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Takahiro Ushijima, Yasutaka Tashiro, Hiromasa Miura, Shuichi Matsuda, ...
2010 Volume 59 Issue 4 Pages
675-680
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Introduction: Spontaneous osteonecrosis of the knee (SPONK) causes acute pain and dysfunction to the knee joint. We perform high tibial osteotomy (HTO) for the treatment of middle-aged, advanced and wide SPONK cases. The purpose of this study was to investigate the cartilage repair and radiographic changes after HTO for SPONK. Methods: Eighteen subjects, with the mean age of 67.3 years, suffering from SPONK underwent HTO using an interlocking wedge osteotomy technique. Subjects were examined with x-ray, and knee alignment, stage of SPONK and osteoarthritis (OA) grade were evaluated before and after the surgery. Arthroscopic findings of articular cartilage were also analyzed. The clinical knee function was assessed with the JOA score and with range of motion (ROM). The mean follow-up period was 2.9 years. Results: JOA score improved substantially from 51 to 90 points. Their ROM also increased significantly. Correction of knee alignment was maintained until the final follow-up. The SPONK stage improved significantly and the OA grade changed only slightly at the final follow-up. Arthroscopically, softening of the articular cartilage disappeared and the cartilage was repaired with fibrocartilaginous tissue. Conclusion: HTO using an interlocking wedge osteotomy was a useful technique for the treatment of SPONK.
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Takuya Ikuta, Mitsuru Sakaguchi
2010 Volume 59 Issue 4 Pages
681-683
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of correction osteotmy using locking plate for tibial malunion.
The patient was a 58-year-old man. He sustained a right tibal fracture when he was 18 years old, and underwent conservative therapy. Since then, he had sometimes experienced right knee pain. When he was 58 years old, he had frequent gait pain on his right knee. His right lower leg was deformed inside. X-ray findings showed 21° varus deformity of his right tibia in upper third.
We operated on his right tibia with correction osteotomy and locking plate fixation. Six months after operation, bone union was achieved and he has had no right knee pain and no disability in daily living.
Locking plate is a useful implant for correction osteotmy for tibial malunion.
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Kounosuke Watanabe, Takashi Miyamoto, Ko Chiba, Chikara Miyamoto, Atsu ...
2010 Volume 59 Issue 4 Pages
684-687
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of lower leg compartment syndrome caused by low energy trauma in an alcoholic liver cirrhosis patient. The patient was a 65-year-old man who had been alcoholic for 25 years. One day, after walking five minutes, right leg pain gradually emerged. Three days later, he complained of severe leg pain and was taken to hospital by ambulance. He was diagnosised with lower leg hematoma and was treated conservatively but because his symptoms did not improve, he was transferred to our hospital. On arrival, he had strong leg pain and marked swelling of the right leg. Compartment pressure was above 50 mmHg. We could not find the source of bleeding by angiograpy. Because of coagulopathy secondary to liver failure, we were uncertain about how to controlling the bleeding and decided not to operate. After four weeks later, the patient died of liver failure and complications. Cases of compartment syndrome secondary to hematoma in coagulopathic end-stage liver disease patients leading to death are rare. Aggressive surgical treatment shoud be carefully considered.
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Takuya Ikuta
2010 Volume 59 Issue 4 Pages
688-691
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Six cases with painful patella bipartita were treated surgically using tension band wiring using cannulated screw. All cases were classified as type 3 according to Saupe's classification.
All cases achieved good pain relief. No implant-related complications were observed. In all cases, bone union was achieved clinically, and in three cases, bone union was achieved completely on X-ray findings.
Tension band wiring using cannulated screw is a useful method for painful patella bipartita.
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Takahiro Norimatsu, Hiroyuki Kitahara, Yoshihiro Yabe, Shinji Adachi, ...
2010 Volume 59 Issue 4 Pages
692-694
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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With the spread of sports, the number of meniscus injuries is increasing amongst the young. Meniscectomy over a wide area must be performed carefully for young patients because it can cause osteoarthritis. Recently, good results are increasingly being reported for the meniscus repair in young patients. At our hospital, we also perform suture as much as possible for such young patients. We report 11 patients (11 knees) who underwent suture of the meniscus between January 2003 and January 2010 at our hospital. The surgical techniques applied were meniscal repair by outside-in or all-inside on a case-by-case basis. For rehabilitation, we started range of motion exercise two weeks later and partial weight bearing three weeks later. We evaluated the results using the Japan Orthopaedic Score. Most of the patients achieved good results but rupture recurred in two. We performed re-repair on one, and meniscectomy on the other.
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Makoto Sasaki, Masatsugu Shimizu, Ikufumi Nagayoshi, Tatsuo Motoyama, ...
2010 Volume 59 Issue 4 Pages
695-699
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We examined shoulder joint sounds using an ES4000 electronic stethoscope (3 M Littmann
TM). The stethoscope was set on the acromion, and joint sounds were recorded during flexion-extension motions and external-internal rotation motions. The joint sound recordings were converted to phonographs displaying sound oscillations or sound frequencies using proprietary software. The objects investigated were 14 normal joints and 14 joints with complete rotator cuff tear. The phonographs showed a high incidence of higher frequency sounds in rotator cuff tear shoulders than in normal shoulders. And in rotator cuff tear shoulders, joint sounds during external-internal rotation motions were higher in frequency level than during flexion-extension motions. We concluded that joint auscultation with the ES4000 stethoscope is a useful method for the early detection of rotator cuff tears in shoulders.
