shoulder instability induces strerching of the brachial plexus, and causes irritated neuritis. Some of them sometimes have psychological problems, so we have to be very careful to dicide surgical treatment.
The pathology of rotator interval lesion has been reported in detail, but there are lots of problem in making diagnosis of rotator interval lesion. Generaly speaking, rotator interval lesion is most common amomg young athletes. We can get arthroscopic findings from 5 cases of rotator interval lesion. We can make diagnosis depending on physical findings and cine-arthrography. The arthroscopic findings should suggest that dysfunction of rotator interval may induce the symptom of rotator interval lesion, and throwing shouldr injury what we call may occur on the base of instabity caused by dysfunction of rotator interval.
We have treated twenty-two cases with complete acromioclavicular dislocation by Dewar's procedure since 1985. Because the acromioclavicular joint has a little movement on shoulder abduction (so-called rankshaft-like motion) we think maintenance of its normal movement is better to treat the acromioclavicular dislocation. Nine cases of twenty-two cases were reported. Almost all cases showed satisfactory results.
Nine patients with complete acromioclavicular dislocation were treated with Leeds-Keio synthetic ligament, supplemented with a temporary fixation of the acromioclavicular joint. Seven patients were re-examined over an average of two years after the operation. The functional results were excellent in four patients, good in two and fair in one. However, we observed roentgenographic changes of the clavicle and the coracoid process, including subluxation of the acromioclavicular joint, erosion and circular sclerosis of the clavicle, and bone atrophy of the coracoid process by the Leeds-Keio synthetic ligament. Indication for the reconstruction of the coracoclavicular ligament using the Leeds-Keio synthetic ligament should be considered prudently.
There are many articles on the capsular mechanism of preventing anterior shoulder dislocation, and few reports on the dynamics of the dislocation. This study investigates the dislocation based on the dynamics. The anterior dislocation usually occurs when an object bumps posteriorly against the forearm during the abduction position. If the force acts posteriorly at distal place from the gravity center of the upper extremity, the center will move posteriorly at a speed of F/M (F: force, M: mass of the upper extremity) and the humeral head will rotate anteriorly as an angular velocity (ω) (ω=F·h/I, h: distance between gravity center and action point, I: moment of inertia). So the head will move anteriorly at a speed of ω·x-F/M (x: distance between gravity center and humeral head). Because of the gyration radius of the extremity is larger than the radius of glenoid, Bankert's lesion will be produced. The volume of upper extermity of a young male was measured at same length rate and the weight was calculated as the specific gravity was one. The moment of inertia was 0.105kgm. If the force (10N) acts to the distal place (h=40cm), humeral head will move 5.4cm anteriorly during 0.01 secoed. The capsule and rotator cuff muscles will be stretched, but stretch reflex of these muscles will not prevent the movement of the head, because the reflex will not happen during 0.01 second. If the moment of inertia is made larger, the incidence of the anterior dislocation may decrease.
Fifty-nine cases of the modified Bristow procedure for recurrent anterior shoulder dislocation were followed-up from 8 months to 13 years with an average length of 3 years and 9 months. Forty-nine patients were male and ten patients were female. In our series the redislocation rate was 5.1 per cent. The mean loss of external rotation was 7.3 degrees. The results were examined by using the Carter Rowe criteria and the shoulder evaluation sheet of the Jpn. Orthop. Assoc.. The results were rated excellent in 78.0 per cent, good in 13.5 per cent, fair in 3.4 per cent and poor in 5.1 per cent using the Rowe criteria. The average points was 95.3 points based on the shoulder evaluation sheet of the Jpn. Orthop. Assoc.. Roentgenograms at follow-up revealed that five had broken screws, three had loosened screws and four had non-union of the transplant. We used the screw of 2mm in diameter. As a results of evaluating the strength of the screw, it was weaker than we had expected.
The factors of recurrence and the many operative methods in recurrent anterior dislocation of the shoulder joint were previously reported. Each operative method showed excellent stabilizing results. We performed the modified Oudard-Iwahara-Yamamoto method for over 200 cases and also could get 98% stabilized shoulders. If the anterior capsule was detached from the anterior margin of the glenoid, the direction of its tension was moved anteriorly. The shear force came to be stronger and directed more anteiorly. Using cadavers, We could confirm that the inferior glenohumeral ligament was the most important structure to stabilize the shoudler joint. The modified Oudard-Iwahara-Yamamoto method made the grafted bone and conjoint tendon, which was changed its direction, to be effected structure as a dynamic stabilizer when the arm abducted and externally rotated. When the humeral head tended to slip out towards anteriorly from glenoid, grafted bone and conjoint tendon made tension force towards subscapularis tendon and/or inferior glenohumeral ligament and they could work effective direction to stabilize the humeral head.
