The purpose of this study is to evaluate the surgical outcomes of ossification of the posterior longitudinal ligament (OPLL) from the viewpoint of occupational recovery after surgical treatment. We reviewed occupational recovery after surgical treatment in 101 patients with OPLL in the cervical spine. The average age of the patients was 56 years (range : 35 to 69) and the average follow-up period was 91 months (range : 12 to 192 months). They were divided into five groups according to profession: light sitting work, light standing work, heavy standing work, working at heights, and drivers. In all cases 52 (51%) patients successfully returned to their preoperative occupations. Although workers in the light sitting and standing groups recovered at a higher rate than those with jobs requring heavy lifting, 41% of patients whose myelopathy improved did not recover well. These results show that improvement of JOA score is not always associated with occupational recovery for OPLL patients after surgical treatments.
We studied 16 patients over 70 years old with cervical myelopathy. The average age at the time of operation was 73.7 years (range : 70 to 80) and the average follow-up time was 45 months (range : 5 to 111 months). The clinical results were evaluated based on the Japanese Orthopaedic Association (JOA) scoring system. The mean JOA score of the patients was 6.8 before operation and 10.0 aftersurgery. Pre-operative complications were hyper tension in 4 patients, diabetes mellitus in 2 patients, liver diseases in 2 patients, and heart failure in 1 patient. Post-operative complications were mental disorder after operation in 4 patients. Grafted bone of anterior decompression and fusion was displaced in 2 patients because of disorder. One of these patients required re-operation.
We evaluated patients after laminoplasty for more than 10 years. We were able to follow up on 38 patients via telephone. Twenty-six patients were men and 12 were women. Thirty patients had cervical spondylotic myelopathy (CSM), and 8 had ossification of posterior longitudinal ligament (OPLL). We examined the Xp of the cervical spine of 13 patients who were able to visit our hospital. After cervical spine operation on these patients, the transverse distance of the spinal canal increased and kyphosis decreased. The ROM of the total cervical spine also decreased, and no new displacement was seen. Generally, though the death rate of patients after operation is relatively high, the JOA score rate of improvement is relatively high.
We observed patients after anterior cervical fusion for more than ten years. Twenty patients had cervical disc hernia, 16 cervical spondylotic myelopathy, 24 cervical spondylotic radiculopathy, 5 were traumatic, and 1 had inflammation of the vertebra disc. We evaluated the X-P of the cervical spine of 32 patients who were able to visit our hospital. 95.4% of patients performed well in their daily life and 83% were abe to continue the same jobs they had before developing the disease. The greatest residual symptom (43.9%) was numbness of the CSM and a new complication (4.5%) of local pain of the cervical disc hernia after operation. Bone fusion rate was 97%, and lordosis of the ASF region tended to decrease. However, in 2 facet joint fusion cases, lordosis remained in the total cervical spine. In the 60% of upper facet joint at the point of fusion, abnormal instability occurred. Residual symptoms were mostly seen in the lordosis cases of the ASF region and total cervical spine. New symptoms were mostly seen in kyphosis cases and unstable cases in the upper facet joint.
Dialysis-associated spondylosis is increasingly recognized in long-term dialysis patients. We reviewed 13 patients who had dialysis-associated cervical spondylosis and required surgical treatment. There were 7 males and 6 females with an average age of 55 years (range 38 to 77). The duration of hemodialysis ranged from 8 to 26 years (mean : 17.2 years) and the follow-up time ranged from 6 months to 6 years and 9 months, averaging 3 years. We performed anterior fusions on 4 cases, laminoplasty on 7 cases, posterior fusion on 1 case and occipito-cervical fusion on 1 case. In 12 cases (excluding 1 case of AAS), we assessed the clinical results by the JOA score and the recovery rate using Hirabayashi’s method. The mean recovery rate was 46%. Eight of the 13 cases had good to excellent results, 3 had fair, and 2 poor. The cases with poor results developed by post-operative infection in the operative wound, and died at 7 and 17 months after operation respectively.
We evaluated the surgical results and complications of 14 patients, aged 80 years or more, who underwent surgical treatment for lumbar canal stenosis. The average age of the patients at the time of operation was 82.2 years and the average follow-up period was 17.5 months. The average Japanese Orthopaedic Association (JOA) score at the time of the operation was 7.7 points and improved to 17.1 points during the follow-up period. The average improvement rate was 45.6%. There were 2 patients who had serious complications postoperatively. We believe that surgical treatment may be considered for patients of an extremely advanced age with severe symptoms of lumbar canal stenosis.