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Yasuhiro Mizuki, Mikihito Tamai, Mitsuhiro Enomoto
2010 Volume 59 Issue 4 Pages
700-703
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Arthroscopic subacromial decompression (ASD) is a procedure required for rotator cuff tears and impingement syndrome, but the amount of bone to be removed and range of decompression depend on the surgery performed. We reviewed the morphology of bony spur using three-dimensional computed tomography (3 DCT). The subjects were 27 cases operated on for rotator cuff tears from October 2008 to July 2009. We took CT images of all cases preoperatively. We classified the morphology of bony spurs into four groups according to size and investigated the characteristics. The bony spur was found to elongate to the coracoid process and show double floor-like configuration inwards. Moreover, when the bony spur size increases, the duration of the disease also increases. In addition, there was a tendency for the size of rotator cuff tears to grow large except in trauma cases. 3 DCT can capture the morphological characteristics of subacromial bony spurs and provide useful information in ASD.
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Akihiko Kura, Yozo Shibata, Teruaki Izaki, Motoyuki Fujisawa, Tsuyoshi ...
2010 Volume 59 Issue 4 Pages
704-707
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report the long-term follow-up of two cases of latissimus dorsi transfer for irreparable rotator cuff tears. Case 1 was a 60-year-old male carpenter with irreparable rotator cuff tear. His active range of motion was elevation of 50 degrees, external rotation of −20 degrees, and internal rotation to the eighth thoracic vertebla. His JOA score was 40 points. Latissimus dorsi transfer was performed, and abduction splint was applied for seven weeks. Nine years after the operation, elevation of 140 degrees, external rotation of 20 degrees, and internal rotation to the ninth thoracic vertebla were observed. His JOA score was 72 points. Case 2 was a 50-year-old male plasterer with irreparable rotator cuff tear who had undergone one cuff surgery in the past. Because he had re-tear six years after the surgery, latissimus dorsi transfer was performed. His active range of motion was elevation of 55 degrees, external rotation of 30 degrees, and internal rotation to the first lumbar vertebla. Nine years after the latissimus dorsi transfer, his active range of motion was 140 degrees, 50 degrees, and first lumbar vertebla respectively. His JOA score was 81.5 points. Although latissimus dorsi transfer is invasive, it should be performed on irreparable rotator cuff tears that cannot be repaired by primary surgery.
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Rintaro Ikeda, Keizo Furukawa, Shiro Kajiyama, Toshiyuki Sakimura, Mas ...
2010 Volume 59 Issue 4 Pages
708-712
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The purpose of this study was to evaluate the the surgical results of arthroscopic rotator cuff repair (ARCR) and investigate the interoperative complications for elderly people (over 75-years).
We evaluated nine patients 75 and over who underwent rotator cuff repair, followed up for more than 12 months, and underwent MRI six months or more after the operation which was performed between December 2004 to July 2008. Their average age was 77.3 years. The control patients were 61 patients less than 75 who underwent ARCR during same term. Their average age was 59.9 years.
Clinical outcome was evaluated based on interoperative complications, the Japanese Orthopaedic Association score (JOA score), and cuff integrity using MRI Sugaya's classification.
In the over 75 patients, anchors came out from the tuberosity in three patients. Postoperative complications were not seen in both groups. No differences were observed in JOA score and cuff integrity using MRI Sugaya's classification compared with patients under 75.
The surgical outcome of ARCR for elderly people (over 75-years) was satisfactory, and ARCR for elderly people (over 75-years) shoud be performed with caution because of the coming out of anchors.
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Hiroyuki Kitahara, Yoshihiro Yabe, Takahiro Norimatsu, Shinji Adachi, ...
2010 Volume 59 Issue 4 Pages
713-716
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The six-month post-operative re-tear rate in 72 arthroscopic rotator cuff repair cases was 16.3% by MRI. The re-tear rate of massive tears was 50%. We investigated the details of the re-tears by MRI and arthroscopic findings. High re-tear rates were connected with cuff tear size and fatty degeneration of muscle belly. Cases with poor cuff quality in arthroscopically showed high re-tear rate. These results suggest that surgery operation should be performed as soon as possible after diagnosis of cuff tear to obtain good results. Cases with damage of LHB are likely to develop impingement causes of re-tears. Some type of rehabilitation is required to avoid impingement in such cases.
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Yasunao Miyai, Kazuo Hayashi, Tetsuro Yoshimura
2010 Volume 59 Issue 4 Pages
717-720
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We compared the clinical results of simultaneous bilateral TKA and unilateral TKA. Between April 2006 and May 2009, we performed 52 simultaneous bilateral TKA (104 TKA) and 91 unilateral TKA. We found a low incidence of serious complications and no significant difference of clinical results between bilateral TKA and unilateral TKA. We consider that simultaneous bilateral TKA is a useful method. But, we should perform enough informed-consent with patients and have a good relationship with operating staffs and doctor of another departments especially cardiology and neurology, because there are many elderly patients in bilateral TKA group.
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Mamoru Mitsukawa, Tatsuhiro Yoshida, Tohru Wakioka, Kei Yamada, Kimiak ...
2010 Volume 59 Issue 4 Pages
721-726
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report the clinical results of a case with huge OPLL at the cervical-thoracic spine belonging to the K-line (−) group.
The case was a 50-year-old male. He received conservative follow-up at a hospital for cervical OPLL. His legs were paralyzed after he slipped and fell on the road on his bicycle. CT and MRI showed huge OPLL from C2 to Th1 spine, especially at C6-C7. CT showed K-line (−), and the occupying ratio was 72% and 70% at the C6 and C7 spinal canal respectively.
We performed not only laminectomy but also fixation using instrumentation from posterior approach. Immediate improvement of myelopathy was seen after the operation. No symptoms were observed one year after surgery.
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Tetsuji Inoue, Tatsuro Yamauchi, Saburo Nakashima, Kazuaki Fukuda, Mak ...
