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Sanshiro Inoue, Yoshikazu Saita, Naoshi Kikuchi, Hironobu Akune, Hideh ...
2011 Volume 60 Issue 2 Pages
169-172
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We investigated severely injured children younger than 12 years old; their new injury severity score (NISS) was higher than 16 points. The subjects were eight children and they were all boys. Causes of injuries were traffic accidents in five children. The mean NISS was 35.8 (17 to 75) points. Four children died. Of the four who died, three died from trauma of the head or upper cervical spine. Of the four alive, three regained their former activity level. The remaining one could walk with a cane and orthosis and returned to school. Most severely injured children not only have fractures but also other injuries, such as head, chest, or abdominal regions. Polytrauma children require immediate treatment based on close cooperation between the different departments.
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Katsuhiko Murakami, Katsutoshi Sunami
2011 Volume 60 Issue 2 Pages
173-175
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Total knee arthroplasty (TKA) is a successful operation to alleviate pain and improve function for patients with advanced arthritis of the knee. But the decision on whether to perform a TKA in extremely patients is controversial. This study was done to review the reliability, durability, and safety of primary TKA for patients 80 years of age and older.
Performing TKA in this elderly group of patients had a high success rate as measured by function and localized knee parameters. No knees have required revision subsequently. TKA was reliable, durable, and safe in this group of patients older than 80 years. Although medical and surgical complications were not uncommon they did not compromise the ultimate outcome of the operation.
The surgeon must be aware of the patient's past medical history so that he or she may know which areas are predisposed for complications to recognize, prevent, and treat them early and effectively.
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Takehiro Nagata, Eiichi Nakamura, Yasunari Oniki, Nobukazu Okamoto, Hi ...
2011 Volume 60 Issue 2 Pages
176-180
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report an operative nonunion fixation technique using a long stem following the realignment of the proximal fragment in total knee arthroplasty (TKA) for nonunion after high tibial osteotomy (HTO). The case was a 78-year-old woman who underwent HTO in another hospital for bilateral medial gonarthrosis. Even at one year after HTO, she suffered pain in both knees due to nonunion at the osteotomy site, and therefre visited our hospital. In the first examination, both knees were swollen, and the range of motion was −15d° to 145°. The radiographs showed the femoro-tibial angle (FTA) to be 202° in the right knee and 198° in the left knee side. Because mobility was seen at the osteotomy site in both knees, we diagnosed nonunion after HTO, and performed TKA in both knees. We carried out osteotomy on her proximal bone using a medullary rod at the same position to achieve union with the tibia component with a long stem. Six months after operation, both knees achieved bone adhesion with range of motion of 0 to 120° and FTA of 173°. Pain had also disappeared in ADL.
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Hideya Kawamura, Tomotaro Yamaguchi, Keiji Hisaeda, Tetsuro Nakamura, ...
2011 Volume 60 Issue 2 Pages
181-183
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We allowed patients after IWO surgery early weight bearing using Surfix lock plate system and obtained satisfactory clinical results. However about 10% of the patients showed delayed union when allowed full weight bearing earlier. Some patients showed opening at the medial tibial cortical bone after interlocking wedge osteotomy, and these patients and some osteoporotic patients showed delayed union. We changed the osteotomy line oblique to keep the medial tibial cortical bone close at the osteotomy. This new oblique osteotomy (New IWO) causeds load distribution and increases the contact area of the osteotomy, so the osteotomy gap contacts more closely when the plate is screwed on. We investigated the roentgenograms and clinical results of fifty-one patients (fifty-seven knees) who underwent this new osteotomy using the Surfix lock plate system from February 2006 to November 2007. They showed earlier bone union and only one patient showed delayed union and another patient showed necrosis of the medial tibial condyle after bone union. They also showed excellent clinical results, but some younger patients complained of pain when climbing stairs.