This study reviewed follow-up results of more than 2 years in 29 cases who underwent lumbar decompression without fusion for acquired lumbar spinal canal stenosis between 1994 and 1998. The average patient age was 68.8 years. The mean JOA score improved to 12.2 in the last follow-up from the preoperative score of 7.8 (total score was 15). Clinical success was defined according to the Hirabayashi scale. The average score was 61.1%. Twenty-four cases were categorized as excellent, good or ; fair only 1 cases was poor. Four cases required re-operation due to worsening of symptoms. The cases required re-operation due to excessive medial facetectomy.
In this study we analyzed 70 patients with lumbar disc herniation treated by blocks since 1996. Fifty-one patients were treated by selective nerve root blocks and 19 were treated by continuous lumbar epidural blocks. The purpose of this paper is to compare the efficacy of the selective nerve root block and continuous epidural block. The functional results were evaluated on the basis of the Japanese Orthopaedic Association (JOA) score, subjective symptoms: 9 points. We assessed the block effectiveness when the JOA score improved by more than 2 points after the blocks. It was effective in 31 patients (60.8%) for selective nerve root blocks and 8 patients (42.1%) for continuous epidural blocks. Selective nerve root block is considered to be superior to continuous epidural block. Selective nerve root block showed better results especially for patients with negative SLR test. The herniated mass was protrusion type and space-occupying ratio was less than 30%.
The clinical results and radiologic findings in 15 cases diagnosed as lumbar radiculopathy and treated with osteoplastic hemilaminectomy were studied. Follow-up period was from 7 months to 4 years, (average 2.3 years. Clinical results were evaluated by JOA score, and the recovery rate was determined by Hirabayashi’s method. Bone union of spinous processes and vertebral arch, which had been dissected with a surgical thread wire saw, was judged by radiographs and computed tomographs (CT). Osteoarthritic deterioration of the facet replaced was judged by CT. The preoperative mean JOA score was 5.2 points, which improved to 12.1 points at the final evaluation. Clinical evaluation improved with statistically significant differences. The mean recovery rate was 70.7%. The bone union rate of spinous processes and vertebral arch was 100% and 56%, respectively. However, the bone union rate showed little correlation with the improvement of clinical symptoms. Osteoarthritic deterioration of the facet progressed in 2 cases and appeared in 1 case. Re-operation was necessary for 1 case due to recurrence of severe leg and lower back pain. These results suggest that osteoplastic hemilaminectomy is effective for short term treatment, and longer follow-up is necessary.
This study, evaluated the clinical outcome of posterior lumbar interbody fusion (PLIF) with threaded cages only (AESCULAP H.M.A. system). We performed the operation on 13 patients (5 males and 8 females) with lumbar spinal canal stenosis, disk hernia with instability and degenerative listhesis. The mean age at surgery was 67.4 years (range : 54 to 75) and the period of follow-up was 6 to 57 months, (average : 23.7). Fusion success was judged by absence of motion on flexion-extension radiographs and absence of bone halo around the implants. The mean JOA score improved from the preoperative score of 12.4 to 23.5 at the last follow-up (average improvement rate 60.1%). Leg pain was reduced in all cases. Intervertebral angle improved to less than 2 degrees in 8 cases which we judged as bone union occurred. No halo around cage, migration, or displacement of implant was observed in any case. We believe that PLIF with interbody cage is useful for elderly patients who have lumbar spinal canal stenosis with spinal instability.
The authors present a case of fracture-dislocation of the thoracic spine without neurologic deficit. The case was a 16-year-old male injured in a traffic accident. Due to fractures of the middle column, alignment of posterior elements in the spinal canal was maintained and there was no neurological deficit. The patient was operatively treated, and was completely asymptomatic at follow-up one year later.
A case of cauda equina entrapment in the vertical lamina burst fracture of the second lumbar vertebra is reported. The patient was a 48-year-old male. He was involved in a motor vehicle accident and sustained a Denis Type B burst fracture of the second lumbar vertebra. CT scan demonstrated a vertical lamina fracture. The patient underwent posterior spinal canal exploration and spinal instrumentation. At operation, a dural tear was found, and cauda equina rootlets were entrapped between the lamina fracture fragments. Neural elements were extracted and replaced within the dural sac, and the dural tear was repaired. The fracture was stabilized in the posterior direction with a pedicle screw and rod system. Ten months postoperatively, the patient experienced a slight bowel-bladder dysfunction. Motor examination showed improvement in the strength of the right leg.
