The purpose of this paper is to evaluate roentgenologic changes of ankylosing ing hyperostosis of the spine (AH) and speculate the factors developing AH.
In this report, 22 patients with spinal injury were studied. All patients were males. The mean age of these patient at the final follow-up was 58 years with a range from 34 to 79 years. The patients were divided into two groups; one group of ossification of the anterior longitudinal ligament of the spine (OALL) and the other of non-ossification of the anterior longitudinal ligament o f the spine (non-OALL). Each group was composed of 11 patients. There was no difference in the background between two groups. Roentgenologic changes were evaluated by comparing two groups with regard to three points; the height of intervertebral discs, the degree of kyphosis and lordosis, and the degree of spodylolisthesis.
The main results found in this long term follow-up study were as follows:
1) In the cervical spine, OALL group has narrowing of the intervertebral discs more commonly than non-OALL group.
2) In the thoracic and lumbar spines, non-OALL group has more narrowing of the intervertebral discs than OALL group.
3) OALL group has tendency to increase the degree of thoracic kyphosis and decrease that of lumbar lordosis.
4) There is no significant difference in the degree of spondylolisthesis between two groups.
According to these results, we think that the important factor in the development of AH is not only diffuse ossifying diathesis but the local biomechanical factor.

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233 cases with trochanteric femoral fracture were treated by a few operative methods (Jewett nail, Ender nailing, Compression hip screw and others'). 78 cases had stable type fracture and 155 cases unstable, 23 per cent of 101 cases treated with Jewett nail osteosynthesis had fracture complication, particularly penetration of the nail in unstable type. 12 cases with Ender nailing (38%) had severe sliding of the nail and varus deformity of the femoral neck in IVand Vtype. In Vtype, 3 cases with Compression hip screw (23%) had shortening of the femoral neck but they had few complications in ADL. We find the Compression hip screw osteosynthesis suitable for the treatment of trochanteric femoral fracture also of the unstable type.

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Manual reduction of intra-articular fracture of the calcaneus had been thought to be impossible and unrealistic. However, I developed a new method of manual reduction by utilizing the tension of the ligaments around the calcaneus. If was published in Clin. Orthop. (177, 104-111, 1983). The following is the manipulation procedure in brief. The patient is placed in a prone position with the knee at 90°. An assistant holds the thigh, and the surgeon compresses the affected heel with interlocked hands. The calcaneal tuberosity is repeatedly squeezed upward with strong traction and quick side to side bending.
This method is gaining wide acceptance in Japan and elsewhere. We believe that this method should be the first choice for treatment of calcaneal fractures.

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We report two cases of Charcot spine: one case due to traumatic paraplegia, and other due to tabes dorsalis.
Case 1 was a 50-year-old man who had been treated for tabes dolsalis since January 1986. He noticed only low back pain in November. The diagnosis of Charcot spine was made by the characteristic X-P findings of L2, 5 and his past history. He was treated with corset and his lumbar spine was reconstructed in May 1988.
Case 2 was a 45-year-old man who had paraplegia below T10 due to a T11-T12 dislocation scince 1964. He complained of an increasing lumbar deformity and abnormal crepitation with movement in November, 1986. He was treated with Harrington compression rod and posterior fusion from L2-L4. Two years later, the fusion between L2-3 progressed to almost complete healing.

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The purpose of this paper is to describe the relation between ossification of the posterior longitudinal ligament in the cervical spine (OPLL) and ankylosing hyperostosis of the spine (AH).
The radiograms of 10 patients who had AH with OPLL comprised the material for this study. The mean age of this group of patients was 64 years with a range from 49 to 81 years. There were 9 males and one female. Duration of follow-up study varied from 51 months to 128 months, the average being 87 months.
The main results found in this study were as follows;
1) Of the 10 patients studied, two advance in the stage of AH and all 10 pateients had growing of ossification of anterior longitudinal ligament in the spine.
2) Common type of OPLL with AH was cotinuous type in Seki's classification.
3) Five patients (50%) had growing of OPLL and advance in the stage of AH in cervical spine. Generally, these patients had the early stage. Four patients advanced from the first stage to the second stage and one patient advanced from the second stage to the third stage.
In cosideration of these results, it is important to pay attention to radiographic changes of the first stage of AH-predical nucleus and the changes along the anterior surface of vertebral bodies-to anticipate growing of OPLL.

