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Yasuyuki Ishida, Etsuo Chosa, Hiroaki Yano, Keitaro Yamamoto, Katsuhir ...
2007 Volume 56 Issue 4 Pages
525-528
Published: 2007
Released on J-STAGE: November 27, 2007
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We report two good results after arthroscopic rotator cuff repair for massive rotator cuff tear with axillary nerve palsy after dislocation of the shoulder.
Case 1: A 60 year-old man had fallen and dislocated his right shoulder.
He visited our hospital six weeks after the injury because he was unable to raise his right shoulder. Muscle atrophy was found in the right deltoid. Numbness was found on the lateral-side of the right shoulder. Arthroscopic rotator cuff repair was performed three months after the injury. Before surgery, JOA score was 31 points, and improved to 94 points one year after surgery.
Case 2: A 47 year-old man had fallen and dislocated his right shoulder.
He visited our hospital three weeks after the injury, because he was unable to raise his right shoulder. Muscle atrophy was found in the right deltoid. Numbness was found on the lateral-side of the right shoulder. Denervation potential was observed in the right deltoid by electromyogram. Arthroscopic rotator cuff repair was performed one month after the injury. Before surgery, JOA score was 45 points, and improved to 93 points six months after surgery.
Considering degeneration of the rotator cuff, early operation may be planned for the treatment of massive rotator cuff tear if nerve recovery prospects can be seen.
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Hikaru Ogawa, Tetsuo Kojima, Tomoyuki Mizoguchi, Kenji Goto, Yoshifumi ...
2007 Volume 56 Issue 4 Pages
529-532
Published: 2007
Released on J-STAGE: November 27, 2007
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We studied 10 cases treated by percutaneous internal fixation for scaphoid fracture more than six months after injury from January 2001 to August 2006. The subjects were eight men and two women, and their average age at the time of surgery was 30.3 years (range: 18 to 65 years). The average time between injury and fixation was 11.2 months (range: 6 to 24 months). According to the Herbert classification, there were eight fractures of type D1 and two of D2. The average operation time was 20.4 minutes, and there was no deformity in the cases of first operation. Bone unions were achieved except in one case, and there were no complications. According to the rating scale of the Japanese Society for Surgery of the Hand, eight were excellent results and one good.
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Yukihiro Furue, Makoto Sasaki, Ikufumi Nagayoshi, Tatsuo Motoyama, Tat ...
2007 Volume 56 Issue 4 Pages
533-535
Published: 2007
Released on J-STAGE: November 27, 2007
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This study reports a case of a rupture of the flexor pollicis longus tendon resulting from a longstanding scaphoid nonunion. A 53-year-old man was admitted to our hospital, complaining of inability to flex the interphalangeal joint of his right thumb. In his youth, he injured his wrist but never sought medical treatment. X-rays showed pseudarthrosis of a scaphoid. Transverse MRI scanning clearly demonstrated the absence of the FPL tendon, which was very helpful for diagnosis. Excision of the distal segment was performed to treat scaphoid nonunion. We chose tendon grafting using palmaris lungus tendon for FPL tendon rupture. The patient was very satisfied with the result of increased pinch power, although he had not recovered full flexion of the thumb IP joint.
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Hidetoshi Onoue, Kazuo Kimura, Kazutaka Matsunaga, Kenji Hamada, Fumih ...
2007 Volume 56 Issue 4 Pages
536-537
Published: 2007
Released on J-STAGE: November 27, 2007
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A 19-year-old male smashed his left hand in a motorbike accident. As no significant pathological finding was made in his first X-ray, no fixation was applied. One month later, the patient suffered mild pain in his left hand. Subsequent CT scan was performed which revealed fracture of the hoof of hamate. The patient refused casting or any special treatment. A CT scan of the fracture at 4 months showed evidence of healing, and no symptoms were found at 8 months. As the patient was right-handed, he could not use his left hand and motorbike, which contributed the complete union of this fracture without any special treatment.
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Takashi Nakadera, Kiyoshi Kihara
2007 Volume 56 Issue 4 Pages
538-541
Published: 2007
Released on J-STAGE: November 27, 2007
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To assess the standard amount of tendon lengthening, we evaluated the results of orthopaedic selective spasticity-control surgery (OSSCS) for twenty-six spastic equinus in sixteen patients with cerebral palsy: gross motor function classification system level 1, 4 patients; level 2, 7 patiens; level 3, 2 patients; level 4, 2 patients; level 5, 1 patient. Mean age at the operation was 10.7 years and mean follow-up was 4.9 years. The evaluation of OSSCS was based on the range of motion, dynamic equinus grade (Matsuo), and Gross Motor Function Measurement (GMFM). These items were approximately good results, but in 3 feet of 3 patients, spastic equinus were recurred. From these results, we thought that our standard amount of tendon lengthening was appropriate to OSSCS for spastic equines, however some adjustment is necessary case by case.
