We treated 15 cases of humeral shaft fracture at Kitakyushu City Hospital from 1989 to 1992. Subjects comprised 10 male and 5 females with a mean age of 35.6 years (range: 17-72 years). Fractures were classified using the AO system. We treated 13 cases surgically and the other 2 cases were managed conservatively. Six cases were treated with plate fixation, 5 cases with Ender nailing, one case with Hackethal stacked nailing and one case with screw fixation. Non-union occurred in 3 cases.
We report 10 cases of acute Galeazzi fracture-dislocations which we treated during a three years period. The mean age of the patients was 51.4 years, and six of them had classical Galeazzi fractures, and four had Galeazzi-equivalent fractures. Three fractures were treated by closed reduction and percutaneous pinning, three with open reduction and internal plate fixation, three with external fixation and bone graft, and one with open reduction and internal K-wire fixation. All fractures were evaluated using Kanazawa's criteria. Results were judged to be excellent in five cases, fair in three, and poor in two. The two poor in two. The two poor cases were older women, one with osteoporosis the other with a comminuted fracture of the distal third of the radius. Computerized tomography was valuable in diagnosing subluxation of the distal RU joint. Postoperative temporary K-wire fixation of the distal RU joint in the neutral forearm position was effective.
Clinical results and problems in treating fractures of the distal radius in children were evaluated. Sixty-two children below the age of 15 years were treated at our hospital either with conservative or surgical treatment (percutaneous pinning). Seventeen cases had epiphyseal plate injuries, 23 were Colles' or Smith's fractures, and 22 had fractures of the distal 1/5 of the diaphysis. There were no cases of intra-articular fractures, and clinical results for all patients were excellent. In two cases with fractures of the distal 1/5 of the diaphysis, re-displacement occurred during plaster immobilization, so that reoperation was necessary. In this study, fracture of the distal radius in children was shown to be rarely characterized by intra-articular fractures and progression of residual deformity. Thus, excellent results were achieved, with fractures of the distal 1/5 of the diaphysis the only ones that occasionally re-displaced.
Carpometacarpal (CMC) dislocation or fracture-dislocation are uncommon hand injuries. We report four cases treated during the past three years. One patient had dislocation in all four ulnar CMC joints. One in the 4th and the 5th, one in the 4th, and one in the 5th CMC joint. Closed reduction and cast mobilization were performed in one case and closed reduction and percutanous fixation in one. Open reduction and internal fixation were performed in two cases. All cases achieved excellent results. Closed reduction and cast mobilization are thought to be good treatment for some cases with CMC dislocation or fracture-dislocation.
The Herbert bone screw was originally developed for internal fixation of fractures of the carpal scaphoid bone but has proved to be so effective its use has now expanded to include fixation of other fractures. We used the cannulated Herbert bone screw for treatment of fractures (ankle ten, foot eight, knee seven, elbow five, shoulder three, distal radial bone one, hand one). The mean age of patients at the time of the injury was 38 years and 11 months, ranging from 17 to 73-years. Good bone union and clinical results were obtained in all cases. Advantages of this procedure are; (1) Lack of a protrusive head allowing it to be positioned in thin soft tissue parts (Malleolar, Olecranon). (2) Surgical technique is easier using the guide pin. (3) Screw threads which are at both ends have different pithces so that during insertion rigid compression is produced across the fracture line.
We report 30 cases of comminuted fractures of the distal end of the radius treated with Hoffmann-C type external fixation. The mean age of patients was 56 years (range, 29-79) years. The follow-up period ranged from 4 to 51 months, with a mean of 19 months. The external fixation device was used for about 4 weeks and then a short arm brace with the wrist in a neutral position was used for about 10 days. We added an other procedure, such as percutaneous fixation with K-wire, or open reduction with bone graft or plating, when the reduction was not maintained solely by external fixation. Anatomical and functional treatment results were good. According to Saito's point system, 26 cases were judged to be excellent, 3 cases were good, and 1 case was fair. The Hoffmann-C type external fixation device is recommended for comminuted fractures of the distal end of the radius.