Expression of BDNF and full-length TrkB in normal adult rat spinal cord and dorsal root ganglion was examined by immunohistochemistry. Rats were fixed with Zamboni’s fixative followed by cryosectioning of the lumbar spinal cord and dorsal root ganglion (DRG). Anti-BDNF and anti-TrkB-fl antibodies were applied. Slides were observed under dark field microscopy. Axon terminal fibers in the dorsal horn of the spinal cord show strong immunoreactivity to anti-BDNF antibody. Many cells in the ventral horn of the spinal cord are immunostained with anti-TrkB-fl antibody. Some small to medium cells in the DRG were stained with anti-BDNF or anti-TrkB-fl antibody. These results suggest distribution of BDNF and TrkB protein in the spinal cord and DRG.
Although harvesting autogenous bone grafts from the ilium for the purpose of bone union and/or stability is a frequent procedure, several complications at the donor site have been reported, such as donor site pain, nerve injury, infection, hematoma, fracture, etc. Particularly, donor site pain persisting for more than three months has been reported in 19.6% to 44.2% of patients. One of the causes is considered to be due to the extensive stripping of strong fascia and muscle which originate in close proximity to the outer table of the ilium. On the contrary, the iliac muscle, which is a synergist, is relatively weak. Secure closure of the fascia is strong enough to tolerate a considerable load. From this viewpoint, inner half thickness grafts including inner cortical bone were employed in our series of anterior fusion of the cervical spine and the posterior fusion of the low back spine from 1995 to 2000. The Kokubun method was employed for the fusion of the anterior cervical spine from one segment to three segments in 10 patients. The combined translaminal facet screw fixation. (Magerl) and inter-spinaous processes spacer (iliac bone) insertion method were utilized for posterior lumber fusion. To avoid or minimize injury of short posterior sacroiliac ligaments, graft bone was harvested at a depth of less than 2.5cm. This method was employed in 75 patients of the low back disorders. Good bony fusion was achieved in all patients. Donor site pain was observed in most patients just after surgery. Nevertheless, in all patients, complaint of the iliac site disappeared within one or two weeks. In conclusion, this method is recommendable for the spinal fusion of some diseases.
Intraspinal cysts are rarely observed in patients. They are distinguished from neoplasm using magnetic resonance imaging (MRI) or computed tomography (CT) because they rarely cause bony erosive changes. We treated three cases of intraspinal cysts causing bony erosion. Patients ranged from fifty-five to seventy-one years, and symptoms and signs resembled disc herniation. Signal-intensity patterns and pathological finding of these lesions were variable. They were adjacent to degenerated facet joints. Treatment involved surgical excision of the cysts. Many lumbar intraspinal cysts may be associated with significantly degenerated facet joints. Bleeding into or around the cysts may invade the vertebral body.
Some patients are simultaneously affected with carpal tunnel syndrome and shoulder joint disorders. The authors operated on seven cases with these indications using arthroscopy, and carried out a study on the effectiveness of the procedure, which showed good results in all patients. It is useful to apply arthroscopic surgery to patients suffering from carpal tunnel syndrome and shoulder joint disorders at the same time.
Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant inherited disorder in which recurrent transitory palsy in the peripheral nerve occurs after a trivial pressure. We report on a case of atypical HNPP in which a long-standing non-restorative radial nerve palsy occurred. (Case) Twenty one-year-old female. This patient slept with her right arm compressed between her body and the arm rest of her seat on the train for approximately 30 minutes in September 1999. When she woke up, she noticed that her right wrist and fingers could not extend. She consulted an orthopaedic surgeon and was diagnosed as having right radial nerve palsy. Because the symptoms had not recovered for three months, she was referred to our hospital. At the initial consultation, her muscle strength of extensers of the wrist and fingers was 2 by MMT (Manual muscle testing) grading. Her mother and sister had a past history of transient mononeural palsy. She was treated conservatively with cock-up splint and a low frequency electronic stimulation. One and half years after the onset of the symptoms, there was no sign of recovery of the palsy, so tendon transfers were performed. Biopsy of the sural nerve, performed simultaneously, showed tomacula of the nerve fibers.
