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A Case Report
Masatsugu Suehiro, Masayuki Kondo, Ryuzou Mashima, Noboru Yatsugi
1994 Volume 43 Issue 4 Pages
1349-1351
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We report on a case of a 45-year old woman with cauda equina syndrome due to lumbar disc herniation at L5/S1.
This patient did not have lower back pain nor gait disturbance.
Muscle strength of her lower extremities and the tension sign was intact.
We consider that this extraordinary status resulted from the location and size of herniation.
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Shoji Gotoh, Takayoshi Torigoshi, Ryohichi Takasuga, Hiroaki Konishi, ...
1994 Volume 43 Issue 4 Pages
1352-1355
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Myelography was performed in 209 cases with lumbar disc hernia treated operatively from 1987. We categorized myelographic findings into 5 types (type 1: defect of root, type 2: 1/3 defect of dural sac, type 3: 2/3 defect of dural sac, type 4: incomplete block, and type 5: complete block). Younger cases tended to have small defects while older cases had large defects. Lower disc level (L4/5, L5/S1) tended to have smaller defects than upper disc levels (L1/2, L2/3, L3/4).
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Correlation of Spinal Instability and Surgical Outcome
Kazunori Yone, Takashi Sakou, Mitsuhiro Yanase, Toshihiro Okano, Yoshi ...
1994 Volume 43 Issue 4 Pages
1356-1358
Published: September 25, 1994
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we exmamined the effect of lumbar spinal instability on surgical outcome of lumbar canal stenosis. Thirty-two patients with lumbar canal stenosis who underwent fenestration were studied. Anteroposterior and angular displacement were determined for each lumbar motion segment on the preoperative lateral flexion-extension radiographs. These measurments were compared with the surgical outcome. Fenestration resulted in good outcome in 12 of 14 patients who had less than 10% of dynamic anteroposterior translation and greater than -5° of angular rotation in flexion. However, fenestration was effective in only 7 of 18 patients who had greater than 10% of dynamic anteroposterior translation and less than -5° of angular rotation in flexion.
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Yuji Taoka, Masakuni Naruo, Eiichi Koyanagi, Misao Urakado, Toshimitsu ...
1994 Volume 43 Issue 4 Pages
1359-1361
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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This study investigated the clinical and radiographic features associated with lumbar canal stenosis in patients over 70 years of age (group A) and compared them with patients under 60 years of age (group B).
Clinical results were evaluated using JOA score and recovery rate using Hirabayashi's method. In group A, the preoperative mean score was 12.4 points and the mean recovery rate was 70.9%. In comparison, in group B, they were 15.3 points and 85.4% respectively. The degree of leg pain, disturbance of gait and ADL in group A was significantly more severe than that in group B.
According to radiographic findings in group A, degenerative lumbar scoliosis which may aggravate symptoms was often found.
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Classification and Trearment
Kunio Sasaki, Eiichi Ishitani, Kazuo Takabatake, Kazuhiro Matsuda, Yos ...
1994 Volume 43 Issue 4 Pages
1362-1365
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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A flexed posture is seen to develop in association with increasing age. Patients with such a flexed posture have several problems, and it is difficult to treat these favorably. To treat this type of deformity, we must understand the alignment of the patient's spine.
We classified lumbosacral kyphosis into three types depending on sacral inclination and disc degeneration in the lower lumbar spine. Patients with a deformity due to loss of sacral inclination and malalignment in lower lumbar spine showed marked disability in daily life and had severe lumbago.
Sacral inclination seemed to be an important factor in the treatment of patients with deformity both surgically and non-surgically. We may operate on them using lumbosacral fusion and correction using Galveston technique with ISOLA instrumentation.
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Nobuaki Tsunoda
1994 Volume 43 Issue 4 Pages
1366-1369
Published: September 25, 1994
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Features of Isolated Lumbar disc resorption (IDR) especially with reference to the relationship between radiological features and clinical symptoms, were investigated in 113 cases of IDR.
34 IDR patients who were treated surgically were also studied to investigate the relationship between the injured discs and IDR.
(1) In 46 consecutive patients (40.7%), leg pain was the main symptom.
(2) In 85.9% of the leg pain group, some types of disorders such as degenerative spondylolisthesis (31.1%) and retrolisthesis (40.0%) were proven, whereas this figure was 70% in the low back pain group, with only 6.0% having degeneratine spondylolisthesis and 32.8% with retrolisthesis.
(3) In 17 of 34 patients (50%), decompressive surgery was performed at the upper levels of the IDR.
(4) In conclusion, IDR causes sciatic irritation more commonly, and more often is accompanied by great instability such as posterior or anterior slipping.
In addition symptoms can sometimes occur from the upper levels of the IDR.
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Yasunori Fuchigami, Sinya Kawai, Hirotsugu Oda, Takatomo Mine, Kazuo K ...
1994 Volume 43 Issue 4 Pages
1370-1372
Published: September 25, 1994
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Magnetic stimulation at the head were applied to the two patients of hysterical paresis. It was difficult to elicit motor evoked potentials (MEPs) from paretic muscle at rest. It was able to record MEPs from paretic muscle during voluntary contraction of contralateral limb. We applied magnetic stimulation in the six healthy volunteers of intentional paresis on left hand (simulation).
