Aneurysmal bone cysts (ABC) arising from the cervical spine in children is relatively rare. Two cases with aneurysmal bone cysts arising from the cervical spine were successfully operated on in order to achieve radical tumor resection and reconstruction cervical spine stability were reported. Case1: A five year-old boy with neck pain and limitation of cervical movements. Clinical and histological investigation revealed ABC at the body of C4. Extensive curettage and bone grafting from C3 to C5 spine were carried out. Complete bony union was achieved. At six years follw-up, no tumor recurrence was seen, the spinal canal had normal growth and the patient had returned to normal activity. Case 2: A twelve year-old girl. Radiological examination and histological findings revealed ABC extensively occupying the body and lamina of C4. Staged resection and reconstruction were done. In the first stage, wide curettage through the posterior approach followed by bone grafting with Luque instrumentation were done. Two weeks later extensive curettage of the C4 lesion, cervical interbody fusion with bone grafting and plating from C3 to C5 were carried out. At three years follow-up, complete bony union was observed with no recurrence of the lesion, nor any disturbance of spinal canal growth.
Eight cases of spinal dumb/bell tumors treated surgically were reviewed. There were 4 males and 4 females, and the average age at surgery was 43.5 years. Pathological diagnosis was 7 neurilemomas and one angiolipoma. Surgical procedures involved seven laminectomies and one enlargement. Facetectomy was required for 3 cases and posterior fusion for 3 cases with satisfactory clinical results. In the post operative radiographic evaluation, instability was seen in one case and angulation in two cases. Two of six cases with intraoperative root resection had neurological deficits after surgery. Recurrence of the tumor was seen in one case. The dumb/bell tumor of the spine treated via the posterior approach achieved a successful result, although posterior fusion may be needed in some cases.
Chordoma is a rare, slow-growing, malignant tumor arising from remnants of notochordal tissue. We report three cases of this tumor, which were operated in our hospital. Case 1: A 49-year-old man. Chief complaints were numbness and motor disturbance of both arms and legs. Tumor was found at C4 level. We removed the tumor by the anterior approach, and did anterior vertebral fixation (C3-C5). Case2: A 60-year-old man. Chief complaint was left buttocks pain. Tumor was found at the sacral level by myelography. It was removed using an anterior and posterior approach and the sacrum was reconstructed using a Harrington-sacral bar. Case 3: A 74 year-old man. Chief complaint was left buttock pain at sitting. Tumor was found below S4 by MRI. We removed in via the posterior approach. Result: No cases developed symptons and signis caused by the removal of tumor postoperahvely except for a mild disturbance in urinatin in case 2. At the time of latest follow-up the post-operative course of these patients was good.
We operated on 33 cases with metastatic spinal tumors, (20 males and 13 females). The mean age of patients was 60 years (range: 43-76 years). The primary lesion in six cases was lung, in three cases each it was liver, breast, prostate and kidney, in four cases it was Myeloma, in two cases Malignant Lymphoma, and so on. All cases suffered from severe pain, and 23 from paralysis. Six types of operative procedures were performed. Posterior stabilization with Luque rod and bone cement was performed in 17 cases. All cases had a satisfactory removal of pain, and 65% of the 23 cases gainedtemporary improvement in their paralysis. Indications and purpose of operative treatments is discussed.
Although the diagnosis of syrinx can be easily made using magnetic resonance imaging its mechanism of formation still remains to be elucidated. We investigated the etiology and mechanism of syrinx formation associated with intramedullary tumors. We reviewed 10 cases of intramedullary tumor, six of which were complicated with syrinx. The tumors with Syrinx were 2 hemangiomas, 2 hemangioblastomas, 1 hemangioendothelioma, and 1 ependymoma. Cases of intramedullay tumors with syrinx, in comparison to those without, had a shorter duration from time of onset of symptoms to operation. These cases also were more likely to have tumors in the upper thoracic region. Active fluid secretions from the tumor and abnormal CSF circulation dynamics are important factors in forming and maintaining syrinx. However, other factors such as gliosis and absorption of fluid guard against syrinx formation, and therefore all of these factors need to be considered.