Bursal osteochondromatosis (B. O. C) is a rare disorder of synovial tissue commonly seen around the knee joint, such as in poplitea bursa or suprapatellar bursa. It is considered that B. O. C. is a condition of metaplasia and focal formation of cartilage in the synovial membrane. A first case of B. O. C in the subscapular bursa is reported. A 22-year-old female was pointed out the calcified bodies in her right shoulder region by accidental radiogram. On arthrogram, several round free bodies were recognized in the subscapular bursa, however, glenohumeral joint appeared nomal. Through axillary approach, eleven osteochondral bodies encapsulated by the subscapular bursa were excised. The synovial membrane of the bursa showed scarring stage without osteochondroma formation, and the osteochondral free bodies showed central ossification, corresponding to stage III of synovial osteochondromatosis reported by Milgram.
Twenty-one limbs with deltoideus contracture due to repeated intramuscular injections were operated between 1982 and 1989 for fourteen patients. Mean follow-up period was five years and two months. Committee on muscular contracture of J. O. A proposed the scoring system for evaluation of the severity based on abduction contracture angle and opposite shoulder test. According to this system, the mean pre-operative score was 5.9, and post-operative score 0.1. The result was exellent in all cases. Operative procedure was advancement of anterior fibers of scapular part to the totally released acromial part of deltoideus. By this procedure, skin depression distal to the acromion was avoidable.
This is retrospective review of 21 patients who underwent anterior acromioplasty for chronic impingement syndrome. Anterior acromioplasty, described by Neer in 1972, is generally accepted as the procedure of choice for symptomatic subacromial impingement. The shoulders were evaluated postoperatively for pain, ROM muscle strength. Results were graded poor, fair, or good. The primary diagnosis of shoulder impingement was made by physical examination, positive impingement sign, relief of pain by a subacromial injection of lidocaine, radiographic changes on plain radiographs, arthrography and ultrasonography. The indication for surgery was lack of pain relief by conservative therapy for two or more months. All of patients had relief of preoperative pain and full or improved motion. Only one patient, who had pseudounion of the postclavicular fracture, was failed because of muscle weakness. Anterior acromioplasty is a procedure that yields predictably good to excellent results, 95% in this study.
Between January of 1987 and December of 1990, eighty Miller-Galante total knee replacements were performed in 59 patients at our institution. Eighteen knees of 14 osteoarthritis (OA) patients and fifty-one knees of 37 rheumatoid arthritis (RA) patients were available for clinical evaluation. The average followup time is 18.7 months. There were no difference demonstrated in pain, range of motion, FTA and patient's satisfaction be tween OA and RA at follow-up. Miller-Galante total knee arthoplasty seems to be useful for reumatoid arthritic knee except for a severely deformed and severely osteoporotic knee.
Radiological and clinical evaluations were carried out on 38 joints (19 wrists, 8 elbows and 11 knees) in 26 rheumatoid patients treated by synovectomy. In all 3 joints, good reduction in pain and swelling was achieved. But differences did exist between these 3 joints regarding improvement in postoperative R. O. M.. In 81% of the knee patients, postoperative R. O. M. was decreased, however, in the majority of the wrist and elbow patients, increased or remained unchanged. The stage of operated joint remained unchanged or progressed in all 3 joints and there was no improved joint, but the majority of the all patients are satisfied with the results of synovectomy. It is suggested that synovectomy seems to be valuable in treating the rheumatoid joints.
Ten patients with chronic rheumatoid arthritis were treated with low-dose methotrexate (MTX) (7.5mg/week). All patients had been treated unsuccessfuly with other anti-rheumatoid drugs. The average age of the patients was 54 years old, and the average duration of the disease was 11.1 years at the time MTX therapy was initiated. In 8 of the 10 patients (80%) there were significant improvements by the usual measures of clinical efficacy after 6 weeks of the treatment, and improvement was evident in the Lansbury score. Compared with base line values, Lansbury score decreased after 6 weeks of the treatment (p<0.05), length of time of morning stiffness decreased after 12 weeks (p<0.05), and the number of the joint score decreased after 4 weeks (p<0.05). The ESR and CRP improved after 6 weeks (p<0.05). Although side effects of MTX were noted in 2 of the 10 patients (20%), which were elevated counts of liver function studies, they were tolerable after adjusment of the MTX dosage. We concluded that low-dose methotrexate is effective against chronic rheumatoid arthritis.