(Objective) The pathological characteristics and clinical findings of tendinitis or tenosynovitis of the extensor pollicis brevis (EPB) were compared to those of the abductor pollicis longus (APL) in de Quervain’s disease. (Subjects) A total of 82 surgeries were performed to treat de Quervain’s disease from November 1996 through August 2001. The clinical conditions of the first dorsal compartment and the presence of septa were analyzed. The number and clinical conditions of tendons for the EPB and APL were then determined. (Results) Thickening of the tendon sheath in the EPB was seen in 42 hands, while ganglion accompanied 5 of these. Thickening of the tendon sheath in the APL was seen in 41 hands, while ganglion accompanied 7 of these. In the first dorsal compartment, complete septum was observed in 50 hands, absence of seputum in 19 hands, distal seputum in 11 hands, and proximal seputum in 1 hand. The number of tendons for the EPB was zero in 4 hands, one in 65 hands, 2 in 7 hands, and 3 in 1 hand. The number of APL tendons was 1 in 3 hands, 2 in 43 hands, 3 in 22 hands, and 4 or more in9 hands. Regarding the clinical conditions of EPB, clear tendon thickening was observed in 9 hands, and fluffiness or fusiform swelling in 20 hands. APL tendon abnormalities were observed in 8 hands.
Wrap around flap procedure is used for finger reconstruction. In most cases, long-pedicle flap was employed because this type of flap ensures safe vascular anastomosis. However, as this operation is aimed at cosmetic improvement, it is necessary to keep the number of incisions as low as possible. In this study, we report one case using a short-pedicle wrap around flap and present on example of the indications of short-pedicle wrap around flap.
Total hip arthroplasty with HA-TCP coated acetabular cup was performed on 17 patients (19 hips) with osteoarthritis. Follow-up was conducted for 1 year, and JOA hip score and X-ray were postoperatively examined at the time of follow-up. The X-ray examination was performed for migration or rotation of the cup and surrounding radiolucent lines. In HA-TCP coated cup no rotation or migration was observed. Radiolucent lines were frequently seen postoperatively but diminished during follow-up without any signs of migration into the gaps. At follow up, the median Japanese hip score was 89.7 points (range: 74-94 points). This proves that clinical results of the HA-TCP coated acetabular cups were good, and the cups fixed to the acetabular bone in a short time.
We report a case of ABS liner dissociation of a Kyocera metal-backed shell used in cementless THA. While the damage in the ceramic inlay was minimal, there was severe destruction of the polyethylene. We believe creep deformity of the polyethylene is responsible for the dissociation.
Recent reports show that in patients with osteonecrosis of the femoral head (ONFH), degenerative changes were already present in the acetabular cartilage, even when radiographs of the acetabulum show no abnormalities. We performed 17 hip arthroscopies to assess whether intra-articular pathological changes of ONFH are associated with the short-term results of hips treated by bipolar hip prosthesis. There were 10 female patients and 6 male patients with a mean age at the operation of 53 years (range: 20 to 82 years) and a mean follow-up of 1.9 years (range: 1.0 to 3.0 years). Eight hips were classified as stage 3A collapse of less than 3mm, 8 hips were determined to be at stage 3B collapse of 3mm or more, and one hip was categorized as stage 4 (associated with osteoarthritic changes). Following arthroscopy, 9 hips (53%) demonstrated more than mild degenerative change of the acetabulum, and 9 hips (53%) exhibited radial fibrillated labral tears. At final follow-up, no hips showed acetabular migration, component loosening, osteolysis, or increased pain. We suggest that short-term results of hips treated by bipolar hip prosthesis are not associated with intra-articular pathological changes of ONFH.
One of the two cases in this paper was a 40-year-old woman with no risk of pulmonary embolism. Seven days after rotational acetabular osteotomy, she complained of chest pain and dyspnea. We found thrombs at the bilateral pulmonary artery by CT scan and started anticoagulant therapy. The next day, oxygen perfusion in the blood improved and her symptoms disappeared. The other case was a 56-year-old woman who had a high risk of pulmonary embolism, obesity, neoplasma, etc. Nineteen days after total hip arthroplasty, she complained of chest pain and suffered cardiopulmonary arrest at defecation though we had carried out some prophylactic treatments from the operation. We started anticoagulant therapy, but she died of disseminated intravascular coagulation and multiple organ failure two days later. It is important to accurately estimate patient susceptibility to pulmonary embolism and to provide proper prophylactic treatment.