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Kazuhiro Yoshimitsu, Toru Matsugaki, Kensei Nagata, Takeshi Nago, Misa ...
2007 Volume 56 Issue 4 Pages
542-545
Published: 2007
Released on J-STAGE: November 27, 2007
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We have developed a pedaling functional electric stimulation (FES) wheelchair with motor assistance for paraplegic patients. In a healthy young male volunteer, electrical stimulation was provided to his bilateral quadriceps femoris and hamstring muscles through surface electrodes to pedal the wheelchair. Motor assistance was linked to the wheelchair speed. On flat road, we examined the speed and approaching time to practical speed with three moving methods, such as; FES, motor drive only, and FES with motor assistance. Speed was insufficient by motor drive only, and FES required high stimulation voltage to achieve practical moving speed. FES with motor assistance provided smooth acceleration and achieved practical speed in a short time. It also reduced the electric stimulation voltage of FES. FES with motor assistance can reduce physical load and realize stable and smooth ambulation for paraplegic patients.
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Yutaka Yonekura, Takahiro Nakamura, Masaaki Mawatari
2007 Volume 56 Issue 4 Pages
546-548
Published: 2007
Released on J-STAGE: November 27, 2007
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Fracture of the proximal clavicle is relatively rare during clavicle fracture. We experienced one case of this fracture treated by locking plate. The case was a 69-year-old man, who fell down from a stairway. Diagnosed with fracture of the proximal clavicle, he underwent operation. Ten months after the operation, range of motion of the shoulder joint was normal and stable, and there was no pain. In Japan, there have been few reports of operative treatments using the locking plate for the fracture of the proximal clavicle. Conservative treatment is applied in a large majority, but when the dislocation of the fracture is large, conservative treatment may cause delayed union and false joint. Operative treatment may therefore be necessary in such cases. The locking plate is considered an effective fixture material for the fracture of the proximal clavicle.
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Shinichi Fukumoto, Junichi Shida, Takashi Kuwano, Takahiro Hamada, Jun ...
2007 Volume 56 Issue 4 Pages
549-553
Published: 2007
Released on J-STAGE: November 27, 2007
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We compared the clinical results of two-directinal osteotomy for painful hallux valgus deformity after using screws (screw group, n=14) or a locking plate (plate group, n=14). The average age at the time of surgery was 55.9 years in the screw group and 50.5 years in the plate group. The average follow-up period was 3.5 years and nine months, respectively. The screw group was 62.6 days and the plate group 41.1 days for average hospitalization period. In the screw group, relative metatarsal protrusion (RMP) (mm) immediately after surgery and at final follow-up was 0.29±2.6mm and −1.36±2.4mm. On the other hand, in the plate group, RMP (mm) was −0.69±2.6mm and −1.54±2.6mm. The screw group was superior to the plate group in terms of American Orthopaedic Foot and Ankle Society score (AOFAS score) at the time of follow-up. Many patients in the plate group complain of problems of pain and dysesthesia around the medial side of the plate. The plate group may therefore have better AOFAS scores and be satisfied with the results after removal of the plate. We concluded that the locking plate is superior to the screw in maintaining the length of the first metatarsal bone after surgery.
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Tatsuya Yufu, Kazuhiko Fukushima, Yoshihiko Tasaka
2007 Volume 56 Issue 4 Pages
554-557
Published: 2007
Released on J-STAGE: November 27, 2007
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These days, strong internal fixation for high tibial osteotomy enables early bearing. Since March 2006, we have been using TomoFix Locking Plate PLT 3 Holes (one of the locking compression plate systems) as the fixing material for closed-wedged high tibial osteotomy. Patients are allowed to bear full weight in two days after the operation. Since March 2006, 25 patients have undergone high tibial osteotomy with TomoFix Locking Plate PLT 3 Holes. They consisted of seven men and 18 women with a mean age of 68 years (range: 48 to 79). All patients showed improved gait and better correction. These good results may be attributed to the shape and strength of this plate.
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Yuki Uesugi, Tadatsugu Morimoto, Masaru Kitajima, Masamori Shigematsu, ...
2007 Volume 56 Issue 4 Pages
558-561
Published: 2007
Released on J-STAGE: November 27, 2007
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Pelvic inclination in the coronal plane is sometimes observed on preoperative pelvic radiographs in patients with osteoarthritis of the hip. However, the frequency and association with joints related to pelvic inclination have not yet been well documented. The purpose of this study was to assess the presence of pelvic inclination in patients with osteoarthritis of the hip.