The measurements of bone mass were carried out by DIP method which was a X-ray microdensimetry of the bliateral second metacarpus in 36 patients with rheumatoid arthritis, not treated by corticosteroid. The bone loss in rheumatoid arthritis was only slow from the periartical region of affected wrist joint. The bone loss in post menoposal patients was much more rapid than in premenoposal patients. The patients who had good results by the medical therapy for rheumatoid arthritis produced no significant changes of bone loss. But the rate of bone loss was more rapid in the patients who had poor results. We thought that the therapy of osteoporotic changes with medical therapy for rheumatoid athritis was necessary.
Serum rheumatoid factors were measured by routine methods in 2, 095 serum samples. In all subjects, 4.7% and 4.2% were positive by RAHA test and RA test respectively. The percent positivity tended to increase with age by RA test, but not significant difference was noted by RAHA test. HLA antigens were determined in 15 healthy individuals, who were positive in rheumatoid factors. HLA-B51 antigen prevalence was increased in healthy seropositive individuals compared with control, but Bw52, Cw7 and DR2 antigens were decreased in them. On the other hand, the prevalence of HLA-DR4 and DRw53 antigens were higher in healthy seropositive individuals. But the prevalence was not statistically significant.
Although increasing number of cases has been reported, polymyalgia rheumatica (PMR) is still a rare disease in Japan. We report three cases of PMR. Three patients were diagnosed as typical PMR. They had noted aching and stiffness in the shoulder and thigh with fever. In blood examination, inflammatory sign was very remarkable, but serum rheumatoid factor was negative. All arthritic conditions disappeared quickly after steroid therapy and the improvement of the inflammatory sign and myalgia was observed.
This paper is a report of four cases of successful arthrodesis for Charcot joints (a shoulder, an elbow, a knee and an ankle) from syringomyelia, tabes dorsalis, hereditary sensory neuropathy and unknown cause. Joint fusions with free vascularized fibular grafts were performed on three cases which had highly destroyed joints and decreased bone stock. Conventional joint fusion was performed on one case which was not so highly damaged and had relatively enough bone stock. Hypertrophied synovium and sclerotic bones were resected completely and secure internal fixations were performed with adequate postoperative care. All of four arthrodeses fused successfully.
In this paper, we reported the clinical courses and discussed the usefulness of laboratory, radiographical and histological examinations from a retrospective review of 13 patients (7 males, 6 females, mean age of 50.8 years) who had been diagnosed as having chronic non-specific arthritis of the hands clinically and histologically. At the time of the final follow-up study, 6 patients (46%) were diagnosed as developing rheumatoid arthritis, 1 was infectious arthritis and the remaining 6 patients were unclassified non-specific arthritis. As a result, the patients with rheumatoid arthritis were significantly younger than those with non-specific arthritis and markedly showed bony atrophy, erosion and joint space narrowing radiographically and lining cell proliferation, villi formation, plasma cell infiltration and lymph follicles formation histologically. These findings could suggest the subsequent clinical courses of rheumatoid arthritis.
A retrospective study of 21 patients with syrinx was carried out about the clinical symptoms, signs, sizes of syrinx and surgical results. There were 5 cases of Chiari I malformation, 5 cases of intramedullary tumor, 4 cases of adhesive arachnoiditis, 4 cases of post-traumatic and 3 cases of idiopathic pathogenesis. MRI was useful in differential diagnosis. Better results were obtained in Chiari I malformation managed by craniovertebral decompression.
Four cases of spontaneous (non-traumatic) spinal epidural hematoma are reported. The spinal epidural hematoma occurred spontaneously in two cases with anticoagulant and one with blood dyscrasia. The clinical presentasion of this entity is uniform with sudden pain followed by sensory and motor dysfunction. The need for prompt diagnosis and surgical treatment to achieve the best neurological outcome is emphasized. For the diagnosis of spontaneous spinal epidural hematoma, magnetic rensonace (MR) is an accurate and rapid method of localizing and characterizing the hematoma. We believe that MR shoud be the primary method of diagnosis in cases in which spinal epidural hematoma is suspected.
A case of spinal epidural hematoma diagnosed by MRI is reported: The patient was a 30-year-old man who experienced sudden onset of back pain and rapidly developed to paraparesis. No history of trauma was observed. MRI done 6 hours later showed a well defined mass in the Th2-Th4 region. The lesion had tapered margins and was isointense on the T1-weithted and partial hyperintense on the T2-weighted images. A Th2-Th4 laminectomy was performed 36 hours later. Postoperatively the patient experienced progressive neurolgical improvement.