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Hidetoshi Ihara, Tsutomu Kawano
2011 Volume 60 Issue 2 Pages
184-187
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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The aim of this study was to determine whether early MRI after anterior cruciate ligament (ACL) injury can predict the morphological recovery of the torn ACL treated by early protective motion. Consecutive acute ruptures of the ACL in 35 patients (mean age; 27.2 years) who were allowed to be healed without surgery were evaluated by repeated MRI. MR images were compared for a few days after injury (initial MRI), approximately one month after treatment (second MRI), and at an average follow-up of 8.5 months (follow-up MRI). The average time from injury to the initial MRI was 7.3 days. The initial MR appearance of the torn ligament was classified into five types of visualized ligament contours. The emergence of restoration signs such as straight band and/or verticalization was examined in the second MRI. The follow-up MR appearance of the treated ACL was categorized into four grades depending on homogeneity, straight band, and size. Relationships between the initial MRI and the follow-up MRI, the restoration signs on the second MRI and the follow-up MRI were analyzed using the Spearman rank correlation coefficient. As a result, the contour of the initial MRI was found to correlate with morphological recovery on the follow-up MRI (r
s=0.565, p<0.001). There was no correlation between the emergence of restoration signs on the second MRI and morphological recovery on the follow-up MRI.
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Tsutomu Kawano, Hidetoshi Ihara, Shinya Kawahara
2011 Volume 60 Issue 2 Pages
188-192
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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【OBJECTIVE】The authors experienced two cases of intra-articular migration of metal fragment in the knee joint.
【CASE 1】A 33-year-old male suffered from a nail gun injury on his left patella. During nail removal in the operating room, the authors found intra-articular penetration of wire fragment and radiographs showed wire fragment remaining in the knee joint after nail removal. We realized that the fragment had migrated into the popliteal fossa in arthroscopic observation and had difficulty removing it arthroscopically.
【CASE 2】A 38-year-old male visited the hospital because of acute pain and swelling on his left knee. Radiographs showed the migration of a broken soft wire used for patellar fracture fixation 10 years ago. The intra-articular fragment was removed under arthroscopy and other broken wires were removed surgically. In the surgical findings, the authors noticed one part of the circumferential wiring for fracture fixation passing intra-articularly, suggesting that the migration of the broken wires had occurred through that portion.
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Hirokazu Matsubara, Yoshinori Yo, Yoshihiko Tasaka, Akira Hosokawa
2011 Volume 60 Issue 2 Pages
193-197
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report a case of osteochondral autograft transplantations for articular cartilage defects of the knee in a middle-age patient. The patient was a 49-year-old male working for the police crimelab. He did not experience any traumatic injuries, so his disease was thought to be caused by running every day. He tried conservative treatment for his right knee pain for three years, however, his pain continued. MRI findings showed signal changes on the medial femoral condyle, suggesting articular cartilage damages. A large articular cartilage defect extended to the femoral groove and bilateral femoral codyle were found on arthroscopy. We performed osteochondral autograft transplantations (Mosaic plasty) and drilling on these areas. Six months after the operation, he became better and was able to return to his previous occupational activities.
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Hisataka Goto, Taketoshi Date, Tokumi Nagaoka
2011 Volume 60 Issue 2 Pages
198-201
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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The purpose of this study is to investigate the correlation between post-operative hemoglobin levels and circulatory complications in elderly patients with proximal femoral fracture. We investigated 298 patients (114 patients with over 20% decrease in Hb level, and 184 patients with less than 20% decrease) who were treated by surgery (osteosynthesis or hemiarthroplasty) for proximal femoral fracture under spinal anesthesia between January 2006 and May 2009.
A significant difference was seen in the two groups for complication rates (6.14% vs. 0 %). The patients who developed complications had several circulatory diseases and their average age was high. Whenever Hb level decreases one week after surgery for proximal femoral fracture in elderly patient, we should consider blood transfusion.
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Hisato Tanaka, Mitsunori Komine, Naoya Yamanouchi
2011 Volume 60 Issue 2 Pages
202-204
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Lag screw cut-out is a problem in bone fusion of the trochanteric fracture of the hip. Failure to position the lag screw correctly is thought to be the cause, and it is important for the tip-apex distance proposed by Baumgaertner (TAD value) to be less than 20mm. The authors have thus developed a device whereby a guide pin is inserted into the edge of the hole after reaming, and the surrounding marrow quality is studied by fluoroscopy. By positioning the guide pin at the reamed edge, the position of the guide pin can be checked three-dimensionally when moved in the hole even in one-direction fluoroscopic observation. This device allows the lag screw to be inserted correctly into the caput sub-cartilage and the caput to be secured firmly. By confirming the surrounding marrow quality, the load permitted time after surgery can also be determined. In addition, the TAD value was found to decrease with this device because the lag screw can be inserted under the sub-cartilage of the caput to a certain degree of safety.
