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Masahiro Shirahama, Kensuke Sakai, Kensei Nagata
2008 Volume 57 Issue 1 Pages
1-5
Published: 2008
Released on J-STAGE: May 23, 2008
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A new plate and method have been devised to immobilize important posterior portions in vertically unstable pelvic ring fractures. We have surgically treated 30 patients with vertically unstable pelvic ring fractures over the past eight years. Mean patient age was 49 years, the most common cause was motor vehicle injury (17 patients), and mean follow-up period was 1 year 8 months. Surgery was performed in the prone position, 5 cm longitudinal incisions were made bilaterally at the posterior superior iliac spine, and an M-shaped transiliac plate adapted to the anatomic configuration of the pelvis was inserted under the paravertebral muscles and fixed. Mean operation time was 85 minutes and mean blood loss was 379.2 ml. Patients began ambulating one week after surgery. The Majeed's score indicated excellent or good results in 25 patients. Vertically unstable pelvic ring fractures are conventionally treated with iliosacral screws or sacral bars and some method of anterior pelvic fixation; however, inadequate immobilization can lead to deformity, pain, and unsatisfactory outcomes. Posterior fixation using an M-shaped transiliac plate is minimally invasive and provides rigid fixation with excellent results.
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Chojo Futenma, Goichi Okahara, Tomohiro Isa, Masaki Kinjo, Kenji Horik ...
2008 Volume 57 Issue 1 Pages
6-9
Published: 2008
Released on J-STAGE: May 23, 2008
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Skin defects on twenty-seven legs were treated with a veno-accompanying artery fascio-cutaneous (VAF) flap or a veno,neuro-accompanying artery fascio-cutaneous(V-NAF) flap.
The etiology of the skin defects were as follows: trauma in seven, osteomyelitis in seven, soft tissue tumors in five, intractable ulcers in four, joint contractures in two and post-TKA and purulent arthritis of the knee joint in one respectively. The age ranged from three to seventy-eight years (mean 43 years). The follow-up period ranged from one month to nine years(mean 2.4 years). The small saphenous VAF or V-NAF flap that had a size from 5.7cm×3.4cm to 13cm×10cm was performed in nineteen legs. The great saphenous VAF or V-NAF flap that had a size from 5cm×4.5cm to 11cm×8cm was performed in eight legs. Complete survival of the flap was observed in twenty-two, however five showed partial necrosis.
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Osamu Kunigo, Kosei Ijiri, Takuya Yamamoto, Fumihiro Miyaguchi, Toshim ...
2008 Volume 57 Issue 1 Pages
10-12
Published: 2008
Released on J-STAGE: May 23, 2008
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We recently encountered two cases of idiopathic vertebral fractures. Case 1 was a 53-year-old male who experienced acute low back pain after lumbago exercise at home. Vertebral fractures at L3,4,5 were diagnosed by X-P and MRI. He had no metabolic or hormonal diseases but DM(II). We performed bone histomorphometry following tetracyclin double labeling, and found low bone turnover. Case 2 was a 13-year-old girl who fell backwards and landed on her rear, resulting in T11, 12 vertebral fractures. She had no metabolic or hormonal diseases and bone mineral density was within normal limitation. Bone histomorphometry following tetracyclin double labeling revealed low bone turnover. We diagnosed her with juvenile idiopathic osteoporosis.
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Akihiko Kobayashi, Kenki Nishida, Koichi Ogawa, Yuichi Takahashi, Masa ...
2008 Volume 57 Issue 1 Pages
13-17
Published: 2008
Released on J-STAGE: May 23, 2008
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We examined old vertebral fractures expressing instability with the use of 64-line CT. Method: From April 2006 to December 2006, CT photographic images of 15 unstable fractures were examined in detail. Results: We confirmed gas or liquid in all vertebral bodies. In 5 cases (33%), vertebral body protruding into the canal was observed. Four cases (23%) had other vertebral fractures. In addition, 12 pedicle fractures (73%) were seen. Conclusion: We confirmed many pedicle fractures in vertebral fractures expressing instability. These results suggest that pedicle fracture is a risk factor for back pain associated with vertebral fracture.
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Hirokazu Matsubara, Tomotaro Yamaguchi, Hideya Kawamura
2008 Volume 57 Issue 1 Pages
18-20
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of the sinking of the tibial component in an early postoperative period after total knee arthroplasty. The patient was a 68-year-old female. She has been on conservative treatment for right knee osteoarthritis for five years.
X-ray showed severe bone loss of her medial tibial condyle. We performed total knee arthroplasty using a 5 mm augmentation block to the medial tibial condyle. However, X-ray showed the loosening and sinking of the tibial component seven months after the operation. We performed revision total knee arthroplasty using a 10 mm augmentation block and long-stem. When treating such cases of severe bone loss of the tibial codyle, MRI is useful for the evaluation of the area of the osteonecrosis. Surgery must also be planned to complete resection of the osteosclerotic area inclusing osteonecrosis.
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Ryodai Kawabata, Hideyuki Kawabata, Yoshiyuki Masuda, Setsuro Komiya, ...
