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Keiichi Kondo, Keita Miyanishi
2007 Volume 56 Issue 3 Pages
337-340
Published: 2007
Released on J-STAGE: November 27, 2007
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The purpose of this study was to evaluate the clinical and functional outcome of total knee arthroplasty retaining the suprapatellar pouch, and compare two groups, one retaining the suprapatellar pouch and one without. The results of range of motion, HSS score, and JOA score all improved from -13.8°/122.3° to -3.8°/130.8°, 54.5/88.8 points, 48.9/85.3 points respectively. Regarding the number of days to reach the preoperative flexion angle, the suprapatellar retaining group was 30 days shorter than the group whose suprapateller was removed. In terms of the rate of achievement of the postoperative flexion angle, significant difference was seen between the two groups after operation. It is concluded that clinical and functional outcomes are good in early stages after total knee arthroplasty retaining the suprapatellar pouch.
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Shinsuke Someya, Toshihiro Ohdera, Masami Tokunaga
2007 Volume 56 Issue 3 Pages
341-345
Published: 2007
Released on J-STAGE: November 27, 2007
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We report three patiens with metal allergy who underwent total knee arthroplasty (TKA).
One patient had allergic reaction to metal, consisting of itching, eczema over the whole body, and dermatitis around the surgical wound, six months after TKA. Patch test revealed allergy to chromium, nickel, and other metals. Fortunately the patients allergic reaction improved by conservative treatment without removal of the components.
Two patients indicated metal allergy before TKA, which was proven by patch test. One patient had allergy to cobalt and nickel, and another had allergy to cobalt. We performed TKA using JMM Bi-surface KU4+® made of zirconia and ceramics.
Patients should be asked about past history of metal sensitivity, and metal allergy should be suspected when incurable dermatitis and eczema occurs after TKA.
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Itaru Yoda, Hiroshi Enomoto, Kunihiko Okano, Makoto Osaki, Shouhei Mat ...
2007 Volume 56 Issue 3 Pages
346-351
Published: 2007
Released on J-STAGE: November 27, 2007
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The purpose of this study is to investigate the relevance if plasmin marker (FDP: Fibrin Degradation Product, D-dimer) and the occurrence of deep venous thrombosis (DVT) / pulmonary thromboembolism (PE).
We report 149 cases undergoing hip joint operation from July 2003 to June 2006. We measured FDP and D-dimer before and after operation, and performed contrasting CT when the D-dimer value was more than 30μg/ml.
Nine cases were checked by contrasting CT. Thrombosis was found in seven cases, in which only two were DVT, while the others were DVT and PE. We perform this screening when D-dimer values are above 20μg/ml.
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Kei Yamada, Jin Soo Park, Kimiaki Sato, Hitomi Wakita, Kotaro Jinbo, K ...
2007 Volume 56 Issue 3 Pages
352-356
Published: 2007
Released on J-STAGE: November 27, 2007
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During spinal scoliosis surgery, compound muscle action potentials (CMAP) were recorded from distal upper and lower limb muscles following multipulse transcranial stimulation of the cortex. Seven patients, who were idiopathic scoliosis, were anaesthetized with propofol. One patient underwent anterior release of the thoracic spine and fusion by ISOLA method. The remaining six were reducted and fused by ISOLA method. The anatomical displacement of the spinal cord was classified into three groups according to Maruta's classification. Two cases were classified as over rotation type, the other two as under rotation type, and the remaining three as reverse rotation type. Three cases showed the decrease of amplitude of CMAP unilaterally after rod rotation maneuver. Three cases showed the decrease of amplitude of CMAP unilaterally after compression of spine. Five patients sustained sensory disturbance of the thigh after the operation. There was no relationship between the change of amplitude of CMAP and sensory disturbance after surgery. Three patients classified as reverse rotation type by Maruta's classification showed decreased CMAP amplitude after rod rotation maneuver and sustained thigh paresthesia after surgery. Rod rotaion maneuver may possibly have caused blood flow insufficiency of the spinal cord.
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Ko Sugata, Shinichiro Kubo, Hiroshi Kuroki, Shoji Hanado, Hideaki Hama ...
2007 Volume 56 Issue 3 Pages
357-361
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced a case of fracture of the sacrum followed by injuries to cauda equina where measurement of anorectal internal pressure was useful for prognostic prediction.
Case; 21-year-old male. The patient fell from the third floor of a building, landed on his back, and was taken to the hospital by ambulance because he had problems with moving. He complained of acute pain from buttocks to both lower limbs, left ankle pain, and right wrist pain. Fractures of the sacrum, left calcaneus, distal end of the right radius, and styloid process of the right ulna were observed on X-ray. With the disappearance of micturition and defecation desires, he neurologically had paresthesias below area S2-3, loss of voluntary contractions of the anal sphincter muscle, loss of BCR, and nearly complete paralysis below area S2. Conservatively following his progress, there was no improvement in pain and paralysis. On day 32 after the injury, we performed nerve decompression including a laminectomy of the sacrum, driving fore fracture segments, etc. Postoperatively, urination, defecation, and sexual dysfunction gradually improved. The serial measurement of anorectal internal pressure enabled early monitoring of improvement of the anal function and was helpful for prognostic prediction.
