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Hideaki Hamanaka, Shinichiro Kubo, Hiroshi Kuroki, Shoji Hanado, Naoki ...
2009 Volume 58 Issue 3 Pages
337-341
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We examined the surgical outcome of microscopic wide fenestration for lumber canal stenosis. Eighty-nine patients with lumber canal stenosis who underwent wide fenestration were studied. There was significant correlation between their preoperative and postoperative JOA scores. The cases were classified into two groups: Good results group (over 50% repair rate) and poor results group (under 50% repair rate). The poor results group showed aggravated slip rate and significantly reduced disc height.
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Hiroyuki Tominaga, Shoichi Wada, Masataka Hirotsu, Tetsuro Shimono, Ka ...
2009 Volume 58 Issue 3 Pages
342-345
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We examined 11 patients with extraforaminal lumbar disc herniation who underwent osteoplastic hemilaminectomy. The follow-up period was more than six years (to ten years).
The subjects included seven male and four female patients, with an average age of 58 years (28 to 77 years).
The level of extraforaminal lumbar disc herniation was L2/3 in two, L4/5 in two, and L5/S1 in seven cases.
Clinical results were evaluated by JOA score. Bone union of spinous processes and vertebral arch was assessed by computed tomographs (CT). The results were as follows. The mean JOA score was 13/15 in the last follow-up, compared to 8.4/15 pre-operatively. Clinical evaluation improved with statistically significant differences. The bone union rate of spinous processes and vertebral arch was 91% and 73%, respectively. No case achieved bone union of neither spinous processes nor vertebral arch. These results suggest that osteoplastic hemilaminectomy is effective for middle to long term treatment.
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Yasuko Fukuda, Takayoshi Suga, Masatoshi Miyazaki, Shoji Yoshida, Masa ...
2009 Volume 58 Issue 3 Pages
346-350
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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In order to perform lower invasive microsurgery for spondylolysis with radiculopathy, we developed a tubular retractor (TR) which comes in close contact with the posterior surface of the lamina.
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Keiichi Kondo, Ryuji Nagamine, Weijia Chen, Toshihiko Hara, Yoichi Sug ...
2009 Volume 58 Issue 3 Pages
351-354
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Lateral release of the patellar retinaculum is performed in order to obtain aligned patellar tracking during total knee arthroplasty (TKA). However, the effects of lateral release on the joint gap distance of the patellofemoral (PF) joint are still obscure. In this study, the joint gap distance of the PF joint was measured before and after lateral release, and the effects of lateral release were assessed. TKA was performed on 43 knees. After the femoral and tibial trial components were inserted, the joint capsule was sutured firmly, leaving the capsule open minimally at the distal medial side for the insertion of the upper and lower arms of the PF tensor. The PF joint was distracted with 30 inch-pounds in full extension, and the joint gap distance was measured in millimeters. Under the distraction, extra synovial lateral retinaculum release was performed, and the joint gap distance was measured. The distance of the PF joint in full extension was 20.6 mm±4.7 mm and 24.3 mm±4.5 mm before and after the lateral release. The results of this study clearly show that lateral release widens the PF joint and increases the flexibility of the patella in the sagittal plane.
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Ryuji Nagamine, D'Lima Darryl, Shantanu Patil, Mitsugu Todo, Keiichi K ...
2009 Volume 58 Issue 3 Pages
355-359
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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During PS-TKA, the cruciates are sacrificed which may have an impact in the stability of the reconstructed knee by virtue of the impact on the gap kinematics. The effect of cruciates excision on the knee kinematics was assessed using five fresh frozen normal cadaver specimens. The femur was fixed to a specially designed machine. Knee flexion was created by elevating the femur. Three dimensional tibial movements relative to the femur and joint gap distances were measured by means of a navigation system during flexion before and after cruciate ligaments excision. The medial gap distance at 90° knee flexion before and after excision was 4.3±2.7mm (mean±SD) and 5.1±2.8mm (p<0.05) respectively. Cruciate ligaments excision significantly influenced the medial and lateral gap distances and tibial movements. The effect of cruciates excision was different between the medial and lateral sides. Concepts of design and operative techniques in current TKA systems have been established based on normal knees. These concepts should be modified according to the knee kinematics without cruciates. On the other hand, the joint gap control technique is thought to be more reliable compared with the measured bone resection technique.
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Daisuke Hara, Hiromasa Miura, Shuichi Matsuda, Ken Okazaki, Taro Mawat ...
2009 Volume 58 Issue 3 Pages
360-364
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report the radiographic evaluation of 89 knees in 86 patients treated by Kirschner Performance Knee total knee arthroplasty (TKA). Patients received clinical and radiological evaluation. Eight males and 68 females with a mean age of 70.5 years were followed up for a period of one to 14 years (mean follow-up 6.6 years). The radiolucent line of 2 mm or more, or the obvious decrease in the insert thickness were observed in 17 knees (19.1%). Revisions were enforced in five cases, three due to aseptic loosening, two due to infection.
The use of Kirschner Performance Knee in our midterm evaluation was associated with worse than other models because of the design and sterilization of the polyethylene tibial insert.
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Takuya Ikuta
2009 Volume 58 Issue 3 Pages
365-368
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We carried out total hip arthroplasty with bone graft using processed plate on eleven hips in eight patients with developmental dysplasia of the hip joint. The average age of the patients at the time of surgery was 56.7 years. The Crowe's classification of hip subluxation or dislocation was group I for three hips, group II for two, group III for five, and group IV for one.