Simulation was continued 8-12 hours. After simulation amplitude of MEPs from left thenar eminence were reduced to 10-50%. It suggesed that motoneuron excitability in cases of hysterical paresis and simulation was inhibited.
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Yasuhiro Hirai, Yasuhiro Shimizu, Mitsuhisa Shigaki, Ko Asayama
1994 Volume 43 Issue 4 Pages
1373-1379
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We recorded somatosensory evoked potentials (SEP) in 6 normal volunteers and 5 patients with spinal cord disorders by stimulating nerve roots with a round coil.
Amplitudes of normal volunteers' SEP were 2 to 4 times as large as those of electric stimulation. The waveshapes of all 5 patients' SEP had normal amplitudes and normal durations with stimulation of nerve roots above the lesions, and small amplitudes and long durations below the lesions.
SEP with electric stimulation is in common use for a diagnosis of C. N. S., but does not identify the level of the spinal cord lesion. In comparison, SEP with round coil magnetic stimulation can detect the level of the spinal cord lesion.
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Michiya Hara, Kousuke Ogata, Hiroshi Nomiyama, Masakatsu Yasunaga, Jun ...
1994 Volume 43 Issue 4 Pages
1380-1382
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Fibular osteotomy at the proximal neck region in high tibial osteotomy (HTO ) was performed in thirty six osteoarthritic knees, and four idiopathic osteonecrotic knees. Follow-up ranged from six to twenty two months, with a mean of one year and one month. An osteotomized region of the fibula was fused in 65% of all cases within three months, and 100% within six months. Complications were found in only a few cases but one had a painful gait and tenderness at the osteotomized region of the fibula. Radiographic findings were classified into three types of bone union, and evaluated with clinical symptoms. Proximal fibular osteotomy required tibial and fibular osteotomy performed with the same incision and stabilization of the osteotomized region with
interlocking fixation. Results showed better union of the osteotomized region so that the new technique of fibular proximal osteotomy should be available for the application of HTO.
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Yasumasa Matsushita, Kousuke Ogata, Michiya Hara, Hiroshi Nomiyama, Ju ...
1994 Volume 43 Issue 4 Pages
1383-1386
Published: September 25, 1994
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Loss of correction due to lack of fixation after high tibial osteotomy still remains an important problem. We have used a new staple that has a bladelike inserting portion and one cortical screw. We radiographically evaluated correlation between position of the staple and its fixation strength. We evaluated forty-one knees after interlocking wedge osteotomy for osteoarthritis and osteonecrosis at Fukuoka University Hospital. The mean length of follow up was 13 months. Staples that were placed 9mm or more distally from the tibial articular surface showed a large amount of loosening. We concluded that the staple should be placed as proximally as possible in the upper tibial fragment to accomplish stable fixation.
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Yasuhide Taniguchi, Kunio Tomonaga, Nobuhisa Uematsu, Masahiro Wada, T ...
1994 Volume 43 Issue 4 Pages
1387-1390
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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From 1982 to 1991, 48 KOM-type total knee prostheses were performed in 44 osteoarthritic knee patients. 34 joints could be followed up, and were evaluated clinically and radiographically. Mean age of patients was 70.4 years (range, 55-83 years). The mean period of follow up was 4.8 years (range, 2-10 years). Mean JOA rating score improved from 44.4 to 74.9 points. Factors which influenced post-operative clinical results were preoperative JOA rating score, preoperative femoro-tibial-angle, and postoperative sinking of the prosthesis.
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Yoshihiro Inoue, Masao Nishizawa, Ryuzi Nagamine, Satoshi Shidahara, Y ...
1994 Volume 43 Issue 4 Pages
1391-1394
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We evaluated 34 cases (50 knees) with total knee arthroplasties clinically and radiographically. The preoperative diagnosis was osteoarthrosis in 25 cases (35 knees), and rheumatoid arthritis in 9 cases (15 knees).
The follow-up period ranged from 1 year to 5 years 7 months (mean 3 years 3 months). Kyocera prosthesis was used in 7 knees, MG I in 26 knees, MG II in 17 knees.
Mean JOA rating score improved from 51.6 to 73.7 points in the OA group and from 45.8 to 76.7 in the RA group. Mean flexion angle at the final follow-up was 98.8°. Loosening was seen in 6 knees using the Kyocera prosthesis.
Results using the Kyocera prosthesis were poor while the MG prosthesis achieved satisfactory results, but P-F disorders and problems of screw fixation were seen.
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Tetsuya Fukumoto, Kazutoshi Nomura, Mako Hirano, Noburo Hashimoto, Juj ...
1994 Volume 43 Issue 4 Pages
1395-1398
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Miller-Galante TKA (MG: 1986-1990 and MG II: 1991-1993) were performed on 119 knees affected by osteoarthritis or rheumatoid arthritis. Forty four MG and 32 MG II were available for follow up. Wear of patellar component was seen in 3 MG knees and revision surgery was performed for these three cases. Patellar dislocation occurred in 3 cases (4 MG knees) and proximal realignment was performed in 3 of these knees. There has been no patellar dislocation and wear on patellar component with MG II.
Three knees which required revision of the patellar component had a wide range of motion and high activity. They also had good congruity of the patellar and femoral components. The patellar component of MG II was strongly constrained in the groove of the femoral component by their design and shape. Therefore the eccentric high contact pressure of the patella is likely to be on the femoral component. The problem of wear of the patellar component has not been resolved but the metal backed patellar component should not be used.