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Minoru Kashihara
2007 Volume 56 Issue 3 Pages
362-365
Published: 2007
Released on J-STAGE: November 27, 2007
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This paper presents a 70-year-old man with schwannoma of the anterior foramen magnum. He complained of occipital, nuchal, and shoulder girdle pain. Physical examination revealed motor weakness and sensory disturbance of the right upper extremity, numbness of bilateral upper extremity and right lower extremity, and long tract sign. MRI showed intradural mass situated at the anterior foramen magnum. Total resection of the tumor was performed by lateral approach which removed right hemilateral occipital condyle and the right side of posterior arch of C1 and lamina of C2 after 7 months from the symptom onset. The final diagnosis of schwannoma of C2 ventral root was based on the intraoperative and histological findings. The clinical appearance of foramen magnum tumor (FMT) is discrepancy between the tumor site and spinal segmental sign. Symptoms of lower cervical spinal cord lesion, including intrinsic muscle atrophy of the hand, often occur in FMT. The advantages of lateral approach are that there is no need for retraction of the spinal cord, good exposure of the tumor located at anterior foramen magnum, no postoperative cervical instability, and no risk for CSF leak and infection that often occur by anterior approach.
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Junya Ogata, Takeshi Arizono, Junichi Shida, Takeshi Tokito, Shinichi ...
2007 Volume 56 Issue 3 Pages
366-369
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced a case of paraplegia by extradural hematoma five days after operation. The case was a 69-year-old woman. Numbness and weakness at both lower extremities, and bladder rectal disorder developed in 2006. MRI examination revealed intradural-extramedullary tumor, and that the spinal cord was compressed by tumor. Excision of the tumor was performed. The tumor tissue was diagnosed as neurilemmoma in pathology examination. No abnormality was recognized after operation, but lower extremity weakness developed during the night at five days postoperatively, and the patient had difficulty in walking. MRI and myelography on the sixth day and CT on the seventh day revealed compression of the spinal cord. Paralysis by extradural hematoma was suspected. Operation was performed to remove the hematoma. The symptoms improved and almost recovered to the preoperative level. Paralysis due to epidural hematoma developing on the fifth day after operation is extremely rare. Because symptoms change depending on patient's posture, the elevation of the pressure around the dural sac depending on postural influence is a factor which causes development of paralysis.
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Tatsuya Okada, Akira Sei, Toru Fujimoto, Masaya Mizutamari, Takuya Tan ...
2007 Volume 56 Issue 3 Pages
370-374
Published: 2007
Released on J-STAGE: November 27, 2007
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We report a case of thoracic scoliosis with dural ectasia and vertebral scalloping in neurofibromatosis type 1. A man, 36 years of age, had a history of back pain for several years. The diagnosis of neurofibromatosis was based on a histological examination carried out another hospital. He came to our hospital because of back pain previously at and evidence of a tumor in his right upper chest which had been found on a chest radiograph. On examination, he had multiple cutaneous cafe-au-lait spots and many cutaneous neurofibromata. There were no neurological abnormalities. Plane radiographs of his spine showed that a 13° right scoliotic curve extended from the third to eighth thoracic, and vertebral scalloping in the fourth to sixth thoracic. Posterior spinal instrumentation and fusion were performed from the third to ninth thoracic. A year after surgery, radiographs demonstrated no graft resorption and unchanged frontal aligment.
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Shunji Matsunaga, Hiroaki Koga, Naoya Kawabata, Shinya Yuasa, Takanori ...
2007 Volume 56 Issue 3 Pages
375-376
Published: 2007
Released on J-STAGE: November 27, 2007
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The authors report a case of dizygotic twins with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine manifesting interesting clinical course. The 69-year-old dizygotic twins with low stature have schizophrenia. The elder sister exhibits continuous type OPLL in the cervical spine with 48% occupied rate in the spinal canal. She developed no myelopathic symptoms. The younger sister exhibited similar OPLL in the cervical spine including severe myelopathy and is cared for by a nursing care unit. The pathomechanism of myelopathy in patients with OPLL has not yet been clarified. The twins presented very similar genetic background and exhibit apparently different clinical course. The accumulation of these cases helps us to clarify the pathomechanism of myelopathy in OPLL. Calcineurin is thought to be related to the development of schizophrenia and regulates bone formation by osteoblast. The association of schizophrenia with OPLL might not be accidental.
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Tetsuo Hayashi, Takayoshi Ueta, Keiichiro Shiba, Eiji Mori, Kozo Kaji, ...
2007 Volume 56 Issue 3 Pages
377-379
Published: 2007
Released on J-STAGE: November 27, 2007
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We report a case of anterior dislocation of cervical spine with difficult reduction because of impingement of the cartilage endplate. A 15-year-old male was admitted to our hospital for C5 anterior dislocation. He had complete palsy and severe stenosis of spinal cord at C5-C6 in MRI and bilateral facet dislocation at C5-C6 in CT scan. Operation was performed on the same day. With the posterior approach, bilateral facet joint was locked, so bilateral superior articular processes were partly excised by air drill. However it was very difficult to perform reduction because of impingement of the cartilage endplate. Anterior approach was supplemented to remove it. Removal of the cartirage endplate enabled complete reduction and anterior fixation was performed. The posterior approach usually allows reduction of anterior dislocation of the lower cervical spine. In this rare case, reduction was very difficult by posterior approach only because of the protruded cartilage endplate. As forcible reduction may deteriorate spinal injury, the method of reduction should be considered according to the case.
