Ankylosing spondylitis is slowly progressive, leading to bony ankylosis of the sacroiliac joint, apophyseal joint, and hip joint. It also greatly increases the risk of spine and spinal cord injury, even from relatively trivial trauma a such as minor falls. We report a case of ankylosing spondylitis in a 53-year-old man who sustained thoracic spinal coard injury due to traffic accident. The Highest dysfunctional neurologic level was at Th. 5 and plain X-P showed a dislocation at the level of Th. 5/6 on admission. The patient was managed conservatively following the standard regimen. High-dose steroid was administered intravenously. But the Highest dysfunctional neurologic level was acutely progressing C3 in 2 days, and the patient became ventilater-dependent.
It is difficult for persons with cervical cord injury (CCI) to live at home, because the increase in the number of nuclear families and families consisting only of old persons have led to a shortage of care given in a family. We followed up 42 persons with CCI injuries from January, 1987 to December, 1996, and evaluated their activities of daily living by the Modified Barthel Index (B. I.) score. There were 26 persons with less than 80 points on the B. I. 16 (61.5%) lived at home and the others were in hospitals or facilities for the disabled. To maintain a proper life at home, they need to remodel their house, at least a care giver in their families, and social resources which support home care.
It is well known that lumbar herniated nucleus pulposus disappears. However, there exists no such report for thoracic disc herniation. We experienced a case of spontaneous regression of thoracic disc herniation. The subject was 25-year-old female. She had right shoulder pain and numbness of the right ulnar upper extremity. MRI showed disc herniation in T1/2, that was enhanced circumferentially by Gd-DTPA enhanced MRI. The shoulder pain and numbness reduced gradually at 1 month after the onset, and disappeared at 2 months. On MRI, the herniation diminished in size at 11 weeks after the onset and more or less disappeared at 4 months.
Spinal deformity in Duchenne muscular dystrophy exerts enormous influence on the prognosis and daily activities of the patients. Spinal bracing and spinal fusion were attempted to prevent the progression of spinal deformity. Spinal bracing however failed to prevent progression and there were no clear indications of the surgical management of spinal deformity.
We examined the spinal deformities in 9 patients who had osteogenesis imperfecta. The patients consisted of 4 males and 5 females, with a mean age of 6.7 years (range, 3 to 11 years) at the initial examination and a mean age of 18.9 years (range; 6 to 33 years) at the most recent examination. The mean period of follow-up was 12 years (range; 2.3 to 25.7 years). AT the time of the most recent follow-up, scoliosis was present in 8 patients (89 per cent), and kyphosis, in 4 (44 per cent). According to the Hanscom's classification, scoliosis progressed rapidly in patients who had D type osteogenesis imperfecta in certain biconcave vertebrae.
Computed tomography-guided biopsy of the spine is considered a safe and relatively inexpensive examination tecnique. We performed CT-guided biopsy for 8 cases without any complications. These cases were 6 thoracic, 1 lumber and 1 sacral. Pathologic examinations revealed 3 primary tumors, 2 metastases, 2 tuberculosis and 1 pyogenic spondylitis. CT-guided biopsy is an important tool in the evaluation of spinal lesions.
We treated 10 cases of deep wound infection after spinal surgery. They accounted for 1.15% of all our spinal surgeries. 9 cases were early infection and the rest were late infection. Spinal instrumentation was performed on 9 cases and removed in 4 cases, and all 9 cases were treated with the continuous irrigation system. 5 patients were infected with MRSA. The risk factor of early infection was the skin necrosis of the wound. Of the 9 cases of early infection, secondary suture of the wound was performed in 7 cases. The risk factor of late infection is thought due to the host's ability to resist infection, which indicates that prophylactic antibiotics should be considered for patients with lower resistance to infection.
We performed hyperbaric oxgenation (HBO) therapy on 30 cases with spinal cord or cauda equina lesion. All these cases were siven postoperative therapy. HBO therapy was performed under the condition of 2.5 ATA for 90 minntes. The effects of the HBO therapy were evaluated to find whether improved the neurogical symptoms of the upper and lower limbs. The results showed improvement in 20 cases, mainly in the cervical of thoracic myelopathy cases. It was however difficult to evaluate the effects of HBO therapy directly, due to natural healing of the diseases and influence of surgery etc. Most of the 10 cases which showed no effects were cauda equina lesion. They suffered severe symptoms, old age, or long durations of morbidity. From these points, we concluded that HBO therapy produces better results for the postoperative therapy of spinal surgery if the patient does not suffer from severe symptoms, old age, or long duration of morbidity.