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Takashi Furugen, Nozomi Hatano, Masaaki Nohara, Tugukazu Touma, Hidema ...
1994 Volume 43 Issue 4 Pages
1399-1402
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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From January 1991 to December 1992, 82 total knee replacements (MG II) were performed in 64 osteoarthritis patients in our hospital. Of these, we were able to follow 45 knees in 37 patients for more than 6 months. The mean age was 71.2 years (range 59 to 85 years). The follow-up period ranged from 6 to 29 months (mean 12.6 months). Clinical results were evaluated using the J. O. A. rating score of OA knee and stress radiography. Postoperative range of motion correlated with preoperative flexion (r=0.524, p<0.01), medial joint laxity (r=0.298, p<0.05) and total antero-posterior laxity (r=0.631, p<0.01). We considered that soft tissue balancing which allows medial joint laxity of about 5mm is appropriate not only to achieve satisfactory range of motion but also to maintain stability after total knee replacement.
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Per- and Post-operative Comparison
Jouji Noguchi, Takanobu Abe, Nobuhiro Tanaka, Takashi Soejima, Akio In ...
1994 Volume 43 Issue 4 Pages
1403-1405
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Six cases (4 males, 2 females) with ACL insufficiency were evaluated by frequency analysis of surface EMG preoperatively and at 4 or 6 months after surgery. Patients ranged in age from 17 to 41 years (mean 27 years). The surface EMG was recorded from above the quadriceps muscle during sustained (30 sec.) isometric contraction. The recorded EMG was computerized by spectrum analyzer. Results were as follows. Mean power frequency showed a more sudden decrease post-operatively compared to per-operative values. In other words, the higher (>81Hz) frequency zone was increased post-operatively compared with pre-operation. We concluded that type II fibres on knee extensors were actived by reconstrution and rehabilitation.
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Objective Findings and Patient Satisfaction
Hideki Asato, Tomomi Uesato, Kei Kadekawa, Shinichi Shirota, Satoshi T ...
1994 Volume 43 Issue 4 Pages
1406-1409
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We evaluated 104 cases (male 59, female 45) with anterior cruciate ligament reconstruction using N-test, anterior translation measured by KT-1000 and extension and flexion force of knee joint measured by Cybex 350. Follow up ranged from 6 months to 8 years, with a mean of 2 years and 11 months. Of these, 64 sports injury patients were questioned for subjective satisfaction score of treated knee compared with their contralateral knee. Objective results were favorably compared with other reports; Ntest was negative in 89% of males and 91% of females, % flexion force compared with the contralateral side was 94% in males and 89% in females, average JOA score for knee ligament injury was 96 in males and 94 in females. 32% of males and 42% of females were able to return to participate in their original sports. Subjective satisfaction score was 65 in males and 61 in females. Satisfaction score showed positive correlation with extension force in both sexes (p<0.05) and satisfaction score in males who returned to their original sports was higher than the score in males who returned to recreational sports (p<0.05).
Discrepancy between objective findings and subjective satisfaction was found. Strengthening of knee extensors in both sexes and rehabilitation programs which enable the return to original sports in males may improve subjective satisfaction.
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Keihan Cho, Kousuke Ogata, Hiroshi Nomiyama, Yutaka Irie, Michiya Hara ...
1994 Volume 43 Issue 4 Pages
1410-1412
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Posterior cruciate ligament grafts are greatly augulated at the edge of the tibial tunnel. The purpose of this study was to develop an intraoperative technique to assess the direction of the tibial tunnel. We measured the direction of the tibial tunnel from the PCL insertion to the anterior part of the tibial condyle with the minimum angulation by using five cadaver knees. Bositioning the tibal tunnel most laterally, distally and medially, the sagittal angle (SA) between the joint line and tunnel was 50.4, 63.2 and 57, the axial angle was 38.2, 6.4 and -20. We suggest that the tibial tunnel must be placed in the same direction of the reconstructed PCL in the coronal plane and maximum SA.
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Kenji Miyahara, Keisuke Sera, Tatsuyuki Taniguchi, Kaname Komuta, Tsuk ...
1994 Volume 43 Issue 4 Pages
1413-1418
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We prospectively studied 20 patients with suspected ligamentous or meniscal tears of the knee. They were examined by both magetic resonance imaging (MRI) and arthroscopy.
The accuracy of the diagnoses from MRI compared with arthroscopy was 90% for the anterior cruciate ligament (ACL), 100% for the posterior cruciate ligament (PCL), 90% for the medial meniscus (MM), and 95% for the lateral meniscus (LM). But there were 2 ‘false positive’ ACL tears, 1 ‘false positive ’ MM tear, 1 ‘false negative’ MM tear, and 1 ‘false negative’ LM tear.
We thought that we can reduce these ‘false positive’ and ‘false negative’ findings by describing the best conditions to take MRI for ligamentous or meniscal tears of the knee, or raising the ability to interpret MRI findings. However it is probable that the MRI findings are different from the arthroscopic findings, because MRI is more sensitive to intermeniscal tears and there is the dead angle of the arthroscope in the knee to be taben into consideration.
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Yutaka Otsuka, Kenji Kubota, Hiroshi Mizuta, Eiichi Nakamura, Noriyosh ...