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Koji Sameshima, Yoshihisa Kawauch, Hiromi Sasaki, Setsuro Komiya
2007 Volume 56 Issue 3 Pages
380-383
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced two cases whose main symptom was drop foot only due to thoracolumber vertebral fracture. The two patients (85-year-old woman and 86-year-old man) underwent conservative treatment for Th12 or L1 vertebral fracture, but they both developed drop foot after a few months. Dynamic myelography revealed nerve compression which indicated epiconus syndrome.
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Hisato Tanaka, Mitsunori Komine, Hiroaki Kurokawa
2007 Volume 56 Issue 3 Pages
384-390
Published: 2007
Released on J-STAGE: November 27, 2007
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We observed the outbreak time of a spinal compression fracture following radiation therapy and its natural course. [Case] Case 1 was a 88-year-old, woman. NTX66.9. Underwent cobalt irradiation 54Gy for esophageal cancer. Three months after irradiation, the first lumbar vertebra was found to de compressed, and low back pain occured. Vacuum cleft phenomenon in X-P appeared after two weeks, but anterior callus formation appeared in eight weeks, after which the low back pain disappeared. Case 2 was a 77-year-old woman. NTX86.5. Underwent irradiation 69Gy for uterine carcinoma. Six months after the irradiation, the fourth / five lumbar vertebra were found to be compressed. Great collapse occured in X-P after two weeks, but stabilized and did not aggravate thereafter. Low back pain also disappeared. [Conclusion] Radiotherapy affects bone cells (osteoblasts, osteoclasts), inhibiting bone remodeling. As a result, deficient elastic resistance occurs. Vertebral bodies are also compressed in such a situation. After that normal callus formation starts from adjacent normal bone cells. The compression fracture observed ranged from three to six months after radiation. Natural course is well. Therefore conservative therapy is recommended.
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Yoshihisa Kawauchi, Koji Sameshima, Hiroyuki Maruyama, Hiromi Sasaki, ...
2007 Volume 56 Issue 3 Pages
391-393
Published: 2007
Released on J-STAGE: November 27, 2007
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Thoraco-lumbar burst fracture damages the upper part of vertebra in most cases. We therefore conducted investigations to determine if fixation between segments can provide bone union without sacrificing the lower part of vertebra or damaging adjacent intervertebral disc. We performed PLIF on three cases of lumber vertebrae fracture which is anterior decompression and fusion between single segment through posterior approach. Correction loss occurred in one case, but bone union was achieved in all cases, providing satisfactory results in a short time. In comparison with other methods, we think that it is a comparatively effective method with a few aggressions.
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Hajime Fukuda, Etsuo Chosa, Shinichiro Kubo, Hiroshi Kuroki, Shoji Han ...
2007 Volume 56 Issue 3 Pages
394-398
Published: 2007
Released on J-STAGE: November 27, 2007
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Diagnostic imaging of pseudoarthrosis and collapsed vertebral body after compression fracture caused by osteoprosis is comparatively easy from vacuum cleft in X-ray or fluid pool around the fractured vertebral body in MRI. We report a case of vertebral compression fracture that was suspected of mass-like lesion requiring differential diagnosis. A 53-year-old woman was diagnosed with malignant rheumatoid arthritis (MRA). Her chief complaint was lumbar backache and lassitude of both lower extremities. Lumbar backache developed from the front for three months. The first lumber vertebra disappeared in X-ray partially, and vacuum cleft or osteosclerosis images were not found. Tumor like density connected with the vertebral body in para vertebral area was revealed on MRI. We performed front and back fixation. There was a large quantity of ooziness, psammous in the mass. The pathologic findings were fibrocartilage, hyaline cartilage, and small inflammatory granulation tissue of bone tissue. The nonspecific inflammatory tissue was thought to add to the vertebral compression fracture caused by rheumatoid arthritis.
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Joji Noguchi, Gishichiro Shimoyama, Toshiro Shinozaki, Kensei Nagata
2007 Volume 56 Issue 3 Pages
399-404
Published: 2007
Released on J-STAGE: November 27, 2007
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The purpose of this research is to evaluate the results of arthroscopic meniscectomy in medial compartment osteoarthritis of the knee. The operation was performed on 25 knee joints (8 male, 17 female) with the mean age of 67 years. The mean period of follow-up was 19 months. Clinical results were more or less excellent, but radiological assessment suggested slight osteoarthritic changes. In addition, two cases progressed to subchondral bone collapse. Of 12 cases which had no bone marrow edema on MRI before surgery, six (50%) cases showed it at follow-up. These findings suggest a possible relationship between arthroscopic meniscectomy and later appearance of osteonecrosis in some cases.