We analyzed 116 patients who had undergone total hip arthroplasty (THA).
We also analyzed associations between the affected joint, and presence of pelvic inclination, angle of pelvic inclination, and leg length discrepancy based on the findings of X-rays of the hip. We assessed pain using the JOA Hip Score and the ability of single-leg standing.
We found that 67 patients (57.8%) had a pelvic inclination of more than two degrees. The pelvis was inclined toward the side of the affected joint in 56 patients (83.6%). Leg length discrepancy was thus found to correlate with the presence of pelvic inclination (p<0.05). This means that the direction of the pelvic inclination in almost all patients with osteoarthritis of the hip tends to be toward the side of the affected joint which normally shows short-leg discrepancy.
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Kazuhiro Tanaka, Hajime Tamaki, Hirotaka Okubo, Yoshiyuki Akamine, Yos ...
2007 Volume 56 Issue 4 Pages
562-565
Published: 2007
Released on J-STAGE: November 27, 2007
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We report three cases of idiopathic transient osteoporosis of the hip (TOH).
Case 1 was a 44-year-old man. He complained of left hip pain after jogging two weeks ago. He was diagnosed with TOH on MRI. After observation by non weight bearing, pain disappeared after six weeks, and abnormal signal on MRI diminished after three months. Case 2 was a 35-year-old woman. She complained of right hip pain in week 30 of her pregnancy. After delivery, she consulted our hospital. MRI findings were identical with TOH. At present, she is instructed to keep partial-weight bearing in the right lower extremity. Case 3 was a 32-year-old-man. He had right hip pain in weight bearing a month ago, and it did not improve by conservative treatment at a nearby clinic. He consulted our hospital. There was no motion pain in the hip, and MRI findings were identical with TOH. At present, he is under observation at our clinic.
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Masahiro Kojima, Satoshi Tomiyama, Akira Arakaki, Moritaka Nagayama, R ...
2007 Volume 56 Issue 4 Pages
566-569
Published: 2007
Released on J-STAGE: November 27, 2007
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We examined the case of 69-year-old woman who had RA from the age of 51. When she was 68, left femoral subtrochanter fracture was found without any particular factors. Bone union operation was performed, utilizing an intramedullary rod. A year later, right femoral substochanter fracture was discovered. Although bone union operation was performed, the bone did not heal satisfactorily after four months, and consequently another operation was performed. At present, bone union has been successful, enabling her to walk again. Imaging examination, tissue remarks (evaluation), and blood tests revealed no morbid fractures or metabolic diseases. She was therefore considered to have had an insufficiency fracture. There are a few reports on insufficiency fracture under the femoral subtrochanter fracture. Consequently, certain examinations from such literature were applied in this study.
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Hiroto Kumagae, Nario Ihara, Yoshiaki Yamanaka, Akinori Sakai, Toshihi ...
2007 Volume 56 Issue 4 Pages
570-573
Published: 2007
Released on J-STAGE: November 27, 2007
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The patient was a 96-year-old female, who underwent Compression Hip Screw (CHS) for her right trochanteric fracture at the age of 79 years, Gamma nail for her left trochanteric fracture at 85, intramedullary nailing for her left femoral shaft fracture after extracting Gamma nail at 87, and Ender nailing for her right femoral shaft fracture at 94. At the age of 96, she had left subtrochanteric fracture and was treated with conservative therapy.
There are some reports of intramedullary nailing or Ender nailing with the removal of CHS for secondary femoral shaft fractures after CHS, but none on surgical procedure without the removal of CHS like this case. We think that this procedure is available for releifing pain.
With the growing aging society, secondary fractures like this case are expected to increase, thus we need various kinds of treatments corresponding to the daily activities of patients.
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Takuya Ikuta, Toshio Kitamura, Junichiro Ishikawa, Takanao Shimabukuro ...
2007 Volume 56 Issue 4 Pages
574-577
Published: 2007
Released on J-STAGE: November 27, 2007
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Twenty six patients with pyogenic arthritis of the knee were treated by open arthrotomy and early passive motion. All patients healed without subsequent operation. Of these patients, five had excellent results, eighteen good results, and four had a fair results according to the modified Ballard's evaluation method.
This is a useful and simple method for treating pyogenic arthritis of the knee.
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Yuichi Maeda, Haruhiko Chuma, Ichiro Seike
2007 Volume 56 Issue 4 Pages
578-580
Published: 2007
Released on J-STAGE: November 27, 2007
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We investigated the difference between surgical and conservative management on gadolinium-enhanced MRI (Gd MRI). Conservative therapy was indicated for patients who have little hypointensity area in the vertebral body on Gd MRI. For those with slight hypointensity area in the vertebral body on Gd MRI, we must considered which is indicated.