The purpose of this study is to clarify the usefullness of intraoperative spinal sonography (IOSS) for spinal diseases. Our IOSS procedure is as follows; 1) After laminectomy or laminoplaty, water is properly applied over the dura surface, 2) The probe used for IOSS is the 7.5MHz Toshiba probe, 3) Scanning of acurate sagittal and axial images. More information the spinal cord can be obtained using IOSS than MRI imaging in some cases. IOSS provides an excellent visualization of the spinal cord and anterior surface of the spinal canal. This method is therefore quite useful for monitoring the decompression of the spinal cord in cervical myelopathy and OPLL. We can also observe the position and extent of syrinx and evaluate the shunt, as well as observe the size of syrinx which changes with breathing in the case of syringomyelia. IOSS may play a significant role for solving the extending mechanism of syrinx. TOSS has thus been concluded as being extremely useful for reconfirming the decompression of the spinal cord during real-time operations. This method also allows evaluation of dynamic spinal cord motion in various kinds of spinal diseases.
We report a case in which torticollis was the first symptom of atlantal tumor. A 4-year-old girl developed neck pain and torticollis following minor neck injury. Computed tomography scan showed atlanto-axial rotatory subluxation. Destructive and osteolytic lesions were also noticed in the right lateral mass of the atlas. We concluded that the etiology of this torticollis was pathologic a dislocation due to atlantal tumor. After performing traction for 2 weeks, neck pain and torticollis disappeared. This was followed by 6 months of simple immobilization. During the follow-up period, we noticed progression in osteosclerosis in the right lateral mass of the atlas by computed tomography scan, and refrained from, biopsy and other treatments except traction and simple immobilization. Up to the present, neck pain and torticollis has not recurred. Although we did not perform biopsy, we concluded that the tumor was eosinophilic granuloma from the age, history, and imaging.
Germinomas are the most common variety of germ cell tumors that originate in the central nervous system, and they occur usually in the intracranial midline location such as the pineal gland or suprasellar cistern. In contrast, intramedullary spinal cord germinoma is rare. We report a case of intramedullary spinal cord germinoma with pain in the left lower extremity and urinary retention in an 11-year-old girl. MRI showed the presence of an intramedullary mass between the L1 and L2 vertebrae. We performed a L1-L2 laminectomy and resected this tumor from the spinal cord. We also gave the patient 50 Gy of postoperative radiation at the tumor site, after which the symptoms disappeared. The patient remains disease-free 13 months after treatment.
Spinal angiolipoma is a rare benign tumor. In the past, authors classified spinal lipomas and angiolipoma together, but now angiolipomas are considered a separate entity from lipomas. The majority of spinal angiolipomas are of the noninfiltrating epidural type, but some are of the infiltrating type including our case and a few cases are intramedullary. Infiltrating angiolipomas extend into the bony compartment of the vertebral column or the thoracic cavity. We experienced a case of epidural angiolipoma infiltrating into the Th3 vertebral body. A 65 year-old male experienced difficulty in controlling his lower limbs. MRI revealed a spindle mass at the level of Th2 to Th4. The lesion was isointense on T1-weighted image and hyperintense on T2-weighted image. After Gd-DTPA, it was enhanced. Resecting the tumor by osteoplastic laminectomy improved the clinical symptoms.
The case of a 72-year-old man with a massive spinal arachnoid cyst is presented in this report. Plane X-rays of the lumbar spine showed scalloping of the posterior aspects of the L5 vertebral body. Magnetic resonance imaging revealed that the T1-, T2-weighted and enhanced signal intensity of the lytic component were similar to the granulation and/or scar tissue. The pathological mechanisms responsible for the production of the cyst and osteolytic lesion are discussed, with a review of literature.
We report two cases of endodermal cyst. Case 1, a 9-year-old male, was admitted to our hospital because of rapidly progressing paraplesia. MRI of the spine revealed that a low intensity cystic mass in the T1 weighted image was located ventrally at the level of the first-second thoracic vertebral bodies. The cyst was removed except for some parts of the cyst wall. He recovered from paraplesia after surgery. The recurrence of the cyst was recognized one year after surgery. The cyst was removed again and did not recur. Case 2, a 70-year-old female, was admitted to our hospital with an intramedurally lesion of the spinal cord at the Th7/8 on MRI. The cyst was removed microscopically. Her pain of the lower extremities decreased, but muscle weakness of her right ankle appeared. Pathological examination revealed endodermal cyst in both cases.