2010 Volume 59 Issue 4 Pages
727-731
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Good neurological outcomes of laminoplasty for cervical compressive myelopathy are reported. However, decrease in range of motion, axial symptoms, and kyphotic change in cervical spine after laminoplasty remain as problems. Shiraishi showed that these problems can be resolved dramatically by preserving bilateral muscular attachments to the spinous processes. We verified whether single open door laminoplasty with Shiraishi's approach can decrease these problems or not. Twenty-two patients who underwent single open door laminoplasty with Shiraishi's approach and were followed up for minimum of one-year were compared to 12 patients without Shiraishi's approach. No significant differences between the two groups were found in the preoperative average JOA score, operating age, and JOA score recovery rates. The postoperative range of flexion-extension motion averaged 73% of the preoperative measures in the group with Shiraishi's approach and 77% in that without Shiraishi's approach. There was no significant difference between the two groups in decrease of ROM and frequency of axial symptoms on cervical spine after laminoplasty. Cervical alignments after operation were maintained in both groups compared with those before operation.
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Hikaru Sakamoto, Takuya Yamamoto, Kosei Ijiri, Michihisa Zenmyo, Ryusa ...
2010 Volume 59 Issue 4 Pages
732-735
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We experienced a case with neurofibromatosis type I (NF-1) of the dystrophic type, who suffered paraplegia with rotational dislocation of the thoracic spine due to slight injury.
The case was a 12-year-old boy who visited our hospital for spinal deformity. He had dystrophic changes of NF-1, scoliosis carve of 40 degrees from T7 to T10, kyphosis of 76 degrees from T7 to T12. On February 25, he fell on the ground, and suffered paralysis and ischuria. Posterior fusion and decompression with correction were performed. After the operation, his neurological symptoms had improved. We added anterior fusion with strut rib. Spinal fusion should be achieved early because spinal deformity due to dystrophic type NF-1 may cause rapid aggravation of neurological symptoms.
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Minoru Kashihara
2010 Volume 59 Issue 4 Pages
736-738
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of thoracic ossification of the posterior longitudinal ligament (OPLL). A 25-year-old woman with retinitis pigmentosa complained of weakness in her legs, difficulty in walking and urinary disturbance. MRI revealed compression of the spinal cord at T4/5, 5/6, 6/7, 7/8, 9/10. CT scan revealed beaked type OPLL at T1/2, 4/5, 5/6, 6/7, 7/8, 9/10. At first, spinous process-splitting laminoplasty from C3 to T2 was performed and two weeks later, posterior fusion from T1 to T10 using pedicle screw with laminectomy from T3 to T10 was performed. Post operative palsy of the lower extremity appeared immediately after operation. Neurological deterioration did not improve at 14 months after operation. Instead of satisfactory outcomes of posterior decompression with posterior fusion, some authors have reported cases of postoperative neurologic deterioration with common beaked type OPLL. We think that additional application of anterior decompressive method is preferrable in cases with beaked type OPLL such as those in our cases.
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Kiyoshi Tarukado, Eiji Mori, Takayoshi Ueta, Takeshi Maeda, Itaru Yuge ...
2010 Volume 59 Issue 4 Pages
739-741
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of severe paralysis caused by spinal epidural hematoma associated with thoracic compression fracture. A 83-year-old man fell down a ladder and was carried to hospital in the morning. Radiogram of the spine showed compression fracture of the T11 body. He had no neurological deficit when he was admitted to the hospital. He was kept in bed but felt numbness and weakness of both legs around 6 pm. Numbness and weakness of both legs exaggerated and he was found to have flaccid paralysis of both legs around 9: 30 pm. He was transferred to our hospital. Computed tomography of the spine showed compression fracture of the body of T11, and magnetic resonance imaging (MRI) of the spine demonstrated a mass located in the epidural space from T10 to L1. The signal intensity of the mass was low on T1-weighted and mixed pattern of low and high on T2-weighted. We suspected spinal epidural hematoma associated with thoracic compression fracture. He underwent removal of the hematoma through laminectomy from T10 to L1 and posterolateral fusion with pedicle screw from T10 to T12. Unfortunately he showed no neurological improvement.
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Takeshi Hiura, Hideo Baba, Atsushi Tagami
2010 Volume 59 Issue 4 Pages
742-747
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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A systematic study of the upper cervical spine was performed using computed tomography in 32 patients (17 men and 15 women) who had been undergoing hemodialysis for more then 20 years. Twenty-one patients had bone cysts in the lateral mass of the atlas. Nine patients had bone cysts in the screw insertion path of the axis during the Magerl technique. Eight patients had bone cysts in the dens of the axis. In patient with destructive Spondyloarthropathy (DSA) of the atlantoaxial joint, this condition tended to progress quickly, resulting in atlantoaxial subluxation and severe myelopathy requiring surgery at this site. Surgical methods for atlantoaxial subluxation include C1/2 transarticular screw fixation (Magerl screw) and wedge compression arthrodesis of the atlantoaxial joint (Brooks method) and atlantoaxial posterior fixation (Goel method or Tan method). But, most patients on long-term hemodialysis over 20 years were found with bone cysts in the lateral mass of the atlas, making atlantoaxial screw fixation difficult. We consider evaluation of bone cysts in the atlantoaxial joint before operation to be important.
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Hidekazu Sakaue, Hideo Baba, Atsushi Tagami, Takeshi Hiura, Hiroyuki S ...
2010 Volume 59 Issue 4 Pages
748-753
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Introduction: Cases of dens axis lesion surgery examined in our department.
Patients and Methods: Eight patients underwent dens axis lesion surgery in our depertment (5 males, 3 females). Six patients had atlantoaxial subluxation and two patients had odontoid pseudotumor. Cases with of atlantoaxial subluxation underwent occipital cervical fixation, while cases with odontoid pseudotumor underwent excision of the posterior arch.
Results: All patients were treated for hemodialysis over a long term for 25 to 30 years (average 27.9 years). Their pre and post operative JOA score improved significantly.
Conclusion: Hemodialysis Patients with lesion of the dens axis had a history of very long-term dialysis, and showed good postoperative progress without any perioperative complications.
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Kosuke Akashi, Tsukasa Kanchiku, Toshihiko Taguchi, Yoshihiko Kato, Ya ...