2008 Volume 57 Issue 1 Pages
21-26
Published: 2008
Released on J-STAGE: May 23, 2008
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We recently encountered a 33-year-old female patient with left leg compartment syndrome. Sixteen hours after surgery, she complained of swelling, tenderness, and sensory disturbance in the left lower leg.
The serum level of CPK was 9,843 IU/L (extra-ordinarily high). Massive myoglobulinuria was also observed. Serum myoglobulin level was 652 ng/mL (normal<64 ng/mL). MRI demonstrated swelling of the left lower leg, edematous fascia. The patient was suspected as having left leg compartment syndrome but we hesitated to perform fasciotomy because the pressure of the intracompartment was not so high. This patient was intensively treated and fortunately recovered.18 months after hysterectomy, she suffered from talipes equinus as a sequela. Calcaneal tendon and posterior tibial tendon were therefore elongated, successflly resulting in plantigrade.
Constriction of bilatral external iliac arteries with intraperative lymph node excision was seen and it was thought to affect the ischemia of inferior limb strongly and suppress compartment pressure.
Operative position, adiposis, operation time perioperative, low blood pressure, bleeding are given as risk factors of perioperative compartment syndrome, but there are no literature focusing on lymph node excision.
This case suggests that lymph node excision may be a risk factor of perioperative compartment syndrome.
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Hisato Tanaka, Mitsunori Komine, Hiroaki Kurokawa
2008 Volume 57 Issue 1 Pages
27-30
Published: 2008
Released on J-STAGE: May 23, 2008
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Case 1. A 22-year-old man with fracture of AO43-C1. There was resorption of the bone image of the fibula at postoperative 6 months. A 3 mm gap was seen, but there was no problems with internal fixation such as loosening. Radiological union was eveutually achieved at postoperative 1 year. Case 2. A 72-year-old woman with open fracture of AO43-C1.3. There was resorption of the bone image of the medial malleorus at postoperative 6 months. A 2 mm gap was seen, but radiological union was achieved at 1 year 2 months after operation. Case 3. A 64-year-old man with open fracture of AO43-A3. There was resorption of the bone image of the fibula at postoperative 6 months. A 3 mm gap was seen, but radiological union was achieved at postoperative 1 year. At postoperative 6 months, there was no sign of bone union and resorption of the bone image was seen, which was diagnosed as pseudarthrosis, but these reported case were able to obtain bone union afterwards. In all cases, there was no problems at internal fixation. Particularly, when there was resorption of bone, these showed membranous ossification in non-fracture portions, which extended from there, and bone union was achieved.
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Hiroki Irie, Teiji Kato, Takeshi Yamashita, Kenshi Kikukawa, Tateki Se ...
2008 Volume 57 Issue 1 Pages
31-35
Published: 2008
Released on J-STAGE: May 23, 2008
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For high energy wounds such as road traffic accidents, we often experience comminuted fracture of the tibia for which we have problems in providing treatment. The distal tibia has little soft tissue and blood circulation is insufficient. Consequently prolonged infection and pseudarthrosis are reported. We therefore attempted ipsilateral pedicle vascularized fibular graft for tibia fracture.
Case 1: 36-year-old male. He suffered tibal open fracture in a road traffic accident and underwent surgery many times, but developed pseudarthrosis. We covered the transplant bone using a Sural flap due to poor surrounding soft tissue blood circulation, and performed pedicle vascularized fibular graft.
Case 2: 58-year-old male. He suffered comminuted fracture of the distal tibia crushed by wood and was treated by external fixation at the first time. We performed a pedicle vascularized fibular graft for the fracture after three months
Both cases started partial weight bearing after four months. They were able to walk without a supporting tool in the last observation.
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Takuya Ikuta, Futoshi Kuga, Junichiro Ishikawa, Takanao Shimabukuro, K ...
2008 Volume 57 Issue 1 Pages
36-39
Published: 2008
Released on J-STAGE: May 23, 2008
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We report two cases of non-union and one case of malunion of malleolar fracture. All cases were treated surgically.
In all cases, bone union was achieved, and satisfactory results were obtained.
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Hirokazu Saiwai, Atsushi Shiranita
2008 Volume 57 Issue 1 Pages
40-46
Published: 2008
Released on J-STAGE: May 23, 2008
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Nonoperative treatment for talar neck fracture may cause loss of reduction and malunion or nonunion even when using a cast. We treated a 16-year-old female who had painful malunion after nonoperative treatment for talar neck fracture. We concluded that the cause of the ankle pain must be an impingement of the medial side of the talus and medial malleolus in preoperative assessment. We treated the malunion with correctional osteotomy along the former fracture plane. The time interval between injury and operation was 14 weeks. Postoperative radiographs showed no signs of avascular necrosis and arthrosis. We evaluated the patient's ankle function by JSSF (Japanese Society for Surgery of the Foot) scale. The score improved from 32 points, preoperatively, to 100 points, postoperatively.
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Yoichi Yoshimura, Hiroshi Tada, Masatomo Miyamoto, Goro Motomura, Yohe ...
