Vascularized iliac bone graft was performed in 5 hips (4 cases) of avascular necrosis of the femoral head. All four patients were male whose ages renged from 32 to 36 years. An averafge follow-up was 19 months (range, 14 to 27 moths). Four of the five hips became asymptomatic after surgery with X-ray film showing no progression of the femoral deformity. In one hip, however, moderate pain persisted and the collaps of the femoral head was increasesd.
We investigated whether or not sex hormones are related to the occurrence of the femoral head lesions, namely, avascular necrosis and ossification disturbance, in spontaneously hypertensive rats (SHRs). SHRs and Wistar Kyoto rats (WKRs) as control were divided into the following groups; group 1-untreated male rats, group 2-castrated male rats, group 3-castrated male rats with testosterone of 2mg/100g. body weight/week, group 4-untreated female rats and group 5-female rats with same amount of testosterone as group 3. The findings of the femoral heads of SHRs in each group were compared with those in each WKR group, radiologically and histologically. The incidence of the femoral head lesions was highest (90%) in group 1 of SHRs. The incidence in group 2 of SHRs decreased to 25%, that was similar to that of WKRs (15%). However, that of group 3 of SHRs increased to 80%, and was significantly higher than that of WKRs (10%). The percentage of group 4 and 5 of SHRs were 30% and 40%, respectively. These findings might indicate that sex hormones are closely related to the occurrence of the femoral head lesions.
Synovial membranes obtained from two patients with pseudogout possesing hip destruction were analysed by immunohistochemical method using IL-1, IL-6, HLA-DR, TfR-1 and CD 2 polyclonal and monoclonal antibodies. The cell numbers of positive staining of HLA-DR antigens in the synovial lining layer and those of TfR-1 antigens in the stromal area were significant than those of osteoarthritis, but less significant than rheumatoid arthritis.
Since 1980, the surgical procedures, which consisted of the Pauwels' osteotomy, the trochanteric curved varus osteotomy and the transposition osteotomy of the acetabulum, have been applied in the treament of Subluxated hip due to acetabular dysplasia in our hospital. We studied the various radiological measurements in the choice of these surgical procedures. We found the helpful measurements to be Sharp angle, acetabular cartilage angle, center edge angle and acetabular head index in choosing the surgical procedures.
Fifty-one hips replaced by bipolar endoprosthesis were reviewed with special reference to the movement among the acetabulum, outer head and inner head for a mean follow-up period of 30 months. Average clinical hip score of Japanese Orthopaedic Association was 78.0 at the follow-up. The results show that the behaviour of the bipolar implants depends on the condition of the host surface of the acetabulum. Namely, in cases with the acetabular cartilage they move chiefly between the acetabulum and outer head. And in cases without the acetabular cartilage, they move chiefly between inner head and outer head.
We have treated two cases of chondrolysis of the hip joint. One case was idiopathic and the other was secondary to a femoral fracture or the prolonged immobilization of the hip joint during its treatment. We treated them by muscle realease around the hip, long-term non-weight bearing and early ROM excercise. As the results were very good, we reported our methods of treatment for chondrolysis of the hip joint.
We report a case of slipped capital femoral epiphysis (SCFE) in an adult male associated with hypothyroidism. A 29-year-old male presented to Nagasaki University Hospital with a six-year history of limp and relapsing pain in his right hip. He had consulted with another hospital because of his pain, however, SCFE had been neglected even though the proximal femoral growth plate had been noticed to be still open. He had a short stature of 152cm which had ceased growth at the age of 13, he also showed a characteristic myxedematous face and dry skin in his appearance. Laboratory findings revealed nearly normal includig various hormonal values, which perhaps refleted the thyroid supplement therapy that had commenced since two months prior to presentation to our clinic. Radiographs showed a moderate slip of the femoral capital epiphysis on the slipped side and had not developed so-called “posterior beak” in spite of a chronic course of six years in history, which might imply of some sort of deficiency of bone metabolism. Open reduction (Dunn's procedure) for this SCFE and prophylactic pinning in situ for the non-slipped side were performed for this condition. This patient has returned to his previous post having a good clinical course without any complications.