The occurrence of an intramedullary epithelial cyst of the spinal cord is a very rare phenomenon. We report a case of a 12-year-old boy complaining of gait disturbance and bilateral leg numbness. Magnetic resonance imaging (MRI) showed a mass at the T2 level. No other abnormalities, including bony defects, were found by the radiologic study of the spine. MRI obtained 3 months postoperatively showed no change when compared with his preoperative one. His right leg attained normal power and reflexes returned to normal. 8.5months after surgery, MRI Showed, that the spinal cord had reverted to a normal configuration but sensory recovery was slow. Postoperative Mri and clinical findings did not correlate.
Two cases of spinal arachnoid cysts are reported, one with Syringomyelia, Spondylosis and tethered cord syndrome, which is considered to be a congenital cyst, the other with RA and Lumbar disc herniation. The former was treated by cyst resection, S-S shunting, transpedicular fusion and resection of the terminal film. The latter was treated by cyst resection and nucleotomy. Treatment in these cases led to improvement in neurological symptoms.
The authors report five patients with thoracic spinal intramedullary hemangiomas that have undergone surgery between 1989 and 1999. Subjects comprised two men and three women, with a mean age of 47 years. Two patients had sudden onset of severe low-back pain, and three had chronic onset. The tumor was totally removed in four patients, and partially removed in one. Intramedullary hemorrhage was found in all patients at operation. In follow-up studies (range 6 months to 3 years, mean 1.5 years) neurological function improved in three patients, remained unchanged in one, and worsened in one. Magnetic resonance imaging was useful in the diagnosis of spinal intramedullary hemangioma.
A case of Brown-Séquard syndrome caused by a spinal arachnoid cyst is reported. A 58-year-old man complained of muscle weakness of the right lower limb and sensory disturbance of the left. MRI showed that the spinal cord was shifted ventrally and the subarachnoid space dilated from Th3 to Th7. Laminectomy was performed from Th2 to Th7 and the dura opened. The arachnoid cyst with a vascular anomaly was observed and the cyst resected, with improvement in the patient's clinical symptoms.
We reported a case of epidural abscess following epidural block. MRI offers a correct, non-invasive and safe method for visualizing the focus, and is expected to be advantageous in the diagnosis of spinal epidural abscesses. Successful treatment was achieved with laminectomy, washing and antibiotics to the focus. As the practice of epidural block management grows, this complication may increase in frequency and it is therefore important to keep the possibility of this complication in mind. In conclusion the prevention, early diagnosis and early treatment are imperative.
We report a patient with an extradural lipoma. A 65-year-old man had a 30-year history of lumbago with pain in the left thigh and leg developing since 1990. Neurological examination revealed mild weakness in the left tibialis anterior, extensor hallux longus, and paresthesia in the left L5 area. MRI of the lumber spine was carried out with both T1-weighted and T2 weighted sequences showing severe narrowing of the dural sac with a high image intensity mass from L2 to S1. A decompressive laminectomy from L2 to S1 revealed a soft mass in the epidural space compressing the dural sac and spinal cord. We stress that MRI is useful for the first step in the diagnosis of patients suspected of having extradural lipoma.
Clinical results of metacarpal (-tarsal) bone lengthening carried out in 8 bones of 7 patients (2 metacarpal and 6 metatarsal bones) by the method of callotasis were reported. Subuects ages ranged from 11 to 27 years with a mean age of 16/0 year. Orthofix M-100 or M-100Y was used as the distraction apparatus, and we recommend that the latter is more use ful for this procedure. Waiting Period was between 10 and 14 days. Although the speed of lengthening varied from 0.37 to 1.0mm/day, good results were obtained in cases lenghened ataspeed of under 0.5mm/day. 11-23mm (average 14.9mm) lengthening which was 21-59% (average 35%) of the original bone length was obtained. Because of callus formation, bone grafting was required in only one case whose metacarpal bone had been Iengthened at a speed of 1.0mm/day.
