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Shuya Ide, Goh Takayama, Kyota Nishifuru, Yutaka Yonekura, Yuki Uesugi ...
2012 Volume 61 Issue 3 Pages
341-345
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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The purpose of this study was to evaluate the radiolucent line around the tibial component in Scorpio total knee arthroplasty with posterior stabilizer by comparing cemented and cementless fixation radiologically. We investigated 150 cases 242 knees (cemented: 114 knees, cementless: 128 knees). The mean age was 74.5 years and the mean follow-up period was 2.7 years. The radiolucent line detected was 18.4% with cement and 10.1% with cementless. The rate of radiolucent line of the cemented fixation group was higher than the cementless fixation group. In the cementless fixation group, the radiolucent line tended to appear early, but improved with time. In cementless PS TKA, initial fixation is the greatest problem. It is therefore important to define the indication of cementless PS TKA.
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Yasuyuki Ishida, Hiroaki Yano, Keitaro Yamamoto, Katsuhiro Kawahara, T ...
2012 Volume 61 Issue 3 Pages
346-349
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report the good clinical outcomes of arthroscopic rotator cuff repair (ARCR). However, as the re-tear rate of massive and large tears in advanced muscle atrophy was high, we performed ARCR on such cases under strict operative indication. The purpose of this study is to review the clinical outcome of ARCR after applying strict operative indication. We investigated two periods. The former period was from October 2005 to July 2009 during which 80 shoulders underwent ARCR. The latter period was from August 2009 to August 2010 during which 58 shoulders underwent ARCR. We compared the size and muscle atrophy of the tear, postoperative cuff integrity, and clinical outcome for each period. For the latter period, the rate of massive and large tears and advanced muscle atrophy was lower and the postoperative cuff integrity was more improved than the former period. When we used strict operative indication, the re-tear rate of ARCR was found to decrease. Our results suggest that it is important to select an optimal treatment plan including conservative treatments for individual cases.
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Masao Eto, Koichiro Sakimura, Shinichi Nakahara, Yusuke Nakazoe
2012 Volume 61 Issue 3 Pages
350-354
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We considered the indications and limitations of repairing massive rotator cuff tears with a patch graft. There were 12 patients, 12 shoulders (male: 10, female: 2) who underwent patch with the long head of biceps (LHB) or tensor fascia lata. LHB patch was performed on three patients, tensor fascia lata patch on five, and tensor fascia lata patch with teres minor transfer on four. Average follow-up period was 21 months (6 to 33 months). Pre- and post-operative JOA scores were evaluated, and the factors affecting the JOA score were examined. Their JOA score significantly increased form a preoperative average of 58.6 points to postoperative average of 80.5 points. Postoperative re-tear was found in three patients with LHB patch and one patient with tensor fascia lata patch. As LHB patch was torn again in all three patients, it is necessary to reconsider the surgical technique for inserting the LHB patch. After surgery, there was no re-tear of the rotator cuff and no decrease in external rotator strength in teres minor transfer. Teres minor transfer is thus a good method for patients requiring large patch grafts.
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Yoshikazu Yanagisawa, Hiroshi Nomura, Atsuko Kohyama, Kensuke Hotta, S ...
2012 Volume 61 Issue 3 Pages
355-361
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Many reports have shown that transforaminal lumbar interbody fusion (TLIF) lowers the risks of nerve injury, shortenes operative time, and reduces intra-operative bleeding than posterior lumbar interbody fusion (PLIF). Since 2007, we therefore started to use TLIF for DLS patients, instead of PLIF. We compared and studied the outcome of PLIF and TLIF for DLS patients between 2007 and 2009. Nine patients with DLS and treated with selective segmental PLIF and TLIF were studied retrospectively. We studied radiographic evaluations by using coronal Cobb and lateral lordosis angles, as well as ADL and pain using the Japanese Orthopaedic Association (JOA) score. The operative time and intra-operative bleeding showed no significant differences between the PLIF and TLIF groups. There were also no significant differences in the Cobb and lordosis angles between the two groups at the final follow-up, nor in the JOA score. The Cobb angle increased after two years in the TLIF group, however clinical symptoms were not bad.
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Kohei Ishihara, Kenzo Shirasawa, Akihisa Yamashita, Tetsuya Watanabe
2012 Volume 61 Issue 3 Pages
362-365
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Degenerative lumbar scoliosis (DLS) is becoming more and more common in our aging society. At our hospital, we basically perform transforaminal lumbar interbody fusion for causable intervertebra to remove radicular or cauda equinal symptoms. On the other hand, there are some DLS cases with severe low back pain and progressive loss of coronal balance. Here we report such cases for which we performed posterior instrumentation (long fusion). Among 60 cases who underwent surgical treatment for DLS between 2003 and 2011, three received long fusion. The age of these three cases were above eighty and their mean age was 81.7 years old. The mean Cobb's angle was 36.3 degrees before operation, and it was slightly corrected to 17.3 degrees after operation. Clinical symptoms such as severe low back pain improved after operation and patient satisfaction was generally good.
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Kosei Ijiri, Fumito Tanabe, Naoya Kawabata, Masahiko Abematsu, Ayumi N ...
2012 Volume 61 Issue 3 Pages
366-368
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Surgical strategy for lumbar degenerative scoliosis (LDS) is still controversial. Some insist minimum decompression and posterior fusion especially for elder patients, while others insist longer fusion for this condition from the point of view of spinal total alignment. In this study, we performed a retrospective survey on our patients treated surgically in order to consider the preferable fusion levels for LDS. Forty-two patients were classified into two types; N type (minimum decompression according to neurological diagnosis and short fusion), and A type (long fusion according to total spine alignment). All patients exhibited more than 15 degrees of main curvature before surgery. Clininal results at the final follow-up were acceptable for both groups (JOA recovery rate; N type 53%, A type 67%). Five cases of N type received additional surgery, but none with the A type. One A type case developed deep infection, resulting in subtraction of the instrument.