Calcifications are commonly found at shoulder joints. In this paper, we discuss two cases of calcifications at the hip joints which were comparatively unusual and caused acute symptoms. Case 1 was a 53-year-old woman. She noticed pain in her right hip joint at night. There was no redness or local heat. Tenderness and swelling were observed at the front of the right hip joint. Slight increase of CRP and leukocytes were noticed. Roentgen examination showed calcification measuring 2cm in diameter around the right hip joint. MRI examination showed calcifications in the tendon of the rectus femoris muscle. Calcifications broke down a week after onset and more or less disappeared a month later. Case 2 was a 41-year-old man with pain in his right hip. From the next day, he found it difficult to walk due to the pain. Tenderness was noticed around the right greater trochanter. Significant increases in CRP and a number of leukocytes were found. There was no local redness and no general fever. Radiographic examination showed calcifications around the right greater trochanter. Gluteus maximus and gluteus minimus were enhanced on MRI. The symptoms disappeared ten days later, and the shadow disappeared on radiograph a month later.
Since transposition osteotomy of the acetabulum is performed to prevent the development of osteoarthritis of acetabular dysplasia, it is relatively often performed on young patients. Early discharge and early social rehabilitation are called for and good results obtained using clinical pathway have been reported. Patients and methods: 32 joints of 31 cases were operated between July 2000 and July 2001 (all female, average age of 34.0 years. Rehabilitation was carried out by clinical pathway and the degree of improvement hospitalization period, and complication were investigated. Results: with the exception of 2 patients with superficial infection or suspected thrombosis, rehabilitation was successfully carried out, achieving movement of patients in wheelchairs after an average of 3.4 days, two crutch gait after an average of 6.8 days, and one crutch gait after an average of 13.7 days. Conclusion: Critical pathway is useful for achieving early discharge and early social rehabilitation.
This study retrospectively reviews the characteristic features of extensor tendon ruptures in the hand of patients with rheumatoid arthritis (RA). Tendon rupture often occurs in rheumatoid hands. We compared 47 hands 38 of patients with RA clinically and radiologically, between those with and without tendon rupture, treated synovectomy with Sauvé-Kapandji procedure from 1982 to 2000. Seventeen hands of 14 patients had tendon ruptures. Eleven underwent transfer, 5 tendon graft, and 1 tenorrhaphy. There were significant differences in the mean age, findings of synovitis and radiological measurement between the tendon rupture group and non-tendon rupture group. It can be concluded that synovectomy is required for rheumatoid hands with persistent tenosynovitis in addition to radiological changes although wrist pain may be moderate.
Total ankle arthroplasty (TAA) with V-shaped ankle was performed for rheumatoid arthritis and osteoarthritis in our hospital. Between August 1994 and March 2001, TAA was performed on 15 ankles of 11 patients. The mean age of the patients (one male and ten females) at operation was 63.2 years (range; 41 to 86 years). The mean follow-up time was 3 years 6 months, ranging from 2 months to 6 years 3 months. 91 percent of the patients showed satisfactory results, experiencing no pain when walking. We also obtained relatively good results with the V-shaped ankle. However, both ankles of a rheumatoid arthritis patient had loosening from an early time after surgery. The indications of TAA must therefore be studied carefully. Treatment failed in one case which had RA with osteoporosis. Both V-shaped ankles loosened from early time after surgery.
We investigated postoperative changes in the ROM (Range Of Motion) of the cervical spine and Occipito-Axial angle (OC2 angle) in a series of rheumatoid arthritis (RA) patients with atlanto-axial subluxation treated by the Occipito-Axial fusion (OC2-fusion) technique. We measured the angle between the McGregor line and line parallel to the inferior edge of the cervical vertebral body on a lateral view film in 10 patients. ROM was calculated from the prescribed angle at each extensional and flexional position. OC2 angle was measured in the same way at one point in the neutral position. No ROM compensation occurred after the operation in the lower cervical spine. Degenerative changes in the lower cervical spine were seen in cases with postoperative OC2 angle less than 10 degrees.