Ossification and bone mineral deposition in three femurs and two tibias of four patients who underwent elongation by callotasis were examined by CT and DEXA to investigate bone formation by this method. Sequential change of callus ossification in CT imaging was observed at three levels of the proximal, middle and distal area of elongation. By using DEXA, three quantitative indices for bone mineral deposition of elongated area such as BMC (bone mineral content), BMD (bone mineral density), %BMD (relative rate of BMD to that of the neighboring area) were measured and analysed against time. In CT imaging, all materials showed a ring-shaped area of ossification around the periosteum, which increased in thickness against time although the thickness of the ring was not always circularly equal. The bone formation was observed always slower at middle part than at prosimal or dixtal part of elongation. All of BMC, BMD and %BMD revealed the time-dependent gradual increase during and after the neutralization stage in callotasis. There was a correlation between their values and the ossification; the better callus ossification provided the higher values in every indexes measured by DEXA. It is suggested, in conclusion, that CT imaging and DEXA are potentially useful for evaluating the degree of the bone formation in callotasis.
We examined the cause of contractures in leg-lengthening for leg-length discrepancy in children. This report reviews 37 cases of leg-length discrepancy. Sixteen cases were due to hemihypertrophy, 14 cases of hemihypotrophy, 4 cases of congenital dislocation of the hip, 2 cases of trauma and one case with slipping of the upper femoral epiphysis. Important factors related to contractures were the interval of elongation each day and the daily rate of elongation length. The longer the daily interval of elongation and the higher the daily rate of elongation length, the greater the contracture. Gait and weight-bearing with a brace early in the post-operative period is useful for avoiding contractures. * Authors Note: Do you mean that the contracture seen in each case is more severe, or do you mean the incidence of contractures increases with increasing interval and rate of elongation.
Seven patients who were treated with human bone allograft transplantations over the past 10 years were evaluated clinically. The average age was 31.4 years (range from 2 to 69 years). Two patients were treated by spinal fusion, two bone defects due to bone tumor and trauma, one congenital pseudoarthrosis, and two with THR and revision. Freezed-dried bone was transplanted in two patients, frozen bone in four patients, and fresh bone in one patient. These results suggest that freezed-dried bone is useful for relatively narrow bone defects and vascularized bone allograft will be useful in the near future. We are eager for the establishment of a regional bone bank system.
It is well known that some kinds of crystal are produced in the human body, uric acid being a famous example. Recently, I have discovered a new crystal, not only in the hip joint, but in muscle, bone, cartilage, capsulo-synovium and fat tissue in seventeen cases of primary osteoarthritis of the hip. However the crystal was not observed in the hip joint in eight cases of secondary osteoarthritis of the hip and in 28 cases of other diseases. The crystal is easily soluble in 10% formalin and alcohol which is one reason why past researchers and pathologists have been unable to observe it. The crystal is possibly derived from a fat or lipoid compound caused by metabolic disorders.
We report on an elderly patient with rapidly progressive unilateral coxopathy, in which their hip joint broke down in a Short period. Under the diagnosis based on various examinations, Total Hip Replacement was performed, with good results obtained.
We reviewed 10 hips of 5 patients with osteochondroma growing in the upper femoral end to investigate the relationship between its occurrence and hip deformity. All cases were hereditary multiple exostosis with the site of osteochondromas extending from the subcapital area of the femur to the distal part of the lesser trochanter in 2 cases, from the middle of the femoral neck to the distal part of the lesser trochanter in 2 cases, and localized on the lesser trochanter in 1 case. coxa valga, acetabular dysplasia and osteoarthritis occurred. The osteochondroma growing in the proximal femur may cause deformity and incongruity of the hip joint and lead to osteoarthritis.
28 hips of 22 patients with highly dislocated coxarthrosis were reviewed to inveshgate the state of ADL disturbance. Patients were divided into two groups according to the radiological degree of dislocation; a group in which articulation was found between the iliac wall and femoral head (group 1), and a group in which the femoral head was buried in the gluteal muscles (group 2). Comparing the JOA score between the two groups, pain in group 1 was more severe than that of group 2. However, there were no differences in walking ability, range of motion and ADL disturbances, walking ability was more disturbed in unilateral than in bilateral dislocation. The main ADL problens consisted of standing up, going upstairs, squatting down and cutting toe nails, and these symptoms were progressive with increasing age.