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Yuki Uesugi, Shuya Ide, Kyota Nishifuru, Yutaka Yonekura, Goh Takayama ...
2012 Volume 61 Issue 3 Pages
369-372
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Whether or not to resurface the patella during total knee arthroplasty remains controversial. The purpose of this study was to review patellofemoral osteoarthritis in patients who had undergone total knee arthroplasty (TKA) without patella resurfacing. Sixty-one patients (100 knees) underwent primary TKA for osteoarthritis with NexGen or Scorpio. We analyzed the associations between lateral tilt, lateral shift ratio, and patella height based on the X-ray findings of the knee. We assessed the exacerbation of patellofemoral ostoarthritis measuring presence or absence of the osteosclerosis, osteophyte, and joint space narrowing. We found that the lateral tilt of Scorpio was significantly smaller than that of Nexgen(p<0.05), and the osteosclerosis was significantly worse in Scorpio than that in Nexgen (p<0.05), We also found that patellofemoral ostoarthritis was significantly worse in Scorpio with radial patellar groove of the femoral component.
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Katsuhiko Sakuma, Kazuhiko Miyamoto, Yuya Imamura, Koujiro Imoto, Taku ...
2012 Volume 61 Issue 3 Pages
373-376
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We evaluated the postoperative alignment of 19 primary total knee arthroplasties (ADVANCE) using the JIGEN system as a landmark of the anterior distal surface of the femur. Femoral component alignment after TKA relative to preoperative plans were obtained: (varus-valgus was 1.1°±1.1°, flexion-extension was 1.1°±0.8°, and internal-external angulations was 1.5±0.9°). The results suggested that the anterior distal surface of the femur serves as a useful landmark in the independent cut technique for achieving good alignment of the femoral component.
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Takaya Todoroki, Yozo Shibata, Tsuyoshi Shinoda, Hajime Seo, Yoshihiro ...
2012 Volume 61 Issue 3 Pages
377-380
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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This report introduces our method and evaluation of clinical results for rotator cuff repairs with a follow-up period of over six months using the Versalok anchor.Twenty-one shoulders(men: 14 shoulders, women: 7 shoulders, average age: 65.9 years old, average follow-up periods: 7.3 months)were evaluated. The average of the elevation angle improved significantly from 118.3 degrees at the preoperative state to 139.5 degrees at the postoperative state (P=0.01).The average of the external rotation angle improved from 47.9 degrees to 51.4 degrees (NS). The average of the internal rotation angle recovered from Th11.9 to Th11.7 (NS). The average of the JOA pain score increased significantly from 9.8 points preoperatively to 26.0 points postoperatively (P<0.0001). The average of the total JOA score significantly increased from 65.6 points preoperatively to 90.2 points postoperatively (P<0.0001). We conclude that transosseous equivalent technique with the Versalok anchor is an effective treatment for rotator cuff tears.
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Mari Tachibana, Hiroshi Yamaguchi, Chojo Futenma, Fuminori Kanaya, Tom ...
2012 Volume 61 Issue 3 Pages
381-384
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Three cases of pectoralis major transfer for the treatment of irreparable massive rotator cuff tear were reported.
A 68-year-old male was referred to our hospital because of severe pain and difficulty of shoulder flexion. Intraoperatively, partial tear of subscapularis (SC), supraspinatus (SSP), and infraspinatus (ISP)were found. Partial SSP and ISP were repaired and pectoralis major (PM) was transferred to the defective anterior part of SSP and SC. Ten months after surgery, he no longer complained of any pain, and range of motion (ROM) had improved.
A 75-year-old male was referred to our hospital because of chronic shoulder pain for seven years. Intraoperatively, partial SC, SSP, and ISP tear were found, and partial SSP and ISP were repaired and PM was transferred. Thirteen months after surgery, he had re-tear on MRI, but did not complain of any pain, ROM had also improved.
A 71-year-old female was referred to our hospital because of severe pain for six months and loss of shoulder flexion. Intraoperatively, partial SC, SSP, ISP, partial teres minor (TM) tear were found, and partial SSP, ISP and TM were repaired and PM was transferred. Nine months after surgery, she no longer complained of any pain, and ROM had improved.
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Tomohiro Ueki, Shinjiro Tomita, Nobuhiro Urakawa, Masakazu Kan
2012 Volume 61 Issue 3 Pages
385-387
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Triquetrum fracture is a relatively rare injury. We report a case of the triquetrum fracture with cystic lesion after injury. The case was a 53-year-old, male. He fell off his bicycle and injured himself in October 2010. He complained of his left hand pain on the dorsal side. The diagnosis was triquetrum bone cyst with fracture. Due to persistent left hand pain, operation was performed in December 2010. Minimal dorsal approach to the triquetrum was conducted and CPC was injected into the defected area. Pathological examination showed necrotic lesions. The final diagnosis was triquetrum fracture without tumor. Hand pain disappeared three months after operation and there was no functional disorder. We experienced a triquetrum fracture case which represented cyst-like lesion after injury. When damage to the cancellous bone is large, careful investigation for triquetrum fracture is necessary to distinguish it from bone tumor.
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Kanenobu Tsuchimochi, Hiroshi Tada, Takashi Matsusaki, Takeshi Nishiji ...
2012 Volume 61 Issue 3 Pages
388-391
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Gangrene in patients with hemodialysis or diabetes mellitus usually occurs in the lower extremity, rarely in the upper extremity. We retrospectively reviewed amputation for upper extremity, excluding tumor and trauma. We examined 21 patients who underwent amputation for upper extremity between January 2002 and August 2011. The 21 patients consisted of 15 males and six females with an average age of 64.2 (40-88). Seventeen patients were on hemodialysis (12 patients were diabetic nephropathy), 13 of them underwent amputation for the side of shunt. Clinical characteristic of patients excluding dialysis included diabetic gangrene (1), heparin-induced thrombocytopenia (1), disseminated intravascular coagulation (1), and Sjogren syndrome (1). The last amputation level was shoulder (1), forearm (2), wrist (5), digital (13). Six patients underwent operation several times. Most cases with amputation of the upper extremity on hemodialysis, especially of the side of shunt, were affected by steal syndrome. Progress of hemodialysis technology improved prognosis. Cases of amputation of the upper extremity is increasing.