External fixation apparatus is a feasible treatment for unstable fracture of the distal radius. We have used two types of apparatus, static and dynamic type. The static type provides rigid immobilization for several weeks after operation. The dynamic type allows early motion of the wrist with the apparatus. Results with these two types were analyzed in a consecutive series of 39 unstable distal radial fractures. The Ace-Colles external fixator was used in 17 patients and the small Hoffmann fixator was used in 4. The Clyburn dynamic external fixator was used in 16 patients and Penning model was used in 2. The maintenance of reduction with the dynamic type was the same worth of the static type by using the Kirshner-wire fixation. Although the patients treated with dynamic type started the exercise of the wrist motion at an average day of 18 after operation, the recovery of the range of motion was not earlier than the recovery treated with static type. Clinical results as assessed according to Satio's point system demonstrated no significant difference between two types. To provide rigid fixation, early ROM recovery and early social recovery, we need the dynamic external fixation with Kirshner-wire fixation for the dorsal fragment and ROM exercise of the wrist as early as possible after operation.
The Pennig model external fixator is a new device, which allows early excercise of the wrist joint without displacement of the fragments, by dynamic axial external fixation. We used this device for treating 6 patients. Internal fixation was supplemented in one patient, and bone grafting in one. The range of motion in the wrist joints with the external fixator was 20 to 58 degrees (mean 28 degrees). Functional results after a follow-up of 5 to 13 months (mean 7 months) were excellent in 2 patients, good in 2 patients and fair in one. Anatomical restoration was obtained in all patients radiographically. One case was complicated by Guyon canal syndrome and RSD, and displacement occurred in one patient following loosening of the screw.
In 1981 a case of spontaneous sternal segment dislocation in a patient with no evidence or history of trauma was reported by Schadmore. We experienced a case similar to the one he described. The patient was a 3-year-old girl who complained of intermittent midsternal pain after her chest was accidentally hit by the head of her one-and-half-year-old friend. No abnormality was detected by roentogenogram at the orthopaedic clinic on the day of injury. Two weeks later., her father noticed that she had a chest deformity and she also exhibited tenderness at the midsernal region, but no redness or local heat were noted. Her lateral chest roentgenogram showed a dislocated first segment of the body of the sternum. At surgery, we found the superior end of the first segment of the body of the sternum. There was no fresh bleeding or reactive granulation tissue. We were able to reposition the segment easily, using a plate to fix it. No finding of osteonecrosis were found on pathological examination. Six months later, after removal of the plate good fixation of her sternal segment was achieved.
We studied nerve injuries caused by supracondylar fractures of the humerus in children. From April 1988 to May 1993, we treated 60 children with supracondylar fractures of the humerus. Ten of these cases (16.7%) had nerve injuries and according to Smith's classification, seven were the complete displacement type and three were the moderate displacement type. Sixteen cases with nerve injuries were examined. The mean duration of follow-up was 7.7 months ranging from 2 to 16 months. The radial nerve was injured in 7 cases, median nerve in 6 cases, radial and median nerves in 2 cases and ulnar nerve in 1 case. Neurolysis was performed in only 2 cases. In radial nerve palsy, recovery of extensor digitorum communis was seen within 4-8 weeks (mean, 7.3 weeks). In median nerve palsy, recovery of flexor pollicis longus began within 4-13 weeks (mean, 9.4 weeks). In the complete displacement type, neural complications were found at a considerably higher rate (43.8%). Almost all cases obtained good results with conservative treatment.
We report a case of injury to the lateral humeral condyle associated with fracture of the olecranon. It was suggested that the mechanism of injury was a varus strain and an indirect force along the forearm on the extended elbow and supinated forearm caused by a fall onto the outstrectched hand. This injury may be included as the equivalent of the Monteggia lesion.
We report a rare case of distal ulnar physeal injury in Kendo players. A 14-year-old male complained of left wrist pain. Radiographs showed a distal ulnar physeal injury, which was judged to be Type I using the Salter-Harris classification system. He was treated conservatively with immobilization for about one month, and was prohibited from playing Kendo for approximately four months. After that time he returned to play Kendo with no complaints.