We report a 54-year-old female with abrupt onset of right hip pain. Physical examination was normal exept for tenderness and limitation of ROM of the affected joint. The conventional radiographs showed only osteopenia in the proximal femur. Bone scintigrams showed diffuse increased uptake in the resion of the affected joint. MRI demonstrated diffuse low intensity on T1-weighted images in the proximal femur with matching area of increased intensity on T2-weighted images. Diagnosis of transient osteoporosis of the hip was made based on clinical and radiographic findings. The patient was treated conservatively. Six months after the onset, her right hip pain disappeared and the examination by radiographs, bone scintigrams, and MRI turned out to be almost normal. No symptoms of any recurrence was recognised. We believe that bone scintigram and MRI are very helpful in the diagnosis of transient osteoporosis of the hip.
Seven patients (12 hips) were treated for slipped capital femoral epiphysis. The average follow up was 3 years and 6 months. The average age was 12.6 years. 5 hips with moderate slip were treated by trochanteric osteotomy (Southwick's procedure). 6 hips with mild slip were treated by in situ pinning, and 1 hip with mild slip underwent hormone therapy for pan-hypopituitarism without surgery. All of the patients were evaluated clinically and radilogically, and satisfactory results were achieved without complications such as avascular necrosis, chondrolysis, or osteoarthrosis.
Fifty-three cases (53 hips) of Perthes disease were examined radiologically to know the validity of the subchondral fracture line (SFL) of the femoral head as an early prognostic sign of this condition. By observing the serial radiographs of each patient, the incidence of this sign and its relevant factors such as the age of onset, sex and severity wete studied. The extent of SFL and the maximum resorption of the femoral heads were divided into four categories (I-IV) with Salter's and Catterall classification respectively to examine the correspondence of the extent of SFL with that of affected involvement of the femoral head. SFL were seen in 27 cases (50.9%) with no relation to age, sex and severity. This sign was most frequently seen at the time between one and three months after the onset and was not found after six months. In 20 out of 27 cases with SFL (74%), the extent of SFL completely coincided with the maximum resorption of the femoral head. However, the other 7 cases failed to show coincidence between these two classifications. They were all Salter II in SFL categories, four of which changed to Salter III during the coures of the disease and resulted in Catterall III involvement eventually. The remaining three also resulted in Catterall III directly without following the steps of changes in Salter's category. In conclusion, SFL is not always valid as a prognostic value especially in the SFL of Salter II type which sometimes does not coincide with catterall classification.
Radiological findings of the physeal involvement reported by Keret were studied in 52 unilateral Perthes' disease. All cases were treated conservatively and twenty and half years was a mean age at the time of review. Forty-three of 52 had one or more of 5 findings. Although the curvature of the physis was closely related with lateral protrusion of the capital nucleus and medial bowing of the femoral neck, premature physeal closure seemed to make the shape of physis flattened. Physeal involvement also resulted in elevation of the tip of the greater trochanter. A child has the abundant growth cartiage in the proximal femur. Overactivity due to hyperemia of the normal perichondral ring and the cartilage in the trochanteric growth plate, and pathological proliferation of the cartilage around the secondary ossification center and physis produce deformed haed characteristic of perthes' disease. Especially premaure closure of the physis seems to play a important role in this process.
165 hips in 132 patients with congenital dislocation of the hip wete reviewed to analyse the radiological course of the capital femoral epihysis assosiated with metaphyseal changes. The mean age at late follow-up was 6.8 years (range, 5-15 years). Epiphyseal deformities wete classified into three types according to the extent of the defect, and metaphyseal changes, which were area of rarefaction, medial beaking and sagging rope sign, were sought in the early period after reduction. Then the late radiologic appearance of the femorel head and neck was graded to the three classes by modified thomas's system. 89 hips wete recognized one of three types of the epiphyseal deformities. 32 hips of 89, in whcih epiphyseal deformities appeared, had one or more metaphyseal changes and were gradaed as poor and fair on the late radiologic apparance. All of 16 hips with poor results had early metaphyseal changes. It is thought that early metaphyseal changes on the epiphyseal deformities may be correlated with the final radiolgic result.