The mean follow-up term was 35 months. The mean JOA score improved from 50.8 points to 89.0 points. All cases achieved bone union, and had no collapse of the grafted bone.
The processed plate is useful for bone graft in total hip arthroplasty with developmental dysplasia.
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Satoshi Nagano, Yasuhiro Ishidou, Yoshiya Arishima, Junichi Kamizono, ...
2009 Volume 58 Issue 3 Pages
369-372
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We have been performing composite graft of the auto- or allogeneic bone and HA granules for the cavitary defect of the acetabulum during primary or revision total hip arthroplasty. Recently, we are using interconnected porous hydroxyapatite (IP-HA) instead of conventional HA, because it provides better osteoconductive potential than conventional HA. Here we report the initial stability of THA using IP-HA. Radiological stability was evaluated in ten cases at an average follow-up of 13 months after surgery. Nine cases were radiologically stable, while one case showed central migration of the cup. The interface between the IP-HA and host bone became vague after five months on average after operation, suggesting the osteoconductivity of the IP-HA.
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Natsuko Tomimura, Yoshitaka Yamashita, Sakura Uchiyamada, Koji Sameshi ...
2009 Volume 58 Issue 3 Pages
373-376
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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More and more senior persons are seeking surgery to ennance QOL. We operated on two patients over 90 years old and obtained good short term results. The patients were a 94-year-old man and a 92-year-old woman. They could not walk due to lumbago, pain and numbness of their legs. We detected lumbar canal stenosis at the L4/5 level on MRI and CT myelography. First, we performed conservative treatment for sharp pain, but symptoms did not improve. We therefore attempted fenestration, which euabled them to walk without pain on postoperative day 3. Both showed good progress after one year from surgery. Despite advanced age, we will cousider surgery for elderly persons with the physical strength to tolerate anesthesia and surgery, and who have the ability to understand the treatment.
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Yohei Masuda, Yoichi Yoshimura, Takeshi Okamura, Takashi Matsuzaki, Hi ...
2009 Volume 58 Issue 3 Pages
377-381
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report seven cases of sacral insufficiency fracture. Their mean age was 79.7 years. One male and six females were diagnosed. Bilateral sacral alae fracture was 71.4%, and unilateral sacral ala fracture was 28.6%. 42.9% of the patients was associated with pubic fracture. Treatment was limited weightbearing, bed rest, and sacral corset. We could not identify fracture on Xp. To clarify image characteristict and facilitate diagnosis, hign sensitive MRI and bone scintigraphy as well as highly specific CT were used.
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Masato Tomita, Kenji Kumagai, Tomohiko Asahara, Kohei Kawaguchi, Tomay ...
2009 Volume 58 Issue 3 Pages
382-386
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Two cases of osteosarcoma with atypical roentogenographic appearances are reported.
Case 1 was a 59 year-old woman. She has been receiving treatment with hemodialysis for chronic renal failure for nine years.
Three months ago, she felt pain in the left knee without any traumatic events. After visiting the orthopedic clinic, she visited our outpatient clinic. X-ray showed fine geographic osteosclerosis in the medulla of the proximal metaphysis of the left tibia. However there was no desructive change nor periosteal reaction. MRI showed an irregular lesion of low signal intensity in T1WI and high signal intensity in T2WI. Very strong high-uptake was seen in bone scintigraphy at the lesion, but no other lesions were detected. Open biopsy found histopathological diagnosis of this lesion to be chondroblastic osteosarcoma.
Case 2 was a 29 year-old woman. She felt pain in the right knee without any trauma four months ago. Another orthopedic clinic introduced her to our outpatient clinic. X-ray showed no destructive changes nor osteosclerotic changes, but slight periosteal reaction on the medial and posterior site of the distal femur. Bone and thallium scintigram revealed very strong high-uptake at the lesion, but no other lesions. Histological diagnosis by open biopsy was revealed to be conventional osteosarcoma. If the lesion had shown typical roentogenographic appearances, correct diagnosis as osteosarcoma may have been easily made. However because some cases show atypical findings as the above cases, great care is needed in diagnosis.
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Yoshiya Arishima, Masahiro Yokouchi, Satoshi Nagano, Naohiro Uezono, H ...
2009 Volume 58 Issue 3 Pages
387-389
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a case of a 17-year old male with osteosarcoma of the proximal tibia and multiple pulmonary metastatic nodules treated by caffeine assisted chemotherapy. He underwent first-line chemotherapy using cisplatin and doxorubicin, followed by wide resection of the tumor. However, he developed multiple pulmonary metastases after the surgery, which were resistant to second-line chemotherapy causing him severe dyspnea due to large pulmonary masses. Caffeine assisted chemotherapy was repeated for a total of ten courses. He died, however, of pulmonary osteosarcoma forty-six months after the first pulmonary mass was found. Caffeine assisted chemotherapy is considered a therapeutic modality of the anti-cancer effect of iosfamide and etoposide.