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This is two cases report of gas gangrene which we recently experienced without therapy of OHP.
Case 1
A-12-year-old girl had a comminuted fracture of her left leg. Three days after the injury, a necrosis and crepitation around the injuried region were recognized and followed by open amptation. Persistent washing of the open wound were carried out with chemotherapy.
Case 2
A-69-year-old man had a few contused wounds of his lef leg. 2 days after, the same findings as 1 st case were observed and we treated as descibed in the 1st case made the same doing. Both of these cases with Cl. infection were survived.

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The etiology of ossification of the spinal ligaments remains obsure. We selected the ossification of the supraspinous ligament (OSSL) as a method to clarify the etiology of ossification.
We perform to calculate the stress on the supraspinous ligament and to discuss causative factors of ossification of the spinal ligaments from the view point of the local mechanical factors.
OSSL can be divided into three types (type I, type II and type III) according to the shape and the size.
The subject of our study are 30 cases with type I, 20 cases with type II, 20 cases with type III and 30 normal persons as a contrpl.
The following results are obtained:
1) stress on the supraspinous ligament mainly depends on the body weight and the distance from the center of gravity to the center of the intervertebral disc,
2) in type II and type III of the ossification, the apex of thoracic kyphosis is chiefly seen at the Th₇ and Th₈, but biggest ossification is almost always found at Th₁₁ and Th₁₂,
3) in type III, thoracolumbar kyphosis (T₁₀-L₂) is increased and lumbar lordosis (L₁-L₅) is decreased, and
4) OSSL has more relation to general factors than local factors.

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This is to analyse roentgenographically 74 cases with ossification of the supra-supinatus ligament (OSSL), including 29 cases of the control. The ossifications occur frequently at the level of lower thoracic and lumbar spine and can be divided into three types according to the shape and the size.
The following results are obtained:
1) type II and type III of the ossification are found more frequently in male than in female, 2) thoracolumbar kyphosis (T₁₀-L₂) is increased in type III, 3) tepe III has higher generalized hyperostotic tendency and is often accompanied with other ossification of the spinal ligaments, and 4) appearance of OSSL isdicates existence of generalized hyperostotic tendency.

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The purpose of this paper is to discribe comparison of the human and rabbit spinal nerve root. Rabbits have been selected in several studies on spine as they are easy to obtain and to keep. However, an appreciation of the differences in structure is essential for the correct extrapolation of results in the human situation.
The cervical spines were removed from fresh cadavers and 6 rabbits. The specimens were fixed in 10% formalin. They were evaluated histologically with the use of HE, Azan, PAS and EVG stains.
The main results found in this study were as follows;
(1) The structure of the connective tissue of spinal nerve roots in the human and rabbts were essentially same.
(2) However, there were a few differences between them.
i) Spinal ganglion of rabbits were closer to spinal cord.
ii) In rabbits, arachnoid and root sheath were thiner and arachnoid villi were underdeveloped.
iii) Subarachnoid space of rabbits was narrower.

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A 37-year-old man was admitted with multiple fractures and on the 5th day after his admission, complained of increasing dyspnea.
Upon auscultation, decreasing breath sound and bowel sound were recognised in the greater part of the left chest.
A chest X-P film revealed that the left lung had collapsed and that there were intestinal gases.
A left side thoracotomy was performed under the diagnosis of traumatic diaphragmatic hernia. The colon, small intestine and spleen were seen in the left thoracic cavity. The left diaphragm was lacerated about 20cm from the central tendon to the antero-lateral end and a 10cm rupture of the pericardium was seen. These two lacerations were not continuous. The spleen also had a small laceration, but the bleeding had stopped.
The rupture of the pericardium was repaired with continuous over and over suture and the diaphragm was repaired with continuous horizontal mattress suture. The postoperative course was uneventful.

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A 64-year-old man who had suffered from syphilis twenty years before complained of numbness and weakness on his left lower extremity in May 1988. He was made a diagnosis of lumbar canal stenosis and treated with laminectomy from L3 to L5. After surgery, his symptom was improved. But he recomplained of lightening pain on his right lower extremity and gait distubance in December 1989. The diagnosis of charcot spine was made by the characteristic X-p findings and his past history. He underwent posterolateral fusion with pedicular screw system (Steffee) from L3 to L5. Solid union is not achieved but clinical result is good.

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168 fractures of the shaft of the femur and tibia operatively treated by various methods have been studied to determine whether these treatments were justified. Especially we compared closed Ender nailing, closed Kuntscher nailing and plating in terms of bone healing. The results are as follows. Generally there were little differences between three methods. But in middle-third of the shaft of the femur, the fractures treated by plating had a tendency to slightly delay in union.
We consider it important to select the right method according to each case.

