This study evaluated the clinical results of surgical treatment for thoracolumbar spine fracture. The subjects were 26 males and 3 females with a mean age of 47 years ranging from 18 to 74 years. The duration of the follow-up varied from 4 months to 72 months, with a mean of 2 years and 4 months. The most common site of injury was L1, which accounted for 55% of the injuries (16/29 cases). The causes of the injuries were 16 falls, 8 traffic accidents, and 5 heavy mass drops. Four kinds of instuments (Roy Comille plate: 16 cases, Kaneda device: 5, Compact CD: 2, Spine system: 6) were used. We operated by the anterior approach for 5 cases, by the posterior approach for 15 cases, and by the anterior/posterior approach for 9 cases. 47 percent of the patients showed improvement of neurological deficits, increcsing by one rank by the Frankel classification. Although no cases deteriorated, 3 patients with complete paraplegia did not improve at all at the time of follow-up. The correction angle in 41 percent of the patients (12/29 cases), which was acquired by operation, decreased radiographically more than 6 degrees at the time of follow-up. No difference was seen in the correction loss between each implant or between each approach. We observed 11 fractures of the extremities, 3 pelvic fractures, 3 head injuries, 4 pulmonary hemorrhages with rib fractures, a cord injury of the cervical spine, a crush syndrome, and a fat embolism syndrome preoperatively. We recognized 8 doner site troubles, a sudden raputure of spleen, a numbness of prineum, etc postoperatively. 10 instrument failures (R-C plate: 6: cases, K-device: 2, CCD: 1, S-system: 1) were found at the time of follow-up. 4 out of 5 screw breakages were R-C plate system, because the screw diameter of R-C was smaller than others.
A case of traumatic lumber ptosis is presented. A 32-year-old man was injured severely by a crushing force to his back. X-P and CT scan showed lumber ptosis of the 5th lumber vertebrae. Neurological complication was B on the Asia impairment scale. Reduction of the lumber ptosis was achieved by skeletal traction through the distal femors. 1 month after the injury, posterior fusion from L3 to S1 was performed using the pediclar screw system (TSRH system). 1 year after the surgery, the patient was able to walk without a cane. The palsy recovered to D on the Asia impairment scale and the patient has returned to his job as a farmer.
Patients with paraplegia often experience slipping of the crutch during swing-through gait on slopes. To solve this problem, we inserted a coil spring into an ordinary axillary crutch and examined its function. We compared the slipping rate and the change in the amount of load on the crutch between the ordinary crutch and spring-loaded crutch. The spring-loaded crutch was found to be superior to the ordinary crutch; it was hard-to-slip and comfortable-to-use. Adjustment of the strength of the coil spring for each patient is considered important.
We examined 52 legs of long distance female runners, except 4 legs with stress fractures, and analyzed with reference to their X-p findings. Their mean age was 18.8 years. The mean height and weight were 159.1cm and 46.3kg respectively. The average distance they ran in a month was 702km. The results revealed that 21 out of 52 legs (40.4%) had shin sprint, and 31 out of 52 legs did not have shin sprint nor stress fracture in their medical history. The legs with shin sprint extended to the tibia vara, suggesting that the morphological feature of the tibial bone is related to the shin sprint.
In this report, we discuss the results of questionnaires and direct examinations on the running injuries of junior-high school and high school runners in Saga city. 354 cases were surveyed (Junior-high school; 130 boys and 102 girls, High school; 76 boys and 46 girls). 92 (39.65%) out of 232 junior high school runners and 60 (49.18%) of 122 high school runners were not satisfied with their performance due to pain during and/or after running. According to the injured lesions, the highest incidence was the foot in junior-high school boys, knee in junior-high school girls, and foot in high school boys and girls, respectively. According to the diagnostic criterea, low back pain including spondylolysis showed the highest incidence, Medial Tibial Stress Syndrome (MTSS) the second, and Chondromalacia Patellae the third, in both the junior-high school and high school athletes. We studied the correlation of the clinical symptoms of MTSS and the specific findings of the periosteum and bone marrow by means of MRI, and found a signicant correlation between them.
