-
Masayuki Kanazawa, Yasuharu Nakasima, Takuaki Yamamoto, Taro Mawatari, ...
2011 Volume 60 Issue 1 Pages
1-4
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Purpose: Tantalum porous is a new material used for the surface of artificial joints because of it is high biocompatibility. We report here the minimum 5-year clinical results of cementless total hip arthroplasty using the tantalum porous acetabular component (TPC).
Methods: The patients examined were 31 cases 32 hips including seven men and 24 women. The mean age at operation was 60.6 years and the mean follow-up period was 63.2 months. Clinical results were evaluated using the Japanese Orthopaedic Association (JOA) hip score and the presence of implant loosening, radiolucency, gap between the implant, and acetabular bone were examined for radiopraphic results.
Results: The JOA hip score improved from to 46.7 points to 84.1 points at the final follow-up. There were no cases of dislocation, infection, and revision surgery. There were also no cases with implant loosening and periprosthetic radiolucency around TPC. Even though a 1 mm oversized sized reamer was used in most cases, eight hips had a the gap greater than 1mm. All of them showed gap filling at an average of 5.2 months after operation.
Conclusions: Because TPC has large scratch effect on the host bone, some cases had gaps between the TPC and bone. However, these gaps were filled with bone in less than six months.
View full abstract
-
Takahiro Yara, Toshikatsu Tominaga, Shintaro To, Hisashi Yamamoto, Hid ...
2011 Volume 60 Issue 1 Pages
5-8
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
This study evaluated the clinical and radiographic results of total hip arthroplasty in 42 cases using the Profemur Z femoral component with a modular neck system.
We followed them up for a period of more than six months, and evaluated their JOA score, range of motion of hip joint, complications, and radiological findings.
As a result, we obtained good clinical and radiological results, and found no complications associated with the use of the modular neck system.
The use of a modular neck system enables the surgeon to have greater control of the limb length while restoring geometry. As both femoral offset and version can be controlled, outcome is better.
It is important for surgeons to pick cases suitable for the modular neck system.
View full abstract
-
Kenta Kamo, Mutsuaki Kai, Masakazu Koduma, Shinya Makino, Michitaka Yu ...
2011 Volume 60 Issue 1 Pages
9-12
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Introduction: The features of large-diameter metal-on-metal articulation were high stability and good range of motion. We reported our experience and short-term results of this method, and compared it with the use of the 32 mm-diameter head.
Subjects: We reviewed retrospectively 11 primary THAs between October 2009 and December 2009. Patients included one male and 10 females. The average age at the time of surgery was 71.6 years. The average BMI was 23.1 kg/m
2.
Results: We used the MIS posterolateral approach. The average skin incision was 106.5 mm. During the short follow-up period (average postoperative days 76.4), there were no dislocations. The hip-flexion angle improved from 87.7 degree to 104 (p = 0.014). However, compared to the use of the 32 mm-diameter head, trial reduction was difficult and additional procedures such as lengthening of skin incision and partial release of gluteus muscle were required.
View full abstract
-
—Possible Mechanisms of Cervicogenic Headache—
Koji Yoshida, Yoshihiko Kato, Toshihiko Taguchi
2011 Volume 60 Issue 1 Pages
13-15
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Cervicogenic headache is pain perceived in the head but referred from a primary source between the trigeminal afferents and afferents from the upper three cervical spinal nerves.
The possible source lies in the structures innervated by the C1 to C3 spinal nerves. To comfirm this theory, we used capsaicin which causes extravasation in the occipital lesion to intervertebral discs in rats. We administered 10 ug of capsaicin into the anterior portion of the cervical intervertebral discs of rats injected with Evans blue intravenously to cause dye extravasation in the occipital area. The results suggested that the administration of capsaicin may contribute to cervicogenic headaches associated with intervertebral disc lesions.
View full abstract
-
Norihiro Nishida, Yoshihiko Kato, Yasuaki Imajo, Kotaro Kimura, Shunic ...
2011 Volume 60 Issue 1 Pages
16-19
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Background: Brown-Séquard syndrome (BSS) is a syndrome caused when there is a lesion in one side of the spine. We analyzed the mechanism of the disease using the finite element method.
Method: Our 3D FEM spinal cord model consisted of gray matter, white matter, and pia matter. The degrees of static compression were 10, 20, and 30% of the AP diameter of the spinal cord.
Results: The stresses of the spinal cord were very low under 10% compression. After 20% compression, the stresses were low in gray matter and the anterior funiculus. After 30% compression, the stresses on the spinal cord became higher in the gray matter and the anterior, lateral, and posterior funiculus. The stress distribution was low in other side posterior funiculus.
Discussion; After 20% compression, myelomere symptoms and dysesthesia developed. After 30% compression, spasticity and bathyesthesia abnormality developed.
Conclusion: We analized BSS using FEM and obtained the above results.
View full abstract
-
Yuichiro Morishita, Hideki Ohta, Masatoshi Naito, Yoshiyuki Matsumoto, ...