212 cases with congenital dislocation of the hip joint (CDH) were treated by the Pavlik harness between 1971 and 1988. 39 cases of them were not successfully reduced initially and 33 cases were reducted by the following over-head traction treatment. Open reduction was done in 6 cases. The factors against reduction were investigated by the radiological measurement, arthrogram, arthroscopy and operative findings. Many factors were considered, but the cases that were unable to have reduction were mainly influenced by the extra-capsular factors.
It is well known that the knee muscle strength decreases after treatment in the knee injured patients. This is a big problem for treatment of the knee, especially for the athletes. We evaluated 45 knee injured patients who were operated from 1986 to 1989. The high sport activity group and the most important athlete group in his team had a great recovery of the isokinetic muscle strength.
A new operative technique for painful bipartite patellae was described in which the painful patellar fragment is released subperiosteally while vastus lateralis tendon and lateral retinaculum are kept attached to the main patellar bone. The procedure was applied for removal of the bone fragment in 3 knees and for release alone in 8 knees. Early return to sport activities with prompt relief of pain was noted in all cases postoperatively.
The terminal extension power of the knee is very important for its stability. Now we can evaluate it in isotonic contraction or low speed isokinetic motion. But we have never been able to measure the strength in the high speed isokinetic motion. High speed measurement is more reasonable to the sports activity. So we used a new machine (MYORET made by kawasaki Juko) which can measure the high speed terminal extension power using so called “passive mode” and evaluated 7 objects (14 knees).
In the surgical treatments for the basketball players of Mitsubishi team of a women's Japan league, the operation for patellar pain has been achieved most frequently in our hospital. To know the actual state of their patellar pain, the direct examination and the roentgenographical measurement of sky-line view of the patella were done. Of fourteen basketball players, five had patellar pain, and one of them was treated by operation. The values of Q-angle and of roentgenographical measurement (tilting angle and lateral shift) of players' were much as those of control group. Joint laxity was predominantly frequent in players. Patella pain in basketball players seemed not to be due to the malalignment and the subluxation of the patella. It is possible that joint laxity induces a source of patellar pain, but the problem of accurate evaluation of joint laxity remains.
Twenty patients who underwent open meniscal repair were evaluated by second look arthroscopy. An average age of the patients was 22.8 years. The time from repair to repeat arthroscopy ranged from 4 months to 5 years (average: 1 years and 7 months). The operative indications were 1) peripheral longitudinal tear, 2) no degeneration of the body, and 3) unstable tear over 1cm in length. All torn menisci were repaired by modified Humberg's method. Associated torn ligaments were also reconstructed when necessary. No patients except one had a symptom of the retear at second arthroscopy. Arthroscopic results were graded as follows: “healed” -no defect (n=18, 90%), “incompletely healed” -a partial defect without hypermobility (n=1, 5%), and “unhealed”-hypermobile defect (n=1, 5%). Out of 18 patients who were evaluated as healed, one had a retear of the repaired meniscus after second arthroscopy. Although this procedure provided good results, it is problematic that a longitudinal tear in more inner part can not be repaired in this technique.
Meniscal lesions caused by sports accidents were observed by arthroscopy in 95 knees. Of these cases 36 (38%) knees had associated anterior cruciate ligament injuty. The examination of arthroscopic findings suggested the following conclusion. 1. Time after initial injury or presence of anterior cruciate insufficiency influences the pattern and the location of meniscus lesion. 2. The medial meniscus with anterior cruciate insufficiency has high risk of secondary injury. 3. In sports activity, it is difficult to prevent primary injury, however, it is possible and beneficial to prevent secondary injury.