Although there exists several methods of internal fixation for displaced proximal humeral fracture, May anatomical bone plate fixation seems to be a useful treatment for this type of fracture. We treated 9 cases (4 males, 5 females) with May anatomical bone plate fixation for displaced proximal humeral fracture. The average follow-up period was 17 months. Good results were obtained even in elderly cases with severe osteoporosis. Plain X-ray findings did not reveal osteonecrotic changes in the humeral head and non-union in all cases.
A 44-year-old male case with congenital constriction of the extensor carpi ulnalis (ECU) is reported. Wrist pain (mainly the insertion of the ECU and 6th extensor compartment) was found to aggravate with handwork. He was born as the 2nd child when his mother was 49 years old. His right wrist joint was ulnary-deviated and dorsaly-flexed due to the constriction of the ECU. Operation consisting of 1. wrist arthroscopy, 2. observation of 6th compartment, and 3. intramuscular tenotomy and elongation of the ECU-was performed on March 31, '97. The operative findings were as follows: 1. Arthroscopic finding was only transverse striae of the lunar joint surface. 2. The ECU in the 6th compartment was more or less intact. 3. Intramuscular tenotomy and elongation of the ECU was performed about 20mm in length. Hyaline degeneration of the tendon was observed pathologically. After one month from the operation, the active range of motion of his right wrist improved 15 degrees dorsaly and 35 degrees radialy. After 8 months from the operation, the active range of motion improved 15 degrees dorsaly and 35 degrees radialy, and pain subsided. Contraction of the ECU was considered a cause of some of the disorders in the fetal period.
High-Pressure injection injuries are relatively rare, but can cause serious damage. We report a case of high-pressure injection injury from thinner to the hand. A 38-year-old painter injected thinner to the dorsal aspect of the first web of the right hand with paint gun. After the injection, he complained of increasing pain, and swelling. Radiographic examination revealed a radiolucent area at the first web, around the third MP joint and distal forearm. We performed an emergency surgery including extensive debridement, followed by debridement, followed by open treatment with normal saline solution and gentamycin. Two days after surgery, a second debridement was performed, and the wound was closed except around the injected area which resulted in skin necrosis. Skin grafting was performed two weeks after the injury, and the wound healed smoothly. 4 months after the injury, the patient showed only 10 to 20 degrees limitation of the wrist and finger flexion, and was able to return to work.
Spontaneous rupture of the extensor digitorum communis is rare and poorly understood. We experienced 9 cases of extensor digitorum communis tendon rupture caused by overuse of hand. Mechanical attrition at the distal edge of the extensor retinaculum was considered the main cause. Most of the cases were treated by tendon transfer and end-to-side suture, and tendon graft was performed on cases with multiple tendon ruptures.
In this report, we discuss nine patients with extension disturbance of the wrist, thumb, and fingers that were treated by the tendon transfer operation. There were five cases of brachial plexus injury and four cases of crush injury of the extensor tendons. The average age of the patients at operation was 23 years. The mean length of the postoperative follow-up was 4.1 years. The improvement of joint motion was acquired in 67% of the wrist cases, 86% of the thumb cases, and 75% of the finger cases. The results were poor in three cases, three in which two cases were brachial plexus injury and one was incomplete amputation of the wrist. The operation was unsuccessful due to evaluation failure of the mover in the two brachial plexus injury cases and adhesion of the transferred tendon in the incomplete amputation case.
Thompson's surgical procedure was carried out on 4 cases of post traumatic swan neck deformity. The mean time from injury to surgery was 88 months, and that following surgery was 26 months, ranging from 8 months to 6 years. Reconstruction of the oblique retinacular ligament was performed with the palmalis longus tencion used as a free tendon graft. In all the cases, the swan neck deformity was corrected. The mean extension of the PIP joint was 36 degrees before surgery, improving to -4 degrees ranging from -12 to 0 degrees during follow up. The mean extension lag of the DIP joint was 32 degrees, improving to -5 degrees ranging from -21 to 0 degrees during follow-up. Thompson's procedure is useful for correcting such post traumatic swan neck deformity.