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Toru Asakura, Kunichika Shin, Kenjiro Ooe, Koumei Matsuura
2011 Volume 60 Issue 2 Pages
205-209
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Many cases of subtrochanteric fractures of the femur after internal fixation of the femoral neck with the Hansson pin system are reported. But trochanteric fracture after the fixation is very rare. We report two cases of trochanteric fractures of the femur after internal fixation with the Hansson pin system. Both cases had achieved bone union after first fixation with the Hansson pin, but fell down again 4 years and 8 months or 3 years and 1 month after the fixation. One case was non-displaced trochanteric fracture treated conservatively, the other case was displaced fracture operated for extraction of the Hansson pin and intramedullary fixation. Bose cases achieved reunion.
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Masanori Sakaino, Taketoshi Kanazawa, Teruto Isayama, Akio Inoue
2011 Volume 60 Issue 2 Pages
210-215
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We treated 40 hips in 20 patients (three males and 17 females) with advanced or terminal-stage coxarthrosis by bilateral Chiari pelvic osteotomy with valgus femoral osteotomy. The mean age of the patients was 47 years (range; 32 to 57 years). The mean follow-up period was 6.8 years (range; 2 to 25 years). The interval between the operation on one hip and the other in bilateral Chiari osteotomy was 4.75 years (range; 1.3 to 19 years). Clinical evaluation was performed according to the Japanese Orthopaedic Association (JOA) hip score system (JOA hip score). Fifteen out of the 20 patients (75% in this series) had scores over 30 in both hips, and 12 patients (60%) had scores over 35.
These results suggest that the general Chiari pelvic osteotomy procedure which combines other osteotomy surgeries can be applied, but there is a need to leave more than one and a half years in between the surgeries of the two hips.
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Satoshi Kido, Tetsurou Nakamura, Kuniyoshi Tsuchiya, Hideya Kawamura
2011 Volume 60 Issue 2 Pages
216-220
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report two cases with pelvic ring instability leading to severe pelvic pain in the puerperal period requiring urgent hospitalization. Case 1 was a 37-year-old female visiting our emergency room due to left pelvic pain two weeks after a Caesarean surgery. Although she did not have fever, she had inflammation reaction (WBC 10100/μl, CRP 6.13mg/dl). X-ray revealed a difference in the pubic tubercle by more than 2 mm, thus we diagnosed her with pelvic ring instability. Her symptoms improved with rest and pain control. Case 2 was a 35-year-old female who was brought to our emergency room due to pelvic pain one week after delivery. She had fever of 38.3 degrees as well as inflammation reaction (WBC 12000/μl, CRP 16.7mg/dl). We diagnosed her with pelvic ring instability, pyogenic sacroiliitis, and pyogenic osteomyelitis of the pubis by X-rays, contrast CT and contrast MRI. Her symptoms were relieved by antibiotic treatment. Many women experience pain around the lower back and pelvic ring in the puerperal period. Pyogenic sacroiliitis and pyogenic osteomyelitis of the pubis are important differential diagnosis.
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Koki Ueda, Koichi Yoshikane, Akihiro Nishii, Kazunobu Tsunoda, Takahir ...
2011 Volume 60 Issue 2 Pages
221-223
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Microendoscopic spinal decompression is commonly performed for lumbar disc hernia, lumbar spinal canal stenosis, cervical spondylotic radiculopathy, etc. When grinding bone tissue, special tools designed for this purpose such as curving Kerrison forceps and high-speed drills are used. The operation is safe when used on the yellow ligament, but sometimes risky when used near the dura mater or nerve root as they may catch the soft tissue. We report our experience in using the ultrasound bone scalpel (SONOPET) safely for grinding bone tissue. The merit of using SONOPET is it does not damage soft tissues, because they are elastic and are able to absorb ultrasound shockwaves. No case of severe adverse effects of SONOPET have been reported, so maybe useful for decompressing bone tissue in microendoscopic spinal decompression.
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Koichi Yoshikane, Akihiro Nishii, Mitsumasa Hayashida, Kazunobu Tsunod ...
2011 Volume 60 Issue 2 Pages
224-227
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report the short term clinical results of percutaneous endoscopic lumbar discectomy (PELD) via interlaminar approach, and compare them with those of micro endoscopic lumbar discectomy (MED). There were no significant differences between PELD and MED in clinical results; JOA score, blood loss during operation. PELD required longer time than MED. Rise in CRP on the next post-operative day was lower with PELD compared with MED. There were no significant major complications for both methods. These results suggest that the clinical outcomes of PELD are similar to those of MED, but PELD is less invasive than MED. PELD via interlaminal approach is a less invasive surgical option for lumber disc herniation.