Extensive laminectomy is widely perfomed to approach spinal cord tumors. This procedure however inevitably damages the structure of the spine. There are many reports on severe cervical deformities following extensive laminectomies. We performed restorative laminoplasty using threadwire saw (T-saw) for upper cervical spinal cord tumors. The cut of T-saw is so thin that bone loss may be negligible. This makes it possible to exactly replace the lamina after cutting it and to complete early bone fusion. This procedure is useful for the removal of spinal cord tumors.
Thirteen patients with dumbbell spinal cord tumor who underwent surgical treatment were studied. They consisted of five males and eight females, and the mean age at surgery was 55.5 years. In seven patients, dumbbell tumor was removed perfectly by posterior approach alone. In the remaining six patients, although the intra-spinal portion of the tumor was removed, extra-spinal canal tumor could not be resected perfectly. Neurological symptoms improved in twelve out of thirteen patients postoperatively, and none showed recurrence of symptoms at the final observation. In patients undergoing total removal of the tumor, development of the tumor was not observed on MRI after surgery. In patients undergoing partial resection of the tumor, there was no significant difference in the size of the remaining tumor in MRI findings before and after surgery. However, MR examinations are needed in the future to determine whether tumors develop or increase in size.
2 cases of Spondyloepiphyseal Dysplasia congenita accompainied by hypoplasia of the odontoid process are presented. Case 1 was a 49-year-old female with primary complaints of dizziness, pain of neck and from the right shoulder to the antebranchium, and numbness from the right antebranchium to the finger tips. Case 2 was a 32-year-old male with primary complaints of left back pain and numbness of the left fingers. Both patients showed hypoplasia of the axial odontoid process and marked instability of the atlantoaxial joint. Myelography also indicated compression of the spinal cord by the vertebral body of the axis and posterior arch of atlas. Case 1 was treated by resection of the posterior arch of the atlas and occipitocervical fusion and application of a halo-vest for 14 weeks postoperatively. Presently, 2 years after operation, bone union has been completed, and the symptoms are alleviated. In case 2, posterior fusion by the modified McGraw method was performed, but bone union was not achieved. Therefore, transoral atrantoaxial fusion was carried out after 11 months, and a halo-vest fixation was applied for 8 postoperative weeks. The symptoms disappeared shortly after operation, and the patient has shown good bone union and an uneventful course to date 14 years after the operation.
We report a case of acute lumbar epidural hematoma with spontaneous resolution. The patient, a 72-year-old woman, experienced a sudden onset of severe low back pain. She had never experienced muscle weakness, sensory disturbance or micturition problems. MRI showed a posterior epidural mass extending from T11 to L5. We diagnosed the mass as lumbar spinal epidural hematoma by characteristic findings and diachronic signal changes on MR imaging. Her symptoms reduced rapidly from the following day. This case suggests that some spinal epidural hematoma in cases may be diagnosed as the so-called acute lumbago.
Cervical decompression and fusion using lateral mass plates (Axis Fixation System) were performed in ten patients with cervical myelopathy. Three patients had cervical spondylotic myelopathy (CSM); three, rheumatoid arthritis (RA); two, OPLL; one, spinal cord tumor and one, traumatic facet locking. At first, laminoplasty was performed in nine patients and facet locking was surgically reduced in one. Secondly, the plates were placed on the bilateral lateral masses and cancellous bone screws (3.5mm in diameter) were inserted outward in the axial plane and parallel to the facet joints in the sagittal plane. Finally, bone chips were packed in the facet joints for all patients and en-bloc iliac bones were placed intersegmentally between the opened lamina for five patients. Neither neurological nor vascular complications were seen. At one-year follow-up on average, neck pain and myelopathy were improved and bone union was completed in all patients. Vertebral body translation in seven patients was 4.2mm before the surgery, 0.7mm after the surgery, and 1.1mm at the follow-up period. The correction of translation was lost in two cases of one-level fusion and osteoporosis. The sagittal alignments of fusion area were preserved in all except for a patient with one-level fusion. CAT analysis of 50 screws showed that screws inserted 15 to 25 degrees outward provided secure anchorage of the bone without artery injuries.
We have surgically treated 5 cases of rheumatoid cervical spines admitted during a period from 1996 to 1998. All patients showed atlant-axial subluxation and subaxial subluxation. Their follow-up period ranged from 6 to 27 months. We considered long posterior fusion with TSRH system with hook and pedicle screw to be one of the best methods for the case of atlant-axial subluxation with subaxial subluxation. After surgical treatment, immediate bed up without halo-vest was allowed. In 4 cases (80%), the follow-up results showed improved activities of daily living.