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Kenji Tsunoda, Kengo Higuchi, Hirofumi Tanaka, Hideki Ishii, Masamori ...
2012 Volume 61 Issue 3 Pages
392-396
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Ulnar shortening osteotomy is used in the management of ulnar-sided wrist pain including ulnocarpal abutment syndrome and triangular fibrocartilage complex injuries, and many authors have reported good results. On the other hand, non-union or delayed union sometimes occurs after osteotomy due to poor cancellous bone and narrow ulna. Various types of ulnar shortening osteotomy procedures including transverse, oblique and step-cut have been reported. V-shaped ulnar shortening osteotomy provides rotational stability and larger surface area of bone to bone contact, which reduces the incidence of non-union and delayed union of ulna. However, freehand osteotomy does not provide good coaptation, so we developed a new device for V-shaped ulnar shortening osteotomy. Eight patients underwent ulnar shortening osteotomy with the new device. All osteotomies healed over an average of 12.4 weeks. Six wrists were graded excellent and two good. These results show that the new device enables V-shaped ulnar shortening osteotomy to be performed accurately.
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Yohei Takahashi, Yasuhiko Tanigawa, Yasuhiro Ochi, Yoshihiko Kunishi, ...
2012 Volume 61 Issue 3 Pages
397-401
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Cubital tunnel syndrome (CuTS) is caused by various etiologies,so the surgical method to be applied must be selected carefully. We performed electrophysiological examination on 24 cases with CuTS prior to surgery. We marked five points along the ulnar nerve at intervals of 2cm, and the center point positioned at the medial epicondyle. We defined the intervals as zones 1 to 4 from the distal side. We stimulated each point and measured the latency between the points. In one group showing a delayed zone between the distal and medial, most of the patients had compression or pseudoneuroma of the ulnar nerve. In another group with a delayed zone between the proximal and medial epicondyle,or in most of the zones (2 to 4), dislocation of the ulnar nerve was seen. It is thought that the main cause of the delayed zone in the latter group is friction neuritis. Anterior translocation of the ulnar nerve was performed on this group and outcome was good. Electrophysiological examination on may be helpful for selecting the surgical method for cubital tunnel syndrome.
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Jun Tanaka, Hidetoshi Onoue, Hitoshi Shirachi, Makoto Sakurai, Masaya ...
2012 Volume 61 Issue 3 Pages
402-405
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Distal radial fractures with extensive comminution of the articular surface and extension into the diaphysis are rare. There are also very few reports on the cure for these fractures. We report two cases of fractures treated using two kinds of plates who achieved good results. Case 1: A 42-year-oldman was injured in a traffic accident. He suffered the so called Galeazzi fracture accompanied by dislocation of the caput ulnae. Five days later, we performed osteosynthesis using an Acu-Loc extra-long plate. Case 2: A 42-year-oldman was injured by falling from the fourth floor. He suffered complex open diaphyseal fracture of the radius and ulnae affecting the distal articular surface. Four days later, we performed osteosynthesis using the LCP-Metaphyseal plate 3.5 as dorsal wrist-forearm plate. As a result, both cases obtained bone union and there were no significant range of motion limitations. Progress was also good in both cases.
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Hideki Ishii, Akihiko Asami, Masamori Shigematsu, Hirofumi Tanaka, Ken ...
2012 Volume 61 Issue 3 Pages
406-409
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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The purpose of this study was to evaluate the effect of double-tiered subchondral support procedure for the surgical treatment of distal radius fractures using the DVR® Anatomic Volar Plate System. The authors reviewed 10 patients who were treated by open reduction and internal fixation using the DVR® Anatomic Volar Plate System. The patients had been followed up for an average of six months (range: 3-9 months). The mean age was 67.6 years (range: 44-81 years). The loss of reduction was evaluated from radiographs taken between just after operation and the last follow-up visit. The functional outcome was excellent in all 10 patients. The loss of volar tilt increased 0.2 degrees, radial inclination increased 0.3 degrees, and ulnar varience increased 0.15 mm. There was no malunion, infection, median nerve compression, implant failure and subcutaneous rupture of the tendon. Use of DVR is effective for distal radius fractures.
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Yukio Abe, Koji Yoshida, Daisuke Nakashima, Yasuhiro Tominaga
2012 Volume 61 Issue 3 Pages
410-413
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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The malunion of the distal radius fracture is still a difficult problem to treat. We performed less invasive corrective osteotomy consisting of open-wedged corrective osteotomy and artificial bone graft through a small dorsal skin incision, and volar locking plate fixation through a volar small skin incision for dorsally displaced malunion of the distal radius. Six cases underwent this procedure. All cases were female, whose age ranged from 47 to 88 years old. Range of motion exercise was applied three days after less invasive corrective osteotomy. They were followed up from 6 to 36 months, 18 months on average.
All cases acquired complete pain relief, two cases were excellent and four cases were good at the final follow-up according to the Mayo modified wrist score. There was no loss of reduction. We consider our procedure to be less invasive because skin incision is small, soft tissue dissection is minimal, and no autogenous bone graft is required. Even though it is a less invasive technique, our procedure provided sufficient clinical results.
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Teppei Murai, Akinori Sakai, Toshihisa Oshige, Kunitaka Menuki, Yukich ...