Twelve cases (thirteen joints) with fracture dislocations of the hip joint were treated during 1983-1991. Dislocation fractures were classified into 5 groups according to Thompson-Epstein's classification; 6 in type 1, 1 in type 2, 1 in type 3, 3 in type 4, 2 in type 5. Four cases were treated by primary closed reduction and secondary open reduction of the acetabular fracture. At the time of follow-up satisfactory results were achieved in 7 cases (54%). Traumatic osteoart hritis was seen in 2 cases (15%); 1 in type 3, and 1 in type 4. Avasucular necrosis of the femoral head was seen in 2 cases (15%) both in type 4.
37 patients (8 male, 29 female) who had Chiari's pelvic osteotomy were reviewed to assess whether there was any difference in severity of surgical technique between male and female. Radiological measurements such as osteotomy angle, medial displacement of distal fragment of pelvic bone, medial and superior displacement of the femoral head were carried out in the antero-posterior X-ray pictures pre and post operatively and compared between the male and female. Results were radiologically evaluated in relation to CE angle, Sharp angle, Acetabular-Head index and approximate acetabular index and clinically evaluated using the JOA score. The degree of medial displacement of the distal fragment of the pelvic bone and improvement in CE angle in males were smaller than that in the female. There was no difference in the JOA score between male and females. The difficulty of medial displacement of the distal fragment in Chiari's operation in the male may be due to the anatomical structure of the male pelvic symphysis.
To assess the cause of hip lesions when combined with pelvic posterior inclinatiop such as osteoarthritic and rapidly destructive coxopathy-like changes, coverage of the femoral head to the acetabulum was measureed on computed torn ograms of 35 patients, and the relationship between degree of inclination and coverage was investigated. Patients were divided to in three groups according to their degree of pelvic posterior inclination: Group 1; less than 20° of inclination, 18 hips; Group 2; 21-25°, 6 hips; Group 3; more than 26°, 11 hips. There was no statistical difference in total coverage of the head among the three groups. Coverage of the anterior part of the head decreased and coverage of the posterior part of the head increased with an increase in posterior inclination. These findings suggest that the decrease in anterior coverage of the head with increasing pelvic inclination may lead fo the developmenf of some hip lesions.
We measured the isometric muscle force (IMF) of the hip abductors of 21 patients who underwent RAO pre- and postoperatively to assess the influence of this procedure on the hip joint. In each patient IMF of the hip abductors was measured using a device of our own design at four different positions of -15, 0, 15 and 30 degrees in abduction. At the same time simultaneous surface electromyogram (EMG) was recorded on the following four muscles, gluteus medius, adductor muscles, gluteus maximus and quadriceps femoris. The influence of RAO was studied by analyzing the sequential change of IMF and the pattern of muscle contribution to hip abduction power by calculating regression coefficients of integrated EMGs to hip abduction power. Maximum value of the muscle force of the hip abductors decreased up till 3 months after operation. Then it increased returning to the preoperative value at 9 months after surgery, in 15 and 0 degrees of abduction. However, in 15 and 30 degrees of abduction, recovery was delayed. The proportion of regression coefficients normalized from the OA pattern postoperatively, suggesting this procedure may act to normalize the muscle coordination around the hip joint.
It is reported that autologous blood transfusion is very useful for decreasing homo-logous blood transfusion in elective orthopaedic surgery. In this paper, we evaluated the method of preoperative transfusion of autologous blood stored as liquid blood to patients for elective hip surgery. Fourteen patients(ABT group) aged 43-77 years(mean 58.6 years) received autologous transfusions, 21 patients (HBT group) aged 35-80 years (mean 64.5 years) did not receive preoperative transfusion of autologous blood. In 7 of the ABT patients, and 2 of the HBT group, homo-logous transfusions were avoided. We conclude that preoperative transfusion of autologouls blood is useful in elective hip surgery.