Achondroplasia shows limb-shortening dwarfism and often involves bowleg. Short stature often leads to social and physical problems. In this series, we report leg lengthening and corrective osteotomy in five patients with achondroplasia. There were two boys and three girls. The first operation was performed at 11.6 years on average and the mean follow-up period was three years. Preoperative height was 118 cm and leg length was 44 cm on average. Three patients with serious bowleg had knee pain. All patients underwent distraction lengthening with simultaneous correction of the bilateral tibia with the Orthofix system. One patient who underwent lengthening of only the bilateral tibia gained 8 cm and the others who underwent lengthening of the bilateral femur and tibia gained 18 cm on average. Treatment time ranged from 9 months to 2.5 years. There were various complications. At final follow-up, there was no pain and no deformity of leg. Average height was 138 cm and average leg length was 61 cm. Their proportion and social disadvantages improved. The results suggest that this method is effective for achondroplasia; however many difficulties are to be anticipated.
We report a case of congential contractual arachnodactyly (CCA) with extentional limitation of the knee joint. CCA is characterized by multiple contractures, arachnodactyly, dolichostenomelia, scoliosis, abnormality of the external ears, and autosomal dominant transmission. A 15-year-old female had been suffering from extentional limitation of the left knee (20 degrees) since age 8. When she was 12, physical examination showed scoliosis of 20 degrees, but scoliosis continued to remain at 20 degrees. She experienced no pain while resting, walking, and in the full flexion position of the left knee. Plain radiograph, MRI and arthroscopy did not indicate abnormal changes of the left knee, but plain radiograph showed elongation of the proximal phalanges. She also had extentional limitation of the fingers in each hand. She was diagnosed with CCA because of multiple contractures, arachnodactyly, dolichostenomelia, and scoliosis.
A case of alcaptonuria was reported. This is a rare, hereditary disorder (occurrence rate 2-5/1,000,000) of amino acid metabolism, secondary to lack of homogentisic acid oxydase. As a consequence, there is an accumulation of homogentisic acid which is excreted in the urine and deposited in the connective tissues. This deposition results in ochronotic pigmentation and arthropathy, of which some characteristic radiological findings are demonstrated. In this paper, we report one case of alcaptonuria who was diagnosed at 61 years of age. Pigmentation of the conjuctiva bulbi and urine was recognized. Osteoarthritic changes were observed in the bi-lateral shoulder and spinal column. Laboratory data showed homogentisic acid in urine. We performed total shoulder replacement, and the clinical results were excellent.
We have been investigating positional problems and symptoms that TOS patients complain of when going to bed, and herein report the results of 1201 cases treated with the TOS-pillow over the past 8 years. Problems related to sleep included patients inability to sleep on their back at night, therefore they slept in the lateral position; they usually did not use their pillows and would often have neck pain, stiffness and numbness when they got up in the morning. The TOS-pillow consists of a head and neck portion designed originally according to the patient’s posture and bilateral shoulder parts. At our outpatient department, patients were instructed according to our pillow guidance, and they purchased the pillow after a 2-week trial. The TOS-pillow fits the shape of patient’s head, neck, and shoulder, enlarges their costoclavicular space, relaxes the surrounding muscles, and allows satisfactory sleep. TOS-pillow treatment has been well received by many patients in the long-term follow-up.
Twenty-six patients with cuff repair were evaluated postoperatively. Six were put on abduction brace for about six weeks (long-term brace group), 15 were put on abduction brace for about three weeks (short-term brace group), and five were placed in a sling (sling group). The average period of hospital stay was 65.5 days (long-term brace group), 28.8 days (short-term brace group), and 22.0 days (sling group). Hospital stay periods correlated with the postoperative fixation method. The average JOA score for the three groups at final follow-up was 94.0 (long-term brace group), 94.6 (short-term brace group), and 93.5 (sling group). The scores were not influerced by the postoperative fixation. These results show that we can shorten postoperative fixation time and improve the comfort of patients in braces.
Complete acromioclavicular dislocation is common, but the joining of acromioclavicular dislocation and fracture of the coracoid process is relatively rare. Satisfactory results may be obtained with operative reduction of both the acromioclavicular joint and coracoid process. We report five cases treated with operative reduction on both and showing good results, taking into account other related literature.