2012 Volume 61 Issue 3 Pages
414-418
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Essex-Lopresti fracture is rare case. We report a case of radial head fracture which have multiple fragments, treated with bioabsorbable bone connecting materials (SuperFIXSORB-MX). The patient was a 26-year-old man. He fell to the ground from a height of 2.5 meters and injured his hand. Physical examination showed swelling and tenderness from the elbow to wrist. X-ray and computerized tomography showed radial head fracture and ulnar head dislocation. Magnetic resonance imaging showed disruption of the interosseous membrane. Comminuted fragments of radial head connected with DTJ mini screw, and fixed to the diaphysis. The distal radio-ulnar joint (DRUJ) was unstable, so we fixed the DRUJ with a K-wire after three weeks. Seven months after the operation, the fracture achieved union, the articular range of motion in an elbow and a wrist was almost good, and there was no postoperative complication. Bioabsorbable bone connecting materials are very useful for comminuted radial head fractures.
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Naoki Okamura, Shinichi Nakashima, Katsuhiko Sakuma, Kazuhiro Honda, K ...
2012 Volume 61 Issue 3 Pages
419-423
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Open pelvic fractures occur in abdominal injuries and potential lethal injuries. We report the case of a patient with open pelvic fracture associated with urogenital injury and rectal injury. A 36-year-old man was injured in a car crash. He suffered unstable pelvic fracture and arteriography, and embolization for massive hemorrhage was done. A few days later, urogenital injury and rectal injury were revealed and suprapubic urinary diversion and diverting colostomy were performed. External fixation was done at the same time. Afterward, he suffered soft tissue infection and sepsis. debridements were required three times. Now he can walk with both short leg braces and a cane. Rectal injury is a rare complication and recognized to carry a high rate of sepsis. It can become a fatal complication in the late phase. Blood in rectal examination suggests the need for diagnostic procedure of rectal injuries, but CT scanning is recommended. For the treatment of open pelvic fracture, urinary diversion and diverting colostomy are recommended for control of soft tissue infection and sepsis.
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Koichi Hara, Koshi Furusho, Naotoshi Ninomiya
2012 Volume 61 Issue 3 Pages
424-428
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Locking compression plate (LCP) are useful implants for osteosynthesis. But recently, difficulty in removal of the LCP is reported. We experienced two such cases, in which we removed the two LCPs with the use of partial resection technique and rotation technique. We should prepare well for such removal operations including tools, and should be well acquainted with the technique, not to mention the correct procedure at the first operation.
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Yosuke Kuwano, Takafumi Torigoshi, Kazushige Maeda, Kunihiko Okano, Ta ...
2012 Volume 61 Issue 3 Pages
429-434
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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There are few reports of comorbid cases of femoral neck, shaft and tibial shaft fractures. We report a method of fixation and outcome of two cases with those fractures. Case l: A 35-year-old man was involved in a traffic injury. There were trochanteric and shaft fractures of the right femur, and both tibiofibular shaft fractures. On the injury day, traction was applied to both legs with external fixator, and direct traction was applied to the right femur. Eighteen days after injury, we fixed both tibiae with intramedullary nails, trochanteric and shaft of the right femur with intramedullary nail. Case 2: A 36-year-old man was hurt in a traffic accident. There were neck and shaft fractures of the right femur, and right tibiofibular shaft fractures. On the injury day, traction was applied to the right leg with external fixator, and direct traction was applied to the right femur. Sixteen days after injury, we fixed the right tibia with on intramedullary nail and the right femoral shaft with plate and the right femoral neck with screws. Choice of implants is difficult in multiple fracture cases. In case of femoral fracture, as the choice of implants, intramedullary nail alone, and combination of plate and screw are available the technique best suiting the fracture type must be selected.
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Makoto Sakurai, Hidetoshi Onoue, Hitoshi Shirachi, Jun Tanaka, Masaya ...
2012 Volume 61 Issue 3 Pages
435-438
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report some cases of intramedullary nailing for tibial shaft fracture which is usually used for open reduction as it often cannot be applied to closed reduction. We report such cases in this paper.
Osteosynthesis was performed on a total of 65 patients to treat closed tibial shaft fractures using T2 tibial nails (Stryker, Michigan) from January 2001 to December 2010. We actively performed open reduction in six of these cases, but evaluated, only five cases in this study as one case moved to another hospital. An incision was made over the fractured point for the intramedullary nailing while maintaining the reduced position of the bone using a bone-holding forceps. Bone union as well as deformities during bone union were assessed.
Bone union was found in all five cases and took 16 to25 weeks (average 20.5weeks). Angular deformity was within 3°.
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Yoshihisa Anraku, Katsuhiko Kunitake, Yasujiro Tsutsumi, Masanori Yasu ...
2012 Volume 61 Issue 3 Pages
439-442
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Targon Femoral Neck (Targon FN) has been designed to incorporate all the optimum features from the sliding hip screw and multiple cancelleous screws specifically for the internal fixation of intracapsular hip fractures. The initial results of treatment for 11 patients treated with this new implant are reported. The mean age of the patients was 69 years (range: 49-89 years), and 3 (27%) were male. Ten (91%) of the fractures were undisplaced and one (9%) was displaced. In radiological examination, all fractures had united. There was no tilting of the fracture into varus and no implant prolapse into the soft tissues. In addition, there was no fracture around the implants and deep wound infection. Observation of those fractures that had healed shows a mean of 3.9 mm of slide of the telescrews. Ninety-one percent of patients regained their walking ability except one case who had a femoral shaft fracture in another side. This new implant may lead to reduced fracture-healing complications..
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Yoshihisa Hidaka, Yukihiro Furue, Hiroaki Tamura, Ikufumi Nagayoshi, T ...
2012 Volume 61 Issue 3 Pages
443-446
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report three cases of secondary femoral shaft fracture after operation for intertrochanteric and subtrochanteric femoral fracture using the gamma nail. All cases were treated using the gamma nail with distal locking screw. All secondary femoral shaft fractures occurred at distal locking screw. We treated these fractures using the long gamma nail.
Concentration of stress to distal locking screw may be one of the causes of secondary femoral shaft fracture. But other reports recommend use of the distal locking screw, especially subtrochanteric femoral fracture, to prevent secondary fracture due to torsional load and to stop subsidence and rotation of the nail. It is necessary to discuss whether to use the distal locking screw when using the gamma nail.