2008 Volume 57 Issue 1 Pages
47-49
Published: 2008
Released on J-STAGE: May 23, 2008
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From January 1st 2000 to December 31st 2005, we treated 55 patients, with 56 major amputations (Above Knee or Below Knee). We examined the prognosis of amputations of lower extrimity in our hospital. We also calculated the survival rate by using the Kaplan-Meier curve. Comorbidities included 49 cases of arteriosclerosis obliterans (ASO), 38 of diabetes (DM), 37 of ischemic heart diseases, and 26 of hemodialysis (HD) by chronic renal failure, etc. Thirty-seven patients had died during investigations, and only 5 patients reqained gait with the artificial leg. The overall 1-year survival rate was 59.6% in the Kaplan-Meier survival curve, 2-year survival rate was 53.5%, and 5-year survival rate was 17.9%. There were significant differences in the ischemic heart disease group and dialysis group, especially in dialysis with diabetic patients. The one-year and two-year survival rates were equal to these reported in various studies, but the 5-year survival rate was considerably lower than these. Careful follow-up is important when selecting amputation level by considering patient's QOL more than ADL, especially for diabetic patients, after considering not only the conditions of the foot but also their life prognosis.
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Yoshihisa Anraku, Tokushige Nishizato, Yosuke Kawatani, Katsuhiko Kuni ...
2008 Volume 57 Issue 1 Pages
50-53
Published: 2008
Released on J-STAGE: May 23, 2008
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We performed total knee arthroplasty with Thompson's quadricepsplasty on three anlylosed knees. Medial parapatellar incision was used for arthrolysis, and vastus lateralis and medialis were isolated from rectus femoris. The joint capsule is divided on either side of the patella, and intraarticular adhesions were released. The vastus intermedius was released. At the end of the procedure, the retinacular release was left open. Despite reduced knee flexions (cases 1 and 2) of the involved knee during the stance phase, the postoperative range of motion achieved -5-115° (case 1) and 0-75° (case 2). Knee function scores also improved from 30 to 90 points (case 1) and 30 to 85 points (case 2), respectively. One case (case 3) of femoral chondylar fracture was operated with LCP (locking compression plate), postoperative range of motion was 0-40°, and extension lag remained. However, RA knee function scores improved from 20 to 57 points. Both cases can now walk freely with no pain.
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Takuya Ikuta
2008 Volume 57 Issue 1 Pages
54-56
Published: 2008
Released on J-STAGE: May 23, 2008
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We evaluated the clinical and radiographic results of total knee arthroplasty in 141 cases using the bisurface type (KU) system. We followed them for a period of more than one year (average 31 months).
Their mean JOA score improved from 58.0 to 83.6 points and mean flexion angle improved from 121.8° to 122.1°.
However the results were satisfactory, they were worse than at post-operative one year or less.
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Masahiro Hamasaki, Yuki Furukawa, Tomofumi Miyasato, Reiko Mawatari, O ...
2008 Volume 57 Issue 1 Pages
57-60
Published: 2008
Released on J-STAGE: May 23, 2008
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A 73-year-old female twisted her knee on the radder and visited our hospital due to swelling of her left knee the nextday Puncture of her leftknee indicated hemoarthrosis, and she was hospitalized. Initial labolatory evaluation revealed a slightly prolonged activated partial thromboplastin time (APTT). After hospitalization, her knee was punctured another three times due to continuous swelling. On the ninth day of hospitalization causeless epistaxis occurred. On 11th day, bleeding continued from the point punctured on her knee. Further examination revealed: Hb 6.8g/dl, APTT 101.8 seconds, remarkably prolonged, factor VIII activity of less than 1%, and factor VIII inhibitor of 12.5 Bethesda Unit (BU)/ml, Acquired hemophilia was diagnosed. Activate prothrombin complex concentrate (APCC) and steroid were used, and bleeding stopped. Acquired hemophilia is a rare disease and rarely canses hemoarthrosis.
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Joji Noguchi, Kenji Kuroki, Gishichiro Shimoyama, Toshiro Shinozaki
2008 Volume 57 Issue 1 Pages
61-63
Published: 2008
Released on J-STAGE: May 23, 2008
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Twenty-two patients (mean age: 67 years) operated for medial meniscal tears were examined with MRI for bone marrow lesion (BML). MRI was performed preoperatively and follow-up averaged 18 months postoperatively. Ten patients (45%) had BML on preoperative MRI and 11 patients (50%) developed BML postoperatively or increased BML after operation.This study suggests that changes in BML after meniscectomy may be associated with osteonecrosis or osteoarthritis.
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Masahiko Arima, Hideyuki Kawabata, Jyunichi Kamizono, Hironori Kakoi, ...
2008 Volume 57 Issue 1 Pages
64-67
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of para-articular osteochondrom which occurred in the infrapatellar fat pad.
A 52-year-old woman complained of a slow-growing mass with mild pain on anterior aspect of her right knee. Roentgenograms and computed tomography showed three osseous masses which were located in the inflapatellar fat pad. Arthroscopic examination did not reveal any morbid synoviums, but we confirmed the hypertrophy of intraarticular fat pad, and a hard mass inside it. So extraarticular marginal resection was performed. The mass was completely placed in the inflapatellar fat pad, and if was apparently osteochondroma. On microscopic examination, it consisted of normal cartilage cells with areas of ossification. There were not any abnormal cells. Fibrous connective tissue surrounded the lesion, but synovial cells were not found inside. Final diagnosis was para-articular osteochoondroma.