1994 Volume 43 Issue 4 Pages
1419-1422
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Magnetic resonance imaging (MRI) was performed on 38 patients with anterior cruciate ligament (ACL) injuries. According to the period from the last injury to evaluation with MRI, knees were divided into three groups. “Bone bruise” was detected in fourteen out of twenty-two (64%) knees in Group I (within three months) and one out of four (25%) knees in Group II (from three to six months). There was no bone bruise detected in twelve knees in Group III (over six months). A total of thirty-one lesions in the fifteen knees were detected as bone bruises. These lesions were most likely to be located in the middle third of the lateral femoral condyle and the posterior third of the lateral tibial plateau. Five out of fifteen knees with bone bruises were reevaluated with subsequent MRI. Reduction of the size and intensity of the lesions were documented in two knees reevaluated within three months from injury, and resoluation of the lesions was documented in knees reevaluated after four months. These findings suggest that bone bruises are associated with ACL injury and resolve within six months, but a precise pethoanatomic understanding of this MRI abnormal signal is not clear.
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Shigeru Ito, Toru Hirano, Katsuro Iwasaki, Masataka Uetani, Yoshitaka ...
1994 Volume 43 Issue 4 Pages
1423-1425
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We studied the MRI finding of pigmented villonodular synovitis (PVS) in the knee joints of two patients. Diffuse nodular lesions of PVS were typically shown as a low intensity area, on both T
1 and T
2 weingted MRI. High intensity areas on T
2 were intermingled within the lesions.
MRI revealed not only the lesions in the joint space but also osseous lesions in the medial, lateral and posterior condyles of the femur and the intercondylar tubercle of the tibia. These results suggest that PVS invades bones from the capsular or ligamentous attachments.
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Tatsuhiro Samuno, Chika Tanaka, Hiroshi Kinuhara, Kunihiko Tomoda, Eij ...
1994 Volume 43 Issue 4 Pages
1426-1428
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Fifteen knees of fourteen patients were treated by percutaneous release of adhesions, bilateral retinaculm release and capsular release under arthroscopic control.
The knee in these patients occurred following fracture of the femoral neck and shaft in 3, fracture of the knee joint (distal end of the femur, proximal end of the tibia and the patellar) in 10, injury of the meniscus in 1 and high tibial osteotomy in 1.
The mean interval between the last surgical procedure and this operation was 16 months (range 2.5mo. to 8y. 7mo.).
Mean passive flexion increased 60° to 119° at the time of final evaluation.
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Eiji Kawaguchi, Chika Tanaka, Hiroshi Kinuhara, Tatsuhiro Samuno, Kuni ...
1994 Volume 43 Issue 4 Pages
1429-1431
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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It is expected that the discoid lateral meniscus has various influence on the knee joint. We classified meniscal tear cases identified at arthroscopic surgery into two groups: complete discoid lateral meniscus group (23 cases) and the meniscal tear group (22 cases).
We measured the femorotibial angles from simple roentgenograms of each group.
In cases aged over fifty years there was a significant difference in the femorotibial angle (FTA) between the two groups (p<0.05).
The complete discoid lateral meniscus influences FTA of the knee joint, and may induce gonoarthrosis.
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Jun Arimizu, Kousuke Ogata, Masakatsu Yasunaga, Keihan Cho, Yasushi As ...
1994 Volume 43 Issue 4 Pages
1432-1435
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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This study investigated the infuluence of a tourniquet on anterior intracompartmental pressure of the lower leg. Thirteen patients who had arthroscopic surgery were measured with a Millar catheter transducer system. A tourniquet was applied in seven patients (tourniquet group) while six controls did not have a tourniquet applied (nontourniquet group). The tip of the Millar catheter was placed in the anterior tibial compartment. No statistically significant difference in age, blood pressure, and interval throughout the operation appeared when the tourniquet and non-tourniquet groups were compared. Immediate postoperative intracompartmental pressures in the tourniquet group were statistically significantly higher than that of the non-tourniquet group (p<0.03). The duration required for the intracompartmental pressure to recover to the normal level in the tourniquet group was statistically significantly longer than that of the non-tourniquet group (p<0.05). Results indicated that it is justified not to use a tourniquet during simple surgical procedures.
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Takayuki Tsuru, Yasuhiro Oniki
1994 Volume 43 Issue 4 Pages
1436-1438
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Permanent patellar dislocation is a relatively rare disorder of the knee and it is particularly rare to be first found in older patients as described by Hamase (1988) and Torisu (1981). We report a 66 year-old female who was admitted for rehabilitation and was found to have an extreme knee deformity for the first time. After a few weeks self-care and use of a wheel chair were able to be performed independently but regarding gait exercises, the patient could not walk out of the parallel bars because of poor improvement in muscle strength in spite of our prescription of LLB (involved side) and knee brace (uninvolved side). As a next step and in a rather experimental trial, we removed her knee brace and changed LLB to SLB. Finally the patient could walk independently corresponding to a general improvement in her ADL.
We analysed her gait from a biomechanical aspect and concluded that hip internal rotation during walking compensated for her malalignment and braces helped to prevent this original movement.
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Jun Itoh, Hideo Watanabe, Toyoko Asami, Yumi Itoh, Tatsuo Kutsuna, Kaz ...