Cervical spondylotic myelopathy with degenerative spondylolisthesis is rare. This paper presents the methods for the surgical treatment of this spinal disorder. Six cases of degenerative cervical spondylolisthesis with myelopathy were treated by three operative procedures. Three cases were treated by laminoplasty and other cases were treated by two types of spinal fusion. One of the cases treated by laminoplaty showed complications with transient shoulder girdle palsy. Segmental instability in C4/5 was observed by plain radiographs in this case. We recommended the fusion procedures for a case whose spinal cord was compressed only at the lesion with spondylolisthesis. On the other hand, when the spinal cord was compressed at multi levels, we recommend laminoplasty. Different methods should be used for cases with segmental instability. For example, we recommend combined with decompression of the nerve root for such cases.
We investigated the results of surgical treatment of 49 trochanteric femoral fractures using the compression hip screw. The patients included 13 males and 36 females, with the mean age of 83 years. According to the classification of Evans, 33 cases were stable and 16 cases were unstable. Local complications were observed in 2 cases; loosening of the lagscrew in 1, cutting out with rotational displacement in 1. The telescoping amount of the lagscrew was significantly (p<0.001) more in the case of unstable fractures and poor reduced group than in that of stable fractures and good reduced group. In stable fractures and good reduced group, positive correlation was found between the length of screw in contact within the barrel and the telescoping amount. These results suggest that the shorter the length of screw in contact within the barrel, the more resistance there is to slide. It is, therefore concluded that an important factor for successful treatment with CHS is to engage the lagscrew with the barrel sufficiently under good reduction.
From 1993 to 1997, we treated 12 cases of femoral subtrochanteric fracture at Kitakyushu City Hospital. Of these cases, 5 were female and 7 were male, ranging in age of 15 to 92 years (mean; 57.3 years). Fractures were classified into Type II A (3 cases), Type II B (1 cases), Type III A (3 cases), Type III B (1 case), Type IV (1 cases), and Type V (3 cases) as defined by Seinsheimer. 6 cases were treated with the gamma nail, 4 cases with the Russell-Taylor interlocking nail (R-T nail), and 2 cases with the intramedullary hip screw (IMHS). The mean surgical time was 107.5 minutes (range: 60-240 minutes), and the mean intraoperative blood loss was 246.9g (range: 20-524g). The mean period of non-weight bearing after surgery was 4.2 weeks (range: 2-10 weeks). 10 cases united within 14 weeks after surgery, but one case treated with the Russell-Taylor interlocking nail needed bone graft for union and the other treated with the gamma nail had not united at the final examination. Gamma nail, R-T nail and IMHS are considered useful for treating femoral subtrochanteric fracture because they realize less surgical invasion and early weight bearing.
We investigated the effects of surgical operation on the prognosis of life and gait of aged patients with fracture of the proximal femur. We surgically treated 73 patients with fracture of the proximal femur above 90 years old on the operation day, between October 1992 and February 1998. We were able to follow-up on 69 patients (age range, 90-101; average 92.6) through direct examination or on the phone from the patients themselves or their care givers. 9 patients were male and 60 were female. 18 patients had femoral neck fractures and 51 had intertrochanteric. 35 patients (50.7%) were dead on the day of hearing. This mortality ratio did not differ from the expected ratio of Japanese same aged population. Only 7 patients (10.1%) had died within a year, in which period, the patients' death was thought to be influenced by the operation. Furthemore, 19 patients (55.9% of the patients who survived) were able to stand and walk. We conclude that surgical operation is a good choice of treatment for aged patients with fractures of the proximal femur, because it did not deteriorate the mortality rate.
In many cases of femoral shaft fractures in the aged, choosing the internal fixation material may be difficult due to the advanced bow of the femoral shaft or osteoporosis. In these cases, we fixed four fractures in the middle third of the femoral shaft in patients 75 years old and over by applying a Mennen plate using an anterolateral approach. CPM began one week postoperatively, and a functional brace was applied in order to start rehabilitation two weeks postoperatively. In all four cases, good bone union was achieved, and ADL returned to the normal level (before fracture) in about two months.