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Takaaki Sagara, Koji Akasaki, Makoto Kimura, Takumi Fukumoto, Yoshihik ...
2007 Volume 56 Issue 4 Pages
581-584
Published: 2007
Released on J-STAGE: November 27, 2007
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Infection by fungi of the genus Aspergillus is uncommon. There have been a few reports on paraplegia secondary to Aspergillus spondylitis. We report a 77-year-old man with paraplegia by Aspergillus spondylitis which was intervened by operation. MRI revealed spinal cord compression by inflammatory granulation at the T3/4 level. He underwent laminectomy from T3 to T4 and posterior fusion by instrumentation. The spinal lesion was directly infiltratied from lung aspergilloma. Postoperatively, symptoms of paralysis have not changed in the category of Frankel C1.
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Takayuki Shida, Hideo Baba, Masao Eto, Keizo Furukawa, Koichi Adachi, ...
2007 Volume 56 Issue 4 Pages
585-588
Published: 2007
Released on J-STAGE: November 27, 2007
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A 29 year-old man first noticed cervical, back, and lumber pain 14 months ago. He was admitted to general hospital for further examination, and was diagnosed with multiple bone tuberculosis. Though medication was started, loss of sensation below Th4 and bilateral lower leg paralysis increased. After six-months of medication, he was admitted to our hospital. We performed operation with the use of posterior instrumentation and bone graft, and achieved significant improvement. Four months after operation, he achieved full leg strength. In this paper, we report the above case and discuss multiple bone tuberculosis, referring to previous literature.
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Yasunari Oniki, Eiichi Nakamura, Hiroshi Mizuta
2007 Volume 56 Issue 4 Pages
589-592
Published: 2007
Released on J-STAGE: November 27, 2007
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Ankle impingement exostosis is a generally accepted diagnosis for conditions characterized by anterior ankle pain with limited and painful dorsiflexion because of bony obstruction. We reviewed four (3 male and 1 female) athletes with a mean age of 15.5 years treated arthroscopically for symptoms due to ankle impingement exostosis. They suffered from anterior pain, and reduction of dorsiflexion with severe impairment in their sports activities. Evaluation included AOFAS Hindfoot pain scores, activity score of Tegner, and time taken to return to sports activity. Conventional radiographs and magnetic resonance imaging (MRI) were done preoperatively. Two of them had lateral instability of their symptomatic ankle.
All patients were available for follow-up after 7.7 months (range, 1 to 14 months) and showed improved AOFAS Hindfoot pain scores from 20 to a mean of 37.5 at the follow-up examination. The mean Tegner score was seven points compared to four points preoperatively. Subjective assessment was made to determine decreased pain and the ability of the athelete to return to competitive sport at 4.5 weeks postoperatively.
These findings demonstrate good results for arthroscopic treatment of ankle impingement exostosis in a group of athletes involved in competitive sport.
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Makoto Morita, Eiichi Nakamura, Yasunari Oniki, Hiroshi Mizuta
2007 Volume 56 Issue 4 Pages
593-596
Published: 2007
Released on J-STAGE: November 27, 2007
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A 75-year-old man was referred to our department with chief complaint of light gait pain and sense of incongruity in the left ankle. The patient had no history of trauma or other joint disease. Soft tissue swelling and local tenderness was detected in the anterior and anterolateral position of the ankle joint in physical examination. Radiographs and MRI showed synovitis and loose bodies corresponding to stageII of Milgram's classification. After three months, the patient underwent arthroscopic treatment for ankle lesion, becase the symptoms continued.
During arthroscopy, the subchondral bone in the articular cartilage of the talar joint was impaired by free bodies. This diagnosis indicated that our case should have been treated earlier.
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Kazuki Kanazawa, Ichiro Yoshimura, Takahiro Ida, Akinori Takeyama, Mas ...
2007 Volume 56 Issue 4 Pages
597-600
Published: 2007
Released on J-STAGE: November 27, 2007
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Between September 2002 and June 2006, we treated nine patients with acute ankle malleolar fractures who underwent ankle arthroscopy before reduction and internal fixation. According to the Lauge-Hansen classification, there were eight SER fractures, 1 PER, and 1 PA. Traumatic osteochondral injury was found in seven ankles (78%). Ankle arthroscopy is a valuable tool for the treatment of acute ankle malleolar fractures.