1994 Volume 43 Issue 4 Pages
1439-1442
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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For patients with muscular weakness and ROM limitation, we developed a special walker for ambulation training which can be used in hospitals and rehabilitation facilities. The special walker supports body weight with a corset and three different types of ischial support, and enables the patient to walk easily without discomfot.
We reported the structure of this walker and the experience of training carried out on a RA patient.
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Shuya Ide, Hideo Watanabe, Toyoko Asami, Yumi Ito, Ai Umemura, Katsuhi ...
1994 Volume 43 Issue 4 Pages
1443-1446
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We evaluated orthotic treatment of 308 orthoses used for 127 cases with various foot disorders.
Orthoses prescribed included 146 foot orthoses, 102 insert type arch supports, 42 orthopedic shoes and 18 other types of orthoses.
76.7% of foot orthoses were prescribed for plano-valgus deformity and 12.4% were prescribed for foot deformities due to rheumatoid arthritis.
54.8% of insert type arch supports were prescribed for plano-valgus and 15.7% were for plantar disorders such as callus, ulcer and other disorders.
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Osamu Suenaga, Kazumasa Yamaguchi, Hiroshi Kuroda, Yoshihisa Okamoto
1994 Volume 43 Issue 4 Pages
1447-1450
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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102 hips of 53 children with cerebral palsy were evaluated radiographically. The length of follow up averaged 7 years, (range, 5 to 11 years).
18 hips of 13 children were subluxated or dislocated before 6 years old, of which AHI was significantly decreased from 2 years of age, and acetabular angle was significantly increased from 3 years.
30 hips of 15 children were not subluxated at 6 years old, and all remained free from subluxation except 1 hip after 6 years. 16 hips of 10 children in which AHI decreased less than 50% were improved by surgery. All except 1 hip were free from subluxation after operation.
2 hips of 2 children were subluxated at 13 years of age both of whom had severe scoliosis.
We concluded that if progressive hip lateralization was observed before the child was 6 years old, it is better to treat operatively. Children with cerebral palsy who had severe scoliosis and pelvic obliquity needed special care when evaluating then radiographcally.
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Toshiya Jinbo, Masaru Higo, Kiyoshi Uchino
1994 Volume 43 Issue 4 Pages
1451-1453
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We evaluated the Grice subtalar arthrodesis which had been performed in cerebral palsy children for treatment of 22 planovalgus feet. We performed Grice subtalar arthrodesis with lengthening of the Achilles tendon and soft tissue release with internal fixa-tion using K-wires in order to correct planovalgus foot deformity. Postoperatively the feet were immobilized with a plaster cast for 6 weeks.
The average age at surgery was 9.9±3.9 years, the average duration of follow-up was 22.3±15.5 months. Of the 22 planovalgus feet, 21 achieved excellent and satisfactory results but one foot with a varus deformity had unsatisfactory results. Two feet in one patient resulted in graft failure. The Grice subtalar arthrodesis was an effective surgical procedure for treatment of planovalgus feet in cerebral palsy children.
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Takashi Iioka, Nobuyuki Ito, Masao Eto, Masayuki Egashira, Katsuro Iwa ...
1994 Volume 43 Issue 4 Pages
1454-1456
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Twenty patients with congenital muscular torticollis who were treated surgically were evaluated with an average follow up period of 10 years. The age at surgery ranged from 1 to 24 years. The patcients were evaluated by Egashira's method. Cosmesis, neck ROM and appearance of the clavicle were examined and the final evaluation was dene. We also investigated factors influencing the results.
Results were very much influenced by the age at operation, particularly with regard to the cosmetic point of view. Below 5 years of age, satisfactory results were obtained, compared to the older group. The post-operative immobilization period and follow up period did not influence the results.
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Nobutada Katori, Atsushige Yoshikawa, Yasunori Usami, Akinobu Yamaguch ...
1994 Volume 43 Issue 4 Pages
1457-1461
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Recently improvements in safety have been introduced in various aspects of our living environment, but patients with burn injuries still appear frequently and they form a considerable part of the medical treatment at the Department of Plastic Surgery. To understand the actual state of the burn injury it is nessesary to look at the presentation of the disease. In this study we carried out a statistical observation on patients with fresh burn injuries who visited our Department from January 1989 to December 1992. We report here the results with some discussion of the literature.
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Yasushi Hirose, Osami Sumisaka, Masamoto Kikkawa, Kiyoo Furuse, Takayu ...
1994 Volume 43 Issue 4 Pages
1462-1464
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Forty-six patients (21 males and 25 females, aged from 1 to 85 years old, mean 38.7 years) with foreign bodies in the extremities were treated from 1983 to 1993.
The foreign bodies were as follows; metallic fragments in 11 cases, glass fragments in 10, needles in 10, fragments of wood in 8, fish bone framents in 3 and others in 4.
Radiographic examinations were useful for detecting the foreing bodies in 32 of 44 cases (72.7%). But only one of the seven cases with fragments of wood was detected by radiographic examination. Fragments of wood were inclined to cause infection, with infection observed in seven (87.5%) of eight cases, compared to other foreing bodies. In conclusion, we should consider the existence of infectious disease due to fragments of wood in cases without any episode of foreign body injury. Microsurgery is helpfulfor removing transparent foreign bodies like glass and fish bone fragments.
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Takeshi Goto, Akio Inoue, Kensuke Yamanaka, Hiroshi Hieda, Hisao Takak ...