A Case of bilateral anterior interosseous nerve plasy in discussed and the literature reviewed. A 25 old man developed pain in his left elbow flexion side. As the pain subsided, the patient noted the inability to flex his left index finger DIP joint. He had not had any previous trauma nor medical history related to the problem. Showing no recovery, he underwent operation three months after the onset. The operation, showed no evidence of the entrapment of the anterior interosseous nerve. Two months after the operation, the patient recovered functions of the index FDP. Five years later the patient experienced pain in his right elbow flexion side. The next day, he could not flex the IP joint of the thumb nor the DIP joint of the index finger actively. We performed neurolysis eight months after the onset, and found fascicular constriction of the anterior interosseous nerve fasciculus within the main trunk of the median nerve by interfascicular neurolysis.
Carpal tunnel syndrome (CTS) is very common in orthopaedic practice. Many authors have reported that prevelence is 9 to 10 times more in female subjects in Japan. Over the last 4 years, we experienced 228 cases of CTS. The male-female ratio in these cases was about 1:3 in which incidence amongst males was higher compared to other studies. Therefore, in this study, we investigated male patients exclusively to reveal the causative factors, and compare the postoperative results with female patients. 78 hands of 65 male patients with CTS were investigated postoperatively. The age of the patients ranged from 26 to 89 with an average age of 57 years. The average postoperative follow-up period was 13 months. The results of the operation were excellent in 38 hands, good in 23 hands, fair in 13 hands, and poor in the remaining 4. From our experience, the so-called idiopathic CTS cases are seen less in male patients than female. CTS in the male patients was mainly due to local causes such as wrist fracture and dislocation, Kienboeck's desease, tumors etc. in comparison with the female patients. The milder cases showed better results in female patients. On the other hand, the results of serere cases were less satisfactory for both sex. Moreover, patients with cervical spondylosis and also obesity showed less improvement. Factors such as snapping finger and diabetes mellitus were not found to affect the results. The results of this study therefore indicated no definite causes for the greater number of CTS in male subjects. Moreover, the reason for why results are less satisfactory in males than females was also not clear.
5 hands of 5 patients with carpal tunnel syndrome (CTS) and thenar muscle atrophy were treated with carpal tunnel release and simultaneous opponenslasty. All patients underwent FDS transfer. The average age of the patients was 60.8 years (range; 53 to 71 years), and the average follow-up was 8 years and 5 months (range; 3 years to 15 years). The patients suffered CTS symptoms for an average of 9 years and 5 months (range; 5 years to 15 years). The average duration of thenar muscle atrophy prior to surgery was 3 years and 5 months (range; 1 year to 5 years). All patients regained functions of their hands post-operatively, but still had thenar muscle atrophy. Two patients demonstrated no reaction to electrophysiologic testing of the median nerve. We concluded that simultaneous opponensplasty should be performed for CTS patients with severe thenar muscle atrophy.
A 19-year-old man with peudoarthrosis of the tibia in neurofibromatosis was followed up for a period of 19 years since his birth. He was treated for the fracture of the lower leg twice and for the deformity of his lower leg with corrective osteotomy and bone grafting. His lower leg remains deformed, but the union is good and he is able to walk without any support in daily life.
We experienced a very rare case of non-ossifying fibroma in the femoral head. The case was a 26-year-old female with a week history of right coxalgia. X-rays showed cystic lesions with surrounding sclerotic areas in the right femoral head, and CT showed cystic lesions extending to the femoral neck. A diagnosis of the non-ossifying fibroma was carried out by biopsy and operation was performed. After curettage of the lesions, only the femoral head was left. To achiere early union and support against mechanical stress, the bone defects were reconstructed with vascularized iliac bone grafts. Good results were obtained.
Eosinophilic granuloma is often found in children below 10 years of age. This is a case report of eosinophilic granuloma of the rib in adult. The patient was a 30-year-old man. Cortical destruction was observed on radiograph and CT. MR imaging showed this tumor as iso intensity on T1-weighted image and high intensity on T2-weighted image, and enhancement with Gd-DTPA. We diagnosed this tumor as eosinohilic granuloma because pathological findings indicated proliferation of the histiocyte with the infiltration of the eosinocyte. Without pathological findings, it would have been difficult to diagnose this case as eosinophilic granuloma.