2010 Volume 59 Issue 4 Pages
754-756
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The purpose of this study is to clarify the correlation between electrophysiological examination and MRI diagnosis. Twenty-four patients with cervical spondylotic myelopathy were examined with magnetic resonance imaging and evoked spinal cord potentials (ESCPs) before surgery. In all the patients, only the intervertebral level was symptomatic, as shown by ESCPs. ESCPs following median nerve stimulation (MN-ESCPs), transcranial electric stimulation (TCE-ESCPs), and spinal cord stimulation (Spinal-ECSPs) were recorded. The patients were grouped into two groups as follows: group A, all ESCPs were abnormal; group B, normal spinal cord stimulation. Spinal cord transverse area and compression ratio (central and 1/4-lateral anteroposterior diameter divided by transverse diameter) were measured on T1-weighted axial imaging, with abnormal ESCPs as indicators of spinal cord morphology. Central and 1/4-lateral compression ratio was significantly lower in group A. Spinal cord morphology of magnetic resonance imaging is useful for functional diagnosis.
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Shuji Kurogi, Shinichiro Kubo, Hiroshi Kurogi, Shoji Hanado, Hideaki H ...
2010 Volume 59 Issue 4 Pages
757-760
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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In recent years, the number of geriatric operations is on the increase, and a similar tendency is seen at our center. This time, we reviewed the results of surgical treatment of the cervical spine in the oldest old (over 85 years old) and report our findings in the following.
Subject of research: Nine cases (five males and four females) over 85 years old who underwent cervical laminoplasty at our center from January 2004 to September 2009. Their mean age was 87.4 years. Preoperative diagnosis was eight cases of cervical spondylomyelopaty and one case of ossification of the posterior longitudinal ligament.
The mean score of the Japan Orthopaedic Association improved from 8.8 (before operation) to 12.9 (in the last clinical evaluation). There are no cases of evolving paralysis and severe complications after surgery.
Invasive treatment for the oldest old is useful with sufficient preoperative evaluation and examination of the operative indicators.
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Fumito Tanabe, Eiji Taketomi, Kosei Ijiri, Takuya Yamamoto, Ryusaku Na ...
2010 Volume 59 Issue 4 Pages
761-763
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The present study was performed to compare the surgical outcomes of anterior cervical discectomy/fusion and posterior microendoscopic foraminotomy since 1999. A total of 30 patients were selected: 17 patients underwent anterior procedures and 13 patients underwent posterior microendoscopic foraminotomy. No serious surgical complications occurred in both groups. Minimal hospitalization, early reinstatement, and preservation of the osteoarthritis of the operated segment were favorable in posterior microendoscopic foraminotomy. The results indicate that posterior microendoscopic foraminotomy is an effective procedure for the treatment of cervical radiculopathy. However, we need to perform further studies through long term follow-up.
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Takayuki Nakashima, Hiroyuki Tominaga, Yoshiya Arishima, Fumihiro Miya ...
2010 Volume 59 Issue 4 Pages
764-765
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We present a rare case of traumatic atlantoaxial dislocation fracture. The patient was a 38-year-old male. March 2009, he fell down from the staircase and hit his head. He suffered pain and dislocation of the neck. He was diagnosed with atlantoaxial dislocation fracture. His neck was treated but dislocation remained. We performed reduction by hand under general anesthesia, which enabled repositioning of the neck. MRI indicated no injury of the vertebral artery and spinal cord. He wore a Philadelphia collar for two months to keep his neck in good position. Bone union was eventually gained.
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Takeshi Setoyama, Hiroyuki Tominaga, Eiji Taketomi, Setsuro Komiya
2010 Volume 59 Issue 4 Pages
766-768
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Normal pressure hydrocephalus (NPH) has three symptoms; namely gait disorder, dysbasia, urinary incontinence, and dementia, and it maybe difficult to distinguish from spinal cord disease.
We present a case of NPH complicated spinal cord injury.
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Shinji Tanishima, Chikako Yakura, Masako Hayashibara, Akira Tanida, Ya ...
2010 Volume 59 Issue 4 Pages
769-772
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Crowned dens syndrome is a disease first reported by Bouvet et al. in 1985, which causes cervical pain and calcification around the odontoid process. We report four cases of crowned dens syndrome which we experienced. The cases consisted of two females and two males whose average age was eighty. They all complained of acute onset of cervical pain and fever. Their cervical rotations were extremely limited and inflammatory reactions were intense. There were no clear finding on plain X-ray films of the cervical vertebra, but calcification at the posterior part of the odontoid process was identified. They were administrated with nonsteroidal antiphlogistic analgetic and treated with cervical collar fixation. Pain disappeared in about a week and inflammatory reactions also became negative. When acute intense cervical pain, limited range of motion especially limited rotation, increased inflammatory reaction and fever are observed in aged people, crowned dens syndrome should be suspected.
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Takahiro Ushijima, Yasuharu Nakashima, Masanori Fujii, Takuaki Yamamot ...
2010 Volume 59 Issue 4 Pages
773-777
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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The purpose of this study was to investigate the changes in the pelvic inclination angle (PIA) by lateral positioning during total hip arthroplasty (THA). Between January 2008 and September 2009, primary THA for osteoarthritis of the hip were performed on 84 hips in 84 patients. They consisted of 12 men 12 hips, and 72 women 72 hips with the mean age of 63.7 years. We measured the sagittal and coronal PIA pre-, intra- and post-operatively using antero-posterior pelvic X-ray films and also measured the anteversion and abduction angles of the acetabular components.
Lateral positioning resulted in 26.2% of cases with posterior sagittal tilt over five degrees compared to preoperative PIA in the supine position and 9.5% anterior tilt more than five degrees. It also resulted in 17.9% with cranial coronal over five degrees and 4.7% caudal tilt over five degrees. The factors influencing these changes were difference between the sagittal PIA in the standing and supine positions, and preoperative adduction contracture. The intraoperative anteversion of acetabular component in the posterior and anterior pelvic tilt groups decreased by 6.3° and 1.7°, respectively at the postoperative supine position. The intraoperative abduction angle of the acetabular component in the posterior pelvic tilt group decreased by 0.9°, but increased by 5.5° in the pelvic anterior tilt group.