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最近, 糖尿病性壊疽に続発し, ガス壊疽菌感染を原因としないガス壊疽が増加してきている. この種のガス壊疽の原因はグラム陽性菌とグラム陰性菌の混合感染であるが, 高圧酸素療法およびガス壊疽菌抗毒素血清は効果的でなく, 可及的すみやかにできるだけ高位で患肢を切断すること炉最良の治療とされている. しかし, この種の病変は進行性であり, 触診によつて初めて皮下ガスに気付くころには, ややもすると救命時期を逸することがあるので, 触診だけによらず経時的にX線写真を撮ることが早期発見につながると思われる. また, 患肢の切断線の決定にあたってはX線写真像を考慮に入れることはもちろんであるが, 本例のように術中所見で切断線の安全域を決定するのもよい方法であると考える.

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症例は53歳, 女性。近医でイレウスと診断され症状の増悪を認めたために, 紹介入院となった。来院後イレウス管による減圧により症状は軽快した。入院後2日目より右上腕の腫脹・発赤・疼痛を認め, ショック状態を呈した。右上肢のガス壊疽の診断にて, 緊急に右上肢切断術・デブリードマンを施行した。全身状態の改善を待ち, 入院後7日目に開腹手術を施行したところ, 左子宮広間膜ヘルニアの嵌頓を認めた。嵌頓腸管は壊死していたが, 巨大な子宮筋腫により高度に圧排されていた。小腸部分切除, 回腸瘻・粘液瘻増設術を施行した。その後, 人工肛門閉鎖術などを行い退院となった。ガス壊疽発症時の動脈血培養よりClostridium septicumが, 右上肢切断部より同様にClostridium septicumが検出された。本症例は子宮広間膜ヘルニアによる絞扼性イレウスが原因となったガス壊疽である。若干の文献的考察を加え報告する。

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Tight hamstrings is spastic contracture of hamstring muscles, but its mechanism has not been well known. We studied about growth factors including age, sex and height when we measured SLR, FFD, Looseness test in 3219 healthy young people (age range, 5-18years). The hamstrings in male were tighter than those in female in each age, which was same in cases with Tight hamstrings. The time of peak of SLR in healthy male and female is seen at the same period as the time of growth spurt. Tight hamstrings tend to appear in this time, and SLR, FFD are severely restricted if some factors of lumbosacral regions are mixed.

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Two cases of gas gangrene in the maxillofacial region and neck that developed after odontogenic infection are reported. Case 1, a 35-year-old man, developed gas gangrene after removal of the mandibular right third molar. In case 2, a 61-year-old man, gas gangrene occurred after apical periodontitis of the mandibular right second premolar. Both cases were treated by digitally opening the site where computed tomography (CT) revealed extension of gas bubbles early after the onset of symptoms and surgical debridement with antibiotics. CT was useful in monitoring the location of gas bubbles to permit opening of the progressive large focus in multiple spaces of maxillofacial region and neck. Digital preparation of the fascia was useful for opening the focus in the early stage of the disease.

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Twenty cadaver distal femora were x-rayed laterally and those anterior cruciate ligament (ACL) attachments were studied by authors' original measurement technique. Authors believe that application of this technique to ACL reconstruction surgeries helps to create femoral tunnels exactly at the sweet spot.

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The gas gangrene usually occurs in the limbs after trauma. We have experienced a case of non-traumatic gas gangrene in the low back. The patient was a forty-year-old female suffering from diabetes. When the patient admitted in our clinic, in the lumbar region and left side part of the neck and thorax, interstitial gas was demonstrated radiographically. On the bacteriological examination, L. coli was detected but clostridium was not detected. We diagnosed non-clostridial gas gangrene. The patient was treated with debridment and antibiotics. The wound was closed by skingraft after fresh granulations occurred. The patient made a good recovery.

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A case of fracture of the neck of the talus with dislocation from both the ankle and subtalar joint was reported.
The patient was 36 years old male. A heavy thing fell on his left thigh and his left ankle joint was dorsiflexed. Closed reduction was performed and the foot immobilized in plaster for 11 weeks. Full weight bearing was started 6 months after the injury. Although he complains limping and slight pain after fatigue 19 months after the injury, there is no collapse of the body and no arthritic change roentgenographically.

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