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Minoru Kashihara
2009 Volume 58 Issue 3 Pages
390-393
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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This paper presents a 79-year-old man with multiple myeloma with pathological fracture of femoral neck. He was admitted with right hip pain and was unable to walk due to the pathological femoral neck fracture two days after admission. Biochemical findings revealed serum M protein of Ig A κ type and urine Bence-Jones protein. Femoral head prosthesis replacement was performed and the excised femoral head contained 5 % plasmacytoid cells histopathologically, and the intercellular materials were stained by Congo red stain. We therefore diagnosed this case as pathological fracture by intraosseous amyloidosis associated with multiple myeloma. Chemotherapy and radiotherapy were not performed on this elderly patient because of age and renal dysfunction. He died of renal dysfunction one year and five months after operation. Aproximately 10% of multiple myeloma patients have associated amyloidosis, and pathological fracture of long bone such as this case and carpal tunnel syndrome have been rarely reported.
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Kazutaka Nishikawa, Yoshiaki Imasawa, Seiichi Kawamura, Kenichi Seo, S ...
2009 Volume 58 Issue 3 Pages
394-398
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We often encounter activities of daily living (ADL) disorder due to pain and neurological deficits of metastatic spine tumor. We evaluated the results of operative treatment for metastatic spine tumor.
The cases were 10 patients who underwent operative treatment for metastatic spine tumor from May 2005 to November 2007. Preoperatively we used the Tokuhashi's scoring system for evaluation of the prognosis to select the surgical procedure. We evaluated Frankel classification, performance status, and the span when patients could walk during they were alive.
Postoperative results of both Frankel classification and performance status improved. Eight patients could walk for more than 70% of their lifetyme.
In all cases, palsy and ADL immediately improved and eight patients could go back home.
We concluded that operative treatment may be a valuable treatment.
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Ayako Kurogi, Kenji Kumagai, Masato Tomita, Tomohiko Asahara, Tomayosh ...
2009 Volume 58 Issue 3 Pages
399-402
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Fibroma of the tendon sheath occurs mostly in the fingers and hands. Fibroma of the tendon sheath of the knee is very rare; only six previous cases have been reported in English literature. We report a rare case of fibroma of the tendon sheath arising from the insertion of the quadriceps femoris tendon in the knee joint. A 22-year-old man had anterior knee pain and a slowly growing mass in his right knee for one year. At his first visit, an elastic hard mass of 33 x 48 mm in size was palpable on the proximal patella. MRI showed low intensity in the mass on T1-weighted images, relatively low signal intensity on T2-weighted images, and contrast enhancement. Arthroscopy of the knee joint revealed a mass with a white surface, located at the quadriceps insertion near the patella. Tiny arthrotomy was carried out to excise the mass. The microscopic diagnosis was a fibroma of the tendon sheath. Fibroma of the tendon sheath arising from insertion of the quadriceps femoris tendon has never been described in the knee joint before.
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Kazuma Yamashiro, Akira Sei, Toru Fujimoto, Masaya Mizutamari, Takuya ...
2009 Volume 58 Issue 3 Pages
403-405
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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OBJECTIVE: We report a case of cervical dumbbell tumor that was totally removed by the single-stage anterior approach.
CLINICAL PRESENTATION: The patient was a 75-year-old woman presenting signs of C7 radiculopathy on the left side. Computed tomographic scan (CT) and magnetic resonance imaging (MRI)demonstrated a dumbbell tumor that had developed through the C6-7 interventebral foramen.
INTERVATION: The tumor was totally removed by the single-stage anterior approach, with control of the vertebral artery. Pathological examination revealed schwannoma. Three months later, neurological examination results were normal, and MRI revealed complete tumor resection.
CONCLUSION: We believe that the anterior approach is effective for total single-stage tumor removal in selected cases of cervical dumbbell type schwannoma with large extension through the wide intervertebral foramen.
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Hiroaki Yukizane, Katsumi Harimaya, Toshio Doi, Yoshihiro Matsumoto, Y ...
2009 Volume 58 Issue 3 Pages
406-410
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Between 1985 and 2008, nine patients with multiple spinal schwannomas without vestibular schwannoma were diagnosed and treated. Of the nine patients, two were female and seven were male. The mean age of onset was 40.0 years. The level of spinal involvement was thoracolumbar in seven cases. In the nine patients, there were 61 spinal schwannomas from the cervical spine to the sacrum. Thirty-two of the 61 spinal schwannomas were surgically resected. In four of the nine patients, the schwannomas were found on peripheral nerves. In the five patients, there were 29 residual tomors. All of the patients are followed with MRI and neurological examinations annually. We recommend that all patients with schwannomatosis be followed up with contrast MRI, since some tumors become obvious after surgery.
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Masaru Hiyoshi, Shinichiro Kubo, Hiroshi Kuroki, Hideaki Hamanaka, Sho ...
2009 Volume 58 Issue 3 Pages
411-414
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Spinal epidural lipomatosis (SEDL) is a rare disorder and is usually associated with long-term steroid administration.
SEDL develops in some patients in the absence of elevated steroid levels. Limited information on idiopathic SEDL comes predominantly from isolated case reports.
We report a case of SEDL in a 70-year-old man presented with intermitted claudication.
He was evaluated by myelography, computed tomography, and magnetic resonance imaging. Surgical treatment was performed by laminectomies and fat debulking. After surgery, he showed gradual improvement in symptoms and neurological conditions.
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Takuya Yamamoto, Kosei Ijiri, Michihisa Zemmyo, Hikaru Sakamoto, Ichir ...
2009 Volume 58 Issue 3 Pages
415-418
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The postoperative course of palliative surgery for undiagnosed spinal tumors with progressive neurological signs was examined.
Six male patients were treated by posterior decompression and instrumentation. The mean age of the patients was 70.3 (56-84) years old. Diagnosis was carried out and neurological status, prognosis were estimated.