In literature, para-articular osteochondroma was a rare disease. And the differential diagnosis between synovial osteochondromatosis and synovial sarcoma is very important.
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Naohide Takeuchi, Nobuharu Shimada, Naohiro Suga, Hiroshi Oba, Yoichi ...
2008 Volume 57 Issue 1 Pages
68-73
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a 5-year-old boy with Langerhans cell histiocytosis (LCH) of multiple osseous lesions. He slipped in the bathroom, and three days later, he complained of acute lumbar pain after swimming. In the L2 vertebra, MRI revealed low intensity in T1WI and high intensity in T2WI, and CT showed fracture and mass lesion with peripheral sclerosis. Conservative treatment with spinal brace was performed, and walking exercise was started six weeks after injury. A new fracture lesion in the T5 vertebra was detected by MRI three months after injury. X-ray showed vertebra plana at the T5 vertebra, and a punched-out lesion in the skull. Biopsy of the skull was performed and Langerhans cells were detected.
Chemotherapy (Ara-C, VCR, PSL) was performed for LCH of multiple osseous lesions. Six months after treatment, neither progression of vertebral collapse nor emergence of new lesions has been detected. Chemotherapy is an effective treatment for preventing tumor progression of multiple osseous LCH.
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Hiroaki Matsuo, Masao Eto, Hideo Baba, Keizo Furukawa, Koichi Adachi, ...
2008 Volume 57 Issue 1 Pages
74-77
Published: 2008
Released on J-STAGE: May 23, 2008
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A case of osteochondroma in the cervical vertebrae with spinal cord symptoms is presented.
A 13-year-old girl experienced enucleation of three degrees (arm right side front, right hand, and both knees) with multiple osteochondroma. Since two months before hospitalization, she had been aware of numbness from the arm on the right to the forearm. At a month before hospitalization, she became aware of difficult maintenance of chopsticks and tendency to fall when walking. She therefore came for examination. It rerealed a tumor deriving from arcus vertebrae, which was pressing the cervical vertebral canal. She was hospitalized. The tumor was found tobe generating from the C5 arcus vertebrae, and spinal cord symptoms appeared. Enucleation of the tumor appeared, and the symptoms improved. The pathology diagnosis was osteochondroma.
Osteochondroma is known well as benign tumor occurring in the metaphysis, and rarely originates in the cervical vertebrae. We report a case of osteochondroma with spinal cord symptoms, adding some bibliographical consideration.
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Masato Tomita, Kenji Kumagai, Tomayoshi Hayashi, Hiroyuki Shindo
2008 Volume 57 Issue 1 Pages
78-83
Published: 2008
Released on J-STAGE: May 23, 2008
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We experienced five cases of leiomyosarcoma (LMS) of the bone, which is a very rare, primary malignant bone tumor. The mean age of the cases was 66 years (49 to 84 years), and they consisted of one male and four females. The affected sites were three distal femora, one proximal tibia, and one distal fibula. The follow-up period ranged from five months to nine years and seven months (mean follow-up period: three years and eleven months).
Two cases were diagnosed with LMS after first biopsy, two cases with giant cell tumor, and one case could not be diagnosed. The two cases diagnosed with LMS after first biopsy showed good prognosis. On the other hand, the three cases not diagnosed LMS had local recurrences, where two cases had bone metastases, and one case had lung metastasis. These cases indicate that good local control can be achieved by resecting the tumor with wide margin. We have to diagnose the tumor as LMS just after biopsy in order to obtain better results and prognosis of LMS of bone.
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Tomofumi Ogoshi, Takeshi Minamizaki, Takeshi Kagawa, Mari Osaki
2008 Volume 57 Issue 1 Pages
84-86
Published: 2008
Released on J-STAGE: May 23, 2008
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[Purpose] We encounted two cases of popliteal cystic disease. The first case was a 63-year-old man. Without any cause, intermittent claudication and cold feeling of the right leg occured. He was admitted to our hospital and the symptoms were found to be caused by the exclusion of popliteal cyst outside the artery. Surgery indicated cystic adventitial disease. After operation, both intermittent claudication and cold feeling disappeared. The second case was a 24-year-old woman. Pain appeared when bending the knee joint. Later, pain at night also appeared, and she was admitted to our hospital. MRI showed a cyst of 1.3 cm in diameter in the popliteal region. This was thought to de due to exclusion of the popliteal artery by a ganglion generating from the articular capsule. Because aspiration with echo did not improve the symptoms, we remove the cyst by operation, and her symptons disappeared. [Conclusion] Intermittent claudication and pain in lower leg are often cause by spinal canal stenosis or arterio sclerosis obliterance. Careful examination is necessary in such cases because they can often cause cystic disease in the popliteal region.
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Masahiro Yokouchi, Junichi Kamizono, Yoshitaka Yamashita, Yasuomi Kawa ...