Recent studies have documented increased multi-directional laxity in the knee and a reduction in muscular strength following exercise. The objectives of this study were to evaluate the effects of fatiguing-practice on lower extremity response in closed kinetic chain. Using a computerized system with two force platforms, subjects stood on these platforms and were instructed to shift their weight from one foot to another or jump as fast as possible following a sudden display of computer instructions which was randamly arranged. The parameters examined were: 1) reverse response time (RRT); time between the presentation of a stimulus and the beginning of the reverse response, 2) peak reverse value (PRV), 3) response time (RT); time between the presentation of a stimulus and the beginning of the shift in the opposite direction, and 4) gradient of shift (GS); acceleration of weight shift. Twenty-three university basketball players (thirteen women and ten men) with their average age being 20 years were tested before, during, and after practice of basketball. Testing took place in a gymnasium and the room temperature was at 12°C. In addition, a group of 11 other healthy volunteers, all of them being physiotheraphy students, were studied for two consecutive days in order to evaluate retest reliability for the measurements included in the study. There were test-retest reliability in RRT, RT, and GS. RRT and GS did not change due to fatiguing practice. No significant difference was found between women and men in any parameter. There were significant improvement in RT between pre- and during-practice (p<0.05) in women. pre- and after-practice (p<0.01), and during- and after-practice (p<0.05) in men. The results obtained from this study were probably affected by two factors. 1) Because of the chill room temperature, warming with practice increased the extensibility of the musculotendinous unit. 2) Practice facillitated special neuromuscular coordination. These factors might thereby improve the response, however, no trends in these value may be identified due to the small sample size.
We recently had two rare cases of a stress fracture in the lower extremity. The first case was a 14-year-old sprinter who suffered a stress fracture of the medial malleolus. The second case was a 15-year-old baseball player who had an initial stress fracture in the femur and later stress fracture in the ipsilateral tibia. We shortly discussed about these cases.
Avulsion fractures of the tibial tuberosity in adolescents have been well described. But there is only a few cases that demonstrate an associated rupture of the anterior capsule of the knee. We are reporting on a case of a fifteen-year-old boy who sustained a Watson-Jones type-I fracture with an associated anterior capsular tear while jumping for hurdles. This case was successfully treated by open reduction and internal fixation with two screws and repair of the anterior capsule and patellar retinaculum. The patellar retinaculum was ruptured along the patellar ligament and farther from the distal end of the patella to the epicondyle of the femur. The mechanism of this injury is anatomically related with transverse fibers of the patellar retinaculum and capsular ligaments, whitch are patellofemoral ligaments. If the displacement of the fragment on the avulsion fracture of the tibial tuberosity is remarkable, the associated rupture of the anterior capsule should be considered and then not only reduction and fixation of the fragment but also repair of the patellar retinaculum and the anterior capsule are necessary.
Forty-four patients with operative treatment of the foot in sports athletes were followed up. Male were thirty-three cases and female were eleven cases. The mean follow-up period was three years and two months in a range of one year to ten years. The average age at surgery was nineteen years in a range of twelve years old to thirty-two years old. They were evaluated by the criteria modified from Kanazawa University. All the patients returned to the same sports except two patients. The indications for these operations were discussed.
From Sep. 1988 to Jan. 1990, we have treated five cases of athlete, who had the posterior and inferior instability of the shoulder joint, with a Kumamoto University—scapular fixed band (k-s band). K-S band, which is desinged by us, fixes inferior angle and medial border of the scapular to keep stability of it. As a result, we found k-s band to be effective and useful. K-s band has certain limitation of the inferior instability. Athletes don't feel the shoulder pain and apprehension of the posterior instability and can start their training again without delay. But it was not effective in some sports, because it limits ROM (horizontal flexion, and horizontal extension).