Twenty four abdominal injury cases with bone fracture of the extremities and trunk were examined retrospectively from January 1994 to December 1997. We considered the increaed level of transaminase and the fracture of the ribs on the lower right side of the body, and its relation to the damaged liver. On the other hand, we think it is important to consider the relation between the fracture of the ribs on the lower left side of the body and the damage to the spleen. The fusion of the bones is considered an important factor for ensuring the well being of the whole body and recovery. It is thus necessary to perform this operation as soon as possible after accidents.
Eight cases with patellar fracture were treated with tension band wiring using cannulated screws. In all cases, satisfactory results were obtained. This method provides stable fixation which allows early range of motion of the knee joint without pin trouble.
The purpose of this study is to study the mechanism of injury and to introduce a reduction method. 13 cases of triplane fracture in the distal tibial epiphysis treated in our hospital were reviewed clinically. There were 8 males and 5 females with an average age of 13.1 years old (range; 9 to 14 years). The average follow up period was 2 years 2 months (range; 6 months to 7.5 years). 8 cases were forced planter flexion-external rotation of the ankle at injury, only external rotation was seen in a case except for other unexplained cases. All cases were challenged closed reduction under spinal anesthesia, of which 7 cases required open reduction and internal fixation. They recorded 98.2 points with the JOA score at follow-up. The length gap of the lower extremities was not explained clearly. The external rotation force of the ankle, in addition to the planter flexion force, is the most suspectable cause of the occurrence of triplane fracture. Manual reduction with K-wire inserted displaced fragments of the tibia is useful for cases which reject closed reduction.
We experienced a case of a broken intramedually nail in the tibia g months after operation for a tibial shaft fracture using the intremedually nail. The proximal portion of the nail was removed easily by the usual method, while the distal portion of the nail was removed using an extra extraction device. This extraction device is useful for the removal of broken intramedually nails, and is also less invasive than some of the methods reported before. Considering that there is no character of metal fatigue from the analysis of the end of broken nail using SEM, the reason for the broken nail lies in the nail strength.
We studied the accuracy of MRI in the rotator cuff tear. We also compared the MRI findings and operative findings in the assessment of the size of the rotator cuff tear. 91 patients who underwent MRI investigation before the operation were chosen for this study. Rotator cuff tear was diagnosed by T2_??_ images. The sensitivity, specificity, accuracy, false positive value and false negative value for complete tears were: 92%, 95%, 92%, 5%, and 8%, respectively: for incomplete tear: 92%, 90%, 90%, 10%, and 8%, respectively. A linear regression analysis showed an excellent correlation between the MRI assessment and the size of the complete tear revealed at operation. We concluded that MRI assessment is useful for the rotator cuff tear. However, in certain cases, it is hard to differentiate incomplete tears from very small complete ones and the degenerative change of the rotator cuff.
In cases of rotator cuff tear, the scapuro-humeral rhythm is usually disturbed. This paper presents an analysis of the scapulo-humeral rhythm of patients with rotator cuff tear during arm elevation through pre and post operational comparisons. Nine patients operated with McLaughlin method were examined before operation, after operation, and at the other side. Their ages ranged from 48 to 78 years old. Patients were asked to elevate both arms in the scapular plane in front of the roentgenofluoscopy. The movements were recorded on a video recorder and three landmarks of the scapula were determined, after which three dimensional motion of the scapula was analyzed using a micro-computer. The recording was done immediately before and after operation from 4 months to 2 years and 10 months. There were no significant differences in the medially tilting angle and upward rotation angle before and after operation. However, the downward tilting angle in the maximum elevated position after operation was smaller than that before operation, and similar to the angle of the normal side.
In 1986, Bigliani studied the relationship between the shape of the acromion and rotator cufftears. He reported that a higher incidence of rotator cuff tears results in a hooked type acromion. The aim of this study is to investigate the relationship between the morphology of the acromion obtained at surgery with that of the pre-operative MR image and Scapular Y view. 56 patients with an average age of 56 years were operated on, pre-operating MR imaging was carried out in 47 cases and Scapular Y view was in 43 cases. The acromion was obtained at surgery by lateral acromioplasty. The acromion was sliced into a thickness of 100μ and it was classified as flat (type 1), smoothly curved (type 2), or hooked (type 3) according to Bigliani's classification. Scapular Y view was taken with a X-ray fluoroscopy so that the undersurface of the acromion could be observed and classified into three groups. The acrominal shape of MRI imaging was classified from the sagital oblique gradient echo images, and Scapular Y view were obtained and classified into the same classification. Specimens type 1, type 2 and type 3 were 19.6%, 48.2% and 32.1% respectively. The accurancy of MRI image and Scapular Y view were 51.1% and 37.2%. In this study, no higher incidence of rotator cufftears was found in hooked type acromion, but there was a difference between the acrominal type in MRI imaging, Scapular Y view and that of specimens.