1994 Volume 43 Issue 4 Pages
1465-1467
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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The relationship between orthopedic complaints, obesity, and ageing of nurses in Kurume University Hospital was investigated by questionnaire. Six hundred and twenty (96%) nurses answered questions about body weight, height and orthopedic problems.
The following results were obtained:
1) Obesity was significantly related to age.
2) Complaints of fatiguability and foot pain, hallux valgus and flat-foot were significantly related to age, and hallux valgus was significantly related to obesity.
3) Pain of the big-toe and second toe were significantly related to age.
4) Pain of weight bearing joints (ankle, knee, hip) were significantly related to age and obesity.
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Hiroshi Hagino, Ryota Teshima, Noriyuki Takasu, Kichizo Yamamoto
1994 Volume 43 Issue 4 Pages
1468-1471
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We studied the clinical features, treatment and disease course in a group of older age onset RA (ORA) patients, defined as disease onset after age 60, and compared these findings with those in a group of RA patients whose illness began at a younger age (YRA).
The sex ratio in ORA contrasted with female predominance in the YRA group. The ORA group tended to have more arthritis in the shoulders and less in toes, and was more likely to have a positive RF. There was no significant difference in treatment between these two groups during the course of their disease. The outcome of the ORA group assessed at the last visit was the same as that of the YRA group.
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Evaluation of Enhanced MR Imaging
Toshihiko Hara, Taro Nakamura, Hirofumi Chosa, Fumitoshi Ihara, Tetsu ...
1994 Volume 43 Issue 4 Pages
1472-1475
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We studied 20 hands in 10 patients with rheumatoid arthritis and 16 hands in 8 healthy volunteers byusing enhanced MR imaging. We could not find any enhanced lesions in the controls. In RA patients, enhanced MR imaging revealed proliferation of synovia when bone erosion doesn't exist in conventional X-P. Enhanced lesions were shown as high signal intensity areas in T2-weighted images and low signal intensity in T1-weighted images.
These results suggested that enhanced MR imaging is useful for early diagnosis of rheumatoid arthritis.
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Tatsukuni Namihira, Shigeru Kuwahara, Hironobu Taniguchi, Naoya Tajima ...
1994 Volume 43 Issue 4 Pages
1476-1478
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Using a force-plate system, gait studies were performed on 30 RA patients with multiply impaired weight bearing joints and compared with 20 normal healthy adults. The following gait parameters were selected for this study: vertical component of stance phase impulse/stance phase duration, fore and after component of stance phase impulse. All parameters showed that there was a statistical significance between the gait of normal adults and that of RA patients. Furthermore, results from this study indicated that the weight of the hip was important with respect to impairment in the lower extremities.
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Hironobu Nagata, Shinji Morita, Ryuji Tabe, Yoshihiko Saku, Kimura Chi ...
1994 Volume 43 Issue 4 Pages
1479-1482
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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It is well known that peptic ulcer occurs frequently in patients with rheumatoid arthritis (RA). To elucidate risk factors of peptic ulcer in RA, we studied 434 cases of definite and classical RA.
The incidence (8.5%) of peptic ulcer in this study was significantly higher than that (1.8%) previorsly reported by mass survey (P<0.001).
Risk factors of peptic ulcer in RA patients were aging (50<), longer disease duration and treatment with many non-steroidal anti-inflammatory drugs (NSAIDs). We could not find a relationship between incidence of peptic ulcer to treatment with steroidal drugs. We should pay careful attention to peptic ulcer in RA patients who have these risk factors.
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Satoshi Tomiyama, Moritaka Nagayama, Naoto Hamasaki, Satoshi Mori, Tom ...
1994 Volume 43 Issue 4 Pages
1483-1487
Published: September 25, 1994
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Bipolar hip arthroplasty for treatment of the rheumatoid hip with acetabular bone defects was performed on 14 joints in 10 cases. For acetabular reconstruction, bone graft alone was needed on 9 joints in 6 cases (BG group) and bone graft with hydroxyapatite granules was needed on 5 joints in 4 cases (HA group).
Radiological progression of migration of the outer head was examined in both groups by X-p films and compared.
Within 1 year after surgery central and upper migration of the outer head was larger in the HA than in the BG group. But, no significant progress was seen after the second post-operative year.
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Yuichirou Yazaki, Yoshiyasu Taniguchi, Sinya Maki, Shinji Yoshino, Too ...
1994 Volume 43 Issue 4 Pages
1488-1490
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Twenty-four primary cemented total hip arthroplasties (Charnley THA) were performed in 18 patients with rheumatoid arthritis. They were evaluated by clinical examination and X-P findings. All patients were followed for an average of 8.1 years, and their mean age at surgery was 56.5 years. 57.1% of the sockets had no cement-bone demarcation, 28.6% had a small line in the upper outer quadrant of the socket, and 21.9% of the stems shawed a demarcation around the femoral bone-cement interface. Revision was performed in one joint for aseptic femoral loosening.
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Daisuke Tachikawa, Minoru Ikeda, Toshio Inoue, Michiya Hara, Kouji Oda ...