We evaluated xeroradiographic image of the knee joint in twenty-one patients with Osgood-Schlatter disease. Main findings in twenty-five knees were as follows: 1) Abnormal bony change (segmentation or fragment displacement) of tibial tuberosity was visible in 21 knees (84%). 2) Thickening of patellar tendon was noted in 19 knees (76%). 3) Dense shadow in the area of infrapatellar fat pad or deep infrapatellar bursa was present in 6 knees (24%). The accentuation of contrast gradation and fine definition in these roentgenological images is available in the study of this disease.
Six female long distance runners in the vocational society were evaluated in order to determine their maximal oxygen uptake (VO2max). In addition, VO2max of high school student girls were measured. The examination proved that the vocational group have a higher level VO2max than the student group. It proved that there is a definite relationship between VO2max and ability to run 5000m. High grade VO2max does not always ensure better competitive records, but it is beneficial for a long distance runner.
From 1982 to 1989, we have eight patients of stress fracture. Seven fractures occured in the tibia and one in ischium. From the routine anteroposterior and lateral X-ray, we measured the narrowest mediolateral and anteroposterior width of the tibia. We also measured the cortical thicknes. Patients of tibial stress fracture had shorter mediolateral width than the control group, but there are no significant difference in the anteroposterior width between the two groups. We cannot find significant difference in the cortical thickness, but there seemed to be tendency that thin cortex might be likely to be affected to the stress fracture. Six out of eight patients were military recruits. They were not athletic at all. About four weeks after the beginning of basic training, they feel pain. So we think that narrow mediolateral width of tibia and sudden increase of physical exercise may be risk factors of tibial stress fractures.
Kin-Com 3 machine was used to measure trunk strength in 174 normal subjects 71 males, 74 females. Both extension and flexion stops were set at 30°. Testing was performed three reciprocal repetitions at 10° and 30°/second isokinetic speed. The study showed that male had 1.6-1.8 times as large as female at the average torque and the peak torque. The trunk muscles were stronger at 10°/sec than 30°/sec. The average torque of males was decreased with ages in the extensor and flexor. The average torque of females was decreased at random in the extensor, and was decreased with ages in the flexor. The ratio of extensors to flexors was greater in the males than in the females. The ratio of extensors to flexors was greater with ages. The trunk muscle strengthwas different among individuals. The trunk muscle strength was different in different ages, sex, and individuals, but the ratio of extensors to flexors was almost fixed. We considered to analyze at this ratio as an index.
The purpose of this study was to investigate the relation between the low back pain and the circumstance of load carriage workers in Yamaguch prefecture from a questionnaire. It comprised 994 persons (849 men and 145 women) in the following three basic occupations: office worker, truck driver and luggage lifter. The 55.2% of office workers, 80.9% of truck drivers and 78.4% of luggage lifters had experienced low back pain. In this study, the percentage of men who had low back pain was 24.3% among office worker, 56.8% among truck driver and 50.0% among luggage lifter. The workers who treat the heavy load complain their low back pain in higher rate than those who don't treat it. Our data indicates that the incidence of low back pain become high in three basic occupations in comparison with the past data.
We evaluated clinically and radiographycally 25 pelvic ring instability patients who met with the standards regulated by Tanaka. Most of the patients complained of sharp pain on lumbosacral, inguinal, and thigh regions when they bent at the waist, carried heavy items, or woke up in the morning. Objective analysis was rare without a pelvic stress test, but when pelvic stress was appraised, a grinding noise occurred in sacroiliac joint in some patients. On the downward motion of the SLR test, some patient complained of pain somewhere in the pelvic region. According to the JOA score, the patients tested received an average score of 20.75±4.25. Ratio was significantly low between length × width of the symphysis and the distance from a third of symphysis pubis to a half of the 1st sacrum. This suggested that pelvic ring instability tends to occur in a woman who had the pelvic structure that showed much smaller symphysis pubis and longer sagittal diameter of the pelvis.