Since 1987 we have used the Harris-Galante (H/G) porous hip system and porouscoated anatomic (PCA) hip system. Thirty-eight H/G prostheses were implanted in 34 patients and thirty PCA prostheses were implanted in 26 patients with minimal follow-up of one year. We examined clinical and radiological findings after a mean follow-up period of 2.6 years (in H/G) and of 1.4 years (in PCA). The results include the following: (1) Slight or or moderate thigh pain occurred in 28% of H/G cases and 17% of PCA cases. (2) Reactive line covered more than half the area of the femoral component in 50% of H/G cases compared to 14% of PCA cases. (3) Bone resorption at the calcar area was seen in 54% (of H/G cases) compared to 30% (of PCA cases). (4) Bone sclerosis at the stem tip was seen in 28% to 27% (5) cortical hypertrophy at the stem tip was seen in 27% to 30%.
Thigh pain is one of the problems encountered after cementless hip arthroplasty. A comparative study of OMNIFIT and OMNIFLEX was done clinically and radiologically. Radiological findings were classified as normal, lucent and sclerotic at proximal, middle, lower and tip of the implant. Correlation between thigh pain and radiological changes were also studied. Incidence of both thigh pain and radiological changes in cases using OMNIFLEX were significantly less than those with OMNIFIT. The incidence of thigh pain correlated well with the incidence of the radiolucent line at the proximal part of the stem. A high incidence of thigh pain was seen in the group with combination of the radiolucent line at the proximal stem and sclerosis at the stem tip.
Fifteen patients had revision of a failed hip arthroplasty using a dual bearing prosthesis. Bone grafting for acetabular bone loss was necessary in seven patients. Two of these seven patients required allografting. These patients were retrospectively reviewed. JOA hip score was used for clinical assessment. The preoperative JOA hip scores averaged 61.6 points and postoperative scores averaged 80.7. Migration of the prosthesis and graft incorporation were monitored roentgenogr aphically. Proximal migration ranging from 1mm to 4mm occurred in four patients. Two patients had 4mm of distal migration. Noprogress ion of migration was seen radiographically at the last follow-up.
Fourteen revision operations of proximal femoral endoprostheses were carried out in our clinic. Eight prostheses were replaced with total hip arthroplasties. It was technically very difficult to remove the Austin-Moore cementless prostheses, which has a designed window for self-locking. Six cases of the cementless prosthesis complained of thigh pain and were treated by injection of cement from the window, into the anterior shaft of the femur which corresponded to tip of the prosthesis. This cementing method was found to be very effective for relief of thigh pain.
Post-operative short and long term results of total hip arthroplasty for patients with hip osteoarthrosis were studied. Fifty-six patients, 61 hips with follow-up periods ranging from more than 2 years to 15 years, were clinically and radiologically evaluated. 26 hips had Charnley THAs for more than 5years postoperatively and 23 hips had Harris cementless THAs for 2 to 5years. Overall results were almost satisfactory. In the more than 10 years postoperative Charnley hips 55% had appearent socket loosening, but no case had stem loosening. In the Harris cementless THA series, one case already showed stem sinking. Advanced socket loosening may lead to hip pain, restricted motion, limp, and ADL disabilities.
Arthroscopy of 15 hip joints in 15 children were performed during the past 2 years. Of these, 13 hips were examined just prior to definitive surgery for evaluation of pathological changes, such as a hypertrophic ligamentum teres in manually unreducible congenital dislocation, a torn acetabular labrum or degeneration of articular cartilage in hip dysplasia and deformity of the femoral head in perthes' disease. Arthroscopic findings were useful for diagnosis, understanding pathology, and planning subsequent treatment. Two patients with residual subluxation after closed reduction of congenital hip dislocation were treated by a new method, “arthroscopic reduction”, in which intracapsular obstacles such as the ligamentum teres and fibrofatty tissue were completely resected arthroscopically. Short-term results of this method showed concentric reduction without coxa magna.
Eleven hips (8 cases) with chronic slipped capital femoral epiphysis were treated depending on their degree of displacement. Two cases with slight and moderate slip were treated conservatively, the other 9 hips were surgically treated. Pinning in situ was performed for 4 hips with mild slips and Southwick's trochanteric osteotomy and Sugioka's anterior rotational osteotomy was carried out for 4 hips with moderate and severe slips. One case with a severe slip (Posterior Tilt Angle=75 degree) was surgically treated by Sugioka's anterior rotational osteotomy with modified Kramer's method, which was safer and corrected the severe deformity better than the other methods. Follow-up averaged 2 years and 10 months, with all patients obtaining a satisfactory clinical result. Although the clinical result was excellent in two conservatively treated cases, the range of internal rotation of these hip joints was restricted. However this limitation only correlated with obesity. We concluded the following indications for treatment of chronic SCFE. <40 degrees: in situ pinning, 40-70 degrees: trochanteric osteotomy, >70 degrees: anterior rotational osteotomy+modified Kramer's method.