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Masami Fujiwara, Hideshi Sato, Kei Yatsuda, Kanji Osaki, Toru Akiyama
2011 Volume 60 Issue 2 Pages
228-231
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report seven cases of lumbar intraspinal cyst (synovial cyst and hematoma in the lumbar ligamentum flavum) who were surgically treated. The seven patients included four males and three females ranging in age from 47 to 80 years. This study consisted of physical examination, diagnostic study, and analysis of operative and histological findings. Micro medial facetectomy was perfomed, and the cysts were resected. Pathologicaly, six cases were synovial cyst, and one was old hematoma with granulmatous change in the ligamentum flavum.
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—A Case Report—
Yusuke Nakazoe, Masato Tomita, Yoshihiro Nozaki, Narihiro Okazaki, Mit ...
2011 Volume 60 Issue 2 Pages
232-235
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Vascular leiomyoma is known as a painful soft tissue tumor. Patients complain of spontaneous sharp pain, which is a diagnostic clinical feature. We reported one case of vascular leiomyoma which was difficult to diagnose differentially from schwannoma based on MRI findings and past history. Based on the characteristics of the pain, we were able to correctly diagnose this case from other painful soft tissue tumors. We suggest that it is very important to obtain detailed pain information for the differential diagnosis of painful soft tissue tumors.
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Masato Tomita, Kenji Kumagai, Yoshihiro Nozaki, Hiroyuki Shindo
2011 Volume 60 Issue 2 Pages
236-237
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We studied the clinical results of liposarcoma in our hospital. We treated fifty cases of liposarcoma from 1999 to 2009. They consisted of twenty-four males and twenty-six females, whose average age at the time of operation was 61.7 years old. Seven of them showed metastases and/or recurrences in the follow-up period.
In this study, we observed these seven cases which showed poor prognoses, and focused on the clinical prognostic factors.
[Results] Two local recurrences, and seven metastases were observed. The primary sites were three thighs, one buttock, one back, one retroperitoneal, and one iliac region. Histopathological classification was five cases of myxoid type, one case of de-differentiated type, and one case of well-differentiated type.
[Discussion] Well-differentiatd liposarcoma of extremities showed no recurrence and metastasis. Cases with liposarcoma on the trunk and those with inadequate resection margin showed recurrences and/or metastases. We concluded that correct diagnosis before operation and adequate resection margin of tumors are very important.
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Akihiro Yanagisawa, Toshitake Yakushiji, Hiroo Sato, Kiyoshi Oka, Hiro ...
2011 Volume 60 Issue 2 Pages
238-242
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report an extremely rare case of intracortical chondromyxoid fibroma. A 38-year-old woman presented with right thigh pain without any precipitating trauma or injury. Plain radiographs showed a lytic lesion with sclerotic rim in the diaphysis of the right femur. Computed tomography (CT) showed intracortical lesion and thinned cortex. Magnetic resonance imaging (MRI) showed heterogeneous high signal intensity on T2-weighted images related to the proportion of the chondroid component within the lesion. Marginal en block excision and bone grafting were performed and pathological findings revealed a chondromyxoid fibroma. At one year after the surgery, local recurrence was not observed.
Chondromyxoid fibroma is a rare cartilage tumor that represents less than 1 % of all bone tumors, and it is usually an intramedullary lesion. There have been only 13 reported cases of intracortical involvement and our report is an extremely rare case.
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Shuichi Eto, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Noboru M ...
2011 Volume 60 Issue 2 Pages
243-246
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report a rare case of synovial chondromatosis of the knee in childhood. A ten-year-old boy suffered from pain and swelling of the right knee. Roentgenograms and MRI showed dozens of calcified masses and suggested synovial chondromatosis. At arthroscopy, dozens of white loose bodies and active synovium were found. Removal of loose bodies and synovectomy were performed. His symptoms more or less improved, but he felt discomfort in knee flexion. Roentgenograms showed loose bodies, so second arthroscopy was performed. Eleven months after operation, he had no symptoms.
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Itaru Yoda, Itaru Furuichi, Masakazu Murata, Noriaki Miyata, Noboru Mo ...