We have performed cryopreserved allografting procedures for benign bone tumors in childen since 1993. The results were investigated by assessing radiographic findings, the clinical outcome, and conplications. There were 11 patients, and seven were boys and four were girls. The mean age at operation was 13 years old. The mean follow-up period was 2 years. The sites of tumors were humerus in 1 patient, femur in 6, fibula in 2, and tibia in 2. All patients received cryopreserved allografts affer curettage of the lesion. The mean operative time was 2.5 hours and blood loss was minimal in the majority of cases. There were no serious complications (e. g., infencion of the grafts) in any of the patients. A mean interval to bone union was 10 weeks and that to homogenity was 6 months. Remodeling of grafted sites was observed in all patients. In summary, allografting caused minimal blood loss and produced satisfactory remodeling, making it a useful technique for children, because their own bone brafting would be invasive to them.
Benign bone tumors and simple bone cysts (171 lesions in 170 cases) in the past seven years were treated by the packing of high porosity hydroxyapatite cubes (HA, 66%) or autogenous bone gaft (27%). After these procedures, three fractures and one late infection were seen but these were cured by casting or curettage. Paching of HA alone was indicated especially for simple bone systs and metaphyseal benign bone tumors, while autogenous bone graft was indicated only for lesions requiring initial and permanent strength to prevent fractures.
Three patients with prostate cancer showed acute paraplegia as a result of multiple osteolytic thoacic spine metastases. Immediate laminectomy induced yecovery of paraplegia. Successful endocrine treatment induced a healing reaction characterized by intensification of the osteoblastic response.
We performed reconstructive surgery using a Huckstep hip system for cases with pathologic fracture caused by metastatic bone tumor in the proximal femur. There were 3 cases altogether, all female. Their average age was 71.6 years. The primary lesions were breast cancer in 1 case and lung cancer in 2 cases. The surgery involved wide resection of the lesion in the proximal femur including the fractured part. The defective part was reconstructed by using the Huckstep hip system combined with a sleeve and spacers. In all 3 cases, walking practice was started from the next day after the surgery. The follow-up period after the surgery was from 2 months to 1 year and 6 months. As a result, pain disappeared and the patienrs gained excellent walking ability. This is considered a useful surgery method for some cases.
Tumoral calcinosis is a rare disorder characterised by calcification of periarticular soft tissue. Although hyperphosphatemia is not always accompanied, it is thought to be a pathogenetic factor. We report such a rare case of tumoral calcinosis in a 17-year-old girl. She had a gradually enlarging mass on her back near the right scapula. Plain radiograph computed tomography, and magnetic resonance imaging revealed a partially calcified lesion between the right scapula and thorax. Laboratory tests including the levels of serum calcium and parathyroid hormone (PTH) were normal, except for increases in serum phosphorus (5.7mg/dl) and slight increases in 1, 25 (OH)2 Vitamin D and calcitonin. The tubular reabsorption of phosphate was increased. High-dose PTH infusion increased urinary phosphorus and cyclic AMP excretion so that renal tubular reabsorption due to exogenous PTH was adequate. The pathogenesis of this disorder should be evaluated further from the aspect of mineral metabolism.
We clinicopathologically analyzed six cases of extraskeletal Ewing's sarcoma (ES) and primitive neuroectodermal tumor (PNET) treated from 1978 to 1996, and found that cases which showed rosettes histologically have better prognosis. The average age of the 2 male and 4 female patients was 21 years. Tumors were located in the thigh (3 patients), lower leg, back, and flank. 5 patients showed localized disease in diagnosis and 1 had metastases. All patients underwent surgical treatment and adjunctive therapy (radiation or chemotherapy, or both). Histologically, Homer Wright-type rosettes were seen in 3 patients who were all alive for following period. The 5-year overall survival was 66.7%. Now ES and PNET are thought to belong to a single group of tumors with neuroectodermal features, ES does not reveal neural features in situ, while PNET shows distinct neural differentiation even in histological sections. This report did not differentiate between ES and PNET, because the same therapy was performed in both tumors, and also the prognostic significance of PNET or neural differentiation in ES is controversial. The 6 cases in this report demonstrate that the neural features in ES (PNET) show good prognosis.