Cross-sectional area of the bilateral gluteus maximus, medius and minimus were measured in 22 cases with Perthes disease using CT scan at the following three levels: lower end of sacloiliac joint, upper end of acetabulum and mid-level between the sacroiliac joint and acetabulum. Summation of cross sectional area of these three levels was used to evaluate the degree of muscle atrophy. Percentage area of the affected site was calculated from that of the unaffected site in individual gluteal muscles. Radiological findings and clinical evaluations were compared with the percentage area. Patients admitted to hospital within 3 months of the onset of Perthes disease showed less atrophy in gluteus maximus than those admitted after 3 months (p<0.05). There was no correlation between muscle atrophy and Catterall classification or between muscle atrophy and the number of radiological findings of head at risk. Patients with both “tear shaped” signs and “pubic varus” signs on radiograph showed more atrophy in both gluteus maximus and medius than patients whith negative radiological signs (p<0.01). Patients who had Perthes disease before 7 years old showed less atrophy in gluteus maximus than those whose onset was after 7 years of age (p<0.05). Less muscle atrophy in patients admitted to hospital within 3 months suggested the benefit of early systematic treatment.
We carried out a Magnetic Resonance Imaging (MRI) study in fourteen patients with unilateral Legg-Calve-Perthes Disease. The purpose of this study was to show the process of deformation of the femoral head in this disease. In the early stage, the perichondral ring of the affected head was thicker than the unaffected hip in all cases and hypertrophy of this cartilage produced lateralization of the femoral head on plain roentgenograms. With progression of the disease, a high signal area appeared around the physis corresponding with the perichondral ring. Although this area extended proximally, the subchondral region near the sumit of the epiphysis remained as a relatively low signal area for a long time. This difference in reparative activity between the base and near the top of the epiphysis produced the typical residual deformity of Legg-Calve-Perthes Disease, the coxa magna and the coxa plana. We also measured the width of the hypertrophied cartilage on MRI films taken in the initial stage and discussed the relationship between the degree of width and final results. The thicker the cartilage was, the poorer the result. The measurement of articular cartilage in the early stage could predict the future of this disease.
We evaluated 22 Salter's innominate osteotomies performed in 21 patients for treatment of residual subluxation and acetabular dysplasia after primary reduction of congenital hip dislocation. We only performed Salter's innominate osteotomy in 18 hips and additionally performed femoral osteotomy in 4 hips. The average age at surgery was 5.1±1.5 years, the average age at evaluation was 10.3±2.1 years and the average duration of follow-up was 5.1±1.6 years. We evaluated radiographic results using Severin's classification. Of the 22 hips, 18 achieved good results (82%) but 4 had poor results (18%). The mean center edge angle and acetabular head index at follow-up in the group with good results was statistically larger than that of the poorer group. Therefore Salter's innominate osteotomy was an effective surgical procedure for treatment of residual subluxation and acetabular dysplasia.
This study was performed to investigate differences in treatment of congenital hip dislocation between breech and cephalic presentations. 30 dislocated hips from breech presentations and 75 dislocated hips from cephalic cases were radiologically and clinically assessed. Smooth reduction by Pavlik Harness was achieved in 20 of 30 hips in breech cases (67%), and in 60 of 75 hips in cephalic cases (80%). There was no statistical difference in reduction ratios. Avascular necrosis was observed in 19% of breech cases and in 11% of cephalic cases but these differences were not statistically significant. Fifteen hips from breech cases and 26 hips from cephalic cases were followed over 6 years. Anatomical healing (Group I of Severin's classification) assessed by X-ray was 60% of breech cases and 88% of cephalic cases. Cephalic cases showed better prognosis on X-ray than breech cases. Distance a and b, as defined by Yamamuro, and acetabular angle did not show any remarkable differences between breech and cephalic cases. In conclusion there were no differences in difficulties of treatment in congenital hip dislocation between breech and cephalic cases.