2011 Volume 60 Issue 1 Pages
20-23
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Conjoined lumbosacral nerve root is often undetected even in advanced imaging studies. In this study, we carried out a retrospective evaluation of the intraoperative identification of three cases of conjoined nerve root anomaly encountered during microendoscopic discectomy (MED). A total of 78 patients with lumbar disc herniation were treated by MED over one year. None of the subjects were diagnosed with conjoined nerve root anomalies preoperatively. Three out of 78 patients were found to have conjoined nerve root anomaly intraoperatively. All patients were male, and all demonstrated L 5-S1 herniated discs. All subjects showed Type 2A of S1 conjoined nerve root based on the classification of Neidre. After surgery, all subjects showed excellent clinical results. In our study, 3.85% of unsuspected conjoined nerve roots were detected intraoperatively. None demonstrated pseudolocalizing neurological sign preoperatively, and preoperative diagnostic images did not clearly identify nerve root anomalies. Surgeons must always bear in mind of the possibility of nerve root anomaly during any surgical exploratory procedure. When unsuspected nerve root anomalies are found intraoperatively, the surgeon should extend decompression proximally and continue the surgery with sufficient space available for operation.
View full abstract
-
Shinji Tanishima, Chikako Yakura, Masako Hayashibara, Akira Tanida, Ya ...
2011 Volume 60 Issue 1 Pages
24-27
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Osteochondroma is most commonly located in the extremities, and rarely located in the spinal canal region. We reported a case of osteochondroma in the thoracic spine.
The patient was a 16-year-old man who experienced giving way of his left knee while practicing baseball. He consulted a physician at our hospital, and was diagnosed as meniscus injury. MRI study revealed no injury in his knee. One month later, he experienced weakness of both lower extremities. The patient underwent magnetic resonance imaging and computed tomography after myelography of the thoracic spine, and the results showed bony tumor from the superior articular process of T8. This tumor existed in the spinal canal and pressed the spinal cord. Because gait disorder had progressed, operation was performed. Postoperative clinical examination demonstrated minimal spastic paralysis. Gait disorder improved and histopathologic examination comfirmed a benign osteochondroma.
View full abstract
-
Takashi Inokuchi, Hironobu Akune, Satoshi Shin
2011 Volume 60 Issue 1 Pages
28-31
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We describe 2 cases of posterior decompression with instrumented fusion by posterior approach for extensive ossification of the posterior longitudinal ligament and good short-term clinical results. Before surgery, patients were unable to stand up and walk independently. There OPLLs were large, beak-shaped, located at the top of the vertebral kyphosis, and T2 high intensity area indicated spinal cord damage at MRI. We performed posterior decompression with instrumented fusion by posterior approach, and combined one of these with the anterior decompression method via posterior approach reported by Otsuka in 1996. No perioparative complications occurred. The patients showed improvement of myelopathy after the operation and those who could not walk before surgery recovered the ability to walk independently or with a cane. Their average Japanese Orthopaedic Association Score for thoracic myelopathy (full score 11 points) improved from 6.0 points preoperatively to 8.5 points postoperatively. We concluded that posterior decompression with instrumented fusion by posterior approach is useful and that anterior decompression can be combined via a posterior approach in some cases with extensive ossification of the posterior longitudinal ligament.
View full abstract
-
Ryuzo Kodera, Hirokazu Yano
2011 Volume 60 Issue 1 Pages
32-35
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
To promote the awareness of locomotive syndrome, we have been carrying out various activities ranging from lectures for doctors and the public promoting awareness in health magazines and on TV.
We first gave a lecture for general doctors on the consept of locomotive syndrome at the East Oita Medical Association in July 2009.
We then gave a public lecture at the Ikoinomura Kunisaki in October 2009.
We also published a health magazine for citizens.
After that, we lectured patients on locomotive syndrome in our hospital, as well as lectured citizens at the Ozai Community Center in March 2010.
We have also been giving lectures on this syndrome to residents in our hospital.
Through these activities, it was found that locomotive syndrome is still generally unknown.
In order to spread the word of locomotive syndrome, orthopedic surgenons need to promote awareness continuously.
View full abstract
-
Shinsaku Ogimoto, Toshio Kitamura
2011 Volume 60 Issue 1 Pages
36-40
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We have been carrying out arthroscopic rotator cuff repair since September 2008. In this study, we reviewed 90 initial cases of arthroscopic rotator cuff repair using suture anchors.
Five cases switched to open surgery because of the dislocation of the suture anchor. Three were male whose rotator cuff tear was larger than massive tear. Their average age was 60.0 years. The other two cases were female older than 70. One has large tear and the other has medium tear.
ARCR with suture anchors in now a common choice in rotator cuff repair. Tendon healing depends on the secure fixation of the rotator cuff to the bone bed. Loosening of the anchor disables ARCR.
View full abstract
-
Yuichiro Nishino, Takafumi Torigoshi, Shinsuke Someya, Takayuki Yamagu ...