We reviewed limb functions after wide resection for 11 soft tissue sarcomas in the thigh of elderly patients over 65 years old with an average age of 72.2 years. Their hist ological diagnoses included 7 MFH cases, 2 liposarcoma cases, and other in 2 cases. The follow-up period ranged from 8 months to 10 years and 5 months, with an average of 3 years and 2 months. To evaluate muscler defects resulting from wide resection, the musclature of the thigh was divided into 6 compartments (vastus medialis, rectus femoris, vastus lateralis, adductors, innerhamstrings, and biceps femoris). The function of the preserved limb was evaluated by the Functional Evaluation System of the Japan Orthopaedic Association (full score; 25 points for 5 items). The average score of all the patients ranged from 15 points to 25 points with an average of 20.6 points (80.4%). The average score of 6 patients who underwent resection of all the whole adductor was 22 points (88%), and that of 3 patients undergoing resection of the whole quadriceps femoris was 17.7 points (70.7%). All the patients could walk on their affected limbs, and most had little limitation in their daily activities.
32 cases of lumbar disc herniation were sequentially followed by MR imagings in order to ascertain its natural course. Herniation consisted of protrusion in 6 cases, extrusion in 13 cases, and sequestration in 13 cases. We analysed the durations until the herniation regressed more than 50% of its A-P diameter. The mean duration was 8.2 months for extrusion, and 5.3 months for sequestration. Only 2 cases of protrusion regressed within 12 months. Huge disc herniations with central protrusion in particular showed slight spontaneous regression.
We report a case of dorsal migrated lumbar disc herniation suspected of extradural tumor in MRI. A 48-year-old male was referred to us for the treatment of low back pain and right leg pain in March, 1997. On admission, the SLR test was negative and other neurological findings were normal. MRI showed high intensity signals in T2-weighted images and an enhanced mass lesion with Gd-DTPA. At surgery, dorsal migrated disk herniation was observed on the dura, and it was resected completely. Histological examination revealed inflammatory cell infiltration of the hyaline cartilage and fibrous connective tissue.
We evaluated radiographical changes in 14 cases after percutaneous discotomy (PD) for lumbar disc herniation. The subjects consisted of 12 males and 2 females, aged between 17 to 64 (average age; 38.1 years). The length of follow-up ranged from 5 years to 7.8 years (average; 6.5 years). The mean decrease in disc height was 15.1%. In 4 cases, the decrease in the disc height was more than 20%. These cases were inclined to show poor clinical results. Only 1 case developed instability of the lumbar spine after surgery, but the amount of resected disc correlated with the spinal segmental motion. Indicating that a large amount of resected disc may lead to spinal instability.
Generally, lumber body fusion is indicated for patients who fail to respond to conservative measures. If neurologic findings such as numbness, leg pain are present with lumbar ithmic spondylolisthesis, lumber body fusion and root decompression may be needed. We performed root decompressino and fixation of the loose lamina without lumber body fusion in 8 cases. With our method, the loose lamina was fixed by facet fusion to the neighboring lumber segment below. We measured the instability of the loose lamina at the lateral view of X-ray. 3 cases showed instability of the loose lamina postoperatively, and preoperative symptoms remaining. 2 cases for which fixation was achiered postoperatively showed reduction of symptoms. 3 cases who showed no instability of the loose lamina preoperatively showed good clinical results. These results suggest that the fixation of the loose lamina affects the postoperative clinical results to some extent. As fixation of the loose lamina was successful in only 2 and of 8 cases our surgical method still regnires considerable improvement.
We analyzed the follow-up results of lumbago in 26 patients who had undergone posterior decompression alone for degenerative sondylolisthesis. The average age at operation was 65 years, and the average follow-up duration was 6 years and 6 months. The lumbago improved well and the JOA score recovered from 1.77 to 2.42. There was no difference in the lumbago between the group with instability or postoperative increase in slipping and the group without these changes. These results suggest that posterior decompression as wide as lateral recesses with preservation of the articular processes dose not require routine spinal fusion for lumbago, and produces satisfactory improvement.
We carried out a three-dimensional computed tomography (3D-CT)study on 33 patients with lumbar degerative spondylolisthesis treated by the enlargement of the lumbar canal without fusion. The purpose of this study was to show the effects of enlargement of canal after operation. We found that good enlargement of canal was achiered and round canal continued for a long time. There were no cases of increasing postoperative instability. The average pre operative JO Ascore was 14.1 points and the average post operative score was 26.3 points. It was very important to roduce the post-superior margin of the vertebral body during slipping. Enlargement of the lumbar canal is proposed as a useful method for lumbar degenerative spondylolisthesis.