We reported two cases of pigmented villonodular synovitis occurring in thr shoulder and hip joint. Case 1: A 55-year-old male who complained of right shoulder joint pain for two years. Roentgenographically there was a radiolucent lesion of the glenoid and the great tubercle. Case 2: A 28-year-old male who complained of left hip joint pain for about one and half years. Roentgenographic findings of joint space narrowing and moth-eaten shadow of the acetabulum and the femoral head were found. We performed arthrodesis on these cases with good results obtained.
Hypertrophic osteoarthropathy is a syndrome characterized by finger and toe clubbing, periosteal new osseous formation of long bones, arthritis, and thickening of skin. It can be classified as primary, which is rarely seen or secondary. The patient is a 20 year-old male. His father's forehead had prominent folds and this case has typical clinical symptoms of primary hypertrophic osteoarthropathy.
A case with adult T-cell leukemia was reported. A 52-year-old man had suffered from low back, bilateral hip joint, and bilateral thigh pain for three years. Multiple osteolytic lesions were found on roentgenogram. Laboratory examination showed normal serum calcium, low serum phosphorus, high serum alkalinephosphatase activity, and normal parathyroid hormone level. Anti HTLV-1 antibody dwas positive and flower cells were found in peripheral blood. Bone biopsy was performed in right femur. Proliferation of osteoclasts and excessive bone resorption were observed but not ATL cells.
We statistically studied 95 cases with mandibular fracture treated in the Department of Plastic Surgery of St. Mary Hospital during the period 1986 to 1991, and obtained the following results. 1) The number of patients increased annually. This accident occurred more often in younger men, and there was a 3:1 male: female ratio. 2) The accident occurred more often at midnight in Summer. 3) Many car and motorbike accidents were found to be the cause of the accident. 4) Out of 386 cases of facial bone fractures during the period of the study, mandibular fracture was the most common subtype. 5) The fracture occurred most often in the mental region (31%), followed by the condylar region.
A 21-year-old female patient who complained of a sunapping hip for several years was treated by z-figure incision of the iliotibial band. While the suapping phenomenon disappeared, the surgical wound did not heal and skin closure was performed three times thereafter, with a pin hole sinus, subcutaneus bleeding and secretion remaining. Neither infection nor allergic reation against nylon suture material were found. Laboratorly data consistent with von Willebrand's disease was found, but there was no bleeding tendency in her past history. Wound closure finally succeeded following currettage of the wound and administration of Vit. K (i. v., 1g×7 days) and Vit. C (p. o., 1g×18 days). The subcutaneus bleeding was thought to be due fo a deficiency of Vit. K caused by several intravenous and parenteral antibiotics (CEZ, CTM, CLL).
Patients with refractory pressure sores resistant to both conservative or surgical treatment are sometimes encountered. We experienced 3 patients whose skin and subcutaneous tissues were not available for local rotation flaps. The island flap procedure was performed in these patients. Postoperative courses were uneventful and this procedure was judged to be very useful for these patients.
A fibrin adhesive agent consists of clotting factors and is applied for tissus adhesion in surgery. We used it for two cases with delayed wound-healing. Case 1 was a 56-year-old-male with diabetic gangrene. After right Syme amputation, wound-healing was delayed. Case 2 was a 48-year-old-female with spinal cord injury. After rotation flap for decubitus in her sacral region, wound-healing was delayed. In both cases, suturing was tried several times but failed, so a fibrin adhesive agent was injectet into the wound and applied to the wound after suturing. Using this fibrin adhesive agent wound-healing was successful. In this case wound-healing appeared to be due to the useful action—adhesion, fixation, filling, hemostasis, etc—of a fibrin adhesive agent based. A fibring adhesive agent is safe and will be used more clinically in the future.
Forty-one cementless total knee arthroplasties in 30 consecutive patients were evaluated radiographically. The average follow-up was 39 months (range 26 to 57 months). Radiolucent lines at the interface between bone and prosthesis were seen in 8 (19.5%) on the femoral side and in 14 (34.1%) on the tibial side. The incidence of radiolucent lines was not significantly different between knees with osteoarthritis and those with rheumatoid arthritis, nor among the three types of prosthesis. Data on component position or postoperative femorotibial angle showed no correlation with the incidence of radiolucent lines. Tibial component subsidence was seen in 6 (14.6%) knees and in these knees tibial component coverage rates were less than 95%.