Postoperative diagnoses were ATL in two cases, and hepatoma, thyroid follicular carcinoma, and plasmacytoma in one case each. In all cases, neurological recovery and restoration of ambulation were obtained. Continuous disease free status was obtained in two cases, survival with disease in two, and death due to other causes in two (5 months and 2 year 4 months after operation).
ADL was good immediately after the surgery in all cases. However, since long term ADL and prognosis depend on adjuvant therapies, sufficient information on the patients and consent for postoperative course are indispensable.
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Seiichiro Shimauchi, Masao Noguchi, Shoji Tsuji, Hirohumi Dokawa, Ai M ...
2009 Volume 58 Issue 3 Pages
419-422
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We reviewed the short-term clinical results of 30 patients with intertrochanteric fractures treated by IPT nail from 2007 to 2008. They consisted of four males and 26 females with a mean age of 81.2 years old (range from 53 to 97 years old). Except one case with femoral neck fracture from falling six months after operation, no cases showed serious complications.
The IPT nail is the dual screw type which has an antirotation screw. In addition, the IPT nail has a set screw preventing rotation of the lag screw and an extra screw. It is an useful implant especially for unstable intertrochanteric fractures.
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Gentaro Hanaishi, Masato Nagashima, Kenichiro Nakai, Katsuhiko Ishibas ...
2009 Volume 58 Issue 3 Pages
423-427
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Purpose
The purpose of this study is to evaluate the reasons for reoperation after intertrochanteric fracture fixation.
Materials and Methods
Between October 1983 and August 2008, 590 intertrochanteric fractures were treated in our hospital. Six patients (two males and four females) with a mean age of seventy-nine years required reoperation. One fracture was Evans group 3, four were group 4 and one was basicervical type.
Results
Nonunion was achieved in three fractures, cut out of lag screw occurred in four, and femoral shaft fracture and necrosis of the femoral head occurred in one respectively. We treated two patieuts with osteosynthesis, hemiarthroplasty, and total hip arthroplasty fractures.
Conclusions
The reasons for reoperation after intertrochanteric fracture fixation were unstable fracture patterns in Evans classification, basicervical fracture, poor reduction, and improper screw placement.
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Kazuomi Fujise, Takahide Kikkawa, Mitsuhito Kamoto, Mari Osaki, Takesh ...
2009 Volume 58 Issue 3 Pages
428-431
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We performed a retorospective study of ambulatory ability before and after operation for the trochanteric fracture of the femur. Between January 2006 and March 2008, we operated on 116 patients (17 males and 99 females). We used implant, Gamma 3 (96 subjects), PFNA (20 subjects). Ambulatory ability was evaluated using classification of the Jensen's.
Ninety examples (77.6%) of the 116 subjects were able to acquire ambulatory ability to the same level as before surgery. However, decrease in ambulatory ability was seen in 26 subjects (22.4%). Fracture type did not play a role in the prognosis of the ambulatory ability. The decrease in ambulatory ability was caused by the dementia.
It is reported that recovery of ambulatory ability that the fracture type, and dementia etc. before wound influence function prognosis. It is thought that the dementia was a big factor in 11 (42.3%) out of 26 subjects to decrease in ambulatory ability. It is important to preveut progress of dementia and prevent the appearance of disease.
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Akira Hozumi, Masakazu Murata, Noriaki Miyata, Shoichi Kuba, Kazumasa ...
2009 Volume 58 Issue 3 Pages
432-436
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The purpose of the present study was to examine the early results of bipolar head prosthesis (Synergy Select II; Smith & Nephew Memphis, TN) for neck fractures in elderly patients. Sixty - two primary femoral neck replacements were performed in 62 patients. There were 14 males and 48 females with an average age of 80 years (range: 51 to 97 years). The average follow - up was 9.6 weeks (range: 2 to 72 weeks). Post - operative stem subsidence ( >3 mm ) occurred in nine hips (14.5%) within two weeks, and the average leugth was 6.18 mm (range: 3 to 12 mm ). The filling rate of implants (zone 2 to 6, A-P view of X-ray) showed significant difference between subcidences and non - subsidences (67.7% vs. 83.2%). Complications related to subcidence occurred in two cases, one dislocation and other peri-prosthetic fracture.
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Eiji Suenaga, Hidetoshi Ihara
2009 Volume 58 Issue 3 Pages
437-440
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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There are few reports that posterior horn of the radial tear occurs as a type of medial meniscus injury frequently observed in middle age and elderly patients. The purpose of this study was to evaluate the incidence rate and type of torn medial meniscus in middle age and elderly patients. Between November 2003 and July 2008, 188 patients (201 knee joints) presenting medial meniscus tear underwent knee arthroscopic surgery at the Kyushu Rosai Hospital. They cousisted of 49 males and 139 females with a mean age of 63 years (range: 50 to 86 years). Of the 201 knees confirmed arthroscopically, 111 (55 %) were classified as radial tear, 33 (16.4 %) were classified as radio-horizontal tear, 30 (15.9 %) were classified as horizontal tear, and 21 (10 %) were classified as longitudinal flap tear. Of the 110 radial tears, 89 (80 %) indicated posterior horn of the medial meniscus. Partial meniscectomy was one choice of treatment, but rasping was also considered as another choice for torn posterior horn of the medial meniscus with persistent pain. It is important to recognize that the incidence of radial tear in posterior horn of the medial meniscus is considerably high in middle age and elderly patients.