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Hiroshi Hosokawa, Shinichi Nakashima, Katsuhiko Sakuma, Kazuhiro Honda ...
2012 Volume 61 Issue 3 Pages
447-452
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We experienced two cases of triple fractures of the ipsilateral femur (neck, shaft and condyle) on whom we operated on. Femoral shaft fractures must be observed carefully due to the possibility of overlooking fracture of the neck. The intramedullary nail is an ideal device for internal fixation in femoral shaft fractures, but it may be difficult to use depending on the type and location of the fracture.
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Shinjiro Tomita, Nobuhiro Urakawa, Masakazu Kan
2012 Volume 61 Issue 3 Pages
453-455
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report our participation as orthopedic surgeons in the rescue operation for victims of the Great East Japan Earthquake on March 11, 2011. Our medical support team worked at the Saka General Hospital and neighboring shelters in the devastated areas of Miyagi Prefecture from April 19 to 22. We provided health checkup and medical care to victims staying at the shelters, as well as medical aid to the Saka General Hospital, and reviewed the significance of the support provided from the orthopedic viewpoint. We experienced 18 refugees and 17 cases complaining of locomotive symptoms; lumbago in 12, neck stiffness in nine, and knee pain in five. Later, another 15 new cases (88.2%) developed locomotive symptoms, At the Saka General Hospital, we experienced two cases operated for femoral trochanteric fracture. Even after the acute phase of the disaster, we found that orthopedic intervention is important for the many victims with locomotive symptoms.
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Hiroshi Nomura, Junichi Arima, Soichiro Nakano, Takayuki Tanaka, Yoshi ...
2012 Volume 61 Issue 3 Pages
456-458
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report our experience as the 4th rescue team of the Hiroshima branch of the Japan Red-Cross Society after the Great East Japan Earthquake on March 11, 2011. Under the direction of the command post in Ishinomaki Red Cross Hospital, our team volunteered for medical activities at a temporary clinic set up as the domestic emergency response unit at the Ishinomaki Senshu University in Ishinomaki-shi, Miyagi Prefecture from of March 20 to 24, 2011. Our main tasks were providing medical examination for flood victims both in the clinic and other shelters, and survey of the disaster areas. According to patient records from March 17to 23, there was a tendency for increased respiratory disorders in a time-dependent manner during this period. At the individual shelters, nursing care for old patients with dementia was the gravest burden for the care givers. Since urgent problems in disaster areas vary all the time, it is important to anticipate arising new problems based on the surveyed information collected on-site and on-time.
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Kenji Ogawa, Itaru Furuichi, Masakazu Murata, Takuma Inoue, Noboru Mor ...
2012 Volume 61 Issue 3 Pages
459-462
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Pregabalin is a novel drug under development for its analgesic, anxiolytic, anticonvulsant properties, and its interaction with alpha (2) delta-subunit of voltage-dependent Ca (2+) channels. As a new pain treatment option, we started use of pregabalin for patients with neuropathic pain, and conducted a survey on proper usage at our hospital. We investigated the department prescribing pregabalin, target disease, efficacy, and side effects in 121 patients on new prescriptions for pregabalin from June 2010 to March 2011. As a result, we found that anesthesiologists (57%) prescribed it the most followed by orthopedic surgeons (19%). It was most often prescribed to patients with postherpetic neuralgia, and patients with spinal disorders in orthopedic surgery. It was also relatively prescribed for patients with cancer pain. Effective pain relief was obtained in approximately 50% of all cases. Prescription was discontinued in 12% of the patients due to side effects. Pregabalin was also prescribed to 35% of the patients for off-label use at our hospital. In conclusion, pregabalin is an effective drug for neurological pain, but because it has relatively many side effects, use of the PainDETECT and BS-POP diagnostic tools is recommended when prescribing it.
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Hirotaka Kawakami, Takashi Setoyama, Sakura Uchiyamada, Hiroyuki Tomin ...
2012 Volume 61 Issue 3 Pages
463-467
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Epidermal suture using suture or skin stapling is generally carried out during orthopedic surgery after subcutaneous or dermal suture. At our hospital, use of skin stapling has been found to cause secondary injuries such as rubor and bullae, as well as pain during removal of the suture, so we started use of skin tape Steri-Strips® (3M) and skin adhesive Dermabond® (Ethicon, Johnson & Johnson) as new methods of closing wounds. The subjects consisted of 48 patients who had undergone invasive surgery for fractures and four who had undergone traumatic and soft tissue surgeries at our hospital after April 2011. Steri-Strips® and Dermabond® were compared and reviewed in terms of effectiveness for postoperative wound care, frequency of skin lesion, and cost performance. A survey was also conducted on the patients. The reason for needing postoperative wound care was separation of skin and hemorrhage. Skin lesion was seen in 14% of the patients using Steri-Strips® and in 28% using Dermabond®. Skin infection was also seen in one patient using Dermabond®. Both methods do not require removal of suture, so patient satisfaction was high. Steri-Strips® is recommended from the viewpoint of cost performance and the ability to use it in joint areas.
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Taka-aki Sagara, Koji Akasaki, Yosuke Kawatani, Hiroyuki Watanabe, Sho ...
2012 Volume 61 Issue 3 Pages
468-472
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We experienced eight cases of myeloma with spinal lesion from 2001. The patients consisted of five males and three females with mean age of 64 years (range: 35 to 78 years). Seven patients had multiple myeloma and a patient had solitary myeloma. Five patients were obliged to undergo operative therapy because of pain and muscle weakness of the lower extremity, but two patients did not recover from Frankel B grade. The prognosis of myeloma patients with vertebral lesions seems to be very difficult to predict.
Cooperation between physicians and orthopedic surgeons will become increasingly important.
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Itaru Yoda, Hideo Baba, Atsushi Tagami, Shinji Adachi, Takeshi Hiura, ...