2011 Volume 60 Issue 1 Pages
41-45
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report the results of the treatment for proximal humeral fractures using locking plate. The subjects consisted of one male and eight females with a mean age of 61.3 years (38 to 76) studied between September 2007 and November 2009. According to AO classification, two fractures were classified as type A3, two as type B1, two as type B2, two as type C1, and one as type C2.
We used the Proximal Humeral Internal Locking System (PHILOS) with a deltopectral approach. Bone union was obtained in all patients, but four complications were seen during the follow-up period. They were two upward transposition of the greater tubercle, one infection, and one complex regional pain syndrome (CRPS). The mean JOA score at final review was 79.7 (59 to 97).
The locking plate is useful because it provides rigid stability, but it was important to set the locking plate at the appropriate location with anatomical reduction.
View full abstract
-
Naotoshi Ninomiya, Koshi Furusho
2011 Volume 60 Issue 1 Pages
46-50
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Proximal humeral fracture is commonly seen in elderly patients with advanced osteoporosis. We report the results of cases treated with intramedullary nails and locking plates at our hospital together with a review of literature published on the use of these fixation devices. PATIENTS: 22 patients (22 cases) of proximal humeral fracture were treated at our hospital between April 2004 and December 2009. Intramedullary nails were used in 12 cases (group N) and locking plates in nine cases (group LP). METHODS: JOA score was used to evaluated the functional outcome of each case. Complications were also analyzed. RESULTS: The average JOA score for both groups was 85.2 points, 86.9 points for group N, and 82.9 points for group LP. Dislocation was seen in two cases, one of which turned into pseudarthrosis. There was no humeral head necrosis, axillary nerve palsy, infection, or re-fracture. DISCUSSION: The advantage of intramedullary nailing is less pain, for the skin incision is small and there is no need for exposure of the operative site. Operation is comparatively easy and short. On the other hand, locking plate offers excellent angular stability and enables osteosynthesis even in cases with severe comminution and osteoporosis.
View full abstract
-
Toru Asakura, Kunichika Shin, Kenjiro Ooe, Koumei Matsuura
2011 Volume 60 Issue 1 Pages
51-54
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Distal clavicular fractures have such small bone fragments at the distal end that osteosynthesis is difficult. Until now, distal fragments of fractures were usually fixed using k-wires and plates across the acromioclavicular joint. This method however had the disadvantage of limiting full abduction. The Scorpion plate was thus developed to resolve this problem by fixing only the clavicle using screws and two hooks.
We treated three patients with distal clavicular fractures at our hospital using the Scorpion plate. Their mean age was 59.0 years old and they consisted of one male and two females. One case was type 2B and the other two were type 5 according to Craig's classification. All cases were fixed with the Scorpion plate and two k-wires from the distal end of the clavicle. The two type 5 cases were bound with fiber wires at the third fragment. Excellent union was achieved in all three cases at follow-up.
View full abstract
-
Yuya Kodama, Meguru Inoue, Yuji Moriya, Naoaki Kahara, Tadashi Miyamot ...
2011 Volume 60 Issue 1 Pages
55-60
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We evaluated the clinical and radiological results of internal fixation with AO clavicle hook plate for the treatment of acromioclavicular joint dislocation of Tossy Grade III and V. Ten patients were reviewed in the study. There were nine males and one female aged 51 to 75 years old (average 32 years old). Mid-term outcome with a mean follow-up of 35 months was evaluated using the JSS score system. Radiological examination of reductive status after surgery and stress X-rays of the shoulder girdle were radiologically examined postoperatively. The average JSS score was 93.4. There were complications included re-subluxation in two (20%) and acrominal bone erosion in six (60%). To prevent subluxation after removal of the implant, we recommend over-reduction of AC joint and to reduce the possibility of bone absorption, we emphasize the importance of checking the implant position and size.
View full abstract
-
Tomoyuki Sawatari
2011 Volume 60 Issue 1 Pages
61-64
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Reverse digital artery flap is useful for treating injuries of finger tips. But congestion of the flap occurs at a high rate due to insufficient venous return. We report the use of "chemical leech" to improve this congestion.
View full abstract
-
Keisuke Saita, Hiroshi Yasunaga, Ken Takeda, Nobuhiko Watanabe
2011 Volume 60 Issue 1 Pages
65-68
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Extensor tendon rupture in association with osteoarthritis of the distal radioulnar joint rarely occurs.
The purpose of this study was to examine seven cases (eight hands), and investigate the factors and mechanism of extensor tendon rupture, as well as the differences between genders and the causes of pain from individual radiographs and previous findings.
The causes of high incidence of a tendon rupture were the dorsal inclination of the sigmoid notch and ulnar plus variance which occurs frequently among males.
The mechanism of tendon rupture was synovitis around the tendon, and disruption of the blood supply to the tendon, as well as mechanical friction to the tendon resulting from the dorsal inclination of the sigmoid notch, ulnar plus variance, and the change of the ulnar head to osteoarthritis.