1994 Volume 43 Issue 4 Pages
1491-1496
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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The clinical results after arthroscopic synovectomy in 24 knees of 14 RA patients with chronic synovitis were reviewed. The follow-up period ranged from 2 to 55 months, with an average of 32 months. The operated knee joints were divided into early synovectomy (Larsen's grade 0, 1, 2) and late synovectomy (Larsen's grade 3, 4, 5). Compared with preoperative findings, pain and swelling was on the whole improved. In early synovectomy, pain and swelling was improved in 11 of 13 knees and the effect was expected to remain for 3 to 5 years. In comparison, in late synovectomy, pain and swelling was improved in 5 of 9 knees (56%) within 3 years after surgery, with none achieving a good result after more than 3 years. This procedure seems to be indicated in early grade patients and appears to provide significant time saving in late grade patients.
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Akira Haraguchi, Takao Jinnnai, Toshiki Katoh, Yukihiko Tsutsumi
1994 Volume 43 Issue 4 Pages
1497-1502
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We evaluated the results of treatment in patients who had received surgery for ingrown and incurvated toenails by other surgeons. We treated 51 cases (52 toes) over on 8 years. Removal of the toenail had been performed in 29 cases, partial removal of the nail in 4 cases, wedge resection of labiomatrics (labiomatricectomy) in 12 cases and labiomatricectomy after removal of the nail in 6 cases. In cases which had required labiomatricectomy, 2 patients relapsed with an ingrown nail, 6 patients relapsed with an incurvated nail (in mild cases, it is undistinguishable from ingrown nails), nail spur arose in 8 patients, epidermal cyst arose in 2 cases. We performed nailbed plasty, using Udagawa's method, for the patient with a relapsed incurvated nail and severe inceuvated nail. To prevent recurrence, it is important to take care to reduce trauma and to distinguish the incurvated nail from ingrown nail.
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Masahiro Yokouchi, Hiroshi Hieda, Hisao Takaki, Hiroshi Goto, Katsuya ...
1994 Volume 43 Issue 4 Pages
1503-1505
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Foot injuries associated with use of nursing shoes are current topics. We studied this problem to investigate the incidence of, and actual conditions encountered. We used a questionnaire to evaluate foot complaints nurses. 130 (92.4%) nurses answered that they had some problems. A large percentage of problems were local pain of the forefoot (52.7%). Due to the development of some problem, only 11 (7.6%) of nurses were satisfied with their shoes.
We found that nursing shoes have many problems but are not always caused by the shoe itself. The choice and size of shoe also indicated nurses's lack of understanding to nursing shoes. We believe that this lack of understanding is a cause of this problem.
To decrease foot injuries caused by nursing shoes, it is equally important both to improve shoes and to educate the nurses to the best choice of shoe.
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Takayuki Yamamoto, Tsukasa Teramoto, Yoshiaki Makino, Katsuro Iwasaki
1994 Volume 43 Issue 4 Pages
1506-1510
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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This study investigated the stable position of the medial arch of the foot for roentgenographic examination.
The length of the medial arch was measured using the electric arch gauge (EAG) in thirty feet of fifteen normal adults in the following positions: sitting (control), both-legs standing, one-leg standing without support, Yokokura's-position, one-leg standing with support, and Yokokura's position with sunnort.
The sway of the medial arch in both-legs standing position was the least among the six positions except for the sitting position.
It was thought that standing on both lets was the most stable position for radiographic examinations in the evaluation of the medial arch of the foot.
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Closed Wedge Osteotomy
Yuichi Nagano, Tsuruhisa Yoshidome, Mitsuhiro Yanase, Nagatoshi Yoshik ...
1994 Volume 43 Issue 4 Pages
1511-1514
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Two patients with osteochondritis dissecans of the capitellum were treated by closed wedge osteotomy.
Case 1: A 14-year-old male volleyball player. Preoperative X-ray films revealed an area of radiolucency. Four months after surgery, he was able to return to full sports activities without pain and with an excellent range of elbow motion.
Case 2: A 13-year-old male judo player. Preoperative X-ray films revealed a loose body. Eight months after surgery he was able to return to full sports activities without pain. Postoperative range of elbow motion, however, was not improved and X-ray films revealed osteoarthrosis.
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Kotaro Kakinami, Itsuro Kaichi, Mototsugu Sugi
1994 Volume 43 Issue 4 Pages
1515-1518
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Five cases of avulsion of the anterior inferior ilaiac spine are presented. All the fractures occurred during sports activities, 4 while playing soccer and 1 while running. As one of the mechanical factors leading to this injury, we suggested that the activity of the vastus medialis muscle may greatly influence the occurrence of this fracture in sports related to kicking such as soccer.
Two cases were treated conservatively, with advice given not to take part in sports and 3 were treated surgically. Generally, conservative treatment is prevalent since the results are nearly equally as good, whether treated conservatively or surgically. However, we prefer surgical fixation if the patient hopes to return to sports activity as early as possible.
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Noriyuki Takasu, Ryota Teshima, Kichizo Yamamoto
1994 Volume 43 Issue 4 Pages
1519-1520
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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The purpose of this study was to evaluate leg-heel alignment (LHA) related to sports injuries of the lower extremities in teen-agers. Subjects comprised 13 patients with sports injuries and 27 normal controls. Injuries included fatigue fracture, tendinitis of Achilles tendon and plantaris, and ilio-tibial band syndrome. We measured LHA in prone and standing positions and the pronation angle (standing-LHA-prone-LHA) was calculated as the clinical relevance of subtalar motion. Prone-LHA was not significant in the two groups. But the pronation angle in subjects who had sustained sports injuries was lower than that of normal controls (p<0.01). We concluded that subtalar motion in the sports injury patients was poor compared with normal controls.