2012 Volume 61 Issue 3 Pages
473-477
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We reviewed the clinical results of dumbbell tumors in our hospital. From July 2005 to July 2011, we surgically treated twelve patients (five males, seven females, average age 50.8 year old). We investigated the localization of tumor, Eden classification, surgical procedure, pathological diagnosis, paralytic symptoms, and progress. We select the surgical procedure according to the localization of tumor. If the tumor occurs in the functional area, we perform nucleotomy to prevent functional deficit. On the other hand, in non-funtional areas we resect the tumor including the capsule.
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Kotaro Jimbo, Yohei Ide, Ryo Tanesue, Hiroki Ozono, Shiro Yoshida, Mic ...
2012 Volume 61 Issue 3 Pages
478-482
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Fragile fractures are increasing with the aging society. Sacrum fracture is easy to miss on X-rays. This time, we experienced two cases of sacrum fracture with tardive neural injury. A 79-year-old woman had her sacrum fractured by bonesetting. Fourteen days later, she developed ischuria. Seventeen days after ischuria occured, laminectomy was performed, but neural injury did not improve. A 81-year-old woman had her sacrum fractured by falling down. Sixteen days later, she developed ischuria. Nine days after ischuria, laminectomy was performed, and urination improved 19 days after operation.
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Hisashi Serikyaku, Tomohiro Isa, Tomoyuki Oshiro, Isoya Goya, Fuminori ...
2012 Volume 61 Issue 3 Pages
483-487
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report three cases with sacral insufficiency fractures complaining of buttock and leg pain. Case 1: A 76-year-old female complaining of lumbosacral pain and left buttock and leg pain visited our hospital. MRI showed old compression fracture of L2,4 but neither stenosis nor lumbar herniation was observed. Because there were high intensity lesions in the sacrum on STIR view, MRI and CT of pelvis were added and fractures of the bilateral sacral alar and left S1 foramen were diagnosed. Case 2: An 80-year-old female presented with lumbosacral pain and bilateral buttock and leg pain. Multiple old compression fractures of the lumbar spine were revealed but neither stenosis nor disc herniation were seen on MRI. Because of knock pain on the sacrum, MRI and CT were taken and fracture of bilateral sacral alar was revealed. Case 3: An 80-year-old female presented with difficuty in moving due to severe pain radiating to the left buttock and leg. Spondylolisthesis of L5 was found but neither stenosis nor disc herniation were seen on MRI. Because of knock pain on the sacrum, MRI and CT were taken and fracture of the bilateral sacral alar was found to be the cause of pain.
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Atsuko Koyama, Hiroshi Nomura, Junichi Arima, Soichiro Nakano, Takayuk ...
2012 Volume 61 Issue 3 Pages
488-492
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report two cases of laminectomy of the atlas for retroodontoid pseudotumor. Case 1 was a 92-year-old man with a one-year history of progressive numbness and clumsy bilateral upper extremities. Plain radiograph showed spondylosis of the atlanto-axial joint in the cervical spine, and subluxation of the atlas was not associated. Magnetic resonance image (MRI) revealed an extradural mass with iso signal intensity on T1 weighted image and low on T2 weighted image behind the odontoid, compressing the spinal cord at the level of the atlas. We performed laminectomy of the atlas. Three years and five months after the surgery, symptoms obviously improved. Case 2 was an 81-year-old man presented with a three-month history of spastic gait and bilateral clumsy hands. He had severe chronic heart failure. Plain radiograph showed slight subluxation of the atlanto-axial joints. MRI revealed an extradural mass behind the odontoid, strongly compressing the spinal cord at the level of atlas.We performed laminectomy of the atlas, and symptoms obviously improved. Thus, we recommend laminectoy of the atlas as an effective treatment for retroodontoid pseudotumor, especially for elder patients with severe complications.
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Masatoshi Fukuda, Takuya Taniwaki, Toru Fujimoto, Tatsuya Okada, Akira ...
2012 Volume 61 Issue 3 Pages
493-496
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We present a 55-year-old woman who visited our outpatient department due to numbness of the arms. We carried out computed tomography (CT) due to numbness and aggravation of leg spastic ataxic. CT showed peridural calcification from the C2 and C3 levels to Th2 and Th3 levels. We diagnosed it as thoracic peridural calcification and performed surgical removal and laminoplasty. Two weeks from surgery, numbness of the arms and leg spastic ataxic improved. Gait was better and she left the hospital. There are several reports on peridural calcification in dialysis patients, but few on peridural calcification in nondialysis patients. However, CT must be carried out for peridural lesions which show low signal intensity area on Tl WI and T2WI in MRI.
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DeogCheol Lee, Hiroshi Kuroki, Hideaki Hamanaka, Keisuke Kawano, Seiji ...
2012 Volume 61 Issue 3 Pages
497-499
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Herpes zoster may be complicated by motor neuropathy such as Ramsay-Hunt syndrome. We experienced a case with left C5 nerve root palsy which complicated herpes zoster. We report on this case with some consideration of literatures. The patient was a 75-year-old male. He was aware of difficulties in left shoulder elevation and abduction. The next day, painful skin lesions appeared on his left C5 region. After being diagnosed as herpes zoster, he was transferred to our department. We recognized weakness of the left deltoid and biceps, deep tendon reflexes of the biceps and brachioradialis. We observed C5 nerve root inflammation in enhanced MRI, and diagnosed C5 radiculopathy derived from herpes zoster. His symptoms were improved by oral steroids in addition to antiviral drugs administered in the early disease. It has been reported that motor nerve palsy due to herpes zoster occurs about in 3% of all patients. It is important to consider this disease when we find rash and limb motor paralysis at the same time.
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Shotaro Kinouchi, Mamoru Mitsukawa, Kimiaki Sato, Kei Yamada, Hiroki Y ...
