We report our experience using the Wolter Claviclar Plate for nine cases with Distal Clavicular Fracture (Neer type II) and twelve cases with Acromioclavicular Joint Dislocation (Tossy grade II; 1 cases, Tossy grade III; 11 cases).
All cases with Distal Clavicular Fracture had bone union and good reduction. The results for the Acromioclavicular Joint Dislocation were comparatively good, but one case had diaphysial fracture of the clavicula. We realized the need for plate remodeling through these experiences.
The Wolter Clavicular Plate provided strong fixation and early ROM exercise. We think that it is very useful for Distal Clavicular Fractures and Acromioclaviclar Joint Dislocations.

抄録全体を表示

Posterior fracture-dislocations (PFD) of the shoulder are rare, accounting for approximately 1 to 4% of all shoulder injuries. We reported 5 cases of posterior fracture-dislocation of the shoulder. One case was only posterior dislocation and the other 4 cases were 2-part PFD. Four out of 5 cases were misdiagnosed at the first examination. It took an average of 4 weeks for correct diagnoses of these 4 cases. Closed manipulation and percutaneous pinning were performed on only one fresh case. Open reduction and/or osteosynthesis were performed on the remaining 4 cases. The average range of motion was 156 degrees in flexion, and 60 degrees in external rotation. In internal rotation, average 3.6 vertebral body was restricted compared to the healthy side. Although the over all results were acceptable, 4 cases in which dislocation was over-looked complained of misdiagnosis of initial medical check.
Posterior dislocation of the shoulder is difficult to detect with only the anteroposterior view of plain X-ray. An awxillary radiograph or CT is essential for the diagnosis of posterior fracture-dislocations.

抄録全体を表示

Recent findings in both basic studies and clinical studies have led to the improvement of the outcome of anterior cruciate ligament (ACL) reconstruction. However, graft failure occasionally occurs, resulting in the need for revision ACL reconstruction. Some technical difficulties exist which are specific to revision surgery. In this paper, we describe our methods for evaluating patients with failed ACL reconstruction in order to investigate the mechanism of failure to improve future preoperative planning. 6 patients consisting of 5 males and 1 female, with an average age of 24 years (ranging from 20 to 31 years) were studied. The average time from primary to revision ACL surgery was 48 months (ranging from 18 to 72 months). All patients who underwent revision ACL surgery were studied postoperatively (all with harvested contralateral patellar tendon grafts). We also reviewed stability (Lachman test, Pivot shift test) and recurvatum, and performed radiographic examination.
Lachman test was-(nagative) in 5 cases and ± in 1 case after the patients resumed their regular sports activity. After revision ACL reconstruction, the findings were-(negateve) in 3 cases and ± in 3 cases. Pivot shift test was-(negative) in 6 cases after the patients resumed their regular sports activity. After revision ACL reconstruction, the findings were-(negative) in 4 cases and ± in 2 cases.
The recurvatum was 15° in 1 case and 5° in 1 case.
The side to side difference in the anterior laxity was 2.2mm measured with Telos SE after the patients resumed their regular sports activity. After revision ACL reconstruction, it was 2.5mm.
From the magnetic resonance imaging (MRI) findings, low signal intensity was observed in 2 cases, intermediate intensity in 3 cases and high signal intensity in 1 case after the patients resumed their regular sports activity. After revision ACL reconstruction, low signal intensity was observed in 1 case while intermediate intensity was observed in 5 cases.
The failure cases were due to sports. In addition, 1 case had inadequate rehabilitation.
The Lysholm Knee Scores were 94.2 after the patients resumed their regular sports activity, 90.5 after revision ACL reconstruction.
The main causes of failed ACL reconstruction were sports related re-injuries. In order to reduce the occurrence of such sports related re-injuries, proper attention should be paid to such factors as: notch impingement, general joint laxity and inadequate rehabilitation.

抄録全体を表示

A 57-year-old man suffering arm pain and numbness in the with left upper extremities subacute onset visited our hospital. He had hypersthesia at the left upper extremities and disturbance of fine movement of fingers. MRI revealed an abnormal lesion behind the C7 vertebra body. CT revealed a cystic body at the extradural area, compressing the spinal cord. Surgical resection was performed. Pathology identified the cyst as ganglion. Based on other reported cases, we made the assumption that this kind of ganglion has some relation with cervical spondlyosis.

抄録全体を表示

Glomus tumors which usually arise in the subunguis may be difficult to diagnose when they occur in unusual locations. We report two cases of glomus tumor in the extra-subunguis. One arised in the subcutaneous of the left proximal knee and the other arised in the left great toe. Magnetic Resonance Imaging of both two cases disclosed a low intensity signal on T1-weighted images and a high intensity signal on T2-weighted images. Both tumors were completely excised. We believe that MR imaging is useful for the preoperative evaluation of soft tissue tumors of these regions.

抄録全体を表示

The prognosis of patients with Ewing sarcoma is poor. Peripheral blood stem cell transplantation (PBSCT) is a kind of hematopoietic stem cell transplantation combined with extremely high-dose chemothrapy. We report two cases of Ewing Sarcoma-one had a huge primary left calf tumor and another a huge primary submaxillary tumor with lung metastasis-successfully treated with extremely high-dose chemotherapy with PBSCT. We suggest that PBSCT combined with chemotherapy is efficacious and could be beneficial in improving the prognosis of highly chemoresponsive tumors such as Ewing sarcoma.