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Komei Tanaka, Kuniyoshi Tsuchiya, Kazuhiro Yamaoka, Toshiaki Sasaki
2007 Volume 56 Issue 4 Pages
601-603
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced a case of lumber single nerve root manifestation of sarcoidosis, which was diagnosed according to histopathology of intraoperative spicemen, without any systemic expression. Preoperative diagnosis was lumbar disc herniation or neurogenic tumor of the nerve root. Tumor like material was excised from the nodular lesion during the surgical procedure. Histopathology strongly suggested sarcoid lesion, namely non-caseating granulomas without central necrosis. Systemic investigations including body CT, cranial MRI, ocular examination, and laboratory data proved no remarkable expession of sarcoidosis on the whole body except single involved nerve root. Although solitary sarcoid nodule on single peripheral nerve root without any general expression of sarcoidosis is very rare, we should take into consideration the possibility of sarcoidosis when treating foraminal nerve root swelling.
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Shunsuke Beppu, Kenji Yoshida, Hisashi Yamashita, Hisashi Hoshiko, Hid ...
2007 Volume 56 Issue 4 Pages
604-607
Published: 2007
Released on J-STAGE: November 27, 2007
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Acromioclavicular injuries in children are very rare. Dameron and Rockwood reported that the clavicle was displaced superiorly out of the periosteal tube and coracoclavicular ligaments remain intact to the periosteal tube. They classified child acromioclavicular injuries into six types, and suggested that reduction and internal fixation should be indicated for types IV, V and VI.
We experienced two cases of pediatric acromioclavicular injuries. The first case involved an 11-year-old boy presenting type IV acromioclavicular injury. Conservative treatment was performed. The second case involved a 12-year-old boy also presenting type IV acromioclavicular injury. In this case, closed reduction and osteosynthesis were carried out. Both cases were observed for over a year. During this period, the patients did not suffer from subjective symptoms although there was new bone formation under the original clavicle.
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Shinri Nobuto, Osamu Soejima, Kei Koga, Masatoshi Naito
2007 Volume 56 Issue 4 Pages
608-611
Published: 2007
Released on J-STAGE: November 27, 2007
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Five patients with nontraumatic paralysis of the anterior interosseous nerve (AINP) and two patients with nontraumatic paralysis of the posterior interosseous nerve (PINP) treated conservatively for more than six months and showing less than manual muscle test (MMT) 2 were treated by interfascicular neurolysis.
Multiple constriction was seen in one case, and other cases showed edema or ischemic changes.
Four of the seven surgical cases (2 AINP, 2 PINP) recovered with MMT increased to more than [4] (good cases) from less than [2] at 12 months (average: 6.3 months) after surgery. Good cases showed muscle recovery with MMT more than [3] within two weeks. AINP with only FDP type and PINP with thumb and finger type showed useful recovery. From the results of these investigations, conservative treatment should be done at least six months after the onset of AINP or PINP and interfascicular neurolysis should be selected for cases of no tendency toward improvement within six months.
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Noriko Urano, Takeshi Arizono, Takeshi Tokito, Toshihiro Fujimoto, Jun ...
2007 Volume 56 Issue 4 Pages
612-614
Published: 2007
Released on J-STAGE: November 27, 2007
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We report failure of the screw in the treatment for cervical spondylotic myelopathy associated with athetoid cerebral palsy. A 30-year-old male who had athetoid cerebral palsy from birth and could not walk, presented with neck pain. Three months later, he presented with muscle weakness of all four limbs and urinary incontinence. Diagnosed as cervical spondylotic myelopathy, posterior spinal fusion was performed. After the operation, the wound was infectious, which we treated with intravenous antibiotics. Inflammation gradually improved. Four weeks later, breakage of the C2 screw was detected on X-ray. Re-operation was performed. His upper limb functions improved.
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Eiichi Ishitani, Komei Matsuura, Kunichika Shin, Toshiaki Sasaki, Yosh ...
2007 Volume 56 Issue 4 Pages
615-618
Published: 2007
Released on J-STAGE: November 27, 2007
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[Purpose] The purpose of this study was to investigate the relationship between methods to examine shoulder muscle strength in healthy volunteers, and to confirm whether there is difference in muscle strength between the dominant and non-dominant sides. [Subjects and Methods] We examined shoulder muscle strength in thirty healthy volunteers (male 15, female 15). The average age of the subjects was 36 years. We measured the isometric muscle strength of both shoulders using MICROFET. We measured both methods three times as well as the mean measurement results. We performed three kinds of abductor muscle strength tests, two kinds of external rotational muscle strength tests and two kinds of internal rotational muscle strength tests. [Results] When we assumed that the abductor muscle strength was 100, the external rotational muscle strength became 115, and the internal rotational muscle strength became 160. We did not find out the statistical differences for the rotational muscle strength between the non-dominant and dominant sides, but determined the difference through the Jobe test and 90 degrees test for measuring abductor muscle strength. The muscle strength of a woman was found to be 60-70% of a man.