Lower contact pressure between the carpals and dorsally shifted ulnar head may reduce symptomatic pain.
Because of painlessness or minimum pain, many patients seek medical assistance long after the tendon ruptures. Therefore as a treatment option, reconstructive surgery is needed which includes treatment of the ulnar head and tendon transfer.
View full abstract
-
Kenji Tsunoda, Akihiko Asami, Hideki Ishii, Tomohito Yoshihara, Hirofu ...
2011 Volume 60 Issue 1 Pages
69-71
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We presented nine cases (four males and five females, age range 19 to 77 years) of spontaneous posterior interosseous nerve palsy. Three cases were treated conservatively, six cases were treated surgically (three for simple interfascicular neurolysis only and others for interfascicular neurolysis by tendon transfer). All cases recovered to 4 or 5 on MMT, except for one case with diabetes and cervical myelopathy. Based on these results, we recommend that posterior interosseous nerve palsy should be treated conservatively for 10 months after onset, and tendon transfer should be considered for patients not showing recovery, for example elder, diabetes and myelopathy.
View full abstract
-
Kunihide Muraoka, Hidetoshi Onoue, Kazuo Kimura, Hikaru Saita, Takeshi ...
2011 Volume 60 Issue 1 Pages
72-75
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
From 1995 to 2009, we treated 11 cases of scaphoid nonunions, and report treatment details due to the excellent outcome. They consisted of eight males and three females, and their mean age at operation was 34 years, ranging from 8 to 67 years. The volar approach was used. First the nonunion gap was exposed and debrided carefully into the medullary cavity, after which the corticocancellous graft obtained form the iliac crest was shaped into a rectangle slightly larger than the defective bone. After this, cancellous bone chips were filled into the medullary cavity, and the cortical side of the corticocancellous graft was driven in towards the palmar aspect with a surgical hammer. Finally, the scaphoid was internally fixed using Acutrak or Herbert screws. The mean operating time was 99 minutes, ranging from 69 to 157 minutes. Postoperatively, the patients wore a thumb spica cast for two to four weeks. All patients achieved union radiographically in 55 weeks on average, ranging from 33 to 118 weeks. No complications nor clinical symptoms were seen.
View full abstract
-
Kuniyoshi Tsuchiya, Kenichi Kawaguchi, Yusuke Kohno, Hideya Kawamura
2011 Volume 60 Issue 1 Pages
76-79
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
A total of ten cases of cervical radiculopathy were treated with posterior foraminotomy. Eight cases were treated microscopically and two were treated microendoscopically. All cases showed obvious improvement and average recovery rate was 92.3%. Although most cervical radiculopathy cases are self-limiting, for those who have persistent symptoms resistant to conservative treatment, microcervical foraminotomy is considered the first choice of surgical treatments in most cases. Strict control of bleeding from the venous plexus around nerve root is considered to be extremely important, and microendoscopic technique is considered to be suitable for this procedure.
View full abstract
-
Hisashi Serikyaku, Tetsuya Yara, Chikashi Yamakawa, Fuminori Kanaya
2011 Volume 60 Issue 1 Pages
80-84
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We reported four cases with spondylotic myelopathy at the cervicothoracic junction. They consisted of three men and one woman whose ages were 54, 62, 65 and 69 years old respectively. All cases complained of gait disturbance and MRI showed compression of the spinal cord at the C7/T1 level and high intensity lesion at the level in T2 weighted images. We investigated sensory change, hand dexterity, deep tendon reflex, pathological reflex and muscle power. All cases showed sensory disturbance below the cervical line but none complained of numbness in either arms or fingers. One case had clumsiness at the rigt hand. Deep tendon reflex of upper extremities were intact in all cases and showed hyper reflexia in the lower extremities in three cases. Hoffmann reflex was negative in all cases and Babinski reflex were positive in two cases. Two patients showed weakness of diversion of the right fingers and one showed weakness of finger flexion. These result suggested that cervicothoracic legion should be taken into account for diagnosis in patients with gait disturbance.
View full abstract
-
Hiroki Yoshimatsu, Kenji Yoshida, Kotaro Jimbo, Kenji Tanaka, Kensuke ...
2011 Volume 60 Issue 1 Pages
85-88
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
In cases of cervical spine trauma in elderly patients, specific problems have been pointed out as the number of cases of cervical spine injury, spinal cord injury, or both increases. In this study, we surveyed 801 elderly cases aged 65 years old or older from among 5,836 cases of cervical spine trauma that visited our hospital's emergency outpatient department. A disturbance of consciousness, severe head injury, extremity-pelvic fracture, and distracting pain in another region were respectively observed in 21%, 15%, 16%, and 27% of the cases. Moreover, cervical spine injury, spinal cord injury, or both were observed in 62 cases (7.7%), while cervical spinal cord injury without fracture or dislocation was observed in 24 cases (3.0%). Complications of spinal canal stenosis and OPLL were observed in a high proportion of both the cases of cervical spine injury, spinal cord injury, or both and cervical spinal cord injury without fracture or dislocation. The results of this study indicate the difficulty of clinically examining cervical spine trauma in elderly patients in the emergency outpatient department. In order to provide medical care for elderly cases of cervical spine trauma, it is necessary to understand both the unique traits of trauma in elderly patients and the characteristics of cervical spine injury, spinal cord injury, or both in elderly patients.