Callotasis is a leg lengthening technique using slow distraction of callus which is formed in response to a subperiosteal osteotomy. This technique is now widely used in the orthopedic field to treat leg length discrepancy and short stature. However, little is known about bone modeling during callus elongation. In this study we evaluated the mineralization and modeling process at the site of leg lengthening by dual energy x-ray absorptiometry and radiographical examination using experimental models. The bone mineral content (BMC) reached a maximum when the distraction gap was filled with newly formed bone according to the x-rays, and decreased when medullarization and corticalization began radiographically. After seven weeks, when the BMC became constant bone modeling in the gap was completed. The BMC changes reflect the mineralization and modeling process at the lengthening site.
We report the experience of leg lengthening by callotasis with Orthofix fixator for 11 femoral and 4 tibial bone segments in 13 patients. Five patients were male and eight female, ranging in age from 11 to 21 (mean, 14.3±2.7 years). Leg length discrepancy before surgery ranged from 2.3 to 9.0cm (mean, 4.5±2.1cm). The amount of lengthening achieved 2.5 to 8.7cm (mean, 3.8±1.4cm). The healing index ranged from 27.2 to 85.9days/cm (mean, 48.2±15.5days/cm). Thirty-four complications occurred in 15 lengthening procedures. Serious complications included 5 fractures following removal of the fixator, one pin-tract infection with osteolysis necessitating fixator removal, one subluxation of the hip, and 4 delayed consolidations. All fractures healed by surgical or conservative methods. One case of hip subluxation was reduced by varus osteotomy of the femur. All delayed consolidations showed good bone formation with pulsing electromagnetic fields. Leg lengthening by callotasis was conchiaded to be a satisfactory procedure for treating patients with leg length discrepancy.
We report three cases with complications following hip arthroplasty. Case 1 was a dislocation after total hip arthroplasty. Case 2 was gaze residue in the femoral shaft. Case 3 was separation of the femoral and acetabular components of the endoprothesis. Each case was assessed, looking at the cause of the complications, and possible preventative measures.
We have investigated case of bipolar end prosthesis after which the patients required revision arthroplasty. There have been 7 osteoarthritis (OA) patients and 4 rheumatoid arthritis (RA) patients and one infection patient after femoral neck fracture. The most important problem is migration, especially in case of acetabular dysplasia. Both the timing of partial weight bearing and revision arthroplasty are very difficult.
We report 45 cases of THR and 81 cases of femoral endoprostheses which were treated at our department over the last ten years, complications included 2 cases of femoral fractures, 1 case of failed cement during surgery and 2 cases of accidental dislocations after surgery. It is important that we make careful preparation for surgery and take steps to cope with post-operative situations. This necessitates the collection of accurate informed consent from our patients so that they frully understand the procedure, and possible risks.
Eighteen cases which developed complications following treatment for fractures and dislocations of the hip were analyzed to avoid and overcome such problems. Complications included re-fracture (7 cases) after osteosynthesis or endoprosthesis, postoperative dislocation of endoprosthesis (6 cases), external rotational mal-union, limitation of ROM, injury of artery, surgical fracture, and dislocation of the hip joint after re-open reduction. Complications were due to lack of knowlege, unskilled surgical techniques, osteoporosis, paralytic disease (spastic paralysis, hemiplasia), mental disease (dementia), and inadequate countermeasures for dealing with those complications or background disease. It is essential to avoid complication and therefore we have to assess patient's conditions more carefully and master skilled surgical techniques. It is even more important for us to be aware of the possibility of such complications developing, and if necessary to start treatment as soon as possible.
We report 2 cases of vascular complications experienced in 76 bipolar hip arthroplasties (BHA) carried out since 1987. Case 1 was a 58-year-old woman with bilateral OA hip. Left BHA and acetabular plasty using resected femoral head were performed. Low blood pressure and progressing anemia were observed after surgery. Anemia persisted for 3 days in spite of blood infusion. Abdominal CT scan revealed retroperitoneal hematoma (700ml). Femoral vein obstruction was found on venography. It was suspected that injury to the external iliac vein occurred during acetabular drilling for reconstruction of acefabular roof using femoral head. Case 2 was a 75-year-old woman with right OA hip. Right BHA was performed without any trouble. On the 2nd postoperative day, she developed sudden dyspnea, cyanosis and shock. In spite of cardiopulmonary resuscitation and intensive care, she died 2 hours later. Ultrasonic cardiogram showed a dilatated right ventricle and filling failure of the left ventricle. A massive pulmonary embolism was found on pulmonary angiogram. In conclusion, accidental perforation of the external iliac vessels can be avoided by careful planning and careful surgical techniques. In a case with massive pulmonary embolism, immediate diagnosis and removal of thrombus may save the patient.