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Wakana Togami, Eiichi Nakamura, Yasunari Oniki, Hiroshi Mizuta
2007 Volume 56 Issue 3 Pages
405-409
Published: 2007
Released on J-STAGE: November 27, 2007
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We report a case of surgical repair of complete avulsion of the hamstring muscles from the ischial tuberosity. When a 32 year-old man, a member of the Self-Defense Forces, did a high kick with his left foot and with his right foot as the pivot leg during a martial arts match, he experienced acute pain in the posterior surface of his thigh and could not walk. He visited our clinic because of the sharp pain though he was treated consevatively at the site diagnosed with muscle strain. At initial visit, massive swelling and severe ecchymosis were found in the posterior surface of left thigh. In the prone position, a depression distal to the ischial tuberosity and loss of contour were seen when the patient was asked to underwent hamstring muscle contraction. Radiographic and MRI showed complete rupture of the left proximal hamstring muscle origin. Tendon repair was performed using two pieces of Staytak placed in the ischial tuberosity. Six months after surgery, he returned to work at the Self-Defense Forces although reduced knee flexor power remained.
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Tomohiro Nomura, Nobuaki Chinzei, Masamichi Fujii, Tsutomu Hannita, Ka ...
2007 Volume 56 Issue 3 Pages
410-413
Published: 2007
Released on J-STAGE: November 27, 2007
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Patellar tendon rapture in healthy individuals is a rare entity. A case was presented where a 27-year-old male, with no known history of systemic disease or knee problem, had two bilateral patellar tendon raptures, with a 15-month interval. Both accidents occured when he jumped off from a ship. Immediately after each injury, he experienced local pain and gait disturbance. Physical examination revealed local tenderness, swelling palpable defect, and inability of active knee extension. X-ray showed patella alta, and discontinuity of the patellar tendon was noted on MRI. In both instances, tendon was repaired using a Doll-Miles wire and suture anchor. After immobilization in a cylinder cast for four weeks, active full-flexion exercise was started. In each case, range of motion of 0-135° and quadriceps strength were regained within five months.
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Takeshi Goto, Yukihiro Furue, Makoto Sasaki, Ikufumi Nagayoshi, Tatsuo ...
2007 Volume 56 Issue 3 Pages
414-417
Published: 2007
Released on J-STAGE: November 27, 2007
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We report two cases of fresh patellar tendon rupture in elderly people without systemic disease. Case1 was a 72-year-old woman who injured herself by missing a step. The patellar tendon ruptured in parenchyma of the tendon. The ruptured tendon was end-to-end anastomosis. Augmentation was done by the use of semitendinosus and soft-wire from the patellar to tuberositas tibiae. Case2 was a 72-year-old woman who injured herself by stumbling over an obstacle. The ruptured tendon was in two layers. The ruptured tendon was repaired, and sutured to the patellar and tuberositas tibiae. Augmentation was done by the use of soft-wire from the patellar to tuberositas tibiae. Flex limitation remained in both cases at seven months postoperatively. In past reports, postoperative knee joint could flex over 130 degrees, but the cases reported were young compared to ours. In our cases, 100 degree-flex limitation remained. Patellar tendon rupture rarely occurs in elderly people without systemic diseases.
Our results for patellar tendon rupture of the elderly differed from the good results of the young flex limitation. It is necessary to review treatment in future studies.
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Hideyuki Kawabata, Shunsuke Nakamura, Ryodai Kawabata, Hironori Kakoi, ...
2007 Volume 56 Issue 3 Pages
418-422
Published: 2007
Released on J-STAGE: November 27, 2007
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Case 1 was a 79-year-old woman. She had pain, and a mass was found on her right knee. Roentgenograms showed osteoarthritis. Cystic tumor connected to the tear of the medial meniscus was also confirmed on MRI.
Arthroscopic findings confirmed meniscul tear and intraarticular curettage of the cyst was attempted. Small extrusion of clear yellow fluid was seen, but the curettage was not able to be done completely. So we performed open cyst extirpation.
Case 2 was a 14-year-old woman. She had pain and catching sensation on her left knee without any trauma. She had found a small mass on anterior side of her left knee. MRI showed cystic tumor with septation and borderd on the anterior horn of the lateral meniscus. Arthroscopic examination showed a cystic tumor extending to the fat pad, but no tear was found in the lateral meniscus. Open excision of the cystic tumor and peripheral meniscal repair were therefore performed via a small capsular anterolateral incision.
Some investigators have reported the effectiveness of intraarticular curettage of meniscal or ganglion cyst by arthroscopic procedure. But some ganglion cysts occur without meiniscul tear, requiring open excision in such cases.
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Masato Tomita, Kenji Kumagai, Shiro Kajiyama, Motoyuki Takagi, Tomoyuk ...
2007 Volume 56 Issue 3 Pages
423-426
Published: 2007
Released on J-STAGE: November 27, 2007
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A case of ossifying fibromyxoid tumor occurring in the popliteal region is reported. A 59-year-old woman noticed a mass lesion in the left popliteal region seven to eight years ago. Because she had no pain, she neglected this mass. But she felt dullness on the left leg a few months ago. She was referred to our clinic. At the first visit, hard mass of 62×47 mm in size was palpable in the left popliteal region. Symptoms such as tenderness, knock pain, and Tinel's sign were not observed on the lesion. X-ray showed geographic calcification in the extra-articular region. On MRI examination, the tumor showed low signal intensity in the T1 weighed image, and high signal intensity in the T2 weighed image. Open biopsy specimen suggested low-grade malignancy, but we were unable to make definitive diagnosis. The tumor was resected on the marginal margin. The surgical specimen was diagnosed as ossifying fibromyxoid tumor. Six months after the operation, she did not have local recurrence or lung metastasis.