View full abstract
-
Kotaro Kimura, Yoshihiko Katoh, Tsukasa Kanchiku, Yasuaki Imajo, Hiden ...
2011 Volume 60 Issue 1 Pages
89-91
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Introduction: To assess the efficacy of posterior spinal shortening for paraparetic or pseudarthrosis patients following vertebral collapse owing to osteoporosis.
Materials and Methods: Twenty-four patients treated with posterior spinal shortening were examined retrospectively. All complications were recorded and analyzed in relation to radiological and clinical outcomes. The group consisted of six men and 18 women aged 57 to 87 years, with a mean age of 75 years. The follow-up period ranged from three to 44 months (average 24 months).
Result: Time of surgery ranged from 185 to 460 minutes, with an average of 307 minutes. Perioperative bleeding ranged from 174 to 3400 g, with an average of 1100 g. The angle of kyphosis was 16.5°; before surgery, 5.2° after, and 8.5° in the last follow-up. 8.2° in the final period. The amount of correction was 11.3°, and correction loss was 3.0°. The mean thoracic JOA score improved from 5.6 points preoperatively to 7.8 points postoperatively.
Discussion: Vertebral compression fractures in osteoporosis are thought to be caused by comparatively minor forces, and are characterized by the late development and slow progression of paraplegia. Posterior spinal shortening can be a choice for treating both delayed paraparesis and pseudarthrosis following vertebral collapse owing to osteoporosis.
View full abstract
-
Koichiro Toyoda, Eiichi Shiigi, Ryutaro Kuriyama, Takenori Fujisawa, Y ...
2011 Volume 60 Issue 1 Pages
92-94
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report our experience in nerve root block using the lateral approach in 13 out of 337 cases (11 males, two females), whose average age was 65. Of the 13, ten underwent surgical therapy. The lateral approach was used because patients could not maintain prone and oblique positions. Many had lateral disc herniation. Only the walking disability score of JOABPEQ differed significantly between the lateral and prone approaches. Nerve root block with the lateral approach is useful for upper lumbar lateral disc herniation in patients who are unable to maintain prone and oblique positions due to lumbar disc disease.
View full abstract
-
Tomonao Chikama, Ko Ikuta, Nobuhiko Yokoyama, Yusuke Takahashi, Takahi ...
2011 Volume 60 Issue 1 Pages
95-100
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
[OBJECTIVE] We conducted a prospective study to assess the effectiveness of a selective nerve root block (SNRB) for lumbar radiculopathy with lumbar disc herniation (LDH) or lumbar canal stenosis (LCS). [METHODS] Between April 2008 and November 2009, 78 patients with radiculopathy were treated with an SNRB. We divided these 78 patients into 49 patients with LDH and 29 patients with LCS. The patients who needed an operation were treated with an SNRB once on an outpatient basis. The SNRB was performed using fluoroscopy. Clinical outcomes were determined by modified Macnab criteria at final follow-up. We assessed the relationships between clinical outcomes and age, disease duration, VAS score, and effective duration of the SNRB. [RESULTS] The efficacy rate in LDH patients was 47%, significantly higher than that in LCS patients (29%). The surgical rate was 39% in LDH patients and 59% in LCS patients. In the effective groups, many patients' SNRB's efficacy exceeded 24 hours. [CONCLUSION] About half of the patients with lumbar radiculopathy could avoid surgery by undergoing an SNRB, so we concluded that SNRBs are useful and that physicians should try one before operating on patients with lumbar radiculopathy with LDH or LCS.
View full abstract
-
Kenta Momii, Kazutoshi Nakaie, Jyunya Ogata, Shinichi Fukumoto, Ryuich ...
2011 Volume 60 Issue 1 Pages
101-104
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Recurrent nerve paralysis after anterior cervical spine operation is a major complication. We report a case of temporary recurrent nerve paralysis after resection of a big cervical anterior osteophyte. An 81-year-old man was referred to our hospital for severe dysphagia. The patient had noted severe dysphagia while eating for the past five or six years. The patient was examined by radiograph, computed tomography, upper gastrointestinal tract endoscopy, and magnetic resonance imaging. Radiography and computed tomography of his cervical spine disclosed osteophytes at the C3-C7 level, and contrast medium swallow test results indicated occlusion of the esophagus at the C3/4 and C5/6 level.
Resection of the osteophytes was performed from C3 to C7 by anterior approach. After operation, he had liquid dysphagia and trachyphomia. Laryngoscope disclosed atrophy and depression of left the vocal cord. He recovered after 158 days.