2012 Volume 61 Issue 3 Pages
500-505
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Lateral mass screws are very useful for cervical fusion. We report the short-term results of cervical fusion surgery with lateral mass screws. We evaluated 13 patients from 2005 to 2011. Though all screws were inserted bicortically, there was no complication. There was no screw breakage in the short-term follow-up. Cervical pedicle screws also demonstrated a significantly higher resistance to pull-out forces than did lateral mass screws. Lateral mass screws can be fixed adequately and inserted safely.
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Hiroshi Masuda, Hiroshi Kuroki, Hideaki Hamanaka, Naoki Inomata, Seiji ...
2012 Volume 61 Issue 3 Pages
506-508
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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To compare the efficacy of 2-octylcyanoacrylate (Dermabond; Ethicon Inc) with standard suture repair in the management of cervical laminoplasty. Fourty-five patients were enrolled in this study. Twenty-two patients were using Dermabond, and 23 were repaired using standard suture. All patients underwent surgery in 2010 and were observed three months or more after operation. Operation time, prone position time, incision length, intraoperative blood loss, days of drain and gauze removal and times to replace the gauze were examined. There were no adverse events in both groups. Significant difference in operation and prone position time, intraoperative blood loss, days of drain removal were not observed. The average days required for gauze removal using Dermabond was 6.73 days, which was significantly less than that required for suture repair (11.87 days) (p<0.05). And the average number of times to replace the gauze using Dermabond was 3.86, which was significantly less than that required for suture repair (5.22 times) (p<0.05). In the management of cervical laminoplasty, Dermabond is an effective repair technique.
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Naoko Kambara, Koichiro Toyoda, Hiroshi Tanaka
2012 Volume 61 Issue 3 Pages
509-512
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report a case of the short-term recurrence of thoracic epidural extramedullary hematopoiesis (EMH) in myelofibrosis after radiation therapy. A 59-year-old man developed leg paralysis and gait disorder, and was hospitalized. Magnetic resonance imaging (MRI) demonstrated a mass in the thoracic vertebra canal at T4-9, which compressed the spinal cord. We performed computed tomography (CT) guiding-Needle biopsy to his mass, and the mass indicated EMH. At first, the mass disappeared and symptoms improved with radiation therapy. But regrowth of the epidural EMH was observed one month later. Therefore, we performed laminectomy of T4-10 and dissected the epidural mass and provided subsequent radiation therapy. About one year later, his conditions worsened and he died of myelofibrosis, but without recurrence. We should consider surgical decompression for progressive leg paralysis due to epidural EMH which causes spinal cord compression.
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Shogo Tahata, Koji Akasaki, Taka-aki Sagara, Yosuke Kawatani, Hiroyuki ...
2012 Volume 61 Issue 3 Pages
513-517
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Ossification of the posterior longitudinal ligament (OPLL) of the upper thoracic spine occurs clinically less frequently than that of the cervical spine. However, thoracic OPLL causes severe myelopathy and surgical treatment becomes necessary. We experienced two cases of upper thoracic OPLL by anterior decompression using the total sternum spitting approach. Case 1: A 62-year-old female with OPLL of T2-3 underwent anterior decompression and fusion of T2-3 using total sternum splitting approach. Her myelopathy improved without critical complication. JOA score improved from four to eight points. Case 2: A 51-year-old female with OPLL of T1-3 underwent anterior decompression and fusion of T1-3 using total sternum splitting approach. Myelopathy improved without critical complication. JOA score improved from three to nine points. The surgical outcome of anterior decompression and fusion by total sternum splitting approach for upper thoracic OPLL was good. This approach has a low risk of the injury of the intra thoracic artery and is useful.
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Yukinaga Yoshimoto, Mamoru Mitsukawa, Kimiaki Sato, Kei Yamada, Hiroki ...
2012 Volume 61 Issue 3 Pages
518-523
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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Two cases of idiopathic scoliosis with Chiari malformation and syringomyelia were treated surgically. Though foramen magnum decompressions were operated first, syringomyelia was observed over one year after operations. It is most important to prevent neural complications during operations for idiopathic scoliosis with Chiari malformation and syringomyelia. Traction X-P Cobb angle is useful for reduction of scoliosis measured at preoperation, and multimodal monitoring system for prevention of neural complications during operations.
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Tomoya Okazaki, Koichiro Toyoda, Eiichi Shiigi, Ryutaro Kuriyama, Take ...
2012 Volume 61 Issue 3 Pages
524-526
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report a case of thoracolumbar spine intradural hematoma. A 70-year-old male was undergoing warfarin internal use medical treatment for atrial fibrillation. When he strained while defecating, he noticed low back pain and left limb pain and was taken to hospital by ambulance. The next day he consulted our hospital due to lower extremity muscle strength weakness. Frankel type was C and the strength of low extremity was weak in the left limb predominantly. To be antagonistic to warfarin, we administered Vit K. However, since loss of muscle strength advanced further, operation was carried out. Our diagnosis was intradural hematoma or extradural hematoma. Hematoma was seen in the intra dura mater. He could walk with T-cane after operation. In patients with known bleeding disorders experiencing low back pain, intradural hematoma must be taken into consideration in mind.
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Keisuke Mori, Hideo Baba, Atsushi Tagami, Shinji Adachi, Takeshi Hiura ...
2012 Volume 61 Issue 3 Pages
527-530
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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The purpose of this study was to clarify the usefulness of correction by spinal osteotomy in adolescent congenital kyphoscoliosis. The case were a 19-year-old male and a 16-year-old male. They had severe kyphoscoliosis and some symptoms. We perfomed correction by spinal osteotomy, and they obtained good correction. No neutrogic defict occurred in both cases. In congenital kyphosis, many authors adovocate the importance of early operative treatment. But, there are many late disagnosed cases, because abnormal vertebral bodies do not often present with significant abnormality until the patient reaches adolescence. Because our two cases had some symptoms, they needed some operative treatment. Corrective surgery with spinal osteotomy was a useful treatment to correct spinal deformity in adolescent congenital kyphoscoliosis.