Change of pelvic inclination by more than five degrees by lateral positioning occurred in 20 to 30% of the patients and significantly affected the placement of the acetabular component.
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Kentaro Nomura, Makoto Osaki, Akira Hozumi, Tatsuya Fukushima, Hiroyuk ...
2010 Volume 59 Issue 4 Pages
778-783
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Short-term and mid-term results of bipolar hip arthroplasty (BHA) and total hip arthroplasty (THA) for idiopathic osteonecrosis of the femoral head (ION) were reviewed. We investigated a total of 73 hips treated with BHA and THA from 1996 to 2006. The follow-up period was between 3 to 13.5 years (average of 7.6 years). Forty-seven hips were treated with BHA and 26 hips with THA. The average age of BHA group at the time of surgery was 45.5 years and THA group was 50.4 years. Clinical evaluation was based on the JOA score. In both groups, the preoperative JOA score improved to the postoperative JOA score and there were no significant differences. Postoperative complications; In the THA group, three hips had dislocation of which two needed revision. In the BHA group, dislocation was not observed and one hip needed revision because of infection. Compared with the THA group, radiographic changes were observed more frequently and postoperative pain score was lower in the BHA group.
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Tomotoshi Murakami, Hiroshi Tanaka, Atsunori Tokushige, Toshihiko Tagu ...
2010 Volume 59 Issue 4 Pages
784-787
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of Down syndrome with acetabular dysplasia resulting in recurrent dislocation of the hip. The case was a 12-year-old girl diagnosed with Down syndrome at birth. She underwent surgery three times in total by the age of 1 year and 6 months for anal atresia. During this time, limited abduction and flexion were not pointed out, and it is not known if she had congenital dislocation of the hip. At age two, she was unable to walk but was capable of the seated position, and was conservatively followed-up. At age six, she walked for the first time. In April 2008, she suffered left dislocation of the hip joint for the first time, and manual reduction under anesthetics was possible. After that, due to frequent dislocation, she started to wear a hip abduction brace. But because dislocation occurred repeatedly, she was introduced to our hospital in June of the same year, and underwent left acetubular rotation osteotomy and capsular plication. There are various reports on recurrent dislocation of the hip accompanying Down syndrome due possibly to the acetabular dysplasia and joint laxity. For this case, we conducted left crotch arthroplasty. There is a need to continue careful follow-up even on healthy sides in the future.
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Makoto Nagasawa, Etsuo Chosa, Takero Sakamoto, Shinji Watanabe, Tomohi ...
2010 Volume 59 Issue 4 Pages
788-791
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of endoscopic iliotibial band release for contracture of the tensor fasciae latae muscle-iliotibial band. A 20-year-old female consulted our hospital complaining of abduction and flexion contracture of the hip joint.
We could not confirm any history of intramuscular injection in her childhood.
We performed operation after she resisted conservative therapy.
Endoscopic iliotibial band release for the contracture of the tensor fasciae latae muscle-iliotibial band improved excursion and claudication.
Use of the endscope is generally good for intra-articular treatments. In this case it was useful for the treatment of hypodermic tissue.
This operation confirms contracture under movement and minimally invasive surgery.
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—Including Operative Cases—
Takuya Akamine, Nobutaka Taguchi, Dai Takata, Shinya Maki
2010 Volume 59 Issue 4 Pages
792-794
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We investigated the effects of therapeutic exercise in water in a temperature-adjusted pool on 12 females, and one male patient with osteoarthrosis of hip joints (average 56.5 years old, average Japanese Orthopaedic Association score 70.2).
Obesity, VO
2 max, elasticity of the trunk and lower extremities improved significantly (p≤0.05) after a six-month course of therapeutic exercise in water (two session a week). Evaluation of their Japanese Orthopaedic Association scores showed that pain, daily activities and total score had significantly improved (p≤0.05) by the six-month course of therapeutic exercise in water. Under-water therapeutic exercise enhances the motivation to become fither in patients with osteoarthrosis of the hip joint regardless of whether they have undergone operation or not.
We conclude that therapeutic exercise in water is an effective treatment for patients with osteoarthrosis of hip joints due to the water buoyancy and resistance.
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Takafumi Tajima, Keiichi Yumisashi, Katsuhiko Ishibashi, Kenichiro Nak ...
2010 Volume 59 Issue 4 Pages
795-798
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We performed 53 femoral head prosthesis replacements for femoral neck fractures in two years since April 2007, but early post-operative infection occurred in five patients (9.4%). This was high incidence in comparison to other reports (0.7 to 3.8%), so we investigated the factors of infection. We compared the infected group consisting of five patients to the non-infected group consisting of 44 patients who were operated in the same period. We investigated retrospectively the standby days, risk factors, pre-operative blood tests, anticoagulant therapy, operating time, amount of bleeding, and perioperative antibiotics. No significant differences were seen for each factor. We could not determine the factors of infection through the comparison of the two groups, but we suspect that influence of operating time and strong anticoagulant therapy are factors.
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Yuko Imamura, Shinjiro Tomita, Nobuhiro Urakawa, Masakazu Kan
2010 Volume 59 Issue 4 Pages
799-801
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Sternoclavicular pyogenic arthritis is a relatively rare infection. We report a case of pyogenic arthritis of the sternoclavicular joint (SCJ).
A 40-year-old healthy man complained pain and swelling in the left of SCJ. X-rays did not show marked change. T2-weighted images showed high signal massive lesion around the SCJ and CT findings showed osteolytic change at SCJ. White blood cell count was 8200 /μl, CRP was 13.95 mg/dl, and ESR was 85 mm/l st h. Aspiration drainage and antibiotic drug therapy were perfomed after admission, but the osteolytic lesion expanded in CT. Needle aspiration of the abscess detected peptococcus, and then operative debridment was performed. After operation, there was no recurrence. Although pyogenic arthritis of the SCJ is rare in healthy adults, differential diagnosis of the SCJ should be considered in the first stage of occurrence. Early diagnosis and appropriate treatment of infections of the SCJ provide better outcome.