We reviewed 22 primary arthroplasties (in 16 patients) in which cementless porous-coated hip prostheses were used and evaluated these case clinically and radiographically. The mean age of patients at surgery was 61 years (range 45 to 76 years) and they were followed up for an average of 54 months (range 37 to 69 months). Osteoarthritis was the most common diagnosis. The average preoperative JOA hip score was 47.5 points and the average postoperative score was 83.5 points. Two hips (9%) had femoral component loosening. In 4 hips (18%) there was calcar resorption of more than 3mm. In 15 hips (68%) there was a radiolucent line in zones 1 and 4. Five patients (31%) complained of thigh pain, and of these, two had radiographic evidence of loosening of the femoral component. There were no revision arthroplasties, although some cases were awaiting revision.
Forty-one rtheumatoid arthritis patients treated with total hip replacement were followed for more than five years. 14 cases had died and 4 were lost to follow-up, so 23 cases were evaluated regarding their ability to move, activity of daily living (ADL), and quality of life (QOL). Among these patients, 21 (51%) were treated with more than 2 total arthroplasties. Among the 23 patients, 2 were on bed rest, 2 were in a wheel chair, and 19 were able to walk. They could walk well according to the decrease in number of affected lower limbs joints. Some patients maintained good function in ADL and QOL for a long period.
Fourteen revisions in 14 patients were evaluated. The cause of revision was aseptic loosening in nine joints, dislocation in two joints and other causes in three. Mean age was 65.5 years (ranging from 46 to 78 years). Mean follow-up period after revision was 4.1 years with a range from 0.5 years to 9.5 years. We used a cemented prosthesis (Charnley) in 10 cases, and cementless ingrowth prosthesis with bone graft in 4 cases. Postoperative clinical results were compared with reference to these two types of prostheses and results achieved using the cemented prosthesis (Charnley) were worse at one year after surgery. In comparison results of the bone ingrowth prosthesis with bone graft showed a good clinical course. In conclusion, the bone ingrowth prosthesis with bone graft appeared to be a preferred candidate for revision of THA.
Transtrochanteric, posterior and antero-lateral approaches are the main surgical approaches used for total hip arthroplasties. An approach which compensates for the disadvantages associated with these methods is the uncommon transgluteal approach for total hip arthroplasties with bone cement. We observed the operation time and blood loss in 59 patients having total hip arthroplasty and found that it is possible to shorten the operation time and to reduce bleeding by this approach.
We investigated hydroxyapatite (HA)-coated metal implants to improve the fixation of cementless total hip replacements (THR). We found postoperative thigh pain in 30.7% (46/150 joints) of Harris Galante Porous (HGP) type THR and 5% (1/20 joints) of HA-coated THR. HA-coatedtitanium sprayed Ti-6Al-4V might improve the fixation of HA-coated THR in which HA was coated onto the flat Ti-6Al-4V.
Patient with metal implants are considered a contra-indication for MR imaging primarily because of the potential hazards associated with their movement, heat production and artifact. To find out whether MR imaging is safe in patient with prosthesis, or can be safe, we evaluated the movement, heat production and artifact. 4 prosthesis (three hip prosthesis, one knee prosthesis) are selected for this study. MR unit was used 0.5T, 1.5T and 2.35T. T1 weighted and T2* weighted MR imaging was performed. To evaluate the movement, we measured deflection forces at the portal of the magnet of each MR unit. And we measured the change of temperature at the prosthesis surface by using an electrical thermomenter. We also studied the artifact which caused by the influence of prosthesis. These results showed patients with prosthesis can be safely and usefuly imaged with MR imaging.