We have many chances to treat a patient suffering from a low back pain and a leg pain, but we cannot diagnose the origin completely except a lumbar disc herniation. We reported the diagnosis and therapy of 19 patients who have pelvic ring instabilities. They visited our hospital with complaints of a low back pain and a leg pain from Nov. '88 to May, '90. They were treated conserva tively by intraarticular steroid injections in the sacro-iliac joints and pelvic fixation braces. The results were excellent in 8 cases, good in 6, fair in 2, and poor in 3.
We investigated the clinical utilities of MRI in patients who underwent percutaneous nucleotomy. Fifty-four patients were examined by MRI pre-and postoperaively, and the degree of the herniated disc was measured in saggital imaging. Reduction of the herniatd disc was seen in 28 cases (54%). In 8 cases, Over 2mm reduction was acquired and all of them had excellent results. We considered that one of the major factors for relieving pain is the direct decompression for the nerve roots and the dural sac.
Twenty-nine patients with spondylolisthesis of the lumbar spine were evaluated by MR imaging, plain radiography and clinical sign. Disc hernia in olisthesis was classified into two types in T 1w-images. Type 1 showed no herniated mass posterior to slipped vertebra. But in Type 2. disc material was displaced posterior to the vertebra. Thirteen discs belonged to Type-1 and 19 discs to type-2. (in 4 patients, there existed olisthesis in two levels) In type-2, fat tissue arround the root decreased in exit zone in eighty per cent cases. Clinical sign was more severe in patients with type-2 MR images. MR imaging in spondylolisthesis seemed to be benefical for estimation of clinical sign. On planning of operative treatment, it is an essential examination for preventing complications.
We treated 10 patients of lumbar spinal canal stenosis with intravenous drip of Prostaglandin E1. Doses were 120μg/day or 60μg/day during a week. Four cases were very good and 4 cases were good on satisfaction of patients. The test of spinal evoked potential was done on 7 cases. We recorded at rest and after load of gait, and compared the prolongation of latency and the decline of amplitude between pre and post-treatment. After treatment, the prolongation of latency by load of gait decreased in comparison with that of pre-treatment. The continuity of effect existed on 4 cases 1 month after treatment. Side effects were vasculitis in 5 cases and the worse of gastric ulcer in 1 case.
41 patients (lumbar canal stenosis: 21, lumbar disc herniation: 18, others: 4) with lumbosacral radicular symptoms were examined for skin temperature before and after the nerve root infiltration (L5: 31 roots, S1: 10 roots). Before the nerve root infiltration, the low skin temperature areas were observed in 15 patients (36.5%). After infiltoration, skin temperature rose in 26 patients (63.4%). 62 patients (all lumbar disc herniation L5: 36, S1: 26) with single root disturbance were examined for the area of sensory disturbance. The high skin temperature areas were similar to the area of sensory disturbance at both L5 and S1. We thought that one of the causes of increased skin temperature was sympathetic nerve system.
Skin temperature measurements were carried out in 70 healthy subjects, and in 35 patients with lumbar disc herniation. In healty subjects, the degree of thermal asymmetry varied in different between each homologous regions of the body. The most of symptomatic patients had the manifestation of thermographic cold area coinciding with the pain distribution. When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in healty subjects, the positive finding was 94% of the patients with lumbar disc herniation. From these results, we consider that the temperature differences obtained in healthy subjects should be used as the reference standard for clinical diagnosis.
The purpose of this paper is to discribe experimental and clinical study for percutaneus electrical denervation of lumbar posterior medial branchi. Experimental study showed that optimum Joules's heat in this procedure is 10W×20seconds×2times. Clinically, 20 patients with lumbar facet pain were done this procedure, There were 12males and 8females. The mean age of this group of patients was 55 years with a range from 25 to 78 years. The duration of follow-up varied from 3 months to 3 years and 9 months, the average being 1 year and 5 months. The main advantages of this procedure are as follows: 1) As target point of denervation is between mammillary process and accessory process, electrical denervation is safe, so that the target point is far from spinal nerve roots. 2) Denervation at this point preserve function of all back muscle except multifidus muscle. Because of this, this procedure can minimize weakness of back muscle after the procedure. 3) Effect of denervation can be judged by electromyography of multifidus muscle. Sixteen cases have good clinical course. Four cases have poor results. Diagnoses of poor cases are 2 psychogenic low back pain, multiple lumbar facet pain and lumbar disc herniation. Indication of this procedure should be strict all the more because it is very easy.