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Takahiro Noguchi, Masami Tokunaga, Satoshi Miyagi, Eiji Yoshimoto, Shu ...
2007 Volume 56 Issue 4 Pages
619-622
Published: 2007
Released on J-STAGE: November 27, 2007
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Between August 1999 and November 2004, we performed 60 femoral neck fracture fixation with Hansson pins.
The average age at surgery was 72.5 years (range: 28 to 92 years), and the average follow-up was 12.2 months (range: 2 to 60 months). According to the Garden classification, six hips were stage I, 27 hips stage II, 22 hips stage III, and five hips were stage IV. The average operation time was 36.4 minutes (range: 15 to 90 minutes). The average full weight bearing time was 3.7 days (1 to 14 days). There were four cases of necrosis of the femoral head, six of nonunion, and three of fractures. Acceptable reduction and pin position are important for decreasing the risk of complications.
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Masahiro Kubo, Osamu Kawano, Keiichiro Shiba
2007 Volume 56 Issue 4 Pages
623-625
Published: 2007
Released on J-STAGE: November 27, 2007
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We report a case of syringomyelia associated with cervical spondylotic myelopathy. A 85-year-old man was admitted for bilateral forearm pain, numbness of limbs, and gait disturbance. Magnetic resonance imaging (MRI) revealed the spinal cord to be compressed at C4/5 and C5/6 levels, and the syrinx was seen to extend from C2 to Th2 level on saggital images.
It was reduced after C3-7 laminoplasty, and his symptoms also improved after surgery.
Postoperative MRI revealed the syrinx had disappeared.
We have concluded that the syrinx in this case may have developed due to disorder of perfusion of cerebrospinal fluid caused by spinal cord compression.
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Tomonori Tajima, Keisuke Nishida, Katsuhiro Aita, Tadatsugu Morimoto, ...
2007 Volume 56 Issue 4 Pages
626-629
Published: 2007
Released on J-STAGE: November 27, 2007
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Hip motion and spine motion in forward bending are related closely. In coxarthrosis patients, limitation of hip motion is though to affect spine motion in forward bending. The purpose of this study was to evaluate the correlation between the motion of lumbar spine and hip with osteoarthrosis. Subjects were 164 female coxarthrosis patients (44 to 88 years, mean age: 62 years) who underwent total hip arthroplasty. The range of motion in hip and lumbar spine was measured in preoperative lateral radiographs (neutral position and sitting forward bending position), and evaluated according to age. The range of hip motion generally decreased for osteoarthritis. The range of lumbar motion correlated with age negatively. These results suggest that, in middle aged patients, because of less degenerative change of lumbar spine, limited of hip motion can be compensated with lumbar spine motion. In elderly patients, because of degenerative change of lumbar spine, limited lumbar spine motion is compensated with hip of osteoarthrosis.
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Osamu Nozaki, Shunsuke Kawano, Masamori Shigematsu, Masaaki Mawatari, ...
2007 Volume 56 Issue 4 Pages
630-633
Published: 2007
Released on J-STAGE: November 27, 2007
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The purpose of the present study was to evaluate the short-term results of revision total hip arthroplasty (revision THA) with long stem. Eight hips of eight patients who underwent revision THA from September 1998 to December 2004 were enrolled. There were two men (two hips) and six women (six hips), and the mean age at revision THA was 72 years. According to the Endo-Klinik classification, seven hips were assessed as grade 3 and the remaining one as grade 4. There were no complications including dislocation and infection, the radiographic evaluation was good. When initial fixation was obtained, early full weight bearing was possible.
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Tamiko Koshiba, Osamu Shigemori, Yoshihito Yukita, Yasuaki Suruga, Shi ...
2007 Volume 56 Issue 4 Pages
634-636
Published: 2007
Released on J-STAGE: November 27, 2007
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Recent treatment of spinal epidural hematoma is controversial. We experienced two cases of spontaneous spinal epidural hemotoma. Case 1: A 15-year-old man had transient neck pain in early morning. Neurological deficit was absent. MRI showed posterior epidural mass from C6 to Th1. Conservative treatment was performed and symptoms improved. Case 2: A 79-year-old woman had low back pain and paraplegia, bladder dysfunction in early morning. MRI showed mass from Th12 to L4. Sixteen hours later, operative decompression was performed, and three months later, paraplegia and bladder dysfunction improved.
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Yoshihiro Kohashi, Kunichika Shin, Komei Matsuura, Eiichi Ishitani, Ya ...