Malignant lymphoma originating in the spine is a rare occurrence, however differential diagnosis from eosinophilic granuloma or pyogenic spondylitis is often difficult because of inflammatory manifestations clinically and pathologically, A 48-year-old house wife with Th9 lymphoma was diagnosed as eosinophilic granuloma pathologically after biopsy and anterior simultaneous vertebral body fusion, However, paraplegia ensued one month after surgery, so that palliative posterior decompression was performed. A 6-year-old girl with Th5 lymphoma had been treated by antibiotics presumably as pyogenic spondylitis. Although emergency biopsy and anterior vertebral fusion was performed as a result of impending paralysis, chemotherapy with regimen of Ki-1 lymphoma ameliorated the desease and the paralysis. Chemotherapy upon malignant lymphoma is mandatory and often effective, however, in the spinal lesion, surgical intervension is inevitable if the paralysis is impending.
We reported two cases of an intradural arachnoid cyst in the thoracic spine. Case 1 was a 53-year-old man and case 2 was a 41-year-old man. Both had neurological deficits. Supine myelogram and MCT showed wide-spread subarachnoid space. MRI also showed same findinds. Laminectomy was performed for both cases and the subarachoid cyst was resected. At three months sfter surgery. MRI showed that the decompression of the spinal cord had been obtained. It may be useful for the early diagnosis of the subarachnoid cyst.
Primary amyloidosis of bone is a rare disease process. Although skeletal involvement in various forms of amyloidosis had been reported in the literature, focal localized amyloidoma of bone is extremely unusual. To the best of our knowledge, only 7 cases involving the spine have been described. We described a 62-year-old woman of primary solitary amyloidoma involving the 12th thoracic vertebra with lower dorsal pain and paraplegia, and discussed the diagnosis, pathological findings, and management. When occurring primarily in a localized anatomic area, the prognosis for survival is excellent, and cure can be expected by local excision of the tumor and reconstruction as necessary.
A total of 70 patients with acute spinal cord injury were identified in Tottori-ken from January 1988 to December 1989. The population of Tottori-ken during that period was 0.61 million. Therefore the incidente of traumatic spinal cord injury of Tottori-ken was 56.7 per million population per year. The average age was 48.5 years, which was significantly older in Japan compared to that in Australia, California and Taipei.
Destructive spondyloarthropathy has recently been described in patients undergoing long-term hemodialysis. The radiologic changes are characterized by severe disc space narrowing and erosion of the adjacent vertebral plates without osteophytosis. We report a 60-year-old man with destructive spondyloarthropathy associated with quadriplegia who was on on hemodialysis for 8 years. Roentgenograms of the cervical spine showed kyphosis of the C-5 vertebral body and OPLL. We performed anterior spinal fusion of the C4-C7 vertebral body. There was no deposit of amyloid in vertebral bone specimens.
We have recently experienced one rare case of the cord symptom caused by acupuncture needle having migrated into the cervical spinal canal. The patient was a 52-year-old man with his main complaint of neck pain. As his history, when he had had acupuncture needle treament by himself in 1988, in august, an acupuncture needle had broken at the left side of theneck, but he has left it alone. In August, 1988 in left neck pain and motion limitation of neck appeared, and when he gradually moved his neck, radiation pain to upper and kower extremities, and sensory disturbance of anal area appeared. X-ray examination revealed the presence of acupuncture needle around the cervical spine and CT scanning confirmed the migration of the needle into the cervical spinal canal. In December, 1988 we operated on him and remoued the needle.
Intraspinal ganglions of cervical facet joints are rare. Those reported have occurred in the lumbar region. We report a case of an intraspinal ganglion of the cervical facet joint causing radiculopathy (C8 root). The patient was a 69-year-old man admitted with a history of severe pain in the right upper extremity. The pain radiated to the right scapula and forearm. At MR imaging, a ganglion of the facet joint was delineated as a smooth extradural well-circumscribed cystic mass arising adjacent to degenerative facet joint (C7/T1). Surgical therapy resulted in satisfactory recovery. Two types of cysts that are known to originate from the facet joint are the synovial cyst and the ganglion. Synovial cysts have a histologically identifiable synovial lining and contain clear fluid, whereas ganglion contains gelatinous, highly viscous fluid, has a connective tissue capsule, and lack of a specific lining. This case was ganglion because of lack of a specific lining and gelatinous, highly viscous fluid.
We report the case of a 17-year-old man with quadriplagia induced by forced hyperextension during playing Judo. Radiographs of the cervical spine revealed Ossiculum terminale and MRI of the the cervical spine obtained a weeks after injury clearly showed a cyst located in the center of the cord at the tip of the odontoid peg. Transoral anterior spinal fusion was performed due to residual sensory deficits. Atlantoaxial instability may predispose even moderate trauma to produce the cystic change of the spinal cord.