2008 Volume 57 Issue 1 Pages
87-90
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of soft tissue sarcoma involving a patient with refractoriness to platelet transfusion (PTR) due to the production of anti-HLA antibodies. The patient was a 49-year-old pregnant woman who had a huge mass with pain in the right thigh. Biopsy was performed and pathological diagnosis was synovial sarcoma. Since the tumor was very close to major nerves and involved major blood vessels, we performed radio-hyperthermo-chemotherapy (RHC) before surgery. After five courses of RHC, tumor cleary shrinked. We then performed marginal resection, and histlogical necrosis on the large cut section was over 95%. She was administered with a couple of blood transfusions during the operation. One month after operation, we performed adjuvant chemotherapy consisting of ifosfamide and etoposide. Pancytopenia gradually developed. On day 12, platelet transfusion was needed for thrombocytopenia. However, the corrected platelet count increment (CCI) was only 2×103/ul, indicating the development of PTR. Anti-HLA antibody was detected by the AHG-LCT and FlowPRA methods, and HLA-matched platelet transfuions were successful in boosting platelet level of the patient. Anti-HLA antibodies, which are produced during pregnancy and blood transfusion, often cause PTR. Although HLA-compatible platelet transfusion is the only way to counteract PTR, it is difficult to prepare HLA-matched concentrated platelets immediately. Therefore, we concluded that it may be necessary to perform anti-HLA screening before high-dose chemotherapy, especially for pregnant women.
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Yoshiya Arishima, Masahiro Yokouchi, Takao Setoguchi, Yoshitaka Yamash ...
2008 Volume 57 Issue 1 Pages
91-93
Published: 2008
Released on J-STAGE: May 23, 2008
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We reviewed 28 cases of pulmonary metastasis of soft tissue sarcomas treated in our hospital. Subjects were 18 males and 10 females, consising of eight with malignant fibrous histiocytomas (MFH), seven with synovial sarcomas (Syno), six with leiomyosarcomas (Leio), three with malignant peripheral nerve sheath tumors (MPNST), two with liposarcomas (Lipo), and two with round cell sarcomas. One-, 2- and 5-year survival rates of all cases were 71.3%, 44.9% and 19.1%, respectively. Two- and 5-year survival rates of Syno subjects were 71.4% and 71.4%, those of Leio subjects were 66.9% and 24.9%, and those of MFH patients were 25.0% and 0%, respectively. Life prognosis at the last followed-up were two with no evidence of disease (NED), five alive with disease (AWD), 21 with dead of disease (DOD). The time of appearance of pulmonary metastases was at the first visit to our hospital in eight cases, during treatment (ex. neo-adjuvant chemotherapies, radio-hyperthermo-chemotherapies) in four cases, and after treatment in 16 cases. Pulmonary metastasectomies were performed in eight cases (29% of all cases). Treatment with combination of metastasectomy and chemotherapy yielded better prognostic results than those with only chemotherapy in our study.
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Tomohiro Hirai, Eiichi Nakamura, Yasunari Oniki, Azusa Tanaka, Nobukaz ...
2008 Volume 57 Issue 1 Pages
94-98
Published: 2008
Released on J-STAGE: May 23, 2008
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We report two rare cases of synovial chondromatosis in the knee joint.
The first case was a 17-year-old female. She came to our hospital because of right knee pain and limitation of motion without traumatic episode. Radiographs of her right knee showed no abnormality, while MRI suggested synovial chondromatosis of the knee. With followed arthroscopy, we found hyperplasia of synovial villi and considerable loose white bodies, and diagnosed her with synovial chondromatosis. Arthroscopic removal of the loose bodies was performed. Eight years after operation, she had no recurrence.
The second case was a 36-year-old male. He came to our hospital because of pain, swelling, and limitation of motion of his left knee for five months. Because MRI suggested synovial chondromatosis of the knee, he underwent arthroscopic examination. The arthroscopic findings and diagnosis were same as that of the first case. Arthroscopic synovectomy and the removal of the loose bodies were performed. Six months after operation, he had no symptons.
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Tetsuo Hayashi, Kozo Kaji, Keiichiro Shiba, Takayoshi Ueta, Eiji Mori, ...
2008 Volume 57 Issue 1 Pages
99-101
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of huge syringomyelia whose symptoms started 15 years ago. A 46-year-old woman was admitted to our hospital for syringomyelia with Chiari type I malformation. Her first symptom was flexional transformation of her little finger 15 years ago. Operation of the hand was performed, but recovery was not achieved. Gradually sensory disturbance and gait disturbance occurred. Magnetic resonance imaging (MRI) showed huge syringomyelia with Chiari malformation, and she was referred to our hospital. Foramen magnum decompression was performed and gait disturbance was improved.
It is difficult to diagnose patients with syringomyelia occurring from muscle atrophy. Sensory disturbance or motor dysfunction tends to remain if syringomyelia causes irreversible disturbance. Patients should be diagrosed and treated before developing irreversible spinal cord disturbance.
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Hideo Kataoka, Yuichiro Yoshida, Toshihiko Taguchi
2008 Volume 57 Issue 1 Pages
102-105
Published: 2008
Released on J-STAGE: May 23, 2008
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We developed a new rat model of vertebra body and spinal cord shortening at the thoracic level. It was designed for future application to treat chronic patients with complete paralysis after spinal cord injury. Although the model is not complete yet, we report the results up to the present. Thirteen-to sixteen-week-old Wistar rats were used. The spinal cord at the Th8 vertebra body was cut and removed after which the Th8 vertebra body was removed. Mini screws were inserted into the Th6 and Th10 pedicles and the spinal cords were drawn using the thread around the screws until both ends joined. At first, the rats did not survive for a long period. However, improvement of the surgical technique and post-operation care have now enabled most rats to survive for more than two months after surgery. One rat showed BBB score of 5 after surgery. Histological examination showed scar formation in the gap between the spinal cord ends.