View full abstract
-
Natsuko Tomimura, Yoshihisa Kawauchi, Koji Sameshima, Shinji Yoshino, ...
2011 Volume 60 Issue 1 Pages
105-108
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We performed lumbar spinal surgery on three patients with Parkinson's disease. After the initial operation, various problems occurred. One patient developed severe scoliosis. One patient contracted lumbar disk herniation at the adjacent level, and another patient underwent post lateral fusion, but the cephalad end plate of the fusion collapsed. Informed consent should be obtained from patients regarding the increased risk of operative complications and they should be followed up for initial operation. Patients with Parkinson's disease must be who have undergone spinal surgery examined carefully taking into consideration the state of the Parkinson's disease.
View full abstract
-
Shunichi Rikimaru, Takahiro Iguchi, Kousuke Sasaki, Takao Mae, Shunsuk ...
2011 Volume 60 Issue 1 Pages
109-111
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We have performed non-fusion stabilization using the semi-rigid screw and rod system on 116 cases for degenerative lumbar spine disease since 2001. During observation, breakage of the pedicle screw was found in the lowest pedicle in nine cases. Most patients were operated in the prone position using the Relton-Hall frame which is a four poster passive support. Lumbar alignment was mainly maintained in the flexion position to achieve decompression. Of the nine cases whose pedicle screws broke, the pedicle screws were inserted into each lumbar vertebral body parallel to each other. One of the reasons for the breakage may be the parallel positioning of the pedicle screws in the flexion position, which can cause excessive stress on the lowest screw in lumbar lordosis at the standing position after surgery. We therefore developed a new device for preventing breakage of lumbar pedicle screws; In the sagittal plane, pedicle screws are inserted radially to the upper and lower lumbar vertebral bodies, and pre-bending rods are used to fasten screw-heads and rods with slight compressive force. At follow-up of at least more than six months postoperatively, the rate of screw breakage was 11.3% (9/80) and 0% (0/36) before and after using the new device. To prevent screw breakage, radial insertion of pedicle screws and use of pre-bending rods taking into account physiological lumbar lordosis at the standing position are desirable.
View full abstract
-
Masatsugu Tsukamoto, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, ...
2011 Volume 60 Issue 1 Pages
112-116
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
[Introduction] Claw toe deformity after low leg injury is a relatively rare complication. We report a case of claw toe deformity after ankle fracture.
[Case] The case was a 67-year-old woman whose lower limb was run over by a heavy agricultural machine during farm work. Medial malleolar fracture was found in the ankle, so open reduction and internal fixation was performed. Postoperatively, external fixation of the ankle was continued for two weeks, and she started walking from partial weight bearing. Four weeks later, she was discharged. But toe clawing developed at a mean interval of six weeks after operation, and she experienced problems in walking. Surgery was performed 3.5 months after surgery. Flexor hallucis longus tendon was stuck together with strong scar tissue, so the scar tissue, was removed, improving the toe deformity.
[Conclusion] There are many causes of claw toe. In this case, it was caused by the adhesion of the flexor hallucis longus tendon. The flexor hallucis longus sends branches into the flexor digitorum longus, and produces flexion contracture of all toes. Correction of the claw toe deformity by the detachment of the flexor hallucis longus produced good results.
View full abstract
-
Koichiro Sakimura, Kotaro Shiraishi, Kazuhisa Kurogi, Masao Eto
2011 Volume 60 Issue 1 Pages
117-121
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We assessed 12 patients with acute malleolar fractures of the ankle which required syndesmosis screw fixation. There were 10 men and two women with a mean age of 38 years (16 to 68). Based on radiographs, the fractures were categorized according to the Lauge-Hansen classification; there were one supination-external rotation fracture and 11 pronation-external rotation fractures. Syndesmosis screws were removed at six to eight weeks after initial surgery. Patients were allowed full weight-bearing after syndesmosis screw removal. All patient achieved bone union with anatomical reduction and pain free ankle with good stability. Two patients had mild limitation of range of motion at follow-up.
Recognition and treatment of syndesmotic injury are essential. Preoperative radiographs are unable to routinely predict the presence of syndesmosis instability. Intraoperative stress fluoroscopy is a valuable tool for the detectation of unstable syndesmotic injuries.
View full abstract
-
Sanshiro Inoue, Naoshi Kikuchi, Yoshikazu Saita, Mitsumasa Ban, Takash ...
2011 Volume 60 Issue 1 Pages
122-124
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We present two 72-year-old men who suffered from a Achilles tendon rupture. They were conservatively treated and successfully achieved their previous activity levels. There were two reasons why they preferred non-operative treatment over surgical treatment. One is high risk of complications of surgery and anesthesia and the other is their low activity level.
View full abstract
-
Noboru Moriguchi, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Mas ...
2011 Volume 60 Issue 1 Pages
125-129
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Pyomyositis and inflammation of the sacroiliac joint are unusual diseases. Pymyositis is potentially serious, and early recognition, appropriate antibiotic therapy, and if indicated, drainage of the muscle abscess are critical to reduce morbidity and mortality. Staphylococcus aureus is the most commonly implicated pathogen, but pneumococcal pyomyositis is very rare.