2011 Volume 60 Issue 2 Pages
247-252
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report a case who suffered rib metastasis and gas gangrene with colon cancer. A 73-year-old man underwent descending-colon resection for colon cancer. Post operative course was good and he was discharged from hospital. Three weeks later, he had right chest pain. Chest CT showed gas formation at the 8 th rib on the right and around the rib. He was treated with surgical debridement. Clostridium species were found at the surgical site and in blood culture. Rib metastasis by colon cancer was also found at the 8th rib. When treating non-traumatic gas gangrene, it is necessary to also take the tumor into consideration, as well as to consider both metastasis and infection.
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Yoshihiro Nozaki, Masato Tomita, Kenji Kumagai, Hiroyuki Shindo
2011 Volume 60 Issue 2 Pages
253-257
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We report three cases of ATL with bone lesions.
Case 1: A 71-year-old male with back pain and muscle weakness of the lower extremities on ALT treatment was admitted to our department. Radiological examination showed osteolytic lesion of the L3 vertebral body. Radiation therapy improved his symptoms in a short time.
Case 2: A 55-year-old male with multiple osteolytic lesions (both hands and tibias) underwent palliative radiotherapy and was periodically administered zoledronic acid. This combined therapy improved clinical symptoms and radiological findings showed callus formation.
Case 3: A 63-year-old male with swelling and pain on the dorsal part of his right foot underwent radiological examination. MRI imaging suggested infiltration of tumor to the right cuboid bone. Palliative radiotherapy improved his symptoms but not radiological findings.
Bone lesions due to ATL cause osteolytic changes and fractures, and those that affect ADL are usually treated by radiation. But the combination of radiation and bisphosphonate may be more efficacious for controlling pain and preventing pathologic fractures.
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Yasuhiro Kawakami, Keiichi Muramatsu, Koji Yoshida, Kazuhiro Seki, Tos ...
2011 Volume 60 Issue 2 Pages
258-262
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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FDG-PET/CT is a useful method for diagnosing primary unknown carcinoma. Recent reports introduce a new application of this method to evaluate neo-adjuvant chemotherapy response. We here present four cases treated in this department with the new application and discuss its advanatges. Four pediatric patient with OS or Ewing were evaluated by FDG-PET. All patients received standard neo-adjuvant chemotherapy. FDG-PET standerd uptake values before (SUV1) and after (SUV2) chemotheraphy were analayzed and correlated with chemotheraphy response assessed by histopathology in surgically excised tumors and by magnetic resonance imaging.
It has decreased to SUV2 2.1 and 2.0 (after chemotherapy) from SUV1 3.6, and 5.0 it (before chemotherapy) for osteosarcoma, and decreased to SUV2 1.93 and 0 from SUV1 9.3, and 3.86 in two cases with Ewing sarcoma. The tumor necrosis rate was 90% or over. FDG-PET/CT is a very accurate method for the localization and the malignancy diagnosis of sarcoma. In this study, it also proved useful for the evaluation of chemotherapy response and tumor activity.
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Kazuhiro Yamaoka, Toshihide Shuto, Manabu Irie, Junji Yasuda
2011 Volume 60 Issue 2 Pages
263-265
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Twenty consecutive minimally invasive unicompartmental knee arthroplasties (MIS-UKA) in 20 patients (mean age; 72.0 years) were studied retrospectively. Seven knees were diagnosed with medial osteoarthritis,and thirteen had osteonecrosis of the medial femoral condyle. The mean follow-up period was 15 months. The mean JOA score improved from 52.0 points to 87.5 points at the final follow-up. The mean range of motion improved from 122° to 132°. Radiographically, preoperative varus alignment (mean FTA 179°) improved to the normal range of alignment (mean FTA 175°). There were no surgical complication. We concluded that MIS-UKA is quite useful, especially for aged patients with unicompartmental osteoarthritis or necrosis.
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Satoshi Ikebe, Shuya Ide, Jun Ito, Masaaki Mawatari, Takao Hotokebuchi
2011 Volume 60 Issue 2 Pages
266-268
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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The purpose of this study was to evaluate the postoperative hospital-changing rate and clinical results associated with shorter length of hospital stay for total knee arthroplasty (TKA). We studied 100 patients who underwent TKA between 2002 and 2005, and compared them with 100 patients who had TKA after 2005. The length of hospital stay was shorter in the second group by four days than the first group, and the postoperative hospital-changing rate was markedly higher in the second group. No significant differences were seen in the ROM between the two groups. As for the postoperative JOA score, significant difference was seen only for total JOA knee score and degree of swelling. Swelling, pain, and local heat generally remain in the early days after TKA, and close collaboration with other medical facilities is indispensable for enhancing clinical results.