Evaluation of bone graft viability for acetabular reconstruction was investigated with single photon emission computed tomography (SPECT). SPECT was helpful in producing anatomic reconstruction of the acetabulum and in evaluating viability of acetabular bone grafts. Data were corrected with reference to sacral activity for the purpose of comparing with serial SPECT. There was a slight aberration in correction of this method when the corrected data were confirmed using the activity of the opposite anterior superior iliac apine. However the aberration was less than 10% of the activity. Progress of incorporation and revascularization of the graft might be able to be assessed using serial standardized SPECT, and this information may be useful in preventing graft migration.
Peri-prosthetic bone mineral density (BMD) was determined using dual X-ray absorptiometry (DXA) (LUNAR DPX). Thirty-three uncemented primary unilateral hip arthroplasties were performed in 33 patients with a mean age of 57.1 years, 26 hips for osteoarthritis and 7 for aseptic femoral head necrosis, with one to 70 months' follow up. The types of prosthesis were Omnifit for 8 hips and Omniflex for 25 hips. The areas measured were Gruen's 7 zones around the femoral prosthesis. Both the operated and contralateral femurs were measured in each patient and the BMD values expressed as BMD ratio (operated/contralateral). The coefficient of variation in BMD determined in 6 subjects was 1.9%. In the cross sectional study, a decrease in BMD ratio as observed at zone 1, 2 and 7. The results suggest that bone loss around proximal prostheses occurs gradually after surgery.
Bone mineral density (BMD) around the stem of OMNIFLEX® was measured 2-4 times (mean 2.9 times) during 15 months after surgery with Lunar DPX in 16 hips of 14 patients (OA, RA or ANF). Percent BMD changes per month were calculated in 7 regions according to Gruen's classification. Bone mineral density reduced most markedly during the first 6 months after surgery in every region, and than stabilized or increased in later periods. During the first 6 months, region 7 (Calcar region) showed the most marked BMD reduction when compared to other regions. BMD was stabilized or increased in at least 50% of patients the earliest (3-9 months) in region 1 and 2, 6-12 months in region 3, 9-15 months in region 4 and 7, while BMD kept reducing in region 5 and 6 throughout all postoperative periods. This finding suggests that BMD stabilized or increased earlier on the lateral rather than medial side of the stem.
Bone mineral density of the hip joint was measured by dual energy x-ray absorptiometry. 134 hip joints were studied by Lunar DPX. Fifty cases had OA, 12 cases had RA, 5 cases had ANF, and 10 cases were normal hips. There was a correlation between OA and normal hip BMD at the neck. BMD of the acetabular load-bearing area of OA was significantly higher density, and that of BMD of RA was lower density. The BMD of hip joint was useful in determining the surgucal method to be used.
The sagittal pelvic tilt angle (A) of 11 patients with rapidly progressive coxopathy (RDC) was calculated using the equations reported by Doiguchi et al. 1992. These were, A=-67.0xL/T+55.7 (male) or A=-69.0xL/T+61.6 (female) based on measurement of the longitudinal (L) and transverse (T) diameters of the pelvic cavity from anterior-posterior radiographs of the pelvis. These were then compared with those of 19 patients with advanced osteoarthritis (OA) hip and of 6 with normal hips selected as age-matched controls. The average pelvic tilt angle with RDC was 34.1±7.2°, which was significantly larger thah the values found with both controls: 26.2±9.1° for the advanced OA and 25.0±2.7° for the normal hip. Results of this study showed that the pelvis of the RDC patient inclines excessively posteriorly which may be associated with the pathomechanism of rapid destruction of the hip joint in this condition. A
We measured preoperative plain radiographs and computed tomograghs (CT) of hip osteoarthritis secondary to acetabular dysplasia in 34 cases. All patients were female, ranging in age from 37 to 76 years (mean 57 years). We studied the preoperative estimation of socket size and position, and compared this to the actual socket size. Preoperative measurement using CT was useful in the determination of socket size. Differences in the estimated and actual sizes were within 2mm in 81% of cases. For a case with over 50 degrees in the Sharp angle, massive bone grafting or high positioning of the socket during THA may be required. In regard to component loosening, larger socket size is useful for planning and actual setting intraoperatively, because larger sockets reduce the amount of bone graft and are set in a lower position.