We report a 4-year-old female with pyomyositis caused by streptococcus pneumonia who presented fever and severe right hip and abdominal pain. Magnetic resonance imaging of the right hip revealed pyomyositis. Abscess grew streptococcus pneumoniae, sensitive to PAPM/BP, CLDM. She was successfully treated with a 5-week course of antibiotic therapy.We report another case of 12-year-old female with inflammation of the sacroiliac joint who presented with fever and severe right hip pain. Magnetic resonance imaging of the right hip revealed inflammation of sacroiliac joint. Blood grew streptococcus aureus, sensitive to CMZ, CFDM. She was successfully treated with a 2-week course of antibiotic therapy.
View full abstract
-
Yoko Katsushima, Ichiro Kadouchi, Akihiro Kawano, Shinji Watanabe, Tai ...
2011 Volume 60 Issue 1 Pages
130-134
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
Pes planovalgus is a common deformity in children and calcaneal lengthning osteotomy is an useful operation. We performed the operation on a 9-year-old female patient with bilateral planovalgus feet and evaluated her pre and post operative states.
Three- dimensional gait data was collected with the ANIMA motion analysis system (MA2000). Four force plates (MG-1090) were used for kinematic analysis. The data of the patient was compared to our data for normal adults before operation and at six months after surgery. The kinetic and kinematic parameter had normalized after treatment. Improvement of feet alignment caused hyperextension of her knees. We have to observe the course of her knees carefully hereafter.
View full abstract
-
Ichiro Kadouchi, Taiichiro Yanagizono, Akihiro Kawano, Yoko Katsushima ...
2011 Volume 60 Issue 1 Pages
135-138
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
In this study, we evaluated the gait characteristics of children who had operated clubfoot, and compared the results with gait parameters without clubfoot or lower extremity abnormalities using gait analysis of the Anima system. Six children with plantigrade and asymptomatic clubfoot (four unilateral clubfeet and two bilateral clubfeet), operated with the posteromedial release method were included. Their mean age at surgery and follow-up time were 1.3 years and 7.5 year respectively. Three-dimensional computerized gait analysis was performed on all subjects, and time-distance, kinematic and kinetic gait characteristics were compared. Time-distance characteristics were almost identical. Ankle power flexion angles, plantar flexor moment, and generated power significantly decreased in the patients. This study shows that even when successfully operated, plantigrade and clinically asymptomatic children with clubfoot have significant gait deviations in ankle joints. Future studies are needed to investigate the accountable factors of gait deviations and possible long-term musculoskeletal morbidity of children with operated for clubfoot.
View full abstract
-
Tetsuhiro Oyama, Takashi Ikeda, Shinichi Miyazaki, Toru Tsuchida, Yasu ...
2011 Volume 60 Issue 1 Pages
139-143
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We encountered a difficult-to-treat case of septic arthritis in which initial treatment failed to control infection. A 10-year-old boy developed fever and pain in the right elbow. An MRI scan during the initial examination revealed retention of synovial fluid in the right elbow and sites with changes in signal intensity on the distal humeral epiphyseal plate. On the same day the patient was seen, emergency surgery was performed. Sites on the epiphyseal plate with changes in signal intensity as indicated by the preoperative MRI could not be identified, so these sites were left untreated. A subsequent postoperative MRI scan revealed enlargement of the sites with changes in signal intensity on the epiphyseal plate. Infection subsided as a result of subsequent surgery in the form of capsulotomy and sequestrectomy on the epiphyseal plate. Subsequent surgery revealed the presence of sequestra at the epiphysis, so the epiphysis is believed to be the source of infection. Surgical treatment in the form of usual synovectomy and irrigation failed to resolve the condition when it initially developed, so an approach as extreme as curettage of the epiphysis was necessary.
View full abstract
-
Yoshiki Matsumoto, Hitoshi Uchida, Toshio Kitamura, Hirokazu Takai, At ...
2011 Volume 60 Issue 1 Pages
144-147
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report a case of atraumatic fracture of the sternum in a 80-year-old female patient. She had a past history of multiple lumbar vertebra pressure fracture. She complained of sudden serious chest pain without trauma. She had severe tenderness of the sternum at the first medical examination. X-ray showed that the fracture was located in the part above 1/3 of the corpus sterni in the sternum, and that it was not pathological fracture.
Double energy X-rays absorption (DXA) revealed her bone mass measurements of the lumbar vertebra to be 58% of the mean value for young adults (YAM) and that of her thighbone to be 38%. The results indicated high fracture risks of WHO.
We diagnosed it as non-traumatic sternum fracture caused by primary oseteoporosis, and treated her conservetively using a bust-band. Shortly afterwards, pain decreased gradually.