We carried out a pathological examination of the inferior surface of the acromion in cases with rotator cuff tears to clarify the pathogenesis of such tears. 21 males and 4 female patients with an average age 53 years were operated. The lateral portion of the acromion was resected to prevent impingement syndrome and was examined microscopically to determine the degree of degeneration of the inferior surface. Degeneration of the outer part of the recected acromion was more severe than that of the inner part. The degree of degeneration was significantly related with an increase in age. These results suggested that degeneration of the inferior surface of the acromion among middle aged men may occur due to aging, or cuff dysfunction may pre-exist before any symptoms become apparent.
Six patients underwent operative repair of massive rotator cuff tear and were followed up after an average of 8.2 months (range 6 to 12 months). The mean age of the patients was 63.2 years; there were 5 male and 1 female patients. All patients experienced significant pain and 5 patients recall a traumatic event. Magnetic resonance imaging (MRI) permits evaluation of the size of the rotator cuff tears. Preoperatively, average JOA shoulder score was 55.0 points. All patients had anterolateral acromioplasty and repair with interpositional graft with fascial lata. Early passive flexion exercises were performed on all cases. All patients showed satisfactory results, with 4 rated as excellent, and 2 rated as good. Five patients had satisfactory pain relief. The mean JOA score was 92.5 points.
We treated rotator cuff tears surgically by the McLaughlin method on 14 cases from 1994 to 1997. They were followed up for an average of 26 months (range, 6 to 52). There were 11 were men and 5 were women. The average age of the patients was 58.1 years (range, 48 to 68). The clinical results were evaluated using the JOA score system and questionnaires on the patients satisfaction and problems and self score system (10 point method). The average JOA score was 96.1 points. The average 10 points score was 8.9 points.
The effect of CPM after rorator cuff repair is unknown. The purpose of this study was to show our postoperative protocol with CPM following the repair of the rotator cuff and to investigate the outcome. 35 patients (12 females, 23 males; mean age 56.3, range 26 to 69) with 35 repaired rotator cuffs (2 massive, 28 small to large, 5 partial) were assigned to CPM postoperative therapy and were followed with a mean period of 36 months. Patients used a CPM for the first 6 weeks after the first postoperative day. After 6 weeks, active ROM exercises were performed. Using the JOA shoulder score, there were 88.6% excellent results, 5.7% good results, and 5.7% fair results. CPM postoperative therapy after the repair of the rotator cuff apparently produces favorable results.
54 shoulder rotator cuff repairs that were rehabilitated by early passive motion exercise were followed up after at least one year post-operatively, and evaluated with the JOA shoulder scoring system. The mean JOA shoulder score improved from 67.4 to 93.4 post operatively. 34 (63%) scored over 95 points, 8 (15%) were less than 95 to 90 points, 8 were less than 90 to 80 points and 4 were less than 80 points, Small cuff tear showed relative low JOA shoulder score (86.7 points) post operatively, due to post operative pain and limited ROM. Though 8 shoulders had weak shoulder external rotation power, threr were no evidence of rupture during early motion exercise. In recent series of 21 shoulders, 17 showed early functional recover.
We treated 7 shoulders in 7 patients with massive tears of rorator-cuff by the transfer of the latissumus dorsi. They consists of 4 men and 3 women. Their average age was 60 years and the average follow-up was 13 months (10-19). Clinical results were evaluated by R. O. M., complications, the latest complaints, and isokinetic muscle strength measured by the Kin-Com machine. Electromyography and MR imaging were performed on the transferred latissmus dorsi. Active forward flexion improved from a preoperative average of 95° to a postoperative average of 165°. Early complications include shoulder-hand syndrom in 2 shoulders and superficial infection in 1. Recovery of muscle strength was fair in the anterior forward flexion in 3 shoulders. EMG studies revealed the transferred latissimus dorsi were not functioning in the forward flexion and external rotation with the arm at 90° abduction. Rerupture was found in 2 shoulders in the MR image. We conclude that latissimus dorsi transfer can be effective for massive tears of rotator-cuff. But as the muscles show no switching of their functional mechanism, this procedure is not recommended for young and manual workers.