The algorithm of rigid body spring models (RBSM) is improved by adding an iteration process, with loading muscle force representing the external force, like a load incremant model. Using such an algorithm, muscle force can be input into computer analyses of human joint mechanics. This methood also means that the center of the femoral head does not need to be assumed. Moreover, changes in pressure distribution do not occur abductor muscle spring constant. This new method may be useful in evaluating muscular systems.
We have been performing spherical acetabular osteotomy (SAO) for treating pre-and early coxarthrosis. An assessment of the acetabular head coverage and stress distribution in SAO using a three-dimensional method was carried out. We evaluated 59 patients (64 hips), 8 of whom were male and 51 female. The ages at the time of operation ranged from 13 to 63 years (mean, 30.5 years) and the mean follow-up period was 4.8 years. The mean acetabular coverage improved from 38% preoperatively to 84.9% postoperatively. The mean preperative CE and Sharp angles improved from-10 and 52.6 degrees respechively to 34.8 and 40.5 degrees postoperatively. In the majority of SAO hips, acetabular coverage and stress distribution improved to reach almost normal values. In assessing pre-and postoprative status, analysis of the 3-D finite element method was useful, added to the 3-D acetabular coverage.
To understand the mechanial charasteristics of vertebral body structures, especially the effect of posterior elements, a stress analysis of the lumnbar spine was performed using the three dimensional finite element method. The FEM model contained two adjacent vertebre and the intervertebral disc, the structures of which were cortical bones, cancellous bones, annulus fibrosis, nucleus pulposus and ligament. We made three models which had different facetal angles. Compulsory displacement was applied to the models and the stresses and displacements were computed using the FEM program. The model which had larger facetal angle revealed bigger displacement.
This study was done clarify the biomechanical factors causing spondylolysis using a three-dim ensional finite element method and 3D-CT. The geometry of the finite element model is based on the L5 posterior element of a 29-year-old man. Simulated loads were applied to the surface of the superior and the inferior facets vertically. Stress distribution results indicate that there were high stresses in the pars interarticularis, especially the ventral cortical bone. The results of finite element studies and the general lesion of spondylolysis were in agreement, and were confirmed with 3D-CT. It is sugested that stress is an important factor in the etiology of spondyloloysis and that 3D-CT is a valuable tool in diagnising the incipient stage of this disorder.
This study investigated the biomechanical characteristics of the lumbar facet joint using a three-dimensional finite element method. The geometry of the finite element model is based on the L4-5 motion segment of a 29-year-old man, obtained from 2mm thick computed tomography scans. The finite element model included material properties of cortical bone, cancellous bone, cartilage, nucleus pulposus and annulus fibrosus. Simulated loads were applied at the top of the upper vertebral body, while the lower vertebra is fixed. Results of the stress distribution showed that the highest stress was on the upper lesions of the inferior facet surface and the upper margin of the superior facet surface in flexion, the lower lesions of the inferior facet and the lower margin of the superior facet in extension.
Recently diagnosis of lumbar spinal desease has been made using radiological imaging techniques such as myelography, CTM, and MRI. Lumbar spinal diseases consist of both structural abnormalities and nerve damage, therefore electromyography is essential for diagnosis. We examined the conduction velocity and amplitude of SNAPs of the saphenous nerve, superficial peroneal nerve and sural nerve, and investigated the effects of increasing age on these. Nerves from 50 healthy subjects were studied and the mean conduction velocities and amplitudes were respectively, : saphenous nerve, 54.6±2.5m/s, 19.5±4.8μV: superficial peroneal nerve, 54.8±2.2m/s, 14.9±4.4μV: sural nerve, 52.4±2.8m/s, 5.44±1.0μV. The decline in conduction velocity and amplitude of these nerves with increasing age was more remarlable in patients over 50 years of age. Electrophysiological investigation of distal sensory nerves is a useful method of determining the site of nerve lesions, but we should give careful consideration to the effects of age.