In the event of hard/soft tissue in the popliteal region indicating calcification on X-ray, ossifying fibromyxoid tumor should be considered a differential diagnosis before operation.
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Yoshiya Arishima, Masahiro Yokouchi, Kazuto Ueno, Yasutaka Baba, Sadao ...
2007 Volume 56 Issue 3 Pages
427-431
Published: 2007
Released on J-STAGE: November 27, 2007
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A 43-year-old man who had been diagnosed with metastatic synovial sarcoma of the lung was treated by radiofrequency ablation. He had previously been diagnosed with synovial sarcoma of the right upper arm, and had undergone right arm amputation after three local recurrences. He also had undergone partial lobectomy for metastatic tumor three times. After surgery, new metastases occurred in his right lung. Radiofrequency ablation was performed for these lesions. Six months after the treatment, he is alive without recurrence. This procedure is minimally invasive and is recommended for patients who have residual tumors despite other treatments, or for inoperable patients due to poor general status.
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Eiji Azuma, Michio Shinohara
2007 Volume 56 Issue 3 Pages
432-435
Published: 2007
Released on J-STAGE: November 27, 2007
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A 74-year-old woman experienced acute onset of severe pain of both her ankle joints and feet without reason in the beginning of March, 2006. She was admitted due to increasing sharp pain, local heat, and swelling. At first, cellulitis or gout was suspected, and treatment was carried out. Although symptoms were reduced once, intermittent fever and breathing difficulties were noted. Acute leukemia was suspected in blood tests and she was transferred to another hospital for the purpose of close examination and treatment. She was diagnosed with acute myelogenous leukemia in the bone marrow and underwent chemotherapy, but passed away without the effect of treatment. Leukemia developing with bone and joint symptoms is rare (6.3%), but special note of this case was considered impertant as differential diagnosis.
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Tomoyuki Taura, Kenji Kumagai, Masato Tomita, Shiro Kajiyama, Motoyuki ...
2007 Volume 56 Issue 3 Pages
436-439
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced a case of chondrosarcoma in the patella, where there have been no reports of chondrosarcoma. The patient was a 65-year-old Japanese woman who had rheumatoid arthritis. She noticed a mass on the distal pole of the patella four years ago which gradually increased in size. She was referred to our Hospital in Nagasaki. In her first visit, the mass existed around the medial side of the left patellar ligament, measuring 43×64 mm in size. Her range of motion was mildly limited. X-ray examination showed the mass with fine calcification on the medial side of the left patella. MRI in T2WI of the left knee showed cluster of high intensity rings. During operation, the tumor was founded to be connected with the patella and it's surface was coverd with normal cartilage. Histological diagnosis was well differenciated chondrosarcoma. So the patella edge was trimed. No recurrence was found about 9 months after the operation.
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Masahiro Yokouchi, Yoshiya Arishima, Yoshitaka Yamashita, Setsuro Komi ...
2007 Volume 56 Issue 3 Pages
440-442
Published: 2007
Released on J-STAGE: November 27, 2007
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We evaluated the clinical results of patients with osteosarcoma using the COSS-86 protocol of the German-Austrian-Swiss Cooperative Osteosarcoma Study Group.
From January 2000 to October 2006, a total of nine patients with osteosarcoma were treated at our department using the COSS-86 protocol as neoadjuvant chemotherapy. The study group included four men and five women with an average age of thirteen years. Definitive surgery was scheduled for week ten, and all the patients had a limb-salvage procedure. Histological examination showed that Grade 2 was observed in four patients, and response rate was 44.4%. The five-year rates of overall and disease-free survival were 74.9% and 62.5%, respectively. The results of the protocol for osteosarcoma in our department were approximately similar to those of other institutes. We may need to establish more potent chemotherapeutic protocols or new therapeutic modalities to improve clinical results, especially for lung metastasis.
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Kenichi Takemura, Toshitake Yakushiji, Hiroo Sato, Kiyoshi Oka, Yasuhi ...
2007 Volume 56 Issue 3 Pages
443-447
Published: 2007
Released on J-STAGE: November 27, 2007
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We experienced a case of Ewing/PNET achieving long-term survival for whom chemotherapy and radiation therapy worked effectively without radical operation on the original nest. The patient has not seen any recurrence of each focus caused by the disease nor any new metastasis in eight years and eight months from the first diagnosis. But we think careful follow-up in future is required.
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Motoyuki Tanaka, Takao Setoguchi, Yasuhiro Ishidou, Kosei Ijiri, Setsu ...