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Eiichiro Okuma, Tsugukazu Toma, Kotatsu Urasaki, Tadakatsu Kinjo, Sato ...
2011 Volume 60 Issue 2 Pages
269-272
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We evaluated 24 patients with drop foot associated with lumbar disc herniation (LDH) or lumbar canal stenosis (LCS) who underwent operative surgery and assessed the factors influencing surgical outcome.
All patients (12 males and 12 females) underwent operations between 2005 and 2007, and were followed up for a mean period of 16 months. The average age at the time of surgery was 44.9 years for LDH and 67.0 years for LCS. Drop foot is defined as having a score below 2 in the manual muscle test.
In conclusion, patients suffering from LDH showed better recovery from drop foot than LCS, and tended to show improvement of drop foot regardless of the time of surgery. But the duration of symptoms before surgery and age at surgery are not significant factors influencing the recovery of drop foot.
On the other hand, patients suffering from cauda equina syndrome in LCS tended to show poor recovery.
These results indicate that patients with drop foot in LDH are better candidates for surgery but those with drop foot in LCS should be carefully considered for surgery.
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Nozomu Inada, Hirokazu Nohara, Takayoshi Rokkaku, Taketsugu Gaja, Sato ...
2011 Volume 60 Issue 2 Pages
273-277
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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The anterior chest wall is the most frequent location of musculoskeletal lesions caused by synovitis-acne-pustulosis- hyperosteosis-osteomyelitis (SAPHO) syndrome. Spinal lesions are present in about 30% of the cases, but kyphosis and neurological complications are unusual. We surgically treated a 42 year-old man with SAPHO syndrome who had myelopathy due to thoracolumbar kyphosis.
In another 31-year-old male case complaining of back pain, abnormal accumulation was observed at the thoracic vertebra, left side of sternum, left clavicle, and left rib in bone scintigram. In another 40-year-old male case, we diagnosed tonsillitis and removed the tonsil. Thoracic X-ray revealed wedge-shaped vertebral body at T12, and kyphosis progressed gradually. MRI showed the compression of the spinal cord at T11 and 12 levels. We performed a vertebral biopsy at T12, the pathologic findings of the specimen indicated nonspecific chronic inflammation, and the culture was negative. We diagnosed the lesion as spondylitis as a part of SAPHO syndrome. The 42-year-old found it difficult to keep standing because of his back pain and was unable to walk by himself due to myelopathy, so we performed anterior vertebral body curettage with anterior ilium transplantation, as well as posterior instrumentation at the same time. After surgery, his kyphosis was corrected, myelopathy improved, and he was able to walk. Two years postoperatively, his clinical course is good without correction loss.
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Mitsumasa Ban, Hironobu Akune, Tatsuya Mori, Yusuke Takahashi, Ryuta I ...
2011 Volume 60 Issue 2 Pages
278-282
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Spinal epidural cavernous hemangioma is a benign tumor, which often occurs in the vertebral body, and very rarely in the primary epidural space. We report a rare case of cavernous hemangioma growing in the thoracic primary epidural space. The patient was a 80-year-old female, who showed paraplegia and vesicorectal failure. A tumor existed behind the spinal cord in the Th5-7 epidural space on MRI. It showed iso-intensity on T1WI, high-intensity on T2WI, and was strongly enhanced with Gd-DTPA homogeniously. Because of progressive paraplegia, we performed tumor resection. At one year after resection, she is free from reccurence, has recovered from vesicorectal failure, and can walk with a cane.
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Tomoyuki Nakamura, Taichi Saito, Isao Saikawa, Tsutomu Irie, Tetsuya T ...