Postoperative infection after joint replacement surgery is widely recognized as difficult to cure. By using minimum inhabitation concentration (MIC) test, we investigated cultured pathogens from 29 patients treated for postoperative infection during the period of 1986 to 1999 at the Nagasaki University Hospital. The first detected pathogen was coagulase negative staphylococci (CNS) in 15 cases, methicillin sensitive staphylococcus aureus (MSSA) in 8 cases, gram positive cocci (GPC) in 3 cases, and gram negative rods (GNR) in 3 cases. They tended to be sensitive to 1st and 2nd generation Cefems, IPM, GM and MINO. Nine of these patients were treated with continuous irrigation system. During the period of irrigation, the number of cultured pathogens changed. MSSA decreased from 6 to 2, and CNS 5 to 2; However, pseudomonas aeruginosa increased from 1 to 2, and GNR from 1 to 13. Because GNR constituted the majority, pathogens had a tendency to be resistant to most antibiotics. The pathogens changed during the therapeutic course as we reported, indicating that it is important to confirm pathogen type, antibiotic sensitivity, and resistance.
Pathogens in patients with traumatic orthopaedic infection were analyzed microbiologically. The patients consisted of 37 males and 5 females, age ranging from 16 to 85 years (mean age of 40.6). 112 total species of pathogen were identified. Compared with pathogens from other orthopaedic diseases, methicillin-resistant staphylococcus aureus and coagulase negative staphylococci were additionally isolated from patients of traumatic infection. A great number of Staphylococcus spp were isolated from patients with closed fractures. On the other hand, gram negative rod and clostridium groups were mainly isolated from patients with open fractures. Deepness of soft tissue injury and contamination of wound with trauma should be considered in determining the exact antibiotics to be used.
We report an infant case of Mycobacterium Bovis Osteomyelitis of the proximal side of the humerus as a complication of BCG Vaccination. BCG vaccination was performed at the age of 5 months. One year and 8 months after vaccination, he presented left shoulder pain. Pyogenic osteomyelitis of the humerus was suspected. After 6 weeks of antibioticotherapy, he showed no response and he was moved to our hospital. At admission, he had a pneumonia complication, and PPD test results were strongly positive. We performed an open biopsy, with curettage of the involved bone. Microscopic examination revealed caseous necrosis in the tissue, and Mycobacterium was isolated in the culture. Genetic analysis of the DNA by a multiplex polymerase chain reaction method detected Mycobacterium bovis, Tokyo strain, the same strain used for vaccination. We started a regimen consisting of rifampicin and isoniazid. Compared with other countries, complications due to BCG vaccination in Japan are relatively rare. We found a total of 11 reports of BCG osteomyelitis in Japan, including this case. It is necessary to consider the possibility of diseases such as lymphadenitis or osteomyelitis after BCG vaccination in infants.
Seven cases of septic arthritis of the hip joint in infancy and childhood were examined from March 1999 to September 2001. Arthrotomy was performed on all patients after diagnosis had been established by joint aspiration. One patient on whom arthrotomy was performed 21 days from onset had fair results with radiological evidence of the developmental disorder of the femoral head. One patient on whom arthrotomy was performed only 2 days from onset had fair results with radiological evidence of the developmental disorder and subluxation of the femoral head because of recurrence on two occasions. We recommend immediate diagnostic joint aspiration for all cases with suspected septic arthritis of the hip joint, and emergency arthrotomy should be performed as soon as septic arthritis is diagnosed.
We made an assessment of the sensory disorders of a Piriformis syndrome patient in pre and post operation with a neurometer. The neurometer is an instrument measuring patients’ CPT (Current Perception Threshold) under double blind conditions to eliminate testers’ and testees’ subjectivity. The case was a 66 year-old man. He had sensory disorders in his left lateral lower extremity for half a year. His lumbar vertebrae showed no abnormality and Piriformis block was effective, which meant the possiblity of Piriformis syndrome. Before operation, CPT in his left ankle were 644 (×0.01 mA) in 2000Hz (normal range: 22 to 591), 246 in 250Hz (9 to 196), and 115 in 5Hz (4 to 144), which were abnormal. Piriformis tendon cutting and sciatic nerve neurolysis were performed. In the operation, no obvious abnormal findings (Valiants, Ganglion etc) were seen. After the operation, the symptoms almost vanished, and CPT improved to 506 in 2000Hz, 112 in 250Hz, and 69 in 5Hz. While sensory disorder is generally assessed in 10 grades with a brush and the assessment often lacks objectivity, neurometrics is effective for measuring sensory disorders objectively and quantitatively. In addition, Piriformis syndrome is generally diagnosed by tests depending on patient’s subjectivity such as the Freiberg test, Pace test, Piriformis block etc; therefore objective tests like neurometrics may be effective as a supplementary test to diagnose Piriformis syndrome.