2007 Volume 56 Issue 3 Pages
448-452
Published: 2007
Released on J-STAGE: November 27, 2007
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The Notch signaling pathway functions as an organizer in embryonic development. Genetic analysis has demonstrated a critical role for the Notch pathway in morphogenesis. Recent studies have shown constitutive activation of the Notch pathway in various types of malignancies. However, it remains unclear whether this pathway is activated in human bone and soft tissue tumor. Here, we determined the expression of the components of the Notch pathway by RT-PCR and immunohistochemical staining in a series of two human osteosarcoma and three cell lines of bone tumors. Furthermore, we added γ -secretase inhibitor in human osteogenic sarcoma (HOS) cell line, and examined cell viability by MTT method. All osteosarcomas and cell lines were displayed in high intensity for Notch-1, 2, Jagged1 by RT-PCR. It was especially confirmed that HOS was expression of all receptors, ligands, transcriptional-factors. γ-secretase inhibitor (GSI) that blocks the Notch pathway, suppresses expression of and the growth of the Notch pathway-activated HOS. These data indicate that the Notch pathway is a new candidate for therapeutic target of osteosarcoma.
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Masataka Hirotsu, Masahiro Yokouchi, Yoshiya Arishima, Takao Setoguchi ...
2007 Volume 56 Issue 3 Pages
453-457
Published: 2007
Released on J-STAGE: November 27, 2007
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We report a case of chondrosarcoma of the distal end of the femur that needs to be distinguished from benign bone tumor. The patient was a fifty-year-old female. Five years ago, she indicated bone tumor of the distal end of the left femur.
She had no symptoms, and there was a marginal sclerotic change in the X-ray. The tumor was therefore diagnosed as benign cartilage tumor. During observation, there was no increase in size and no pain. But, biopsy of the tumor was performed in response to her request. In the pathological findings, the tumor was chondrosarcoma. We performed resection of the tumor, and bone graft with her iliac bone. There was no recurrence and metastasis. Recent studies have reported that endosteal scalloping and large lucent area in the calcification of the tumor were the findings of malignant cartilage tumors. These facts leads us to think that if these findings exist, we should perform biopsy and obtain pathological diagnosis.
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Kiyoshi Higa, Etsuo Chosa, Takero Sakamoto, Shinji Watanabe, Tomohisa ...
2007 Volume 56 Issue 3 Pages
458-461
Published: 2007
Released on J-STAGE: November 27, 2007
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We report three cases of giant bone defect after resection of osteofibrous dysplasia (OFD), which was treated with β-TCP. The mean age was 14 years and 11 months (one male, two female). We fixed the bone with a plate or plaster cast because of instability. It has been reported in the past that recurrence occurs frequently when OFD is treated by simple curettage and bone transplantation. Thus many hospitals including ours are choosing enlarged tumorectomy. However, we are often unable to fill bone defect with self bone because that part is too large. We filled it with only β-TCP, because our hospital have no bone bank system and patients are young. In our cases, β-TCP caused no side effect when it was converted to bone. We suggest that β-TCP is a useful bone filling material for defects.
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Nobuaki Chinzei, Tomohiro Nomura, Masamichi Fujii, Tsutomu Hannita, Ka ...
2007 Volume 56 Issue 3 Pages
462-465
Published: 2007
Released on J-STAGE: November 27, 2007
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Nine patients with fractures of the distal femur treated from January 2004 to July 2006 were reviewed retrospectively. They were all female and the mean age at operation was 88 years. The follow-up period averaged six months. According to the AO classification system, four cases were classified as type A1, two type A3, two type C2, and one type C3. The operative procedures performed were internal fixation, using retrograde intramedullary nail on seven cases, and plate fixation on two.
Each case was evaluated by Neer's clinical criteria and the results were excellent in two cases, satisfactory in two, unsatisfactory in three, and failed in no cases. Re-acquisition of elderly patient's ADL is difficult because of coexisting illness before the fracture and limit of briskness. Even among our cases, there was a tendency where a patient who had overall good results but hemiparalysis or dementia after brain hemorrhage gave a low value compared with the others.
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Takuya Ikuta, Futoshi Kuga, Junichiro Ishikawa, Takanao Shimabukuro, K ...
2007 Volume 56 Issue 3 Pages
466-469
Published: 2007
Released on J-STAGE: November 27, 2007
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We report four cases of non-union of femoral trochanteric fracture. All cases were treated surgically, using CHS in one, external fixator in one, and DCS in two cases. In all cases, bone union was achieved, and satisfactory results were obtained.
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Ken Narita, Joji Noguchi, Toshiro Shinozaki, Gishichiro Shimoyama, Tak ...
2007 Volume 56 Issue 3 Pages
470-475
Published: 2007
Released on J-STAGE: November 27, 2007
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Femoral neck fractures are a challenge to orthopeadic surgeons due to the high rate of complications accompanying the fracture. The aim of this study is to demonstrate the management of the fracture by considering failure cases after surgery. We studied 33 patients with a mean age of 72 years. They were treated either by internal fixation with Hansson pin or canullated cancellous hip screw (CCHS). The hip complication rate was 21%, and revision rate 15%. Hip complications occurred in some cases of displaced femoral neck fractures, subcapital fractures and severe osteoporosis etc. We conclude that the best method for the fracture should be determined by considering multi-factors surrounding these patients.