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Hidetoshi Ihara, Sayuri Oka, Masanobu Takayama, Takahiko Fukumoto, Chi ...
2009 Volume 58 Issue 3 Pages
441-443
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Female athletes exhibit smaller knee flexion angles than male athletes during jump landing. This decreased knee flexion at the time of the jump landing loads remarkably to the anterior cruciate ligament (ACL), which has been reported as a cause of ACL injury risk. The aim of this study was to investigate differences between extended knee and 20 degree flexed knee positions through evaluation of postural control ability on an unstable board. The evaluation was carried out on 12 female members of a university handball team (average age: 19.9 years). Accelerometers were attached firmly to the skin on both knees and to unstable boards. First, the subjects were instructed to stand barefoot on the small unstable board on one leg with their eyes open and maintain their balance for 10 seconds against the sway of the board until three successful trails were accomplished. The movement of their lower limbs was recorded using the accelerometers. The calculated maximal amplitudes of forward and reverse acceleration were used as the maximal amplitudes. The number of failures was also recorded. Next, the subjects were asked to stand bare-foot on the large unstable board with their eyes open. A therapist applied sudden tilt to the board by pushing it from the rear end for a total of 10 times. The subjects were instructed to maintain, as far as possible, the posture that they had been holding when the perturbation began. Maximal amplitudes were used as indicators of the strength of stepping power. When comparing the maximal amplitudes of the acceleration, the number of the failure, and the strength of stepping power in the 20 degree knee flexion versus extended position, no significant difference was found.
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Hiroaki Nishioka, Jun Hirose, Eiichi Nakamura, Yasunari Oniki, Azusa T ...
2009 Volume 58 Issue 3 Pages
444-446
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Purpose: Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping are used to characterize articular cartilage. As the contrast agent Gd-DTPA
2- may affect the inherent T2 of cartilage, T2 mapping and dGEMRIC are typically conducted in two separate MRI sessions. The aim of this study was to determine whether double-dose (0.2 mmol/kg) Gd-DTPA
2- contrast agent has an impact on T2 mapping in clinical studies. Materials and Methods: Five knee joints of five patients with ACL tear were studied using 3T MRI before Gd-DTPA
2- administration and 120 minutes after for T2 mapping. We compared the T2 values of each femoral and tibial condyle and evaluated their relation between the two MRI sessions. Results: The mean T2 values before Gd-DTPA
2- administration did not differ from those after Gd-DTPA
2- administration in each condyle. There was a significant correlation of the T2 values between the two MRI sessions. Conclusion: This study demonstrated that T2 is only slightly affected by clinical Gd-DTPA
2- and that combined dGEMRIC and T2 mapping analyses in the presence of Gd-DTPA
2- can be applied in a single MRI session.
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Ichiro Kawamura, Kosei Ijiri, Hikaru Sakamoto, Ryusaku Nagayosi, Michi ...
2009 Volume 58 Issue 3 Pages
447-450
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We radiologically studied the effects of infliximab and methotrexate on the craniocervical region of rheumatoid arthritis (RA) patients. In patients who already showed atlantoaxial subluxation (AAS) before the treatment, infliximab and methotrexate significantly prevented the progression of AAS. However, the treatment did not affect the course of the vertical subluxation of the atolantoaxial joint. The class of RA was found to be significantly associated with the inhibitory effects of infliximab and methotrexate on AAS. We conclude that infliximab helps prevent AAS in RA patients.
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Yoichi Murata, Toshihide Shuto, Kazuhiro Yamaoka, Manabu Irie, Toshiak ...
2009 Volume 58 Issue 3 Pages
451-455
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The patient was 56-year-old woman, who visited a different hospital ten years ago for close inspection for acute pain of the cervix and a left shoulder ache, however the causes remained unknown. The pain appeeared on her left shoulder from the crevix every winter, with repeated exacerbation and remission. This pain also started to occur other than winter time since two years ago. NSAIDs were ineffective. Blood pressure was not affected and Raynaud and exanthema were not seen. CRP was 0.2 mg/dl, ESR was 24/53 mm (h/2h) , and rheumatoid factor, CCP antibody, and antinuclear antibody were all negative, WBC was 5290, HLA was A2/A24, and B60/B/16. Though not clear on X-ray, CT indicated significant bone destruction to the chest chain joint, and MRI showed T1 low signal and T2 high signal in this region. Although the causes were unknown, joint inflammation with the destruction of the sternoclavicular joint was suspected. The symptoms promptly improved with a small dosage of prednisolone and SASP. Taking into account differential diseases that can cause the destruction of the sternoclavicular joint, etiology and clinical state are discussed.
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Kohei Kawaguchi, Hideo Baba, Atsushi Tagami, Narihiro Okazaki, Hiroyuk ...
2009 Volume 58 Issue 3 Pages
456-459
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a case of Uni-Magerl Method for atlanto-axial subluxation with Down syndrome. The case was a 8-year 6-month old female with Down syndrome who had severe neck pain. X-ray examination found os odontoideum and ADI 7 mm. MRI revealed no canal stenosis. It was difficult to perform atlanto-axial fixation by Magerl Method, because the navigation system showed that the Magerl transarticular screw root was too narrow for surgery. So we performed uni-Magerl transarticular screw fixation and Brooks Method. After operation, patient wore a neck protector for three months. Now, the patient has no neck pain. We report that uni-Magerl transarticular screw fixation is an effective alternative for the treatment of infants with complicated atlanto-axial subluxation.