2011 Volume 60 Issue 2 Pages
283-286
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Obturator hernia is a very rare disease, and the frequency of this hernia is 0.1% of all intestinal hernia. Treatment is delayed because diagnosis by palpation and ocular inspection are difficult, and mortality rate is high because of infectious accompanying necrosis and perforation of the intestinal tract. As a characteristic symptom of obturator hernia, patients complain not only of abdominal symptoms such as intestinal obstruction but also of leg pain due to compression of the obturator nerve by the incarcerated intestinal tract. We report a case of obturator hernia with left thigh pain and left coxalgia arising from the irritation of the obturator nerve. The patient was diagnosed with computed tomography of iliac. It was possible to treat patients at a comparatively early stage when small bowel obstruction is not presented.
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Keita Nagira, Yasuhiro Kameyama, Masaaki Murata, Tetsuya Otsuka, Ryuno ...
2011 Volume 60 Issue 2 Pages
287-290
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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Fractures of the traumatic anterior glenoid rim of the scapula are relatively rare. We surgically treated two patients with fresh anterior glenoid rim fracture of the scapula with instability. According to Ideberg's classification system, the two cases were type I b. The bone fragment size was evaluated by computed tomography. The fracture of case 1 involved 38%, and that of case 2 involved 53.3% of the anterior glenoid rim, with shoulder instability. Open reduction and internal fixation were performed with screw for the two cases by the deltopectoral approach. There were no recurrent instability of the shoulder after operation. The results were almost satisfactory except for the limitation of shoulder ROM in case 2.
Anterior glenoid rim fracture of the scapula associated with shoulder instability is an indication for open reduction and internal fixation. It seems that the relative ratio of the fragment in respect to the anterior glenoid rim is helpful for treating this type of fracture.
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Kuniyoshi Tsuchiya, Kenichi Kawaguchi, Satoshi Kido, Hideya Kawamura
2011 Volume 60 Issue 2 Pages
291-294
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
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We reviewed a total of 80 hemodialytic (HD) patients who had underwent spine surgery and who had been followed up more than three months. One case revealed early neurological deterioration five days after surgery. One case developed hemorrhagic shock due to massive bleeding from the gastric ulcer. Four cases died within six months after surgery. Three cases developed adjacent level problems, all of them occurring within a year after surgery. Although good neurological recovery can be expected even in HD patients when performed properly, high complication rate must be taken into consideration for appropriate indication of surgery. Early occurrence of adjacent level problems in fusion surgery must be also noted.
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Kuniyoshi Tsuchiya, Kenichi Kawaguchi, Satoshi Kido, Hideya Kawamura
2011 Volume 60 Issue 2 Pages
295-297
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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Seven cases of microendoscopic discectomy (MED) for one-level lumbar disc herniation requiring more than 90 minutes operation time were reviewed. Three were cases converted to microscopic surgery during surgery, of these one had dural tear and two had difficulties of retracting nerve roots. Other factors were L3/4 herniation, distal migrated herniation, spina bifida at L5, and severe degenerative change. In this series, factors for prolonged operation time and comparative advantages of microscopic and microendoscopic surgery were discussed.
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Toru Asakura, Koumei Matsuura, Kunichika Shin, Kenjiro Ooe
2011 Volume 60 Issue 2 Pages
298-302
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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The commonly occurring position of calcification in the calcific tendinitis of the shoulder is said to be the supraspinatus tendon. In the anatomical field, it has been newly discovered that the infraspinatus tendon crosses over the supraspinatus tendon to the superior facet of the greater tuberosity. In this study, we thus attempted to determine the occurring position of calcification on MRI quantitatively. We measured the angle between the bicipital groove and center of calcification, and found it to be 49.5±16.5 degrees.
On the other hand, it has been reported that the boundary line between the superior and middle facets is 45.4 degrees externally rotated from the bicipital groove. The protrusion formed at the greater tuberosity at this position imposes mechanical stress on the rotator cuff tendon. As we confirmed that these two angles are very close in this study, it suggests that calcification occurs at the boundary line of the superior and middle facets. Our findings also indicate that calcification often occurs at the infraspinatus tendon.
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Kunio Iura, Taichi Saito, Isao Saikawa, Tsutomu Irie, Tetsuya Tanaka, ...
2011 Volume 60 Issue 2 Pages
303-307
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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We evaluated the clinical results of vertebroplasty with posterolateral fusion for nonunion following osteoporotic vertebral fracture. The cases included two males and eight females, with an average age of 73.8 years. The fracture levels were between T11 and L3. We employed hydroxyapatite block for vertebroplasty. The average number of fusion area was 3.5 and follow-up period was 11.7 months. Physiologically, ambulatory disability improved in most cases after surgery. In radiological assessment, 2.5 mm collapse of the vertebral height and 5.3° loss of local kyphosis correction were observed. It is essential to continue medication for basal osteoporosis and radiological follow-up for both loss of correction and occurrence of new vertebral fractures.