Forty eight cementless Miller-Galante total knee arthroplasties in 35 patients were evaluated rentogenographically. Twelve patients (15 knees) had rheumatoid arthritis and 12 patients (35 knees) had osteoarthritis. Mean age was 66.9 years, ranging from 53 to 80 years. Mean follow up period was 28.8 months with a range from 12 to 60 months. Good position of femoral and tibial components and good alignment of femoro-tibial angle was obtained in all joints, but incongruency of patello-femoral joint increased with time. Gap which was seen one month postoperatively disappeared one year later. Femoral subsidence was seen anteriorly and tibial subsidence was seen postero-laterally but these changes had not increased one year postoperatively. No patellar subsidence was seen in any joints. No radiolucency occurred around the pegs of any components. Tibial radiolucency was seen antero-medially and patellar radiolucency was seen at the edge. Femoral radiolucency was not seen in the majority of cases. These radiolucencies were less than 1mm and the width of radiolucency did not increase after one year postoperatively. These data were considered to be satisfactory except for the patero-femoral joint.
Sixteen cases (20 knees) of arthroplasties using the AMK prosthesis were clinically and radiographically evaluated. The mean age was 69 years in the osteoarthritic group (11 cases) and 58 years in the rheumatoid arthritic group (5 cases). The follow-up period ranged from 6 to 27 months (mean 19 months). Mean JOA knee rating score improved from 55 to 78 points in the OA group and from 51 to 73 in the RA group. Supine active flexion averaged 125° preoperatively and 111° postoperatively in the OA group, and 100° preoperatively and 105°postoperatively in the RA group. Radiolucencies, present in two cemented tibial components, were less than 1mm. Sclerotic lines were noticed at the bone-implant interface in five tibial components and one femoral component. No cases of dislocation or subluxation of the patellofemoral joint were seen on the axial view.
A rare case of total aplasia. of the posterior arch of the atlas is presented. A 67-year-old man complained of left forearm numbness. X-ray and CT findings showed a complete absence of the posterior arch of the atlas. No bone or catilage was seen there on MRI. A week later he had been completely free of symptons with no treatment. This case is the second report of total aplasia of the posterior arch of the atlas in Japan.
We studies 57 knees in 55 patients. 47 knees in 43 had osteoarthritis (OA), and 9 knees in 7 had rheumatoid arthritis (RA). Average age was 71.0 years and the mean follow-up was 3.5 years. On radiological examination, no cases had a “Clear Zone” of over 2mm. Six knees (10.5%) had patella malposition. Using the criteria described by three universities, clinical score was 83.0 points in OA and 80.0 points in RA. These successful results may have been due to preoperative traction, ROM exercise, and exact surgical technique.
Total Knee replacement for cases with knee ankylosis or revision of TKR with Patella infra require extra surgery. Two cases of tibial fracture following TKR with osteotomy of the tibial tubercle as an extra operation were reviewed in this report. We believe that the cause of the tibial fractures was initiation of full weight bearing at too early a stage in recovery.
We monitered the anterior compartmental pressure of the lower leg continuously using the Millar transducer systems following high tibial osteotomy. We measured 8 anterior compartmental pressures [7 women, 1 man, average age 61.3 (50-68) years old] who were diagnosed as seven cases of osteoarthrosis and 1 aseptic necrosis of the medial femoral condyle preoperatively. We measured the anterior compartmental pressure 6 hours postoperatively and investigated factors that influence this pressure. These factors were (1) active and passive dorsiflexion, plantarflexion of the ankle, (2) to elevate and lower the lower limb, (3) to clamp the drain for 1 hour, (4) attachment of venous foot pump to the plantar portion for 1 hour. We found that active dorsi and plantar flexion of the ankle, and clamping the drain increased the anterior compartmental pressure significantly, but elevating the lower limb and attachment of venous foot pump decreased compartmental pressure significantly.