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Yosuke Matsumura, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Aki ...
2009 Volume 58 Issue 3 Pages
460-463
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We performed lower extremity amputation on 37 patients between January 2005 and December 2007. We investigated prognosis after lower extremity amputation and found gangrene in 33 patients (17 males and 16 females). The average age of the patients was 77 years old. Causal disease was arteriosclerosis (ASO), diabetes mellitus (DM), etc. (Buerger disease, osteomyelitis). Region of amputation was above knee amputation (AK, 20 cases), below knee amputation (BK, 4 cases), and foot amputation (9 cases). Twelve patients required reoperation and had delayed healing (36.4%).
Survival rate of one year was seen in 51.5% of the patients. Patients who died within one year postoperatively were older and less active than patients who lived. Healing of wound is difficult in patients with high CRP.
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Michihiro Katouda, Fumitake Ono, Takanobu Abe, Yohei Natsuaki, Yukiko ...
2009 Volume 58 Issue 3 Pages
464-468
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a rare case of motor paralysis in the right upper limb which developed after herpes zoster, refewing also briefly to literature. A 76-year-old male with herpes zoster showed persistent difficulty in elevating his right shoulder. Close examinations were performed regarding the possibility of disease of the cervical spine and rotator cuff injury, but they revealed no definite abnormalities. Based on the timing of the development of blisters and the areas of paralysis coinciding with those of the blisters, a diagnosis of segmental nerve paralysis derived from herpes zoster was made. Herpes zoster is often observed in daily practice, but its involvement in not only sensory nerves but also motor nerves is not widely known in the orthopedic field. The prognosis of segmental nerve paralysis derived from herpes zoster is good even when treated only conservatively. It may be important to provide more information on this disease for its widespread recognition, correct understanding, and appropriate treatment.
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Michihisa Zenmyo, Masahiro Yokouchi, Yoshiya Arishima, Satoshi Nagano, ...
2009 Volume 58 Issue 3 Pages
469-472
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Synovial sarcoma comprises approximately 6 to 9 % of all adult patients with soft tissue sarcomas. Although relatively rare, synovial sarcoma accounts for 12 to 15% of adult extremity soft tissue sarcoma. Chewotherapy has been shown to generate impressive responses in the treatment of synovial sarcoma. In this study, the clinical outcome of six patients with synovial sarcoma who underwent chemotherapy is reported. Six patients (two males, four females) with synovial sarcoma who underwent chemotherapy between 1995 and 2008 were considered for the analysis. Histopathologically three were monophasic type, two were poorly differentiated type, and one was biphasic type. Five of the six were detected with SYT-SSX fusion genes in biopsy samples. Two patients had metastatic lung lesions in their first visit to our hospital. Five of the six patients underwent preoperative chemotherapy. Three died due to the disease and the three remaining survivors underwent chemotherapy for lung metastasis.
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Kensaku Yamaga, Hideki Yamashita, Koji Endo, Mitsuhiko Osaki, Takeshi ...
2009 Volume 58 Issue 3 Pages
473-477
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Diagnoses of soft tissue tumors (STTs) are difficult because of various atypical histopathologic features, even if the pathologist is similar with STTs. The expression of fusion genes resulting from specific chromosomal translocations in STTs and its diagnostic significance for STSs have recently been reported. We report seven cases in whom detection of fusion genes by reverse transcriptase-polymerase chain reaction was significant in STSs, including two cases of synovial sarcoma, two cases of myxoid liposarcoma, two cases of malignant peripheral nerve sheath tumor (MPNST), a case of solitary fibrous tumor (SFT), and a case of epithelioid sarcoma (ES). All of them could not be diagnose by clinical findings and histopathological findings, including immunohistochemistry. Although specific fusion genes have not been reported in MPNST, SFT, and ES, detection of specific fusion genes of the differential diagnosis helps diagnosis. The detection of fusion genes is significant as a reliable index for the molecular diagnosis of STTs and a useful tool for confirming the diagnosis of STTs in diagnostically difficult cases.
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Ryutaro Shimada, Hideki Kawamura, Masahiro Nakagawa, Kyoji Hayashi, Hi ...
2009 Volume 58 Issue 3 Pages
478-481
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Recently, the incidence of retropharyngeal abscess in adults has been increasing because of the increasing numbers of elderly individuals and compromised hosts. We present a case of a healthy woman with retropharyngeal abscess and severe neck pain. She was a 49-year-old healthy woman who consulted our hospital because of severe resting neck pain and restriction of neck motion. Blood tests showed revealed increased CRP. A radiograph of the neck demonstrated enlargement of the retropharyngeal area. Magnetic resonance imaging (MRI) showed an abscess in the retropharyngeal area which was low in intensity on T1-weighted images and high in intensity on T2-weighted images. Intravenous administration of antibiotics cured the retropharyngeal abscess. Recently, the incidence of retropharyngeal abscess in adults has increased. Because second cervical vertebral osteomyelitis, mediastinitis, and meningitis have been reported as sequelae of retropharyngeal abscess, accurate diagnosis and treatment of it are important. Retropharyngeal abscess should be suspected in individuals with severe neck pain and symptoms of infection even of they are otherwise healthy.
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Tetsurou Masuda, Eiichi Nakamura, Yasunari Oniki, Hiroaki Nishioka, Az ...