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A Retrospective Study
Shinji Watanabe, Naoya Tajima, Toshimasa Kuroki, Hironobu Taniguchi, N ...
1994 Volume 43 Issue 4 Pages
1521-1523
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Overuse injuries related to sports include disorders of muscle, tendons, and bones caused by giving a small amount of force again and again. Recently, sports activities are increasing regardless of age and sex.
We carried out an epidemiological survey of overuse injuries in Miyazaki prefecture. We found overuse injuries more commonly occur during the period when athletes are growing. Therefore, there are several problems related to physiological characteristics of the growing period for athletes, and these need to be considered by the school sports coaching system and be rememberd by coaches in junior high school and high school.
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Toyoaki Yamanouchi, Eiji Nishioka, Kou Momota, Teiji Yano, Kumi Kurano ...
1994 Volume 43 Issue 4 Pages
1524-1527
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We estimated twenty-five subjects' muscle strength of the lower extremities for two years. Subjects were members of a high school baseball club, and were either first or second-year students. Estimating muscle strength of extension and flexion of bilateral knees using the KIN-COM500H at 30 degree/second, we investigated changes in the strength of extension with eccentric contraction and of flexion of concentric contraction both increased on the dominant side. We inferred that this was because the pivot legs became stronger. We found that some subjects had an imbalance between muscle strength of extension and of flexion and therefore need personal guidance not only for advancement of ability but also for preventing the development of any disorders.
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Toru Abe, Nobuyuki Ito, Masao Eto, Kitau Teshima, Katsuro Iwasaki
1994 Volume 43 Issue 4 Pages
1528-1532
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Modified Bristow's procedure is a satisfactory operation for recurrent anterior dislocation of the shoulder. However it restricts external rotation and there is a probability of weakness of the internal rotator muscle strength postoperatively. This report analyzed the influence of modified Bristow's procedure on muscular strength on the shoulder post-operatively.
Twenty patients (13 male, 7 female) were evaluated postoperatively. Out of 13 males, 8 cases were operated on the non-dominant side and 5 cases were operated on the dominant side. All 7 females were operated on the dominant side. Age at the final examination ranged from 15 to 48 years with an average of 29.1 years. The average follow-up period was 63 months (range, 10 to 176 months). As a control group, 19 normal individuals were also examined.
Using CYBEX 340, we examined internal and external rotator muscle strength at 90° abduction (the angular testing velocity was 60deg./sec, 120deg./sec. and 180deg./sec.), adductor and dbductor muscle strength (60deg./sec, 180deg./sec. and 240deg./sec.).
In normal cases, no statistical differences in the peak torque and endurance between the dominant and non-dominant side were noted. In operated cases, there was no statistical difference in the peak torque and endurance between the sound side and the involved side.
These results show that modified Bristow procedure does not decrease the muscular strength on the shoulder postoperatively.
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Yozo Shibata, Koji Midorikawa, Teruaki Izaki, Genn Emoto, Youko Uchida ...
1994 Volume 43 Issue 4 Pages
1533-1536
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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Thirty cases were assessed using the isokinetic machine (Cybex 340) before and after being operated on by the modified Boytchev procedure. All subjects were males ranging in, age from 14 to 36 years (average, 22.5 years.). Eighteen had disorders of the dominant side. Follow-up time was 12 to 41 months (average, 21 months). Peak torque of external and internal rotation power and abduction power were assessed. Rotation power was measured from 60 degrees internal rotation to 60 degrees external rotation at 30 degrees abducted position, and the abduction power was measured from 0 to 120 degrees abduction in the scapular plane. Measurement speeds were 60deg/sec, 180deg/sec, 240deg/sec in each motion. Uninvolved and involved sides were compared before and after surgery except for abduction.
The following results were founed;
1. External rotation
Statistical significance was not seen between uninvolved and involoved side before and after surgery.
2. Internal rotation
Peak torque of the involved side was lower than univolved side before surgery (p<0.05), but this statistical significance was not seen after surgery.
3. Abduction
Statistical significance was not seen between uninvolved and involved side after surgery.
In our modified Boytchev procedure, the coracoid process is passed through between the joint capsule and the subscapular tendon without detaching the subscapular tendon and it increases the tension of the subscapular tendon. For this reason, we concluded that the modified Boytchev procedure didn't decrease the power of shoulder joint.
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Yutaka Irie, Masayoshi Kido, Akio Matsuzaki
1994 Volume 43 Issue 4 Pages
1537-1539
Published: September 25, 1994
Released on J-STAGE: February 25, 2010
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We reported a case of anterior dislocation of the shoulder with fracture of the coracoid process. A fifty-four-year-old man injured his left shoulder when he fell from a roof and hung with his left arm. He was treated surgically because the coracoid tip was displaced combined with an antero-inferior glenoid fracture. The left arm was rested in Velpeau bandage for 3 weeks, then active exercises were begun. Seven months after the operation, full range of motion was present with normal strength of the shoulder muscles without pain. We suggest that the mecanism of injury of this avulsion fracture of the coracoid tip was as a result of a rapid contraction force of the conjoined tendon.
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