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Yasuto Tsukutani, Yasuhiro Kameyama, Toshinobu Umeki, Ryunosuke Kono
2010 Volume 59 Issue 4 Pages
802-805
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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A 10-year-old boy was admitted with a 38°C fever and pain in the right hip, tenderness in the right hip, and buttock limiting movement of the right hip joint. Magnetic resonance imaging (MRI) showed a buildup of joint fluid, but no abnormalities in the pelvic region. The joint fluid could not be aspirated; suspecting septic hip arthritis, we administered intravenous antibiotics resulting in a reduction of the inflammatory response. However, on the 26th day of admission, T2-weighted MRI showed areas of high signal intensity in the iliac and pubic bone; we administered intravenous antibiotics again. However, MRI images on the 39th day showed increased buildup of joint fluid; discharge of pus was also aspirated from the right hip joint. Diagnosing septic hip arthritis, we performed drainage. Continuous irrigation and intravenous antibiotics led to reduced inflammatory response and MRI free of abnormalities. The use of intravenous antibiotics and drainage provided a good results. In this paper, we studied the route of infection from case history and MRI.
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Nobuhiro Urakawa, Masakazu Kan, Shinjiro Tomita
2010 Volume 59 Issue 4 Pages
806-808
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Thirty-nine patients with highly active rheumatoid arthritis (RA) were treated with leukocytapheresis (LCAP). The clinical response was evaluated at four and eight weeks after a series of LCAP using the 28-joint disease activity score (DAS28). DAS28 after this treatment improved with significant difference at four weeks and eight weeks. There were no serious side effects. LCAP is a safe and effective therapy for patients with RA.
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Kazuhiko Sonoda, Junichi Shida, Takahiro Hamada, Toru Yamaguchi, Mitsu ...
2010 Volume 59 Issue 4 Pages
809-812
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Many reports on the efficiency of etanercept in patients with rheumatoid arthritis (RA) have been reported to date. The authors have been doubtful about administering the approved doses in Europe and the U.S. to Japanese patients with RA weighing 20kg less than European and American patients on average. Thus in this study, we examined the appropriate dose for Japanese patients. We investigated whether state of remission can be maintained even if we extend the interdose interval to once in two weeks for patients with remission of RA taking etanercept twice a week. Five out of six patients succeeded in maintaining remission. The results of this study suggest that decreasing etanercept gradually is effective for patients with remission of RA and that efficacy of etanercept can be maintained even with a once-every-two weeks dosage.
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Tomonori Tajima, Takahiro Nakamura
2010 Volume 59 Issue 4 Pages
813-816
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We present a case report of cubital tunnel syndrome caused by angioleiomyoma with calcification. A 61-years-old man complained of numbness of his right 4 th and 5 th fingers and grip strength weakness. The tumor was palpable as an elastic hard mass in the right cubital tunnel. Radiographic studies revealed a mass with calcification. Magnetic resonance imaging showed a mass in the subcutis. Resection biopsy was performed. The specimen, measuring 3.0×2.0×1.5 cm, was a well-encapsulated white mass with calcification in the distal part. Histopathological analysis showed vascular structures and interlacing bundles of smooth muscle fibers. Angioleiomyoma is a benign smooth muscle tumor which arises from the tunica media of small veins and arteries, and usually occurs in the extremity. Angioleiomyoma with calcification and neuropathy is rare case.
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Shuta Yamada, Akihiko Yonekura, Tomohiko Asahara, Takashi Miyamoto, Hi ...
2010 Volume 59 Issue 4 Pages
817-821
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case of intra-articular lipoma of the knee limiting range of motion. A 37-year-old woman presented with left knee pain and limited range of motion. Although she felt only pain at first, gradually knee motion became limited. X-ray and magnetic resonance imaging (MRI) showed no pathologic evidence. Arthroscopic examination revealed that the tumor was located between ACL and PCL. Extension movement showed impingement of the tumor at the intercondyler notch. Histological examination confirmed the diagnosis of lipoma. Intra-articular lipoma is rarely seen. According to past literatures, half of all intra-articular tumors of the knee limiting range of motion is pigmented Villonodular synovitis. On the other hand, lipoma is seen only rarely. In such cases, it is difficult to diagnose tumor by MRI, and arthroscopic examination is reguired.
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Takayuki Nakamura, Toshitake Yakushiji, Hiroo Sato, Kiyoshi Oka, Takuy ...
2010 Volume 59 Issue 4 Pages
822-825
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a rare case of intra-articular lipoma with cartilaginous metaplasia. The case was a 54-year-old female woman who developed a tumor in her right knee without cause. Because it started growing, she visited our hospital. In the first medical examination, soft elastic tumor of 7×5 cm in size was seen at the distal lateral side of the right knee patella. There were no plessure pain nor localized warmth, and range of motion of the right knee was not limited. MRI findings showed the tumor to have high signal intensity in T1WI and T2WI. Fat suppression was carried out by fat saturation. The tumor also had a region of low signal intensity in T1WI, and iso signal intensity in T2WI. Suspecting the tumor to be intra-articular lipoma of the right knee, we made an incision of the right knee capsule, and resected the marginal tumor. The tumor was found to obtain the feeder from the infrapatellar fat-pad, no adhesion with the surroundings was seen, and the tumor could be removed as one mass. In addition, the tumor was covered with thin capsule, composed of mature fat cells, and found to be fibrous cartilage in histological tests. As a result, the tumor was diagnosed as lipoma in the knee joint with cartilage metaplasia.
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Kentaro Sugiyama, Kenji Kumagai, Masato Tomita, Yoshihiro Nozaki, Hide ...