24 patients operated by partial laminectomy and 22 patients operated by wide laminectomy, with out fusion, were compared. There were no difference between partial laminectomy and wide laminectomy about subjective symptom, ADL, return to the work and satisfaction. But in wide laminectomy, instability after operation increased as time goes on and as degrees of lumbago.
In order to determine indication of operation for lumbar disc herniation, comparision of the results of surgical therapy with those of non-surgical therapy was made 4 years after the hospital stay. In non-surgical group, the subjects with similar situation to surgical group were selected to obtain more reliable data. There was no significant difference in symptom and sign between both groups after 4 years. However, half of the patients in non-surgical group was unsatisfactory with results, whereas 80% of the patients was satisfactory in surgical group. The findings of this study may help to select patients for surgical therapy of lumbar disc herniation.
Generally, we perform radical resection of spinal focus and bone grafting by the anterior approach for tne patients with tuberculosis of the thoracic or lumbar spine. But sometimes the spine does not fuse. Recently for such 3 cases, we performed secondary posterolateral spinal fusion with Luque segmental instrumentation. Two patients have recovered and are doing well with solid fusion. But in the another case, the spine did not fuse because of severe complications (diabetes melltitus and cirrhosis). This technique seemed to be valuable for tuberculous spondylitis resistant to theraphy.
To study the contribution of the special morphological features of lumbo-sacral spine as causes of the slipping in the spondylolisthesis, the roentgenographic measurements were performed in 47 cases of spondylolysis, 77 of spondylolisthesis and 597 of several low back pain as a control. Higher incidence of the spina bifida occulta was noted in both spondylolysis and spondylolisthesis groups than in the control group, but there was no difference between them. The lumbar index (the trapezoid shape of the L5 lumbar vertebral body) was the lowest in the spondylolisthesis group. The highest was seen in the control group, but the higher the slipping in the spondylolisthesis, the lower the lumbar index was. The transitional lumbo-sacral spine was more frequently seen in the spondylolisthesis group, but there was no difference between the spondylolysis and control. The angle between the superior surface and the posterior border of the sacral vertebral body (posterior superior sacral angle) was apparently low in the spondylolisthesis, whereas no difference was noted between another groups. In conclusion, special morphological features such as low prices of the posterior superior sacral angle is considered one of the risk factors for the cause of slipping.
The association between aging factor and auto graft bone remodeling was studied in 48 cases who had been operated for lumber radiculopathy or canal stenosis. PLF was carried out for all cases. We made 4 indexes as follows: 1) end-time when resorption for graft bone stopped. 2) radiodensity peak-time of graft bone. 3) iso-radiodensity time between graft bone and neighbouring bone tissue. 4) the time when range of movement decreased to below 3 or 2 degrees at PLF level. Our study indicated that resorption of graft bone ended within 6-8 months after operation, iso-radiodensity time for graft bone was gradually lengthened as aging or bone density mass decreased, and bone union was also delayed.
The diagnostic accuracy of myelography, CT and MRI for the diagnosis of lumbar herniated nucleus pulposus is compared in 32 patients, all of whom underwent surgical exploration. The accuracy rates in these patients were 76.5% for myelography, 85.3% for CT, 79.4% for MRI, and 94.1% for CT and MRI. Although CT and MRI can be viewed as an alternative to the invasive myelography in diagnosing lumbar disk herniation, myelography was more sensitive to change of nerve root. Further advances in MRI technology can be expected to be primary noninvasive diagnostic technique for evaluation of lumbar spine intervertebral disk disease.