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Masahiro Izumi, Masaki Miyazaki, Shuuya Ide, Masaaki Mawatari, Takao H ...
2011 Volume 60 Issue 2 Pages
308-311
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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We evaluated the association between postoperative complications and knee joint function and degree of obesity in 294 TKA patients (444 knees) at our hospital from January 2006 to January 2009. The patients were grouped into three weight classes according to bodymass index. Patient age, medial history, complications, knee joint function, length of hospital stay were recorded.
The average BMI of all cases was 25.7. The high BMI group (BMI≥30) cousisted of 46 cases (15.6%). No significant difference was seen in age, hospitalization days, knee joint function between the groups.
The high BMI gruop showed history of diabetes preoperativery and high rate of complications (wounds complication).
Through TKA, high BMI the corpulence patients were able to achieve the same surgical results as 10w BMI patients, but surgical complications need to be taken into consideration.
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Tatsuya Mori, Toshihiro Ohdera, Shusaku Matsuda
2011 Volume 60 Issue 2 Pages
312-317
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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Serious complications due to metal allergies in orthopedic surgery are rarely seen. We experienced 26 cases in 19 patients diagnosed with metal allergies in the process of receiving knee surgery. Twenty-two cases had osteoarthritis, three had anterior cruciate ligament (ACL) injury, and one had tibial fracture. Cases diagnosed with metal allergies before surgery consisted of 12 total knee arthroplasty (TKA) cases (19 knees), three cases of ACL reconstruction, and one case of tibial osteosynthesis. Cases who developed metal allergies after surgery were two cases of TKAs and one case of hemicallotasis. For cases who tested positive for metal allergies before surgery in skin patch tests, JMM bi-surface KU4+s (non metal) was used for TKA, ceramic buttons for ACL reconstruction, and titanium pin for tibial osteosynthesis. In those who developed metal allergies after surgery, fheir conditions were alleviated by conservative treatment. When using metal fixtures in orthopedics, there is a need to ask patients if they have metal allergies, and test those who do in more detail through skin patch tests, etc.
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—A Report of Three Cases—
Chikashi Yamakawa, Hisashi Serikyaku, Tetsuya Yara, Fuminori Kanaya
2011 Volume 60 Issue 2 Pages
318-321
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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We report three cases of spontaneous spinal epidural hematoma successfully treated by conservative methods. Case 1: A 67-year-old female felt severe pain of the neck and numbness on the right arm before she was taken to our hospital. She suffered tetraparesis. Spinal epidural hematoma was revealed at the C 3-7 levels by MRI and her symptoms started to improve after two days. Hemostatics were administrated intravenously and she was discharged from the hospital on foot after two weeks. Case 2: A 52-year-old female noticed difficulty in walking herself following neck pain and pain in both shoulders. MRI revealed spinal epidural hematoma at the C 2-T 3 levels. She was treated with hemostatics. She could walk five days after admission. Case 3: A 72-year-old female suffered neck pain and numbness of both hands two hours after swimming in the sea. She rushed to our hospital 3.5 hours after swimming because she could not walk. Tetraparesis caused by spinal epidural hematoma at the C 3-4 levels improved two days by resting on bed alone without any use of medications.
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Akira Hashimoto, Shunsuke Kawano, Masaru Kitajima, Motoki Sonohata, Ma ...
2011 Volume 60 Issue 2 Pages
322-324
Published: March 25, 2011
Released on J-STAGE: June 02, 2011
JOURNAL
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The purpose of the present study is to report the results of total hip arthroplasty (THA) or bipolor hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral Head (ION). One hundred and twenty-three hips of 92 patients who underwent THA from 1998 and could be followed up for one year or more were enrolled in the study. The patients consisted of 54 males and 38 females, whose mean age was 56 years. The canse in about one third of the patients was steroids. The ratio of THA was 44.6% in Type C-1, and 58.4% in Type C-2. Dislocation was recognized in 18 hips. BHA migration was seen in one hip. Revision THA was performed on only one hip for recurrent dislocation. There was no severe stress shielding and progressed clear zone. Implant stability was good. The result of THA for ION was good although the dislocation rate was slightly high.
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