We think that primary osteoporosis caused multiple lumbar vertebra pressure fracture in this patient. Serious deformity of the spine increased compressive stress to the sternum and continuous stress is thought to have caused this atraumatic sternal fracture.
View full abstract
-
Yuji Kishimoto, Toru Okano, Ryota Teshima
2011 Volume 60 Issue 1 Pages
148-151
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report a patient with osteomalacia associated with Fanconi's syndrome caused by adefovir, an anti-viral drug for chronic hepatitis B. A 48-year-old male was hospitalized because of pain in the hip, ankle, and trunk. Five years previously, he was diagnosed with chronic hepatitis B and had been prescribed adefovir. Then two years ago, he was diagnosed with an unknown renal failure. Serum alkaline phosphatase was 1,314 IU/L; phosphate, 2.0 mg/dL; 1,25 (OH)2 vitamin D, 17.4 pg/mL; creatinine, 1.6 mg/dL. Calcium, phosphate and urinary acid were elevated in the urine, and aminoaciduria and renal glucosuria were also noted. In addition to these findings, renal and bone biopsy specimens indicated osteomalacia associated with Fanconi's syndrome. Because renal failure and elevation of serum alkaline phosphatase followed adefovir administration, we concluded adefovir as a cause of Fanconi's syndrome. After dose reduction of adefovir and calcitriol administration, he was on the road to recovery.
View full abstract
-
Takuya Tokunaga, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Az ...
2011 Volume 60 Issue 1 Pages
152-156
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report a case of adult osteomyelits of the talus treated with hydroxyapatite blocks impregnated with antibiotics. A 46-year-old woman visited our outpatient department due to sudden onset of swelling and pain of her left ankle. In laboratory examination, C-reactive protein (CRP) increased up to 10 mg/dl. Culture of synovial fluid aspirated from her ankle joint showed
Streptococcus pneumoniae infection. Radiographs showed a lytic lesion in the posterolateral aspect of the talus and MRI on T2WI and STIR indicated a high signal intensity lesion within the body of the talus. We diagnosed it as osteomyelitis of the talus. She was immediately admitted and underwent surgery in our department. After debridement, hydroxyapatite blocks impregnated with vancomycin was filled in the talus. After the operation, local symptoms and fever improved. CRP decreased within normal range up to five weeks after surery. At follow-up after nine months, there was no relapse of infection and collapse of the talus.
View full abstract
-
Shinya Matsumoto, Ken Sugita, Tomofumi Miyazato, Ayahito Kawabata, Mas ...
2011 Volume 60 Issue 1 Pages
157-160
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We reported a case of cancellous bone graft based on the Papineau method for a broad soft tissue defect with tibia compound fracture. A 18-year-old man, riding motorcycle, was hit from behind by a car at the intersection, and thrown several meters away. He suffered bilateral tibias open fracture (Rt: Gustilo III-a, Lt: Gustilo II) for which we performed bilateral monotube external fixation, wound washing, and debridment. The left side healed, but not the right. Necrosis spread from the wound border so debridment was repeated. The tibia was exposed, and MRSA was detected from the wound region. We performed surgery including sequestrum osteoectomy, decortication of the exposed tibia surface, but not dermal flap. After surgery, granulation tissue hyperplasia occured in the soft tissue defect, and the wound was healed.
View full abstract
-
Shinjiro Moriwaki, Kenji Kido, Yoshihiko Kunishi, Yasuhiro Ochi, Yohei ...
2011 Volume 60 Issue 1 Pages
161-163
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We report the treatment for fracture of the distal tibial between September 2003 and March 2010. The subjects consisted of 23 male patients and 16 female patients, with an average age of 52.5 years old (range: 17 to 92). The fracture type (AO classification) was A (33 patients), B (three patients), and C (three patients). The surgical methods were intramedullary nail fixation in 29 patients and fixture by plate in 10 patients. Surgery took an average of 103.5 minutes with the intramedullary nail and an average of 116.5 minutes with plate fixture. Bleeding amount was average of 82 ml with the intramedullary nail and average of 123 ml with plate fixture. Pain relief took an average of 25 days to achieve with the intramedullary nail and 44.7 days with plate fixture. Postoperative complications included above knee amputation due to poor blood circulation, peroneal paralysis, pulmonary embolism, skin necrosis, postoperative infection, and pseudarthrosis (one patient each). Implant of the distal screw of the intramedullary nail may be difficult for some fractures, and plate fixture may be used instead. However, use of the cannulated screw should be considered to widen the applications of the intramedullary nail.
View full abstract
-
Takuya Ikuta, Shinsaku Ogimoto
2011 Volume 60 Issue 1 Pages
164-167
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
FREE ACCESS
We performed minimally invasive plate osteosynthesis on one case of femoral fracture initially treated by external fixation and another case initially treated by external fixator after femoral lengthening.
Both cases achieved good bone union without infection.
Minimally invasive plate osteosynthesis is useful after external fixation of the femoral fracture or femoral lengthening which is not suitable for intramedullary nailing.
View full abstract