2009 Volume 58 Issue 3 Pages
482-487
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Cryptococcus neoformans is known as an organism infecting the pulmonary and central nerve system but infection of the bone and soft parts is rare. We report here a rare case of Cryptococcal myositis in the musculus quadriceps femoris. The patient was a seventy-year-old woman. She was being treated for rheumatoid arthritis and interstitial p neumonia with the administration of predonizorone 17.5mg/day, and also had diabetes mellitus and hepatitis C cirrhosis. She presented with a three-day history of progressive pain, and swelling and redness of the lateral side right thigh. Her temperature was 37.3°C and laboratory examination showed increase in white blood cell count and CRP. We suspected subcutaneous abscess and performed paracentesis, and started her on intravenous CEZ. Symptoms however exacerbated and she was urgently hospitalized at our hospital. Magnetic resonance imaging showed increased signal intensity in the lateral great muscle. Because fluid culture grew Cryptococcus neoformans, we diagnosed her with Cryptococcal myositis. After treatment with fluconazole for about two weeks, her symptoms improved and laboratory examination showed negative CRP.
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Daisuke Noda, Kei Shiramizu, Satoshi Kamada, Masatoshi Naito, Naoko Ao ...
2009 Volume 58 Issue 3 Pages
488-490
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We experienced two cases of total hip arthroplasty postponement due to oral infection which required preoperative oral treatment. Oral infection may lead to transient bacteremia and subsequent prosthetic joint infection. Dental extractions are among one of the causes of the bacteremia. Infected arthroplasty is a serious condition. Therefore it is important to reduce the risk of infection, which can be partially achieved by checking and treating any oral infection preoperatively. However the preoperative evaluation of oral infection varies among facilities and there is a lack of a well-established procedure for this purpose. It is desirable to keep the patient's oral conditions good prior to arthroplasty and have the patient consult a dentist frequently if necessary.
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Hirotaka Kawakami, Tomoka Sanno, Tsuyoshi Takenouchi, Yasuhiro Tsuneyo ...
2009 Volume 58 Issue 3 Pages
491-495
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Comparison examination was performed on usefulness and problems of dressing materials postoperatively.
Although wound observation is facilitated by the use of Karayahesive, the dressing material needs to be replaced. Frequent dressing material replacement prevents closing environment which promotes wound healing. Therefore, when Opsite Visible was introduced, wound care was simplified, but skin disturbance was observed. According to the trait of dressing material. It is important to choose the postoperative dressing material according to the characteristics of the dressing material.
In this examination, no significant difference was seen in the frequency of the adverse event.
Exudate, risk of infection, etc. must be reviewed and use of suitable postoperative dressing material is necessary.
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Sakura Uchiyamada, Yoshihisa Kawauchi, Koji Sameshima, Natsuko Tomimur ...
2009 Volume 58 Issue 3 Pages
496-498
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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The outbreak of surgical site infections is a serious postoperative complication. Surgical site infections are caused by various reasons, one of which is insufficient hand washing during surgery.
We introduced a waterless hand washing method for surgery, and investigated clinical and medical viability.
We compared the number outbreaks of surgical site infections (SSI), time of hand washing, degree of hand roughness, costs, and bacteria detection rate by finger culture inspection during a six-month period from March to August in 2008 after introducing the waterless method with the six-month period before it.
The results showed that the waterless method does not differ from conventional hand washing methods and is also medically cost-effective.
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Takehiro Miyazaki, Naoki Toba, Natsuki Hara, Teppei Murai, Yasunari Hi ...
2009 Volume 58 Issue 3 Pages
499-502
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Olecranon fractures in children are rare. The olecranon physis distally extend to include the coronoid process, before ossification of the olecranon occurs at approximately 8 years of age. Only a few reports mention the type of avulsed fracture through the epipyseal plate iucluding the coronoid process. Experiencing the same case, We could not sufficiently assess it by plane radiography and computed tomography because of the large amount of cartilage matrix in the olecranon. Magnetic resonance imaging (MRI) is not invasive and useful for diagnosing olecranon fractures in chirdren.
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Masaru Higo, Shinji Yoshino, Masahiro Nakamura
2009 Volume 58 Issue 3 Pages
503-506
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We evaluated 35 patients in 36 hips with Perthes' disease for long-term results of treatment with a weight-bearing, containment abduction brace. The patients were 33 boys and two girls. The mean age at the time of diagnosis was 5.3 years. The patients wore the orthosis for an average of 13.7 months. The mean follow-up period was nine years. The epiphyseal involvement were 14 hips with Catterall's group III involvement and 22 hips with Catterall's group IV involvement. At risk sign of lateral subluxation, metaphyseal cystic lesion showed radiographically in 32 hips. At final follow-up, radiographic results of all hips were evaluated according to Stulberg's criteria, with 12 hips in class I, 11 hips in class II, 12 hips in class III, one hip in class IV. Long -term results revealed 23 hips 64% in good and 13 hips 36% in poor result. Older patients showed poor results, Catterall's group IV involvement and combined lateral subluxation and metaphyseal cystic lesion. The weight-bearing abduction brace was simple, amubulatory and good compliant orthosis. We recommend the use of this brace for the treatment of the hips in Catterall's group III involvement under eight years.
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Yumiko Kanamaru, Akihiko Yonekura, Takashi Miyamoto, Narihiro Okazaki, ...