(Purpose) It is well known that lumbar bone mineral density is high in spondylosis deformans. We examined the relationship between change in spondylosis and general bone mineral density. (Subjects and Methods) The subjects of our investigation consisted of 90 women (average 46.4 years) around post menopouse. We examined A-P X-ray of their lumbar spine and measured bone mineral density of the lumbar spine, radius, and calcaneous. The deformed degree of the lumbar spine indicated bone spur (from L1 to L5 vertebral body), and we compared these three parts using the total estimated value of five stages (0-4) with Nathan classifications. For bone mineral density, we examined relationship with the degree of lumbar spinal deformity by using Z-score. (Results) We divided the patients into two groups: H group and L group. The H group scored above 4 points with the Nathan classification, and the L group below 4 points. The bone mineral density of all three parts was highly significant (P<0.05). (Conclusion) The degree of spinal deformity correlated with bone mineral density of the lumbar vertebral body and the general bone mineral density
Kaschin-Beck disease is endemic in Eastern Siberia, Northern China and North Korea. This disease causes short statue due to multiple focal necrosis in the growth plate of the tubular bones. This leads to secondary, sometimes severe osteoarthrosis. We report two cases of this disease. Case 1: A 70-year-old Chinese man visited our clinic complaining of numbness in the ulner side of his right hand on March 13, 2000. Radiographs of his elbow showed very severe degenerative change. After radiographical examination of other joints, detailed physical examination and taking a detailed life history, he was diagnosed as right cubital tunnel syndrome and kaschin-Beck disease. Case 2: a 65-year-old woman, the wife of the first case, was coincidentally admitted for malignant tumor in this hospital. She is a Japanese national who was born in Northern China. She was left there after the second world war and married the present husband at 12 years of age. She showed the same statue, joint deformities, radiological symmetrical changes of the hand, elbow, knee, and hip joints. She was also diagnosed as Kaschin-Beck disease. We treated the man conservatively and are now observing his natural course, because he has little awareness of the disease due to a poor living environment, and has complained little about the disease and ulner neuropathy.
Injury in the oral cavity is common in infants, but injury penetrating into the deep tissue in the oral cavity is rare. We reported a rare injury penetrating into the paraspinal canal from the mouth by a wooden chopstick. A three-year-old boy fell on his face during dinner, and the wooden chopstick he was using pierced his mouth. The broken chopstick could not be found by X-ray examination, but continuous examination to detect the broken chopstick was necessary to determine penetrating injury into the cavity. On CT examination, the broken chopstick was found in his paraspinal canal, and it was removed by posterior cervical spinal approach. He was discharged without any complications.
Generally, in patients with Pipkin type I femoral head fracture, broken head fragments are treated conservatively or removed. In this study, our patient was treated by closed reduction and six days later the fragment was fixed using a Herbert-screw. At final follow up, his outcome was good. Slight heterotopic ossification was found, but avascular necrosis and arthrosis were not.
We report eleven supracondylar fractures treated using the intramedullary supracondylar Nail (IMSN). The mean age of the patients was 72.7 years (56 to 87 years) and the mean period of follow-up was 11 months (range: 0.5 to 47 months). They were classified according to AO classification into Type A1 (7 cases), Type A2 (2 case), Type A3 (1 case), Type C3 (1 case). Clinical results were evaluated using Neer’s criteria: Excellent=8; Satisfactory=1; Failure=2. Factors which were associated with unsatisfactory results were not type of fracture and stability of distal locking screw, but the ratio of marrow width to nail width at the height of proximal locking screw. We treat supracondylar fractures with the supracondylar nail if its width is same as the marrow width.
We used AO small proximal femoral nail in 47 patients with trochanteric fracture of the femur from March 1999 to December 2000. Cut-outs were seen in eight patients (17%). We suspected that it might be related with the motion of two lag screws. The sliding distances of two screws were calculated by the measurement of radiographs, and statistic analysis was performed. The femoral neck screw slid significantly compared with the hip pin in cut-out patients. We think cut-outs occur due to the knife-like effect of stiff and small diameter top screws. Selection of suitable screw length and accurate insertion technique are necessary for the prevention of cut-outs.