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Masahiro Kubo, Takayoshi Ueta, Keiichiro Shiba, Eiji Mori, Kozo Kaji, ...
2008 Volume 57 Issue 1 Pages
106-109
Published: 2008
Released on J-STAGE: May 23, 2008
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We report a case of multiple thoracic intradural subarachnoid cyst. A 59-year-old woman was admitted for spastic gait and muscle weakenss of left lower limbs. She was operated for subarachnoid cyst in pontine angle at the age of 58. MRI showed multiple subarachnoid cyst in the thoracic spine. CTM showed that the most severe compression level was on the left side of Th8/9 and 9/10. We performed Th8-10 laminectomy, cystectomy and transarachoidal cystectomy. Spastic gait and muscle weakness of the left lower limbs improved after surgery. These results suggest that some kind of congenital factors are related to the onset of subarachnoid cysts.
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Kei Yamada, Keisei Nagata, Kimiaki Sato, Soo Park Jin, Kenjiro Nakama, ...
2008 Volume 57 Issue 1 Pages
110-115
Published: 2008
Released on J-STAGE: May 23, 2008
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We studied 20 patients (ten men and ten women) with ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine.
Posterior approach was performed on all patients, anterior decompression through posterior approach on four patients (Otsuka group), laminoplasty on 11 patients (LP group), and laminectomy on five patients (LN group). The average of age of the patients was 55.4 years and the mean follow-up period was 41.5 months. The Otsuka group had greatest progression of kyphosis of the thoracic spine compared with the other groups. The results of the LN group were better than the Otsuka group in terms of Hirabayashi's recovery rate.
All cases were divided into two groups according to ossification type of the posterior longitudinal ligament, flat type or local beak type. There was no correlation between Hirabayashi's recovery rate and ossification type, por any correlation between progression degree of thoracic spine kyphosis and ossification type. There is likely to be negative-corelation between Hirabayashi's recovery rate and progression of thoracic spine kyphosis.
These results suggest that de-kyphosis and fusion with instrumentation are more important than anterior decompression in the posterior decompression by the posterior approach.
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Shinjiro Moriwaki, Yoshihiko Kato, Hideo Kataoka, Toshihiko Taguchi, K ...
2008 Volume 57 Issue 1 Pages
116-120
Published: 2008
Released on J-STAGE: May 23, 2008
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We report three cases of pre-exisiting ankylosing spinal hyperostosis (ASH) and vertebral fractures at the thoraco-lumber level. The cases consisted of two males and one female. Their ages ranged from 77 to 86 years. All vertebral fractures were at the thoraco-lumber level and occurred when the patients fell down. Bone union at the fractured parts was delayed, and they developed pseudarthrosis. All cases showed delayed paralysis. One case was treated with anterior fixation and two cases were treated with posterior fixation. Pre-exisiting ASH causes adjacent intervertebral stability and mechanical power to concentrate on fractured parts, which cause the fractured parts to become pseudarthrosis easily. In order to decide treatment, X-ray examination with body flexion and extension positions and evaluation of instability are very important. In cases of neurological paralysis, instability of the fractured parts or continuing severe pain, surgical treatment should be performed as soon as possible.
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Fumito Tanabe, Eiji Taketomi, Yasuhiro Ishido, Nobuhiko Sunahara, Yasu ...
2008 Volume 57 Issue 1 Pages
121-124
Published: 2008
Released on J-STAGE: May 23, 2008
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We have been performing posterior microendoscopic foraminotomy for cervical radiculopathy since October 2005.
Six patients were selected for this surgical technique. They consisted of four men and two women who ranged in age from 38 to 54 years (mean 47.6). Three cases hau cervical disc herniations and three cases spondylotic foraminal stenosis caused by unilateral radiculopathy. We performed foraminal decompression and removed herniated disc for herniation.
We studied the operation time, intraoperative hemorrhage, period to discharge after operation, complications and Tanaka's score for cervical radiculopathy.
We report that posterior microendoscopic foraminotomy is an effective alternative for the treatment of cervical radiculopathy.
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Akihisa Yamashita, Kenzo Shirasawa, Hidehiko Kido, Toshihiro Imamura, ...
2008 Volume 57 Issue 1 Pages
125-129
Published: 2008
Released on J-STAGE: May 23, 2008
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Upper-airway obstruction due to hematoma or phalangeal edema is a crucial complication of cervical anterior spinal fusion (ASF). We experienced a case of this complication due to hematoma immediately after ASF. A 71-year-old female complained of numbness of the bilateral hand and gait disturbance. MRI, myelography, and myelo CT showed a cervical disc herniation at the level of C3/4. To resolve the spinal compression, ASF was performed. Immediately after the operation, respiratory arrest and marked swelling of the surgical site occurred and narrow reintubation was required. Re-operation to remove the hematoma was performed. Blood was spouted from the C4 vertebral body, and compression and application of bone wax were effective to stop bleeding. Total bleeding reached 1,500ml and postoperative transfusion was needed, but the patient recovered from myelopathy well three months after the operation. As a consequence of postoperative CT angiography to clarify factors causing hematoma, right vertebral artery (VA) showed stricture and bilateral VA run wind, but VA injury was no apparent. Fortunately, VA injury had not occurred in this patient, and adequate preoperative assessment about the VA abnormality was recommended. These results indicate the importance of the management of the upper-airway obstruction after the ASF.