MRI is very useful for diagnosing of spinal disorders. But there exists several problems when MRI is performed and its imaging must be interpreted with care. We have four cases of misdiagnosis on MRI. Because, histological diagnosis is difficult by MRI, sometime additional examinations such as myelogram, discogram, CT and biopsy are needed.
Fifteen patients with lumbar disk herniation and lumbar cannal stenosis werer studied Comparing preoperative MRI with postoperative MRI, and preoperative myelogram with postoperative myelogram. Eight patients were lumbar disc herniation and the another were lumbar cannal stenosis. In lumbar disc herniation group, five patients were found to be improved in myelogram, and three patients were found to be improved in MR-image. These three patients were found to be improved in myelogram. In lumbar disk herniation, the improved group in myelogram and MRI were not related to non improvement group in myelogram and MRI. All patient with lumbar canal stenosis were found to be improved in myelogram and MRI.
In a comparison of Myelogram and sagittal MRI, the disc herniation's image of MRI was seen more largely. At 1988-1990, lumbar disc herniations were diagnosed on the 20 persons and intervertebral disc by posterior lumbar opration. In these, a comparison rate of dural sac by disc herniation was calculated at Myelogram, CTM, sagittal MRI and axial MRI. And then, statistical testing was performed using analysis of variance with them. Differences observed between the values of Myelogram and sagittal MRI, or CTM and axial MRI were not statistically significant. But if the rates were calculated on not only disc herniation and proximal dural sac but also disc her-niation and distal dural sac, the differences would be observed between the values of Myelogram and sagittal MRI. The disc herniation's image of the sagittal MRI would be seen more largely than those of the Myelogram at L4/5 and L5/S1.
A 40-year-old female of extradural arachnoid cyst was escribed. She suffered from lumbago, but showed no neurological symptoms. X-rays films showed widening of the interpedicular space, and erosion of the laminae. Magnetic resonance imaging revealed the cyst over the dorsal aspect of the cord. The lamina of the L2 was extremely thin, and a cyst was exposed. The cyst had communication with the subarachnoidal space. The partial removal of the cyst was attempted, and the dural defect was sutured. The postoperative course was uneventful, and there was no lumbago.
This is a report of two cases with an atraumatic myositis ossificans of the iliopsoas muscle, which is a rare disease. In the first case, the iliopsoas muscle was operatively dissected since an infectious muscle desease had been suspected. However, no abscess was observed in the muscle, and no bacteriae was detected in culture. Histological examination of the muscle suggested that it was the initial stage of myositis ossificans. In the second case, CT scanning showed an ossified lesion in the iliopsoas muscle. The lesion disappeared with conservative therapy using Uronase injection.
We reported two cases of tuberculosis of peripheral joints. Case 1: a 56 year-old man suffering from tuberculous arthritis in the left ankle. Case 2: a 54 year-old man with tuberculous granuloma of the right knee the origin of which was suspected to be from the prepatellar bursa. Both cases were proved to be infections of tubercle bacillus by smear and/or pathological studies. The cases were treated with both antituberculous chemotherapy and surgery resulting in complete resolution. From these cases we learn that we must never forget tuberculosis when we encounter a refractory infection.
We report two rare cases that had a refractory fistula after the operation. Case 1: A 65-year-male who had a refractory fistula after the curettage. Preoperative diagnosis was tuberculous hypostatic abscess from the pelbic cavity, and judging from operative findings, we were sure that the diagnosis was compatible. But the histological diagnosis was “Actinomycosis”. The fistula had closed by many dose of Penicillin-G treatment for four weeks. Case 2: A 55-year-male who was diagnosed as osteomyelitis of the sternum and had the curettage. But the lesion didn't infiltlate into the sternum. After the operation he had a refractory fistula and reoperation was performed. The fistula infiltlated into the left third cost-sternal joint and the third rib, and healed by the partial costectomy and the curettage of the cost-sternal joint area. In histological findings, there were no evidence of osteomyelitis of the rib. Therefore, we suspected that the focus was in the third cost-sternal joint.