2010 Volume 59 Issue 4 Pages
826-829
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Inflammatory well-differentiated liposarcoma is a rare subtype of liposarcoma. This tumor often mainly occurs in the retroperitoneum. We present a case in which it occured in a 75-year-old female. An elastic hard mass measuring 15×10 cm was found in the medial right thigh did not show any pain, tenderness, redness, or local warmth.
MRI located the tumor in the right adductor magnus muscle. The tumor showed high intensity in T1 weighted image (WI) and T2WI, and suppressed signal intensity of fat-suppressed T1WI. There were multiple non-adipose nodular lesions which showed iso-intensity in T1WI and iso to high intensity in T2WI in the tumor. As we could not obtain the exact diagnosis from incision biopsy, we resected the tumor and diagnosed the tumor as inflammatory well-differentiated liposarcoma histologically. After operation, we performed radiation therapy (50Gy/25fr) in order to control the operation site. The postoperative course was uneventful and the patient survived for seven months after surgery with no evidence of recurrence.
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Yoshihiro Nozaki, Masato Tomita, Rintaro Ikeda, Hideyuki Hayashi, Masa ...
2010 Volume 59 Issue 4 Pages
830-835
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Arteriovenous malformation (AVM) is classified as a type of congenital venous malformations. It is sometimes difficult to distinguish AVM from malignant soft tissue tumor based on the clinical findings. The authors report a case of AVM that brought about pseudoaneurysm without any events.
A 49-year-old female who recognized a tumor on her left thigh from one year ago complained of an increase in the size of the tumor and pain. Physical examination showed a large tumor from the medial to posterior part of the left thigh. The size of the tumor was about 31×27 cm, an elastic hard mass by palpation, and resembled arterial murmur by stethoscope.
A malignant soft tissue tumor was suspected based on the rapid increase in size and physical findings at the first visit to our outpatient clinic. Ultimately, diagnosis was made as AVM with pseudoaneurysm using enhanced CT and angiography. Embolization procedures were required three times to prevent blood flow into the pseudoaneurysm, occluding the branches of superficial femoral artery and superficial iliac artery, which fed the AVM. Psudoaneurysm was occluded finally, but all feeders were not occluded because of broad AVM exposure. Continuous follow-up is necessary due to the risk of rebleeding from AVM.
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Daisuke Shiraishi, Toshitake Yakushiji, Hiroo Sato, Kiyoshi Oka, Takeh ...
2010 Volume 59 Issue 4 Pages
836-839
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report a case with chronic expanding hematoma complicated by lung cancer. A 63-year-old man noticed a mass of his left dorsal region about one year ago. The elastic soft mass, 10 centimeters in diameter, was palpable at the inferior angle of the left scapula. Magnetic resonance imaging showed mass heterogeneous signal intensity on both T1WI and T2WI, mild enhancement on gadolinium. Chest CT indicated a nodular lesion of the right lung. As both lesions continued growing for six months, the dorsal lesion was resected and diagnosed as CEH and the lung lesion was diagnosed as SCC from CT-guided biopsy.
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Mitsuru Doi, Kenji Kumagai, Masato Tomita, Yoshihiro Nozaki, Katsumi T ...
2010 Volume 59 Issue 4 Pages
840-843
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Malignant Fibrous Histiocytoma (MFH) is the most common malignant soft tissue tumor. Most have been found in the extremities and trunk. We report a rare case of MFH on the chest wall. A 61-year-old woman noticed a mass on the right chest wall. Malignant tumor was suspected as a result of radiographic examination. The tumor was resected widely and the chest wall was reconstructed with Dualmesh and vasculavized musculocutaneous flap. The postoperative course was uneventful seven months after operation. She had no evidence of recurrence and metastasis, and was able to return to her daily activities.
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Hideki Yamashita, Koji Endo, Yuki Hamamoto, Ryota Teshima
2010 Volume 59 Issue 4 Pages
844-846
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Radiofrequency ablation (RFA) and subsequent alcohol ablation (AA) were performed on two cases with osteoid osteoma of the femur.
Case 1 was a 17-year-old male and case 2 was a 16-year-old male who had received surgical therapy before arriving at our hospital.
The procedure was performed in the CT room in aseptic conditions under general anesthesia. During the procedure, no complication was encountered in both cases. After treatment, pain relief was observed within two days. The patients were free of pain during follow-up for seven and 15 months, respectively.
We were not able to obtain the histological diagnosis of each case because could not remove sufficient specimens by needle biopsy.
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Shinichi Nakahara, Naohiro Tanaka, Takeshi Uchida, Tadashi Tomonaga, A ...
2010 Volume 59 Issue 4 Pages
847-851
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We experienced one case of pyogenic sacroiliitis in pregnancy. The patient was a 22-year-old female complained of left low back pain and left posterior thigh pain in the 26 th week of her pregnancy. Hematologic examination showed severe infection. Because there was no evidence of herniated lumbar disk but hydronephrosis by MRI, we suspected pyelonephritis. Blood culture was positive for Staphylococcus aureus. Intravenous antibiotic treatment for seven days provided good response and she was discharged. But soon she visited our hospital for recurrent pain. MRI findings showed pyogenic sacroiliitis. Another three-week intravenous antibiotic treatment improved her subjective and objective findings. It is generally difficult to diagnose pyogenic sacroiliitis, but it should be suspected especially in pregnant women.
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Takuya Oyaizu, Hiroaki Tamura, Masayuki Kawashima, Mahito Kawashima
2010 Volume 59 Issue 4 Pages
852-854
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Squamous cell carcinoma is known to occur from Marjolin's ulcer in chronic osteomyelitis, but this is very rare. The most significant signs of malignant degeneration are any unusual changes in the ulcer including hemorrhagic tendency, modification in size, increase of discharge, foul smell and pain. Multiple biopsies are required at the suspected location promptly.
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Kousuke Shigetome, Kei Yamada, Kensei Nagata, Kimiaki Sato, Mamoru Mit ...