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Mamoru Mitsukawa, Kimiaki Sato, Kei Yamada, Hiroki Yoshimatsu, Kohtaro ...
2012 Volume 61 Issue 3 Pages
531-534
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We compared the clinical results of idiopathic scoliosis treated with the hybrid technique and segmental screw fixation technique by a single surgeon from June 2007 to August 2011. Twenty-four cases were treated with the hybrid technique and twelve cases with the segmental screw fixation technique.
The average reduction rate with the segmental screw fixation technique (67.8%) was better than that with hybrid technique (61.9%) significantly. Each technique achieved good coronal and sagittal balance with no significant differences. The authors believe that both techniques are effective and provide spinal balance after surgery.
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Kazuyuki Karasuyama, Masami Fujiwara, Hideshi Sato, Ken Miyaoka, Toru ...
2012 Volume 61 Issue 3 Pages
535-538
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We experience several cases of small herniation difficult to identify by MRI, but need operative treatment. We studied the clinical results and tendency of eight cases of lumbar disk small herniaition treated operatively. The eight cases (four males and four females) underwent partial laminectomy and hernia discectomy (LOVE method) from September 2005 to October 2011. Small herniation is defined as hernia which can be or is difficult to identify with only one slice (5 mm) of transverse MRI findings. Myelography was performed in all cases, and root block and discography were performed in all cases in order to diagnose the responsible lesion. Operation views showed subligamentous type in three cases and transligamentous type in five. Herniation was found under the root nerve in all cases. The mean score of JOA improved from 10 (pre-operation) to 24.1 (post-operation). Small herniation requiring operative treatment should be diagnosed accurately using additional examination from clinical evidence.
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Koji Sameshima, Yoshihisa Kawauchi, Shinji Yoshino, Natsuko Tomimura, ...
2012 Volume 61 Issue 3 Pages
539-542
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We examined cases of early reoperation after microendoscopic discectomy (MED) for lumbar disc herniation in our hospital. The subjects were 148 patients who underwent MED for lumbar disc herniation between September 2007 and July 2011 at our hospital. The causes and measures for reoperations within two postoperative weeks in patients with MED were compared with those in 106 patients who had undergone conventional discectomy around the same time. Reoperation was performed in seven patients (4.7%) after MED, and was performed in two (1.9%) patients after conventional discectomy. The causes of reoperation after MED were recurrent herniation in four patients, spinal epidural hematoma in one, decompression end syndrome in one, and exacerbation of unexplained pain in one. The causes of reoperation after conventional discectomy were spinal epidural hematoma in one patient and wound infection in one. Recurrent prolapse of the patients who underwent MED showed transligamentous type at their initial operation, and the prolapse was considered caused by residual degenerated lumbar disc rather than by early ambulation.
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Toshifumi Tamura, Toru Fujimoto, Akira Sei, Takuya Taniwaki, Tatsuya O ...
2012 Volume 61 Issue 3 Pages
543-546
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We report a case of foraminal stenosis with conjoined nerve roots treated with microendoscopic surgery. A 69-year-old woman with right leg pain was referred to our department. Neurological examinations revealed L5 and S1 radiculopathy on the right side. MRI showed the presence of conjoined L5･S1 nerve root and that it was entrapped in the L5/S1 foramen on the right side. She underwent microendoscopic surgery. Operative findings showed anomalous conjoined nerve root was much less mobile than normal spinal nerve roots. The symptoms were relieved immediately after surgery. Microendscopic surgery was very useful for such a foraminal stenosis with conjoined nerve roots.
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Yasuhito Motojima, Akihiko Hijioka, Kayoko Furukawa, Yasuaki Okada, Ke ...
2012 Volume 61 Issue 3 Pages
547-550
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We experienced a case of extraforaminal entrapment of the L5 nerve root at the lumbosacral junction. A 54-year-old man suffered from right sciatica and leg pain in the L5 nerve root distribution. He was completely relieved from pain after surgery for the decompression of the L5 nerve root. At the operation, the inferior part of the L5 transverse process, a part of the sacral ara, and the lumbo-sacral ligament were removed.
Although the diagnosis of the extraforaminal entrapment is difficult, L5 nerve root block provided temporary pain relief, L5 nerve rootgraphy, and axial and coronal CT after nerve rootgraphy were useful for diagnosing extraforaminal stenosis at the lumbosacral junction.
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Yasuhiro Kawazoe, Takashi Ikeda, Shin-ichi Miyazaki, Tetsuhiro Oyama, ...
2012 Volume 61 Issue 3 Pages
551-553
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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We have been performing microscopic lateral fenestration with Wiltse approach for extraforaminal lumbar disc herniation from January 2008. From then, 183 lumbar disc herniations were operated at our hospital. Among these cases, there were eight (five males and three females) extraforaminal lumbar disc herniation (4.4%); six levels at L4/5 and two at L5/S. The average age was 60.4 years old (range, 42-74). The average duration of surgery was 82 minutes and average volume of blood loss was 40ml. All patients were allowed to walk on the next day. There were no complications during surgery and no neurological deterioration after surgery. JOA score was improved from 11.0 (range, 6-17) to 25.5 (range, 20-27) postoperatively, and Hirabayashi's improved ratio was 80.6%. The current study demonstrated that microscopic lateral fenestration with Wiltse approach provides good clinical results owing to minimal skin incision and minimal muscle damage.
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Hiroya Ikari, Takamasa Yoshimoto
2012 Volume 61 Issue 3 Pages
554-556
Published: September 25, 2012
Released on J-STAGE: November 27, 2012
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The aim of this study was to show the detail techniques of microscopic bilateral decompression through unilateral approach for lumber spinal canal stenosis (LSCS) and assess the clinical results of this procedure. Thirty patients with LSCS who underwent this procedure were included in this study. JOA score improved 13.5 points preoperatively to 24.5 points with significant difference. This procedure provided good clinical results with less invasiveness for paravertebral muscles.
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