In cervical spondylosis typical electromyographic findings are 1) normal insertional activity, 2) no spontaneous activity, 3) normal motor unit potential (MUP), and 4) reduced interference pattern with slow rates of firing of individual MUPs. We examined spontaneous activity (fibrillation potential) from deltoid, biceps brachii, triceps branchii, abductor pollicis brevis and abductor digiti minimi in 10 cases of cervical spondylotic myelopathy and 5 cases of cervical spondylotic amyotrophy. Fibrillation potentials were recorded from one muscle (abductor pollicis brevis) in 10 cases of cervical spondylotic myelopathy. Fibrillation potentials were recorded from eight muscles (deltoid 4, biceps branchii 3, triceps branchii 1) in 5 cases of cervical spondylotic amyotrophy. All muscles which had fibrillation potentials were atophic. MMT of those muscles were poor. Fibrillation potentials in cervical spondylosis indicate necrosis of anterior horn cell or degeneration of radix ventralis.
We report a patient with osteopetrosis who suffered the rare occurrence of traumatic multiple fractures of the cervical spine (C2-C6). The patient was a 14-yeas-old boy who fell head-first onto a high-jump mat while wrestling with a friend. Flexion and compression were apparently caused by the sudden external force exerted on the cervical spine, resulting in multiple fractures of the cervical vertebrae. Plain X-ray films, CT scans, and MRI revealed a continuous fracture extending across multiple vertebrae like a crack in a china plate. Bone union was delayed in this patient when compared with that in healthy individual. The possibility of cervical spinal deformity and intervertebral disc degeneration needs to be checked during long-term follow-up, and education of the patient is necessary to prevent spinal cord injury that may be brought about due to bone fragility in this condition.
It is not well-known that articular pillar fractures often occur in association with whiplash injuries. We evaluted the pillar views of 74 patients who were injured in traffic accidents. In 44.8% of patients, we detected articular pillar fractures. Most of the fractures occurred at C6 or C7. However on the standard lateral view, no articular pillar franctures were detected. Pillar view is a useful screening method for articular pillar fractures. Noboribetsu Kouseinenkin Hospital
We report a case of dural laceration occurring with lumbar burst fractures which was suggested by preoperative MRI and confirmed by Surgery. The patient was a 37-year-old man who fell from a 6m height while working and was transported to our hospital. Plain X-ray studies showed burst and laminar fractures of the third and fourth lumbar vertebrae. However, only slight numbness was noted in the left dorsal femoral reqion. Since preoperative MRI suggested dural laceration, posterior decompression and fixation with pedicle screws were performed and the patient's postoperative course was uneventful. Surgical treatment is indicated for thoracolumbar burst fractures especially when accompanied by neurological symptoms or shows marked instability. However, dural laceration may be present even though neurological symptoms are unremarkable as in the present case. Preoperative detection of dural laceration is considered to be important for selection of appropriate treatment.
We report our investigations into the detailed pathogenesis of cervical spondylotic radiculopathy from examining the anatomical morphology of the cervical spine in 111 cadavers, and the spinal cord in 5 cadavers. At the facet joints, most of the superior articular processes at C4 and C5 were located anterior from the posterior margin of the vertebral body, while most of the superior articular processes at C3 and C7 were located posterior from the posterior margin of the vertebral body. Examination of the nerve roots derived from the spinal cord, revealed that the motor roots at C4, C5, C6, and C7 were derved from the spinal cord with significantly more width than the C8 motor root. Also, sensory roots derived from the spinal cord with a smaller width than motor roots. We postulate that main causes for cervical spondylotic radiculopathy are these morphological differences at the level of the cervical spine.
Cervical orthoses are always used to treat neck diseases and injuries. In these diseases, the orthotic goals may be to relieve pain and to support the unstable spine. However cervical orthoses are not comfortable for patients with rigid fixation. Since 1990, we have used the “Neck—Chest brace” following surgery on the cervical spine (C2 or C3-C7). Features of this orthosis are: (1) This brace is very light (about 300g) (2) We are able to use this orthosis for patients confined to bed. (3) After cervico—thoracic fixation, we can use this as a collar.
Application of the sternum-splitting approach is relatively rare in anterior spinal surgery. We treated a 66-year-old woman with a metastatic lesion in the second and third thoracic vertebrae. The first operation using this approach was not successful, with the cause of failure appearing to be inability to gain a sufficiently large operative field for removing the metastatic tumor. When removing metastatic tumors, bleeding occurs easily. The second operation using the posterior approach was conducted 2 months after the first. Following resection of the tumor in the spinal canal, Luque instruments and bone cement encasement were used to reconstruct the spine. Therefore, we concluded that treatment of upper thoracic metastatic tumors by this sternum-splitting approach appears difficult.