2009 Volume 58 Issue 3 Pages
507-510
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a case of a 13-year-old boy who had varus knee deformity after severe open knee fracture.
At age eight, he was involved in a traffic accident and received treatment at another hospital. After initial debridement, MRSA wound infection occurred, which was treated by multiple washouts and skin graft. Infection was successfully suppressed but knee contracture of extension -25 degrees and flexion 55 degrees occurred.
He was introduced to our hospital for treatment of joint contracture. After arthroscopic joint manipulation, MRSA infection relapsed and was treated by multiple washouts. He had a knee range of motion extension -5 degrees and flexion 105 degrees after the last manipulation and was able to walk without limping. We noticed that the patient achieved epiphyseodiaphyseal fusion one year after trauma. Followed up closely, the patient was advised to undergo surgery, but since his daily activities were unaffected, the patient and family did not ask for any kind of treatment until he developed severe varus knee deformity four years after the trauma. We planned correction osteotomy of the proximal tibia using the Taylor Spatial Frame and femorotibial angle was over-corrected from 191 degrees to 173 degrees. Because the patient was still growing, FTA increased to 177 degrees oue year later. We believe that the patient will need further surgery at the appropriate timing.
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Mitsuhiro Katoku, Hiroko Mine, Takahiko Aoyagi, Norihito Kitagawa, Tak ...
2009 Volume 58 Issue 3 Pages
511-515
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Between September 2002 and March 2008, we performed arthrodesis of the ankle joint in 19 feet. In 12 feet, we fixed the ankle and subtalar joints using the intramedullary (IM) nail, and in another seven feet, we fixed only the ankle joint with multiple screws. The mean follow-up period was 3.1 years (34 weeks to 6.2 years). The mean age of the patients was 67.5 years in the IM nail group, and 56.5 years in the other group. We compared the two methods according to full weight bearing time, time to union, length of hospitalization, and hospitalization costs. Clinical evaluation was carried out according to the Japanese Orthopaedic Association (JOA) score. Bone union was achieved in 50 days with the IM nail, and in 91 days with the multiple screws. The IM nail group required 38 days until discharge from hospital, while the other group required 46 days. Hospitalization costs were 1,015,050 yen for the IM nail group, and 1,013,060 yen for the other group. The JOA score of the IM nail group was 36.5 points, and 36.4 points for the other group. We concluded that the IM nail is useful not only for rheumatoid arthritis but also osteoarthritis of the ankle joint.
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Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Akira Hozumi, Shoichi ...
2009 Volume 58 Issue 3 Pages
516-521
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Total ankle arthroplasty (FINE Total Ankle System, Nakashima Medical Co., Ltd.) was performed on destructed ankle joints of RA (n=3) and OA (n=3) patients, and the short-term clinical results were investigated for at least nine months. The subjects included one male and five females with an average age of 73 years (range: 60 to 81). The average pre-operative and post-operative JOA score was 35 points and 82 points, respectively. After the operation, the pain relief was satisfactory, and the range of motion was improved. One OA patient experienced loosening of the artificial joint, although there was no infection. Necrosis of the skin occurred in one RA patient and dermal flap formation was needed. This patient was able to recover after plastic surgery. We paid attention to the treatment of the soft tissue and points of the setting position for the components. This ankle model consists of three parts, which allow the joint to accommodate rotational motion ten degrees inside and outside, and slide in the forward and backward directions. Stress is decentralized by the design of the polyethylene socket at the center. The FINE total ankle system is therefore useful for patients with ankle joint destruction.
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Kunihide Muraoka, Ichiro Yoshimura, Kazuki Kanazawa, Tomonobu Hagio, Y ...
2009 Volume 58 Issue 3 Pages
522-527
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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Purpose: Arthroscopic surgery for posterior ankle impingement syndrome is less invasive good results have been reported. We treated two cases with os trigonum disorder arthroscopically. They are reported here because of the good results achieved.
Cases: We treated two cases diagnosed with posterior ankle impingement syndrome by clinical symptoms, X-rays, CT and MRI. Case l was a 26-year-old female nurse and Case 2 was a 15-year-old male high school baseball player. In both cases, the chief complication was pain in the posterolateral aspect of the ankle joint when hyperplantar flexion was forced. We resected os trigonum via posterolateral and posteromedial portal at the side of the Achilles' tendon. No cast immobilization was performed, weight bearing as tolerated was allowed and early range of motion was achieved immediately following surgery.
Conclusion: Endoscopic treatment of the posterior ankle impingement syndrome yields good results with minimal surgical morbidity and short term recovery time.
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Kazuhisa Kurogi, Takashi Miyamoto, Akihiko Yonekura, Hiroyuki Shindo
2009 Volume 58 Issue 3 Pages
528-531
Published: September 25, 2009
Released on J-STAGE: November 24, 2009
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We report a case of equinus foot correction using the Taylor Spatial Frame (TSF). A 25-year-old man was involved in a traffic accident. He had severe multiple injury (ISS 43 points) and open left foot fracture, which were treated by debridement and osteosynthesis. He had equinus foot deformity after skin graft and unfortunately rehabilitation was not effective. We used the TSF for equines foot correction and removed it after four weeks. Short brace of lower leg was used after the removal of TSF. Range of motion exercise was continued during TSF fixation, and his gait improved after correction.
The TSF is an effective device for correction, since it has low risk of injury to soft tissue, and it allows prediction of progress of correction using web-based programs.
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