2007 Volume 56 Issue 4 Pages
637-639
Published: 2007
Released on J-STAGE: November 27, 2007
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In 2003, Forley reported the clinical use of a tube retractor for minimally invasive surgery of the transforaminal lumbar interbody fusion (MIS-TLIF), and this has gradually been spreading as the process for MIS. We began introducing this method in 2004, and will report about the problems and advantages that we have found.
We have performed MIS-TLIF on 24 cases. Operation time, bleeding, postoperative CK value, and postoperative CRP value were examined against TLIF's conventional methods. The MIS group and conventional group were operated over two intervertebral fusions; the MIS group's bleeding, postoperative CK value, postoperative CRP value was significantly low. However, it was noticed that one intervertebral case did not show any significant differences.
Since the MIS method was problematic in one intervertebral case, this could pose to be a problem in the future.
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Masahiro Yokouchi, Yoshiya Arishima, Kohei Yamazaki, Hiromi Hamada, Ic ...
2007 Volume 56 Issue 4 Pages
640-642
Published: 2007
Released on J-STAGE: November 27, 2007
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It is recently demonstrated that radio-hyperthermo-chemotherapy (RHC) is the most potent and relatively safe treatment method for soft tissue sarcoma (STS), which is available clinically.
From November 2004 to June 2006, a total of 15 patients with unresectable STS were treated at our department using RHC. We hereby report the short-term results of RHC in patients with STS.
PR was observed in two patients with an clinical response rate of 25%. However, histological examination showed that Grade 3 was observed in three patients and Grade 2 in one, with response rate of 66.6%.
Regarding adverse events, RHC often causes serious complications because of the combined therapy. We may have to decide the application of RHC to STS carefully.
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Tomohiro Hirai, Toshitake Yakushiji, Hiro Sato, Kiyoshi Oka, Masashi K ...
2007 Volume 56 Issue 4 Pages
643-646
Published: 2007
Released on J-STAGE: November 27, 2007
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Intraosseous schwannomas are rare neoplasms. In one large series, schwannomas accounted for 0.35% of all primary bone tumors. These schwannomas most commonly arise in the vertebra and have also been observed, very rarely, in the tibia. We report a 79-year-old woman with an unusual intraosseous schwannoma in the tibia. Interestingly, in this case, the magnetic resonance imaging (MRI) signal intensities highly correlated with pathological findings (Antoni type A and B).
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Futoshi Murakoshi, Masahiro Minami, Hironobu Sugimoto, Hiroyuki Shiget ...
2007 Volume 56 Issue 4 Pages
647-648
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced four cases where the locking screw of LHSP penetrated the humeral head. Two cases out of these four deformed after operation gradually. All cases showed cancellous bone defect, either fracture or osteoporosis, so we performed calcium phosphate bone cement filling. However, deformation occurred after operation again. We think that the causes are (1) decline of bone material deusity. and (2) fracture type with comminution. In cases of serious osteoporosis or inadequate reduction, fracture site is not rigid with calcium phosphate bone cement. We should use more rigid internal material, for example bone cement.
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Takehiro Kimura, Hitoshi Hatanaka
2007 Volume 56 Issue 4 Pages
649-653
Published: 2007
Released on J-STAGE: November 27, 2007
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After reductoin of severely communited fracture of the distal radius, such as AO types A3, C2, and C3, significant bone defect theoretically occurs at the metaphyseal potion. Previously, the primary aim of bone graft had been to maintain the reduction of fragments. Initially, however, the authors did not perform bone graft to bury the defect according to recommendations providing that no bone graft is needed after the development of the volar locking plate, which supports the articular surface of the radius despite significant bone defects of the metaphyseal portion. The authors used HA as bone substitutes because delayed unions occurred at the fracture site with significant bone defect. Recently, however, we use beta-TCP because delayed union occurs at the fracture whose defect is buried with HA, and have observed no delayed union nor nonunion. The purpose of the current study is to show that beta-TCP is effective for burying the significant bone defects in fractures.
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Hideya Kawamura, Hiroko Tanaka, Tomotaro Yamaguchi, Miho Ihara, Hideto ...
2007 Volume 56 Issue 4 Pages
654-656
Published: 2007
Released on J-STAGE: November 27, 2007
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To minimize hospitalization days after TKA surgery, we investigated past TKA cases in 2005. The subjects were fifty-two knees of fifty-one primary TKA cases except rheumatoid arthritis patients. We inspected the relationship between hospitalization days after surgery and difference in the anesthesia, the extent of pain after surgery, and post-operative complications.
The average hospitalization days after surgery in these cases was 30.8 days and patients with complication such as delay of surgical wound healing and attack of deep venous thrombosis postponed hospitalization days to 40.4 days. As a result, we will devise preventive measures for complications which extend hospitalization days after TKA surgery in the beginning of the next year.