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Takeshi Yamashita, Tateki Segata, Tomohiro Horikawa, Kensuke Yonemura, ...
2008 Volume 57 Issue 1 Pages
130-134
Published: 2008
Released on J-STAGE: May 23, 2008
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We report an extremely rare case of radial nerve palsy caused by two globular bursitis of the right elbow associated with Jaccoud's arthritis in a 59-year-old woman with systemic lupus erythematosus (SLE). She had been diagnosed with SLE at the age of 27. She had noticed pain and swelling of the right elbow at the end of June, 2006, and it gradually became difficult for her to extend her right wrist and finger joint. When she visited our hospital on July 7, the swelling in her elbow was palpable, and drop hand was presented. X-ray revealed non-erosive but deforming arthritis, called Jaccoud's arthritis, of the head of radius. MRI revealed two cystic inflammatory regions in the anterior and lateral sites of the head of the radius. They were diagnosed as radial nerve palsy caused by this regions, and surgical excision was carried out. Two globular bursitis of the size of about 2 cm in diameter were located in the anterior and lateral sites of the head of radius, and the radial nerve was compressed, extended and pulled. The symptoms disappeared after excision of these bursitis. This case was thought to present radial nerve palsy caused by two bursitis associated with the Jaccoud's arthritis.
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Takako Baba, Yudai Baba, Shinya Maki
2008 Volume 57 Issue 1 Pages
135-139
Published: 2008
Released on J-STAGE: May 23, 2008
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Three cases of comminuted forearm fractures were treated surgically by minimally invasive plate osteosynthesis (MIPO) between November 2003 and October 2006. The patients consisted of two men and one woman. Two cases had ulna diaphysial fractures and one case had ulna metaphysical fracture. The age of the patients ranged from 30 to 82 years. We examined bone union, range of motion of the elbow, and that of the forearm. All cases achieved good bone union. But, the range of motion of forearm rotation was restricted in two cases. MIPO is a useful method for comminuted forearm fractures, but early range of motion exercise is necessary to achieve good range of motion of the forearm.
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Yukio Abe, Kenzo Fujii, Tetsu Tsubone, Yasuhiro Tominaga, Kazunari Tsu ...
2008 Volume 57 Issue 1 Pages
140-142
Published: 2008
Released on J-STAGE: May 23, 2008
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Triangular fibrocartilage complex (TFCC) injury is considered one of the main causes of ulnar sided wrist pain. However, we can sometimes recognize TFCC injury without pain, especially when complicated with distal radius fracture. We studied the relationship between the injury patterns of TFCC and wrist pain. Forty-eight wrists of 47 patients were divided into two groups. Group 1: 28 wrists of TFCC injury without ulnar abutment but complaining of ulnar wrist pain, and recovered with surgical procedure. Group 2: 18 wrists of TFCC injury complicated with distal radius fracture, and complaining of no ulnar wrist pain during treatment. TFCC injury was classified by Palmer's classification and our original classification.
Injury patterns in each group were as follows: 1A: 15, 1B: 9, 1C: 3, horizontal tear: 4, dorsal tear: 5, fovea tear: 4 and combined tear: 11 in group 1, and 1A: 10, 1B: 3, combined tear: 1 and massive tear: 6 in group 2. These results suggest that 1) the relation between 1A tear and ulnar wrist pain cannot be explained by its injury pattern, 2) injury around the TFCC is predictable for ulnar wrist pain, and 3) massive tear is not the cause of ulnar wrist pain.
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Minoru Hayashida, Takashi Ikeda, Shinichi Miyazaki, Toru Tsuchida, Yas ...
2008 Volume 57 Issue 1 Pages
143-145
Published: 2008
Released on J-STAGE: May 23, 2008
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We report two cases of neuropathy of a motor branch of ulnar or median nerve caused by a midpalm ganglion.
In the first case, the ganglion originated from the third or fourth carpometacarpal joint, and compressed only the motor branch of the ulnar nerve. It was resected in microscopy, and symptoms recovered well. In the second case, the ganglion oriented below the thenar muscle, and compressed the motor branch of the median nerve. Carpal tunnel releasing, resection of the tumor, and opponoplasty were performed. The patient became able to carry out an opposition task and the activities of daily living were recovered.
Many reports of neuropathy of the ulnar or median nerve caused by ganglion have been published, but it is rare for the ganglion to compress the motor branch only. Entrapment neuropathy, distal to the carpal tunnel or Guyon's tunnel occur accompanied by many symptoms. Correct physical examination is there fore required, and MRI or electromyography is useful for establishing precise diagnosis.
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Ryo Date, Seiji Sumiura, Manabu Yamamoto, Kenji Yamamoto, Kazushige Se ...