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Yuji Kishimoto, Akira Fukushima, Koji Kuranobu, Toshiaki Takahashi
2007 Volume 56 Issue 3 Pages
476-478
Published: 2007
Released on J-STAGE: November 27, 2007
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There is growing interest in reducing hospital stay by providing home care after hip fracture surgery. We investigated nursing care of elderly persons with hip fractures after they were discharged from our hospital, and the risk factors which made them difficult to receive health care services at home. We reviewed patients who had lived in their homes before they were injured, and had undergone surgical repair for hip fracture at our hospital from 2003 to 2005. One-hundred and seventy-four patients (29 males and 145 females) participated in this study. Thirty-five patients (20.1%) needed care in nursing care institutions after discharge. The risk factors analyzed by logistic regression were male, living alone, loss of walking ability, and patients incapable of gait without support before injury. We conclude that early forecast of prognosis and cooperation between hospitals and nursing care institutions are important to support hip fracture patients and their families.
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Hisataka Goto, Juei-tang Chang, Toshio Kawahara
2007 Volume 56 Issue 3 Pages
479-481
Published: 2007
Released on J-STAGE: November 27, 2007
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We evaluated perioperative complications in 268 patients over the age of 70 years with proximal femoral fracture from 2004 through 2006. Seventy-eight out of 268 patients were taking anticoagulant drugs. We determined the length before operation and that of hospitalization, bleeding volume and the incidence of perioperative complications. Preoperative length and the duration of hospitalization in anticoagulated patients were longer than in non-anticoagulated. The incidence of intraoperative arrhythmia increased in the anticoagulated. In patients taking warfarin potassium or ticlopidine hydrochloride (PanaldineR), the incidence of intraoperative arrhythmia and postoperative brain infarction increased. Also the length before operation was associated with perioperative complications. We should think about the risk of preoperative interruption of anticoaglant drugs in proximal femoral fractures.
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Tatsuhiko Nakamura, Makoto Okuno, Kichizo Yamamoto
2007 Volume 56 Issue 3 Pages
482-485
Published: 2007
Released on J-STAGE: November 27, 2007
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The background of 51 vertebral compression fractured women, 51 cervical fractured women, and 74 trochanteric fractured women was compared. The average age was 78.8, 82.6, 83.8 years respectively, and significant difference was found between the vertebral compression fracture group and trochanteric fracture group. Weight, body mass index, WBC, CRP, RBC, Hb, total cholesterol, total protein, albumin, Ca, ALP, bone alkaline phosphatase (BAP), bone mineral density (BMD) of the neck region show significant differences even after age matching. Body structure, nutrition condition, and BAP activity have some influence on BMD according to the difference in the type of fracture.
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Takuto Tsuchiya, Satoshi Ikeda
2007 Volume 56 Issue 3 Pages
486-490
Published: 2007
Released on J-STAGE: November 27, 2007
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The aim of this study was to clarify that curative efficiency of the measurement of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) on the distal forearm, and correlations between the forearm and both lumbar and femur in postmenopausal women. ΔBMD (changing in BMD during six months) in the bisphosphonate-treated group was significantly increased compared with the other osteoporosis drug-treated (except for bisphosphonate) group on distal radius 1/3, and was significantly increased compared with non-treated group on distal radius 1/10 (0.52% vs -0.90% and 1.34% vs -5.16%, respectively). The bone mass on distal radius (1/3) was significantly correlated with femoral neck (BMD: R
2=0.211, Z score: R
2=0.253 and T score: R
2=0.225, respectively). In conclusion, the measurement of BMD measured by DXA on the distal forearm (both distal radius 1/3 and 1/10) may include the evaluation of curative efficiency in postmenopausal women, and bone mass on distal radius 1/3 was found to be significantly correlated with femoral neck.
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Taiki Murakami, Koji Nawata, Yoshihiro Nasu, Hideaki Kishimoto, Hiroka ...
2007 Volume 56 Issue 3 Pages
491-494
Published: 2007
Released on J-STAGE: November 27, 2007
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We evaluated the clinical results of 22 cases of Little Leaguer's shoulder between 2001 and 2006. The average age of patients in this series was 13.7 years (range, 11 to 17), and all patients were male. All patients were treated with rest, and conservatively. The sport activity was baseball in 20 patients, softball in 1, and soft tennis in 1. Eight patients (36%) were in the 5th and 6th grade of elementary school, and eight (36%) in the 1st and 2nd grade of senior school. X-ray images revealed partial separation in the lateral epiphysis in 14 patients, full separation in six and slipping in two. All patients were treated with rest, preventing from throwing for an average of 52 days. One patient had relapse. It appears that early- to mid-teens X-ray images are prone to the development of proximal humeral epiphyseal overuse. We recommend that coaches and parents encourage young and adolescent baseball players to report any throwing-related shoulder pain as soon as it occurs.
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Noboru Moriguchi, Masao Eto, Keizo Furukawa, Keiichi Tsuda, Takayuki S ...