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Hideya Kawamura, Goro Motomura, Tomotaro Yamaguchi, Hisashi Sakamoto
2007 Volume 56 Issue 4 Pages
657-660
Published: 2007
Released on J-STAGE: November 27, 2007
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Minimal invasive surgery of knee arthroplasty is useful, but some problems are surfacing over the past years. We performed TKA surgery to minimize incision using conventional guides in 2004 (Mini-Incision TKA). We started MIS (Minimally Invasive Surgery) TKA with mini-mid vastus approach in April 2005. In the current study, the effects of the two methods were compared.
The subjects were cases of primary TKA performed in Kyushu Kosei Nenkin Hospital for the treatment of osteoarthritis and osteonecrosis of the knee joint, except rheumatoid arthritis, from April to December in 2005. Forty-five cases were selected for investigation. We compared the mini-incision TKA and MIS TKA for operation time, length of incision, the day when patients can raise their legs (straight leg raising) after surgery and hospitalization days after surgery.
The average length of incision in MIS TKA was shorter than that in mini-incision TKA, while the average operation time of MIS TKA was longer than that of mini-incision TKA. Statistical analysis showed no difference in the number of days when the patients can raise their legs after surgery and the hospitalization days of these two methods.
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Hiroki Yoshimatsu, Toshiharu Nishida, Kenji Yoshida, Hisashi Yamashita ...
2007 Volume 56 Issue 4 Pages
661-663
Published: 2007
Released on J-STAGE: November 27, 2007
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We report on the diagnosis of pyogenic spondylitis in 59 cases. They included 50 cases that underwent detailed orthopaedic examination, among which 13 presented spondylosis deformans. We also examined 10 cases of spinal compression fracture, and seven of suspected pyogenic spondylitis. MRI examination confirmed pyogenic spondylitis in 34 cases overall. Cases that were difficult or late to diagnose included those with fever of unknown origin, and those in which orthopaedic differential diagnosis was necessary. These results suggest that we need clearer diagnostic criteria and methods for pyogenic spondylitis.
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Kuniyoshi Tsuchiya, Kazuhiro Yamaoka, Mitsuharu Miyagi, Takeshi Okamur ...
2007 Volume 56 Issue 4 Pages
664-668
Published: 2007
Released on J-STAGE: November 27, 2007
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Microfibrillar collagen (Avitene) was used in a novel semi-solid (suspended in water) form in spine surgery for a total of 41 patients. This form provided effective hemostasis in cases of woozing from bone resection site or bleeding from extradural venous plexus around the neural tissue. Bleeding from the deep narrow slit was difficult to control even with this form of Avitene. Such a dosage form was beneficial for spine surgery in terms of efficiency for hemostasis, accuracy for local distribution, and protection of neural tissue, thus facilitating surgical procedure, and may decrease postoperative complication risks related with continuous bleeding. No adverse effect was observed.
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Kuniyoshi Tsuchiya, Kazuhiro Yamaoka, Mitsuharu Miyagi, Takeshi Okamur ...
2007 Volume 56 Issue 4 Pages
669-672
Published: 2007
Released on J-STAGE: November 27, 2007
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One-hundred thirty-three patients underwent spine surgery using ultrasonic bone scalpel. Safe and quick bone resection was provided for all cases. Dural tear was observed in two patients and was estimated to be related to the use of ultrasonic bone scalpel. Both were considered to be caused by inappropriate use of handpiece, and thus preventable. Ultrasonic bone scalpel was useful especially for cervical laminoplasty, anterior decompression and fusion, decompression for the ossification of spinal ligaments, and pars resection in osteoplastic laminectomy of the lumbar spine. The device was beneficial for additional bone resection after exposure of the neural tissue.
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Azusa Hojyo, Jin Soo Park, Kotaro Jimbo, Kimiaki Yokosuka, Kei Yamada, ...
2007 Volume 56 Issue 4 Pages
673-676
Published: 2007
Released on J-STAGE: November 27, 2007
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We reviewed the clinical outcome of patients with rheumatoid cervical spine who underwent surgical treatment. There were nineteen patients, aged 41 to 79 (mean, 63 years), and the mean follow-up time was 50 months (18 to 86 months). Three patients were treated for severe pain at the back of the head. All had no pain after operation. Sixteen patients were treated for severe myelopathy. Twelve showed improved myelopathy and four showed no improvement of myelopathy, but no patients aggravated in condition after operation.
Though the results of short-term follow-up are good, the long-term follow-up is important for the clinical outcome of RA spine after operation.
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