Most reports on the results of treatment of tears of the rotator cuff have included surgical results, and only a few results of long-term therapy in non-surgically treated patients have been reported. We followed up non-surgically treated patients whose course had been monitored, and performed questionnaire surveys and direct examinations about 2, 6 and 19 years after the start of follow-up. The subjects were 14 conservatively treated patients diagnosed with the complete tear of the rotator cuff by shoulder arthorgraphy in our department during the 3-year period between 1986 and 1989 and whose course had been known at the time of the survey in 1990 and 1994 and 1998. They could be followed up by questionnaire and direct examination. Their mean age at the time of the initial examination was 61.6 years, and the mean follow-up period was 10.2 years. Patients with only slight pain after initial conservative treatment and who did not want to undergo surgery, were treated conservatively. The evaluation was based on the scoring of JOA. All but 2 had favorable long term courses.
We examined 22 rugby football players of a college rugby football team and analyzed the X-p findings of their cervical spine. We divied them into 2 groups, “FW group” and “BK group”, and compared them with 21 healthy volunteers as the control group who never played rugby football in their lives. The mean age, height, and weight of the team was 23 years old, 171.1cm, and 72.9kg. The mean age, height, weight of the control group was 24 years old, 170.2cm, and 68.5kg. The average of their experiment years of rugby was 3.5 years. The results revealed that the “FW group” had kyphosis, disc narrowing (C4/5, C5/6), and flatness of the spinal body. It suggests that cervical spondylotic change is hastened by the chronic stress on the cervical spine.
175 high school basketball players in Miyazaki were studied with regard to basketball injuries through questionnaires on the history of knee and ankle injuries and basuketball shoes. Many players were found to high-top shoes to decrease ankle sprains. They mentioned the need for basketball shoes that are soft and stable with better spring. Many prevention of ankle sprains. We emphasize the importance of checking shoes and footwork when examining players. In the future, we will conduct further studies on the relationship of injuries and shoes.
In this paper, we report a case of bilateral ankylosis of the hip joint caused by ankylosing spondylitis, successfully treated with bilateral total hip arthroplasty. The patient was a 67-year-old man, who complained of ankylosis in the bilateral hips and severe disturbance especially in gait and toileting. He developed arthritis in the bilateral wrist and knee joints at the age of 20 and ankylosis in the bilateral hip joints at 60. On his first visit to our clinic, the range of motion of the spine was limited and bony change in the sacro-iliac joint was seen on X-ray. Bilateral hips showed ankylosis in flexion 15 degrees and abduction 5 degrees. Our diagnosis was definite ankylosing spondylitis (modified criteria of New York, 1984). Bilateral total hip arthroplasty was performed and 800mg/day of Etidronate disodium was given for 3 months after the operation. One year after the operation, the range of motion of both hips and the JOA score improved. The patient's gait and toilet problems also improved although some recurrence of heterotopic ossification (class 3 after Brooker) was seen.
We experienced 10 cases with hip disease for renal failure for 5 years. 10 patients with an average age of 54.3 years underwent operative treatment. They consisted of 3 hip fractures, 2 avascular necrosis of the femoral head, 2 coxarthrosis' and 3 ectopic calcification of the hip joint. The average hemodialysis period was 9.3 years, and the average follow-up period was 2.9 years. 1 femoral neck fracture case showed nonunion after fixation with screws, for which we performed cemented bipolar hemiart-hroplasty. Revision was however required due to osteolysis around the prosthesis. Because the ratio of loosening due to hemodialys is still high, further tmprorement of the operation is neccessary.
Synovial osteochondromatosis is a benign disease of the synovial tissue, most commonly affecting the knee and elbow joints, and is rarely found in the hip joint. We report a case of the synovial chondromatosis of the hip joint in this paper. A 42-year-old woman was admitted to the Fukuok University Hospital in February 1998 due to a 2-year history of pain of the right hip joint. On admission, the motion of the right hip joint was found to be slightly restricted. Roentgenogram of the right hip joint revealed expansion of the joint cavity. Arthrogrogram of the right hip joint showed a honeycomb shadow. We performed rthrotomy, taking care not to dislocate the femoral head because of the potential hazard of necrosis associated with this. Many loose bodies and synovial tissue were removed. Postoperatively, the patient showed good results.