2010 Volume 59 Issue 4 Pages
855-859
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Bacterial spondylitis is rarely caused by anaerobic organisms. We report a case with lumbar spondylitis caused by Bacteroides species. A 77-years old male was admitted for lumbar pain and drainage from dermal fistula. He had a medical history of tuberculous bronchopneumonia and spondylitis. Plain X-ray showed fused vertebral bodies between L4 and L5. Magnetic resonance image comfirmed mass lesion at the level of L4 and L5 with low signal intensity on T1-weighted and high on T2-weighted images, and the peripheral rim of the lesion was enhanced by intravenous injection of gadolinium on T1-weighted images. Though these findings suggested tuberculous spondylitis, laboratory evaluation disclosed erythrocyte sedimentation rate of 103 mm/hour, which is relatively high for tuberculous spondylitis. We performed transcutaneous vertebral biopsy in L5. Bacterial investigation revealed bacteroides caccae and Peptostreptococcus micros. Polymerase chain reaction could not detect tubercle bacillus from the biopsy specimen. The patient underwent antibiotherapy following anterior curettage of infectious vertebral body and bone grafting from the iliac bone. Five weeks after the operation, laboratory data improved and he did not have lumbar pain. Though anaerobic bacteria is an uncommon cause of infectious spondylitis, antibiotherapy and surgical curettage are useful for treating Gram-positive cocci spondylitis.
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—Radiographic Changes—
Ryosuke Yamaguchi, Taichi Saito, Isao Saikawa, Tsutomu Irie, Tetsuya T ...
2010 Volume 59 Issue 4 Pages
860-864
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Crowned dens syndrome (CDS) is characterized by acute severe neck pain, mobility restrictions of the neck, calcifications around the odontoid process of the axis on computed tomography and elevated inflammatory responses. We encountered a protracted CDS patient for whom corticosteroid administrations were effective. We report the clinical course and radiographic changes of the patient from follow-up radiographs. In radiographs of the cured patient, calcifications around the odontoid process on CT had reduced, and atlantoaxial joint-centered wide inflammatory changes on MRI had disappeared.
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Toru Okano, Masako Hayashibara, Kei Kawaguchi, Ryoji Otsuki, Ryota Tes ...
2010 Volume 59 Issue 4 Pages
865-868
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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Two hundred fifty-eight primary total hip arthroplasties (THA) were performed via the anterolateral approach at this institution between March 2000 and December 2008.
A fracture of the greater trochanter developed in 6 cases (2.3%). No fractures occurred from 2000 to 2005, 1 occurred in 2006, 1 in 2007, and 4 in 2008.
Three oblique fractures of the greater trochanter occurred intraoperatevely. The other 3 transverse fractures of the greater trochanter all occurred postoperatively.
All oblique fractures were fixed with wires, and displacement of the greater trochanter and posterior dislocation of the hip occurred in one case of three cases.
All transverse fractures were followed up without any treatment, and no complications occurred except for non-union, which occurred in two of three cases.
While the skin incisions have gradually become smaller since 2003, there was also an increased incidence of fracture of the greater trochanter after 2005.
This indicates that careful manipulation is necessary to avoid fractures of the greater trochanter when manipulating the femur in THA via the anterolateral approach with a small incision. Proper bone fixation is required for oblique fractures of the greater trochanter, because such cases may result in the posterior instability of the hip.
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Kazumasa Maeda, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Akira ...
2010 Volume 59 Issue 4 Pages
869-871
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We report two cases of crowned dens syndrome.
Case1: A 68-year-old woman had severe neck pain. CT showed calcium deposits posterior to the odontoid process of the axis. She was treated with a nonsteroidal anti-inflammatory drug (NSAID), and was cured in five days.
Case2: A 38-year-old woman had severe neck pain and headache. CT showed calcification at the left side. She was administered with a combination of NSAID and predonisolone, and her symptoms were relieved in two days.
In both two cases, drug therapy relieved their symptoms within a week.
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Umito Kuwashima, Kuniyoshi Tsuchiya, Hidehiko Yuge, Osamu Tomishige, H ...
2010 Volume 59 Issue 4 Pages
872-874
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We reviewed six patients (three males and three females, mean age 72 years) who underwent hemilaminectomy for cervical spondylotic myelopathy. Three patients underwent level 1 laminectomy, and three patients underwent level 2 laminectomy. Mean operation time was 103 minutes and mean blood loss was 63 ml. All patients improved neurologically. One patient had postoperative neurological deterioration caused by epidural hematoma, who recovered with the removal of the hematoma. Although it is a safe surgical procedure the indications for this technique still need to be studied. However cervical hemilaminectomy for myelopathy should be less invasive and effective for preventing post-operative problems such as axial pain.
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Ken Miyaoka, Shinji Tomari, Yasumasa Ito, Kenichi Seo, Katsuhiko Kikuc ...
2010 Volume 59 Issue 4 Pages
875-879
Published: September 25, 2010
Released on J-STAGE: December 08, 2010
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We examined and report changes in MRI findings for cervical or thoracic epidural hematoma treated conservatively at our hospital. Case 1 was a 16-year-old man who experienced sudden back pain during muscle exercise, followed by muscle strength reduction of both lower extremities 30 minutes later. Paralysis occurred below both iliopsoas, and MRI findings indicated thoracic epidural hematoma. Case 2 was a 41-year-old man who experienced acute posterior neck pain without reason while taking a bath, and right hemiplesia appeared. MRI findings indicated cervical epidural hematoma. Case 3 was a 80-year-old woman. She had affected myocardial infarction and used warfarin sodium internally. Sudden pain and palsy occured from her right shoulder to upper extremity and MRI findings indicated cervical and thoracic epidural hematoma. We decided to cure these three cases conservatively and enforced steroids pulse therapy. Improvement of their palsy began two or three hours after examination, palsy improved completely in all three cases after four to 12 days of rest, and their hematomas were seen to well reduce on MRI.
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