2007 Volume 56 Issue 3 Pages
495-498
Published: 2007
Released on J-STAGE: November 27, 2007
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The purpose of this study was to evaluate the surgical outcome of arthroscopic Bankart repair in patients with traumatic anterior shoulder instability. The subjects were twenty-two patients consisting of fifteen males and seven females. The age at the time of surgery ranged from fourteen to fifty-six years (mean: twenty-three). The age at the time sports was played at the competition level was sixteen. Sports consisted of: rugby foot ball in six cases, volleyball in two, field-and-track event in two, badminton in two, and others in four. The follow-up period was between eight months and three years (mean: twenty months) and the therapeutic results were evaluated according to the JOA score, JSS shoulder instability score, JSS shoulder sports score. All cases were able to return to sports. Relocation occurred in one rugby player at tackle. The clinical results of arthroscopic Bankart repair were favorable.
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Toshiro Shinozaki, Joji Noguchi, Taishi Nagano, Gishichiro Shimoyama, ...
2007 Volume 56 Issue 3 Pages
499-502
Published: 2007
Released on J-STAGE: November 27, 2007
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Ishiguro reported that good therapeutic results can be obtained by conservative treatment for the proximal humeral neck fractures. We examined patients following his method in this study. The patients consisted of nine females and one males with a mean age of 74.4 years. The follow-up period ranged from 12 weeks to one year and six months (mean; 37 weeks). The mean range of motion in the shoulder was 138° in elevation, 51° in extension, 140° in abduction, and 48° in external rotation. JOA score was a mean of 92 points. Favorable therapeutic results can be obtained by this therapy.
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Yoshiaki Yamanaka, Nario Ihara, Hiroto Kumagae, Akinori Sakai, Toshihi ...
2007 Volume 56 Issue 3 Pages
503-507
Published: 2007
Released on J-STAGE: November 27, 2007
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As a therapy for four-part fracture-dislocation of the proximal humerus, prosthetic replacement is usually recommended because pseudoarthrosis and avascular necrosis frequently occur. We report a case which underwent osteosynthesis with Kirschner wire fixation and wire cerclage for four-part fracture-dislocation of the proximal humerus. The case was a 67-year-old female injured in falling from bed. We recognized fracture dislocation of the right proximal humerus on X-ray, and performed closed reduction gently by the upper extremity elevation method at the non-anesthesia. But the humeral head dislocated completely. We promptly attempted to open reduction and internal fixation. Eight months after surgery, bone union was recognized on X-ray, and there were no signs and symptoms of avascular necrosis of the humeras head. The range of motion in the right shoulder joint was 90° at flexion, 45° at extension, and 70° at abduction. These results suggest that osteosynthesis can even be indicated for four-part fracture-dislocation of the proximal humerus, and that prosthetic replacement is not always the optimum treatment.
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Takashi Ando, Junji Ide, Akinari Tokiyoshi, Jun Hirose, Hiroomi Ogata, ...
2007 Volume 56 Issue 3 Pages
508-512
Published: 2007
Released on J-STAGE: November 27, 2007
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The combination of posterior dislocation and fracture of the anatomical neck represents an extremely rare injury. A patient with posterior dislocation of the shoulder and ipsilateral fracture of the humeral anatomical neck was treated with open reduction and internal fixation with two Kirschner wires. He was followed up for 11 years. The functional results were excellent, and X-ray and MRI investigations revealed the absence of avascular necrosis of the humeral head. Early and accurate open reduction with minimal osteosynthesis resulted in excellent function of the injured shoulder without avascular necrosis.
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Taisaku Kawamoto, Koumei Matsuura, Eiichi Ishitani, Kunichika Shin, Ak ...
2007 Volume 56 Issue 3 Pages
513-518
Published: 2007
Released on J-STAGE: November 27, 2007
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We analyzed 21 patients with proximal humeral neck fracture, who had been surgicaly treated in our hospital between 2001 and 2006. The cases were classified into three groups: those treated with intramedullary nails, with Node pin, and with K-wire. We compared age at operation, cortical thickness of humerus, and JOA score between groups.
There was significant correlation between JOA score and cortical thickness. Good clinical results were obtained with all operative methods when the cortical thickness was over 3 mm. There was a tendency for decreasing cortical thickness and JOA score to decrease with aging. We concluded that cortical thickness is a reliable predictive factor of surgical results for proximal humeral neck fracture.
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Eiichi Ishitani, Komei Matsuura, Kunichika Shin, Taisaku Kawamoto, Aki ...
2007 Volume 56 Issue 3 Pages
519-523
Published: 2007
Released on J-STAGE: November 27, 2007
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High re-tear rate is reported after rotator cuff repair in large and massive tear cases. Previously, we reported that 15% of patients after rotator cuff repair showed re-tear in MRI findings. In this study, 116 consecutive rotator cuff repaired patients who had been operated arthroscopically since 2003 were evaluated for size, torn site, fixation methods, mobility, and tendon quality. In addition, rehabilitation methods and occupation after revision were also evaluated. There were four patients who underwent re-operation. Rotator cuff repairs by revision surgery failed mechanically due to two reasons: the main factor of failure was suture material breakage in three cases and the second was tendon pulling through sutures in one case. The lack of thread strength was suggested. In addition, it is important to pull cuff stump to greater tubercle without excessive tension. Of re-operated cases, three engaging in manual labor suffered large and massive tear. In two cases, premature return to manual labor suggested cause of re-tear.
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