Synovial osteochondoromatosis (SOC) rarely occurs in the hip joint, and it is difficult to diagnose cases that show no ossification on X-rays. We experienced 2 cases of SOC of the hip joint. Case 1 was a 37-year old man and Case 2 was a 68-year old woman. Both complained of right coxalgia and limitation of hip motion. Their X-rays showed widening of the joint space and bone atrophy. However, arthrogram showed multiple loose bodies and Gd-enhanced MRI with fat suppression showed enhanced synovium and no enhanced nodular lesion. These cases were there fore diagnosed as SOC, extirpation of the loose bodies and synovectomy. Their symptoms subsided after operations. MRI and arthrogram are considered useful for the diagnosis of SOC without ossification.
Radiographs of 84 hips with advanced or terminal stage osteoarhritis were evaluated after transtrochanteric vaigus osteotomy (TVO). Improvement of radiographical changes after osteotomy usually correlate with the clinical conditions of each osteoarhritis hip. The average age at operation was 44 (17-60) years old. Radiographical changes including joint space narrowing, osteosclerosis and cystic change were evaluated at 2 and 5 years after operation. Additionally, at the last time after operation (average 8.3 years (7-11)), they were evaluated comparing with those just before operation. Two years after operation, most hips whose acetabular head index (AHI) was more than 60% showed better radiographical appearances than before operation. The higher was the AHI of operated hips, the better the radiographical appearances remained for a longer time after operation. The radiographs of the hips after TVO with acetabuloplasty improved similarly to those of the hips whose AHI was more than 60%. These data show that the improvement of the radiographical sign of the operated hips depends on AHI, suggesting that the acetabular coverage of the head is an important factor when selecting operation methods. When AHI is low, acetabuloplasty should be carried out with TVO.
Transtrochanteric anterior rotaional osteotomy was performed on 7hips in 7 patients with steroid-induced osteonecrosis of the femoral head. Bipolar endoprosthesis arthroplasty was performed on 3 hips and collapse was progressive in 1 hip after osteotomy. In steroid-induced osteonecrosis of the femoral head, since it is difficuls to determine the width of hecrotic lesion the often resulting in the misjudgment of the indication for osteotomy. Steroid induced osteoporosis and reduced repair ability for osteonecrosis. In addition, continuous dose of steroid after osteotomy induced reccurent necrosis. These reasons cause postosteotomy conditions to worsen.
We evaluated 23 hips in 21 patients at 7 months to 8 years (average 3.2 years) after Sugioka Transtrochanteric rotational osteotomy for non-traumatic avascular necrosis of the femoral head. 6 hips had secondary collapse of the femoral head after the surgery. To clarify the risk factors for secondary collapse, we measured the intact area of the femoral head on the postoperative X-ray and preoperative MRI as well as measured the intact surface commonly used. In conclusion, the intact surface rate of the loading area was important as previosly reported, the reasons for secondary collapse could not be explained in several cases. The incidence of secondary collapse was higher in those with intact area of the lateral region in the femoral head that is less than 90%.
We reviewed 18 cases of arthrodesis for hip osteoarthritis at advanced or terminal stage. The average age at operation was 43 years old (22-52), and the mean postoperative period was 10 years (2-20). The mean walking and daily activity life (ADL) JOA scores were 14.8 and 17.0 points, respectively. Although most cases showed good walking and ADL scores, the results of 3 cases with contralateral hip osteoarthritis at operation were poor. Most of the patients could go up and down the stairs without any support, sit on chairs, and put socks on the operated limb by themselves. On the contrary, many could cut the toe nails of the operated limb nor sit on the floor (SEIZA). There was a tendency for gradual increage in low back pain or contralateral-sided knee joint pain after arthrodesis in patients with there symptoms. The degree of pain was low, and no cases underwent operation of the lumbar spine or knee joints after hip arthrodesis. There results suggest that arthrodesis is a promising operation for hemilateral hip osteoarthritis of young patients, especially those who need to stand or walk for long periods in their work.
We report a case of a 74-year-old woman who underwent revision surgery of acrylic femoral head prosthesis (Katayama-Hirakawa type) 32 years after the replacement. At 42-years old, she suffered a left femoral neck fracture, and as a result, underwent a femoral head replacement using acrylic prosthesis, after which she enjoyed a painless daily life for about 30 years. In March 1995, she suffered left coxalgia which was followed by gradual increasing pain. She therefore underwent revision surgery in August 1996. We found 3 damaged parts in the removed femoral head prosthesis. These include distortion of the proximo-medial stem, crack of distal stem, and rusting of the internal metal. But the head of the prosthesis showed minimun change. The factors for long-term survival of the patient's were minimun influence of the acrylic resin on the bone and joint, maintanance of the cartilage of the acetabulum in good condition at replacement, and the patient had been light weight for the past 35 years.