2008 Volume 57 Issue 1 Pages
146-149
Published: 2008
Released on J-STAGE: May 23, 2008
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We evaluated short-term results of infliximab therapy in 16 patients with rheumatoid arthritis. The subjects consisted of two males and 14 females, with an average age of 56.8±10.8 years. We studied CRP, DAS28 (CRP), and secondary invalidness. Swelling and joint pain improved in the first stages of the administration, decreasing at 2, 6, 14 weeks, although the CRP level was 3.9±2.7mg/dl remaining from before administration. However, decrease was not significant, and it tended to concentrate in the final stage of investigations. DAS28(CRP) was also similar. Three cases failed for secondary invalidness. Infliximab therapy requires more investigations with regard to shortening of administrative interval and increase of dose in the future.
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Kenichi Seo, Seiichi Kawamura, Yoshiaki Imazawa, Shinichi Sasaki, Hide ...
2008 Volume 57 Issue 1 Pages
150-154
Published: 2008
Released on J-STAGE: May 23, 2008
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Three RA patients with severe valgus deformity were treated with total knee arthroplasty. Two patients were treated with posterior stabilized TKA and one was treated with constrained TKA. Clinical data were summarized using the scoring system of the Japanese Orthopaedic Association (JOA score). The femoro-tibial angle (FTA) averaged 155.7° (range, 155°-156°) preoperatively and 174.7° (range, 169°-179°) postoperatively. JOA score was 29 (range, 16-43) preoperatively and 73 (range, 58-93) postoperatively. There were two complications in the group related to superficial wound problems. All patients were satisfied with the operation.
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Hironobu Koseki, Kenshiro Takaki
2008 Volume 57 Issue 1 Pages
155-158
Published: 2008
Released on J-STAGE: May 23, 2008
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We experienced a 57-year-old female with chronic severe inferior glenohumeral instability after two-part fracture-dislocation of her left shoulder. She had a dull pain over her left upper extremity, weakness, and contracture of shoulder resistant to conservative therapy. The first treatment with open inferior capsular shift to repair static stabilizer failed and resulted in recurrent inferior glenohumeral subluxation. In order to obtain the inclination of glenoid and high tension of rotator cuff as a dynamic stabilizer, corrective glenoid osteotomy and iliac bone grafting were attempted. Functional results two years after surgery were satisfactory. Radiographs showed no evidence of re-dislocation or degenerative change. Our case suggests that glenoid osteotomy is effective for patients with severe inferior glenohumeral instability of the shoulder.
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Teruaki Izaki, Yozo Shibata, Takafumi Kumano, Tsuyoshi Shinoda, Satosh ...
2008 Volume 57 Issue 1 Pages
159-161
Published: 2008
Released on J-STAGE: May 23, 2008
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Two professional baseball players with acute traumatic anterior shoulder dislocation were managed by arthroscopic Bankart repair. Case1: 25-year-old man, infielder, bats: right, throws: right. He dislocated his right shoulder while sliding headfirst into second base on a pickoff attempt at a pre-season game in 2003. Three days after injury, arthroscopic Bankart repair was performed. Case2: 20-year-old man, outfielder, bats: right, throws: right. He dislocated his left shoulder while sliding into second base trying to steal second from first during the regular season in 2003. Five days after injury, arthroscopic Bankart repair was performed. After seven months, he redislocated his left shoulder in the same episode. Seven days after injury, revision arthroscopic Bankart repair was performed. Both of them have been able to return to their preoperative level of participation. Arthroscopic Bankart repair can provide satisfactory outcome and reliable functional return in high demand athletes.
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Tomomi Sakihama, Yasuyuki Ishida, Hiroaki Yano, Keitaro Yamamoto, Kats ...
2008 Volume 57 Issue 1 Pages
162-166
Published: 2008
Released on J-STAGE: May 23, 2008
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Acromioclavicular joint (ACJ) ganglion in patients associated with massive cuff tear has been repoted. But we report a case of ACJ ganglion after arthroscopic rotator cuff repair. The case was a 62-year-old woman. She suffered right-hand massive rotator cuff tear in April 2006. She underwent rotator cuff tear repair by arthroscopic surgery. Seven month later, a soft-tissue mass developed above the right acromioclavicular region. Physical examination showed almost complete active motion and no impingement sign. Arthrogram of subacromial bursa indicated geyser sign. On MRI, the ganglion was found arising from the ACJ. Twelve-months after cuff tear repair, the ganglion was resected at the lateral end of the clavicle. At the six-months follow-up examination, the patient had no shoulder pain nor recurrence of ACJ ganglion.
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Masataka Hirotsu, Hideyuki Kawabata, Hironori Kakoi, Junichi Kamizono, ...
2008 Volume 57 Issue 1 Pages
167-169
Published: 2008
Released on J-STAGE: May 23, 2008
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The patient was a 51-year-old male. He had right hip pain, but was not diagnosed with anything for one year at several hospitals. The pain was induced in the internal and external rotation of the hip. There were no abnormal findings on X-ray. But MRI and CT arthrography indicated acetabular labrum tear. The patient's symptoms disappeared after intraarticular injection of local anesthetic. We diagnosed it as the hip acetabular labrum tear and performed arthroscopic partial resection of the acetabular labrum. As a result, pain disappeared. These results suggest that if acetabular labrum tear is suspected, we should perform hip arthroscopy.
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