A 51-year-old male with right C8 radiculopathy and a 59-year-old male with severe myelopathy, resulting from cervical disc herniation at the C7/Th1 level, were treated with anterior decompression and fusion. After surgery atrophy of the intrinsic muscles in the right hand showed marked recovery in the first case, and the gait disturbance seen in the second case completely resolved. Murphey reported that only 50 of the 648 operated cases (8%) showed C8 radiculopathy. There were no cases with myelopathy due to C7/Th1 disc herniation in Kokubun's 120 surgical cases. Therefore it was rare to find disc herniation at this level. We should take care not to incise the C7/Th1 disc too laterally, because our radiological study demonstrated that the uncinate process of Th1, indicating the lateral disc margin, had not been well developed.
Oxygenation at high pressure (OHP) has been used to treat a range of conditions, including decompression sickness, peripheral obstructive disease, anaerobic infection, and sudden deafness. Recently the effect of OHP on spinal lesions was reported. We used OHP to treat seven patients with spinal disorders. In the OHP chamber, we gradually increased the atmosphere up to 2.5 atmospheres absolute (ATA) over fifteen minutes and kept it at this level for 60 minutes. We then reduced the atmosphere to 1.0 ATA. This treatment was given once a day. However improvement in symptoms was observed in only one case, and we concluded that this therapy was not effective for treatment of spinal lesions.
Twenty one patients who underwent needle biopsies for spinal disease were analyzed. The final diagnoses in these patients were 11 cases of pyogenic osteospondylitis, 3 tuberculous osteospondylitis, 3 metastatic spinal tumors and 4 compression fractures. Ten of the 11 cases with pyogenic osteospondylitis, 2 of 3 tuberculous osteospondylitis, 1 of 3 metastatic spinal tumor and all compression fractures were correctly diagnosed by needle biopsy. Needle biopsy is easy, less invasive and has a high diagnostic ratio, so is useful in the diagnosis of spinal diseases.
Thoracic degenerarive diseases have many clinical signs and symptoms. In particular when multiple thoracic lesions and complications with cervical or lumbar lesions are suspected, it is often difficult to diagnose their main focus. We clinically investigated 30 patients with thoracic degenerative diseases, with a post-operative follow-up period of over one year. Of the main thoracic lesions, ossification of the yellow ligament (OYL) was found in 18 cases, ossification of the posterior longitudinal ligament (OPLL) was seen in 4, OYL+OPLL in 5, thoracic disc lesions in 2, and spondylosis in 1 case. Patient's ages ranged from 19 to 70 years old (mean, 51.4 years). The duration of symptoms ranged from 2 weeks to 20 years (mean, 5.4 years). The main factors which influenced the prognosis were severity of symptoms and trauma. Average improvement rate with JOA score (by Hirabayashi) was 63.9%.
We measured urinary excretion of pyridinium crosslinks (pyridinoline and deoxypyridinoline) as bone resorption markers to clarify the cause of OPLL. Twenty-two male patients with cervical OPLL aged from 53 to 69 years (mean 61.5 years) and 19 healthy males aged from 50 to 68 years (mean 59.5 years) were measured. Pyridinoline in urine in the patients with OPLL was significantly higher than that in controls. However, deoxkypyridinoline in urine was not significantly higher in the patients with OPLL. This type of basic study on bone metabolism may provide useful data to clarify the etiologicao mechanism of OPLL.
Bone Mineral Density (BMD) was measured by Dual-Energy X-Ray Absorptiometry (DXA) in 101 patients with OPLL who were treated conservatively and compared to 86 healthy adult volunteers. Estimation of BMD was carried out in the cervical, and lumbar vertebral bodies, and radius. In the cervical and lumbar vertebral bodies BMD of OPLL patients were higher than that of controls. However, BMD in the radial diaphysis was not significantly different betwreen OPLL patients and controls. In the metaphysis of the radius BMD was slightly higher in OPLL patients compared to controls. BMD value incveased in cancellous bone in comparison with cortical bone in OPLL.