抄録全体を表示

We have been using posterior lumbar interbody fusion (PLIF) for degenerative lumbar diseases. Our indications for PLIF are spondylolisthesis, local angulation and segmental instability.
In this report, we studied 33 cases (spondylolisthesis; 16 cases, spondylolytic spondylolisthesis; 3 cases, lumbar disc hernia; 7 cases, degenerative lumbar canal stenosis; 4 cases, lumbar kyphosis; 3 cases). The mean age at operation was 57 years old (16 to 84). The patients were followed up for more than 1 year, and the mean follow-up was 26 months (13 to 49). We assessed bony union and changes in disc height in serious radiographs. Bony union was confirmed in all cases. The disc height was 0.52 at the first stand and 0.48 at the last follow up. Eight percent loss of the disc height occurred. No particular problems were encountered around surgery and during follow-up.
Carbon cage proved to be a useful tool for PLIF in degenerative lumbar diseases.

抄録全体を表示

A 30-year-old female with idiopathic hematoma in the isolated suprapatellar pouch of the knee was treated in our hospital.
She experienced left knee pain and realized swelling at the proximal area to the patella from 1997. She had hardly been able to sit down and ascend the stairs. We could touch the click at the proximal area to the patella at the 20 degrees flexed position. Though there were no obvious abnormal findings on plain roentgenographs, there was an isolated cystic leision enhanced by arthrography in the puncture of the suprapatellar pouch. It interrupted into the P-F joint at the 20 degrees flexed position. On Gadolinium enhancement of magnetic resonance imaging, the peripheral area of the cyst showed clear contrast.
In May 1999, we found the plica to be Sakakibara type C of the knee joint and diffuse mild synovitis in the knee joint by arthroscopy examination. We resected the isolated cyst and found bloody fluid inside. The inner surface of the capsule was very smooth, there were no findings similar to a nodule usually found in pigmented villonodular synovitis. On the other hand, there were no angioendotheliocells and hyperplastic inflammatory cells.
We therefore diagnosed hemorrhagic bursitis in the isolated suprapatellar pouch. At 5 months after the operation, the patient felt no knee pain and there were no recurrent findings.

抄録全体を表示

We report a case of duplicated lateral meniscus. One side of the upper meniscus was attached to the mid-lateral segment of the lower meniscus, and another side to the posterior horn. Both surfaces were smooth. Differential diagnosis was necessary for bucket handle type tears.

抄録全体を表示

We investigated treatises on the QOL scale of spinal diseases published within the last five years. Thirty treaties were published and fifteen scales were used. For every scale, we investigated how eating, sleeping, voiding and pain were assessed.
For these scales, the subject of study is mostly lumbar disease. Thirteen out of fifteen scales mainly assessed QOL by degree of pain. Only two out of fifteen scales assessed ADL (activity of daily living). It is necessary to reinvestigate the QOL scale of spinal diseases.

抄録全体を表示

Spinal nerve roots were stimulated by magnetic stimulation over the spine percutaneously. Peripheral motor conduction time (PMCT) was calculated by the latencies of the M-wave and F-wave. The difference between the PMCT and the latency of CMAP elicited by magnetic stimulation over the spine showed the cauda equina conduction time (CELT). The target muscle was abductor hallucis. In 58 healthy volunteers, CECT was 3.5±1.0ms. CECT showed within the normal range in 12 cases of lumber disc herniation and 13 cases of lumbar spinal canal stenosis with L5 or S1 radiculopathy. CECT was 5.3±2.0ms in 15 cases of lumber spinal canal stenosis with cauda equina lesions. In conclusion, the cauda equina conduction time was delaied in lumber spinal canal stenosis with cauda equina lesion.

抄録全体を表示

We investigated the indication of endoscopic carpal tunnel release (ECTR) for carpal tunnel syndrome (CTS) based on the results of a nerve conduction study (NCS). 38 hands of 35 patients with CTS were divided into 4 types preoperatively based on the results of the NCS. The compounds muscle action potentials (CMAPs) were recorded at the abductor pollicis brevis (APB) and the second lumbrical muscle (L2) following median nerve stimulation at the wrist. CTS with similar prolonged distal motor latency of the APB and L2 was included in type 1 (25 hands). CTS with prolonged distal motor latency of the APB longer than that of L2 (>0.7ms) was included in type 2 (10 hands). CTS with the CMAPs at the APB alone recordable was included in type 3 (3 hands). CTS in which the CMAPs at the APB and L2 were not elicited was included in type 4 (2 hands). After ECTR, all the CTS of type 1 and 2 improved well and the latency difference between APB and L2 was reduced for type 2. In 1 type 3 hand, the CMAPs at the APB were not elicited, although the CMAPs at L2 improved. In 1 of 2 type 4 hands, CMAPs at L2 alone were elicited.
In conclusion, the ECTR was indicated for CTS of type 1 and 2 abnormality, but a few patients with type 3 and 4 abnormality had poor results with the ECTR probably due to the anatomical variation of the recurrent motor branch to the APB.

抄録全体を表示

In sensory map, interphalangeal creases are regarded as the only border line between phalanxes. So there have been only a few investigations on the sensation of the interphalangeal crease. In this study, we tested the sensation of th distal interphalangeal crease, finger tip, and finger pulp.
The subjects were 88 middle fingers of 44 volunteers. We tested sensation at 8 points from the finger tips to the proximal interphalangeal creases. The sensation was examined by pinprick test, 2-point discrimination test, and Semmes-Weinstein monoffilament test.
In the pinprick test and S-W test, highest sensitivity was at the finger pulp. In the 2PD test, highest sensitivity was at the finger tip. In all the tests, the distal interphalangeal crease had the lowest sensitivity at 8 points. There was statistical significance in sensory transition (Friedman test).

抄録全体を表示